title: Influence of neurological lesion level on heart rate variability and fatigue in adults with spinal cord injury.
abstract: METHODS
  Group cohort design.
  
  
  OBJECTIVE
  To determine the influence of spinal cord injury (SCI) and neurological level on heart rate variability (HRV) and associations with fatigue.
  
  
  METHODS
  SCI rehabilitation outpatient and community settings in New South Wales, Australia.
  
  
  METHODS
  Participants included 45 adults with SCI living in the community and 44 able-bodied controls. Socio-demographic, neurological injury, psychological, HRV and eye blink variables were assessed. Multivariate analysis of variance and post hoc protected t-tests were used to determine differences in HRV and fatigue as a function of the neurological level. Pearson's correlation analysis was used to determine the relationships between these factors.
  
  
  RESULTS
  Participants with SCI had significantly reduced sympathetic activity. Those with tetraplegia had lowered sympathetic activity compared with those with paraplegia and able-bodied controls. Neither were differences in parasympathetic activity found between groups nor were there any significant differences found for the time domain or non-linear domains. Higher levels of fatigue were found in the SCI sample, and participants with tetraplegia had higher fatigue levels compared with those with paraplegia. Fatigued participants were more likely to have altered autonomic function-that is, reduced sympathetic activity.
  
  
  CONCLUSIONS
  Higher levels of neurological impairment in people with SCI are more likely to result in disordered cardiovascular control involving reduced sympathetic activity, whereas elevated fatigue was found to be associated with increased sympathetic dysfunction. Findings highlight the need to address risks associated with this dysfunction, such as improved HRV and fatigue screening for people with SCI and improved education on cardiovascular risk factors.
authors.affiliation: John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney Medical School Northern, The University of Sydney, St. Leonards, New South Wales, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Rodrigues
authors.affiliation: John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney Medical School Northern, The University of Sydney, St. Leonards, New South Wales, Australia.|Key University Centre for Health Technologies, University of Technology, Sydney, New South Wales, Australia.
authors.forename: Y
authors.initials: Y
authors.lastname: Tran
authors.affiliation: John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney Medical School Northern, The University of Sydney, St. Leonards, New South Wales, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Guest
authors.affiliation: John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney Medical School Northern, The University of Sydney, St. Leonards, New South Wales, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Middleton
authors.affiliation: John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney Medical School Northern, The University of Sydney, St. Leonards, New South Wales, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Craig
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D001767:Blinking / Q000502:physiology; D015331:Cohort Studies; D004562:Electrocardiography; D004585:Electrooculography; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D009460:Neurologic Examination; D010045:Outpatients; D012111:Residence Characteristics; D013119:Spinal Cord Injuries / Q000150:complications*