title: Comparison of Autonomic Reactions during Urodynamic Examination in Patients with Spinal Cord Injuries and Able-Bodied Subjects.
abstract: OBJECTIVE
  This study compares heart rate variability (HRV) and systolic blood pressure (SBP) changes of spinal cord injury (SCI) patients during urodynamic study (UDS) with able-bodied controls.
  
  
  METHODS
  Twenty four complete suprasacral SCI patients (12 tetraplegia and 12 paraplegia) and 12 age-matched able-bodied volunteers received BP and HRV evaluation throughout urodynamic examination. We chose seven time points during the examinations: resting, Foley catheter insertion, start of infusion, and infused volume reaching 1/4, 2/4, 3/4 and 4/4 of maximal capacity. At each time point, electrocardiogram with a duration of 5 min was used for power spectral density analysis of HRV.
  
  
  RESULTS
  Only control subjects displayed significant elevation of SBP during Foley catheter insertion compared to resting values. Both control and tetraplegic groups experienced significant elevation of SBP at maximal bladder capacity compared to resting values. Tetraplegic values were also significantly greater than the other two groups. Control subjects displayed significant elevation of low frequency/high frequency (LF/HF) ratios during Foley catheter insertion and when approaching maximum bladder capacity. These findings were not seen in the paraplegic and tetraplegic groups. However, subgroup analysis of tetraplegic subjects with SBP elevation >50 mmHg demonstrated a similar LF/HF response to the able-bodied controls.
  
  
  CONCLUSIONS
  Tetraplegic patients experienced BP elevation but did not experience significant changes in HRV during bladder distension. This finding may imply that different neurological pathways contribute to AD reaction and HRV changes during bladder distension. However, profound AD during UDS in tetraplegic patients was associated with corresponding changes in HRV. Whether HRV monitoring would be beneficial in SCI patients presenting with significant AD, it needs further studies to elucidate.
authors: Department of Physical Medicine & Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan.|School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors: Yu-Hui
authors: YH
authors: Huang
authors: School of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan.|Room of Physical Therapy, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors: Hsiao-Yun
authors: HY
authors: Chang
authors: Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.|Department of Physical Medicine and Rehabilitation, School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors: Sen-Wei
authors: SW
authors: Tsai
authors: Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan.|School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
authors: Li-Wei
authors: LW
authors: Chou
authors: School of Medicine, Chung Shan Medical University, Taichung, Taiwan.|Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors: Sung-Lang
authors: SL
authors: Chen
authors: Department of Physical Medicine & Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors: Yu-Hao
authors: YH
authors: Lin
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D016022:Case-Control Studies; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000502:physiology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D014563:Urodynamics; D055815:Young Adult