Clinical Implications for Cardiovascular Compromise in Patients With Spinal Cord Injury: A Case Study of Autonomic Dysreflexia, Cardiac Pacing Abnormality, and Orthostatic Hypotension in Contemporary Physical Therapy Management

Abstract

Purpose: Although recent advances in the neurological care of spinal cord injury have made great strides, cardiovascular disease has emerged as a leading contributor to mortality within this population. Achieving a greater understanding of the pathophysiology of acute cardiovascular dysfunction may aid the physical therapist in establishing more effective clinical care and decision making. The purpose of this article is to review the pathophysiology of acute cardiovascular dysfunction after cervical and thoracic spinal cord injury (injuries above the T6 vertebrae) and translate this knowledge to the clinical management of a medically complex patient case. Methods: A 62-year-old man sustained a traumatic sensory and motor complete T2 spinal cord injury. During the course of acute hospitalization, the patient suffered multiple episodes of cardiac arrest, and a permanent pacemaker was implanted. Inpatient rehabilitation was further complicated by orthostatic hypotension and emergence of autonomic dysreflexia. Results: Orthostatic hypotension was addressed with a combination of positional tolerance progression and patient education. Autonomic dysreflexia episodes required prompt recognition and appropriate response. After a 6-month hospitalization, the patient was discharged to home. Conclusion: Cardiovascular concerns after spinal cord injury have become increasingly prevalent leading to significant implications to physical therapists. Understanding the pathophysiology of these conditions as well as normal and abnormal cardiovascular responses to activity is crucial for establishing safe patient outcomes.