UBC Theses and Dissertations

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UBC Theses and Dissertations

Management of autonomic dysfunction following spinal cord injury : current practices, barriers, and potential treatment options Kalimullina, Tamila


Spinal cord injury (SCI) results in devastating effects on activities of daily living, including a range of serious autonomic dysfunctions, including autonomic dysreflexia (AD), bowel and bladder dysfunction. AD is a condition marked by uncontrollable surges in blood pressure (BP) triggered by stimuli occurring below the injury site. With AD posing severe risks like stroke and seizures, restoring BP control is among the top priorities. The first chapter provides an overview of the consequences of SCI, contextualizing current priorities against the backdrop of clothing and offers practical recommendations collected from individuals with SCI and healthcare practitioners. The second chapter evaluates an existing clinical recommendation. The application of lidocaine jelly to the rectum has been recommended to mitigate AD severity by attenuating sensory input. However, clinical investigations have yielded varying results. In our pre-clinical study, conducted using a standardized rodent T3 transection model, we evaluated the efficacy of rectally administered lidocaine. Our findings reveal that lidocaine significantly diminishes AD severity, lending support to the current recommendation. A key factor in cardiovascular dysfunction is the loss of control over sympathetic neurons that regulate blood vessels due to SCI. Inflammation following SCI can worsen the damage. Research emphasizes early interventions to reduce spinal cord damage and preserve key pathways. Neuroprotective agents with anti-inflammatory properties have been explored for motor recovery in rodents following SCI, however, their potential impact on cardiovascular function remains relatively underexplored. This study evaluated four FDA-approved neuroprotective agents for promoting cardiovascular recovery after SCI in rats with severe T3 SCI. Indomethacin and valproic acid caused high morbidity and mortality rates, contrary to prior findings. On the other hand, fluoxetine, and glyburide were well-tolerated. None of the agents significantly improved cardiovascular or motor function, underscores the need for further investigation. Overall, the work presented in this thesis follows data sourced directly from individuals afflicted with SCI, and their caretakers, encompassing the insights of end users and the broader community, to rigorous experimentation within the laboratory setting. This approach aims to uncover avenues for enhancing quality of life across three distinct tiers: through non-medical interventions, validated clinical methodologies, and innovative experimental approaches.

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