Autonomic Dysreflexia: Current Evidence Related to Unstable Arterial Blood Pressure Control Among Athletes With Spinal Cord Injury

Objective: To present the complex issues of the impact of spinal cord injury (SCI) in sport, with a specific focus on autonomic dysreflexia (AD) and the potential debilitating effects of unstable blood pressure control among athletes. Data Sources and Methods: A literature review based on a key word electronic literature search of articles, practice guidelines, and review articles pertaining to AD was conducted using MEDLINE, Sport Discus, and EMBASE. Results: Spinal cord injury results not only in devastating paralysis; it also commonly is associated with a range of autonomic dysregulation that can interfere with cardiovascular, bladder, bowel, temperature, and sexual function. Individuals with a cervical or high-thoracic SCI face lifelong abnormalities in systemic arterial pressure control. In general, their resting arterial pressure is lower than that in able-bodied individuals and is commonly associated with persistent orthostatic intolerance. In addition, they experience transient episodes of life-threatening hypertension, known as "AD," which often is associated with disturbances in heart rate and rhythm. Autonomic dysreflexia occurs in up to 90% of individuals with a cervical or high-thoracic SCI and requires prompt intervention. It also is known that, during athletic activities, self-induced AD is used by some individuals to improve their performance, a technique known as "boosting." For health safety reasons, boosting is officially banned by the International Paralympic Committee. Conclusions: Devastating paralysis, a variety of autonomic dysfunctions, and abnormal cardiovascular control after SCI present significant challenges in terms of individuals remaining active in competitive sports. Medical practitioners who are involved in the care of wheelchair athletes should be aware of the unique cardiovascular dysfunction that results from SCI and may occur at any time, even with seemingly innocuous triggers. Prompt recognition and appropriate management of these conditions, including episodes of AD, could be life saving.