KSCIRC Autonomic Systems

Cardiovascular Assessments

• Orthostatic Stress Test (CV-Cat)
  This test assesses the cardiovascular responses to postural changes. Beat-by-beat blood pressure, heart rate, cerebral blood flow, echocardiographic measures of the heart and vessels, pulse wave velocity, and respiratory kinematics are measured while participants lay on their backs and when the position is rapidly changed to the head up tilt position. During this test, before and after the position change, licensed personnel may also take blood samples from a catheter inserted into the antecubital vein to measure catecholamine levels.
• Ambulatory Blood Pressure and Heart Rate Monitoring (ABPM and BioRadio)
  Performed outside of the laboratory, heart rate and blood pressure are monitored with portable devices as the individual completes normal daily activities with a regular sleep schedule. Each participant is asked to complete a daily diary of any activity that may alter blood pressure or heart rate.  The blood pressure is recorded at set intervals while heart rate is monitored continuously. Participants may also be given the Autonomic Dysfunction Following Spinal Cord Injury (ADFSCI) questionnaire that asks about their blood pressure stability and episodes of autonomic dysreflexia during their daily life.
• Cardiovascular and Respiratory Stimulation Configuration Mapping (CVsc-ES and RTsc-ES)
  These assessments are used for finding the optimal cardiovascular and respiratory epidural stimulation configurations to modulate arterial blood pressure and the motor control of breathing. These assessments may be done with recordings of muscle activity, blood pressure, heart rate, respiratory rate, and lung volume and airway pressure.
• Arterial pulse wave velocity (aPWV)
  Blood vessel properties are assessed using a pressure detection technique. The test is performed while the participant is laying down or in the head up tilt position. Pressure sensors are placed over the carotid and femoral artery pulse locations for 7-10 consecutive beats. The software calculates the mean velocity of the pulse waves and compares the values to a normative data set.
• Trans-Cranial Doppler
  A special headset with ultrasound sensors that rest against the temples is placed on the participant to measure the blood flow in the middle cerebral and posterior cerebral arteries. This technique of measuring blood flow in the brain can be paired together with other assessments of cardiovascular, pulmonary, and cognitive function.
• Echocardiography
  This assessment, utilizing Doppler Ultrasound, is used to assess the function of the heart.
• Vascular Ultrasound:This assessment, utilizing Doppler Ultrasound, is used to assess the function of the major blood vessels in the body.
• Immunological Blood Panel (IBP)
  For this test, two tablespoons of blood are drawn and analyzed to provide information about the individual’s immune system, the gene profile of the blood cells, as well as the number and type of blood cells in the sample.
• Cognitive Assessment Battery (CAB)
  This series of tests is used to assess various domains of cognitive function such as memory and verbal fluency. These tests may include remembering a list of words read out loud, identifying colors and shapes, looking for patterns, generating a list of words beginning with a certain letter, etc. During these tests blood pressure, heart rate, cerebral blood flow, respiratory rate and CO₂ levels may be monitored.

Bladder and Bowel designs protocols using standard medical and research equipment to obtain objective assessments of urogenital and bowel functions. These assessments are essential to helping us better understand, improve and ultimately overcome dysfunction in these areas.

Bladder Function Assessments

• Questionnaire
  Adapted from an internationally accepted standardized questionnaire (Biering-Sorensen et al. (2018)  Spinal Cord Ser Cases. 2018 Jul 6;4:60-Version 2) our Bladder Function Questionnaire is used to assess overall bladder health and management.
• Bladder Diary
  An individual’s record of liquid intake and urine output provides valuable insight into kidney and bladder function and use of our Bladder Diary complements our lab-based assessments.
• Uroflowmetry
  Measures the amount of urine emptied during urination as well as the speed (rate) and pattern (constant, interrupted) of urination.
• Cystometrogram (CMG)
  Measures the size of your bladder (how much fluid your bladder can hold) and how full the bladder is when you begin to feel the need to urinate. It also records the pressure inside the bladder during bladder filling and emptying.
• Electromyography (EMG)
  Small sensors are used to measure the strength and electrical activity of muscles and nerves in and around the bladder and sphincters (the pelvic floor).
• Bladder and Kidney Ultrasound
  A noninvasive technique that transmits sound waves through the body; images of the bladder and kidneys help to assess damage from chronic high pressure in the bladder and potential backflow of urine into the kidneys (urinary reflux).

Bowel Function Assessments

• Questionnaire
  Adapted from an internationally accepted standardized questionnaire (Krogh et al. (2017) Spinal Cord 55: 692–698-Version 2) our Bowel Function Questionnaire is used to assess overall bowel health and management of fecal elimination.
• Anorectal Manometry (ARM)
  Evaluates bowel function in individuals that have difficulty with constipation and/or experience stool leakage. It measures the strength of the anal sphincter muscles, sensation in the rectum as well as the neural reflexes necessary for bowel movements.

Sexual Function Assessments

• Questionnaires
  Standardized questionnaires are used to assess overall sexual health and management in both Males (adapted from Rosen, R. et al. (2006) Urology 68 (Suppl 3A): 6-16 and Alexander, M. et al. (2011) Spinal Cord 49: 795-798) and Females (adapted from Alexander, M. et al. (2009) The Journal of Spinal Cord Medicine 32 (3): 226-236 and Alexander, M. et al. (2011) Spinal Cord 49: 787-790).

Interventions

• Exercises to improve locomotor function
  We design training individualized interventions consisting of gait-specific exercises (walking over ground and on a treadmill) and non-gait specific exercises (bipedal and quadrupedal cycling, elliptical exercises) selected from your locomotor function assessment.
• Exercises to improve upper extremity function
  We design individualized training interventions consisting of reaching, grasping, arm swing and daily tasks selected from your upper extremity function assessment.
• Stimulation techniques
  Alongside the exercises presented above, we use various stimulation techniques such as neuromuscular electrical stimulation and spinal cord transcutaneous stimulation to further improve the ability of your nervous system to control the movements while increasing the ability of your muscles to produce force.

What to Expect During Testing

• Our experienced scientists, research technicians, physical and occupational therapists and activity-based technicians perform assessments in dedicated laboratory spaces and evaluation rooms
• Our experienced nurses perform assessments in private, dedicated evaluation rooms
• Any special preparations or requirements, such as stopping certain medication, is communicated prior to testing
• A medical history interview and physical exam are performed prior to any testing
• Blood pressure and heart rate are monitored throughout any testing

Research-driven

We employ a “Discovery-to-Recovery” approach and work closely across disciplines to expand knowledge and bring innovative treatments to practice so that individuals with spinal cord injuries can experience their own personal Victory Over Paralysis. Our work is published in leading scientific journals.

Evidence-based

The assessments we perform are leading to greater understanding of how we can use interventions such as Respiratory Training (RT); Locomotor Training (LT); Neuromuscular Electrical Stimulation (NMES); spinal cord Epidural Stimulation (scES); and Transcutaneous Electrical Spinal Cord Stimulation (TcESCS) to regain respiratory-cardiovascular function and improve quality-of-life for individuals with spinal cord injuries.

The majority of individuals with spinal cord injury experience autonomic dysfunction that impacts the urogenital and bowel systems. The assessments we perform are leading to a greater understanding of how interventions such as Locomotor Training (LT), Neuromuscular Electrical Stimulation (NMES) and spinal cord Epidural Stimulation (scES) have helped individuals with spinal cord injuries regain function and improve their quality-of-life.

Epidural Stimulation Program

Motor Control

Studies

Proof of Principle

Interventions

Cardiovascular and Respiratory

Studies

Proof of Principle

Inter-system Participation

Interventions

Bladder, Bowel, and Sexual Function

Studies

Publications: Epidural Stimulation

Epidural Stimulation Timeline

KSCIRC Research Labs

KSCIRC Motor Systems

KSCIRC Autonomic Systems

KSCIRC Neurophysiology

KSCIRC Engineering

KSCIRC Research Medical

KSCIRC Biostatistics Outcomes, Database, and Communications

KSCIRC Finance and Administration