Grant: CIHR Fellowship

Spinal cord injury (SCI) disrupts many aspects of life, including cardiovascular function, which, unlike the loss of voluntary movement, tends to be "invisible". Although older individuals with SCI remain underrepresented in rehabilitation research, their life expectancy continues to grow. As a result, total healthcare expenditures and overall disease burden in this population have also risen in tandem. Cardiovascular dysfunction is the leading cause of mortality among older individuals with SCI. Autonomic dysreflexia (AD) is the most common adverse cardiovascular event associated with SCI. AD is a sudden and life-threatening elevation of blood pressure that may result in retinal detachment or vascular infarction within the brain and heart. We propose to implement an AD-prediction algorithm based on changes in heart rhythm oscillations, obtained non-invasively from the earlobe. We will couple this approach with transcutaneous spinal cord stimulation (TSCS) to prevent AD in individuals > 65 years old. TSCS is a non-invasive, safe, and inexpensive therapy that activates specific areas of the spinal cord without causing pain or discomfort. The TSCS will be applied before an AD event occurs, once it is predicted by our algorithm. Since bladder overdistention is the main trigger for AD, we will test the efficacy of our system to prevent AD during a standardized bladder capacity evaluation and during normal urine storage after fluid intake. We expect this precision prevention will decrease the incidence of AD. Addressing cardiovascular dysfunction may ultimately improve health-related quality of life and reduce cardiovascular health risks for older individuals living with SCI. The broader SCI community will also benefit from the outcomes of the project, as the results will 1) improve quality of life and 2) advance health care to serve the priorities of individuals with SCI who rank cardiovascular health among their top health concerns.