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During the last decade an international community of clinicians and scientists in the area of spinal cord injury (SCI) medicine became aware of the need to improve evaluation of autonomic function in individuals with SCI to optimize clinical management and determine efficacy of therapeutic interventions. This prompted an international collaboration between the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS) to develop the International Standards documenting the remaining autonomic functions following SCI.
The autonomic nervous system (ANS) plays a key role in regulation of many physiologic processes. Impact of SCI on autonomic control cannot be overstated because supraspinal control of many bodily systems and organs is partially or completely lost following an injury to the spinal cord. Although autonomic dysfunctions are well recognized clinically, the mechanisms of these dysfunctions are still poorly understood and present significant challenges during clinical management of the secondary complication of SCI.
Understanding the role of autonomic dysfunction in persons with SCI is crucial to improving health and longevity in these individuals because ANS dysfunction may be the underpinning of many secondary complications post-SCI. Furthermore, it is known that restoration of autonomic function is among the highest health priorities for individuals with SCI. However, research initiatives aimed at gaining insight into the direct impact of ANS dysfunction on health outcomes in persons with SCI are currently lacking.
This publication presents a revised edition of the International Standards on documentation of remaining Autonomic Function after SCI (ISAFSCI) and will be of interest to anyone involved in clinical management of individuals with SCI. The objectives of this ISAFSCI initiative are to describe the impact of SCI on ANS function and to provide clinicians with an assessment tool which is recommended for evaluation of autonomic dysfunctions following SCI. This newly designed form is recommended to be completed during the evaluation of individuals with SCI as an adjunct to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) to document the neurological level and completeness of the spinal lesion in individuals with SCI including the ASIA Impairment Scale (AIS). A compilation of what is known about cardiovascular, respiratory, bladder, bowel, temperature, and sexual dysfunction after SCI, as it relates to the changes within the ANS control of these functions, can be found in the Autonomic Standard Assessment Form.
Additionally, a web-based training course has been developed to assist clinicians with understanding autonomic dysfunctions following SCI: the Autonomic Standards form (ASTeP). We encourage the reader to access ASTeP for additional information (www.ASIAlearningcenter.com).
Members of the Autonomic Standards Committee expect that publication of the ISAFSCI will facilitate the practical use and testing of the Autonomic Standards which will promote improved clinical care, and subsequent health and longevity for the SCI community. Considering the complexity of ANS function and the paucity of standardized tests for evaluation in individuals with SCI we expect this document to be revised and refined over time and we welcome comments and constructive criticism that will facilitate further refinement and improvement of this evaluation process for autonomic function post-SCI. This is just the beginning of an exciting future in the exploration of autonomic function, and establishment of a validated autonomic classification tool for individuals with SCI.