The knowledge about autonomic dysreflexia among nursing and physiotherapy students

The Clinical Relevance of Autonomic Dysfunction, Cerebral Hemodynamics, and Sleep Interactions in Individuals Living With SCI

A myriad of physiological impairments is seen in individuals after a spinal cord injury (SCI). These include altered autonomic function, cerebral hemodynamics, and sleep. These physiological systems are interconnected and likely insidiously interact leading to secondary complications. These impairments negatively influence quality of life. A comprehensive review of these systems, and their interplay, may improve clinical treatment and the rehabilitation plan of individuals living with SCI. Thus, these physiological measures should receive more clinical consideration. This special communication introduces the under investigated autonomic dysfunction, cerebral hemodynamics, and sleep disorders in people with SCI to stakeholders involved in SCI rehabilitation. We also discuss the linkage between autonomic dysfunction, cerebral hemodynamics, and sleep disorders and some secondary outcomes are discussed. Recent evidence is synthesized to make clinical recommendations on the assessment and potential management of important autonomic, cerebral hemodynamics, and sleep-related dysfunction in people with SCI. Finally, a few recommendations for clinicians and researchers are provided.

Autonomic dysreflexia in patients with spinal cord injury

ABSTRACT

Patients with traumatic spinal cord injury have a vast array of secondary pathophysiologic effects, one of which is autonomic dysreflexia (AD). It can be triggered by noxious stimuli and cause severe and fatal consequences that require rapid intervention. This article examines AD and its implications for nursing care.

Spinal Cord Injury and Autonomic Dysreflexia: A Case Report on an Overlooked Complication of Spinal Cord Injury

Autonomic dysreflexia (AD) is a life-threatening condition that affects patients with spinal cord injuries (SCI) at the sixth thoracic vertebrae (T6) and above due to a noxious stimulus below the level of spinal cord injury. This is a case report of a 48-year-old man with a history of paraplegia T1 (American Spinal Injury Association Impairment Scale - ASIA A) spinal cord injury due to a road traffic accident 16 years ago who presented with recurrent episodes of hypertension, sweating, bradycardia, and hypothermia. Previous hospitalizations suggested that his symptoms were caused by sepsis from a urinary tract infection; however, further assessment revealed that his symptoms were consistent with untreated and undiagnosed autonomic dysreflexia. This case report provides an overview of AD, including its distinctive presentation, etiology, pathophysiology, and management. Autonomic dysreflexia can be a life-threatening condition associated with spinal cord injury patients at the T6 level and above due to various noxious stimuli below the neurological level of injury. Bladder distension appears to be the trigger in most of the cases reported. AD can be easily missed by medical staff unfamiliar with this condition. Patient and healthcare provider education and a thorough evaluation are essential for diagnosis and management.

Nurses and physiotherapists' knowledge levels on autonomic dysreflexia in a rehabilitation hospital

OBJECTIVE

Autonomic dysreflexia is a clinical syndrome that affects people with spinal cord lesions at or above the sixth thoracic vertebral level (T6). This study aims to determine the level of knowledge about autonomic dysreflexia among nurses and physiotherapists involved in spinal cord rehabilitation.

DESIGN

Single-center survey study.

SETTING

This was conducted at a rehabilitation hospital.

OUTCOME MEASURE

: Autonomic dysreflexia knowledge test.

PARTICIPANTS

Nurses (N = 36) and physiotherapists (N = 32) working at a local rehabilitation hospital participated in this study.

RESULTS

In the autonomic dysreflexia knowledge test, the nurses obtained an average score of 6.63 ± 2.2 and the physiotherapists obtained an average score of 6.87 ± 1.89; there was no significant difference between the two groups (P > 0.05). Less than 25% of the participants had experience with autonomic dysreflexia and the test scores of the participants with this experience were significantly higher (P < 0.001).

CONCLUSION

Similar to previous studies, the knowledge level of autonomic dysreflexia among nurses and physiotherapists working in rehabilitation hospitals was low. We think that there is a need for internationally standardized training programs to increase the knowledge level of autonomic dysreflexia for patients, caregivers, and health professionals.

What do physiotherapists and physiotherapy students know about autonomic dysreflexia?

CONTEXT/OBJECTIVE

Autonomic dysreflexia (AD) is an emergency condition typical for individuals with spinal cord injury (SCI). Adequate health professionals' knowledge of AD is important for the effective and safe rehabilitation of persons with SCI. The purpose of the study is to assess the knowledge of AD in undergraduate and postgraduate physiotherapists. The data gained will be useful for better addressing of AD in clinical practice.

DESIGN

An observational study.

SETTING

Rehabilitation College in Warsaw, Medical University of Warsaw, Poland.

PARTICIPANTS

52 undergraduate and 68 postgraduate physiotherapists.

INTERVENTION

AD knowledge testing.

OUTCOME MEASURES

A test assessing knowledge of causality and consequences of AD created at the Medical University of Warsaw.

RESULTS

No significant differences in test scores between under- and postgraduates were found (P = 0.09). Higher scores were noted in physiotherapy masters as compared to bachelors (P = 0.01), in participants who have an in-patient practice (P = 0.04), a practice longer than 5 years (P = 0.02) and those who see patients with SCI more frequently (P = 0.01). A self-assessed knowledge of AD was admitted as poor or none by 96.2% of undergraduates and 86.8% of postgraduates.

CONCLUSION

In the studied population the knowledge of causality and consequences of AD presented by undergraduate and postgraduate physiotherapists was low. Lower test scores were associated with a lower level of professional education achieved, having an outpatient practice only and having fewer patients with spinal cord injury. Efforts should be made to improve undergraduate and postgraduate education on AD of physiotherapists.