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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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Europa Medicophysica 2002 June;38(2):73-87

language: English

The cardiovascular system in individuals with spinal cord injury

Occhi E., Pedrini D., Brambilla M.

From ­the Spinal Unit E. Morelli Hospital, Sondalo (Sondrio)


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Spinal ­cord inju­ry (­SCI) ­with resul­tant par­a­ple­gia ­and tet­ra­ple­gia is ­often asso­ciat­ed ­with sig­nif­i­cant alter­a­tions of ­the car­di­o­vas­cu­lar (CV) ­system ­due to ­the ­loss of sym­pa­thet­ic con­trol, immo­bil­ity ­and hor­mo­nal-meta­bol­ic dys­reg­u­la­tion. The ­main alter­a­tions relat­ed to sym­pa­thet­ic dys­func­tion ­are: ­low rest­ing ­blood pres­sure, ­reflex brad­y­car­dia, orthos­tat­ic hypo­ten­sion, periph­er­al ede­ma, ­reduced ­venous ­return, ­altered ­response to phys­i­cal exer­cise, auto­nom­ic dys­re­flex­ia ­and, rare­ly, car­diac ­arrest. These alter­a­tions ­occur in ­patients ­with tet­ra­ple­gia or ­high par­a­ple­gia as a con­se­quence of ­the ­loss of supras­pi­nal con­trol of ­the sym­pa­thet­ic ner­vous ­system direct­ed to ­the ­heart ­and cer­vi­co-tho­rac­ic ves­sels. Immobility ­and hor­mo­nal-meta­bol­ic dys­reg­u­la­tion ­are respon­sible ­for a ­series of com­pli­ca­tions ­such as ­deep ­vein throm­bo­sis (some­times com­pli­cat­ed by pul­mo­nary embo­lism), obes­ity, ­altered lip­id pro­file, hyper­ten­sion ­and ath­ero­scler­o­sis. All ­these com­pli­ca­tions ­reduce ­the exer­cise capac­ity of ­many indi­vid­u­als ­with ­SCI ­and ­are respon­sible ­for a ­high mor­tal­ity ­rate ­from CV dis­ease. Regular aero­bic phys­i­cal exer­cise, in ­some cas­es asso­ciat­ed ­with ­FES ergom­e­try pro­gram, ­diet ­and peri­od­ic ­check up of CV ­system, ­seem to ­improve CV fit­ness ­and ­reduce com­pli­ca­tions.

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