Abstract
Study design
Systematic review.
Objectives
A spinal cord injury (SCI) commonly results in alterations of cardiovascular physiology. In order to investigate such alterations, the cold pressor test (CPT) has been used as an established challenge test. This review summarizes the basic physiology underlying a CPT, discusses potential mechanisms responsible for abnormal pressor responses following SCI, and highlights the utility of CPT in the SCI population.
Setting
Canada and Switzerland.
Methods
We have completed a comprehensive review of studies that have investigated the effect of foot or hand CPT on hemodynamic indices in individuals with SCI.
Results
Depending on the level of spinal cord lesion and the location of cold application, i.e., above or below the lesion, mean arterial pressure typically increases (ranging between 4 and 23 mmHg), while heart rate responses demonstrated either a decrease or an increase (ranging between −4 and 24 bpm) during CPT. The increase in blood pressure during foot CPT in high-level lesions might not necessarily be attributed to a physiological CPT response as seen in able-bodied individuals, but rather due to a reflexic sympathetic discharge below the level of lesion, known as autonomic dysreflexia.
Conclusions
Further investigations in a wider range of individuals with SCI including incomplete injuries might be helpful to examine the ability of CPT assessing the integrity of the autonomic nervous system following SCI. Furthermore, additional autonomic tests are needed to emphasize the integrity of autonomic pathways and to account for the complexity of the autonomic nervous system.
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Acknowledgements
The authors are grateful to the Swiss National Science Foundation for providing an advanced postdoc mobility fellowship to MH. Research in AVK’s laboratory is supported by grants from the Canadian Institutes of Health Research and the Craig. H Neilsen Foundation.
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Hubli, M., Bolt, D. & Krassioukov, A.V. Cold pressor test in spinal cord injury—revisited. Spinal Cord 56, 528–537 (2018). https://doi.org/10.1038/s41393-017-0037-z
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DOI: https://doi.org/10.1038/s41393-017-0037-z
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