103 JRRD JRRD Volume 44, Number 1, 2007 Pages 103–112 Journal of Rehabilitation Research & Development Assessment of autonomic dysfunction following spinal cord injury: Rationale for additions to International Standards for Neurological Assessment Andrei V. Krassioukov, MD, PhD; 1* Ann-Katrin Karlsson, MD, PhD; 2 Jill M. Wecht, PhD; 3 Lisa-Ann Wuermser, MD; 4 Christopher J. Mathias, DPhil, DSc, FRCP, FMedSci; 5 Ralph J. Marino, MD, MSCE 6 1 Department of Physical Medicine and Rehabilitation, International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; 2 Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; 3 Department of Veterans Affairs (VA) Rehabilitation Research and Development Center ofExcellence Spinal Cord Injury and Medical Services, VA Medical Center, Bronx, NY; 4 Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Chicago, IL; 5 Neurovascular Medicine Unit, Faculty of Medicine, Imperial College London, London, UK; and Autonomic Unit, National Hospital for Neurology and Neurosurgery, Institute of Neurology, Queen Square, University College London, London, UK; 6 Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA Abstract—We present a preliminary report of the discussion of the joint committee of the American Spinal Injury Associa- tion (ASIA) and the International Spinal Cord Society concern- ing the development of assessment criteria for general autonomic function testing following spinal cord injury (SCI). Elements of this report were presented at the 2005 annual meeting of the ASIA. To improve the evaluation of neuro- logical function in individuals with SCI and therefore better assess the effects of therapeutic interventions in the future, we are proposing a comprehensive set of definitions of general autonomic nervous system dysfunction following SCI that should be assessed by clinicians. Presently the committee rec- ommends the recognition and assessment of the following con- ditions: neurogenic shock, cardiac dysrhythmias, orthostatic hypotension, autonomic dysreflexia, temperature dysregula- tion, and hyperhidrosis. Key words: assessment standards, autonomic dysfunction, autonomic dysreflexia, bradycardia, cardiovascular control, orthostatic hypotension, rehabilitation, spinal cord injury, sweating, temperature. INTRODUCTION That autonomic dysfunctions, including abnormal car- diovascular control, are common consequences of spinal cord injury (SCI) in humans is well known. During the first weeks postinjury, alterations in autonomic function may be life-threatening. Severe bradycardia and even asys- tole are seen in patients with cervical injuries. The majority of these patients require admission to the intensive care unit because of hemodynamic instability, including severe Abbreviations: AD = autonomic dysreflexia, ASIA = American Spinal Injury Association, ECG = electrocardiogram, HF = high frequency, HR = heart rate, HRV = HR variability, HUT = head- up tilt, ISCoS = International Spinal Cord Society, LF = low fre- quency, SCI = spinal cord injury, T = thoracic. * Address all correspondence to Andrei V. Krassioukov, MD, PhD; Department of Physical Medicine and Rehabilitation, ICORD, University of British Columbia, 6270 University Blvd, Vancouver, BC, Canada, V6T 1Z4; 604-822-2673; fax: 604-822-2924. Email: krassioukov@icord.org DOI: 10.1682/JRRD.2005.10.0159