Indian Journal of Physical Medicine and Rehabilitation

Register      Login

VOLUME 26 , ISSUE 1 ( March, 2015 ) > List of Articles


Assessment of Autonomic Dysfunction in Chronic Complete Spinal Cord Injury by Heart Rate Variability

BP Navin, Amitava Dube

Citation Information : Navin B, Dube A. Assessment of Autonomic Dysfunction in Chronic Complete Spinal Cord Injury by Heart Rate Variability. Indian J Phy Med Rehab 2015; 26 (1):11-16.

DOI: 10.5005/ijopmr-26-1-11

Published Online: 01-03-2015

Copyright Statement:  Copyright © 2015; The Author(s).



Non-invasive assessment of cardiac autonomic dysfunction in spinal cord injury (SCI) by means of heart rate variability analysis (HRV). Also, to assess the effect of postural change on neural outflow.


Rehabilitation research center, Sawai Man Singh Hospital, Jaipur.


110 patients with SCI were screened, of whom, 12 patients aged between 20 and 30 years with chronic complete SCI and neurological level of T6 or above were included. An equal number of age and sex matched healthy individuals were the controls.


Five minute ECG recording, first in supine position and then in sitting position was done.

Outcome measures

Frequency domain measures of heart rate variability.


No significant differences were observed between both the groups in supine rest. On sitting, the absolute power of the low frequency (LF) and high frequency (HF) components were significantly less in the SCI patients than that in the controls. A significantly increased LF-to-HF ratio along with a higher mean heart rate (HR) was observed in the controls on postural change.


On change of posture, the controls showed a physiologically patterned response, which was not observed in the SCI patients. The loss of this homeostatic mechanism in the SCI subjects was observed, which may reflect a dysfunctional autonomic nervous system interplay in patients with complete SCI.

PDF Share
  1. Autonomic dysreflexia in acute spinal cord injury: an under-recognized clinical entity. J Neurotrauma 2003;20:707-16.
  2. Assessment of autonomic dysfunction following spinal cord injury: Rationale for additions to International Standards for Neurological Assessment. J Rehabil Res Dev 2007;44:103-12.
  3. Reduced sympathetic skin response in the isolated spinal cord of subjects with spinal cord injury. Arch Phys Med Rehabil 2006;87:1201-06.
  4. Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury. Arch Phys Med Rehabil 2000;81:506-16.
  5. Clinical correlates of frequency analyses of cardiovascular control after spinal cord injury. Am J Physiol Heart Circ Physiol 2008;294:H668-78.
  6. The isolated sympathetic spinal cord: cardiovascular and sudomotor assessment in spinal cord injury patients: A literature survey. Ann Phys Rehabil Med 2010;53:520-32.
  7. A prospective assessment of mortality in chronic spinal cord injury. Spinal Cord 2005;43:408-16.
  8. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil 1999;80:1411-9.
  9. Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology. Spinal Cord 2006;44:341-51.
  10. Beat to beat variability in cardiovascular variables: noise or music? J Am Coll Cardiol 1989; 14: 1139-48.
  11. Hemodynamic regulation: investigation by spectral analysis. Am J Physiol Heart Circ Physiol 1985;249:H867-75.
  12. Reproducibility of heart rate variability and blood pressure variability in individuals with spinal cord injury. Clin Auton Res 2005;15:387-93.
  13. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 1996;93:1043-65.
  14. Assessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol Heart Circ Physiol 1985;248:H151-3.
  15. International Standards for Neurological and Functional Classification of Spinal Cord Injury. Spinal Cord 1997;35:266-74.
  16. R: A Language and Environment for Statistical computing. [online] 2013. Available from URL:
  17. RKWard: Frontend to the R statistics language. [online] 2013. Available from URL:
  18. Mechanism of blood pressure and R-R variability: insights from ganglion blockade in humans. J Physiol 2002;543:337-48.
  19. Autonomic control of the heart and renal vascular bed during autonomic dysreflexia in high spinal cord injury. Clin Auton Res 2002;12:457-64.
  20. Orthostatic influence on heart rate and blood pressure variability in trained persons with tetraplegia. Eur J Appl Physiol 2008;104:75-8.
  21. Human autonomic rhythms: vagal cardiac mechanisms in tetraplegic subjects. J Physiol 1994;474:483-95.
  22. Influences of neural mechanisms on heart period and arterial pressure variabilities in quadriplegic patients. Am J Physiol Heart Circ Physiol 1994;266:H1112-20.
  23. Autonomic dysfunction in spinal cord injury: clinical presentation of symptoms and signs. Prog Brain Res 2006;152:1-8.
  24. Blunted heart rate response to vagal withdrawal in persons with tetraplegia. Clin Auton Res 2006; 16: 378-83.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.