Engel‐Haber, Einat

Background: The National SCI Model Systems (SCIMS) Database was established in 1973 to study longitudinal data from persons with traumatic SCI (TSCI). The SCIMS provides an ideal platform to explore the feasibility of a parallel data collection effort to understand the characteristics of individuals with nontraumatic SCI (NTSCI). In the current data collection cycle (2021-2026), all SCIMS centers gathered data specific to NTSCI. Objectives: To (1) describe the demographic and injury-specific characteristics of participants with NTSCI and (2) assess neurological changes from admission to discharge. Methods: The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination data of participants with NTSCI who were enrolled at an SCIMS center were extracted from the medical records at admission and discharge from inpatient rehabilitation. Data from 178 participants with NTSCI were analyzed. Results: Among the 93 participants who had adequate ISNCSCI data on admission, only 8.6% had neurological complete injuries. More participants had paraplegia ( n = 58, 62.4%) than tetraplegia ( n = 35, 37.6%). For participants with full ISNCSCI data at both admission and discharge ( n = 47), there were significant improvements in the lower extremity motor score and pinprick and light touch scores on discharge. Conclusion: On admission to acute rehabilitation, more people with NTSCI had paraplegia than tetraplegia, and neurological incomplete injuries were more common. People with NTSCI experienced significant improvement in ISNCSCI neurological variables by the time of discharge from rehabilitation.

The expanding application of spinal stimulation therapies in spinal cord injury (SCI) rehabilitation necessitates a critical reexamination of cardiovascular (CV) responses to these interventions. A key question arises: How should blood pressure (BP) responses to stimulation be interpreted, and does the conventional definition of autonomic dysreflexia (AD) adequately capture these phenomena? Researchers remain divided—some classify BP elevations during stimulation as AD, while others attribute them to intentional neuromodulation targeting sympathetic preganglionic neurons. This review scrutinizes the various AD definitions in the literature, including the conventional threshold (systolic BP increase >20 mmHg), revealing substantial limitations in research contexts. While symptomatic AD occurs in only 4-7% of stimulation study participants, asymptomatic BP increases are considerably more frequent. This established threshold lacks robust physiological rationale and creates significant interpretive challenges, particularly when evaluating interventions designed to modulate BP responses. The current limitations of guideline-based definitions of AD challenge research interpretation and clinical translation. Although several publications describe AD as “unregulated” or “uncontrolled,” it has not yet been incorporated into formal guideline definitions. This review underscores the need for a collaborative effort to refine AD definitions in research, particularly in the context of spinal stimulation. Future consensus development should address whether uniform thresholds should apply across different contexts, how to integrate heart rate dynamics and absolute BP values alongside symptomatic status, and how to meaningfully distinguish therapeutic BP modulation from adverse autonomic responses. This is essential for standardizing research approaches, optimizing stimulation parameters, and ensuring efficacy and safety as spinal stimulation technologies advance clinically.