FROM MY PT SCHOOL NOTES · NEUROLOGY · UNIT 5 · CHAPTER 18
Which SCI complications require immediate action?
An SCI rehabilitation session can change quickly when autonomic, respiratory, skin or medical complications emerge. Safety begins by knowing the person’s baseline and recognizing patterns that require stopping activity and involving the medical team.
Build the clinical picture
Recognize autonomic dysreflexia promptly
Autonomic dysreflexia (AD) is a potentially life-threatening blood-pressure emergency, most often in patients with neurological injuries at or above T6. A sudden systolic rise of about 20 mmHg or more above that person’s baseline is concerning in adults—even if the absolute value would appear unremarkable in someone else. Severe headache, flushing/sweating above the lesion, nasal congestion, goosebumps and anxiety may accompany AD, but it may be largely silent.
Stop the session, initiate the established emergency/medical protocol, bring the person upright when safe, loosen constrictive items, and arrange urgent assessment of common triggers such as bladder drainage, bowel distention or skin pressure by qualified personnel. Continue blood-pressure monitoring under protocol. Do not perform untrained catheter or bowel procedures. See PVA/Consortium guidelines.
Distinguish hypotensive and autonomic conditions
Orthostatic hypotension is a fall in blood pressure associated with upright positioning; the patient may feel lightheaded or faint, especially early after SCI. Change position safely, monitor symptoms and vitals, and coordinate the team’s graded-upright, compression or medication plan as indicated. This differs from the hypertensive AD response.
Neurogenic shock is an acute medical condition after high cord injury characterized by loss of sympathetic tone, potentially hypotension and bradycardia. Spinal shock describes an early period of suppressed reflex activity below the injury. The similar names describe different processes.
Monitor systemic and musculoskeletal risk
High cervical injury may impair ventilation, cough and secretion clearance. Limited sensation and prolonged loading contribute to pressure injury risk. Also consider venous thromboembolism, heterotopic ossification, urinary/bowel problems, pain, altered temperature control and new neurologic changes. These require trained assessment, prevention and timely team communication.
The person may not feel injury or excessive temperature on insensate skin. Support regular skin inspection, safe positioning, appropriate cushions and individualized pressure relief; follow current wound/skin and SCI care guidance.
At a glance
| AD | Relative hypertension; stop, sit upright if safe, activate medical protocol |
| Orthostatic hypotension | Fall in pressure upright; respond to symptoms and monitor tolerance |
| Respiratory change | Consider cough/ventilation, oxygenation and immediate medical readiness |
| Skin or VTE concern | Inspect/refer promptly; prevention must match individual risk |
What matters in PT?
Know baseline systolic BP, lesion level, current bladder/bowel management plan and acute medical restrictions before escalating activity. The PT’s role is recognition, safe positioning, monitoring, team communication and medically appropriate rehabilitation—not independent emergency pharmacotherapy.
Clinical reasoning case
During seated exercise a patient with a T4 SCI develops a severe headache and facial sweating. Their usual systolic pressure is 100 mmHg and it now reads 136 mmHg. Should treatment continue because 136 is not a ‘severely high’ number for the general population?
Reasoning: No. A 36 mmHg increase from baseline is concerning for autonomic dysreflexia. Stop activity and activate the patient’s emergency management pathway promptly.
Check your understanding
Contrast AD with orthostatic hypotension and explain why a patient’s usual BP matters more than a general-population cutoff.
Original uploaded class notes: 7 SCI Complications.pdf; SCI Terms.pdf; 8 SCI Acute Care and Active Rehabilitation.pdf; HALO.pdf (2012 institutional document, not replicated). Historical note: Some older lecture statements about frequency and timing of autonomic dysreflexia are oversimplified. Compare your notes with current SCI clinical practice guidelines and your facility’s emergency procedures. These student notes are educational, not a substitute for supervised clinical assessment or emergency care.
