Autonomic Dysfunction in Neurologic Physical Therapy
Presented by Karen L. McCulloch
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Nonfinancial: Karen serves on editorial boards for Brain Injury, Journal of Neurologic Physical Therapy, and Journal of Head Trauma Rehabilitation. She has no competing nonfinancial interests or relationships with regard to the content presented in this course.
The autonomic nervous system (ANS) has central nervous system components and peripheral nervous system components (both sympathetic and parasympathetic responses), all of which could be affected by neurologic conditions. Physical therapy activities that are commonly affected by ANS dysfunction include postural transitions (supine or sitting to standing) and exercise. This course reviews common ANS-driven hypotensive and hypertensive responses that may be observed in physical therapy practice and strategies for addressing them.
Meet your instructor
Karen L. McCulloch
Karen L. McCulloch is a professor in physical therapy in the Division of Physical Therapy, Department of Health Sciences, School of Medicine at University of North Carolina at Chapel Hill, where she has taught entry-level and advanced-level students in neurorehabilitation since 1993. She has served in multiple roles within…
Chapters & learning objectives
1. Autonomic Nervous System Dysfunction
The central and peripheral components of the ANS are reviewed with a focus on how these elements interact during postural transitions and during exercise. In addition, the importance of links within the ANS to the limbic system is reviewed, emphasizing the role of perceived threat on sympathetic responses and how this may manifest in neurologic conditions.
2. When Autonomic Dysfunction Is Hypotensive
Neurologic hypotension can commonly occur in spinal cord injury, Parkinson’s disease, and other neurologic conditions. Methods for assessment and self-report of hypotensive responses are reviewed to provide outcome indicators. Intervention approaches are reviewed for postural transitions and during exercise.
3. Paroxysmal Autonomic Responses: Hypertensive Activity
The physiology of abnormal blood pressure responses driven by neurologic dysfunction is reviewed in instances of traumatic brain injury and spinal cord injury. A patient example (Guillain-Barré syndrome) emphasizes the importance of activity-based blood pressure monitoring for patients with neurologic conditions to detect hypertensive responses.
