Abstract
Objective: Autonomic Dysreflexia (AD) is a potentially life-threatening syndrome which occurs in individuals with higher level spinal cord injuries (SCI). AD is caused by triggers which can lead to rapid escalation of pathophysiological responses and if the trigger is not removed, AD can be fatal. There is currently no objective, non-invasive and accurate monitoring system available to automatically detect the onset of AD symptoms in real time in a non-clinical setting. Technology or Method: We developed a user-independent method of symptomatic AD detection in real time with a wearable physiological telemetry system (PTS) and a machine learning model using data from eleven participants with SCI. Results: The PTS could detect onset of AD symptoms with an average accuracy of 94.10% and a false negative rate of 4.89%. Conclusions: The PTS can detect the onset of the symptoms AD with high sensitivity and specificity to assist people with SCIs in preventing the occurrence of AD. It would enable persons with high level SCIs to be more independent and pursue vocational activities while granting continuous medical oversight. Clinical Impact: The PTS could serve as a supplementary tool to current solutions to detect the onset of AD and prepare individuals who are newly injured to be better prepared for AD episodes. Moreover, it could be translated into a system to encourage individuals to practice better healthcare management to prevent future occurrences.
Highlights
Autonomic dysreflexia (AD) is a potentially life threating syndrome which occurs in roughly 70% of all persons with a spinal cord injury (SCI) above the T6 level [1]
We have developed a user-friendly and intuitive physiological telemetry system using a commercially available smartwatch for tetraplegics to detect the onset of AD symptoms with high accuracy and low error rate of missing AD symptoms
In this paper we present a highly accurate and sensitive, user-independent Physiological Telemetry System which can detect the onset of AD symptoms
Summary
Autonomic dysreflexia (AD) is a potentially life threating syndrome which occurs in roughly 70% of all persons with a spinal cord injury (SCI) above the T6 level [1]. AD is caused by hyperactivity of the sympathetic nervous system initiated by noxious or innocent stimuli below the level of injury. These include urinary tract infections, impacted bowels, wounds, or sexual activity [2], [3]. Notable pathophysiological responses when AD occurs are paroxysmal hypertension of at least 20 mm Hg [4]–[6], the onset of sweating above the level of injury, bradycardia and/or tachycardia, and changes in skin temperature [7], [8]. If the trigger is not removed, AD can escalate rapidly leading to systolic hypertension of over 200 mmHg, seizures, hemorrhagic strokes or even death [9], [10]
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