REF-636 · West, Wong & Krassioukov, 2014 · Medicine & Science in Sports & Exercise, · Paper · PubMed
Autonomic cardiovascular control in 52 Paralympic athletes with SCI
Neurological level plus autonomic completeness (sympathetic skin response), not the motor/sensory ASIA grade, identifies who has abnormal blood-pressure control
Participants
n=52 highly trained male Paralympic athletes (age 34.8 ± 7.1 y) from 14 countries with chronic SCI (C2–L2). Three trials: motor/sensory assessment on the ASIA Impairment Scale; autonomic function via sympathetic skin responses (SSR); cardiovascular control via beat-by-beat blood pressure during an orthostatic challenge.
Protocol
Cross-sectional study: 52 highly trained male Paralympic athletes with chronic SCI (C2-L2), from 14 countries and aged 34.8 ± 7.1 yr, each took part in three experimental trials (from the abstract).
Trial 1: motor and sensory function by the American Spinal Injury Association Impairment Scale; trial 2: autonomic function via sympathetic skin responses (SSR); trial 3: cardiovascular control via the beat-by-beat blood pressure response to orthostatic challenge.
Analysis: linear regression of the blood pressure indices on neurological level and autonomic completeness of injury.
Key Findings
Athletes injured at the cervical level showed the lowest seated blood pressure and the worst orthostatic hypotension (P < 0.025).
Cardiovascular function did not differ by ASIA Impairment Scale grade (motor/sensory completeness) (P > 0.96); athletes with the lowest SSR scores (autonomic completeness) had the lowest blood pressure when seated and the worst orthostatic hypotension (P < 0.002).
A combined model of neurological level + autonomic completeness explained the most variance in all blood-pressure indices; the authors advocate autonomic testing in the clinical and sporting classification of SCI athletes.
Context stated by the authors: disrupted autonomic control after SCI produces life-threatening cardiovascular dysfunction and impaired endurance performance, so identifying those at risk matters clinically and in sport. Exercise responses (HR, cardiac output) were not measured in this study.
Not from this paper (REF-563): lesions at or above about T6 risk autonomic dysreflexia — a stimulus below the lesion (full bladder, tight strap, skin pressure) triggers an uncontrolled sympathetic reflex and a sudden, severe blood-pressure rise; deliberately inducing it for performance ("boosting") is prohibited by the IPC and dangerous. Blauwet 2013 (DOI 10.1136/bjsports-2012-092103; not checked against its abstract) describes the IPC's boosting testing.
Practical Application
In 52 Paralympic athletes with SCI, cervical lesions and low sympathetic skin responses — not the ASIA motor/sensory grade — marked the athletes with low resting blood pressure and severe orthostatic hypotension.Practical meaning: an athlete's motor classification tells you little about their cardiovascular control; ask the medical team about autonomic status and expect resting/orthostatic BP problems in high-lesion athletes (dizziness on transfers, after long sits, in heat).
Know the autonomic-dysreflexia red flags (pounding headache, flushing or sweating above the lesion, sudden BP rise, blotchy skin) as a safety escalator: stop activity, remove obvious triggers if trained, get medical help immediately. Never facilitate, suggest or ignore boosting. (Not from this paper; REF-563 and the base's own practice.)
High-lesion athletes: pace around a genuinely blunted cardiovascular response — no able-bodied HR targets; keep a documented emergency plan. (Inference from the authors' framing plus REF-635; exercise responses were not measured here.)
Limitations
Cross-sectional, resting/orthostatic measures only (no exercise or intervention data); male, highly trained; the boosting/AD content is from other sources, not this paper.
How this entry was checked and changed
Content correction 2026-09-27
Title and lead were about boosting/AD, which this paper does not study; retitled to its actual finding (level + SSR identify abnormal BP control; ASIA grade does not). AD/boosting content kept but labelled "Not from this paper" and pointed at REF-563.
"Blunted HR/BP response to exercise, lower peak cardiac output" removed as a finding — the study measured orthostatic blood-pressure responses, not exercise.
Added n=52, age, countries, lesion range and the P-values; "IPC withdraws at systolic ≥180 mmHg" removed (not verified). Sport line normalised.
2026-09-28: added Protocol from the abstract (Europe PMC PMID 23739527).
2026-09-28: PMID 23793233 belonged to an unrelated paper; replaced with 23739527, the PubMed record for this entry's own DOI.