Episode 15- Autonomic Dysreflexia


What is it?

  • Excessive autonomic nervous system activity triggered by afferent stimuli below the level of the spinal cord injury (usually level T6 and above)
    • The stimulus can be noxious or non-noxious
    • Usually it is a noxious stimulus
    • Example: kinked catheter, tight clothing, overheating, UTI, bowel impaction, skin irritation
  • Need to realize that the patient does not have sensation at this level, so their body is telling them that something is wrong via AD/excessive ANS activity and you as the PT need to figure out what is causing this response



  • Know what level it can occur at (T6 level of injury and above)
  • Noxious/non-noxious stimuli


Differential Diagnosis

  • Orthostatic hypotension: presents similarly, check BP! OH: BP drops, AD: BP stays the same or is rising
  • Migraine: a lot of reports from patients involve a pounding headache
  • Essential hypertension: a person is becoming hypertensive with a certain activity
  • Anxiety
  • Withdrawal from pharmacologic drugs


Special tests

  • BP
  • Clinical diagnosis: look at the signs & symptoms
    • Signs: very rapid increase in BP (doesn’t always increase, but if it does, it will be rapid), decreased heart rate, goosebumps, diaphoresis, flushed skin above the level of the injury
    • Symptoms: pounding headache, chills, anxiety, nausea


How it will look on the test:

  • Incorporating a patient with a SCI and identifying AD and knowing how to manage it, what level injuries it may occur with
  • How to manage: sit the patient up! (the direct opposite of orthostatic hypotension), quickly identify what the irritant is

Fun way to remember how to treat immediately:

  • AD: BP up, sit the patient up
  • OH: BP down, lay patient down