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Autonomic Dysfunction in Neurologic Physical Therapy

presented by Karen L. McCulloch, PhD, PT, MS, NCS(E), FAPTA, FACRM

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Disclosure Statement:

Financial: Karen McCulloch has past and current grant support for research from the U.S. Department of Defense. She serves as assistant editor for Elsevier, for which she receives royalties. She receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

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.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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Video Runtime: 112 Minutes; Learning Assessment Time: 46 Minutes

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, PhD, PT, MS, NCS(E), FAPTA, FACRM

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 the Academy of Neurologic Physical Therapy,…

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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.

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