Project 454439

Paralysis is often regarded as the most devastating consequence of spinal cord injury (SCI), but what is less apparent is the widespread dysfunction of unconscious bodily systems that many of us take for granted. These functions, such as the ability to regulate heart rate, blood pressure, as well as bowel and bladder function, are controlled by the sympathetic and parasympathetic divisions of the autonomic nervous system (ANS). Accordingly, individuals with SCI consistently report the need for improvements in ANS function as their top health priority after injury (more important than walking again). Because of the damage sustained to the ANS after SCI, many patients have reduced ability to increase the rate and force at which the heart pumps blood to the rest of the body. As such, the risk of heart disease and heart failure is 3 times higher in individuals with SCI. Unfortunately, clinical options for managing impaired heart function are limited. Pharmacological therapies to improve the pumping force of the heart can only be tolerated for short periods of time, meaning that long-term clinical management of heart function in individuals with SCI is extremely difficult. Fortunately, new technology capable of electrically stimulating the spinal cord has become a promising therapy for recovering both motor control and autonomic functions after SCI. We recently published that electrical stimulation of the spinal cord can restore blood pressure control after SCI by improving ANS signaling to blood vessels. The present study aims to utilize targeted electrical stimulation of the spinal cord to acutely improve the heart's ability to pump blood to the body and to understand the mechanisms by which it does so. This technology would provide a novel, rapid, nonpharmacologic approach to improve cardiac function after SCI, and improve health outcomes in people living with this devastating injury.