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Autonomic Dysreflexia

Prevention of AD During FES Exercise

Functional electrical stimulation (FES) is a widely-used modality in the rehabilitation of individuals with SCI (Sampson et al. 2000Wood et al. 2001). Similar to any non-noxious or noxious stimuli below the level of injury, FES itself may also lead to significant afferent stimulation and trigger the development of AD (Ashley et al. 1993Matthews et al. 1997).

Author Year; Country
Research Design
Sample Size
Methods Outcome
Matthews et al. 1997; Canada




Population: Injury level: C4-C7; all injuries were complete; age range: 23-44 years; 3-21 years post-injury.

Treatment: Randomized to: a) topical anesthetic or: b) placebo creams applied to the quadriceps muscles during graded FES exercise.

Outcome Measures: heart rate, blood pressure, serum catecholamines.

1.   No differences in HR, BP or catecholamine responses or FES force were seen between the two conditions.

One RCT (n=7) assessed the effect of topical anaesthetic and placebo creams applied to the skin area over the quadriceps muscle 1 hour prior to FES on two different days (Matthews et al. 1997). As cardiovascular and AD responses during FES were unaffected by topical anaesthetic cream application at the stimulation site, the authors suggested that mechanisms other than skin nociception contributed to FES-induced AD.


There is level 1 evidence (from one RCT: Matthews et al. 1997) supporting no effect of topical anesthetic for the prevention of AD during FES.

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