# Autonomic Effects of Transcutaneous Spinal Cord Stimulation in Veterans with SCI

> **NIH VA I21** · JAMES J PETERS VA  MEDICAL CENTER · 2024 · —

## Abstract

Most individuals with spinal cord injury (SCI) retain spared neural activity at and below the site of
injury, activating these neural circuits may enhance neural plasticity to promote recovery of motor,
sensory, and autonomic function. Individuals with SCI struggle with life-long autonomic nervous
system (ANS) dysfunction with serious adverse consequences. The dynamic balance between the
sympathetic and parasympathetic branches of the ANS is impaired in individuals with SCI at or above
T6, which negatively impacts internal homeostasis during daily activities such as transferring from the
supine to the seated position, regulating core body temperature (Tcore), and exercise performance.
For the estimated millions of people living with SCI globally, impaired ANS regulation is common, and
has been implicated in widespread cardiovascular complications, which are a leading cause of
morbidity and mortality in this population. One of the most prominent consequences of cardiovascular
ANS impairment is blood pressure (BP) instability, which includes hypotension, orthostatic
hypotension (OH), and autonomic dysreflexia (AD). These BP impairments lead to an absence or
reversal of the nocturnal BP dip, and increased daytime sleepiness, which detract from
wellbeing, independence, social engagement and quality of life. Further, ANS cardiovascular
impairment in athletes with SCI limits the heart rate (HR) response during competition, lowers BP,
and increases fatigue, thereby compromising endurance and sports performance. In fact, some
athletes with SCI enhance their performance in competition by self-inducing AD, a practice
known as “boosting,” to increase BP and create a generalized efferent sympathetic response.
In addition to cardiovascular complications, ANS deficits post-SCI also contribute to abnormal
sudomotor function and dysregulation of Tcore. With climate change becoming increasingly
apparent, the effects of wide variation in environmental conditions are anticipated to be more
severe and more devastating to overall health, independence, and quality of life in individuals
with SCI who lack adequate ANS thermoregulatory control. For these reasons, individuals with
SCI prioritize restoration of ANS functions higher than regaining the ability to walk; however, there are
no clinical interventions proven to be safe and effective for managing widespread ANS dysfunction
following SCI. This project will focus on using non-invasive, transcutaneous spinal cord stimulation
(TSCS) to restore intrinsic ANS control of BP and determine the effects on exercise endurance and
Tcore. A recent report found that the use of TSCS in 6 individuals with cervical SCI (C3-C5)
improved ANS regulation of HR, sudomotor, thermoregulation, and bladder control and a separate
team found that TSCS restored ANS control of orthostatic BP, cardiac contractility, and cerebral blood
flow velocity in 5 individuals with chronic motor-complete SCI (C5-T2). Most recently, the safety and
efficacy ...

## Key facts

- **NIH application ID:** 10815562
- **Project number:** 5I21RX004373-02
- **Recipient organization:** JAMES J PETERS VA  MEDICAL CENTER
- **Principal Investigator:** Jill M. Wecht
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-04-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10815562

## Citation

> US National Institutes of Health, RePORTER application 10815562, Autonomic Effects of Transcutaneous Spinal Cord Stimulation in Veterans with SCI (5I21RX004373-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10815562. Licensed CC0.

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