• Kirshblum SC, House JG and O'Connor K C (2002). Silent autonomic dysreflexia during a routine bowel program in persons with traumatic spinal cord injury: a preliminary study. Arch Phys Med Rehabil 83:1774-6. Summary: OBJECTIVE: To determine the existence and frequency of silent autonomic dysreflexia in subjects with a complete spinal cord injury (SCI) above the neurologic level of T6. DESIGN: Prospective design. SETTING: Blood pressure monitoring of subjects during a routine bowel program. PARTICIPANTS: Ten subjects with chronic (>1 y), complete (American Spinal Injury Association Impairment Scale class A) SCI with a neurologic level of injury above T6. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: An increase in systolic blood pressure (SBP) of greater than 20 to 40 mmHg above baseline or an SBP greater than 150 mmHg. RESULTS: The mean resting blood pressure for the subject group was 104/65 mmHg. During the bowel program, no subject reported experiencing any of the classic symptoms of autonomic dysreflexia. The mean maximum blood pressure recorded during the bowel program was 160/90 mmHg. All of the patients had an increase in SBP greater than 20 mmHg above baseline, and 70% had an increase in SBP greater than 40 mmHg above baseline. Sixty percent of subjects had an increase in SBP greater than 150 mmHg, with 40% of subjects reaching an SBP greater than 170 mmHg at least once during their bowel program. CONCLUSION: Silent autonomic dysreflexia occurs frequently in SCI during bowel programs. Further study is recommended to determine whether preventative measures or treatment is needed. Spinal Cord Injury and Ventilator Dependent Program, Kessler Institute for Rehabilitation, West Orange, NJ 07052, USA. skirshblum@kessler-rehab.com