Commentary: Spinal Cord Stimulation to Improve Autonomic Regulation After Spinal Cord Injury: Can Reflex Control Be Restored?

Spinal cord electrical stimulation has recently become popular as a research tool to improve function in individuals with spinal cord injuries (SCI). Headline-worthy study after study demonstrate that this form of neuromodulation can allow individuals with paralysis to move, stand, and even walk— a previously unthinkable achievement.^1–4  Subsequent work has sought to replicate these gains within the autonomic nervous system.^5–7  This is a commendable undertaking; autonomic dysfunction has broad and significant clinical implications and is the source of many patients’ top health concerns.⁸  Studies using spinal cord stimulation to address autonomic dysfunction have largely been aimed at ameliorating orthostatic hypotension⁹  by supporting blood pressure.¹⁰  Blood pressure falls with upright tilt in those with SCI due to lack of sympathetic activity below the injury, despite appropriate compensatory tachycardia.¹¹  Hence, spinal cord stimulation may be used to stimulate vascular sympathetic outflow below...