Uncovering the Spectrum of Orthostatic Hypotension in Athletes with Spinal Cord Injury: Implications for Diagnosis, Classification, and Performance
Bibliographic record
Abstract
BACKGROUND: Orthostatic hypotension (OH) is classified into three subtypes based on when blood pressure drops during an orthostatic challenge: initial (IOH; within <15 s), classic (COH; within 3 min), and delayed (DOH; after 3 min). These subtypes have varying degrees of sympathetic dysfunction. OH subtypes have not been characterized after spinal cord injury (SCI), potentially leaving many undiagnosed. This study determined the prevalence and severity of autonomic impairment across OH subtypes in SCI athletes. METHOD: Ninety-nine Paralympic athletes with chronic SCI underwent blood pressure and heart rate assessments while supine and during a sit-up test to classify OH subtypes. Autonomic functions were assessed using the Valsalva maneuver (VM) and by calculating Valsalva ratio, total recovery, pressure recovery time, and overshoot. Finally, we examined the distribution of OH across the International Wheelchair Rugby Federation (IWRF) Classification in SCI-rugby athletes. RESULTS: Notably, 33.3% of the athletes experienced OH, which included 10.1% with IOH, 9.1% with COH, and 14.1% with DOH. Compared with athletes without OH, those with OH exhibited prolonged pressure recovery time ( P = 0.02) and blunted overshoot ( P = 0.006) during VM. The altered VM metrics were associated with hemodynamic changes during the sit-up test. OH presence was distributed throughout all IWRF classifications. CONCLUSIONS: SCI athletes can experience different subtypes of OH that might interfere with sports performance and cognition. Recognizing athletes with DOH is important since this group may be missed if their orthostatic challenge test is terminated early. Evaluation of VM outcomes could supplement an orthostatic challenge to provide valuable insight into autonomic dysfunctions after SCI. Future research is required to check how the presence of OH throughout IWRF classifications can affect performance.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".