If the patient becomes hypertensive during therapy and autonomic dysreflexia is the suspected cause, the therapist should place the patient in an upright position immediately. This takes advantage of an orthostatic response and helps with the pooling of blood in the lower extremities. The therapist needs to complete careful inspection to identify the source of painful stimuli (eg, catheter, restrictive clothing, leg bag straps, abdominal supports, orthoses).[8] A less common cause of autonomic dysreflexia during physical therapy sessions may originate with muscle stretching, either from range-of-motion or passive stretching.
If the patient develops autonomic dysreflexia, the physical therapist needs to treat it as a medical emergency and be familiar with established protocols for medical management within his or her particular setting. The individual therapy session then must be discontinued to allow the patient to stabilize and recover. Please refer to Guidelines of the Consortium for Spinal Cord Medicine for the management of autonomic dysreflexia if no guidelines are available at your facility.