%PDF-1.3
%
7 0 obj
<>>>/BBox[0 0 612 792]/Length 54>>stream
xs
w3T0WI2P0T5T0P06T04S @$P5 d
k
endstream
endobj
5 0 obj
<>>>/BBox[0 0 612 792]/Length 54>>stream
xs
w3T0WI2P0T5T0P06T04S @$P5 d
k
endstream
endobj
6 0 obj
<>>>/BBox[0 0 612 792]/Length 54>>stream
xs
w3T0WI2P0T5T0P06T04S @$P5 d
k
endstream
endobj
4 0 obj
<>>>/BBox[0 0 612 792]/Length 54>>stream
xs
w3T0WI2P0T5T0P06T04S @$P5 d
k
endstream
endobj
3 0 obj
<>>>/BBox[0 0 612 792]/Length 54>>stream
xs
w3T0WI2P0T5T0P06T04S @$P5 d
k
endstream
endobj
1 0 obj
<>>>/BBox[0 0 612 792]/Length 54>>stream
xs
w3T0WI2P0T5T0P06T04S @$P5 d
k
endstream
endobj
9 0 obj
<>stream
Acrobat Distiller 8.1.0 (Windows); modified using iText 4.2.0 by 1T3XT
Arbortext Advanced Print Publisher 9.0.114/W
2018-01-24T02:02:05-08:00
2017-12-06T07:16:34+05:30
application/pdf
NEU-2017-5082-ver9-Phillips_4P 1..6
uuid:bb2113a8-c6b4-4d4d-9b89-4648930627ba
uuid:21d0742c-30ff-4566-a78b-49418fc3dfa2
endstream
endobj
10 0 obj
<>stream
x+ |
endstream
endobj
11 0 obj
<>stream
xS**T0T0 Bi yS&
endstream
endobj
12 0 obj
<>stream
x+ |
endstream
endobj
13 0 obj
<>stream
xS**T0T0 Bi y\'
endstream
endobj
14 0 obj
<>stream
x+ |
endstream
endobj
15 0 obj
<>stream
xS**T0T0 Bi ye(
endstream
endobj
16 0 obj
<>stream
x+ |
endstream
endobj
17 0 obj
<>stream
xS**T0T0 Bi y8#
endstream
endobj
18 0 obj
<>stream
x+ |
endstream
endobj
19 0 obj
<>stream
xS**T0T0 Bi yA$
endstream
endobj
20 0 obj
<>stream
x+ |
endstream
endobj
21 0 obj
<>stream
xS**T0T0 Bi yJ%
endstream
endobj
23 0 obj
<>stream
/GS1 gs
BT
/F4 1 Tf
8.9663 0 0 8.9663 62.022 725.7825 Tm
0 0 0 rg
0 Tc
0 Tw
[(OH)-189(is)-181.3(capable)-193.6(of)-185(acutely)-182.6(improving)-186.8(BP)-185.7(as)-186(well)-188.8(as)-186(integrated)-187.8(cardiac)]TJ
0 -1.2203 TD
[(and)-304.5(cerebrovascular)-311.1(functions.)]TJ
6.7246 0 0 5.9768 173.0834 718.8093 Tm
[(7,11,17)-9.8(,18)]TJ
8.9663 0 0 8.9663 204.4346 714.8408 Tm
[(Although)-304.6(pharmacological)]TJ
-15.8832 -1.2266 TD
[(approaches)-369(certainly)-371.6(have)-369.6(a)-362.3(role)-373.8(clinically,)-366.8(they)-364.9(have)-369.6(signicant)]TJ
0 -1.2203 TD
[(limitations)-367.3(given)-358.1(that)-362.6(they)-364.9(require)-364.7(a)-362.3(number)-359.7(of)-362(minutes/hours)-364.4(to)]TJ
T*
[(become)-437.8(active,)-432.6(and)-430.9(then)-434.4(persist)-435.7(for)-433.7(hours,)-427.9(with)-433(signicant)-435.4(side)]TJ
0 -1.2266 TD
(effects.)Tj
6.7246 0 0 5.9768 88.2708 674.9856 Tm
(19)Tj
8.9663 0 0 8.9663 97.1716 670.9604 Tm
[(Conversely,)-236.7(OH)-239.6(experienced)-247.3(by)-239.3(people)-239.9(with)-237(SCI)-238.4(is)-238.2(often)]TJ
-3.9202 -1.2203 TD
[(unexpected)-350.2(and)-348.7(much)-345.4(more)-348(transient,)-348(occurring)-351.1(in)-344.5(just)-348.7(minutes.)]TJ
6.7246 0 0 5.9768 297.7511 663.9872 Tm
(7)Tj
8.9663 0 0 8.9663 62.022 649.077 Tm
[(One)-225.6(recent)-225.9(study)-224.1(focused)-226.5(on)-220.3(restoring)-227.4(lower-limb)-224(function)-224.1(through)]TJ
0 -1.2266 TD
[(electrical)-348.4(spinal)-343.8(cord)-344.5(stimulation)-344.3(mentioned)-347.1(anecdotes)-345.6(indicating)]TJ
0 -1.2203 TD
[(that)-349.9(autonomic)-347.1(function)-350.6(may)-345.9(be)-349.2(acutely)-353.3(improved)-350.1(in)-344.5(their)-352.1(spinal)]TJ
T*
[(cordinjured)-214.6(participants,)-207.6(but)-211.2(did)-211.2(not)-204.9(provide)-208(any)-209.6(supporting)-209.3(data.)]TJ
6.7246 0 0 5.9768 297.7511 620.1636 Tm
(5)Tj
8.9663 0 0 8.9663 62.022 605.2534 Tm
[(No)-476.5(study)-483.3(has)-476.4(evaluated)-481.2(the)-479.2(potential)-484.4(for)-478(electrical)-481.1(spinal)-482.9(cord)]TJ
0 -1.2266 TD
[(stimulation)-224.2(to)-224.3(restore)-226.8(autonomic)-220.7(cardiovascular)-228.3(function)-224.1(after)-226.6(SCI.)]TJ
1.1128 -1.2203 TD
[(Herein,)-507.9(we)-510.6(introduce)-510.6(a)-507.8(novel)-509.8(strategy)-505.9(to)-508.9(manage)-513.7(a)-507.8(cardio-)]TJ
-1.1128 -1.2203 TD
[(vascular)-573.9(dysfunction)-571.6(system)-572.2(using)-565.5(noninvasive)-571.4(transcutaneous)]TJ
0 -1.2266 TD
[(electrical)-525.4(spinal)-520.9(cord)-521.5(stimulation)-521.4(after)-523.8(SCI.)-519.5(We)-521.8(reasoned)-525.6(that)]TJ
0 -1.2203 TD
[(stimulation)-439.2(of)-437.9(the)-441.3(thoracic)-437.6(spinal)-445(cord,)-435.9(where)-438.3(sympathetic)-442.3(pre-)]TJ
T*
[(ganglionic)-340.8(neurons)-337.9(cell)-339.7(bodies)-339.8(are)-341.1(located,)-343.6(would)-340(elicit)-340.5(acute)-337.6(in-)]TJ
0 -1.2266 TD
[(creases)-245.2(in)-237(BP,)-239.2(cerebral)-242.6(blood)-241.9(ow,)-237.3(and)-241.2(cardiac)-240.5(function)-243.1(when)-237.7(they)]TJ
0 -1.2203 TD
[(were)-280.7(dangerously)-285.5(reduced)-278.3(because)-285.6(of)-279.8(orthostasis.)]TJ
/F1 1 Tf
27.9978 23.2241 TD
(Methods)Tj
/F4 1 Tf
1.1128 -2.447 TD
[(Four)-416.6(individuals)-412.7(all)-413.7(sustained)-415.5(motor-complete)-416.8(cervical)-414.8(injury)]TJ
-1.1128 -1.2203 TD
[(\(C5)-290.4(American)-288.7(Spinal)-290.6(Injury)-284.5(Association)-289.1(Impairment)-292.2(Scale)-285.6([AIS]-)]TJ
T*
[(B;)-304.9(C5)-294.6(AIS-B;)-303.8(C5)-300.9(AIS-A;)-296(C6)-300.9(AIS-A\))-300.9(whereas)-301.8(the)-302.2(fth)-294.1(was)-302.6(motor)]TJ
0 -1.2266 TD
[(complete)-274.2(at)-271(the)-264.2(T2)-270.7(level)-269.7(AIS-A)-267.2(\(1)-267.2(female\),)-272.4(all)-268.2(occurring)-268.9(at)-271(least)-270.9(3)]TJ
0 -1.2203 TD
[(years)-227.5(before)-215.8(the)-219.9(assessments.)-227(All)-218.5(participants)-223.6(were)-223.8(between)-219.8(23)-220.3(and)]TJ
T*
[(32)-403.7(years)-398.2(of)-400(age)-395.4(and)-399.3(instructed)-401.5(to)-395.1(prepare)-401.1(for)-402.1(the)-397(testing)-398(day)-399.3(as)]TJ
0 -1.2266 TD
[(previously)-502.6(described,)]TJ
6.7246 0 0 5.9768 392.2015 642.1038 Tm
(20)Tj
8.9663 0 0 8.9663 403.4267 638.0786 Tm
[(and)-500.5(provided)-498.3(written)-503.8(informed)-504.5(consent)]TJ
-10.0787 -1.2203 TD
[(in)-470.9(accord)-468.5(with)-471(the)-466.5(University)-465.6(of)-469.5(California,)-467.5(Los)-467.4(Angeles)-471.5(\(Los)]TJ
T*
[(Angeles,)-189.9(CA\))-192.5(Institutional)-188.4(Review)-191(Board,)-187.3(who)-185.2(approved)-186.9(this)-190.6(study.)]TJ
T*
[(Participants)-196.9(were)-192.2(tested)-194.5(over)-186.4(a)-191.6(1-h)-190.8(protocol)-192.5(that)-191.9(consisted)-187.9(of)-191.3(at)-188.8(least)]TJ
0 -1.2266 TD
[(15)-169.7(min)-271.7(of)-267.2(resting)-270.1(in)-268.6(the)-270.5(supine)-270.3(position,)-271.5(while)-270.6(being)-269.6(outtted)-268.4(with)]TJ
0 -1.2203 TD
[(assessment)-311.9(equipment,)-299.5(followed)-309.6(by)-302.5(at)-302.6(least)-302.5(10)-169.7(min)-303.3(of)-298.8(supine)-308.2(rest,)]TJ
T*
[(which)-342.4(preceded)-343.5(a)-337(progressive)-339.9(orthostatic)-341.8(challenge)-342.1(that)-337.3(has)-337.3(been)]TJ
0 -1.2266 TD
[(previously)-287.6(described)-282.6(and)-279.2(shown)-280.3(to)-281.3(be)-279.7(a)-280.1(reliable)-283.6(test)-281.6(of)-279.8(OH.)]TJ
6.7246 0 0 5.9768 528.6046 565.3983 Tm
(21)Tj
8.9663 0 0 8.9663 323.0361 550.4313 Tm
[(Participants)-532(were)-533.6(asked)-528.4(to)-527.8(rank)-527.9(their)-529.1(symptoms)-534.4(of)-526.4(nausea/)]TJ
-1.1128 -1.2203 TD
[(dizziness)-203(110)-187.7(\(10)-197.1(being)-193.7(most)-196.5(severe\))-193.6(each)-195(minute)-194.4(of)-197.6(the)-194.7(test.)-196(After)]TJ
0 -1.2266 TD
[(BP)-318.5(decreased)-321.3(sufciently)-317.4(to)-312.9(clinically)-319.7(indicate)-318.9(OH)-315.5(\(i.e.,)-319.8(a)-311.8(2)0(0)-169.7(m)0(m)]TJ
0 -1.2203 TD
[(Hg)-622(decrease)-619(in)-616.4(systolic)-619.9(BP\),)-614.4(transcutaneous)-622.9(stimulation)-622.5(was)]TJ
ET
q
1 i
72.737 494.646 m
541.474 494.646 l
541.474 193.606 l
72.737 193.606 l
W n
q
468.916 0 0 301.039 72.737 193.606 cm
/Im1 Do
Q
Q
BT
/F7 1 Tf
8.9663 0 0 8.9663 62.022 176.8252 Tm
[(FIG.)-252.6(1.)]TJ
/F4 1 Tf
4.0277 0 TD
[(Vignette:)-253.8(Electrical)-250.9(spinal)-249(cord)-249.7(stimulation)-249.5(improved)-255.3(integrated)-251(cardiovascular)-253.6(responses)-246.9(to)-249.6(orthostatic)-253.3(challenge.)-250.2(Participant:)]TJ
-4.0277 -1.1128 TD
[(female,)-245(32)-239.3(years)-246.5(of)-241.9(age,)-240.2(spinal)-242.7(cord)-243.3(injury)-241.7(at)-239.4(C6)-244(\(AIS-A\),)-242.7(injured)-243.6(August)-239.5(2009.)-241.2(Left)-240.9(blue)-244.8(inlet:)-243.2(Although)-241.4(experiencing)-242.1(severe)-248.4(orthostatic)]TJ
0 -1.1065 TD
[(hypotension)-240.2(when)-237.7(assuming)-242.4(upright)-241.2(posture,)-237.4(electrical)-247.2(stimulation)-243.2(at)-239.4(the)-238.9(TVII)-240.3(level)-238.1(restored)-245.3(blood)-235.5(pressure,)-245.4(cerebral)-242.6(blood)-235.5(ow,)-243.6(cardiac)]TJ
0 -1.1128 TD
[(function,)-321.9(and)-317.1(symptoms)-319.4(of)-317.8(orthostatic)-316.5(intolerance)-322.5(to)-319.2(supine)-320.8(levels.)-317.6(Note:)-321.1(Increasing)-322.6(current)-314.1(\(20,)-320.2(40,)-318.1(and)-317.1(50)-169.7(mA\))-317.8(resulted)-316.3(in)-319.2(step-wise)]TJ
T*
[(increases)-273.5(in)-262.3(cardiovascular)-272.6(function.)-265(Right)-269.6(red)-269.1(inlet:)-268.5(electromyography)-265.2(recording)-268.9(of)-267.2(lower)-269.1(limbs)-269.6(shows)-262.5(that)-267.8(skeletal)-269.5(muscle)-269.9(contraction)]TJ
T*
[(was)-290(not)-280.8(activating)-290.3(the)-289.5(skeletal)-288.5(muscle)-288.9(pump)-279.8(of)-286.2(the)-289.5(venous)-285.2(vasculature,)-290.9(indicating)-287.9(that)-286.7(excitation)-284(of)-286.2(sympathetic)-290.6(preganglionic)-287.5(neurons)]TJ
0 -1.1065 TD
[(was)-239.4(responsible)-233.8(for)-237.7(the)-232.6(cardiovascular)-241(restoration.)-235.8(Note:)-238.9(Without)-238.2(stimulation,)-233.4(self-reported)-241.8(symptoms)-230.9(of)-235.6(pre-syncope)-242.2(were)-236.4(severe,)-238.7(being)]TJ
0 -1.1128 TD
[(between)-257.8(6)-246.1(and)-253.9(9,)-249(whereas)-257.5(with)-249.7(stimulation)-255.8(symptoms)-249.8(were)-255.4(completely)-251.9(abrogated.)]TJ
/F6 1 Tf
33.1257 0 TD
[(Participant)-248.1(reported)-253.9(that)-252.7(cognitive)-255.2(processing)-254.1(was)-251(so)]TJ
-33.1257 -1.1128 TD
[(slow)-362.1(in)-363.5(the)-359.1(upright)-366.2(position)-363.4(that)-360.2(she)-362.5(was)-358.5()54.8(not)-365.1(conversational)52.6()-362.5(until)-363.7(the)-359.1(stimulation)-367(was)-358.5(turned)-365.1(on)]TJ
/F4 1 Tf
41.0989 0 TD
[(.)-363.3(AIS-A,)-358.6(American)-364.6(Spinal)-366.5(Injury)]TJ
-41.0989 -1.1128 TD
[(Association)-263.8(Impairment)-260.5(Scale)-254(Grade)-261.2(A;)-259.3(BP,)-258.2(blood)-254.5(pressure;)-265(MCA,)-256.8(middle)-257.7(cerebral)-261.6(artery;)-261.3(PCA,)-254.7(posterior)-265.4(cerebral)-255.3(artery;)-261.3(vmean,)-261.8(mean)]TJ
0 -1.1065 TD
[(ow)-341.9(velocity;)-345.3(PCAvmean,)-342.8(mean)-341.5(ow)-341.9(velocity;)-345.3(SV,)-338.9(stroke)-342.4(volume;)-345.7(dP/dt,)-335.9(delta)-345.5(pressure)-343.6(over)-344.5(delta)-339.2(time)-340.8(\(cardiac)-350.1(contractility\);)-343.1(S)14.5(O)16.2(L)19.6(,)]TJ
0 -1.1128 TD
-.0163 Tc
[(s)-16.3(o)15.1(leus;)-342.3(T)-3(A,)-341.7(tibia)-16.3(l)9.9(i)-.9(s)-339.5(a).7(nterior;)-342.3(MH,)-341.7(m)-.4(e)-16.3(d)13.9(ia)-16.3(l)-325.3(h)-3.2(ams)-16.3(t)11.1(ring;)-342.3(V)-.1(L,)-341.7(vas)-16.3(t)11.1(us)-345.8(latera)-16.3(l)9.9(i)-.9(s;)-342.3(SCG,)-341.7(supe)-16.3(r)11.3(i)-.9(or)-340.9(c)-16.3(e)11.5(rvical)-342.3(ganglia;)-342.3(S)-1.7(G,)-341.7(s)-16.3(t)11.1(ellate)-340.7(ganglia;)-342.3(C)-1.6(G,)-341.7(c)-16.3(e)11.4(liac)]TJ
T*
[(ganglia;)-323.2(S)-1.6(MG,)-322.6(s)2.1(upe)-16.2(r)11.4(ior)-321.8(m)-.3(e)-16.2(s)12.8(enteric)-321.6(g)-3.1(anglia;)-323.2(I).7(MG,)-322.6(i)-.8(nfe)-16.2(r)11.4(ior)-321.8(m)-.3(e)-16.2(s)12.8(enteric)-321.6(g)]TJ
28.1622 0 TD
-.0158 Tc
[(anglia.)-322.2(C)-1.1(olor)-321.4(image)-321.2(i)-.4(s)-320(a)1.2(vailable)-321.2(o)3.7(nline)-321.2(a)-15.8(t)-305.8(www)-15.8(.)10.1(l)-.4(i)6(e)-15.8(b)14.4(e)-15.8(r)11.8(t)-.4(pub.c)-15.8(o)14.4(m/neu)]TJ
/F1 1 Tf
-28.1622 77.2217 TD
0 Tc
(2)Tj
46.5935 0 TD
[(PHILLIPS)-337.4(ET)-338.7(AL.)]TJ
ET
endstream
endobj
26 0 obj
<>stream
Adobe d
t
s !1AQa"q2B#R3b$r%C4Scs5D'6Tdt&
EFVU(eufv7GWgw8HXhx)9IYiy*:JZjz m !1AQa"q2#BRbr3$4CS%cs5DT
&6E'dtU7()euFVfvGWgw8HXhx9IYiy*:JZjz ? N*S6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*VjsNeV6 GJV(& |
(ZuUb4+at+>xXKMK
-"
\r~UE)\HncH7A$|qX`|i#+NK(I\ѫ/fDŽ#ĒԺmPJX_/MW6 _
H.z؟DŽ/[2[bS0!;?F8]7u߾MSJ6r[,L(c!WcЮ@!94z.XRŀc#ޟ<%Gy/沉h/{cáeaCm [[$T+/Z(rlUثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثbIܞF[i.I4XgX@I>k'¸xZaѿik夸f2J%Ll$֬Z٨Wr}j
RFԒO$W9I(n#6+W'¹x3b͊6*إٱCb͊6*ثb͊*V횃Z\YUUeGIbH_S[\=PAjQ֍`1R9'%KF7P-FI9־Efb2ghle_d`k@UPպYt'E?l+(C!a^)A]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWe3LPd4Usw0>1<̒ƁnLF,Eh<QܼA%=b$`zT&IGf5(^ BI.dBYر'{clP3!V2HƬIb}ffffff.́]
vlUٱKb͊vl vl(vlUٱK`Wf®+S\6_o<,Ҵ3/ّ
ެp;S
IfYE][nNŒO`:6vrC KTW1UuaU50SjՔ~BEA= AT3b͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*d"{}-/zr_) Wyݾ¸DZM mc+&g'`j&=\NJڼֻǠ/R͊66;6*ث`Kb͊ͅ];6)vlPثb͊];6*إٱCbf͊6*ثb͊n_5SCAH+vp+*+qŲ9OU{1W);JUxb*8"Ch+/t-Gr}A,
x&Wf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]vlUٱWf]v2Ix 0FZiޤ]LQ5YON
Zފ{diBU kp[Qf2}JclDmhb&=.V%V
Ҳ5M`4O{Ckc"ܱ;S3)S*E.ԴGKNn)IєV(lإC[f[͊ZZ8Zg
"k{:s]QE A͊6(nKUn6*rI Z;EеwPM7EQYAɈQ(aE 2VYI#͊1"0[1M6>_Qk\R^<N\M1;IQzd+( TkVCL,FlU͊Z6*lPإ
]Qn6(kQPz|1ZL&m{:qXO8#{u[Xp!қS*o-L̎|GȀrJ6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثb͊6*ثbgUcLPH?NK$Vf=3;T.ñi[䪏cq3_9P`Mܶ3z-knnkZiH k6(Rš?O9ݍ_C5 :
Ų%~P~E31VYzHg!Z .0ie__f[-5C]Nb2Cq|mM4m!y7Ou-
F7\B^Hv9)djRxY}使Կ=b]F+mb!o]ꅫ3xҝ*:Ԇ7eʭsH&|eq}^Xߩ knf4{eӱD w埑<[jZηkUc-c2I#
j|]X&p~@h_v6vڴ[5&UKaN>fQZt5l,JT&?*o55M]OJo4wە_ނZ)j3*<ΛA ?3VyK>Z[n54vF/֞
* M
zhZWx ~_ȵb)ZjMj28z8i'C\|mGKݽr\D2"qz6 ;R8s?"Qz6ay7:,[M.IVg=F`O|ub'>~yywOuMSOѵIm@#z^nf )hJ>5STCѬXOAK<2 "?^ʢa0{n4O:ph݄@1"W#}D1}ugOO lկ / 3lԧK[,n}j1}[zl:p w'ɚG :yEȴIV2K _D9roوNkA>\-#͞k5_0]yDıZy ![/Z
Gd?:iy[YtICJaO%E:}|A4>4?1<}a4V4[,_ex4XHԂiЎbe~g