Center for Autonomic Medicine: Inpatient & Outpatient Care

Inpatient CAMP Evaluations

The inpatient service is central to the Center for Autonomic Medicine in Pediatrics (CAMP). Most of the admissions are for children with congenital central hypoventilation syndrome (CCHS) or rapid-onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation (ROHHAD)​ due to Center of Excellence status for both disorders and a worldwide referral base.

Typically, CAMP admissions include four days and four nights with extensive physiologic recording during spontaneous breathing and assisted ventilation (a ventilator or diaphragm pacers) while the child is asleep, in addition to an assessment of spontaneous breathing and assisted ventilation (a ventilator or diaphragm pacers) during varying activities of daily life (including exercise, doing school work and reading, and neurocognitive testing). Many other tests from other hospital divisions (specific to each child’s needs) are performed as well, all aimed to improve the clinical care and management of these special children, and to decrease overall disease burden for the child and family.

These clinical studies assist in the following:

• Establishing the diagnosis
• Clarifying the seriousness of the issue as it affects breathing and all organ systems served by the autonomic nervous system
• Providing comprehensive recommendations for ongoing ventilator or diaphragm pacemaker implantation/management
• Designing interventions to improve the patient’s quality of life

An inpatient evaluation typically lasts from Monday morning to early Friday afternoon.

Outpatient CAMP Evaluations

In addition to inpatient services, CAMP offers a limited outpatient service.

Understanding that the autonomic nervous system affects all systems of the body, the comprehensive (as opposed to system-specific) evaluation is the new approach to evaluation for autonomic dysfunction in pediatrics. Accordingly, objective and non-invasive measures offered through CAMP with formal autonomic testing can shed light on the presence/absence, type and severity of autonomic dysfunction in children.

These tests have particular applicability to children with the following conditions:

• Apnea
• Disorders of respiratory control
• Cardiorespiratory dysregulation
• Syncope
• Orthostatic intolerance
• Dizziness
• Heat intolerance
• Flushing
• Anhidrosis
• Hyperhidrosis
• Vasomotor abnormalities (cool hands and feet)
• Paresthesias
• Disorders known to have related autonomic dysregulation including:
• Diabetes
• Rett Syndrome
• Familial
• Dysautonomia
• Prader-Willi
• Fragile X
• Chronic Fatigue Syndrome
• Menkes
• Fabry disease
• Addison/Cushing disease
• CCHS
• ROHHAD
• Thyroid disorders
• Autism

Tests & Appointments

To schedule the following non-invasive clinical tests, please call 312.227.3300.

Autonomic Balance Analysis: Heart Rate Deep Breathing

Through a short series of guided, repeated deep inspirations and exhalations, cardiovagal function can be determined.

• Valsalva Ratio: Through a guided forceful exhalation against a fixed resistance (Valsalva maneuver), concomitant measures of heart rate and blood pressure can determine cardiovagal, adrenergic and baroreflex function.
• Pulse Wave Velocity Analysis: Non-invasive evaluation of large and small vessel vascular stiffness through peripheral (digit) tonometry measures the transmitted pressure wave following a systolic contraction.

Tilt Testing

Evaluation of the inter-relationship of breathing, regional blood flow, heart rate and blood pressure in transition from lying supine to the upright position (head up tilt) and back to the supine position can determine mechanisms of orthostatic intolerance.

Thermoregulatory Chamber Sweat Test

Evaluation of both pre-ganglionic and post-ganglionic sudomotor function over the anterior surface of the entire body to identify focal neuropathies using color change powder. This testing is also informative for any children who have difficulty tolerating heat (reflecting possible anhidrosis) or who sweat excessively (hyperhidrosis). Simultaneously, ThermalPrint testing evaluates vasomotor disparities at baseline and in response to a heated environment.

Q-SWEAT

With topically placed, quarter-sized capsules (on the forearm, leg, and foot), a tiny electrical current is used to determine the functional integrity of the post-ganglionic sympathetic sudomotor axon.

Pupillometry

Using a hand held device each eye is evaluated before and after a brief light source to generate measures of sympathetic and parasympathetic function specific to the eye. Baseline measures are particularly valuable for children participating in sports and at risk for head injury or for children with photophobia, receiving medications that might impact pupillary responsiveness or with aim to objectively quantitate autonomic dysregulation of all potentially affected systems.

Respiratory & Autonomic In-Laboratory Sleep Physiologic Recording

Continuously attended recording, with hands-on and audiovisual surveillance, the continuous waveform acquisition recording montage includes: respiratory inductance plethysmography of chest and abdomen, ECG, heart rate, oral/nasal end tidal carbon dioxide, hemoglobin saturation (SpO2), pulse waveform, EEG, EOG, and EMG, finger digit blood pressure (systolic, diastolic, mean), and intermittent left ear and room temperature. Waveforms are reviewed in a breath-by-breath and beat-to-beat manner to determine cardiorespiratory dysregulation.

Noxturnal Portable In-Home Monitoring

Small, portable, lightweight wireless monitor provides overnight continuous recordings of respiratory inductance plethysmography of chest and abdomen, ECG, SpO2 and pulse rate in the comfort of home. Waveforms are reviewed in a breath-by-breath and beat-to-beat manner to determine cardiorespiratory dysregulation.