Detection of Autonomic Dysreflexia in Individuals With Spinal Cord Injury Using Multimodal Wearable Sensors

Autonomic Dysreflexia (AD) is a potentially life-threatening condition characterized by sudden, severe blood pressure (BP) spikes in individuals with spinal cord injury (SCI). Early, accurate detection is essential to prevent cardiovascular complications, yet current monitoring methods are either invasive or rely on subjective symptom reporting, limiting applicability in daily file. This study presents a non-invasive, explainable machine learning framework for detecting AD using multimodal wearable sensors. Data were collected from 27 individuals with chronic SCI during urodynamic studies, including electrocardiography (ECG), photoplethysmography (PPG), bioimpedance (BioZ), temperature, respiratory rate (RR), and heart rate (HR), across three commercial devices. Objective AD labels were derived from synchronized cuff-based BP measurements. Following signal preprocessing and feature extraction, BorutaSHAP was used for robust feature selection, and SHAP values for explainability. We trained modality- and device-specific weak learners and aggregated them using a stacked ensemble meta-model. Cross-validation was stratified by participants to ensure generalizability. HR- and ECG-derived features were identified as the most informative, particularly those capturing rhythm morphology and variability. The Nearest Centroid ensemble yielded the highest performance (Macro F1 = 0.77+/-0.03), significantly outperforming baseline models. Among modalities, HR achieved the highest area under the curve (AUC = 0.93), followed by ECG (0.88) and PPG (0.86). RR and temperature features contributed less to overall accuracy, consistent with missing data and low specificity. The model proved robust to sensor dropout and aligned well with clinical AD events. These results represent an important step toward personalized, real-time monitoring for individuals with SCI.