Unusual blood pressure response during standing therapy in tetraplegic man.
ABSTRACT We report a case of an individual with cervical spinal cord injury who showed a unique blood pressure response during passive standing and passive walking-like leg movement, i.e., hypertension with standing and hypotension with leg movement.
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ABSTRACT: 1. A study has been made of the effect of spontaneous and induced muscle spasms on blood pressure, heart rate, hand blood flow, calf blood flow and occluded vein pressure in the hand and foot in non-bedridden patients with chronic, closed, complete, localized transection of the cervical spinal cord.2. Both types of spasm produced a similar response consisting of an increase in blood pressure and occluded vein pressure and a decrease in heart rate and hand and calf blood flow. The changes commenced within 2-3 sec and usually reached maxima in 20-30 sec. On some occasions there was a temporary initial increase in heart rate and calf blood flow.3. The changes occurred independently of changes in bladder pressure.4. It is concluded that the changes in peripheral blood vessels result from a spinal sympathetic reflex to somatic afferents associated with muscular contraction.The Journal of Physiology 07/1971; 215(2):381-93. DOI:10.1113/jphysiol.1971.sp009475 · 4.54 Impact Factor
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ABSTRACT: Prospective assessment of cardiovascular parameters in individuals with spinal cord injury (SCI) in response to harness application and postural changes including orthostatic stress. To evaluate arterial blood pressure and heart rate (HR) with and without harness application during sitting, supine, and standing positions in able-bodied and SCI individuals. Measurements were obtained in all SCI research participants (n=11) before a locomotor training intervention and compared to data with able-bodied individuals (n=9). During standing, all research participants wore a harness and were suspended by an overhead, pneumatic body weight support system. Resting arterial blood pressure and HR in individuals with cervical SCI were significantly lower during sitting than in thoracic SCI and able-bodied individuals (P<0.05). Orthostatic stress significantly decreased arterial blood pressure only in individuals with cervical SCI (P<0.05). Harness application had no effect on cardiovascular parameters in able-bodied individuals, whereas diastolic blood pressure was significantly increased in those with SCI. Orthostatic changes in cervical SCI when sitting were ameliorated by harness application. However, while standing with harness, individuals with cervical SCI still developed orthostatic hypotension. Level of injury to the spinal cord influences baseline cardiovascular parameters. Application of harness in individuals with SCI could alter baseline cardiovascular parameters and the response to orthostatic stress. This should be carefully considered when assessing effects of therapeutic interventions using body weight support in individuals with SCI.Spinal Cord 01/2007; 44(12):780-6. DOI:10.1038/sj.sc.3101952 · 1.70 Impact Factor
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ABSTRACT: To evaluate the effects of functional electric stimulation (FES) of lower limb muscles during 30 minutes of upright standing on the central and peripheral hemodynamic response in persons with spinal cord injury (SCI). A repeated-measure design. Subjects were used as their own control and underwent 2 testing protocols of FES-augmented standing (active standing) and non-FES standing (passive standing). Rehabilitation hospital. Fourteen individuals with SCI (7 with tetraplegia, 7 with paraplegia). During active standing, FES was administered to 4 muscle groups of each leg in an overlapping fashion to produce a pumping mechanism during standing. During passive standing, subjects stood for 30 minutes using a standing frame with no FES intervention. Central hemodynamic responses of stroke volume, cardiac output, heart rate, arterial blood pressure, total peripheral resistance (TPR), and rate pressure product (RPP) were evaluated by impedance cardiography. All measurements were performed during supine and sitting positions before and after standing, and during 30 minutes of upright standing. Comparisons between the groups with paraplegia and tetraplegia showed a significant increase in heart rate in the paraplegics after 30 minutes of active standing. During active standing, paraplegics' heart rate increased by 18.2% (p = .015); during passive standing, it increased by 6% (p = .041). TPR in the tetraplegics significantly (p = .003) increased by 54% when compared with the paraplegics during passive standing. Overall, the tetraplegic group had a significantly lower systolic blood pressure (p = .013) and mean arterial pressure (p = .048) than the paraplegics during passive standing. These differences were not detected during active standing. When data were pooled from both groups and the overall groups response to active and passive standing were compared, the results showed that cardiac output, stroke volume, and blood pressure significantly decreased (p < .05) during 30 minutes of passive standing, whereas TPR significantly increased (p < .05). All of the hemodynamic variables were maintained during 30 minutes of active standing, and there were increases in RPP and heart rate after 30 minutes of active standing. FES of the lower extremity could be used by persons with SCI as an adjunct during standing to prevent orthostatic hypotension and circulatory hypokinesis. This effect may be more beneficial to those with tetraplegia who have a compromised autonomic nervous system and may not be able to adjust their hemodynamics to the change in position.Archives of Physical Medicine and Rehabilitation 11/2001; 82(11):1587-95. DOI:10.1053/apmr.2001.25984 · 2.44 Impact Factor