Abdominal binder and laser therapy in orthostatic hypotension management patient with tetraplegia
- Authors: Bushkov F.A.1, Razumov A.N.2, Sichinava N.V.2
-
Affiliations:
- Rehabilitation Center “Overcoming”
- Spasokukotsky Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine
- Issue: Vol 27, No 4 (2024)
- Pages: 209-217
- Section: ORIGINAL STUDY ARTICLE
- URL: https://journals.rcsi.science/1560-9537/article/view/312039
- DOI: https://doi.org/10.17816/MSER676969
- ID: 312039
Cite item
Abstract
BACKGROUND: Spinal cord injury at the cervical level leads to tetraplegia with severe autonomic disfunctions, one of which is orthostatic hypotension. Nonpharmacological management of the orthostatic hypotension may have a positive effect on functional status.
AIM: To create and study the effectiveness and safety new method of rehabilitation which includes wearing an abdominal binder and laser therapy for correcting orthostatic hypotension in patients with tetraplegia.
MATERIALS AND METHODS: The study involved 120 patients with tetraplegia motor level C5-C8, aged 18–50 years, time since spinal cord injury from 6 mouth till 5 years who were divided into 3 groups using randomization. Group 1 (control) received a traditional rehabilitation program based on existing Russian’s clinical guidelines for physical rehabilitation spinal cord injured patients, group 2 received the same traditional rehabilitation and additional wearing of an abdominal bandage in a sitting position during the daytime, group 3 received the same rehabilitation as group 2 additionally with low level laser therapy (LLLT) using a combined method (neck and heart points). The results were assessed at the beginning (T1) and at the end (T2) of a 30-day course inpatient rehabilitation, the drop out bias was 4 patients (3%).
RESULTS: In all groups, positive dynamics were noted in the functional, autonomic and psychological states. In 2 and 3 groups relative 1 group were noted increasing values 24-hour systolic blood pressure (SBP) (109±8.2 and 109 ±8.6 mm Hg against 106±7.6 mm Hg), daytime SBP (111±8.8 and 111±9.1 versus 108±8.4 mm Hg), a decreasing nighttime SBP dipping (10±2.1 and 11±2.4 versus 7±1.8 mm Hg), SBP loss during tilt table test (13±3.3 and 12±3.2 versus 16.0±3.5 mm Hg), increasing parasympathetic reactivity (sinus arrhythmia) (1.23±0.13 and 1.26±0.15 versus 1.21±0.11). Additionally decreasing level of depression (by 25% and 28% versus 20%) and improvement quality of life (11% and 11% versus 5%) were seen in the 2 and 3 groups.
CONCLUSION: The proposed method of orthostatic hypotension nonpharmacological management using wearing an abdominal bandage and a laser therapy (LLLT) combined method is safe, effective in improving orthostatic tolerance, quality of life, and reduce depressive disorders in tetraplegic patients.
Full Text
##article.viewOnOriginalSite##About the authors
Fedor A. Bushkov
Rehabilitation Center “Overcoming”
Author for correspondence.
Email: bushkovfedor@mail.ru
ORCID iD: 0000-0002-3001-0985
SPIN-code: 7593-3400
MD, Cand. Sci. (Medicine)
Russian Federation, MoscowAlexander N. Razumov
Spasokukotsky Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine
Email: a-razumov@mail.ru
ORCID iD: 0000-0001-5389-7235
SPIN-code: 8793-5173
MD, Dr. Sci. (Medicine), Professor, Academician of the Russian Academy of Sciences
Russian Federation, MoscowNino V. Sichinava
Spasokukotsky Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine
Email: sichi.24@mail.ru
ORCID iD: 0000-0002-7732-6020
SPIN-code: 2568-8150
MD, Dr. Sci. (Medicine)
Russian Federation, MoscowReferences
- Krassioukov A, Biering-Sørensen F, Donovan W, et al. International standards to document remaining autonomic function after spinal cord injury. J Spinal Cord Med. 2012;35(4):201–10. doi: 10.1179/1079026812Z.00000000053
- Claydon VE, Steeves JD, Krassioukov A. Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology. Spinal Cord. 2006;44(6):341–51. doi: 10.1038/sj.sc.3101855
- Illman A, Stiller K, Williams M. The prevalence of orthostatic hypotension during physiotherapy treatment in patients with an acute spinal cord injury. Spinal Cord. 2000;38(12):741–7. doi: 10.1038/sj.sc.3101089
- Wecht JM. Management of blood pressure disorders in individuals with spinal cord injury. Curr Opin Pharmacol. 2022;62:60–63. doi: 10.1016/j.coph.2021.10.003
- Canosa-Hermida E, Mondelo-García C, Ferreiro-Velasco ME, et al. Refractory orthostatic hypotension in a patient with a spinal cord injury: Treatment with droxidopa. J Spinal Cord Med. 2017;41(1):115–118. doi: 10.1080/10790268.2016.1274093
- Furlan JC, Fehlings MG, Shannon P, Norenberg MD, Krassioukov AV. Descending vasomotor pathways in humans: correlation between axonal preservation and cardiovascular dysfunction after spinal cord injury. J Neurotrauma. 2003;20:1351–1363.
- Stewart JM. Mechanisms of sympathetic regulation in orthostatic intolerance. J Appl. Physiol. 2012;113(10):1659–1668. doi: 10.1152/japplphysiol.00266.2012
- Krassioukov A, Eng JJ, Warburton DER, Teasell R; The SCIRE Research Team. A Systematic Review of the Management of Orthostatic Hypotension Following Spinal Cord Injury. Arch Phys Med Rehabil. 2009;90(5):876–885. doi: 10.1016/j.apmr.2009.01.009
- Shimoyama M, Fukuda Y, Shimoyama N, Iijima K, Mizuguchi T. Effect of He-Ne laser irradiation on synaptic transmission of the superior cervical sympathetic ganglion in the rat. J Clin Laser Med Surg. 1992;10(5):337–342. doi: 10.1089/clm.1992.10.337
- Deuchars SA, Lall VK. Sympathetic preganglionic neurons: properties and inputs. Compr Physiol. 2015;5(2):829–69. doi: 10.1002/cphy.c140020
- Sayed MA, El-Sherif RM, Ismail A, Essam A, Warda A. Effect of low-level laser physiotherapy on left ventricular function among patients with chronic systolic heart failure. Egypt Heart J. 2023;75(1):12. doi: 10.1186/s43044-023-00337-6
- ASIA and ISCoS International Standards Committee. The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)-What’s new? Spinal Cord. 2019;57(10):815–817. doi: 10.1038/s41393-019-0350-9
- Hubli M, Gee CM, Krassioukov AV. Refined assessment of blood pressure instability after spinal cord injury. American Journal of Hypertension. 2015;28(2):173–181. doi: 10.1093/ajh/hpu122
- Boakye M, Leigh BC, Skelly AC. Quality of life in persons with spinal cord injury: comparisons with other populations. J Neurosurg Spine. 2012;17(1 Suppl):29–37. doi: 10.3171/2012.6.AOSPINE1252
- Hosseini SM, Oyster ML, Kirby RL, Harrington AL, Boninger ML. Manual wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury. Arch Phys Med Rehabil. 2012;93(12):2237–243. doi: 10.1016/j.apmr.2012.05.021
- Sisto SA, Evans N. Activity and Fitness in Spinal Cord Injury: Review and Update. Curr Phys Med Rehabil Rep. 2014;2:147–157. doi: 10.1007/s40141-014-0057-y
- Wadsworth BM, Haines TP, Cornwell PL, Paratz JD. Abdominal binder use in people with spinal cord injuries: a systematic review and meta-analysis. Spinal Cord. 2009;47(4):274–85. doi: 10.1038/sc.2008.126
- Ditterline BEL, Aslan SC, Randall DC, et al. Effects of respiratory training on heart rate variability and baroreflex sensitivity in individuals with chronic spinal cord injury. Arch Phys Med Rehabil. 2018;99(3):423–432. doi: 10.1016/j.apmr.2017.06.033
Supplementary files
