AA

Summary

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There is level 2 evidence (from 1 RCT and 1 pre-post study) (Nieshoff et al. 2004; Wecht et al. 2010) that Midodrine enhances exercise performance in some indivicuals with SCI, similar to other clinical populations with cardiovascular autonomic dysfunction.

There is level 4 evidence (from 1 case series) (Barber et al. 2000) that fludrocortisone is not effective for OH in SCI.

There is level 5 evidence (from 1 case report) (Groomes & Huang 1991) that Ergotamine, combined daily with fludrocortisone, may successfully prevent symptomatic OH.

There is level 5 evidence (from 1 observational study) (Frisbie & Steele 1997) that Ephedrine may prevent some symptoms of OH.

There is level 4 evidence (from 1 pre-post study) (Wecht et al. 2013) that droxidopa may be effective for reducing OH.

There is level 5 evidence (from 1 case report) (Muneta et al. 1992) that L-DOPS, in conjunction with salt supplementation may be effective for reducing OH.

There is level 2 evidence (from 4 prospective controlled trials) (Wecht et al. 2007, 2008, 2009 and 2011) that L-NAME may be effective for reducing OH. 

There is no evidence on the effect of sodium or fluid regulation alone for OH management in SCI. Sodium and fluid regulation was evaluated in combination with other pharmacological interventions and thus, the effects of sodium and fluid regulation cannot be determined. 

There is conflicting evidence based on limited research that elastic stockings/abdominal binders have any effect on cardiovascular responses in individuals with SCI. 

There is level 2 evidence (Krassioukov & Harkema 2006) that application of a harness in individuals with SCI could alter baseline cardiovascular parameters and orthostatic responses.

There is level 1 evidence (Yarar-Fisher et al. 2013) that whole-body vibration increases standing mean arterial pressure in individuals with SCI.

There is level 2 evidence (from small, lower quality RCTs) (Faghri & Yount 2002; Elokda et al. 2000; Sampson et al. 2000) that FES is an important treatment adjunct to minimize cardiovascular changes during postural orthostatic stress in individuals with SCI.

There is level 2 evidence (from 1 RCT) (Lopes et al. 1984) that simultaneous upper extremity exercises does not improve orthostatic tolerance during a progressive tilt exercise. 

There is level 4 evidence (from 1 pre-post study) (Ditor et al. 2005) that 6 months of BWSTT does not significantly improve orthostatic tolerance during a tilt test.

There is level 4 evidence (from 1 post-test study) (Otsuka et al. 2008) that regular physical activity (2hrs/day, 2x/wk, ≥ 2yrs) may improve orthostatic tolerance during a tilt test.

There is level 4 evidence (from 1 pre-post study) (Harkema et al. 2008) that 80 sessions of active stand training improves cardiovascular control such as response to orthostatic stress after cervical SCI.