Blood Pooling Prevention in Management of OH

The application of external counter pressure using devices such as abdominal binders or pressure stockings is thought to decrease the capacitance of vasculature beds in the legs and abdominal cavity, both major areas of blood pooling during seating and standing.

Discussion

A systematic review by Krassioukov et al (2009) found prospective controlled trials showing that pressure from elstic stockings and abdominal binders may improve cardiovascular physiologic responses during submaximal upper-extremity exercises. The studies examining external pressure interventions generally test different pressure conditions with the same group of individuals (e.g. with and without stockings) either in a randomized order (RCT) (Wadsworth et al. 2012;Hopman et al. 1998a; Hopman et al. 1998b) or assigned order (non-RCT) (Helmi et al. 2013; Rimaud et al. 2012, Rimaud et al. 2008; Krassioukov & Harkema 2006; Kerk et al. 1995).

The application of these interventions must be interpreted with caution, as none of these studies assessed more than the effect of pressure application during acute phase. Whether these effects would persist with chronic use or cause any detrimental effects upon removal after extended use is unknown. Rimaud et al. (2008) suggested that graduated compression stockings worn by individuals with paraplegia may prevent blood pooling in the legs after observing a decrease in venous capacitance. However, these effects were seen when the participants were at rest and in the absence of orthostatic stress. Additionally, Rimaud et al. (2012) found that with the graduated compression stockings, sympathetic activity increased and parasympathetic activity decreased after maximal exercise in men with SCI. Furthermore, Kerk et al. (1995) reported that the application of an abdominal binder did not significantly improve cardiovascular or kinematic variables at submaximal or maximal levels of exercise. Similarly, a RCT by Wadsworth et al. (2012) found that abdominal binders did not significantly affect mean arterial pressure, and Bhambhani (2002) concluded that the use of abdominal binders does not influence cardiovascular responses. Conversely, Hopman et al. (1998b) demonstrated with nine participants with SCI that stockings and an abdominal binder have effects on cardiovascular responses during submaximal exercises, but not during maximal exercises. Moreover, Krassioukov and Harkema (2006) found that the use of a harness (which applies abdominal pressure) during locomotor training increased diastolic BP in those with SCI, but not in individuals without SCI.

Conclusion

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 (e.g., during submaximal arm exercise).