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Orthostatic Hypotension

Effect of Standing Training on OH

Active stand training that emphasizes weight bearing is thought to stimulate the neuromuscular system below the level of injury in individuals with SCI and may affect the response to orthostatic stress by increasing venous return (Harkema et al. 2008).

Author Year; Country
Score
Research Design
Total Sample Size		 Methods Outcome
Harkema et al. 2008; USA
Pre-post
N=8

Population: 8 SCI subjects, all AIS grade A (4 cervical, 4 thoracic), with no cardiopulmonary disease, aged between 21-55, mean(SD) 33.8(12.6) yrs.
Treatment: Stand locomotor training (stand LT), for 60 minutes, five times per week.
Outcome Measures: BP and HR, measured while seated, seated with a harness, and standing with a harness; weight bearing load on legs; measurements taken before training, after 40 sessions, and after 80 sessions of training.
  1. OH present prior to training was not evident after 80 sessions of stand LT.
  2. Significant improvements in cardiovascular response to standing in cervical SCI subjects.
  3. Resting arterial BP increased significantly in cervical SCI subjects after 80 sessions.
  4. Hemodynamic parameters showed no significant difference pre- and post-training in thoracic SCI subjects.
  5. All subjects were able to bear more weight on legs after training.

Discussion

Only one study examined the effect of active stand training using the body weight support treadmill system on cardiovascular function among individuals with complete SCI. Harkema et al. (2008) found that after 80 sessions (60 minutes/session; 5x/week) of active stand training, individuals with complete cervical SCI demonstrated increased resting blood pressure and improvements in the cardiovascular responses to standing.

Figure 3. Normal Cardiovascular Response to Change in Position (e.g., Sitting to Standing)

Conclusion

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.

There is limited evidence that active stand training improves the response to orthostatic stress in cervical SCI.

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