Clinical Treatment of Orthostatic Hypotension After Spinal Cord Injury with Training Based on Electric Uprise Bed Coupled with Remote ECG and BP Monitor
Dantong Shen, Huai Huang, Hui Yuan, Xu Zhang, Min Li
2nd Department of Neurologic Rehabilitation, Neurologic Specialized Hospital, Guangzhou General Hospital of Guangzhou Military Command, Guangdong, China (mainland)
Med Sci Monit 2014; 20:2767-2775
The treatment for orthostatic hypotension (OH) after spinal cord injury (SCI) is an important part of rehabilitation in late-stage SCI. Electric uprise bed training is a relatively commonly used method in treating OH, and how to carry out uprise bed training safely and effectively is an urgent problem. In the early stage of SCI, we used a remote monitoring system to monitor the whole process of uprise bed training, and we explored a safe and efficient method of electric uprise bed training.
Material and Methods: The experimental group consisted of 36 patients diagnosed with orthostatic hypotension (OH) after SCI and who received training with an electric uprise bed coupled with remote monitoring system, and the control group of 18 subjects who used a traditional training method.
Results: There were no differences in baseline data between the 2 groups. There were no severe symptoms during training in the experimental group, but 3 patients had severe symptoms in the control group. Among the 32 enrolled subjects reaching upright training status within 30 days (17 subjects in the experimental group and 15 subjects in the control group), time interval of training from horizontal position to erect position in the experimental group was 18.00±3.12 days and 21.40±4.95 days in the control group. Time interval in the experimental group was significantly less than in the control group. However, among all 36 subjects, by combining results of follow-up, there was no significant difference of time interval of training from horizontal position to erect position between the experimental group and the control group. In the experimental group 90.52% of patients finished training compared to 78.19% in the control group (P<0.01). After training, values of OCs and OCd of the experimental group were lower than in the control group. There was no significant difference between groups in number of re-diagnosed OH.
Conclusions: Implementation of training with electric uprise bed coupled with remote monitoring system is generally safe for patients with OH after SCI. For patients who could reach standing training status within 30 days, implementation can improve efficiency of training by shortening time interval of training from horizontal position to erect position. It can increase orthostatic blood pressure change during position change.
Keywords: Blood Pressure, Beds, Adult, Blood Pressure Determination - instrumentation, Electricity, Electrocardiography, Hypotension, Orthostatic - rehabilitation, Monitoring, Physiologic - instrumentation, Morbidity, Posture, Spinal Cord Injuries - complications, Supine Position