Influence of passive leg movements on blood circulation on the tilt table in healthy adults

David Czell, Reinhard Schreier, Rüdiger Rupp, Stephen Eberhard, Gery Colombo, Volker Dietz, David Czell, Reinhard Schreier, Rüdiger Rupp, Stephen Eberhard, Gery Colombo, Volker Dietz

Abstract

BACKGROUND: One problem in the mobilization of patients with neurological diseases, such as spinal cord injury, is the circulatory collapse that occurs while changing from supine to vertical position because of the missing venous pump due to paralyzed leg muscles. Therefore, a tilt table with integrated stepping device (tilt stepper) was developed, which allows passive stepping movements for performing locomotion training in an early state of rehabilitation. The aim of this pilot study was to investigate if passive stepping and cycling movements of the legs during tilt table training could stabilize blood circulation and prevent neurally-mediated syncope in healthy young adults. METHODS: In the first experiment, healthy subjects were tested on a traditional tilt table. Subjects who had a syncope or near-syncope in this condition underwent a second trial on the tilt stepper. In the second experiment, a group of healthy subjects was investigated on a traditional tilt table, the second group on the tilt ergometer, a device that allows cycling movements during tilt table training. We used the chi-square test to compare the occurrence of near-syncope/syncope in both groups (tilt table/tilt stepper and tilt table/tilt ergometer) and ANOVA to compare the blood pressure and heart rate between the groups at the four time intervals (supine, at 2 minutes, at 6 minutes and end of head-up tilt). RESULTS: Separate chi-square tests performed for each experiment showed significant differences in the occurrence of near syncope or syncope based on the device used. Comparison of the two groups (tilt stepper/ tilt table) in experiment one (ANOVA) showed that blood pressure was significantly higher at the end of head-up tilt on the tilt stepper and on the tilt table there was a greater increase in heart rate (2 minutes after head-up tilt). Comparison of the two groups (tilt ergometer/tilt table) in experiment 2 (ANOVA) showed that blood pressure was significantly higher on the tilt ergometer at the end of head-up tilt and on the tilt table the increase in heart rate was significantly larger (at 6 min and end of head-up tilt). CONCLUSIONS: Stabilization of blood circulation and prevention of benign syncope can be achieved by passive leg movement during a tilt table test in healthy adults.

Figures

Figure 1
Figure 1
The tilt table with stepping device (tilt stepper)
Figure 3
Figure 3
The tilt table with ergometer device (tilt ergometer)
Figure 2
Figure 2
The tilt stepper: generation of leg movements
Figure 4
Figure 4
Blood pressure +/- SE during 75° the tilt table and tilt stepper test
Figure 5
Figure 5
Blood pressure +/- SE during 75° the tilt table and tilt ergometer test
Figure 6
Figure 6
Typical recordings illustrating a subject with syncope. RF = M. rectus femoris, BF = M. biceps femoris, TA = M. tibialis anterior, GM = M. gastrocnemius
Figure 7
Figure 7
Typical recordings illustrating a subject without syncope. RF = M. rectus femoris, BF = M. biceps femoris, TA = M. tibialis anterior, GM = M. gastrocnemius
Figure 8
Figure 8
Muscle activity during the tilt table and tilt stepper test
Figure 9
Figure 9
Muscle activity during the tilt table and tilt stepper test

References

    1. Dietz V, Muller R, Colombo G. Locomotor activity in spinal man: significance of afferent input from joint and load receptors. Brain. 2002;125:2626–2634. doi: 10.1093/brain/awf273.
    1. Graybiel A, McFarland RA. The use of the tilt table in aviation medicine. Aviat Med. 1941;11:194–211.
    1. 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;38:741–747. doi: 10.1038/sj.sc.3101089.
    1. Morillo C, Eckberg D, Ellenbogen K, Beightol L, Hoag J, Tahvanainen K, Kuusela T, Diedrich A. Vagal and Sympathetic Mechanisms in Patients With Orthostatic Vasovagal Syncope. Circulation. 1997;96:2509–2513.
    1. Oberg B, Thorne P. Increased activity in the left ventricular receptors during hemorrhage or occlusion of caval veins in the cat: a possible cause of the vasovagal reaction. Acta Physiol Scand. 1972;85:164–173.
    1. Browse NL. Physiology and pathology of bedrest. Springfield: Charles C Thomas; 1965. pp. 1–221.
    1. Kenny RA, Bayliss J, Ingram A, Sutton R. Head-up tilt: a useful test for investigating unexplained syncope. Lancet. 1986;1:1352–1354.
    1. Natale A, Akhtar M, Jazayeri M, Dhala A, Blanck Z, Deshpande S, Krebs A. Provocation of Hypotension During Head-Up Tilt Testing in Subjects eWith No History of Syncope of Presyncope. Circulation. 1995;92:54–58.
    1. Mallat Z, Vicaut E, Sangaré A, Verschueren J, Fontaine G, Frank R. Prediction of Head-Up Tilt Test Result by Analysis of Early Heart Rate Variations. Circulation. 1997;96:581–584.
    1. Ericson M. On the biomechanics of cycling. A study of joint and muscle load during exercise on the bicycle ergometer. Scand J Rehabil Med Suppl. 1986;16:1–43.
    1. Furlan R, Porta A, Costa F, Tank J, Baker L, Schlari R, Robertson D, Malliani A, Mosqueda-Garcia R. Oscillatory patterns in sympathetic neural discharge and cardiovascular variables during orthostatic stimulus. Circulation. 2000;101:886–892.
    1. Hainsworth R, Al-Shamma Y. Cardiovascular responses to upright tilting in healthy subjects. Clinical Science. 1988;74:17–22.
    1. Issekutz B, Blizzard JJ, Birkhead NC. Effect of prolonged bed rest on urinary calcium output. J Appl Physiol. 1966;21:1013–1020.
    1. Kautz SA, Brown DA. Relationships between timing of muscle excitation and impaired motor performance during cyclical lower extremity movement in post-stroke hemiplegia. Brain. 1998;121:515–526. doi: 10.1093/brain/121.3.515.
    1. Wagner HN. Orthostatic hypotension. Bull Johns Hopkins Hosp. 1959;105:322–359.
    1. Morse JT, Staley RW, Juhos LT, Van Beaumont W. Fluid and electrolyte shifts during bed rest without isometric and isotonic exercises. J Appl Physiol. 1977;42:59–66.
    1. Neirokhir ZV, Burdenko NN. Prevention of postural reactions in patients with spinal cord lesions. 1977. pp. 44–48.
    1. Welch R. Tilt-table therapy in rehabilitation of the traumatic patients with brain damage and spinal injury. Nurs Clin North Am. 1970;5:621–630.
    1. Faghiri PD, Yount J. Electrically induced and voluntary activation of physiologic muscle pump: a comparison between spinal cord-injured and able-bodied individuals. Clin Rehabilitation. 2002;16:878–885. doi: 10.1191/0269215502cr570oa.
    1. Jardine D, Ikram H, Frampton C, Frethey R, Bennett S, Crozier I. Autonomic control of vasovagal syncope. American Journal of Physiology. 1998;274:H2110–H2115.
    1. Werner C, Von Frankenberg S, Treig T. Treadmill training with partial body weight support and an electromechanical gait trainer for restoration of gait in subacute stroke patients: a randomized crossover study. Stroke. 2002;33:2895–2901. doi: 10.1161/01.STR.0000035734.61539.F6.
    1. Movahed M, Hassapoyanes C. Prediction of non-occurrence of syncope during a tilt table test by early heart rate variations. J S C Med Assoc. 2001;97:207–210.
    1. Allen SC, Taylor CL, Hall VE. A study of orthostatic insufficiency by the tiltboard method. Clin Sci Lond. 1950;9:79–90.
    1. Benditt DG, Ferguson DW, Grubb BP. Tilt table testing for assessing syncope. J Am Coll Cardiol. 1996;28:263–275. doi: 10.1016/0735-1097(96)00236-7.
    1. Benditt DG, Sakaguchi S, Remole S, Adler S, Lurie KG. Syncope. Diagnostic considerations and the role of tilt table testing. Cardiol Rev. 1993;1:146–156.
    1. Cottier C. Vasovagale Synkope. Therapeutische Umschau. 1997;54:3.
    1. DeMey C, Enterling D. Assessment of hemodynamic responses to single passive head up tilt by non-invasive methods in normotensive subjects. Methods Find Exp Clin Pharmacol. 1986;8:449–457.
    1. Greenleaf JE, Silverstein L, Bliss J, Langenheem V, Rossow H, Chao C. Physiological responses to prolonged bed rest: a compendium of research. NASA 1974–1988, TM-81324 US National Aeronautics and Space Administration, Washington DC.
    1. Muraki S, Ehara Y, Yamasaki M. Cardiovascular responses at the onset of passive leg cycle exercise in paraplegics with spinal cord injury. Eur J Appl Physiol. 2000;81:271–274. doi: 10.1007/s004210050042.
    1. Petersen M, Williams T, Gordon C, Chamberlain-Webber R, Sutton R. The normal response to prolonged passive head up tilt testing. Heart. 2000;84:509–514. doi: 10.1136/heart.84.5.509.
    1. Diehl R. Differential orthostatic dysregulation disorders diagnosis. Nervenarzt. 1999;70:1044–1051. doi: 10.1007/s001150050538.
    1. Sumiyoshi M, Nakata Y, Mineda Y, Tokano T, Yasuda M, Nakazato Y, Yamaguchi H. Does an Early Increase in Heart Rate During Tilting Predict the Results of Passive Tilt Testing? Pace. 2000;23:2046–2051.
    1. Abe H, Sumiyoshi M, Kohshi K, Nakashima Y. Effects of orthostatic self-training on head-up tilt testing for the prevention of tilt-induced neurocardiogenic syncope: comparison of pharmacological therapy. Clin Exp Hypertens. 2003;25:191–198. doi: 10.1081/CEH-120019151.
    1. Leonelli F. False positive Head-up tilt: Hemodynamic and neurohumoral profile. Journal of Americal College of Cardiology. 2000;35:188–193. doi: 10.1016/S0735-1097(99)00500-8.
    1. Benditt DG, Lurie KG, Adler SW, Sakaguchi SW. Rationale and methodology of head-up tilt table testing for evaluation of neurally mediated (cardioneurogenic) syncope. In: Zipes DP, Jalife J, editor. Cardiac Electrophysiology: From Cell to Bedside. Philadelphia: WB Saunders; 1995. pp. 1115–1128.
    1. Liu J, Hahn R, Stein K, Markowitz S, Okin P, Devereux R, Lessman B. Left Ventricular Geometry and Function Preceding Neurally Mediated Syncope. Circulation. 2000;101:777.
    1. Fitzpatrick P, Theodorakis G, Sutton R. Methodology of head-Up tilt testing in patients with unexplained syncope. J Am Coll Cardiol. 1991;17:125–130.
    1. Mosqueda-Garcia R, Furlan R, Tank J, Fernandez-Violante R. The Elusive Pathophysiology of Neurally Mediated Syncope. Circulation. 2000;102:2898.
    1. Dietz V, Wirz M. Locomotion in patients with spinal cord injuries. Phys Ther. 1997;77:508–516.
    1. Stefanovska A, Vodovnik L, Gros N, Rebersek S, Acimovic-Janezic R. FES and spasticity. IEEE Trans Biomed Eng. 1989;36:738–745. doi: 10.1109/10.32106.
    1. Cornuz J, Bize R, Gobelet C. Promotion of physical activity: some guidelines for the prevention of osteoporosis] Rev Med Suisse Romande. 2002;122:371–375.

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