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Rehabilitation Practice and Science

Translated Title

脊髓損傷病患直立性暈眩之血氧濃度復原研究

Abstract

Orthostatic hypotension (OH) is a common clinical problem for patients with spinal cord injury (SCI) at the cervical or high thoracic level when they move from the supine position to the upright position. Patients with severe SCI frequently suffer from symptoms of OH during head-up tilt, ranging from slight lightheadedness to full syncope. Tilt-table training is commonly used in clinical physiotherapy to overcome OH syncope, but this also relies on carefully manual control of the tilt angle and training time by the therapist during training. Up till now, it still has no method to estimate the recovery process of OH syncope.Therefore, in this study we attempted to use the oxygen saturation (SpO2) responses during tilt table training in patients with SCI to estimate the recovery index of orthostatic syncope. This study collected 8 SCI patients with American Spinal Cord Injury Association (ASIA) grade A. All SCI subjects had a recent history of presyncope symptoms in the early stages of tilt-table training. The SCI patients were trained when they had recovered from any symptoms and had experienced all tilt angles. Before training, subjects were given a 10-min recovery period in a supine position, and then measurements were made at tilt angles of 0, 30, 45, 60, and 75 degree for 6 min each, once per day. All subjects were trained using the same protocol. If the subject appeared discomfort or experienced severe symptoms, training was terminated and the tilt angle was turned back to supine. The recovery condition is designed that patient finish two continuous times of tilt table training without any syncope symptoms. The recovery index from orthostatic syncope was defined as the ratio of the difference between the measured SpO2 and the mean value of SpO2 in the lowest presyncope symptoms and the difference between the recovered value of SpO2 and the mean value of SpO2 in the lowest presyncope symptoms. We tested following hypotheses: (1) that the recovery index can present the recovery process of OH syncope; and (2) that there were significant difference between the training before recovery and training after recovery. The result showed that the presyncope symptoms in 8 patients occurred from the tilt angle of 45 degree at initial training to the training before recovery, and the levels of presyncope symptoms of patients recovered from level 4 to level 1(no symptom). The recovery indexes had the same trend as the changes of presyncope symptoms during the tilt table training. When the patients suffered from orthostatic syncope (n=53), the recovery index distributed over the range from 26±15% to 68±19%. When the patients had recovered from orthostatic syncope (n=20), the recovery index distributed over the range from 81±9% to 95±6%. All 8 patients had significantly recovered from the mean recovery index of 50±22%, by which patients were syncope existence to the mean value of 88±10%, by which patients had no symptoms (p＜0.05). We suggested that this recovery index of oxygen saturation was an effective method to estimate whether patients recovered from orthostatic syncope during the rehabilitation, and the recovery index could offer the therapist to design the appropriate rehabilitation training.

Language

Traditional Chinese

First Page

227

Last Page

234

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