Hi, we work in a acute neurorehabilitation clinic admitting SCIs in the first 8 weeks of the injury onset and we have difficulties with the tetraplegic patients during upright positioning trials. Nonpharmachologic(ie: corset,pneumotic compression, fluid intake, meal, urinary and GI tract precautions) and pharmachologic (ie: midodrine up to 30mg) management strategies usually do not work in the first months. For example many patients do not tolerate upright positioning although they can be positioned 60 degree on the tilt table for 15-20 minutes or ortostatic hypotension problems do not resolve in complete tetraplegics up to 4-6 months. Can anyone have experience about ideal timing for upright positioning of tetraplegics and ideal pharmachologic (forexample fluidrocortisone?) treament strategies for ortostatic hypotension during the acute phase rehabilitation process?
Have you attempted to wrap the patient's legs with ace wraps or place an abdominal binder on the patient's? Sometimes it is also beneficial to place 2 abdominal binders around the patient. I am an Occupational Therapist who works mostly with SCI in OP and IP settings, and have good results by providing external support for the patient's when attempting to get those that don't tolerate upright positioning into the position. Then from there grade the patient's standing tolerance while monitoring the blood pressure.
Also, standing frames work better than tilt tables most of the time. I'm not exactly sure on the mechanism, but I would assume that it has to deal with how quickly the patient's blood moves from the head down the body on a tilt table vs. standing frame.
Hope this is helpful.
I am a rotating physiotherapist who has some recent experience in spinal cord injury. While working with the more senior experienced physios immediately have often put patients in tilt in space wheelchair as soon as tolerable. This can be as early as week 2 as long as they are haemodymanically stable. While the patient is at intensive care we try to sit them up or tilt bed to start the gradual process early as long as the spin is stable. Abdo binder pass 30 degrees is used to help with coughing and BP. It is important to start the process early so quite often when patients arrive at the acute wards from ICU they can start trialling to sit in wheelchair as mentioned above while monitoring BP, and slowly increasing the sitting time. This really helps with future standing practices.
Hello Ibrahim Gundogdu
please check the resources
https://books.google.co.in/books?isbn=0781798396
www.rch.org.au › Othe
https://quizlet.com/87885177/chapter-61-peripheral-nerve-spinal-cord-problems-flash-cards/
www.hindawi.com/journals/bmri/2013/168757
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