Abdominal functional electrical stimulation and binder to reduce orthostatic hypotension in individuals with a subacute spinal cord injury

Abstract Study design Repeated measures comparative study. Objectives Compare acute effects of 4 treatment conditions: (i) abdominal binder (Binder), (ii) abdominal functional electrical stimulation (AFES), (iii) AFES and binder (AFES-Binder), and (iv) no intervention (Control), on signs of orthostatic hypotension (OH) and blood pressure (BP) maintenance in individuals with acute and subacute spinal cord injury (SCI). Setting Spinal injury inpatient ward. Methods Eleven participants with SCI (C3-T5) with at least one sign or symptom of OH underwent a passive sit-up test on 4 days with the 4 treatment conditions. Non-invasive continuous recordings of systolic BP, diastolic BP and calculated mean arterial pressure (MAP) were measured during 4 periods: (1) supine without treatment (5 min); (2) supine with treatment (5 min); (3) upright with treatment (up to 15 min); and (4) supine post-treatment (10 min). Results Largest drops in BP still resulted in OH in all conditions ( p < 0.001), with the largest instantaneous change in MAP in the Binder condition (−41 mmHg [95% CI, −47 to −34]). AFES-Binder condition maintained mean upright MAP relative to supine (−1 mmHg [95% CI, −5 to 2], p = 0.291). Mean upright MAP decreased in all other conditions [Control: (−4 mmHg [95% CI, −7 to −1], p = 0.002); Binder: (−7 mmHg [−10 to −4], p < 0.001); AFES: (−6 mmHg [95% CI, −9 to −2], p < 0.001)]. Mean upright MAP was highest in the AFES-Binder condition. Conclusions No single treatment condition prevented OH completely. While AFES with abdominal binder does not eliminate OH, it shows potential to mitigate BP instability during postural transitions in acute and subacute SCI.