Epidural stimulation with locomotor training ameliorates unstable blood pressure after tetraplegia. A case report

Annals of Clinical and Translational Neurology, 2022 · DOI: 10.1002/acn3.51508 · Published: April 1, 2022

Spinal Cord Injury Cardiovascular Science Rehabilitation

Simple Explanation

This case report explores how epidural stimulation of the spinal cord, combined with treadmill training, can help manage unstable blood pressure in a person with complete tetraplegia (paralysis of all four limbs). The study found that this approach improved resting blood pressure and reduced symptoms of orthostatic intolerance (lightheadedness upon standing). However, these positive effects lessened after the training stopped for a few weeks, suggesting continued intervention is needed.

Study Duration

20 weeks

Participants

1 male with C7 complete tetraplegia

Evidence Level

Level 4; Case Report

Key Findings

1
BWSTT + SCES safely and effectively regulated resting BP and mitigated symptoms of orthostatic intolerance.
2
Resting systolic BP decreased and diastolic BP increased, yielding a safe mean arterial BP.
3
There was a ﬁvefold increase in BWSTT bouts per session, and percentage of body weight support decreased to 69%.

Research Summary

This case report describes the effects of body weight supported treadmill training (BWSTT) combined with spinal cord epidural stimulation (SCES) on unstable blood pressure (BP) in a male with C7 complete tetraplegia. The 14-week intervention improved resting BP and tolerance to orthostatic challenges, but these effects were not maintained after a 4-week break from training. The study suggests that SCES combined with task-specific training may safely stabilize BP in individuals with tetraplegia, warranting further research into the underlying mechanisms.

Practical Implications

Clinical Practice

SCES combined with BWSTT may be a viable therapeutic option for managing unstable blood pressure and orthostatic intolerance in individuals with tetraplegia.

Future Research

Further research is needed to investigate the specific mechanisms by which SCES improves BP regulation and to determine the optimal parameters for its application.

Rehabilitation Programs

Integrating SCES with task-specific motor training, such as BWSTT, could enhance rehabilitation outcomes for individuals with spinal cord injuries by addressing both motor function and cardiovascular stability.

Study Limitations

1
It is difﬁcult to segregate between the effects of BWSTT and SCES on mitigation of symptoms of orthostatic intolerance.
2
BP was also not directly measured during standing or BWSTT to demonstrate hypotension, instead we relied on clinical symptoms of orthostatic intolerance.
3
The research team was not involved in the placement of the SCES paddle which was placed higher than that typical anatomical location that covers T11-L1 vertebrae

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