Cardiovascular response of individuals with spinal cord injury to dynamic functional electrical stimulation under orthostatic stress.

In this pilot study, we examined how effectively functional electrical stimulation (FES) and passive stepping mitigated orthostatic hypotension in participants with chronic spinal cord injury (SCI). While being tilted head-up to 70 (°) from the supine position, the participants underwent four 10-min conditions in a random sequence: 1) no intervention, 2) passive stepping, 3) isometric FES of leg muscles, and 4) FES of leg muscles combined with passive stepping. We found that FES and passive stepping independently mitigated a decrease in stroke volume and helped to maintain the mean blood pressure. The effects of FES on stroke volume and mean blood pressure were greater than those of passive stepping. When combined, FES and passive stepping did not interfere with each other, but they also did not synergistically increase stroke volume or mean blood pressure. Thus, the present study suggests that FES delivered to lower limbs can be used in individuals with SCI to help them withstand orthostatic stress. Additional studies are needed to confirm whether this use of FES is applicable to a larger population of individuals with SCI.

Electroacupuncture improves orthostatic tolerance in healthy individuals via improving cardiac function and activating the sympathetic system.

AIMS: Orthostatic intolerance (OI) is a common clinical problem; however, effective and applicable clinical prevention/treatment is limited. The aim of this study was to investigate whether electroacupuncture (EA) is a novel effective treatment in attenuating OI in healthy individuals. METHODS AND RESULTS: This study used a randomized, controlled, crossover design using two protocols. Orthostatic intolerance was induced with a combination of head-up tilt (HUT) and lower body negative pressure (LBNP). Twenty healthy individuals in Protocol 1 and 10 healthy individuals in Protocol 2 received no EA, EA at PC-6 acupuncture points (acupoint), and EA at a non-acupoint in a random order with an interim of 1 week. Electroacupuncture was administered prior to HUT/LBNP in Protocol 1 and simultaneously during HUT/LBNP in Protocol 2. Electroacupuncture at PC-6 administered either before or during HUT/LBNP postponed the occurrence of pre-syncopal symptoms, improved haemodynamic responses to HUT/LBNP (including increased diastolic blood pressure, stroke volume, and total peripheral resistance and a decreased heart rate), blunted decreases of maximum velocity and velocity time integral of blood flow in the middle cerebral artery, and increased plasma noradrenalin and adrenalin concentrations. In addition, heart rate variability analysis revealed that EA at PC-6 either before or during HUT/LBNP decreased high-frequency ranges of R-R interval while increasing low-frequency ranges of R-R interval, which indicates an elevated heart sympathetic tone. CONCLUSION: Electroacupuncture at PC-6 is effective in improving orthostatic tolerance. Cardiac function improvement and sympathetic activation are responsible for the improved orthostatic tolerance after EA. EA represents a novel intervention against OI.