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Role of physical countermaneuvers in the management of orthostatic hypotension: efficacy and biofeedback augmentationOBJECTIVE: To evaluate the efficacy of various physical countermaneuvers in reducing orthostatic hypotension and its associated symptoms and to assess the efficacy of biofeedback training in enhancing the effectiveness of physical countermaneuvers. MATERIAL AND METHODS: In nine study subjects with neurogenic orthostatic hypotension, four training sessions on physical countermaneuvers were performed after tilt-up, three with visual feedback on the effect of physical countermaneuvers on blood pressure and other cardiovascular variables. Blood pressure change and orthostatic symptoms during tilt-up were determined, as were the changes in total peripheral resistance, stroke index, and heart rate. RESULTS: The five female and four male patients had a mean age of 53 years and a mean duration of symptoms of 4.2 years. On an orthostatic symptom scale of 0 to 10, these patients had a mean symptom score of 7.3. The increment in systolic blood pressure was better for some maneuvers (such as leg crossing and a combination) than others (such as neck flexion and abdominal contraction). Three patterns of responses to biofeedback were found. Simple maneuvers such as squatting did not improve with training; visual feedback was needed for maneuvers such as thigh contraction, and performance declined without biofeedback; the third pattern, seen in maneuvers such as leg crossing, showed continued improvement with training, even without biofeedback. A survey at 3 to 4 months after training revealed continued use of physical maneuvers (3.8 +/- 3.1 per day), increased standing time with each episode of presyncopal symptoms (8.3 +/- 5.8 minutes), and continued global symptomatic improvement. Total peripheral resistance, but not heart rate or stroke index, showed significant regression with blood pressure improvement. CONCLUSION: Physical countermaneuvers are efficacious in reducing orthostatic hypotension, can be augmented by use of biofeedback, and may significantly improve the functional outcome. The major mechanism of improvement is an increase in total peripheral resistance, presumably by reducing the vascular capacitance.
Document ID
20040173160
Acquisition Source
Legacy CDMS
Document Type
Reprint (Version printed in journal)
Authors
Bouvette, C. M.
(Mayo Clinic Rochester Minnesota 55905, United States)
McPhee, B. R.
Opfer-Gehrking, T. L.
Low, P. A.
Date Acquired
August 22, 2013
Publication Date
September 1, 1996
Publication Information
Publication: Mayo Clinic proceedings
Volume: 71
Issue: 9
ISSN: 0025-6196
Subject Category
Aerospace Medicine
Funding Number(s)
CONTRACT_GRANT: NS 32352 P01
Distribution Limits
Public
Copyright
Other
Keywords
NASA Program Space Physiology and Countermeasures
NASA Discipline Number 14-10
NASA Discipline Cardiopulmonary
Non-NASA Center

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