What other treatment options are there?

Author: SCIRE Community Team | Reviewer: Darryl Caves | Published: 9 April 2018 | Updated: ~

Several other treatment options may be used to treat orthostatic hypotension. Although there is limited evidence to determine whether these treatments are effective, they may be used in addition to drug treatments to help manage orthostatic hypotension after SCI.

Adequate fluid and salt intake may help to increase blood volume and maintain blood pressure. There is weak evidence that fluid and salt intake combined with medications may be effective for treating orthostatic hypotension after SCI. However, no research studies have been done using fluid and salt alone.

Blood pooling happens when gravity causes blood to collect in the abdomen and legs. This limits blood flow to other areas of the body and contributes to orthostatic hypotension. Compression garments are devices that apply pressure to these areas of the body to help blood circulate back up toward the heart. Compression garments used after SCI include:

• Abdominal binders are devices that are placed around the lower torso to apply pressure to the abdomen. Most abdominal binders are elastic wraps with Velcro closures that are fitted around the waist.
• Compression stockings are long socks that apply pressure to the calves.

Compression garments are commonly used for orthostatic hypotension after SCI because they are inexpensive and unlikely to cause side effects. However, there is conflicting evidence about whether they are effective to reduce orthostatic hypotension after SCI.

Click here to read more about Abdominal Binders.

After a prolonged period of bed rest (such as very early after an SCI) it may take time for the body to adjust to getting upright. Health providers will usually gradually progress a person towards getting upright to help adjust the body to the new position slowly.

This may be done by dangling the legs on the edge of the bed for a period of time before slowly raising the head and getting into a wheelchair. It may also be done by gradually increasing the degree of incline of a tilt table while being mindful of symptoms.

Gradual progression towards moving upright is commonly used in the management of orthostatic hypotension, however, it has not been investigated in research studies.

Regular exercise improves blood flow and may enhance the body’s ability to adapt to changes in posture. However, after an SCI, there are many different ways that the body responds to exercise, depending on the characteristics of the injury itself. People who have complete injuries in the cervical spinal cord can actually sometimes cause a drop in blood pressure (see above).

Exercise regimens should be tailored to each individual following SCI.¹⁴

There is moderate evidence that arm exercise is not beneficial for reducing orthostatic hypotension in people with SCI.

There is weak evidence that

body weight-supported treadmill

training does not significantly improve orthostatic hypotension in people with SCI.

There is weak evidence suggesting that two hours of daily exercise twice a week for a period of at least two years may help reduce orthostatic hypotension in individuals with SCI.

Standing treatments, especially those that involve some type of stimulation to the leg muscles, are thought to stimulate the nervous system and potentially improve blood pressure responses to standing. There is weak evidence that standing with a harness and assistance from health providers may help to increase resting blood pressure and improve orthostatic hypotension in people with cervical SCI.

See our article on Supported Standing for more information!

FES can be applied to the leg muscles during assisted walking.¹⁵

Functional electrical stimulation (FES) is a treatment where electrical stimulation is applied to the nerves and muscles to cause muscle contractions during an activity. Functional electrical stimulation stimulates the nerves and produces muscular contractions, which may help pump blood back to the heart. There is moderate evidence that functional electrical stimulation can help stabilize blood pressure during changes in position and may be used to supplement other forms of orthostatic hypotension treatment after SCI.

See our article on FES for more information!

Whole-body vibration is a primarily experimental treatment that involves exercising on a vibrating platform. This treatment is thought to cause muscle contractions which may help improve blood flow. There is strong evidence that whole-body vibration can increase blood pressure in people with SCI, but the direct effects of vibration on orthostatic hypotension after SCI has not been studied. Currently, whole-body vibration is not usually available outside of research settings.