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Orthostatic hypotension during early mobilisation after Traumatic Brain Injury (TBI)

Orthostatic hypotension during early mobilisation after Traumatic Brain Injury (TBI). Physical therapist Christian Riberholt, Physical therapist Tina Jørgensen , Head of Department, MD, Annette Nordenbo, PT, MHSc, PhD student Jakob Lorentzen. Background.

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Orthostatic hypotension during early mobilisation after Traumatic Brain Injury (TBI)

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  1. Orthostatic hypotension during early mobilisation after Traumatic Brain Injury (TBI) • Physical therapist Christian Riberholt, • Physical therapist Tina Jørgensen, • Head of Department, MD, Annette Nordenbo, • PT, MHSc, PhD student Jakob Lorentzen

  2. Background • Positive effects on arousal / level of consciousness(Chang et al 2004a; Elliot et al 2005) • Prevent secondary complications such as pneumonia or contractures(Carr J & Shepherd R 1998; Chang et al 2004b) • Central sympathic dysfunctions or missing venous pump may lead to a syncope or pre- syncope(Nordenbo et al, 1989; Czell et al, 2004) • Luther et al (2008) 7/9 patients experienced syncope’s

  3. Tilt-table project • Primary objective • Incidence of syncopes or pre-syncopes • Secondary objective • Does changes in awarenessappear during mobilization • Does changes in muscle-toneappear after mobilization

  4. Definition Syncope / pre-syncope Luther et al 2008; American Autonomic Society 1996

  5. Method • Prospective observational study • Patients are consecutively enrolled • Outcome parameters: • Blood pressure, pulse rate, respiration frequency, pallor and increased sweating (1) • Eye opening before treatment and during treatment (sec) (2) • Modified Ashworth Scale (2)

  6. Inclusion criteria • All patients admitted to the Department of Neurorehabilitation, TBI unit, Copenhagen University Hospital of Glostrup / Hvidovre • Patients must be relevant for tilt-table treatment • Lack of muscle-strength which prevents other mobilization methods to be used • Age = +18 • Within 3 months after injury

  7. Exclusioncriteria • Wounds • Fractures • Deep vein thrombosis • which makes weight bearing impossible

  8. Project timeline Protocol approved by the local ethics committee in March 2010 Project period: August 9th 2010 – March 2011 15 – 20 patients

  9. Future perspective • Hypothesis: • Amount of standing time = improved level of consciousness • Higher treatment intensity = better function • How do we deal with “syncopes”? • Clinical guidelines for the therapists • ERIGO-project (Luther et al 2008)

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