Effect Of Changes In Position Research Articles

Effect of Positional Changes of Ankle Joint on Exercise Intensity and Muscular Activities during the Nordic Hip Extension Exercises

Effect of Positional Changes of Ankle Joint on Exercise Intensity and Muscular Activities during the Nordic Hip Extension Exercises

Orthostatic variation of pulmonary artery pressure in ambulatory heart failure patients

AimTo study effect of change in position (supine and standing) on pulmonary artery pressure (PAP) in ambulatory heart failure (HF) patients.MethodsSeventeen patients with CardioMEMS® sensor and stable heart failure were consented and included in this single center study. Supine and standing measurements were obtained with at least 5 min interval between the two positions. These measurements included PAP readings utilizing the manufacturer handheld interrogator obtaining 10 s data in addition to the systemic blood pressure and heart rate recordings.ResultsMean supine and standing readings and their difference (Δ) were as follows respectively: Systolic PAP were 33.4 (± 11.19), 23.6 (± 10) and Δ was 9.9 mmHg (p = 0.0001), diastolic PAP were 14.2 (± 5.6), 7.9 (± 5.7) and Δ was 6.3 mmHg (p = 0.0001) and mean PAP were 21.8 (± 7.8), 14 (± 7.2) and Δ was 7.4 mmHg (p = 0.0001) while the systemic blood pressure did not vary significantly.ConclusionThere is orthostatic variation of PAP in ambulatory HF patients demonstrating a mean decline with standing in diastolic PAP by 6.3 mmHg, systolic PAP by 9.9 mmHg and mean PAP by 7.4 mmHg in absence of significant orthostatic variation in systemic blood pressure or heart rate. These findings have significant clinical implications and inform that PAP in each patient should always be measured in the same position. Since initial readings at the time of implant were taken in supine position, it may be best to use supine position or to obtain a baseline standing PAP reading if standing PAP is planned on being used.

Ultrasonographic examination of the safe zone for medial needle approach towards the median-innervated flexor digitorum profundus muscle: Effect of changes in position of the forearm.

The flexor digitorum profundus (FDP) is a forearm flexor muscle. Certain cases require the needle to be inserted accurately and safely into the deep, lateral portion of the FDP, which is innervated by the anterior interosseous nerve. In this study, we compared 2 techniques for approaching the median-innervated FDP (MFDP) medially, each according to the position of the forearm, supinated or pronated. The forearms of healthy volunteers without any musculoskeletal problems of the upper extremities were examined. Using high-resolution ultrasonography, the medial aspects of the forearms were scanned with elbows flexed at 90°. Using the images obtained, several parameters for distance and angle were measured in 2 different positions: forearm-supinated and forearm-pronated. Thirty-seven forearms from the volunteers were subject to examination. The angle α, which is the valid angle of insertion when approaching with the needle towards the deeply located MFDP, slightly increased from 22.89° to 23.41° when the forearm was pronated from the supinated position; however, this increase was not statistically significant. In contrast, the angle β, which is the safe angle of insertion when approaching with the needle towards the MFDP without contacting the ulnar nerve, was significantly increased from 41.40° to 46.80° upon forearm pronation. Because the safe angle of insertion of the needle medially into the MFDP increases with forearm pronation, the forearm-pronated position is recommended, instead of the forearm-supinated position, when inserting a needle into the MFDP in the medial aspect of the forearm.

Effect of Positional Changes on Skin Landmarks in Midface Filling.

The design lines for midfacial filling shift upward with a patient's position changes from upright to supine during operation. This will cause the actual filled part to deviate from the target area. This authors aimed to evaluate the effect of positional changes on midfacial landmarks and find the optimal body position for midface filling. The process involved the grading and evaluation stages. The midfacial laxity of each sample in the evaluation stage was graded into minimal, moderate, and severe by the system established in the grading stage. Measured through the 3-dimensional images in each grade, the vertical distances from landmarks C, D, and E (representing the region of the tear trough, infraorbital area, and nasolabial fat pad, respectively) to the horizontal line of the inner canthus and depth of nasolabial fold at an angle of 90° were separately compared with those from the other angles (60°, 45°, 30°, and 0°) of the operating table. In the minimal midfacial laxity group, all 3 landmarks significantly moved upward when the angle decreased to 30°. However, landmark E of the moderate and severe and landmark D of the severe midfacial laxity groups both significantly moved upward when the angle decreased to 45°. The depth of the nasolabial fold at a 45° angle was significantly less than that at a 90° angle in the moderate and severe groups. In midface filling, a patient's body position should be optimally selected according to the midfacial laxity and filling area.

0828 Positional Central Sleep Apnea

Abstract Introduction Obstructive sleep apnea (OSA) is well known to often improve with non-supine positioning as opposed to supine positioning. The prevalence of OSA that may improve on proper positioning is 50-60% and the prevalence of OSA that appears when supine and disappears when non-supine is 25-30%. Sleeping in a lateral positioning is thought to reduce pressure on the airway, shift the directional effect of gravity on airway structures, and counteract physiologic genioglossus collapse that occurs when supine. On the other hand, the effect of positional changes on the severity of central sleep apnea (CSA) is not well documented aside from Cheyne-stokes breathing in congestive heart failure. Report of Cases: We present two cases of positional CSA. One patient is a 52-year-old male with a history of traumatic brain injury, hypogonadism, hypothyroidism and Parkinson’s Disease. He underwent split-polysomnography (PSG) for dream enactment behavior, was found to have severe CSA, which occurred almost exclusively supine (Supine Apnea-Hypopnea Index (AHI) 66/hr, Non-Supine 0.8/hr). A positional belt was recommended to the patient. The second patient is an 89-year-old male with history of chronic obstructive pulmonary disease and chronic kidney disease who underwent PSG for symptoms of sleep apnea. He was found to have severe obstructive and central sleep apnea with periods of Cheyne-stokes breathing. This also occurred almost exclusively supine (Supine AHI 69/hr, Non-Supine 0/hr) and improved on continuous positive airway pressure (CPAP) independent of position (AHI 6/hr). CPAP or positional belt was recommended to the patient. Conclusion Positional CSA unrelated to congestive heart failure is an uncommon phenomenon with poorly understood pathophysiology. Treatment of CSA is often challenging and based on elucidating and addressing the underlying cause such as optimizing treatment of heart failure. Positional therapy is characteristically thought of as a potential treatment option for OSA. However, our findings further support the presence of a phenotype of central sleep apnea that may respond to positional therapy. Support (If Any)

Clinical Utility of Superior Vena Cava Flow Velocity Waveform Measured from the Subcostal Window for Estimating Right Atrial Pressure

The superior vena cava (SVC) flow velocity waveform from the supraclavicular window reflects right atrial pressure (RAP) status. Recent guidelines have stated that the subcostal window is an alternative view for recording SVC flow, but the validity of this approach remains unclear. The aim of this study was to determine the usefulness of SVC flow evaluation from the subcostal window for estimating RAP. Differences in SVC flow characteristics between opposite approaches were examined in 38 healthy adults. In 115 patients with cardiovascular diseases who underwent cardiac catheterization and echocardiography within 48hours, the ratio of peak systolic to diastolic forward SVC flow (SVC-S/D) was measured, and the diagnostic ability of SVC-S/D for elevated RAP was tested. A validation cohort was used to confirm the diagnostic ability of SVC-S/D in 48 patients who underwent both cardiac catheterization and echocardiography within 24hours. In 59 patients in the derivation and validation cohorts, the relationship between SVC flow and RAP was compared between the opposite windows. Both systolic and diastolic SVC flow velocities were higher in the subcostal than in the supraclavicular approach, and effect of position change on subcostal SVC-S/D was smaller than that on supraclavicular SVC-S/D in healthy adults. Measurement of SVC-S/D from the subcostal window was feasible in 98 patients (85%). RAP was inversely correlated with SVC-S/D (r=-0.50, P<.001) and was an independent determinant of SVC-S/D after adjustment for right ventricular systolic function (β=-0.48, P<.001). A cutoff value of 1.9 for SVC-S/D showed 85% sensitivity and 74% specificity in identifying elevated RAP. Additionally, SVC-S/D showed an incremental diagnostic value combined with inferior vena cava size and collapsibility (P=.006). When a cutoff value of SVC-S/D<1.9 was applied to the validation cohort, it showed acceptable accuracy of 72% and incremental diagnostic value combined with inferior vena cava parameters (P=.033). SVC-S/D from the subcostal window correlated better with RAP than that from the supraclavicular window (P<.001, Meng's test). Measurement of SVC flow velocity from the subcostal window was feasible, and SVC-S/D from the subcostal window could be an additive parameter for estimating RAP.

Effect of Position Change From the Bed to a Wheelchair on the Regional Ventilation Distribution Assessed by Electrical Impedance Tomography in Patients With Respiratory Failure.

Background: There is limited knowledge about the effect of position change on regional lung ventilation in patients with respiratory failure. This study aimed to examine the physiological alteration of regional lung ventilation during the position change from lying in bed to sitting on a wheelchair.Methods: In this study, 41 patients with respiratory failure who were weaned from the ventilators were prospectively enrolled. The electrical impedance tomography (EIT) was used to assess the regional lung ventilation distribution at four time points (Tbase: baseline, supine position in the bed, T30min: sitting position in the wheelchair after 30 min, T60min: sitting position in the wheelchair after 60 min, Treturn: the same supine position in the bed after position changing). The EIT-based global inhomogeneity (GI) and center of ventilation (CoV) indices were calculated. The EIT images were equally divided into four ventral-to-dorsal horizontal regions of interest (ROIs 1–4). Depending on the improvement in ventilation distribution in the dependent regions at T60min (threshold set to 15%), the patients were divided into the dorsal ventilation improved (DVI) and not improved (non-DVI) groups.Results: When the patients moved from the bed to a wheelchair, there was a significant and continuous increase in ventilation in the dorsal regions (ROI 3 + 4: 45.9 ± 12.1, 48.7 ± 11.6, 49.9 ± 12.6, 48.8 ± 10.6 for Tbase, T30min, T60min, and Treturn, respectively; p = 0.015) and CoV (48.2 ± 10.1, 50.1 ± 9.2, 50.5 ± 9.6, and 49.5 ± 8.6, p = 0.047). In addition, there was a significant decrease in GI at T60min compared with Tbase. The DVI group (n = 18) had significantly higher oxygenation levels than the non-DVI group (n = 23) after position changing. ROI4Tbase was significantly negatively correlated with the ΔSpO2 (R = 0.72, p < 0.001). Using a cutoff value of 6.5%, ROI4Tbase had 79.2% specificity and 58.8% sensitivity in indicating the increase in the dorsal region related to the position change. The corresponding area under the curve (AUC) was 0.806 (95% CI, 0.677–0.936).Conclusions: Position change may improve the ventilation distribution in the study patients. The EIT can visualize real-time changes of the regional lung ventilation at the bedside to guide the body position change of the patients in the intensive care unit (ICU) and measure the effect of clinical practice.Trial Registration: Effect of Early Mobilization on Regional Lung Ventilation Assessed by EIT, NCT04081129. Registered 9 June 2019—Retrospectively registered. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00096WT&selectaction=Edit&uid=U00020D9&ts=2&cx=v2cwij.

Analysis of Concrete Column Reinforced Internally with Hollow Composite Sections

Abstract: Hollow Concrete Columns (HCCs) are one of the preferred construction systems in civil infrastructures including bridge piers, ground piles, and utility poles to minimize the overall weight and costs. HCCs are also considered a solution to increase the strength to mass ratio of structures. However, HCCs are subjected to brittle failure behaviour by concrete crushing means that the displacement capacity and the strength after steel yielding in HCCs are decreasing due to the unconfined concrete core. Absence of the concrete core changes the inner stress formation in HCCs from triaxial to biaxial causes lower strength. A new type of Hollow Composite Reinforcing System (HCRS) has recently been designed and developed to create voids in structural members. This reinforcing system has four external flanges to facilitate mechanical bonding and interaction with concrete. Therefore, providing the inner Hollow Composite Reinforced Sections (HCRS) can significantly increase strength by providing a higher reinforcement ratio and confining the inner concrete core triaxially. The corrosion of steel is also a notable factor in the case of steel reinforced HCCs which became more critical because their outer and inner surfaces exposing more concrete surface area. An alternative reinforcement is Glass Fibre Reinforced Polymer (GFRP) bars, can overcome the brittle behaviour of steel reinforced HCC. In previous studies, HCC shows high strength capacity, when appropriate reinforcement in the form of longitudinal GFRP bars, laterally using GFRP spirals and internally using newly developed HCRS which provide enough inner confinement. Therefore, this study aims to determine the effect of HCRS of different cross sections and also the effect of change in position of its flanges on the axial performance of HCC analytically using ANSYS software. Keywords: Hollow Concrete Column, Hollow Composite Reinforced Sections, GFRP bars, GFRP Spirals, Nonlinear Static Analysis, ANSYS.

Gyro-Free Inertial Measurement Unit With Unfettered Accelerometer Array Distribution and for the Object With Position Change in Center of Gravity

Previous gyro-free inertial measurement units (GF-IMU) usually suffered from installation errors induced by mutual placements and mutual sensing directions of accelerometers, and underlying mechanism for eliminating the effect of position change in the center of gravity (PCGC) was not presented clearly. This paper reports a GF-IMU compensating for the effect of PCGC and installation errors by using two parallel mounted accelerometers as a group in designing accelerometer array configuration. The underlying kinematics is first developed and indicates that subtraction of accelerations within a group can remove the effect of PCGC. Nine acceleration subtractions from nine independent groups with irrelevant sensing directions and arbitrary installation distances can determine the square of angular velocity and angular acceleration directly, which does not induce installation errors. Then three configurations fitting different requirements are proposed based on three accelerometer placement rules. The motion quantities at the center of gravity (GC) can also be obtained if mutual installation distance among different groups is known. The validity and performance of schemes are finally verified by SimMechanics simulations. The rotational motion measurement scheme proposed in this paper does not need to know mutual placement information of accelerometers as well as the GC position, which greatly simplifies its installation, and make it possible to develop a convenient product for the rotational motion measurement with only accelerometers.

Postural Changes and the Trans–Lamina Cribrosa Pressure Difference: A Pilot Study in Neurosurgical Patients without Glaucoma

To evaluate the effect of changes in position in the trans-lamina cribrosa pressure difference (TLCPD) by simultaneously measuring and comparing intracranial pressure (ICP) with intraocular pressure (IOP) in seated and supine positions. Prospective cohort study. Patients admitted to the neurosurgery unit at Toronto Western Hospital with an external ventricular drain placed for ICP monitoring. Exclusion criteria were any ophthalmic surgical procedures within the preceding 6 months, history of glaucoma, and corneal abnormalities affecting IOP measurement. Intraocular pressure and ICP were recorded simultaneously in both the supine and seated positions with the order of positions randomized. Measurements were made 10 minutes after assuming each position. The TLCPD (IOP minus ICP) was calculated for the sitting and supine positions. The paired t test was used to assess significance of differences. The TLCPD. Twenty patients were included in the study. The average age was 54±17 years. Results were similar for left and right eyes. Data are shown for right eyes only. Mean sitting and supine IOPs were 15.3±3.5 mmHg and 15.9±3.7 mmHg, respectively (P= 0.32). Mean sitting and supine ICPs were 12.5±6.8 mmHg and 12.8±5.1 mmHg, respectively (P= 0.66). Mean TLCPD was 3.1±6.0 mmHg in the sitting position and 3.1±7.0 mmHg in the supine position (P= 1.00). Supine TLCPD increased in 10 patients (50%), decreased in 8 patients (40%), and was unchanged in 2 patients (10%). In this pilot study of 20 neurosurgical patients without glaucoma, posture-induced TLCPD changes were variable.

Effect of Change in Position of Finger on SpO&lt;sub&gt;2&lt;/sub&gt; Value by Pulse Oximetry: A Cross Sectional Study

Background: Pulse oximetry is widely used in patients of respiratory diseases for monitoring the oxygen saturation in blood. First commercial pulse oximetry was used in 1975. Although there have been many improvements in its design since then, still there are a few limitations. The limitations of pulse oximetry include mechanical artefacts accuracy, electromagnetic interference, calibration, delay, pulse dependencevolume and rhythm, abnormal haemoglobins, other absorbents, pulsatile veins, pigmentation. Objective: Despite so many studies on the pulse oximetry, there still isn’t any study on pulse oximetry which focused changes in the readings of pulse oximeter with respect to position of finger in relation to the sensor. So in this study we tried to analyse the effect of anatomical plane of finger on O 2 saturation as measured by pulse oximetry. Material and Method: This study was done on 400 patients and included both healthy and unhealthy patients. Portable pulse oximeter was used in the study. Pulse oximetry was done on the subjects with finger in supine, prone and lateral position in respect to the probe, while the patient was in sitting position with a waiting period of 1 min between each reading. Results: The study shows no significant difference (p value &gt; 0.05) between Spo 2 value obtained from any position of finger in relation to the sensor while applying the pulse oximeter. Conclusion: Pulse oximetry is a very safe, non-invasive and inexpensive way of continuous O 2 saturation monitoring in critical patients. Mal-positioning of sensors can be potentially dangerous as it may give erroneous high or low readings. The ways to prevent mal-positioning of the sensor are good design of pulse oximeter and ensuring that it is properly visible to the clinician.

Effect of change in position of particle dampers on wind turbine blade for vibration suppression

Wind turbine energy minimizes due to vibration of blade. In this research we focus on vibration suppression by using particle damping technique. Containers are used for fill the particles and mounted on the blade. As vibration of blade increases, it increases the movement of containers along with particles this brings particle to particle and particle to container wall collision takes place which results to energy loss. In this study we use four different positions for mounting containers, firstly on all four different positions we mount containers simultaneously and take three readings for three different ball sizes respectively, keeping 50 % fill constant in all readings. Then we reduce one container among four and take the readings. Repeat this procedure up to single container. Compare with damping results with without damping results and finding out optimum locations for mounting of dampers.

Importance of locking plate positioning in proximal humeral fractures as predicted by computer simulations.

Multifragmented proximal humeral fractures frequently require operative fixation. The locking plates commonly used are often placed relative to the greater tuberosity, however no quantitative data exists regarding the effect of positional changes. The aim of the study was to establish the effects from variations in proximal-distal PHILOS humeral plate positioning on predicted fixation failure risk. Twenty-one left-sided low-density virtual humeri models were created with a simulation framework from CT data of elderly donors and osteotomized to mimic an unstable three-part malreduced AO/OTA 11-B3.2 fracture with medial comminution. A PHILOS plate with either four or six proximal screws was used for fixation. Both configurations were modelled with plate repositioning 2 and 4 mm distally and proximally to its baseline position. Applying a validated computational model, three physiological loading situations were simulated and fixation failure predicted using average strain around the proximal screws-an outcome established as a surrogate for cycles to failure. Varying the craniocaudal plate position affected the peri-implant strain for both four and six-screw configurations. Even though significant changes were seen only in the latter, all tests suggested that more proximal plate positioning results in decreased peri-screw strains whereas distalizing creates increases in strain. These results suggest that even a small distal PHILOS plate malpositioning may reduce fixation stability. Plate distalization increases the probability of being unable to insert all screws within the humeral head, which dramatically increases the forces acting on the remaining screws. Proximal plate shifting may be beneficial, especially for constructs employing calcar screws. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Comparison of Horizontal Displacement from Horizontal Control Network Adjustment Result Using Observation Model and Time-Variant Methods (Case Study : Horizontal Control Network of Borobudur Temple, Epoch 2002, 2003 and 2012)

Borobudur Temple is the biggest Buddhist Temple in the world protected by UNESCO. Therefore the periodical maintenance of Borobudur temple become important, deformation study through displacement analysis can be applied for it, by conducting Geodetic observation periodically. The design for Borobudur horizontal monitoring network is a relative one, the control point and monitoring points are in the deformation area. Therefore, the effect of position changes of the control point used in the horizontal network for displacement analysis of Borobudur needs to be considered, as it affects the result for the least square adjustment of the monitoring points. Two different adjustment methods used to overcome this problem, Least square adjustment using observation model and time-variant methods. This research aims to compare the horizontal displacement analysis of Borobudur resulted from these two adjustment methods. First by giving position correction for the control point at each epoch according to its displacement in least square adjustment using observation model. The second by computing position and velocity vector directly using time-variant method. The comparation of 2D horizontal displacement vector analysis was done by using vector velocity of 2D horizontal displacement from the analysis of the two adjustment methods on the interval displacement epochs between 2002 and 2003 and between 2002 and 2012. This research showed the vector magnitude and the accuration of the displacement from the analysis resulted from the two adjustment methods was different. The resulted of least square adjustment using observation model with correction of control point showed that there was significant increase in magnitude of displacement vector of the monitoring points. Displacement analysis between 2002 and 2003 the magnitude in average were 7.97 mm and the analysis between 2002 and 2012 were 37.78 mmwith consistent displacement direction of the both interval displacement to the northwest. The Time-Variant adjustment method showed an increase in the vector velocity of 2D horizontal displacement from 0.29 mm/year to 0.32 mm/year with different displacement direction. The vector magnitude of the displacement from time variant method was smaller than observation model and the standard deviation for the horizontal displacement from time variant method was slightly bigger about 0.5 mm compared to the observation model.

Studi Analisis Pengaruh Perubahan Posisi Terhadap Efisiensi Panel Surya LPJU By Pass Ngurah Rai

Utilization of sunlight as a source of renewable electrical energy by using photovoltaic (PV) has been done by many public and private agencies. One of them is Badung Regency Government. Power source for Main Street Lighting (LPJU) with the number of lamp posts 305 installed along the road By Pass I Gusti Ngurah Rai. This study analyzed the effect of position change on the efficiency of LPJU solar panel. The simulation of this research using PVSyst software and compared with real measurement result to get the position of solar cell that can produce optimal output power and better efficiency value. The result of comparison of rill measurement with PVSyst simulation, in zone 1 obtained maximum energy generation of 60,42 kWh, 186,40 kWh, at zone 2 equal to 72,54 kWh, 186,40 kWh, at zone 3 equal to 33,97 kWh, 186.40 kWh, in zone 4 of 61.52 kWh, 186.40 kWh. The PVSyst simulation results show that the solar cell output power is higher than the rear measurement in different directions and the efisiesin value obtained is better than the previous rill measurement.

Effect of Change in Position and Back Massage on Pain Perception during First Stage of Labor

Background: Labor is one of the most painful events in a women's life. Frequent change in positions and back massage may be effective in reducing pain during the first stage of labor. Aim: The focus of this study was to identify the impact of either change in position or back massage on pain perception during first stage of labor. Design: A quasi-experimental study. Setting: Teaching hospital, Kurdistan Region, Iraq, November 2014 to October 2015. Subjects: Eighty women were interviewed as a study sample when admitted to the labor and delivery area and divided into three groups: 20 women received frequent changes in position (group A), 20 women received back massage (Group B), and 40 women constituted the control group (group C). Methods: A structured interview questionnaire to collect background data was completed by the researcher in personal interviews with the mothers. The intervention was performed at three points in each group, and pain perception was measured after each intervention using the Face Pain Scale. Results: The mean rank of the difference in pain scores among the study groups was as follows after the first, second, and third interventions, respectively: group A—52.33, 47.00, 49.2; group B—32.8, 30.28, 30.38; group C—38.44, 42.36, 41.21. There were significant differences between groups A, B, and C after the first, second, and third interventions (p1 = .011, p2 = .042, p3 = .024). Conclusions: Back massage may be a more effective pain management approach than change in position during the first stage of labor.

The Effect of Position Change on Arterial Oxygen Saturation in Cardiac and Respiratory Patients: A Randomised Clinical Trial

The Effect of Position Change on Arterial Oxygen Saturation in Cardiac and Respiratory Patients: A Randomised Clinical Trial

Dynamic wheelchair seating positions impact cardiovascular function after spinal cord injury.

BackgroundInnovative wheelchairs allow individuals to change position easily for comfort and social situations. While these wheelchairs are beneficial in multiple ways, the effects of position changes on blood pressure might exacerbate hypotension and cerebral hypoperfusion, particularly in those with spinal cord injury (SCI) who can have injury to autonomic nerves that regulate cardiovascular control. Conversely, cardiovascular benefits may be obtained with lowered seating. Here we investigate the effect of moderate changes in wheelchair position on orthostatic cardiovascular and cerebrovascular reflex control.MethodsNineteen individuals with SCI and ten neurologically-intact controls were tested in supine and seated positions (neutral, lowered, and elevated) in the Elevation™ wheelchair. Participants with SCI were stratified into two groups by the severity of injury to cardiovascular autonomic pathways. Beat-to-beat blood pressure, heart rate and middle cerebral artery blood flow velocity (MCAv) were recorded non-invasively.ResultsSupine blood pressure and MCAv were reduced in individuals with lesions to autonomic pathways, and declined further with standard seating compared to those with preserved autonomic control. Movement to the elevated position triggered pronounced blood pressure and MCAv falls in those with autonomic lesions, with minimum values significantly reduced compared to the seated and lowered positions. The cumulative duration spent below supine blood pressure was greatest in this group. Lowered seating bolstered blood pressure in those with lesions to autonomic pathways.ConclusionsIntegrity of the autonomic nervous system is an important variable that affects cardiovascular responses to orthostatic stress and should be considered when individuals with SCI or autonomic dysfunction are selecting wheelchairs.SponsorshipThis work was supported in part by the Heart and Stroke Foundation of British Columbia and the Yukon (V.E.C).

The effect of positional changes on oxygenation in patients with head injury in the intensive care unit.

Background:Following head injury, cardiopulmonary functions are impaired and this disturbs the oxygenation transport pathway. Expanding cardiopulmonary physical therapy to encompass the oxygen transport system as a whole has implication for treatment as well as assessment and treatment outcome. Therefore, the aim of the study is to assess the oxygenation level in head injury patients with relation to body positioning in the intensive care unit (ICU).Methodology:Thirty consecutive patients with head injury with hemodynamically stable were included from the surgical ICU, ages ranging from 15 to 50 years. Noninvasive vital parameters (oxygen saturation [SpO2], pulse rate [PR], respiratory rate [RR], and blood pressure [BP]) were observed and recorded in different body positions at regular intervals of 5 min for 15 min in each position.Results:There was increment in SpO2 value in all positions from 0 min to end of 15 min in supine (98.63 ± 0.36–98.73 ± 0.30), right-side lying (98.77 ± 0.30–98.93 ± 0.20), left-side lying (98.73 ± 0.29–99.03 ± 0.24), and recline sitting (30°–70°) (99.03 ± 0.24–99.50 ± 0.22). However, there was statistically significant increment in recline sitting (30°–70°) compared to other positions (P = 0.036) while other parameters (PR, RR, and BP) were getting stabilized at lower values at end of 15 min in every positions tested.Conclusion:We conclude that upright position bring about significant increase in arterial SpO2 compared to any other positions. Other vital parameters were seen to stabilize at lower values at the end of 15 min in every position tested.

Early Mobilization in the Neuro-ICU: How Far Can We Go?

Immobility that is frequently encountered in the intensive care unit (ICU) can lead to patient complications. Early mobilization of patients in the ICU has been shown to reduce the complications associated with critical illness; however, early mobilization in the neurological intensive care unit (NICU) presents a unique challenge for the multidisciplinary team. The early mobilization of patients with acute neurologic injuries such as acute ischemic stroke, aneurysmal subarachnoid hemorrhage, intracerebral hemorrhage, and neurotrauma varies because of differing disease processes and management. When developing an early mobility program in the NICU, the following should be considered: the effect of positional changes and exercise, the time from symptom onset to the initiation of early mobilization, and the type and intensity of the exercise prescribed.