Supine Body Research Articles

Subjective vertical and postural activity

Three experiments were conducted to test the effect of postural information, resulting from the active control of balance, on the perception of the vertical. Subjects were required to adjust a luminous rod in two different visual contexts: in the dark or within a tilted visual frame. In these experiments, postural activity was manipulated by placing observers either in a situation of slight postural imbalance (Experiment 1) or in a situation of postural immobilization (Experiment 2). In both situations performance was compared with a control condition in which subjects were standing upright freely (Experiment 1) or sitting unconstrained (Experiment 2). Results showed no main effect of active posture or of immobilization on the visual perception of the vertical. In the third experiment, subjects were supine with their Z body axis perpendicular to the plane of the luminous rod. Thus, body orientation relative to gravity was modified and motor activity reduced. In this position, the physical vertical was perceived quite accurately in a dark environment. Moreover, in the tilted frame condition, the supine body position clearly improved vertical judgments. These results are discussed in relation to the ecological theory of orientation (Stoffregen and Riccio, 1988).

The role of plasma renin activity in evaluating the adequacy of mineralocorticoid replacement in primary adrenal insufficiency.

Elevation of plasma renin activity (PRA) is a feature of mineralocorticoid deficiency in patients with primary adrenal insufficiency. This study was designed to assess the usefulness of PRA as an index of adequacy of fludrocortisone (FC) replacement in patients with primary adrenal failure, paying particular attention to the variability in PRA levels during FC and glucocorticoid treatment. Twenty-two patients with mineralocorticoid deficiency due to primary adrenal diseases were studied at 3 time points: 8, 24 and 32 hours following the administration of FC replacement. Body weight, blood pressure while supine and erect, PRA, and plasma or serum levels of aldosterone, urea, sodium and potassium were measured at each time. The clinical and biochemical consequences of adjusting the FC dose were monitored in 5 patients with PRA levels above the range seen in normal subjects and in one hypokalaemic patient with normal PRA levels. At 8 and 32 hours following FC administration, PRA levels were not significantly different. PRA levels were significantly higher at 32 hours following FC administration (4.7 +/- 1.1 nmol/l/h) than at 24 hours (4.2 +/- 1.1 nmol/l/h, mean +/- SEM, P < 0.05). At 8 and 32 hours following FC administration, potassium levels were similar. Potassium levels were significantly higher at 32 hours following FC administration (3.9 +/- 0.1 mmol/l) than at 24 hours (3.6 +/- 0.1 mmol/l, P < 0.05). No changes in measurements of sodium, urea, mean supine and erect arterial pressure or body mass index were noted at the different study points. Attempted lowering of elevated PRA in 5 normokalaemic subjects by raising the dose of FC led to normalization of PRA in all of these patients but 2 developed hypokalaemia and oedema. Lowering of FC dose in one hypokalaemic patient with normal PRA levels led to the PRA levels rising to a supranormal value while the hypokalaemia was corrected. These results indicate that when plasma renin activity is estimated in patients with primary adrenal insufficiency replaced with daily doses of fludrocortisone, the time of day of blood sampling is not critical. Lowering elevated plasma renin activity levels to normal in patients who were considered to be otherwise normal may lead to over-treatment in some patients. Therefore, optimal fludrocortisone replacement may be associated with mildly elevated plasma renin activity levels. The information obtained by monitoring plasma renin activity adds little to the assessment of patients based on clinical evaluation and measurement of urea and electrolyte levels in blood.

Reproducibility and condylar position of a physiologic maxillomandibular centric relation in upright and supine body position

Better understanding of the physiologic features of the masticatory system has led to the evolution of the concept of maxillomandibular centric relation from the mechanical to physiological bases. However, the reproducibility of physiologic methods for centric relation determination has been criticized. In this clinical study the swallowing technique was modified to establish a physiologic centric relation in a reproducible manner. Condylar and disk positioning and reproducibility of the proposed modified swallowing technique (MST) were compared with the same parameters of a traditional technique, namely, the chin point guidance technique (CGT). Both techniques were studied with the patient in the upright and supine positions. Three interocclusal records were obtained for each technique-position combination for each of the 30 patients. The recorded maxillomandibular relations were analyzed on the three-dimensional analyzer. MST positioned the condyles in a more superoanterior position than did CGT, which was interpreted as a better seating of the condyles and disk in the articular fossae. There was no significant difference in reproducibility between MST and CGT on x, y or z axes ( p > 0.05), indicating that it is possible to establish a physiologic centric relation in a reproductible manner. The term “functional centric area” was proposed in this study to define a neuromuscularly determined centric occlusal scheme.

Influence of body position on breathing and its implications for the evaluation and treatment of speech and voice disorders

This paper examines how breathing differs in the upright and supine body positions. Passive and active forces and associated chest wall motions are described for resting tidal breathing and speech breathing performed in the two positions. Clinical implications are offered regarding evaluation and treatment of breathing behavior in clients with speech and voice disorders.

Effects of gravity on velopharyngeal muscle activity during speech.

Assessment of the role of gravitational forces in the motor control of the velopharyngeal mechanism was the focus of this study. Specifically, the effect of gravity on activation levels of the levator veli palatini and palatoglossus muscles was assessed. Nineteen volunteers repeated a CV syllable in upright and supine body positions. Overall, lower peak activation levels of levator veli palatini were observed in the supine body position. The results suggest that less muscle activity was seen in the levator veli palatini in the supine body posture, where gravitational effects worked in the same direction (i.e., toward closure). No statistically significant group effects were seen in muscle activation levels of palatoglossus across the two body postures, although clear gravity effects were observed in some subjects. The implications of these findings from a speech motor control perspective are discussed in relation to normal and disordered velopharyngeal function.

Effects of Gravity on Velopharyngeal Muscle Activity During Speech

Assessment of the role of gravitational forces in the motor control of the velopharyngeal mechanism was the focus of this study. Specifically, the effect of gravity on activation levels of the levator veli palatini and palatoglossus muscles was assessed. Nineteen volunteers repeated a CV syllable in upright and supine body positions. Overall, lower peak activation levels of levator veli palatini were observed in the supine body position. The results suggest that less muscle activity was seen in the levator veli palatini in the supine body posture, where gravitational effects worked in the same direction (i.e., toward closure). No statistically significant group effects were seen in muscle activation levels of palatoglossus across the two body postures, although clear gravity effects were observed in some subjects. The implications of these findings from a speech motor control perspective are discussed in relation to normal and disordered velopharyngeal function.

Intractable Cough Associated With the Supine Body Position: Effective Therapy With Nasal CPAP

We describe five patients with severe nocturnal cough and daytime somnolence in whom the coughing attacks are triggered by assuming the supine body position. Quantity and quality of the nocturnal cough were evaluated in the sleep laboratory with and without nasal continuous positive airway pressure (N-CPAP). Air flow characteristics were assessed using flow volume and airway resistance loops. Airway anatomy was evaluated bronchoscopically. In all five patients, the cough had a barking quality. Flow-volume loops showed an expiratory collapse phenomenon in two of the patients. Endoscopically, all five patients had signs of airway collapse. All patients had difficulty falling asleep because of coughing and were awakened by it frequently. Sleep times ranged from 2.5 to 4.5 h per night. With N-CPAP pressures ranging from 5 to 13 cm H2O, all five patients had clinically significant improvement in their symptoms. Their sleep times increased to a range of 5 to 7.5 h per night and the daytime somnolence markedly improved or resolved. All five patients requested a N-CPAP unit for home use. We conclude that a cough that is predominantly associated with or exacerbated by the supine body position may be treated effectively with N-CPAP.

Effects of body position on the upper airway of patients with obstructive sleep apnea.

Fast-CT scanning was used to study the effects of changes in body position on upper airway (UA) size and shape in 11 awake subjects with obstructive sleep apnea (OSA). Six patients with position (P)-dependent OSA were compared with five patients with nonposition (NP)-dependent OSA. Scans were repeated in the prone (PRN), right side (RS), and supine (SUP) body positions at both functional residual capacity and end-inspiratory tidal volume. Significant group, group by position, and borderline group by respiration effects were detected for minimum but not mean UA dimension data. Significant differences between groups were noted in minimum cross-sectional area and minimum lateral distance but not in minimum anteroposterior distance in the RS and SUP positions. Turning from the PRN to the RS or SUP position tended to decrease UA size in the NP group by decreasing the lateral distance, while the opposite effect was found in the P group. The results indicate that changes in body position during wakefulness affect the lateral but not the anteroposterior dimensions of the UA, and the UA behaves differently in patients with NP and P OSA in response to changes in body position.

Vasomotor and sudomotor responses of human head skin during hyperthermia; strategy of prevention of heat stroke

Vasomotor and sudomotor responses of human head skin during hyperthermia; strategy of prevention of heat stroke

Early leg blood flow adjustment during dynamic foot plantarflexions in upright and supine body position.

The time courses of leg blood flow, systolic peak velocity, heart rate and blood pressure have been studied in nine health volunteers during dynamic exercise in upright sitting and in a tilted sitting body position. In both positions the subjects performed single and repeated foot plantarflexions against light and moderate forces corresponding to 5%-10% and 25%-30% of maximal voluntary contraction. The following measurement techniques were used: Doppler ultrasound method (blood flow parameters), FINAPRES device (arterial blood pressure) and standard ECG chest leads (heart rate). At rest the supine blood flow parameters measured in the arteria femoralis were significantly higher than in the upright sitting position. In both positions, even one single plantarflexion at the light exercise intensity caused significant increases in blood flow for almost 20s. The major part of the blood flow response to repeated contractions always occurred within the first 10s at virtually unchanged blood pressures. During this initial phase upright leg blood flow increased by factors of 2.5 (light exercise) and 3.1 (moderate exercise). The corresponding values in the tilted sitting posture were 1.7 and 1.9, respectively. The initial increases in the upright position were too large to be attributed only to the increase of the perfusion pressure caused by the withdrawal of the hydrostatic pressure on the venous side ("muscle pump"). Additional, fast decreases in local resistance have to be considered. In the supine posture effects on local resistance have to be taken into account for the early increases in blood flow since hydrostatic effects on arterio-venous pressure differences are too small. The present findings indicate that the effects of repeated contraction-relaxation cycles on the early adjustment of muscle blood flow are not sufficiently described by a "muscle pump" that induces only venous volume shifts and hydrostatic pressure changes. Additional fast effects on local resistance have to be taken into account.

Postural effect on cardiac output, oxygen uptake and lactate during cycle exercise of varying intensity

Owing to changes in cardiac output, blood volume distribution and the efficacy of the muscle pump, oxygen supply may differ during upright and supine cycle exercise. In the present study we measured, in parallel, circulatory (heart rate, stroke volume, blood pressure) and metabolic parameters (oxygen uptake, lactic acid concentration [la]) during incremental-exercise tests and at constant power levels ranging from mild to severe exercise. In supine position, cardiac output exceeded the upright values by 1.0-1.5 l.min-1 during rest, light ([la] < 2 mmol.l-1) and moderate ([la] = 2-4 mmol.l-1) exercise. At higher exercise intensities the cardiac output in an upright subject approached and eventually slightly exceeded the supine values. For both rest-exercise transitions and large-amplitude steps (delta W > or = 140 W) the cardiac output kinetics was significantly faster in upright cycling. The metabolic parameters (VO2 and [la]) showed no simple relationship to the circulatory data. In light to moderate exercise they were unaffected by body position. Only in severe exercise, when cardiac output differences became minimal, could significant influences be observed: with supine body posture, [la] started to rise earlier and maximal power (delta W = 23 W) and exercise duration (64 s) were significantly reduced. However, the maximal [la] value after exercise was identical in both positions. The present findings generally show advantages of upright cycling only for severe exercise. With lower workloads the less effective muscle pump in the supine position appears to be compensated for by the improved central circulatory conditions and local vasodilatation.

Changes in lower limb muscle cross-sectional area and tissue fluid volume after transition from standing to supine.

Lower limbs show acute fluid shift in response to transition from upright to supine body position. It is hypothesized that this would affect tomographic estimations of muscle mass and composition. Seven healthy subjects were investigated during the initial 120 min of bed rest, using repeated computerized tomography (CT) and continuous bioelectrical impedance analysis (BIA). Thigh and calf muscle cross-sectional area (CSA) decreased (P < 0.05) by 1.9 and 5.5% whereas fat CSA decreased (P < 0.05) by 4.1 and 4.4%, respectively. Radiological density (RD) of muscle showed a simultaneous increase (P < 0.05) by 4.8% in calf but not (P > 0.05) in thigh. No changes occurred (P > 0.05) in muscle or fat CSA or muscle RD in either thigh or calf between the first and second hour of bed rest. Fluid shift, as estimated by BIA, showed an exponential decay in thigh (tau th = 30 min) and calf (tau c2 = 37 min) by 2.5 and 8.7%, respectively, from first to 120 min of bed rest. Moreover, the calf showed an initial rapid (tau c1 = 8 s) 2.2% decrease. The demonstrated short-term changes in leg CSA were more pronounced in the calf than in the thigh. They were similar in muscle and subcutaneous fat. These fluid shifts merit consideration when tomographic imaging techniques are used to estimate muscle mass and composition.

Prone or Supine Body Position and Sleep Characteristics in Infants

To evaluate the potential relation between body position and sleep characteristics in normal infants. Two groups of 3-month-old healthy infants were evaluated: 40 infants who usually slept supine, and 40 who usually slept prone. The two groups were matched for gender, gestational age, postnatal age, birth weight, and total recording time. RECORDING TECHNIQUES: The 80 infants were studied polygraphically during one night in the pediatric sleep laboratory. They were allowed to fall asleep in their usual sleep position, and every 3 hours were gently turned from prone to supine, or from supine to prone. In each group, 6 infants were excluded from the analysis, because they woke up after having been turned over. In both groups, no significant difference was seen between the prone and the supine body positions for the following variables: number of sleep state changes; number of gross body movements; percent of rapid eye movement sleep; saturation with oxygen, arterial blood levels; number and duration of acid esophageal reflux; rectal temperature; mean respiratory rates; water evaporation rates from the forehead skin; and number or duration of central or of obstructive apneas. In both groups of infants, prone body position was associated with a significant increase in sleep duration (+16%) and in non-rapid eye movement sleep (+25%) and a significant decrease in number of arousals (-40%) and in their duration (-43%). No explanation has been found for the sleep-promoting effect of prone body positioning. The finding could be of interest to the study of infants' sleep quality, as well as to the potential relation between body positions and sudden death during sleep.

Mean acidity or percentage reflux time in oesophageal pH-monitoring

Objectives: The reflux parameter mean acidity, which is independent of any pH threshold, was compared with the established parameter percentage of time when the pH is less than 4 with respect to the discriminatory diagnostic accuracy in gastro-oesophageal reflux disease and the evaluation of drug effects. Methods: Normal values, sensitivity and specificity of pH-monitoring were calculated using receiver operating characteristic (ROC) analysis in 35 reflux patients and 19 healthy controls. In addition, 32 patients were studied twice, without medication (baseline) and with either antacids (five patients), ranitidine (13 patients) or omeprazole (14 patients). Results: The percentage reflux time was superior to the mean acidity in the diagnosis of gastro-oesophageal reflux disease (maximal sensitivity/specificity was 91/95% compared with 83, 84%). Antacids did not reduce the percentage reflux time or the mean acidity. Ranitidine only reduced the percentage reflux time for the supine body position from 7.7 (0.2–46.4) to 0.72% (0.0–14.9, P < 0.05). Omeprazole reduced all reflux parameters; the percentage reflux time for the upright body position from 9.6 (5.0–52.3) to 1.6% (0.0–22.5, P < 0.01) and for the supine position from 4.9 (0.0–23.7) to 0.0% (0.0–48.5, P < 0.050, and the mean acidity from 0.84 (0.02–76.0) to 0.01 mmol/l (0.0–0.71, P < 0.001). Mean acidity described the effect of omeprazole significantly better than percentage reflux time. Conclusions: In the diagnosis of gastro-oesophageal reflux disease, percentage reflux time is superior to mean acidity. Mean acidity, however, seems to be the better parameter to describe the reduction in acid gastro-oesophageal reflux afforded by potent antisecretory drugs.

Effect of graded changes in extracellular muscle volume on cardiovascular drives during static exercise.

The effects of graded changes in peripheral extracellular volume on heart rate and blood pressure during isometric exercise were studied in 12 healthy male subjects. Each subject performed four calf ergometer tests with each calf. In all tests, static plantar flexion of one foot was performed in a supine body position with the knee joint flexed to 90 degrees. After a pre-exercise period of 18 min, during which the calf volume was manipulated, the subjects had to counteract a spring force of 120 N for 8 min. In the pre-exercise period the peripheral extracellular volume of the calf muscle to be tested was manipulated in four ways. Test 1:15 min of rest in the exercise position. During the last 3.5 min, the calf volume was increased by venous congestion [80 mmHg (10.67 kPa) applied to the distal part of the thigh by pneumatic cuff]. Test 2: the same protocol as in test 1 but with 7.5-min venous congestion. Test 3:15 min of venous congestion. Test 4: the calf volume was decreased by a negative hydrostatic pressure for 15 min (calf raised about 40 cm above heart level). To clamp the changed calf volume, the thigh cuff was rapidly inflated to 300 mmHg (40.0 kPa) at the end of the volume manipulation and the subjects remained resting for a further 3 min. In test 4, the leg of the subject was passively brought into the exercise position. The occlusion was maintained until 2 min after exercise. The calf volume manipulation led to changes ranging from +105 ml (test 3) to -134 ml (test 4) as measured by water displacement plethysmography. The blood pressure response to exercise was inversely related to the calf volume changes while the heart rate response during exercise showed no clearcut relationship to the pretreatments.

Effects of an acute saline infusion on fluid and electrolyte metabolism in humans.

Several hormonal systems participating in body fluid and electrolyte homeostasis were investigated in six healthy volunteers in a supine body position during a period of 9 days and nights. Under strictly controlled conditions, striking circadian rhythms were observed for plasma levels of vasopressin, renin, aldosterone, guanosine 3',5'-cyclic monophosphate, cortisol, and epinephrine. Nocturnal decreases and diurnal increases in urine flow rate and urinary excretion of electrolytes were observed and closely paralleled the urinary excretion of urodilatin. During 48 h after an acute isotonic saline infusion (2 liters within 25 min) and after a 48-h control experiment the urinary excretion of H2O and electrolytes, and simultaneously the alterations in endocrine systems participating in body fluid homeostasis, were determined. Urine flow and urinary electrolyte excretion rates were significantly increased during 2 days after the saline infusion. The largest increase in urinary fluid and electrolyte excretion was observed between 3 and 22 h postinfusion. These long-term changes were paralleled by altered H2O and Na balances and also by elevated body weights that returned to baseline values with an approximate half-life of 7 h. These data suggest that vasopressin, atrial natriuretic peptide, and catecholamines are unlikely to be of major importance for the renal response to this hypervolemic stimulus. The renin-aldosterone system was suppressed during 2 days postinfusion. This suppression correlated with the effects of saline load on Na excretion. However, the closest relation with Na excretion was observed for the kidney-derived member of the atrial natriuretic peptide family, urodilatin, which was considerably increased during the long-term period up to 22 h postinfusion. Thus these data show that the human body in supine position requires approximately 2 days to regulate the amount of Na and H2O provided by an acute saline infusion. The data also suggest that urodilatin and the renin-aldosterone system might participate in the long-term renal response to an acute saline infusion and also in the mediation of circadian urinary excretion rhythms.

BODY POSITION MAY AFFECT PULMONARY ASPIRATION.

Pulmonary aspiration of gastric contents is probably an important cause of nosocomial pneumonia in patients receiving mechanical ventilation. These authors assessed whether supine body position might predispose patients to aspiration. Researchers instilled radiolabeled material via …

Cardiovascular Adaptation to Spaceflight

Data are presented on the rate of adaptation of the human cardiovascular system to conditions of spaceflight, with particular attention given to data obtained during spaceflight in the U.S. Space Shuttle Program. It is pointed out that many of the cardiovascular changes that occurred during spaceflights that lasted from 2 to 11 days can be traced directly to changes in the body fluid volume. The beneficial effects of a fluid loading countermeasure (oral rehydration) and of the supine body position on the heart rate during the spaceflight are demonstrated. It is noted that, after hours or a few days of spaceflight, a state of adaptation is reached, in which the subject is well adapted and appropriately hydrated for the weightless environment. However, the return to the normal gravity of the earth leaves the individual especially sensitive to orthostatic stress.

Comparison of effects of upright versus supine body position and liquid versus solid bolus on esophageal pressures in normal humans

New studies monitoring ambulatory esophageal pressures during food ingestion often compare results to normal values obtained from supine liquid swallows. We compared distal esophageal peristaltic and lower esophageal sphincter (LES) pressures in 15 normal subjects during six liquid swallows in the upright and supine positions, and six solid (small marshmallow) swallows in upright position. LES pressures were significantly (P less than 0.05) higher supine than upright but no differences were noted in LES pressure, relaxation, and duration of relaxation between upright solid and liquid swallows. Distal peristaltic wave velocities were faster upright than supine. Peristaltic wave amplitudes, durations, and DP/DT were significantly (P less than 0.05) greater in supine than in upright position. Atypical wave forms, defined as nontransmitted, simultaneous, and simultaneous/repetitive, increased in the upright position compared to supine (P less than 0.01), and during solid vs liquid swallows (P less than 0.05). These results indicate that body position substantially affects normal distal esophageal peristalsis and LES pressure and that "abnormal" wave forms occur more frequently during swallowing solids than liquids in the upright position. Conclusions regarding "abnormal" motility over prolonged periods and during food ingestion in patients should be tempered by these findings.

Shape of the chest wall in the prone and supine anesthetized dog

The shape of the passive chest wall of six anesthetized dogs was determined at total lung capacity (TLC) and functional residual capacity (FRC) in the prone and supine body positions by use of volumetric-computed tomographic images. The transverse cross-sectional areas of the rib cage, mediastinum, and diaphragm were calculated every 1.6 mm along the length of the thorax. The changes in the volume and the axial distribution of transverse area of the three chest wall components with lung volume and body position were evaluated. The decrease of the transverse area within the rib cage between TLC and FRC, as a fraction of the area at TLC, was uniform from the apex of the thorax to the base. The volume of the mediastinum increased slightly between TLC and FRC (14% of its TLC volume supine and 20% prone), squeezing the lung between it and the rib cage. In the transverse plane, the heart was positioned in the midthorax and moved little between TLC and FRC. The shape, position, and displacement of the diaphragm were described by contour plots. In both postures, the diaphragm was flatter at FRC than at TLC, because of larger displacements in the dorsal than in the ventral region of the diaphragm. Rotation from the prone to supine body position produced a lever motion of the diaphragm, displacing the dorsal portion of the diaphragm cephalad and the ventral portion caudad. In five of the six dogs, bilateral isovolume pneumothorax was induced in the supine body position while intrathoracic gas volume was held constant.(ABSTRACT TRUNCATED AT 250 WORDS)