{"id":43504,"date":"2025-04-29T10:30:19","date_gmt":"2025-04-29T08:30:19","guid":{"rendered":"https:\/\/www.ablehumanmotion.com\/?p=43504"},"modified":"2025-07-29T14:50:18","modified_gmt":"2025-07-29T12:50:18","slug":"orthostatic-hypotension-after-sci","status":"publish","type":"post","link":"https:\/\/www.ablehumanmotion.com\/en\/orthostatic-hypotension-after-sci\/","title":{"rendered":"Why Some SCI Patients Feel Dizzy When Standing? Orthostatic Hypotension after Spinal Cord Injury"},"content":{"rendered":"\n<p class=\"has-small-font-size wp-block-paragraph\"><strong>Author:<\/strong><br>Helena L\u00f3pez (Clinical Manager), Carmen Arreola (Marketing Manager)<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What is Orthostatic hypotension?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Orthostatic hypotension (OH) <strong>is a cardiovascular disorder characterised by a significant drop in blood pressure after a change of position<\/strong>, from a supine to an upright position (i.e. sitting or standing). It is defined as a decrease in systolic blood pressure (SBP) of at least 20 mmHg or diastolic blood pressure (DBP) of at least 10 mmHg within three minutes of changing the body position from lying down to standing or sitting, or even during a head-up tilt<sup>1,2<\/sup>. This condition can lead to dizziness, lightheadedness, fainting, and an increased risk of falls, particularly in older adults and individuals with underlying neurological or cardiovascular disorders<sup>1,2<\/sup>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Symptoms<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most patients with OH are either asymptomatic or experience only mild, nonspecific symptoms, resulting in a significant number of undiagnosed cases<sup>1,4<\/sup>. Symptoms tend to be worse in the morning, especially right after waking up, they can get worse with things like heat, not drinking enough water, alcohol intake or standing still for too long, because these can cause blood to stay in the legs and reduce blood flow to the brain<sup>1<\/sup>. Some of the most common symptoms are:<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<ul class=\"wp-block-list\">\n<li>Dizziness<\/li>\n\n\n\n<li>Lightheadedness<\/li>\n\n\n\n<li>Chronic fatigue<\/li>\n\n\n\n<li>Confusion<\/li>\n\n\n\n<li>Nausea<\/li>\n\n\n\n<li>Falls<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<ul class=\"wp-block-list\">\n<li>Fainting<\/li>\n\n\n\n<li>Blurred vision<\/li>\n\n\n\n<li>Fatigue<\/li>\n\n\n\n<li>Muscle weakness<\/li>\n\n\n\n<li>Syncope (temporary loss of consciousness)<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Diagnosis<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The diagnosis of OH involves measuring blood pressure in both supine and standing positions. A structured evaluation includes:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Blood pressure measurement:<\/strong> After five minutes of rest in a supine position, followed by measurements at one and three minutes after standing<sup>5<\/sup>.<\/li>\n\n\n\n<li><strong>Head-up tilt test:<\/strong> Used in specialised settings to evaluate autonomic function<sup>1,4,5<\/sup>.<\/li>\n\n\n\n<li><strong>24-hour ambulatory blood pressure monitoring: <\/strong>Helps detect fluctuations in blood pressure throughout the day, including nocturnal hypertension<sup>1,5<\/sup>.<\/li>\n\n\n\n<li><strong>Autonomic function tests: <\/strong>The Valsalva maneuver and heart rate variability tests to determine if the condition is neurogenic<sup>5<\/sup>.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Causes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Orthostatic hypotension is classified into 2 different categories that are differentiated by its cause:  neurogenic and non-neurogenic<sup>1,4<\/sup>. In both cases, the OH is caused by an autonomic nervous system* failure:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>the <strong>neurogenic <\/strong>includes spinal cord injuries, traumatic brain injuries, neurogenetive disorders or diabetes,<\/li>\n\n\n\n<li>and the <strong>non-neurogenic<\/strong>, which are caused by external factors, mainly by medication use, dehydration or blood loss<sup>1,4,5<\/sup>.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">*The <a href=\"https:\/\/www.physio-pedia.com\/Autonomic_Nervous_System_and_Spinal_Cord_Injury\" target=\"_blank\" rel=\"noopener\">autonomic nervous system<\/a> (ANS) is responsible for controlling involuntary physiologic processes, including blood pressure, heart rate, respiration, digestion, and sweating. This system is divided into <strong>sympathetic<\/strong>, which emerges in the thoracic area (T1) and terminates in the lumbar (around L2-3) area of the spinal cord; and <strong>parasympathetic <\/strong>originates in the craniosacral axes (which means it begins in the cranial nerves and in the sacral (S2-S4) area of the spinal cord).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">OH in SCI<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.ablehumanmotion.com\/en\/spinal-cord-injury\/\">Spinal cord injury<\/a> (SCI) can significantly disrupt the ANS, resulting in a range of issues, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Cardiovascular dysfunction<\/li>\n\n\n\n<li>Temperature regulation problems<\/li>\n\n\n\n<li>Bowel and bladder control issues<\/li>\n\n\n\n<li>Potential development of autonomic dysreflexia<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The neurological level of injury and severity is directly related to the severity of cardiovascular dysfunction in individuals with chronic SCI.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Moreover, reduced muscle function in the lower limbs limits the muscle pump effect, decreasing normal blood return to the heart. Other contributing factors to OH include: low blood volume, low blood sodium levels, and deconditioning of the heart and blood vessels due to prolonged bed rest<sup>6<\/sup>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Prevalence of OH in SCI<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Research has revealed a <strong>high prevalence of OH in SCI patients<\/strong>, with one study finding that 14 acute SCI patients experienced OH during mobilization therapy<sup>7<\/sup><em>. <\/em>Additionally, one study demonstrated that <strong>higher complete injuries are more likely to experience OH<\/strong> than lower and incomplete injuries during the first month of rehabilitation<sup>8<\/sup>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Treatments<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">There are different <strong>treatments <\/strong>whose main goal is <strong>to reduce the symptoms<\/strong>, such as falls<sup>4,5<\/sup>. These treatments can be non-pharmacological as patient education, abdominal compression, bed elevation and more, and\/or pharmaceutical, like midodrine or fludrocortisone<sup>1,3,5,9,10<\/sup>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">However, not all treatments have been tested to show efficacy in managing OH symptoms in persons with SCI. The ones that have more evidence are the following:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Non-Pharmacological Treatments<\/strong><\/td><td><strong>Pharmacological Treatments<\/strong><\/td><\/tr><tr><td><strong>Functional Electrical Stimulation (FES)<\/strong>: FES increases venous return by muscle-induced contractions. This helps reduce the blood pressure changes during postural changes<sup>11<\/sup><em>. <\/em><\/td><td><strong>Midodrine<\/strong>: By activating some receptors, it increases the vascular tone and blood pressure, which helps in the management of OH symptoms in people with SCI<sup>13<\/sup>.<\/td><\/tr><tr><td><strong>Exercise:<\/strong> It may improve the cardiovascular system and increase blood pressure, which might improve OH tolerance<sup>12<\/sup><\/td><td><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Role of Rehabilitation in OH<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Rehabilitation plays a critical role in individuals with neurological conditions<\/strong> such as spinal cord injury<sup>9,14<\/sup>. Physical therapy, strength training, and endurance exercises can help improve autonomic function and cardiovascular regulation, which can lead to reducing OH symptoms<sup>14<\/sup>. However, OH itself can be a challenge in rehabilitation programs, as patients may experience symptomatic drops in blood pressure during therapy sessions, which may lead to discouraging patients with SCI in their rehabilitation<sup>6<\/sup>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Robotic exoskeletons assist in rehabilitation by promoting functional ambulation and maintaining an upright posture<sup>15<\/sup>, but they are not universally suitable for all individuals with OH. In some cases, OH may serve as exclusion criteria for exoskeleton use, as the condition could increase the risk of dizziness and falls during training. Additionally, exoskeleton-assisted gait training may trigger episodes of OH in susceptible individuals, necessitating careful monitoring and individualised adjustments to rehabilitation plans.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img fetchpriority=\"high\" decoding=\"async\" width=\"415\" height=\"1024\" src=\"https:\/\/www.ablehumanmotion.com\/wp-content\/uploads\/2025\/04\/OH-EN-copia-415x1024.webp\" alt=\"Orthostatic hypotension (OH) is a cardiovascular disorder characterised by a significant drop in blood pressure after a change of position. Rehabilitation can reduce OH sypmtoms.\" class=\"wp-image-43554\" srcset=\"https:\/\/www.ablehumanmotion.com\/wp-content\/uploads\/2025\/04\/OH-EN-copia-415x1024.webp 415w, https:\/\/www.ablehumanmotion.com\/wp-content\/uploads\/2025\/04\/OH-EN-copia-122x300.webp 122w, https:\/\/www.ablehumanmotion.com\/wp-content\/uploads\/2025\/04\/OH-EN-copia-768x1895.webp 768w, https:\/\/www.ablehumanmotion.com\/wp-content\/uploads\/2025\/04\/OH-EN-copia-623x1536.webp 623w, https:\/\/www.ablehumanmotion.com\/wp-content\/uploads\/2025\/04\/OH-EN-copia.webp 818w\" sizes=\"(max-width: 415px) 100vw, 415px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li class=\"has-small-font-size\">Gibbons, C. H., &amp; Freeman, R. (2015). Orthostatic hypotension: Epidemiology, prognosis, and treatment. <em>Journal of the American College of Cardiology<\/em>, 66(7), 848\u2013860.<a href=\"https:\/\/doi.org\/10.1016\/j.jacc.2015.06.1084\" target=\"_blank\" rel=\"noopener\"> https:\/\/doi.org\/10.1016\/j.jacc.2015.06.1084<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">SCIRE Project. (n.d.). <em>Orthostatic Hypotension \u2013 Introduction<\/em>. Retrieved from<a href=\"https:\/\/scireproject.com\/evidence\/orthostatic-hypotension\/introduction\/\" target=\"_blank\" rel=\"noopener\"> https:\/\/scireproject.com\/evidence\/orthostatic-hypotension\/introduction\/<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Freeman, R., Wieling, W., Axelrod, F.B. <em>et al.<\/em> Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. <em>Clin Auton Res<\/em> 21, 69\u201372 (2011). <a href=\"https:\/\/doi.org\/10.1007\/s10286-011-0119-5\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1007\/s10286-011-0119-5<\/a> &nbsp;<\/li>\n\n\n\n<li class=\"has-small-font-size\">Kim, M. J., &amp; Farrell, J. (2022). Orthostatic Hypotension: A Practical Approach. <em>American family physician<\/em>, <em>105<\/em>(1), 39\u201349.<\/li>\n\n\n\n<li class=\"has-small-font-size\">Gibbons, C.H., Schmidt, P., Biaggioni, I. <em>et al.<\/em> The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. <em>J Neurol<\/em> 264, 1567\u20131582 (2017). <a href=\"https:\/\/doi.org\/10.1007\/s00415-016-8375-x\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1007\/s00415-016-8375-x<\/a>&nbsp;<\/li>\n\n\n\n<li class=\"has-small-font-size\">SCIRE Project. (n.d.). <em>Orthostatic Hypotension<\/em>. Retrieved from<a href=\"https:\/\/scireproject.com\/evidence\/orthostatic-hypotension\/\" target=\"_blank\" rel=\"noopener\"> https:\/\/scireproject.com\/evidence\/orthostatic-hypotension\/<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Illman, A., Stiller, K., &amp; Williams, M. (2000). The prevalence of orthostatic hypotension during physiotherapy treatment in patients with an acute spinal cord injury. <em>Spinal cord<\/em>, <em>38<\/em>(12), 741\u2013747. <a href=\"https:\/\/doi.org\/10.1038\/sj.sc.3101089\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1038\/sj.sc.3101089<\/a>&nbsp;<\/li>\n\n\n\n<li class=\"has-small-font-size\">Sidorov, E., Townson, A., Dvorak, M. <em>et al.<\/em> Orthostatic hypotension in the first month following acute spinal cord injury. <em>Spinal Cord<\/em> 46, 65\u201369 (2008). <a href=\"https:\/\/doi.org\/10.1038\/sj.sc.3102064\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1038\/sj.sc.3102064<\/a>&nbsp;<\/li>\n\n\n\n<li class=\"has-small-font-size\">Sarafis, Z.K., Monga, A.K., Phillips, A.A. and Krassioukov, A.V. (2018), Is Technology for Orthostatic Hypotension Ready for Primetime?.<em> PM&amp;R<\/em>, 10: S249-S263. <a href=\"https:\/\/doi.org\/10.1016\/j.pmrj.2018.04.011\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1016\/j.pmrj.2018.04.011<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Juan J. Figueroa, MD, Jeffrey R. Basford, MD, PhD &amp; Phillip A. Low, MD. Preventing and treating orthostatic hypotension: As easy as A, B, C. <em>Cleveland Clinic Journal of Medicine<\/em> May 2010, 77 (5) 298-306; DOI: <a href=\"https:\/\/doi.org\/10.3949\/ccjm.77a.09118\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.3949\/ccjm.77a.09118<\/a>&nbsp;<\/li>\n\n\n\n<li class=\"has-small-font-size\">SCIRE Project. (n.d.). <em>Effect of Functional Electrical Stimulation (FES) on OH<\/em>. Retrieved from<a href=\"https:\/\/scireproject.com\/evidence\/orthostatic-hypotension\/non-pharmacological-management-of-oh\/effect-of-functional-electrical-stimulation-fes-on-oh\/\" target=\"_blank\" rel=\"noopener\"> https:\/\/scireproject.com\/evidence\/orthostatic-hypotension\/non-pharmacological-management-of-oh\/effect-of-functional-electrical-stimulation-fes-on-oh\/<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Otsuka, Y., Shima, N., Moritani, T., Okuda, K., &amp; Yabe, K. (2008). Orthostatic influence on heart rate and blood pressure variability in trained persons with tetraplegia. <em>European journal of applied physiology<\/em>, <em>104<\/em>(1), 75\u201378. <a href=\"https:\/\/doi.org\/10.1007\/s00421-008-0783-x\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1007\/s00421-008-0783-x<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">SCIRE Project. (n.d.). <em>Pharmacological Management of OH in SCI<\/em>. Retrieved from<a href=\"https:\/\/scireproject.com\/evidence\/orthostatic-hypotension\/pharmacological-management-of-oh-in-sci\/\" target=\"_blank\" rel=\"noopener\"> https:\/\/scireproject.com\/evidence\/orthostatic-hypotension\/pharmacological-management-of-oh-in-sci\/<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Nas, K., Yazmalar, L., \u015eah, V., Ayd\u0131n, A., &amp; \u00d6ne\u015f, K. (2015). Rehabilitation of spinal cord injuries. <em>World journal of orthopedics<\/em>, <em>6<\/em>(1), 8\u201316. <a href=\"https:\/\/doi.org\/10.5312\/wjo.v6.i1.8\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.5312\/wjo.v6.i1.8<\/a>&nbsp;<\/li>\n\n\n\n<li class=\"has-small-font-size\">Karelis, A. D., Carvalho, L. P., Castillo, M. J., Gagnon, D. H., &amp; Aubertin-Leheudre, M. (2017). Effect on body composition and bone mineral density of walking with a robotic exoskeleton in adults with chronic spinal cord injury. <em>Journal of rehabilitation medicine<\/em>, <em>49<\/em>(1), 84\u201387. <a href=\"https:\/\/doi.org\/10.2340\/16501977-2173\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.2340\/16501977-2173<\/a><\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Orthostatic hypotension (OH) is a cardiovascular disorder characterised by a significant drop in blood pressure after a change of position. Rehabilitation can reduce OH sypmtoms.<\/p>\n","protected":false},"author":3,"featured_media":44511,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[81],"tags":[57,74,91,90],"class_list":["post-43504","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clinical","tag-able-exoskeleton-en","tag-neurorrehabilitacion-2","tag-orthostatic-hypotension","tag-sci"],"_links":{"self":[{"href":"https:\/\/www.ablehumanmotion.com\/en\/wp-json\/wp\/v2\/posts\/43504","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ablehumanmotion.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.ablehumanmotion.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.ablehumanmotion.com\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ablehumanmotion.com\/en\/wp-json\/wp\/v2\/comments?post=43504"}],"version-history":[{"count":14,"href":"https:\/\/www.ablehumanmotion.com\/en\/wp-json\/wp\/v2\/posts\/43504\/revisions"}],"predecessor-version":[{"id":45370,"href":"https:\/\/www.ablehumanmotion.com\/en\/wp-json\/wp\/v2\/posts\/43504\/revisions\/45370"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.ablehumanmotion.com\/en\/wp-json\/wp\/v2\/media\/44511"}],"wp:attachment":[{"href":"https:\/\/www.ablehumanmotion.com\/en\/wp-json\/wp\/v2\/media?parent=43504"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ablehumanmotion.com\/en\/wp-json\/wp\/v2\/categories?post=43504"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ablehumanmotion.com\/en\/wp-json\/wp\/v2\/tags?post=43504"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}