The Nintendo® Wii Fit Balance Board can be used as a portable and low-cost posturography system with good agreement compared to established systems.

BACKGROUND: Almost all epidemiological studies over the past 40 years have determined that the incidence of fragility fractures is increasing. Therefore, the assessment of postural stability and monitoring any progress during balance training for geriatric patients to prevent falls are becoming more important. The Nintendo® Wii Fit Balance Board, with its integrated software and scoring system, might be a cheap and easily accessible tool for this purpose. METHODS: This prospective study analyzed the diagnostic value of the Wii Fit Balance Board in 41 healthy subjects using two measurements: the yoga task "tree," which is performed in one-leg stance; and the balance game "table tilt." Our investigation compared these tasks to two established, regularly used systems, the MFT-S3 Check and the Posturomed, by looking for correlation and agreement, using Bland-Altman plots, as well as for differences to demographic data. All measurement tools were also compared to the Sensory Organization Test-the gold standard for detecting impaired balance. RESULTS: We found a moderate correlation between the yoga exercise "tree" and the Sensory Organization Test (correlation coefficient r = 0.514, p = 0.001) as well as the MFT-S3 Check (r = 0.356-0.472, p = 0.002-0.022) and the Posturomed (r = 0.345, p = 0.027). However, results from the balance game "table tilt" did not show a significant correlation with those of the systems to which we compared it (p = 0.301-0.953). CONCLUSIONS: According to the literature, the raw data from the Wii Fit Balance Board are comparable to that obtained by laboratory-grade force platforms. We have found, however, that the yoga pose "tree," as integrated into the Nintendo® Wii Fit Balance Board with its own scoring system, also correlates with the gold-standard Sensory Organization Test. It also correlates with two frequently used diagnostic and therapeutic devices. We, therefore, conclude that the Wii Fit Balance Board is suitable for the evaluation of postural stability and may be useful in preventing falls among the geriatric population. LEVEL OF EVIDENCE: 2b.

Síncope / Syncope

El síncope es una pérdida transitoria de conciencia y tono postural debido a hipoflujo sanguíneo cerebral que se recupera espontáneamente sin maniobras de RCP. En esta actualización se plantea el síncope vasovagal con sus diagnósticos diferenciales y posibles etiologías, fisiopatología y métodos de estudios. También se presenta la experiencia sobre este tema en nuestro hospital su estudio, tratamiento y diagnostico (tilt test) (AU)

Syncope is a transient loss of consciousness and postural tone due to cerebral blood hypoflow that recovers spontaneously without CPR maneuvers. This update discusses vasovagal syncope with its differential diagnoses and possible etiologies, pathophysiology, and diagnostic methods. Additionally, the experience on this topic of our hospital regarding investigations, treatment, and diagnosis is presented. (AU)

A Trunk Support System to Identify Posture Control Mechanisms in Populations Lacking Independent Sitting.

Populations with moderate-to-severe motor control impairments often exhibit degraded trunk control and/or lack the ability to sit unassisted. These populations need more research, yet their underdeveloped trunk control complicates identification of neural mechanisms behind their movements. The purpose of this study was to overcome this barrier by developing the first multi-articulated trunk support system to identify visual, vestibular, and proprioception contributions to posture in populations lacking independent sitting. The system provided external stability at a user-specific level on the trunk, so that body segments above the level of support required active posture control. The system included a tilting surface (controlled via servomotor) as a stimulus to investigate sensory contributions to postural responses. Frequency response and coherence functions between the surface tilt and trunk support were used to characterize system dynamics and indicated that surface tilts were accurately transmitted up to 5 Hz. Feasibility of collecting kinematic data in participants lacking independent sitting was demonstrated in two populations: two typically developing infants, [Formula: see text] months, in a longitudinal study (eight sessions each) and four children with moderate-to-severe cerebral palsy (GMFCS III-V). Adaptability in the system was assessed by testing 16 adults (ages 18-63). Kinematic responses to continuous pseudorandom surface tilts were evaluated across 0.046-2 Hz and qualitative feedback indicated that the trunk support and stimulus were comfortable for all subjects. Concepts underlying the system enable both research for, and rehabilitation in, populations lacking independent sitting.

Test-retest reliability and four-week changes in cardiopulmonary fitness in stroke patients: evaluation using a robotics-assisted tilt table.

BACKGROUND: Exercise testing devices for evaluating cardiopulmonary fitness in patients with severe disability after stroke are lacking, but we have adapted a robotics-assisted tilt table (RATT) for cardiopulmonary exercise testing (CPET). Using the RATT in a sample of patients after stroke, this study aimed to investigate test-retest reliability and repeatability of CPET and to prospectively investigate changes in cardiopulmonary outcomes over a period of four weeks. METHODS: Stroke patients with all degrees of disability underwent 3 separate CPET sessions: 2 tests at baseline (TB1 and TB2) and 1 test at follow up (TF). TB1 and TB2 were at least 24 h apart. TB2 and TF were 4 weeks apart. A RATT equipped with force sensors in the thigh cuffs, a work rate estimation algorithm and a real-time visual feedback system was used to guide the patients' exercise work rate during CPET. Test-retest reliability and repeatability of CPET variables were analysed using paired t-tests, the intraclass correlation coefficient (ICC), the coefficient of variation (CoV), and Bland and Altman limits of agreement. Changes in cardiopulmonary fitness during four weeks were analysed using paired t-tests. RESULTS: Seventeen sub-acute and chronic stroke patients (age 62.7 ± 10.4 years [mean ± SD]; 8 females) completed the test sessions. The median time post stroke was 350 days. There were 4 severely disabled, 1 moderately disabled and 12 mildly disabled patients. For test-retest, there were no statistically significant differences between TB1 and TB2 for most CPET variables. Peak oxygen uptake, peak heart rate, peak work rate and oxygen uptake at the ventilatory anaerobic threshold (VAT) and respiratory compensation point (RCP) showed good to excellent test-retest reliability (ICC 0.65-0.94). For all CPET variables, CoV was 4.1-14.5 %. The mean difference was close to zero in most of the CPET variables. There were no significant changes in most cardiopulmonary performance parameters during the 4-week period (TB2 vs TF). CONCLUSIONS: These findings provide the first evidence of test-retest reliability and repeatability of the principal CPET variables using the novel RATT system and testing methodology, and high success rates in identification of VAT and RCP: good to excellent test-retest reliability and repeatability were found for all submaximal and maximal CPET variables. Reliability and repeatability of the main CPET parameters in stroke patients on the RATT were comparable to previous findings in stroke patients using standard exercise testing devices. The RATT has potential to be used as an alternative exercise testing device in patients who have limitations for use of standard exercise testing devices.

Tilt table testing in neurology and clinical neurophysiology.

Reflex syncope is responsible for 1-6% of hospital admissions and the economic burden of syncope is huge. A considerable part of these high costs is still spent on tests that are not indicated. Till now few neurologists have taken an interest in syncope and tilt table testing (TTT). However, reflex syncope and epilepsy are often in each other's differential diagnosis and require a similar emphasis on history taking and deductive reasoning. A TTT can be helpful for diagnosis and treatment. The pathophysiological rationale behind the TTT is the fact that it uses gravity to provoke a downwards shift of blood that in turn triggers syncope. Various indications and methods of the TTT are discussed in this paper.

Postural influence on intracranial and cerebral perfusion pressure in ambulatory neurosurgical patients.

We evaluated postural effects on intracranial pressure (ICP) and cerebral perfusion pressure [CPP: mean arterial pressure (MAP) - ICP] in neurosurgical patients undergoing 24-h ICP monitoring as part of their diagnostic workup. We identified nine patients (5 women, age 44 ± 20 yr; means ± SD), who were "as normal as possible," i.e., without indication for neurosurgical intervention (e.g., focal lesions, global edema, abnormalities in ICP-profile, or cerebrospinal fluid dynamics). ICP (tip-transducer probe; Raumedic) in the brain parenchyma (n = 7) or in the lateral ventricles (n = 2) and cardiovascular variables (Nexfin) were determined from 20° head-down tilt to standing up. Compared with the supine position, ICP increased during 10° and 20° of head-down tilt (from 9.4 ± 3.8 to 14.3 ± 4.7 and 19 ± 4.7 mmHg; P < 0.001). Conversely, 10° and 20° head-up tilt reduced ICP to 4.8 ± 3.6 and 1.3 ± 3.6 mmHg and ICP reached -2.4 ± 4.2 mmHg in the standing position (P < 0.05). Concordant changes in MAP maintained CPP at 77 ± 7 mmHg regardless of body position (P = 0.95). During head-down tilt, the increase in ICP corresponded to a hydrostatic pressure gradient with reference just below the heart, likely reflecting the venous hydrostatic indifference point. When upright, the decrease in ICP was attenuated, corresponding to formation of a separate hydrostatic gradient with reference to the base of the skull, likely reflecting the site of venous collapse. ICP therefore seems to be governed by pressure in the draining veins and collapse of neck veins may protect the brain from being exposed to a large negative pressure when upright. Despite positional changes in ICP, MAP keeps CPP tightly regulated.

Effect of head-up tilt-table testing on left ventricular longitudinal strain in patients with neurocardiogenic syncope.

Recent studies have shown conflicting data regarding left ventricular (LV) function in patients with neurocardiogenic syncope, with some investigators reporting a marked decrease in LV end-systolic wall stress and stress-corrected fractional shortening. We sought to determine the characteristics of resting LV deformation in patients with neurocardiogenic syncope by selective motion tracking of subendocardial and subepicardial regions using speckle tracking echocardiography. We assessed resting LV function in 82 patients undergoing head-up tilt-table (HUTT) testing. Patients were divided into 3 groups based on a positive HUTT test with associated co-morbid conditions (n = 30), no associated co-morbid conditions (n = 30), or negative HUTT results (n = 22). LV longitudinal, circumferential, and radial strains were obtained by speckle tracking echocardiography of subendocardial and subepicardial regions in each group and compared with resting LV deformation in 20 healthy control subjects. Compared with endocardial longitudinal strain in control subjects, that in patients with positive HUTT results was attenuated, irrespective of co-morbid conditions (p <0.05). Circumferential and radial strains did not differ among groups. On multivariate logistic regression analysis, endocardial longitudinal strain was an independent predictor (odds ratio, 1.16; p = 0.01) of positive HUTT test results. In conclusion, resting LV longitudinal strain is attenuated in patients with positive HUTT test results. Overall, these results may suggest that an increase in resting LV contractility is not a prerequisite for development of neurocardiogenic syncope.

Tilt testing with combined lower body negative pressure: a "gold standard" for measuring orthostatic tolerance.

Orthostatic tolerance (OT) refers to the ability to maintain cardiovascular stability when upright, against the hydrostatic effects of gravity, and hence to maintain cerebral perfusion and prevent syncope (fainting). Various techniques are available to assess OT and the effects of gravitational stress upon the circulation, typically by reproducing a presyncopal event (near-fainting episode) in a controlled laboratory environment. The time and/or degree of stress required to provoke this response provides the measure of OT. Any technique used to determine OT should: enable distinction between patients with orthostatic intolerance (of various causes) and asymptomatic control subjects; be highly reproducible, enabling evaluation of therapeutic interventions; avoid invasive procedures, which are known to impair OT(1). In the late 1980s head-upright tilt testing was first utilized for diagnosing syncope(2). Since then it has been used to assess OT in patients with syncope of unknown cause, as well as in healthy subjects to study postural cardiovascular reflexes(2-6). Tilting protocols comprise three categories: passive tilt; passive tilt accompanied by pharmacological provocation; and passive tilt with combined lower body negative pressure (LBNP). However, the effects of tilt testing (and other orthostatic stress testing modalities) are often poorly reproducible, with low sensitivity and specificity to diagnose orthostatic intolerance(7). Typically, a passive tilt includes 20-60 min of orthostatic stress continued until the onset of presyncope in patients(2-6). However, the main drawback of this procedure is its inability to invoke presyncope in all individuals undergoing the test, and corresponding low sensitivity(8,9). Thus, different methods were explored to increase the orthostatic stress and improve sensitivity. Pharmacological provocation has been used to increase the orthostatic challenge, for example using isoprenaline(4,7,10,11) or sublingual nitrate(12,13). However, the main drawback of these approaches are increases in sensitivity at the cost of unacceptable decreases in specificity(10,14), with a high positive response rate immediately after administration(15). Furthermore, invasive procedures associated with some pharmacological provocations greatly increase the false positive rate(1). Another approach is to combine passive tilt testing with LBNP, providing a stronger orthostatic stress without invasive procedures or drug side-effects, using the technique pioneered by Professor Roger Hainsworth in the 1990s(16-18). This approach provokes presyncope in almost all subjects (allowing for symptom recognition in patients with syncope), while discriminating between patients with syncope and healthy controls, with a specificity of 92%, sensitivity of 85%, and repeatability of 1.1±0.6 min(16,17). This allows not only diagnosis and pathophysiological assessment(19-22), but also the evaluation of treatments for orthostatic intolerance due to its high repeatability(23-30). For these reasons, we argue this should be the "gold standard" for orthostatic stress testing, and accordingly this will be the method described in this paper.

Leg skin temperature with body-weight-supported treadmill and tilt-table standing training after spinal cord injury.

STUDY DESIGN: Randomized crossover. OBJECTIVES: Effects of body-weight-supported treadmill (BWST) and tilt-table standing (TTS) training on skin temperature and blood flow after spinal cord injury (SCI). SETTING: McMaster University, Canada. METHODS: Seven individuals with SCI participated in BWST and TTS training (3 times per week for 4 weeks, 4-week detraining between protocols). Skin temperature was measured before and after a single session of BWST or TTS, pre- and post-training. Leg blood flow was measured at rest pre- and post-training. RESULTS: Resting skin temperature decreased at four sites after 4 weeks of BWST training in comparison with the pre-training. Four weeks of TTS training resulted in resting skin temperature decreases post-training at the right thigh only. Both BWST and TTS training resulted in altered reactivity of skin temperature at all sites except the right calf in response to a single session of BWST and TTS. Post-BWST training, a single session of BWST stimulated increased temperature at all sites, whereas after TTS training a single session of TTS resulted in temperature decreases at two of the six sites. No changes were observed in resting blood flow with either BWST or TTS training. CONCLUSION: Increased resting skin temperature and decreased skin temperature reactivity have been linked to the development of pressure sores. BWST and TTS may stimulate different skin temperature responses and the impact on pressure sore development warrants further investigation.

Sex differences in vasoconstrictor reserve during 70 deg head-up tilt.

Women are generally recognized to be less orthostatically tolerant than men. We hypothesized that during head-up tilt (HUT), women would demonstrate less splanchnic vasoconstriction, leading to splanchnic pooling, lower blood pressure and lower orthostatic tolerance. Mean arterial blood pressure (MAP), heart rate (HR), cardiac output ((.)Q(c), assessed by C2H2 rebreathing), stroke volume, splanchnic blood flow (SpBF, assessed by Indocyanine Green clearance) and vascular conductance (systemic, SVC = (.)Qc/MAP; splanchnic, SpVC = SpBF/MAP; non-splanchnic, non-SpVC = SVC - SpVC) were measured during supine baseline conditions, 70 deg HUT and recovery in 14 healthy women (23 +/- 6 years old; mean +/- S.D.) and 16 men (23 +/- 5 years old). The proportion of sexes surviving 45 min of HUT trended towards significance (chi(2) = 2.92, P = 0.09). The MAP was lower in women than in men (supine, 77 +/- 5 versus 86 +/- 9 mmHg, P < 0.01; tilt, 72 +/- 8 versus 83 +/- 10 mmHg, P < 0.01), while HR and cardiac index ( /body surface area) were not different between the sexes (heart rate supine, 66 +/- 6 versus 64 +/- 8 beats min(-1); heart rate tilt, 96 +/- 13 versus 94 +/- 10 beats min(-1); cardiac index supine, 3.8 +/- 0.9 versus 3.7 +/- 0.7 l min(-1) m(2); cardiac index tilt, 2.7 +/- 0.8 versus 2.3 +/- 0.5 l min(-1) m(2)). The SpBF and SpVC were lower in women at rest but not during tilt (SpBF supine, 1174 +/- 243 versus 1670 +/- 391 ml min(-1), P < 0.01; SpVC supine, 14.83 +/- 3.61 versus 19.59 +/- 4.95 ml min(-1) mmHg(1), P < 0.01; SpBF tilt, 884 +/- 300 versus 1094 +/- 271 ml min(-1); SpVC tilt, 13.14 +/- 4.28 versus 14.82 +/- 4.16 ml min(-1) mmHg(-1)). However, in the women the SpVC did not decrease from baseline to tilt (SpVC, in women, 1.70 +/- 3.19 ml min(-1) mmHg(-1), n.s.; in men, 4.81 +/- 3.44 ml min(-1) mmHg(-1), P < 0.01), suggesting a blunted vasoconstrictor response. In conclusion, women tended to have lower tilt-table tolerance associated with a smaller splanchnic vasoconstrictor reserve than men.

Development and evaluation of new blood pressure and heart rate signal analysis techniques to assess orthostatic hypotension and its subtypes.

Orthostatic hypotension (OH) is a clinical condition, which frequently results in symptoms such as syncope, dizziness during standing, weakness, blurred vision and fatigue. It is defined as a sustained drop in blood pressure exceeding 20 mmHg systolic or 10 mmHg diastolic occurring within 3 min of assuming upright posture, and is a common causal factor for falls in the elderly. Since 1986, tilt-table testing has become widely used in the diagnosis of OH. The Finometer provides non-invasive monitoring of haemodynamic changes during tilt-table testing. In this study, new algorithms for parameter extraction from Finometer data were developed, with specific reference to the diagnosis of OH. Algorithms were developed to assess the rates of change of haemodynamic variables in response to head-up tilt testing, a previously unexamined aspect of tilt-table testing. These algorithms were applied to the Finometer measurements of 20 patients, who underwent tilt-table testing in the Mid-Western Regional Hospital, Limerick. The data extraction algorithms were shown to accurately record changes in haemodynamic variables for further analysis. It was also demonstrated that the rate of change of blood pressure during the head-up tilt-table testing could have prognostic significance for OH.

Development of a biofeedback tilt-table for investigating orthostatic syncope in patients with spinal cord injury.

The purpose of this study was to develop a biofeedback tilt-table for automatic tilt-table training, helping patients with spinal cord injury (SCI) to recover more rapidly from orthostatic hypotension, and increasing safety to avoid syncope during training. This biofeedback tilt-table implemented automatic training maneuvers and included three closed feedback loops to monitor the acquisition of physiological signals from patients and the feedback of presyncope symptoms (PS) to regulate the angle of tilt. The results of clinical testing revealed that the mean blood pressure and oxygen saturation represented the most useful physiological signals for determining PS feedback and the quantitative criteria adopted were practicable and useful in describing the level of PS. This novel biofeedback tilt-table system offered higher patient throughput, faster training and safety in training of SCI patients to overcome their orthostatic hypotension than traditional tilt-table training, and could provide quantitative information of PS to assist medical staff in studying the mechanism of orthostatic syncope.

Assessment of orthostatic fluid shifts with strain gauge plethysmography.

We evaluated the use of strain gauge plethysmography (SGP) for the assessment of orthostatic fluid shifts during head up tilt (HUT). Subjects wore a parachute harness fixed to the tilt table to avoid muscle tension in the lower limbs during HUT. 22 Healthy subjects (9 women) were tilted for 5 minutes. Calf volume changes as measured by SGP, surface EMG, heart rate and blood pressure were measured continuously. Ten subjects underwent a second tilt test during which circulation in one leg was occluded with a pressure cuff at 250 mmHg. During HUT with occlusion, calf volume increased in the non-occluded leg by 1.9+/-0.3% (mean +/- SEM) and 0.2+/-0.2% in the occluded leg (p<0.001). During HUT without occlusion a significant correlation (r = 0.9) was found between measurements of the left and right leg with a mean difference of 0.03+/-0.1%. HUT did not cause significant changes of surface EMG. An unexpected gender effect was found: calf volume increased significantly more in men than in women. Men were significantly taller, but the hemodynamic response to HUT did not differ between both sexes. The gender effect on orthostatic increases of calf volume remained significant after adjustment for heart-to-calf distance. SGP during HUT with a parachute harness is a new, promising method to assess orthostatic fluid shifts. The gender differences in orthostatic pooling in the calf may be explained by a higher calf compliance in men together with a greater hydrostatic pressure due to a greater height in men.

[Tilt-table-testing in childhood: non-invasive, continuous hemodynamic monitoring]. / Nichtinvasives, kontinuierliches Kreislaufmonitoring bei der Kipptischuntersuchung im Kindesalter.

BACKGROUND: Approximately 15% of children experience a syncope before the age of 18 years. Tilt table testing represents the diagnostic gold standard whenever a neurocardiogenic spell is suspected. Two methods of continuous, non-invasive hemodynamic monitoring during the tilt table test are presented and their usefulness for clinical routine is discussed. PATIENTS: 4 patients with suspected neurocardiogenic syncope. METHODS: Tilt table testing according to standard protocol; non-invasive, continuous blood-pressure measurement by finger cuffs; impedance cardiography for the assessment of cardiac output. RESULTS: In 3 patients a syncope occured during the tilt table test. In pt. 4 characteristic symptoms led to diagnosis prior to syncope. Every patient represents a definite type of neurocardiogenic syncope (cardioinhibitory with asystolia, vasodepressory, mixed as well as postural tachycardia syndrome). CONCLUSIONS: Both monitoringmethods allow a differentiated analysis of the cardiovascular interactions during the tilt table test. Thus, specific regulatory patterns may be diagnosed and specific treatment strategies may be offered.

Short-term heart rate variability response to head-up tilt in young syncope patients and controls with respect to age.

This study aims at characterizing the short-term time-courses of time- and frequency-domain heart rate variability (HRV) parameters during head-up tilt test (HUTT). Data from 44 young patients with a history of syncope and 34 age-matched controls was analysed in two age-groups related to puberty (< or =13 and > or =14 years), and separately for gender, by extracting minute-by-minute progression of mean RR-interval, standard deviation of RR-intervals (SDNN) and their first difference (SDSD) as well as low-frequency (LF, 0.05-0.15 Hz) energy, high-frequency (HF, 0.15-0.4 Hz) energy and the LF/HF-ratio. Time-courses were individually normalized and averaged after synchronization to the events of tilt and tilt-back/syncope. We observed remarkable age-related differences not only with respect to response to tilting but also regarding the differentiation of patients with positive HUTT from controls with negative HUTT. ROC-analysis in three regions of interest (0-2 min after tilt, 2-5 min after tilt, 5-2 min before tilt-back) revealed generally much weaker and less persistent differences in younger subjects whereas in elders the differences were clearer and often most pronounced immediately before syncope. For both age-groups, the relative change of mean RR provided best separation, however in elders in the ROI just before syncope (sensitivity: 74%, specificity 80%) in young immediately after tilt (sens.: 71%, spec.: 74%). In elder subjects, the relative reduction of SDNN 2-5 minute after tilt achieved almost the same performance (sens.: 74%, spec. 80%) as in the ROI before syncope (sens. 78%, spec. 73%), indicating the existence of rather early precursors of syncope that might help to predict the outcome of the HUTT in subjects in or after puberty.

Tilt table testing in childhood: improved sensitivity by non-invasive haemodynamic monitoring devices?

OBJECTIVE: Tilt table testing represents a valuable diagnostic method in suspected neurally mediated syncope. As sympathovagal imbalance and impaired baroreceptor sensitivity (BRS) have been observed in these patients, both methods were used in this study to investigate whether a combination of these parameters would improve sensitivity and whether specific patterns of neurally mediated syncopes would correspond to characteristic trends in heart rate variability (HRV) and BRS. METHODS AND RESULTS: Fifty-one pts. (29 female, mean age 14.5 +/- 3.9 y) with unexplained syncope and 15 control subjects (9 female, mean age 14.8 +/- 3.0 y) were tested following a standard tilt table test protocol. Power spectral analysis (PSA) of HRV and BRS calculation were used additionally to beat-to-beat blood pressure and ECG-monitoring. Twenty-three out of 51 pts. (45%) experienced a syncope after 18 +/- 10.2 min of tilting. In 2/23 patients (8.6%) a postural tachycardia syndrome (POTS), in 14/23 (60.8%) a neurally mediated syncope of mixed type, in 2/23 (8.6%) a vasodepressor syncope and in 5/23 (21.7%) a cardioinhibitory syncope with asystole were observed. PSA of HRV and BRS revealed a specificity, sensitivity, and positive and negative predictive values of the cut-off points in combination (LF/HF > or = 2.7 and BRS > or = 8) of 93.3%, 65.2%, 93% and 39%, respectively. CONCLUSION: In this study population, BRS and PSA of HRV were able to improve sensitivity of tilt testing after unexplained syncope. Specific BRS or HRV patterns in different mechanisms of neurally mediated syncope could not be identified possibly due to the small sample size.

[Vasovagal syncope--diagnostic difficulties in adolescents]. / Omdlenia wazowagalne--trudnosci diagnostyczne u mlodziezy.

Consciousness disturbances in adolescents may be caused by different reasons. Among them, cardiologic and neurological backgrounds should be considered. The most important diagnostic tests the vasovagal syncopes are: tilt-table test, brain oxygenation measurement, routine and extended elektroencephalography. Performing of these examinations simultaneously may help in determining cause of symptoms. Our patient serves us as an example.

Standing with assistance of a tilt table in intensive care: a survey of Australian physiotherapy practice.

Although tilt tables are used by physiotherapists to reintroduce patients to the vertical position, no quantitative evidence is available regarding their use within intensive care units (ICUs) of Australian hospitals. The purpose of this study was to evaluate the use of tilt tables in physiotherapy management of patients in ICUs across Australia. Ninety-nine physiotherapists working in Australian public ICUs were contacted via mail and asked to complete a questionnaire regarding their use of tilt tables in practice. Reasons for the use of the tilt table, contraindications, commonly used adjuncts, monitoring, and outcome measures were also investigated. Eighty-six questionnaires were returned (87% response). The tilt table was used by 58 physiotherapists (67.4%). The most common reasons for inclusion of tilt table treatment were to: facilitate weight bearing (94.8% of those who tilt); prevent muscle contractures (86%); improve lower limb strength (81%); and increase arousal (70%). The tilt table was most frequently applied to patients with neurological conditions (63.8%) and during long-term ICU stay (43.1%). Techniques often combined with tilt table treatment included upper limb exercises (93.1%) and breathing exercises (86.2%). Standing with assistance of the tilt table is used by the majority of physiotherapists working in Australian ICUs. A moderate level of agreement is demonstrated by physiotherapists regarding indications to commence tilt table treatment and adjunct modalities combined with standing with assistance of the tilt table.