体位改变短期心血管反应涉及自主神经系统，调节血压和脑血流自动调节之间复杂的相互作用，维持脑灌注（Olufsen et al，2005）。
常用的神经动力学试验在下腹诊断直腿抬高（SLR）和坍落度试验（- 1985）。有由梅特兰形容坍落度试验的许多变化（1985）。它是一个更功能相关的测试，很容易转换成积极和有意义的活动（管家2000，290）。该测试要求受试者在一个下跌的位置胸腰椎和颈椎屈曲，这增加了机械应力对神经系统受损的膝和踝关节背屈伸（- 1984）。神经组织在整个测试过程中逐渐增加。疼痛，运动和肌肉反应的适用范围，而非神经组织如皮肤、血管监测、筋膜和结缔组织也可以玩下张力（伽铎斯克RL等人1985和Barker PJ等人，1999）。同样在颈椎屈曲成分的变化将导致颈静脉受压，导致腹腔内压力增加，中心静脉压和脑脊液压力增加（J. Dinsmore等，1998）。并发症而进行颈椎屈曲是有力的呼气时通过声门紧闭，在intrathorasic压力阻碍静脉回流，从而增加。这将导致心输出量和动脉血压下降。当颈椎前屈释放突然调血压和心率增加（EP沙比1955）。Education Essay 代写: Blood Pressure Variability In Slump Test Physical
Education Essay 代写: Blood Pressure Variability In Slump Test Physical
通过研究（J Dinsmore等，1998）看到脑脊液脊柱前屈度增加的影响（CSF）和中心静脉压（CVP）在3个位置进行测量，充分弯曲（下巴上胸部）弯曲90度直。结果发现有脑脊液增加充分弯曲，弯曲的位置（P <；0.0001）和CVP小升。发现颅内压和脑脊液压力的影响，其他因素是颈静脉压迫，神经肌肉阻滞程度，和气道压力和麻醉剂PaCO2的变化。静脉系统在ICP的贡献和代表最终流出压力起着一个重要的因素
Education Essay 代写: Blood Pressure Variability In Slump Test Physical
Short term cardiovascular responses to postural changes involve complex interactions between the autonomic nervous system which regulate blood pressure and cerebral autoregulation, which maintains cerebral perfusion (Olufsen et al, 2005).
The commonly used neurodynamic test to diagnose in the lower quadrant are Straight Leg Raise (SLR) and Slump test (Maitland 1985). There are many variations in slump test describe by Maitland (1985). It is a more functionally relevant test which is easy to convert into active and meaningful activity (Butler 2000, 290). The test requires the subjects to be in a ‘slumped’ position of thoracolumbar and cervical flexion, which increases the mechanical stress on impaired nervous system as knee is extended and ankle is dorsiflexed (Maitland 1984). The neural tissue is progressively increased throughout the test. Pain, available range of movement and muscle response are monitored while non-neural structure such as skin, blood vessels, fascia and connective tissue may also play under tension (Gajdosik RL et al 1985 and Barker PJ et al, 1999). Similarly changes in cervical flexion component will lead to jugular venous compression, leading to increase in intra abdominal pressure thereby increase in central venous pressure and cerebrospinal fluid pressure (J. Dinsmore et al, 1998). Complication while performing cervical flexion is when forcefull expiration through closed glottis, thereby increase in intrathorasic pressure impeding venous return. This will result in decreased cardiac output and arterial blood pressure. When cervical flexion is released there is sudden overshoot in blood pressure and increase in heart rate (EP sharpey 1955).
The ANS plays a fundamental role in the control of BP and heart rate, therefore it is an important physiological factor in the development of arterial hypertension (Malik M, 1996). Heart rate variability is the variation in the duration between intervals of two R waves on an electrocardiogram, where in stimulation or inhibition of sympathetic and parasympathetic activity in heart, modulate heart rate response. Arterial blood pressure is a function of vascular resistance and cardiac output, two variables that are controlled by the ANS (Renzaperini et al 2004).
Despite its widespread use, little research has been done in relation to blood pressure response in slump test. The aim of this study: 1. to determine any changes in blood pressure variability before and after applying slump test in asymptomatic subjects. 2. To compare the blood pressure changes between these positions.
REVIEW OF LITERATURE
According to the Guyton (1992) the ability of baroreceptors to maintain constant arterial pressure is extremely important when a person sits or stands from a lying position. Immediately the arterial pressure in the upper portion of the body obviously tends to fall, and mark reduction of this pressure can cause loss of consciousness. Fortunately, however, the falling pressure of the baroreceptor elicits an immediate reflex resulting in strong sympathetic discharge throughout the body and this minimize the sudden drop of blood pressure in the upper portion of body.
According to Ganong the cerebral circulation is regulated in such a way that total blood flow remains relatively constant in spite of local fluctuation in brain blood flow with neural activity. The factors involved in regulating the flow, is when the cerebral vessels are compressed whenever the intracranial pressure rises. Any change in intracranial pressure cause a similar change in venous pressure. Thus a rise in venous pressure decreases cerebral blood flow both by decreasing the effective perfusion pressure and by compressing the cerebral vessels. This relationship helps to compensate for changes in arterial blood pressure at the level of the head. When ICP is elevated to more than 33 mmHg over a short period, the cerebral blood flow is significantly reduced. The resultant ischaemia stimulates the vasomotor area and systemic blood pressure rises (Cushing reflex). Stimulation of vagal produces bradycardia and respiration is slowed. Over a period of time a point is reached where the intracranial pressure exceeds the arterial pressure and cerebral circulation ceases.
A study done by (J Dinsmore et al, 1998) to see the effect on increasing degrees of spinal flexion on cerebrospinal fluid (CSF) and central venous pressure (CVP) were measured in 3 positions, fully flexed (chin on chest) flexed at 90 degree and straight. The results found out that there was significantly increase in CSF from fully flexed to flexed position (P <0.0001) and small rise in CVP. The other factors that have seen effect on intracranial pressure and cerebrospinal fluid pressure are jugular venous compression, the degree of neuromuscular blockade, changes in PaCo2 and airway pressure and anaesthetic drugs. The venous system plays a single important factor in the contribution of ICP and represents final outflow pressure for both cerebrovascular system and CSF (Ravassin P et al, 1995). Further the author hypothetized that compression of jugular vein was immediate on ICP and will remain as the compression lasts. They found that there was a statistical significant rise in CVP from moving flexed to fully flexed position. They thought that due to changes in posture there was an increase in the intraabdominal pressure resulting in jugular venous compression and increase in CSF pressure and CVP.
A study done by (Yoshida et al, 1993) found the difference between the effects of head down (chin to chest) with neck extension. The head down position increased ICP and decreased cerebral perfusion pressure.
According to (Kevin D et al, 2001) head down rotation, which activates the vestibulo sympathetic reflex, increases leg muscle sympathetic nerve activity and produces calf vasoconstriction. Forearm and calf muscle sympathetic nerve activity and blood flow response were determined during head down rotation. Fifteen healthy volunteers were studied with mean age 25 +/- 2 years, height 168 +/- 2 cm and body mass 70 +/- 2 kg respectively. Subjects were placed prone on a table with neck extended and chin supported (Shortt and Ray,1997). Measurements were taken with right arm used for forearm blood flow and right knee for measurement of calf blood flow (Essandoh et al, 1988), arterial blood pressure and heart rate were measured in all subjects. The protocol consists of 2 minute base period with chin in upright position followed by head down rotation for 3 minutes. To allow head down rotation, chin supported was removed and head was passively rotated until maximal rotation of neck was achieved. Data was analyzed using repeated measure ANOVA. Results obtained from baseline and head down rotation for heart rate were (64 +/-2 versus 63 +/-2 beats per minute) and arterial blood pressure were (103 +/- 4 versus 104 +/- 4 mmHg). A significant small changes were noted. Calf and forearm blood flow were (2.8 +/- 0.3 and 2.7 +/- 0.4 mL/100 mL).
Study done by ( Maraec et al , 2004 ) suggests that valsalva manoeuvre (VM) causes and overload in the cardiovascular system , activating arterial baroreceptors , chemoreceptor and cardio pulmonary receptors . This changes interactions between sensory receptors and central nervous system, triggering autonomic responses that modulates the heart rate response. The author states that with the movement of kyphotic thoracic spine with flexion of lumbar spine and extension of upper cervical spine, may possibly put the tension on the sympathetic trunk. Since the autonomic fibres of the peripheral nervous and neuroaxis must adapt similarly to neighbouring sensory and motor fibres. Dificiencies in Autonomous nervous system and excitatory symptoms may produce mechanical stimulation or chemical irritation such as stretching and compression.
(I vol Kerppers et al, 2008) determine heart rate variability in cerebral palsy (CP), patient submitted to slump test. 18 individuals with mild / moderate spastic CP, according to modified asworth scale had good cognitive skills. Slump test was carried out for 1 minute for 3 times with 3 minute rest intervals. Data was collected using nerve express system (Terenchchenko L et al, 2003) and compare for same as well as between different individuals. Data was analysed using paired t tests. Results of the study reveals that there was an improvement in chronotropic myocardial activities, functioning of physiological system and adaptation reserve.
RESEARCH PROPOSAL QUESTION
Effect of blood pressure responses due to slump test in asymptomatic individuals.
There will be changes in blood pressure due to slump test in asymptomatic individuals.
There will be no changes in blood pressure due to slump test in asymptomatic individuals.
Quasi- experimental study.
The study will be purposive. This is a one way experimental group wherein pre and post outcomes will be measured and the individuals will be randomized.
The individuals will be recruited by convenience sample with voluntary participation. Sample of 80 – 90 asymptomatic subjects will be taken between the age group of 18 -30 years. Posters will be posted in all the departments of hospitals.
This will include:
M.S Ramaiah memorial hospital
M.S Ramaiah teaching hospital
The participants will be required to do a straight leg raise of 70 degrees.
In sitting knee extension of 0 degree and ankle dorsiflexion will be included.
Any history of back or leg problems.
Any acute back pain or leg pain.
Any physical limitations while performing slump test.
Any neurological symptoms, lower limb muscular or joint injury will be excluded.
Before conducting a study, a certificate of Ethical clearance certificate will be obtained from the ethical committee board of M. S. Ramaiah Hospital. All the subjects will be given a written informed consent. The information pack will include all the details of the study.
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Venue/location of the study:
The study will be conducted in the department of physiotherapy M. S. Ramaiah Memorial Hospital.
Demographic data will be collected from each subject and a neurological examination will be conducted prior to the study. Individuals will be randomized to one group.
All subjects satisfying the inclusion criteria will be made to achieve relaxed sitting position will be made to sit on a plinth with feet above the floor (hips and knees 90 degree flexion) for 3 minutes. Prior to the test baseline systolic blood pressure and diastolic blood pressure will be measured and recorded.
Convenience of the individuals lower limb will be used for testing. Verbal instructions will be given to each individual about the procedure. The slump test will be applied which has a good inter therapist reliability (Phillip et al, 1989).
Step 1: Each individual will be asked to sit on a plinth with back straight and knees close together. The legs should be above the grass level. The individuals should place his hand behind his back. The researcher will stand next to the individual for which the lower limb is tested.
Step 2: The patient will be instructed to let his back slump with full thoracic and lumbar flexion of spine. At the end range of subject’s flexion, the researcher will passively flex furthermore. The researcher will be holding the subject’s chin in neutral position.
Step 3: While the researcher maintaining this overpressure of spine, the subject will be instructed to fully flex his head taking chin to touch his chest.
Step 4: The researcher will dorsiflex the ankle.
Step 5: The subject will be instruct to straighten his knee until available range. At the end range, the researcher will passively straighten his knee.
This position will be maintained for 30 seconds, at the end of it systolic blood pressure and diastolic blood pressure will be measured and recorded.
Baseline measurements: Systolic blood pressure and Diastolic blood pressure will be measured during relaxed sitting position.
Post test measurement after 30 seconds: Immediately after the ‘slumped’ position is released, the systolic blood pressure and diastolic blood pressure will be measured. These measurements will be recorded in tabular column were mean and standard deviation will be used to asses the blood pressure parameter.
Statistical analysis will be done using Statistical Package for Social Science (SPSS) version 14.0. Repeated measures ANOVA will be used for comparison of measured variables.
Measured variables will be compared in sitting relaxed position and administration of slump test after 30 seconds.