TILT TABLE

Lincoln Thio

MOT 1st Year

SVNIRTAR

INTRODUCTION

A padded table with a top capable of being rotated on its transverse axis so that a patient lying on it can be brought into the erect position.

Initially used as a diagnostic tools ‘Tilt Table Test’ for assessment of syncope.

However with repeated use, improvement in upright tolerance was observed. So serial tilt training has came to used as a therapy for the treatment of syncope.

CONTD…

Serves as an integral part of therapy for

physiological accommodation to an

upright position

It also provides an opportunity for early

weight bearing in lower limbs.

IMI No. 1330

PARTS

The padded table top is 24’’ wide , 80’’

long, 34” high and is fitted on heavy

duty 47’’ square steel tube legs.

Mounted on 4 lockable 4’’ diameter

wheels for mobility.

Two wide straps to hold the patient.

(108”)

Crank with handle

180 degree Protractor

CONT..

Footrest ( 17/14’’)

Removable grip bar/Hand rill

(34/28’’)

Adjustable grab bar holder

Side bar with 6 holes

TYPES

Manual Tilt Table

Electric Tilt Table

Pediatric Tilt Table

W/H accessible Hi-lo Tilt

Table

MANUAL TILT TABLE

ELECTRIC TILT TABLE

PEDIATRIC TILT TABLE

WHEEL CHAIR ACCESSIBLE HI- LO TILT TABLE

COMMON SETTINGS

Home

Early intervention centers

Hospitals

Therapy centers

rehabilitation centers

extended centers

PROCEDURE

Before transferring to Tilt Table,

measure the baseline resting BP

and Pulse rate.

Transfer the patient to the Tilt Table.

The patient lies supine on top of

the table with foot flat on the foot

board.

PROCEDURE

Therapist secures the safety straps

over the knee, pelvic and chest.

Secure abdominal binder and

antiembolism stocking/elastic

stocking.

Then gradually elevate the Tilt table to

upright position.

RAISING AND LOWERING THE PATIENT

Slowly elevate to 20*

Take BP/HR

Elevate the pt. To 45*- repeat vitals.

Elevate the pt. To 85*-repeat vitals

Check the BP & HR of the Pt. every 3-5 minutes

Gradually to return to horizontal position and

check vitals signs

Transfer the Pt back.

SPECIAL CONSIDERATION

Let the Pt. determined the tilt angle and

duration of elevation

Avoid prolong upright position because it may

lead to venous stasis

Never leave Pt. unattended because marked

physiological changes such as hypotension

/severe headache etc may occur suddenly

Chest strap should be secured properly and

make sure that it is not too tight so that patient

could breathe comfortably.

CONTD…

Be alert for signs and symptoms of insufficient cerebral circulation like- dizziness, nausea, pallor, diaphoresis, tachycardia, sensation of fainting and edema in L/E .

If the above signs develop, immediately return to the horizontal position.

While transfer from W/C to tilt table and vice versa therapist must take care of his/her proper posture.

If person is elevated beyond 70*, chest strap should be applied.

DURATION FOR TRAINING

Perform once/twice a day regime for up to

10-30 min each session.

One level below where the fainting starts.

Up to 4 weeks, then try a higher level

PHYSIOLOGICAL EFFECTS

Increased circulation in upright position.

Increased urinary drainage

Musculoskeletal: muscle tone increases in antigravity muscle, Increased bones density.

Neurologic: Sensory receptors of the soles of the feet, Joint proprioceptors, muscle spindles, semicircular canals get stimulated.

Respiratory: increased ventilation, gravity drains bronchioles.

Tilt at 60 degree onwards can gives Pt. the physiological effect and sensation of upright standing.

INDICATIONS

Prolonged recumbence.

Generalized weakness

Disturbance in balance , proprioception,

kinesthesia, lower limb circulation

Orthostatic hypotension/ postural hypotension

drop of 10-20mmhg in response to upright

position

CONT…

HEAD INJURY

SCI

CP

SPINA BIFIDA

MUSCULAR DYSTROPHY

STROKE

POST POLIO SYNDROME

THERAPEUTIC BENEFITS

Reintroduce patient to vertical position.

Facilitate early weight bearing

Promote and maintain bone density in L/E

Prevent muscle contracture.

Improve lower limb strength .

Increase arousal.

Cardiovascular conditioning.

Allow to become acclimated to an upright position without rapid changes in BP.

Decrease spasticity

CONT…

Prevention of osteoporosis, hypercalciurea,

pathological fracture.

Postural improvement

Enhance bowel and bladder function

Provide early weight bearing experiences for

patients too weak to stand on their own.

Decreases prolonged bed rest complications.

Improve psychological outlook and also

motivates

Pt. to participate in ambulation program.

CONTRAINDICATIONS

Bone tumors

Fresh fracture

Fresh implant

Neoplastic disease of spine

Pregnancy

Acute inflammatory condition in pelvis or L/L

Patient refusal

Acute spinal or pelvic fractures

Acute cardiac infarctions.

ADAPTATION

Wooden box can be placed under weight

bearing leg if one of the Pt. leg is non weight

bearing

Adjustable and removable table/lapboard can

be attached to Tilt Table for writing, reading,

food, communication devises etc

Adjustable footboard

DIFFERENCE FROM STANDING FRAME

Same goal with same benefits in a more

functional position

Standing Frame is more challenging and

allows more active participation from the

individuals using it

Standing Frame an be used as a progressing

from Tilt Table

DISADVANTAGE

Passive

Cumbersome

Fainting

Edema of L/L

Time consuming

REFERENCES

Abe, H., K. Kohshi, et al. (2003). "Effects of orthostatic self-training on head-up tilt testing and balance in paraplegic patients . J CardiovascPharmacol 41 Suppl 1: S73-6

Standing with assisstance of a tilt table in ICU A survey of Australian Physiotherapy Practise2004 50(1)

Tolerance of a Standing Tilt Table Protocol by Patients an Inpatient Stroke Unit Setting: A Pilot Study

Equipment Designed for Occupational Therapy. Florence M. Stattel, MA, OTR

Tilt table protocol by Mary Egbert.

CONT…

Tilt Training: A new challenge in treating of

neurally mediated syncope- Tony Reybrouk,

Hugo Ector

Benefits of prolonged standing for SCI by

janice j eng stephen m levins

Early mobilization emphasizes upright

positioning and weight bearing By Darin

Trees, DPT, PT, CWS