Epidural stimulation with locomotor training ameliorates unstable blood pressure after tetraplegia. A case report

Figure 1. (A) Radiographic scan of the SCES paddle placed at the T9‐T10 interspace and extended to the mid T11 vertebral body. (B) Schematic and settings of the SCES program used for stepping during BWSTT. Cathodes (red); anodes (gray); inactive (white). (C) Schematic and settings of the SCES program used for activation of core muscles after developing symptoms of orthostatic intolerance. Cathodes (red); anodes (gray); inactive (white). [Colour figure can be viewed at wileyonlinelibrary.com]

Figure 2. Average seated resting systolic, diastolic, and mean arterial BP over the course of 14 weeks and the 2 weeks of follow‐up visits. During the follow‐up visits, the effects on BP were attenuated but remained in a safe range.

Figure 3. (A) Average time (minutes) of walking during BWSTT sessions over weeks 1–4 (2 visits per week), weeks 5–9 (2 visits per week), weeks 10–14 (once weekly), and during the two weekly follow‐ups (once weekly) at 4 weeks after cessation to determine carry over effects. (B) Average number of walking bouts during BWSTT sessions over weeks 1–4, 5–9, 10–14, and during the 2 weeks of follow‐up after cessation of training for 4 weeks. The total number of bouts per session was determined based on the ability to withstand orthostatic standing challenges. There was a threefold increase in the average number of bouts per session and a 33% increase in the duration of the session in weeks 10–14 compared to weeks 1–4. (C) Average minutes per bout over the course of training. The minutes per bout decreased by 69% over the course of 14 weeks and was maintained during the 2‐week follow‐up visits. This reflected the decrease in percentage of BWS as indicated in 3D. (D) The percentage of BWS provided by the suspension that ensured erect posture without buckling of the knees. The percentage of BWS decreased from 83% to 69% over the course of the initial 14 weeks. The percentage of BWS was maintained at…

Figure 4. Relationships between percentage of BWS and (A) total duration; (B) minutes per bout; and (C) SCES amplitude, this negative relationship reflects the increasing energy required to maintain the corresponding decrease in percentage of BWS during training. The increase in SCES amplitude appeared to be related to the decrease in Systolic BP and mean arterial BP; (D) resting systolic BP; and (E) resting mean arterial BP. Each point represents the average of multiple visits during the course of the trial. [Colour figure can be viewed at wileyonlinelibrary.com]