These are primarily used in the acute phase of rehabilitation following trauma [eg Spinal Cord Injury or Traumatic Brain Injury], in ICU’s, functional rehabilitation of handicapped or disabled patients and in cardiac assessments. Patients are generally positioned supine on the tilt table while horizontal with their feet supported on a foot plate and straps around the body for security. The surface of the table is then progressively tilted until the patient’s partial body weight is supported by the legs. The angle selected and the period of treatment is adjusted to the patient’s weight bearing capacity. Tilt table therapy helps with early mobilization of patients too weak to stand unaided by improving weight bearing, increasing lower limb strength, reducing muscle spasticity and improving circulation to name just a few.
used to evaluate the cause of unexplained fainting.
Your doctor might recommend a tilt table test if you have repeated, unexplained episodes of lightheadedness, dizziness or fainting. The test can help determine if the cause is related to your heart rate or blood pressure.
Why it's done
Your doctor might recommend a tilt table test to try to trigger your signs and symptoms — lightheadedness, dizziness or fainting — while your heart rate and blood pressure are being monitored.
Your nervous system controls your heart rate and blood pressure. It may suddenly lower your heart rate and blood pressure for a short time when you're moved to an upright position during the tilt table test. As a result, less blood flows to your brain, possibly causing you to faint.
A tilt table test is generally safe, and complications are rare. But, as with any medical procedure, it does carry some risk.
Potential complications include:
- Nausea and vomiting after fainting
- Weakness that can last several hours
- Prolonged low blood pressure after the test
These complications usually go away when the table is returned to a horizontal position.
How you prepare
You might be asked not to eat or drink for two hours or more before a tilt table test. You can take your medications as usual, unless your doctor tells you otherwise.
What you can expect
To prepare you for the test, a member of your health care team will:
- Have you lie flat on a table that has a footboard and place straps around you to hold you in place.
- Place sticky patches (electrodes) on your chest, legs and arms. Wires connect the electrodes to an electrocardiogram machine that monitors your heart rate.
- Place a blood pressure monitor or cuff on your finger, on your arm or on both to check your blood pressure during the test.
- Place an IV line into a vein in your arm for delivering medication, if needed.
During a tilt table test
- You'll start by lying flat on your back on the motorized table for about five minutes.
- You'll be moved to a nearly vertical position, where you'll remain from five to 45 minutes, depending on the reason for the test. While vertical, you'll be asked to remain as still as possible but to report signs and symptoms such as nausea, sweating, lightheadedness or irregular heartbeats.
- If you don't faint or have other symptoms after 45 minutes, you might receive the medication isoproterenol (Isuprel) through an IV line in your arm. The medication might prompt the abnormal nervous system reflex that causes you to faint.
- You then remain in the upright position for another 15 to 20 minutes.
Your heart rate and blood pressure will be monitored in each position to evaluate your body's cardiovascular response to the change in position.
After a tilt table test
If you faint while vertical, the table will be returned to a horizontal position immediately and you'll be monitored. Most people regain consciousness almost immediately.
In some cases, if blood pressure and heart rate changes indicate you are about to faint, the table is returned to a horizontal position so that you don't lose consciousness.
When the test is complete, you can return to your normal activities.
The results of a tilt table test are based on whether you faint during the test and what happens to your blood pressure and heart rate.
The result is positive if your blood pressure decreases and you feel dizziness or faint during the test.
The result is negative if your heart rate increases only slightly, your blood pressure doesn't drop significantly, and you don't have signs or symptoms of fainting.
Depending on the results, your doctor might recommend additional tests to exclude other causes of fainting.
Primary Use of the Tilt Table:
Tilting Tables support a patient from a horizontal plane (flat bed-like position). From the horizontal position, a manual crank or electric motor is then activated to slowly initiate the process of transitioning the table from a horizontal plane toward an increasingly vertical standing position, while the patient is properly secured to the table with safety positioning straps. The tilt table relies upon the use of gravity to do it's work. Gravity is known to benefit and support the functioning of our internal organs and physiological systems. Research has proven that extremity weight bearing will improve bone density and joint development. When standing occurs, even from within a partial vertical plane position, our muscles are elongated and physiological respiration and endurance can be improved upon. Tilt tables are proudly offered by Rehabmart from high quality manufacturers such as Bailey Manufacturing and Hausmann Industries.
What additional features should I consider?
Tilt Tables feature a footplate to support the patient’s weight and offer positioning for the feet while standing in a tilted position. Some Tilt Tables are designed to tilt a few degrees below horizontal, while others go from a 90 degree angle to a completely flat 180 degree horizontal position. Powered table versions with electric motors are available to make the process smoother and less taxing on the caregiver. Most electric motors offer a soft start-up and landing which may be less disturbing for the patient as compared to sudden stopping or bumping. Choose from a wide variety of widths and from a range of durable vinyl upholstery to suit your needs. Metal walk off plates may also feature safety tread. Safety straps should always be used to ensure optimal safety and security for the patient.
How does a Tilt Table function?
A Hi-Low Tilt Table provides an add-on feature of vertically raising and lowering the entire table from the horizontal "bed-like" starting position, which is useful for transfers and for preparing the patient for treatment. With pneumatic hand controls or foot controls, the therapist may adjust both the vertical height and the angle of tilt accordingly during the procedure, facilitating a smooth and efficient treatment session without physical strain to the healthcare professional. The upholstery is designed to be easy to clean and hygienic. Locking casters prevent any migration of the table during a procedure. Electric tables are designed to operate efficiently with quiet motors. Additional features are described on each individual table.
What are other common uses for a Tilt Table?
Your doctor or therapist may recommend a Tilt Table test if he/she suspects that neurocardiogenic syncope is responsible for fainting and needs additional testing to confirm the diagnosis. This test allows doctors to evaluate your body's cardiovascular response to the change in position in space. Not all Tilt Tables are designed for these procedures and those specific tables will be labeled to indicate their intended use. Tilt Tables are often used to acclimate a bed-ridden patient to standing. They are great treatment choices to use for patients who may not be ready to begin standing in a standing frame.
A tilt table test is used to evaluate the cause of unexplained syncope (fainting, loss of consciousness). It is a non-invasive procedure that involves moving you from a lying to a standing position while your symptoms and vital signs are monitored. You might also receive a medication, Isuprel (isoproterenol), that can trigger a response to help in the assessment of your fainting spells.
Purpose of the Test
The main utility of the tilt table study is to help your healthcare provider diagnose the cause of unexplained dizziness, lightheadedness, fainting spells, and falls.1 It does this by replicating your symptoms so your physician can get a better sense of the circumstances under which you have these experiences.
However, a tilt test is not considered a highly reliable test, and it is normally done only when common causes of syncope, such as heart disease and cerebrovascular disease, are ruled out. Often, a tilt table test is only done after your healthcare provider has excluded these serious causes of syncope with tests such as brain magnetic resonance imaging (MRI), brain magnetic resonance angiography (MRA), electrocardiogram (EKG), or echocardiogram.
What the Test Looks For
When you normally stand, your cardiovascular system has to adjust itself in order to prevent too much of your blood from pooling into your legs. These adjustments consist of a mild increase in heart rate and a constriction (narrowing) of the blood vessels in your legs. Normally, these cardiovascular adjustments occur very quickly, and you shouldn't have a significant drop in your blood pressure.
This, however, is not the case if you have orthostatic hypotension or vasovagal syncope—the primary conditions the tilt table test can help identify. Orthostatic hypotension is an excessive drop in blood pressure that occurs when you stand up. Vasovagal syncope is caused by a dramatic fall in blood pressure due to a reflex that causes sudden dilation of the blood vessels in the legs and a slowing of the heart rate. Numerous triggering events can initiate this vasomotor reflex, including physical stress, sudden anxiety, or fatigue.2
Because your body does not adjust to the standing position normally if you have either one of these conditions, you will likely experience loss of consciousness or substantial changes in physical measures when you are moved from a lying down to an upright position during a tilt test. Any major response to the tilt table test is considered suggestive of orthostatic hypotension or a vasovagal episode.
The tilt table test can also be useful in distinguishing epilepsy from syncope, as seizures are not always associated with physical movements, and sometimes syncope is associated with jerking movements.
Many people confuse a tilt table test with a stress test because both monitor heart function under modified conditions. However, a stress test is normally done for evaluation of chest pain, while a tilt table test is done for evaluation of fainting or dizziness.
The main limitation of the test is that it does not provide a diagnosis, but rather information that is used along with your medical history to help your healthcare providers determine that a diagnosis is more likely or less likely. Even for people who have definite vasovagal syncope based on symptoms, the tilt table study reproduces the symptoms only about 70% to 75% of the time.1 In other words, 25% to 30% of people with vasovagal syncope have false-negative studies.
The tilt test, therefore, is not considered a gold standard in the diagnosis of vasovagal syncope; results need to be interpreted along with your medical history and your physician's examination.
Risks and Contraindications
A tilt table test can induce dizziness, nausea, vomiting, or loss of consciousness. It is done under monitored conditions and therefore, these risks, while not uncommon outcomes of the test, can be managed safely.
If you have a serious heart condition or severely low blood pressure, you should not have a tilt table test. Not only will these conditions predispose you to a high chance of fainting, there is little chance that the test could provide your healthcare providers with additional useful information if you already know that you have these conditions.
Before the Test
If you are scheduled for a tilt table test, you should ask your healthcare provider if you need to stop taking any of your usual medications. Your practitioner might ask you to stop taking those that alter your heart rate or blood pressure for a day or so before the test, but, because the evaluation of unexplained syncope is so complex and individualized, there is no hard and fast rule about this.
You should expect that the test and recovery time should take about half a day.3 There will be a check-in and wait time, which can range from half an hour to several hours. The test itself should take about an hour.
After the test, some people may feel dizzy or lightheaded, while others may recover right away. It is almost impossible to predict how long the positional changes or medications will affect you, so it is best to anticipate a two- to three-hour recovery time when the test is done.
You won't receive your results the day of the test and may need to wait several days for them.
Your tilt table test will most likely be done in an outpatient suite, although some healthcare providers have this capability in their offices.
What to Wear
You can wear whatever is comfortable for your test, and you will likely be asked to change into an examination gown.
Food and Drink
You should not eat or drink for three to four hours before your test, mainly because the test can induce nausea.
Cost and Health Insurance
As with many diagnostic tests, you may need insurance pre-authorization. The facility where your test is scheduled should be able to tell you if your health insurance requires this and how long the process should take. You may also need to pay a co-pay, and the facility can provide you with this information as well.
If you are going to pay for the test yourself, you should expect the test to cost several hundred dollars, but you should ask about the total cost, because the price can be highly variable.
What to Bring
You should bring your test order form, your insurance information, a form of identification, and a form of payment. You should also be sure to have someone with you who can drive you home in case you become dizzy during the test.
During the Test
Your own healthcare provider may be performing your test, or it may be performed by another physician. You will also have one or more technicians assisting the practitioner with the test.
Before the test, you will have to check in and sign a consent form, as well as patient privacy forms. Right before your test, you may be asked to change into an examination gown.
You will then lie down on a table and be secured to it so that you can maintain your position when it is moved. You will have a blood pressure cuff placed on your arm, as well as EKG leads placed on your chest. Your pulse and oxygen saturation will be monitored by a pulse oximeter, which is a small clip that is placed on the tip of your finger.
Throughout the Test
Initially, the team will assess your vital signs while you are lying down, and then the table will be mechanically tilted to an upright position. Because you are secured, this requires no effort from you. Your team will monitor your symptoms and physiological signs, such as blood pressure, heart rate, and possibly oxygen levels, while you are in a motionless standing position for 10 to 60 minutes.
In some instances, you may receive a medication such as nitroglycerin or Isuprel (isoproterenol), which speeds the heart rate, making symptoms more noticeable. During this test, you may experience dizziness, lightheadedness, or syncope, but not pain.3
After the test is completed, all monitoring and straps will be removed.
After the test, your team will make sure that you have recovered from any dizziness or nausea and will provide you with instructions regarding eating, drinking, and resting based on your symptoms, clinical signs, and how well you are recovering. You will then be permitted to be driven home.
After the Test
You should expect to recover within a few hours, even if you experience dizziness or loss of consciousness during the test.
Managing Side Effects
If you experience mild dizziness within the first 24 hours after your test, it is fine to lie down.
If you experience persistent symptoms that last longer than one day after the test, you should call your healthcare provider. If you feel more lightheaded than usual, or have vision changes, chest pain, or seizures, these are not expected outcomes of a tilt table test, and you should seek urgent medical attention.
The test itself does not provide a definitive diagnosis of any medical condition. It provides information that your healthcare providers can use along with your medical history. In fact, it is important to know that the results are not based in any clear positive or negatives.
For example, almost everyone has a minor drop in blood pressure and a slight increase in heart rate when moving from sitting to standing, but the rate at which these changes occur, as well as the degree to which they occur and their association with symptoms, are all evaluated together to come to a conclusion.
The healthcare provider who does your tilt table test will probably need some time to evaluate the outcomes of your test to compile a report. If your healthcare provider is not the same person who did your tilt table test, then your practitioner will need to review that report and assess it in combination with your symptoms and medical history to be able to discuss a diagnosis and plan with you. It may take several days for the team to be able to combine all of this information to determine the next steps.
To give you a sense of what certain observations during the test can indicate:
- If you have orthostatic hypotension, your pulse would have increased markedly and your blood pressure would have dropped precipitously during the shift to the upright position.
- If you have vasovagal syncope and are among those who experience symptoms during the test, you would have adjusted normally to an upright tilt, but possibly experienced a sudden and marked change in your vital signs (with a dramatic drop in blood pressure and pulse) within 20 to 30 minutes after the position change. You might have even passed out. Recovery would have been observed within seconds after the table was brought back down.
A primary use of tilt table is to transitionally bring a patient into a progressively upright standing position.
The tilt table relies upon the use of gravity to do its work. Gravity is known to benefit and support the functioning of our internal organs and physiological systems.
Research has proven that extremity weight bearing will improve bone density and joint development. When standing occurs, even from within a partial vertical plane position, our muscles are elongated and physiological respiration and endurance can be improved upon.
Commonly, doctor or therapist may use tilt table as part of tilt table test to diagnose neurocardiogenic syncope. Not all tilt tables are designed for these procedure. Tilt table are often used to acclimate a bed-ridden patient to standing. They are great treatment choices to use for patients who may not be ready to begin standing in a standing frame.
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