Counterpressure Maneuvers for Fainting
Recruiting in Palo Alto (17 mi)
Age: < 65
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Simon Fraser University
Must not be taking: Cardiovascular medications
Disqualifiers: Cardiac arrhythmia, Seizure disorder, Pregnancy, others
No Placebo Group
Trial Summary
What is the purpose of this trial?The investigators are interested in whether discrete counterpressure maneuvers, or muscle movements in the lower body, will boost blood pressure and cardiovascular control in children who faint. We will record cardiovascular responses to maneuvers of exaggerated sway, leg crossing, crouching, and gluteal muscle tensing in children who faint (N=20), as well as their height, weight, muscularity, and pubertal (Tanner) stage. Autonomic cardiovascular control will be measured using a Valsalva manoeuvre (expiration against a closed airway for 20 seconds) and a supine-stand test. The primary outcomes are noninvasive measures of cardiovascular responses to the maneuvers (blood pressure, cerebral blood flow, and stroke volume (volume of blood pumped per heartbeat). Comparisons will be made across levels of sex, diagnosis, Tanner stage, muscularity, height, and degree of autonomic control.
Do I need to stop my current medications to join the trial?
Yes, if you are taking any cardiovascular acting medications or medications for orthostatic syncope, you will be excluded from the study.
What data supports the idea that Counterpressure Maneuvers for Fainting is an effective treatment?
The available research does not provide any direct data supporting the effectiveness of Counterpressure Maneuvers for Fainting. The studies focus on muscle activation in different contexts, such as gluteus maximus activation during chair-rise in stroke patients or muscle activity during sit-to-stand movements. None of these studies directly address the use of Counterpressure Maneuvers for Fainting or compare it to other treatments for fainting.
12345What safety data exists for counterpressure maneuvers for fainting?
The provided research abstracts do not directly address the safety data for counterpressure maneuvers for fainting. They focus on muscle activation and contractility in various contexts, such as gluteal muscle contraction, abdominal muscle strength, and motor strategies for movements like sitting and squatting. None of these studies specifically evaluate the safety of counterpressure maneuvers or related techniques for fainting.
14678Eligibility Criteria
This trial is for English-speaking children aged 6-18 with recurrent fainting due to vasovagal syncope or POTS, having fainted at least twice in the last year. It excludes those not fully vaccinated against COVID-19, with seizure disorders, cardiovascular diseases, pregnancy, disabilities affecting test completion, on certain medications for syncope or heart issues.Inclusion Criteria
I am a child aged 6-18 and speak English.
I have fainted or almost fainted at least twice in the past year.
I have been diagnosed with recurrent fainting or POTS by a pediatric cardiologist.
Exclusion Criteria
I have been diagnosed with fainting spells due to a heart rhythm problem.
I have had fainting spells due to low blood sugar.
I have heart disease and experience frequent fainting.
+8 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
1-2 weeks
Testing Session
Participants attend a single testing session to perform various counterpressure maneuvers and cardiovascular tests.
1 day
1 visit (in-person)
Follow-up
Participants are monitored for any adverse effects or changes in cardiovascular responses post-testing.
2 weeks
Participant Groups
The study tests if counterpressure maneuvers like exaggerated sway and muscle tensing can prevent fainting by improving blood pressure and heart function in kids who faint. Researchers will measure how these movements affect blood flow and heartbeat during a stand test and Valsalva maneuver.
2Treatment groups
Experimental Treatment
Placebo Group
Group I: Counterpressure ManeuversExperimental Treatment2 Interventions
Counterpressure maneuver (CPM) trials will be performed in front of a neutral wall in silence to ensure that visual or auditory stimuli do not affect movement.
CPM:
* Leg crossing and muscle tensing: Legs are crossed while upright and lower body musculature is isometrically contracted (clinical)
* Crouching: Participant crouches down resting weight on the balls of their feet, pressing calves against the back surface of the thighs (clinical)
* Exaggerated anterior-posterior sway: Participant sways back and forth with feet planted on ground at a pace/amplitude that is comfortable (discrete)
* Gluteal clenching: Participant rhythmically tenses and relaxes the gluteal muscles at a pace/duration that is comfortable (discrete)
Participants serve as their own controls and complete both testing arms.
Group II: Baseline StandPlacebo Group2 Interventions
Participants will perform a sit-stand test, followed by 5-minutes of baseline (quiet) standing trial on a force platform while cardiorespiratory responses are recorded.
Sit-stand test: following 5-minutes of supine rest, the participant will be passively moved into the seated position. They will then be asked to actively move into the standing position.
Baseline stand: immediately following the sit-stand test, the baseline trial will begin. Participants will stand quietly on the force platform for 5-minutes. This trial will be performed in front of a neutral wall in silence to ensure that visual or auditory stimuli do not affect their movement.
Participants serve as their own controls and complete both testing arms.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Simon Fraser UniversityBurnaby, Canada
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Who Is Running the Clinical Trial?
Simon Fraser UniversityLead Sponsor
Natural Sciences and Engineering Research Council, CanadaCollaborator
University of British ColumbiaCollaborator
Provincial Health Services AuthorityCollaborator
References
A comparison of two gluteus maximus EMG maximum voluntary isometric contraction positions. [2022]Background. The purpose of this study was to compare the peak electromyography (EMG) of the most commonly-used position in the literature, the prone bent-leg (90°) hip extension against manual resistance applied to the distal thigh (PRONE), to a novel position, the standing glute squeeze (SQUEEZE). Methods. Surface EMG electrodes were placed on the upper and lower gluteus maximus of thirteen recreationally active females (age = 28.9 years; height = 164 cm; body mass = 58.2 kg), before three maximum voluntary isometric contraction (MVIC) trials for each position were obtained in a randomized, counterbalanced fashion. Results. No statistically significant (p
Gluteus Maximus Muscle Activation Characteristics During a Chair-Rise in Adults With Chronic Stroke. [2023]A successful chair-rise is an important indicator of functional independence post-stroke. Lower extremity electromyographic analyses provide a basis for muscle activation from which clinical intervention protocols may be derived. Gluteus maximus activation during the chair-rise has not been thoroughly researched in the chronic stroke population. This study investigated the magnitude and onset of gluteus maximus activation during the chair-rise comparing adults post-stroke with healthy controls.
Treatment of internal rotation gait due to gluteus medius and minimus overactivity in cerebral palsy: anatomical rationale of a new surgical procedure and preliminary results in twelve hips. [2013]Spastic overactivity of the anterior fibers of the gluteus medius and minimus can result in an internal rotation gait associated with excessive hip and pelvic rotation. The currently advocated operation for this problem can result in weakness of hip abduction. The anatomical features of the gluteal muscles suggest that this gait abnormality can be corrected by selectively reducing the internal rotator function of the anterior fibers of the glutei without disturbing the abductor fibers. Such an operative procedure was devised and performed on 12 hips. The gait improved in all hips without any demonstrable weakness of the hip abductor power.
Congenital heart disease in adolescents with gluteal muscle contracture. [2022]Gluteal muscle contracture (GMC), presented with hip abduction and external rotation when crouching, is common in several ethnicities, particularly in Chinese. It remains unclear that the reasons why these children are weak and have no choice to accept repeated intramuscular injection. Here, we found some unique cases which may be useful to explain this question. We describe a series of special GMC patients, who are accompanied with congenital heart disease (CHD). These cases were first observed in preoperative examinations of a patient with atrial septal defect (ASD), which was proved by chest X-ray and cardiac ultrasound. From then on, we gradually identified additional 3 GMC patients with CHD. The original patient with ASD was sent to cardiosurgery department to repair atrial septal first and received arthroscopic surgery later. While the other 3 were cured postoperative of ventricular septal defect (VSD), tetralogy of fallot (TOF), patent ductus arteriosus (PDA), respectively, and had surgery directly. The study gives us 3 proposals: (1) as to CHD children, it is essential to decrease the use of intramuscular injection, (2) paying more attention to cardiac examination especially cardiac ultrasound in perioperative period, and (3) taking 3D-CT to reconstruct gluteal muscles for observing contracture bands clearly in preoperation. However, more larger series of patients are called for to confirm these findings.
Comparison of the gluteus medius and rectus femoris muscle activities during natural sit-to-stand and sit-to-stand with hip abduction in young and older adults. [2020][Purpose] The purpose of this study was to compare the relative levels of activation of the gluteus medius (Gmed) and rectus femoris (RF) muscles during natural (N) sit-to-stand (STS) and STS with hip abduction (ABD) in young and elderly females. [Subjects] We recruited 15 healthy young females and 15 healthy elderly females. [Methods] The activities of the dominant lower extremity gluteus medius (Gmed) and rectus femoris (RF) muscles were measured using a wireless electromyography (EMG) system for natural STS and STS with hip abduction. [Result] In the elderly subjects, the Gmed increased significantly and RF decreased significantly when STS was performed with hip ABD compared with when it was performed naturally. The Gmed in the elderly subjects was significantly increased during natural STS compared with in the young subjects. [Conclusion] These results indicate that the Gmed was recruited to compensate for weakened RF muscle function in the elderly adults.
Assessment of abdominal muscle contractility, strength, and fatigue. [2006]We evaluated abdominal muscle contractility and fatigue by measuring twitch gastric pressure (Pgat) after percutaneous supramaximal electrical stimulation of the abdominal wall before and after sit-ups to task failure. Mouth pressures during maximal voluntary expulsive maneuvers (PEmax) at TLC and FRC with superimposed twitches, and maximum voluntary ventilation (MVV) were also assessed. Mean fresh Pgat was 36.1 +/- 3.0 cm H2O with a coefficient of variation that ranged between 3.0 to 4.8%. Pgat decreased by 25% (p
Comparison of Hip Stabilization Muscle Use during Neutral Sit to Stand and Sit to Stand Involving Isometric Hip Abduction in Elderly Females. [2020][Purpose] The purpose of this study was to compare the activation of the gluteus medius (Gmed), rectus femoris (RF), and biceps femoris (BF) muscles during neutral (N) sit to stand (STS) and STS involving hip abduction (ABD) in elderly females. [Subjects] We recruited 16 healthy elderly females with no pain in the knee joint or any other orthopedic problems of the lower limbs. [Methods] The activities of the dominant lower extremity muscles were measured using a wireless electromyography (EMG) system. Subjects then undertook a total of six STS trials: three for neutral STS and three for STS involving hip abduction. [Results] In the pre-TO phase, activation of the RF muscle was significantly increased during hip ABD. In the post-TO phase during hip ABD, Gmed muscle activation was significantly increased, and RF muscle activation was significantly decreased. [Conclusion] This study suggests that STS involving hip ABD is more effective in decreasing Gmed activation and reducing RF effort in elderly females.
Motor strategies for initiating downward-oriented movements during standing in adults. [2018]Sitting down and squatting are routine activities in daily living that lower the body mass by flexing the trunk and legs, but they obviously require different motor strategies for each goal posture. The former action must transfer the supporting surface onto a seat, whereas the latter must maintain the center of mass within the same base of both feet. By comparing the performance of both maneuvers, the mechanisms involved in initiating the downward-oriented movements and the process of optimizing the performance during their repetitions were studied. Twelve healthy subjects were asked to perform sitting-down and squatting actions immediately when a light cue was given, but at a natural speed. Electromyograms, angular movements of the joints of the right leg, and center of pressure (COP) displacement were recorded before and during each task. The initial mechanisms to initiate the break from the upright posture and the changes of postural adjustments during repetitive movements were analyzed separately. The sitting-down movement was achieved by a stereotyped motor strategy characterized by a gastrocnemius muscle burst coupled with deactivation of the erector spinae muscle. The former produced a transient COP displacement in the forward direction, and simultaneous unlocking of the trunk prevented a fall backward. By contrast, because of the absence of any need to produce momentum in a given direction, a variety of motor strategies were available to initiate squatting. The direction of initial COP displacement to initiate squatting varied with the muscles involved in unlocking the upright posture. During repetition of sitting down, the average COP position of the initial standing posture in the preparatory period was immediately shifted forward after the second trial. Simultaneously, the erector spinae muscle was deactivated earlier in the later trials. These resulted in a decreased momentum in the backward direction while the subjects were transferring themselves onto the seat. In the squatting task, however, these changes could not be identified, except for a slight flexed position of the knee during standing in the first trial. These findings suggest that in the case of transferring the body-mass to another supporting base the central nervous system immediately adjusts the size of the initial impetus to optimize the performance.
The effect of experimentally induced gluteal muscle weakness on joint kinematics, reaction forces, and dynamic balance performance during deep bilateral squats. [2023]Squatting is a common daily activity and fundamental exercise in resistance training and closed kinetic chain programs. The aim of this study was to investigate the effects of an experimentally induced weakness of the gluteal muscles on joint kinematics, reactions forces (JRFs), and dynamic balance performance during deep bilateral squats in healthy young adults. Ten healthy adults received sequential blocks of (1) branch of the superior gluteal nerve to the tensor fasciae latae (SGNtfl) muscle, (2) superior gluteal nerve (SGN), and (3) inferior gluteal nerve (IGN) on the dominant right leg. At the control condition and following each block, the participants were instructed to perform deep bilateral squats standing on two force plates. Hip, knee, ankle, and pelvis kinematics did not differ significantly following iatrogenic weakness of gluteal muscles. The most important finding was the significant differences in JRFs following SGN and IGN block, with the affected hip, patellofemoral, and ankle joint demonstrating lower JRFs, whereas the contralateral joints demonstrated significantly higher JRFs, especially the patellofemoral joint which demonstrated an average maximum difference of 1.43 x body weight compared with the control condition. When performing a deep bilateral leg squat under SGN and IGN block, the subjects demonstrated an increased center of pressure (CoP) range and standard deviation (SD) in mediolateral compared with the control condition. These results imply that squat performance changes significantly following weakness of gluteal muscles and should be considered when assessing and training athletes or patients with these injuries.
The acute effect of lower-limb warm-up on muscle performance. [2018]It has been purported that the mechanism for muscular improvement after a gluteal warm-up protocol is likely to occur from neural activation. However, little is known about whether changes in muscular performance are due to changes in muscle activity. Therefore, the aim of this study was to determine whether a lower-limb warm-up that targets the gluteal muscle group would improve countermovement jump and short-distance sprinting through increased muscle activity. Ten semi-professional rugby union players (age 25.4 ± 2.9 yr; height 1.83 ± 6.7 m; body mass 96.8 ± 10.6 kg) with at least three years of resistance training experience volunteered for the study. In a cross-over design, participants performed countermovement jumps and 5 m sprints before and after a gluteal warm-up and a 10 min rest (control). Electromyography was used to measure muscle activity of the gluteus maximus and biceps femoris. Countermovement jump height significantly improved (7.9%, p