How can the therapist reduce the risk of orthostatic hypotension during rehabilitation sessions?
To reduce orthostatic hypotension, the therapist decided to place the patient on the tilt table for the first day after imipramine was started and to monitor blood pressure regularly. The therapist had the patient perform weight shifting and upper-extremity facilitation activities while he was on the tilt table. The patient tolerated this well, so the therapist had him resume ambulation activities using the parallel bars on the following day. With the patient standing inside the bars, the therapist carefully watched for any subjective signs of dizziness or syncope in the patient (i.e., facial pallor, inability to follow instructions). Standing bouts were also limited in duration. By the third day, ambulation training continued with the patient outside the parallel bars, but the therapist made a point of having the patient's wheelchair close at hand in case the patient began to appear faint. These precautions of careful observation and short, controlled bouts of ambulation were continued throughout the remainder of the patient's hospital stay, and the therapist observed no incident of orthostatic hypotension during physical therapy.