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G - Independence in Breathing

There is considerable disparity among Canadian rehabilitation sites in the use of best-available evidence summaries. Few sites report using guidelines or systematic reviews to inform management of respiratory dysfunction. Four of 12 sites (33%) report using the Paralyzed Veterans of America’s (PVA) Consortium for Spinal Cord Medicine guideline, and three of 12 sites (25%) report using the Rick Hansen Institute’s Spinal Cord Injury Rehabilitation Evidence review. At the time of the Rehabilitation E-Scan survey, the Canadian Thoracic Society guideline was not yet published, so its current utilization by rehabilitation sites is yet to be determined. There is also disparity in Canadian rehabilitation sites’ capacity to provide evidence-based respiratory care. For example, level 2 evidence, and strong recommendation support use of mechanical insufflation/ exsufflation to remove secretions, but only seven of 12 sites (58%) have a mechanical insufflator-exsufflator available for clinical care (Table 1.0).1,18 Table 1.0 Availability of Equipment for Respirator y Care Similarly, the PVA’s guideline recommended continuous positive airway pressure (CPAP) therapy for individuals with obstructive sleep apnea, but only seven of 12 sites (58%) have the equipment necessary to provide care (Table 1.0).15 The most disparate aspect of Canadian SCI respiratory rehabilitation can be found in the care of Canadians with high tetraplegia who are ventilator- dependent. Most Canadian rehabilitation sites are not equipped with ventilators (Table 1.0). Even though most sites report availability of environmental controls for individuals with high tetraplegia (Table 2.0), only three sites confirm admission of individuals with SCI who are ventilator-dependent. One site accepts out-of-province individuals who are ventilator-dependent. Table 2.0 Availability of Mobility Aids and Environmental Controls for Individuals with High Tetraplegia Environmental Controls Available for Clinical Care Sip and Puff Controller 12/12 (100%) Shoulder Switches 9/12 (75%) Hands free in room – Call Bells 10/12 (83%) Hands free in room – Phones 9/12 (75%) Hands free in room – Head Master 8/12 (67%) Hands free in room – Environmental Controls 9/12 (75%) In many regions of the country, Canadians with SCI who are ventilator- dependent are unable to access specialized SCI rehabilitation. These individuals may receive respiratory rehabilitation at sites that do not provide SCI rehabilitation, and may not receive care from clinicians with expertise in SCI. This can limit access to interventions, such as phrenic nerve pacing and diaphragm pacing, which offer alternatives to mechanical ventilation (level 4 evidence).1,18 Ventilator y Equipment Available for Clinical Care Ventilator – BiPAP 7/12 (58%) Ventilator – CPAP 7/12 (58%) Ventilator – Volume 5/12 (42%) Ventilator – Pressure 3/12 (25%) Insufflator- Exsufflator 7/12 (58%) Suction Units 12/12 (100%) 80 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


G - Independence in Breathing
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