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Table 3.0 Guidelines and Approaches for Physical Activity and Nutrition Physical Activity • SCI Action Canada. Physical Activity Guidelines for Adults with Spinal Cord Injury. Hamilton, ON: McMaster University; 2011. http://www. sciactioncanada.ca/guidelines/ (see Physical Activity Chapter). Nutrition • Health Canada. Eating Well with Canada’s Food Guide. Health Canada; 2011. http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php/ • Block G, Hartman AM, Dresser CM, Carroll MD, Gannon J, Gardner L. A data-based approach to diet questionnaire design and testing. Am J Epidemiol. 1986;124(3):453-69. • Subar AF, Kirkpatrick SI, Mittl B, et al. The automated self- administered 24-hour dietary recall (ASA24): A resource for researchers, clinicians, and educators from the National Cancer Institute. J Acad Nutr Diet. 2012;112(8):1134-7. http://www.science direct.com/science/article/pii/S2212267212005898 Accessed September 24, 2012. • Academy of Nutrition and Dietetics (formerly American Dietetic Association). SCI: Nutrition Screening for Lipid Abnormalities. Spinal Cord Injury Evidence-Based Nutrition Practice Guideline. ADA Evidence Analysis Library; 2012. http://www.adaevidencelibrary.com/ topic.cfm?cat=3485. Accessed August 21, 2012. Table 4.0 Guidelines and Approaches for Autonomic Dysfunction and Orthostatic Hypotension Autonomic Standard Assessment • Alexander MS, Biering-Sorensen F, Bodner D, et al. International standards to document remaining autonomic function after spinal cord injury. Spinal Cord. 2009;47(1):36-43. Autonomic Dysrefle xia (AD) • Consortium for Spinal Cord Medicine. Acute management of autonomic dysreflexia: adults with spinal cord injury presenting to healthcare facilities. J Spinal Cord Med. 1997;20(3):284-308. • Consortium for Spinal Cord Medicine. Acute Management of Autonomic Dysreflexia: Individuals with Spinal Cord Injury Presenting to Healthcare Facilities. 2nd ed. Washington, DC: Paralyzed Veterans of America; 2001. http://krassioukov.icord.org/files/2012/08/ DysreflexiaCPG.pdf. Accessed August 20, 2012. • Consortium for Spinal Cord Medicine. Autonomic Dysreflexia: What You Should Know. Washington, DC: Paralyzed Veterans of America; 1997. http://www.scicpg.org/cpg_cons_pdf/ADC.pdf. Accessed August 20, 2012. Orthostatic Hypotension (OH) • The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology. 1996;46(5):1470. What Cardiovascular Integrity Diagnostic Services are Available in Canada? Lifestyle-related CVD: Although many SCI rehabilitation facilities, across Canada, possess CVD diagnostic devices (Figure 3.0), their use varies substantially: only three sites report routine conduct of these assessments, and two others report using them either as appropriate or sometimes. Physiatrists, pharmacists and nurses, at three of the 12 sites, routinely conduct assessment and management of CVD risk (e.g., blood glucose, lipid profile, blood pressure, weight monitoring, and smoking cessation counselling and intervention), for clinical purposes. One site routinely conducts CVD risk assessment, and another reports sporadic CVD risk assessment. Given the morbidity associated with CVD, this rate of service utilization is inadequate to diagnose and change the natural history of CVD, in this population. In terms of advanced CVD assessment, one site reports use of the ankle brachial index, as an index of peripheral vascular disease. One site reports long-term assessment of CVD risk, over time. Clearly, uptake of these assessments, nationally, is needed to reduce CVD-related morbidity and mortality. Nutritional assessments are conducted at several sites, but the extent of the practice varies. Five of 12 sites report that they routinely provide nutrition assessments. Six sites report conducting nutrition assessments (as indicated by using Food Frequency Questionnaires), a modified food record, and 24-hour recall, conducted by dietitians and nutritionists. Physical activity is one of the key factors associated with CVD risk (for assessment details see Physical Activity chapter). Figure 3.0 Figure 3.0 Available CVD Diagnostic Tests and Equipment 0 2 4 6 8 10 12 Automatic Blood Pressure Monitor ECG Doppler Ultrasound Ultrasound 2D/3D Blood Test Sestamibi* Number of Sites *Sestamibi: test to look at the blood supply to the muscle of heart and the function of the heart muscle. 130 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


M - Cardiovascular Integrity
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