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M - Cardiovascular Integrity

CVD is now recognized as the leading cause of morbidity and mortality, after SCI. Further, AD (the autonomic dysfunction accompanying SCI, particularly), is recognized as a life-threatening condition and contributes to arterial disease. Nevertheless, less than half the E-Scan sites (five of 12) report that they conduct CVD risk assessments routinely/as appropriate - likely because of the tendency of SCI clinicians to attend more to neurologic assessments, and to diagnose and treat infectious conditions; and/or the paucity of longitudinal follow-up programs. However, CVD risk factor evaluation should be an integral part of routine clinical assessments, for all individuals with SCI, during inpatient rehabilitation and across their lifespan, after discharge into the community. Cardiovascular Rehabilitation Cardiac rehabilitation is also important for individuals diagnosed with heart disease. Participation in cardiac rehabilitation programs, which emphasize exercise, can lower chances of cardiac-related death by about 20 percent. Currently, eight of the 12 sites have some type of cardiac rehabilitation service for their patients, whether screening and/or assessment and services. Metabolic Syndrome Screening Metabolic syndrome is a term used to describe a group of conditions that puts individuals at higher risk of developing heart disease and/or type II diabetes. According to an American Heart Association/National Heart, Lung and Blood Institute scientific statement (AHA/NHLBI), metabolic syndrome is defined if there are any of three or more conditions (see Table 2.0). Criteria used for this assessment are seen in Table 5.0. Table 5.0 Screning Criteria for Metabolic Syndrome Reproduced from Grundy SM, Cleman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association /National Heart, Lung, and Blood Institute Scientific Statement . Circulation . 2005;112:2735-52. © 2005 American Heart Association , Inc. Reprinted with permision. However, according to the report by the SHAPE-SCI Research Group, metabolic syndrome definitions underestimate true CVD risks, in individuals with SCI,7 and C-reactive protein (CRP) is a well-established constellation of CVD, in the general population. In fact, among individuals with SCI, CRP may be a potential factor to consider, in the development of SCI-specific screening tools, instead of using metabolic syndrome definitions. CRP cut points of 3.1-9.9, 1.0-3.0 and < 1.0mg/L indicate high, average and low heart disease risk.8 Cardiovascular Fitness Testing It is well known that low cardiovascular fitness (VO2peak: ml/kg/min), assessed by maximal exercise testing, is one of the key risk factors of CVD, in the general population. Like other sites in the country, Toronto’s Lyndhurst Centre is currently working on a clinical protocol, for implementation of maximal exercise testing, using both arm and leg ergometry, among individuals with tetraplegia. Current results indicate that 10% of individuals (two of 20) experienced early termination of the test, before reaching their peak volitional effort; and 20% (five of 20) were unable to complete the test. Reasons for VO2peak test termination were related to arm, leg and general fatigue; along with abdominal spasm, dyspnea, insufficient hand strength and shoulder pain. One individual reached physiological maximum. Establishing the VO2 peak, duration (min) and power (kpm) parameters for test termination will assist the development of the much-needed testing protocols. It appears that maximal exercise testing can be attained in individuals with tetraplegia, by customization of the test protocols. Elevated waist circumference: Men ≥ 40 inches (102 cm) Women ≥ than 35 inches (88 cm) Elevated triglycerides: ≥ 150 mg/dL (1.7 mmol/L) or on drug treatment for elevated triglycerides Reduced HDL cholesterol: Men ≤ 40 mg/dL (1.03 mmol/L) Women ≤ 50 mg/dL (1.3 mmol/L) or on drug treatment for reduced HDL cholesterol Elevated blood pressure: ≥ 130/85 mm Hg or on antihypertensive drug treatment, in a patient with a history of hypertension Elevated fasting glucose: ≥ 100 mg/dL (5.6 mmol/L) or use of medication for hyperglycemia SUGGESTED ADAPTATIONS FOR EXERCISE TESTING AMONG INDIVIDUALS WITH TETRAPLEGIA Leg ergometry for those with AIS C or D impairment and LEMS > 20 Reduced leg ergometry work loads of < 100kpm/min Reduced arm ergometry work loads of 30kpm/min Grip adapta��ons (e.g. velcro gloves) CARDIOVASCULAR INTEGRITY | BODY STRUCTURE AND FNUCTION 133


M - Cardiovascular Integrity
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