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M - Cardiovascular Integrity

Ongoing Cardiovascular Health-Related Research Much of what we know about cardiovascular health and/or CVD, in individuals with SCI, has come from researchers in academic health science centers, in Canada (University of British Columbia, University of Toronto, McMaster University and Brock University), and their affiliated clinical rehabilitation programs (GF Strong, Centre for Health Promotion and Rehabilitation and TRI-UHN Lyndhurst Brain and Spinal Cord Rehab Program), where therapists, clinicians and scientists often interact regarding best practices (Table 6.0). These sites are forging ahead with new research on cardiovascular physiology, assessments and new interventions for optimizing cardiovascular health, in individuals with SCI. Additionally, researchers in these sites have been collaborating in attempts to minimize redundancy in research, and to enhance translation of research evidence to clinical practices. Researchers and clinicians, in these institutes, have recently begun cardiovascular studies using pulse wave velocity assessments (a gold standard method to assess arterial stiffness), taking note of the clinical benefit of this method, as a novel assessment of CVD risk, in the SCI population. Table 6.0 Current Cardiovascular Health Research, for Individuals with SCI, in Canadian REHABILITATION SITES What is Required for Best Practice? Many CVD risk factors are modifiable by changing lifestyle and/or pharmacotherapy, in the normal population, and can be transferred to individuals with SCI. Moreover, the management of CVD risks continues to be improved, as risk assessment tools become more accurate, and treatment interventions more effectively targeted. However, CVD is often asymptomatic and has, therefore, been undertreated. Facilitating cardiovascular integrity, in a rehabilitation setting, requires a coordinated CVD risk management system of health professionals (family practice physicians, physiatrists, cardiologists, nurses, dietitians, physiotherapists, occupational therapists, pharmacists and kinesiologists) and patient educators. As well, integrated strategies and best practice indicators, to achieve better CVD risk assessment and management, in Canada, for individuals with SCI, are warranted. Best Practice Indicators To address current gaps in practice, the following best practice indicators, for SCI cardiac rehabilitation, need to be developed: • Individual education and consultation regarding lifestyle self- management (e.g., smoking, stress, diet, and physical activity), using e-learning approaches • Lifestyle-related CVD risk assessment (e.g., hypertension, hyperlipidemia, obesity, diabetes) using standard validated protocols, at all annual follow-up visits, with a physiatrist • Assessments of autonomic function, for individuals with tetraplegia, as a standard of care in all SCI rehabilitation sites, and incorporated into Canadian Accreditations Standards • Wallet cards for recognizing AD as a standard practice, matching the prominence of medical alert wristbands • Documentation in all health records to demonstrate that education has been provided to individuals for the management of AD, post discharge from rehabilitation • Training on the signs of AD and OH, in the medical and health professional curricula (particularly emergency medicine), at all Academic Health Science Centres in Canada • Standard guidelines for the provision of Cardiac Rehabilitation for the acute, sub-acute, rehabilitation and chronic phases of SCI, by Canadian Physiatry and Rehabilitation Medicine • Training module for a standard CVD screening protocol for individuals with SCI, by SCI clinicians and researchers, for introduction at the 6th National Spinal Cord Conference, in 2014. SiteS Research Focus Leads UBC GF Strong ICORD • Autonomic Dysfunctions (AD and OH) • Cardiovascular Health/Effects of Exercise • Targeted Education • Physical Activity and Heart Rate Levels Andrei Krassioukov, MD, PhD Darren Warburton, PhD Janice Eng, PhD TRI-UHN • Associations between Arterial Stiffness and CVD Risk Factors • Physical Activity and Heart Rate Levels Masae Miyatani, PhD Cathy Craven, MD, MSc Paul Oh, MD, PhD Molly Verrier, MHSc McMaster University Centre for Health Promotion and Rehabilitation • Effect of BWSTT on Cardiovascular Health • Exercise Guidelines for Cardiovascular Health • Effect of Exercise on Cardiovascular Health Audrey Hicks, PhD Kathleen Martin Ginis, PhD Maureen MacDonald, PhD University of Guelph • Body Composition, Energy Expenditure and Chronic Disease Risk Andrea Buchholz, PhD Brock University • Secondary Health Complications and Effect of Exercise on Cardiovascular Health Dave Ditor, PhD 134 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


M - Cardiovascular Integrity
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