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Non-Pharmacological Management of AD

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The initial management of an episode of AD involves placing the patient in an upright position to take advantage of an orthostatic reduction in blood pressure (Consortium for Spinal Cord Medicine 2001). While there are no studies that evaluate the effect of a sit-up position on blood pressure during the episodes of AD, significant decreases in resting blood pressure have been shown during a tilt or sit-up test from supine position in individuals with SCI (Claydon & Krassioukov 2006; Krassioukov & Harkema 2006; Sidorov et al. 2007). It is proposed that an upright posture will induce pooling of blood into the abdominal and lower extremity vessels as peripheral vasoconstriction is compromised or lost following SCI; thus arterial blood pressure is reduced.  The next step is to loosen any tight clothing and constrictive devices (Consortium for Spinal Cord Medicine 2001).  This procedure will also allow more blood to pool into the vessel beds below the level of injury as well as removal of a possible trigger of peripheral sensory stimulation.  Blood pressure should be checked at a minimum of 5 minute intervals until the individual is stable (Consortium for Spinal Cord Medicine 2001), at which time it is necessary to search for and eliminate the precipitating stimulus, which in 85% of cases can be found to relate to either bladder distention or bowel impaction (Teasell et al. 2000; Mathias & Bannister 2002). The use of antihypertensive drugs should be considered as a last resort and used if the systolic blood pressure remains at 150 mmHg or greater following the steps outlined above (Consortium for Spinal Cord Medicine 2001). The goal of such an intervention is to alleviate symptoms and avoidthe complications associated with uncontrolled hypertension (Yarkony et al. 1986; Pine et al. 1991; Eltorai et al. 1992; Valles et al. 2005).