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Commentary – Addition:

Vertebral subluxation may be associated with alterations in muscular strength and has the potential to affect multiple organ systems and overall health. 141-144

QUESTIONNAIRES

Sub-Recommendation – Unchanged

Commentary - Unchanged

HEART RATE VARIABILITY - Added

Sub-Recommendation – Added:

Heart rate variability may be used to assess autonomic dysfunction associated with vertebral subluxation.

Rating: Established Evidence: E,L

Commentary – Added:

Variability in heart rate reflects the vagal and sympathetic function of the autonomic nervous system, and has been used as a monitoring tool in clinical conditions characterized by altered autonomic nervous system function.167 Spectral analysis of beat- to-beat variability is a simple, non-invasive technique to evaluate autonomic dysfunction. 168

Heart rate variability analysis has been used in the assessment of diabetic neuropathy and to predict the risk of arrhythmic events following myocardial infarction.169 The technique has also been used to investigate autonomic changes associated with neurotoxicity, physical exercise.171 anorexia nervosa,172 brain infarction,173 angina,174 and panic disorder. 170 175

49

_________________________________________________________ Council on Chiropractic Practice Clinical Practice Guideline Number 1 Vertebral Subluxation in Chiropractic Practice – 2003 Update & Revision

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