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Spotlight Best Practice Organization Brain and Spinal Cord Rehab Program – Toronto Rehabilitation Institute (TRI), University Health Network, Toronto The breadth, depth and integration of the clinical and research expertise of the clinicians and scientists at this site are noteworthy. Walking assessments using a standardized, valid and reliable battery of measures are routinely collected during admission and at discharge from rehabilitation. GAITRite technology is being used to identify patients, with particular impairments in symmetry as well as variability, especially since gait symmetry doesn’t appear to be a major problem for many individuals with SCI. GAITRite data is then used to tailor therapeutic approaches to specifically target the asymmetry and variability of gait. Algorithms using Lower Extremity Motor Scores (LEMS) are employed to determine the timing for initiation of an enhanced walking-training program. Therapeutic interventions are patient specific, and incorporate all interventional approaches (with the exception of robotics). The therapy interventions are individually customized to capture the capacity of the individual’s ability to sit, to stand, to step and to walk, with a major emphasis on strengthening and enhancing posture and trunk control during transitions, propulsion and progressions. Refinement of each of these components is captured during therapy paradigms requiring weight shifting, unilateral and bilateral stepping activities, and walking at various speeds incorporating rotation. All components are initiated and practiced with body weight support, when required, during treadmill and/or over-ground walking. There is limited use of gait aids, and careful attention is paid to customizing their application to progress walking performance, over time. Once the basics are captured, contextual and circumstantial challenges are incorporated such as inclines, obstacle avoidance and altered terrains. Careful attention is paid to repetition, with timely progression to more challenging components and longer durations of activities. Quality and safety are emphasized and performance and endurance are routinely assessed during rehabilitation. Ongoing research studies are investigating the effectiveness of FESassisted posture and gait training, BWSTT, whole-body vibration and postural feedback training. Outpatient walking rehabilitation programs are being strengthened to address the gaps in rehabilitation service. Lyndhurst investigators belonging to the SCIMobility Team, funded by a grant from Réseau provincial de recherche en adaptation-réadaptation (REPAR) and the Ontario Neurotrauma Foundation (ONF), are interacting on a routine basis to enhance the development of patient-specific training protocols. The interactive approach of researchers and clinicians is also present in other centers, at different levels. The integration of research, evaluation and intervention at this site is transforming physical therapy clinical practice. 50 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


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