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Interview with Orthopaedics professor and researcher, Bonita Sawatzky, Part 1

Researcher and teacher Bonita (Bonnie) Sawatzky is passionate about all things wheeled, and making research practical. An Associate Professor in Orthopaedics at the University of British Columbia, in the Spine Division; and a Principal Investigator at ICORD (International Collaboration on Repair Discoveries), she focuses on the physiological and biomechanical effects of wheelchair propulsion to decrease pain, fatigue and long-term overuse injuries, in adults and children. She also help to bring together therapists, engineers, student and physicians, from around the world, to present ideas, innovations and research to improve mobility at the bi-annual International Seating Symposium.

In this first of a two part interview, she talks about becoming a researcher, and the quest for inventive mobility solutions.

 

Are you from Vancouver originally? I’m a local! I grew up in Steveston (south of Vancouver).image2

Tell me about your education…where did you go to school? I attended UBC, doing my undergrad and master in human kinetics, or kinesiology. After that, I was a Research Assistant and then completed my PhD at Simon Fraser University.

 

Bonnie Sawatzky observes a study participant 
using the SmartWheel.

How did you come to study this field? In high school, I wanted to be a forest ranger, to work in the bush but my dad urged me to enroll in something more practical.  So, I enrolled in computer science at first but was more interested in human kinetics...I wanted to be doing things, not just sit at a desk.  I became intrigued with biomechanics but thought there had to be a more important use for what we were learning than helping an athlete jump an inch further.

I had a part time job in a community centre helping adults with disabilities with recreation and exercise, which inspired me to work on more helpful applications.

Did you have a specialty? Yes, I focused on scoliosis research - a painful but treatable condition which predominately affects teenage girls -- a very interesting biomechanical problem. I wanted to find out about how the spine rotates…all vertebrae at once or individually…to determine the best treatment options.  After my PhD graduation, there was a position waiting for me at UBC as a faculty member in paediatric orthopaedics.

It’s clear this work is your passion.  There’s a personal connection for you, isn’t there? Yes, I was born with anterior horn cell disease called arthrogryposis, which affected my arms and feet.  And, in 1993, I was in a car accident (just when I was starting my PhD, which meant over a year’s delay) which left me with a broken pelvis and a nerve injury.  That experience changed my focus.

How so? It was when I got my wheelchair.  First, I was a competitive cyclist and someone who always loved wheels, so when I needed my first wheelchair, I put a lot of thought into it and got one that was light and efficient.  Then, when I saw kids in the spina bifida clinic in wheelchairs at Children’s Hospital, I ached for them.  Theirs were twice the weight with steel frames, poorly set up.  It was wrong.  They made good coat racks for their family’s jackets but that was about it.

So, I went to GF Strong (Rehabilitation Centre, in Vancouver) where they were in tune with the latest equipment.  Ian Denison, the equipment specialist, taught me an awful lot about chairs and funding for them.  We started to look at tire pressure, how they were set up, axel position relative to arms, hyperextension, efficient pushing.  We asked ‘how can we change behaviours in the clinic?’ and started doing research.

What did you do? I try to make my work relevant to people, with practical research. Our first study was in wheeling efficiency for kids. We found that those participating in sports and with a higher body mass index did better. But they’re not yet developed in their upper extremity so shoulder pain was a huge issue.

We compared them with adults who grew up in chairs, and those injured as adults.  To my surprise, the ones who grew up in chairs had less shoulder pain – even in heavy chairs – possibly because the muscle and bones remodel. We compared shoulder MRI and CT scans of adults who began wheeling as kids versus those who began as adults and found differences in the joint area size - kids having a larger surface area. If you’re applying a force to something that is still growing and developing, it will respond to forces of wheeling.

The other thing is that kids, because they grew up with mums and dads, had help…someone would push them…they don’t have to lift their chair into the car.  The help they get preserves their bodies. But there’s no one to help an adult – a 25- or 30-year old push all the time.  And they wouldn’t ask for help.

image1How did that change your thinking? You know the saying ‘use it or lose it?”  Now the thinking is that it’s better to ‘conserve it to preserve it’. Don’t always do the max.  Ask for help.  The other recommendation is to use a power chair earlier on.  We should be getting to people before shoulder pain. 

So, ideally, people would have a manual chair and a power chair, to alternate use. Yes, but many can’t afford that, and we need to change funding policies.  Private funding is better (my insurance policy lets me get a chair every five years)…government funding the least.  We must encourage multi forms of mobility.  In our day-to-day life, we need options.

Are there other options? To provide a mobile alternative at GF Strong, I got a grant to look at who can use a Segway. You have to be able to stand, but we could use standing devices (like long leg braces) for people with spinal cord injury (SCI), multiple sclerosis and amputees. We had a great debate and excluded complete SCI’s because we thought it wasn’t safe.  But Ian was determined because he had someone with a T5 (thoracic injury) who wanted to try.  We used an overhead harness to hold this individual on the Segway and, within minutes, he wanted out of the harness.  We were nervous.  Within half an hour, he figured it out. It was the most amazing thing! We had another individual who tried and subsequently bought one! He used it to go camping with his girls.  It was so emotional…he said we changed his life.

How wonderful to have such results! Research can make such a difference.  Most researchers provide data but don’t often get to hear the success stories.  When you do, it’s amazing.  Even small things…like teaching people to pump their tires properly.  They come back and say ‘Thank you for doing a study…you’ve made it make sense to us.”

What else are you working on? Pain and fatigue is a huge issue in spinal cord injury. We need to find ways of reducing that…to give people the energy to go back to work, to do what’s important to them.  Our current focus is physical strain - how we kinetically use our energy, and how much oxygen we consume.  We’re looking at different aspects of the wheelchair in the Skills Lab at ICORD… measuring forces during propulsion and technique.

Tell me more about this technique. 85% of people wheel inefficiently, so propulsion – proper biomechanics - needs to be taught. Wheelchair skills are not typically part of rehabilitation program, because patients are being released too early and there just isn’t enough time.  If you’re injured, there’s so much to learn…to understand your body sensations, learn how to catheterize, to breathe, sometimes. 

At GF Strong, the biggest panic for patients before they leave rehab is to find the right chair.  It can take six to eight weeks to arrive so often you go home with a loaner chair. You may get the new chair shipped to you and may not be set up properly…you need a good occupational or physical therapist to do that.

So, how can this practical education be done? We’re looking at a couple of solutions:I’ve been involved in helping to develop a wheelchair education program for SCI-U (a customized e-learning tool for SCI patients) which will be great for people who live remotely or don’t have access to support services near home.

We’re also trying to develop a Physical Activity Research Centre at ICORD where people can learn skills, exercise and participate in research.  We want to be connected to the community more.