The Rick Hansen Institute (RHI) and the Ontario Neurotrauma Foundation (ONF) work collaboratively to implement a program of research and best practice implementation designed to enhance the well-being of people with spinal cord injury (SCI).
In order to meet its objectives, ONF and RHI launched a funding opportunity in September 2015 to support modest and focused projects related to the development of emerging interventions and innovative technologies with direct application to SCI.
To be eligible, projects were required to directly address the relevant areas of focus described below:
- Secondary complications – including, but not limited to pressure ulcers, urinary tract infections, respiratory infections and neuropathic pain.
- Neuro-recovery – activities supporting the improvement of neurological outcomes which includes; pre-hospital triage, acute care management and rehabilitation to maximize recovery.
- Long term health, wellness and community participation – with a focus on creating the optimal ‘environmental’ conditions to support long-term health, wellness and participation.
All applications were reviewed for relevance to ONF and RHI objectives (Business Case Review), potential of uptake and impact on stakeholders (Relevancy Review) and methodology/interpretation (Scientific Review). The Business Case and Relevancy Review were undertaken internally with invited input from consumers and by subject matter experts. The Scientific Review was undertaken by an invited panel of external subject matter experts. Six projects were chosen for funding following the review process.
Thank you to all those that participated in the application review, and a sincere congratulations to the successful funding recipients – all the best as you move forward with your projects.
Continue reading to view summaries of the successful projects.
Project Title: Enhancing Primary Care for SCI Consumers by Clinical Use of Videoconferencing
Principal Investigator: James Milligan
Lead Organization: Center for Family Medicine
Personal Computer Videoconferencing (PCVC) offers potential in addressing some of the existing gaps in primary care for SCI consumers by increasing their access to care in a timely manner, eliminating the barriers associated with travel to an in-clinic appointment, diverting patients away from emergency room visits that could be more appropriately addressed in primary care, and making more efficient use of limited healthcare resources by using the appropriate healthcare provider at the appropriate time. The proposed descriptive, mixed method purposive study will utilize qualitative and quantitative data collected by a PCVC clinical assessment tool, end of consult surveys and end of study interviews with clinicians and SCI consumers to examine the feasibility of clinician utilization of personal computer video conferencing (PCVC) to increase primary care clinician capacity to improve complex chronic care and secondary complications for people with SCI.
Project Title: Preventing Falls One Step at a Time: Reactive Balance Training for Spinal Cord Injury
Principal Investigator: Kristin Musselman
Lead Organization: Toronto Rehabilitation Institute
Falling is common among individuals with incomplete spinal cord injury (iSCI), with most falls occurring while walking. Falls result in injuries (e.g., broken bones), hospital readmission, and reduced participation in work and recreation. In able-bodied people, falls can be prevented by taking one or more rapid, reactive steps. People with iSCI, however, have difficulty taking the reactive steps needed to prevent a fall. Research in the elderly and people with stroke has shown that repetitive training of reactive steps in a safe environment improves this balance reaction and prevent falls. We will examine the feasibility and effectiveness of reactive step training in people with iSCI. This unconventional training may change current rehabilitation for iSCI, which presently has little emphasis on balance and fall prevention. By improving balance and reducing falls, people with iSCI will experience fewer complications (e.g., injuries), and greater recovery of function and community participation.
Project Title: Development and Implementation of a Clinical Decision Support System to Improve Outcomes Associated with Activity-Based Therapies
Principal Investigator: Dalton Wolfe
Lead Organization: Lawson Health Sciences Center
The Parkwood Program of Rehabilitation Innovation for Movement Enhancement (PRIME) initiative, underway since Spring 2015, aims to develop, test, implement and sustain an electronic clinical decision support and data management system that includes clinical protocols to guide clinical decision-making and reporting functions in the area of locomotor training for persons with spinal cord injury and acquired brain injury. The primary rationale is that it will help coordinate and standardize more intensive, innovative therapeutic approaches including manual and robotic body-weight support treadmill training along with conventional overground therapies so as to optimize neuro-recovery, enhance walking outcomes and also support a clinical-research environment. These goals will be achieved through a set of activities under a participatory research design conducted over 3 phases: 1. Development; 2. Pilot Testing; and 3. Implementation and Pilot Test Expansion.
Project Title: Enhancing Recovery in Non-Traumatic Spinal Cord Injury: Implementation of an Integrated Program for the Assessment of Rehabilitation Therapies
Principal Investigator: Neil Duggal
Lead Organization: London Health Sciences Center
We have spent the last decade uncovering unique metabolic and functional abnormalities in the brains of patients with spinal cord compression. Degenerative spinal cord compression represents a unique model of reversible spinal cord injury. Our previous work has demonstrated that cortical reorganization and recruitment is associated with metabolic changes in the brain of patients recovering from spinal cord compression and is correlated with recovery and improved neurological scores.
Our goal is to combine a rigorous platform of clinical care spanning preoperative evaluation, surgery and rehabilitation with state of the art imaging techniques to demonstrate how rehabilitative therapy can increase brain plasticity and recovery of neurological function in patients with spinal cord injury. We will carefully evaluate neurological function in two groups of patients, those receiving rehabilitation and those not receiving rehabilitation after spine surgery, and correlate this with advanced imaging.
Project Title: EEG-Triggered Functional Electrical Stimulation Therapy for Upper Limb Rehabilitation
Principal Investigator: César Márquez Chin
Lead Organization: Toronto Rehabilitation Institute
Over the last decade, there has been an increasing interest in using brain-computer interfacing technology as a short-term therapy to help patients with paralysis recover the ability to move. A brain-computer interface translates brain signals into control commands for electronic devices. Early results suggest that using brain interfacing as a form of therapy for people who have had a stroke is effective, even for the most severe forms of paralysis. To date, we do not know if therapies that include a brain interface will also work with individuals who have had a spinal cord injury, often also paralyzed. In this project, we will test for the first time if a brain-computer interface, combined with movements produced with electrical discharges, restores the ability to grasp objects in people with spinal cord injuries with paralyzed hands. We will compare its effects against conventional and functional electrical stimulation therapies.
Project Title: Nerve Transfers in Tetraplegia: A Multi-Centre, Multi-Disciplinary Pilot Study
Principal Investigator: Kirsty Boyd
Lead Organization: Ottawa Hospital
As a surgical technique, nerve transfers have been widely used to treat peripheral nerve injuries. A nerve transfer involves borrowing portions of a healthy functioning donor nerve and connecting them to a recipient nerve that has been injured and does not function. The donor nerve provides function to the desired recipient. Recently this technique has been applied to tetraplegics to rewire their nervous system and restore volitional control to paralyzed muscle. However, little data exists regarding selection of the ideal candidate and long term outcomes.
This study will bring specialists from a variety of medical disciplines and several medical centres together to investigate nerve transfers in tetraplegics. Specifically we will investigate appropriate patient selection, operative technique, and rehabilitation. Measurements of changes in quality of life and upper extremity function will improve our understanding of the benefits of this procedure and facilitate counselling future patients wanting to explore this intervention.