Session Descriptions

Pre-Course – Thursday, November 9

13:15 – 14:05  Keynote Presentation
Without Compassion there is no Healthcare Brian Hodges

The 21st century is already characterized by profound discussions about what health professionals are and should be.

Unprecedented levels of burnout, depression and substance abuse among clinicians are coupled with growing demands for equitable, safe and compassionate care – the delivery of which is more often systems-based than under the control of individual clinicians.

Simultaneously the explosion of technological advances including computers that increasingly solve problems and display forms of empathy, challenges us to question what a health professional of the future will be.

This presentation argues that while healthcare will continue to be underpinned by cognitive skills and technical prowess, it is an anchor in humanism and compassion that will prove the value of the (human) health professional of the future.

Objectives:

  1. Describe the challenges of sustaining compassionate care.
  2. Understand factors that tilt health professionals and healthcare settings either toward burnout and compassion fatigue or in the direction of engaged, compassionate, patient centred care.
  3. Describe approaches for nurturing and sustaining the practice of compassionate care.

14:20 – 15:50  Concurrent Workshops – Session One

Workshop 1: NOVEL WEARABLE TECHNOLOGIES FOR TRACKING UPPER LIMB FUNCTION IN THE COMMUNITY AFTER SPINAL CORD INJURY

Speakers: Jose Zariffa, Sukhvinder Kalsi-Ryan, and Milad Alizadeh-Meghrazi The workshop will consist of:

  • Presentations describing recent technological advances relevant to UL monitoring, with an emphasis on wearable cameras and electronic textiles.
  • Interactive case studies to analyze the potential contributions of different technologies, and how they relate to existing outcome measures.
  • Open discussions on the best strategies to incorporate existing and emerging wearable technologies into UL neurorehabilitation, in research and clinical environments.

Workshop 2: ASSESSMENT OF UPRIGHT MOBILITY AFTER SPINAL CORD INJURY: A “HOW-TO” GUIDE TO THE CANADIAN SPINAL CORD INJURY STANDING AND WALKING ASSESSMENT TOOL

Speakers: Kristin Musselman, Jean-François Lemay, Shane McCullum, Kristina Guy, and Kristin Walden The workshop will involve lecture-based and case-based learning, along with hands-on practice of staging.


Workshop 3: SPINAL CORD INJURY PRIMARY CARE AND COMMUNITY SUPPORT SUMMIT: PROCEEDINGS AND RECOMMENDATIONS

Speakers: Joseph Lee, James Milligan, Matt Smith, Peter Athanasopoulos, Tara Jeji, and Jennifer Howcroft A 2016 provincial summit brought together multiple stakeholders to direct research, education, and innovation in primary and community care for SCI. This workshop presents the summit proceedings and recommendations based on the perspectives of consumers, primary care providers, specialists, funders, researchers and program leaders. Over 100 individuals representing people with SCI, care partners, primary care and rehabilitation clinicians, community services, researchers, and policy makers. Perspectives on SCI management and access to care were shared by primary care, neurosurgery, rehabilitation, and members of the SCI community. Panel discussions were delivered by members of the SCI community and primary care clinicians, sharing their lived experiences of primary care and their experiences managing and providing SCI primary care, respectively. Workshop discussions provided an opportunity to identify key barriers and gaps in SCI primary and community care and potential solutions.


Workshop 4: LEADERS LOUNGE: SHARING IDEAS FOR PROGRAM PLANNING
This is a 3 hour workshop and will continue in Session Two

Speakers: Andrea Townson, Rhonda Willms, and Tova Plashkes This session will have two 1.5h parts which will be independent of each other. Those who have been invited specifically to this pre-course are asked to attend both halves; attendees who have not been specifically invited to this pre-course are welcome to attend either half (or both) of the sessions.

This session will bring together leaders from across the country to discuss lessons learned in the area of inpatient and outpatient program planning. The focus will be on inpatient and outpatient models and delivery of care, discharge planning and sustainable length of stay management.

Clinical leaders from across Canada will share their experiences and challenges in the delivery of spinal cord injury program planning. This dialogue will enable programs to reflect upon current best practices and to work together with their national counterparts to develop future benchmarking activities. The session will have three parts:

Brag and steal – submit your 1-2 slides (5 minute presentation) to demonstrate a practical application, resource, or tool that can be shared with other leaders.
The journal of negative results – what ideas have you tried that haven’t worked that you could save others from trying? Submit your 1-2 slides (5 minute presentation).
Open forum – what questions do you have for like minds across the country? What trends are you noticing that need more discussion? Bring your questions for an informal round-table.

Audience: Administrators, Physicians and other clinicians involved in the planning and delivery of SCI care.

Please submit your powerpoint slides to tplashkes@rickhanseninstitute.org by September 29, 2017.


16:05 – 17:35  Concurrent Workshops – Session Two
Workshops 1, 2 and 3 from Session One will be repeated, and Workshop 4 will continue. Please see above for workshop descriptions and details.


Friday, November 10

08:50 – 09:40 Wings For Life Keynote Presentation: Intermittent Hypoxia and Neurorecovery
Speaker: Gordon Mitchell


09:50 – 10:30     The Dr. Nimmi Bharatwal Lectureship Keynote Presentation
Linking Spinal Cord Rehabilitation Between Wars: The Deaver-McKenzie Legacy John F. Ditunno, Jr.

In recognition of Dr. Nirmala Dilip Bharatwal’s 40 years of service to the improvement of human health at the Lyndhurst Centre, Toronto Rehab Foundation established the Dr. Nirmala Dilip Bharatwal Lecture Series in Spinal Cord Injury Research. The Lectureship offers the opportunity to become informed about the latest medical research, diagnosis and treatments for both brain and spinal cord related issues, and allows us to honor the outstanding legacy of Dr. Nimmi Bharatwal – who has selflessly dedicated her life and work to advancing spinal cord injury care.

We are delighted to welcome Dr. John F. Ditunno Jr. as this year’s speaker. Dr. Ditunno is a Professor of Rehabilitation Medicine at the Jefferson Medical College, Thomas Jefferson University and Investigator for the Regional Spinal Cord Injury Center of the Delaware Valley (RSCICDV) which he directed for almost three decades. In his lecture, entitled ‘Linking Spinal Cord Rehabilitation Rehab Between Wars: The Deaver-McKenzie Legacy,’ Dr. Ditunno will explore the lessons and failures to organize care for individuals with spinal cord injuries between World War I and World War II.

At the end of the session, the participants will be able to:

  • Describe the pioneers of rehabilitation from World War I
  • Restate the pioneers of spinal cord rehabilitation centers from World War II
  • Compare and contrast the origins of spinal cord injury rehabilitation between the wars

War creates mass casualties with loss of function due to injuries to the nervous system requiring long term rehabilitation services. Military medicine had responded to these challenges in WW I with categorical treatment centers for peripheral nerve injuries, which were well organized in Germany, England and North America. This model provided guidance for the development of similar services for SCI in WW II. Revolutionary gains in survival, functional restoration, and return to a fuller life was made possible with advances in medicine/surgery and the pioneering efforts of physicians and consumers motivated to restore life with meaning. The lessons learned from WW I regarding failure to provide continuing systematic care resulted in veteran’s programs led by consumers, who have identified their needs and aspirations. In North America, the Canadian model has led the effort that includes civilians, women and children, in addition to veterans in providing comprehensive long-term care for persons with SCI. Target audience: The session will be of value to: Physiatrists, Medical Students, Residents and Rehabilitation Professionals.


10:40 – 12:10  Significant SCI Snippets

Presentation # 1: Social Isolation after Spinal Cord Injury

Speaker: Sander Hitzig

At the end of the session delegates will be able to:

  • Understand the different ways to conceptualize social isolation
  • Describe the influence of social networks post-spinal cord injury on health and wellbeing.

Presentation # 2: Upper Limb Recovery

Speakers: TBD


Presentation # 3: Family Caregiving Skills: Indicators of Successful Caregiving of Individuals with Spinal Cord Injury

Speaker: Gaya Jeyathevan

At the end of the session, delegates will be able to:

  • Summarize current and evolving family caregiving skills
  • Discuss how these indicators of varying levels of skill provide a basis for measurement
  • Discuss how the findings could be used to bridge gaps in the supportive care system and reduce caregiver burden
  • Explain the applicability of the findings at the system level

Family members are most often relied upon to provide complex care at home to individuals with spinal cord injury (SCI), which was formerly provided by traditional healthcare professionals. However, most family caregivers are thrust into this new caregiving role without any formal preparation or training, and this can lead to caregiver burden. Furthermore, such care requires a level of caregiving knowledge and skills. Thus, the purpose of this presentation is to summarize the indicators of family caregiving skill post-SCI, with the ultimate goal of developing a family caregiving skills assessment tool which can be used within any stage along the family care trajectory. The objective of this qualitative descriptive study was to identify the skills needed by family members in caring for individuals with SCI through thematic analysis of semi-structured interviews of individuals with SCI (n=19) and their family members/caregivers (n=15). Thirty-one indicators of caregiving skill were identified for eight caregiving processes. There will also be a brief discussion on how the varying levels of skill can provide a basis for measurement to create a skills assessment tool, which can be applied in clinical settings. Furthermore, the applicability of the findings at the system-level in order to bridge the gaps of the supportive care system as well the individual-level outcomes will be discussed.


Presentation # 4: Redefining UTI: One patient at a time

Objectives: At the end of the session participants will be able to:  

  1. Share proposed new definitions of  a Urinary Tract Infection
  2. Highlight  TRI activities to reduce UTI incidence and prevalence in the inpatient tertiary rehabilitation setting

Speakers: B. Catharine Craven


Presentation # 5: Epidural Stimulation and Cardiovascular Function

Speaker: Chris West

Learning objectives:

  1. Describe what epidural stimulation is and how it works
  2. Describe how the cardiovascular responds to epidural stimulation

Presentation # 6: GRASSP: Next Generation

Speaker: Sukhvinder Kalsi-Ryan

At the end of the session delegates will be able to:

  1. Describe the need for new versions of GRASSP and the process of development.
  2. List the changes to GRASSP Version 2 and implementation strategies.

13:30 – 14:05  Keynote Presentation


14:15 – 15:15  Concurrent Workshops – Session One

Workshop 5: CASE-BASED APPLICATION OF THE CANPAINSCI NEUROPATHIC PAIN CLINICAL PRACTICE GUIDELINES: A WORKSHOP

Speakers: Eldon Loh, Stacey Guy, John Kramer, Tara Jeji, Nancy Xia, and Swati Mehta

Neuropathic pain (NP) is a common secondary complication after spinal cord injury (SCI). The treatment of NP in acute SCI may improve motor recovery, and the management of chronic NP is important to reduce pain intensity, maintain function, and improve quality of life. However, successful management of NP is often challenging. The clinical evidence for management of chronic NP after SCI was recently reviewed as part of the CanPainSCI Clinical Practice Guidelines (CPG), resulting in recommendations for screening and diagnosis, treatment, and models of care. This workshop aims to apply, assess and discuss NP after SCI using the CanPainSCI CPG.
Learning Objectives:

  1. Apply the CanPainSCI CPG in different scenarios using a case-based approach;
  2. Assess the research and clinical implications of the CanPainSCI CPG;
  3. Discuss the long-term goals and priorities for:
    1. research into NP after SCI, and
    2. improving the clinical management of this common complication.

This workshop involves interactive, small-group based case studies focusing on the application of the CPG. The discussion will be facilitated by a multi-disciplinary panel including persons with lived experience, clinicians, and researchers.

This workshop will provide practical examples for the clinical use of the CanPainSCI CPG, allowing participants to gain an appreciation of the current recommendations for management of NP after SCI, as well as gaps in the available evidence. The future research and clinical priorities that should be addressed in order to improve the care of those with NP will be discussed. Barriers to pursuing these priorities, including the challenges of conducting research in NP after SCI, will also be discussed. The importance of integrating the person with lived experience throughout the research to practice spectrum will be emphasized.

This workshop will review the findings of the CanPainSCI CPG, and explore a long-term vision to improve NP management after SCI in Canada. This workshop is relevant to persons living with SCI, clinicians, researchers, and administrators.


Workshop 6: THE 2017 INTERNATIONAL PHYSICAL ACTIVITY GUIDELINES FOR ADULTS WITH SCI

Speakers: Kathleen A. Martin Ginis, Christopher McBride, Robert Shaw, Christopher West The guideline development process was guided by AGREE-II (Appraisal of Guidelines for Research and Evaluation) as well as the principles and values of community-engaged research.

Steps consisted of: (a) conducting a systematic review of relevant literature to provide a guideline evidence base; (b) holding three international consensus panel meetings to formulate the guidelines; and (c) engaging with SCI consumers and other end-users to develop a knowledge translation strategy for promoting and implementing the new guidelines.


 

Workshop 7: GETTING THE RIGHT CARE TO THE RIGHT PERSON AT THE RIGHT TIME!! COLLABORATIVE PRACTICE AMONGST THOSE WISHING TO IMPROVE THE CARE OF PEOPLE LIVING WITH PRESSURE ULCERS.

Speakers: Pamela E., Houghton, Lyndsay Orr, Paul Holyoke, Anna Kras-Dupuis, Dalton Wolfe.

People with SCI and other conditions that impair mobility are very susceptible to pressure ulcers. However, pressure ulcer care available to those living in the community is often disjointed and clinicians working in the field are not connected.  Electrical Stimulation therapy (E-Stim) is a treatment that has long been known to accelerate healing, however, few clinicians provide this treatment.  E-Stim treatment is an excellent example of a best practice that requires a number of people from different backgrounds to come together to make a sustainable change in practice.   It takes collaboration to identify appropriate recipients, secure appropriate equipment and resources, and deliver daily treatments in a safe and effective manner.

Objectives:

  • Review key processes put in place for a best practice implementation project that used KT frameworks to promote sustainable practice changes.
  • Share educational strategies and resources that promote awareness and provide advanced training about Pressure Ulcer care and E-Stim to providers with a variety of backgrounds.
  • Develop and discuss ways to connect and support those interested in implementing pressure ulcers best practices including E-Stim

This interactive session is designed to link clinicians, care providers and consumers interested in promoting best practices in pressure ulcer care provided in the community.  Learnings and preliminary results from a large multi-year best practice implementation project will be used to understand challenges and opportunities facing people working in this field.   Discussions stemming from this session will inform future collaborative initiatives that brings together people from across Canada who are interested in promoting optimal pressure ulcer care with better clinical outcomes.  Lessons learned from this best practice implementation project will certainly be generalizable to other health settings and interventions.


 

Workshop 8: “TEACH-BACK SCI” – PATIENT ORIENTED DISCHARGE STRATEGY (PODS): DESCRIBING A PROCESS FOR OPTIMIZING TRANSITIONS FROM INPATIENT SPINAL CORD INJURY REHABILITATION TO COMMUNITY

Speakers: Sandra Mills, Heather Flett, Carol Scovil, Filomena Mazzella, Helen Morris, and Anellina Ventre A panel of clinicians, leaders and a patient partner involved in PODS will describe the method used to develop and implement this unique approach to planning for discharge. The workshop will include a project overview and key processes and patient and staff outcomes. The panel will share the approach taken to develop and create the unique SCI PODS strategy. Participants will engage in a PODS style meeting to consolidate their own learning of the process.


16:15 – 17:15  Concurrent Workshops – Session Two

Workshop 9: AN INTERACTIVE WORKSHOP IN THE ASSESSMENT AND TREATMENT WITH CANNABINOIDS FOR NEUROPATHIC PAIN AND SPASTICITY IN PEOPLE WITH SPINAL CORD INJURY

Speakers: Karen Ethans & Colleen O’Connell Two internationally known experts in managing pain and spasticity in SCI with cannabinoids will have interactive discussions with interdisciplinary team and case presentations.

At the end of the workshop, delegates will be able to:

  1. Describe the use of medicinal cannabinoids in neuropathic pain and spasticity, including historical use
  2. List the potential therapeutic mechanisms of cannabinoids, in particular THC and CBD
  3. Critique current evidence of cannabinoids and inhaled herbal cannabis, for neurogenic pain and spasticity.
  4. Describe how to prescribe cannabinoids for pain and spasticity in the clinical setting and be able to counsel a patient about the selection of cannabinoids when appropriate
  5. List the rules and regulations for accessing medical marijuana in Canada, and be able to counsel a patient, when appropriate, on the informed process of obtaining medical cannabis.

 

Workshop 10: FAMILY CAREGIVING FOR VETERANS WITH SPINAL CORD INJURY – STRESSES AND BENEFITS

Speaker: Susan Charlifue Twelve focus groups were convened at three Veterans Administration facilities across the US. Participants were family caregivers who agreed to have the sessions audiotaped and transcribed. The transcripts were then coded by three staff members (the lead investigator and two research assistants) to identify themes. Further analysis was performed using NVivo-8 qualitative software.


 

Workshop 11: SCI RESEARCH TODAY ~ VIDEO SERIES DESIGNED TO EDUCATE, EMPOWER, AND INFORM SCI RESEARCH

Speakers: Barry Munro and Anita Kaiser The videos will begin breaking down the biology of the spinal cord and what happens following an injury. The research sections will be broken into five divisions including using cell replacement strategies, stem cells, using technology to ‘wake up” the spinal cord, drugs that can protect the spinal cord from further injury and drugs that can dissolve the barrier of regeneration ~ the glial scare. A section highlighting all the obstacles that come along with research on a small population like spinal cord injury including a lack of funding and the timely process of clinical trials. Each video will end with a call to advocacy outlining how you can become an advocate with an interactive guide.


 

Workshop 12: LOCOMOTOR TRAINING USING AN OVERGROUND ROBOTIC EXOSKELETON IN INDIVIDUALS WITH A CHRONIC MOTOR COMPLETE SPINAL CORD INJURY: LESSONS LEARNED FROM A FEASIBILITY STUDY IN TERMS OF RECRUITMENT, ATTENDANCE, PERFORMANCE, LEARNABILITY, AND SAFETY

Speakers: Dany H. Gagnon, Manuel Jose Escalona Castillo, Martin Vermette, Lívia Pinheiro Carvalho, Mylène Aubertin-Leheudre, and Cyril Duclos Individuals with a SCI were invited to participate in a 6 to 8-week locomotor training program with a robotic exoskeleton encompassing a total of 18 sessions. Selected participants underwent a comprehensive screening process and completed two familiarization sessions with the robotic exoskeleton. The outcome measures are the rate of recruitment of potential participants, the rate of attendance at training sessions, the ability to walk with the exoskeleton and its progression over the course of the program, and the adverse events.


17:25 – 18:15  Top 6 Articles You Need to Read

Randomized Trial of a Peer-Led Telephone-based Empowerment Intervention for Persons with Chronic Spinal Cord Injury Improves Health Self-Management Archives PM&R 2017 (accepted 1 Feb)


Saturday, November 11

08:50 – 09:40  Keynote Presentation: Neural Stem Cells: From Basic Biology to Tissue Repair
Cindi M. Morshead


Scientific Poster Presentations by Award Winning Recipients

RE-SHAPING AND RE-INVIGORATING SCI REHABILITATION PRACTICE THROUGH A PRACTICE-BASED RESEARCH APPROACH

Speakers: Dalton Wolfe, Stephanie Cornell, Julie Gagliardi, and Stephanie Marrocco Illustrative examples will be presented by a researcher, a front-line clinician and a program manager that outline key adopted methods, processes and resulting outcomes associated with the practice-based approaches initiated over the past 1.5 years. These will include formation of research to practice (R2P) teams, intentional reflective practice methods, clinical protocol development, integrated systems for data management and clinical decision support and development of key indicators within an evaluative framework – all directed toward improving practice, outcomes and evidence generation associated with conventional and advanced therapies for locomotor training. The audience will be encouraged to reflect and share their own experiences that relate to the examples.


 

BARRIERS AND FACILITATORS TO SKIN CARE IN PEOPLE WITH A SPINAL CORD INJURY

Speakers: Justine Baron, Jennifer Tomasone, Dorothyann Curran, Toba Miller, and Jeremy Grimshaw People with a SCI were recruited to semi-structured interviews featuring questions designed using a behaviour change framework, the Theoretical Domains Framework (TDF). Transcripts were double-coded according to their relevance to the 14 determinants of behaviour proposed in the TDF (knowledge; skills; social influence; beliefs about consequences, etc.).


 

MANAGEMENT OF OBESITY AFTER SPINAL CORD INJURY: A SYSTEMATIC REVIEW

Speakers: Mir Hatef Shojaeia, Mohammad Alavinia, and B. Catharine Craven This review included English and non-English articles, published prior to January 2017 found in PubMed/Medline, Embase, Cinahl, Psychinfo and Cochrane databases. Studies evaluating any obesity management strategy alone or in combination including diet therapy, physical exercises, passive exercises like neuro-muscular electric stimulation (NMES), pharmacotherapy, and surgery, among individuals with chronic SCI were included. Outcomes of interest were declines in waist circumference, body weight, body mass index and Total Fat Mass (TFM) and increases in total lean body mass (TLBM). From 3553 titles and abstracts were selected, 34 articles underwent full text review and 23 articles for data abstraction. Weight loss due to inflammation, cancer or B12 deficiency was excluded. The quality of the selected studies was evaluated by Cochrane Collaboration’s tool and found to be generally poor with 2 exceptions.


 

MONITORING FUNCTIONAL HAND USE WITH WEARABLE CAMERAS: TOWARDS A NOVEL OUTCOME MEASURE FOR UPPER EXTREMITY FUNCTION AT HOME

Speakers: Jirapat Likitlersuang, Elizabeth Sumitro, Sukhvinder Kalsi-Ryan, and José Zariffa The first step of the video-processing algorithm is to segment out the hand from the cluttered and variable background. The second step is to extract image features associated with interactions, based on motion and shape descriptors. These features are inputted into a Random Forest classifier to classify video frames as representing interactions or not. The output is filtered with a moving average.


 

BARRIERS AND FACILITATORS TO AN ANTI-INFLAMMATORY DIET IN INDIVIDUALS WITH SPINAL CORD INJURY

Speakers: Katie Lenz, Katie, K. Alysse Bailey, David Allison, and David Ditor People with a SCI were recruited to semi-structured interviews featuring questions designed using a behaviour change framework, the Theoretical Domains Framework (TDF). Transcripts were double-coded according to their relevance to the 14 determinants of behaviour proposed in the TDF (knowledge; skills; social influence; beliefs about consequences, etc.).


 

CLUSTERING RECURRENT HAND POSTURES OF INDIVIDUALS WITH SPINAL CORD INJURY IN WEARABLE CAMERA VIDEO

Speakers: Elizabeth Sumitro, Jirapat Likitlersuang, Sukhvinder Kalsi-Ryan, and José Zariffa The clustering algorithm employed was based on the Determinantal Point Process. Image features were extracted by representing each hand using a masked histogram of orientated gradients descriptor, which has been shown to work well for videos of able-bodied individuals. We validated this approach using 1,125 hand images from 3 individuals with SCI.


 

SINGLE NEURON CONTROL IN BRAIN-MACHINE INTERFACES

Speakers: Martha Garcia-Garcia, Cesar Marquez-Chin, and Milos R. Popovic A rat was implanted with an electrode array in the motor cortex and trained to trigger a reward dispenser by activating a single cortical neuron at progressively higher firing rates. Biofeedback of the firing rate was provided as the change in brightness of a light-emitting diode. The rat was trained in 10-20-minute long experiments at a time. Neurons were classified based on their firing behaviour and spike waveform shape.


 

EFFECT OF SPECIALIZED INPATIENT REHABILITATION ON RETURNING HOME FOR PEOPLE WITH TRAUMATIC SPINAL CORD INJURY

Speakers: Christiana L. Cheng, Tova Plashkes, Tian Shen, Nader Fallah, Suzanne Humphreys, Colleen O’Connell, Angelo Gary Linassi, Chester Ho, Christine Short, Karen Ethans, Rebecca Charbonneau, Jerome Paquet, and Vanessa Noonan The Rick Hansen SCI Registry (RHSCIR) was used to identify patients with tSCI discharged from one of 18 participating acute specialized spine facilities between 2011-2013 to either one of 13 participating specialized rehabilitation facilities, or another discharge destination. To determine if specialized rehabilitation affected likelihood of returning home, multiple logistic regressions and propensity score matching were performed. Chi-square test was used to compare rate of return home between matched groups.


 

SECONDARY HEALTH CONDITIONS: IMPACT ON FUNCTION, HEALTH-RELATED QUALITY OF LIFE, AND LIFE SATISFACTION FOLLOWING TRAUMATIC SPINAL CORD INJURY

Speakers: Carly S. Rivers, Nader Fallah, Vanessa K. Noonan, David Whitehurst, Carolyn Schwartz, Joel Finkelstein, B. Catharine Craven, Karen Ethans, Colleen O’Connell, Catherine Truchon, Chester Ho, Gary A. Linassi, Christine Short, Eve Tsai, Brian Drew, Henry Ahn, Marcel Dvorak, Jérôme Paquet, Michael G. Fehlings, and Luc Noreau Participants from the Rick Hansen Institute

Spinal Cord Injury Registry, treated at 31 Canadian acute/rehabilitation SCI centres with community follow-up between 9-18 months were included. Relationships among SCI severity ASIA Impairment Scale A-D and level (cervical/thoracolumbar), age at injury, post-discharge education, number of SHCs, function [Functional Independence Measure (FIM)], HRQoL [Short Form-36 physical/mental component scores (PCS, MCS)], and life satisfaction [Life Satisfaction-11 (LiSat-11)] were analyzed. Path analysis was conducted using Mplus (v7.1); model fit was assessed using published indices.


 

GARMENT DEVICES FOR DELIVERY OF COMPLEX FUNCTIONAL ELECTRICAL STIMULATION IN INDIVIDUALS WITH SPINAL CORD INJURY

Speakers: Bastien Moineau, Milad Alizadeh-Meghrazi, Gabriel Stefan, Kei Masani, and Milos Popovic We designed novel wearable devices, the stimulation garments, to deliver FES on several predefined muscles without use of conductive gel. The devices have the appearance of stockings, which can stimulate lower-limbs (e.g., to stand up), and shirts capable of stimulating upper-limbs (e.g., to pick up objects). Up to 8 different muscles can be activated independently. The fabric electrodes and necessary wires are incorporated in the garment. We tested its usability with healthy individuals.


 

A COST-UTILITY ANALYSIS COMPARING ELDERLY AND YOUNGER INDIVIDUALS WITH TRAUMATIC CERVICAL SPINAL CORD INJURY REGARDING THEIR INITIAL CARE AND REHABILITATION

Speakers: Julio Furlan, Michael G. Fehlings, and Catharine B. Craven The aging of the population has modified the epidemiology of traumatic spinal cord injury (SCI) with an increased frequency of fall-related injuries among the elderly. Given the paucity of economic studies involving elderly individuals with SCI, a cost-utility analysis (CUA) was undertaken to assess the economic impact of older age (65 years of age or older) in the context of acute surgical management and rehabilitation of traumatic cervical SCI.

At the end of this session, participants will be able to:

  1. Describe how the aging of the population has recently changed epidemiology of traumatic spinal cord injury;
  2. Identify the potential effects of older age on the recovery after acute traumatic spinal cord injury;
  3. Describe the economic impact of older age on the initial management of patients with acute traumatic spinal cord injury.

 

13:30 – 14:20 Keynote Presentation: Post Traumatic Stress Disorder & Military Veterans – Reggie Edgerton


15:30 – 16:30  Concurrent Workshops

Workshop 13: TOWARDS BETTER MANAGEMENT OF OBSTRUCTIVE SLEEP APNOEA (OSA) IN TETRAPLEGIA

Speakers: Marnie Graco, Susan Cross and David Berlowitz

Background
Prevalence of OSA in people with chronic spinal cord injury (SCI) is estimated at between 28% and 77%; three to five times higher than in the able-bodied. OSA is associated with reduced quality of life and substantial neurocognitive deficits in people with SCI. Current guidelines recommend polysomnography (PSG) for all people with SCI and symptoms of OSA, and continuous positive airway pressure (CPAP) for those with a positive diagnosis. However PSG is a resource intensive and frequently inaccessible test, especially in SCI. Most people remain undiagnosed and access to treatment is typically delayed by long waiting lists and complex clinical pathways. To address these problems in the able-bodied population, alternative screening and treatment models have been developed.

Objectives
This workshop aims to present the current literature regarding the management of OSA in the able-bodied and SCI populations, including our validation of an alternative screening model for detecting moderate to severe OSA in chronic tetraplegia. We will also present our qualitative research describing current clinical practice in the diagnosis and management of OSA in SCI. Using this information, workshop participants will discuss how alternative screening and treatment models could be integrated into the clinical care of people with tetraplegia, to improve diagnosis rates, access to treatments, and ultimately, quality of life.

Design and Methods
A two-stage model of questionnaire followed by oximetry, initially developed and validated in the able-bodied, was modified in an existing dataset of 78 people with tetraplegia. Model accuracy was evaluated in the development dataset and is being prospectively validated in 100 participants with chronic, traumatic tetraplegia across four international SCI units. A sub-set of this sample has been implemented with CPAP and participants are being prospectively followed to determine adherence rates, qualitative and quantitative determinants of CPAP use. In-depth semi-structured interviews are being conducted with physicians managing people with tetraplegia to describe current practice in the management of OSA and to identify factors influencing practice.

Results
Multivariate analysis identified five risk factors for inclusion in the new screening questionnaire. To date, 76 of 100 participants have completed the validation study. The two-stage model had a sensitivity of 90%(95%CI=74-97) and a specificity of 90%(78-96) in the development group, and 76%(60-87) and 77%(62-87) in the validation group. Better CPAP adherence appears associated with more severe OSA and higher early use, but CPAP adherence overall is poor. Qualitative analysis of participant interviews suggests that many participants do not recognise the extent of their OSA symptoms until after they are treated. Most spinal physicians do not routinely screen for symptoms of OSA. When OSA is suspected, patients are typically referred to specialist sleep/respiratory services for diagnosis and ongoing management.

Conclusions
There is potential for safe, alternative screening and treatment models that could substantially increase the detection of OSA in tetraplegia and improve access to treatments.


 

Workshop 14: SHIFTING THE FOCUS: DELIVERING PEER-LED, PERSON-CENTERED PEER MENTORSHIP IN SCI INPATIENT REHABILITATION AND COMMUNITY SETTINGS

Speakers: Shane N. Sweet, Julie Gassaway and Rob Shaw

This workshop will highlight interrelated examples of person-centered peer mentorship across the rehabilitation-community spectrum. First, a SCI peer mentor-mentee interaction will be demonstrated and discussed. Next, two successful US peer mentorship programs will be presented: an inpatient rehabilitation initiative and a health empowerment community-based program. Two Canadian project discussions will highlight the effectiveness of providing standardized training to peer mentors using a person-centered Transformational Leadership (TFL) approach and lessons learned from an evaluation of an existing, community-based peer mentorship service. Throughout the workshop, we will engage participants in discussing the person-centered approaches presented. At the end of the workshop, participants will be able to:

  • Identify client-centered strategies in SCI peer mentorship
  • Discuss how client-centred approaches can be useful in SCI peer mentorship
  • Summarize the emerging evidence for the efficacy of person-centered SCI peer mentorship

Workshop 15: MOVING FROM PRIORITIZATION TO IMPLEMENTATION: THE SPINAL CORD INJURY REHABILITATION CARE HIGH PERFORMANCE INDICATORS (SCI-HIGH) PROJECT

Speakers: B. Catharine Craven, Heather Flett, Sander Hitzig, Farnoosh Farahani, Mohammad S. Alavinia, Maryam Omidvar, and Mark Bayley An external advisory committee of stakeholders was assembled to rank the top 10 of 37 RC domains using an established prioritization methodology (Hanlon method) and feasibility scoring. Eleven RC domains were identified and national working groups formed to develop and implement structure, process and outcome indicators relevant to these RC domains. Working groups deliberated regarding health system deficiencies and gaps in knowledge generation and clinical application. Ishikawa diagrams , outcome measure audits, clinical practice guidelines, and optimal models of service delivery were used to inform the working group’s consensus processes and subsequent indicator outputs. Potential indicators were piloted to assess feasibility and inform standard operating procedure (SOP) development and formulation of preliminary benchmarks.


Workshop 16: THE ABILITY NETWORK – AN INTERNATIONAL INITIATIVE TO OPTIMIZE THE MANAGEMENT OF SPASTICITY FOLLOWING SPINAL CORD DAMAGE

Speakers: Anthony Burns, Gerald Bilsky, and Indira Lanig Methods: The Ability Network consists of 18 clinical experts from Australia, Canada, Europe (9 countries), and the United States. Three working groups were established – definition and assessment, outcomes and access, and clinical pathway. Consensus was sought on common definitions through facilitated, in-person meetings. Literature reviews of existing measures and face-to-face meetings were conducted to incorporate clinical experience and develop expert consensus. The process led to the development of recommendations for initial assessment, clinical management, and evaluation of treatment outcomes.


Workshop 17: How to find a mentor and mentorship session for graduate students and young investigators

Moderators: Julio C. Furlan & Sukhvinder Kalsi-Ryan At the end of this session, participants will be able to:‎

  • Describe how to find or select the right mentor;
  • Identify the mentee’s roles and responsibilities;
  • Describe the key attributes of an effective mentor-mentee relationship;
  • Recognize quality mentorship based on the small group discussions with experienced mentors.