Triti Khorasheh, Lucie Langford, Mariza Croosfernando, Dawn Richards, B. C. Craven
The engagement of people with lived experience (PLEX) of spinal cord injury/disease (SCI/D) in rehabilitation research can lead to relevant questions and improved data collection, interpretation, knowledge translation, and research impact. We describe the process to create a toolkit which elaborates the roles that PLEX can play in rehabilitation research to ensure engagement is authentic and effective. Five separate working groups were convened to each focus on a specific role of PLEX: research team member, peer reviewer, knowledge translator, decision-maker, and fundraising ambassador. The roles of PLEX in research, relevant training tools, and indicators to measure engagement were explored through 17 virtual meetings with 45 scientists, research staff, learners, and PLEX. Menti-meter and Survey Monkey were used to select training tools via consensus. A summative meeting was held with all participants to achieve consensus regarding the role descriptions. Meeting transcripts and survey data informed iterations of the materials prior to achieving consensus. The Toolkit contains five role descriptions for PLEX as well as example activities, training requirements for scientists and PLEX, and specific indicators for each role. The Toolkit includes several best practice considerations and three practical tools for researchers to plan engagement, facilitate compensation, and implement/evaluate engagement. The Toolkit can be used by researchers and research organizations to develop, implement, and evaluate engagement plans with PLEX in SCI/D rehabilitation research. This Toolkit can be used to transform the SCI/D rehabilitation research and advocacy agenda, and contribute to more relevant research with a greater impact.
{"title":"Poster (Clinical/Best Practice Implementation) ID 1985364","authors":"Triti Khorasheh, Lucie Langford, Mariza Croosfernando, Dawn Richards, B. C. Craven","doi":"10.46292/sci23-1985364s","DOIUrl":"https://doi.org/10.46292/sci23-1985364s","url":null,"abstract":"The engagement of people with lived experience (PLEX) of spinal cord injury/disease (SCI/D) in rehabilitation research can lead to relevant questions and improved data collection, interpretation, knowledge translation, and research impact. We describe the process to create a toolkit which elaborates the roles that PLEX can play in rehabilitation research to ensure engagement is authentic and effective. Five separate working groups were convened to each focus on a specific role of PLEX: research team member, peer reviewer, knowledge translator, decision-maker, and fundraising ambassador. The roles of PLEX in research, relevant training tools, and indicators to measure engagement were explored through 17 virtual meetings with 45 scientists, research staff, learners, and PLEX. Menti-meter and Survey Monkey were used to select training tools via consensus. A summative meeting was held with all participants to achieve consensus regarding the role descriptions. Meeting transcripts and survey data informed iterations of the materials prior to achieving consensus. The Toolkit contains five role descriptions for PLEX as well as example activities, training requirements for scientists and PLEX, and specific indicators for each role. The Toolkit includes several best practice considerations and three practical tools for researchers to plan engagement, facilitate compensation, and implement/evaluate engagement. The Toolkit can be used by researchers and research organizations to develop, implement, and evaluate engagement plans with PLEX in SCI/D rehabilitation research. This Toolkit can be used to transform the SCI/D rehabilitation research and advocacy agenda, and contribute to more relevant research with a greater impact.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"14 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Darren J. Mann, Jane A. Porter, Deborah O. Okusanya, Justin Lee, Zahra Karamzadeh, Monique Yuan, Trevor S. Barss, Vivian K. Mushahwar
Functional electrical stimulation (FES)-assisted arm and leg (A&L) cycling is an effective rehabilitative intervention for improving walking following an incomplete spinal cord injury (SCI). The goal of this study was to assess the potential benefits of combining transcutaneous spinal cord stimulation (tSCS) with A&L cycling to potentially improve functional mobility and activities of daily living for persons living with motor complete SCI. This is a case study of a participant with AIS B SCI. The participant has been undergoing FES-assisted A&L cycling training combined with cervical and lumbar tSCS (1 hr/day, 5 days/week) for 37 weeks. Assessments were performed pre-training and every 6 weeks thereafter and include the International Standards for Neurological Classification of SCI (ISNCSCI), time able to stand while assisted, and training load of each exercise session. Although there were no changes in the ISNCSCI scores, the duration of assisted standing increased from 10s per-training to 33.5s at 36 weeks post-training. Interestingly, the addition of tSCS enhanced standing duration to 38.5s. Moreover, the total power output exerted by the participant consistently increased over time. This study provides, for the first time, evidence that FES-assisted A&L cycling paired with non-invasive tSCS can be safely completed after severe SCI and leads to improvements in training load and assisted standing. Additional assessments will be incorporated to further identify improvements in function and quality of life. Future work will assess the benefits of using epidural spinal cord stimulation combined with A&L cycling after motor complete SCI.
{"title":"Student Competition (Knowledge Generation) ID 1985170","authors":"Darren J. Mann, Jane A. Porter, Deborah O. Okusanya, Justin Lee, Zahra Karamzadeh, Monique Yuan, Trevor S. Barss, Vivian K. Mushahwar","doi":"10.46292/sci23-1985170s","DOIUrl":"https://doi.org/10.46292/sci23-1985170s","url":null,"abstract":"Functional electrical stimulation (FES)-assisted arm and leg (A&L) cycling is an effective rehabilitative intervention for improving walking following an incomplete spinal cord injury (SCI). The goal of this study was to assess the potential benefits of combining transcutaneous spinal cord stimulation (tSCS) with A&L cycling to potentially improve functional mobility and activities of daily living for persons living with motor complete SCI. This is a case study of a participant with AIS B SCI. The participant has been undergoing FES-assisted A&L cycling training combined with cervical and lumbar tSCS (1 hr/day, 5 days/week) for 37 weeks. Assessments were performed pre-training and every 6 weeks thereafter and include the International Standards for Neurological Classification of SCI (ISNCSCI), time able to stand while assisted, and training load of each exercise session. Although there were no changes in the ISNCSCI scores, the duration of assisted standing increased from 10s per-training to 33.5s at 36 weeks post-training. Interestingly, the addition of tSCS enhanced standing duration to 38.5s. Moreover, the total power output exerted by the participant consistently increased over time. This study provides, for the first time, evidence that FES-assisted A&L cycling paired with non-invasive tSCS can be safely completed after severe SCI and leads to improvements in training load and assisted standing. Additional assessments will be incorporated to further identify improvements in function and quality of life. Future work will assess the benefits of using epidural spinal cord stimulation combined with A&L cycling after motor complete SCI.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"10 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Exercising after spinal cord injury (SCI) is necessary to prevent or reduce secondary complications such as obesity, cardiovascular disease, or type II diabetes. The effects of SCI on muscle and autonomic functions determine type, duration, and intensity of exercise capacity. Although SCI exercise guidelines exist, achieving these recommendations requires a comprehensive understanding of how muscle and autonomic function affect a person’s exercise capability. Therefore, we reviewed the effect of SCI level on muscle and sympathetic function during exercise for those living with SCI to better develop strategies to achieve these guidelines. A literature review of exercise, muscle control and SCI was performed to identify muscles innervated by each level and how key sympathetic tissues and organs required for exercise are affected by SCI. We identified spinal levels responsible for increasing heart rate, cardiovascular smooth muscle contraction, inducing sweat and activating adrenal glands since these are essential in maintaining high intensity and long duration exercise. We translated the information into a comprehensive user-friendly poster. A comprehensive graphical poster was developed for those living with SCI to understand and identify how their level of SCI affects their muscle and sympathetic function needed for optimal exercise and to meet exercise guidelines. This infographic fills a void since this type of ‘person-centred’ information is lacking in the SCI and exercise field. The knowledge acquired through this infographic could further guide training practices and exercise modifications to increase exercise capacity and quality of life for those living with SCI.
{"title":"Student Competition (Knowledge Generation) ID 1985154","authors":"Juanita Garcia, Kristine Cowley","doi":"10.46292/sci23-1985154s","DOIUrl":"https://doi.org/10.46292/sci23-1985154s","url":null,"abstract":"Exercising after spinal cord injury (SCI) is necessary to prevent or reduce secondary complications such as obesity, cardiovascular disease, or type II diabetes. The effects of SCI on muscle and autonomic functions determine type, duration, and intensity of exercise capacity. Although SCI exercise guidelines exist, achieving these recommendations requires a comprehensive understanding of how muscle and autonomic function affect a person’s exercise capability. Therefore, we reviewed the effect of SCI level on muscle and sympathetic function during exercise for those living with SCI to better develop strategies to achieve these guidelines. A literature review of exercise, muscle control and SCI was performed to identify muscles innervated by each level and how key sympathetic tissues and organs required for exercise are affected by SCI. We identified spinal levels responsible for increasing heart rate, cardiovascular smooth muscle contraction, inducing sweat and activating adrenal glands since these are essential in maintaining high intensity and long duration exercise. We translated the information into a comprehensive user-friendly poster. A comprehensive graphical poster was developed for those living with SCI to understand and identify how their level of SCI affects their muscle and sympathetic function needed for optimal exercise and to meet exercise guidelines. This infographic fills a void since this type of ‘person-centred’ information is lacking in the SCI and exercise field. The knowledge acquired through this infographic could further guide training practices and exercise modifications to increase exercise capacity and quality of life for those living with SCI.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"76 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Drug-induced myelopathy has been reported widely for heroin use, but less frequently for amphetamines or fentanyl. Hyperglycemia-induced acute myelopathy has not previously been described. We present a case of toxic/metabolic myelopathy secondary to the aforementioned results in a patient presenting for tertiary inpatient rehabilitation. A 28-year-old man with Type 1 Diabetes without complications and polysubstance use (fentanyl and crystal methamphetamine) presented to hospital with quadriparesis and anesthesia. Patient reported he fell down a flight of stairs while using substances and remained on the ground for hours-days as he was acutely paralyzed when he awoke. Initial examination demonstrated a C5 motor level. Pan-CT demonstrated no intracranial or spinous abnormalities. MRI with gadolinium showed cord edema from C1-T4 and patchy enhancement from C4-C7 without cord compression. Diffusion restriction and hemorrhagic transformation were later seen in C4-C7. Initial blood glucose was 66 with no serum ketones. Serum toxicology was negative and urine toxicology was positive for amphetamines and fentanyl. Autoimmune and infectious workups were negative. He received 5 days of pulse steroids and 7 sessions of plasmapheresis with minimal functional or neurological improvement. He was admitted to rehabilitation as a C5 AIS-B and did not exhibit further improvement in motor or sensory function over 3 months of active inpatient rehab. Given the pattern of cord enhancement with hemorrhagic transformation, this injury most likely represents acute myelitis induced by hyperglycemia and amphetamines/fentanyl. To our knowledge, this is the first case report where hyperglycemia may have contributed to acute myelopathy.
{"title":"Student Competition (Knowledge Generation) ID 1984525","authors":"Nicholas Sequeira, B. C. Craven","doi":"10.46292/sci23-1984525s","DOIUrl":"https://doi.org/10.46292/sci23-1984525s","url":null,"abstract":"Drug-induced myelopathy has been reported widely for heroin use, but less frequently for amphetamines or fentanyl. Hyperglycemia-induced acute myelopathy has not previously been described. We present a case of toxic/metabolic myelopathy secondary to the aforementioned results in a patient presenting for tertiary inpatient rehabilitation. A 28-year-old man with Type 1 Diabetes without complications and polysubstance use (fentanyl and crystal methamphetamine) presented to hospital with quadriparesis and anesthesia. Patient reported he fell down a flight of stairs while using substances and remained on the ground for hours-days as he was acutely paralyzed when he awoke. Initial examination demonstrated a C5 motor level. Pan-CT demonstrated no intracranial or spinous abnormalities. MRI with gadolinium showed cord edema from C1-T4 and patchy enhancement from C4-C7 without cord compression. Diffusion restriction and hemorrhagic transformation were later seen in C4-C7. Initial blood glucose was 66 with no serum ketones. Serum toxicology was negative and urine toxicology was positive for amphetamines and fentanyl. Autoimmune and infectious workups were negative. He received 5 days of pulse steroids and 7 sessions of plasmapheresis with minimal functional or neurological improvement. He was admitted to rehabilitation as a C5 AIS-B and did not exhibit further improvement in motor or sensory function over 3 months of active inpatient rehab. Given the pattern of cord enhancement with hemorrhagic transformation, this injury most likely represents acute myelitis induced by hyperglycemia and amphetamines/fentanyl. To our knowledge, this is the first case report where hyperglycemia may have contributed to acute myelopathy.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"3 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Monitoring skin integrity is a critical issue for patients with spinal cord injury. Damage to the skin can go unnoticed due to sensory loss or diminution and can result in pressure injuries or wounds that can be difficult to heal. A team of inpatient clinicians and people with lived experience worked together to create a ‘SkIn-fo-Graphic’ that would be used to teach all new inpatients how to do a full body skin check. A full picture of the body, contributed by Spinal Cord Injury Ontario (SCIO), was marked with the names of specific bony prominences and areas which should be viewed daily to ensure a skin check is complete. Staff at our Centre modified the graphic and created step-by-step instructions. Patients provided feedback on terminology and placement of words/ arrows for clarity. Further refinement was completed by SCIO and clinical staff to create the final tool and instructions. A graphic was developed iteratively by a community organization, physicians, allied health professionals and patients to provide a tool with instructions that can be used by both clinical staff (to teach daily skin check) and patients (as a reference for doing their own checks). A QR Code link was also created to directly link patients to more in-depth skin education on the community partner website. Engaging all stakeholders in the development of a key tool for instruction of skin check in patients with spinal cord injury is important to ensure complete clarity and utility.
对于脊髓损伤患者来说，监测皮肤完整性是一个至关重要的问题。由于感觉缺失或减弱，皮肤损伤可能会被忽视，并可能导致难以愈合的压力伤或伤口。一个由住院临床医生和有生活经验者组成的团队共同制作了一张 "SkIn-fo-Graphic"，用于教所有新住院病人如何进行全身皮肤检查。 由安大略省脊髓损伤协会（SCIO）提供的人体全图上标注了特定骨骼突起和部位的名称，这些部位应每天查看，以确保皮肤检查完整。我们中心的员工对图形进行了修改，并制作了分步说明。患者就术语和字词/箭头的位置提供了反馈意见，以提高清晰度。SCIO 和临床工作人员进一步完善了最终的工具和说明。 一个社区组织、医生、专职医疗人员和患者反复开发了一个图形，以提供一个带有说明的工具，供临床工作人员（教授日常皮肤检查）和患者（作为自己进行检查时的参考）使用。还创建了一个 QR 码链接，直接将患者链接到社区合作伙伴网站上更深入的皮肤教育。 让所有利益相关者都参与到脊髓损伤患者皮肤检查关键工具的开发中，对于确保工具的清晰度和实用性非常重要。
{"title":"Poster (Clinical/Best Practice Implementation) ID 1984775","authors":"Andrea Chase, Vidya Sreenivasan, Dorothyann Curran, Monica Robichaud, Lorraine Maddigan, Tory Bowman","doi":"10.46292/sci23-1984775s","DOIUrl":"https://doi.org/10.46292/sci23-1984775s","url":null,"abstract":"Monitoring skin integrity is a critical issue for patients with spinal cord injury. Damage to the skin can go unnoticed due to sensory loss or diminution and can result in pressure injuries or wounds that can be difficult to heal. A team of inpatient clinicians and people with lived experience worked together to create a ‘SkIn-fo-Graphic’ that would be used to teach all new inpatients how to do a full body skin check. A full picture of the body, contributed by Spinal Cord Injury Ontario (SCIO), was marked with the names of specific bony prominences and areas which should be viewed daily to ensure a skin check is complete. Staff at our Centre modified the graphic and created step-by-step instructions. Patients provided feedback on terminology and placement of words/ arrows for clarity. Further refinement was completed by SCIO and clinical staff to create the final tool and instructions. A graphic was developed iteratively by a community organization, physicians, allied health professionals and patients to provide a tool with instructions that can be used by both clinical staff (to teach daily skin check) and patients (as a reference for doing their own checks). A QR Code link was also created to directly link patients to more in-depth skin education on the community partner website. Engaging all stakeholders in the development of a key tool for instruction of skin check in patients with spinal cord injury is important to ensure complete clarity and utility.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"13 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139345097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shajaky Parameswaran, Thomas P. Walden, Louise Brisbois, B. C. Craven
Following a traumatic spinal cord injury (tSCI), patients prioritize being able to manage their bowels independently. A reduction of independence can impact an individual’s quality of life. The current study investigates the relationships between sphincter control, level of independence and quality of life. We hypothesized that sphincter control would relate strongly to levels of independence and quality of life. Adults with tSCI who consented to participate in the Rick Hansen Spinal Cord Injury Registry at the Lyndhurst Rehabilitation Centre completed community follow-up interviews from 2014-2021. Data was collected at baseline, year 1, 2 and 5 (n = 330). Descriptive data and neurological level of injury (NLI) were collected, along with the Life Satisfaction Questionnaire (LiSAT-11), 36-item Short Form Survey Quality of Life measures (SF-36v2) and the Spinal Cord Independence Measure III (SCIM). Separate analyses were conducted for NLI C1-T10 (upper motor neuron [UMN] [n=280]), and T11-S5 (lower motor neuron [LMN] [n=50]). Associations between sphincter management and life satisfaction were calculated using Spearman’s correlation coefficient, adjusted for age and sex. SCIM had a moderate, yet significant relationship with LiSAT-11 (r2=0.48, p<0.001) for LMN, but no relationship for UMN (r2= 0.17, p<0.001). A weak relationship was observed between SCIM and SF-36v2 for LMN (r2=0.30, p=0.014) but no relationship for UMN (r2=0.01, p=0.59). Sphincter management scores after rehabilitation discharge are not a strong predictor of life satisfaction following tSCI suggesting that a multifaceted approach is required to assess an individuals’ quality of life post tSCI.
{"title":"Student Competition (Knowledge Generation) ID 1984770","authors":"Shajaky Parameswaran, Thomas P. Walden, Louise Brisbois, B. C. Craven","doi":"10.46292/sci23-1984770s","DOIUrl":"https://doi.org/10.46292/sci23-1984770s","url":null,"abstract":"Following a traumatic spinal cord injury (tSCI), patients prioritize being able to manage their bowels independently. A reduction of independence can impact an individual’s quality of life. The current study investigates the relationships between sphincter control, level of independence and quality of life. We hypothesized that sphincter control would relate strongly to levels of independence and quality of life. Adults with tSCI who consented to participate in the Rick Hansen Spinal Cord Injury Registry at the Lyndhurst Rehabilitation Centre completed community follow-up interviews from 2014-2021. Data was collected at baseline, year 1, 2 and 5 (n = 330). Descriptive data and neurological level of injury (NLI) were collected, along with the Life Satisfaction Questionnaire (LiSAT-11), 36-item Short Form Survey Quality of Life measures (SF-36v2) and the Spinal Cord Independence Measure III (SCIM). Separate analyses were conducted for NLI C1-T10 (upper motor neuron [UMN] [n=280]), and T11-S5 (lower motor neuron [LMN] [n=50]). Associations between sphincter management and life satisfaction were calculated using Spearman’s correlation coefficient, adjusted for age and sex. SCIM had a moderate, yet significant relationship with LiSAT-11 (r2=0.48, p<0.001) for LMN, but no relationship for UMN (r2= 0.17, p<0.001). A weak relationship was observed between SCIM and SF-36v2 for LMN (r2=0.30, p=0.014) but no relationship for UMN (r2=0.01, p=0.59). Sphincter management scores after rehabilitation discharge are not a strong predictor of life satisfaction following tSCI suggesting that a multifaceted approach is required to assess an individuals’ quality of life post tSCI.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"9 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139345683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Merna Seliman, Julianne W. Y. Hong, Stephanie Marrocco, Erica Lo, K. Walden, Andrea Chase, Jean François Lemay, Sarah Donkers, D. Wolfe
Rehabilitation approaches after Spinal Cord Injury (SCI) differ across rehabilitation centres and between therapists. Differences may be influenced by factors such as therapeutic approaches, equipment availability, training provided for therapists, or demographics of admitted patients. A measure of physical function that is widely used within Canadian rehabilitation centres is the Standing and Walking Assessment Tool (SWAT). It is not clear what factors or therapeutic approaches lead to optimal standing and walking outcomes in the SCI population. To explore the perspectives of physio-therapists on factors that affect standing and walking outcomes in inpatient SCI rehabilitation. Three focus groups were conducted with nine physiotherapists representing seven inpatient rehabilitation centres across Canada to provide their perspectives on current practices and to gain in-depth insights into centre-specific factors that may influence standing and walking outcomes. Thematic analysis was used to analyze the focus group data. Thematic analysis revealed that high treatment intensity and frequency are needed for optimal standing and walking outcomes. Physiotherapists emphasized that appropriate length of stay was essential to deliver an effective treatment plan. They noted, however, that there is pressure to discharge patients quickly leading to shorter length of stays and a perceived compromise in outcomes. Physiotherapists emphasized the importance of building rapport with patients, creating an exciting therapeutic environment, and the availability of enough staff for optimal recovery. The findings of this qualitative study will inform the implementation and development of opportunities to optimize standing and walking outcomes across rehabilitation centres in Canada.
{"title":"Poster (Knowledge Generation) ID 1985172","authors":"Merna Seliman, Julianne W. Y. Hong, Stephanie Marrocco, Erica Lo, K. Walden, Andrea Chase, Jean François Lemay, Sarah Donkers, D. Wolfe","doi":"10.46292/sci23-1985172s","DOIUrl":"https://doi.org/10.46292/sci23-1985172s","url":null,"abstract":"Rehabilitation approaches after Spinal Cord Injury (SCI) differ across rehabilitation centres and between therapists. Differences may be influenced by factors such as therapeutic approaches, equipment availability, training provided for therapists, or demographics of admitted patients. A measure of physical function that is widely used within Canadian rehabilitation centres is the Standing and Walking Assessment Tool (SWAT). It is not clear what factors or therapeutic approaches lead to optimal standing and walking outcomes in the SCI population. To explore the perspectives of physio-therapists on factors that affect standing and walking outcomes in inpatient SCI rehabilitation. Three focus groups were conducted with nine physiotherapists representing seven inpatient rehabilitation centres across Canada to provide their perspectives on current practices and to gain in-depth insights into centre-specific factors that may influence standing and walking outcomes. Thematic analysis was used to analyze the focus group data. Thematic analysis revealed that high treatment intensity and frequency are needed for optimal standing and walking outcomes. Physiotherapists emphasized that appropriate length of stay was essential to deliver an effective treatment plan. They noted, however, that there is pressure to discharge patients quickly leading to shorter length of stays and a perceived compromise in outcomes. Physiotherapists emphasized the importance of building rapport with patients, creating an exciting therapeutic environment, and the availability of enough staff for optimal recovery. The findings of this qualitative study will inform the implementation and development of opportunities to optimize standing and walking outcomes across rehabilitation centres in Canada.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"231 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Merna Seliman, Charlie Giurleo, Stacy Elliott, Marie Carlson, A. Kras-Dupuis, D. Wolfe, Kate McBride
Sexual health is an important component of overall health. Yet, sexuality is often neglected in rehabilitation. Studies indicate that typically clinicians do not address the sexual health concerns of patients because of lack of adequate training, comfort, and knowledge in this area. The purpose of this initiative was to develop and implement an e-learning module to address the current gap in rehabilitation practice. In 2021, an interdisciplinary team of rehab clinicians worked with an Instructional Designer based at Parkwood Institute to develop e-Learning modules aimed to introduce rehab teams to sexual health rehab and application to practice. The modules were launched at Parkwood Institute in January 2022 and were compulsory education for all rehabilitation staff in Spinal Cord, Acquired Brain Injury and Stroke programs. They were subsequently launched more broadly at Vancouver Coastal Health in March 2022. Surveys were conducted to assess the impact of the modules on clinical application. To date,186/209 (89%) of rehabilitation staff at Parkwood Institute and a total of 55 clinicians from Vancouver Coastal Health have completed the modules. Preliminary results show improvement in confidence, knowledge, and ability to address the sexual health needs of rehabilitation patients. The e-Learning modules help fill the current practice gap and facilitate sustainability of sexual health practice in clinical settings. Accessible educational opportunities such as the e-modules are valuable tools in enhancing self-efficacy of staff when addressing sexual health concerns of patients.
{"title":"Poster (Clinical/Best Practice Implementation) ID 1985003","authors":"Merna Seliman, Charlie Giurleo, Stacy Elliott, Marie Carlson, A. Kras-Dupuis, D. Wolfe, Kate McBride","doi":"10.46292/sci23-1985003s","DOIUrl":"https://doi.org/10.46292/sci23-1985003s","url":null,"abstract":"Sexual health is an important component of overall health. Yet, sexuality is often neglected in rehabilitation. Studies indicate that typically clinicians do not address the sexual health concerns of patients because of lack of adequate training, comfort, and knowledge in this area. The purpose of this initiative was to develop and implement an e-learning module to address the current gap in rehabilitation practice. In 2021, an interdisciplinary team of rehab clinicians worked with an Instructional Designer based at Parkwood Institute to develop e-Learning modules aimed to introduce rehab teams to sexual health rehab and application to practice. The modules were launched at Parkwood Institute in January 2022 and were compulsory education for all rehabilitation staff in Spinal Cord, Acquired Brain Injury and Stroke programs. They were subsequently launched more broadly at Vancouver Coastal Health in March 2022. Surveys were conducted to assess the impact of the modules on clinical application. To date,186/209 (89%) of rehabilitation staff at Parkwood Institute and a total of 55 clinicians from Vancouver Coastal Health have completed the modules. Preliminary results show improvement in confidence, knowledge, and ability to address the sexual health needs of rehabilitation patients. The e-Learning modules help fill the current practice gap and facilitate sustainability of sexual health practice in clinical settings. Accessible educational opportunities such as the e-modules are valuable tools in enhancing self-efficacy of staff when addressing sexual health concerns of patients.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"33 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep disorders are more common among individuals living with spinal cord injury and spinal cord disease (SCI/D) than among non-disabled people. Upon completion of this workshop, attendees will (1) understand the pathophysiology, diagnosis, classification, clinical consequences and management of the most common sleep disorders in non-disabled people; (2) recognise the current knowledge, knowledge gaps, and recently research-generated knowledge on sleep disorders in individuals living with SCI/D; and (3) appreciate the use of an educational tool to raise awareness on sleep disorders among individuals with SCI/D. This workshop will include two 20-minute lectures with illustrative cases followed by open discussion on the following topics: (i) pathophysiology, diagnosis, classification, clinical consequences and management of the most common sleep disorders in non-disabled people; and (ii) the current knowledge, knowledge gaps, and recently research-generated knowledge on sleep disorders in individuals living with SCI/D. Finally, an example of educational tool on sleep for individuals living with SCI/D will be presented. Untreated sleep disorders can have significant short-term and long-term consequences. Early diagnosis and timely treatment is key in the prevention or mitigation of consequences of sleep disorders. Proper management of sleep disorders can have psychosocial and functional impacts on the lives of individuals with SCI/D; it may also mitigate other secondary medical conditions after SCI/D. Finally, there is a pressing need to raise awareness of this issue among individuals living with SCI/D and healthcare professionals. Sleep disorders are common and understudied in the SCI/D population. Early diagnosis and proper treatment is key to improve the lives of individuals with SCI/D and, likely, reduce other secondary medical conditions from SCI/D. Raising awareness on sleep disorders among individuals with SCI/D is needed.
{"title":"Workshop (Clinical/Best Practice Implementation) ID 2000430","authors":"Julio C Furlan, Mitsue S. Aibe, M. Boulos","doi":"10.46292/sci23-2000430s","DOIUrl":"https://doi.org/10.46292/sci23-2000430s","url":null,"abstract":"Sleep disorders are more common among individuals living with spinal cord injury and spinal cord disease (SCI/D) than among non-disabled people. Upon completion of this workshop, attendees will (1) understand the pathophysiology, diagnosis, classification, clinical consequences and management of the most common sleep disorders in non-disabled people; (2) recognise the current knowledge, knowledge gaps, and recently research-generated knowledge on sleep disorders in individuals living with SCI/D; and (3) appreciate the use of an educational tool to raise awareness on sleep disorders among individuals with SCI/D. This workshop will include two 20-minute lectures with illustrative cases followed by open discussion on the following topics: (i) pathophysiology, diagnosis, classification, clinical consequences and management of the most common sleep disorders in non-disabled people; and (ii) the current knowledge, knowledge gaps, and recently research-generated knowledge on sleep disorders in individuals living with SCI/D. Finally, an example of educational tool on sleep for individuals living with SCI/D will be presented. Untreated sleep disorders can have significant short-term and long-term consequences. Early diagnosis and timely treatment is key in the prevention or mitigation of consequences of sleep disorders. Proper management of sleep disorders can have psychosocial and functional impacts on the lives of individuals with SCI/D; it may also mitigate other secondary medical conditions after SCI/D. Finally, there is a pressing need to raise awareness of this issue among individuals living with SCI/D and healthcare professionals. Sleep disorders are common and understudied in the SCI/D population. Early diagnosis and proper treatment is key to improve the lives of individuals with SCI/D and, likely, reduce other secondary medical conditions from SCI/D. Raising awareness on sleep disorders among individuals with SCI/D is needed.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"100 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study examined the effects of concomitant TBI on injury epidemiology, management and outcomes of individuals with traumatic SCI. A propensity-score matched cohort study compared a SCI+TBI group (n=1018) with a SCI-only group (n=3687), which were matched on a 1:1 ratio by age, sex, severity and level of SCI, and Charlson Comorbidity Index. TBI was defined as a Glasgow coma score of <15 at admission. Both groups were compared regarding injury epidemiology (mechanism, ethnicity, GCS, other injuries), management (mechanical ventilation, traction, Methylprednisone, surgery, time to decompression), and post-SCI outcomes (length of stay [LOS], International Standards for Neurological Classification of SCI [ISNCSCI] motor subscore, Functional Independence Measure, discharge destination, spasticity and pain at discharge). Overall, being white (OR=5.332, p=0.0265) was associated with having TBI, while having other body injuries (OR=0.095, p=0.0065) was associated with the SCI-only group. Odds of dying in a hospital were 2.442 times larger for the TBI+SCI group. The TBI+SCI group had longer acute-care LOS. Both groups had similar rehabilitation LOS. Odds of being discharged to nursing homes/long-term care facilities were 1.949 times higher for TBI+SCI individuals. Concomitant TBI did not influence change in ISNCSCI motor subscore from initial admission to final discharge. Odds of individuals with pain was 1.52 times higher for the TBI+SCI group. Occurrence of spasticity was similar between the groups. This study highlights discrepancies between the TBI+SCI and SCI-only groups regarding injury epidemiology, survival, discharge disposition, and pain. Both groups experienced similar access to treatment services, motor recovery, and spasticity. These data were presented in the 2022 Annual Meeting of the American Neurological Association, which has a different attendance audience.
{"title":"Poster (Clinical/Best Practice Implementation) ID 1969157","authors":"Julio C Furlan, Di Wang","doi":"10.46292/sci23-1969157s","DOIUrl":"https://doi.org/10.46292/sci23-1969157s","url":null,"abstract":"This study examined the effects of concomitant TBI on injury epidemiology, management and outcomes of individuals with traumatic SCI. A propensity-score matched cohort study compared a SCI+TBI group (n=1018) with a SCI-only group (n=3687), which were matched on a 1:1 ratio by age, sex, severity and level of SCI, and Charlson Comorbidity Index. TBI was defined as a Glasgow coma score of <15 at admission. Both groups were compared regarding injury epidemiology (mechanism, ethnicity, GCS, other injuries), management (mechanical ventilation, traction, Methylprednisone, surgery, time to decompression), and post-SCI outcomes (length of stay [LOS], International Standards for Neurological Classification of SCI [ISNCSCI] motor subscore, Functional Independence Measure, discharge destination, spasticity and pain at discharge). Overall, being white (OR=5.332, p=0.0265) was associated with having TBI, while having other body injuries (OR=0.095, p=0.0065) was associated with the SCI-only group. Odds of dying in a hospital were 2.442 times larger for the TBI+SCI group. The TBI+SCI group had longer acute-care LOS. Both groups had similar rehabilitation LOS. Odds of being discharged to nursing homes/long-term care facilities were 1.949 times higher for TBI+SCI individuals. Concomitant TBI did not influence change in ISNCSCI motor subscore from initial admission to final discharge. Odds of individuals with pain was 1.52 times higher for the TBI+SCI group. Occurrence of spasticity was similar between the groups. This study highlights discrepancies between the TBI+SCI and SCI-only groups regarding injury epidemiology, survival, discharge disposition, and pain. Both groups experienced similar access to treatment services, motor recovery, and spasticity. These data were presented in the 2022 Annual Meeting of the American Neurological Association, which has a different attendance audience.","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"51 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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