Workshop 1-1

Individualized balance assessment and training for people with spinal cord injuries: A hands on workshop

Janelle Unger 1,2, Kristin E Musselman 1,2,3
1. Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
2. Lyndhurst Centre, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
3. Department of Physical Therapy, University of Toronto, Toronto, ON, Canada

Background: People with spinal cord injuries/disease (SCI/D) are at high risk for falls, which can have negative consequences such as injury, mobility restriction, and social isolation. Poor balance may contribute to fall risk in this population. More specifically, a deficit in reactive balance, the component of balance control that allows recovery from a loss of balance, has been linked to falls. Despite this link, standardized assessments of reactive balance are not commonly used in clinical practice. Further, balance training is often not prioritized during inpatient rehabilitation. To address the SCI/D population’s high fall risk, greater emphasis on the assessment and training of balance, and in particular reactive balance, is needed. We have used the Systems Framework for Postural Control to create systematic and individualized assessment and treatment plans for individuals with SCI/D. The Systems Framework describes the components that are used to maintain postural control, with the knowledge that impairment in any component could increase fall risk. These components, including biomechanical constraints, movement and sensory strategies, orientation in space, control of dynamics, and cognitive processing, can be targeted through individualized treatment plans depending on where impairments exist.

Learning Objectives: After completing this workshop, participants will be able to:

  • Comprehensively assess balance control, including reactive balance, in individuals with SCI/D in a clinical setting. Assessments to be discussed include the Mini-Balance Evaluation Systems Test and the Lean-and-Release Test;
  • Understand key principles of perturbation-based balance training, a method of training reactive balance control, and;
  • Plan and execute an individualized balance training program for individuals with SCI/D based on the Systems Framework for Postural Control.

Workshop Structure: This workshop will discuss how researchers and clinicians can optimize balance control for individuals with spinal cord injuries or diseases (SCI/D). Using lecture content, small group discussion, case-based learning, and hands-on practice, the speakers will discuss and explain various balance assessments and treatment plans for people with SCI/D, with a focus on reactive balance.
Keywords: Therapies, Rehabilitation outcome, Clinical application


Workshop 1-2

Improving communication in care and research: Health Literacy 101

UHN Toronto Rehab Brain and Spinal Cord Injury Program, Lyndhurst Centre Toronto, ON Canada

Objectives: At the end of the workshop, participants will be able to:

  • Describe the extent of low literacy in Canada and the adverse effects that low literacy has on health
  • Relate how plain language materials support patient-centred care
  • Assess the readability of the materials you use in patient care and research
  • Apply plain language techniques to your own communication
  • List available resources

Design This workshop will be an engaging look at the implications of health literacy on clinical practice and research initiatives. You are encouraged to bring an example of a patient education resource or research letter to people with spinal cord injury to review and revise during the workshop.
Keywords: Effective practice, Healthcare delivery, Self-management


Workshop 1-3

The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury: What’s new?

Kristen Walden 1 , Lise Belanger 2
1. Rick Hansen Institute, Vancouver, BC, Canada
2. Vancouver Spine Program, Vancouver General Hospital, Vancouver, BC, Canada

Background:The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) represents the gold standard for determination of the level and severity of an SCI. Over the years, ISNCSCI has undergone several revisions with its eighth edition released in April 2019. The most recent changes include:1) A new taxonomy for documentation of non-SCI related impairments, such as peripheral nerve injuries, fractures, burns, pain or age-related muscle weaknesses. 2) The Zone of Partial Preservation (ZPP) definition has been refined. In prior ISNCSCI editions, ZPPs were only defined for AIS A injuries, which is not intuitive and restricts the value of ZPPs for effective clinical communication to complete lesions only. Motor ZPPs are now defined and should be documented in all cases including patients with incomplete injuries with absent Voluntary Anal Contraction (VAC). The sensory ZPP on a given side is defined in the absence of sensory function in S4-5 (Light Touch, Pin Prick) on this side as long as Deep Anal Pressure (DAP) is not present. In addition, an Expedited ISNCSCI exam, or E-ISNCSCI, has also been developed for use. Methods: This workshop will be an interactive session to get informed about the newest ISNCSCI changes. It will involve lecture-based and case-based learning, along with practice in classifying using the updated ISNCSCI classification rules.
Participants: This workshop is for participants who use the ISNCSCI in either clinical practice or research. Participants should come with a basic knowledge of ISNCSCI. Learning

Objectives: At the end of the workshop, participants will be able to:

  • Explore the changes introduced with the 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).
  • Apply the new definitions and rules in practical sample cases.
  • Interactively classify difficult ISNCSCI cases.
  • Recognize the appropriate use of the E-ISNCSCI exam

Keywords: Physical examinations and diagnoses, Rehabilitation outcome, Knowledge translation


Workshop 1-4

Leaders Lounge: Bridging the gap through knowledge exchange and the drive to improve care

B. Catharine Craven 1,2, Farnoosh Farahani 1
1. Neural Engineering & Therapeutics Team, KITE, Toronto Rehabilitation Institute –UHN, Toronto, ON, Canada
2. Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada

This workshop will be comprised of two 1.5h sessions which will be related to one another. Attendees are welcome to attend either half (or both) of the sessions. The yield for leaders will likely be greater for those attending 2 sessions. This workshop will bring together leaders from across Ontario to discuss lessons learned from the activities of the Spinal Cord Injury Implementation & Evaluation Quality Care Consortium (SCI IEQCC). Clinical leaders will share their experiences and challenges in adopting a health indicator framework model for measuring quality improvement within their program. The focus will be on evaluation priorities, implementation strategies, and building capacity for use of performance information to manage and advance rehab care delivery.
The session will have three elements:

  • 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 – Discussion of learning systems to inform, support, and transfer knowledge related to enhancing practice accountability.

Objectives: At the end of the workshop, participants will be able to:

  • Identify best practices which can support a framework of performance indicators that may be compared across various SCI rehabilitation jurisdictions
  • Describe strategic plans for sustainability of indicator development, and improvement in efficiency which can lead to future benchmarking activities

Audience: Administrators, physicians and other clinicians involved in the planning and delivery of SCI care.
Keywords: Best practice implementation, Healthcare delivery, Knowledge translation


Workshop 2-1

“Pearls & Oysters” in the methodology for clinical SCI research: A practical approach to write and review research proposals

Julio C. Furlan 1,2 and Mohammad Alavinia 1,2
1. Toronto Rehabilitation Institute – KITE, University Health Network, Toronto, Canada
2. Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada

Objectives: At the end of the workshop, participants will be able to:

  • Review the main study designs and their advantages and disadvantages;
  • Discuss potential sources of bias in clinical research;
  • Describe strategies to control for potential confounding effects; and
  • Examine relevant aspects of the sample size estimation and feasibility analysis in the context of spinal cord injury (SCI) research.

Design/Methods: The workshop will include didactic presentations from the workshop leaders, and allow for small group discussions of “pearls & oysters” in methodology for clinical research in the field of SCI.
Participants: This workshop will be of interest to trainees, scientists and stakeholders in the area of clinical research in SCI.
Results: The research question is the backbone of a clinical study. Selection of the most appropriate study design to address the research question is essential for the success of a project. Proper evaluation of the potential challenges and pitfalls of a research project can prevent interim protocol corrections, delays and regrets. The choice of the most appropriate outcome measure for a particular research question is the fundament to precisely estimate the sample size in order to test the study hypothesis. Feasibility analysis requires an ample overview of the study protocol and available resources for the research project.
Conclusion: Ideally, anyone ought to know the principles and guidelines of the methodology for clinical research when either writing or reviewing a project proposal. Clinical research in the field of SCI has several peculiarities that must be considered when analysing a research proposal. Methodological flaws can prevent a clinical study to efficiently address a great research question and, hence, everyone should embrace the “pearls” and avoid the “oysters”.
Keywords: Clinical application, Statistical data analysis, Medicine, Evidence-based


Workshop 3-1

Sex and Gender Considerations in Health Research

Angela Colantonio,
Toronto Rehabilitation Institute-UHN Toronto, Ontario, Canada

The integration of sex and gender considerations in research is considered good science however this has not been systematically implemented in research including in spinal cord injury research. Further, the Canadian Institutes for Health Research and other funding agencies are requiring that sex and gender to be addressed in grant proposals. The overall aim of this workshop is to provide participants with an introduction to sex and gender based analyses in health research. Learning objectives include 1) to identify definitions of sex and gender and 2) to recognize elements of sex and gender based analyses in quantitative and qualitative research. The workshop will provide examples from the neurotrauma literature. Resources pertaining to sex and gender in research will be provided to participants
Keywords: Healthcare delivery, Analysis, Decision, Practice equity/gaps


Workshop 3-2

“Back to the Future”- Functional Electrical Stimulation (FES) therapy combined with task-specific training versus FES integrated to Brain-Computer Interface (BCI) technology

Julio C. Furlan 1,2, Cesar Marquez-Chin 1
1. Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada   2. University of Toronto, Toronto, ON, Canada

Objectives: At the end of the workshop, participants will be able to:

  • Examine the potential benefits of FES therapy combined to task-specific training for the rehabilitation of voluntary extremity movement after spinal cord injury or disease (SCI/D);
  • Discuss potential mechanisms of action of FES therapy combined to task-specific training;
  • Describe concept and components of brain-computer interface technology, and
  • Share the results of a FES integrated to BCI technology study.

Design/Methods: The workshop will include didactic presentations from the workshop leaders, and allow for small group discussions of pathophysiologic mechanisms and procedures. The studies that will be discussed included individuals with either SCI/D or stroke.
Participants: This workshop will be of interest to stakeholders, clinicians and scientists in the field with interest in neurorehabilitation.
Results: Numerous prior studies reported improved outcomes after FES-therapy in combination with task-specific training in terms of reduction of impairment and disability after SCI/D. A recent systematic review with scoping synthesis examined the literature on the potential mechanisms of action of FES therapy along with task-specific training. While this neuromodulation strategy is well recognised, its limitations have driven investigations on a novel rehabilitative modality using FES integrated to BCI technology. This session will outline the results that were achieved using a BCI-triggered FES therapy.
Conclusion: Neuromodulation plays a key role in the rehabilitation of individuals with SCI/D. The combination of FES-therapy and task-specific training has been used in the restoration of voluntary movements for individuals with motor impairment from different neurological diseases including SCI/D. In the quest for new neuromodulation therapies, it was conceptualized the FES integrated to BCI technology that represents a challenge and opportunity increase the efficacy of FES therapy.
Keywords: Therapies, Technology, Biomedical, Engineering


Workshop 3-3

Autonomic dysreflexia and heterotopic ossification: Barriers to optimal management in the spinal sord injury population.

Christine Ann Short 1,2, Sonja D McVeigh 1,2, Andrea Townson 3,4
1. Dalhousie University Faculty of Medicine
2. Nova Scotia Health Authority
3. University of British Columbia
4. Vancouver Costal Health

Background: Heterotopic Ossification (HO) and Autonomic Dysreflexia(AD) are both common complications of spinal cord injury that can be challenging to treat. Recent changes in access to medications that have some evidence base for treating these conditions has made management even more difficult. Along with this lack of knowledge in non-rehabilitation specialties often creates barriers to patients accessing timely appropriate care for these conditions.

Objectives: At the end of the workshop, participants will be able to:

  • Review the current treatment guidelines for AD and HO
  • Explore the barriers to managing patients under these guidelines including access to medications for treatments and knowledge of these conditions in the non-rehabilitation medical settings.

Design/method: This will be an interactive focus group exercise.
Participants: consumers with spinal cord injury (including families and care givers) and medical experts in spinal cord injury
Results: The hope of this session is to start preliminary work toward a Canadian document to guide the treatment of these conditions despite the current lack of access to evidence based therapies. This would include recommendations how to move forward with research and education to optimize the treatment of these two challenging complications of spinal cord injury. Conclusions: Changes in access to medications to treat AD and HO are presenting new challenges to persons with spinal cord injury and their treatment teams. Pooling knowledge and experience from consumers and rehabilitation experts can help us find new ways to optimize management.
Keywords: Therapies, Physical medicine and rehabilitation, Medicine, Evidence-based


Workshop 3-4

The Multidisciplinary Use of the Sexual Rehabilitation Framework in Persons with SCI

Stacy Elliott, BA, MD, 1-3
1Departments of Psychiatry and Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
2International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada
3GF Strong Rehabilitation Centre, and the Blusson Spinal Cord Centre, Vancouver Coastal Health, Vancouver, BC, Canada

Objectives: At the end of the workshop, participants will be able to:

  • Explain the reasons behind the development of the SRF
  • Demonstrate, with clinical examples, the inclusiveness of sexual issues beyond sexual functioning per se
  • Compare how different disciplines can utilize the SRF to the same therapeutic end
  • Provide resources for further information in this area.

The Sexual Rehabilitation Framework (SRF) is a valuable user- friendly one-page tool designed to be used by numerous disciplines to move sexual health and reproductive issues forward towards therapeutic management in persons with SCI or other chronic illnesses. Inclusive of primary sexual issues (sexual interest, genital arousal, orgasm, ejaculation) it also covers the secondary consequences of SCI including sensory and motor, bladder and bowel, autonomic and fertility and contraceptive issues, and recognizes the individual’s psychosexual issues such as sexual self-esteem and relationships. The emphasis will be on women with SCI as clinical examples of individual sexual and reproductive issues, their consequences and therapeutic opportunities the SRF can assist with.


Workshop 4-1

Developing an effective mentor and mentee relationship: What graduate students and young investigators should know and do.

Sukhvinder Kalsi-Ryan 1, Nora Cullen 2.
1. Affiliate Scientist, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network; and Assistant Professor, Department of Physical Therapy, University of Toronto
2. Chief of Staff, Westpark Healthcare Centre Scientist, Toronto Rehabilitation Institute Associate Professor, Department of Medicine, University of Toronto

Objectives: At the end of this workshop, 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.

This workshop will provide an overview of the important aspects that graduate students and young investigators should consider prior to selecting their mentors. While interpersonal affinity plays a role in the choice for a mentor, there are many other attributes that the graduate students and young investigators should consider before making their decision. The key elements of a well suited mentor, mentee’s roles and responsibilities, and an effective mentor-mentee relationship will be reviewed.
Attendees will have the opportunity to meet with experienced mentors to clarify their questions in small groups.
Keywords: Postgraduate medical students, Community groups, Knowledge translation


Workshop 4-2

It’s legal – now what? Practical guidance for cannabis use in spinal cord injury

Colleen M O’Connell 1, Karen Ethans 2
1. Stan Cassidy Centre for Rehabilitation, Fredericton, NB CAnada
2. University of Manitoba, Winnipeg, MB Canada

Herbal cannabis, in various forms of administration, has emerged as a popular choice for self-management of pain and spasticity among persons with spinal cord injury. Whole cannabis contains hundreds of compounds, including approximately 60 or more cannabinoids, of which delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD, non-psychoactive) are two of the major bioactive compounds. Cannabinoids show promise as therapeutic agents, but for decades their development through research, trials and clinical use has been complicated by the placement of herbal cannabis in the Schedule I category by the UN and its drug conventions. Despite the difficulties in doing research with a product that has been/is illegal depending on country, a number of clinical studies have been conducted which suggest that cannabinoid therapy may provide at least a subjective reduction of spasticity in patients, and recent reviews have concluded there is at least moderate evidence for use in chronic pain. Although research on endogenous cannabinoid systems and potential cannabinoid pharmaceuticals is increasing, there has been intense societal pressure to make herbal cannabis available for medicinal use; in Canada cannabis for medical purposes has been legal since 2002. In 2018, recreation cannabis was legalized in Canada.
This interactive session will present current guidance on use of cannabis for symptom management in spinal cord injury, with focus on minimizing risks including drug interactions, misuse, and contraindications, while optimizing therapeutic outcomes, including patient selection, product choice, dosing and titration, and comprehensive management of patients using cannabis.
Keywords: Medicine, Evidence-based, Emerging evidence, Treatment effectiveness


Workshop 4-3

Addressing the elephant in the room: Integrating sexual health practice in spinal cord injury (SCI) rehabilitation

Charlie Giurleo 1, Anna Kras-Dupuis 1
1. St. Joseph’s Health Care London Parkwood Institute Main Building, London, ON, Canada

Background: Sexual health, a basic human right, may be disrupted after SCI. Many people with SCI have questions about their sexuality that are often not addressed in rehabilitation. An interdisciplinary team at Parkwood Institute identified sexual health as a significant gap in clinical practice. 90% of patients surveyed were unaware of resources and their sexual health concerns were not addressed during rehabilitation.

Objectives: At the end of the workshop, participants will be able to:

  • Embed sexual health education and support for patients with SCI into clinical practice, by increasing clinicians’ knowledge and confidence.

Methods/Overview: In 2017-18, a team of clinicians, researchers and persons with lived experience followed a systematic process and Implementation Science principles (Fixsen et al., 2005) to fully develop the new sexual health practice. The PLISSIT model (Annon, 1974) and Sexual Rehabilitation Framework (Elliott et al., 2017) were incorporated into the new practice. A comprehensive education plan included awareness sessions and a 2-day interactive workshop. Adult SCI inpatients on the 15-bed Regional Rehabilitation unit and SCI outpatients have been the recipients of the new sexual health practice as of June 2018.
Results/Discussion: At 6 months into the launch of the new sexual health practice both patient and health care provider surveys were conducted. Patients reported increased awareness of sexual health resources from 39% to 55% and increased satisfaction that their sexual health concerns were addressed from 35% to 72%. Multi-faceted education on a variety of topics has been offered. A resource area on the SCI unit has been created for patients and caregivers. Clinicians reported increased knowledge and self-efficacy in addressing patients’ sexual health concerns from 62% to 85% and increased knowledge of sexual health resources from 46% to 88%. This has played a major role in normalizing sexual health concerns and questions, thereby addressing the “elephant in the room”. Pending results of chart audits and qualitative interviews with clinicians and patients will inform any potential improvements, with an ultimate goal of sustainable and consistent practice for all SCI patients. This practice will then be scaled to other patient populations.
Conclusions: Embedding this practice facilitates reintegration of sexual health into the daily lives of SCI patients and supports a more comprehensive and holistic rehabilitation. A systematic process for practice implementation, a sound evaluation plan, and a participatory approach, have been the key factors for sustainability.
Keywords: Physical medicine and rehabilitation, Best practice implementation, Clinical application


Workshop 4-4

A staged framework for the clinical implementation of new rehabilitation technologies after SCI

José Zariffa 1,2,3, Brian C. Chan 1, Heather Flett 1, Kristin E. Musselman 1,3,4
1. Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
2. Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
3. Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
4. Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada

In recent years, spinal cord injury (SCI) rehabilitation research has emphasized the promotion of functional neurorecovery, or the restoration of function through repetitive movement training of the affected limbs. Technologies including robotic devices and functional electrical stimulation have been developed to facilitate repetitive motor training. However, few of these technologies have been implemented into mainstream clinical practice. In order to facilitate the planning of clinical implementation for new rehabilitation technologies, this workshop will describe a novel staged version of the FAME (Feasibility, Appropriateness, Meaningfulness, Effectiveness, Economic Evidence) Framework. The staged FAME Framework provides researchers, clinicians and technology developers with a structured approach to evaluate the translational potential of new rehabilitation technologies and interventions.

Objectives: At the end of the workshop, participants will be able to:

  • Identify how a staged approach to the development and implementation of new rehabilitation technologies can facilitate the translation of research to rehabilitation practice for individuals with SCI.
  • Identify methods that may be used to evaluate the feasibility, appropriateness, meaningfulness, effectiveness, and economic evidence of new rehabilitation technologies. Methods discussed will include identifying implementation barriers, gathering input from literature and end-users, evaluating patient experience, and evaluating costs and resource utilization.
  • Develop a staged translation plan for a research study or clinical implementation project using the staged FAME Framework.

The workshop will involve lecture-based and case-based learning, in which participants will be asked to apply the staged FAME Framework to one of their research studies or clinical implementation projects. The workshop will provide participants with skills and resources that can be used to facilitate the translation of knowledge and technologies from research to clinical settings.
Keywords: Health care technology, Knowledge implementation, Benefits and costs


Workshop 5-1

Through the lens of participants: Incorporating photovoice into research and clinical environments

Hardeep Singh 1,2, Olinda Habib Perez 1, Kristin E. Musselman 1,2,3
1. Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada;
2. Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada;
3. Dept. of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
Capturing detailed information is essential for researchers, clinicians and policy makers working in healthcare. An organized approach is necessary for the collection, analysis and dissemination of such detailed information. Photovoice is a qualitative participatory research method that allows detailed information to be collected on a topic; for example, the accessibility of community environments or the factors impacting an individual’s or groups’ function, participation, and quality of life.1 With photovoice, participants capture photographs of a issue or topic and then participate in an interview and/or focus group discussion of how the photographic content relates to their life. It is a person-centered approach that can inform potential solutions to address individual and public health needs and priorities.2 Photovoice can also help researchers form appropriate research questions, hypotheses, and theories based on the participants’ perspectives,2 or it can be used as a needs assessment tool to guide clinical interventions.2 As well, the photographs and narratives can communicate areas of concern to policy makers, health practitioners, and/or researchers.3 In this workshop, we will introduce the photovoice approach, outline practical steps on how to conduct photovoice, and discuss the utility of photovoice in research and clinical environments.
The target audience is healthcare professionals, researchers and policy makers.

Objectives: At the end of the workshop, participants will be able to:

  • Describe the principles, rationale, and value of using photovoice in research and clinical settings;
  • Create a photo-assignment and collect information using the photovoice approach for clinical or research purposes;
  • Analyze, interpret, and synthesize photographic and narrative information generated from photovoice to fulfil their research or clinical purposes.

Information in this workshop will be delivered through small and large group discussions, and through examples from the presenters’ experiences of using photovoice to inform fall prevention initiatives for individuals with spinal cord injury. During the workshop participants will be asked to plan a photovoice project to address one of their research or clinical questions. Participants will gain a unique approach for gathering detailed information using photovoice that can be easily applied in research and clinical contexts.
Keywords: Clinical application, Knowledge generation, Knowledge translation


Workshop 5-2

Functional electric stimulation cycling guidelines for adults with SCI: a presentation and engagement workshop focussing on implementation

Dr Jan W. van der Scheer 1,2, Dr Chester Ho 1
1. University of British Columbia | Okanagan (Kelowna, BC, Canada)
2. Loughborough University (Loughborough, United Kingdom)
3. University of Alberta (Edmonton, Alberta, Canada)

Objectives: At the end of the workshop, participants will be able to:

  • Present the process and outcomes of developing evidence-based, international, co-produced functional electrical stimulation cycling guidelines for adults with spinal cord injury (SCI);
  • Provide feedback on how to best implement the guidelines in clinical and community settings

Methods of developing the guidelines:

  • Scoping review mapping the literature on various types of FES exercise for any FES user group
  • Engagement workshop and steering group meetings with researchers, clinicians, practitioners and SCI consumers to define the scope and purpose of the guidelines
  • A systematic review in accordance with the decided scope and purpose of the project, i.e. FES cycling exercise for adults with SCI
  • Deliberating the evidence synthesis and guideline recommendations from the systematic with international expert panels including researchers, practitioners and FES users to reach consensus about the guidelines
  • External feedback round about the guideline draft from SCI clinicians, practitioners and SCI consumers, leading to the final draft of the guidelines
  • Assessment of the guidelines and the development process by an independent Appraisal of Guidelines for Research and Evaluation (AGREE) consultant

Participants of the workshop: Aimed at researchers, clinicians, practitioners and SCI consumers interested or engaged in functional electrical stimulation, exercise, rehabilitation and/or guideline implementation. Methods used during the workshop: Presentations (by Dr Jan van der Scheer and Dr Chester Ho), followed by a live, interactive survey about values and preferences on how to best implement the guidelines in practice; workshop participants will answer questions using their mobile device, which will be displayed anonymously on the overhead projector’s screen, followed by discussions with the audience about the answers provided (led by Dr Jan van der Scheer and Dr Chester Ho)
Conclusion: The feedback gained during the workshop will be further discussed in a steering group meeting about implementation of the guidelines in Canadian clinical and community settings, leading to a draft of national, provincial and/or local plans to use the guidelines across Canada.
Keywords: Physical medicine and rehabilitation, Clinical application, Knowledge implementation


Workshop 5-3

Home care for individuals with spinal cord injury: what does the data tell us and does it reflect reality?

Brian C.F. Chan 1, James Milligan 2, Peter Athanasopoulos 3,4
1. Toronto Rehabilitation Institute, Toronto, ON, Canada
2. Centre for Family Medicine, Kitchener, ON, Canada
3. Spinal Cord Injury Ontario, Toronto, ON, Canada
4. Ontario SCI Solutions Alliance, Toronto, ON, Canada

Objectives: At the end of the workshop, participants will be able to:

  • Review the results of a home care utilization study conducted using Ontario health care administrative data.
  • Contextualize the results of the study from different perspectives.
  • Develop a path forward for further evidence development and dialogue for the purpose of ensuring that individuals with SCI receive adequate home care.

Design/Methods: To understand the trends regarding home care use for individuals with SCI in Ontario, an analysis was conducted using health care administrative data. The findings from this study were interesting and surprising in terms of the volume and nature of services. However, are the study results reflective of clinician’s observations and lived experience? In this workshop, numerous stakeholders will provide different perspectives on home care support for individuals with SCI and offer context regarding the Ontario home care study. The workshop will begin with a quick summary of the methods and results presented by the clinical researcher from Toronto Rehab Institute. This will be followed-up by a 5-10 minute commentary provided by each of the panelists. An open question and answer period with participation from the audience and panel members will then follow for 15 minutes. The facilitator will then close the workshop by summarizing the key learnings.
Participants: The study was based on individuals with traumatic SCI living in Ontario.
Results: In Ontario, the median number of hours of Community Care Access Centre home care nursing received by an individual with SCI per month ranges from 2 to 8 in the first year after discharge from the initial inpatient acute hospital or inpatient rehabilitation stay. Individuals with SCI receive a median of 23 to 28 hours of personal support per month in the same period. In the first year, individuals with SCI receive less than 6 hours of care from physiotherapy, occupation therapy, speech language pathology and nutrition.
Conclusions: By the end of the workshop, individuals attending this workshop will gain a better understanding of the complexities of funding and delivery of home care to individuals with SCI.
Keywords: Healthcare delivery, Burden of illness, Therapies

 


The Dr. Nimmi Bharatwal Lectureship Keynote Presentation – #nevertheless she persisted…again The Struggle for Women with SCI to obtain Reproductive Health Care

Amie B. McLain, MD
1. Chair and Professor, Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham

Learning Objectives: After completing this workshop, participants will be able to:

  • Describe several events in medical history that contributed to the awareness of disparate reproductive health care for women with SCI.
  • List at least 5 broad categories of Access Barriers for women with SCI that impeded obtaining appropriate health care.
  • What are some of the misconceptions regarding women with SCI becoming pregnant?
  • What maternal-fetal issues should providers (and their patients) know when a woman with SCI is considering pregnancy?
  • Describe unique SCI issues that women with SCI face during pregnancy, labor and delivery?
  • Why should “sex” and “SCI” be considered separate variables when planning Reproductive Health Studies in women with SCI?

Workshop Structure: The title of this presentation, “#nevertheless she persisted…again” is taken from a tweet that occurred after a situation whereby a woman was publicly speaking and was then interrupted so that she would be silent. The woman would not be intimidated and proceeded to discuss her cause. This is an appropriate analogy for the history of women with SCI and their advocates, who have persistently pursued the ability for these women to obtain quality reproductive health care. Despite the medical community’s attempt to ignore these women’s voices, their determination to be heard has led to a separate women’s rights movement. Challenging the barriers that interfere with access to health care and then questioning why they are not “allowed” motherhood exposed the lack of knowledge of their reproductive health and SCI. Women with SCI refused to be intimidated by the dual discrimination resulting from their gender and disability and have pushed back from decade to decade for changes in practice and research. This presentation will highlight the specific challenges that women with SCI have faced and the progress they have made in this journey to discover and care for their unique bodies.


Keynote Presentation – Sexual and Fertility Rehabilitation in Women following SCI

Stacy Elliott
Sexual Medicine Physician, consultant and medical director,BC Center for Sexual Medicine and GF Strong Sexual Health Rehabilitation Service

Learning Objectives: After completing this workshop, participants will be able to:

  • Explain the sexual changes that occur to women following SCI
  • Explain the sexual changes that occur to women following SCI
  • Demonstrate a user- friendly Framework to capture the complexity of this rehabilitation
  • Discuss findings on women with SCI and pregnancy, labour, delivery and lactation.

Workshop Structure: Women with SCI have been under the wire with sexual and fertility rehabilitation and are generally frustrated with the lack of available resources. This lecture, geared to the multidisciplinary health care professional, will give a broad overview of the major sexual and fertility rehabilitation issues, including sexual dysfunctions in ow and their therapeutic management, as well as considering secondary consequences of SCI in sexual activities, using the Sexual Rehabilitation Framework. A description of fertility, pregnancy, labour and delivery changes after SCI will be given along with recent findings of an international study on lactation.


Sex and Gender Considerations in Health Research – Angela Colantonio & Elizabeth Mansfield

Background: The integration of sex and gender considerations in research is considered good science however this has not been systematically implemented in research including in spinal cord injury research. Further, the Canadian Institutes for Health Research and other funding agencies are requiring that sex and gender to be addressed in grant proposals.

By the end of the workshop participants will be able to:

  • Identify definitions of sex and gender
  • Recognize elements of sex and gender based analyses in quantitative and qualitative research.

Participants: This workshop will be of interest to clinicians, scientists, service users and other stakeholders in neurorehabilitation.

Design: The workshop will provide examples from the neurotrauma literature and will include lecture and interactive group discussion. Resources pertaining to sex and gender in research will be provided to participants. Participants will be encouraged to share experiences and interests to promote knowledge exchange as well as ideas for future grant proposals.