CSCI-RA 2023 | 10th National SCI Conference

(10 min presentation, 5 min Q&A/transition)1. Mapping of cervical spinal cord using transcutaneous spinal stimulation provides characterization of neurological status in individuals with tetraplegia

2. How does the nature of the bowel impairment influence longitudinal sphincter control after discharge from inpatient rehabilitation?

3. The impact of COVID-19 on health care utilization among persons with spinal cord injury/dysfunction

4. Validity and feasibility of different functional electrical stimulation protocols for walking in individuals with incomplete spinal cord injury: a case series.

Background: Spinal cord injury (SCI) affects every aspect of a person's bodily functions. As such, for a person to survive and strive in the community after SCI, both a comprehensive and effective rehabilitation program, as well as life-sustaining healthcare (i.e., SCI-specific medical services, equipment, and supplies) is needed. Although Canada has a publicly funded universal healthcare system, provinces have flexibility in determining how rehabilitation is delivered and in defining 'essential' healthcare. Methods/Overview: This workshop will consist of two lectures on current standards of care in acute SCI rehabilitation and provision of life-sustaining SCI healthcare services, equipment, and supplies in Canada, followed by an initial overview of standards in other comparable countries and discussion of next steps for developing equity and consistency in Canada for SCI rehabilitation and provision of SCI-related healthcare needs.Keywords: Spinal cord injury healthcare, Spinal cord injury rehabiltation, Medical equipmentThe authors have no conflicts of interest to declare, other than that Kristine Cowley is a member of the Board of Directors of Praxis. This work was supported by the Praxis Spinal Cord Research Institute, the Canada Research Chairs Program and University of Alberta SCI Endowed Research Chair Fund. 

Background: Guided internet-delivered CBT (ICBT) offers an alternative approach for mental health service delivery in the community for those with spinal cord injury (SCI). However, there is a lack of evidence to support its use through large, controlled trials. Study Objectives: The primary aim of the current study is to explore the efficacy of ICBT in reducing symptoms of depression and anxiety among persons with SCI compared to an online SCI Rehabilitation Education program. Overview: The presenters of this workshop will engage in lecture to provide current state of evidence for ICBT among those post SCI, conduct small-group discussions to apply CBT skills and examine barriers and facilitators of implementing the program . Methods: Participants (n=122) endorsing symptoms of depression and/or anxiety related to SCI were randomized to an 8 week transdiagnostic ICBT program for those with SCI or an online SCI Rehabilitation Education program. Participants completed measures on depression, anxiety, self-efficacy, quality of life, and pain at pre-, post-, 3-months, and 6-months post-intervention. Results: Significantly greater improvements in depression, anxiety, self-efficacy, quality of life, and pain interference were seen in the ICBT group compared to the Education group at post treatment and follow-up. Completion rates (~90%) and satisfaction (>90%) were high in both groups. Conclusions: The findings provide evidence for the superiority of ICBT over education in improving wellbeing among those with SCI. Keywords: internet delivered cognitive behaviour therapy; spinal cord injury; depression; anxiety; self-efficacy; pain; quality of lifeFunding: This research was supported by funding provided by the Craig H. Neilsen Foundation (reference number 595092).

(10 min presentation, 5 min Q&A/transition)1. Yes, you can talk about 'it': creating sexual health education for the rehabilitation team (Clinical/Best Practice)

2. A mixed-method study on screening methods for sleep-related breathing disorders in individuals living with spinall cord injury: a call for policy changes to improve their healthcare access (Health Services)

3. Internet-delivered cognitive behavioural therapy for caregivers of persons with spinal cord injury: study protocol for a pilot feasibility study (Technology Innovation)

4. Oral administration of 5-hydroxytryptophan (5-HTP) increases spinal cord excitability in individuals with chronic, motor complete spinal cord injury (Knowledge Generation)

Background: As more research funding agencies require grant applications to include an array of stakeholder expertise, a clear and well-thought-out Engagement Plan is necessary to ensure grant reviewers understand how projects will engage relevant stakeholders. Overview: This presentation will describe in detail the key components you should include in your grant Engagement Plan, including tools you can utilize to select ideal project partners, develop an activity timeline, choose appropriate engagement methodologies, and prepare an accurate budget. Drawing on established best-practices in meaningful engagement, this presentation will guide delegates through the various components funding agencies expect to see in a thorough Engagement Plan. A novel framework will be shared that addresses common shortcomings in Engagement Plans and provides clear guidance on the elements to include in your grant submissions. Conclusions: A detailed Engagement Plan clarifies to grant reviewers the steps you intend to take to ensure meaningful engagement in your proposed work, and will help set your application apart in the highly competitive research funding market.

(10 min presentation, 5 min Q&A/transition)1. Upper extremity reconstruction in spinal cord injury: a three-year follow-up of an inter-disciplinary colalboration

2. Neuroplasticity in the spinal cord: what do we know and how do we encourage it?

3. Understanding educational needs for pressure injury prevention and management

4. Spinal cord neuromodulation and the control of arm movements

Background: Multi-morbidity is common in persons with spinal cord injury (SCI). Network Analysis is a tool used to visualize and estimate complex relationships among variables. Three network models: Gaussian Graphical Model, Ising model, and Mixed Graphical Model were applied to the 2011-2012 Canadian SCI Community Survey dataset, which included individuals with traumatic and non-traumatic SCI. Data utilized included demographic and injury data as we well as 30 secondary health conditions (comorbidities and secondary complication) that are included in the Multi-Morbidity Index (MMI-30). Five health outcomes were included: healthcare utilization (HCU), health status (i.e. Short Form-12 physical and mental component summary (SF-12 PCS & MCS) score), life satisfaction, and quality of life. Using Network Analysis, we reduced the number of items in the Multi-Morbidity Index (MMI-30) by 5 items (MMI-25) and the psychometric properties were comparable. This interactive workshop will include presentations from a clinician, researcher and person with lived experience (PLEX). Conclusion: This workshop will demonstrate the benefit of using Network Analysis, a type of Machine Learning, in SCI research. Specifically, the example of how Network Analysis identified key associations among 30 secondary health conditions and five health outcomes which resulted in the MMI-25 will be discussed as well as future opportunities for using Network Analysis and other Machine Learning methodologies in SCI research. Keywords: health outcomes, multimorbidity, network analysis, SCI

Background/Objectives: Sleep disorders are more common among individuals living with spinal cord injury and spinal cord disease (SCI/D) than among non-disabled people.Methods/Overview: 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. Results: 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. Conclusion: 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.Keywords: spinal cord injury, sleep disorders, sleep apnea, secondary medical conditionFunding: Ministry of Health (Ontario), Ontario Neurotrauma Foundation, Craig H. Neilsen Foundation, Praxis Spinal Cord Institute

Wagner Souza:

Katrina DeZeeuw:

Viet Vu:

Kristine Cowley:

John Shepherd:

Anthony Burns:

This event aims to bring together conference attendees with a shared interest in mentorship, offering an enriched learning experience and a valuable opportunity to build meaningful connections within the field of SCI rehabilitation. Whether you are seeking mentorship or are interested in providing mentorship in academia, policy, industry, or healthcare, this is an event you won't want to miss! Interested attendees must sign up to attend: Sign Up

The session aims to enhance the understanding of best practices in wheelchair prescription, focusing on the utilization of online resources and sharing insights into the World Health Organization's (WHO) wheelchair provision process.

(10 min presentation, 5 min Q&A/transition)1. Subcommissural organ-derived peptide enhances tissue preservation and promotes functional recovery in a rat cervical traumatic spinal cord injury model

2. Testing of fully implantable and stretchable intraspinal microstimulation device in domestic pigs

3. A novel mouse model of neurogenic heterotopic ossification induced by polytrauma with spinal cord injury

4. Activation patterns of epidural spinal cord stimulation and intraspinal microstimulation

Teams with diverse perspectives and experiences have been increasingly recognized for their ability to identify key issues and utilize creativity and problem solving to plan and implement research and clinical initiatives that lead to greater impact. Yet, often we are unsure how to best engage individuals with differing expertise, such as those with lived experience, clinicians, healthcare administrators, engineers, researchers, funders and policy experts. Methods/Overview: A combination of lecture-based and case-based learning will be used to explain the guiding principles and best-practices for meaningful engagement and to discuss relevant resources, such as the North American Spinal Cord Injury (SCI) Consortium's SCI Resource Advocacy Course and the Integrated Knowledge Translation Guiding Principles. Participants will be asked to apply these principles and practices to one of their own research or clinical initiatives through small group discussion. The Canadian Activity-Based Therapy (ABT) Community of Practice, which brings together diverse groups to address priorities for ABT research and clinical care, will be used as a case example during large group discussion.

We request 2 volunteers to submit a case of lower limb complex spasticity in SCI and prepare 1 brief PPT slide, with very little details, to start the conversation - Please email kethans@hsc.mb.ca by Friday Nov 17 and submit the case by Sunday Nov 19.Methods: The complexities of spasticity management will be identified through case-based presentations, including assessment and treatment directed by patient-oriented goals. Facilitated interactive discussion on these cases will engage participants for input, debate and critique. Procedural techniques for neurolysis will be discussed.Results: Goals of spasticity management in SCI often include both proximal and distal lower limb problems. Therapies include oral medications, chemodenervation with neuromuscular junction blockade with botulinum toxin or neurolysis with phenol, intrathecal baclofen, bracing, and surgery. Many patients require multiple of these therapeutic options during their course of spasticity management. Discussion: Multimodal therapy as part of the clinician toolbox is essential in tone management. Patient-oriented goals are important guideposts in spasticity management. SCI is a lifespan condition, and often patient goals and health conditions change over the years, requiring different tools to address such longitudinal needs.

(10 min presentation, 5 min Q&A/transition)1. Automated hand function assessment from egocentric video after spinal cord injury

2. Recommendations for dose and dosage parameters of exoskeleton gait training in SCI/D populations seeking functional restoration

3. Exploring how bowel management post rehabilitation discharge influences quality of life when living with a traumatic spinal cord injury

4. Estimating push phase duration of wheelchair propulsion using hand mounted IMU

Background: Persons with lived experience of SCI (PLEX) living in rural areas have difficulty accessing optimal care and are required to travel long distances to access specialized services. Clinicians not affiliated with specialized urban centres recognize that developing knowledge and skills specific to SCI will improve care outcomes. Praxis has conducted multiple workshops on SCI topics throughout the BC Interior Health Region to improve clinician knowledge about SCI. Topics include pressure injuries, autonomic dysreflexia, specialized equipment, bowel and bladder, etc. Utilizing evidence-based information and PLEX experiences, these workshops have increased clinician confidence when working with clients with SCI. This interactive workshop explores the development and implementation of the sessions, from the perspectives of a clinician, a PLEX, and a knowledge exchange expert. Conclusion: This workshop demonstrates the benefit of SCI knowledge exchange for clinicians working in rural areas. Furthermore, it highlights key factors in developing these workshops, and provides an opportunity to connect with other rural SCI initiatives and networks aimed at enhancing the care and well-being of PLEX. Keywords: Education, workshops, clinical

Background: Hamilton's Spinal Cord Injury (SCI) Regional Rehabilitation Program in collaboration with SCI Consortium is implementing tissue integrity monitoring for pressure injury (PI) prevention. An increased prevalence of PI was found in 2021 - 2022 compared to 2020 on Hamilton's SCI Rehabilitation Unit. To address this finding, the clinical team introduced a staff and patient education program focused on PI prevention. Methods: Using a Continuous Quality Improvement model, a systematic approach was used to enhance the education model for staff and patients on skin assessment and appropriate interventions. A process map was created outlining steps for each discipline involved in skin assessment, intervention, and patient education. Education plan included Skin & Wound Management workshop, individual and group patient education, daily skin check calendar for patient/staff use. The workshop will be delivered in a lecture format, ending with discussion time.Results: Preliminary data post partial implementation of the education program showed a decrease of 12% in the prevalence of PIs in the patients discharged from the program between July 2022 and March 2023 compared to January 2021 – June 2022. Conclusion: Preliminary results are encouraging in demonstrating that implementation of a comprehensive education plan for staff and patients using a structured framework is effective in reducing the prevalence of pressure injuries in the inpatient SCI rehab unit. Keywords: Education, Implementation, Pressure InjuryFunding/Acknowledgement: Ministry of Health Grant MOH 719-B

Research trainees and post-doctoral fellows are the fundamental backbone of all research and innovation. Yet, challenges and barriers that affect the recruitment and retainment of skilled research trainees and post-doctoral fellows have been a growing concern in recent years that can disrupt this delicate structure.Interested attendees must sign up to attend: Sign Up

Background: Spinal Cord Injury or Disease (SCI/D) are complex chronic conditions associated with multiple morbidities and many social and emotional challenges. Understanding the current gaps in care, the health services and policy priorities of Ontarians with SCI/D is integral to transforming services and meeting their needs over time. Design/Methods: The intended audience includes people with lived experience, family/friends, clinicians, community service providers, funders, advocacy groups, health system planners, administrators, and policymakers. Synthesized results from the Neurotrauma Care Pathways Project (neurotraumapathways.ca) and the SCI Implementation and Evaluation Quality Care Consortium (sciconsortium.ca) will be shared using infographics and lay language. These Ontario Ministry of Health funded projects are intended to inform practice and drive innovations in care. Participants will have an opportunity to discuss priorities regarding inclusion and service equity. The dilemmas of marginalized groups and special populations will be highlighted and the planned next steps shared with workshop attendees. Results/Findings: Our hope is that participants will take away a shared understanding that might influence their near term health policy, advocacy, and health behaviours. Keywords: Health Services and Systems, Rehabilitation, Spinal Cord Injury or DiseaseFunding: MOH719A, MOH 719B, Praxis G2021-48, CIHR PO4 187025.Conflicts of Interest: The views presented are those of the authors and not those of the Ministry of Health. Drs. Craven and Bayley acknowledge support from the UHN Foundation for the Chair in Spinal Cord Injury Rehab and Coriat Family Chair in Rehabilitation Service Innovation.

Background/Objectives: This workshop aims to overview degenerative cervical myelopathy (DCM), which is the most common cause of non-traumatic spinal cord injury across the world. DCM is estimated to affect approximately 1 in 50 adults; however, < 10% receive a diagnosis, and lifelong disability remains a common outcome. Methods/Overview: This workshop will review the diagnostic criteria and investigations for individuals with different degrees of DCM, the current clinical practice guidelines for management of DCM with focus on the role of surgical decompression of spinal cord, the role of prehabilitation and rehabilitation, current non-operative options for patients with DCM, and some initiatives focused on raising awareness of this disease.Results: This workshop will include lectures (10-15 minutes each) with illustrative cases followed by open discussion on the following topics: (i) diagnosis, misdiagnosis and investigations in DCM; (ii) surgical management of DCM; (iii) prehabilitation and rehabilitation in DCM; and (iv) non-operative management of DCM.Conclusions: Although DCM is the most common cause of non-traumatic spinal cord disease, there is a need for the development of a tailored and multi-disciplinary care framework for management of DCM, which would improve patients' outcomes. Greater awareness of DCM among healthcare professionals is urged to avoid misdiagnosis and mitigate the long-term consequences of this disease. Keywords: degenerative cervical myelopathy, non-traumatic spinal cord injury, research initiative

(10 min presentation, 5 min Q&A/transition)1. Promoting access to research projects for individuals with acute spinal cord injury to improve outcomes: a populations-based cohort study from the Rick Hansen Spinal Cord Injury Registry

2. From discussion to development: Employing a partner-engaged approach to design an adaptive sport program for aging adults with spinal cord injury

3. Determining equitable compensation guidelines for persons with lived experience of spinal cord injury (PLEX) involvement in research.

4. Patients' and families' perspectives on the current status of the peripheral nerve transfer clinic at Lyndhurst

This workshop will begin with a brief introduction of the course outline and learning objectives, and the presenters, which will be followed by two presentations. First, Dr. Noonan will provide an overview of the impact of the aging population on the epidemiology of traumatic and non-traumatic SCI and discuss future projections(15 minutes). In brief, there has been an escalation of fall-related SCIs in the older population globally. This phenomenon is anticipated to continue in the next few decades as a consequence of the aging population and as a result, there is an increasing focus on how to prevent falls in older individuals. While the incidence of traumatic SCI has been apparently unaffected, the prevalence of traumatic SCI has increased due to increased survival that reinforces the need for a better understanding on the aging process after SCI. Second, Dr.Furlan will discuss the literature on the influence of older age on outcomes following traumatic SCI (35 minutes). Generally speaking, the literature consistently showed that older age has a negative impact on the survival afterSCI. Among the survivors, chronological age does not appear to adversely affect the neurological and functional recovery following SCI when data analyses are controlled for major potential confounders. Those clinical findings are also supported by the results of recent studies on the axonal preservation, inflammatory response to, and oligodendroglial apoptosis in postmortem spinal cord tissue.Further, economic analyses suggest age-related differences in the cost of caring for the elderly with traumatic SCI.Finally, the workshop will end with a 10-minute period for questions & answers.

Moved to a post-conference VIRTUAL workshop. Stay tuned for the date and time. Background/Objectives: According to the WHO nearly one billion people world-wide live with some form of disability and one fifth of those have significant difficulty functioning as a result. Climate change is a reality and the impacts on health care and the care of our communities is significant. From food and water supply, housing emergency preparedness and safety to the effects on our health, climate change has a disproportionate impact on persons with disabilities. We will then move to a group discussion on what we can do individually and as health systems to address these challenges and make sure the rights and safety of persons with disabilities are protected as we navigate our world with Climate Change. Methods/Overview: We will use power-point slides, polls and group discussion to explore this topic.Results: This workshop will further educate SCI experts nationally/internationally and collect their thoughts and ideas on climate impact on persons with disabilities. Conclusions: Our hope is that this information will help inform a more formal position statement from the CSCIRA.Keywords: Climate Change, Disability, Health and SafetyDisclosures: no financial disclosures to reportConflict of interest: none for this topicThis is an original works. Some aspects of the presentation slides have been presented by myself and Dr. O'Connell at Physicial Medicine and Rehabilitation Grand Rounds March 30, 2023 and in July 2022.

Background/Objectives: Following an initial summit in March 2019, various Canadian stakeholders have collaborated within a Community of Practice (CoP) with a vision to increase the access to, and quality of activity-based therapies (ABT) for persons with spinal cord injury/disease (SCI/D). This workshop will describe key knowledge products and study findings emanating from working groups of the ABT CoP as well as a study initiated through the Canadian SCI Standing and Walking Module Group. Design/Methods: Priority areas were identified by consensus across the ABT CoP, leading to several studies and development of specific knowledge products. Key challenges included defining and standardizing ABT, gaps in knowledge/training and practice variation with a focus on achieving optimal timing, dosage and intensity of ABT. Various knowledge products and study findings related to these challenges will be presented, with audience interaction encouraged through polls and open discussion.Results: Presentation highlights include a framework for structured reporting of ABT and a series of videos, podcasts and information cards promoting ABT. In addition, a mixed methods study of Canadian physiotherapists demonstrated that ABTs were a much desired, yet not fully available treatment option. Therapists identified needs for more fulsome research partnerships, improved and more creative staffing models, enhanced training methods and the importance of a strong therapeutic alliance. Conclusion: The work of the ABT CoP will continue to focus on these and other priorities, with the ultimate goal of universal access and identification of approaches that will enhance outcomes for persons with SCI/D.