Publications & Resources

Background:

Adults with spinal cord injury/dysfunction (SCI/D) often take multiple medications to manage secondary conditions. Consequently, adults with SCI/D often engage in activities related to medication self-management, but there are few comprehensive resources for this population.

Objective:

To co-design the prototype of a toolkit to support medication self-management among adults with SCI/D.

Methods:

A participatory multi-methods study was conducted. Participants included adults with SCI/D, caregivers, and healthcare providers. Using the Good Things Foundation Pathfinder Model to guide the co-design process, three stages were followed: (1) understanding and defining the problem through a scoping review, concept mapping study, and working group sessions; (2) creating a prototype of the toolkit through working group sessions and website development meetings; and (3) testing the prototype through working group sessions.

Findings:

In Stage 1, the need for a medication self-management resource was identified through the scoping review. Participants brainstormed content for the toolkit, and thematized and prioritized the content through a concept mapping study. In Stage 2, feedback on the visual content was categorized and the name, MedManageSCI, was selected by the working group. Through an iterative process, an online version of the toolkit prototype was created (www.medmanagesci.ca). In Stage 3, participants provided recommendations to improve the website’s functionality.

Conclusion:

The co-design of the MedManageSCI prototype is a significant step toward addressing the medication self-management needs of adults with SCI/D. Future work is needed to refine the content, assess the feasibility, acceptability, and appropriateness of the toolkit, and examine outcomes related to medication self-management.

Background:

Adults with spinal cord injury/dysfunction (SCI/D) commonly take multiple medications and have described challenges with medication self-management. To help support medication self-management, a web-based toolkit, MedManageSCI, was co-designed by our team of researchers, adults with SCI/D, caregivers, and healthcare providers (www.medmanagesci.ca). Together, we created an initial prototype of the toolkit by co-developing the content areas, design, and brand elements.

Objective:

To finalize the prototype prior to implementation, the primary objective of this qualitative study was to further refine MedManageSCI by examining the clarity, comprehensiveness, relevance, and delivery of the toolkit modules.

Methods:

Cognitive interviews were conducted virtually between July 2024 and September 2024 with adults with SCI/D (N=16). A concurrent verbal probing approach using scripted and spontaneous probes was followed. The interviews were audio-recorded and data were coded using a pre-established coding matrix.

Findings:

Participants provided 193 recommendations to improve the clarity, comprehensiveness, relevance, or delivery of the MedManageSCI toolkit modules. These recommendations were categorized as: Comprehension, Design, and Delivery. The Comprehension category contained three subcategories: Written Refinements, Ensuring Accessibility, and Revamping Resources. The Design category contained three subcategories: Formatting Content, Streamlining Function, and Enhancing Visuals. Participants perceived the website as an ideal way to deliver the toolkit.

Conclusion:

Participants found the MedManageSCI modules to be comprehensive and highly relevant. Involving individuals with SCI/D in the development and refinement of self-management materials will help ensure that the content and resources are tailored and appropriate; thereby elevating its likelihood of uptake and dissemination during implementation.

Background/Objectives:

People with spinal cord injury/disease (SCI/D) experience numerous barriers to sport participation, such as transportation and lack of coaches with lived experience. Remote programs can mitigate these challenges. Moreover, interventions conducted in partnership with individuals with SCI/D can strengthen program credibility, increase sense of community, and enhance relevancy for the SCI/D community. However, no studies have gathered feedback on a co-designed, peer-facilitated, remote sport program serving adults aging with SCI/D. The purpose of this study was to explore perceptions of intervention participants (people with SCI/D aged 50+ years) and leaders (peer-facilitators, physical therapist) on this program.

Methods/Overview:

A remote handcycling sport intervention, designed using integrated knowledge translation, was delivered for 60 minutes 2 times/week for 12 weeks by peer-facilitators and a physical therapist. Individuals who participated in or led the program were eligible for this study. Participants completed one semi-structured interview gathering feedback on the program, which was audio-recorded, transcribed verbatim, and analyzed using codebook thematic analysis.

Results:

Intervention participants (n=5) and leaders (n=3) participated. The identified overarching theme was that partnered remote sport interventions facilitate health equity and ongoing sport participation across a lifetime. Four sub-themes included: (1) Authentic partnerships: This journey is about the “we”; (2) Teamwork as a key component throughout sport intervention; (3) Preferences and feedback on sport intervention; and (4) Beyond research to ongoing sport participation.Conclusions:Authentic partnerships with individuals with SCI/D are critical when designing and implementing sustainable sport programs that mitigate barriers for, and are inclusive of, aging adults with SCI/D.

Background/Objectives:

The digital rectal examination (DRE) remains the clinical standard for assessing neuro-sacral function after spinal cord injury or lesion (SCI/L), but it is subjective, invasive, and heavily dependent on examiner expertise. Surface electromyography (s-EMG) offers an objective alternative, yet remains underutilized in clinical practice. This study aimed to: 1) develop and validate the ElectroSacroGram (ESG), an innovative s-EMG tool assessing sacral motor (resting tone, maximal voluntary anal contraction [maxVAC], bulbocavernosus reflex [BSR]) and sensory (electrical perceptual threshold [EPT]) functions; and 2) evaluate its diagnostic performance in detecting radiologically confirmed SCI/L.

Methods/Overview:

In this prospective cohort study at a specialized Level 1 trauma center, 52 patients with suspected SCI/L and 21 healthy participants underwent ESG assessment. An expert panel of nine SCI/L specialists defined the ESG protocol based on established DRE parameters. Content validity was determined using item and scale content validity indices (I/S-CVI). ESG-DRE agreement was assessed with Cohen’s kappa, and diagnostic performance was evaluated against imaging findings.

Results:

Healthy participants established normative ESG values. Neurologically impaired patients showed reduced maxVAC and BSR amplitudes and elevated EPT. ESG demonstrated perfect content validity (S-CVI=1) versus poor validity for DRE (S-CVI=0.43). ESG identified VAC in 3% of cases missed by DRE, with near-perfect agreement for VAC (k=0.876) and EPT (k=0.881). ESG achieved 83.3% sensitivity, 100% specificity, and 86.5% accuracy.Conclusions:The ESG is a promising transformative, point-of-care tool delivering objective, real-time neuro-sacral assessment. By surpassing the limitations of DRE, it holds promise to redefine early SCI/L diagnosis. Multicenter validation is now warranted to support clinical adoption.

Background/Objectives:

Spinal cord injuries significantly affect mobility, independence, and quality of life, making effective rehabilitation crucial. Ideally, treatment plans should integrate best practices with the personalized needs and priorities of individuals. However, algorithmic approaches that combine these elements require extensive linked therapeutic and functional outcome data. This research introduces a simulation framework to evaluate how well algorithmic approaches can accurately determine underlying linkages between varying levels of data within databases and suggest the appropriate rehabilitation intervention to obtain functional outcomes.

Methods/Overview:

A “ground truth” simulated dataset was created to model SCI recovery through the Standing and Walking Assessment Tool (SWAT) stages. Patient-specific factors such as age, injury severity, and care-provider support were incorporated using probabilistic methods to reflect recovery variability. Therapy effectiveness was simulated through weighted probability algorithms, mimicking real-world therapist decision-making. Using this “ground truth”, a machine-learning algorithm, Sparse Identification of Nonlinear Dynamics (SINDy), was used to estimate the underlying governing equations and identify influential features when presented with various levels of linked data (e.g. completeness, actions vs. outcomes).

Results:

The SINDy model successfully captured realistic governing equations, highlighting therapy contributions to SWAT stage progression, provided the dataset was sufficiently diverse and included adequate temporal resolution.

Conclusions:

Algorithmic approaches are feasible using existing datasets, as long as they reflect real-world patient trajectories, establish therapy-response relationships, and maintain statistical robustness for accurate modeling. Future work will validate the model with real-world data and refine predictive capabilities to support evidence-based rehabilitation planning.

Background:

Barriers prevent persons with spinal cord injury (pwSCI) from adhering to recommended exercise guidelines, increasing risks of secondary health conditions. Mainstream technology, such as virtual reality (VR) systems, has potential to facilitate exercise adherence. However, research on VR exercise modalities is needed to determine feasibility, effectiveness, and ultimately guide practice recommendations.

Objectives:

This study aimed to determine whether VR exergaming results in comparable cardiovascular exertion to standard exercise of arm cycle ergometry (ACE), in pwSCI.

Design/Methods:

Participants with any level of SCI were recruited from a SCI rehabilitation centre program. Testing was conducted in a single session. Ten minutes of VR exercise and 10-minutes of ACE exercise at a self-selected pace were completed in random order. Participants additionally completed VO2-maximal testing using ACE, determining peak VO2. The primary outcome measure was relative oxygen consumption (VO2) collected during VR and ACE sessions compared to peak VO2. Secondary outcome measures included heart rate (HR) and self-reported Rate of Perceived Exertion (RPE) collected at baseline, 5-minutes, and 10-minutes for each exercise.

Results:

Seventeen participants (N=4 female, N=6 tetraplegia, N=11 paraplegia) completed the study. RPE and HR were not significantly different between VR and ACE, but ACE resulted in a significantly higher VO2 compared to VR. VR exergaming met the moderate-to-vigorous intensity threshold (40-60% VO2-peak) in 59% of participants.Conclusion:Results of this study suggest that VR has potential to provide meaningful exercise stimulus capable of inducing health-related cardiovascular adaptation. Future research should focus on strategies to increase intensity of exergaming in pwSCI.

Background/Objective:

Individuals with spinal cord injury (SCI) frequently depend on homecare services; however, the impact of the COVID-19 pandemic on these services remains underexplored. The objective of this study was to investigate the COVID-19 pandemic impact on homecare services in individuals with traumatic or non-traumatic SCI.

Methods:

A repeated cross-sectional study using linked health administrative databases in Ontario, Canada (March 2015–June 2022) assessed monthly homecare utilization in 3,381 adults with SCI using Autoregressive Integrated Moving Average (ARIMA) models. Services examined were personal support worker (PSW), nursing, therapies, and case management.

Results:

Compared to pre-pandemic levels, between March 2020 to June 2022, the traumatic group experienced a decrease in PSW services, as well as an increase in nursing services from April 2020-March 2022 and June 2022. Case management increased at various times for the traumatic group, however therapies decreased in May 2020 only. The non-traumatic group experienced a decrease in PSW services in July 2020, as well as an increase in nursing services from March 2020 to February 2021 and sporadically throughout 2020. Case management also increased at certain points for the non-traumatic group, but therapies decreased in April 2020, July 2020, and September 2021.Conclusion: The COVID-19 pandemic caused shifts in homecare use among individuals with traumatic and non-traumatic SCI, with both groups showing increases in nursing and case management, but only the traumatic group experiencing reduced PSW services. Investigation is warranted to understand the root cause of these changes, and if they resulted in adverse outcomes.

Background/Objectives:

Persons with disabilities experience numerous barriers to healthcare access including vaccine accessibility. This study investigated the COVID-19 vaccine uptake in the spinal cord injury (SCI) population of Ontario and identify potential factors influencing the vaccine uptake.

Methods:

This was a retrospective closed-cohort study using administrative health data on 3,574 individuals with traumatic and non-traumatic SCI. Monthly number of COVID-19 vaccine doses received between December 2020 and December 2023 were examined. Logistic regression analyses were used to examine the association between socio-demographic, clinical, and neighbourhood characteristics with vaccine uptake.

Results:

By the end of December 2023, 82.9% of the cohort received the full two-dose coverage and 65.6% received at least one additional booster dose. Significant (p<0.05) disparities in vaccine uptake were found: individuals aged 44 and under were less likely to receive full coverage than those 65+ (OR: 0.64), individuals with non-traumatic SCI were more likely to receive full coverage than those with traumatic SCI (OR: 1.29), individuals with no medications were less likely to receive full coverage compared to individuals using greater or equal to 20 medications (OR: 0.43), and those in lower-income neighborhoods had lower vaccination rates (OR: 0.41). Additionally, individuals without a prior mental health diagnosis were more likely to receive a COVID-19 booster (OR: 1.47).Conclusion: Sociodemographic, clinical, and neighbourhood characteristics were associated with COVID-19 vaccine uptake in the SCI population. Further investigation is necessary to determine the causation effects of these relationships with vaccine uptake to address health equity concerns.

Background/objective:

The COVID-19 pandemic may have disproportionately impacted individuals with spinal cord injury (SCI), highlighting the importance of understanding mortality trends in this population to inform targeted interventions and support. This study investigated the impact of the COVID-19 pandemic on mortality rates in a community-dwelling spinal cord injury (SCI) population in Ontario.

Methods:

Using health administrative databases, monthly mortality rates were evaluated pre-pandemic, during the pandemic, and post-pandemic from March 2014 to May 2024. Data were stratified by sex, injury etiology, and mental health status. Group differences were evaluated using t-tests. Autoregressive integrated moving average (ARIMA) models evaluated the pandemic’s impact on mortality rates.

Results:

A significant increase of 21.4% in mortality rates during the pandemic was found for the SCI cohort. With the exception of the traumatic group, all subgroups also experienced a significant increase in mortality rates (males: 13.9%, females: 31.9%, non-traumatic: 32.3%, mental health diagnoses: 19.6%, and mental health diagnoses: 29.4%). During the pandemic, females had a significantly higher mortality rate than males. The non-traumatic group had higher mortality rates than the traumatic group at all time periods. Individuals with mental health diagnoses had higher mortality rates than those without at the pre-pandemic and pandemic periods.Conclusions: Community-dwelling individuals with SCI in Ontario experienced elevated mortality rates during the pandemic, with higher risks observed among females, those with non-traumatic injuries, and individuals with mental health diagnoses. These findings underscore the need for further research to identify contributing factors and develop equitable interventions.

Background:

Accurate prediction of Functional Independence Measure (FIM) change after spinal cord injury (SCI) is essential for clinicians communicating prognostic information. While statistical models such as Generalized Least Squares (GLS) are widely used for outcome evaluation, they may not capture complex nonlinear relationships; Machine Learning (ML) models handle high-dimensional data to improve predictive accuracy.

Objective:

This study compares the predictive performance of GLS, Random Forest (RF), and XGBoost models in estimating FIM change scores from rehabilitation admission to discharge among adults with SCI.

Methods:

Demographic and impairment data and FIM change were obtained for adult inpatients with SCI from the National Rehabilitation Reporting System at the University Health Network (2020-2024). Three models, RF and XGboost, were employed to predict FIM change. Independent variables included age, AIS, LOS, and Service Interruption. Model performance was assessed using Root Mean Squared Error (RMSE) and coefficient of determination (R²).

Results:

RF achieved the lowest RMSE (15.18) and the highest R² (0.237), indicating superior predictive accuracy for FIM change. GLS, with an RMSE of 16.18 and an R² of 0.123, performed moderately but offered more interpretable results for clinicians. XGBoost exhibited the highest RMSE (17.78), but a slightly higher R² (0.145) than GLS, without outperforming RF. Conclusion: ML models, particularly RF, demonstrate improved predictive performance for estimating FIM change compared to GLS. However, a critical trade-off exists between predictive accuracy and clinical interpretability. RF excels in capturing complex relationships. The ML models demonstrated superior predictive power but require clinical applicability refinement to enhance prognostication.

Background/Objectives:

Wearable cameras enable the assessment of hand function after spinal cord injury (SCI) outside of clinical settings. Previous studies have found that clinicians recognize the potential of egocentric video for personalized rehabilitation, however, large volumes of video data present a challenge for efficient use in clinical practice. To address this, we implemented different video summarization algorithms.

Methods/Overview:

A dataset comprising 371 egocentric videos from 23 individuals with cervical SCI was used. Participants wore head-mounted cameras to record daily activities in their home environment. Two video summarization algorithms, CTVSUM and CA-SUM, were trained in an unsupervised manner using contrastive learning and self-attention mechanisms, respectively, and evaluated with 5-fold cross-validation. The summaries were evaluated based on coverage (proportion of video frames retained), temporal distribution (uniformity across the video timeline), diversity (uniqueness of included segments), and representativeness (similarity to the original video based on color histograms).

Results:

CTVSUM generated longer summaries (15% of the original frames) compared to CA-SUM (12%) and achieved higher diversity (CTVSUM: 0.23; CA-SUM: 0.16) and representativeness (CTVSUM: 0.96; CA-SUM: 0.95). In contrast, CA-SUM achieved a more uniform temporal distribution (CTVSUM: 0.11; CA-SUM: 0.13).Conclusions: This study demonstrates the feasibility of using unsupervised video summarization to condense egocentric video data collected from individuals with cervical SCI. Both CTVSUM and CA-SUM produced concise video summaries with distinct strengths. These findings suggest that automated summarization can support the integration of egocentric video into clinical practice. However, further qualitative evaluation of the generated summaries is needed to assess their clinical value.

Introduction:

Activity-Based Therapy (ABT) is a rehabilitation approach for individuals with spinal cord injuries (SCI) to promote neurorecovery and has been shown to improve independence and quality of life. Currently in Canada, there is limited awareness and availability of this approach; therefore, the objective of this project is to develop an evidence-based Clinical Best Practice Guideline (CPG) to support health care professionals in the implementation of ABT in SCI clinical care.

Methods:

The development of the ABT CPG will follow the updated Appraisal of Guidelines for REsearch & Evaluation (AGREE II). Clinical recommendation statements were developed based on the findings from a comprehensive search of the literature as well as existing CPGs. An expert panel of individuals from key interest groups will decide on which recommendations to include in the CPG through consensus voting using a modified Delphi approach.

Results:

The recommendations for consensus voting are structured by the context of ABT and intervention type with the level of evidence described for each.

Findings:

are sub-categorized by the most common outcomes in the included studies.Conclusions: People living with SCI and clinicians who work with this population have advocated for the use of ABT in Canada due to the benefits experienced in function and quality of life. This CPG will provide clinicians with the best available evidence in a format that depicts the strength of the source as well as precise recommendations to positively impact SCI clinical care practices in Canada.

Objective:

The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) light touch (LT) and pinprick (PP) assessments were compared to a novel, fully automated computer-controlled electrical perceptual threshold (CCEPT) method in spinal cord injury patients (SCI) to evaluate their agreement.

Methods:

This prospective pilot study included six individuals with SCI (2 males, 4 females; age mean ± standard deviation (SD): 60.0 ± 21.2 years) with complete (L1 AIS A, n=1) and incomplete injuries (C5 AIS D, n=2; T1 AIS D, n=1; L3 AIS C, n=1; L4 AIS D, n=1). LT and PP were assessed 20-97 days post-injury upon admission. CCEPT testing was performed later (63-195 days post-injury) using 3 Hz electrical stimulation (0.5 ms monophasic pulses; 0-10 mA in 0.2 mA increments) across 56 dermatomes (C2-S4/S5) in random order. Participants pressed buttons to identify sensations. By comparing CCEPT results to the normative template, dermatomes with CCEPT scores above normative limits or no response were categorised as impaired. The agreement was compared to ISNCSCI using sensitivity, specificity, accuracy, and Cohen’s Kappa.

Results:

Individual participant plots illustrated that CCEPT frequently identified more dermatomes as “impaired” than ISNCSCI, resulting in high sensitivity (up to 1.00) but low specificity (0.36). Overall accuracy remained moderate. Cohen’s Kappa varied from disagreement to moderate agreement due to testing condition variability.Conclusion: CCEPT is a straightforward, reproducible, valid SCI sensory evaluation tool for subtle and multi-level impairment. These impressive pilot results suggest clinical utility and longitudinal monitoring from the cervical to high-lumbar dermatomes in a broader SCI group.

Hope Jervis-Rademeyer1, Kristin E. Musselmanr2,3, Scott Forrester4, Michelle Riendeau1, William Tung5, Sandi Marshall6, Camira Cunningham 7, Jessica D’Amico8,9, Jennifer Leo4, Pete Andrews10, Sarah J. Donkers1, Ivan English11, Chester Ho8,9,12 1School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, CA 2Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, ON, CA 3KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, ON, CA 4The Steadward Centre, University of Alberta, Edmonton, AB, CA 5Royal Alexandra Hospital, Alberta Health Services (AHS), Edmonton, AB, CA 6First Steps Wellness Centre, Regina, SK, CA 7AHS, AB, CA, 8Glenrose Rehabilitation Hospital, Alberta Health Services, AB, CA 9Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, CA 10URO Medical Supplies, Saskatoon, SK, CA11Saskatchewan Health Authority, Saskatoon, SK, CA 12 AHS Neurosciences & Stroke Program Improvement and Integration Network (PIN), Edmonton, AB, CA.

Background/Objectives:

Functional electrical stimulation (FES) cycling is an intervention that enhances both physical and psychosocial wellbeing for people living with spinal cord injury (SCI). Our community of practice (CoP) brings together a network of individuals to advance access to and clinical implementation of FES cycling for SCI rehabilitation, exercise, and sport as part of an interprovincial collaboration between Alberta and Saskatchewan. We aim to 1) improve FES cycling knowledge and confidence among practicing healthcare providers, 2) accelerate access to FES cycling for individuals with SCI, and 3) facilitate exchange of evidence-based FES cycling tools, research, training opportunities, and practical strategies.

Methods/Overview:

We have developed our group according to the five phases of a CoP: _Define, Design, Grow, Perform, and Transform._

Results:

First, we _defined_ a ‘brave space’ and terms of reference for all-member and steering committee meetings. Second, we _designed_ bi-monthly meetings and webinars, while planning other forms of interaction. Next, to _grow_, our group provides free membership targeting members from Alberta and Saskatchewan who are living with SCI, care supports, clinicians, physical and occupational therapists, kinesiologists, community clinic volunteers, administrators, researchers, community groups, or others interested in FES cycling. To promote our CoP, we have a branding and social media strategy. Next, we will _perform_ through engaging in the planned activities. Lastly, we will _transform_ to meet the needs of members (e.g., expansion).

Conclusions:

Establishing this CoP is a first step in supporting the implementation and improving access to FES cycling across healthcare and recreational settings throughout the Prairies.

Funding:

Praxis Spinal Cord Institute

Conflict of Interest:

The authors disclose that Pete Andrews is employed by URO Medical Supplies, which is a distributor of the MyoCycle FES cycle. This relationship was disclosed to the relevant committees and measures have been taken to ensure that the findings are not biased by this affiliation.

Background/ObjectivesPeripheral:

nerve interfaces can be used to create advanced assistive technologies after spinal cord injury. Neural networks associated with multicontact nerve cuff electrodes can selectively record and discriminate electroneurography (ENG) signals and facilitate neuroprosthetic control. Due to variations in device positioning and anatomy, neural networks trained on one subject currently cannot generalize to other subjects. To take advantage of available data from other subjects, the objective was to train a neural network whose encoder portion can extract representations that generalize effectively when using transfer learning to adapt ENG classification to new subjects.

Methods:

The study applied neural networks to classify naturally evoked compound action potentials corresponding to three different sensory stimuli. The datasets were obtained from the sciatic nerves of 9 Long-Evans Rats through 7×8-channel cuff electrodes. To leverage data from multiple subjects for better generalizability, we pre-trained the network on either one subject or merged subjects and retrained it on the separate target subject. Layer freezing was also applied to the models to identify which part of the encoder would best generalize.

Results:

Pre-training with merged datasets led to a significant increase in mean macro-F1 score compared to subject-specific models trained from scratch (0.810±0.130 vs 0.733±0.121, p < 0.05), regardless of the number of frozen layers.ConclusionsBy using a pre-training approach combining data from multiple subjects, our method shows significant improvement in classification performance. The study developed a generalizable encoder that benefits the classification performance on unseen subjects despite the anatomical variability and device positioning differences.

Background:

The Spinal Cord Injury Evaluation and Quality Care Consortium (SCI-IEQCC) is a national QI initiative focused on enhancing rehabilitation care for individuals with SCI/D within 11 care domains. The Wheeled Mobility Domain aims to maximize safe community mobility by implementing routine wheelchair mobility assessments. The Wheelchair Skills Test Questionnaire (WST-Q) is the chosen outcome indicator to measure wheelchair mobility skills training effectiveness from a participant perspective.

Overview:

To improve WST-Q implementation and uptake of WST-Q into clinical practice, three consecutive multi-site Plan-Do-Study-Act (PDSA) cycles were initiated:1.Training & Engagement: Clinicians participated in the Wheelchair Skills Program Course to increase their confidence and competence in teaching wheelchair skills and WST-Q administration.2.Practice Integration: Sites developed practice profiles to embed WST-Q into clinical workflows and documentation systems.3.Adaptation for Feasibility: An abbreviated WST-Q, decision trees and patient self-administration were piloted to reduce clinician burden.

Results:

1.Clinicians demonstrated increased knowledge and WST skills competence following training, although WST-Q completion rates remained poor.2.Practice profiles helped tailor implementation, but challenges with consistent WST-Q completion by clinicians persisted.3.The abbreviated WST-Q was well received. However, concerns arose around patient competency with self- administration and time consuming clinician follow-up.4.Future PDSA cycles will focus on patient and clinician engagement to enhance completion rates and use longitudinally.Conclusions:Implementation efforts continue to enhance the feasibility of implementing the WST-Q and its face validity, by pairing it with WST completion driving refinement of the Wheeled Mobility Domain outcome indicator.

Introduction:

SCI&U is an online health self-management program that utilizes a Peer Health Coaching (PHC) model to support health, well-being, and enhanced quality of life for those living with spinal cord injury (SCI). Eight PHCs living with SCI were trained, certified and paid to coach 60 community-living Canadians with SCI. This qualitative research investigation contributes to the growing literature on peer-support interventions for people with SCI by reporting on the perspectives of coaches regarding the program.

Methods:

In-depth interviews were conducted remotely with eight PHCs. Three authors (JS, SS, LC) read the transcripts and developed a coding scheme using NVivo software; two of these authors (LC and SS) shared the coding, overlapping on two interviews to ensure consistency. The University of Toronto granted ethics approval. All authors declare no conflicts of interest.

Results:

Topics explored include the value of professionalism and the role of training in professionalizing the PHC role. The importance of team support and the development of a community of practice featured strongly. PHCs described many benefits and certain challenges. PHCs shared perspectives on the differences between peer support and peer health coaching.Conclusion:Peer Health Coaching is a highly valued role that benefits both PHCs with SCI and the people living with SCI who received coaching.

Background:

As length of stay in inpatient rehabilitation decreases, the limited time for provision of health education and skill acquisition means that individuals with SCI are entering the community with fewer self-management skills. To address this, we developed SCI&U, an online self-management peer health coaching program.

Objectives:

1) Conduct a RCT to evaluate the effectiveness of SCI&U on increasing self-management skills and self-efficacy and decreasing secondary complications 2) Explore stakeholder experiences 3) Identify sustainability considerations Design/MethodsThis is a two-group stratified RCT with a waitlist control and an embedded qualitative component. Eligible participants are adults living in the community with SCI for <2 years recruited from the United Spinal Connecticut Chapter and SCI BC. Projected sample size is 76, stratified by country, paraplegia/quadriplegia, and randomly assigned to SCI&U or existing peer support. During the program, clients and peer health coaches trained in motivational interviewing, goal setting and brief action planning can engage in up to 14 online (1 hour) sessions. The primary outcome is the Health Education Impact Questionnaire (heiQ) Emotional Distress scale. Secondary outcomes are other heiQ scales, self-efficacy, patient activation and secondary conditions and usability. Data will be collected at 0, 6 and 12 months.

Results:

Research ethics has been approved. The coaching platform has been built. Data collection instruments have been entered into a REDCap database. Recruitment began in March 2025. ConclusionThe professionalization of peer-mediated support holds the promise of delivering more effective support to those who face the many challenges of living with SCI.FundingCraig H. Neilsen Foundation

Background:

After a spinal cord injury (SCI), the transition from inpatient acute care to home is a complex, multifaceted process. The duration of inpatient care following an SCI, from acute hospitalization to rehabilitation, has decreased in recent years. This often leaves individuals with an SCI unprepared to handle the physical and psychological effects and challenges of adjusting to community life after discharge.

Objectives:

SCI&U is a health coaching program utilized by individuals with chronic spinal cord injuries to have one-on-one private online sessions with a peer health coach, who also has a spinal cord injury. To meet the needs of people with acute SCIs across Canada and the United States, the SCI&U program is being tailored to meet the unique needs of that audience.

Design:

Peer health coaches, already trained and employed to deliver the SCI&U coaching program, were engaged to revisit their job responsibilities. The study team, which includes six peer health coaches, identified and modified program tools, skills, and delivery. Targeted focus in training sessions with Mental Health First Aid, Brief Action Planning, and practice sessions with scripts and resources ensued.

Results:

The SCI&U platform, coaching scripts, resources, and, most importantly, the coaches’ focus were adapted to address the nuances of situations typical in that acute injury timeframe.Conclusions: The SCI&U program can be tailored to address the needs of individuals at various stages post-injury. A randomized clinical trial will assess the effectiveness of this approach among those with acute SCIs.Funding: Craig H. Neilsen Foundation

Background/Objective:

The loss of hand function is an impactful consequence of cervical spinal cord injury (SCI), affecting activities of daily living (ADLs) and independence. The clinical assessment of hand function plays an important role in implementing evidence-based protocols and evaluating the efficacy of new interventions. However, assessing hand function can be difficult due to the diversity of grasps and standardized clinical assessments have been shown to not fully reflect real-world function. This gap has resulted in increasing interest in assessing hand function within the community using wearable technology. The use of egocentric videos has been validated for measuring hand function quantity, however hand use quality remains under-explored. This study aims to define novel metrics of hand function quality in unconstrained activities after cervical SCI, as observed in egocentric video.

Methods:

A modified Delphi process will be used to define metrics that quantify the quality of hand use after SCI in unconstrained environments and activities. This process will include clinicians, researchers, and individuals with SCI. Possible metrics will be generated from semi-structured focus groups, with final consensus using a Delphi process. Interviews will be transcribed verbatim and analyzed using content analysis, while the Delphi surveys will use descriptive statistical methods with consensus set at 75%.

Anticipated results:

A list of consensus-derived metrics that define good quality hand function in real-world settings after SCI will be established.

Conclusion:

The results will guide future work on validating the psychometric properties of the developed metrics and identifying the minimal clinically important difference (MCID).

Background:

Spinal cord injury (SCI) causes long-term disability, with over 50% of individuals experiencing upper extremity impairments that limit daily activities (1,2). Robotic rehabilitation offers intensive, repetitive, task-oriented training for motor recovery, yet many systems fail to mimic real-life activities. This shortcoming limits robotic rehabilitation’s real-world impact despite benefits including reduced therapists’ workload (3,4) . Our study proposes an approach using 3D-printed replicas of real every day objects presented by a robotic arm at various dynamic target placements for reaching and grasping training.

Objectives:

a.Develop a robotic rehabilitation system that uses 3D-printed objects for reaching and grasping tasks.b.Dynamically assess upper extremity capabilities and adjust target placements accordingly.

Methods:

Our system includes a robotic arm mounted on a height-adjustable table, equipped with a gripper, audio-visual cues, force sensors, and a shelf with 3D-printed objects. We developed adaptive algorithms that assess reach and adjust target placements in real time. We evaluated usability and performance with individuals without neurological conditions.

Results:

We integrated 3D-printed objects (e.g., a mug, can, paper) into our system for reaching and grasping tasks. Our adaptive algorithm positioned targets within the user’s reach 75% of the time and in a challenge zone beyond their initial calibrated reach 25% of the time, demonstrating the system’s adaptability to different user capabilities.#ConclusionsThis work enhances robotic rehabilitation through functional task training, showing potential for tailored intervention that may encourage greater independence for people with upper extremity impairment.#References1- World Health Organization. (2023). Spinal Cord Injury Fact Sheet. Geneva: WHO.2- Snoek, G., IJzerman, M., Hermens, H. et al. Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics. Spinal 3- Mehrholz, J., et al. (2020). “Robotic-assisted training for upper limb function after spinal cord injury: A systematic review.” Journal of NeuroEngineering and Rehabilitation, 17(1), 45.4- Zariffa, J., et al. (2021). “Functional task practice versus repetitive movement training in robotic rehabilitation for cervical SCI: A comparative study.” IEEE Transactions on Neural Systems and Rehabilitation Engineering, 29, 1124-1134.Cord 42, 526–532 (2004). https://doi.org/10.1038/sj.sc.3101638

Background:

Transitions from hospital to home are particularly complex for individuals recovering from spinal cord injury (SCI), who often require coordinated interdisciplinary support to safely reintegrate into community. In December 2023, Providence Care Hospital launched a Hospital-to-Home (H2H) Transitional Care Program, which supports SCI patients following discharge from high intensity inpatient rehabilitation. This initiative aims to reduce avoidable readmissions and emergency department (ED) visits while supporting continued functional recovery at home.

Objectives:

To evaluate the effectiveness of the H2H Transitional Care Program in supporting SCI patients post rehabilitation, with a focus on program uptake, health system utilization, and functional outcomes.

Methods:

A retrospective cohort review was conducted for SCI patients referred to the H2H program between December 2023 and March 2025. An interdisciplinary care team—comprising occupational therapists, physiotherapists, social workers, and recreational therapists—provided pre-discharge planning, in-home safety assessments, and coordinated in-home rehabilitation. Data were drawn from hospital administrative systems and clinical records. Primary outcomes included program uptake, 30-day ED revisit and readmissions, and length of in-home service.

Results:

Fifty individuals with SCI were referred, with 88% proceeding to transitional care services. Participants averaged 65 years, with 43% identifying as female. The average duration of in-home service was 104 days. 4.0% had an ED revisit within 30-days of discharge and no one was readmitted to hospital. Over 90% of discharged participants met their individualized therapy goals.Conclusions: Early findings suggest that H2H programs can enhance functional recovery and reduce acute care re-utilization among SCI patients, supporting safer transitions home.

Background:

The Standing and Walking Assessment Tool (SWAT) is a 12-stage assessment used to monitor standing and walking function and trigger outcome measure completion during inpatient rehabilitation. This study compares SWAT staging in participants with traumatic (TSCI) and non-traumatic spinal cord injury (NTSCI) and identifies factors influencing stage changes to improve rehabilitation outcomes.

Method:

Data from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) (2014-2022) were analyzed for participants who had SWAT stages at both admission and discharge. Descriptive, bivariate, multivariable regression analyses, and ANCOVA were conducted to identify factors associated with stage changes.

Results:

Of 1988 participants, 1552 (78%) had TSCI and 436 (22%) had NTSCI. TSCI-participants had significantly lower median SWAT scores at admission (2 vs. 6), discharge (8 vs. 10), and stage change (2 vs. 3) compared to NTSCI-participants. Multivariable analysis showed that more severe neurology at admission, shorter length of stay (LOS), and longer time to rehabilitation admission were significantly associated with decreased stage change. ANCOVA revealed significant variability in stage changes across facilities (e.g., Facility A: 2.2 vs. Facility H: 3.5, p=0.027).

Conclusion:

Factors such as time to rehabilitation and LOS are modifiable and can influence SWAT stage changes, highlighting opportunities for optimizing rehabilitation outcomes. Neurological severity at admission, although not modifiable, remains an important determinant of recovery potential. Additionally, variability across facilities suggests that institutional practices play a key role in recovery. Tailoring rehabilitation strategies to individual profiles and addressing facility-related differences may enhance functional recovery for both TSCI and NTSCI patients.

The extensive use of electronic health record data to drive national health quality initiatives, necessitates robust data collection, transfer, sharing, storage, and re-use procedures. Data stewardship processes are crucial for adhering to privacy legislation and safeguarding QI project participant data.The Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI-IEQCC), a multi-site (n=13) quality improvement (QI) initiative, has developed 54 quality indicators (11 rehabilitation domains) for collection at admission, discharge and 18 months after admission among adult Canadians with SCI. To date, SCI-IEQCC has implemented indicators and best practices in 7 care domains. Prior to QI project conduct, the University Health Network central team establishes confidentiality agreements, Data Sharing Agreements and Statements of Work for sites with active QI and institutional approvals. The central team provides training regarding: strategies to maintain data quality and Standard Operating Procedures for secure data storage and transfer. National Rehabilitation Reporting System (NRRS), and indicator data are collected. Virtual data quality checks are conducted by the central team to ensure the completeness, and de-identification of the data elements, site leaders then review and approve prior to secure data transfer. Training, data check-ins and transfer logs are maintained by the central team. The central team maintains the statistical analysis plan, the data management plan and the secure de-identified data pool. NRRS and indicator data are linked centrally and analyses completed to drive audit and feedback at sites, produce and share national benchmarks, and drive reflections regarding data quality and the fidelity of best practice implementation.

Background/Objectives:

Saskatchewan (SK) has the highest incidence of traumatic spinal cord injury (tSCI) in Canada. According to health administrative data analyzed between 2005-2016, 41.3 individuals per million were admitted to SK hospitals with tSCI. Currently, there is no SCI pathway in SK. Therefore, this study aims to determine the essential elements of a provincial SCI care pathway to facilitate timely, equitable, efficient, safe, effective, person-centred care. Our main objectives are 1) to identify and propose solutions to barriers to accessing SCI care in SK and 2) to co-develop a provincial SCI care pathway.

Methods/Overview:

This project will use a qualitative descriptive design. Purposive sampling will be employed to recruit individuals representing these groups: clinicians, healthcare providers, site administrators, individuals living with SCI or care supports, and community group members) from Saskatoon or Regina, SK. Pre-analysis, we will facilitate four mixed focus groups (n=6-10) to identify barriers and facilitators to accessing SCI care in SK. After conducting a reflexive thematic analysis, we will facilitate two focus groups with the same composition to co-develop the SCI pathway. Data will be managed using NVivo 14.

Results:

We will produce a SK SCI care pathway co-developed using a participatory action approach. We will use reflexive thematic analysis applied by focus groups to identify gaps and potential solutions to support users’ needs within the co-developed pathway.

Conclusions:

This project will provide a Saskatchewan SCI care pathway template for further co-development focusing on working with rural hospitals, people from Indigenous backgrounds, and other equity seeking groups.

Background:

Transcutaneous spinal cord stimulation (tSCS) is a non-invasive neuromodulation technique aimed at improving voluntary movement, autonomic function, spasticity, and other complications in individuals with spinal cord injury (SCI).

Objective:

The objective of this scoping review is to evaluate reporting practices relating to safety, stimulation parameters, and outcomes among studies employing tSCS among persons living with SCI.

Design/Methods:

CINAHL, EMBASE, PubMed, and Web of Science databases were searched for studies published up to December 2024. Eligible studies met these criteria: (1) full-length, English-language article; (2) SCI population aged 18+; (3) tSCS intervention. Data extracted included study year, subject characteristics, design, outcomes, adverse events, and stimulation parameters.Participants: N/AResults/Findings: Sixty-five studies met the inclusion criteria. Of these, 13 (20%) were case studies, 14 (21.5%) were repeated measures, 18 (27.7%) were pre-post, and 20 (30.8%) were controlled trials. Many studies, particularly in repeated measures and pre-post categories, lacked details on total intervention time, complicating full assessment. Reporting of stimulus intensity varied significantly, and concurrent therapies were inconsistently documented, making it difficult to assess interaction effects with other interventions.Conclusion: The heterogeneity in tSCS parameter reporting highlights the lack of standardized definitions and metrics. A comprehensive reporting guide could improve study replication and ensure consistency in both research and clinical practice.

**Evaluating Accessibility in New Brunswick High Schools: A Qualitative Analysis of Structural Barriers for Wheelchair Users**Raeghan O’Leary¹, Najmedden Attabib², Shane McCullum³, Colleen O’Connell⁴ ¹Dalhousie Medicine New Brunswick, Saint John, NB, Canada ²Department of Clinical Neurosurgery, Horizon Health Network, Saint John, NB, Canada ³Stan Cassidy Centre for Rehabilitation, Fredericton, NB, Canada ⁴Stan Cassidy Centre for Rehabilitation, Fredericton, NB, Canada; Dalhousie Medicine New Brunswick, Saint John, NB, Canada

Background:

Structural accessibility is essential for fostering inclusion and participation among students with mobility impairments. Research on students with spinal cord injuries highlights physical barriers as a key challenge, suggesting that current policies require evaluation.

Objectives:

This study examines the accessibility of New Brunswick high schools from the perspective of those requiring the use of a wheelchair, focusing on the impact of structural barriers on their educational and social participation, and their sense of self.

Methods:

Semi-structured interviews will be conducted with up to 10 students who have attended high school in the last five years and require the use of a wheelchair. Participants will be recruited through the Stan Cassidy Centre for Rehabilitation and the Saint John Regional Hospital. Thematic analysis will be used to identify and describe student experiences and to inform feedback on the provincial accessibility strategies in New Brunswick High Schools.

Results:

Preliminary findings suggest that the absence of independently operable elevators leads to a perceived loss of autonomy and limits the ability of students to attend sessions with peers. These structural barriers negatively impact their educational experiences.

Conclusions:

This study aims to offer actionable recommendations for policymakers and educators to address structural inequities and promote inclusive practices.

Findings:

are expected to inform improvements in alignment with the Government of New Brunswick’s Policy 322 and the UN Convention on the Rights of Persons with Disabilities.

Objective:

Spinal cord injury can profoundly impact the person, family and healthcare system. While accurate incidence estimates for both traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI) are needed for care planning and delivery, current epidemiological studies are focused on TSCI. The objective of this study is to estimate national incidence rates of NTSCI over time and stratified by age, sex and etiology, using administrative data.

Methods:

Discharge Abstract Database data were requested from the Canadian Institute for Health Information from April 2004 to March 2021 for all Canadian provinces and territories (excluding Quebec). NTSCI cases were identified using a case definition based on ICD-10 codes capturing both neurological impairment (paraplegia/tetraplegia/cauda equina) and etiology (e.g. degenerative, infection, etc.) of NTSCI. Data from 2020 were excluded due to the Covid-19 pandemic.

Results:

We estimated incidence in Canada for NTSCI from 2009 to 2019 of 32.9/million population, with no clear temporal trends. The incidence rate increased with age, from 4.3/million for ages 0-19, to 97.3/million for ages 80+. Males had higher rates (40.5/million) than females (25.5/million). Paraplegia was the most common impairment (46%), followed by cauda equina (35%) and tetraplegia (19%). The most common etiologies were degenerative conditions (30%), myelopathies (19%) and infections (11%).

Conclusions:

The incidence of NTSCI reported here is aligned with previously reported incidence of TSCI in Canada (32.0/million). Accurately estimating the incidence of NTSCI in Canada allows for understanding the burden of disease, public health strategies, and allocating resources to best support this important population.

Background:

Pressure injuries (PI) are a common and costly complication in patients with spinal cord injuries (SCI) during acute care. Although clinical guidelines recommend repositioning every 2–3 hours, traditional approaches have largely overlooked other forms of mobility such as transient hip movements, which may contribute to tissue perfusion and pressure redistribution.

Objective:

To determine how different types of nighttime bed movements, including standard repositioning and transient hip (pelvic) shifts, affect the development of pressure injuries in patients with acute traumatic spinal cord injuries.

Methods:

In this prospective observational study, 53 patients with traumatic SCI were monitored for an average of five nights following acute care admission. Each participant wore two GT9X-Link actigraphs positioned on the torso and thigh to record repositioning events and transient pelvic movements. A custom algorithm analysed data at one-second intervals to calculate repositioning frequency, duration spent in supine, lateral, and sitting positions, mean activity rate, and the number of transient pelvic movements while supine. Sociodemographic and clinical data, as well as PI incidence, were also collected.

Results:

Only two participants adhered to the recommended repositioning frequency every three hours. Among those who developed PIs, 40% experienced fewer than four repositionings per night compared to 18% among patients without PIs. Additionally, patients without PIs exhibited on average 30% more transient pelvic movements. Regression tree analyses demonstrated significant correlations between all mobility parameters and PI incidence.Conclusion.This study is the first, to our knowledge, to objectively assess nighttime bed mobility using actigraphy in acute SCI patients, highlighting the significance of transient pelvic movements in PI prevention. Combining active movements with passive repositioning may more effectively reduce PI incidence, suggesting the need for updated clinical guidelines.

Background:

Individuals with spinal cord injury (SCI) are at highest risk of developing pressure injuries (PI), with rates exceeding 85% over their lifetime. Frequent in-bed repositioning can reduce the risk of PI, but assessing in-bed mobility in the community is challenging and relies mainly on subjective measures.

Objective:

This study introduces a novel method using actigraphy to objectively measure in-bed mobility during sleep among SCI individuals living in the community, aiming to facilitate PI risk assessment.

Methods:

Nighttime repositioning habits were assessed in 28 individuals who had previously sustained a traumatic SCI. In-bed repositioning frequency and time spent in different positions were obtained for 14 consecutive nights using an actigraph placed on the sternum. The occurrence of PI was assessed over the year following repositioning assessment.

Results:

Participants spent most of their sleep time in the supine (70%) or lateral (28%) position. In-bed repositioning occurred at an average of 2.2 ± 2.4 times per night, corresponding to a mean duration of 3.4 ± 2.3 hours between repositionings. Only 10% of subjects repositioned at least once every 3 hours during nighttime. Forty percent of individuals developed a PI within the year, and these individuals repositioned significantly less frequently (1±1 vs. 3±2 times per night, p=0.01).Conclusion: This study pioneers the safe use of an objective actigraphy-based method to assess nocturnal repositioning behaviors in individuals with SCI living in the community.

Findings:

indicate that less frequent repositioning is associated with higher incidence of PI, supporting the need for objective nighttime repositioning assessments in clinical practice.

Background:

Augmented reality (AR) can be leveraged to aid hand rehabilitation but is reliant on accurate joint position detection. Pose estimation models, however, are only trained on videos from uninjured populations and degrade when interacting with real objects due to hand occlusions.

Objectives:

To assess the impact of hand impairment and occlusions on hand pose estimation accuracy in an AR system.

Methods:

Eight uninjured (4 male, 4 female) and four individuals with cSCI (4 male, Neurological Level of Injury: C4-C6) performed reaching and grasping movements. To evaluate the impact of occlusions, transparent or opaque versions of 3D printed blocks, credit cards, and marbles were used. Multiple cameras recorded participants’ hands and pose estimates from those cameras were triangulated and subjected to quality checks to generate ground truth estimates of hand joint positions. An egocentric perspective from a HoloLens 2 AR headset also provided ongoing joint position estimates. Pose estimation accuracy was measured as the average Euclidean distance between HoloLens 2 predictions and ground truth annotations.

Results:

Preliminary data shows an object by transparency interaction, with lower pose estimation accuracy when grasping transparent compared to opaque blocks but higher when grasping transparent compared to opaque credit cards. Further, there was no difference in pose estimations accuracy overall when comparing uninjured and cSCI populations. Conclusion: This work provides initial evidence that object transparency but not hand impairment may influence pose estimation accuracy. Additionally, this dataset can be leveraged to benchmark, train and improve hand tracking technology for populations with hand impairment.

Background:

Creating high-quality, home-based rehabilitation tools is integral for hand function recovery among individuals living with cervical spinal cord injury (cSCI). Specifically, effectiveness of home-based exercises is limited by compliance issues and a lack of guidance and performance feedback.

Objectives:

The current study assessed the perceived feasibility and meaningfulness of an Augmented Reality (AR) system that provided guidance and grasping feedback while individuals with cSCI interacted with real objects in their real environment.

Methods:

Six individuals with cSCI (4 male, 2 female; Neurological Level of Injury: C4-C6) tried a custom HoloLens 2 application that employed speech recognition, tracked hand joints and repetitions, and provided visual guidance of correct grasping postures for different objects (e.g., tip pinch for marble grasping). Following a grasp, feedback included visual comparisons between actual and target postures and a color-coded overall matching score out of 100 based on joint angle differences. After trying the system, participants completed one 30-minute semi-structured interview and the System Usability Scale (SUS) to assess perceived meaningfulness and feasibility in the context of home-based rehabilitation.

Results:

From the SUS, participants reported above average usability. Further, three themes emerged from the interviews: 1) high-quality feedback beyond previous at-home rehabilitation, 2) increased motivation, and 3) tailoring the application to individual needs. Critically, individuals with cSCI had several suggestions to increase the system’s meaningfulness. Conclusion: This study demonstrates the potential for AR to provide high-quality, hand function feedback for at-home rehabilitation. Further, iterative user-based refinement can lead to more meaningful systems for individuals with cSCI.

Background:

Functional electrical stimulation (FES) can improve outcomes for individuals with cervical spinal cord injury (cSCI). However, while neurorecovery relies on mass practice, current interventions rely on therapists to control the stimulation patterns. Thus, there is a need to develop high-quality, automated methods for home-based FES interventions.

Objectives:

To assess the feasibility and meaningfulness of a combined augmented reality (AR) and closed loop FES system for individuals with cSCI.

Methods:

Four individuals with cSCI (3 male, 1 female; Neurological Level of Injury: C4-C6) grasped different objects while wearing a HoloLens 2 AR headset and with FES electrodes over finger and thumb flexors. Leveraging the headset’s hand tracking, continuous error scores were computed comparing the individual’s postures to displayed object specific target postures. In a closed-loop fashion, continuous error scores modulated stimulation amplitudes linearly and helped achieve the correct grasping patterns (i.e., higher error = higher stimulation). After trying the system, participants completed one 30-minute semi-structured interview and the System Usability Scale (SUS) to assess perceived meaningfulness and feasibility in the context of home-based rehabilitation.

Results:

From the SUS, participants reported average usability. Further, participants perceived that the system could improve their recovery and relearning of grasping movements but emphasized a need for additional training regarding FES system setup (i.e., setting amplitudes and electrode placements). Conclusion: This study demonstrates the potential feasibility and meaningfulness of AR to guide FES stimulation patterns and use for home-based rehabilitation. Moreover, incorporating specific feedback from individuals with cSCI will improve the meaningfulness of the system.

Background:

The International Spinal Cord Injury (InSCI) Community Survey aims to describe the lived experience of community-dwelling persons with SCI globally. Canada joined the second InSCI survey in 2023 and results provide opportunities to describe community participation.

Objective:

To describe the Canadian InSCI sample and employment post-SCI; including personal, health-related, and environmental factors.

Methods:

The Canadian InSCI included International and Canadian-specific modules with 77 questions covering domains including sociodemographics, secondary health complications, environment, activity and participation. Recruitment occurred between Jan–Aug 2024 through Praxis Spinal Cord Institute’s recruitment databases and community partners such as SCI Prince Edward Island.

Results:

There were N=218 eligible respondents; 142 (65.1%) male, 190 (87.6%) traumatic SCI, median age at injury 26 years, median time since SCI 23 years, and 199 (91.2%) urban-dwelling. 166/217 (76.5%) and 115/198 (58.0%) worked pre- and post-SCI. 78/217 (35.9%) received vocational rehabilitation. At the time of the survey, 82/217 (37.7%) were engaged in paid work and 27/81 (33.3%) felt their salary was inadequate considering their efforts and achievements. The secondary health complications most identified as moderate or extreme problems were sexual health (101/213; 47%), pain (101/217; 47%) and sleep (81/217; 37%), with <50% receiving treatment for each.

Conclusion:

Due to the small sample, results are likely not representative of the Canadian SCI population, however, employment-related factors were highlighted that may benefit from further support, such as access to vocational rehabilitation and health services. Future work includes comparing results internationally and exploring how this data can support developing solutions with community partners.

Background:

Cardiometabolic Disease (CMD) after Spinal cord injury (SCI) refers to a collection of interrelated conditions stemming from changes in body composition (e.g., insulin resistance, abdominal and visceral obesity, and hypertension) that increase the risk of diabetes and heart disease. CMD contributes to 46% of deaths, with few rehabilitation strategies known to modify CMD risk among individuals with chronic SCI and CMD. Identifying novel, accessible, and safe rehabilitation strategies to combat CMD risk among adults with SCI is a priority.

Objective:

This project will investigate the feasibility of functional electrical stimulation cycling (FES-cycling) with blood flow restriction (BFR) in adults with chronic SCI. The concept builds on prior research of upper-limb BFR resistance training in SCI and is the first investigation into aerobic lower–limb BFR exercise in SCI.

Methods:

We will use a convergent mixed-methods approach, implementing a pre-test/post-test quasi-experimental design. Six adults (18-75yrs) with chronic SCI (>1yr) will attend 12 sessions over 2-weeks to include: two testing sessions (pre/post), two device orientation sessions, four FES-cycling, and four FES-cycling with BFR. Participant screening to recruitment ratio, attendance and retention, and adverse and serious adverse events will be recorded. Descriptive statistics will establish the success criterion. Deductive and inductive content analysis will assess participant feedback regarding the exercise modality’s feasibility, perceived safety, and protocol implementation.

Anticipated Results:

Positive outcomes for success criteria across all measurements and demonstrate increased aerobic stress in the absence of adverse events. Analysis of participant feedback will inform future clinical protocols and BFR prescription parameters.

Background:

Gaze behaviour plays a critical role in safe and effective walking, particularly among those who experience impairments in visual-motor coordination such as older adults and individuals with neurological conditions (i.e., including individuals with spinal cord injury). These deficits can increase likelihood of obstacle contact, compromise balance, and elevate fall risk. Although a growing body of research has explored interventions and technologies aimed at assessing and training gaze behaviour during walking, findings remain fragmented across population and approaches.

Objectives:

To synthesize the available literature on interventions and technologies used to assess or train gaze behavior during walking in older adults and individuals with neurological conditions.

Methods:

The scoping review will follow the methodological framework outlined by Arksey and O’Malley (_2007_) and adhere to the PRISMA-ScR reporting guidelines. A comprehensive search strategy will be developed in collaboration with the University Health Network Libraries and implemented across seven databases. Studies will be included if they: 1) involve older adults or individuals with neurological conditions, and 2) assess or train gaze behavior during walking. Study and participant characteristics, details of interventions, technology used, gaze metrics assessed, and outcomes will be extracted.

Anticipated Contribution:

This scoping review will provide a comprehensive summary of the interventions and technologies used to assess and train gaze behaviour in older adults and individuals with neurological conditions. Identifying shared and differing features in the approach to gaze research between a broad spectrum of populations could offer the first step towards standardized protocols for gaze-focused rehabilitation.

Background:

SCI&U is a health coaching program that individuals with chronic spinal cord injuries utilize in one-on-one private online coaching sessions with a peer health coach. The SCI&U study housed an extensive library of resources related to living with a spinal cord injury, including a variety of information from local and international resources.

Objective:

To meet the unique needs of participants in a new iteration of the program, the SCI&U Resource Library needed to be assessed and updated to ensure that inclusion in it is adequate and appropriate for people who have acquired a new spinal cord injury.

Design/MethodsEvery:

original resource was vetted, and all newly considered resources were assessed for relevant and appropriate content, ease of access, and topic. The project team, which includes people living with a spinal cord injury, redesigned the library format. New filtering categories were introduced and now include apps, podcasts, infographics, and infocomics, along with the originally offered websites, videos, PDFs, and articles. This provides the user with the ability to choose the format type they prefer. Users can also mark items as “Favorites,” which will build their own curated list of resources saved for future quick and easy access. ConclusionThe newly updated SCI&U Resource Library is an extensive set of appropriate resources that are centered on healthy living with a spinal cord injury. It is applicable for use by people who are newly injured and for those who have been injured for decades.

Background:

Adjustment to life after spinal cord injury (SCI) is multifactorial and overwhelming. To address the complexities of adapting to life with paralysis, we developed SCI&U, a self-management program for people living with SCI. SCI&U is delivered virtually using a peer health coaching model and supports people with SCI in learning how to manage their health and life.

Objective:

Peer health coaching is a strengths-based, person-centered approach that utilizes lived experience in supporting participants with developing skills in identifying goals, finding resources, and building knowledge. The focus is on participant preferences and values. The SCI&U study was conducted to evaluate the feasibility of participant and PHC recruitment, interest in the program by the SCI community, and participant and PHC retention.

Design:

A feasibility study that proposed to recruit and enroll participants and Peer Health Coaches (PHC) from the SCI community. Program satisfaction, acceptability, and relevance post-intervention were rated by participants using the Health Education Impact Questionnaire (heiQ). Conducted during the pandemic, PHCs were trained to coach participants using a virtual platform that promotes skill-building in health self-management.

Results:

6 PHCs were trained and 18 participants completed a minimum of 3 coaching sessions. HeiQ mean scores averaged 3.7/4 for goal setting, information sharing, relevance, feeling validated, and the importance of the coaching relationship.ConclusionParticipants and PHCs highly valued the SCI&U program, showing virtual coaching provided by a PHC is a viable and promising way to address health needs and improve quality of life for the SCI community.

Background:

Neurogenic bladder dysfunction, or neurogenic lower urinary tract dysfunction, is a common consequence of spinal cord injury (SCI). Previous studies have shown that the Lower Extremity Motor Score (LEMS) from the International Standards for Neurological Classification of SCI (ISNCSCI) is a strong predictor of bladder continence at 1-year post-injury, with reported AUC values of 0.912 (Pavese et al., 2016) and 0.919 (Elliott et al., 2018). This study aims to validate the predictability of LEMS on bladder continence using data from the Canadian Rick Hansen SCI Registry (RHSCIR).

Methods:

Participants with traumatic SCI (TSCI) from the RHSCIR dataset (2004–2023) were included. Bladder continence at 1-year post-SCI was assessed using the bladder management item from the Spinal Cord Independence Measure (SCIM-III, score = 15) and the Functional Independence Measure (FIM, score = 7). Descriptive statistics, bivariate analysis, and logistic regression were conducted.

Results:

Among 2336 participants, 37% had AIS D at acute admission, increasing to 47% at rehabilitation discharge. The median LEMS was 9 at acute admission and 22 at rehabilitation discharge. Bladder continence was achieved by 38% at rehabilitation discharge and 47% at 1-year follow-up. Logistic regression showed good predictive power for LEMS at both acute admission (AUC 0.828) and rehabilitation discharge (AUC 0.828), with high specificity (0.853 and 0.825, respectively), but low sensitivity (0.585 and 0.399, respectively).

Conclusion:

LEMS is a promising predictor of bladder continence 1-year after SCI; however, the low sensitivity indicates that other factors may influence bladder continence, and the model could be improved.

Background:

The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is the gold standard for classifying SCI level and severity. While validated for non-traumatic SCI (NTSCI), its use during rehabilitation remains underexplored. This study evaluates ISNCSCI performance in persons with NTSCI during rehabilitation.

Method:

Participants with NTSCI from the Rick Hansen Spinal Cord Injury Registry (2020-2022) were grouped by rehabilitation admission (N=728) and discharge (N=619). ISNCSCI data included: assessment performance and timing (≤7 days), completeness, missing items, worksheet use, and mismatches between clinician- and algorithm-generated American Spinal Injury Association (ASIA) Impairment Scale (AIS) and neurological level of injury (NLI) classification. Descriptive and bivariate statistics were conducted.

Results:

The median age was 62 years, with 58% male and 48% with degenerative disease. The median length of stay in rehabilitation was 55 days. At admission, 89% had an exam, 8% did not, and 3% had missing exam dates, while at discharge, 36% had an exam, 61% did not, and 3% had missing dates (P<.0001). Incomplete exams were more common at discharge compared to admission (40% vs 25%, P=.0001), with rectal components missing in 73%. Additional, mismatch rates for AIS (Admission: 16%; Discharge: 31%) and NLI (Admission: 28%; Discharge: 42%) were higher at discharge.

Conclusion:

Incomplete ISNCSCI assessments and higher mismatch rates for AIS and NLI classifications were more frequent at rehabilitation discharge. Given the importance of tracking ISNCSCI changes after discharge to monitor recovery and detect complications, further implementation support and consideration of a standardized abbreviated exam at this timepoint may be worthwhile.

Background:

Canadians living with spinal cord injury (SCI) have noted gaps in the quality and continuity of care while navigating the healthcare continuum. These gaps can be addressed by a Canadian SCI model of care (MoC), which other countries have implemented to support continuity of care, community reintegration, and provider engagement, to improve health outcomes. Due to differences in healthcare systems and demographics, international SCI MoCs may not suit the Canadian context. Thus, a modified Delphi approach is being employed to establish a Canadian SCI model of care spanning acute care to community living.

Methods/Overview:

The Canadian SCI MoC initiative is led by a diverse group of Canadian experts (n=18) including people living with SCI, clinicians, healthcare providers, community organization representatives, researchers, and administrators. A workshop will be held to 1) describe proposed consensus statements that describe an ideal Canadian SCI MoC and 2) illicit feedback and input about the statements. Thirty consensus statements will be presented for discussion. These statements, informed by evidence-based documents (n=55), were initially framed using seven categories from the Alberta Quality Care Matrix for Health and similar provincial initiatives and frameworks: respect, safety, accessibility, appropriateness, effectiveness, equity, and efficiency. Workshop participants will provide feedback on the statements and ideas for regional modifications and implementation strategies.

Results:

N/A

Conclusion:

Development of a national SCI MoC will guide advocacy efforts and inform adaptable, regionally responsive models across Canada, potentially benefiting not only those people living with SCI, but others with neurological and complex conditions.

Funding:

University of Alberta SCI Chair Endowed Research Funds, Alberta Innovates, Praxis Spinal Cord Institute

Conflict of Interest:

None declared

Background:

Gait adaptability (i.e., ability to adjust walking in response to environmental demands) is critical for safe community walking. The Spinal Cord Injury Functional Ambulation Profile (SCI-FAP), a measure of gait adaptability, has strong psychometric properties in chronic spinal cord injury (SCI); however, in sub-acute SCI, the psychometric properties of the SCI-FAP are unknown.

Objective:

To evaluate the convergent validity, predictive validity, and the responsiveness of the SCI-FAP in sub-acute SCI.

Design/Methods:

A retrospective observational study using data from the Rick Hansen Spinal Cord Injury Registry (2015-2024) was completed. Demographic/injury-related data and clinical data (e.g., 10-meter walk test (10MWT), Berg Balance Scale (BBS)) from the Standing and Walking Assessment Tool (SWAT) were extracted. Convergent validity was evaluated using Spearman’s correlation between SCI-FAP scores and other SWAT measures. Logistic regression models and receiver operating characteristic curve analyses were completed to evaluate predictive validity of community walking. SCI-FAP responsiveness was assessed using effect size between admission and discharge scores.

Results:

Data from 215 individuals with motor incomplete SCI were included. The SCI-FAP correlated with the 10MWT and BBS at both admission (rs=-0.62, -0.81, p<0.001) and discharge (rs=-0.82, -0.88, p<0.001). The 10MWT had the highest area under the curve (0.88) and was a significant predictor (p=0.021), while the SCI-FAP (0.75) and BBS (0.73) had the lowest and were non-significant (p>0.079). The SCI-FAP demonstrated a large effect size (0.85).Conclusions: The SCI-FAP correlates the strongest with the BBS, has non-significant predictive and fair discriminative ability of community walking, and is responsive in sub-acute SCI.

Background:

Regaining upright balance is a key rehabilitation goal for individuals with motor incomplete spinal cord injury (iSCI), as it directly impacts mobility and independence. Functional electrical stimulation (FES) activates paralyzed muscles non-invasively, helping individuals to perform functional tasks such as standing and walking. Transcutaneous spinal cord stimulation (TSS) enhances spinal excitability and promote motor recovery. Although both FES and TSS have demonstrated therapeutic benefits for improving motor functions, combining them may provide a more comprehensive therapeutic approach. TSS may increase spinal cord network excitability, potentially amplifying FES-induced muscle activation and neuroplasticity, thereby improving balance through both central and peripheral mechanisms.

Objective:

To investigate the therapeutic effects of a combined TSS and FES intervention (TSS+FES) on balance recovery in individuals with iSCI.

Methods:

To date, twelve participants with iSCI have been randomized into two groups: TSS+FES (n=6) and FES-only (n=6). Both groups received 12 sessions of visual feedback balance training (VFBT) with closed-loop FES targeting the ankle muscles. The TSS+FES group additionally received sub-motor threshold TSS (30 Hz) at spinal levels T10–T11 and L1–L2. Balance outcomes were assessed at baseline, immediately post-intervention, and at six-week follow-up, and included the Activities-specific Balance Confidence Scale, Timed Up and Go, and mini-BESTest.

Results:

Preliminary findings indicate that the TSS+FES group showed greater and more sustained improvements in balance confidence and clinical performance compared to the FES-only group.Conclusion: These preliminary results suggest that combining TSS with FES is a feasible and potentially more effective approach to improve balance and mobility in individuals with iSCI.

Background:

Persons with spinal cord injury/dysfunction (SCI/D) face many barriers to participation in active living programming (e.g., physical activity, behavioural support, nutrition support). Online programming may be one way to mitigate some of these barriers and facilitate access, while promoting participation.

Objective:

To develop a set of priorities that should be considered when developing an online active living program.

Methods/Overview:

A qualitative study using nominal group technique is being undertaken to guide the co-design of an online active living program. Four focus groups (two in English and two in French) with persons with SCI/D and persons who have delivered or developed programming for persons with SCI/D have been conducted (e.g., kinesiologist, fitness instructors). A consensus vote was completed at the end of each focus group.

Results:

Fifteen individuals have completed the focus groups (n=7 persons with SCI/D, n=5 kinesiologists, and n=3 fitness instructors). Top priority areas included: 1) Creating a sense of community and social opportunities; 2) Technology considerations; 3) Personalized programming (e.g., modifications, progressions, goal setting); and 4) Staffing (e.g., access to 1-on-1, availability of qualified professionals). In addition, participants from the French groups identified cost, availability of the programming in French as well as additional resources on other topics (e.g., nutrition, mental health, sexuality) as priorities.

Conclusions:

Persons with SCI/D, fitness instructors and kinesiologists have identified key aspects that will be used to develop an online active living program. Next steps will include a final consensus vote, followed by program development and evaluation of the co-design process.

Funding:

Funding for this project is provided by the Craig H. Neilsen Foundation – Psychosocial Research Portfolio. Stephanie R. Cimino, post-doctoral fellow, is supported by the Craig H. Neilsen Foundation Psychosocial Research Post-doctoral Fellowship.

Conflict of Interest:

The authors have no conflict of interest to disclose.

Background:

Persons with spinal cord injury/disease (SCI/D), multiple sclerosis (MS), cerebral palsy (CP), and spina bifida (SB) are at an increased risk of cardiometabolic disease (CMD), but are less likely to receive appropriate screening, diagnosis, and treatment. Little is known about how persons with these conditions or their healthcare providers view CMD.

Objective:

(1) Understand current knowledge, importance, confidence, and concern related to CMD among physiatrists, primary care providers (PCPs), and persons with SCI/D, MS, CP, and SB; (2) Learn of CMD practices within primary care and rehabilitation settings; and (3) Identify areas for improvement in CMD care.

Methods:

Mixed-methods approach using a cross-sectional survey ((5-point Likert scale from Strongly Disagree (-2) to Strongly Agree (+2)) and semi-structured interviews. Descriptive statistics and thematic analysis were used to interpret data.

Results:

Fifty participants completed the survey and 19 interviews were conducted. Persons with SCI/D, MS, CP, and SB reported limited knowledge of CMD (-0.49) but confidence in their ability to manage it (+0.62). Physiatrists and PCPs reported confidence in CMD treatment provision (+0.55) and agreed that responsibility for CMD management falls primarily to PCPs. All groups identified a need for more resources and education to inform bedside care and promote self-management. Physiatrists and PCPs also identified barriers to providing CMD care, including limited time and communication between specialties. Conclusions: These findings highlight gaps in knowledge and resource availability. Future work should aim to address identified barriers and develop resources across all groups to promote comprehensive CMD care across Canada.

Fahreen Ladak, Martha McKay, Pema Zela, Toronto Rehab, University Health Network. Toronto, Ontario, CanadaBACKGROUND.In the Spinal Cord Rehab Program (SCRP), Toronto Rehab (TR), UHN, patient and staff safety is compromised at times due to non-medical related behavioural concerns. A need to support patients, staff and leaders to safely and successfully navigate these types of situations was identified. A UHN-wide working group that consisted of patient partners, patient experience, bioethics, psychology, safety services, legal, operational management, educators, and human resources was established. OBJECTIVE.To develop an algorithm and manager toolkit to help leaders navigate non-medical behavioral related incidents using a standardized approach. METHOD.One inpatient unit in the SCRP was selected to help develop and pilot the algorithm and toolkit which includes roles and responsibilities and resources to support staff, patient and managers to navigate behavioural concerns. PARTICIPANTS.UHN working group; manager, patients, SCRP team membersRESULTS/FINDINGS.The pilot took place from May-Nov 2024, during which eight behavioural incidents were reported. Three were resolved through open and supportive conversations between the manager and the patient/visitor. The team was engaged throughout to ensure effective behaviour support plans were developed and revised in a timely manner. Five incidents required letters of expectation to be provided to the patient/visitor. The team was engaged throughout the process to ensure awareness of triggers and consistent implementation of strategies. No incidents required escalation beyond the initial letter of expectation. CONCLUSION.Use of the algorithm and toolkit was efficient and effective during the pilot and is now being expanded to other programs across Toronto Rehab and UHN.

Background:

The intersection of menopause and spinal cord injury (SCI) presents unique challenges for females. Particularly, vasomotor symptoms (VMS), including hot flashes and night sweats, are common in menopause but may also be linked to SCI-related complications. However, the relationship between these conditions remains unclear.

Objective:

This scoping review aimed to map the extent and nature of available literature on menopause and SCI, evaluating how SCI influences the experience and management of menopause and identifying existing knowledge gaps.

Design/Methods:

The review included studies of females with SCI, particularly peri/postmenopausal females. A comprehensive search across multiple databases included peer-reviewed articles and grey literature. Studies were analyzed for their focus on SCI and menopause symptoms (VMS), and menopause-related complications (genitourinary syndrome of menopause [GSM] and skin changes, osteoporosis, ovarian and breast cancer, and cardiometabolic diseases).

Results/Findings:

A total of 29 peer-reviewed articles and 22 grey literature sources were included. Of the 29 academic studies, 11 were narrative reviews that cited literature and postulated hypotheses. One randomized controlled trial tested an educational intervention on menopause knowledge and satisfaction with care. VMS and mood changes were common in females with SCI undergoing menopause. Many studies had small sample sizes, and results were inconsistent.

Conclusion:

Current research is limited, with many studies lacking robust data or clear conclusions. While there is some evidence of the challenges faced by females with SCI during menopause, more focused, high-quality research is needed to inform healthcare practices and improve menopause detection and management in females with SCI.

Background:

Functional electrical stimulation (FES) is an effective therapy for improving standing balance in individuals with spinal cord injury (SCI) and can be enhanced through closed-loop systems that respond to user instability. However, clinical use is limited by the complex setup (correct placement of multiple electrodes, wire clutter, etc.) . Frequent travel for therapy can also be burdensome. Textile electrodes offer a promising alternative by embedding electrodes into a single garment for easier, home-based use. Yet, many current textile systems require wetting, rely on tight compression garments, and lack robust durability testing.

Methods:

We developed a flexible textile electrode material that attaches to fabric using a commercial heat press. A prototype lower leg sleeve was created, featuring Velcro flaps for easy donning and an adjustable fit with repositionable electrodes to accommodate different users. A magnetic connector simultaneously connects all electrodes, minimizing wire clutter and setup time. Electrode-skin interface performance was evaluated via electrochemical impedance spectroscopy (EIS) against standard gel electrodes. Durability is assessed through adhesion peel tests, abrasion resistance (via modified Martindale testing), and washability (30 wash cycles).

Results:

EIS testing showed that textile electrodes have impedance comparable to gel electrodes. Peel tests confirmed strong adhesion to fabric. Ongoing user studies with able-bodied participants are assessing stimulation performance (torque output), comfort, and usability. Durability tests are in progress to evaluate long-term performance after abrasion and washing.Conclusions: This prototype addresses key barriers to FES adoption by offering a user-friendly, durable, and clinically comparable textile electrode solution for at-home rehabilitation use.

Background:

Estrogen regulates menses, reproductive and urinary tracts, heart and blood vessels, skin, mucous membranes, pelvic muscles, and the brain. Menopause presents unique challenges for females with spinal cord injury or disease (SCI/D) due to the combined effects of hormonal changes and neurological impairments.

Objective:

This project aims to develop and disseminate a podcast series and related handouts focused on menopause symptom recognition, managing menopause-related health complications, and empowering women to discuss their symptoms and related health complications with their healthcare provider.

Design/Methods:

Using a co-design framework, the team collaborated with people with lived experience (PLEX), researchers, and clinicians. A scoping review informed the content of the Menopause and SCI: In a Hot Flash series, which includes six podcast episodes, each focusing on a different aspect of menopause. PLEX partners co-developed the content, served as co-hosts, and contributed to question development for guest experts. Each episode concludes with a specific health action item. Educational Action Planning Tool handouts were created for each episode, featuring key takeaways, and infographics.

Results/Findings:

The project produced six user-friendly podcast episodes and handouts including; an introductory overview and episodes discussing vasomotor symptoms, genitourinary syndrome of menopause (GSM) and skin changes, mood and cognition, breast and ovarian cancers, cardiometabolic disease and bone health.

Conclusion:

This initiative aims to fill a critical knowledge gap for females with SCI by providing accessible, reliable information to improve health literacy and support self-advocacy regarding menopause-related health concerns.

Background:

Urinary tract infections (UTIs) are common complications of spinal cord injury or disease (SCI/D) and the leading cause of sepsis, contributing to increased morbidity and mortality.

Objective:

We describe UTI frequency, sepsis risk factors, and report UTI-related sepsis incidence over time among inpatients with SCI/D, at University Health Network.

Design/Methods:

Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI-IEQCC) Quality Improvement (QI) UTI data were evaluated from January 2020 to March 2024. UTI data was abstracted from medical records, de-identified, and linked to National Rehabilitation Reporting System data. Adults with SCI/D and UTI (positive urine culture and bladder symptoms) were included. Sepsis was defined by ≥2 clinical signs- abnormal temperature, Heart Rate >90, Respiratory Rate >20, or abnormal WBC within 1 week of positive culture.

Results/Findings:

923 patients had a confirmed UTI (positive culture and bladder symptoms), 67% were male, 79% had incomplete injuries, and 75% were paraplegic. Overall 11% (n=114 patients) developed sepsis. In 2021, UTI-sepsis incidence was 18.9%, decreasing to 14.9% in 2022 and 6.2% in 2023. Fever (76.4%) and elevated heart rate (94.5%) were common. Fever is a highly significant predictor of UTI-sepsis (p < 0.001), with an odds ratio of 8.02 (95% CI: 4.59 to 13.97) using Multiple logistic regression. Age, Sex, NLI, AIS, and spasticity were not associated with UTI-sepsis (p > 0.05).Conclusion: UTI-related sepsis has declined from 2021 to 2023 which demonstrates improved sepsis detection with SCI-IEQCC UTI best practices highlighting the effectiveness of routine temperature monitoring, and timely intervention.

Background:

Persons living with spinal cord injury or disease (SCI/D) rate neurogenic bowel dysfunction (NBD) as a priority for cure above issues such as walking or pain management. Despite this, NBD is understudied with limited evidence to guide management.

Objective:

1) Report the prevalence of NBD in individuals participating in inpatient rehabilitation following SCI/D; 2) Describe the clinical management of NBD during inpatient rehabilitation.

Methods:

Individuals admitted to the UHN Spinal Cord Rehabilitation Program were screened for NBD. Prescribed medications were extracted from medical records. NBD was assessed serially by administering a battery of outcome measures within 20 days of rehab admission and within a week prior to discharge.

Results:

Approximately 80% of screened individuals (58/73) met criteria for NBD and were eligible for study enrolment; 62% (36/58) were enrolled (male n = 21, female n = 15). NBD persisted in 96% of participants (21/22) at rehabilitation discharge (study ongoing). 97% (35/36) of enrolled participants were prescribed medications for bowel management; mean of 3 medications per participant at enrolment (mean 2.6 at discharge). 78% (28/36) required suppository administration to evacuate their bowels. Of these individuals, 82% (23/28) required digital stimulation or manual disimpaction as an additional adjunct.

Conclusion:

There is a high prevalence of NBD among adults admitted for inpatient SCI rehabilitation. This persists in the overwhelming majority to rehabilitation discharge, necessitating ongoing pharmacotherapy and clinical management in the community. Study results indicate a pressing need to improve our understanding and clinical management of NBD following SCI/D.

Background:

Communities of Practice (CoPs) are groups of people that share a concern or a passion for a particular topic or activity. Interacting regularly promotes sharing, and attaining group goals. CoPs can grow organically in size and scope. The Pride in Patient Engagement in Research (PiPER) team at the University Health Network (UHN) leads a CoP to promote a culture of meaningful PLEX engagement in research.

Objective:

To share the PiPER CoP format, content and progress to date.

Methods/Overview:

Each CoP is led by a PLEX-researcher dyad. One-hour virtual sessions are held monthly. Each CoP session has a formal presentation followed by a discussion. A one-page summary and video recording of the formal presentation are posted on the PiPER website after each CoP.

Results:

PiPER has hosted 21 CoPs co-led by PLEX-researcher dyads from UHN and external organizations, totalling 600+ attendees. Hot topics included youth engagement, family and caregiver engagement, advocacy for novel therapies in spinal cord injury, and PLEX as co-authors. Our CoP evaluation found 93% of respondents gained knowledge about PLEX engagement in research, and 97% intend to use the knowledge gained in their own research.

Conclusions:

The PiPER CoP is unique as it is co-led by a PLEX-researcher dyad. The videos and easy-to-read summaries of the formal presentations promote accessibility. Non-recorded, open discussion after the formal presentation supports a culture of belonging and shared learning. We hope to serve as a model for other CoPs in healthcare and PLEX engagement in research beyond UHN.

Funding:

This work is funded by the UHN Foundation.

Background/Objectives:

Following spinal cord injury/dysfunction (SCI/D), individuals undergo intensive rehabilitation and often ask: _Where and how will I live?_ Housing needs intersect with finances, geography, accessibility, equipment, preferences, and support services, and vary by injury severity, age, and life circumstance. Little research explores how these needs affect adults in different life stages or how they change over time. This study aimed to examine the housing needs and experiences of adults with SCI/D and their family caregivers across the adult life course.

Methods/Overview:

A qualitative descriptive study was conducted with Canadian community-dwelling adults with SCI/D, co-habitant family caregivers, and accessible housing professionals. Participants were recruited through rehabilitation hospitals, provincial SCI/D associations, social media, flyers, and professional outreach. Semi-structured interviews were conducted via Zoom or telephone and analyzed using inductive thematic analysis.

Results:

Participants (N=98) included 74 people with SCI/D (aged 27–80; time since injury 1–50+ years), 5 family caregivers, and 19 professionals. Newly injured individuals emphasized needs for accessible transitional housing, peer support, and assistance navigating financial aid and home modification. Those with children and pets described limited family-friendly housing options. Older adults voiced difficulties related to impacts on retirement, financing renovations or moves, and progressive needs for home modification and attendant care.

Conclusions:

Housing needs after SCI/D are dynamic and shaped by life stage and circumstance. The findings highlight the need for better access to peer support, information, funding for home modifications, and a broader stock of accessible, family-friendly housing. Policy changes are needed to address systemic gaps.

Background:

Engaging people with lived experience (PLEX) in research is increasingly being valued by Canadian health research organizations and funders. Compensation is a critical component of PLEX engagement; however, rates and processes vary. We conducted an environmental scan of PLEX compensation guidelines in Canada to drive a University Health Network (UHN) policy.

Methods:

We reviewed literature from 2015-2023 related to compensating PLEX participating in research as partners. Sources include: 1) scientific papers from academic databases; 2) policy/procedure reports from research organizations; and 3) a broad internet search, including local living wage values. A UHN financial policy working group reviewed outcomes and voted on ideal rates for specific PLEX research roles.

Results:

We identified 39 documents (33 policies, 6 literature sources). Honoraria was the most common compensation type (51%) followed by fixed service income (33%). Among fixed service income, 64% of organizations paid hourly rates, averaging $30.82/hour. Most (56%) provided half-day rates (average $110.23) and full-day rates (average $209.09). Most paid with cash (79%) or gift cards (28%). Alignment of working group feedback with cost of living resulted in $36-40/hour rates, depending on PLEX roles.

Conclusion:

The UHN compensation range ($36-40/hour) was increased from the $30.82/hour to align with Research Associate hourly rates and a living wage in Toronto. Payment type and frequency are based on PLEX roles (e.g., research team member – salary; steering committee member – hourly rate). Standardized compensation rates embedded in UHN policy will create a culture where the experience and expertise of PLEX are recognized and valued.

Background:

Engaging people with lived experience (PLEX) in research is a priority for communities, funders, and research organizations. We developed the Pride in Patient Engagement in Research (PiPER) Toolkit to promote meaningful and equitable PLEX engagement in research at the University Health Network (UHN). Here we describe the Toolkit development and outreach to date.

Methods:

Fifty-five diverse working group members (10 PLEX) met virtually over 17 months and 25 hours to co-develop the Toolkit. Content includes terminology and key concepts of PLEX engagement in research, PLEX roles, role-specific compensation guidelines, an evaluation framework, and checklists for organizations to use in planning and implementing PLEX engagement.

Results:

Since its release in 2023, 3,500+ printed and 500+ digital Toolkits have been distributed. We delivered over 17 presentations about the contents of the Toolkit to 290+ leaders, research staff, and trainees at UHN. The Toolkit value was recognized through the CIHR Research Excellence Prize, and PLEX working group members received a UHN Mission Excellence Award for their contributions.

Conclusion:

The PiPER Toolkit adds to current initiatives driving PLEX engagement in research with the definition of five PLEX roles, education and training resources specific to each role, and an evaluation framework and tools. Future work will focus on improving the accessibility of the Toolkit to ensure its utility and impact extend to broader audiences. Preliminary feedback suggests focusing on adaptable colour schemes and font size, improved technological compatibility (mobile-friendly, text-to-audio), language availability, and learning-friendly options (videos, podcasts, summarized version).

Background:

The Rick Hansen Spinal Cord Injury Registry (RHSCIR) is a multisite Canadian registry of individuals with spinal cord injury/disease. RHSCIR seeks to obtain clinical and demographic information through a participants’ care journey.

Objectives:

We compared the Toronto Rehab community follow-up (CFU) completion rates to describe participant engagement beyond rehab discharge in two 4-year periods, Cohort-1(2011-2015) and Cohort-2(2020-2024).

Methods:

For consented adult(18+) participants with traumatic SCI, a CFU is conducted at the 18-month timepoint from the date of injury, again at the 5-year and 10-year timepoint. We report and compare CFU completion rates and detail the reasons for lack of CFU completion.

Results:

Cohort-1 (RHSCIR-1.0) included 486 consenting participants, Cohort-2 (RHSCIR-3.0) included 527 consenting participants. CFU completion rates for Cohort-1 and Cohort-2 were consistent at 48%(n=233) and 53%(n=277), respectively. Cohort-1’s 2- and 5-year completion was 40%(n=84) and 0%(n=0). Cohort-2’s 5- and 10-year completion was 54%(n=100) and 49%(n=85). There was a small increase in the initial CFU completion rate between Cohort-1 (49%(n=233) for year 1 and 2) and Cohort-2 (54%(n=92) at 18 months). Cohort-1 and Cohort-2 had 52% and 47% incomplete CFUs, respectively, with 5% and 4% declined, 2% and 5% withdrawn, 2% and 4% deceased, 10% and 16% missed, and 34% and 19% invalid contact information. Conclusions:Currently we face challenges in sustaining resources to complete CFU interviews and maintaining updated participant contact information. Implementation of Epic(2022) has improved CFU completion by providing valid contact information and death notifications. Enabling Epic reminders for CFU participants is an opportunity for improvement.

Background/Objectives:

At Parkwood Institute, a rehabilitation centre in London ON, a rise in pressure injury (PI) incidence among individuals with SCI/D led to its designation as a corporate priority. In response, the Spinal Cord Injury Implementation, Evaluation and Quality Care Consortium’s local Site Implementation Team (SIT) was leveraged to build on existing work and co-develop a process map aimed at standardizing PI prevention practices and clarifying roles. Ensuring shared understanding and alignment across disciplines was a key motivator for this initiative.

Methods/Overview:

A multi-stakeholder team, comprising persons with lived experience, clinicians, leaders etc. collaboratively designed the process map through the bi-weekly SIT meetings. Over several sessions, the team reviewed and refined the process map through iterative feedback cycles to ensure alignment with real-world workflows and frontline feasibility.Once the process map was finalized, implementation strategies were introduced, including: •Dissemination through engagement•Integration and access to map•Embedded evaluationsResults:The final output was a comprehensive, role-specific process map that clarified team responsibilities and created a shared model around PI prevention. The tool has been disseminated to staff across all roles and shifts is readily available for use. It is also being integrated into new staff orientations. Early results suggest good adoption of the process.Conclusions:This initiative demonstrates the value of applying an implementation science approach to co-develop practical, context-specific solutions. The process map is now embedded as a core resource, with ongoing audits guiding further adaptation to support sustainable and equitable PI prevention across the SCI/D program.

Background:

The Possibilities Project Plus (PPPlus) program is a free assistive device marketplace that has been active since 2023. This program offers a solution to promote the re-circulation of used assistive devices, which too often end up in landfills due to the absence of structured processes aimed at recirculation. This work focuses on describing the integration of this service within a rehabilitation institution to promote equitable device access.

Overview:

To facilitate the integration of a solution for the recirculation of assistive devices within a rehabilitation institution, the following processes have been established:1) Collaborate with institution’s risk department to identify potential risks associated with re-circulating used devices.2)Integrate risk feedback into the platform’s operational processes to promote safety and organizational alignment.3)Foster an ongoing feedback loop with the risk team to monitor and adapt processes necessary for scale up.

Outcomes:

In alignment with integrated knowledge translation principles, the inclusion of stakeholder perspectives is an ongoing and iterative process. Regular meetings with key stakeholders (i.e., risk department, rehabilitation leads, etc.) served as mechanisms for structured feedback and change. The work outline supported the implementation of a device donation policy at a rehabilitation institution in Southwestern Ontario.

Conclusion:

This collaborative process helped promote shared ownership, enhancing the feasibility and safety of the service and enabling the implementation of a solution to mitigate device inaccessibility. Future efforts will involve iterative revision cycles to streamline and enhance the service, ensuring lasting impact and enabling implementation across various health care settings.

Background:

The Spinal Cord Injury Implementation, Evaluation and Quality Care Consortium (SCI-IEQCC) is a national initiative committed to advancing the quality and consistency of care for individuals with spinal cord injury or disease (SCI/D). The Consortium collaborates with rehabilitation sites across Canada to implement and evaluate best practices within key domains, including wheeled mobility.During domain reviews, one finding showed discrepancy in overall time from seating assessment to wheelchair dispense.This abstract will explore the variability in service delivery at two sites in Ontario and shed light on regional differences.

Methods/Overview:

Wheelchair prescription data from 2024 were collected at two rehabilitation sites in Ontario. The following dates were extracted in a retrospective chart review: seating assessment, wheelchair prescription, and wheelchair dispense to compare timelines ResultsThe practice of wheelchair prescription is comparable between sites, following the World Health Organization 7-step model. However, significant differences were observed in total time from assessment to device dispense for both high technology (CEP) and standard wheelchairs. For CEP devices, Site 1 had a significantly longer average total time (237.8 days) compared to Site 2 (56.8 days, p = 0.016). Similarly, for standard wheelchairs, Site 1’s average total time (121.2 days) was significantly higher than Site 2 (79.5 days, p = 0.043).ConclusionFurther investigations are needed to elucidate reasons for differences and determine optimal timing for initiating wheelchair provision. Advocacy efforts should be focused on both corporate and Ministry of Health levels to better support equitable provision of wheelchairs across Ontario.

Background:

Sleep-related breathing disorders (SRBDs) are common, but under-recognized medical conditions after spinal cord injury (SCI).

Objectives:

This study assessed the feasibility, criterion validity and the economic impact of an unattended home-based screening sleep test (HBSST) in the detection of SRBDs in the SCI population.

Methods:

This prospective multi-method study included (a) a feasibility analysis using quantitative and qualitative data from an unattended HBSST; (b) a validity analysis of the HBSST when compared with in-laboratory polysomnography; and (c) the economic analysis of the HBSST was compared with polysomnography using cost-minimization analysis on the perspective of a single publicly-funded insurer. Qualitative data were obtained during a semi-structure interview with every participant who shared their experience when undergoing the HBSST. Participants: We recruited adult participants with subacute/chronic (>1 month after injury) SCI who have never been screened for SRBDs.

Results:

We included 28 participants (11 females, 17 males; mean age: 54.9 years) with complete (n=7) or incomplete SCI at cervical (n=18) or lumbosacral levels; nine individuals were diagnosed with a moderate-to-severe SRBD. All participants successfully completed the HBSST and the majority (78.5%) set up the device without assistance. A high apnea-hypopnea index (AHI) from the HBSST was significantly correlated with high AHI from the polysomnography (r=0.717; p=0.0248). The use of HBSST was found to be a cost-saving approach when compared with polysomnography.Conclusions: Our results demonstrate the feasibility and validity of a HBSST. Additionally, the HBSST is more cost-effective strategy for detection of SRBDs in the SCI population than the polysomnography.Funding: Praxis Spinal Cord Institute (G2021-40).

Background/objectives:

The Standing and Walking Assessment Tool (SWAT) is a standardized approach to walking assessment after spinal cord injury/disease (SCI/D). Physical therapists (PTs) provide informal feedback about patients’ standing and walking performance, but there is no standardized method for providing feedback. We aimed to develop a feedback form to provide patients with SCI/D with information about their standing and walking ability.

Methods/overview:

Four steps of a conceptual framework for patient-healthcare provider communication were followed. 1) Identify patients’ and PTs’ goals for communication. 2) Identify the needs, values, skills and emotions underlying each group’s goals. 3) Determine the preferred communication process. 4) Consider the environment where communication will occur. Prior literature was surveyed, including a qualitative study exploring patients’ preferences for feedback about walking ability after SCI/D. To understand therapists’ goals for SWAT communication, six PTs familiar with the SWAT met twice.

Results:

1) Patients and PTs identified similar communication goals: facilitate goal setting and transfer of care, and adopt a common language about walking recovery. 2) Patients valued feedback that was relevant to their lives. PTs had concerns about providing unrealistic expectations about walking. 3) Combined verbal and written feedback were preferred by patients. PTs suggested written, quantitative feedback could provide patients agency to self-advocate. 4) Communication must be personalized, but efficient as time is limited in the hospital setting. Conclusion: A SWAT Feedback Form was created. It requires inserting a patient’s scores in a form pre-populated with simplified descriptions of measures and interpretations of scores in relation to function.

Background/Objective:

The Standing and Walking Assessment Tool (SWAT) provides physiotherapists with standardized measures of walking and balance for spinal cord injury (SCI) rehabilitation. Since the implementation of the SWAT in 2014, SCI demographics have changed and new measures and technologies for walking/balance have been developed. Thus, there is a need to evaluate the SWAT’s appropriateness for current SCI rehabilitation. As a first step, a rapid review of reviews was conducted to identify measures of walking and balance currently used in SCI research.

Design/Methods:

Two databases (CINAHL and PubMed) were searched using terms developed from the target population (SCI) and constructs (walking/balance, measurement). Systematic and scoping reviews published in the past ten years were included. Title/abstract and full-text screening were completed by two researchers. Measures of walking and balance were identified, along with their psychometric properties and rating of clinical utility. Descriptive statistics and narrative summaries were used for reporting.

Results:

Of the 197 citations, nine reviews were included on balance (n=5), walking (n=2), walking and balance (n=1) and motor function in cervical myelopathy (n=1). Considering frequency of use, psychometric properties and clinical utility, the 10-meter walk test is the most appropriate walking measure, while the Berg Balance Scale and Mini-BESTest are the most appropriate balance measures. Two gaps were identified: low use of measures of walking adaptability and minimal inclusion of walking and balance measures in cervical myelopathy studies. Conclusions: There are new measures (i.e., Mini-BESTest), constructs (i.e., walking adaptability) and populations (i.e., cervical myelopathy) to consider for the SWAT.

Background:

Most sexual rehabilitation programs for women with Spinal Cord Injury (SCI) exclude important aspects of sexuality such as intimacy and pleasure. There is a lack of practical knowledge and resources about sexuality that target the needs of women with SCI. Interventions focused on a holistic approach to sexuality are lacking throughout the current SCI rehabilitation programs.

Objectives:

The purpose of this qualitative study was to explore the sexuality needs and priorities of women with SCI and document the women’s educational needs and recommendations for sexuality interventions.

Methods:

This study used participatory action research which involved working with anadvisory research team (three women with lived experience and two sexual health clinicians) who were involved in the research from the beginning. Fifteen women with SCI (13 withtraumatic or non-traumatic SCI and 2 with congenital spine conditions) from different Canadianprovinces participated in semi-structured interviews. Thematic analysis was used to analyze the interview data.

Results:

Thematic analysis revealed that participants connected sexuality with self-confidence and empowerment. Priority topics include intimacy, orgasm, and sex toys and assistive devices. The women also emphasized the importance of education on navigating grief caused by changes in the body after SCI. Participants expressed a need for practical knowledge that they could access on their own, learning in virtual group sessions with other women, and access to experts and peer mentors.ConclusionsThe findings inform the development of holistic sexuality interventions as well as innovative resources and approaches to sexual rehabilitation for women with SCI.

Background:

As health care facilities transition from paper-based medical records to digital systems, it is important that standardized assessments and outcome measures used in Spinal Cord Injury (SCI) care are built into electronic medical records to ensure timely completion, accurate documentation of injury, and ease of access to information.

Objective:

To build the American Spinal Injury Association (ASIA) International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Worksheet into an electronic medical record (EPIC) to ensure proper classification and documentation of SCI across the care continuum.

Methods:

SCI clinicians working with an EPIC Clinical Informatics Specialist built the ASIA ISNCSCI Worksheet with computational algorithm into the EMR (EPIC) with guidance from the Praxis Spinal Cord Institute and Epic Care documentation technical services.

Results:

SCI clinicians at Hamilton Health Sciences now have the ability to document the ASIA ISNCSCI assessment in the EMR in a timely manner and ensure accuracy in the classification of a patient’s SCI. Conclusion:Although the building of the ASIA ISNCSCI worksheet with calculation algorithm into the EMR proved to be a challenging and tedious endeavor, it has already shown to be worthwhile undertaking. Documentation and accurate classification of a patient’s SCI can happen in a timely manner thus allowing clinicians to assist with monitoring changes in neurological status, establishing realistic rehabilitation goals and determining clinical trial eligibility throughout the continuum of care.

Background:

Functional electrical stimulation (FES) therapy has been shown to improve motor function during upright tasks by enhancing corticospinal excitability, inducing neuroplastic changes in corticospinal pathways. We previously demonstrated that FES for standing balance—using closed-loop stimulation of plantarflexors and dorsiflexors—enhances corticospinal excitability in the soleus and tibialis anterior muscles. These findings suggest the corticospinal tract plays a more prominent role in postural control than traditionally believed, complementing subcortical contributions. Understanding cortical involvement in balance could inform effective rehabilitation strategies, highlighting the need for methods to assess cortical drive during posture. This study investigated spectral-temporal patterns of cortical contributions to standing control.

Methods:

Electroencephalography (EEG) and electromyography (EMG) were recorded during standing tasks evoking natural and voluntary postural sway. Within each postural sway, spectral-temporal patterns in cortical EEG and shank EMG were assessed. Corticomuscular coherence (CMC), intramuscular coherence (IMC), and phase-amplitude coupling (PAC) were used to assess functional EEG-EMG connectivity. These measures are key in defining the degree of corticospinal involvement in postural regulation.

Results:

Changes in cortical activity aligned with fluctuations in natural postural sway, becoming more pronounced during voluntary sway. CMC, IMC, and PAC collectively revealed that plantarflexor muscle activity is modulated by corticospinal inputs as anterior-posterior sway velocity peak. This suggests the corticospinal pathway plays a dynamic role in upright balance control.

Conclusion:

The corticospinal tract exhibits distinct, phasic modulation during postural sway, supporting its role in balance regulation. These insights strengthen the rationale for using FES therapies to enhance corticospinal excitability in standing posture rehabilitation.

Background/Objective:

Nearly 60% of individuals with traumatic spinal cord injury (SCI) present with physical and cognitive deficits from concomitant traumatic brain injury (TBI). These additional deficits likely impair balance and walking; yet the combined impact of SCI+TBI is poorly understood. This study compared balance and walking outcomes during inpatient rehabilitation between individuals with SCI+TBI and individuals with SCI only.

Design/Methods:

This retrospective study used Standing and Walking Assessment Tool (SWAT) data from the Rick Hansen SCI Registry (2014-2024). Demographic and injury data (e.g., age, Glasgow Coma Scale (GCS)) were extracted along with Berg Balance Scale (BBS) scores and Ten-meter Walk Test (10mWT) speeds at inpatient rehabilitation admission and discharge. Presence of TBI was identified by GCS score <15 in acute care. Participants with SCI+TBI and SCI only were matched by age, neurological injury level and sex. Descriptive statistics and two-way ANOVAs were used for analysis.

Results:

This study included 368 participants (males=290, females=78). For BBS scores, there were significant main effects of time (p<0.01, F=307.9) and group (p<0.01, F=11.5), indicating greater balance control at discharge and in the SCI group. There was a significant interaction (p<0.01, F=14.4), with the TBI+SCI group scoring significantly lower on the BBS at admission. For 10mWT performance, there was a significant main effect of time (p<0.01 F=29.9); walking speed improved from admission to discharge.Conclusion: Walking speed during inpatient SCI rehabilitation was not affected by concomitant TBI. Despite inpatients with TBI+SCI having poorer balance control upon admission, balance control was similar between groups upon discharge.

Background:

Functional electrical stimulation (FES) elicits artificial muscle contractions, enabling individuals with spinal cord injury (SCI) to regain functional movements. FES applied to the quadriceps femoris (QF) is commonly used in interventions such as FES cycling and rowing to promote cardiovascular and muscular health. Standard FES protocols typically involve placing a pair of large electrodes on the proximal and distal ends of the QF. While this setup is assumed to activate the entire muscle group, there is limited evidence supporting this assumption.

Objective:

This study aimed to investigate the degree of muscle activation across QF compartments during twitch contractions induced by conventional FES.

Methods:

To date, five able-bodied participants have been enrolled. Motor points corresponding to individual QF compartments were identified, and surface EMG electrodes were placed adjacent to each point. Maximum M-wave amplitudes (Mmax) were obtained via localized stimulation at each site. Subsequently, a conventional FES protocol was applied using a standard electrode pair placed at the proximal and distal ends of the QF. The resulting M-wave responses were recorded at each EMG site and normalized to the corresponding Mmax values.

Results:

Normalized M-wave responses indicated partial activation of the QF muscle heads: 50–90% in vastus lateralis, 50–60% in vastus medialis, and 60–70% in rectus femoris.##ConclusionThese preliminary findings suggest that conventional FES placement activates only a portion (50–90%) of the quadriceps femoris muscle compartments, highlighting the need for more targeted stimulation strategies to achieve more uniform muscle recruitment.

Background/Objectives:

Following a spinal cord injury/dysfunction (SCI/D), housing frequently emerges as a primary concern as individuals transition out of inpatient care and into the community. Despite being a priority, limited research examines the post-discharge housing experiences of individuals post-SCI/D. To address this gap, the objective of this study was to obtain the perspectives of individuals with SCI/D in navigating housing services and supports in Ontario.

Methods/Overview:

A qualitative descriptive design was undertaken to explore the housing experiences of adults with SCI/D in Ontario. Participants (N=21) were recruited through rehabilitation hospitals, SCI/D associations, and flyers. A demographic survey was completed by participants, collecting data on their socio-demographics, SCI/D, and housing situation. Semi-structured interviews were conducted remotely via telephone or Zoom, and inductive thematic analysis was used to analyze study data.

Results:

Preliminary themes revealed that individuals with SCI/D faced multiple barriers to securing appropriate housing. Attitudinal barriers, such as landlord resistance or restrictive building policies, created challenges for renters seeking home modifications. Participants also identified insufficient financial support for home care as a barrier, noting that existing policies often did not adequately support access to self-directed funding. In the absence of formal supports, peer networks had an integral role in providing housing-related information and guidance.

Conclusions:

The ability to obtain housing post-SCI/D was influenced by factors such as impairment level, location, and funding access; all of which constrained personal choice. The research findings provide valuable insights to inform evidence-based housing decisions, guide policies, and improve rehabilitation outcomes within the SCI/D community.

Background and Objectives:

Spinal cord injury (SCI) leads to a transformation of the body, varying from impairment of posture and gait to total paralysis below the neck. The experience of living in a profoundly altered body is unusual, intriguing, and potentially enlightening. Medical literature covering the physiological aspects of SCI is extensive, but the insider experience of life with SCI is poorly described.The objectives of this study are to:• Explore the experience of embodiment for people living with SCI;• Describe concrete examples of the ways people living with SCI experience their body;• Develop an understanding of how insiders experience change over time in their experienceof their body.

Methods:

A phenomenological approach will be used to explore the experience of persons living with SCI. Interviews will be conducted with persons living with SCI for at least 5 years. Each participant will complete an initial interview focused on biographical experience and life with SCI overall, and a second interview focused on the recall of specific salient moments related to the experience of embodiment.To access the perspective of interview participants and solicit their full engagement, persons with lived experience of SCI are involved in the conceptualization and conduct of research. In particular, the lead researcher is a person who lives with SCI.

Results:

The shared experience of life with SCI provides a fertile common ground for the exploration of insider perspectives. Qualitative research that uses peer engagement is a powerful and promising way to study important SCI-related questions.

Backround:

Sleep disorders are amongst the common secondary medical conditions after spinal cord injury (SCI). Yet, sleep disorders are underdiagnosed and undertreated in individuals living with SCI. Objcetives: This systematic review was undertaken to comprehensively review the current literature on sleep disorders after SCI in order to identify discrepancies and similarities in the occurrence of sleep disorders among non-disabled people.

Methods:

This systematic review was conducted in accordance with the PRISMA guidelines and registered in the PROSPERO (CRD42023380475). Six databases were searched from inception to March 2023 (i.e., APA PsycInfo (EBSCO), CINAHL Ultimate, Embase, Emcare Nursing, Medline, and Web of Science. Only two topical concepts were used to extract the full spectrum of materials discussing Spinal Cord Injuries and any aspect of Sleep. The search was limited to humans but no language limits were applied.

Results:

Of 3,120 publications captured using the search strategy, 111 publications met inclusion/exclusion criteria and were included in the review. They were focused on insomnia (n=3), circadian rhythm disorders (n=12), sleep-related movement disorders (n=14), sleep-related breathing disorders (n=53) and sleep quality in general (n=32). The frequency of insomnia varied from 15.1% to 56%. Most studies suggest a higher frequency of circadian rhythm disorders associated with abnormal levels of melatonin and cortisol in the SCI population. Most studies on sleep-related movement disorders reported a higher risk for restless leg syndrome and periodic limb movement disorder during sleep in the SCI population. Sleep-related breathing disorders are much more frequent in individuals living with tetraplegia > paraplegia than among non-disabled people. Continuous Positive Airway Pressure (CPAP) therapy can improve daytime sleepiness and, potentially, improve other secondary medical conditions after SCI. Finally, poor quality sleep was more often reported in people with SCI (up to 78.3%) when compared with non-disabled people (up to 40%). Conclusions: Sleep disorders are more frequent among individuals living with SCI than in non-disabled people. There are several knowledge gaps in the literature regarding screening, treatment and consequences of sleep disorders in the SCI population.

Introduction:

Activity-based therapy (ABT) provides intensive, repetitive sensorimotor stimulation to promote neuroplasticity following spinal cord injury (SCI). Coupling ABT with transcutaneous spinal cord stimulation (tSCS) could enhance motor recovery.

Objective:

To co-develop a combined ABT+tSCS protocol to improve upper limb recovery during in-patient rehabilitation in people with subacute cervical SCI.

Methods:

The ABT + tSCS protocol was developed using a participatory research approach. The co-development team included five clinicians, one patient-partner, one caregiver and three researchers. Through an iterative process between co-development sessions and pilot testing with three people with cervical SCI, the protocol structure, therapeutic content, time allocation for each element of the ABT protocol and stimulation parameters were optimized to ensure that the ABT+tSCS was feasible.

Results:

The standardized ABT+tSCS protocol consisted in 20 sessions, 3x/week of training in supplement of usual therapy. Key elements integrated into the final protocol included stimulation frequency and intensity, electrode placement targeting the cervical spinal cord, data acquisition methods, safety measures, consideration of participant impairment heterogeneity, as well as the content and dosage of ABT.Conclusion: This study underscores the importance of using participatory research approaches in designing rehabilitation interventions tailored to the needs of individuals with subacute cervical SCI. The collaborative approach between the research team and the experts ensured the resulting ABT + tSCS protocol was both user-centered and applicable to in-patient clinical contexts. This study provides the foundation for a large-scale randomized controlled trial to test the efficacy of the ABT+tSCS protocol and its long-term impact. Disclosures or conflict of interest statement:This project was funded by the LRH Foundation. The authors declare no conflict of interest.

Background:

Evidence suggests that combining transcutaneous spinal cord stimulation (tSCS) with activity-based therapy (ABT) may enhance spinal excitability and voluntary motor output in chronic spinal cord injury (SCI). Yet, its feasibility and benefits in the sub-acute phase, when neuroplasticity is heightened, remain unclear.

Objectives:

This study aims to: (1) assess feasibility of tSCS+ABT into standard rehabilitation, (2) evaluate its added effect on motor recovery and (3) explore underlying neural mechanisms.

Methods:

Ten participants (AIS A–D; <3 months post-SCI) will be randomly assigned to a sham or experimental group to assess tSCS added value. The intervention includes 40-minute robotic-assisted gait training, four times weekly over five weeks. tSCS (T11-L2, 30–80 Hz, 0–100 mA) aims to support weak movements or elicit motor activity in complete injuries. Feasibility is assessed via recruitment, retention and adverse events. Motor recovery and neuroplasticity are evaluated pre/post using clinical tests (e.g., Lower Extremity Motor Score) and electrophysiology (e.g., transspinal evoked potentials (TEP)).

Results:

Five participants (AIS A[1], B[1], C[2], D[1]) have been enrolled: three completed all sessions, one withdrew (hospital discharge) and one is ongoing. Recruitment was supported by strong interest and engagement was high. Adverse events (hypotensive episodes, harness-related pain) were managed effectively. LEMS gains ranged from 1 point (participant #1) to 4 or 5 points (participants #2 and #4). TEPs in the soleus muscle were not observed until after the intervention in participants 1 and 2.Conclusions. Preliminary findings suggest tSCS is feasible and safe, and may improve function and spinal excitability.

#**_1.

Background/Objectives:

_**Rehabilitation for individuals with spinal cord injury (SCI) is evolving from compensatory strategies toward restorative approaches focused on maximizing sub-injury function. Combining activity-based therapy with spinal cord stimulation is a promising restorative strategy for enhancing neurological recovery. To support the integration of these interventions into clinical practice, we developed the Spinal Cord Injury Intensification and Neuromodulation Clinic (SCI CIME) research program. This Living Lab based initiative aims to co-develop and implement six innovations targeting upper and lower limb function, bowel and cardiovascular function, balance, and neuropathic pain within the existing SCI rehabilitation pathway. To describe the governance and communication structures supporting implementation of the SCI CIME Living Lab Program.#**_2.

Methods/Overview:

_**Using a Living Lab approach grounded in participatory research, co-creation, and real-world experimentation, six innovations were developed in partnership with patient partners, clinicians, researchers, and managers at the Institut de réadaptation Gingras-Lindsay-de-Montréal. Together, they co-constructed the program’s governance and communication strategies to support its implementation within the clinical context.#**_3.

Results:

_**A governance structure was established, including a Steering Committee (strategic oversight), Coordination Committee (implementation and collaboration), Communication Committee (dissemination and engagement), and Safety Advisory Committee. Six Operational Committees were also created to guide each innovation. Communication strategies (e.g., weekly implementation meetings) and tools (e.g., summaries of committee meetings, newsletters, website) have been developed to inform stakeholders and promote engagement.#**_4.Conclusions:_**The Living Lab approach is a promising strategy to foster collaboration in SCI research rehabilitation innovation. A formal evaluation is underway to assess its impact on implementation outcomes.

Background/objectives:

Activity-based therapy (ABT) is widely used for upper-limb rehabilitation after spinal cord injury (SCI), and transcutaneous spinal cord stimulation (tSCS) has recently shown promising results. However, the combined effects of ABT and tSCS applied early after the lesion remains poorly explored. This study aims to examine: (1) the feasibility of applying ABT+tSCS in SCI individuals undergoing inpatient rehabilitation; (2) potential sensorimotor improvements; and (3) changes in sensory pathways using somatosensory evoked potentials (SSEPs).

Methods:

Participants were randomized into ABT+tSCS (electrodes over C4–T1, 30–50 Hz, motor-facilitating intensity) or ABT+placebo (sensory-threshold intensity) groups. The 20-session ABT (active 45 minutes/session) included mental imagery, strengthening and task-oriented training. Feasibility was assessed by recruitment, adherence (≥75%), intervention duration (≤1.5 hours), retention to post-training (T2; ≥80%), and adverse events. Upper Extremity Motor Score (UEMS) and SSEPs (ulnar nerve) were measured at baseline (T1) and T2.

Results:

So far, eight participants (AIS A [1], B [4], C [1], D [2]) completed an average of 15.6 training sessions over 8 weeks. Retention was 87.5% (n=7); one withdrew due to lesion-related pressure fluctuations. Minor events (skin redness, hand swelling) but no serious adverse events occurred. UEMS improved from 22.7 to 26.3 in the placebo and from 22 to 32 in the tSCS group (above Minimal Clinically Important Difference). SSEPs were lower in SCI compared to healthy participants.#Conclusions:Preliminary results suggest that early intervention using ABT+ tSCS is feasible, well-tolerated and safe for upper-limb rehabilitation during SCI inpatient care. SSEP assessment could reflect excitability changes post-lesion in sensory pathways.

Background/Objective:

Activity-based therapy (ABT) is a promising rehabilitative approach for people with spinal cord injury/disease (SCI/D), often accessed at community clinics in Canada. The use of validated, reliable, and responsive outcome measures (OMs) is essential for monitoring change and refining treatment plans; however, selection of OMs is varied and inconsistent in community ABT clinics. In an effort to standardize assessment procedures, we obtained consensus on the OMs to include in a core outcome set (COS) for people with SCI/D participating in community-based ABT.

Design/Methods:

Following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline for COS creation, a Delphi e-survey was completed. Nineteen Canadian clinicians who delivered ABT to individuals with SCI/D participated. The survey contained 37 clinically feasible and psychometrically-sound OMs for ABT identified through a literature review and expert focus group. Survey participants rated the importance of including each OM in an ABT COS on a 9-point Likert scale. OMs that ≥70% of participants rated seven to nine were considered important for the COS.

Results:

In Delphi round 1, OMs evaluating goal attainment, self-efficacy, walking, and balance control were identified as important. In round 2, OMs evaluating upper/lower limb sensorimotor impairment, spasticity, upper limb function, and quality of life were identified. A total of 12 OMs were identified for inclusion in a COS that is applicable to all individuals with SCI/D. Conclusions: The findings were used to create a COS that will potentially standardize assessment procedures for community-based ABT in Canada.

Background/Objectives:

The primary motor cortex is involved in the initiation and adaptive control of locomotion. In animals, cortical neuromodulation allows precise control of step height. However, its role in controlling gait trajectories remains unclear in humans. This study aims to understand how cortical networks influence limb trajectory during the swing phase of walking in healthy subjects using Transcranial Magnetic Stimulation (TMS). The main hypothesis is that phase-coherent stimulation of the leg motor cortex increases lower limb elevation during the swing phase. A secondary hypothesis is that kinematic effects depend on stimulus timing within this phase.

Methods/Overview:

Ten healthy adults (aged 20-32 years) walked on a treadmill at 1.5 km/h. TMS was applied over the left motor cortex at 120% of the threshold eliciting dorsiflexion of the right ankle during swing. Electromyographic measurements and three-dimensional lower limb kinematics were collected to assess muscle activation and leg trajectory.

Results:

Changes in limb trajectory were observed only when TMS was delivered during the first 40% of the oscillatory phase. Specifically, stimulation between 20% and 40% led to a significant increase in the maximum height of the right toe and knee. Toe height increased by 34.9% ± 9.6% (21.4 mm ± 7.9 mm, p = 0.032), and knee height by 52.8% ± 14.1% (28.8 mm ± 7.7 mm, p = 0.0021), compared to spontaneous steps. Conclusions These findings show that TMS can modulate limb trajectory during walking in healthy subjects, highlighting its potential as a tool to study cortical control of locomotion.

Background:

Regaining optimal function is a primary goal for individuals who experience a spinal cord injury. Activity-based therapy (ABT) focuses on the retraining of the nervous system to accomplish a motor task. Blood flow restriction training (BFRt) is an emerging mode of training for persons with neurologic conditions. BFRt may promote neuro recovery when paired with ABT.

Objective:

To report on the feasibility of using BFRt to augment ABT, and to assess the impact on the level of functional mobility for a person with chronic incomplete spinal cord injury (iSCI). **Design & Methods:** Single-subject case report using pre and post-testing of functional outcomes. Interventions included BFRt using 40% occlusion pressure, paired with gait training and functional strengthening 2x’s/week for 7 weeks.

Participant:

A 27-year-old male status post 2 years of ASIA C T2 iSCI resulting from a fall from a substantial height. Prior to initiation of BFRt, the patient had participated in physical therapy across hospital settings, gaining independence with wheelchair activities, while needing physical assistance for ambulation and prolonged standing tasks.

Results:

Application of BFRt was feasible and without adverse events. Functional outcomes of: gait speed, 6 min walk test, TUG, and Berg Balance Scale met MDC. Additional improvements in patients’ level of lower extremity spasticity were measured with the Tardieu Scale.

Conclusion:

Application of BFRt during activity-based physical therapy for a patient with iSCI was safe and appeared to support functional gains for gait, balance, and reduced spasticity.

Background/Objectives:

Optimal distribution of mechanical loads through connective tissue, such as the skin, is critical for preventing pressure injuries in individuals with spinal cord injury (SCI). Active movement of the center of mass (COM) over the base of support during upright posture preserves this distribution, yet traditional metrics fail to capture the frequency dynamics of these adjustments. Therefore, we propose an approach to characterize the low- and high-frequency dynamics of COM movement and provide an initial proof of concept.

Methods:

Five able-bodied adults completed three 20-second quiet standing trials with an IMU positioned on the upper thorax (C7 spinous process, sampling frequency 100 Hz). Net acceleration (X, Y, Z) was filtered using 4th-order Butterworth filters (low-pass <0.7 Hz; bandpass 1-20 Hz) to isolate low- and high-frequency components. A peak detection algorithm identified low-frequency peaks (≥ 1 s apart, prominence ≥ 0.02 m/s²) and high-frequency peaks (120–300 ms apart), including amplitude measures (max, min, mean).

Results:

Low-frequency analysis identified 6-15 peaks per trial, with a maximum amplitude of 8.92 m/s², minimum of 7.79 m/s², and a mean of 8.47 m/s². The high-frequency analysis identified 205-462 peaks per trial, with a maximum amplitude of 0.466 m/s², minimum of -0.066 m/s², and a mean of 0.015 m/s².

Conclusion:

This proof-of-concept demonstrates the feasibility of using a single cervical IMU to quantify micro postural deviations during standing. Further work is planned to better understand how postural position and underlying conditions may be related to these patterns.

Background:

Pressure injuries (PIs) are “NEVER events”, preventable complications with significant clinical consequences. Among adults with spinal cord injury or disease (SCI/D), lifetime PI prevalence is 85%–95%. Despite well-established prevention strategies, gaps in skin check conduct, documentation and education may compromise skin integrity during rehabilitation.

Objective:

To reduce the incidence of PIs during inpatient SCI/D rehabilitation through the conduct, documentation and education of patients regarding daily head-to-toe skin checks.

Design/Methods:

We conducted an interrupted time series study using 4 prospective cohorts admitted for inpatient rehabilitation between January 2020 and December 2023. Data were obtained from 6 SCI-IEQCC rehabilitation sites in Ontario (SCI-IEQCC). Each patient’s skin check frequency and skin integrity were reported from admission to discharge. The primary outcomes were PI incidence during rehabilitation and secondarily prevalent PI at admission.

Results/Findings:

Among 2,098 patients, 581 (30%) had PIs at admission, with sacral injuries being most prevalent. Daily head-to-toe skin checks were done for 60% (range) of inpatients across sites. Patients with prevalent/incident PIs were older (mean age=61 vs. 59 years; p<.001), had lower FIM change (t(940) =-6.57, p<.001), and longer rehab length of stay (t(687)=13.37, p<.0001). A trend of rising prevalent PIs (6.5%) at admission among patients awaiting rehabilitation and declines in PI incidence (2%) were observed.

Conclusion:

Daily skin checks reduced PI incidence during rehabilitation over time. Early acute care prevention—alongside system-level investments in head-to-toe skin check conduct, documentation and education, and appropriate sleep surfaces are essential to reduce PI prevalence, incidence, morbidity and system costs.

Background:

Menopause (MP) marks a life-altering stage in a female’s with spinal cord injury or disease (SCI/D) life impacting their physical and psychosocial well-being with many experiencing challenges distinguishing MP symptoms from SCI/D-related complications. Providing trustworthy health information is critical to health literacy and storytelling by people with lived experience (PLEX) may catalyze self-advocacy and behaviour change.

Objective:

To introduce a podcast series “Menopause and SCI: In a Hot Flash”, which features storytelling by PLEX and Q&A sessions between PLEX and subject matter experts, partnered with evidence-based information to educate females with SCI/D about MP.

Design:

A co-design framework involving clinicians, researchers, and PLEX living with SCI/D was used. Podcast content was informed by a scoping review, with 7 episodes focused on different MP aspects. PLEX partners co-developed the interview questions, and served as co-hosts for each episode. Subject matter experts were episode guests and dialogued with two PLEX while sharing trustworthy information and a health action recommendation.

Results:

The, Menopause and SCI: In a Hot Flash podcast series covers the following topics: a MP overview; vasomotor symptoms; genitourinary syndrome and skin changes; osteoporosis; cardiometabolic disease; breast and ovarian cancers; and impact on mood, cognition and sleep.

Conclusion:

Podcasts are a popular means of disseminating trustworthy health-related information in an accessible format for females living with SCI/D. Storytelling was used to build confidence and empower females with SCI/D to share their experience with peers, care providers and healthcare providers. PLEX storysharing may increase listener’s relatability, connection and retention of content.

Background:

Individuals with significant mobility impairments are less likely to meet physical activity (PA) guidelines, despite the known physiological and psychosocial benefits of regular PA. Barriers such as limited access to appropriate programs, transportation challenges, and lack of instructor expertise hinder participation. Community-based adapted PA programs may help address these barriers. This pilot study explored the feasibility and quality of participation in an adapted PA program held at a YMCA.

Methods:

A pilot used a Sequential Explanatory Mixed Methods design. Eight adults with mobility impairments were enrolled, with n = 6 completing pre- and post-program surveys (PROMIS Physical Function and WHO-5 Wellbeing Index) and n = 5 participating in semi-structured exit interviews. The 8-week program included one group-based studio session and one self-directed fitness floor session per week. Feasibility was assessed using a survey, based on Bowen’s framework. Quality of participation was measured using the Measure of Experiential Aspects of Participation (MeEAP). Thematic analysis was conducted on interview transcripts.

Results:

Significant improvement in subjective wellbeing (WHO-5; p = 0.006) was observed, with no significant change in physical function (PROMIS PF). All feasibility domains were rated positively, with “Demand” and “Expansion” scoring highest. MeEAP scores indicated high-quality experiences, especially in Belongingness. Interviews highlighted positive experiences with peer support, alongside challenges related to exercise appropriateness.Conclusions: Delivering adapted PA programs in community settings is feasible, acceptable to participants and can enhance participants’ wellbeing.

Findings:

support future expansion and refinement to improve appropriateness of activities and access to such programs in the community.

Background:

The Bare Bones Podcast Series, consisting of nine episodes and related Educational Action Planning Tool (EAT) handouts, were developed to improve access to bone health information for individuals with spinal cord injury (SCI). The active involvement of people with lived experience (PLEX) was key to ensuring the resources were user-friendly, relevant, and practical.

Objective:

To evaluate and refine the Bare Bones Podcast Series and EATs through structured feedback from PLEX with SCI.

Methods:

Local PLEX living with SCI were invited as reviewers. Three groups of PLEX (5-9 per group) reviewed a set of three podcast episodes and related EATs. Participants completed either a 1:1 online interview or joined a 60-minute focus group. A semi-structured guide explored six domains: (1) design/format; (2) language; (3) presentation of key messages; (4) cultural-linguistic acceptability; (5) knowledge translation; and (6) usability. The project team thoroughly examined and discussed the recommendations from the PLEX. Substantial revisions were made to the podcasts, EATs, and dissemination plans based on feedback from PLEX.

Results:

Feedback from 22 PLEX highlighted the need for clearer design, simplified language, improved message flow, and visual enhancements. Changes included re-recording two episodes, simplifying EATs layout, splitting content to reduce cognitive load, and refining take-home messages. Cultural-linguistic feedback was positive. Dissemination strategies were expanded to include a printed EAT booklet, magnets, bookmarks, and in-clinic displays.

Conclusion:

Integrating feedback from PLEX improved the clarity, relevance, and usability of the resources. This collaborative model offers a promising approach for accessible health education and knowledge translation.

Introduction/Background:

Improving hand and arm function is an important goal in rehabilitation for individuals with tetraplegia. Neuro-rehabilitation after spinal cord injury (SCI) must incorporate components that influence neuro-restoration, neural re-organization and function. Benefits of an Activity Based Therapy (ABT) approach coupled with Non-Invasive Spinal Cord Stimulation (NISCS) remains understudied particularly for paradigms specific to the upper extremity (UE).

Objective:

1) To develop, assess and determine benefits of an UE ABT protocol combined with NISCS in an outpatient neuro-rehabilitation environment for individuals with chronic traumatic and non-traumatic cervical SCI.

Methods:

A single arm study with an ABT only period followed by an ABT+NISCS period was conducted with 11 individuals with chronic SCI. Treatment was delivered three times per week, using the Myndsearch for the NISCS. Electrophysiological testing was conducted pre and post the NISCS period. Interviews with patients and clinicians were also conducted to understand benefits, barriers and challenges in implementing such a treatment.

Results:

All participants made gains. Significant GRASSP strength gains are noted in 45% of the sample, and GRASSP performance gains were made in 64% of the sample. Electrophysiology assessment is consistent with the clinical changes. Conclusions: ABT is an effective method to restore upper extremity function in people with chronic SCI. Adding NI-SCS amplifies the effect of the ABT. The NI-SCS increases the functional gains more so than the strength alone and fosters neuroplasticity. This study contributes excellent pilot data to improve study subject selection, and begin creating paradigms for implementation.

Purpose:

Spinal cord injury (SCI) is a severe neurological condition affecting an estimated 250,000 to 500,000 individuals worldwide each year, with millions living with long-term disabilities. The Spinal Cord Independence Measure—self-care score (SCIM-SS) is a widely used measure of a patient’s ability to perform daily activities. A total GRASSP strength score is positively related to the SCIM-SS. However, individual contributions of each muscle to self-care remain unclear. This study investigates the relationship between the 10 muscles assessed in the GRASSP and their individual contributions to self-care as measured by SCIM-SS.

Methods:

We apply machine learning models combined with SHapley Additive exPlanations (SHAP) to identify which muscles most significantly influence self-care ability by analyzing both cross-sectional and longitudinal datasets.

Results:

After evaluating model performance based on accuracy, precision, recall, F1 score, and AUC, XGBoost emerged as the best-performing model in both datasets, achieving accuracies of 86% and 79%, respectively. The most important muscles in predicting a high score on SCIM-SS are Anterior Deltoid, Extensor Digitorum, Opponens Policis, Wrist Extensors and Dorsal Interrossei. The American Spinal Injury Association Impairment Scale (AIS) also appeared as an important factor influencing the self-care score. Conclusions: Our study highlights the usefulness of machine learning in unveiling key muscles that affect the self-care score.