Toronto Rehab +10 Report on Rehabilitation ResearchDocument Transcript
+10 Report on Rehabilitation Research Questions, answers, solutions.
Revolutionizing rehabilitation, maximizing life A message from Mark Rochon President and CEO One in two. It’s a statistic that always jumps out together a wide range of disciplines is the work We believe, and others agree, that these are at me—that one in two of us will be touched by we are leading in the use of artificial intelligence promising solutions to pressing problems. disability, either personally or through someone to help individuals with cognitive issues cope Our scientists work to quickly apply or in our immediate family circle. better at home. Imagine a house that can detect commercialize findings. As you will read, we However, one person in two is the reality in if someone has fallen and, someday soon, even are delivering new products to market, helping today’s society, with a rapidly aging population monitor a person’s nutritional intake, medication people who need them to maintain their and an increase in the incidence and prevalence use, heart rate and blood pressure. Toronto independence while creating good jobs and of people who live with multiple chronic Rehab’s fall-detection supporting a knowledge- conditions. As a result of medical advances, system was cited by The “As a result of medical advances, based economy. living with a disability is often a fact of life for Economist as one of several living with a disability is often You may have seen the growing number of people surviving heart advances in computer-vision Toronto Rehab’s latest disease, cancer, stroke and traumatic injury. software that are “begetting a fact of life for the growing public awareness As a consequence, more and more people will a host of new ways for number of people surviving campaign, launched in need rehabilitation in the years to come—and machines to view the world.” heart disease, cancer, stroke and 2010 to build awareness we will need new and more effective treatments, We believe that our about the hospital and and assistive devices and technologies to discoveries and innovations traumatic injury.” how rehabilitation saves support people, help them remain in their will enhance the efficacy and – Mark Rochon life. It describes our bold homes for as long and as safely as possible, and cost-effectiveness of health vision to revolutionize support their caring family members. services delivery. For example, our portable sleep rehabilitation—and maximize life. We do this Rehabilitation research—one of the most apnea device—much less expensive than an every day through quality and innovative important frontiers in healthcare today—is all overnight test in a sleep lab—provides an easier, clinical care and groundbreaking research. about meeting these needs. Toronto Rehab’s more convenient way to diagnose obstructive Making this research possible are the Ontario program of research is uniquely equipped to sleep apnea. Our new electronic hand hygiene Ministry of Health and Long-Term Care, and lead the charge. In just 10 years, we have built monitoring system prompts healthcare other ministries, agencies and foundations. one of the most comprehensive rehabilitation professionals to wash their hands. The goal: to These include the Ontario Ministry of Research research programs in the world. We’ve attracted prevent hospital-acquired infections that are and Innovation, the Ontario Innovation Trust, a remarkable team of scientists, clinician- so costly to patients and the healthcare system. the Canadian Institutes of Health Research, the scientists, students and postdoctoral fellows, Canada Foundation for Innovation, and the drawn by our first-rate facilities and the culture Ontario Neurotrauma Foundation. We are also of collaboration between researchers and deeply grateful to the generous individuals and clinicians across all our sites. We also value our corporations who support our research with their collaborations with our affiliate, the University contributions to the Toronto Rehab Foundation. of Toronto, and with other post-secondary We also thank the International Scientific institutions and private sector partners. Advisory Committee (ISAC), which provides an It’s remarkable how research filters throughout objective assessment of our research program Toronto Rehab, and the way that we’re integrating and advises on directions to accelerate future research and patient care. Featured in this report growth. are stories that illustrate how our research can With our tremendous research staff, we are help people recover more effectively, stay healthy producing solutions that will revolutionize and stay home. We also report on the important rehabilitation and maximize life for millions of work undertaken to assess and recommend Canadians, and millions more worldwide, living improvements to the delivery of health services. with disabling injury and illness or age-related An excellent example of research that knits conditions.
+10 Contents 2 3 4 Answering questions, offering solutions Scott Fraser: a timely answer to a devastating problem Research in the news 6 Retraining the brain 11 Matthew Linton: exploiting brain plasticity 12 Preventing falls on stairs 16 Dealing with dementia 20 Fighting disease with exercise 25 Wendy Angelo: an “amazing journey” 26 The scourge of sleep apnea 31 Mary Grzywna: breathing easier, getting on with life 32 Helping people hear better 36 Senior drivers: staying safe on the roads 40 The cold weather challenge 44 Taking care of caregivers 48 Rehab innovations 52 Open for business: the world’s most advanced rehabilitation research environmentOn the front cover 54 Eric Wan: helping a star to shineJennifer Hsu of the Winter Research Groupis studying how to prevent falls in winter. 55 GovernanceShe is one example of how Toronto Rehab 56 Who we areresearchers are dealing with issues oneveryone’s minds. On the pages of this 60 Acknowledgement of supportreport, you will meet other researcherswho are are working to revolutionizerehabilitation and maximize life forpeople everywhere affected by disabilitiesand age-related conditions. Top of mindfor all our researchers are the people whowill benefit from Toronto Rehab research,from patients to family caregivers.
Answering questions, offering solutions Introduction by Dr. Geoff Fernie VP, Research Not long ago, I was guiding a visitor through with advancing age. On these pages, you’ll accurately study and measure the difficulties one of our labs when he turned to me with a find surprising insights into why people fall. people encounter in the real world and produce personal question. His father had fallen down Innovations like insoles to help people keep their solutions that make a difference. the stairs at home and the family had no idea balance as they walk, are now on the market. Ten years ago, Toronto Rehab’s research how it had happened. “We’re all very worried,” he And we don’t only focus on the individual; program was created with a grant from the told me. “How can we prevent this kind of thing every day, we think about the wider Ontario Ministry of Health and Long-Term from happening?” environment, from the design of streets to winter Care (hence the title of this report, +10). Today, So many of us have questions relating to the apparel. The fact is that, during winter, mortality hundreds of projects are unfolding and showing challenges that come with older age, disability rates, injury rates and the incidence of acute and promise in all kinds of different directions. It’s and disease. In this report, you’ll find some of chronic illness all increase, making this season all so exciting that I can’t wait to get cracking in those questions, posed by people living in the particularly hazardous for older adults. Our the morning—and to tackle the questions on community, observations and practical recommendations everyone’s minds. And so, we present you with“So many of us have questions patients and will allow older people—and the general 10 of those questions and some of the answersrelating to the challenges that their families. Research at population—to stay safe and active in winter. Supporting family members is another big and solutions we’re producing.come with older age, disability Toronto Rehab focus. Incredibly, over one-quarter of Ontarioand disease.” is dealing with families have been providing constant care for – Dr. Geoff Fernie issues that are someone at home for more than two years. on everyone’s We’re determined to ease the burden on family minds. Our research is highly relevant to caregivers, and on professional caregivers such people’s lives. We’re producing practical as nurses, who experience high rates of back solutions to real-life challenges so we can injury. As you’ll read, Toronto Rehab scientists maximize life. are addressing these urgent needs through One of our goals is to help people recover some highly innovative projects. from injury or illness so that they can return And we’re having a real impact. Our research home as soon as possible and participate in is already producing new and more effective work or other activities. In the first section of treatments, assistive devices and technologies. this report, you’ll read about novel treatment We’re generating new knowledge and sharing approaches that involve stimulating the brain— our approaches—like our award-winning and harnessing its innate ability to recover after research-based cardiac rehab home program— injury. You’ll meet a young man who is back at with others. On top of that, we’re shaping work after taking part in a study investigating a practices and policies, such as building codes. new way of dealing with brain injury. The next few years will bring an explosion of Another goal is to support people safely in new ideas that can be developed and tested in their own homes so that they never need to our gleaming new research labs. We now occupy occupy a hospital bed or enter a nursing home. the most advanced rehabilitation research We do this by preventing injury and illness, and facility anywhere in the world. It’s a place helping people adjust to the limitations that can where researchers have the tools to recreate come with older age. Falls are a major concern real-life conditions. This allows us to safely and 2 ANSWERING QUESTIONS, OFFERING SOLUTIONS
Scott Fraser a timely answer to a devastating problem “Will I ever be able to eat normally again and to problems—a condition called dysphagia—were pneumonia, he had to tuck his chin to his chest enjoy meals at home with my wife and son?” devastating. “It was very, very depressing,” he every time he swallowed. For more than two years while hospitalized says of the time he was unable to drink liquids In the Toronto Rehab study, Fraser learned after a traumatic brain injury that left him and eat regular, solid food. a series of tongue-pressure exercises using unable to swallow, this question consumed It all began in November 2007 when Fraser’s his tongue to squeeze a bulb positioned in his Scott Fraser’s thoughts. The answer came in an family was involved in a car crash with an mouth. In 24 sessions, he mastered the exercises unexpected way: his wife Lorraine stumbled impaired driver. Fraser was left with many that Dr. Steele calls “boot camp for the tongue,” upon it in a copy of Toronto Rehab’s +8 Report challenges, including dysphagia. Tube feeding regained his swallow and moved a giant step on Rehabilitation Research that she found in a directly into his stomach deprived him of the closer to being able to go home from hospital. lounge a few doors down from her husband’s taste, texture and social aspects of eating, but it Dysphagia often occurs with conditions such room in a Toronto area hospital. kept him alive and nourished. as brain injury, stroke, Parkinson’s disease and A story about a man with a similar swallowing Eventually, he graduated to drinking multiple sclerosis. It also increases as people age problem led the couple to Dr. Catriona Steele, thickened liquids and eating puréed foods by (up to 80 per cent of people in nursing homes director of Toronto Rehab’s Swallowing mouth but he didn’t like the taste and texture. have swallowing problems). A major contributor Rehabilitation Research Laboratory. Fraser Every meal was a painfully slow process. Fraser is a loss of muscle strength in the head, neck enrolled in a research study, being conducted had to swallow twice for each mouthful of food and especially the tongue, which is composed by Dr. Steele, to test a new swallowing therapy and wash it down with a sip of thickened liquid. entirely of muscle. involving tongue-pressure exercises. He was To prevent food and liquid from going down “We want to be able “We want to be able more than willing to give it a try. His swallowing his airway and to his lungs, which can cause to train those muscles so to train those muscles that a person’s swallowing improves without needing so that a person’s to think about it every time swallowing improves they swallow,” says Dr. Steele. without needing to “After a brain injury, there’s enough to worry think about it every about,” says Lorraine Fraser. time they swallow.” “My husband has had to learn to walk again, his – Dr. Catriona Steele quality of speech has been affected and he has some cognitive challenges. So to have his swallowing resolved is a huge thing. Dr. Steele has no idea how our quality of life has improved. Her research has helped our family tremendously.” In the summer of 2010, after two-and-a-half years in hospital and treatment at Toronto Rehab, where he participated in the study, Fraser was discharged home. Every day, he enjoys meals with his family. He can safely drink liquids and eat the most challenging food including meat, popcorn and nuts. “I have the same food as Lorraine and my son Kyle, and I can eat my meal in half an hour. Scott and Lorraine Fraser: I enjoy these times with my family. It’s very “our quality of life has improved”. important to me.” n + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 3
Research in the news Toronto Rehab’s research program is constantly making news, whether it’s for our innovative new therapies and technologies, The Canadian Press The Toronto Star CBC News: The National CTV.ca Canadian researchers developing Creating a passion for elder care ‘Winter tire’ boot aims to Painkiller abuse sparks new specialized video games for thwart icy falls Canadian guidelines stroke treatment Seniors are the fastest growing population group in Canada, and Why do winter falls occur? It’s a Canada is the world’s third-largest per More than 50 per cent of stroke Dr. Kathy McGilton is a leading question that preoccupies Jennifer Hsu, capita consumer of opioid painkillers. survivors have speech and language advocate for their needs. The Toronto a Toronto Rehab student researcher These painkillers, such as morphine, impairments. Treatment and exercises Star profiled Dr. McGilton, a Toronto studying how well different types of codeine and oxycodone, help people for these disorders can be laborious Rehab senior scientist and University winter boots do on a variety of winter deal with chronic non-cancer pain. and repetitive. What if we could bring of Toronto professor who is pioneering surfaces. The CBC caught up with Hsu But there’s a growing misuse of these the excitement of gaming technology new approaches to senior care. at the hospital’s special ClimateLab, medications. CTV.ca reported on to speech therapy? As The Canadian Working with colleagues at Toronto which can simulate winter conditions new Canadian guidelines to help Press reported, Toronto Rehab Rehab, Dr. McGilton has developed as cold as -20C. Currently, Hsu is doctors when they are considering researchers are working with Algoma a new model of care for cognitively- focusing on postal workers, who are whether to prescribe opioids for their University in Sault Ste. Marie, Ontario, impaired hip fracture patients. Usually, particularly at risk of winter slips and patients. “We hope that one of the to do exactly that. The research team these patients move directly from falls because they work outdoors benefits of these guidelines will be is taking speech language techniques acute care to a nursing home, based in all types of weather on a wide to reduce the diversion and abuse currently used one-on-one in the clinic on a belief that they can’t benefit from variety of surfaces. Her goal: to make and addiction problems with these and turning them into a computerized, active rehabilitation. However, when recommendations on effective forms drugs, because these are really good game-like application. “The idea that Toronto Rehab offered a personally- of footwear against slips and falls on medications,” lead author Dr. Andrea we could take some of the therapies tailored form of rehabilitation, “they inclines and transitions, and to develop Furlan told CTV.ca. Dr. Furlan is an that we do that often have a repetitive were just as likely to walk out of the improved winter footwear design associate scientist at the Institute for component to them and make them hospital under their own steam and to criteria. Ultimately, the findings will Work and Health, a Toronto Rehab fun and alluring and keep people live in the community after discharge,” benefit everyone who spends time adjunct scientist and clinician, and an engaged was very attractive,” Toronto Dr. McGilton told The Star. It’s an outdoors, says Hsu, a PhD candidate assistant professor in the Faculty of Rehab senior scientist Dr. Elizabeth approach, she added, that can take in biomedical and mechanical Medicine’s division of physiatry at the Rochon told CP. It’s still early days in pressure off long-term care facilities engineering at the University of University of Toronto. The guidelines the technology’s development but, and acute care hospitals. Dr. McGilton Toronto. In the winter of 2005 to 2006 include 24 practice recommendations eventually, patients could play the is an associate professor at the alone, more than 21,000 Ontarians for doctors to use. video-game therapy on their own Lawrence S. Bloomberg Faculty of visited an emergency room because of time, in hospital or at home. Nursing. injuries related to falling on ice or snow. 4 RESEARCH IN THE NEWS
advances in knowledge, or expertise on disability, disease and aging. Some of the latest media coverage is listed below. Canadian Business Online Global News The Globe and Mail Most comprehensive study of its kind Sole support Rehab reprieve: games add a little fun shows impact of brain injury on women’s to recovery reproductive health It’s an all-too-common scenario: an elderly person falls, breaks a hip, has surgery and then, because Playing on a Nintendo Wii gaming system can help After a brain injury, women often ask how the injury of limited mobility, moves to a nursing home. And patients recover upper-arm function after stroke, will affect their fertility, pregnancy and postpartum there’s an even bleaker scenario: 20 per cent of new findings show. The Globe and Mail reported health. New findings, reported in Canadian Business people who break a hip die within a year. As Global on a study comparing 10 stroke patients who used Online, provide some much-needed answers. News reported, Toronto Rehab scientists have Wii gaming technology with 10 patients who did The insights come from a study which examined developed a simple footwear insole to improve standard recreational therapy, such as playing the health outcomes of 104 pre-menopausal balance and reduce the risk of falls and fractures. cards or bingo. After using the Wii for just eight women five to12 years after moderate to severe Sole Sensor™ enhances balance by heightening hours over two weeks, patients showed greater brain injury. It found that women with traumatic foot-sole sensation, explains Dr. Stephen Perry, arm speed and strength, compared to those in the brain injury (TBI) were more likely to experience a Toronto Rehab adjunct scientist and associate recreational therapy group. “Just having that variety menstrual disturbances, but did not appear to professor of kinesiology and physical education of different tools you can use that are adapted have significantly more problems with getting at Wilfrid Laurier University. The special insole has to the level of the individual and to their own pregnant when compared to women without a raised ridge that surrounds the perimeter of personal interest is where the field needs to go,” brain injury. However, women with TBI had fewer the foot, stopping just short of the large toe. The study co-author Dr. Mark Bayley, a Toronto Rehab children, reported lower levels of perceived health, ridge is designed to enhance the sole’s sensory scientist, told The Globe. Repetitive exercises are and experienced more postpartum difficulties. perception—something that declines with age— important for regaining upper-arm function, but “Our findings provide important information for by stimulating tiny sensors located in the outer they can get tedious, so making it more fun makes women who have experienced a traumatic brain edges of the sole. Published results show that sense, added Dr. Bayley, head of the hospital’s injury, and for health professionals working with Sole Sensor reduced the number of falls by half. Neuro Rehabilitation Program where the study these women,” says Dr. Angela Colantonio, a senior In Canada, fall-related injuries cost the economy was conducted. The findings were published in scientist at Toronto Rehab and lead author of the an estimated $2.8-billion a year. (For more on Sole the journal Stroke. A larger study is now underway, study, published in the Journal of Women’s Health. Sensor, see page 50.) headed by Dr. Gustavo Saposnik of the Stroke Dr. Colantonio holds the Saunderson Family Chair Outcomes Research Unit at Li Ka Shing Institute at in Acquired Brain Injury Research at Toronto Rehab St. Michael’s Hospital, to determine if Wii should be and is a professor of occupational science and widely used in stroke rehab. occupational therapy at the University of Toronto. + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 5
Q.1 Retraining the brain Last year, I had a bad fall from a ladder and fractured my skull. The brain injury has affected my ability to solve problems. I’m hoping to get back as much of this function as possible. I’ve read about the adult brain’s remarkable capacity to change. How can we – Roger in Toronto* retrain the human brain? 6 RETRAINING THE BRAIN *Some names have been changed for confidentiality.
Brenda Colella is a member of theCognitive Neurorehabilitation Sciences Lab. Researchers are working to improve recovery for brain injury survivors, like Sue Stewart (at right in inset picture). Stewart experienced a serious brain injury in 2005.
A.Dr. Robin Green has simple advicefor her Toronto Rehab patients inthe months and years followingtreatment for traumatic braininjuries: “Use it or lose it.” For Dr. Green, ‘using it’ involves ongoing stimulation of the brain to maximize recovery. It begins while the patient is still in hospital. Dr. Green, a Toronto Rehab scientist and neuropsychologist, is currently leading a major study with brain injury patients to investigate the effects of doubling therapy on the brain’s ‘plasticity’—its ability to change and recover in response to stimulation. But Dr. Green is also looking at the impact of intensive brain stimulation when patients go home. She’s already shown that less cognitive atrophy of the brain after severe brain injury. On the positive side, this work suggests that engaging in stimulating activities—such as returning to work or school, or even meditating— preserves an important part of the brain and its functioning. It all relates to neuroplasticity. Brain cells communicate through chemical messengers at ‘synapses’, the junctions between neurons. Dr. Green says that it’s possible to change the strength of these connections and even grow new synapses through stimulation, thereby preserving stimulation is associated with greater chronic intact areas of the brain that would otherwise 8 RETRAINING THE BRAIN
can be tailored to a person’s abilities, environment and available resources. A recent review of the literature on meditation and the brain by Dr. Green suggests that meditation may be particularly effective for patients recovering from brain injury because it engages the brain, improves its structure and can be self- administered. Dr. Geoff Fernie, Toronto Rehab’s vice president, research, says that it’s important to keep the mind active, through everything from “We can push cells to playing electronic games to simply make new associations or being in a stimulating reconnect with old ones.” environment. “You need to exercise your – Dr. Robin Green brain the same way you exercise your heart,” he says, noting that this can make brain injury survivors more independent and productive, and less demanding on the A study being conducted at healthcare system. Toronto Rehab will show what The same may be true for people with other happens when therapy hours neurological disorders such as stroke and are doubled for patients with dementia, and also for the elderly, Dr. Green says. traumatic brain injury. Older people are especially prone to negative neuroplasticity, she says, because they are often removed from their previous professional and social situations, as well as experiencing hearing and vision problems and low self-esteem. “If we can stop the behavioural withdrawal from activities,” Dr. Green says, “we can minimizebe isolated when they are disconnected from the likelihood of healthy areas of the braindamaged ones. “We can push cells to make new Dr. Robin Green becoming understimulated and ultimatelyassociations or reconnect with old ones,” she says. losing their functional capacity.” Dr. Green and The findings of Lesley Miller, a student of Dr. colleagues recently expounded on this idea in aGreen’s who recently received her PhD at the paper published in the journal NeuropsychologicalUniversity of Toronto, revealed that patients who Rehabilitation.got more cognitive stimulation in the five to 12 Dr. Green holds a Tier 2 Canada Research Chairmonths after a brain injury maintained greater in Traumatic Brain Injury/Cognitive Rehabilitationvolume of the hippocampus, a part of the brain Neuroscience at the University of Toronto.that’s critical in functions such as memory, over An associate professor in the Department ofthat same time period and longer. Psychiatry, she leads the Social and Cognitive “Cells need input to remain viable,” Dr. Green Sciences field of the Graduate Department ofsays, adding that the level and type of stimulation Rehabilitation Sciences. n + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 9
Electrostimulation sparking brain changes When Dr. Milos R. Popovic dreams of brilliant The idea is that, after many repetitions, the In a landmark study published this year control systems, it’s not supercomputers or patient can perform the movement on his or in the journal Neurorehabilitation and NASA mission control he’s thinking of—it’s the her own—without the device. Neural Repair, Dr. Popovic and colleagues human brain. But how can this be? proved the power of FES therapy. Tested in “The brain is the most sophisticated control “The combination of the desire to move a randomized clinical trial, their approach system anywhere in existence,” says the and the sensory feedback flowing to the worked considerably better than conventional biomedical engineer and Toronto Rehab senior brain causes changes in the brain’s circuitry,” occupational therapy alone to increase spinal- scientist. Dr. Popovic says. “It forces the brain to adapt cord injured patients’ ability to pick up and hold Dr. Popovic marvels, in particular, at the and form new neural pathways to control objects. phenomenon known as ‘neuroplasticity’ —the movement. Neuronal cells are forced to take What’s more, the nine study participants brain’s remarkable ability to more responsibility.” who received stimulation therapy also saw adapt and perform new tasks, “The brain is the most It’s possible something else is big improvements in their independence and even after an injury. going on too. “The brain creates ability to perform everyday activities such as And he’s developed a way sophisticated control stem cells all the time. And those dressing and eating. to make use of this ‘plasticity’ system anywhere in new stem cells have to decide “This has real implications for people’s to help stroke and spinal cord existence.” whether they will become quality of life and independence, and for injury survivors who have lost neurons or supporting tissue in their caregivers,” says Dr. Popovic. “Even small key functions, like the ability to – Dr. Milos R. Popovic the brain. If there’s a lot of activity improvements in the ability to perform daily grasp, reach or walk. someplace, they will probably go activities can have a large impact on people’s “With these injuries, the brain is damaged there to assist.” Dr. Popovic hopes to prove this lives.” and some of its control mechanisms are gone,” hypothesis with brain-imaging studies. Dr. Popovic’s team is working hard to put he explains. “Motor or sensory commands It’s clear that patients are benefiting, and its approach into widespread use at hospitals, cannot be relayed from the brain to the significantly so, from Dr. Popovic’s novel use of physiotherapy clinics and in people’s homes. muscles, or from the muscles back to the brain. functional electrical stimulation (FES). The new The researchers have almost completed a But the fact is that some of the neuronal cells treatment approach has already helped some prototype of a stimulator for clinicians to use can be retrained to do new tricks.” stroke and spinal cord injury survivors to reach (See Rehab innovations on page 50). Here’s how Dr. Popovic and Toronto Rehab’s and grasp again—in some cases, years after At Toronto Rehab, Dr. Anthony Burns, Neural Engineering and Therapeutics Team are injury. medical director of the hospital’s Spinal Cord teaching injured brains to perform new tasks— Rehabilitation Program, says he will work with with extraordinary results: Dr. Popovic “to make this intervention available First, the patient is asked to imagine a to our patients, and to answer important movement that he or she wants to do but questions such as the duration of the effect.” cannot, such as grasping a glass. “This engages Dr. Popovic holds the Toronto Rehabilitation the brain in creating signals. But the signals Dr. Milos R. Institute Chair in Spinal Cord Injury Research. cannot go anywhere due to the injury.” Popovic He is an associate professor in the Institute of At the same time, an external device is used Biomaterials and Biomedical Engineering at the to stimulate the person’s muscles with tiny University of Toronto. n bursts of electricity. This causes the desired movement to actually happen. “As the hand moves, the patient gets sensory Go to www.torontorehab.com to watch lab video feedback from the movement, plus visual from our recent study in which patients with spinal feedback from seeing his or her hand move.” cord injury received stimulation therapy. The whole process is repeated many times. 10 RETRAINING THE BRAIN
Matthew Linton exploiting brain plasticity everything I could possibly do to get better,” he says. For eight weeks, Linton’s physical, occupational and speech therapies were doubled to six hours a day. The treatment was exhausting, he says. “It was the most difficult thing I’ve ever done in my life.” But there was constant improvement, against all odds. Since leaving Toronto Rehab, Linton has maintained a “managed lifestyle” of exercise, a strict diet, lots of rest and constant stimulation, such as listening to audio books. He continues to cope with fatigue, headaches, balance problems, memory lapses and blind spots in his eyes. Yet a positive attitude, strong support from those around him and a determination to “never stop trying” have allowed him to return to a near-normal life. The 31-year-old has resumed his career part- time in venture capital and corporate finance,Matthew and Stefanie Linton (at right) watch the and recently startedSuper Bowl with friends. his own consultancy “There was no expectation in the field. He’s that I would survive, or Matthew Linton believes in the capacity of survive, or that I would ever have a functional mindful that his the brain to regenerate itself with intensive life,” says Linton. He attributes his recovery “truly exceptional” that I would ever have a therapy. He’s living it. to enrolling in a research program at Toronto improvement is functional life.” On Victoria Day weekend in 2009, while Rehab that capitalizes on the ‘plasticity’ of the not shared by all of staying at a Collingwood chalet, Linton fell brain to repair and recover functions that might those with injuries as – Matthew Linton from a deck and hit his head on a concrete otherwise have been lost. severe as his. slab below. Friends found him unconscious Specifically, the research project is “We’ve got a long way to go before we have and roused him, but he later fell into a coma. examining the value of intensifying treatment a solid understanding of how the brain works.” Flown by air ambulance to a Toronto by doubling the amount of therapy. Results will His recovery to date has been “a miraculous hospital, doctors found massive internal show whether recovery is greater or faster, and surprise,” Linton adds. With his unflinching bleeding and damage in his brain. They whether the ‘intensity’ is tolerated or too tiring. commitment to achieving the best possible operated to relieve the pressure, but told When Linton arrived at Toronto Rehab two quality of life and the support of family, the his wife Stefanie, family and friends to say weeks after regaining consciousness, he was rehabilitation and research community, he goodbye. paralyzed on his left side and had little short- hopes this progress will continue well into the “There was no expectation that I would term memory or ability to read. “I signed up for future. n + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 11
Q.2 Preventing falls on stairs My 82-year-old mother recently came to stay. One day, she decided to take a shower. After gathering her toiletries, she started down the stairs to our basement bathroom. I was in another room when I heard an awful noise—the sound of my mother falling. I found her at the bottom of the stairs. She had What can we broken her arm. But we do to prevent both knew it could have been a whole lot worse. people from – Alex in Toronto falling on stairs? 12 P R E V E N T I N G FA L L S O N S TA I R S
Dr. William McIlroy is producingastounding insights into howpeople act on stairs. The aim: togenerate new knowledge thatcan help prevent falls, which area very common cause of injuryamong older people.
In a study with University of Waterloo colleagues, Dr. William McIlroy (right) foundA. that people rarely look at the handrail even while using it. “In Canada, we suspect it’s even worse. So this is a were surprising. People tended to look only at theIt’s incredible to think that every big problem,” says Dr. Geoff Fernie, vice president, first step or two and the last, ignoring the ones inyear in North America more research, at Toronto Rehab. “Stairs can be very dangerous places, and yet between. And they rarely looked at the handrail even while using it.than a million people are sent to we don’t always treat them with appropriate The brain, it seems, relies on an internal map of respect,” says Dr. William McIlroy, a senior scientist what a staircase looks like. “This can get you intohospital because of falls on stairs. and Mobility Team leader at Toronto Rehab and professor in the Department of Kinesiology at the University of Waterloo. Many of those injuries are extremely serious. Dr. McIlroy’s career in balance research was In fact, falls on steps and stairs account for initially inspired by his grandmother, who tripped about 60 per cent of hip fractures, which can have on a curb and broke her hip. “She never recovered disastrous, even fatal, consequences. In addition, from the fracture,” he recalls, “which is all too Dr. Brian Maki devastating head injuries are much more likely to common in older people.” occur when falling on stairs, compared to falls on Dr. McIlroy’s studies are yielding astounding level surfaces. insights into how people act on stairs. In a newly And the numbers are only getting more completed study, he put ‘eye trackers’ on people worrying. In the United States, deaths from falls to determine where they look while climbing or on stairs are increasing at six per cent per year. descending a laboratory staircase. The findings 14 P R E V E N T I N G FA L L S O N S TA I R S
“Stairs can be very dangerous places, and yet we don’ttrouble if you are on stairs with always treat them with using Toronto Rehab’s new In June 2011, Toronto Rehab will host a specialany variation. If even one stair appropriate respect.” state-of-the-art stair laboratory. international symposium bringing together moreis slightly higher, it creates a The new lab, opening in 2011, than 30 experts in the field. Together, saystremendous fall risk.” – Dr. William McIlroy will launch a new generation Dr. Fernie, they will develop a coordinated Carrying things on the stairs of research. It features eight strategy on how best to use the new stair lab tois also risky. Amazingly, Dr. McIlroy has found that steps fixed to a sophisticated motion platform that answer crucial research questions that will helppeople tend to cling to an object like a coffee moves on cue to cause a stumble or fall. A harness prevent falls on stairs. ncup rather than grab for the handrail when losing system attached to the ceiling keeps researchbalance. “For some reason, the central nervous subjects safe while sensors in the stairs and LED Born in the Russian city of Salsk, not far from thesystem has difficulty letting go of objects. This markers on the body collect key data. Black Sea, Dr. Dimitry Sayenko used to work withis true even if people are holding something “We will know exactly how you move on the cosmonauts. Now, he’s helping people with spinalinconsequential like a plastic tube.” stairs, how close you come to tripping and we can cord injuries to stand and balance. Understanding stair behaviour will allow watch what happens when you do fall,” Dr. Fernie Find out more at www.torontorehab.comresearchers to develop personalized therapy explains.programs that improve strength and balance,and change behaviours (discouraging holdingof objects on stairs, for example). These are notcurrently a regular component of rehabilitationprograms. Computer vision Improving handrail design can also helpprevent falls. Research by Dr. Brian Maki, a Toronto keeping an eye on mobilityRehab senior scientist, shows that older peoplerely more on arm movements for balance and are When patients go home person could then be advised on how to minimize risk.twice as likely to use handrails as younger adults. after rehabilitation, Dr. Allin has a personal connection to her research.But they are also much less likely to look at the rail there’s something Her 70-year-old father suffers from a condition calledand more likely to make errors such as missing the potentially dangerous foot drop (difficulty raising the foot at the ankle) that waiting for them: stairs. causes him to stumble. “I do worry that he might fall onrail, or hitting it with the back of the hand. Ongoing research the stairs in his house,” she says. One of Dr. Maki’s solutions is a cueing system by Dr. Sonya Allin, a She hopes to start testing the system in 2011 in thedesigned to improve ability to grab the rail Toronto Rehab adjunct homes of people recovering from hip replacementeffectively in response to sudden loss of balance. scientist, will provide surgery.It can also prompt people to grab the rail before vital information to Meanwhile, Dr. Alex Mihailidis and PhD studentlosing balance. As someone approaches a decrease the danger of Jasper Snoek are using similar technology for acustom-built handrail, a row of LED lights flashes a fall on stairs. Dr. Allin different goal—saving researchers time and money.and a voice recording is triggered, attracting the is developing low- Their computer-vision technology sifts through videoperson’s attention. cost computer vision footage collected in public settings and automatically technology to monitor identifies unusual stair behaviours like slips, trips and A study testing the system on 120 older adults people’s mobility, misuse of handrails.has just been completed. “We’re still analyzing Dr. Sonya Allin including their stair use, “Right now, researchers who study falls have tothe data but it looks like the verbal cueing in in the home. manually review each video, perhaps watching hundredsparticular is effective in getting people to use “The goal is to develop a system that determines of hours of tape just to find one fall,” says Dr. Mihailidis,the handrail,” says Dr. Maki, a senior scientist at when a person is at risk, delivers information to a a senior scientist at Toronto Rehab and associateSunnybrook Research Institute and director of the therapist and prompts the person to take corrective professor in the Department of Occupational ScienceCentre for Studies in Aging at Sunnybrook, as well action,” says Dr. Allin, a postdoctoral fellow in the and Occupational Therapy at the University of Toronto.as a professor at the University of Toronto. Department of Occupational Therapy at the University “These are great examples of how we can apply Other studies by Dr. Maki have led to changes of Toronto. artificial intelligence to collect much larger volumesto building-code requirements for handrail height, For instance, the system might indicate that of data in real-life settings,” says Dr. Mihailidis, who someone is going down the stairs too quickly or failing holds the Barbara G. Stymiest Chair in Rehabilitationshape and size, to help ensure that people are able to lift their feet enough to safely clear the stairs. The Technology Research at Toronto Rehab.to use the rails effectively to maintain balance. Drs. Maki and McIlroy are also eager to start + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 15
Q.3 Dealing with dementia A few months ago, I learned that my mother has dementia. She is still living at home but getting increasingly forgetful. Things go missing and turn up in odd places. The other day, the TV remote vanished. It was in the bathroom. Sometimes, my mother sits down for a meal, forgetting that she has already How can we eaten. She is happy in help people her home and wants to live there for as long as with dementia possible. My siblings and who are living I want that too, but we worry about her. at home? – Sylvie in Toronto 16 DEALING WITH DEMENTIA
Student Yulia Eskin is with a Toronto Rehab-University of Toronto team developing ‘intelligent’ assistive technologies to support seniors, those with disabilities and their caring family members—like these ones—in daily living.
A.As an engineering graduate in1996, Dr. Alex Mihailidis waslooking for a challenging areaof research that would have ameaningful impact in his field—and on people’s lives. washing, dressing and meal preparation. Today, Dr. Mihailidis is on the leading edge of research in the use of artificial intelligence, computer visioning and voice- recognition to support older in daily living. The internationally recognized senior scientist, who leads Toronto Rehab’s Artificial A nutritional detection system, now under development, uses computer vision to monitor what a person eats and drinks to guard against malnutrition and dehydration. a number that will double in the next generation. Providing greater assistance in the home can enhance quality of life and independence, reduce caregiver burden and lower Dementia affects 20 healthcare costs, Dr. Mihailidis says. people and those with disabilities per cent of people by Intelligence and Robotics Team, is cent by the age of 90. developing a range of ‘intelligent’ devices to allow people to live longer and more For his master’s, he created The the time they are 80, COACH, which ‘prompts’ users to carry out the different steps involved and more than 40 per in hand washing. Through his PhD He found it in a chance encounter at a conference safely at home. with a fellow engineer whose wife had early-onset “People want to remain in their communities Alzheimer’s disease. and they do better in their own homes,” says There was little available in terms of Dr. Mihailidis, holder of the hospital’s Barbara technologies to help his wife cope in the home, G. Stymiest Chair in Rehabilitation Technology the man said. For Dr. Mihailidis, who had started Research and an associate professor of Dr. Alex Mihailidis a master’s in biomedical engineering, the story occupational science and occupational therapy struck a chord—and charted a lifelong career at the University of Toronto. “We have to have path. To assist people with dementia and their concrete ways of supporting them there.” caregivers, he thought, a computer could model, Dementia affects 20 per cent of people by the monitor and then offer prompts for the various time they are 80, and more than 40 per cent by the steps involved in routine tasks such as hand age of 90, amounting to 500,000 Canadians today, 18 DEALING WITH DEMENTIA
Powered mobilityand beyond, he adapted and took on more complexaspects of the technology, applying artificial helping people to get aroundintelligence and advanced theoretical computertechniques. His hand washing system is today beingtested at an Alzheimer’s clinic. The team is adapting It’s a cruel To see how the prototype worked in a long-termit for tooth brushing and other activities. paradox. Many care environment, Dr. Wang recruited six residents nursing home with different degrees of cognitive impairment There’s also a system, under development, that residents with and asked them to “test drive” the prototype, withmonitors what—and how often—a person eats dementia some residents testing it for up to several months.and drinks, to guard against dehydration and need powered The results were unexpected.malnutrition. wheelchairs and “We thought users would warm to this device,” “Because an intelligent home learns and adapts scooters to get says Dr. Fernie. “In fact, they were embarrassedto the habits of its occupants, it can interact with around—but to be seen trundling around slowly in somethinga person if his or her behaviour does not fit with aren’t allowed to that looked like a tank.”typical patterns and, if necessary, alert caregivers,” use them because Adds Dr. Wang: “Users felt a certain social of the risks to stigma because of the chair’s speed andDr. Mihailidis explains. themselves and appearance. They felt ‘different’ because their Different devices could stand alone or be fellow residents. wheelchairs were obviously different—slow andincorporated into the very architecture of a “If they bump cumbersome—and this perception was reinforcedhome—a concept he calls “brick computing”. into another by well-meaning remarks by staff and residents.” Dr. Rosalie WangSensors embedded in floor tiles, for example, resident, the result There were even surprising reactions to thewould monitor and record someone’s blood could be serious injury or even fatal,” explains idea itself. Some residents said they actuallypressure, respiration, heart rate and body Dr. Rosalie Wang, a member of Toronto Rehab’s enjoyed having other people push them intemperature through the soles of the feet. Technology Team and postdoctoral fellow with manual wheelchairs because it gave them more the Intelligent Assistive Technology and Systems opportunity to socialize. Of course, the power Dr. Mihailidis has also developed a device that Lab at the University of Toronto (U of T). wheelchair—once perfected—should offerdetects if someone has fallen. It ‘learns’ and tracks But a high proportion of people in long-term residents new opportunities to link up with othersthe actions of the user—and can interact with the care can’t walk or use a manual wheelchair and socialize.person and call for help. because of a physical disability, Dr. Wang points Lessons learned from on-site research are now Fifteen years ago, says Dr. Mihailidis, people out. “So our challenge is to develop technology being incorporated into the next prototype, whichin his field saw little need for such technologies. that will allow nursing home residents with is being developed by Tuck-Voon How, a formerToday it’s a different picture, with collaborators dementia to use powered wheelchairs safely.” It’s U of T graduate student and now researcharound the world focused on various aspects of estimated that at least half of residents in long- developer at the Intelligent Assistive Technology term care are cognitively impaired. and Systems Lab. The wheelchair uses computerthe ‘intelligent’ home. “You can’t go to a conference Developing a powered wheelchair that’s safe for vision and has improved sensor capabilities andwhere someone isn’t presenting on this topic.” this population is harder than it might seem. For faster processing speeds to avoid obstacles. Dr. Mihailidis envisages a practical and starters, the system must be absolutely reliable; Meanwhile, Dr. Wang is field-testing ancommercially viable product that incorporates even a single collision is unacceptable. upgraded interface that helps users navigate byprompts for a range of tasks and can be tailored The Toronto Rehab-U of T team initially giving audio and visual prompts, as well as touch-to individuals. Now 36, he’s optimistic such experimented with collision-avoidance systems based feedback from the joystick, which will nottechnology is “totally doable” in his lifetime, based on infrared and ultrasound sensors, but move in any direction where the system ‘senses’adding that he sees a day when he himself will rejected them as too unreliable. Ultimately, the an obstacle. Users are responding positively. researchers came up with a completely different “These trials remind us that technology is onlybenefit from his research. “I’ve got to make sure I design. part of the solution,” says Dr. Wang. “To helpget the technology perfect.” n “The prototype looked a bit like a bumper people with cognitive impairments become more car, with a wide bumper or ‘skirt’ at the bottom mobile by using power wheelchairs, we have to containing an array of micro-sensors,” says pay close attention to what they tell us, as well as Semantic dementia is a rare kind of dementia Dr. Geoff Fernie, vice president, research, at to social and organizational issues.” that tends to strike people in their 50s and 60s Toronto Rehab. “If the chair hit something, the Dr. Wang’s new research in this area is partially who are otherwise quite functional. ‘skirt’ would collapse without applying any force supported by CanWheel, a cross-Canada research Dr. Elizabeth Rochon is working on a language to the obstacle and the chair would stop. It was collaboration formed to enhance the mobility of therapy that is showing promising results. ugly but effective.” older wheelchair users. Read the article at www.torontorehab.com + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 19
Q.4 Fighting disease with exercise I was diagnosed with Type 2 diabetes several years ago. I take medication to control my diabetes and I keep a close eye on my blood glucose levels. I also try to follow a healthy diet and have taken off some weight. But I do not get much physical activity. I’m considering joining Does exercise an exercise program for really pay off seniors. for people with – Maria in Windsor diabetes? 20 FIGHTING DISEASE WITH EXERCISE
Dr. Pearl Yang is tracking the progress of people with diabetes as they complete Toronto Rehab’sDiabetes, Exercise and Healthy Lifestyle program.Suzanne Parsons (at left in inset picture, sharing a laugh with family) participated in the program.
A.With a disease like diabetes,it’s all too tempting to just takemedication and hope for betterhealth. But there’s anotherapproach with a big payoff—and Toronto Rehab researchshows how and why it works. “Exercise works as well as medication in reducing blood sugar levels and it has only positive side effects. You lose weight, you gain muscle strength and you feel better,” says Dr. Paul Oh, a scientist and medical director of Toronto Rehab’s Cardiac Rehabilitation and Secondary Prevention Program. The new research quantifies those benefits. Researchers tracked the progress of 62 people with Type 2 diabetes, the most common kind, as they completed Toronto Rehab’s Diabetes, Exercise and Healthy Lifestyle program. Participants work out in a weekly class, and four times a week at research-based exercise and education programs for people with diabetes in Canada. • • • • And the results are remarkable. After completing the program, participants showed significant improvement on several key measures: • blood sugar levels dropped 9.5 per cent on average aerobic capacity improved 17 per cent on average average weight loss was 3.4 pounds body fat dropped from an average 32 to 31per cent questionnaires showed lower depression scores and higher quality-of-life scores. home using a personalized program of walking and resistance training. It’s one of the largest The lowered blood sugar levels can mean people 22 FIGHTING DISEASE WITH EXERCISE
Explaining how a glucometer works: blood sugar levels were one of the key areas that showed significant improvement in a study of people with diabetes. did less exercise. “Knowing this, we can start to tailor the program to meet their needs and help them stick with it,” says Dr. Pearl Yang, the Toronto Rehab researcher who led the study. The program is continually being fine-tuned to improve outcomes with each new research result. Scientists want to know how much exercise is required, at what intensity and duration. Dr. Yang’s research has found that resistance “Exercise preserves all training can control blood sugar levels whether at the systems of the body, high or low intensity. from muscles and bones “What’s most important is to heart and brain.” to find the protocol that’s right for each person,” she – Dr. Paul Oh says. “Adherence is key.” Dr. Oh, meanwhile, is reaching out to family doctors to spread the message about diabetes and exercise. Working with the Canadian Diabetes Association, he’s developing a tool kit of posters, prescription pads and information sheets for national distribution. In his eight years at Toronto Rehab, Dr. Oh has seen thousands of cardiac and stroke patients benefit from structured exercise programs. The evidence is irrefutable, he says. Exercise works. Now he’s developed a similar program forneed less medication or, in the case of pre- women with breast cancer, supported by a one-diabetics, none at all. year grant from Pfizer Canada. The program has “It’s easier to give a pill but lifestyle changes been modified to meet the specific needs ofcan work just as well,” says Dr. Oh. “People just this group ensuring, for example, that they canneed the right support to stay with it and make it exercise safely during chemotherapy or radiationsuccessful.” treatments. “The research has just begun but Dr. Paul Oh anecdotally it works and people love it.” The improvements in aerobic capacity, weightand body fat can be ultimately lifesaving because In fact, says Dr. Oh, exercise is good for virtuallythey lower the risk of heart disease. Diabetes is every disease and disability, as well as healthyone of the greatest risk factors for coronary heart aging. “Past the age of 40 we’re all unfortunatelydisease. “But regular exercise can cut your risk in on a downward path. Exercise preserves all thehalf,” Dr. Oh explains. systems of the body from muscles and bones to Another key finding: people who started the heart and brain. There is good evidence that itprogram with higher depression scores typically helps with almost everything.” n + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 23
Changing unhealthy behaviours The behaviours of today are tomorrow’s that showed obese people have medical costs used by 70 to 80 per cent of U.S. employers. It diseases, says Toronto Rehab senior scientist that are about 30 per cent greater than their identifies a person’s individual risk and provides and cardiologist Dr. David Alter. normal weight peers. educational materials and telephone coaching The most obvious warning sign: “the rising Governments can change behaviours in healthy behaviours such as diet, exercise, tide of obesity.” Almost 24 per cent of Canadians through policies, such as banning public stress management and smoking cessation. are now obese, up from 11.1 per cent in 1976. smoking and taxing cigarettes. Another way is In the healthcare setting, hospitals need to Obesity causes numerous health conditions and through workplace programs better understand a person’s is a leading cause of preventable death. that target people who are “When we visit the doctor, readiness to change behaviour “The root causes of obesity are not all still healthy and productive. we tend to go because of and to stick with lifestyle that complicated,” says Dr. Alter, pointing to Unfortunately, Canadian programs, says Dr. Alter. He is sedentary behaviour and unhealthy diets. employers lag behind their complaints and symptoms devising patient surveys and But the solutions are more complicated. Our U.S. counterparts in this —not for a two-hour other tools to help hospitals healthcare system, for instance, is primarily set area, according to Dr. Alter’s lifestyle coaching lesson.” do this. up to deal with disease. research. Another way hospitals “We tend to go to hospitals for things like “In Canada, we have yet – Dr. David Alter can change behaviour and angioplasty, bypasses and stents. When we to really develop workplace increase adherence is through visit the doctor, we tend to go because of programs that target lifestyle and behaviours; outreach programs, Dr. Alter stresses. “On-site complaints and symptoms—not for a two-hour whereas, in the U.S., as a solution to rising costs, services are not the be-all and end-all, mostly lifestyle coaching lesson.” employers have implemented many more self- because they rely on patients to proactively As research director of Toronto Rehab’s care programs, laced with incentives for their come in to seek care.” Cardiac Rehabilitation and Secondary employees to become more active and healthy.” Toronto Rehab, for instance, is sharing its Prevention Program, Dr. Alter says there’s a huge Dr. Alter cites a phone-based, lifestyle successful cardiac rehab home program with opportunity to save lives and reduce the burden modification program, which he says is now distant providers to further extend the reach. on our healthcare system—if we act now. Last year, the hospital guided a Cambridge, “What’s at stake is our health, our productivity Ontario ambulatory specialty clinic through the in the workplace and our healthcare system. steps of setting up a cardiac home program. There is a sustainability crisis. Our population is “We are still learning what makes people becoming more sedentary, and getting more change their habits, but tailoring programs obese. The burden of disease is growing, and it’s to the individual certainly maximizes the getting more costly to our system.” possibility for change,” adds Dr. Alter, who is The costs of obesity alone are staggering. also a senior scientist at the Institute for Clinical Dr. Alter co-authored a study last year with Evaluative Sciences (ICES) and an associate Queen’s University researcher Diana Withrow professor at the University of Toronto. n Dr. David Alter 24 FIGHTING DISEASE WITH EXERCISE
Wendy Angelo an “amazing journey” first time in her life, she started regularly lifting weights. Exercise leaders adapted the exercises as needed to protect Angelo’s knees, getting down on the floor beside her to show proper technique. “The personal interaction was key. Going to class every Monday, I felt so revitalized,” Angelo enthuses. She and her classmates had the benefit of a program informed by rigorous research. They also had the support of a whole healthcare team that included a dietitian, psychologist and doctor who gave education sessions on everything from diet to stress management and glucometers. Partway through the program, Angelo’s sister suffered a heart attack, a painful motivator to keep exercising. Another, sweeter motivation was her son’s impending wedding. “She really wanted to look great for that wedding,” says Angelo’s case Wendy Angelo with husband, Van, at their son’s wedding. manager, cardiac rehab supervisor Diane Nixon. “And she did!” Just a year ago, Wendy Angelo had trouble research-based Diabetes, Exercise and Angelo dropped 20 pounds on the program walking even just a few blocks. At 63, she was Healthy Lifestyle program. Over six months, it and the compliments overweight and endured painful osteoarthritis transformed the retired schoolteacher into an flowed on wedding day. “I kept to the rules in her knees. Then came a diagnosis of pre- avid exerciser who now walks 20 kilometres a Her energy levels and and I saw the results.” diabetes. “I sat in the doctor’s office and week with ease. sleep have improved thought, oh no, not another chronic disease!” Angelo had always avoided exercise and, most important, her – Wendy Angelo People with pre-diabetes have blood because of her knee pain. Toronto Rehab staff blood glucose levels have glucose levels that are higher than normal but carefully drafted her ‘exercise prescription,’ a dropped enough that she does not require not high enough to be diagnosed as diabetes. personalized program that began with slow medication. They often go on to develop Type 2 diabetes. walking. Walking once a week in class and four “I kept to the rules and I saw the results,” she Angelo knew how serious the diagnosis times a week on her own, she increased first says proudly. “It’s very empowering.” could be. An aunt had died in her 60s from her distance and then her speed. As her leg On the last day of class, Angelo handed complications of diabetes. “I figured I had to do muscles strengthened and she lost weight, the Diane Nixon a thank you card. “It was an something,” Angelo says. knee pain subsided. amazing journey,” she wrote, “and a wonderful That “something” was Toronto Rehab’s Next came the resistance training. For the opportunity to take a part in my own care.” n + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 25
Q.5 The scourge of sleep apnea My husband snores loudly and shifts a lot in bed at night. He says he often feels sleepy during the day. I’m wondering if he might have sleep apnea. I’m trying to get him to go to his doctor. – Abiba in Toronto How important is it to test for sleep apnea and to treat it? 26 THE SCOURGE OF SLEEP APNEA
Dr. Clodagh Ryan of Toronto Rehab’s SleepResearch Laboratory, where scientistsare researching the relationship betweensleep apnea and cardiovascular diseases.The consequences of sleep apnea can beserious. With couples, the partner is oftenaffected too when sleep is disrupted.
A.Imagine waking up hundreds oftimes during the night—and noteven knowing it. “In severe cases, people with obstructive sleep apnea could be waking up 500 or 600 times a night—and they don’t remember,” says Dr. Douglas Bradley, a senior investigator and director of the Sleep Research Laboratory at Toronto Rehab. seven-hour night. The disorder causes a person to stop breathing repeatedly during sleep because of recurrent collapse of the throat. Common symptoms are loud snoring, restless sleep and daytime sleepiness. About five to 10 per cent of otherwise healthy people are believed to have obstructive sleep apnea—but very few are diagnosed. “A lot of people don’t make the connection between being very sleepy in the daytime and having obstructive sleep apnea,” says Dr. Bradley. It’s vital that the connection be made because that people with the disorder are at increased risk of high blood pressure, strokes, heart attacks and heart failure. Those with daytime sleepiness have a car crash rate that is three to four times greater than those who do not have sleep apnea. Their risk of industrial accidents is also higher. And there’s something else. Dr. Bradley’s research also suggests that obstructive sleep apnea plays a role in inhibiting recovery from stroke. There are more than 50,000 strokes in Canada every year. Dr. Bradley has shown that stroke patients who have sleep apnea spend Even in more routine cases, people with sleep the consequences of obstructive sleep apnea can much longer in rehabilitation and do not recover apnea wake about 120 to 180 times during a be serious. Studies by Dr. Bradley and others show as well physically compared to stroke patients 28 THE SCOURGE OF SLEEP APNEA
Researchers are studying whether use of acontinuous positive airway pressure (CPAP) mask, placed over a person’s nose during sleep, can improve recovery in people with strokes. About five to 10 per cent of otherwise healthy people are believed to have placed over the patient’s nose a 40 per cent decrease in the during sleep that alleviates obstructive sleep apnea— severity of their obstructive obstructive sleep apnea, while but very few are diagnosed. sleep apnea. the other half did not receive This finding, says Dr. Bradley, CPAP. The study, expected to be published in proves that fluid retention in the legs during the 2011, will compare patient outcomes. The lead day, and its movement into the neck overnight, author is Dr. Clodagh Ryan, a Toronto Rehab is a treatable cause of obstructive sleep apnea. adjunct scientist who conducted the study with “Further studies will be needed to determine Dr. Bradley and colleagues. whether such effects become greater with longer The latest research coming out of Toronto Rehab use of compression stockings, and whether such is also shedding new light on who is most at risk stockings will be useful in the general obstructive for sleep apnea in the general, otherwise healthy sleep apnea population including those who are population. Here, too, there are revelations. Being obese.” overweight or obese is already known to be the Meanwhile, Dr. Bradley and his colleague, major risk factor. But many people with sleep Dr. Sandy Logan, are probing the effects of apnea are not obese or overweight. diuretics on obstructive sleep apnea. Their current Thanks to Dr. Bradley’s work, we now know that focus: patients with drug-resistant hypertension. sedentary living is another major risk factor. “The It’s already known that these individuals have longer you sit, the more fluid you accumulate in greater fluid movement out of their legs at night your legs, just by gravity,” explains Dr. Bradley. “And and much more severe obstructive sleep apnea when you go to bed at night, you lift your legs up than people whose blood pressure is more easily which causes the fluid to shift. One of the places controlled. A trial, now underway, will determine the fluid goes is into your neck, where it causes the whether diuretics can reduce the severity of their throat to narrow.” obstructive sleep apnea. It’s worrying news for people who spend long All the evidence emerging from Dr. Bradley’s hours in front of a computer. But Dr. Bradley’s lab underlines how important it is to detect research also opens the door to potentially new obstructive sleep apnea in the first place. But ways to treat sleep apnea. Some people could Dr. Bradley points out that only about 15 per cent deal with fluid build-up through exercise, diuretics of people with the condition are diagnosed. One (medications to reduce fluid levels) or compression reason is the limited number of sleep labs where without the sleep disorder. Obstructive sleep stockings that prevent fluid build-up in the legs. people can be tested, particularly outside of apnea is common among stroke patients; as many Already, these novel approaches are being Ontario. as 70 per cent have the disorder. actively followed up by Dr. Bradley and his “People are often on waiting lists for more than Dr. Bradley has been investigating whether associates. Dr. Stefania Redolfi at Pitié-Salpêtrière a year, sometimes even two years, just to get a treating sleep apnea in disabled people with Hospital in Paris, France, who worked at Toronto sleep study—never mind getting treated. A lot of stroke and heart disease can improve their Rehab as a research fellow with Dr. Bradley, has people simply give up,” says Dr. Bradley. It’s one recovery from these conditions. “If we treat just published a fascinating study investigating of the reasons he is working with Drs. Hisham their sleep apnea, we may improve these the effect of wearing compression stockings Alshaer and Geoff Fernie to develop a portable people’s functional capacity and shorten their on obstructive sleep apnea. Although the device that can be used to detect sleep apnea at hospitalization,” he explains. study is small, it showed, in six non-obese men home (see article on page 49). His team recently completed a randomized trial with obstructive sleep apnea, that wearing Dr. Bradley also holds appointments at the involving stroke patients with obstructive sleep compression stockings for just one day caused a University of Toronto, Toronto General Hospital/ apnea. Half of the patients received continuous marked decrease in the amount of fluid moving University Health Network and Mount Sinai positive airway pressure (CPAP), a small mask from their legs to their necks at night, along with Hospital. n + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 29
Treating sleep apnea in people with heart failure A multi-year international study is underway Heart failure (known as congestive heart the legs, that leads to swelling of the ankles. to determine whether heart failure patients failure) is the third most common cause of In people with sleep apnea, the recurrent who have obstructive or central sleep apnea do death in Canada. It is a condition in which the episodes of apnea and oxygen deprivation better when their sleep apnea is treated. heart cannot pump enough blood throughout expose their hearts to stresses that do not allow The treatment involves adaptive servo- the body. People with heart failure are often their hearts to rest at night and benefit from ventilation (ASV), a ‘smart’ version of tired and short of breath. About 50 per cent of the restorative effects of sleep, says Dr. Bradley. continuous positive airway pressure (CPAP) that heart failure patients have either obstructive or The ASV device treats the disorder by applies air pressure through a mask worn over central sleep apnea. delivering positive airway pressure to patients the nose at night. The air pressure prevents the The study will also determine whether when they stop breathing. This prevents throat from collapsing in treating sleep apnea reduces hospitalization obstructive apneas by forcing the throat to stay“This is a potentially the case of obstructive rates, which are high in this group of patients. open, and central apneas by assisting breathinghistoric trial in which apnea, and assists The need for hospital care is usually related to when the device detects that patients stop breathing in the case of the development of edema (fluid retention) in breathing.we will truly find out central sleep apnea. the lungs, that leads to shortness of breath, and “The device has sensors in it that detectwhether treating sleep Spanning 45 sites when you are breathing and when you are not.apnea in heart failure in eight countries, If you stop breathing, it kicks in to help youpatients saves lives.” the study—led senior Toronto Rehab by breathe. But it turns off if you are breathing on your own. It’s like a cardiac pacemaker, but – Dr. Douglas Bradley scientist Dr. Douglas made for the lungs.” Bradley—will involve There’s another special feature. Some people up to 1,000 patients. Funding is from the with heart failure flip back and forth between Canadian Institutes of Health Research and obstructive and central sleep apnea. The ASV industry-partner Philips Respironics Inc., which device “can tell when you do this and provide manufactures the ASV device. the necessary level of support.” “We’re reading all the sleep studies in our core In addition to Canada, countries laboratory at Toronto Rehab,” says Dr. Bradley. participating in the randomized trial include: “This is a potentially historic trial in which we Brazil, Germany, Ireland, Italy, Spain, the will truly find out whether treating sleep apnea United Kindom, and the United States. The first in heart failure patients saves lives.” patients were enrolled in the fall of 2010. n Dr. Douglas Bradley 30 THE SCOURGE OF SLEEP APNEA
Mary Grzywna breathing easier, getting on with life study testing the benefits of treating sleep apnea in stroke rehabilitation patients with a device known as continuous positive airway pressure (CPAP). CPAP consists of a small mask placed over the patient’s nose during sleep to eliminate sleep apnea and restore normal oxygen delivery to the injured brain. During her stay at Toronto Rehab, Grzywna’s words and numbers returned. When friends came to visit, she was relieved to discover that she could play bridge with them. “I was lucky,” she says. Some of this improvement was probably due to elimination of her sleep apnea and improved oxygen delivery to the brain by CPAP. After one month, Grzywna went home— with her trusty CPAP device. It was always byMary Grzywna (second from right) her bed and with hertakes a break from a bridge game with friends. when she travelled. “I knew that I had trouble “I used it faithfully Mary Grzywna will never forget the day in June problems. “When the occupational therapist for over five years,” sleeping. I would wake 2000 when everything went wrong. First, she asked me to say the alphabet, I could only get says the retired up several times during a burned the food she was preparing for a party to G or H,” she recalls. “When she showed me a nurse coordinator. night to catch my breath.” the next day. Later, at a restaurant, she couldn’t picture of asparagus, I knew what it was, but I “Then, when it died, understand the menu—or find her car when couldn’t produce the word.” I found that I could – Mary Grzywna she came out. “I couldn’t figure out what was Along with speech therapy, Grzywna was sleep normally. I had going on with me,” she says. given something else—a sleep test. The results lost weight and I think that helped too.” Since It turned out that Grzywna had experienced revealed that she had sleep apnea, a disorder weight loss can alleviate sleep apnea, it’s likely a stroke. “I was really upset because I didn’t that causes repetitive pauses in breathing, that some of Grzywna’s ongoing improvement believe I’d had a stroke,” says Grzywna, who leading to oxygen deprivation of the brain, and was due to alleviation of sleep apnea by weight was taken to hospital by ambulance and sleep disruption. loss. ultimately transferred to Toronto Rehab’s Neuro “I knew that I had trouble sleeping. I would Today, at 75, Grzywna leads a full life. Bridge Rehabilitation Program for stroke rehabilitation. wake up several times during a night to catch is still a big part of it. She’s also a voracious Although the stroke had no physical effects, my breath,” she says. reader who can’t believe she ever had trouble Grzywna was alarmed to discover perceptual Grzywna agreed to take part in a research with the alphabet. n + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 31
Q.6 Helping people hear better My hearing has started to go downhill now that I’m in my 80s. I finally got hearing aids two years ago. But I almost never wear them. I find them difficult to put in. They don’t really seem to help all that much and I’m tired of going back to the What can we do audiologist to have to help people them adjusted. hear better? – Anne in Toronto 32 HELPING PEOPLE HEAR BETTER
Dr. Gurjit Singh of Toronto Rehab’sCommunication Team is determinedto remove barriers to hearing-aid use.This 81-year-old piano teacher (ininset picture) is among those who gethearing aids but seldom wear thembecause of frustrations with the devices.
A. Understanding manual dexterity and hearing-aid use is one of the issues being investigated by University of Toronto-Toronto Rehab researchers.Hearing aids are sometimes low? Roughly one in 10 people who could benefit Data from the U.S. suggest that dexterity is from hearing aids actually gets them, says Dr. Singh. indeed an issue for some hearing aid users. That’sdisparaged for being awkward What’s more, 20 per cent of those who do get not surprising, considering that hearing loss and hearing aids stop using them. It’s a sad fact, given arthritis are both among the most common chronicor unsightly but they have the importance of hearing in our daily lives—and conditions facing older people in North America. Dr. Singh is determined to do something about it. So how can we make it easier for people to usecome a long way since the days The mysteries surrounding hearing loss hearing aids, which can be tricky to insert in theof King Goa VI. have always fascinated Dr. Singh, who was an audiologist at a hearing clinic before he began ear when you can’t really see what you’re doing? Dr. Singh set out to understand what types of work on his PhD. “I had all kinds of questions I controls are better suited to aging hands. He wanted to answer, such as why is tested a variety of buttons, switches, During his reign in the early 1800s, the Portuguese there such variability with success 20 per cent of those toggles and remote controls. ruler used his throne as a hearing aid. The arms of when people use hearing aids?” who do get hearing A key finding of his study: “Even if a the chair were shaped like lions’ heads. Subjects Today, his research is all about button was smaller, as long as the user spoke into the lion’s mouth and their words were removing barriers to hearing aid aids stop using them. has some kind of ‘haptic’ feedback, carried through a tube that ran into the King’s ear. success. As a PhD student, or sensation, he or she had more By the first quarter of the 1900s, a typical carbon- Dr. Singh looked at what he believes is one of confidence that they were controlling the device.” based hearing aid was the size of a car battery, says the barriers to hearing aid use: manual dexterity Based on his findings, he developed researcher Dr. Gurjit Singh, a member of Toronto problems faced by older people. recommendations for which types of controls Rehab’s Communication Team. “Compare that to “The combined effects of diminished hand should be used in the future. today, when we have hearing devices that are small function and hearing aid miniaturization translate Last summer, the Toronto Rehab researcher and enough to be entirely positioned in the ear canal.” into a potential crisis in handling difficulties,” he University of Toronto postdoctoral fellow received So why do hearing aid adoption rates remain so wrote in a recent paper. a special federal grant that, he hopes, will remove 34 HELPING PEOPLE HEAR BETTER
another barrier to hearing-aid use by bringing the clinician interactions. telecommunication technologies, says Dr. Singh.hearing clinic closer to the patient via the Internet. “This new technology could potentially The grant supporting his communication Currently, getting a hearing aid involves three revolutionize the way professionals work with technology research is managed by MITACS, ato four visits to a clinic. “Hearing aids have to be their patients, enabling audiologists to connect national research network that connects Canadiantailored to the individual. On return visits to the with people in the actual environments in which businesses with the next generation of skilledclinic, the audiologist fine-tunes the hearing aid,” they work or live. It shouldn’t replace all face- workers.explains Dr. Singh. to-face interactions, but there’s the potential to Dr. Singh’s academic supervisor is Dr. Kathy But for some people, especially those who have greatly improve access for patients and to address Pichora-Fuller, a Toronto Rehab adjunctmobility issues or live in remote areas, or even untreated hearing loss.” scientist. Dr. Pichora-Fuller collaborated onthose who simply have heavy demands on their With this and other recent advances, Ontario Dr. Singh’s manual dexterity research, along withtime, return visits can be a real challenge. This may has the potential to become a world leader in Drs. Heather Carnahan, Donald Hayes and Herbertbe one of the reasons people discontinue use of the delivery of hearing-related services using von Schroeder. ntheir hearing aids—a situation that is “not ideal,given all that we know about the importance ofkeeping socially active and having networks ofsupport which are important for successful aging,”says Dr. Singh. Unsolved hearing problems also Hearing loss why people aren’t listeningmake it harder to prevent and treat many otherhealth problems because most care involves Kathy Pichora-Fuller has had a life-long fascination hearing-aid technology. She points to innovationscommunication. with language. such as wireless communication that allows better Dr. Singh is using funding from Elevate, a new It began at the age of 12 when she invented a coordination between a person’s two hearing aids,program to keep top PhD holders in Ontario, secret language with friends, inspired by the aliens in and noise-reduction features that help people to hearto study what he describes as a “potentially Star Trek “who had all kinds of interesting languages.” in crowded, noisy situations. At university, she studied literature, languages and “Hearing technology has come a very long way, yetrevolutionary” way of delivering hearing-aid linguistics. She did a master’s degree in audiology people still aren’t lining up to get a hearing aid,” saysservices over the Internet. The new technology and speech sciences, before earning a doctorate in Dr. Pichora-Fuller. In fact, hearing-aid adoption rates—developed by his industrial partner Unitron psychology. have remained about the same for the past 40 years,Hearing/Sonova Holding AG—is a breakthrough “Communication is our connection to people,” says she says.because it lets audiologists remotely program Dr. Pichora-Fuller, a Toronto Rehab adjunct scientist Dr. Pichora-Fuller wants to know what’s holdingpeople’s hearing aids. and University of Toronto (U of T) psychology people back from getting the help they need. “Is it In his study, Dr. Singh is looking at several professor. “It defines our identity and creates our stigma about hearing loss, or stigma about aging, orissues, including clinical outcomes and the relationships with other people.” is it both?”effect of the new remote technology on patient- Today, her research is about helping people with To find out, she is conducting a study involving hearing loss communicate with others. Untreated people aged 55 and older. Among the various groups hearing problems can lead to social isolation, being studied are people who have just received a depression, poorer quality of life, even reduced recommendation to get their first hearing aid. Others longevity, she says. in the study include those who would benefit from a And hearing loss is on the rise. “The population is hearing aid—but who have not yet been to a hearing aging and there is a marked increase in hearing loss clinic.Dr. Kathy with age,” says Dr. Pichora-Fuller. “Are the people who are not running to get hearingPichora-Fuller Typically, hearing loss starts in our 40s, yet studies aids feeling more fear of aging?” asks Dr. Pichora- show it takes people between 10 and 20 years from Fuller, who is collaborating on the study with U of T the time they first notice hearing problems to the psychology professor Dr. Alison Chasteen and the time they enter the door of a hearing clinic. Canadian Hearing Society. Dr. Pichora-Fuller is trying to understand the The next step will be to develop interventions that reasons for this “limbo time” during which people’s encourage people to take action to deal with their lives, and their ability to communicate, begin to be hearing loss. “We want to find ways to improve their affected. “People start to have a tough time at work readiness to try,” explains Dr. Pichora-Fuller. meetings, dinner parties, church or club meetings.” “Hearing is important, but it’s communication As an audiologist, Dr. Pichora-Fuller doesn’t blame that’s really important to our lives.” + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 35
Q.7 Senior drivers staying safe on the roads I am 84 years old and depend on my car to get around. I have had joint replacements and using public transit is not an option for me. I feel confident behind the wheel, but I no longer like to drive at night. – Lee in Ottawa What can we do to help older people drive safely for as long as possible? 36 S E N I O R D R I V E R S : S TAY I N G S A F E O N T H E R O A D S
Novlette Fraser is working on a study that will leadto a screening tool which family doctors can useto identify older drivers who are safe and unsafe todrive. Margaret Granger (in inset picture) uses hercar daily and is participating in the study.
A.It’s one of the toughest calls aphysician can make—decidingwhen it’s time for an elderlypatient to hang up the car keys. Driving means independence for many adults, corner as baby boomers reach retirement age, it’s a problem that urgently needs a solution. “As drivers move into older age—past 70 or 75 let’s say—they tend to have a higher risk of crash per kilometre driven,” says geriatrician Dr. Gary Naglie, a Toronto Rehab senior scientist and chief of medicine at Baycrest. “However, it’s important to treat this statistic with great caution. It’s true that some older people have chronic medical conditions, or are taking medications, which made them less safe. However, most older people are safe, experienced drivers.” Centre are leading the Toronto portion of a research study tracking over 1,000 elderly drivers at centres in Canada, Australia and New Zealand. Now in its second year, the study is already accumulating valuable information from interviews with participants, as well as a range of data from GPS-like devices installed in their cars. Dr. Naglie says the Candrive (Canadian Driving Research Initiative for Vehicular Safety in the Elderly) study takes a unique approach. “Previous studies have been based on driving information supplied by drivers,” he explains. “This so taking the privilege away is a serious blow to The frustration for doctors is the lack of a reliable, can be unreliable. Our data collection methods a person’s autonomy. Yet, at the moment, there’s easy-to-use tool to help them identify who is safe give us exact distances driven by participants, as no clear-cut way for physicians to decide when behind the wheel and who is not, says Dr. Naglie. well as what kind of roads they travelled on and someone is no longer safe to drive. With a huge To help develop such a tool, Dr. Naglie and the speed limits on those roads.” The sophisticated increase in the elderly population just around the Dr. Mark Rapoport of Sunnybrook Health Sciences tracking technology can also register data 38 S E N I O R D R I V E R S : S TAY I N G S A F E O N T H E R O A D S
Sophisticated tracking technology isbeing used to collect data in this studyof older drivers. Dr. Gary Naglie (left) is one of the study investigators. The frustration for doctors is the lack of Driving distractions a reliable, easy-to- about weather use tool to help them conditions and driving behaviours. identify who is safe For example, it will behind the wheel be possible to tell and who is not. if participants are braking forcefully or – Dr. Gary Naglie more gradually. When the five-year study is completed, researchers will use the data to design a simple, reliable tool that physicians can use to identify unsafe drivers—and those who are fit to drive. There’s another category of driver to think about too: older people who drive just fine under the right conditions. “Some drivers are perfectly safe on quiet neighbourhood streets but may not do so well on Proposed driving simulator (cutaway view) a busy, unfamiliar highway at night,” says Dr. Geoff Fernie, vice president, research, at Toronto Rehab. GPS systems. Hands-free phones. Audio devices. How do “One solution would be to institute a graduated these electronic systems in our cars affect our ability to delicensing program. Instead of saying ‘you can’t drive? drive anymore,’ maybe we should say, ‘you need “We’ve known for a long time that distractions lead to be tested to see if you can drive safely on local to unsafe driving. Now we need to understand the streets in daylight.’” effect that different hands-free electronic systems have on drivers,” says Dr. Geoff Fernie, Toronto Rehab’s vice A program of this sort is already in effect in president, research. Quebec, where some seniors hold restricted Toronto Rehab scientists believe that a driving licenses, allowing them to drive only during simulator can help answer these questions. “We want daylight hours or near home. But for the approach to develop evidence-based performance standards so to be most effective, regulators need a realistic, that automakers can design systems that truly benefit affordable method of testing that can be drivers,” says Dr. Fernie. implemented anywhere. A driving simulator can also be used for research into To help design such a method, Toronto Rehab the effects of opioids on drivers’ risk-taking behaviour. is seeking funding for a driving simulator module Opioids are a type of medication often prescribed for chronic pain. Canadians are the third-largest per capital for its new research facilities, the most advanced users of opioids in the world, after the United States and rehabilitation research environment in the world. Dr. Andrea Furlan Germany. The facilities include an underground lab where “Opioids are very effective,” says Dr. Andrea Furlan, people can be studied safely in life-like situations. a physiatrist and Toronto Rehab adjunct scientist. “With these new facilities, we can provide an “However, they can cause side effects, including extremely sophisticated driving simulator at a sleepiness, dizziness and a kind of euphoria which may relatively modest cost because of the way the be linked to risk-taking behaviour.” At present, little is facility is designed,” says Dr. Fernie. “We’ve got known about the effect of opioids on driving safety. simulation and driving experts on our team, and An associate scientist at the Institute for Work we’ve got real patients with well-characterized and Health, Dr. Furlan is an assistant professor in the Department of Medicine’s Division of Physiatry at the conditions, such as strokes, mild dementia and University of Toronto. arthritis. As a result, we’re in a perfect position to study this and other driving-safety issues.” n + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 39
Q.8 The cold weather challenge I enjoy winter, especially the beauty of the snow. But as an 80-year-old who recently had knee surgery, winter can be a challenge for me. My doctor has told me that I must be very careful not to slip. So I walk with a cane and, on very snowy days, I try not to What can we do go outside. to help older – Dharum in Toronto people and those with injuries get around more safely in winter? 40 T H E C O L D W E AT H E R C H A L L E N G E
Student Oliver Chung is working withToronto Rehab’s Winter Research Group to help older people, those with disabilities and other individuals cope better with the challenges of winter. Cold weather is particularly hazardous for older people.
A.Toronto Rehab’s ClimateLab can replicatea range of environmental conditions,including freezing winter. Work isunderway to examine how the bodyresponds to cold andhow to improveslip-resistance inwinter footwear. Freezing temperatures, ice and severe weather conditions. “We are introducing a greater level of science and falls on ice and snow send 21,000 people to emergency rooms in Canada each winter. snow are a fact of life in northern to winter,” says Dr. Geoff Fernie, Toronto Rehab’s Meanwhile, there is little science behind the vice president, research. “Everything gets worse in boots, shoes and other devices that claim to be climates. So are the illnesses, winter: more people get injured, more people get designed for winter conditions, she says, which sick, the death rate goes up, depression happens. leads to a false sense of security. The special cardiovascular distress, slips There’s a lot to learn.” traction devices that can be and falls they bring. But to the New areas of research “Everything gets worse in winter: strapped under the soles of and findings by the group more people get injured, more shoes and boots, for example, scientists in Toronto Rehab’s include studies on how people get sick, the death rate can actually be problematic, people walk on ice and Hsu explains. The cleats Winter Research Group, these snow, whether hats and goes up, depression happens. meant to offer stability are hazards of the Canadian cold are special face masks can There’s a lot to learn.” often in the wrong place, keep people warmer their configurations are not necessarily inevitable. and healthier, and how – Dr. Geoff Fernie incorrect and they don’t grip pedestrian crossings can be surfaces such as concrete. made safer in winter. Ironically, the cleats themselves can even be trip For example, Jennifer Hsu, a PhD candidate in hazards for wearers. biomedical and mechanical engineering at the The ClimateLab at Toronto Rehab is perfect for University of Toronto and a member of the team, testing out such products and devices. The state- A growing body of research at the hospital is is making progress with her work to improve of-the-art lab, which can simulate conditions from focusing on how to keep people safe in winter, winter slip-resistance in footwear. The boot and frozen winter (-20C) to stifling summer (+35C), with findings that will have a practical impact on shoe industry is now collaborating with the team. has been used to test winter attire and to examine everything from the design of pedestrian road Slips and falls generate the largest number of how the body responds to cold. crossings in cold climates to what people wear in insurance claims of any type of accident, Hsu says, Dr. Yue Li, the biomedical engineer who leads 42 T H E C O L D W E AT H E R C H A L L E N G E
cuts so the road surface rises to meet the sidewalk. Toronto Rehab’s focus on making indoor and outdoor spaces more liveable, particularly in winter, is part of a unique cross-border project in Masking the universal design that also involves the Center for Inclusive Design and Environmental Access (IDEA effects of winter Center) at the University at Buffalo: The State University of New York. The U.S. Department of Wondering how to stay safe and warm on the Education’s National Institute on Disability and coldest day? You might consider wearing a Rehabilitation Research recently announced that heat and moisture exchange mask, originally developed for people who participate outside in the U.S.-Canada research partnership has been cold weather activities, including sports, hunting renewed for another five years. and ice fishing. Dr. Fernie says that universal design guidelines Toronto Rehab scientists are exploring the for winter are critically needed. potential benefits of the fabric-style mask for a “Until now, winter has been an evidence-free wider population. The face mask is designed to zone,” he says. The important research at Toronto warm cold air before the wearer breathes in. It has Rehab “to strengthen people’s muscles, improve a small pouch or chamber, positioned at the front balance and enhance nervous systems only helps of the mouth, which is criss-crossed with coils of if the environment cooperates,” Dr. Fernie adds. fine copper wires. “The world is challenging.” In tests conducted at Toronto Rehab, this pouch was shown to act as a “passive heating system” He says that improving the environment and when air was breathed in and out through it, says clothing in winter can also have a big impact on biomedical engineer Dr. Yue Li. those who are healthy and fit but end up trapped Dr. Li says that having a steady supply of warm,the Winter Research Group, has recently used the in their homes out of fear of illness and injury. moist air to breathe can mitigate the effects oflab to look at the impact of wearing winter hats There is a good deal of commercial interest inhaling cold and dry air—and the stress to theon people of different ages, as well as the use in Toronto Rehab’s cold climate clothing and cardiovascular system that freezing temperaturesof a special face mask to keep users warm (see footwear studies, Dr. Fernie says, which could have bring.sidebar). She has also started a study on the effect an impact on what people wear in the near future. Significantly, Toronto Rehab’s results showedof the cold on hand functioning, an important “One day soon, you will not only put winter tires that blood pressure increased more in cold when a mask was not used, says Dr. Li.issue given the ubiquitous use of hand-held on your car but winter soles on your feet.” n The mask being studied is made by Tennessee-computers among the general population and the based AirGuard Medical Products Co.many jobs people do outdoors and in cold places. Dr. Fernie says that Canada, and especiallyToronto Rehab’s Winter Research Group, “leadthe world in understanding the intersection ofmedicine and engineering.” A review of the literature on pedestrian winter Dr. Yue Liaccessibility by Dr. Fernie’s team found thatguidelines for promoting universal accessibility insnow and ice conditions need to be established. As temperatures drop, people walk faster,Dr. Fernie explains, and some 80 per cent ofpedestrians cross roads illegally, often becausethe snow and ice are not cleared for walkers asthey are for cars. He says that a Toronto Rehabreport, now before Toronto City Council, suggestsamendments to pedestrian crossings, such aslengthening cross-walk times and revising curb- + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 43
Q.9 Taking care of caregivers When my father was in his 80s and in declining health, I was involved in helping to care for him so that he could continue to live at home with my mother. As he became less mobile, looking after him became more demanding. He needed assistance to walk and to use the stairs, and could never be left on his own. I found the situation What can we stressful. I worried all the do to help time that he would fall or hurt himself. people care for – Suzu in Toronto someone at home? 44 TA K I N G C A R E O F C A R E G I V E R S
Emily King is part of a team developing innovative assistivedevices and advanced technologies to help family and friends care for loved ones at home.
Researchers useA. motion-tracking technology to understand challenges faced by family caregivers who deliver care in the home.More than one-quarter of look after people with heavier and heavier care needs,” says Dr. Geoff Fernie, Toronto Rehab’s vice Care Access Centre on the project. Together, they are also working with private industry partners toOntario families have been president, research. bring these new products to market quickly and Toronto Rehab scientists are tackling this at a reasonable cost for consumers.providing constant care for challenge head on with the help of a $4.6-million Initially, the research project will focus on the grant from the Ontario Ministry of Research development of four products:someone at home for more and Innovation. Teams of engineers, computer an easy-to-assemble mobility system ofthan two years. scientists, designers and clinicians are working together to develop innovative assistive devices handrails and supports to help the person and advanced technologies made specifically receiving care to walk safely and as to help family and friends care for loved ones at independently as possible Nearly half of family caregivers report a high level home. of physical and mental stress while 14 per cent “We are addressing the urgent need to help an overhead lifting system to help caregivers experience physical discomfort or pain. caregivers with the physically demanding tasks with the heavy tasks of repositioning in bed “We’ve always been concerned about of lifting, moving, toileting and dressing the or a chair, lifting, moving, bathing, dressing and institutional caregivers, nurses in particular, people they care for, as well as monitoring their toileting people who cannot move because they get injured more than any other safety,” explains Dr. Fernie. “We are coming up with independently due to illness or injury profession. But this pales in comparison to the solutions that are practical, affordable and easy to situation of family caregivers at home because install without home modification.” a toileting chair that accommodates clothing they work on their own in crowded spaces Toronto Rehab is partnering with St. Elizabeth removal, positioning over the toilet, cleaning without proper equipment or training, and they Health Care and the Toronto Central Community the person and putting their clothing back on 46 TA K I N G C A R E O F C A R E G I V E R S
A recent survey found that 70 per cent of Canadiansan intelligent fall detection and emergency frail or disabled themselves. want to ‘age in place’. individuals assessed as ‘high need’ response system that does not require Dr. Fernie believes that advanced for long-term care placement could the care recipient to wear or use a push-button technologies and assistive devices will support be safely and cost-effectively supported at home.” alarm. caregiving in the home, and help to ensure that In addition to the quality of life benefits that vulnerable caregivers don’t overtax themselves and home care products will provide for caregivers Once Toronto Rehab’s new state-of-the-art end up sick or injured. and care recipients, Dr. Fernie says that theresearch facilities are fully open in 2011, many more He also hopes that this kind of research will manufacturing of these technologies will createproducts to assist with care in the home will be take some of the pressure off hospitals and long- new opportunities for economic growth in thedeveloped, tested and brought to market. term care facilities. “About one-third to one-half of assistive devices sector and generate jobs. n As part of the project, PhD student Emily King hasbeen working with Dr. Fernie and his team to gather The trouble with liftinginformation about the needs of family caregivers andhealth professionals who deliver care in the home. Through a series of home visits and focusgroups, she learned that “family and professionalcaregivers want to provide the best quality of life, Nurses sustain the highest level of back injuries that can lead to injury. In a series of studies on sling compared to any other profession, including insertion, and on the use of overhead versus floor lifts,support, dignity and independence to the person construction workers, loggers and miners. Dutta found that “an overhead lift resulted in muchthey are caring for. But they’re doing an extremely “The problem of nurses with back injuries is lower back load for the caregiver, whether the personchallenging job with little advance notice and very huge—it’s an epidemic,” says Tilak Dutta, a Toronto was working alone or with a second caregiver.”few resources,” says King. “The focus of this project Rehab research associate, Technology Team member Dutta is now analyzing data from a study comparingis to make their lives easier and make the caregiving and PhD candidate. a Toronto Rehab invention called SlingSerter™—a novelthey do safer. That’s incredibly important.” Back injury is the most common complaint among pneumatic sling insertion device—to the conventional After a hospital stay, more and more people are nurses and 80 per cent of these injuries occur during method of rolling a patient to tuck a sling under themchoosing to live and receive care at home. A recent the transfer, lifting or repositioning of a patient. for lifting purposes (see Rehab innovations on page 50).survey found that 70 per cent of Canadians want A 2005 Statistics Canada study found that in the Older nurses are at greater risk for back injury than previous year, 37 per cent of nurses had experienced younger nurses, yet Dutta has discovered that moreto ‘age in place’. With the number of people over pain serious enough to prevent them from carrying experienced nurses have lower levels of back loadingthe age of 65 expected to double in the next two out their normal daily activities, and one in 10 nurses “because they have learned tips and tricks to reducedecades, home care is the fastest growing sector of reported severe or unbearable pain. the amount they are bending, and their movementsthe healthcare system in Canada, according to the Dutta is determined to make things better for are more fluid and efficient compared to youngerCanadian Home Care Association. nurses. He hopes his research will help them avoid nurses and nursing students.” Already, one in five people in Ontario are back injuries that can be costly, both in terms of He is also working on an intriguing project tocaregivers and 15 per cent of those caregivers are quality of life and economically. determine if height can be measured precisely “The question is, despite the availability of enough to be used as a tool for monitoring mechanical patient lifts over the past 25 years or so, cumulative back loading in caregivers, and then why do we continue to see such high levels of back adjusting their routines to avoid injury. injuries among nurses?” “The spine actually shrinks over the course of a One reason is that due to time pressure, some day based on the amount of load it is under,” Dutta nurses may not be using the overhead or floor lifts. explains. Experts now agree that cumulative load Obesity is another factor: in Canada, there has been over the course of the day is a greater risk factor for a 225 per cent increase in obesity since 1985 and injury than a single lifting activity. the prevalence of obesity among new nursing home “If we can find a way to measure cumulative load admissions has increased from 15 to 25 per cent over and prevent shrinking a little, it’s a good indication a 10-year period. “People are bigger now—not only that the caregiver will be at less risk of injury too.” Tilak Dutta the patients but the caregivers too, which means Adds Dutta’s PhD supervisor, Toronto Rehab senior they’ve got more load on their spines to start with.” scientist Dr. Geoff Fernie: “Getting sound evidence Another complication is that pushing, pulling and on best practice to avoid back injuries when lifting turning a floor lift, and getting a sling under a patient patients is very important. That’s where Tilak’s in order to lift the person, causes caregiver back stress research is starting to make a real impact.” + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 47
Q. A10 Rehab innovations Over the years, I’ve seen my parents through several hospitalizations and watched them deal with older age. There have been lots of frustrating times, both for my parents and for the people looking after them. What new ideas – Duncan in Toronto and practical products are out there to help people who need them now? 48 R E H A B I N N O VAT I O N S
A. Practical products delivering on ideasWe believe that Rehab robot Sleep apnea Institutional safety polesgreat ideas are not detection device Stroke patients require extensive For many older people and those withenough. At Toronto practice to rebuild upper-body This portable sleep apnea detection mobility difficulties, a simple pole strength and motor skills. Therapists device will provide an easier, that stretches from floor to ceilingRehab, researchers typically spend a lot of time guiding less expensive way to diagnose is an indispensable aid for gettingwork closely with patients through repetitive exercises. With this new robotic device, obstructive sleep apnea, a condition that affects five to 10 per cent of into and out of bed. Without a pole, some patients are at risk of fallingindustry partners to patients will be able to do these otherwise healthy Canadians. Right and unable to be self-sufficient. Yet exercises on their own at any time now, people being tested for sleep in hospitals, these poles are difficultput our ideas into of day—in a hospital room or even apnea must spend a night at a sleep to install because they cannot beaction. The goal: at home. The device uses haptic (or sensation) technology so that users lab, which can be inconvenient and uncomfortable. Many labs have securely attached to the false ceilings so common in healthcare institutions.to get products to actually ‘feel’ resistance when they long waiting lists. With this portable, Enter StandEASi™, which is specially push on a robotic arm. With the easy-to-use device, people will be designed for hospital and long-termpeople who need benefit of artificial intelligence, the tested at home while they sleep. A care facilities. Instead of attachingthem. Our busy labs system can adapt to users’ needs, lightweight open mask with a small to the ceiling, the D-shaped device adjusting exercises when necessary. microphone senses and analyzes the attaches to and sticks out fromand workshops are The rehab robot was developed by sounds of breathing to produce a the wall. It can be easily removedfeeding a pipeline senior scientist Dr. Alex Mihailidis and others at Toronto Rehab and the diagnosis. The device has now been tested on more than 50 people with from the wall brackets to swap the installation from one side of the bedof new commercial University of Toronto in collaboration impressive results that closely match to the other side, or for use by patients with Quanser Inc. Testing of a new those obtained in sleep labs. This year in other beds. Recently installed atproducts, including prototype is expected to begin in prototypes will be built for testing in Toronto Rehab’s E.W. Bickle Centre forpatient-lifting 2011, following a survey of over 200 the home. MaRS Innovation is helping Complex Continuing Care, StandEASi therapists in Australia, Canada and Toronto Rehab to commercialize is getting an enthusiastic responsedevices and an array the U.S. that helped to inform new the device. Obstructive sleep apnea from patients and caregivers alike. Itof rehabilitation and design specifications. is strongly linked to cardiovascular disease—yet only a small percentage allows caregivers to perform physical tasks with less stress and risk of injury.home care tools: of cases are diagnosed. StandEASi will be available for sale and use by other institutions in 2011. + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 49
Rehab innovations Sole Sensor™ Fall-detection system SlingSerter™ RoboNurse In an aging society, falling is a growing This high-tech emergency response Poised to go to market, this novel This patient-lifting robot is designed problem. Just one bad fall can mark and fall detection system is in the patient lifting system is designed to preserve the backs of caregivers the start of a downward spiral in an final stages of development. The to make it easier and safer to who are dealing with a growing older person’s health and quality of technology includes a ceiling- move patients. SlingSerter™ uses population of obese patients. life. The cost of treating falls also puts mounted camera and uses artificial compressed air to shoot a strap-in- RoboNurse can lift extremely heavy a heavy burden on the healthcare intelligence to ‘learn’ and track the a-sleeve under an immobile person. patients out of bed and move them system. Sole Sensor™ is a simple actions and patterns of the user. The strap ‘crawls’ between the to another part of the hospital. footwear insole proven to improve If the system senses that a person person and the bed. Once the lifting With matching grants from the balance and prevent falls. It does has fallen or stopped moving, it straps are in place—typically at the Canadian and Chinese governments, this by heightening sole sensation, automatically calls out a series of shoulders, mid-section and legs— Toronto Rehab is working with which dulls as we age. Sole Sensor questions with yes/no answers. If the the patient can be attached to a lift Chinese manufacturers to make the has a raised ridge that surrounds the person says that help is needed or and raised a few inches so that a full robot commercially available. Hart perimeter of the foot, stopping just no response is heard, the system can lifting sling can be effortlessly placed Enterprises, along with electronic short of the large toe. If the wearer alert relatives or dial an emergency underneath them. The SlingSerter controls specialists Quanser Inc., are sways back and forth, the raised edge number. The latest version has now reduces the likelihood of injury from the Canadian private-sector partners. applies pressure to the side of the been tested in private homes and, placing lifting slings under a patient. Production of the first prototypes foot, so that the wearer can adjust his in 2011, is expected to be tested The SlingSerter straps are designed will take place in 2011 with a goal of or her body movements to prevent in a seniors condominium. Once to be pulled out with ease, creating making the robot available in 2013 a fall. Sole Sensor is now available an industrial partner is secured, no friction. Several hundred devices to healthcare facilities around the in select pharmacies and specialty the system will take a year or two have been tested and Toronto Rehab world. The Canadian partners will get home healthcare stores across to commercialize. The inventors is working with the manufacturer, the European and North American Canada, and online at www.well.ca. are Toronto Rehab senior scientist Andrew J Hart Enterprises Limited, markets, while the Chinese will Manufactured by AJ Hart Enterprises, Dr. Alex Mihailidis and his team at to make SlingSerter commercially cater to the Asian markets. the insole was co-developed by Toronto Rehab and the University available in 2011. researchers at Toronto Rehab and of Toronto. Sunnybrook Health Sciences Centre in collaboration with Dr. Stephen Perry, a Toronto Rehab adjunct scientist based at Wilfrid Laurier University. For more, see www.hartmobility.com 50 R E H A B I N N O VAT I O N S
Aspirometer Hand hygiene HandyAudit™ Electrical stimulation monitoring systemSwallowing problems (dysphagia) HandyAudit™ is a simple, easy-to- A Toronto Rehab start-up companycan be dangerous. If food or liquid This much-needed new approach use electronic system for measuring called Simple Systems is working toslips into the windpipe or lungs, the to hospital infection control is hand hygiene compliance. It commercialize a stimulator deviceresult can be fatal pneumonia. The jumping into clinical trials this was created at Toronto Rehab used to reawaken paralyzed muscles.‘Aspirometer’ is a new screening year. The urgency? Every year in to help institutions efficiently The stimulator was developed bydevice that measures vibrations on Canada, one in 10 patients will catch monitor and report hand hygiene senior scientist Dr. Milos R. Popovicthe surface of the neck to detect something in hospital, and roughly compliance rates. The current and colleagues to help peopleabnormal ‘swallows’. If someone half of these infections are because paper-based observation system paralyzed from stroke and spinalis found to be at risk of aspiration, someone did not wash their hands. requires one hand hygiene auditor cord injury to regain the abilityprecautions can be put in place to Toronto Rehab’s new hand hygiene to simultaneously monitor the to reach, grasp and walk (seekeep pneumonia at bay. Recent prompting system is designed to hand washing practices of up to Electrostimulation: sparking brainresults show the device can monitor and modify caregivers’ four healthcare workers at once, changes on page 10). The start-up isaccurately distinguish between hand hygiene behaviour. A portable and to decide when they have seeking funds to take a prototypehealthy and abnormal swallows. electronic device, worn by the made an error. HandyAudit saves forward for therapeutic use inA licensing agreement is now being caregiver, interacts with ceiling- time and reduces human error. hospitals, physiotherapy clinics andnegotiated, and it’s hoped that large- mounted ‘emitters’ in zones where Auditors simply record actions homes. Already tested in studies,scale clinical trials can begin soon hand hygiene monitoring is critical. of health providers using a small it’s thought the device could bein hospitals across North America. If the user forgets to wash his or her electronic device and HandyAudit available within a year of beingToronto Rehab senior scientist hands, the electronic device vibrates automatically calculates compliance funded. Dr. Popovic sees a hugeDr. Catriona Steele, who has been or gives a verbal reminder. Backed according to provincial guidelines. market. In North America alone,researching the device with its by a new grant from the Canadian It can also be used to calculate half-a-million patients have strokesdeveloper, Dr. Tom Chau, a scientist Institutes of Health Research (CIHR), compliance rates in other every year. By reducing disabilityat Holland Bloorview Kids Rehab, the system will be tested in a 50-bed jurisdictions. More than 20 academic and increasing independence,sees an immediate need for the unit at Toronto Rehab’s E.W. Bickle hospitals and infection control stimulation therapy can help peoplescreening tool in emergency rooms. Centre for Complex Continuing groups across Ontario are now using to be more productive—and lessSwallowing problems affect many Care to measure how much the HandyAudit. For more, see reliant on costly attendant care, addspeople, including 50 per cent of technology improves hand hygiene www.handyaudit.com Dr. Popovic.people who have had strokes. compliance. + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 51
Open for business the world’s most advanced rehabilitation research realistic soundscape—and sensations like bumpy sidewalks or vibrations from a passing streetcar— StreetLab provides a multi-sensory experience. Unlike a regular lab, StreetLab allows scientists to present people with realistic scenarios while manipulating certain aspects of the environment. For instance, traffic signals, ‘intelligent’ vehicles and streams of virtual pedestrians can be A motion simulator adjusted to interact with the research participant. can mimic everyday Landmarks and signage can be altered. This environmental will allow researchers to better understand challenges faced how people with head injuries and dementia, by older people for instance, use cues to navigate at busy and those with intersections. disabilities. Then there’s StairLab, where scientists can conduct studies to better understand how people manage on stairs—a common place for falls. StairLab features a staircase and handrails loaded with equipment so that scientists can precisely measure how people use stairs and handrails, and develop practical solutions. In real life, people who fall on stairs don’t always know exactly what happened. But StairLab tracks every aspect of a fall. WinterLab can generate the worst of winter— sub-zero temperatures, snow and winds up to 30 km/hour. A real ice floor means scientists can study winter slips and falls—without exposing Motion tracking systems. 3D streetscapes. Snow older adults and people with disabilities interact study participants to risks of the outside world. and ice. Tilting floors. These are just some of the with their environment.” The goal: to develop The simulator base can be tilted to create slopes, extraordinary features of Toronto Rehab’s new practical solutions that will help people live as or moved suddenly to safely throw people off research and development facilities, opening in fully and independently as possible. balance. 2011. Using a large crane, several labs can be lifted And safety is paramount. Anyone taking part in With over 65,000 square feet of new and on and off the simulator base, providing different a research study is strapped into a body harness renovated labs, workshops and other research ‘settings’ in which to carry out studies—such as connected to an overhead robot that will move spaces, the $36-million facilities take rehabilitation busy streetscapes, stairs and snowy surfaces. with them as they go about their tasks. A pulley research to a whole new level. “This is revolutionary because, until now, mechanism, like a seatbelt, tightens immediately, A central feature is the huge hydraulic motion scientists have been limited by a lack of research but gently, to prevent injury in the event of a fall. simulator, located deep below the hospital’s facilities where ideas can be cultivated, tested and In coming months, WinterLab will be used University Centre. One of the most advanced applied in the real world,” says Dr. Fernie. for myriad projects, including development and simulators in the world, it rolls, tilts and even has a One of the new labs, called StreetLab, testing of new winter clothing and footwear moveable ice floor. allows study participants to move through and improvements to mobility aids, such as “We’ve brought the real world into the lab,” says 3D streetscapes of downtown Toronto—or wheelchairs and walkers, so that they perform Dr. Geoff Fernie, vice president, research, “so that anywhere else in the world. With a curved better on inclined and winter surfaces. researchers can safely and accurately study how projection screen that extends onto the floor, a As experiments are conducted in these labs, 52 OPEN FOR BUSINESS
At a glance newly createdenvironment or renovated research spaces • CareLab • Challenging Environment Assessment Lab researchers can measure exactly what’s going problem: developing and testing products in (houses StairLab, StreetLab and WinterLab) on in people’s bodies, such as eye movements, people’s real homes is intrusive and inefficient. • ClimateLab heart rate, and electrical brain and muscle activity. “If we develop a product to make it easier for • Communication Function Lab Motion-tracking equipment—like the kind used in your mother to manage at home, she probably • Electronics and Instrumentation Development Workshop Hollywood to animate characters—can measure wouldn’t like us to drill holes in her walls to install • FallsLab • HomeLab people’s body positions as they move about doing it, and have researchers hanging around and • Intelligent Assistive Technology and Systems Lab different tasks. hiding in cupboards and taking measurements,” • Mechanical Workshop “We’re bringing together the latest technology says Dr. Fernie. “Now we can do this kind of thing • Rapid Prototyping Workshop and brightest minds to advance rehabilitation in a real-life setting.” • Rehabilitation Engineering Lab research in a really CareLab This lab offers a • Research and Design Studio unprecedented way,” says “We’re bringing together convenient way to study new • StairLab Dr. Jennifer Campos, lead the latest technology and lifting and other devices for • StreetLab scientist of the Challenging the hospital room. Instead of brightest minds to advance disturbing patients and staff • Swallowing/Rehabilitation Research Lab Environment Assessment • WinterLab Lab (CEAL), the subterranean rehabilitation research in a in actual patient rooms, the laboratory which houses the really unprecedented way.” new CareLab offers a simulated motion simulator. environment in which to do this. There are also newly created or renovated Above ground, other new – Dr. Jennifer Campos It consists of a typical patient spaces to study sleep, stroke, mobility and labs offer life-like settings care room, complete with ensuite biomechanics, to name but a few other areas of in which to develop new therapies and well- bathroom. This lab will also be used to continue investigation. designed products. These include: Toronto Rehab’s development of products to A cutting-edge design studio and workshops HomeLab This ‘home within a lab’ is a setting reduce the transmission of infections. provide a unique environment where products, where researchers can create and test new tools FallsLab With a 2D motion platform that can such as assistive devices and rehabilitation robots, to help older people and those with disabilities make the whole lab shake, FallsLab can be used can be designed, prototyped, studied and tested stay at home longer and more safely. The lab to safely study balance control. Sophisticated with patients. Workshop services are available for resembles a typical single-storey dwelling. With measurement systems track subjects while they use by Toronto Rehab’s academic and commercial functional plumbing and wiring, people can are walking, standing or sitting down. “We can partners as a way of testing innovative solutions occupy the living space and test innovations. find out, for instance, if a new treatment promotes quickly and efficiently before commercialization. All can be observed from an overhead catwalk. better recovery, or whether new footwear keeps The new workshops and labs are attracting HomeLab gets around a long-standing people more stable,” says Dr. Fernie. significant interest, both from academia and private industry. “We have academic collaborators from many countries around the world, as StreetLab StairLab WinterLab well as industry partners interested in product development,” says Dr. Campos. Toronto Rehab’s research facilities are located at the hospital’s University and Lyndhurst Centres, and the Rehabilitation Sciences building of the University of Toronto (U of T). Built in collaboration with U of T, the new spaces came into being thanks to contributions from the Canada Foundation for Innovation, the Ontario Innovation Trust, Ontario Ministry of Research and Innovation, Toronto Rehab Foundation and our corporate partners. n + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 53
Eric Wan helping a star to shine For months, Erin Wan lay in a hospital bed unable Toronto Rehab’s vice president, research, said to speak or move. Paralyzed from the neck down, in presenting the scholarship to Wan. “We need he could only nod and shake his head. Few could people with disabilities as core competitive understand what the 18-year-old was thinking or researchers working with us.” feeling. Wan has spent the past six years studying One day, someone gave him a TV remote, under Dr. Tom Chau, Canada Research Chair in adapted for people with quadriplegia. It allowed Paediatric Rehabilitation Engineering and head him to change a TV channel by moving his cheek. of Holland Bloorview’s Paediatric Rehabilitation It was the closest Wan had felt to happiness Intelligent Systems Multidisciplinary (PRISM) lab. since contracting a rare illness that immobilized Under Dr. Chau’s direction, Wan found most of his body. his research niche in computer software “It was a huge step forward because I went development aimed at improving the lives of from not being able to do anything at all—even children with disabilities. Eric Wan (seated) just to be able to change the channel, it gave me Wan was part of a team that developed the with Dr. Tom Chau and colleagues a lot of joy,” Wan recalls. software for a project—called the Virtual Music Fourteen years later, Wan is one of the bright Instrument—that allows people with limited use the scholarship is made possible by TD Bank lights in the University of Toronto’s engineering of their limbs to ‘play’ music without physically Financial Group, which has pledged $550,000 faculty. His ambition is to help children with severe holding a musical instrument. The program to date for the TD Grant in Medical Excellence: A disabilities by designing technology that brings works like the musical equivalent to a Wii sports Scholarship in Rehabilitation-related Research for them exactly what he craved: independence. game. When the user makes a motion in front of a People with Disabilities. In recognition of his academic achievement and computer screen, musical notes ring out. The prize covers tuition but also expenses the quality of his research, Wan has won the 2010- Sitting in front of his computer, Wan incurred by people with disabilities—from note- 2011 Toronto Rehabilitation Institute Scholarship demonstrates how the slightest movement can takers and specialized software to taxis. The goal: in Rehabilitation-related Research for Graduate prompt a computer-generated version of Twinkle, to alleviate barriers and make it possible for more Students with Disabilities. The scholarship will help Twinkle Little Star. Making music again has been students with disabilities to pursue research careers. Wan pursue a master’s degree by providing him therapeutic. “I played violin for eight years. And then People with disabilities are under-represented with $20,000 plus additional funding for educational I couldn’t. It was something I missed for a long time.” in the fields of science, technology, engineering expenses incurred as a result of his disability. Wan wants to use his scholarship to forge and mathematics, according to a 2010 study by It was a rare reaction to a routine measles a career developing these kinds of assistive the National Educational Association of Disabled vaccination in 1996 that caused paralysis in technologies. He knows firsthand which Students. The study said Canada fared poorly Wan’s limbs. The high innovations can help—and which ones fail. compared to U.S. institutions in recruiting,“We need people with school student, whose His own path in academia was fraught with retaining and training students with disabilities. world had revolved logistical barriers. Ten years ago, Wan used Morse One shining exception in the bleak landscape,disabilities as core around computers and code and voice recognition to write papers, and the report said, was Toronto Rehab’s scholarship.competitive researchers violin practice, was a mouth stick to flip pages of a textbook. Both “Other Canadian institutions should follow theworking with us.” forced to withdraw were slow and cumbersome. Today, his textbook lead of Toronto Rehab and undertake initiatives from school. He moved material is scanned onto a computer and he uses that actively support students with disabilities in – Dr. Geoff Fernie to a rehabilitation a reflective sticker mounted on his eyeglasses to science and technology fields while helping raise hospital where, at first, navigate and control his computer curser. the profile of young scientists.” he couldn’t breathe without a respirator. There But two bouts of pneumonia forced him to For Wan, research has opened the world to were setbacks and bouts of despair. But Wan drop courses, slowing his studies further. It took him again. Last fall, the Virtual Music Instrument was eventually able to finish high school, a nurse 10 years to complete his undergraduate degree. Team at Holland Bloorview won a da Vinci Award, accompanying him to classes. Such setbacks often prevent gifted students the ‘Oscars’ for researchers developing assistive Then he entered the University of Toronto with disabilities from pursuing research careers, technologies. Wan travelled to the reception where, today, he is pursuing twin degrees in says Nancy Lawson, who chairs the Toronto in Dearborn, Michigan. He flew there—his first electrical computer and biomedical engineering. Rehab committee that awards the scholarship. airplane trip since the age of 10. “It was great to “Eric is a star student,” Dr. Geoff Fernie, Believed to be the first of its kind in Canada, fly. I really enjoyed that.” n 54 E R I C WA N : H E L P I N G A S TA R T O S H I N E
Governance International Scientific Research and Education Advisory Committee Committee of the Board Carol L. Richards, OC, PhD, DU, PT, FCAHS – Chair P. Bradley Limpert, LLB, MASc (Biomedical Engineering) – Chair Holder of the Université Laval Research Chair in Cerebral Palsy Partner, Barrister and Solicitor, Patent Agent, Cameron MacKendrick LLP Professor, Department of Rehabilitation and CIRRIS Research Centre Faculty of Medicine, Université Laval Barbara G. Stymiest, FCA Group Head, Strategy, Treasury & Corporate Services, RBC Anne Martin-Matthews, PhD Scientific Director, Institute of Aging, Canadian Institutes of Health Research Karen Louie, JD, LLM Professor, Department of Sociology, The University of British Columbia Vice President, General Counsel and Secretary Harlequin Enterprises Limited Bruce M. Gans, MD Executive Vice President & Chief Medical Officer Mark Rochon, BCom (Hons), MHSc Kessler Institute for Rehabilitation, West Orange, NJ, USA President and CEO, Toronto Rehabilitation Institute National Medical Director for Rehabilitation, Select Medical Corporation Professor of Physical Medicine and Rehabilitation UMDNJ-New Jersey Medical School Sandy Wise, MEd President, Sandy Wise & Associates Inc. Jerker Rönnberg, PhD Professor and Director, Linnaeus Centre for Research on Hearing and Thomas MacMillan Deafness (HEAD) and Swedish Institute for Disability Research Chairman, CIBC Mellon Department of Behavioural Sciences and Learning (IBL) Linköping University, Linköping, Sweden Trent Gow, BA (Hons), MA (Econ) Consultant John Steeves, PhD Professor, ICORD (International Collaboration On Repair Discoveries) University of British Columbia and Vancouver Coastal Health Ex-officio Martin Ferguson-Pell, PhD Professor and Dean, Faculty of Rehabilitation Medicine, University of Alberta Geoff Fernie, PhD, PEng, FCAHS Vice President, Research, Toronto Rehabilitation Institute William C. Mann, OTR, PhD Distinguished Professor and Chair, Department of Occupational Therapy Susan Jewell, RN, BA, MHSc & PhD Program in Rehabilitation Science Vice President, Patient Care and Chief Nursing Executive Director, Rehabilitation Outcomes Research Center Toronto Rehabilitation Institute Veterans Health Administration + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 55
Research faculty Senior Scientists Adjunct Scientists Pamela Houghton, PhD Pascal van Lieshout, PhD Alex Mihailidis, PhD, PEng Alastair Flint, MD, FRCPC, FRANZCP Richard Staines, PhD Angela Colantonio, PhD, OT Reg (Ont) Alex Shaw, PhD Ron Baecker, PhD Brian Maki, PhD, PEng Andrea Furlan, MD, PhD Sandra Black, MD, FRCPC Catriona M. Steele, PhD, CCC-SLP, Reg. CASLPO Brian Levine, PhD Scott Thomas, PhD Cheryl Cott, BPT, PhD Brian Murray, MD FRCP(C) D, ABSM Shaun Boe, MPT, PhD David Alter, MD, PhD, FRCP Cliff Klein, PhD Sherry L. Grace, PhD Dina Brooks, BSc (PT), PhD Clodagh Ryan, MB, MD, MRCPI, CCSCST Sonya Allin, PhD Douglas Bradley, MD, FRCPC Deirdre Dawson, PhD Stephen Perry, PhD Elizabeth Rochon, PhD Denise Reid, PhD Tim Bressmann, PhD Gary Naglie, MD, FRCPC, FGSA Doug Richards, MD, Dip SM Tom Chau, PhD, PEng Geoff Fernie, PhD, PEng, FCAHS Ethne Nussbaum, PhD, MEd, BScPT Veronica Wadey, BEd, MD, MA, FRCSC Katherine McGilton, RN, PhD Fraser Shein, PhD, PEng Ze’ev Seltzer, DMD Milos R. Popovic, PhD, PEng G. Ross Baker, PhD Robin Green, PhD, CPsych Gary J. Gerber, PhD, CPsych Molly Verrier, Dip(P&OT), MHSc George Mochizuki, PhD Postdoctoral Fellows Susan Jaglal, PhD Graham Strong, MSc, OD Albert Vette, PhD Susan Rappolt, PhD, OT Reg (Ont) Heather Carnahan, PhD Avril Mansfield, PhD William McIlroy, PhD Jack Goodman, BPHE, MSc, PhD Boaz M. Ben-David, PhD James (Jay) Pratt, PhD Cheryl Bradbury, PhD Scientists Jan Angus, RN, PhD Jill Cameron, PhD Dimitry Sayenko, PhD Elias Guestrin, PhD Catharine Craven, MD, FRCPC Joel Katz, PhD, CPsych Gurjit Singh, PhD Jennifer Campos, PhD John Zettel, PhD Jocelyn Harris, PhD Kei Masani, PhD Julie Mendelson, PhD Kathryn Sibley, PhD Mark Bayley, MD, FRCPC Julio Furlan, MD, PhD Laura Middleton, PhD Nora Cullen, MD, MSc, FRCPC Karl F. Zabjek, PhD Luigi Taranto, MD Paul Oh, MD, FRCPC Kathleen Pichora-Fuller, Aud(C), PhD Lyn Sibley, PhD Pia Kontos, PhD Krista Lanctôt, PhD Masae Miyatani, PhD Sander Hitzig, PhD Kristiina M. Valter McConville, PhD Mika Nonoyama, PhD Shabbir M. H. Alibhai, MD, MSc, FRCP(C) Lora M. Giangregorio, PhD Rosilene Coelho, MD, PhD Walter Wodchis, PhD Mary Fox, RN, PhD Sandra McKay, PhD William Gage, PhD Mary K. Nagai, MD, PhD Santa Concepción Huerta Olivares, PhD Matthew Muller, MD, PhD, FRCPC Takatoshi Kasai, MD, PhD Michel Landry, PhD Veronique Boscart, PhD Michelle Keightley, PhD Nancy Salbach, PhD Nicole Anderson, PhD, CPsych Nizar Mahomed, MD, ScD 56 WHO WE ARE
Research support Aaron Marquis César Márquez Chin, MASc Janis Andrews, RN, BSc Lisa Zeng, BSc Samantha Fazio Research Associate Research Associate Project Manager Research Associate Data Entry Clerk Abdolazim Rashidi, HND Elec, TS Charlene Chu, RN, H. BScN Jason Escobar, BCom Lois Ward, AOS (NY) Samantha Singh, BSc Research Technologist Research Associate Financial Analyst Manager, Research Operations Research Associate Adam Sobchak Chen Wu, MSc Jasmin Corbie, BA Louise Brisbois BA (Hons) Sandra Lian, BCom Industrial Designer Research Associate Research Associate Research Assistant Senior Financial Analyst Ailene Kua, MSc Chip Rowan, MSc Jen Tinning, MASc, PEng Maggie Szeto, BEd Sandra Sokoloff, MLIS Research Assistant Research Coordinator Research Technician Research Associate Administrative Assistant Alex Karabanow BAA, BSc Christina Taggart, MA Jennifer Yong-Yow, BAS Marissa Malkowski, MA Sara O’Neil BEd, MSc Manager, Research Ethics Research Associate Computer Support Specialist Research Assistant Research Assistant Alexander Levchenko, PhD, Clemence Tsang, BSc (Hons) Jessica Neuman, MA Michael Belshaw, MASc Shaghayegh Bagher, BASc PEng Research Associate Research Coordinator Research Associate Research Assistant Control Systems Specialist Colin Brackenridge Jordanne Dalgeish, BA (Hons) Mohammad Ghotbi, MPH Shazareen Khan, BSc (Hons) Amy Chen, BSc Senior Machinist Research Associate Research Assistant Research Associate Research Associate Colin Harry Jude Delparte, MSc Naaz Desai, MSc Shoshana Teitelman, BSc Andrea Brown, BSc, CDT Research Technologist Research Coordinator Research Coordinator / Administrative Assistant Research Assistant Physiotherapist Daeniell Miller, BSc Judy Gargaro, BSc, MEd Sonja Molfenter, MSc Angie Andreoli, MSc Research Ethics Officer Project Coordinator Natalia Nugaeva, PhD Research Associate Research Coordinator Research Assistant Dan Smyth, BASc, PEng Julia Fraser, BSc Stephanie Smith, BSc (Hons) Anitha Gaddam, BSc CAD Specialist Research Assistant Novlette Fraser, MA Research Technician Admin Coordinator Research Associate Daniel Hill, RPSGT Julie Mendelson, PhD Steven Pong, MDes Anna J. Bowes, PhD Sleep Lab Technologist Scientific Writer / Editor Olga Yaroslavtseva Industrial Designer Research Associate Research Associate Darek Wojtowicz, MCSE Kadeen Johns, BA Sue Woodard Babak Taati, PhD Computer Support Specialist Research Admin Assistant Olivia Garay, BA, RPSGT Research Secretary Research Associate Sleep Technician Dayle Levine, BPHE Karen Lepper, BA (Hons), CRA Susan Gorski, MHSc, PEng Barry Baichoo, BSc, RPSGT Manager, Infrastructure and Research Coordinator Pam Holliday, BSc (PT), MSc Chief Engineer, CEAL Sleep Technician Special Projects Research Associate Kent Lee, BArchSc Suzanne Lafolla, MScPT Bart Scieranski, CCNA,VCP Diana Frasca, MSc Senior Technical Support Patricia Aznar, HBSc Physiotherapist Senior Technical Support Research Assistant Specialist Research Associate Specialist Tara Anderson, MSc, CSEP-CEP Egor Sanin, BSc Laura Laird, BA Pushpinder Saini, MA, CPsych Patient-Research Liaison Betty Chan, BSc Research Engineer Research Secretary Psychometrist Research Associate Tiffany Fei, BSc Farnoosh Farahani, BSc Laura Langer, BSc (Hons) Rachel Fine, BA Research Associate Bhavnita Mistry, MA Research Associate Research Assistant Research Associate Research Coordinator Vanessa Daisy, BSc, RPSGT Fiona Rankin, BSc, RPSGT Le-Anh Ngo Chiang, MSc Rebecca Cliffe Polacco, MHSc Sleep Technician Brenda Colella, MA Sleep Technician Psychometrist Research Associate Research Coordinator Vera Zivanovic, MD Geetha Sanmugalingham, Li Chen, CGA Romeo Colobong, MA Research Associate Bridgette Murphy, MSW BSc, BHA Senior Financial Analyst Research Associate Knowledge Translation Officer Administrative Assistant Yue Li, PhD Lily Miguel-James, MA Ruth Rutherford, BSc, BEd, Research Associate Bruno Maruzzo, MBA, PEng Jae Ho Lee Psychometrist RPSGT Commercialization Officer Research Assistant Chief Technician Sleep Lab Zina Bezruk Lindsie Blencowe, MSc, CCRA Research Secretary Carolyn Go, BSN, PhD Janessa Dee, BSc Research Coordinator Research Associate Research Associate + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 57
Graduate students Anderson, Nicole Carnahan, Heather Colantonio, Angela Giangregorio, Lora Department of Psychology Graduate Department of Rehabilitation Science Graduate Department of Rehabilitation Science Department of Kinesiology, University of Waterloo Andree-Ann Cyr (PhD) Eric Hagemann (MSc) Veronica Law, MSc Kayla Hummel (MSc) Brandon Vasquez (PhD) Sara Salehi (MSc) Deena Lala (MSc) Institute of Medical Science Emma Guild (Phd) Catherine Wiseman-Hakes (PhD) Ryan Brydges (PhD) Hwan Kim (PhD) Grace, Sherry L. Angus, Jan Ontario Institute for Studies in Education Tatyana Mollayeva (PhD) School of Kinesiology and Health Science Lawrence S. Bloomberg Faculty of Nursing Catharine Walsh (MEd) York University Craig Dale (PhD) Maya Sardesai (MEd) Colantonio, Angela / Shamila Shanmugasegaram (PhD) Marnie Kramer-Kile (PhD) Oleg Safir (MEd) Comper, Paul Shannon Gravely-Witte (PhD) Samim Al Quadhi (MEd) Graduate Department of Rehabilitation Science Yvonne Leung (PhD) Baecker, Ron Michael Hutchison (PhD) Department of Computer Science Chau, Tom Green, Robin Jessica David (MSc) Department of Electrical and Computer Engineering Cott, Cheryl Department of Psychology, York University Justin Chan (MASc) Graduate Department of Rehabilitation Science Alexandra Oatley (PhD) Bradley, Douglas Mohammad Nikjoo (PhD) Laura Moll (PhD) Graduate Department of Rehabilitation Science Institute of Biomaterials and Biomedical Engineering Sarah Power (PhD) Yuko Koshimori, MSc Hisham Alshaer (PhD) Graduate Department of Rehabilitation Science and Fernie, Geoff Lesley Miller, PhD Institute of Biomaterials and Biomedical Engineering Department of Mechanical and Industrial Institute of Medical Science Diana Frasca (PhD) Andrea McCarthy, MSc Engineering Joseph Gabriel (MSc) Catharine Hancharek (PhD) Denine Ellis, MSc Jaglal, Susan Emily King (PhD) Bressmann, Tim Heidi Schwellnus (PhD) Department of Health Policy, Management & Jennifer Hsu (PhD) Department of Speech-Language Pathology Institute of Biomaterials and Biomedical Engineering Evaluation Janette Quintero, MSc Ahmed Faress (MASc) Graduate Department of Rehabilitation Science Chamila Adhihetty, MSc Kyle Stevens, MSc Amanda Fleury (MASc) Rosalie Wang, PhD Sara Guilcher (PhD) Bojana Radovanovic (MSc) Andrew Myrden (MASc) Sarah Munce (PhD) Institute of Biomaterials and Biomedical Engineering Brett Ayliffe (MSc) Celeste Merey (MHSc) Daniel Vena (MHSc) Graduate Department of Rehabilitation Science Marc Yarascavich (MSc) Colleen Smith (MASc) Kathleen Denbeigh (MASc) Sonia Pagura (PhD) Eric Wan (MASc) Larry Crichlow (MASc) Brooks, Dina Hayley Faulkner (MASc) Rowa Karkoli (MASc) Keightley, Michelle Graduate Department of Rehabilitation Science Idris Aleem (MHSc) Kaveh Momen (PhD) Department of Occupational Science and Kerseri Scane (MSc) Larissa Schudlo (MASc) Tilak Dutta (PhD) Occupational Therapy Institute of Medical Science Leslie Mumford (MHSc) Nick Reed (PhD) Susan Marzolini (PhD) Luke Gane (MHSc) Gage, William Stephanie Green (PhD) Rachel Zhang (MHSc) School of Kinesiology and Health Science Graduate Department of Rehabiliation Science Cameron, Jill Sanaz Rezaei ( MASc) York University Sabrina Agnihotri (MSc) Graduate Department of Rehabilitation Science Natasha Alves, PhD Amy Underhill (MSc) Marco Raggi (MSc) Negar Memarian, PhD Alexander Smilansky (MSc) Lanctôt, Krista Marina Bastawrous (MSc) Bassma Ghalil (PhD) Jeevaka Kiriella (MSc) Department of Pharmacology Victrine Tseung (PhD) Brian Leung (PhD) Brian Street (PhD) Graham Mazereeuw (MSc) Saba Moghimi (PhD) Dmitry Verniba, MSc (PhD) Mahwesh Saleem (MSc) Department of Mechanical and Industrial Engineering Martin Vergara, MSc (PhD) Walter Swardfager (PhD) Alex Posatskiy (MASc) Levine, Brian Department of Psychology Nadine Richard, PhD 58 WHO WE ARE
Primary Supervisor University of Toronto Department or Institute (unless otherwise stated) Graduate Research Student: Degree completed, (Degree) in progressMaki, Brian Naglie, Gary Rappolt, Susan Verrier, MollyInstitute of Medical Science Department of Health Policy, Management & Graduate Department of Rehabilitation Science Graduate Department of Rehabilitation Science Kenneth Cheng (PhD) Evaluation Tanya Eimantas, MSc Kristina Guy (MSc) Erik Prout (PhD) Oana Predescu (MSc) Karen Fisher (MSc) Sukvinder Kalsi-Ryan, PhD Tim Pauley (PhD) Tracy Paulenko (MSc) Andresa Marhino (PhD) Perry, Stephen Evelyn Durocher (PhD) Department of PhysiologyMcConville, Kristiina Department of Kinesiology & Physical Education Lynn Rutledge (PhD) Meredith Kuipers (MSc)Department of Electrical and Computer Engineering Wilfrid Laurier University Mary Kita (PhD)Ryerson University Brittany McGregor (MSc) Institute of Medical Science Matija Milosevic (PhD) Jennifer Childs (MSc) Richards, Doug Sharon Gabison (PhD) Jessica Berrigan MSc Graduate Department of Exercise ScienceMcGilton, Kathy Justin Silverman (MSc) Ming Tsai (PhD) Wodchis, WalterLawrence S. Bloomberg Faculty of Nursing Pierre-Denis Plante (MSc) Department of Health Policy, Management & Charlene Chu (PhD) Rochon, Elizabeth Evaluation Graduate Department of Rehabilitation Science Rola Moghabghab (PhD) Department of Speech-Language Pathology Chelsea Hellings (MA) Amanda Chisholm (PhD) Jennifer Cupit, PhD Kevin Walker (MA)McIlroy, William Rozanne Wilson (PhD) Shannon Reynolds (MA) Pichora-Fuller, KathyDepartment of Kinesiology, University of Waterloo Bjanka Pokorny (PhD) Dina Franchi (PhD) Department of Psychology Rupesh Patel, MSc Gustavo Mery (PhD) Gurjit Singh, PhD Amanda Marlin (MSc) Staines, Richard Maude Laberge (PhD) Huiwen Goy (PhD) Emily Brown (MSc) Department of Kinesiology, University of Waterloo Sara Clemens (PhD) Katherine Dupuis (PhD) Kit Beyer (PhD) Alison Smith, PhD Payam Ezzatian (PhD) Veronica Miyasike da Silva (PhD) Zabjek, Karl Steele, Catriona Graduate Department of Rehabilitation ScienceGraduate Department of Rehabilitation Science Popovic, Milos R. Department of Speech-Language Pathology Justin Chee, MSc (PhD) James Tung, PhD Institute of Biomaterials and Biomedical Engineering Minn-Nyoung Yoon (PhD) Olinda Habib (PhD) Bimal Lakhani (PhD) David Agnelo (MASc) Sonja Molfenter (PhD) Institute of Biomaterials and Biomedical Engineering Ivan Solano (PhD) Noel Wu (MASc) Mike Sage (PhD) Albert Vette, PhD Regina Leung (MSc) Strong, Graham César Márquez Chin (PhD) School of Optometry, University of WaterlooMihailidis, Alex Cheryl Lynch (PhD) Nicholas Lorentz (MSc)Department of Computer Science Robart Babon Pilipos (PhD) Patricia Hernendez (MSc) Yulia Eskin (MSc) Steve McGie (PhD) Jasper Snoek (PhD) Takashi Yoshida (PhD) Thomas, Scott Michael Tsang (PhD) Department of Mechanical and Industrial Engineering Graduate Department of Exercise ScienceInstitute of Biomaterials and Biomedical Engineering Egor Sanin, MASc Shazareen Khan (MSc) Tuck Voon How, MASc Department of Electrical and Computer Engineering Graduate Department of Rehabilitation Science Victor Monroy, MASc Diane Kostka (MHSc) Pearl Yang, PhD Elaine Lu (MHSc) Isaac Chang (MASc) Pratt, Jay van Lieshout, Pascal Ahmad Akl (PhD) Department of Psychology Department of Speech-Language Pathology Stephen Czarnuch (PhD) Davood Ghara Gozli (MA) Anneke Slis (PhD) Vicky Young (PhD) Naseem Al-Aidroos, PhD Heidi Diepstra, MEd (PhD)Graduate Department of Rehabilitation Science Greg West (PhD) Amy Hwang (MSc) Scott Young, PhD + 1 0 R E P O R T O N R E H A B I L I TAT I O N R E S E A R C H 59
Acknowledgement of support We acknowledge the support of the following agencies and organizations during 2010-2011 Andrew J Hart Enterprises Inc. Panel on Research Ethics (CIHR, NSERC, SSHRC) ArjoHuntleigh Canada Inc. Phoenix Technology Inc. A-Tech Instruments Ltd. Phonak AG Baffin Inc. Physicians’ Services Incorporated Foundation BHM Medical Inc. Physiotherapy Foundation of Canada BioDiscovery Toronto Quanser Consulting Inc. Bosch Rexroth AG Respironics, Inc. Canada Foundation for Innovation Saint Elizabeth Health Care Canada Post Corporation Shandong Relax Health Industry Co Ltd. Canadian Health Services Research Foundation Shanghai Jiaotong University Canadian Institutes of Health Research Shanghai Ninth People’s Hospital Canadian Paraplegic Association Shoppers Home Health Care Canadian Stroke Network (NCE) Sunnybrook Health Sciences Centre CDW Healthcare Spinal Cord Injury Solutions Network Composotech Structures Inc. St. Michael’s Hospital Council of Academic Hospitals of Ontario (CAHO) T.H.E. Medical ECHO: Improving Women’s Health in Ontario (agency of MOHLTC) Toronto Central CCAC Government of Canada Toronto Rehab Foundation HandyMetrics University Health Network Health Care, Technology and Place University of Alberta Heart and Stroke Foundation of Ontario University of British Columbia Hocoma AG, Switzerland University of Toronto IBM Canada Ltd. Vicon International Development of Technology b v Vizcan Systems International Science and Technology Partnerships Canada Inc. Workplace Safety and Insurance Board Japan Osteoporosis Foundation Lakehead University ———————————————————————————— Lenovo (Canada) Inc. MaRS Funding 2010-2011 MaRS Innovation Ontario Ministry of Health and Long-Term Care $ 3,000,000 Micrylium Toronto Rehab Foundation $ 1,100,000 Mount Sinai Hospital External Research Grants $ 6,934,063 National Institute on Disability and Rehabilitation Research (USA) Total $11,034,063 (does not include infrastructure awards) National Institutes of Health Natural Sciences and Engineering Research Council of Canada ———————————————————————————— ONF-REPAR Partnership Publications Ontario Innovation Trust Journal articles 224 Ontario Mental Health Foundation Book chapters 1 Ontario Ministry of Health and Long-Term Care Total 225 Ontario Ministry of Research and Innovation Ontario Neurotrauma Foundation ———————————————————————————— Ontario Research Fund – Research Excellence Program Research Ethics Board (REB) Ontario Stroke Strategy of South Eastern Ontario Oversight of current studies 229 Otto Bock Independent ethics assessment of new proposals 67 60 ACKNOWLEDGEMENT OF SUPPORT
June 5 - 8, 2011 Toronto, Canadawww.ficcdat.ca Festival of International Conferences on Caregiving, Disability, Aging and TechnologySix Conferences for the Price of One! Post-Festival Growing Older With A Disability International RESNA / 3rd International Conference on Technology and Aging Conference on Advances in Neurorehabilitation Stairway Usability and Safety Caregiving in the 21st Century 34th Canadian Medical and Biological Engineering Conference June 9 - 10, 2011 International Conference on Best Practices in Universal Design Register as a Delegate. Purchase an Exhibit Booth. Go to www.ficcdat.caCo-hosted by: Festival Sponsors: MARCH OF DIMES CANADA Diamond Sponsor Platinum Sponsor Editor Margaret Polanyi Design David Wyman, Wyman Design Lead Photography Mark Ridout Photography Additional photography and illustration Jim Atkinson/MediMedia Group; iStockphoto; Shutterstock; Stephen Pond / newsteam; S.K. Advani and Mario Potter, IDT Some images in this report have been electronically altered.