Workshops

Program Workshop ID: W1-1 (Clinical/Best Practice Application)

Activity-based therapy after spinal cord injury or disease: An introductory workshop

Lovisa Cheung^{1, 2}, Hope Jervis Rademeyer^{1, 2}, Anita Kaiser^{1, 2, 3}, Cindy Gauthier^{2, 4}, Sarah J. Donkers⁵, Kris Walden⁶, Kristin E. Musselman^{1, 2, 4}

¹Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada;²KITE-University Health Network, Toronto, ON, Canada;³Canadian Spinal Research Organization, Toronto, ON, Canada;⁴Dept. of Physical Therapy, University of Toronto, Toronto, ON, Canada;⁵School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada;⁶Praxis Spinal Cord Institute, Vancouver, BC, Canada

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

• Identify the goals and key characteristics of ABT interventions for people living with SCI/D

• Describe how ABT is currently being used in Canada across the continuum of care (i.e., acute, rehabilitation, community and home settings)

• Discuss pragmatic ways to structure and monitor SCI/D rehabilitation to apply an ABT approach within the current healthcare landscape.

In recent years, rehabilitation following spinal cord injury or disease (SCI/D) has transformed from a discipline largely focused on helping patients learn to compensate for their lost function to one focused on neurorecovery. This transformation resulted from research demonstrating that the nervous system can change and re-organize in response to a variety of triggers, such as task-specific, intensive activity. The increasing interest in neurorecovery after SCI/D led to the development of activity-based therapy (ABT). ABT describes a group of interventions that target neuromuscular activation below the level of the spinal lesion during intensive, task-specific movement. Though ABT can be provided with low tech equipment (e.g., mats, balls), an increasing number of higher tech devices, such as functional electrical stimulation, body-weight support treadmills, and robotic devices, have also been developed and used to provide ABT. Canadians living with SCI/D have described ABT as an important part of their lifelong recovery process, yet limited awareness and availability of ABT are believed to hinder access in Canada [1].

This workshop will consist of lecture- and case-based learning, small group activities and large group discussion. This workshop will provide an evidence-based overview and update on ABT in Canada with a focus on pragmatic clinical implementation. ABT interventions throughout the continuum of care for individuals with SCI/D will be described. Pragmatic ways to facilitate ABT use and uptake in the current healthcare system will be discussed. Participants will be encouraged to share their experiences with ABT and/or the use of neuroplasticity principles in their practice.

[1] Swaffield E, Cheung L, et al. Perspectives of People Living with a Spinal Cord Injury on Activity-Based Therapy. Disabil Rehabil 2021.

Target Audience: Researchers, clinicians, students, physical and occupational therapists, therapy assistants, caregivers, managers, educators and researchers who work in SCI/D rehabilitation, as well as to people living with SCI/D

CanMEDS Roles: Communicator, Collaborator, Leader, Scholar, Professional

Funding: Granting Agency/Funding Source: Praxis Spinal Cord Institute Granting Agency/Funding Source: Canadian Institutes of Health Research Grant Number: PAO 169401

Keywords: Physical Medicine and Rehabilitation, Rehabilitation Outcome, Health Care Technology

Program Workshop ID: W1-2 (Clinical/Best Practice Application)

Challenging neurogenic bowel cases in spinal cord injury

Kate Montgomery¹, Sonja McVeigh¹

¹Division of Physical Medicine and Rehabilitation, Dalhousie Univeristy Halifax, NS, Canada

Neurogenic bowel management in spinal cord injury can present a significant challenge for clinicians. We plan to present a difficult case of neurogenic bowel resulting in severe autonomic dysreflexia. Our other objective is to review the typical bowel management for individuals with spinal cord injury at our centre, as well as options for more advanced care in patients who are refractory to the typical treatments.

Funding: None

Keywords: Physical Medicine and Rehabilitation, Treatment Effectiveness, Best Practice Implementation

Program Workshop ID: W2-1 - Technology Innovation

The feasibility of delivering brain-computer interface-controlled functional electrical stimulation therapy for upper limb motor rehabilitation in a clinical environment

Lazar I. Jovanovic^{1, 2, 3}, Naaz Kapadia^{2, 3, 4}, Colleen McGillivray^{5, 6}, Sukhvinder Kalsi-Ryan^{2, 4, 5}, Milos R. Popovic^{1, 2, 3, 4}, Cesar Marquez-Chin^{1, 2, 3}

¹Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada;²The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada;³CRANIA, University Health Network, Toronto, ON, Canada;⁴Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada;⁵Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada;⁶Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada

Objectives: Our team developed a clinically-oriented brain-computer interface (BCI) and integrated it with functional electrical stimulation therapy (FEST) for reaching and grasping. Recently we evaluated the feasibility and preliminary clinical efficacy of this BCI-FEST as an intervention to restore upper limb function in individuals with sub-acute cervical traumatic spinal cord injury (cTSCI).

Methods: We conducted a single-arm interventional study to deliver a maximum of 40 one-hour-long BCI-FEST sessions per participant. To assess feasibility, we recorded the occurrences of adverse events, number of completed therapy sessions, BCI sensitivity (defined as the success rate of the BCI in triggering the stimulation), and BCI setup duration. We also assessed the potential efficacy for restoring upper limb function using Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM), 3D-printed Toronto Rehabilitation Institute-Hand Function Test (3D-TRI-HFT), and Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) at four time points: baseline (i.e., before starting the intervention), midpoint (i.e., after 20 sessions), discharge (i.e., after completing the intervention), and a 6-months follow up. FIM and SCIM were primary outcome measures, while 3D-TRI-HFT and GRASSP were secondary outcome measures.

Participants: The study included five individuals with cTSCI (C4-C7, AIS B-D).

Results: No adverse events were recorded throughout the study. The study participants completed 29.8 sessions on average. The average BCI sensitivity across participants was 74%, while the average BCI setup duration was 11 minutes and 5 seconds. Three participants exceeded minimal clinically important differences (MCIDs) on primary outcome measures. Four participants exceeded MCIDs on secondary outcome measures. The individual who did not achieve MCIDs on secondary outcome measures completed 28, rather than the targeted 40 sessions.

Conclusion: Our BCI-FEST intervention is safe and feasible, with promising clinical efficacy in the recovery of reaching and grasping after spinal cord injury.

Funding: Ontario Neurotrauma Foundation (in partnership with Praxis Spinal Cord Institute); Grant Number: 2016-RHI-EEG-1020.

Keywords: Brain-Computer Interface, Physical Medicine and Rehabilitation, Engineering Biomedical

Program Workshop ID: W2-2 (Clinical/Best Practice Application)

Interdisciplinary pain education for spinal cord injury: An engagement workshop

Erica J de Passille, Rebecca M.I. Mills, Allison C. Banks

Stan Cassidy Centre for Rehabilitation, Fredericton, NB, Canada

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

• Share experiences to integrate pain science education into clinical practice for clinicians involved in the management of persons with SCI.

• Determine barriers to and facilitators of effective delivery of pain education to persons with SCI, considering both in-person and virtual models.

Design: This workshop will be delivered by an interdisciplinary team and will include an overview of non-pharmacological pain management as well as collaborative problem-solving of barriers and facilitators to SCI pain management, including how to meet the needs of this population in the current climate of a global pandemic.

Background: Current pain science research and evidence highlights the need for an interdisciplinary biopsychosocial approach to pain management. The reported prevalence of pain in persons with chronic SCI ranges from 26% to 96% and although medication can be helpful, it rarely fully addresses the problem. When pain persists, it profoundly affects quality of life. The initiative to develop a non-pharmacological self-management program for pain at the Stan Cassidy Centre for Rehabilitation (SCCR) evolved following the Knowledge Mobilization Network Pain Profile Implementation project which highlighted a need for more consistent provision and documentation of pain education. A review of 50 traumatic spinal-cord injured (SCI) patients admitted to SCCR prior to January 2015 found that the majority experienced pain, however, pain education was documented as provided to only 12%. Further team training in chronic pain management reinforced the need to bring change to our practice to ensure optimal pain management for clients

Workshop Results: SCCR Pain Education group data has shown in-patients of varying diagnoses (many with SCI) reported significant improvements in average pain and reduced interference in activity levels and enjoyment of life, despite no overall change in reported current levels of pain. Outpatients had experienced pain for longer and reported worse average and current pain, relative to the in-patients. Following group sessions, the out-patients reported improvements in average pain and less interference in activity, mood, sleep and enjoyment of life.

Conclusion: We have strong evidence that our patients are improving their pain self-management, associated with our change in practice. Covid-19 forced adoption of a virtual model which has allowed us to reach more clients in our rural province and referrals have increased. This workshop will further facilitate delivery of pain education to persons living with SCI.

Funding: None

Keywords: Clinical Application, Rehabilitation Outcome, Knowledge Implementation

Program Workshop ID: W3-1 (Clinical/Best Practice Application)

Podcasting: Plan it, produce it, post it

Hope Jervis Rademeyer^{1, 2}, Anita Kaiser^{1, 2}

¹Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada;²KITE Rehabilitation Institute-Toronto Rehab-UHN, Toronto, ON, Canada

Podcasting is an effective and impactful way to disseminate your research findings to relevant stakeholders, discuss research topics and ideas, or share light-hearted stories related to life within your research lab or as a graduate student. This interactive workshop will provide an overview of podcast creation by describing: 1) the benefits to podcasting, 2) what you need to do to get started, 3) how to plan, produce and edit your podcast, 4) how to advertise and get the word out to key stakeholders, and 5) how to avoid common pitfalls in podcasting. The step-by-step creation of the podcast "Spinal Moves: Conversations about Activity-based therapy with Hope Jervis Rademeyer" will be used as a working example throughout the workshop to illustrate key concepts and ideas.

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

• Identify common errors in podcast production.

• Create a ready-to-publish podcast.

• Market their podcast to appropriate stakeholder groups.

Target audience: Faculty, Residents, Medical Students

CanMEDS Roles: Communicator, Collaborator, Leader, Health Advocate

Funding: None

Keywords: Knowledge Translation, Community Groups, Multidisciplinary Approaches

Program Workshop ID: W3-2 (Health Services, Economics and Policy Change)

Health economics in spinal cord Injury and disease: From evidence to policy change

Julio C. Furlan^{1, 2, 3, 4, 5}, Brian C.F. Chan^{1, 5}, Peter Athanasopoulos⁶

¹KITE Research Insititute and Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada;²Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada;³Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada;⁴Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada;⁵Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada;⁶Spinal Cord Injury Ontario, Toronto, ON, Canada.

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

• examine the burden of spinal cord injury and spinal cord disease (SCI/D);

• discuss recently published economic studies related to SCI/D,

• describe how health economics can be leveraged to improve decision making for interventions in the management of SCI/D, and

• review the process of policy change in the context of SCI/D.

Design/Methods: This workshop will include a review of the burden of the SCI as well as costing analyses, cost-effectiveness studies and systematic reviews on the treatment of spine disease and determinants of higher health care costs in the management of SCI. Several real-world case studies will be presented to highlight how economic evidence was incorporated into advocating for health care policy change from the Ontario (Canada) perspective of Spinal Cord Injury Ontario’s Public Policy work.

Participants: All studies that will be discussed included individuals with either traumatic SCI or non-traumatic spinal cord disease.

Results: In Canada, the estimated lifetime costs per individual with SCI vary from $1.5 million CAD (paraparesis) to $3.0 million CAD (tetraplegia). The most significant determinants of the higher total health-care costs are cervical level injury, complete injury, time period (i.e. first year post-injury and end-of-life year), and presence of pressure ulcers. Age at the time of trauma has an impact of the costs of management of acute spine trauma, even though pre-existing medical co-morbidities have an important confounding effect. The current literature includes several cost-saving opportunities for healthcare professionals when managing acute spine trauma that should be taken into consideration in the context of escalating healthcare costs and scarce financial sources. The translation from research to change in policy requires the engagement of multiple stakeholders and familiarity of government structures and levers.

Conclusion: Although SCI has a relatively low prevalence and incidence, its economic impact is substantial for individuals and society. Given the healthcare budgetary constraints, knowledge on more cost-effective therapies and the key determinants of healthcare costs are crucial for policy makers, healthcare and hospital administrators, and healthcare professionals. This workshop will underscore key aspects of the current literature on Health Economics, and discuss the process for policy change from the evidence to practice in the area of SCI/D.

Target audience: Faculty, Residents, Medical Students, Allied-health professionals, consumers and administrators

CanMEDS Roles: Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar, Professional

Funding: Craig H. Neilsen Foundation; Ontario Neurotrauma Foundation; Wings for Life Spinal Cord Research Foundation; Spinal Cord Injury Ontario

Keywords: Economic Policy, Healthcare Costs, Cost

Program Workshop ID: W4-1 (Clinical/Best Practice Application)

Identifying and prioritizing key domains for implementation of the Canadian Spinal Cord Injury Best Practice (Can-SCIP) guideline

Mark T. Bayley^{1, 2}, Eleni M. Patsakos^{1, 3}, Ailene Kua¹, B. Catharine Craven^{1, 2}, on behalf of the Can-SCIP Expert Panel¹

¹KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada;²Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada;³Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

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

• Identify and prioritize Can-SCIP Guideline domains and subdomains for implementation.

Background: The Canadian Spinal Cord Injury Practice (Can-SCIP) Guideline is the first comprehensive living guideline for adults with spinal cord injury (SCI) in Canada. The Can-SCIP Guideline was developed using a systematic and rigorous evaluation of previously published clinical practice guidelines and evidence. An interprofessional panel of experts in SCI, including clinicians, consumers, program directors, knowledge translation experts, administrators, and other relevant SCI stakeholders, was formed.

Design/Method: The Can-SCIP Guideline includes 559 recommendations with a total of 23 domains; 125 recommendations that pertain to the Components of the Ideal SCI system with 9 domains, and 434 recommendations that pertain to the Management of SCI Complications with 14 domains. Prioritization of the Can-SCIP Guideline domains occurred using an online survey platform tool. In Round 1, the Can-SCIP Expert Panel members (n=50) were required to rank each domain of the Can-SCIP Guideline in order of implementation priorities for section 1, Components of the Ideal SCI system, and section 2, Management of SCI Complications. The Expert Panel was asked to consider domains where there is a significant gap between current care and best practices. The top five priority domains identified by the Expert Panel were included in Round 2. During Round 2, Expert Panel members were required to rank each subdomain in terms of importance, urgency, the weight of the evidence in order to prioritize subdomains for implementation (top 3). The final list of 30 prioritized recommendations (15 per section) for implementation was compiled.

Results: Five priority domains within the Components of the Ideal SCI system section were identified: Specialized Inpatient Rehabilitation, Early Acute Care, Education & Support of People with SCI and their Families across the Continuum, Community-Based Rehabilitation and Cross-Continuum Education of Clinicians & Staff Working with People with SCI. The five priority domains for implementation in the Management of SCI Complications included: Bowel, Bladder, Skin Integrity, Neuropathic Pain, and Respiratory.

Conclusion: This study identified the key domains and subdomains within the Can-SCIP Guideline that will be prioritized and inform the implementation of the Guideline. Participants in the workshop will be engaged in discussing the facilitators and barriers to the implementation of these priorities.

Funding: Praxis Spinal Cord Institute Grant Number: G2019-11

Keywords: Knowledge Implementation, Knowledge Translation, Rehabilitation Outcome

Program Workshop ID: W4-2 (Clinical/Best Practice Application)

Cognitive impairment after spinal cord injury: Identification assessment, treatment challenges and opportunities

Christine A Short^{1, 2}, Colleen O'Connell^{1, 3}, Tony Trask², Matthew A Short⁴

¹Department of Medicine, Dalhousie University, Faculty of Medicine, Halifax N.S.;²QEII Health Sciences Centre, Nova Scotia Rehabilitation and Arthritis Centre, Central Zone, Nova Scotia Health;³Stan Cassidy Rehabilitation Centre, Horizon Health, Fredericton N.B.;⁴Department of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax N.S.

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

• Describe the epidemiology of cognitive impairments in the settings of both Acute and Chronic SCI

• Recognize and evaluate cognitive impairment in the setting of SCI

• Develope strategies including use of technology and exercise in the prevention and treatment of cognitive impairment in the setting of SCI

• Describe the need for national standards and guidelines for management of this important complication associated with SCI.

Background: Cognitive issues related to Spinal Cord Injury (SCI) are common and can have a significant impact on function and quality of life. Early literature supports a prevalence of to 64% (Wilmot CB et al. 1985) with individuals suffering from SCI at 13 times the risk of having a cognitive impairment then their age matched controls (Craig, A et. Al 2015). Cognitive impairment can stem from many factors such as a known or missed traumatic brain injury (TBI), autonomic instability, and in chronic SCI due to the increased risk for cognitive decline secondary to increased cardiovascular risk or the impact other chronic SCI factors like autonomic dysreflexia or labile blood pressure. Secondary factors such as anxiety, depression, medications and substance use can also contribute. Whatever the timing or cause, cognitive impairments after SCI are under recognized and have negative impacts on outcomes both early and late after SCI. Recognition is critical; as understanding the root cause of cognitive dysfunction helps us to target treatments that can affect function and quality of life.

Results: the goal is to increase awareness and understanding of cognitive dysfunction after spinal cord injury and the importance of early recognition and management on maximizing outcomes for this population.

Conclusion: Early recognition and management of cognitive impairment after SCI should optimize function and quality of life and have a positive impact on health care use and costs.

Target audience: Physicians and Allied Health professionals with some knowledge base in spinal cord injury acute and/or chronic management.

Funding: None

Keywords: Multidisciplinary Approaches, Best Practice Implementation, Physical Medicine and Rehabilitation

Program Workshop ID: W5-1 (Clinical/Best Practice Application)

Physical Activity and Cardiometabolic Health in SCI: Shared reflections from an eLearning module, community-based activity programs, and collecting quality care indicators

Matheus J. Wiest^{1, 2}, Chip P. Rowan³, Krista L. Best^{4, 5}, B. Catharine Craven^{1, 6}

¹KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada;²Ontario Neurotrauma Foundation, Toronto, ON, Canada;³School of Kinesiology & Health Science, York University, Toronto, ON, Canada;⁴Faculty of Medicine, Université Laval, Québec, QC, Canada;⁵Center for Interdisciplinary Research in Rehabilitation and Social Integration - CIRRIS, Québec, QC, Canada;⁶Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada

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

1. Combine an interactive demonstration of a PA eLearning module;

2. Discussion of PA implementation challenges; and

3. Implementation of CMH quality care indicators, all aimed at improving PA adherence and CMH after SCI.

Background: The physiological and psychosocial factors influencing community integration after spinal cord injuries (SCI) are well-known among healthcare professionals and inform current practice. However, less is known about physical activity (PA) and lipid abnormalities beyond the initial rehab. Increasing knowledge about physical inactivity-induced cardiometabolic health (CMH) risk factors is important for ensuring optimal PA prescription.

Methods: The eLearning module summarizes current SCI-specific PA prescription guidelines, details the unique physiological, psychosocial, and environmental barriers to PA after SCI; and, provides SCI-specific strategies that emphasize individualized approaches, behavioural change, PA selection, intensity monitoring, and safety. We will also share experiences from community-based PA programs that rely on recruitment and training of peer-based health coaches to deliver online programs, and the feasibility and effectiveness of a 10-week, community-based smartphone-driven program to improve PA after SCI. The SCI-High (www.sci-high.ca) CMH quality care indicators address: 1) availability and type of PE patient education programs during rehab; 2) type of education, certification, or experience from the clinicians; 3) education and adherence to SCI-specific PE guidelines; and 4) if lipid profile assessment is done routinely during and after rehab. Participants: Individuals living with SCI, health practitioners, researchers.

Results: This workshop will provide an interactive experience with the eLearning module emphasizing its potential as a staff training resource. Further, attendees will have a firm understanding of the benefits and barriers of implementing community-based PA programs and how CMH indicators can be used to assess health systems performance and patient outcomes.

Conclusion: Through the delivery of evidence-informed content to health professionals that fills potential gaps in understanding about PA after SCI and dissemination of real-world experiences, this workshop will promote the adoption of appropriate PA prescription to reduce CMH risk, improve health-related fitness and quality of life after SCI. The indicators will help to identify national benchmarks and characterize the CMH needs of individuals with SCI in-hospital and in the community.

Funding: Dr. Wiest is funded by the Ontario Neurotrauma Foundation and the Canadian Institute of Health Research (CIHR - HI5-166374). Dr. Rowan has received fellowship support from the Paralyzed Veterans of America Education Foundation (846) for the creation of the eLearning module. Dr. Best received a salary award from the FRQS J1 and project funding from the Ontario Neurotrauma Foundation (2016-SCI-REPAR-1026)Craig H. Neilsen (Grant# 542515) and CIHR. The SCI-High indicator development was funded by Praxis Spinal Research Institute (former Rick Hansen Institute - Grant #G2015-33)Ontario Neurotrauma Foundation (#2018-RHI-HIGH-1057; 2016-SCI-REPAR-1026)and the Toronto Rehab Foundation. Dr. Craven acknowledges support from the Toronto Rehab Foundation as the Toronto Rehabilitation Institute Chair in Spinal Cord Injury Rehabilitation. We acknowledge the support of Drs. Kristin Musselman and Cindy Gauthier in the development of the eLearning module featured during this workshop.

Keywords: Clinical Application, Community Groups, Rehabilitation Outcome

Program Workshop ID: W5-2 (Clinical/Best Practice Application)

Upper extremity nerve transfers in spinal cord injury : A collaborative inter-disciplinary clinical model between a rehabilitation center and a hospital

Philippe Ménard^{1, 2}, Catherine Dansereau^{1, 2}, Véronique Maes¹, José Dubois¹, Elie Boghossian³, Dre Dominique Tremblay³

¹CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Institut de Réadaptation Gingras-Lindsay de Montréal;²Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain;³CIUSSS de Centre-Sud-de-l'Île-de-Montréal, hôpital Maisonneuve-Rosemont

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

• Introduce the clinical model and its history

• Discuss the evidence-based rehabilitation protocol

• Provide an overview of the organization of this specialized clinical model

• Discuss the challenges of implementation

• Discuss future implications and orientations

Background: Nerve transfer surgery for patients with spinal cord injuries is an emergent practice for upper extremity reconstruction currently being implemented in many clinical settings around the world. Over the past two years, a team of plastic surgeons from Hôpital Maisonneuve-Rosemont in Montreal, who have acquired this expertise overseas, joined with the spinal cord rehabilitation team from the Institut de readaptation Gingras-Lindsay to implement a specialized upper extremity surgery and rehabilitation clinic. This intervention model between a rehabilitation center and an acute care hospital is unprecedented in Canada. The purpose of this collaborative interdisciplinary clinical model is to optimize the identification of eligible patients, carry out early assessment, perform surgery and provide an adapted rehabilitation process. Presentation

Methods & Results: Patients with SCI admitted in our rehabilitation center are screened by their inpatient rehabilitation team (OT, PT, physiatrist) for early assessment by the nerve transfer clinic, approximately 3 months post-injury. The nerve transfer clinic team includes: 2 occupational therapists (OT), two physiotherapists (PT) and two plastic surgeons. Interdisciplinary sessions are planned every 6 weeks to assess the selected patients, the evolution of their motor recovery and their personal objectives in relation to their upper extremity function. Surgery is timed for optimal recovery of upper extremity function specific to each patient. The team supervises the post-operative rehabilitation protocol, which includes active strengthening, muscle stimulation and use of EMG-biofeedback. It also involves partnerships with community therapists. Patients undergo routine outcome assessments at 0, 6, 12 and 24 months post nerve transfer surgery. Specific outcome measures selected from existing literature are used.

Conclusion: This upper extremity clinical model for nerve transfers in SCI patients allows for the standardization of patient care, the optimization of surgical indication according to patient objectives and interdisciplinary evaluations as well as the maximization of nerve transfer surgery outcomes.

Target audience: Faculty, Residents, Medical Students, physical and occupational therapists, researchers, nurses

CanMEDS Roles: Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar, Professional

Funding: None

Keywords: Best Practice Implementation, Multidisciplinary Approaches, Emerging Evidence

Program Workshop ID: W6-1 (Knowledge Generation)

North American Spinal Cord Injury Consortium - Consumer Engagement Program

Barry Munro^{1, 2}

¹Chief Development Officer, Canadian Spinal Research Organization (Toronto, Ontario Canada);²North American Spinal Cord Injury Consortium (Niagara Falls, NY, United States)

Background:There have been successful efforts in consumer engagement (patient-orientated research) in other conditions, such as Parkinson’s disease and ALS, where the people living with the condition have become equally valued partners with stakeholders including research/clinical entities, industry, funders, and regulatory agencies.

The SCI community has fallen behind and the time is now to educate and facilitate knowledge exchange between the community of people living with SCI and the stakeholders across the spectrum of SCI research and care to become true partners in research. This program aims to help make SCI research more relevant and responsive to the needs of people living with SCI by greatly increasing the number of consumers who engage in the research process.

At the end of this workshops, participants will be able to:

• Engage individuals whose participation in research is hindered by lack of knowledge.

• Increase knowledge of the research process within the SCI community through resources and online training.

• Organize and educate researchers and healthcare providers who are interested in consumer engagement.

• Facilitate placement of individuals living with SCI as advisors on research projects.

Methods: Phase 1: Resource Identification Identify existing knowledge translation and consumer engagement resources and gather needed partners of interest within the SCI and research community, in an inclusive and diverse manner. Phase 2: Develop an Online Curriculum Develop an online training curriculum that fills in knowledge gaps and organizes content in a way that is tailored to the needs of people with SCI and the research community, who want to learn about and participate in patient-orientated research. This curriculum will incorporate and build from the Integrated Knowledge Translation (IKT) Guiding Principles for Conducting and Disseminating Spinal Cord Injury Research developed by Dr. Heather Gainforth (www.iktprinciples.ca). Phase 3: Dissemination NASCIC will provide recruitment/matchmaking for SCI research studies from those who have successfully completed the online curriculum.

Participants: NASCIC has formed a working group to advise and review the Community Engagement Program as it is developed. The working group is comprised of 18 individuals who represent different areas of the SCI community in North America.

Results/Findings: This program is in development with a target completion date of Fall 2021. In advance of completion the online curriculum will be subject to beta group analysis.

Conclusion: The evidence is clear that consumer engagement can have a profound impact on the quality of research and implementation of best practices; the time is now for the SCI community to close this gap and band together to educate themselves and the research community to become true partners in research.

Funding: This program is currently being funded by the North American Spinal Cord Injury Consortium with additional funds from AbbVie PharmaceuticalsUniversity of Kentuckyand Onward Medical Inc.

Keywords: Knowledge Translation, Knowledge Implementation, Best Practice Implementation

Program Workshop ID: W6-2 (Knowledge Generation)

Neurophysiological tests as outcome measures in research studies in the field of spinal cord injury: A bench-to-bedside translational research overview.

Julio C. Furlan^{1, 2, 3, 4, 5}, Gustavo Balbinot¹, Jose Zariffa^{1, 4, 6, 7}

¹KITE Research Institute and Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada;²Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada;³Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada;⁴Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada;⁵Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada;⁶Institute of Biomedical Engineering, University of Toronto, Toronto, Canada;⁷Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Canada

At the end of the workshop, participants will be ablet to:

• Review and appraise the scientific literature on the utility of neurophysiological tests in animal models of spinal cord injury and spinal cord disease (SCI/D)

• Assess the literature on the use of surface electromyography in research projects focused on the treatment of individuals with SCI/D, and

• Review and critically analyze the scientific literature on use of neurophysiological tests in clinical studies in the field of SCI/D

Design/Methods: This workshop will include: (i) a scoping review of literature on the preclinical and clinical studies on the treatment of individuals with SCI/D, where different neurophysiological tests were used as outcome measures; and (ii) a scoping review of the literature on the use of surface electromyography in clinical research in the SCI/D population.

Participants: Studies including individuals with either traumatic SCI or non-traumatic spinal cord disease (SCD) will be reviewed and discussed.

Results: From preclinical to clinical studies, outcome measures represent an essential pillar of the scientific research. Behavioral outcome measures and clinical assessments most commonly offer a general evaluation of the sensorimotor function in animal SCI/D models. Nevertheless, different electrophysiological methods can be used to provide further neuroanatomical and physiological evaluation of the peripheral and central nervous system refining assessment and prediction. The most frequently used neurophysiological tests include nerve conduction studies, late response tests, surface or needle electromyography, repetitive nerve stimulation, and a myriads of evoked potential tests. Each neurophysiological testing has advantages and limitations that should considered during study design.

Conclusion: Using behavioural and histopathological outcome measures, promising results from many prior preclinical animal studies on neuroprotection and regeneration for SCI/D have failed to translate into clinical use. A better understanding of the use of neurophysiological outcome measures in preclinical and clinical investigations could facilitate translational research. This workshop will review and critically evaluate the scientific literature on the use of neurophysiological outcome measures in research studies in the field of SCI/D. Strengths, potential pitfalls and knowledge gaps will be discussed.

Target audience: Faculty, Residents, Medical Students, Allied-health professionals, consumers and administrators

CanMEDS Roles: Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar, Professional

Funding: Craig H. Neilsen Foundation; Granting Agency/Funding Source: Ontario Neurotrauma Foundation; Granting Agency/Funding Source: Wings for Life Spinal Cord Research Foundation

Keywords: Medicine Evidence-Based, Clinical Application, Knowledge Generation

Program Workshop ID: W7-1 (Clinical/Best Practice Application)

Setting the stage for successful and sustained surgical closure of pelvic pressure injuries in persons with spinal cord injury: A collaborative program approach

Colleen McGillivray^{1, 2}, Laura Teague^{3, 4}

¹Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada;²Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada;³Sinai Health System, Toronto, ON, Canada;⁴Faculty of Nursing, University of Toronto, Toronto, ON, Canada

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

1. Identify risk factors for surgical wound complications as well as cost and healthcare utilization in persons with SCI undergoing pelvic PI reconstruction.

2. Recall how provincial funding was utilized to provide post-operative convalescent care and remobilization.

3. Review long term outcome post pelvic PI reconstructive surgery in 43 patients from an outpatient SCI rehab wound clinic.

4. Propose potential physiological, behavioural, environmental and societal factors that may predict surgical success or failure.

5. Identify implications from a clinical, research and policy perspective.

Background: The impact of pressure injuries (PI) in persons with spinal cord injury (SCI) is high, both from a quality of life and health care burden perspective. Operative closure of stage 4 pelvic PI has been shown to reduce cost and healthcare utilization. A recent historical cohort study (n=76 patients; 96 surgical encounters) conducted in Toronto, ON, (Teague et al 2020) found the median cost of SCI persons with pelvic PI in the year prior to surgery was $42,012 (IQR 21,351-64,279). One year following surgery, the median cost was $80,041 (IQR 46,390-109,560), but in post-op years 2 and 3, the median costs decreased to $10,194 (IQR 2,607-35,475) and $13,184 (IQR 2,435-37,890) respectively. Health care utilization was highest with respect to nursing visits, which were significantly reduced in 1,2 and 3 years following the surgical procedures. In a second study (Teague et al 2020), bivariate and Poisson regression analyses were used to model predictors of open vs. closed wounds, 3-6 weeks following the surgical procedures. Greater than 50 nursing visits in the year prior to surgery was a predictor of sustained surgical closure (p=0.048), while having revision surgery was a predictor of complications (p=0.01). Currently, we have no validated criteria to identify appropriate surgical candidates nor predict long term PI closure in this population. Along with this knowledge gap, there are barriers to accessing timely surgical intervention and post-operative convalescent care and re-mobilization.

Conclusions: Through sharing experiences, participants will be able to thoughtfully speculate about future research, funding and clinical considerations to optimize long term successful outcome in the surgical management of pelvic PI in persons with SCI.

Funding: None

Keywords: Clinical Application, Healthcare Delivery, Treatment Costs

Program Workshop ID: W7-2 (Clinical/Best Practice Application)

Degenerative cervical myelopathy (DCM): Findings from an Ontario summit to provide a framework to advancing knowledge and management of DCM in Ontario.

James Milligan¹, Michael Fehlings², Tara Jeji³, Eldon Loh⁴

¹McMaster University, Hamilton;²University of Toronto and University Health Network, Toronto;³Ontario Neurotrauma Foundation, Toronto;⁴Western University, London

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

• Present the process and goals of the Ontario DCM Summit (November 23 & 30, 2020) and its findings related to advancing research and knowledge in DCM. Review the epidemiology of DCM and its importance as the leading cause of spinal cord injury (SCI) in adults.

• Review the pathophysiology of DCM.

• Present the barriers and gaps in knowledge and treatment, reviewing the AO Spine RECODE-DCM project.

• Present the survey results and consensus findings for priority research topics.

• Discuss next steps and future goals.

• Identify the key research priorities

Degenerative Cervical Myelopathy (DCM) is the leading cause of SCI in adults and the prevalence is growing. However there are barriers related to awareness, timely diagnosis and management. This presentation will review the process and goals of the Ontario DCM Summit (2020) and its findings related to advancing research and knowledge in DCM. The epidemiology and pathophysiology of DCM will be reviewed. We will present the current knowledge and barriers and gaps that still exist. The survey/consensus findings for priority research topics from the Ontario DCM Summit will be presented. We will discuss next steps and future goals. The Ontario DCM Summit is the first summit of its kind to bring together key stakeholders to develop consensus on priority research issues for this important condition.

Design/Methods: Key stakeholder summit, survey, consensus Participants: 35 key stakeholders (persons with lived experience, researchers, clinicians, advocacy agencies, funders)

Results: Through survey, working groups and consensus, 4 key areas were identified for further research: 1. Raising Awareness 2. Diagnostic Criteria 3. Assessment and Monitoring 4. Rehabilitation

Conclusion: DCM is the leading cause of SCI in adults and the prevalence is growing. However there are barriers related to awareness, timely diagnosis and management. The Ontario DCM Summit is the first summit of its kind to bring together key stakeholders to develop consensus on priority research issues for this important condition.

Target audience: Faculty, Residents, Medical Students

CanMEDS Roles: Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar Professional

Funding: None

Keywords: Best Practice Implementation, Healthcare Delivery, Knowledge Translation