Spinal cord injury care in the pandemic era – the Canadian Spinal Cord Injury – Rehabilitation Association responds with innovation

Innovation can take many forms. While commonly defined as, a new method, idea, or product,¹ in rehabilitation practice, innovation is found in a myriad of outputs device prototypes, new physical interventions and rehabilitation methods, systematic reviews, clinical practice guidelines and applied clinical research trials. Within this special issue, the reader can find evidence of innovation across the translational continuum. This includes the abstracts and articles highlighting the processes behind knowledge creation, such as knowledge inquiry, synthesis, and tool or product development, as well as the processes of implementation, such as tailoring the knowledge to the needs of end-users and evaluating implementation initiatives.²

The global pandemic is a recent profound catalyst for change that has sparked innovation. During the last two years, rehabilitation providers, family caregivers and individuals living with spinal cord injury (SCI) have had to adapt to rapid cycle changes imposed by the COVID-19 pandemic, pandemic-related policies, and societal transformations. Specific overarching priorities have been elaborated:

1. Identifying the importance of taking care of ourselves and one another;

2. Recognizing our unconscious biases in care delivery;

3. Identifying individuals who are marginalized due to race, gender, religion, obesity, economic status, or geography;

4. Contemplating an individual’s social, emotional and physical environment when negotiating goals, a treatment plan, and defining success in rehabilitation;

5. Ensuring our safety and that of others within our organizations and the agencies and services with whom we routinely interact;

6. Supporting the training and development of the next generation of rehabilitation professionals;

7. Transitioning to a virtual care environment; and,

8. Protecting our elderly and vulnerable subgroups (ventilated, immunocompromised, indigenous, homeless) and those with housing instability or food insecurity within the SCI population.

Following the third wave of the pandemic in Canada, there have been many new insights into the role and importance of SCI rehabilitation services as they pertain to:

• Flow of patients within the health system;

• Capacity to manage common neurologic impairments among individuals with long COVID;

• The value of redeployed rehabilitation service providers in acute care settings;

• The ability of rehabilitation teams to adapt and provide interprofessional care; and,

• Recognition of community agencies and care providers (family and agency) as the mission critical “frontline in healthcare.”

In the coming weeks and months, we will need to reflect as a community and identify which temporary changes in service delivery introduced during the pandemic to embrace as innovations and make sustainable, and to pinpoint those changes that are intolerable, inefficient, and require suspension. Specific examples for contemplation include but are not limited to: physician fees for virtual and telephone visits, suspension of home visits during the peak of the pandemic, limited access of families to the rehabilitation center, closing of community fitness centers, expansion of outpatient wait lists, creation of electronic funding approvals, a myriad of curbside services, and an increased focus on emotional wellbeing and therapeutic recreation services.

We celebrate with pride our health care workers ability to stand together, adapt and provide quality care to individuals with SCI. We recognize the sustained contributions of Dr. Chester Ho as he joins the ranks of our Champions of Change, who collectively inspire the Canadian SCI community to overcome the challenges to rendering the best possible care to our individuals living with SCI. Our 9th National SCI Conference celebrates our response to the challenges of conducting research and delivering care in the pandemic era, as we plan, create, and collaborate to establish the framework for implementing innovations intended to advance person-centred care.

We acknowledge the critical support and sustained collaboration of the Journal of Spinal Cord Medicine, which has been integral to our organization’s academic growth, membership expansion, and relevance to civilians and veterans living with spinal cord injury or disease in Canada.