Abstract

As the demographic and profile of the traumatic spinal cord injury (SCI) population changes, the approaches to treat the altering presentation of this disease must also evolve. The field in the past 15 years has observed among other factors that: almost 2/3 of all SCI are cervical; the prevalence of incomplete injuries has increased to almost 60%; and the mean age of the population at time of injury is increasing. Declined upper limb (UL) (arm and hand) function is one of the most devastating consequences of cervical SCI (tetraplegia) and it has been shown to be the priority of recovery for this sub-group. Both subtle and significant improvements in UL function can lead to increased independence in daily activities, improving independence and quality of life.
Researchers in the rehabilitation field have developed a number of upper limb interventions that can enhance independence, function and restore neurological deficit. Over the last three decades, various interventions such as: functional electrical stimulation, exercise, practice and training coupled with peripheral nerve stimulation and activity based restorative therapy, have evolved in an attempt to improve UL function in individuals with SCI.
Despite the efforts and discovery of new concepts and interventions, widespread uptake and translation remain limited for a number of reasons: 1) Incidence of SCI is low, meaning that studies are often-underpowered, and multi-site studies are needed to conduct randomized controlled trials with even modest sample sizes; 2) development is funded, however uptake and translation methods are not well thought out or funded. As a result, methods found to be promising in initial studies do not always receive the follow-up work needed to refine and deploy them.
Thus, an algorithm to facilitate clinical decision making and progression for uptake from an already existing body of knowledge was defined on three principles: 1) Recovery profiles of the upper limb post SCI; 2) Scoping of current practices in UL rehabilitation; 3) Established neuro-musculoskeletal restorative approaches; and 4) Knowledge translation and implementation strategies needed for uptake.
This talk will consider and review existing knowledge regarding recovery and innovation as well as define some of the gaps in and effort to establish a process to create concepts for improved uptake and KT of neuro-restorative techniques.

About the Speaker

Dr. Kalsi-Ryan gained her Bachelor of Science in Physical Therapy from the Department of Physical Therapy at the University of Toronto (UofT) in 1995. She has worked in a clinical capacity with many neurological populations through the acute and sub-acute phases of recovery. For the last 15 years she has worked specifically with the spinal population at the Toronto Western Hospital in the Krembil Neuroscience Program. She is a Licensed Physical Therapist who has been involved in the rehabilitation care of both ambulatory and non-ambulatory patients. In addition to her clinical work she gained a Master’s degree from the Graduate Department of Rehabilitation Science (GDRS) at UofT in 2006 where she studied her interest of upper limb recovery through the development of the Tetraplegia Hand Measure. Sukhvinder was awarded her PhD in 2011, again from GDRS at UofT. Her PhD work consisted of leading the GRASSP project; an international collaboration of six researchers who developed an upper limb measure that targets quantification of impairment post cervical SCI. She established the psychometric properties of the GRASSP along with the utility of the GRASSP in the current field. Sukhvinder continues research as a Post Doctoral Fellow at the Toronto Western Hospital, where she continues to develop the GRASSP measure (www.sci-grassp.org), and study upper limb recovery in the traumatic and non traumatic SCI population. Dr. Kalsi-Ryan continues to work on a number of clinical studies: she is currently leading the GRASSP Longitudinal Study and developing an objective measurement protocol specific for Cervical Spondylotic Myelopathy. In addition she currently works within the Neurorecovery Network and the North American Clinical Trials Network. She is a member of the Canadian Physiotherapy Association, North American Spine Society and AO Spine. Future plans for Dr. Kalsi-Ryan include moving into a clinician scientist role, that will service both the rehabilitation and neurosurgery departments