The Spinal Cord Injury Rehabilitation Program

Program Lead: Dr. Denise Hill

The Spinal Cord Injury (SCI) Rehabilitation Program provides inpatient and outpatient rehabilitation services to persons with traumatic and non-traumatic SCI for southern Alberta, eastern British Columbia and western Saskatchewan. 

There were 403 physician patient visits, 145 physician patient phone call follow ups, 105 nurse or nurse practitioner followup visits, and 96 nurse or nurse practitioner phone call followup visits (for a total of 753 patient encounters) from July 1, 2017 to June 30, 2018.

Highlights 

The SCI program admitted 70 persons for acute inpatient rehabilitation on Unit 58 between July 1, 2017 and June 30, 2018. Outpatient rehabilitation cIinics for people with spinal cord injuries were conducted year round—by both physiatrists and the SCI rehab nurse practitioner, Raj Parmar. 

The diaphragm pacer system continues to operate at the Foothills Medical Centre. Diaphragm pacing is facilitated by a collaborative team, with pulmonology, respiratory therapy, thoracic surgery and physiatry. Patients are able to be off the ventilator for improved quality of life. This also has potential to translate into improved cost benefits for the health care system.

The exoskeleton research study that was initiated in 2016 is complete. The main outcome was to measure the safety and feasibility of its use for gait training shortly after an acute spinal cord injury. Qualitative interviews were also conducted to capture patient-reported outcomes. Data analysis is complete and a manuscript is expected to be ready for submission for publication by early 2019. 

Results of this research were presented at the Academy for Spinal Cord Injury Professionals (ASCIP) conference in Denver in September 2017. The study continues to be funded by the Alberta Paraplegic Foundation, Calgary Health Trust, Cumming School of Medicine and Hotchkiss Brain Institute.

The provincial SCI registry initiative entered its fourth year in 2018. The main achievements of this project include the development and pilot testing of a patient-reported tool for spasticity called the Spas-Q, the collection of information on non-traumatic SCI patients during the rehabilitation phase, the development, validation and refinement of an algorithm to leverage administrative data, and a redesign of long-term community followup (CFU) for persons with SCI. 

The algorithm work and the Spas-Q initiative resulted in two poster presentations at the Academy for Spinal Cord Injury Professionals (ASCIP) conference in New Orleans in September 2018, while the development and implementation of the new CFU was presented at the SCI Canada Conference in Niagara Falls, Ont., in November 2017 and at the Strategy for Patient Oriented Research (SPOR) Summer Institute in Calgary in May 2018. 

The new CFU model sees our community partner organization, Spinal Cord Injury Alberta (SCI AB), completing the ongoing CFU for registry participants. This facilitates real time followup of concerns identified in the CFU and has resulted in positive feedback from patients, along with increased completion rates and retention. 

Collaborations were strengthened with individuals and groups from Campus Alberta Neuroscience, Universities of Calgary, Edmonton and Toronto, Alberta Health Services, AHS Analytics, SCI AB, the Ward of the 21st Century, the SPOR support units, and the Brain and Mental Health Research Clinic. 

This registry initiative was funded by Brain Canada with support from the Alberta Paraplegic Foundation, Rick Hansen Institute, University of Alberta’s Neuroscience & Mental Health Institute, and the University of Calgary’s Hotchkiss Brain Institute. Work is underway to embed the registry into standard clinical care and to expand enrollment opportunities to all persons living with an SCI in Alberta. The registry will serve as a foundational platform to continue to track, evaluate and address patient outcomes and concerns moving forward. 

A scoping review was conducted to understand international models of care for SCI. A health care utilization project was also conducted to leverage AHS administrative data to learn about the demographics and health care utilization and associated costs for persons with SCI in Alberta. This will all contribute to the work of the provincial network that is collaborating to develop and implement a model of care for SCI in our province. 

Jason Knox, Michelle Wallace, Tanya McFaul and Dr. Rebecca Charbonneau were awarded a provincial seed grant from the Alberta Paraplegic Foundation to look at standardized, best practice implementation of neurogenic bladder management across the province. The goal of the implementation of standardized provincewide protocols is to ensure patients are receiving evidence-informed care in Alberta’s two major urban spinal cord injury rehabilitation centres. The learnings from this quality project can inform other SCI practices, including approach to standardizing best practice for neurogenic bowel and autonomic dysreflexia.

Members 

Dr. Denise Hill, Dr. Rebecca Charbonneau, Dr. Dan McGowan, Raj Parmar (Nurse Practitioner)

 (Updated Dec. 2018)