ONF SCI Research Network

Ontario Spinal Cord Injury Research Network (OSCIRN)

In order to improve care for people with spinal cord injury (SCI), current practices must be re-examine to determine which are effective, and secondly develop new treatments and management approaches and test their ability to provide cost-effective improvements in quality of life.

This is best accomplished by combining the intellectual, clinical, and research resources of different clinical research centres throughout the province. The goal is to improve the evidence-base upon which clinical practice and health policy is established.

OSCIRN was developed by ONF to support SCI research along the continuum of care

OSCIRN is a collaborative network of clinicians and scientists, from five academic health science centres in the province of Ontario, working together to facilitate multi-centre clinical research from pre-hospital care, acute treatment, rehabilitation, primary care to community re-integration of individuals with a spinal cord injury.

The network provides an opportunity for diverse groups to share intellectual and physical resources, benefit from infrastructural supports such as an informatics platform and centralized, web-based, multi-centre study management, and introduce cost-efficiencies in the conduct of multi-site collaborations.

A white paper summarizing the OSCIRN efforts is currently being updated.

The Network’s mandate is:

  1. Translational research across the continuum of care
  2. Integrated knowledge translation and implementation
  3. Integrated health economics
  4. Provision for investigator and industry-driven research
  5. Attract cutting-edge research to Ontario

In 2012 OSCIRN funded three team grants – each three-years in duration

The goal is for these teams to use the OSCIRN seed funding to develop solid plans and to apply for larger research grants based on their results.

  1. Led by Dr. Michael Fehlings, "Time is Spine”: Streamlining the Pre-hospital Transport of Patients with Acute Traumatic Spinal Cord Injury in Ontario has been completed. Related publication: Wilson JR(1), Voth J(2), Singh A(1), Middleton J(3), Jaglal SB(2,)(4), Singh. Defining the Pathway to Definitive Care and Surgical. www.ncbi.nlm.nih.gov/pubmed/26652196 Feb 11, 2016
  2. Led by Doctors Femida Sridhar and Susan Jaglal: SCINET—Informatics for Spinal Cord Injury (SCI) Research.
  3. Led by Doctors Joseph Lee and James Milligan: Integration of Health Services and Supports (Self-Management, Primary Care, Rehabilitation) in Persons with Spinal Cord Injury. This study is completed.

OSCIRN Network Meetings

The network including SCI researchers, clinicians, students and ONF partners gathers biennially. The next meeting is a combined National Spinal Cord Injury and OSCIRN meeting, May 12 – 14, 2017 at the Marriott Hotel, Eaton Centre. Entitled “Regeneration, Rehabilitation, Reintegration.” Researchers, clinicians and students working in the area of SCI and interested in attending should contact Dr. Tara Jeji or asingh@uhnresearch.ca.

2015 Research Initiatives in partnership with RHI

In September 2015 Ontario Neurotrauma Foundation in partnership with Rick Hansen Institute a funding initiative in support of research looking at secondary complications, neuro-recovery and long term health, wellness and community participation for those with SCI. Grants were available for up to 3 years with maximum $50,000/year. Twenty-four letters of intent were with19 letter of intent chosen to submit detailed proposals. Fifteen full proposals were received and six applicants were successful. These grants are for a period of 3 years.

Projects funded through the ONF and RHI Partnership:

Enhancing Primary Care for SCI Consumers by Clinical Use of Videoconferencing

Dr. James Milligan, Center for Family Medicine, Kitchener

The purpose of this study is to examine the feasibility of clinician utilization of personal computer video conferencing (PCVC) to increase primary care clinician capacity to improve through efficient use of limited resources complex chronic care and secondary complications such as pressure ulcers, bowel and bladder dysfunction for people with SCI. Secondary outcomes include investigating SCI consumer perception of clinician capacity to improve complex chronic care.

This study has been developed with input from people living with SCI and their families, clinicians, researchers, advocacy agencies and the CFFM eHealth Centre of Excellence. The Centre for Family Medicine (CFFM) in Kitchener-Waterloo is the principal location of this study.

Preventing Falls One Step at a Time: Reactive Balance Training for Spinal Cord Injury

Dr. Kristin Musselman, Toronto Rehabilitation Institute, University Health Network

This study will examine the feasibility and effectiveness of reactive step training in people with iSCI. The main objective is to determine if reactive balance training leads to greater improvements in balance reactions, scores on clinical scales, and fall rates compared with conventional walking training. This unconventional training may change current rehabilitation for iSCI by placing greater emphasis on balance and fall prevention. By improving balance and reducing falls, people with iSCI will experience fewer complications (e.g., injuries), and greater recovery of function and community participation.

Development and Implementation of a Clinical Decision Support System to Improve Outcomes Associated with Activity-Based Therapies

Dr. Dalton Wolfe, Lawson Health Sciences Center

The Parkwood Program of Rehabilitation Innovation for Movement Enhancement (PRIME) initiative, underway since Spring 2015, aims to develop, test, implement and sustain an electronic clinical decision support and data management system that includes clinical protocols to guide clinical decision-making and reporting functions in the area of locomotor training for persons with spinal cord injury (SCI) and acquired brain injury (ABI).

An initial prototype incorporating features of existing protocols and locomotor training principles (e.g., optimizing sensor input, enhancing normal movement, minimizing compensation, task specificity) was developed as the basis for continued iterative, end-user directed development and feasibility testing. PRIME prototypes encompass manual and robotic over ground and treadmill-supported approaches, but further development and improvement cycles continue.

The clinical treatment and assessment procedures embedded in PRIME will enable systematic tracking of practices and related outcomes, thereby representing a practice-based research platform to serve both quality improvement and research purposes.

Enhancing Recovery in Non-Traumatic Spinal Cord Injury: Implementation of an Integrated Program for the Assessment of Rehabilitation Therapies

Dr. Neil Duggal, London Health Sciences Center

The goal of this study is to improve the quality of life for patients who undergo surgery for arthritis in the neck, which accounts for less than two percent of all hospital admissions and is the most common cause of spinal cord injury in patients older than 55 years. The study will review clinical care spanning preoperative evaluation, surgery and rehabilitation in conjunction with state-of-the-art imaging techniques to demonstrate how rehabilitative therapy has the ability to accelerate recovery of neurological function and improve quality of life in patients by triggering brain recruitment and plasticity. Using hand function as a proxy of neurological recovery, this study will carefully evaluate neurological function in two groups of patients, those receiving rehabilitation and those not receiving rehabilitation after spine surgery, and correlate patient outcomes through the application of advanced imaging.

EEG-Triggered Functional Electrical Stimulation Therapy for Upper Limb Rehabilitation

Dr. Marquez Cesar, Toronto Rehabilitation Institute, University Health Network

This brain-controlled electrical stimulation therapy will be delivered over several weeks in addition to daily occupational therapy. In each session, participants will be asked to perform repeatedly a series of functional tasks that require hand opening, grasping an object, and releasing it. Each one of these motions will be assisted by functional electrical stimulation which in turn will be activated by a brain-computer interface capable of identifying the intention to move through analysis of electroencephalographic (EEG) activity. We will measure differences in Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM), and Toronto Rehabilitation Institute Hand Function Test (TRI-HFT) scores between the beginning and end of the intervention, and compare its effects against conventional and functional electrical stimulation therapies.

Nerve Transfers in Tetraplegia: A Multi-Centre, Multi-Disciplinary Pilot Study

Dr. Kirsty Boyd, Ottawa Hospital

The overall goal of this research is to determine how nerve transfer surgery can be optimized to improve upper extremity function in patients with cervical SCI. This study will lay the groundwork for future studies to compare the effectiveness of nerve transfers to traditional tendon transfer/tenodesis surgery in cervical SCI, investigate the role of combining these surgeries and assess best practices for timing of nerve transfer surgery after SCI particularly in cases of combined upper and lower motor neuron injury patterns.