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Guidelines and Best Practice Solutions

Solutions for improving SCI patient care

Canadian Best Practice Guidelines for Pressure Ulcers

Pressure sores are the most common secondary health complication of Spinal Cord Injuries (SCI) given that many people are typically sitting for more than 16 hours a day in a wheelchair. This often leads to pressure sores, a complication that traditionally was prescribed bed rest. But for many with SCI, bed rest does not lead to successful outcomes. Too often it leads to further complications, infections, hospitalization, even a life-threatening complication of septicemia. Pressure ulcers compromise activities of daily living, disrupts employment, education and family life, as well as increasing the burden on the caregiver.

Ontario Neurotrauma Foundation (ONF), in partnership with the Rick Hansen Institute (RHI), responded to the need to develop a more effective approach to prevent and manage pressure ulcers by supporting research to create standardized, evidence-based practices for the treatment of pressure sores.

Working with those living with SCI, as well as wound care and SCI experts, this partnership was able to implement the best practices for treating pressure sores. These guidelines are now current and applicable within the Canadian healthcare context.

ONF in partnership with Spinal Cord Injury Ontario developed a parallel set of guidelines for people living with SCI and their caregivers: Preventing and Treating Pressure Sores: A guide for people with spinal cord injuries.
ONF partnered with RHI and the Alberta Paraplegic Foundation in taking the lead for implementing these best practices in Ontario, Quebec, Alberta, and ultimately across Canada.

Neuropathic Pain Practice Guidelines Development

Chronic pain, is a common secondary health condition for people with SCI. Almost 40 percent of individuals with SCI have chronic and/or neuropathic (nerve-based) pain. Recognizing the critical need for guidelines in this area, a team led by Dr. Eldon Loh from Parkwood Hospital in London, Ontario developed guidelines for management of neuropathic pain. Effective pain management is important to improve psycho-social, as well as physical health and overall quality of life for people with SCI.

Electrical Stimulation Collaboration

The Estim Collaboration project supports sites implementing Estim in the treatment of pressure ulcers and difficult-to-heal wounds. Led by Dr. Pamela Houghton, it has more than 30 members located across Canada who meet each month to discuss knowledge transfer techniques and other strategies they have used to implement best practices care.

Rehabilitation Interventions for Individuals with Spinal Cord Injuries in the Community

The Rehabilitation Interventions for Individuals with a Spinal Cord Injuries in the Community (RIISC) Research Team aims to develop and implement innovative, multimodal, and inter-professional community-based rehabilitation solutions to mitigate endocrine-metabolic disease (EMD) risk among individuals with chronic SCI living in the community.

Specifically, these solutions will target detection, prevention and treatment initiatives to reduce the risk of fracture, diabetes and heart disease. We anticipate that the developed solutions will positively impact the functional capacity, social participation and wellbeing among individuals with chronic SCI living in Ontario and Quebec.

In order to understand Endocrinal Metabolic Disease risk, one needs to understand how dramatic changes in body composition including reductions in bone and muscle mass, and increases in fat mass together with inflammatory stress, manifest as health complications and significant fractures, diabetes and heart disease burden many years after onset of spinal cord impairment. Understanding the complex interactions between changes in body composition, biomarkers and inflammatory stress are an important initial construct, these processes are further accelerated by impairment imposed activity limitations, and the individual’s personal and environmental context, which often combine to result in diverse EMD expression (fracture, diabetes, dyslipidemia, heart disease alone or in combination) and adverse personal and societal health, well-being and participation outcomes, after many years of an unchecked elevation in EMD risk.

Physical Activity Guidelines and Guide

ONF supported the development of physical activity guidelines for individuals with SCI by a team of researchers at McMaster University. These guidelines recommend the ideal amount of exercise individuals with SCI should do to live active, healthy and independent lives. They suggest that to improve fitness, healthy adults with SCI should participate in at least 20 minutes of moderate to vigorous aerobic activity twice per week, as well as strength training exercises twice per week. The guidelines are reflected in the ProActive SCI Toolkit.

Acute Spinal Cord Injury Guideline Development

Five acute SCI guidelines were developed by a team led by Dr. Michael Fehlings (University of Toronto) and supported by AOSPINE. ONF participated in the development of the guidelines – Magnetic Resonance Imaging; early versus late surgical decompression; use of Methyl Prednisolone; Anticoagulation; and Rehabilitation timing and duration. Learn more:

Spinal Cord Injury Rehabilitation Care High Performance Indicators (SCI-HIGH)

The ongoing Spinal Cord Injury Rehabilitation Care High Performance Indicators (SCI-HIGH) Project was initiated in 2015 to establish a core set of indicators that represent optimal rehabilitation care for those living with SCI. The goal of this project is to facilitate uniform measurement and benchmarking of high-quality care among individuals with SCI in the first 18 months after inpatient rehabilitation admission.

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