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Improving Secondary Health Conditions

Neuropathic Pain

Principle Investigators: Dr. Eldon Loh and David Ditor (Parkwood Hospital, London)

Neuropathic pain is a common complication following spinal cord injury (SCI) that significantly decreases quality of life. Treatment options are limited, and current treatments can have significant side effects. Those with SCI have identified a need for additional treatment options, alternative to traditional medications.

Cannabinoids and an anti-inflammatory diet are two newer treatments that may provide pain relief while being better tolerated. This study will evaluate the benefits of these treatments for neuropathic pain after SCI. Study participants will receive either an anti-inflammatory diet, cannabinoids or a placebo for 6 weeks. Following this, a combined effect of these treatments will be evaluated for a further 6 weeks.

It is expected that an anti-inflammatory diet and cannabinoids will significantly decrease pain intensity and improve function. The combination of both treatments together is expected to have a greater effect than each alone.

Urologic and Women’s Health

Principle Investigator: Dr. Blayne Welk (University of Western Ontario, London)

Maintaining bladder and kidney health are important priorities for people who have suffered a spinal cord injury. Bladder changes can happen with few symptoms, and these can lead to a higher risk of urinary infections, incontinence, and kidney dysfunction, and can negatively impact quality of life. In order to diagnose these changes, with the support of ONF, Canadian experts have created the Canadian Urology Association Guideline for the Management of Neurogenic Bladder. This guideline outlines the routine kidney ultrasounds, kidney function testing, and urodynamics for people with SCI; different testing intervals are required based on risk factors for serious bladder dysfunction.

This project will determine how well these risk factors predict serious bladder dysfunction when routine bladder and kidney tests are performed as suggested and measure patient satisfaction with this process. The project will also produce important complementary knowledge translation tools through consultation with key stakeholder groups.

Principle Investigator: Dr. Anne Berndl – Accessible Care Pregnancy Clinic, Sunnybrook Health Sciences Centre

An increasing number of women with physical disabilities are choosing to become pregnant. Spinal cord injuries (SCI) often affect bladder function requiring medical intervention to achieve social continence and prevent infections and kidney damage. Women with SCI have specific considerations during pregnancy, especially surrounding bladder health. The effect of pregnancy and birth on long-term urogenital health in women with SCI is unknown, however this information is essential to provide evidence-based prenatal care.

The Canadian Spinal Cord Injury Urohealth Summit 2016 Stated that longitudinal patient registries are necessary to understand and study neurogenic bladder as a research priority. This study aims to assess the effect of pregnancy on urogenital health in women with SCI through the creation of an international registry. The initial project plan is slated for 3 years, but this registry has the potential to continue running and provide long-term data on the urogenital health of women with SCIs.

References

A perinatal health framework for women with physical disabilities

Neurogenic bladder in spinal cord injury patients

Pregnancy and spinal cord injury

Primary Care

Primary Investigators: James Milligan & Joseph Lee, Center for Family Medicine, Kitchener-Waterloo

This grant will focus on knowledge translation and dissemination of the Mobility Clinic model to achieve the goals and future directions. Building on the work of our previous grant through the ONF, “Improving the Access to Care for Spinal Cord Injured Patients, Forwarding the Mobility Clinic Model Throughout the Province and Beyond”, this grant focuses on the second phase of dissemination by engaging with Primary Care Physicians across the province and creating a network to share and learn from each other. The Mobility Clinic will continue to work with partner organizations on advocacy and research of spinal cord injuries in primary care.

Primary care providers and patients have indicated a desire for a Mobility Clinic to help address the needs of their patients and this has been echoed by individuals with SCI and participants at the primary care summit 2016. The research team intend to identify interested primary care locations to create Mobility Clinics in the province.

The Mobility Clinic was founded in 2010 as a joint venture between the Ontario Neurotrauma Foundation and Center for Family Medicine, Kitchener Waterloo. It is a primary care-based interprofessional clinic (part-time) that helps individuals with SCI (and other physical disabilities) and their regular family physicians access primary care. It has an accessible clinic (hi-lo table, overhead lift, w/c scale) and help to manage issues that would otherwise be difficult in many family doctors’ offices. They do research in SCI in primary care. They have created tools, manuals and resources to help others and are involved in a lot of SCI related activities representing primary care (ASIA Primary Care Committee).

Mobility Clinics:
– Iroquois Falls Family Health Team, Iroquois Falls, ON
– Andrew Street Family Health Organization, Kitchener, ON
– Langs Community Health Centre, Cambridge, ON

Visit the Mobility Clinic website to learn more about the resources for providers.
Twitter: @CFFM_Mobility

List of publications:

2020

• Jithin Varghese, Kim D. Anderson, Eva Widerström-Noga, and Upender Mehan (2020) A Primary Care Provider’s Guide to Pain After Spinal Cord Injury: Screening and Management. Topics in Spinal Cord Injury Rehabilitation: Summer 2020, Vol. 26, No. 3, pp. 133-143: https://doi.org/10.46292/sci2603-133

• James Milligan, Stephen Burns, Suzanne Groah, and Jeremy Howcroft (2020) A Primary Care Provider’s Guide to Preventive Health After Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation: Summer 2020, Vol. 26, No. 3, pp. 209-219; https://doi.org/10.46292/sci2603-209

• Joseph Lee, Jithin Varghese, Rose Brooks, and Benjamin J. Turpen (2020) A Primary Care Provider’s Guide to Accessibility After Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation: Spring 2020, Vol. 26, No. 2, pp. 79-84: https://doi.org/10.46292/sci2602-79

• James Milligan, Lance L. Goetz, and Michael J. Kennelly (2020) A Primary Care Provider’s Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation: Spring 2020, Vol. 26, No. 2, pp. 108-115: https://doi.org/10.46292/sci2602-108

• Sigmund Hough, Colleen Clemency Cordes, Lance L. Goetz, Angela Kuemmel, Jesse A. Lieberman, Linda R. Mona, Mitchell S. Tepper, and Jithin G. Varghese (2020) A Primary Care Provider’s Guide to Sexual Health for Individuals With Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation: Summer 2020, Vol. 26, No. 3, pp. 144-151: https://doi.org/10.46292/sci2603-144

2019

• Milligan J, Ryan K, Lee J. (2019). Demystifying spasticity in primary care. Canadian Family Physician. 65(10): 697-703: https://www.cfp.ca/content/65/10/697

• Milligan J, Ryan K, Fehlings M, Bauman C. (2019). Degenerative cervical myelopathy: Diagnosis and management in primary care. Canadian Family Physician. 65(9): 619-624: https://www.cfp.ca/content/65/9/619

2018

• Milligan J, Lee J, Smith M, Donaldson L, Athanasopoulos P, Bassett-Spiers K, Howcroft J, Howcroft JW, Jeji T, Joshi PB, Mehan U, Noonan V. (2018). Advancing primary and community care for persons with spinal cord injury: Key findings from a Canadian summit. The Journal of Spinal Cord Medicine: https://pubmed.ncbi.nlm.nih.gov/30557085/

• Milligan J, Lee J, Hillier LM, Slonim K, Craven C. (2018). Improving primary care for persons with spinal cord injury: Development of a toolkit to guide care. Journal of Spinal Cord Medicine. DOI: 10.1080/10790268.2018.1468584: https://pubmed.ncbi.nlm.nih.gov/29733260/

2017

• Patel T, Milligan J, Lee J. (2017). Medication-related problems in individuals with spinal cord injury in a primary care-based clinic. Journal of Spinal Cord Medicine. 40(1): 54-61: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376141/

• Lee J, Milligan J, Smith M, Athanasopoulos P, Jeji T, Howcroft J, Howcroft J. (2017). Spinal cord injury primary care and community support summit: proceedings and recommendations. The Journal of Spinal Cord Medicine. 40(6): 857-858: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054958/

• Milligan J, Lee J, Hillier LM, Slonim K. (2017). Mobility clinic team composition: optimizing care for individuals with spinal cord injury. The Journal of Spinal Cord Medicine. 40(6): 827-828: https://hipe-pub.org/articles/abstract/10.7710/2159-1253.1145/

CORPORATE ANNOUNCEMENT – February 2021(Click to learn more)
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