The New Face of Rehabilitation Research in Toronto
At Toronto Rehab, functional electrical stimulation (FES) is being applied in
new ways. The pocket-sized device stimulates nerves and makes muscles
move. After many repetitions, some patients actually "relearn" how to do
basic tasks - without the device. A pilot study showed that people with
partial paralysis from spinal cord injury who were injured up to two
decades earlier could dramatically improve their walking abilities with
FES. Another pilot study found that FES helped patients - even those with
complete paralysis - to do things like pick up food or flip through a book.
Coming next: a portable FES prototype for clinical and home use.
When Geoff Fernie came from the U.K. to Canada
in 1973, rehabilitation science was in its infancy.
Recruited by the Division of Othopaedics in U of T's
Department of Surgery, he quickly saw what he had to
do. "Orthopaedic surgeons at that time felt they were
advancing surgery, but that the rehabilitation part was
lagging," Dr. Fernie recalls. His role: to advance rehabilitation
for the Department of Surgery, helping patients
return to their daily lives after surgery.
As Dr. Fernie explained at Surgery Rounds in January,
a lot has changed since those days. "Today, rehabilitation
science is the emerging frontier in health research and
Toronto is a world leader in this field." Engineering and
computer science are a particular specialty in Toronto.
In fact, the city has the largest rehabilitation engineering
research group in the world and, arguably, the leading
artificial intelligence group in computer science.
And a lot has changed for Dr. Fernie as well. He is
Vice President of Research at the Toronto Rehabilitation
Institute (Toronto Rehab), Canada's largest teaching
and research hospital specializing in adult rehabilitation,
complex continuing care and long-term care, and
Professor, Department of Surgery, U of T, with crossappointments
that include the Institute of Biomaterials
and Biomedical Engineering, the Graduate Department
of Rehabilitation Science and the Departments of
Mechanical and Industrial Engineering, Physical
Therapy and Occupational Therapy.
Combining two branches of medicine - surgery
and rehabilitation - makes total sense to Dr. Fernie.
"Surgeons and engineers come from the same mould.
We tend to talk the same language because we're both
faced with practical problems that we are required to
solve. So our mindset, as well as skills, are very similar.
And technology is a big part of our lives."
When surgeons and engineers work together, the
potential for success is great, Dr. Fernie said. He cited
a current collaboration between Toronto Rehab scientist
Milos Popovic, an associate professor in U of T's
Institute of Biomaterials and Biomedical Engineering,
and the Department of Surgery's Andres Lozano, who
pioneers deep brain stimulation. "Dr. Lozano has
implanted stimulators in people and Dr. Popovic has
been using the signals from those wires to enable people
with disabilities to control the environment through a
direct brain interface. Dr. Popovic is the first person in
the world to do this."
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The rapidly expanding field of rehabilitation is producing
other exciting new treatments and technologies
that are highly relevant to patients recovering from
surgery. Take, for example, the advances Toronto Rehab
is making with a technique that can stimulate paralysed
muscles to work again. Functional electrical stimulation
is being used in a new way to help restore reaching and
grasping function in stroke patients. "Surgeons want to
provide the best service to their patients, and advances
such as these can help them do so," Dr. Fernie said.
Like all of us, surgeons are well aware of the needs of
our aging population. "We are all getting older or have
aging relatives who need the technologies we are developing,"
Dr. Fernie said. "All our lives, we've saved up for
a house, a cottage, maybe a boat. And none of us want
to swap that for 240 square feet in a nursing home."
Scientists at Toronto Rehab are developing practical
solutions to assist older people in day-to-day living and
help them stay longer in their homes.
The focus is not only on physical issues. "Many of
us know the worry of having a relative who is slightly
confused, perhaps prone to wander in the middle of
the night. You have to be with them all the time." Alex
Mihailidis, a Toronto Rehab scientist and assistant professor
of occupational science and occupational therapy
at U of T, is working with colleagues on artificial intelligence
systems to help older people "age at home". One
project is the Talking Bathroom, which guides people
with dementia through the task of hand washing and
will eventually be able to guide them through a full
range of washing and toileting activities. The Toronto
Rehab-U of T team has also developed a personal emergency
response system that can detect when a person
has fallen and call for help. Speech recognition allows
the system to ask questions and recognize different
responses. The impact, Dr. Fernie predicts, will be huge
for older people and their caregivers.
Toronto Rehab is also tackling the problem of caregiver
injuries, so common in hospitals. Nurses are more
likely than any other workers to be injured on the job,
to miss work or to quit their jobs due to injury. So
scientists at Toronto Rehab are developing high-tech
lifting tools to help caregivers safely lift and move
patients. One is the SlingSerter, which uses compressed
air to effortlessly slide a sling under a patient. While the
first users will be hospital staff, Dr. Fernie anticipates
the SlingSerter will become popular with home-based
caregivers as well.
Rehabilitation has something else to offer surgeons.
"We have tools, such as sophisticated measurement
systems, that can help surgeons solve some of their own
research problems." These capabilities are increasing
as rehabilitation research takes another leap forward:
Toronto Rehab is building one of the most advanced
rehabilitation research facilities. iDAPT (Intelligent
Design for Adaptation, Participation and Technology) is
an initiative to create an integrated network of research
facilities where ideas can be cultivated, tested and applied
in the real world, leading to practical new therapies and
devices. One lab will house a giant motion simulator
which can mimic everyday environmental challenges.
It's all part of the new face of rehabilitation research
in Toronto, featuring innovation and collaboration to
improve the lives of people everywhere affected by disability
and aging.
Margaret Polanyi
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