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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."

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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