Convergent validity and responsiveness of The Standing and Walking Assessment Tool (SWAT) among individuals with non-traumatic spinal cord injury.

Aim: This study aimed to (1) describe the use of the Standing and Walking Assessment Tool (SWAT) among individuals with non-traumatic spinal cord injury or disease (NT-SCI/D); (2) evaluate the convergent validity of SWAT for use among inpatients with NT-SCI/D; (3) describe SWAT responsiveness; and (4) explore the relationship between hours of walking therapy and SWAT change.

Methods: A quality improvement project was conducted at the University Health Network between 2019 and 2022. Participants' demographics and impairments data, rehabilitation length of stay, and FIM scores were obtained from the National Rehabilitation Reporting System.

The Effect of a Brief Physician-Delivered Neurobiologically Oriented, Cognitive Behavioural Therapy (Brief-CBT) Intervention on Chronic Pain Acceptance in Youth with Chronic Pain-A Randomized Controlled Trial.

At the Stollery Children’s Chronic Pain Clinic, new referrals are assessed by an interdisciplinary team. The final part of the intake assessment typically involves an explanation and compassionate validation of the etiology of chronic pain and an invitation to the youth to attend the group outpatient Cognitive Behavioural Therapy (CBT) program, called Pain 101, or to individual outpatient CBT. It was hypothesized that a brief physician-delivered CBT (brief-CBT) intervention at first point of contact improves subsequent pain acceptance.

Validity and responsiveness of the Standing and Walking Assessment Tool for sub-acute traumatic spinal cord injury.

Study Design: This is a retrospective longitudinal study.

Objective: The Standing and Walking Assessment Tool (SWAT) combines stages of standing and walking recovery (SWAT stages) with established measures (Berg Balance Scale (BBS), 10-m walk test (10MWT), 6-min walk test (6MWT), and modified Timed Up-and-Go (mTUG)). We evaluated the SWAT's validity (known-groups and convergent) and responsiveness among inpatients with sub-acute, traumatic spinal cord injury (SCI).

Minimal Clinically Important Difference of Graded Redefined Assessment of Strength, Sensibility, and Prehension Version 1 in Acute Cervical Traumatic Spinal Cord Injury.

The Graded Redefined Assessment of Strength, Sensibility, and Prehension Version 1 (GRASSP v1) is a validated measure of upper extremity impairment shown to be sensitive and responsive for traumatic cervical spinal cord injury (SCI) in both North American (NA) and European (EU) cohorts. The minimal clinically important difference (MCID) is the quantitative change in an assessment scale that patients perceive as being beneficial. Our aim was to establish the MCID of all subtests of the GRASSP v1 for cervical SCI.

Central Recruitment: A process for engaging and recruiting individuals with spinal cord injury/disease in research at Toronto Rehabilitation Institute.

Context: Insufficient recruitment is a barrier to research and limits statistical power. We describe an initiative aimed to streamline recruitment and consent processes for inpatients with spinal cord injury or disease (SCI/D) via implementation of a Central Recruitment (CR) process. The CR process adhered to ethical standards, reduced participant burden, and maximized research participation.

Development of Reaching, Grasping & Manipulation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project.

Objective: To describe the development of structure, process, and outcome indicators aimed to advance the quality of Reaching, Grasping & Manipulation (RG&M) rehabilitation for Canadians living with spinal cord injury or disease (SCID).

Method: Upper extremity rehabilitation experts developed a framework of indicators for evaluation of RG&M rehabilitation quality. A systematic search of the literature identified potential upper extremity indicators that influence RG&M outcomes.

A prospective observational study of persistent opioid use after complex foot and ankle surgery.

Purpose: The incidence of persistent postsurgical opioid use (PPOU) after complex foot and ankle surgery is unknown. We aimed to determine the incidence and characteristics of PPOU in opioid-naïve, occasional, and regular opioid users at baseline and at six weeks, three months, and six months postoperatively.

Methods: We conducted a prospective observational study in patients undergoing complex foot and ankle surgery over an 18-month period.

Characteristics of Upper Limb Impairment Related to Degenerative Cervical Myelopathy: Development of a Sensitive Hand Assessment (Graded Redefined Assessment of Strength, Sensibility, and Prehension Version Myelopathy).

Background: Degenerative cervical myelopathy (DCM) involves spinal cord compression, which causes neurological decline. Neurological impairment in DCM is variable and can involve complex upper limb dysfunction including loss of manual dexterity, hyperreflexia, focal weakness, and sensory impairment. The modified Japanese Orthopaedic Association (mJOA) score relies on the patients' subjective perceptions, whereas existing objective measures such as strength and sensory testing do not capture subtle changes in dexterity and function.

Effects of water immersion on gait initiation: part II of a case series after incomplete spinal cord injury.

Study Design: Case series.

Objectives: This case series describes how the aquatic environment influences gait initiation in terms of the center of pressure (COP) excursion, impulses, trunk acceleration, and perceptions of participants with incomplete spinal cord injury (iSCI).

Setting: Tertiary Rehabilitation Hospital, Ontario, Canada.

The graded redefined assessment of strength sensibility and prehension version 2 (GV2): Psychometric properties.

GRASSP Version 1 (GV1) was developed in 2010, is an upper extremity measure specifically designed to assess recovery after traumatic tetraplegia. second version was developed to reduce length of the test and refine instructions/standardization. The purpose of this analysis was to calculate psychometric properties of GRASSP Version 2 (GV2).

Development of Walking indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project.

To describe the development of structure, process and outcome indicators that will advance the quality of walking rehabilitation for Canadians with spinal cord injury or disease (SCI/D) by 2020. A framework for the evaluation of the quality of walking rehabilitation was developed by experts in walking after SCI/D. A systematic literature review identified factors influencing walking outcomes and potential walking indicators.

The standing and walking assessment tool for individuals with spinal cord injury: A qualitative study of validity and clinical use.

The Spinal Cord Injury (SCI) Standing and Walking Assessment Tool (SWAT) combines stages of walking recovery with measures of balance and walking. It standardizes the timing and content of walking assessment in inpatient rehabilitation. The study aims were: (1) Evaluate the content validity of the SWAT stages of walking recovery, and (2) Understand physical therapists' (PTs) experiences using the SWAT to gauge acceptance, implementation and impact.

The relationship between pressure offloading and ischial tissue health in individuals with spinal cord injury: An exploratory study.

To compare thickness and texture measures of tissue overlying the ischial region in able-bodied (AB) individuals vs. individuals with spinal cord injury (SCI) and to determine if there is a relationship between pressure offloading of the ischial tuberosities (IT) and tissue health in individuals with SCI. Exploratory cross-sectional study.

Effects of water immersion on quasi-static standing exploring center of pressure sway and trunk acceleration: a case series after incomplete spinal cord injury.

Study Design: This work is a case series.

Objectives: We assessed the influence of the aquatic environment on quasi-static posture by measuring center of pressure (COP) sway and trunk acceleration parameters after incomplete spinal cord injury (iSCI) in water and on land.

Setting: Tertiary Rehabilitation Hospital, Ontario, Canada.

Effects of exercise interventions on cardiovascular health in individuals with chronic, motor complete spinal cord injury: protocol for a randomised controlled trial [Cardiovascular Health/Outcomes: Improvements Created by Exercise and education in SCI (CHOICES) Study].

Introduction: Recent studies demonstrate that cardiovascular diseases and associated complications are the leading cause of morbidity and mortality in individuals with spinal cord injury (SCI). Abnormal arterial stiffness, defined by a carotid-to-femoral pulse wave velocity (cfPWV) ≥10 m/s, is a recognised risk factor for heart disease in individuals with SCI. There is a paucity of studies assessing the efficacy of conventional training modalities on arterial stiffness and other cardiovascular outcomes in this population.

Quantitative ultrasound imaging over the ischial tuberosity: An exploratory study to inform tissue health.

Background: Characterization of ischial tissue health using a standardized diagnostic ultrasound protocol capturing thickness and gray scale analysis has not been established.

Objectives: This study evaluates inter-participant and inter-trial reliability of thickness and gray scale analysis of ultrasound images of tissues overlying the ischial tuberosity. It provides recommendations for the number of images required to minimize the standard error of measurement (SEM) and determines the number of images required for thickness, gray scale and contrast values that exceed an a-priori minimal detectable change (MDC) for repeated tissue assessment.

Assessing Heart Rate Variability As a Surrogate Measure of Cardiac Autonomic Function in Chronic Traumatic Spinal Cord Injury.

Although cardiac autonomic dysfunction is a contributing factor for cardiovascular disease development in individuals with a spinal cord injury (SCI), it remains poorly understood. Heart rate variability (HRV) analysis has the potential to non-invasively assess the cardiac autonomic nervous system. The study objectives are (a) to determine if there are differences in HRV measures across neurological level of impairment (NLI) and American Spinal Cord Injury Association Impairment Scale (AIS) subgroups, and (b) to determine if there is a relationship between HRV frequency measures (low frequency [LF] and high frequency [HF]) at rest.

Life after personalized adaptive locomotor training: a qualitative follow-up study.

Study Design: Qualitative follow-up study.

Objectives: Intensive locomotor training can improve physical and psychological functioning for individuals with spinal cord injury. Few studies have examined long-term effects of locomotor training.

The influence of the aquatic environment on the center of pressure, impulses and upper and lower trunk accelerations during gait initiation.

Gait initiation is defined as the transition from stationary standing to steady-state walking. Despite the frequent use of therapy pools for training walking in early stages of rehabilitation, none have been reported on the effects of immersion on gait initiation. We aimed to analyze the center of pressure (COP) trajectories, the vertical and anteroposterior impulses and upper and lower trunk accelerations during anticipatory (APA) and execution phases of gait initiation.

Cardiovascular Stress During Inpatient Spinal Cord Injury Rehabilitation.

Objectives: (1) To measure the amount of cardiovascular stress, self-reported physical activity, and accelerometry-measured physical activity by individuals with spinal cord injury (SCI) during physical therapy (PT) and occupational therapy (OT); and (2) to investigate the relations between these measures.

Design: Observational study.

Setting: Two inpatient SCI rehabilitation centers.

Trunk Function and Ischial Pressure Offloading in Individuals with Spinal Cord Injury.

Objective: To determine if there is a relationship between trunk function and offloading of the ischial tuberosities in individuals with Spinal Cord Injury (SCI).

Design: Prospective cross-sectional evaluation.

Setting: Sub-acute rehabilitation hospital.