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Inquire. Inspire. Imagine. 2011- 12 ANNUAL R EPORT


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2011-12 annual report – inquire. inspire. imagine.


LETTER FROM SHEILA JARVIS, PRESIDENT AND CEO & DAVID ALLGOOD, CHAIR, BOARD OF TRUSTEES

Inquire. Inspire. Imagine. Dear Friends, 2011-12 was a proud year of accomplishment at Holland Bloorview. With each step forward, we were guided by our vision of a world of possibility. However, at Holland Bloorview, we know that possibility does not emerge from determination alone. The magic of possibility comes from knowledge, skills and a culture of inquiry. The theme of this year’s annual report, Inquire. Inspire. Imagine., celebrates teaching and learning as the foundation from which our staff, volunteers and students provide transformative care. As a fully affiliated teaching hospital of the University of Toronto, Holland Bloorview is passionate about promoting and reinforcing a spirit of inquiry and learning. In the last year, this spirit has led us to countless accomplishments: a virtual tour that opens our doors to the world, a video-game powered by a therapeutic bicycle, a simulation lab for student and staff training, and a leadership program that empowers family members to teach staff from their own experience.

A major milestone this year was the establishment of Holland Bloorview’s Teaching and Learning Institute. Rather than a physical space, the Teaching and Learning Institute is an aligned network of leaders, programs and services that support enhanced learning and education, while recognizing and rewarding educators for their contributions to teaching. In essence, it integrates teaching and learning into the fabric of all the work accomplished at Holland Bloorview. In March, we held our second annual Teaching and Learning Institute Day and launched our new labs for simulation-based education. Participants were treated to a plenary presentation by the world-renown Dr. Amitai Ziv, founder of the Israeli Centre for Medical Simulation. A major focus for the next five years, simulation provides a unique and authentic learning experience for students and hospital staff leading to better care for kids with disabilities.

As we move forward with our new five-year strategic plan, Leadership in childhood disability: 2012-2017, we will “lift off” our teaching and learning potential by empowering more staff to engage in academic endeavours, and creating more opportunities for interprofessional education and training that brings together evidence-based research and best-practice clinical care. Teaching and learning unlocks our potential and allows us to do more, every day, for kids with disabilities and their families. Join us as we reflect on a year of achievements. What will be next …? Sheila Jarvis

David Allgood

President and CEO

Chair, Board of Trustees

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HOLLAND BLOORVIEW SNAPSHOT 2011-12

Medicine: 59 Research: 162

Number of students

Clinical technology: 8 Nursing: 176 Professional health disciplines: 126 Other: 2

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2011-12 annual report – inquire. inspire. imagine.

52,646

568

47.2 days

6,827

Outpatient visits

Inpatient visits

Average length of stay

Total clients

870

533

52,418

62

Employees

Students

Volunteer hours

Family leaders


BLOORVIEW RESEARCH INSTITUTE SNAPSHOT 2011-12

Bloorview Research Insititute Indicators 2011 Scientists:

Trainees: Total external funding:

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162

Peer-reviewed funded projects:

$4.9 million

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Peer-reviewed publications: 60 Ratio of external to internal funding:

2:1

Peer-reviewed publications per full-time scientist:

5.1

Peer-reviewed grants per full-time scientist:

5

Trainees per full-time scientist:

13.7

International: 17% National: 17%

External research funding by source 2011

Provincial: 19% Donations: 9% Industry: 1% Royalties: 5% Tri-council agencies: 32%

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2011-12 annual report – inquire. inspire. imagine.

Teaching and Learning runs on imagination.


IMAGINE

Virtual tour opens our doors to the world TEACHING: Holland Bloorview’s new online virtual tour teaches the world about our hospital environment and experience. Beyond still images and slideshows, this interactive website offers 53 videos, detailed maps, images and services information to help visitors discover who we are, what we do, and what to expect when visiting Holland Bloorview. Learning: A family’s first few visits to Holland Bloorview may feel overwhelming: new people to meet, new therapies to try, or unfamiliar equipment to use. The virtual tour was created primarily as a learning tool for clients and their families. By simulating the experience of walking through

our doors, visiting our floors, and speaking to staff, kids and parents, the tour is designed to reduce some of the anxiety of a new environment and address common questions and concerns. Holland Bloorview’s referring clinicians and community partners will also use the tool to improve their understanding of Holland Bloorview’s dayto-day operations and better prepare clients for transitions, appointments and therapies. Possibilities: Soon to be available as an iPad application, the possibilities for the virtual tour are limited only by the imagination. “When clients and families feel more at ease with our staff and our facility, the

“Logic will get you from A to B. Imagination will take you everywhere.” Albert Einstein

experience is better for everyone,” says Laura Williams, director of client and family integrated care.

Holland Bloorview’s virtual tour offers a unique interactive experience:

In the coming months, we will be adding great new content to the tour, including:

• A slideshow touring exterior and interior levels zero to five. • Detailed descriptions of the programs and services that Holland Bloorview offers with links to supporting information. • 53 videos about our programs and services featuring clients and staff.

• 30 new videos about our programs and services. • Accessible iPad kiosks in the main reception and 2nd floor waiting areas. • Two new iPads for client and family use. • New content to cover teaching and learning, early learning and development, and community based child development services.

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INVOLVE

Teens teach how to integrate fun into therapy Teaching: Five teens with cerebral palsy (CP) are teaching scientists how to make therapy more motivating and exciting. These teens are key partners in the Cycle-to-Fun research team, a multidisciplinary group exploring virtual world exergames – video games that require physical activity to play as a tool for gaining strength and improving fitness. The team’s new multiplayer exergame, in which players pedal a stationary bicycle to control an avatar, is not your average therapy experience – it is a competitive quest with lots of twists and rewards.

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Learning: In this study co-funded by NeuroDevNet and GRAND, two Canadian Networks of Centres of Excellence, physician director and Bloorview Research Institute scientist Dr. Darcy Fehlings, together with Professor Nick Graham of Queen’s University, are learning directly from teens with CP about the potential for multiplayer exergames to promote fitness and social inclusion. By partnering with teens throughout the research process, researchers have had a unique opportunity to receive ongoing feedback on what makes a game genuinely

2011-12 annual report – inquire. inspire. imagine.

“cool” as well as comfortable and convenient for kids with reduced gross motor function. Possibilities: Virtual world exergames hold great promise for engaging youth with CP, especially during the pivotal time when children are transitioning through their teens and commonly experience loss of function, due, in part, to poor physical fitness and muscle weakness. Teens involved in the study will be testing the cyclepowered virtual game at home this spring to shed more insight on its effectiveness for ongoing therapy and fun.

“We wanted to make a game with adventure and competition. We’ve made a lot of changes, but the newest version is turning out to be pretty fun.” Lara, teen participant

Teaching and learning works best with involvement.


“Tell me and I forget. Teach me and I remember. Involve me and I learn.� Benjamin Franklin

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2011-12 annual report – inquire. inspire. imagine.

Teaching and learning strives to inspire.


INSPIRE

Family teachers spark lasting client and family-centred attitudes Possibilities: Client and familyintegrated care is a core value for Holland Bloorview and our goal is to make the practice instinctive. The experience of being a family teacher can be empowering. At the same time, the early learning opportunities are valuable for staff who partner with families at every level of care: from input at the bedside to participation on key decision-making bodies.

Holland Bloorview has over 60 family leaders who help ensure the family is central to every child’s unique care. Family leaders advise on hospital policies and programs, share their story and offer support as mentors to other families.

“If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” John Quincy Adams

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Teaching: Family teachers at Holland Bloorview are members of our active family leadership program. Their role is to participate in small group discussions or present at conferences and forums designed to train health care providers about client and family-centred care. Cheryl, whose daughter has CP, speaks regularly at new staff orientation, sharing her family’s story and experience of care. No matter what area staff work in, Cheryl stresses the importance of listening carefully to understand the family perspective and the supports they need. Cheryl says, “I offer valuable insights into my

family’s experience and bring a different perspective to the table that new staff may not have had the opportunity to consider.” Learning: Introducing new staff to family-centered concepts during their orientation is essential for building lasting attitudes and behaviours. Cheryl’s story provides a first-hand view about the family side in a health care story and brings staff closer to understanding the family mindset which helps to foster authentic and respectful partnerships. “Talks like Cheryl’s help us to understand the family perspective. It’s a voice we need to listen to,” says Ritu, new advanced practice nurse.


INQUIRE

Students put their knowledge on trial through simulation Teaching: At Holland Bloorview, our Teaching and Learning Institute’s ambition is to blaze a trail in simulation for pediatric rehabilitation education. We currently have two labs/ classrooms that are predominantly used for simulation-based education. A simulated “moot court” is an exercise that teaches nursing students to think through the real-life consequence of a safety incident. For instance, students may be put on trial to prosecute or defend the charge of poor handling of an adverse event. A discussion then follows about best practices.

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Learning: Simulation helps to reinforce a culture of patient safety among nursing students.“The moot court simulation is a great way to learn,” says Stephanie, a nursing student who did the opening and closing statements for the defense. “Having to defend your actions really drives home the consequences of errors, without the distress of being involved in a real life adverse event.” Possibilities: Simulation has the potential to invigorate our teaching practices, facilitate our professional development and impact our client care. “We are

2011-12 annual report – inquire. inspire. imagine.

mindful of how complex our healthcare delivery system is and we are extremely excited to build simulation opportunities which reflect that complexity,” says Dr. Kathryn Parker, the Institute’s director of academic affairs and simulation lead. Simulation is new to the field of pediatric rehabititation, positioning Holland Bloorview to become a leader in the area.

Simulation at Holland Bloorview • Partnering with the University of Toronto to develop eight simulation scenarios focusing on improving communication and collaboration skills. • Working with SIM-one, an interprofessional health-care simulation network that links simulation facilities, resources and services across the province of Ontario. • Two simulation labs/classrooms at Holland Bloorview.

The power of teaching and learning is unlocked by the spirit of inquiry.


“Reason and free inquiry are the only effectual agents against error.� Thomas Jefferson

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Dr. Amitai Ziv of the Israeli Centre for Medical Simulation with Dr. Denis Daneman of SickKids 14

2011-12 annual report – inquire. inspire. imagine.

The outstanding impact of teaching and learning should be celebrated.


IMPACT

Holland Bloorview recognizes teaching excellence In March, over 70 members of the Holland Bloorview community took part in our second annual Teaching and Learning Institute Day. “Simulation” was this year’s theme and participants were pleased to host keynote speaker, Dr. Amitai Ziv, founder of the Israeli Centre for Medical Simulation. Known worldwide for changing the face of medical education through the innovative use of simulation-based training, Dr. Ziv highlighted how simulation can be used to build a culture of patient safety and decrease medical error. This year’s Teaching & Learning Institute Day also marked the launch of the Teaching and Learning Recognition Awards. These recognition awards are staffnominated and salute teachers at Holland Bloorview for their

outstanding contribution and commitment to education. Awards are in three categories: spirit of education; innovation in teaching and learning; and excellence in interprofessional education. And the winners were….

The centralized equipment pool (CEP) were awarded for their unique and innovative ideas for the augmentative communication program. The trio was recognized for their work in the evolution of the program and its impact in education.

Spirit of education: Dr. Janice Hansen, psychologist, was recognized with this award for her commitment and dedication to the academic mission. Known for her ability to integrate education with research and clinical practice, Janice consistently approaches teaching with enthusiasm and excitement and is an inspiration to others.

Excellence in interprofessonal education: Chitra Gnanasabesan, respiratory therapist, was recognized for consistently demonstrating enthusiasm, commitment and knowledge of interprofessional education. She is widely acknowledged for her leadership and role modeling of interprofessional collaboration.

Innovation in teaching and learning: The team of Anne-Marie Renzoni, Tracy Sheppard and Nahum Sloan of

“If you have knowledge, let others light their candles at it.” Margaret Fuller

Chitra Gnanasabesan

Anne-Marie Renzoni, Tracy Sheppard and Nahum Sloan

Dr. Janice Hansen

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A Year in Review at the Bloorview Research Institute (BRI)

Affordable prosthetic knee brings hope to amputees in the developing world Dr. Jan Andrysek, scientist, was named a rising star in global health by Grand Challenges CanadaTM. He has received a generous grant to continue his work on a low cost prosthetic knee that has the potential to be mass-produced and distributed to amputees in the developing world. At a manufacturing cost of $50, a key component of the limb is a built-in locking and unlocking mechanism that closely mimics natural motion.

Virtual Musical Instrument makes its concert debut with the Montréal Chamber Orchestra ®

Developed at the BRI, the Virtual Musical Intrument (VMI) uses computer-based technology to allow people with limited mobility or impaired motor skills to make music using body movements or

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signals. Eric Wan, a quadriplegic engineering student at Holland Bloorview, worked personally on developing the VMI software. Wan had the opportunity to demonstrate the VMI in its first concert performance at the famed Place des Arts Theatre in November with the Montréal Chamber Orchestra.

Holland Bloorview at the centre of world-leading brain research The honourable Brad Duguid, Minister of Economic Development and Innovation, joined the Ontario Brain Institute to announce funding for three brain research projects, two of which are headed by BRI scientists. Dr. Darcy Fehlings leads CP-NET, a multidisciplinary research network focused on improving understanding of cerebral palsy and accelerating new treatment opportunities. Dr. Evdokia Anagnostou heads a provincial biomedical research initiative to address gaps in

2011-12 annual report – inquire. inspire. imagine.

knowledge around the treatment of neurodevelopmental disorders, such as autism.

New clinical trial in robotic therapy Robotic therapy has the potential to transform treatment for children with cerebral palsy (CP). With the support of CIBC, THREE TO BE Foundation and KRG Children’s Charitable Foundation, the BRI will be conducting the first known randomized trial to evaluate the impact of robotic assisted gait training for children with CP. Clinical research will be conducted using a state-of-theart robotic device known as the Pediatric Lokomat® Pro.

Team explores how environment impacts youth with severe disabilities Led by Holland Bloorview senior scientist, Gillian King, the CIHR Team in Optimal Environments for Severely Disabled Youth is addressing how to enhance the

social inclusion of the most excluded and overlooked youth – those with severe disabilities. Since 2009, the team has brought together eight university and community-based researchers, 11 children’s service organizations, and 25 other interested groups. The team has developed innovative tools and techniques to measure youth experiences and qualities of environmental settings. Their work has been published in two articles.

Autism Research Centre launches microsite Dr. Evdokia Anagnostou and Dr. Jessica Brian co-lead the Autism Research Centre (ARC) in its mission to improve outcomes and quality of life for children with autism spectrum disorders and their families. The new ARC microsite is an important resource for those interested in learning more about research highlights or becoming involved in studies.


Jan Andrysek, scientist “One of the most rewarding aspects of research is when you can take a project from the beginning, with the conceptualization, and actually get it to a point where it starts having an impact on people’s lives.’’

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A Year in Review OF Our Programs and Services

Proud to be a Best Practice Spotlight Organization Holland Bloorview was one of 14 organizations in 2012 to be named a Best Practice Spotlight Organization by the Registered Nurses Association of Ontario. We earned our designation for implementing internationally recognized clinical best practice guidelines over the last three years in four areas: supporting and strengthening families through expected and unexpected life events; client-centred care; assessment and management of pain; and collaborative practice.

Holland Bloorview prescribes social networking In partnership with TELUS, Kids’ Health Links Foundation (KHLF) and Sheridan Nurseries, Holland Bloorview celebrated the launch of Upopolis, an innovative social networking tool that helps hospital inpatients stay connected to their

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families, friends and school while they are in hospital. A private, secure and trusted online social network, Upopolis provides the best features of social networking while offering unique features for kids in hospital, like homework support, health info, and the chance to connect to others with similar conditions.

Evidence to Care takes off While evidence has long informed decision-making at Holland Bloorview, the Evidence to Care (EtC) team is focused on advancing more consistent practices for documentation and knowledge sharing with clinicians, families, or policy makers. The EtC team’s first project was to review evidence related to pain assessment for kids with cerebral palsy and to develop pain management guidelines and tools for clinicians.

2011-12 annual report – inquire. inspire. imagine.

Holland Bloorview makes GTA top employer list

Filmpossible brings visibility to disability once again

For the second year in a row, Holland Bloorview was named one of Greater Toronto’s Top Employers for 2012 in an editorial report published in the Globe and Mail in partnership with Mediacorp. This special designation recognizes us as an industry leader in offering an exceptional place to work.

Open to all ages and abilities, filmpossible is an online video and photo contest designed to raise the profile of childhood disability. This year, 69 people entered videos and photos and thousands of votes were cast. Denise Wilson claimed first prize for her video As long as it’s healthy, which challenges us to think differently about disability and differences. Annya Miller took first place for her photo Lucky fin love, a playful peek at two young friends with limb differences.

Building capacity in Qatar In partnership with SickKids International, Holland Bloorview has continued to build on our consulting work at the Hamad Medical Corporation (HMC) in Doha, Qatar. We are sharing our knowledge and expertise to build capacity for kids with disability in two areas: 1) the development of a pediatric rehabilitation continuum of care; and 2) the building of a model for an early intervention program.

BLOOM gets a boost BLOOM, our magazine and blog on parenting kids with disabilities, received a $100,000 donation from David and Lynn Coriat, helping the publication to expand. BLOOM now offers a regular speaker series and online video content - just a few more ways to connect with supporters across 114 countries.


Upopolis launch 2011 “I like that I can make friends all over Canada through Upopolis. I’m also really happy that once I am discharged I can still use Upopolis to stay in contact with my child life specialist and the friends I have made.� Jessica, client, age 13.

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Announcements, Honours and Awards

announcements Tom Chau Named vice president of research and director of the Bloorview Research Institute at Holland Bloorview. Jackie Schleifer Taylor Named vice president of programs and services at Holland Bloorview. Evdokia Anagnostou Recipient of Ontario Brain Institute funding for Province of Ontario Neurodevelopmental Disorders Network (POND). Darcy Fehlings Recipient of Ontario Brain Institute funding for Childhood Hemiplegic Cerebral Palsy Integrated Neuroscience Discovery Network “CP-NET”. No Limits, The Campaign for Childhood Disability The Holland Bloorview Kids Rehabilitation Hospital

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Foundation reached millions of GTA radio listeners and online viewers during the second phase of its No Limits awareness campaign. Holland Bloorview has successfully raised $49.5 million of its $80 million goal.

RESEARCH HONOURS AND AWARDS Barbara Gibson University of Toronto Faculty of Medicine Teaching Award for Early Career Excellence. Unni Narayanan Dr. John Whittaker Memorial Cerebral Palsy Award for dedication to improving the quality of life of children with CP and other developmental disabilities. Doug Biggar Elsevier WMS Membership Award, World Muscle Society, Algarve, Portugal.

2011-12 annual report – inquire. inspire. imagine.

Jan Andrysek Grand Challenges CanadaTM Rising Star in Global Health and grant winner for continued work on his Low Cost Knee. Amy McPherson Awarded a Spina Bifida and Hydrocephalus Association research grant for an environmental scan of weight assessment and management practices in pediatric spina bifida clinics across Canada. Elaine Biddiss Awarded a CIHR grant for research on the impact of ScreenPlay, the new interactive waiting room for kids with disabilities.

RESEARCH COLLABORATIONS Université Laval Research Chair in Cerebral Palsy – Bloorview Research Institute Collaborative Catalyst Grant Program for Junior Scientists/Researchers.

• Jan Andrysek and Julien Voisin, co-principal investigators: A pilot study to explore the short-term impact of acute physical fatigue on sensory, motor and cognitive processes in ambulatory youth with cerebral palsy. • Sally Lindsay and Chantal Desmarais, co-principal investigators: Working with immigrant families in pediatric rehabilitation: Exploring successes and challenges in providing culturally sensitive care. Family Impact of Assistive Technology Scale Scientist Steve Ryan is collaborating with researchers, clinicians, and students from Holland Bloorview, the University of Toronto, University of British Columbia, the Shriner’s Hospital for Children in Montreal, and 12 children’s rehabilitation centres across Canada to study the effect of new wheelchairs using the Family Impact of Assistive Technology Scale (FIATS).


International reach OF THE BRI Australia • Virginia Wright: Invited keynote, Physiotherapy Association meeting, October 2011: Outcome measurement – just another good idea or truly family centred? Brazil • Virginia Wright and Linda Patrick: Led two-day course on the Quality FM (a measure of quality of movement for ambulatory children with CP developed at Holland Bloorview) at the Associacao di Assistenzia a Crianza Deficiente (AACD), a children’s rehabilitation centre in Sao Paolo. China • Darcy Fehlings: Assessment Tools for Hypertonia and Medical Management of Hypertonia. Presented at the Paediatric Neuroscience Conference, Centre for International Child Health, Guangzhou Project.

Germany • Nancy Thomas-Stonell with Peter Rosenbaum and Bruce Oddson: Request from the University of Cologne to translate the FOCUS© outcome measure into German. Iceland • Barbara Gibson: Troubling times: temporalities and trajectories of life limiting childhood conditions. Presented at the Nordic Network on Disability Research (NNDR 2011) 11th Research Conference.

The Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital is proud to present the Pursuit Award – Health Research 2012.  The Pursuit Award is funded by the Holland Bloorview Kids Rehabilitation Hospital Foundation donors David and Anne Ward and the Bloorview Research Institute. The Health Research 2012 award recognizes PhD students from across the globe for their outstanding achievements in childhood disability research. Pursuit Award – Health Research 2012 Winners

Slovakia • Karl Zabjek: The evaluation of postural control in children and youth diagnosed with Idiopathic Scoliosis. Presented at the International Posture Symposium.

Dr. Jill Zwicker, Department of Physical Therapy, University of British Columbia Dr. Chantal Camden, Faculté de médicine, Université de Montréal Dr. Margaret Wallen, School of Health and Rehabilitation Sciences, The University Of Queensland Dr. Nora Fayed, CanChild Centre for Child Disability Research, McMaster University

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PEER REVIEWED PUBLICATIONS

Ameis SH, Fan J, Rockel C, Voineskos AN, Lobaugh NJ, Soorya L, Wang AT, Hollander E, Anagnostou E. Impaired structural connectivity of socioemotional circuits in autism spectrum disorders: a diffusion tensor imaging study. PLoS One 2011;6(11):e28044.

Andrysek J, Christensen J, Dupuis A. Factores que influyen en la práctica basada en la evidencia en los campos protésico y ortésico (Factors influencing evidence-based practice in prosthetics and orthotics). Ortoprostetica-Ayudas 2011;72:52-60.

Anagnostou E, Hansen R. Medical treatment overview: traditional and novel psycho-pharmacological and complementary and alternative medications. Current Opinion in Pediatrics 2011 Dec;23(6):621-627.

Christensen J, Andrysek J. Examining the associations among clinician demographics, the factors involved in the implementation of evidencebased practice, and the access of clinicians to sources of information. Prosthetics and Orthotics International 2012 Mar;36(1):87-94.

Anagnostou E, Chaplin W, Watner D, Silverman JM, Smith CJ, Zagursky K, Kryzak LA, Corwin TE, Feirsen N, Tanel N, Hollander E. Factor analysis of repetitive behaviors in Autism as measured by the Y-BOCS. The Journal of Neuropsychiatry & Clinical Neurosciences 2011 Summer;23(3):332-339. Kushki A, Chau T, Anagnostou E. Handwriting difficulties in children with autism spectrum disorders - a scoping review. Journal of Autism and Developmental Disorders 2011 Feb;41(12):1706-1716. Anagnostou E, Taylor MJ. Review of neuroimaging in autism spectrum disorders: what have we learned and where we go from here. Molecular Autism 2011 Apr 18;2(1):4.

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Andrysek J, Klejman S, Steinnagel B, Torres-Moreno R, Zabjek KF, Salbach NM, Moody K. Preliminary evaluation of a commercially available videogame system as an adjunct therapeutic intervention for improving balance among children and adolescents with lower limb amputations. Archives of Physical Medicine and Rehabilitation 2012 Feb;93(2):358-366. Furse A, Cleghorn W, Andrysek J. Improving the gait performance of non-fluid-based swing-phase control mechanisms in transfemoral prostheses. IEEE Transactions on Biomedical Engineering 2011 May 16. Andrysek J, Klejman S, TorresMoreno R, Heim W, Steinnagel B, Glasford S. Mobility function

2011-12 annual report – inquire. inspire. imagine.

of a prosthetic knee joint with an automatic stance phase lock. Prosthetics and Orthotics International 2011 Jun;35(2):163-170. Furse A, Cleghorn W, Andrysek J. Development of a low-technology prosthetic swing-phase mechanism. Journal of Medical and Biological Engineering 2011;31(2):145-150. Andrysek J, Christensen J, Dupuis A. Factors influencing evidencebased practice in prosthetics and orthotics. Prosthetics and Orthotics International 2011 Mar;35(1):30-38. Berry T, Howcroft J, Klejman S, Fehlings D, Wright V, Biddiss E. Variations in movement patterns during active video game play in children with cerebral palsy. Journal of Bioengineering and Biomedical Science 2011;1(1). doi:10.4172/21559538. Howcroft J, Fehlings D, Zabjek K, Fay L, Liang J, Biddiss E. Wearable wrist activity monitor as an indicator of functional hand use in children with cerebral palsy. Developmental Medicine and Child Neurology 2011 Nov;53(11):1024-1029. Biddiss E, McKeever P, Lindsay S, Chau T. Implications of prosthesis funding structures on the use of prostheses: experiences of individuals with upper limb absence. Prosthetics

and Orthotics International 2011 Jun;35(2):215-224. Myrden AJ, Kushki A, Sejdić E, Guerguerian AM, Chau T. A braincomputer interface based on bilateral transcranial Doppler ultrasound. PLoS One 2011;6(9):e24170. Gane L, Power S, Kushki A, Chau T. Thermal imaging of the periorbital regions during the presentation of an auditory startle stimulus. PLoS One 2011;6(11):e27268. Nikjoo M, Steele C, Lee J, Sejdic E, Chau T. Discriminating between healthy and abnormal swallowing by combining classifiers on the basis of reputation. Biomedical Engineering Online 2011;10:100. Falk TH, Tam C, Schwellnus H, Chau T. On the development of a computer-based handwriting assessment tool to objectively quantify handwriting proficiency in children. Computer Methods and Programs in Biomedicine 2011 Dec;104(3):e102-e111. Memarian N, Venetsanopoulos AN, Chau T. Client-centred development of an infrared thermal access switch for a young adult with severe spastic quadriplegic cerebral palsy. Disability and Rehabilitation: Assistive Technology 2011;6(2):179-87. Epub 2010 Jun 23.


Sejdić E, Steele CM, Chau T. Scaling analysis of baseline dual-axis cervical accelerometry signals. Computer Methods and Programs in Biomedicine 2011 Sep;103(3):113-120.

Myrden AJ, Kushki A, Sejdić E, Guerguerian AM, Chau T. A braincomputer interface based on bilateral transcranial Doppler ultrasound. PLoS One 2011;6(9):e24170.

Lesperance A, Blain S, Chau T. An integrated approach to detecting communicative intent amid hyperkinetic movements in children. Augmentative and Alternative Communication 2011 Sep;27(3):150162.

Kushki A, Fairley J, Merja S, King G, Chau T. Comparison of blood volume pulse and skin conductance responses to mental and affective stimuli at different anatomical sites. Physiological Measurement 2011 Oct;32(10):1529-1539.

Power SD, Kushki A, Chau T. Towards a system-paced near-infrared spectroscopy brain-computer interface: differentiating prefrontal activity due to mental arithmetic and mental singing from the no-control state. Journal of Neural Engineering 2011 Dec;8(6):066004.

Lee J, Steele CM, Chau T. Classification of healthy and abnormal swallows based on accelerometry and nasal airflow signals. Journal of Artificial Intelligence Medicine 2011 May;52(1):17-25.

Moreno S, Bialystok E, Barac R, Schellenberg EG, Cepeda NJ, Chau T. Short-term music training enhances verbal intelligence and executive function. Psychological Science 2011 Nov;22(11):1425-1433. Steele CM, Molfenter SM, Bailey GL, Cliffe RE, Waito AA, Zoratto DCBH, Weeda A, Buesselberg N, Chau T. Exploration of the utility of a brief swallowing screening protocol with comparison to concurrent videofluoroscopy. Canadian Journal of Speech-Language Pathology and Audiology 2011;35(3):228-242.

Falk TH, Guirgis M, Power S, Chau TT. Taking NIRS-BCIs outside the lab: towards achieving robustness against environment noise. IEEE Transactions on Neural Systems and Rehabilitation Engineering 2011 Apr;19(2):136-146. Memarian N, Venetsanopoulos AN, Chau T. Client-centred development of an infrared thermal access switch for a young adult with severe spastic quadriplegic cerebral palsy. Disability and Rehabilitation: Assistive Technology 2011;6(2):179-187. Kushki A, Schwellnus H, Ilyas F, Chau T. Changes in kinetics and kinematics of handwriting during a prolonged writing

task in children with and without dysgraphia. Research in Developmental Disabilities 2011 May-Jun;32(3):1058-1064. Beheshti S, Hashemi E, Sejdić E, Chau T. Mean square error estimation in thresholding. IEEE Signal Processing Letters 2011;18(2):103-106. Alves N, Chau T. Mechanomyography as an access pathway: corporeal contraindications. Disability and Rehabilitation: Assistive Technology 2011;6(6):552-563. Gibson BE, Teachman G, Wright V, Fehlings D, Young NL, McKeever P. Children’s and parents’ beliefs regarding the value of walking: rehabilitation implications for children with cerebral palsy. Child: Care, Health and Development 2012 Jan;38(1):61-9. doi: 10.1111/j.13652214.2011.01271.x. Epub 2011 Jun 22. Gibson BE, Stasiulis E, Gutfreund S, McDonald M, Dade L. Assessment of children’s capacity to consent for research: a descriptive qualitative study of researchers’ practices. Journal of Medical Ethics 2011 Aug;37(8):504-509. Daudji A, Eby S, Foo T, Ladak F, Sinclair C, Landry MD, Moody K, Gibson BE. Perceptions of disability among south Asian immigrant mothers of children with disabilities in Canada: implications for rehabilitation service delivery.

Disability and Rehabilitation 2011;33(6):511-521. King G, Tam C, Fay L, Pilkington M, Servais M, Petrosian H. Evaluation of an occupational therapy mentorship program: effects on therapists’ skills and familycentered behavior. Physical and Occupational Therapy in Pediatrics 2011 Aug;31(3):245262. King G, Wright V, Russell DJ. Understanding paediatric rehabilitation therapists’ lack of use of outcome measures. Disability and Rehabilitation 2011;33(25-26):26622671. King GA, Servais M, Bolack L, Shepherd TA, Willoughby C. Development of a measure to assess effective listening and interactive communication skills in the delivery of children’s rehabilitation services. Disability and Rehabilitation 2012;34(6):459-69. King G, Zwaigenbaum L, Bates A, Baxter D, Rosenbaum P. Parent views of the positive contributions of elementary and high school-aged children with autism spectrum disorders and Down syndrome. Child: Care, Health and Development 2011 Sep 15. doi: 10.1111/j.13652214.2011.01312.x.

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Lindsay S, Kingsnorth S, Hamdani Y. Barriers and facilitators of chronic illness self-management among adolescents: a review and future directions. Journal of Nursing and Chronic Illness in Health Care 2011;3:186-208. Lindsay S. Employment status and work characteristics among adolescents with disabilities. Disability and Rehabilitation 2011;33(10):843-54. Lindsay S. Discrimination and other barriers to employment for teens and young adults with disabilities. Disability Rehabilitation 2011;33(1516):1340-1350. Lindsay S, Tsybina I. Predictors of unmet needs for communication and mobility assistive devices among youth with a disability: the role of socio-cultural factors. Disability and Rehabilitation: Assistive Technology 2011;6(1):10-21. Lindsay S, McPherson AC. Experiences of social exclusion and bullying at school among children and youth with cerebral palsy. Disability and Rehabilitation 2012;34(2):101-9. Lindsay S, McPherson AC. Strategies for improving disability awareness and social inclusion of children and young people with cerebral palsy. Child: Care, Health and Development 2011 Sep 1. doi: 10.1111/j.13652214.2011.01308.x.

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Gladstone BM, Boydell KM, Seeman MV, McKeever PD. Children’s experiences of parental mental illness: a literature review. Early Intervention in Psychiatry 2011 Nov;5(4):271-89. McLaren C, Edwards G, Ruddick S, Zabjek K, McKeever P. Kindergarten kids in motion: rethinking inclusive classrooms for optimal learning. Educational and Child Psychology 2011;28 (1):100-113. Blain S, Kingsnorth S, Stephens L, McKeever P. Determining the effects of therapeutic clowning on nurses in a children’s rehabilitation hospital. Arts & Health 2011;4(1):26-38. Narayanan UG. Dexamethasone added to antibiotics improved clinical and laboratory outcomes in children with septic arthritis. The Journal of Bone and Joint Surgery (American) 2011 Nov 16;93(22):2124. Janicki JA, Wright JG, Weir S, Narayanan UG. A comparison of ankle foot orthoses with foot abduction orthoses to prevent recurrence following correction of idiopathic clubfoot by the Ponseti method. The Journal of Bone and Joint Surgery Br 2011 May;93(5):700-4. Narayanan UG. Botulinum toxin: does the black box warning justify change in practice? Developmental Medicine and Child Neurology 2011 Feb;53(2):101-2.

2011-12 annual report – inquire. inspire. imagine.

Kingsnorth S, Gall C, Beayni S, Rigby P. Parents as transition experts? Qualitative findings from a pilot parent-led peer support group. Child: Care, Health and Development 2011 Nov;37(6):833-40. Rigby P, Ryan SE, Campbell KA. Electronic aids to daily living and quality of life for persons with tetraplegia. Disability and Rehabilitation: Assistive Technology 2011;6(3):260-267. Ryan SE. Overview of systematic reviews of adaptive seating interventions for children with cerebral palsy: where do we go from here? Disability and Rehabilitation: Assistive Technology 2012 Mar;7(2):104-11. Washington KN, Warr-Leeper G, Thomas-Stonell N. Exploring the impact of a novel computer-assisted treatment program targeting expressive-grammar deficits in preschoolers with SLI. Journal of Communication Disorders 2011 MayJun;44(3):315-330. Levac D, Missiuna C, Wishart L, Dematteo C, Wright V. Documenting the content of physical therapy for children with acquired brain injury: development and validation of the motor learning strategy rating instrument. Physical Therapy 2011 May;91(5):689-699.

Igoe D, Peralta C, Jean L, Vo S, Ngan Yep L, Zabjek K, Wright V. Evaluation of the test-retest reliability of the Dimensions of Mastery Questionnaire (DMQ) in preschool-aged children. Infants & Young Children 2011;24:280291. Wilson A, Kavanaugh A, Moher R, McInroy M, Gupta N, Salbach NM, Wright FV. Development and pilot testing of the Challenge Module: a proposed adjunct to the Gross Motor Function Measure for high functioning children with cerebral palsy. Physical and Occupational Therapy in Pediatrics 2011 May;31(2):135-149.


Introducing our new strategic plan 2012-2017: Leadership in childhood disability Holland Bloorview’s new five-year strategic plan sets out to define us as world leaders in the field of childhood disability. Possibility is a plan. Discover ours.

We will: • Transform Care • Accelerate Knowledge • Lead the System • Inspire our People

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HOW WE MEASURE UP Holland Bloorview is always looking for better ways to track our performance and communicate how we are doing. Here is an at-a-glance report on our performance. To determine our ratings, Holland Bloorview invited the input of representatives from the Provincial Council for Maternal and Child Health, University of Toronto, Erinoakkids, GTA Rehab Network, Holland Bloorview’s board of trustees, and Holland Bloorview’s family and youth advisory committees.

GOAL MEASURES Impact on high quality safe care Improve inpatient rehabilitation outcomes

Provide client and family centred care

Good = H H(2) Excellent = H H H (3)

• Average achievement score for goals set by client and/or therapist1 • % of goals achieved to expectations (T-Score between 45 and 55) • % of goals exceeding expectations (T-Score above 55)

12% point improvement 52%

T-score between 45-55 35% 30%

T-Score 51 47% 29.6%

5.7 4.6 5.6 5.8 5.9

5.59 4.70 5.60 5.75 5.84

95% 65%

96.6% 66.8%

HHH

HHH

Average rating within each category of Holland Bloorview’s ‘Tell Us What You Think Survey’ that achieve or exceed average scores found in literature2 and also exceed past performance. The ‘Tell Us What You Think Survey’ uses the CanChild Measures of Process of Care Tool for family feedback:

Improve the client experience

• % of clients and families who rate Holland Bloorview excellent or good3, 4 • % of clients and families who rate Holland Bloorview excellent4

Ensure timely access to services

Wait in days for new clients seen at Holland Bloorview :

3 ***

4

HHH

Q4 Results (January to March 2012)

80% seen in 137 days or less 80% seen in182 days or less 90% seen in 61 days or less 90% seen in 122 days or less 90% seen in 3 days or less

80% seen in 99 days 80% seen in 286 days9 90% seen in 70 days 90% seen in 119 days 90% seen in 0 days

Annual Infections per 1,000 inpatient days

3.4

2.36

HHH

Reported Medication Adverse Events (inpatients) – number of mild to moderate events per 1000 patient days

0.19

0.50

HHH

0 1095 days

0 1095 days

• Child Development Program Neuromotor clients • Child Development Program Autism clients11** • Writing Aids clients12 • Augmentative Communication clients13 • Inpatient Rehabilitation clients14 Ensure the safety of the client and family

10% point improvement 40-60%

SCORE

Achievement of goals set by the client and/or therapist using Goal Attainment Scaling:

• Enabling and partnership (out of 7) • Providing general information (out of 7) • Providing specific information (out of 7) • Coordinated and comprehensive care (out of 7) • Respect and supportive care (out of 7)

Guideline: Fair = H(1)

ACTUAL

Improvement in clients’ functional abilities from admission to discharge using WeeFIM® Instrument: • Average improvement in clients’ functional abilities1 • % of clients with a 10% point improvement or greater in functional abilities1

Achieve inpatient and outpatient rehabilitation therapy goals

BENCHMARK*

10

HH

Client adverse events at Holland Bloorview in 2011-12 associated with serious harm to the client • # of client adverse events causing serious harm • # of days without serious harm

(since collected in 2009/10)

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2011-12 annual report – inquire. inspire. imagine.

HHH


GOAL MEASURES Building capacity Lead education in childhood disability

BENCHMARK*

ACTUAL

• # of medical trainees (per physician full time equivalent [FTE]) • # of professional health discipline and nursing students (per professional health discipline and nursing FTE) • # of research students (per research FTE)

6.6 1.0

6.2 1.14

9.9

13.7

Number of students who participated in the interprofessional education experience

70

137

89% (FY 2009-10)

86%

5.5

5.1

SCORE

Students training at Holland Bloorview:

Percentage of professional health discipline and nursing students satisfied with their clinical experience • % of student responses of very good or excellent

HHH

HHH HHH

Advancing knowledge Enhance the output and impact of research

Number of peer reviewed publications per FTE scientist – publications are attributed to principal author or senior responsible author

HHH

(Note: Other clinical research institutes standard is 2.0) Number of peer reviewed external grants per FTE scientist – principal or co-investigator status with funding are included in this number

4.6

5

HHH

(Note: Other clinical research institutes standard is 2.0)

Finances Ensure a sound financial position

Current ratio of short-term assets and liabilities5

1.0

1.3

HHH

Total Margin (consolidated)

0.5%

0.4%

HHH

9.2%

6.2%

HHH

10.5 days

7.9 days

HHH

Other teaching hospitals 56% positive response

68%

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Human resources Offer staff a satisfying, healthy, and safe workplace

Staff turnover rate compared to 2008-096 Staff average sick time compared to 2009-10

7

Employee engagement and commitment (e.g. proud to be part of Holland Bloorview, similar values, inspired to do their best) compared to survey of hospitals in Ontario8

HHH

*Unless otherwise indicated, benchmarks are internal performance targets. Where there is no agreed-upon industry/literature benchmark or where Holland Bloorview outperformed the industry/literature benchmark in 2009-10, internal performance targets are set to actual results reported in How We Measure Up: 2009-10. **Actual results are not within range of the benchmark. Holland Bloorview has made an active commitment to improvement science methodologies designed to help us reach wait time benchmarks. *** The score reflects the progress that has been achieved over the past year; however, recognizes that key programs still require further improvement, and the results have not been sustained for over a year.

1 Based upon peer-reviewed literature. Average improvement is not adjusted for acuity. 2 Measure of Process of Care, CanChild Centre for Childhood Disability Research (2004) 3 ‘Tell Us What You Think’ incorporates the Measure of Processes of Care questionnaire for families/clients. The response rate ranges from 10%-23% quarterly (improved significantly from last year) with 489 surveys completed for the fiscal year. The rating allocated recognizes the achievement in satisfaction, however reflects the low sample size. 4 Targets for these key strategic priorities were set based on improvement in performance seen in 2009-10 and setting stretch goals. Reported performance is based on data from January 2012 to March 2012 to reflect the significant improvement work achieved across every area. For comparison, last year’s performance is also denoted further down in the footnotes. 5 Based upon Toronto Central LHIN standards 6 Based upon Ontario Hospital Association Labour Market Survey (2008-09) 7 Based upon Ontario Hospital Association Survey (2010-11) 8 Compared to other hospitals in Ontario, NRC Picker Survey. Of particular note is the 80% response rate employees unprecedented in satisfaction surveys. 9 Note that while the wait times have not changed since last fiscal year the number of referrals have increased 3 fold since fiscal year 2010/11 and the number of assessments have increased 40% 10 Based on performance last fiscal year January to March 2011 - 80% of clients were seen in 189 days 11 Based on performance last fiscal year January to March 2011 - 80% of clients were seen in 282 days 12 Based on performance last fiscal year January to March 2011 - 90% of clients were seen in 65 days 13 Based on performance last fiscal year January to March 2011 - 90% of clients were seen in 96 days 14 Based on performance last fiscal year January to March 2011 - 90% of clients were seen in 8 days 15 Percent by which total corporate (consolidated) revenues exceed or fall short of total corporate (consolidated) expense, excluding the impact of facility amortization, in a given year.

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T: 416-425-6220

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F: 416-425-4531

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E: info@hollandbloorview.ca足足 |

www.hollandbloorview.ca

Principal photography: www.williamsuarez.ca

Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8


Holland Bloorview 2011-12 Annual Report