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TORONTO REHAB’S 8th ANNUAL RESEARCH DAY Conference Program & Abstracts

2012 Cover Images: iDAPT Research Labs Toronto Rehab is home to some of the world’s most technologically advanced research facilities, including the Balance, Mobility and Falls Clinic (top L), Communication Function Lab (top R) and StairLab (centre L and R), which is part of CEAL - Challenging Environment and Assessment Laboratory. We invite collaborators, decisionmakers and members of the public to tour our labs, meet our scientists and learn about cutting edge research.

Sharing Our  Research  with  the  World A Message from Inez Gannicott Volunteer Tour Lead, Toronto Rehabilitation Institute - University Health Network You  may  have  seen  me  in  the  hallways  of  Toronto  Rehab  giving  tours  of  our  new   iDAPT  research  facili;es.  Over  the  past  few  years,  I’ve  ushered  hundreds  of   people  through  these  labs,  including  scien;sts,  businesspeople  and  government   officials.  Just  the  other  day,  we  had  a  group  of  ophthalmologists  who  couldn’t   believe  their  eyes,  if  you’ll  forgive  the  pun.  And  not  long  ago,  we  welcomed  a   bunch  of  medical  students  from  Brazil.  Whoever  it  is,  the  reac;on’s  always  the   same:  “Wow!  I  had  no  idea  it  would  be  this  big!”   It’s  not  only  the  enormous  mo;on  simulator  and  the  other  impressive  labs  that   make  jaws  drop.  It’s  the  work  you  are  doing  in  these  seNngs  that  stops  people  in  their  tracks.   Everyone  can  immediately  relate  to  the  pressing  problems  you  are  studying.  They  ‘get’  why  your   research  maQers.  People  are  so  inspired  by  what  they  are  seeing  and  hearing.   Like  so  many  families,  mine  has  been  touched  by  disability.  My  mother  suffered  a  stroke  years  ago.   It  meant  that  our  whole  family  became  caregivers.  So  I  know  first-­‐hand  how  important  your  work  is.   For  me,  it’s  an  honour  to  conduct  tours  at  Toronto  Rehab  ―  and  an  honour  to  volunteer  at  Toronto   Rehab’s  8th  Annual  Research  Day.  Today  is  a  great  occasion  to  share  your  work  with  others  and   highlight  the  impact  it’s  having  on  people’s  independence  and  quality  of  life.  As  you  present  your   work  today,  I  predict  that  the  reac;on  will  be  a  resounding:  “Wow!”   A Message from Tim Giblin Volunteer Tour Lead, Toronto Rehabilitation Institute - University Health Network Like  Inez,  I  love  giving  tours  of  the  incredible  iDAPT  research  facili;es.  When  I   begin  a  tour,  I  always  introduce  myself  as  a  former  Toronto  Rehab  pa;ent.  I   explain  how,  when  I  arrived,  I  was  unable  to  walk  or  even  talk.  I  was  30  and  had   experienced  a  cerebral  aneurysm.  As  I  tell  my  tour  groups,  it  was  Toronto   Western  Hospital  that  saved  my  life.  But  it  was  Toronto  Rehab  that  gave  me  back   my  life.  Your  team  put  me  back  together  again  with  outstanding  rehab.  And  the   reason  I’m  wri;ng  this  message  to  you  today  is  because  someone  did  the   research  that  led  to  my  treatment.  I’m  profoundly  grateful  for  that. The  research  you  are  doing  represents  hope  for  pa;ents  and  families.  Your  work  to  prevent  injury   and  illness  helps  everyone.  And  you  are  inspiring  the  next  genera;on  of  rehab  researchers.  Just  the   other  day,  I  toured  a  group  of  industrial  design  students  through  iDAPT.  You  should  have  seen  their   amazed  looks  when  they  stepped  into  HomeLab  for  a  demo  of  an  innova;ve  fall-­‐detec;on  system.   The  visit  sparked  a  spirited  exchange  of  ideas.   I  volunteer  for  Toronto  Rehab  because  I  want  to  give  back.  I  applaud  you  for  giving  so  much  to  so   many  through  your  groundbreaking  research.  Research  Day  is  a  wonderful  opportunity  to  introduce   that  work  to  others,  including  non-­‐researchers  ― and  to  spread  the  word  about  all  you  are  doing  to   help  people  like  me  live  life  to  the  fullest.    

8th Annual Research Day Friday, November 23, 2012 Sheraton Centre Toronto Hotel 123 Queen Street West, Toronto ON


7:30am – 9:00am

Registration (Dominion Foyer)

9:00am – 9:15am

Welcome & Introduction (Dominion Ballroom) Dr. Geoff Fernie, Institute Director, Research, Toronto Rehabilitation Institute – University Health Network

9:15am – 10:25am

Minute Madness Oral Presentations – Session 1 (Presentations from Sleep & Upper Airway, Cardiopulmonary Fitness, Neural Engineering & Therapeutics, AI & Robotics and Cognition Teams)

10:25am – 10:45am


10:45am – 11:50am

Minute Madness Oral Presentations – Session 2 (Presentations from Optimize, Communication, Technology and Mobility Teams)

11:50am – 12:15pm

Keynote Presentation – Novel Uses of Electrical Stimulation for Improving Ambulation and Preventing Pressure Ulcers after Spinal Cord Injury Dr. Vivian Mushahwar, Associate Professor and AHFMR Senior Scholar Division of Physical Medicine & Rehabilitation and Centre for Neuroscience, University of Alberta

12:15pm – 12:30pm

Student Scholarship & Award Presentations Toronto Rehab Team Excellence Awards TD GRANTS IN MEDICAL EXCELLENCE: Scholarships in RehabilitationRelated Research for Graduate Students with Disabilities

12:30pm – 1:30pm

LUNCH (available in the Churchill Foyer)

1:30pm – 3:00pm

Poster & Interactive Display Sessions (Dominion Foyer, Churchill Room, City Hall Room)


Poster & Interactive Display Awards / Close of Research Day Best Poster (Master’s, Doctoral and Postdoctoral) Best Interactive Display People’s Choice Award (Best Minutes Madness)


ARTIFICIAL INTELLIGENCE  &  ROBOTICS  IN  REHAB  TEAM Amy  Hwang Amy  is  a  PhD  student  focusing  on  the  development  of  user  interfaces  for  the   COACH  system.    She  is  applying  an  in-­‐depth  human  computer  interaction   (HCI)  approach  in  her  research  to  develop  and  test  these  interfaces.    She  has   made  significant  progress  having  completed  design  sessions  with  informal   caregivers  to  learn  about  their  needs  and  preferences  of  such  an  interface.   She  completed  a  pilot  usability  test  with  her  prototypes,  which  resulted  in  a   full  conference  paper  at  the  recent  Pervasive  Healthcare  Conference.    In   addition  to  her  research  Amy  has  completed  the  majority  of  her  course  work   with  outstanding  marks  and  is  now  completing  her  comprehensive  exams.    In  the  past  year  she   has  been  award  the  Mary  Gertrude  L'Anson  scholarship  and  the  Peterborough  K.M.  Hunter   award  to  support  her  PhD  studies.    She  is  an  excellent  writer,  impressing  her  committee   members  with  her  high  level  of  skill  in  expressing  her  research  in  a  manner  that  is  clear,   concise,  and  understandable  by  a  wide  range  of  readers.    Amy  is  supervised  by  Dr.  Alex   Mihailidis.  

CARDIOPULMONARY FITNESS  TEAM Kerseri  Scane Part  of  Kerseri’s  Master’s  research  focused  on  adherence  to  cardiac   rehabilitation  in  the  home  based  model  of  care.  The  study  compared  the   real-­‐world  effectiveness  of  home  vs.  traditional  on-­‐site  cardiac   rehabilitation  programs  among  200  cardiac  rehabilitation  TRI  participants.   Those  participating  in  home  programs  had  similar  adherence  rates  and   experienced  similar  improvements  in  cardiovascular  fitness  as  those   experienced  by  their  on-­‐site  cardiac  rehab  program  comparators.  While  both  home-­‐based  and   on-­‐site  programs  promote  an  individualized  approach  to  self-­‐managed  preventative  care,  the   ability  to  deliver  cardiac  rehabilitation  “virtually”  to  selected  populations  without  the  need  for   on-­‐site  facilities  may  also  have  favorable  cost-­‐effectiveness  implications.  Her  article  was   published  this  year  and  the  study  has  received  significant  media  attention.  This  study  sets  the   seeds  for  further  research.    Kerseri  is  supervised  by  Dr.  Dina  Brooks.




COGNITION TEAM Tatyana  Mollayeva Dr.  Mollayeva  received  her  medical  degree  from  Moscow  Medical  Academy   and  worked  as  a  Senior  Epidemiologist/technical  expert  for  the  Ministry  of   Health  in  Central  Asia.  She  has  also  served  as  a  Long  Term  Disability  Case   Manager  with  Manulife  Financial.  She  is  currently  an  award  winning  doctoral   student,  receiving  awards  from  the  Ontario  Neurotrauma  Foundation,  the   University  of  Toronto,  the  Toronto  Rehabilitation  Institute,  the  Ontario   Graduate  Scholarship  and  a  MITACs  scholarship.    This  year  she  is  also  co-­‐ supervising  graduate  students  in  the  Dept  of  Occupational  Science  and   Occupational  Therapy  and  is  a  highly  regarded  teaching  assistant.  Her   research  addresses  prevalence  of  sleep  quality  after  traumatic  brain  injury  in  injured  workers   and  outcomes  at  the  Toronto  Rehabilitation  Institute,  which  builds  upon  her  previous  work  as  a   disability  manager.    She  has  developed  a  screening  battery  based  on  a  systematic  review  of  the   literature,  which  has  been  adopted  by  clinicians  in  clinical  practice.    Tatyana  is  supervised  by  Dr.   Angela  Colantonio.

COMMUNICATION TEAM Namita  Multani Namita  Multani  is  now  a  Master’s  student  having  also  completed  her   undergraduate  degree  working  with  the  Communication  Team.  Namita  is   responsible  for  the  development  and  testing  of  a  new  paradigm  to  assess  the   ability  of  patients  with  Alzheimer  disease  to  process  emotion  in  spoken   language  in  both  verbal  (lexical)  and  intonation  (tone  of  voice)  dimensions.   Very  hard-­‐working  with  a  good  grasp  of  the  complexities  and  challenges   involved  in  doing  behavioural  research  with  patients,  she  has  consistently   demonstrated  a  strong  work  ethic,  scientific  curiosity,  attention  to  detail,  respect  for  persons   and  their  privacy,  a  high  level  of  organization  and  a  creative  mind,  working  around  challenging   problems  while  conducting  the  various  studies  she  was  involved  in.    In  addition,  she  has  signed   up  for  an  observer  internship  at  the  Memory  Clinic  at  TWH  to  improve  her  understanding  of  the   clinical  issues  working  with  these  patients.  She  understands  the  relevance  of  research  to  build   the  foundations  of  clinical  care.  Namita  is  supervised  by  Dr.  Pascal  van  Lieshout.




MOBILITY TEAM Liz  Inness Liz  Inness  has  been  a  leader  for  many  years  in  the  area  of  clinical  research   related  to  balance  and  mobility.    She  was  one  of  the  co-­‐developers  of  the   Community  Balance  and  Mobility  Scale  and  she  developed  and  now  co-­‐leads   the  Balance,  Mobility  and  Falls  Clinic  at  Toronto  Rehab.    Liz  began  her  doctoral   studies  within  the  last  2  years  in  the  Graduate  Department  of  Rehabilitation   Sciences,  University  of  Toronto.    Liz  already  has  an  impressive  CV  with  many   peer-­‐reviewed  papers,  presentations  and  abstracts  to  her  name  and  she  also   holds  peer-­‐reviewed  grant  funding  to  support  her  work.  In  recognition  she  was   recently  awarded  a  CIHR  Doctoral  Fellowship  to  support  her  graduate  studies.     Liz  is  supervised  by  Dr.  William  McIlroy.  

NEURAL ENGINEERING  &  THERAPEUTICS  TEAM Takashi  Yoshida Takashi  Yoshida’s  MHSc  studies  involved  a  project  to  integrate  the  tilt  table,   stepper  and  functional  electrical  stimulation  intervention  for  the  purpose  of   improving  blood  pressure  regulation  in  sub-­‐acute  spinal  cord  injured  (SCI)   individuals.  This  was  an  extremely  challenging  project  and  Takashi  was  the   first  person  in  the  world  to  successfully  design  the  system,  and  test  it  on  12+   SCI  patients.  A  few  centres  in  the  world  tried  to  accomplish  this  task  before,   but  failed  and  all  were  unsuccessful.  The  results  of  Takashi’s  project  are  presently  being  reviewed   for  publication  in  IEEE  Transaction  on  Neural  Systems  and  Rehabilitation  Engineering,  the  most   prestigious  journal  in  the  rehabilitation  engineering  field.  Takashi  also  partnered  with  Dr.  Albert   Vette  and  they  jointly  published  two  journal  publication  in  the  journal  Medical  Engineering  and   Physics.  It  is  very  unusual  that  a  master  student  produces  3  journal  publications  during  his   tenure.  Currently,  Takashi  is  engaged  in  a  PhD  program.  He  is  examining  brain  activity  during   walking  in  Parkinson’s  patients.  In  particular,  he  will  be  recording  brain  activity  from  the   implanted  electrodes  in  the  subthalamic  nucleus  of  the  brain  to  examine  the  involvement  of  this   neuronal  centre  in  the  control  of  balance  and  locomotion.    Takashi  is  supervised  by  Dr.    Milos     Popovic.




OPTIMIZATION OF  THE  REHAB  SYSTEM  TEAM Sara  Guilcher Sara  has  been  an  active  doctoral  student  over  the  past  6  years.  In  November   2012,  she  will  graduate  with  her  Doctorate  in  Philosophy  within  the  Clinical   Epidemiology  program.  Sara  also  completed  two  collaborative  programs   during  her  doctoral  training,  the  Ontario  Training  Collaborative  Program  in   Health  Services  and  Policy  Research,  as  well  as  the  Collaborative  Program  in   Women's  Health.    During  her  training  Sara  has  published  14  peer-­‐reviewed   papers  (6  first  author),  been  an  active  co-­‐investigator  on  6  grants,  and  received   6  awards  for  her  various  works  in  both  the  provincial  and  national  setting.    In  recognition  of  these   efforts,  Sara  has  also  received  numerous  scholarships  throughout  her  PhD,  such  as  a  Canadian   Institute  for  Health  Research  fellowship  for  health  care  professionals.  Sara’s  productivity  is  a   reflection  of  her  dedication  to  interdisciplinary  collaboration.  Sara  has  worked  with  several  Team   Optimize  members  including  Dr.  Susan  Jaglal,  Dr.  Cheryl  Cott,  Dr.  Nancy  Salbach  and  Dr.  Walter   Wodchis.  Sara’s  work  is  not  only  recognized  by  her  academic  peers,  but  also  valued  by  other  key   stakeholders  such  as  consumers,  clinicians  and  policy-­‐makers.  Her  research  aims  to  minimize   health  equity  gaps  for  persons  with  complex  conditions  and  disabilities.    Sara  is  supervised  by  Dr.   Susan  Jaglal.

SLEEP &  UPPER  AIRWAY  TEAM Hisham  Alshaer Hisham  Alshaer  is  a  PhD  student  doing  extraordinary  work  developing  a   portable,  cordless  battery  operated  device  for  home  sleep  apnea  diagnosis.  He   has  developed  software  to  identify  and  score  apneas  from  breath  sound   recordings  during  sleep.  He  has  also  worked  with  Toronto  Rehab  engineers   and  researchers  from  Technology  Team  to  develop  the  portable  device   and  has  validated  its  accuracy  for  diagnosing  sleep  apnea  against  gold   standard  polysomnography.  From  this  he  has  published  4  papers  with  2  more   accepted,  and  has  filed  4  patent  applications.  He  has  been  instrumental  in   ! working  with  MaRS  Innovation  to  create  a  company,  ApneaDx,   to  commercialize  the  device.    Hisham  is  supervised  by  Dr.  Douglas  Bradley.




SLEEP &  UPPER  AIRWAY  TEAM Sonja  Molfenter Sonja  is  in  the  final  year  of  her  PhD  work  and  has  been  exceptionally   productive.    She  has  published  or  submitted  5  peer-­‐reviewed  manuscripts   related  to  her  dissertation  research  this  year.    Additionally,  she  has  embarked   upon  a  new  area  of  collaborative  research  arising  from  her  PhD,  this  time  with   colleagues  in  Germany.    This  work,  which  will  enable  much  more  precise   measurement  of  swallowing  impairment  following  cervical  spine  surgery  is   novel  and  will  form  the  focus  of  Sonja’s  postdoctoral  work  beginning  in  2013.     She  has  already  done  proof-­‐of-­‐principle  work  to  demonstrate  the  utility  and   feasibility  of  this  work.    Sonja  is  attracting  attention  and  recognition  from  leaders  in  the  field,   and  her  publications  are  being  heavily  cited,  both  in  the  research  literature  and  in  workshops  and   presentations  addressing  best  practices  for  clinicians.    Sonja  is  supervised  by  Dr.  Catriona  Steele.

TECHNOLOGY TEAM Emily  King Emily  is  a  Mechanical  Engineering  PhD  candidate.    Her  project  focuses  on   understanding  the  risk  of  injury  to  homecare  workers  due  to  bathing  and   toileting  activities.  Her  goal  is  to  identify  the  most  dangerous  phases  of  these   activities  to  find  ways  of  reducing  the  risk  of  injury  to  these  workers.    Emily   has  managed  to  balance  the  demands  of  her  PhD,  along  with  taking  on  the   role  of  coordinating  the  broader  set  of  our  HomeCare  projects.  She  is  in   charge  of  arranging  home  visits  for  members  of  our  team  to  go  out  into  the   community  to  better  understand  the  challenges  faced  by  caregivers  and  people  living  with   disabilities.  She  plays  an  important  role  in  identifying  opportunities  to  develop  new  technologies   to  address  problems  identified  by  the  team.  For  instance,  Emily  has  been  instrumental  in  the   final  phases  of  commercialization  of  two  products:  the  Home  Mobility  Kit  and  SlingSerter,  both   of  which  are  planned  for  release  in  the  coming  year.  In  fact,  SlingSerter  was  the  result  of  a   project  Emily  completed  as  an  undergraduate  student  and  she  is  one  of  the  inventors  of  this   device.  Emily  displays  a  remarkable  willingness  to  help  others  on  the  team,  which,  when   combined  with  her  work  ethic,  creativity  and  sense  of  humor,  embodies  excellence  and  sets  an   example  for  the  rest  of  the  team.  Emily  is  supervised  by  Dr.  Geoff  Fernie.  



TD GRANTS IN MEDICAL EXCELLENCE: Scholarship In Rehabilitation-Related Research for Graduate Students with Disabilities Believed to  be  the  first  of  its  kind  in  Canada,  the  TD  GRANTS  IN  MEDICAL  EXCELLENCE:   Scholarship  in  Rehabilitation-­‐Related  Research  for  Graduate  Students  with  Disabilities  acts   as  a  spur  to  involving  people  with  disabilities  in  rehabilitation-­‐related  research.  Scientists  with   disabilities  understand  both  the  needs  and  opportunities  that  exist  in  science  and  technology.   Their  unique  knowledge  and  perspectives  enrich  research. The  scholarship  bestows  awards  of  $20,000  to  exemplary  masters  and  doctoral  students  to   assist  them  in  becoming  world-­‐class  scientists.  By  also  funding  special  educational  expenses   incurred  as  a  result  of  the  student’s  disability,  such  as  assistive  software  and  devices,  the   scholarship  levels  the  playing  field.  Toronto  Rehab  actively  works  with  the  scholars  to  support   their  academic  and  research  success  and  future  career  goals.   TD  Bank  Financial  Group  has  pledged  $750,000  to  the  program  since  2006.  With  TD  Bank’s   generous  support,  the  program  has  supported  14  scientists  with  disabilities  to  date.

The scholarship is “one notable exception to the dearth of Canadian programs working to improve the representation of persons with disabilities in science and technology sectors... Other Canadian institutions should follow the lead of Toronto Rehab and undertake initiatives that actively support students with disabilities in science and technology fields while helping to raise the profile of young scientists.” - National Educational Association of Disabled Students. Success in STEM: Studying and Pursuing a Science or Technology Career as a Post-Secondary Student with a Disability, 2010.

Toronto Rehab  and  TD  Bank  Financial  Group  are  proud  to  announce  the  2012/13  scholarship   recipients:  Stefania  Moro,  Ivan  Solano  and  Meagan  Warnica.



TD GRANTS IN MEDICAL EXCELLENCE: Scholarship In Rehabilitation-Related Research for Graduate Students with Disabilities Stefania Moro Highly  motivated  and  committed,  Stefania  Moro  is  the  first  to  study  auditory   and  visual  processing  in  a  rare  group  of  patients  who  have  had  one  eye   surgically  removed  at  a  young  age  due  to  cancer.  Her  research  addresses   cross-­‐modal  plasticity  or  how  people  with  one  eye  adapt  to  the  loss  of   binocularity.  Her  findings  suggest  that  those  experiencing  the  loss  of  an  eye  in   early  life  may  be  able  to  compensate  for  their  visual  loss  by  using  both  their   remaining  eye  and  other  senses.  Stefania  believes  that,  with  training,  people   with  a  sensory  deficit  can  adapt,  resulting  in  rich  perceptual  experiences  and  less  stress  on  their   remaining  senses.  Stefania  appreciates  firsthand  the  importance  of  a  typically  developing  visual   system,  and  of  achieving  a  normal  sensory  experience  throughout  life.  As  a  child,  she  suffered  a   traumatic  injury  to  her  left  eye.   Stefania  completed  her  Master's  degree  with  support  from  the  scholarship.  She  has  now  entered   the  first  year  of  her  PhD  in  Psychology  at  York  University.  While  conducting  her  cutting  edge   research  at  the  Perceptual  Neuroscience  Laboratory  at  the  Centre  for  Vision  Research,  Stefania   published  her  research  in  Experimental  Brain  Research,  and  co-­‐authored  a  book  chapter,  “Living   with  one  eye:  Plasticity  in  visual  and  auditory  systems”,  in  Plasticity  in  Sensory  Systems.  She  has   also  presented  her  findings  at  the  highly  prestigious  international  conference  of  the  Vision   Sciences  Society,  as  well  as  at  the  International  Multisensory  Research  Forum,  the  International   Conference  on  Plastic  Vision,  and  the  Society  for  Neuroscience.

Ivan Solano After  training  at  the  top-­‐ranked  University  of  the  Philippines,  Ivan  Solano   began  his  career  as  a  physiotherapist.  While  assisting  patients  strengthen   muscles,  improve  balance  and  return  to  walking,  he  realized  the  importance  of   the  built  environment  and  assistive  devices  in  helping  people  with  disabilities   attain  their  goals.  His  focus  became  environmental  design  and  assistive   technology.  Ivan  pursued  a  Masters  in  Design  and  Ergonomics  at  Japan’s   Kyushu  University,  researching  wheelchair  propulsion  on  ramps.  Currently  a  PhD  candidate  in   University  of  Toronto’s  Graduate  Department  of  Rehabilitation  Science,  Ivan  is  investigating  the   use  of  rollators  on  ramps  among  the  elderly,  and  the  role  of  the  upper  extremities  in  maintaining   balance  and  mobility. Ivan  has  previously  been  awarded  the  Ontario  Graduate  Scholarship,  and  several  competitive   international  academic  awards,  including  the  prestigious  Panasonic  Scholarship  Award  (Japan),   which  is  awarded  to  a  very  select  group  of  young  academics  in  Asia. RESEARCH DAY 2012


TD GRANTS IN MEDICAL EXCELLENCE: Scholarship In Rehabilitation-Related Research for Graduate Students with Disabilities Ivan has  a  working  memory  deficit,  a  form  of  a  learning  disability,  which  affects  processing  and   recall  of  information.  He  strongly  believes  that  despite  the  challenges  that  people  with   disabilities  face,  they  can  achieve  and  use  their  personal  understanding  for  the  benefit  of   humanity  in  creating  more  inclusive  and  usable  environments.  An  active  volunteer,  Ivan  serves  as   a  role  model  for  people  with  learning  and  other  disabilities.  

Meagan Warnica Meagan  recently  graduated  with  a  BSc  (Hons)  in  Kinesiology.  She  completed   her  thesis  on  the  “Influence  of  Ankle  Stiffness  on  Balance  Control  Mechanisms   during  Quiet  Stance”.    Meagan  was  awarded  the  Dean’s  Entrance  Scholarship   from  the  University  of  Waterloo  where  she  will  begin  her  Master’s  of  Science   in  Biomechanics  with  an  Ontario  Graduate  Scholarship  in  addition  to  a   scholarship  through  TD  Grants  in  Medical  Excellence.  Her  graduate  research   will  focus  on  experimental,  mechanical,  and  mathematical  modelling  of  the   biomechanical  effectiveness  of  novel  compliant  flooring  across  three  body   parts  (head,  hip  and  wrist).  The  effectiveness  of  this  compliant  flooring  as  an  injury  prevention   technique  is  being  investigated  to  reduce  the  frequency  of  fall-­‐related  injuries.    

In 2005  Meagan  was  a  passenger  in  a  motor  vehicle  collision,  which  resulted  in  chronic  low  back   pain  and  a  traumatic  brain  injury.  The  experience  gave  her  a  greater  understanding  of  how   injuries  and  disability  can  affect  quality  of  life  and  contributed  to  her  research  interests  in  injury   prevention.  An  insightful  student  with  a  long-­‐term  commitment  to  excellence  and  challenging   academic  pursuits,  she  has  already  presented  her  findings  at  the  Ontario  Biomechanics   Conference,  and  is  excited  to  be  able  to  apply  her  knowledge  to  injury  and  rehabilitation  science.



TD congratulates recipients of this year’s scholarships. We are working together with the Toronto Rehab Foundation to make a difference in our communities.

M04198 (0610)


Sleep & Upper Airway Abstracts 1 – 5

Page 11 – 13

Cardiopulmonary Fitness Abstracts 6 – 14

Page 14 – 18

Neural Engineering & Therapeutics Abstracts 15 – 33

Page 19 – 28

Artificial Intelligence & Robotics in Rehab Abstracts 34 – 43

Page 29 – 33

Cognition Abstracts 44 - 60

Page 34 – 42

Optimization of the Rehabilitation System Abstracts 61 – 71

Page 43 – 47

Communication Abstracts 72 – 91

Page 48 – 57

Technology Abstracts 92 – 103

Page 58 – 63

Mobility Abstracts 104 – 117

Page 64 – 70




Relationship between Non-Invasive Measures of Pharyngeal Size and Hyoid Excursion

A Yadollahi1,2, SM Molfenter1,2, CM Steele1,2,3 1 Toronto Rehabilitation Institute; 2 University of Toronto; 3 Bloorview Research Institute

Introduction: Recent videofluoroscopic (VFS) evidence suggests that peak hyoid position varies with a person’s height. Acoustic pharyngometry (AP) is a non-invasive tool, which uses acoustic reflection to measure upper airway cross-sectional area (UA-XSA) and length. The aim of this study was to verify whether measures of upper airway morphology on AP correlate with hyolaryngeal excursion on VFS. Method: Nine healthy young adults (5 females) completed height measurements, VFS (3X5ml swallows of ultrathin barium) and AP (4 breathing tasks: oral, nasal, ‘silent /o/’ controlled expiration). VFS measures included: maximum X, Y and XY hyoid positions, pharyngeal area, C2-C4 length. Task-averaged AP measures included: length-to-velum (LV), length-to-glottis (LG), oropharyngeal length (LOP= LG - LV), UA-XSA and UA volume (UAV). Correlations between VFS and AP measures were explored using an a priori cut-point for reporting established at r>=0.3. Results: Participant height was correlated with Max X (r=0.6) and Max XY (r=0.56) hyoid position (but not Max Y). All AP UA morphology measures were correlated with participant height. LOP was correlated with both pharyngeal area (r=0.54) and C2-4 length (r=0.31). Correlations were observed between all AP UA morphology measures and Max X and Max XY hyoid position. Conclusion: Acoustic pharyngometry of upper airway morphology capture differences in participant size, including pharyngeal lumen size. These measures are correlated with hyoid displacement. AP may be a useful noninvasive tool for monitoring pharyngeal changes that may impact swallowing function. Explorations in populations with post-surgical pharyngeal narrowing are particularly warranted. 2. Non-Invasive investigation of fluid redistribution in various body segments between sexes A Yadollahi1,2, PJ Millar3, JS Floras3,4, TD Bradley2,4 1 University of Toronto, Institute of Biomaterial and Biomedical Engineering; 2 Toronto Rehabilitation Institute; 3 Toronto General Hospital; 4 University of Toronto, Department of Medicine

Introduction: Obstructive sleep apnea (OSA) is more common in men than in women, but the underlying reasons are not fully understood. Recently, we have shown that rostral fluid shift from the legs to the neck is significantly related to the severity of OSA in men, but not women. Therefore, we hypothesized that in women, a larger proportion of the fluid displaced from the legs while supine may be sequestered below the neck, contributing to the reduced risk of developing OSA. Method: The study involved 31 healthy volunteers (11 women), age of 40.5±10.6 years. Subjects rested in the supine position for 30 minutes with no other interventions. During this time, we simultaneously recorded the fluid volumes in the right leg, abdomen, thorax and neck (LFV, AFV, TFV and NFV) using bioimpedance. Linear models with repeated measurements were fitted to the segmental fluid volumes to compare the effect of sex over time. Results: There were no significant differences between sexes in the amount of fluid shifted out of the legs after 30 min (p=0.36) nor the slope of change in LFV over time (p=0.42). However, although women did not accumulate significantly more fluid in their abdomen after 30 min than men (p=0.31), the slope of the increase in AFV was greater in women (F/M: 0.0032/0.0014, p=0.14). Consequently, there were smaller increases in both TFV and NFV in women than in men after 30 min (TFV: p=0.02, NFV: p=0.02). Also the slopes of increases in TFV and NFV were significantly smaller in women than in men (TFV: F/M: 0.044/0.065, p<0.0001; NFV: F/M: 0.0070/0.0094, p=0.009). Conclusion: Our results suggest that men and women have different patterns of fluid redistribution to various body segments when lying supine. In particular, men accumulate more fluid in their chest and neck than women. This may help to explain why women are less susceptible to OSA than men in response to nocturnal fluid shifts during sleep since less of this fluid accumulates in their necks.




3. Functionality, Usability, and Initial Results of a Home Monitoring Device of Sleep Apnea H Alshaer2,3,4, AI Levchenko3, TD Bradley2,5, S Pong3, WH Tseng2, GR Fernie1 1 Toronto Rehabilitation Institute; 2 Toronto Rehabilitation Institute, Sleep Research Laboratory; 3 Toronto Rehabilitation Institute, Technology Team; 4 University of Toronto, Institute of Biomaterials and Biomedical Engineering; 5 University of Toronto, Faculty of Medicine

Introduction: Sleep apnea (SA) is very under-diagnosed, partially because of the high cost and limited accessibility of in-laboratory polysomnography (PSG). The currently available portable devices suffer from low accuracy or from high failure rates in un-attended home settings. The purpose of this work is to introduce a newly developed portable system for the diagnosis of SA at home that is both reliable and easy to use. Methods: Toronto Rehab researchers designed a personal device for recording breath sounds and airflow during sleep and diagnostic algorithms to process the recorded data. The device consists of a wearable face frame with an embedded electronic module, with no external electrodes. The device provides continuous data capturing for eight hours. Subjects used the device independently at home, after which they answered a usability questionnaire. A subset of subjects used the device on two different nights and their results were compared to examine diagnostic reproducibility. Results: Fifty subjects were recruited in which the overall success rate of applying the device in un-attended settings was 94% and the ease-of-use rating excellent. Ten of the 12 (83%) subjects who had two-night recordings had equivalent results on both nights. Their scores ranged from 0 to 81 apnea and hypopneas per hour. Conclusion: Our results suggest excellent usability and performance of this system for home diagnosis of sleep apnea.

4. Timing differences between cued and non-cued swallows in healthy adults A Nagy1, C Leigh1, S Hori1, S M Molfenter1,3, T Shariff1, C M Steele1,2,3 1 Toronto Rehabilitation Institute; 2 Bloorview Research Institute; 3 University of Toronto

Purpose: Videofluoroscopic swallowing assessment involves measurement of several timing parameters: Stage transition duration (STD), bolus location at swallow onset (BLSO), and pharyngeal transit time (PTT). The aim of our study was to replicate and extend a prior study by Daniels et al. (2007), suggesting that timing differences in these parameters might vary for thin liquid swallows depending on procedural instructions, i.e., between cued and non-cued conditions Methods: 10cc boluses of ultrathin barium were swallowed by 20 healthy adults (10 women; mean age 31 years) in videofluoroscopy. The cued condition was to hold the bolus orally for 5 seconds before swallowing. Three non-cued swallows were recorded. Timing measures (STD, BLOS and PTT) were extracted. Results: BLOS in the pyriform sinuses was significantly less frequent and significantly shorter STDs were seen in the cued condition (p < 0.05). Interestingly, PTTs were significantly longer in the cued condition. Conclusion: Our study in healthy young adults confirms findings previously observed by Daniels in older adults. Timing measures in swallowing differ between cued and non-cued conditions. In particular, swallow onset is prolonged with further bolus advancement in non-cued conditions. These differences should not be mistaken for impairment in swallow onset timing.




5. Evaluation of the Magnetic Field Strength Exerted by the Electromagnetic Articulograph (EMA) AG501 R Yue1,2, M Peladeau-Pigeon1, C Lau2, P van Lieshout1,2, C Steele1,2,3 1 Toronto Rehabilitation Institute; 2 University of Toronto; 3 Bloorview Research Institute

Traditionally, movement of the tongue has been studied using techniques such as x-ray, and more recently, MRI and ultrasound. Although articulography has been around for quite some time, there has been a recent release of the electromagnetic articulograph AG501 capable of tracking movement of marker points in 3D over time. Exposure to the electromagnetic field, however, could potentially lead to health concerns. An evaluation of the safety of the AG501 system was necessary to ensure that experiments performed do not pose a risk to participants and investigators. An oscilloscope wand was used and voltage measurements were recorded. The range of locations investigated approximated the size an adultâ&#x20AC;&#x2122;s head and the exact positions were determined using the transmitter coils attached to the wand. The magnetic field strength was calculated using the voltage measured and the frequencies of the transmission coils. This protocol was conducted on the AG501 prototype and the commercial version. The magnetic field strength was between 0.003A/m to 0.077A/m for the prototype and 0.007A/m to 0.056A/m for the commercial version. The observed field strength is well below the admissible exposure limit from Health Canada of 2.19A/m suggesting that the device is safe to use in studies.



ABSTRACTS 6 â&#x20AC;&#x201C; 14

6. Poorer sleep quality is associated with worse cognitive performance in patients with coronary artery disease M Saleem1,2, N Herrmann1,2, W Swardfager1,2,3, PI Oh3, KL Lanctot1,2,3 1 University of Toronto; 2 Sunnybrook Health Sciences Centre; 3 Toronto Rehabilitation Institute

Background: Sleep disturbances are associated with an increased risk of coronary artery disease (CAD) and cognitive dysfunction. However, the association between sleep quality and cognitive function in CAD is unknown. Objective: To assess sleep quality as a predictor of cognitive performance in CAD patients. Methods: CAD patients were interviewed at entry into a 1-year cardiac rehabilitation program with the Mini-Mental State Examination (MMSE; global cognitive performance) and the Pittsburgh Sleep Quality Index (PSQI; sleep quality). Linear regression analyses were used to assess sleep quality as a predictor of overall cognitive performance. Results: In CAD patients, (n=59, mean (SD) age 67 (6) years, 85% male), higher global PSQI scores significantly predicted lower MMSE scores controlling for age, gender and sleep apnea (β=-0.44, p=0.001). Upon further exploration, MMSE scores were significantly lower with poorer sleep latency (F1,52=5.82, p=0.002) and habitual sleep efficiency (F1,52=3.88, p=0.014) PSQI component scores. Conclusion: Poorer sleep quality, particularly sleep latency and sleep efficiency were predictive of worse cognitive performance in patients with CAD. Given the known influence of exercise on sleep quality, these findings suggest a need to further explore the relationship between sleep quality and cognitive function following exercise in CAD patients.

7. Platelet Activating Factors Predict Change In Depressive Symptoms In Coronary Artery Disease Patients Over 12 Weeks Of Cardiac Rehabilitation G Mazereeuw1,2,5, N Herrmann1,2, SAL Bennett4,5, H Xu4,5, PI Oh1,2,3, KL Lanctot1,2,3,5 1 Sunnybrook Health Sciences Centre; 2 University of Toronto; 3 Toronto Rehabilitation Institute; 4 University of Ottawa; 5 CIHR Training Program in Neurodegenerative Lipidomics

Background: Platelet activating factors (PAFs) are inflammatory phospholipids associated with coronary artery disease (CAD) and leading mechanisms underlying depression including inflammation, endothelial dysfunction, and platelet reactivity. PC(O-16:0/2:0) is a potent PAF and can be neurodegenerative. Here, we investigate PC(O-16:0/2:0) as a novel biomarker of depressive symptoms in CAD. Methods: 20 CAD patients were recruited from the Toronto Rehabilitation Institute cardiac program (CR). Depression was diagnosed using DSM-IV criteria. Depression severity was assessed at baseline and week-12 using the 17-item Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI)-II. Plasma PAF concentrations were measured at baseline and week-12 using electrospray ionization mass spectrometry.Results: 18 patients completed the study and attended at least 80% of the CR sessions (16 male, aged 59.9 +/- 9.6). An association between greater PC(O-16:0/2:0) at baseline and improvement in depressive symptoms over 12-weeks was observed using both the HAMD (Rho= -0.540, p=0.025) and the BDI-II (-0.642, p=0.005). A similar association was present between the lyso-PAF [PC(O-16:0/0:0)] and depressive symptoms on the HAMD (-0.482, p=0.050) and the BDI-II (-0.507, p=0.038). Conclusions: These preliminary data support the investigation of PAFs as novel biomarkers of depressive symptoms in CAD patients. Future studies with a larger sample size are warranted.




8. Efficacy of a stress reduction program for cardiac and non-cardiac medical conditions – A Pilot Study G Dashi1,2, L Finkler2,3, P Oh2, D Alter2,4, J Reitav2 1 University of Toronto; 2 Toronto Rehabilitation Institute; 3 York University; 4 Institute for Clinical Evaluative Sciences

Background: Cardiac rehabilitation programs reduce morbidity and mortality, but it is not clear how. One explanation may be improvement of psychiatric symptoms, like distress. Reductions in distress, achieved through Stress Reduction Programs (SRPs), are correlated with less: depression, anxiety, insomnia, recurrence of MIs, and mortality from MIs. Are SRPs equally effective in cardiac and non­ cardiac patients? If they are, we may be able to explain and enhance the benefits of cardiac rehabilitation programs. Objectives: We examined whether SRP outcomes differed between uncomplicated cardiac (MI) and non-cardiac patients with single or multiple medical conditions (SMC and MMC, respectively). Methods: Patients participated in a 7-week, skill-based SRP containing weekly classes and daily practise. We compared self-reported psychiatric symptoms at the start and end of the SRP to assess the efficacy of the program. Results: All patient populations experienced reduced distress, depression, and anxiety. Reductions in distress represented a 30% decrease in mortality hazard ratio. Presence of insomnia may also be an important factor. Conclusion: SRP can lead to significant and comparable improvements of psychiatric symptoms in cardiac and non-cardiac patients. These improvements may be a mechanism by which cardiac rehabilitation programs improve survival. If so, cardiac rehabilitation programs should consistently offer SRPs.


The Prevalence of ADHD and its Impact Among Cardiac Rehabilitation Patients: A Pilot Study.

L Finkler1, G Dashi2, P Oh3, D Alter3, J Reitav3 1 York University, Glendon College; 2 University of Toronto; 3 Institute for Evaluative Clinical Sciences; 4 Toronto Rehabilitation Institute

Background and Aims: It has been proven that psychological treatment such as a Stress Reduction Program (SRP) combined with usual care reduces mortality in the first two years post cardiac event for some patients, and improves quality of life. Adult ADHD is commonly undiagnosed in the CR context, and adults with this disorder are more vulnerable to distress, anxiety and depression. The goals of this study are: 1) evaluate the prevalence of ADHD among patients enrolling in an SRP, and 2) to examine whether the presence of ADHD impacts the outcomes achieved by these patients. Methods: The participants of this study were those who enrolled in TRI’s SRP. All 106 of these patients were screened for adult ADHD using the World Health Organization (WHO) Adult ADHD Self Report Scale. Dependent measures included validated measures of anxiety, depression, insomnia and stress. Results: Results showed that 47% of the patients enrolling for SRP screened positively for adult ADHD. Four separate 2 (ADHD or non-ADHD) x 2 (Pre-Training and Post-Training) mixed measures ANOVAs were conducted. The main effect of SRP training was significant for distress, anxiety, depression and insomnia. The main effect of ADHD was significant only for measures of anxiety and insomnia. No interactions were statistically significant. Conclusion: These results confirm that SRP successfully reduces levels of stress, anxiety, insomnia and depression for TRI’s SRP participants. ADHD in CR should be investigated further to determine its true impact on CR patients’ outcomes in SRPs.




10. Identification of Educational Learning Needs of Cardiac Rehabilitation Patients and Health Providers GLM Ghisi1,2, SL Grace2,3, S Thomas1, M Evans4, P Oh1,2 1 University of Toronto, Faculty of Kinesiology and Physical Education, Exercise Sciences Graduate Department; 2 Toronto Rehabilitation Institute, Cardiac Rehabilitation and Prevention Program; 3 York University, School of Kinesiology and Health Science; 4 St Michael’s Hospital, Health Design Lab

Objective: to identify educational learning needs of cardiac rehabilitation (CR) patients and health providers. Methods: Two CR samples consisting of 306 patients and 28 health providers completed the Educational Needs Assessment Questionnaire (ENCR). Participants were also asked to inform their preferences for educational delivery formats. Pearson’s chi-square, t-tests and ANOVAs were used for data analysis, when applicable. Mann-Whitney U tests were used to compare needs between samples. Results: The mean total CRBS for the whole sample was 4.38±0.44. Health providers respondents reported significantly greater needs than patients overall. For 34 of 60 items, health providers’ respondents reported significantly greater barriers than their patients. However, both patients and health providers generally reported items as “important” to learn. The areas that presented the highest scores were medication, emergency/safety, and diagnosis and treatment for patients, and stress/psychological factors, emergency/safety, and risk factors for health providers. Books, lectures and discussion during consultation were identified as the preferred choices of learning by both groups. Conclusion: The findings from this study support previously studies suggesting that health providers have higher and different educational needs compared to patients. Therefore, CR patients seem to be aware of the importance of educational items presented at the ENCR. 11. The relationship between very long chain plasma ceramides and anxiety in coronary artery disease. R Rovinski1,2, M Saleem1,2, WL Swardfager1,3, PI Oh1,3, N Herrmann1,2, KL Lanctot1,2,3 1 Sunnybrook Research Institute, Neuropsychopharmacology Research Group; 2 University of Toronto; 3 Toronto Rehabilitation Institute

Purpose: Anxiety is highly prevalent in coronary artery disease (CAD), is associated with cardiovascular risk factors, and predicts poorer outcomes. Very long chain ceramides have been implicated in the development of cardiovascular disease and neurodegenerative processes previously linked to mood and anxiety disorders. This study assesses very long chain plasma ceramide concentrations as correlates of anxiety in patients with CAD. Methods: Patients with CAD were interviewed prior to beginning cardiac rehabilitation. Trait anxiety was assessed using the Spielberger State-Trait Anxiety Inventory (STAI). Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Plasma ceramide concentrations were measured by ESI-MS/MS. Linear regression analyses were conducted to investigate cross-sectional relationships between C22:0 and C24:0 ceramide concentrations and trait anxiety. Results: In CAD (n=30, mean age=62±9 years, 86.6% male), C22:0 and C24:0 concentrations showed non­ significant trends with trait anxiety (β = 0.316, p=0.092; β = 0.340, p=0.068) controlling for gender and BMI. Controlling for depression still yielded trends between ceramide concentrations and trait anxiety [C22:0 (β = 0.165, p=0.165); C24:0 (β = 0.177, p=0.163)]. Conclusions: Higher plasma C22:0 and C24:0 ceramide may be associated with more severe trait anxiety. A larger sample is necessary for further investigation.




12. Higher plasma ceramide concentrations are associated with lower hippocampal thickness in patients with coronary artery disease C Santiago1,2, N Herrmann1,2, W Swardfager1,2,3, M Saleem1,2, M Mielke4, N Haughey5, PI Oh3, KL Lanctot1,2,3 1 Sunnybrook Health Sciences Centre; 2 University of Toronto; 3 Toronto Rehabilitation Institute; 4 Mayo Clinic Rochester; 5 Johns Hopkins University School of Medicine

Coronary artery disease (CAD) is associated with increased hippocampal atrophy, a key marker of increased risk of cognitive decline. Higher concentrations of ceramide sphingolipids (C22:0 and C24:0) are associated with the development and progression of CAD but their relationship with hippocampal thickness has not been assessed in this population. CAD patients were recruited at entry into a one-year cardiac rehabilitation (CR) program. 3T structural MRI scans were acquired at baseline and medial temporal lobe thickness was measured using semi-automated procedures. Baseline plasma ceramide concentrations were measured using electrospray ionization-tandem mass spectrometry. Spearman rho correlations were used to determine the association between plasma ceramide concentrations and medial temporal lobe thickness. In CAD patients (n=9, mean age 64+/-7, 77.8% male), trends were observed between C22:0 (ρ=-0.62, p=0.07) and C24:0 (ρ=­ 0.56, p=0.11) concentrations and lower hippocampal thickness. There was a non-significant relationship found between higher baseline plasma ceramide concentrations and lower hippocampal thickness; however, results were limited due to a small sample size. These preliminary findings strongly warrant examining the possible role of ceramides in neurodegenerative processes. Additionally, neurodegeneration may be reversed in individuals undertaking exercise and future studies will determine the role of exercise in the relationship between ceramides and hippocampal atrophy.

13. Adherence to a Cardiac Rehabilitation Home Program Model of Care K Scane1,4, P Oh1, D Alter2,3,4, D Brooks4 1 Toronto Rehabilitation Institute; 2 Institute for Clinical Evaluative Sciences; 3 Sunnybrook Health Sciences Centre; 4 University of Toronto

Despite the benefits of cardiac rehabilitation (CR), adherence to programs remains suboptimal. To improve adherence, alternative models of care, such as using home programs (HP), have been recommended. Little information exists, however, about its effect on adherence in real-world settings. The primary objective was to compare adherence of patients in a HP and traditional on-site program (TP) model of CR. The secondary objective was to compare clinical and demographic profiles at baseline and changes in cardiovascular fitness. We implemented a retrospective review of 200 consecutively enrolled patients who chose either a TP or HP model. Adherence, defined as attendance to prescheduled contacts or on-site visits in each respective cohort, served as a primary outcome measure. Secondary outcomes included completion of program and cardiopulmonary fitness levels at 6 months. The HP cohort had patients who were significantly younger, had more males, were more geographically removed from the on-site centre, were employed, and had greater cardiopulmonary fitness at initiation. Similar mean attendance (p = 0.21) and completion rates (p = 0.22) were seen between models. Both groups attained similar gains in cardiovascular fitness (p = 0.79). The HP shows to be a suitable option for patients who face barriers for TP-CR participation.




14. The relationship between cardiopulmonary fitness and hippocampal volume depends on the val66met BDNF genotype in patients with coronary artery disease W Swardfager1,2,3, N Herrmann1,2, SM Nestor1,2, M Saleem1,2, M Daigle4, PR Albert4, SE Black1,2,3, PI Oh1,2,3 & KL Lanctot1,2,3 1 Sunnybrook Research Institute; 2 University of Toronto; 3 Toronto Rehabilitation Institute; 4 Ottawa Hospital Research Institute (Neuroscience)

Coronary artery disease (CAD) is associated with smaller hippocampal volume and accelerated memory decline. Brain derived neurotrophic factor (BDNF) has been implicated in stimulating hippocampal neurogenesis and in the cognitive benefit of exercise. A polymorphism (val66met) in the BDNF gene impairs activity dependent BDNF release, resulting in partial loss of function, which may affect the relationship between fitness and hippocampal volume. Patients with CAD entering cardiac rehabilitation undertook a cardiopulmonary fitness assessment (VO2Peak) and the California Verbal Learning Test 2nd Ed.. BDNF genotype was determined from buccal cell samples. Magnetic resonance imaging was performed for automated hippocampal segmentation. Hippocampal volume was associated with VO2Peak in val/val subjects (ρ =.463, p=.023, n=24) but not in subjects carrying at least one copy of the met allele (ρ =-.150, p=.579, n=16). Delayed verbal recall was associated with VO2Peak (β=.244, p=.002, n=156), particularly in val/val subjects (β =.277, p=.004, n=104), but not met allele carriers (β=.143, p=.343, n=52). These results identify a differential relationship between fitness and hippocampal volume based on the val66met BDNF polymorphism in patients with CAD. A similar dissociation between fitness and verbal memory in met carriers suggests that these findings may be clinically significant.




15. Effects of the aquatic environment on the control of upright stance: a pilot study AR Marinho2,3, AM Barela4, ML Celestino4, MR Camargo4, MR Popovic2,3, MC Verrier1,2,3 1 University of Toronto, Department of Physical Therapy; 2 University of Toronto, Graduate Department of Rehabilitation Science; 3 Toronto Rehabilitation Institute; 4 University of Cruzeiro do Sul - Movement Analysis Laboratory, Sao Paulo, Brazil

Background: Upright stance control is essential for locomotor recovery after a spinal cord injury. We pioneered the investigation on how immersion in thermal water influences the control of standing compared to the performance on land. Methods: Seven female able-bodied volunteers stood on an AMTI-waterproof platform for 10 30-seconds trials, in water and on land. They remained stable without moving their feet with upper limbs crossed over the chest. Visual condition was pseudorandomly assigned to 10 trials: 5 with eyes closed (EC) and 5 with eyes opened (EO). COP (Center of Pressure) parameters were calculated: anterior-posterior and medial-lateral mean sway amplitude (MSAAP and MSAML), velocities (VAP and VML), and body sway area (BSA). Results: Age, height, body mass and percentage of body mass offloading of all participants ranged from 22 to 54 years, 151 to 167 cm, 55 to 70 kg, and 55% to 69%. Body sway expressed by MSAAP, MSAML, VAP, VML and BSA was higher in water than on land (p<0.0001). Participants oscillated more with EC than with EO (p<0.01), however, MSAML and VML were not affected by visual conditions. Conclusion: The aquatic environment differently challenges posture and could be valuable to stimulate upright stance control during functional recovery.

16. Associations Between Arterial Stiffness & Heart Disease Risk Factors In People with Chronic Spinal Cord Injury M Miyatani1, C Moore1,2, K Masani1,3, PI Oh4,5, MR Popovic1,3, BC Craven1,5 1 Toronto Rehabilitation Institute, Brain and Spinal Cord Program; 2 University of Waterloo, Department of Kinesiology; 3 University of Toronto, Institute of Biomaterials and Biomedical Engineering; 4 Toronto Rehabilitation Institute, Cardiac Rehabilitation and Secondary Prevention Program; 5 University of Toronto, Department of Medicine

Background: Aortic arterial stiffness assessed by pulse wave velocity (aPWV) is an independent predictor of heart disease. To date, the associations between aPWV and heart disease risk factors in people with chronic Spinal Cord Injury (SCI) are unknown. Objective: To explore the associations between aPWV and heart disease risk factors among people with SCI. Methods: Forty-one men and women with chronic SCI participated (C2-T12; AIS A-D; time post injury: 14.7 yrs; Age: 50.8 yrs; Height: 175.4cm; and Weight: 85. 1 kg). aPWV and heart disease risk factors were assessed. Heart disease risk factors included: Age, Gender, Smoking status, Family history, Waist circumference, % body fat, BMI, Triglycerides, HDL-Cholesterol, Total Cholesterol/HDL-Cholesterol, LDL-Cholesterol, Fasting glucose, C-reactive protein concentration, HbA1c, Blood pressure, and Cardiopulmonary fitness (Vo2peak). Correlation coefficients between aPWV and each risk factor were calculated. Results: There were high correlations between aPWV and age, Vo2peak (r=0.467and -0.426 respectively, p<0.01). Moderate correlations were found between aPWV and waist circumference, BMI, Triglyceride, and HbA1c (r=0.368, 0.371, 0.360, and 0.404 respectively, p<0.05). Conclusion: The correlation results imply that age and Vo2peak are primary predictors of aPWV. Further multivariate modeling with a larger sample is planned.




Exploring the Feasibility of Central Recruitment for Subacute SCI patients

BC Craven 1,2, LM Brisbois 1, MC Verrier 1,3,4. 1 Toronto Rehabilitation Institute; 2 University of Toronto, Department of Medicine; 3 University of Toronto, Department of Physical Therapy; 4 University of Toronto, Graduate Department of Rehabilitation Science

Background: Recruitment of subacute SCI patients is a common barrier to clinical study implementation. This initiative aims to streamline recruitment and consent processes, thereby reducing patient burden and maximizing research participation. Methods: The RN ensures the patient is suitable for research screening, based on fluency, health status, and interest. The central recruiter (CR) then serves as a single contact for information about ongoing research. The CR meets with the patient to determine their willingness to participate, conducts a chart audit to determine eligibility, and then discusses one or multiple studies with the patient. The CR completes the informed consent process(es). Results: During a 15-month period, 265/321 patients were deemed â&#x20AC;&#x2DC;suitableâ&#x20AC;&#x2122; for research by their RN. Eighty percent (211/265) of suitable patients consented to chart review to determine eligibility. Overall 65% of patients consented to participate in at least one study (192/302), 35% declined participation. Discussion: Overall RN screening and CR appears to reduce the burden of consent as: 1) study eligibility is addressed prior to meeting with patients; 2) the number of study coordinators approaching the patient is reduced; and 3) screening to recruitment ratios are higher. This process facilitates consistent accrual rates. Evaluation of CR process scalability is planned.


Can We Reliability Estimate Ischial Tissue Health?

S Gabison1,2, MC Verrier2, EN Nussbaum2 MR Popovic1, S Mathur3 1 Toronto Rehabilitation Institute, Rehabilitation Engineering Lab; 2 Toronto Rehabilitation Institute, SCI Mobility Lab; 3; University of Toronto, Department of Physical Therapy, Muscle Performance Lab

Purpose/Rationale: To quantify ischial tissue health using ultrasound (US) imaging, colorimetry, and skin temperature. Relevance: Changes in skeletal muscle and skin over the ischial tuberosity (IT) have been used to predict pressure ulcers (PUs) in spinal cord injury (SCI). To date, standardized assessment methods and standardized estimates of tissue health have not been developed. Furthermore, the reliability of US imaging, colorimetry, and skin temperature have not been established. Materials and Methods: Ten healthy individuals, mean age 42.8 years participated. US images, skin temperature, and redness were collected over the dominant IT in side lying, pre and post one hour of sitting. Thickness and percentage of skin, muscle, and subcutaneous tissue from US images were estimated using OSIRIX. Skin redness was quantified using Spectrophotometry. Analysis: Descriptive statistics and intra-class correlation (ICC) coefficients with confidence intervals were calculated. Results: Skin and muscle thickness and percentage of subcutaneous tissue can be reliability quantified in healthy individuals (ICC=0.88-0.94). Skin redness and skin temperature change following one hour of continuous sitting. Conclusion: While methodological challenges exist in establishing tissue health measures, reliability of quantifying tissue health is high, and can be used for comparisons with SCI populations who are at risk of developing PUs.




19. Associations Between Bone Density and Geometry and Prevalent Fractures Among Individuals with Spinal Cord Injury D Lala1,2, BC Craven2,3, L Thabane4, A Papaioannou5, JD Adach5, M Popovic2,6, L Giangregorio1,2 1 University of Waterloo, Department of Kinesiology; 2 Toronto Rehabilitation Institute; 3 University of Toronto, Department of Medicine; 4 McMaster University, Department of Clinical Epidemiology and Biostatistics; 5 McMaster University, Department of Medicine; 6 University of Toronto, Institute of Biomaterials and Biomedical Engineering

Among individuals with spinal cord injury (SCI), we examined whether indices of bone density and geometry can discriminate between those with or without fragility fracture. Participants with chronic SCI reported prior lower extremity fragility fractures since injury. Dual energy x-ray absorptiometry was used to measure distal femur (DF) and proximal tibia (PT) areal bone mineral density (aBMD). Peripheral quantitative computed tomography was used to measure trabecular volumetric BMD (TbvBMD), cortical thickness (CTh), buckling ratio (BR), cross-sectional and polar moments of inertia (CSMI, PMI). Logistic regression and univariate analyses were used to identify whether clinical characteristics or bone geometry variables were associated with fractures. Among 68 participants (mean age 49.2±11.4) with SCI (C2-L1, AIS A-D), those without fractures had better bone density and geometry compared to those with fractures. Every SD decrease in a BMD (DF: OR=0.19, 0.05­ 0.55; PT: OR=0.17, 0.04-0.50) and TbvBMD (OR = 0.14, 0.03-0.53) was associated with fracture prevalence (p<0.0001). After adjusting for aBMD and/or motor complete injury, the indices of bone geometry were no longer associated with fracture prevalence. Future studies should confirm which bone density and geometry variables best predict fracture risk. The current distal femur aBMD assessment practice is supported by these findings.

20. Cardiovascular Fitness Testing Considerations for Persons with Tetraplegia C Moore1,2, M Miyatani1, PI Oh3,4, BC Craven1,4 1 Toronto Rehabilitation Institute, Spinal Cord Rehabilitation Program; 2 University of Waterloo, Department of Kinesiology; 3 Toronto Rehabilitation Institute, Cardiac Rehabilitation and Secondary Prevention Program; 4 University of Toronto, Department of Medicine

Objective: To describe the challenges associated with implementing maximal exercise testing recommendations among adults with chronic tetraplegia. Design: Cross-sectional. Subjects/Patients: Twenty adult men and women with chronic tetraplegia (C3-C8, AIS A-D; time post injury 14.0±11.9 yrs; Age 53.7±11.0 yrs) Methods: Participants performed a maximal continuous ramp test via arm or leg ergometry to identify VO2peak. Work rate was increased at 30 kpm/min or 60 kpm/min for arm ergometry, and 100 kpm/min for leg ergometry at one minute intervals. Results: Fifteen participants (VO2peak 11.2±3.72 ml/kg/min; peak workload 219±156kpm, duration 5.1±2.0 min) completed arm (n=13) or leg (n=2) testing. Five participants did not complete the test due to insufficient hand strength (n=3) or shoulder pain (n=2). One participant achieved physiologic peak; arm/leg fatigue (n=11), general fatigue (n=1), dyspnea (n=1), and abdominal spasms (n=1) were reasons for early test termination. Conclusion: The benefits of maximal exercise testing can be attained in individuals with tetraplegia by customization of testing protocols. Recommended provisions include: 1) reduced work loads of <30kpm/min for arm and <100kpm/min for leg ergometry; 2) height adjustable ergometers; 3) grip adaptations and; 4) leg ergometry for those with LEMS >20.




Physical Activity Characteristics of Older Adults with Low Bone Mass

H Ng1, J Tung1, C Moore1, L Giangregorio1 1 University of Waterloo

Background Information: The Canadian Physical Activity Guidelines recommend ≥150 minutes/week of moderate- to vigorous-intensity physical activity (MVPA) and ≥2 days/week of muscle strengthening for older adults. Muscle strengthening and balance training may be best for maintaining bone mass or preventing falls. It is unknown whether individuals with osteoporosis meet the guidelines, particularly when it comes to muscle strengthening. Walking may supplant other types of exercise in older adults with low bone mass. Objectives: 1) To determine whether individuals with low bone mass achieve recommended levels of MVPA; and 2) to identify the activities they engage in. Methods: Adults aged ≥50 years with self-reported osteoporosis or osteopenia wore hip accelerometers during waking hours for 4 days, and completed daily activity logs. MVPA was calculated by summing minutes exceeding 1952 counts/min and extrapolated to provide weekly rates. Resistance training recorded in activity logs was interpreted as muscle strengthening exercises. Results: Thirty-eight individuals aged 60-88 with osteoporosis (68%) or osteopenia (32%) participated. 60% of the sample performed ≥150 min of MVPA/week. Walking (4.03±0.43 days/week) was the most commonly reported activity type.19% of individuals did strength training ≥2 days/week. Conclusions: Older adults with low bone mass may require greater encouragement to adhere to physical activity guidelines, particularly muscle strengthening activities.


Toward Portable Simultaneous Imaging of Cortical Blood Oxygenation and Flow

D Ringuette1, S Dufour1,2, Y Atchia1,2, R Gad1,2, I Sigal1,2, O Levi1,2 1 University of Toronto, Institute of Biomaterials and Biomedical Engineering; 2 University of Toronto, The Edward S. Rogers Sr. Department of Electrical and Computer Engineering

We seek to develop devices for real-time monitoring of stroke recovery and seizure prediction. We have previously demonstrated simultaneous imaging of blood oxygenation and flow in live rodent brains during ischemia using a rapidly switch vertical-cavity surface-emitting laser source across three near-infrared wavelengths. Additionally, we have used these sources to measure changes in blood flow associated with an acute rodent seizure model. The small size and high efficiency of these sources make them well suited for portable imaging applications. We are currently developing a portable prototype utilizing a complementary metal-oxide-semiconductor detector array. Furthermore, we are integrating near-infrared fluorescence imaging to simultaneously track neural activity.




Adverse Events During Whole Body Vibration Among Men with Paraplegia

BC Craven1,2, M Szeto1, JJ Delparte1, L Giangregorio1,3, MR Popovic1,4 1 Toronto Rehabilitation Institute; 2 University of Toronto, Department of Medicine; 3 University of Waterloo Department of Kinesiology; 4 University of Toronto, Institute of Biomaterials and Biomedical Engineering

Background:Whole body vibration (WBV) therapy emulates mechanical strains on bone and muscle during activities of daily living. We described the frequency and severity of adverse events (AEs) and serious adverse events (SAEs) among males with paraplegia enrolled in a nine-month WBV study. Methods: Male subjects (n=15), age 20-60 years, with chronic paraplegia (T2-T10 AIS A-D) were enrolled. Passive standing and intermittent WBV at 45Hz, 0.7mm amplitude, 160o knee angle was implemented using the WAVE device for 45 minutes 10 times/ month for 9 months. The frequency and severity of AEs and SAEs were assessed and collated. Results:Fifteen subjects participated in 931 WBV sessions. Eighty-six AEs and 13 SAEs were reported with the most common SAEs being fractures, pressure sores, and urinary tract infections. Most frequent AEs determined to have possible (n=11) or probable (n=9) relationship to WBV included: dizziness, headache, autonomic dysreflexia, low back pain, and orthostatic hypotension. The most common acute WBV side effects (incidents >5) included back pain, spasms exacerbation, increased muscle tone, increased sensation, pins and needles sensation, and dizziness. Discussion: Although WBV is relatively safe and well tolerated, participants require screening and a meaningful discussion of the anticipated adverse effects prior to implementation. 24.

Exercise for Improving Age-Related Hyperkyphotic Posture: A Systematic Review

S Bansal1, LM Giangregorio1 1 University of Waterloo, Department of Kinesiology

Background: Age-related hyperkyphosis affects approximately 20-40% of older adults and can negatively impact QOL, performance of ADLs, and measures of gait and balance. Treatment modalities, such as surgery and spinal orthoses, are not indicated for everyone with hyperkyphosis. Some reviews have summarized evidence for exercise to improve hyperkyphosis, however, a systematic review has not been conducted. Objective: To evaluate current evidence to determine if exercise can improve pre-existing hyperkyphosis, or forward head posture, in adults aged 45 and up. Methods: Pubmed, CINAHL, and Embase databases were searched for papers that tested the effect of exercise on ≥ 1 measure of posture in people ≥ 45 years of age with hyperkyphosis at baseline. Reviews and meta-analyses were excluded, as well as papers that examined posture in specific subgroups (e.g. stroke). Results: The final review included 16 studies, of which, 9 were RCTs. 9/16 studies saw significant improvements in ≥ 1 measure of posture following an exercise intervention. All studies had issues with lack of clarity in publications and high risk of bias. Conclusions: It cannot definitively be concluded that exercise improves pre-existing hyperkyphosis in older adults. The results of some studies suggest that further investigation in this area is warranted.




25. Implementing the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for Risk Assessment CY Scovil1, HM Flett1,2, LT Nguyen1, DJ Leber1, J Brown3, AS Burns1,4, SCI KMN Team5 1 Toronto Rehabilitation Institute, Brain and Spinal Cord Rehabilitation Program; 2 University of Toronto, Dept. of Physical Therapy; 3 University of North Carolina, National Implementation Research Network (NIRN), Chapel Hill; 4 University of Toronto, Division of Physiatry, Dept. of Medicine; 5 Ontario Neurotrama Foundation, Spinal Cord Injury Knowledge Mobilization Team

Pressure Ulcers (PU) are a serious secondary health complication after Spinal Cord Injury (SCI). We are participating in a 6-centre SCI Best Practices Implementation (BPI) project to reduce health complications, initially focusing on PU prevention. Implementation experts provided support to increase BPI effectiveness. A consensus-based approach prioritized BPI recommendations for PU prevention, including using a validated PU risk assessment (RA) tool. An existing RA measure, the Braden Scale, is widely used but is not SCI specific. In contrast, the SCIPUS is SCI specific, but has less-established psychometric properties.Using implementation science principles, feedback from front-line staff and chart audits were used to evaluate current practice. Braden completion rate was 29%, and staff perceived it of questionable utility in SCI. Audit results were used to engage and educate stakeholders and justify replacing the Braden with the SCIPUS. Implementing the SCIPUS required institutional policy change, including its inclusion as a RA measure, and approval of the form itself. Practical SCIPUS training sessions were required for all nurses. SCIPUS champions were trained, and provided ongoing coaching and support. Ongoing chart audits evaluated implementation fidelity and provided feedback to clinicians. A concurrent research project is also assessing the psychometric properties of the SCIPUS.

26. Brain-controlled functional electrical stimulation for retraining of grasp function S McGie1, M Popovic1,2 1 University of Toronto, Institute of Biomaterials & Biomedical Engineering; 2 Toronto Rehabilitation Institute

Functional electrical stimulation (FES), originally proposed for use as a permanent assistive device, has since been shown to have beneficial effects when applied as part of the early rehabilitation regimen for individuals with incomplete spinal cord injury (SCI). An FES user can therefore potentially gain function to the point that they no longer need to use it. Brain-machine interfaces (BMI) offer an access pathway by which individuals with high-level SCI can potentially control various systems, including FES stimulators. While this pairing has previously been proposed for longterm application in the individuals daily lives (in line with the original intention of FES), the question of whether or not BMI can facilitate the rehabilitative benefits of FES remain largely unanswered. Neurophysiological theory suggests that the consistent involvement of both the central and peripheral nervous systems that would be provided by such a system could induce greater neuroplasticity than FES alone. A BMI-controlled FES system has therefore been developed to test this theory. At the time of writing, development of the system is complete, and the recruitment of individuals with SCI has been opened, although no participants have yet been enrolled.




27. Sitting Posturography with SCI during application of FES on Trunk Muscles M Milosevic1,2, K Masani2, MJ Kuipers2,3, MC Verrier2,4, KMV McConville5, MR Popovic1,2 1 University of Toronto, Institute for Biomaterials and Biomedical Engineering; 2 Toronto Rehabilitation Institute, Lyndhurst Centre; 3 University of Toronto, Department of Physiology; 4 University of Toronto, Department of Rehabilitation Science; 5 Ryerson University, Department of Electrical Engineering

Posturography can characterize dynamics of postural control during standing and sitting. Center of pressure (COP), a measure of postural stability has been used to study balance control among ablebodied individuals and those with neurological impairments, both during standing and sitting balance. This study investigated sitting balance control during use of functional electrical stimulation (FES) to artificially activate trunk flexor and extensor muscles of individuals with cervical-level spinal cord injury (SCI). Posturography measures were obtained from COP fluctuations during unsupported quiet sitting and FES-assisted quiet sitting. Results suggest that body sway distance decreased during FES-assisted sitting, compared to unsupported quiet sitting for all participants. A change in the velocity of the COP and a shift in the dominant frequency of the COP were also observed, suggesting that a unique control strategy is used when FES is applied. The results suggest that FES could potentially be used to improve sitting balance in individuals with SCI.

28. Improved Fatigue Resistance in Leg Muscles During Spatially Distributed Sequential Stimulation DG Sayenko1, MR Popovic1,2, K Masani1,2 1 Toronto Rehabilitation Institute, Lyndhurst Centre; 2 University of Toronto, Institute of Biomaterials and Biomedical Engineering

A critical limitation with neuromuscular electrical stimulation (NMES) approach is the rapid onset of muscle fatigue during repeated contractions, which results in the muscle force decay and slowing of muscle contractile properties. In our previous case study, we demonstrated that spatially distributed sequential stimulation (SDSS) show a drastically greater fatigue-reducing ability compared to a single active electrode stimulation (SES) with an individual with spinal cord injury when applied for plantar flexors. The purpose of the present study is to explore the fatigue-reducing ability of SDSS for major lower limb muscle groups in the able-bodied and spinal cord injury population. SDSS was delivered through four active electrodes applied to the muscle of interest, sending a stimulation pulse to each electrode one after another with 90 phase shift between successive electrodes. For comparison, SES was delivered through one active electrode. For both modes of stimulation, the resultant frequency to the muscle as a whole was 40 Hz. We demonstrated the fatigue-reducing ability of SDSS in both populations by higher fatigue indices as compared with single active electrode setup for major leg muscles. Application of this technique can improve the usefulness of NMES during functional movements in the clinical setup.




29. Hand Function Restoration using Electrocorticographic Signals and Functional Electrical Stimulation O Talakoub1,2, C Marquez Chin2,3, R Chen4,5, MR Popovic2,3, W Wong1,2 1 University of Toronto, Department of Electrical and Computer Engineering; 2University of Toronto, Institute of Biomaterials and Biomedical Engineering; 3 Toronto Rehabiltiation Institute; 4 Toronto Western Research Institute; 5 University of Toronto, Department of Medicine

Many stroke survivors or individuals with incomplete spinal cord injury have chronic motor and sensory impairments. Recently, evidence has emerged that Functional Electrical Stimulation (FES) can be used as part of a clinical intervention to improve voluntary control of paralyzed muscles. However, effectiveness of FES therapy depends on correlation between time-course and pattern of stimulation, and attempted movement. If a device decodes the movements from corticomotor potentials, an FES system could implement the functions that will generate the desire movement. A multi-linear regression model is employed to express arm kinematics as linear combination of ElectroCorticoGraphy (ECoG) recordings from four electrodes implanted over the primary motor cortex. Our predictions show a high degree of correlation with arm velocity (exceeding 80%) even though placement and choice of number of implanted ECoG contacts were dictated by clinical requirements. In our system, the kinematic parameter of reaching task would be reconstructed and then electrical stimulation pulses would be generated by a FES device to generate attempted reaching and grasping motion. Consequently, the user is not limited to pre-defined reaching or grasping movements but rather he can reach to any object within close proximity of his body.

30. Decrease in Venous Return due to Postural Change is Mitigated by Functional Electrical Stimulation for People with Spinal Cord Injury T Yoshida1,2, K Masani2, DG Sayenko1,2, M Miyatani2, JA Fisher3,4, MR Popovic1,2 1 University of Toronto, Institute of Biomaterials and Biomedical Engineering; 2 Toronto Rehabilitation Institute, Rehabilitation Engineering Laboratory; 3 University of Toronto, Department of Anaesthesia; 4 Toronto General Research Institute, Division of Clinical Investigation and Human Physiology

We examined how effectively functional electrical stimulation (FES) and passive stepping mitigated orthostatic hypotension (OH) in participants with spinal cord injury (SCI). Ten people with chronic SCI participated in the experiment. While being tilted head-up to 70 degrees from the supine position, the participants underwent four 10-minute conditions in a random sequence: 1) no intervention, 2) passive stepping, 3) isometric FES of the leg muscles, and 4) FES of the leg muscles combined with passive stepping. Each condition was preceded by a 10-minute rest in the supine position. Without any intervention, the orthostatic stress of head-up tilt significantly increased heart rate and significantly decreased stroke volume (SV). FES and passive stepping independently mitigated a decrease in SV and helped to maintain the mean blood pressure (MBP). Passive stepping did not induce venous return as effectively as FES but still somewhat mitigated a decrease in arterial pressure. When combined, FES and passive stepping did not synergistically increase SV or MBP. Nonetheless, combining them resulted in a greater increase in MBP. Thus, a combined intervention of FES and passive stepping may prevent OH more effectively than FES or passive stepping alone in people with chronic SCI.




Hand outline detection using a wearable computer-vision system

J Zariffa1,2, MR Popovic1,2 1 Toronto Rehabilitation Institute; 2 University of Toronto, Institute of Biomaterials and Biomedical Engineering

Monitoring hand function at home is needed to better evaluate the effectiveness of rehabilitation interventions. Our objective is to develop wearable computer vision systems for hand function monitoring. The specific aim of this study is to develop an algorithm that can identify the outlines of the hand in video recordings from a wearable camera, without the need for markers. Video was recorded using a small commercial camera that is worn over the ear and records the userâ&#x20AC;&#x2122;s point of view. The image processing approach for each video frame consists of two tasks: (1) Determine whether a hand is present in the image, and identify 1 point that lies within the hand. This is accomplished by using standard models of skin colour to identify regions of the image that correspond to patches of skin. (2) Identify the outline of the region containing the point identified in step 1. This is accomplished by determining the region within a colour histogram that corresponds to hand colours, setting the rest of the histogram to zero, and finally backprojecting the image using the reduced histogram. The current performance of the system is illustrated using videos recorded in settings relevant to activities of daily living.

32. Evaluating the effects of posture and FES on respiratory function in able-bodied and SCI populations MJ Kuipers1,2,8, M Milosevic3,8, KMV McConville3,7,8, MR Popovic3,4,8, MC Verrier1,4,5,6,8 1 Departments of Physiology; 2 Neuroscience; 3 IBBME; 4 Departments of Rehabilitation Science 5 Physical Therapy; 6 University of Toronto, Institute of Medical Science; 7 Ryerson University, Department of Electrical and Computer Engineering; 8 Toronto Rehabilitation Institute

In spinal cord injury (SCI) respiratory dysfunction stems from paralysis and altered respiratory and trunk muscle activation. Functional electrical stimulation (FES) increases lung capacity and postural alignment in SCI by activating trunk musculature (Triolo, 2009); effects of FES on respiratory function during quiet breathing are unknown. Two studies were conducted: 1) able-bodied individuals (ABs) participated in trials of static unsupported sitting in upright (SITUP) and slouch (SITSL) postures; 2) three individuals with tetraplegia participated in trials of unsupported sitting with or without FES to study respiratory function (tidal volume (VT), respiratory rate (RR), and minute ventilation (VE)) using a MetaMaxâ&#x201E;˘. In ABs, SITUP versus SITSL VT increased by 14% (p<0.01); VE increased by 6% (p<0.05); while RR did not change (p=0.18). In two SCI cases, VE increased by 10% due to a combination of bidirectional changes in VT and RR. Upright posture may provide an optimal mechanical advantage for diaphragmatic function to achieve peak VT, without altering RR in ABs. In tetraplegia, VE increased with FES, but it remains to be determined if this is only due to respiratory mechanics. The results inform the development of subject-specific FES protocols to test the relationship between postural control and RFQ in SCI.




33. Response of Individual Muscles to Neuromuscular Electrical Stimulation Training of Knee Extensors T Hirabayashi1, AS Hassan1,2, D Nozaki3, K Masani1,2 1 Toronto Rehabilitation Institute, Lyndhurst Centre; 2 University of Toronto, Institute of Biomaterials and Biomedical Engineering; 3 University of Tokyo, Graduate School of Education, JAPAN

Neuromuscular electrical stimulation (NMS) is one of the most popular advanced methodologies for athletes to gain muscle strength. Usually, NMS uses a pair of large electrodes to stimulate one muscle group (Group Stimulation, GS) instead of stimulating individual muscles. The purposes of this study were 1) To identify the unique force vector produced by individual knee extensors, and 2) to investigate the contribution of individual knee extensors to the force vectors produced by GS in NMS training. Three knee extensors (vastus medialis, vastus lateralis, and rectus femoris) were individually stimulated. Additionally, knee extensors were stimulated simultaneously using regular NMS electrodes at three different locations (GS1-3). The relative contribution of individual muscles to GS1-3 was estimated based on an assumption that the force vector measured during each GS was a linear vector summation of force vectors of the three individual muscles. The unit force vector was statistically different among the three knee extensors (MANOVA, p < 0.001). The contributions of the three knee extensors were statistically different among muscles (ANOVA, p < 0.001), while not different among GS1-3 (p = 0.09). In conclusion, distinct contributions from individual muscles were found, suggesting that NMS training may unevenly affect knee extensors.




34. When Words Matter: Automatic Identification of False Alarms in Personal Emergency Response Calls V Young1, A Mihailidis2,3 1 University of Toronto, Department of Rehabilitation Science and the Institute of Biomaterials & Biomedical Engineering; 2 University of Toronto, Department of Occupational Science & Occupational Therapy and the Institute of Biomaterials & Biomedical Engineering; 3 Toronto Rehabilitation Institute

Background: Personal emergency response systems (PERS) provide older adults with access to immediate emergency assistance when required. These devices help ease caregiver and user anxiety, support aging-in-place, and reduce overall healthcare costs. Despite their benefits, non-use among PERS owners is common. Reasons include feelings of stigmatization, fear of independence loss, access and design issues. Objective: To re-design and improve the PERS by incorporating artificial intelligence and automatic speech recognition. Currently, we are investigating the aspects of live personal emergency response call dialogue to model. Also, which utterances are key determinants of false alarms versus true emergencies? Methodology: Discourse and conversational analyses were performed on live personal emergency response calls. Key utterances were selected by three independent raters. Calls were categorized into three risk levels by a non-expert and expert rater. 'Term frequency-index document frequency' (TF-IDF, Salton-McGill-1983) weights were calculated to assess key word relevance at each individual risk level. Results: 388 possible key words were identified from 84 transcripts; 56 in low risk, 322 in medium risk, and 257 in high risk calls. TF-IDF calculations identified certain key words specific to low and higher risk calls. Implications: Recognition of key words might help differentiate false alarm calls from true emergencies.

35. The Smart Floor Tile: Evaluation and Investigation of Passive Monitoring of Vital Signs S Chang1, A Arcelus2, A Mihailidis1,2 1 University of Toronto, Institute of Biomaterials and Biomedical Engineering; 2 Toronto Rehabilitation Institute

A holistic and dynamic representation of a person’s health can be constructed by sampling a person’s physiological status in a regular basis, allowing more informed health management decisions. Previous research has used wearable sensors; however wearable sensors may not be ideal for monitoring older adults, especially those with cognitive impairments, because the users may forget to wear the device or could use them incorrectly. Passive devices that are embedded into the environment, measure signals unobtrusively, and require little or no effort on the part of the user are likely more suitable for monitoring the health of older adults. For the current research, a smart floor tile that aims to measure vital signs (heart rate, respiration rate, and systolic blood pressure (SBP)) of a stationary person standing on the tile is being developed. The vital signs are extracted from ballistocardiogram (BCG), a vibration of the body caused by circulation and ECG acquired from feet (F-ECG). To date, the smart floor tile could acquire clear BCG from a quietly standing subject using a modified weight scale with load cells and clear F-ECG from a quietly sitting subject using dry electrodes. Acquisition of these signals enabled detection of the heart rate.




Development of an automated balance assessment tool for the home

E Dolatabadi1,2, A Mihailidis2,3 1 University of Toronto, Institute of Biomaterials and Biomedical Engineering; 2 Toronto Rehabilitation Institute; 3 University of Toronto, Department of Occupational Science and Occupational Therapy and Department of Computer Science

In this project, we seek to develop a set of commercially-viable technologies that can perform automated and quantitative balance assessments in an elder’s own home through the monitoring and analysis of functional activities and movements. In terms of monitoring, Kinect sensor will be deployed in common areas of homes of elder’s in order to capture the functional activities including mobility, walking and sit to stands. The state of the art, machine learning algorithms will be used to map the kinematic features to clinical measures and discriminates older adults based on levels of balance impairment. Therefore, the main objectives of this study are to (1) determine a gold standard for our study design, (2) design and develop an automated tool and (3) validate the general accuracy of the tool in mapping kinematic features to clinical measures. We will also (4) start exploring how this automated tool can be deployed in an older adult’s home. This study will offer an opportunity to develop a novel technology which can be easily deployed at older adult’s home environment. It is expected that the system has the potential to automatically differentiate and understand balance impairments using low cost and portable technologies. 37.

Fatigue Estimation from Human Movement

M Karg1,2,3, J Hoey2,3, and D Kulić 1,3 1 University of Waterloo, Department of Electrical and Computer Engineering; 2 University of Waterloo, Cheriton School of Computer Science; 3 Toronto Rehabilitation Institute

Fatigue influences the way a training exercise is performed and influences the efficacy of the exercises during rehabilitation. This work investigates whether human movement analysis can provide an objective measure for fatigue. In recent years, major progress has been made in human movement analysis, e.g., action recognition, gait as biometrics, and gesture-based human-computer interaction. Therein, machine learning is applied to select the most relevant features and to automatically train models. This approach analyzes the way a movement is performed and proposes the use of a parametric Hidden Markov Model. The methodology is evaluated on a squat database. The model is capable of predicting different levels of fatigue and follows the increase of fatigue over time. Challenges are in particular inter-individual differences in performing an exercise, differences in expressing fatigue during the exercise, and different levels of fitness.The use of machine learning to estimate fatigue from human movement can be used for monitoring the training progress or for continuing rehabilitation at home. It can be further used as an objective measure during clinical trials or as input to a robotic system advising to take breaks during training exercises.



ABSTRACTS 34 â&#x20AC;&#x201C; 43

Learning to Identify Unusual Events from Mobile Sensor Data

S Khan1, ME Karg1,2,3, J Hoey1,3, D KuliÄ&#x2021;1,2,3 1 University of Waterloo, David R. Cheriton School of Computer Science; 2 University of Waterloo, Department of Electrical and Computer Engineering; 3 Toronto Rehabilitation Institute

The present research addresses the problem of identification of unusual motion related events in a mobile sensor network. Most existing activity recognition systems based on computer vision devices or wearable sensors attempt to recognize normal activities of daily living, however they may not be well-suited to identify abnormal activities, especially the ones that have not been encountered before. In this work, we present three Hidden Markov Model based approaches to identify unusual events based on mobile sensor data, using only normal activity data for training. The proposed algorithms are based on low-cost features across different individual and placement of sensor device.


Elderly Acceptance of a Socially Assistive Human-Like Robot

WG Louie1,2, D McColl2, G Nejat1,2 1 Toronto Rehabilitation Institute; 2 University of Toronto, Mechanical and Industrial Engineering

Recent studies have supported the positive effects that cognitive and social interventions can have on the functioning of older adults including reducing the risk of dementia and delaying age-related decline in health and mortality. However, activities to promote such stimulation are lacking in longterm care facilities because implementing and sustaining such interventions requires considerable resources, people, and skill. Our objective is to develop and use innovative robotic technologies to provide person-centered cognitive and social interventions to improve the quality of life of elderly adults. In this study, we performed human-robot interaction studies with the human-like socially assistive robot Brian 2.1 and the elderly to investigate the acceptability of the robot as a tool for cognitive interventions and social engagement. The study results showed that in general most participants had a positive attitude towards the robot and enjoyed interacting with it. In particular, they enjoyed the social attributes of the robot and its ability to display facial expressions. During the interactions elderly participants were also both engaged and complied with the robotâ&#x20AC;&#x2122;s prompts. Overall, these results are promising and motivate further development and long-term one-on-one testing of the robot for the elderly population.




40. Measuring lifespace in older adults with mild Alzheimer’s disease using smartphone GPS JY Tung1,2, RV Rose1, E Gammada3, I Lam3, SE Black3,4, EA Roy2, P Poupart1 1 University of Waterloo, David Cheriton School of Computer Science; 2 University of Waterloo, Department of Kinesiology; 3 Sunnybrook Research Institute; 4 University of Toronto, Department of Medicine

Lifespace, or the extent of spatial movement covered during daily functioning, is a behavioural indicator of physical and cognitive functioning in community-dwelling older adults. However, lifespace can be challenging to assess due amnesia associated with Alzheimer’s disease (AD). The purpose of the study was to evaluate the utility of using GPS to measure lifespace in communitydwelling older adults with mild AD. We hypothesized that GPS –measured parameters (area, perimeter, time and mean distance away from home) would be reduced in AD compared to healthy older adults. Nineteen patients with mild AD (MMSE=14-28, age=70.7±2.2y) and 35 controls (CTL, age=74.0±1.2y) wore a GPS-enabled smartphone for 3 days. Area and perimeter were determined using the convex hull of the GPS data. Distance was determined using home as the origin, and time away was measured as the percentage of time spent >25m from home. All measures were log10 transformed and tested for group effect (2-sample t-tests). Lifespace size is smaller in the AD group, indicated by lower area, perimeter, and mean distance. No group difference in time away from home was observed. Preliminary findings support the capability of GPS to objectively measure lifespace patterns, and potential use as an outcome measure.

41. Personal Robots to Support Aging-in-Place: Pilot Testing of a Novel Robot-Smart Home Platform RH Wang1,2, M Begum1,2, R Huq1,2, A Mihailidis1,2 1 Toronto Rehab; 2 University of Toronto

We are developing smart homes with embedded sensors and artificial intelligence to enable older adults with dementia (OAs) to age-in-place by supporting performance of daily activities. Embedded systems, however, may not adequately engage users during activities and result in impersonal interactions. A personal, mobile robot may help to address these concerns. The objective is to examine the potential of a robot to provide step-by-step prompting assistance to complete daily activities. We used a tele-operated robot that moves in a simulated home, provides prompting for hand-washing and tea-making and engages in social conversation. Six OAs with mild/moderate Alzheimer’s disease interacted with the robot who prompted them to complete tasks. The caregivers of the OAs observed the tasks. Both were interviewed following the tasks. Observations and interview transcripts were made from recordings. A robot prompt to complete daily activities is promising as OAs and caregivers generally accepted the technology. OAs tended to follow prompts when they were uncertain of the next task step. Most OAs did not require hand-washing prompts and those with moderate dementia showed a lower prompt adherence, particularly with tea-making. Further development will increase the social capabilities of the robot and improve task engagement with those with moderate dementia. Testing with four additional dyads is pending.



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An Intelligent Powered Wheelchair for Users with Dementia: Case Studies with NOAH (Navigation and Obstacle Avoidance Help)

P Viswanathan1,2, J Little3, A Mackworth3, A Mihailidis1,2 1 University of Toronto, Department of Occupational Science & Occupational Therapy and the Institute of Biomaterials & Biomedical Engineering; 2 Toronto Rehabilitation Institute; 3 University of British Columbia, Department of Computer Science

Cognitively-impaired older adults who lack the strength to self-propel in manual wheelchairs are excluded from powered wheelchair use because of safety concerns. An intelligent powered wheelchair system is proposed to help restore mobility, while ensuring safety, in the long-term care setting. When an imminent collision is detected, the wheelchair is stopped, and motion towards the obstacle is prevented. Adaptive audio wayfinding prompts that account for the usersâ&#x20AC;&#x2122; cognitive state are then issued using a probabilistic user model. The intelligent wheelchair is tested with older adults with mild-to-moderate dementia through a single-subject research design. Results highlight the need for assistive technologies that can automatically adapt to the user based on his/her needs and capabilities. The system improves safety for all users by lowering the number of frontal collisions, and assists users in navigating along shorter routes to the destination. Results show that users who are unsure about the route rely more highly on system prompts, thus improving their wayfinding performance by following correct prompts. Improvements in wheelchair position estimation accuracy and joystick usability can improve user performance and satisfaction. Further user studies will help refine user needs and hopefully allow us to increase mobility and independence of several elderly residents.


An Intelligent Nutritional Assessment System

Y Eskin1, A Mihailidis1,2 1 Intelligent Assistive Technology and Systems Lab, University of Toronto; 2 Toronto Rehabiltiation Institute

Background: Ageing leads to a higher prevalence of chronic diseases, such as cancer and dementia. The current toll on society, in terms of medical and social care costs, is projected to keep escalating with the elderly population growth. The link between malnutrition and dementia highlights the need to study disease causation and closely monitor nutrition as early as possible. However, current assessment methods are labour-intensive, time-consuming and inaccurate. Objective:Therefore, we propose an intelligent nutritional assessment system that will monitor the dietary patterns of older adults with dementia at their homes. Methods: Our system consists of food recognition algorithms that can provide nutritional analysis of an image of meal. We formulate the problem in the context of classification. Results: We have created a novel food image dataset consisting of 49 food categories, on which we achieve an 87.2% Âą 12.5 classification accuracy. Conclusion: Segmantation is very challenging in foods and heavily influences subsequent recognition and portion estimation accuracy. Recognition performs well, however, more data is required to improve generalizability. Implications: This proof-of-concept system demonstrates the potential of an intelligent nutritional assessment system that could be installed at the home and monitor nutrition in an accurate, consistent and unbiased way.



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44. Can difficulty with community integration after brain injury be explained by social multi-tasking impariment? D Frasca1,2, BJ McFadyen4, RE Green1,2 1 University of Toronto, Graduate Department of Rehabilitation Science; 2 Toronto Rehabilitation Institute; 3 Laval University; 4 Centre interdisciplinaire de recherche en riadaptation et intigration sociale

Background: After acquired brain injury (ABI), successful community reintegration is a major concern. One contributing factor is impairment in reading facial emotions. The ability to perceive facial emotions is frequently compromised after ABI and this deficit has been correlated with poorer reintegration to the community. We speculate that a further compounding factor is multi-tasking. Multi-tasking is often impaired after ABI, and social situations require multi-tasking, for example maintaining posture, holding a cup or handbag, trying to keep up a conversation as well as reading facial emotions. The current study aims to examine if problems with community integration after ABI can be explained by difficulties with multi-tasking, specifically with tasks involving facial emotion perception and balance. Methods: 30 adults with moderate-severe brain injury and 30 healthy adults will receive a brief neuropsychological assessment and then complete the experimental tasks individually: (1) Stroop; (2) facial emotion perception; (3) maintaining posture, and then concurrently (perceptual/psychosocial and postural tasks). Results: To date, we have tested 22 participants (n= 4 brain-injured; n=18 healthy). Preliminary results will be presented. Discussion: By understanding the relationship between psychosocial, motor and cognitive functioning, we can better understand multi-tasking difficulties that many people with ABI report, which act as barriers to returning to a successfully integrated lifestyle.

45. Traumatic brain injury in traumatic spinal cord injury: Prevalence of dual-diagnosis and incidence of missed acute care diagnoses B Sharma1,2, CL Bradbury1, J Corbie1, DJ Mikulis3, SL Hitzig1, CF McGillivray1, C Craven1, RE Green1 1 Toronto Rehabilitaiton Institute; 2 University of Toronto; 3 University Health Network

Background. Traumatic brain injury (TBI) sustained with traumatic spinal cord injuries (SCI) negatively influence outcomes. For example, cognitive and mood effects of TBI can impede SCI rehabilitation; and, uncertainties regarding underlying cause of sensory and/or motor deficits compromises diagnosis and treatment. Thus, this dual diagnosis requires specialized expertise. It is important to know, therefore, the scale of concomitant SCI-TBI for policy makers/managers to determine whether and how much specialized care should be offered. Past research has been inconclusive due to methodological limitations. Further, to triage to appropriate services, we must identify dual diagnosis patients as early as possible. However, anecdotal evidence suggests that acute care diagnosis of TBI in SCI patients is often missed. Objectives & methods. To measure (1) prevalence of TBI in traumatic SCI patients in 100 consecutively recruited traumatic SCI patients in a large, spinal cord rehabilitation program; (2) incidence of TBI diagnoses missed in acute care. Results. (1) 51.6% of our final sample (N=91) sustained a concomitant TBI, (2) of these, 19.6% were not diagnosed in acute care. Discussion. The high incidence of TBI in traumatic SCI underscores the need for specialized dual-diagnosis services (or programs). Given the number of missed diagnoses, diagnostic procedures in acute care must be examined.



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46. The development of a novel treatment approach for moderate-severe TBI to improve recovery and diminish post-acute brain atrophy. D Mikulis1, B Sharma2,3, B Colella2, G Turner4, RE Green2 1 University Health Network; 2 Toronto Rehabilitation Institute; 3 University of Toronto; 4 York University

Our group has demonstrated that following moderate-severe TBI, (1) recovery at 1 year post-injury is well below pre-injury levels for most cognitive functions, (2) there are frank declines in cognitive function from 1-2 years post-injury, (3) the brain also atrophies in this post-acute period, and (4) this atrophy is associated with degree of environmental enrichment in the post-discharge environment. To date, there is limited efficacy for enhancing long-term outcomes. For TBI, meta cognitive therapies such as cognitive behaviour therapy (CBT) and goal management training (GMT) have shown efficacy for emotional and cognitive functioning; environmental enrichment (EE) approaches have shown efficacy at both behavioural and neural levels of analysis. Based on our findings, we designed a multi-pronged treatment approach. Primary Objectives: (1) To evaluate feasibility and preliminary efficacy of two kinds of meta-cognitive training (CBT and GMT) for improving mood and executive functioning, (2) to evaluate feasibility and efficacy of EE administered for diminishing post-acute brain atrophy and white matter integrity loss, and (3) to examine the combined benefits of these approaches. Methods: Participants: 3 groups with moderate-severe TBI: (1) 15 will receive CBT, GMT and EE; (2) 15 patients will receive EE only; (3) 30 previously received standard care. Outcomes: pre- and post-treatment (or standard care) neuropsychological testing, MRI and functional assessment. Rehabilitation Implications: This intervention stands to improve long-term brain health, clinical outcomes and quality of life people with moderate-severe TBI.

47. Negative neuroplasticity in normal aging and chronic-stage traumatic brain injury JC Tomaszczyk1, N Green2, D Frasca1,3, GR Turner4, and RE Green1 1 Toronto Rehabilitation Institute, Cognitive Neurorehabilitation Sciences Lab; 2 University of Toronto, Human Biology Department; 3 University of Toronto, Graduate Department of Rehabilitation Science; 4 York University, Department of Psychology

Recent studies demonstrate that atrophy and white matter loss in non-damaged brain tissue occurs in the chronic stages of recovery from moderate to severe traumatic brain injury (TBI). Moreover, this atrophy is associated with poorer cognitive outcomes. This suggests a neurodegenerative facet of TBI. Borrowing from a framework developed for older adults, neural deterioration has been postulated to be related to disuse of healthy brain areas. Disuse is thought to result from reduced engagement in novel and challenging cognitive activities, cognitive and perceptual impairments, and changes in vocational schedules ( use it or lose it ). This neural deterioration as a result of reduced cognitive activity is referred to as negative neuroplasticity . Applying this framework to TBI, progressive deterioration of non-damaged brain tissue may similarly result from a downward spiral of negative neuroplastic change. To this end, we review literature demonstrating similarities between older adults and TBI patients in the progression of cognitive and neural decline, and in lifestyle changes that may lead to disuse-mediated decline. We conclude that (1) mechanisms of negative neuroplasticity that explain age-related decline also offer explanatory power for declines in chronic TBI, and (2) neural mechanisms underlying remediation include prevention of negative neuroplasticity and enhancement of neurogenesis.



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Efficacy of teletherapy for depression-mediated memory impairment in older adults

JC Tomaszczyk1, RE Green1 1 Toronto Rehabilitation Institute, Cognitive Neurorehabilitation Sciences Lab

Background: Depression in older adults is associated with reduced cognitive function, including memory impairment. Cognitive behaviour therapy (CBT) is a powerful approach to depression treatment in older adults, but many cannot access treatment due to physical disability, health problems, or geographical remoteness. Teletherapy offers a solution. To date, there has been no research on the efficacy of telephone-administered CBT (tele-CBT) in older adults. Importantly, it is unknown whether tele-CBT may alleviate depression-mediated memory impairment in this population, and whether benefits of therapy can be maintained over time. Objectives: To examine (1) the efficacy of tele-CBT for older adults, (2) whether tele-CBT sessions may improve depressionmediated memory impairment, and (3) the optimal format of maintenance therapy sessions to provide ongoing benefits. Method: 60 community-dwelling depressed older adults (45 immediate treatment;15 waitlist education control with subsequent treatment) will complete a battery of neuropsychological and memory tasks to provide a baseline for cognitive function and mood. After receiving tele-CBT sessions, mood and memory performance will be re-assessed immediately post treatment and again after maintenance sessions (self-initiated vs. clinician-initiated) to examine change in functioning. Relevance: The proposed project stands to improve quality of life of older adults by alleviating depression and depression-mediated memory impairment.

49. Fearful face recognition tasks: Is there a confounding effect of order that could differentially influence patients and controls? AEA Oatley1,2, G Monette3, MG Wintre2, REA Green1,2,4 1 Toronto Rehabilitation Institute - UHN; 2 York University, Department of Psychology; 3 York University, Department of Mathematics and Statistics; 4 University of Toronto, Department of Psychiatry and GDRS

Background and Rationale: Several studies have shown that individuals with traumatic brain injury (TBI) have difficulty reading facial emotions (Green et al., 2004). As between-group studies continue to illuminate avenues for facial emotion perception (FEP) and social integration treatment, it is imperative that paradigms be accurately controlled. Several studies have employed facial emotion batteries in which the same model displays several different emotions. If control participants benefit from prior exposure to (1) a particular model, or (2) a particular emotion, it is possible that presentation order could differentially influence control- and patient-group accuracy . For example, controls could reap greater advantage given the frequency of TBI-related memory impairments. Objective: To determine whether control participant FEP accuracy improves 1) with prior exposure to a model and 2) depending on the emotion displayed in the previous stimulus. Methods: In this study, several of the models will display more than one emotion (e.g., fearful, neutral, surprised). Sixty typically developing participants (30 females) will label the emotion and their degree of confidence. The battery will include pictures of models displaying neutral faces and the 6 basic emotions (e.g., happiness, surprise, fear, anger, disgust, saddness). Hypotheses: We hypothesize emotion by order effects, with participants accuracy for fearful faces improving if they are preceeded by (1) a surprised or disgusted face of any model or (2) prior exposure to the model displaying the fearful face. Implications for Rehabilatation: If our hypotheses are supported, it will be important to control for order effects as FEP and social intergration treatments are developed.



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50. Patient Profiles in Canada of Persons with Traumatic Brain Injury Across Clinical Settings: The Ideas Project J Hsueh1, A Colantonio1,2, K Berg1, J Hirdes3 1 University of Toronto; 2 Toronto Rehabilitation Institute; 3 University of Waterloo

Objectives: Much of the current publish traumatic injury research targets traumatic brain injury patients in hospitals and tertiary care centres. This analysis is an opportunity to examine and compare the clinical profile of adults with traumatic head injury in Canadian home care, mental health, nursing home and complex continuing care inpatient settings. Methods: Descriptive analysis was conducted using Resident Assessment Instruments for Home Care (RAI-HC), Mental Health (RAI-MH) and Minimum Data set 2.0 (RAI-MDS 2.0). All data collection was performed as a part of the larger Public Health Agency of Canada - Persons with Neurological Conditions (PHAC-PNC) project. Results: Persons with traumatic head injury were different on several demographic and health issues when compared to other occupants and across multiple care settings. The TBI population was younger and the majority was male. TBI survivors are more likely to have experienced trouble swallowing (51.7%), bladder (54.7%) and bowel (57.5%) incontinence, communication impairments (47.4%) and mobility issues. Conclusion: Key characteristic are identified for traumatic head injury survivors and provide ground work for service providers in home care, mental health, nursing homes and complex continuing care settings to integrate more targeted approaches towards coordinating and managing traumatic head injury survivors.

51. Traumatic Brain Injury and Falls in Ontario: Where and How Do They Happen? M Kugadas1, V Chan1,2, A Colantonio1,2, B Zagorski3, D Parsons4 1 Toronto Rehabilitation Institute; 2 University of Toronto, Graduate Department of Rehabilitation Sciences; 3 University of Toronto, Institute of Health Policy, Management, and Evaluation; 4 Ontario Neurotrauma Foundation

Objective: To examine the rate of traumatic brain injury (TBI) in the emergency department (ED) and acute care from falls by age, falls subtypes, and Local Health Integration Networks (LHINs). Rates of falls from TBI and head injury diagnostic codes from the Ontario Injury Data Report were compared. Method: Patients admitted to Ontario EDs and acute care with a TBI diagnostic code resulting from falls were identified in the National Ambulatory Care Reporting System and Discharge Abstract Database, respectively. Results: From 2007/08-2009/10, there were 24,402 patients (62.9 per 100,000) and 10,370 patients (26.7 per 100,000) with TBI admitted to the ED and acute care, respectively. The highest rates were in the South East LHIN (104 per 100,000) for ED and North East LHIN (33.1 per 100,000) for acute care. The most common specified falls were slip/trip on same level and on stairs/steps. The rate using head injury codes was 4.2-27.2 times higher than the rate of TBI among children/youth and older adults. Conclusion: The disparity in the rates of head injuries and TBI suggests that current rates of TBI are likely underestimates for the youngest and oldest age groups. Inclusion of head codes to define TBI prevention is recommended.



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52. Sleep Dysfunction in Ontario Workers with Head Injury: Prevalence and Relationship with Disability: Preliminary findings TL Mollayeva1,2,3, CM Shapiro3,4, D Cassidy3,5, A Colantonio1,2,3 1 Toronto Rehabilitation Institute; 2 University of Toronto, Graduate Department of Rehabilitation Science; 3 University of Toronto, Faculty of Medicine; 4 University Health Network; 5 Syddansk Universitet

Background: The deleterious effects of poor sleep in persons who sustained head trauma have been reported for many years. Future progress depends on an improved understanding of the interaction between sleep disturbance and disability. Aim: To assess sleep functioning and review links between sleep dysfunction and disability. Methods: Cross-sectional study. Sleep functioning was assessed by scales, in accordance with the ICSD; daytime sleepiness by ESS; fatigue by FSS; alertness by THAS. Psychological status was assessed by the HADS and PHQ-9; pain by the Pain visual analogue scale. Disability was evaluated by the CIQ and its subscales. Findings: Twenty five Ontario workers with head trauma: mean age 48110.5; median time since injury 186 days. Eighty percent reported difficulty falling asleep and 88% in maintaining sleep. Significant association was found between outcome of interest (CIQ, total score) and PHQ-9 (r=-0.55, p=0.005), and ISS (r=-0.56, p=0.004). Linear regression revealed that ISS total score, after adjustment for gender, was independently associated with disability. Research advances: Sleep dysfunction rates are striking in head injured workers. Screening for sleep dysfunction should be routine; positive findings call for detailed diagnosis. Management should acknowledge the multifactorial etiology of sleep dysfunction, to alleviate the disability rates.


Fatigue in Ontario Workers with Head Injury: Frequencies and Correlations

S Mollayeva1, T Mollayeva1,2,3, A Colantonio1,2 1 University of Toronto; 2 Toronto Rehabilitation Institute; 3 University Health Network

Background: Fatigue is one of the most disabling symptoms in patients with Traumatic Brain Injury (TBI) and it is difficult to clarify the nature of this symptom and manage it. In the context of workplace disability, fatigue is defined as degraded performance. The aim of this study was to evaluate the frequency and correlations of fatigue. Methods: Twenty-five Ontario workers with head trauma (60% males, 40% females) were asked to complete the Fatigue Severity Scale (FSS), Patient s Health Questionnaire (PHQ-9), Anxiety Severity Scale (ASS), Insomnia Severity Scale (ISS), Epworth Sleepiness Scale (ESS) and Toronto Hospital Alertness Scale (THAS). Frequency distribution and Pearson correlation were used for data analysis. Findings: Fatigue requiring further evaluation was found in 88%, excessive daytime sleepiness in 52%, and impaired alertness in 68%. Insomnia was found in 96%, depression in 96%, and anxiety in 64%. A significant associations between FSS and PHQ-9 (r=0.48, p=0.015), and THAS (r=-0.78, p<0.0001); no association between FSS and ESS (r=0.29, p=0.15) were observed. Conclusions: A strong negative association between fatigue and alertness may indicate workers inability to perform tasks that require sustained attention. Future research in the area of sleep functioning as a determinant of fatigue, alertness and performance is warranted.



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54. Heath professionals' perspectives: Realities of a linked model of pediatric to adult rehabilitation transitional care Y Hamdani1, M Proulx2, S Kingsnorth2,3, S Lindsay2, J Maxwell3,4, C Macarthur5, M Bayley4 1 University of Toronto, Dalla Lana School of Public Health; 2 Bloorview Research Institute; 3 Holland Bloorview Kids Rehabilitation Hospital; 4 Toronto Rehabilitation Institute; 5 Hospital for Sick Children

Background & Rationale: In response to advances in medical interventions and long-term survival, two health science centres partnered to develop a linked model of care to support transition from pediatric to adult rehabilitation services for youth with cerebral palsy and acquired brain injuries. Objective: To explore the experiences of health care professionals in the implementation of the LIFEspan model, concluding the process evaluation component of the LETS (Longitudinal Evaluation of Transition Services) study. Methods: Using a qualitative design, interviews were conducted with 14 LIFEspan health care professionals. Challenges and successes were identified within a framework for service integration and coordinated care1. Results: 1) Client/family level: Challenges in addressing varying client needs and willingness/ability to self-advocate and manage health care. 2) Organization/agency level: Successes identified with respect to appropriate staffing, skill development opportunities and pediatric-adult rehabilitation linkages. Model growth impeded by current staffing limitations and inter-agency communication methods. 3) Systems/sector level: Efforts by health care professionals to create appropriate linkages negatively affected by gaps in resource availability. Conclusion: LIFEspan supports many facets of continuity of care for young people with childhood onset physical disabilities. However, partnerships at the systems level are required to positively influence sustainability of the model.

55. Toronto Rehabilitation Neurology Service Chart Review: A Retrospective Analysis of WSIB Referral Clinical Data from the 2003 fiscal year. A Pilot Study T Belben1,2, M Scherer1,2, T Mollayeva2,3, MD, PhD Candidate & A Colantonio2,3 1 University of Toronto, Graduate Department of Occupational Therapy & Occupational Science; 2 Toronto Rehabilitation Institute; 3 University of Toronto, Faculty of Medicine, Graduate Department of Rehabilitation Science

Background and Rationale: Persons with head trauma sustained at workplace often report symptoms related to poor sleep (e.g. fatigue, daytime sleepiness), impacting their abilities to return to work and sustain pre-disability duties. Extend and impact of these complains remain unclear, as is unclear whether injury to the brain worsens oneâ&#x20AC;&#x2122;s self-insight and presentation. Objectives: Identify the proportion of workers complaining of poor sleep of the cohort of workers who had an assessment at WSIB clinic at TRI during 2003; document self-reported and objective evidence of sleep; compare sleep quality of workers with injury to the brain to those without, adjusted for sex, age, and injury severity. Methods: Retrospective medical record review of 300-500 outpatients with work-related head trauma, referred to the WSIB clinic at TBI for assessment in 2003. Data Analysis: A descriptive analysis will be performed to describe the study population. Comparison of categorical data will be performed using the chi-square test. Relevance: Better understanding of the extent and nature of sleep impairments in workers with persistent symptoms will raise awareness of the importance to address sleep in the rehabilitation setting. Objective data reported may have important implications for future treatment and long-term outcomes of workers with head trauma.



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56. Promoting Employment Success Through Workplace Accommodations Following Traumatic Brain Injury and Electrical Injury M Stergiou-Kita1,2, A Colantonio2,3 1 St. John's Rehab, Research; 2 University of Toronto, Department of Occupational Science and Occupational Therapy; 3 Toronto Rehabilitation Institute

Returning to work following brain or electrical injuries can be difficult due to physical, cognitive and psychosocial impairments. Workplace supports and accommodations have been shown to assist individuals to find and keep work; moreover, employers are legally required to provide such accommodations. However despite their importance, little is known about what types of workplace accommodations are best for individuals who have survived such injuries. Additionally, very little is understood about how personal, sex, gender, environmental factors, and the provision of accommodations can affect return to work outcomes. To fill this gap, we will interview male and female workers with brain and electrical injuries who have returned to work to gain an indepth understanding of their accommodation needs and how accommodations are implemented. Workers will be recruited from the Toronto Rehabilitation Institute Neurology Services and St. John's Rehab Outpatient Services (which provide work assessments for the Ontario Workplace Safety and Insurance Board), as well as the Ross Tilley Burn Centre at Sunnybrook (which provides acute care to workers with electrical injuries). Employers who have assisted with return to work following brain or electrical injuries will also be interviewed. Findings will be used to establish recommendations for developing successful accommodation plans. 57. A Population Based Perspective of Older Adults with Acquired Brain Injury: Functional Independence Measures after Inpatient Rehabilitation V Chan1,2, A Colantonio1,2 B Zagorski3, D Parsons4 1 Toronto Rehabilitation Institute; 2 University of Toronto, Graduate Department of Rehabilitation Sciences; 3 University of Toronto, Institute of Health Policy, Management, and Evaluation; 4 Ontario Neurotrauma Foundation

Objective: To examine the profile of older adults with acquired brain injury in inpatient rehabilitation and their functional outcomes. Method: Older adults aged 65 years and older admitted to inpatient rehabilitation from acute care with traumatic (TBI) or non-traumatic brain injury (nTBI) from 2003/04 to 2009/10 in Ontario were identified. Demographic and clinical characteristics and functional independence measure (FIM) scores were examined. Results: From 2003/04 to 2009/10, there were 1,214 patients with a TBI diagnostic code and 1,530 patients with a nTBI diagnostic code admitted to inpatient rehabilitation from acute care. During this period, the majority of older adults with TBI and nTBI stayed in inpatient rehabilitation for 25 days or longer (60.7% and 65.8% respectively). Older adults with TBI had significantly higher FIM scores than those with nTBI at admission and at discharge (p<.001). However, both groups made significant gains in FIM (p<.001) and their gains were not significantly different (p>.05). Conclusion: Older adults with TBI and nTBI make similar gains in inpatient rehabilitation. Differences in FIM scores between these two groups may be due to characteristics intrinsic to these patients. Lower initial functional ability on admission for nTBI patients and different clinical profiles has implications for clinical care.



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Changes in Physiological Parameters Following Concussion: Two Case Studies

D Dobney1,2, M Keightley2,3 S Thomas4, T Taha4 1 Ryerson University, Department of Athletics and Recreation - Athletic Therapy;, 2 University of Toronto, Graduate Department of Rehabilitation Science; 3 Holland Bloorview Kids Rehabilitation Hospital; 4 University of Toronto, Faculty of Kinesiology and Physical Education

Background: Recent research suggests impairment of some physiological functions following concussion (Gall et al., 2004, Leddy, et al., 2010). We aim to clarify the influence of sports-related concussion on physiological parameters by comparing heart rate, grip strength and blood pressure measured post-concussion in varsity athletes to individual pre-injury baseline records. Monitoring heart rate and blood pressure, both pre and post-concussion will help to better understand the physiological mechanisms affected by concussion and how these systems respond during recovery from concussion. Methods: Data collected: 1.Heart Rate Variability, 2. Blood Pressure, 3. Grip Strength, 4. Sport Concussion Assessment Tool 2, and 5. Profile of Mood States (Brief). Participants who experienced a sports-related concussion were re-assessed every day for the first 3 days following injury, and then on alternate days until symptomatic recovery. Results: Blood pressure measurements remained stable through the post-injury phase. Observable trends across both cases were a decrease in non-dominant hand grip strength and heart rate variability compared to baseline scores. Conclusions: This is a preliminary analysis of two cases from an ongoing study. Future analysis will help to identify other trends and if these findings are consistent amongst all participants. 59.

Evaluating Appropriate Access to Care for Concussions in Ontario

C Levy3, L Langer1, K Grant4, N Boaro5, J Rizos6, D Sauve7, B Barry8, D Maynard9, M Bayley1,2 1 Toronto Rehabilitation Institute; 2 University of Toronto; 3 Toronto ABI Network; 4 Provincial Trauma Network; 5 Registered Nurses Association Of Ontario; 6 Canadian Association of Emergency Physicians; 7 Canadian Association of Pediatric Health Centres; 8 Insurance Bureau of Canada; 9 Ontario Physiotherapy Association

Concussion/ Mild Traumatic Brain Injury (mTBI) can result from motor vehicle crashes, falls, assaults, sports and recreational injuries, and other causes, and affects people of any age. MTBI is common. Although most individuals recover, some experience ongoing and persistent symptoms affecting physical, cognitive and psychosocial function. Management of those who do not recover as expected becomes a significant health services issue as well as having an economic impact. There is evidence of inconsistency in management of concussion across Ontario and access to specialized concussion care is variable. To determine the extent of the variability, specilaized concussion clinics were surveyed about their servies and the ICES databases were used to track individuals with a diagnosis of mTBI across the treatment spectrum and analyzed who received specialized follow up care and who did not.



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Current State of Community Stroke Resources in Ontario

M Bayley1,3, J Cameron2, M Huigbregts2,5, A Kagan4, N Salbach2, R Teasell6,7, A Kovacevic1, O Yaroslavtseva1 1 Toronto Rehabiltiaion Institute; 2 University of Toronto; 3 Univerisity of Toronto, Faculty of Medicine; 4 Aphasia Institute â&#x20AC;&#x201C; The pat Arato Aphasia Institute; 5 Baycrest Centre for Geriatric Care; 6 Parkwood Hospital SJHC Health Care London, 7 Lawson Health Research Institute

Persons with stroke live on average seven years after a stroke. These individuals have chronic health issues that could be ameliorated if they participate in community activities. Yet, community based resources for persons with stroke are limited. The objective of this project is to evaluate the extent to which currently available community stroke support programs follow evidence-based practices and are accessible to the residences of stroke survivors and identify barriers to best practice implementation. The project identified the neighbourhoods within each of the municipalities that have the highest prevalence of stroke survivors and examined the extent to which existing stroke resources are located in areas of highest stroke survivor prevalence. The project evaluated the visibility and accessibility of available community stroke resources and identified factors facilitating and impeding the implementation of best practices. The project assessed internal and external barriers to participation as well as successful strategies enabling stroke survivors and their caregivers to access the available resources.



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The Timing it Right Stroke Family Support Program

JI Cameron1,2, AI Czerwonka1, G Naglie3, G Warner4, T Green5, M Gignac6, M Bayley2, M Huijbregts3, A Cheung6, F Silver6, S Phillips7 1 University of Toronto, Department of Rehabilitation Sciences; 2 Toronto Rehabilitation Institute; 3 Baycrest; 4 Dalhousie University, School of Occupational Therapy; 5 University of Calgary, Faculty of Nursing; 6 University Health Network; 7 Queen Elizabeth II Health Science Centre

Background: Family caregivers play a central role in the recovery, rehabilitation, and community re integration of stroke survivors. We developed the Timing it Right Stroke Family Support Program (TIRSFSP) to provide stroke families with timely education and support as they care for stroke survivors across the care continuum. Objective: To test the randomized controlled trial (RCT) protocol, determine the time required for intervention delivery and collect pilot quantitative and qualitative data. Methods: Participants were recruited into a mixed methodology RCT at 3 acute care hospitals across Canada. Caregivers were randomized to: 1) standard care, 2) Self-directed TIRSFSP, or 3) TIRSFSP delivered by a stroke support person for the first 6 months post stroke. Participants complete surveys at baseline, 1, 3, 6, and 12-months post-stroke. A sub-set of participants also completed qualitative interviews. Stroke support persons kept journals of each session. Results: From the pilot study, no significant changes were observed in any outcome variables, as expected with the small sample size (N=31). Stroke support persons spent an average of 2.5 hours per participant over approximately 5 sessions. Qualitative findings (n=19) suggest that the TIRSFSP benefits family caregivers. Conclusion: Caregivers who access support have a higher hunger for support.


Engaging patients and families to develop safety indicators for rehabilitation

G Tardif1,2, C Fancott1,2, A Andreoli1,2, M Lowe1,2, S Sharpe1, F Schwartz1, S Solway3, J MacNeil 1 Toronto Rehabilitation Institute; 2 University of Toronto; 3 Baycrest Centre for Geriatric Care

Background: Most hospitals measure safety in terms of adverse events such as falls and pressure ulcers. While important, this approach offers a limited view of safety in rehabilitation and does not necessarily reflect the goals and priorities important to key stakeholders, including patients, who may have broader perspectives of safety. Purpose: This project aimed to engage patients, families, leaders and staff in the development of patient safety indicators relevant for rehabilitation settings. Methods: Patients, families, staff, and leaders (n=39) were engaged in a series of focus groups to help identify safety concerns, then gathered for a consensus-building q-sort process to further refine and prioritize safety indicators for rehabilitation. Results: Nine safety indicators emerged in areas related to communication, care transitions, coordination of care, staffing, and the physical environment. Data for these indicators were collected over a 6-month period from patient satisfaction and care transition surveys and a staff survey on safety culture and a new safety scorecard was developed. Conclusion: The indicators developed by key stakeholders represent those aspects of safety that are relevant and meaningful within rehabilitation settings. This project represents a new level of engagement of patients and families to co-design systems and processes of care together with staff and leaders to improve the safety and quality of rehabilitative care.




63. Long-Term Outcomes after Prolonged Mechanical Ventilation: Family Caregiver Outcomes from the Towards RECOVER Study JI Cameron1,8, L Chan1,2, A Czerwonka1,2, LM Chu2, A Matte2, G Tomlinson2, ND Ferguson1,2, S Mehta1,3, J Friedrich1,4, N Adhikari1,5, R Fowler1,5, F Lamontagne9, J Rudkowski6, H Meggison7, N Ayas11, Y Skrobik1,2, JA Batt4, CC dos Santos3 1 University of Toronto; 2 University Health Network; 3 Mt.Sinai Hospital; 4 St. Michael’ s Hospital; 5 Sunnybrook Health Sciences Centre; 6 McMaster University; 7 The Ottawa Hospital; 8 Toronto Rehabilitation Institute;9 Centre Hospitalier de Universitaire Sherbrooke

Objective: Family caregivers play a central role in caring for and supporting intensive care unit survivors who experienced prolonged mechanical ventilation but many will experience negative health outcomes. The objective of this research is to identify aspects of the care-giving situation that influence caregiver emotional health and quality of life. Method: We are enrolling patients and caregivers at 10 hospitals across Canada. Caregivers are assessed 7 days and 3, 6, 12 and 24 months after survivors’ ICU discharge and complete standardized measurement instruments. Results: To date, 249 caregivers have been enrolled. Modeling the dependent variables over the one year period suggests caregivers’ depression improves between 7-days and 3-months post-ICU discharge. Psychological well-being is stable over time. Multivariable longitudinal modeling suggests that caregivers experience more depression and less psychological well-being when they have difficulty maintaining participation in valued activities, have less social support, have less mastery, and gain less personally from their caregiving role. Conclusions: Programs to support caregivers should begin within the first 3-months post-ICU discharge and continue as survivors’ reintegrate into community living. Interventions should assist caregivers to maintain participation in valued activities, access social support, gain positive experiences from providing care, and contribute to their mastery. 64. Long-Term Patient Outcomes After Prolonged Mechanical Ventilation: The Towards RECOVER Study MS Herridge1,2, LM Chu1, AL Matte1, L Chan1,2, G Tomlinson2, ND Ferguson1,2, S Mehta2,3, J Friedrich2,4, N Adhikari2,5, R Fowler2,5, F Lamontagne9, J Rudkowski6, H Meggison7, N Ayas11, Y Skrobik12, JA Batt4, CC dos Santos4, JF Flannery8 1 University Health Network; 2 University of Toronto; 3 Mt. Sinai Hospital; 4 St. Michael’s Hospital; 5 Sunnybrook Health Sciences Center; 6 McMaster University; 7 The Ottawa Hospital; 8 Toronto Rehabilitation Institute; 9 Centre Hospitalier Universitaire de Sherbrooke; 10 Institut Universitaire de Giriatrie de Sherbrooke; 11 St. Paul’s Hospital; 12 Hospital Maisonneuve Rosemont

Objective: Towards RECOVER is a multi-centre prospective Canadian cohort study designed to evaluate detailed outcomes to 2 years after ICU to inform risk stratification for an early and ongoing rehabilitation intervention for patients mechanically ventilated for 7 or more days and their family caregivers. Hypothesis: Older age and a greater burden of comorbidities at ICU admission are associated with poor functional, neuropsychological, QOL outcomes and increased cost and healthcare utilization at 1 and 2 years after ICU discharge. Results: We report preliminary multivariable modelling results on 301 patients. ICU LOS was significantly associated with 7d Functional Independence Measure (FIM) Motor subscale score. Older age was significantly associated with 7d FIM Motor score and there was a trend towards significance at 1-year (p<0.05). There was a trend toward significance between these same variables and outcome for the 1-year FIM and 6 MWD. Conclusions: Preliminary data suggest important early functional disability captured best by FIM and 6MWD with improvement but persistent impairment to 12 months after ICU discharge. Early modeling results suggest that patients may be risk stratified for early inpatient rehabilitation at 7 days after ICU discharge based on age and ICU LOS.



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65. Using Drama to Increase Exercise Amongst Older Hemodialysis Patients: The Making of 'Fit for Dialysis' J Gray1,2,3, P Kontos2,3, G Naglie4,3, SV Jassal3,2, D Brooks3,1 1 Ontario Institute for Studies in Education, 2 Toronto Rehabilitation Institute-University Health Network, 3 University of Toronto, 4 Baycrest

End-stage renal disease (ESRD) and its sequelae lead to reduced physical capacity and functional impairment. These limitations are greater in older hemodialysis patients, and have been shown to compromise their rehabilitation potential. Many of the sequelae of ESRD are caused or are influenced by deconditioning. Exercise can significantly improve many of these outcomes even in older hemodialysis patients, yet exercise remains extremely low in this patient population. There is the need for more innovative approaches to redress this. To fill this gap, we developed a researchbased drama as an educational intervention to increase exercise for wellness amongst older hemodialysis patients. This poster examines the process of developing a research-based film called 'Fit for Dialysis.' 'Fit for Dialysis' is an arts-based intervention that has enormous potential to facilitate an evidence-based culture of practice. Understanding the artistic and technical elements will inform an evaluation of this research-based film. 66. 'No Place to Grieve': The Suppression of Emotion in Neurorehabilitation P Kontos1,2, K-L Miller1,2, C Cott1,2, A Colantonio2,1, R Colobong1 1 Toronto Rehabilitation Institute; 2 University of Toronto

The emotional impact of traumatic brain injury is profound. The nature of brain injury often results in significant losses for an individual, causing anxiety, depression, and post-traumatic stress. Yet studies have shown that clients are not supported in their efforts to resolve their emotional issues. Research examining the lack of attentiveness to emotional issues by rehabilitation therapists has overlooked important ways in which the organization of rehabilitation itself produces and sustains emotional suppression. The objective of this study was to explore aspects of neurorehabilitation that facilitate and impede grieving and loss. 67. The Opioid Manager App for iPhone/iPad: Development, Design, Distribution, Promotion and Demonstration A Furlan1,2,3 1 Toronto Rehabilitation Institute; 2 University of Toronto, Division of Physiatry, Department of Medicine, Faculty of Medicine; 3 Institute for Work & Health

The Opioid Manager App is intended to assist physicians prescribing opioids for chronic non-cancer pain. The following steps were taken in the development of the Opioid Manager App: 1) Credible content (all content was extracted from the Canadian Opioid Guideline), 2) Structured content (the paper version of the Opioid Manager was released in 2010, it has been tested and revised), 3) Assess the need for the App (many physicians offices are paperless and there was a need for mobile or electronic resources). The steps to design the App included: 1) Secure funding (obtained from the AFP Innovation Fund from Ontario Ministry of Health), 2) Find an experienced developer; and 3) Beta-testing. Distribution: it is distributed by Apple iTunes store; Promotion was done via media release (UHN), twitter, facebook and website. Demonstration: The Opioid Manager App can be used to assess the risk of overdose, risk of addiction, to calculate daily morphine equivalent doses, to calculate switching doses of opioids, to do an initial screening of patients and to monitor patients at each visit. It also contains other resources such as patient information, treatment agreement template and a video.




68. Is the emergency department an appropriate substitute for primary care for persons with traumatic spinal cord injury? SJT Guilcher1,2, BC Craven1,2, A Calzavara3, MA McColl4, SB Jaglal1,2,3,5,6 1 University of Toronto, Institute of Health Policy, Management and Evaluation; 2 Toronto Rehabilitation Institute; 3 Institute for Clinical Evaluative Sciences; 4 Queen’s University, School of Rehabilitation Therapy; 5 University of Toronto, Department of Physical Therapy; 6 Women’s College Hospital

Introduction: Persons with disabilities, such as those with traumatic spinal cord injury (TSCI) face numerous challenges in navigating through the primary care system. Emergency department(ED) utilization has been used as an indicator of insufficient access to primary care. Objectives: To describe the patterns and characteristics of ED visits made by persons with TCI over a 6 year period. Methods: Rates of ED utilization and reasons for ED visits were calculated between the fiscal years 2003-2009 for persons with TSCI living in Ontario, Canada. Reasons for visits were categorized by acuity level: potentially preventable visits were defined as visits related to ambulatory sensitive conditions; low acuity and high acuity visits were defined by the Canadian Triage and Acuity Scale. Results: The total number of ED visits for the six year period is 4403 (n=1217). Of these visits, 752 (17%) were classified as potentially preventable, 1443 (33%) as low acuity and 2208 (50%) as high acuity. ED use was highest in the first year following injury but remained high over the subsequent years. Conclusions: Given the high rates of ED use for low acuity and potentially preventable conditions, these results suggest that the ED is being used as an inappropriate substitute for primary care.

69. Direct costs of adult traumatic spinal cord injury in Ontario. SEP Munce1, WP Wodchis1,5,7, SJT Guilcher1, CM Couris2,3, M Verrier4,5,6, K Fung7, BC Craven1,5,8 and SB Jaglal1,4,5,6,7 1 University of Toronto, Department of Health, Policy, Management and Evaluation; 2 Canadian Institute for Health Information; 3 Hospices Civils de Lyon, Universiti Lyon, Lyon, France; 4 University of Toronto, Department of Physical Therapy; 5 Toronto Rehabilitation Institute and University of Toronto; 6 University of Toronto, Graduate Department of Rehabilitation Science; 7 Institute for Clinical Evaluative Sciences; 8 University of Toronto, Department of Medicine

Study design: Retrospective economic analysis. Objectives: To determine the total direct costs of publicly funded health care utilization for the three fiscal years 2003/04 to 2005/06, from the time of initial hospitalization to 1 year after initial acute discharge among individuals with traumatic spinal cord injury (SCI). Methods: Health system costs were calculated for 559 individuals with traumatic SCI for acute inpatient, emergency department, inpatient rehabilitation (that is, short-stay inpatient rehabilitation), complex continuing care (CCC), home care services, and physician visits in the year after index hospitalization. All care costs were calculated from the government payer's perspective. Results: Total direct costs of health care utilization in this traumatic SCI population (including the acute care costs of the index event and inpatient readmission in the following year after the index discharge) were substantial: $102 900 per person in 2003/04, $100 476 in 2004/05 and $123 674 in 2005/06 Canadian Dollars (2005 CDN $). The largest cost driver to the health care system was inpatient rehabilitation care. From 2003/04 to 2005/06, the average per person cost of rehabilitation was approximately three times the average per person costs of inpatient acute care. Conclusion: The high costs and long length of stay in inpatient rehabilitation are important system cost drivers, emphasizing the need to evaluate treatment efficacy and subsequent health outcomes in the inpatient rehabilitation setting.



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Reaching Consensus on a Core Set of Balance Measures for Research and Practice

KM Sibley1,2, SE Straus3,4, K Berg2, BE Maki1, SB Jaglal1,2 1 Toronto Rehabilitation Institute; 2 University of Toronto, Department of Physical Therapy; 3 St. Michael's Hospital; 4 University of Toronto, Department of Medicine

Background: Falls are a major health concern for older adults. Balance is a modifiable risk factor for falls and a component of exercise programs that reduce falls. However, synthesizing evidence on balance interventions has been hampered by extensive variation in the use of balance outcome measures between studies. There is a need to reach consensus on a core set of measures for balance assessment that can be used across a range of populations and settings. The objective of this project is to create recommend a core set of measures for evaluating balance in older adults. Methods: A modified Delphi Technique involving a combination of anonymous rating and group discussion is planned to achieve consensus on a core set of balance measures among 18 expert researchers and clinicians. Consensus will be reached over three rounds, and in each round participants will rate measures on specific indicators for inclusion and defined criteria will be used for establishing consensus. Anticipated Outcomes: A recommended core set of measures to evaluate between-subject and within-subject differences in balance in adult populations at risk for falls.

71. What's it going to take to implement caregiver education and support programs in Ontario: A key informant study V Tseung1, NM Salbach2,4, SB Jaglal2,4, JI Cameron3,4 1 University of Toronto, Graduate Department of Rehabilitation Science; 2 University of Toronto, Department of Physical Therapy; 3 University of Toronto, Department of Occupational Science & Occupational Therapy; 4 Toronto Rehabilitation Institute

Background: Family caregivers play a crucial role in the ongoing care of stroke survivors. Their unpaid labour saves the Canadian health care system over 25 billion dollars annually. Evidence shows that caregiver programs are beneficial for caregiver skill and well-being, but these programs are not being implemented by the health care system. Objectives: 1) To gain insight into the organizational/system level factors influencing caregiver program implementation; 2) To identify other potential stakeholder groups. Methods: This study employs a qualitative case study design using the Ontario Stroke System (OSS) as the research case. This first phase entailed qualitative interviews with a purposive sample of 11 key informants representing the Ontario Stroke System and Network, non-stroke caregiver programs, and Ontario' s Ministry of Health, Local Health Integration Networks, and Community Care Access Centres. Participants were asked to discuss the factors influencing caregiver program implementation. Results: Caregiver program implementation requires: 1) demonstrating the need for such programs; 2) having a strong business case; 3) incorporating caregiver education and support into clinical practice; and 4) involving key stakeholders in the implementation process. Conclusions: The factors identified as affecting caregiver program implementation will be explored further in the next phase with broader representation from the OSS.




72. The Impact of Emotional Prosody on Cognitive Processing NAM Durham1,2,5, V Nieborowska2,3, BM Ben-David1,2,3,6, PHMM van Lieshout1,2,3,4,5 1 Toronto Rehabilitation Institute; 2 University of Toronto, Oral Dynamics Lab, Department of Speech-Language Pathology; 3 University of Toronto, Department of Psychology; 4 University of Toronto, Institute of Biomaterials and Biomedical Engineering; 5 University of Toronto, Graduate Department of Rehabilitation Science; 6 The Interdisciplinary Center (IDC) Herzliya, School of Psychology

Background and Rationale: The ability to recognize emotional prosody in speech is important for communication. How does emotional prosody affect cognitive processing? Can we explain this by investigating different emotion dimensions present in distinct prosodies? Objective: To understand how valence and arousal dimensions of emotional prosody can influence cognitive performance. Method: 80 healthy young adults were instructed to monitor the presence of target phonemes in spoken words. Half of the trials are phoneme present, and the other half are phoneme absent. The words were lexically neutral and spoken in five affective categories: happy, sad, anger, fear, and neutral. Results: Average response latencies for happy and sad prosodies were shorter than for neutral prosody. Ratings of valence corresponded to task performance, therefore emotional prosodies with higher valence had shorter response latency. Conclusion: Our study suggests that emotional prosody high in valence will enhance cognitive processing. During communication, if an utterance is spoken in a negative or positive prosody the listener will allocate more immediate resources to speech, in comparison to neutral prosody. Further research in this area will provide greater understanding of the extent of the impact of emotional prosody on cognitive processing in both healthy and pathological populations.

73. Patient-centred communication intervention study to evaluate nurse-patient interactions in complex continuing care KS McGilton1,5, R Sorin-Peters2, S Sidani3, E Rochon1,4, V Boscart1,5, M Fox6, C Chu1,5 1 Toronto Rehabilitation Institute, E.W. Bickle Centre, Department of Research; 2 Sunnybrook Health Sciences Centre, The Regional Stroke Team, North & East; 3 Ryerson University, School of Nursing; 4 University of Toronto, Department of Speech-Language Pathology; 5 University of Toronto, Lawrence S. Bloomberg Faculty of Nursing; 6 York University

Background: Stroke patients are often left with communication impairments that make it difficult to articulate their needs which causes frustration for both the patient and the caregiver. A key component of patient-centred care is the ability of staff to communicate effectively to understand the patient’s needs. Objectives: To examine 1) the effect of a patient-centred communication intervention (PCCI) on quality of life, depression, satisfaction with care, and agitation in stroke patients with communication impairments; targeting stroke patients and the nursing staff caring for them, 2) the extent to which the PCCI improves nursing staff’s attitudes and knowledge in caring for stroke patients with communication impairments. Design: A quasi-experimental repeated measures, non-equivalent control group design. Patients with a communication impairment post-stroke admitted to complex continuing care facility are eligible to participate. All staff nurses are eligible. Intervention: The PCCI consists of three components to facilitate interaction with patients: (1) an individualized patient communication care plan; (2) a one-day workshop focused on communication strategies for nursing staff; and (3) a staff support system. Significance: The improvement of these interactions will lead to stroke patient’s reduction of agitation, and increase patients well-being, quality of life, and satisfaction with care.



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74. Auditory Spatial Attention in a Complex Acoustic Environment While Walking: Investigation of Dual-Task Performance ST Lau1, J Maracle1, D Coletta1, G Singh1,2, J Campos1,2, & MK Pichora-Fuller1,2 1 University of Toronto; 2 Toronto Rehabilitation Institute

Listening environments in everyday life are often complex, involving multiple conversation partners, background noise and/or speech, and non-auditory stimuli. Speech comprehension in these situations requires listeners to identify the target speech amongst competing stimuli. Adding another layer of complexity is that listeners often perform this target identification simultaneously with a competing tasks (e.g. driving, walking). The focus of this study is to understand the effects on listening while walking. The objective was to determine whether the listening performance of young adults was affected by walking. This pilot study began by examining the performance of healthy, young adults. Phase 1 of the study involved taking existing methods used to study a multi-talker listening environment in a sound booth and adapting them to a Virtual Reality (VR) laboratory, called StreetLab. Following this, in Phase 2 participants completed the listening task in two conditions, standing still and while walking in StreetLab. Investigating the performance of this dual-task is crucial to better understanding fall-related injuries (Scott et al., 2005) that are commonly experienced by older adults. Listening task performance was comparable in both sound booth and VR environments and when standing still or walking.

75. Automated classification of primary progressive aphasia subtypes from narrative speech samples KC Fraser1,2, JA Meltzer3, NL Graham2,4, C Leonard5, G Hirst1, SE Black6,7, E Rochon2,4 1 University of Toronto, Department of Computer Science; 2 Toronto Rehabilitation Institute 3 Rotman Research Institute - Baycrest Centre; 4 University of Toronto, Department of Speech-Language Pathology; 5 University of Ottawa, School of Rehabilitation Science; 6 Sunnybrook Health Sciences Centre, L.C. Campbell Cognitive Neurology Research Unit; 7 University of Toronto, Department of Medicine

In the early stages of neurodegenerative disorders, individuals may exhibit a decline in language abilities that is difficult to quantify with standardized tests. Careful analysis of connected speech can provide valuable information about a patient's language capacities. However, this type of analysis has been limited in the past by its time-consuming nature. In this study, we present a method for evaluating and classifying connected speech in primary progressive aphasia (PPA) using computational techniques. Syntactic and semantic features are automatically extracted from transcriptions of narrative speech for three groups: semantic dementia (SD), progressive nonfluent aphasia (PNFA), and healthy controls. Features that vary significantly between the groups are used to train machine learning classifiers, which are then tested on held-out data. We achieve accuracies above baseline on the three classification tasks. An analysis of the influential features shows that the computationally extracted measures agree well with previous findings in the PPA literature, suggesting that this method could have valuable applications to diagnosis and research.



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76. Language Comprehension in Progressive Aphasias and Atypical Parkinsonian Syndromes NL Graham1, MT Carthery-Goulart2, T Bak3 1 Toronto Rehabilitation Institute and University of Toronto, Department of Speech-Language Pathology; 2 Universidade Federal do ABC, Mathematics, Computing & Cognition Center and Cognitive & Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Behavioural Neurology Unit, Brazil; 3 University of Edinburgh, Human Cognitive Neuroscience Unit and Medical Research Council, Cognition & Brain Sciences Unit, Cambridge, United Kingdom

Background and Rationale: Until recently the neurodegenerative brain diseases tended to be divided into two broad categories: cognitive disorders and movement disorders. The first comprised mainly dementias and aphasias, while the second was dominated by Parkinson's Disease and atypical parkinsonian syndromes, such as Progressive Supranuclear Palsy (PSP), and Corticobasal Syndrome (CBS). A significant level of overlap between cognitive and motor symptoms has, however, been reported. Objective: We investigated the overlap between cognitive and movement disorders by evaluating cognitive skills, specifically language comprehension, in degenerative conditions of both types. Methods: A language comprehension task (Test of Reception of Grammar) was administered to 39 individuals with progressive nonfluent aphasia (PNFA), 43 with progressive fluent aphasia, 33 with PSP, and 37 with CBS, as well as 20 controls. Results: The groups with PNFA and CBS were impaired on syntactic comprehension, while the PSP and fluent aphasic groups had normal performance. Conclusion: Language comprehension impairment can be a feature in parkinsonian syndromes (specifically CBS) which are considered to be primarily movement disorders. Implications: Our results question the usefulness of separating neurodegenerative conditions into aphasias and movement disorders, and lend strong support to the notion that CBS and PNFA form part of a diagnostic continuum. 77. Speech Pausing as a Diagnostic Marker of Cognitive Decline in ALS and FTD K Phuong1, Y Yunusova1,2, NL Graham1,3, E Rochon1,3, SE Black2,5, L Zinman2,5 1 Department of Speech Language Pathology, University of Toronto; 2 Department of Speech Language Pathology, University of Toronto, Sunnybrook Research Institute; 3 Toronto Rehabilitation Institute, Department of Speech Language Pathology, University of Toronto; 4 Toronto Rehabilitation Institute, Department of Speech Language Pathology, University of Toronto; 5 Department of Neurology, University of Toronto; 6 Departments of Speech Language Pathology and Neurology, University of Toronto

Background and Rationale: Amyotrophic Lateral Sclerosis (ALS) is a multisystem disorder that affects cognition and motor functions. Cognitive deficit in ALS is difficult to diagnose and better measures are needed. Speech pausing is a candidate measure, but is affected by changes in respiratory and speech motor control. Objective: We aimed to understand the contribution of cognitive, respiratory and motor factors to changes in speech pausing behaviours, to ultimately develop a speech pause-based measure of cognitive decline. Methods: Participants with either bulbar or respiratory ALS read aloud a paragraph. Performance was compared to two groups: 1) frontotemporal dementia (FTD) with concomitant cognitive impairment, without bulbar or respiratory problems; 2) normal controls. A semi-automatic speech pause analysis enabled quantification of speech and pause durations based on acoustic recordings. Results: In comparison with controls, the ALS respiratory deficit group showed increased pausing at non-grammatical junctures, while the ALS bulbar deficit group showed longer speech duration (indicative of reduced articulatory rate). The FTD group showed more frequent and longer pauses. Conclusion: Cognitive decline, bulbar and respiratory deficits all cause measurable and distinguishable effects on speech pausing behaviour. Implications: Analysis of speech pausing may be useful in neurodegenerative disease screening and should be developed further.



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RAVDESS: The Ryerson Audio-Visual Database of Emotional Speech and Song

SR Livingstone1, K Peck1, FA Russo1,2 1 Ryerson University, Department of Psychology; 2 Toronto Rehabilitation Institute, Adjunct Scientist

This study introduces a new database of emotional speech and song. Our purpose in creating this database was to provide researchers with an open-access, high-quality set of audio-visual recordings of emotional speech and song in North American English. The battery consists of 25 highly trained actors, speaking and singing short statements with 8 different emotions, each with two emotional intensities. Containing over 7000 files (audio-only, video-only, fullAV in 1080i), the battery will allow researchers to pursue questions involving emotion in the context of facial and vocal communication. Stimuli from the database will be used in our new singing therapy to improve the communication of facial and vocal emotion in patients with Parkinsonâ&#x20AC;&#x2122;s Disease.


Attitudes toward Teleaudiology and the Technology Adoption Lifecycle

G Singh1,2,4, MV Malkowski2, MK Pichora-Fuller1,2,3, M Boretzki4, S Launer4 1 University of Toronto, Department of Psychology; 2 Toronto Rehabilitation Institute; 3 Linkoping University; 4 Phonak AG

Hearing impairment affects an estimated 278 million individuals globally and most of these individuals face difficulties accessing audiological services. The delivery of audiological services via telecommunication mediums such as the internet (teleaudiology) is one possible way to address this lack of accessibility to audiological services. Interestingly, research suggests that telemedicine interventions frequently fail by not taking into account the attitudes of the users toward the underlying technologies. Given the dearth of research on this topic, we set out to investigate the attitudes of patients toward teleaudiology. This research was undertaken through the lens of the technology lifecycle model, a model that describes how new innovations spread through cultures. Specifically, the model posits that innovators and early adopters are the first individuals who are open to accepting new ideas and innovations. Our goal was to observe the relationship between the role of personality (specifically openness to novel experiences) and willingness to use teleaudiology in a sample of audiology patients. Preliminary results suggest that openness, as measured by the Big 5 Personality index, is positively associated with greater willingness to use teleaudiology. Ultimately, this research will help inform the future uptake of teleaudiological solutions. 80.

Linguistic Auditory Threat Test Effect

J Zimmermann1, N Durham1, P van Lieshout1,2 1 University of Toronto; Toronto Rehabilitation Institute

The current project evaluates human participant physiological responses to auditorally presented emotional words (Happy, Sad, Fear, Anger and Neutral) spoken in neutral tone using the Galvanic Skin Response. Comparison to neutral words will be provided. GSR is a measure of skin conductance, which is used to evaluate autonomic arousal. A phoneme monitering task will be used, accompanied by GSR to measure physiological arousal. Participants will be undergraduate students. Three word lists will be used: threat word list, word list pertaining to traumatic brain injury, and neutral word list. Responses of undergraduate participants to traumatic word list will be compared to responses of traumatic brain injury patients in a seperate study from the current one.



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81. Inter-generational Communication Breakdown: Age-Related Differences in Processing of Emotions in Speech N Multani1,2,4, BM Ben-David1,2, PHHM Van Lieshout1,2,3,4,5 1 Toronto Rehabilitation Institute; 2 University of Toronto, Oral Dynamics Lab, Department of Speech-Language Pathology; 3 University of Toronto, Department of Psychology; 4 Graduate Department of Rehabilitation Sciences; 5 Institute of Biomaterials and Biomedical Engineering

Background and Rationale: The ability to comprehend emotions in speech is a crucial component of social interaction. Emotions in speech are mainly conveyed by two dimensions: the lexical content and the prosody (tone of speech). Current evident indicates that older adults have difficulty understanding emotions in speech; however, the nature of this deficit is not apparent. Objective: In order to understand age-related differences in processing of emotions, healthy young and older adults were presented with 50 lexical sentences in five different emotions (anger, fear, sad, happy and neutral). Method: Twenty-four healthy young and 24 older adults were instructed to rate these sentences on four emotions (anger, fear, happy and sad) for three different tasks (combined, lexical content and prosodic), using a 6-point Likert scale. Results: Compared to older adults, young adults indicate a higher preference for prosody, whereas, older adults demonstrate a preference for the lexical content. Conclusions: Healthy young adults and older adults differ in their ability to process emotions in speech. Implications: A modified version of this tool will be used to assess emotion processing in patients with Alzheimer 's disease.

82. Communicating with machines F. Rudzicz1,2 1 Toronto Rehabilitation Institute; 2 University of Toronto, Department of Computer Science

I am starting a new lab called SPOClab (Signal Processing and Oral Communication) whose purpose is to produce software that helps people with disabilities communicate. Our main goal is to improve the core technology in computer speech interfaces and to use this technology within applications that help people in their daily lives. Our work will involve fundamentally changing the way that speech recognition is currently done, because this technology simply does not work properly for people with very different kinds of speech. Our new approach will include teaching the computer to understand how speech is physically produced; for example, if the computer can see the speakerâ&#x20AC;&#x2122;s face, it makes understanding them much easier. We will build tools to help people communicate with humans and with machines. One project involves transforming hard-to-understand speech with advanced signal processing to be more intelligible to human listeners. Another project involves building new ways of interacting with intelligent software that combines audio and video input into single commands. A third project will involve studying computer models of brain signals during language production and perception that will help people to communicate merely by thinking of words.



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83. Automatic Detection of Selective Auditory Attention Via Transient Evoked Otoacoustic Emissions E Wan1,2,3, T Chau1,3 1 Bloorview Research Institute; 2 University of Toronto, Edward S. Rogers Sr. Department of Electrical and Computer Engineering; 3 University of Toronto, Institute of Biomaterials and Biomedical Engineering

Many children with severe physical disabilities still face challenges with communication and control of their surrounding environment due to verbal and motor impairments. This problem affects a significant fraction of 84,280 Canadian children with severe disabilities. The search for a solution enables them to improve their quality of life. Past studies have shown that the effects of selective auditory attention are evident in medial olivocochlear (MOC) efferent activity, manifested as the contralateral suppression (CS) of transient evoked otoacoustic emissions (TEOAEs). This finding suggests the possibility for the use of TEOAE in the design of an auditory body-machine interface. A design of TEOAE-based access pathway was tested for its performance in the current research study. Thirteen participants were instrumented with a TEOAE ear probe and instructed to alternate between a non-attentive and an attentive auditory attention conditions as visually cued by symbols on an LCD display. Signal processing involved a typical two-class classification problem, where the best tested feature was based on the extraction of frequency specific information on the CS of TEOAEs. The attentive auditory condition was detected with an overall accuracy that is comparable with other auditory-based access pathways.

84. Connected speech in fluent and nonfluent variants of primary progressive aphasia : A DTI study K Marcotte1, NL Graham1, SE Black1,2,3,4, DF Tang-Wai3,5, TW Chow4, M Freedman3,4, JA Meltzer3,4, C Leonard6, E Rochon1,3 1 Toronto Rehabilitation Institute; 2 Sunnybrook Health Sciences Centre; 3 University of Toronto; 4 Rotman Research Institute - Baycrest Centre; 5 University Health Network Memory Clinic; 6 University of Ottawa

Objective: White matter changes in language related tracts have been shown to distinguish the different variants of primary progressive aphasia (PPA). Dorsal fibres have been specifically related to syntactic processing. To date, little is known about white matter disruption and how this relates to connected speech in PPA. Methods: We used diffusion tensor imaging in 15 non-fluent PPA (nfPPA), 12 fluent PPA (fPPA) and 18 age-matched controls. Probabilistic tractography was used to identify the ILF, SLF and uncinate bilaterally. We compared the tracts mean fractional anisotropy (FA) with a univariate ANCOVA, using sex, age and intracranial volume (ICV) as covariates. For both groups of patients, partial correlations were performed using ICV as covariate.Results: No FA abnormalities in nfPPA as compared to controls, but greater diffusivity in the left SLF and right ILF. For the fPPA, lower FA in the uncinate and ILF bilaterally and greater MD in all tracts. Correlational analyses showed that words per minute in connected speech depend primarily on the left SLF and the left uncinate. Conclusion: These findings suggest probabilistic tractography is important to reflect differences in the white matter pathology in PPA. This study provides evidence that structural compromise to multiple tracts is associated with connected speech impairments in patients with PPA



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A novel singing therapy to improve communication of facial and vocal emotion

LM McGarry1, S Livingstone1, P van Lieshout2, W Wong2, A Lang3, FA Russo1 1 Ryerson University, SMART Laboratory; 2 University of Toronto, Oral Dynamics Laboratory; 3 Toronto Western Hospital, Movement Disorders Clinic

Individuals with Parkinsonâ&#x20AC;&#x2122;s Disease (PD) often exhibit disruptions in the capacity to perceive and produce emotional expressions in the voice, face, and body. These deficits can negatively impact social communication. We describe a forthcoming pilot study that uses facial and vocal mimicry to retrain facial and vocal expressiveness and understanding in PD. In our lab, we have successfully used an emotional singing paradigm to reliably elicit spontaneous mimicry in healthy participants. We plan to implement a 13-week singing therapy employing an imitative facial mimicry task for participants with PD. In the experimental condition, participants facial motion and vocal output will be recorded while actively imitating audio-visual recordings of emotional singing. In the control condition, participants will be asked to observe the same recordings only. Motion capture and acoustic analyses will be used to assess changes in facial motor expressive range and vocal capability. Pre- and post-assessments of facial and vocal recognition of emotion will be assessed using a standardized assessment battery for non-verbal emotion recognition. By retraining expressive functionality, we aim to improve the smoothness of social interactions, quality of life and emotional wellbeing of individuals with PD and their caregivers.


Design, Training And Evaluation Of A Vocalization Recognition System As An Assistive Technology For Pediatric Individuals With Dysarthric Speech

N Thalanki Anantha1,2, T Chau1,2 1 University Of Toronto, Institute of Biomaterials and Biomedical Engineering; 2 Holland Bloorview Kids Rehabilitation Hospital

Assistive Technology (AT) in the form of computer-based access switches and communication boards are developed for these individuals. Many of these tools are abandoned within the first few months of use due to motor limitations. In such cases, it remains essential to design AT tools which take advantage of their abilities, such as their ability to produce speech. The use of Automatic Speech Recognition (ASR) systems has demonstrated success as an AT tool for individuals with CP that also have mild or moderate dysarthria. ASR tools could potentially increase the ease of use and leading to improved performance, effectiveness, reliability and durability of the AT. Speech input from a pediatric participant characterized with extrapyramidal CP with Gross Motor Function Classification System (GMFCS) level- II-III will be used as input to facilitate switch closure and activate functions on a computer. A customised speech/vocalization recognition system will be developed which has greater tolerance to variability of speech utterances. Using switch interface adapted to the needs of the user, this system will then be tested for performance. Upon successful adoption by the participant, this system will be used to customize access technologies for similar population desiring vocalization activation of their



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87. Multivariate Index of Synchrony S Rezaei1,2, T Chau1,2 1 University of Toronto, Institute of Biomaterials and Biomedical Engineering; 2 Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute

Social interaction is critical to child development. Non-verbal children with severe disabilities often cannot interact meaningfully with their environment. Understanding their needs and desires can be an insurmountable challenge to caregivers. In this study, we have developed Index of Synchrony, a method to quantitatively ascertain the extent of interactions between two individuals by measuring their physiological synchrony. Our method is based on developing an automatic synchrony detection algorithm. Given that real dyadic data contain unknown levels of alignment, we have exploited wellcontrolled, simulated data to build, test and calibrate an index of synchrony. The index of synchrony, introduced in this work, reflects the level of temporal alignment between corresponding subsets of physiological signals of two or more people. Combined index of synchrony combines the results from synchrony measurements from individual pairs of signals into one single quantity as an indicator of the extent of interaction between two individuals. Currently we are collecting data from adult pairs participating in our experiment. The data is being analyzed using the Index of Synchrony method explained above. In future work, this method will be applied to the study of interactions between non-verbal children and their caregivers.

88. Treatment Intensity and the Reduction of Phonological Processes in Children with Apraxia of Speech M Komeili1, A Namasivayam1,2,3, M Pukonen1, P van Lieshout2,3,4,5,6, B Maassen7, R Kroll1,2 1 The Speech & Stuttering Institute, 2 University of Toronto, Department of Speech-Language Pathology; 3 Toronto Rehabilitation Institute, 4 University of Toronto, Department of Psychology; 5 University of Toronto, Institute of Biomaterials and Biomedical Engineering; 6 University of Toronto, Graduate Department of Rehabilitation Science; 7 University of Groningen

Childhood apraxia of speech (CAS) is a subtype of motor speech disorder (MSD) where subjects demonstrate inconsistent speech production, difficulties in articulatory transitions and inappropriate prosody (ASHA, 2007). Currently there is insufficient research literature relating to treatment dosage and a child's progress. The paper describes an eclectic intervention approach called the motor speech treatment protocol (MTSP) on its effectiveness on children with CAS. The purpose of the current study was to identify the relationship between treatment intensity (1x or 2x week for 10 weeks) and changes in speech production patterns (phonological process errors, PPE) in children with CAS. 37 children with features of CAS (M=3;4, S.D.=5.6) participated and were given either low-intensity (1x/week) or high-intensity (2x/week) treatment for 10 weeks. PPE measures were obtained from standardized tests of phonological processes (Khan-Lewis Phonological Analysis and Hodson's Computerized Assessment of Phonological Patterns). Significant reductions in PPEs and medium-large effect sizes were found only for children receiving high-intensity treatment. The results of the current study may be used as a basis for future research and may have implications for service delivery models for children with CAS.



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Motor Speech Treatment Protocol: Preliminary Data

E Kearney1, A Namasivayam1,2,3, M Pukonen1, P van Lieshout2,3,4,5,6, R Jahnke1, C Spavor1, R Kroll 1,2 1 The Speech & Stuttering Institute, 2 University of Toronto, Department of Speech-Language Pathology; 3 Toronto Rehabilitation Institute, 4 University of Toronto, Department of Psychology; 5 University of Toronto, Institute of Biomaterials and Biomedical Engineering; 6 University of Toronto, Graduate Department of Rehabilitation Science

This study aimed to establish and quantify the treatment effects for specific outcome measures in children with Speech Sound Disorder (SSD) following Motor Speech Treatment Protocol (MSTP). Six children aged 3:0 to 3:5 years with moderate to profound SSD participated in this study. The participants attended individual, 45 minute speech therapy sessions, twice a week for 10 weeks for a total of 20 treatment sessions. Treatment goals were selected based on the motor-speech treatment hierarchy and focused on mandibular, labial-facial and lingual control. A prospective pre-post design was employed and the outcome measures recorded changes in speech motor control, articulation, phonology, and speech intelligibility. The results indicate large effect sizes and significant change post-treatment in articulation and phonology. Large effect sizes and a statistical trend for word- and sentence-level speech intelligibility were found. These results provide preliminary evidence that the Motor Speech Treatment Protocol may directly and positively impact speech production, thereby improving speech intelligibility.


Directional Hearing Aid and Cocktail Party Problem

B Wang2, W Wong1,2,3 1 Toronto Rehabilitation Institute;2 University of Toronto, Department of Electrical and Computer Engineering; 3 University of Toronto, Institute of Biomaterials and Biomedical Engineering;

Hearing aids have been receiving increasing attention in recent years; with the aging of global population, hearing loss due to aging has become an increasingly common problem. Current hearing aids are often lacking; for example, many hearing loss patients reported that they could not effectively focus their attention to a particular speaker in a group environment due to inability to perform target acquisition and selective hearing. The loss of these critical functions could be the results of damages or reduced performance in the auditory cognition system, therefore in order to solve these problems an algorithm that models corresponding cognitive processes is necessary. Human selective hearing is a complex process that involves several steps. In order to selectively attend to one particular speaker amongst other speakers, humans need to be able to be able perform pitch identification, sound source separation, as well as signal tracking. These individual processes are each modelled and combined to estimate the human selective hearing process. The algorithm demonstrates significantly improved SNR and has met requirements such as computational speed for real time applications in hearing aid. Such an algorithm has been integrated with hardware to demonstrate the aforementioned concept and performance.



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A Neurofeedback-Based Near-Infrared Spectroscopy Brain-Computer Interface

S Weyand1,2, T Chau1,2,4, E DeRosa3 1 Bloorview Research Institute; 2 University of Toronto, Institute of Biomaterials and Biomedical Engineering, 3 University of Toronto, Department of Psychology; 4 Holland Bloorview Kids Rehabilitation Hospital

Over half a million people worldwide have severe motor impairments. These individuals are cognitively aware; however, due to a lack of motor control, they are unable to express their intentions through conventional communication. Brain-computer interfaces (BCIs) allow individuals with severe motor impairments to use only cognitive activities to communicate. The widespread use of current BCIs is limited due to their complexity, inaccuracies, and non-intuitive control. The main goal of this work is to explore the development of a neurofeedback-based near-infrared spectroscopy BCI that uses personalized mental tasks, training, and self-regulation. The proposed neurofeedback based NIRS BCI has the potential to be more accurate, more intuitive, and easier to use than current BCIs. Preliminary testing conducted on two members of the research team has shown the potential enhancements in accuracy and ease of use due to personalized mental tasks, and neurofeedback guided training. Preliminary results have also shown the possibility of increasing the intuitiveness of the BCI by achieving self-regulation. Future work, will involve testing the proposed protocol on thirty able-bodied participants and three clients with motor impairments. This novel BCI may provide a more effective means of communication and a better quality of life for individuals with severe motor impairments.



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92. Evaluation of a home transfer pole for assisted sit-to-stand in older adults with mobility limitations A Novak1, E King1,2, GR Fernie1,3 1 Toronto Rehabilitation Institute; 2 University of Toronto, Department of Mechanical and Industrial Engineering; 3 University of Toronto, Institute of Biomaterials and Biomedical Engineering

Rising from a chair is one of the most common activities of daily life (ADL) and also one of the most physically demanding, requiring high lower-limb joint torques and balance control. One common form of assistance for sit-to-stand are transfer poles - a non-permanent, pressure fit pole that is installed in the home in front of any form of seating (chair, couch, bed, toilet, etc.). The device provides support in balance and reduces muscular effort of the lower-limbs during sit-to-stand. The most common configurations of the transfer pole include a single vertical pole, double vertical poles and vertical pole with an attached horizontal grab-bar; however there is no evidence supporting that these configurations are optimal for assisting mobility limited older adults in standing up. This thesis explores three different configurations of the transfer-pole: 1) single vertical 2) vertical with a horizontal grab-bar and 3) double vertical poles as well two positions: 1) near (occupational therapist recommended) 2) far (additional 20 degree trunk flexion). Assisted sit-to-stand performance will be characterized using the following outcome variables: 1) joint-torques (peak and asymmetry) 2) balance (COP displacement, COM sway, and time to stabilization of COP) 3) force on pole and 4) user preferences.

93. SafetyGrip Pole Kit: A Modular System for Safer In-Home Mobility V Komisar1,2, EC King1,2, GR Fernie1,2 1 Toronto Rehabilitation Institute; 2 University of Toronto

The need: Patients are being discharged from hospitals before they are ready to walk independently. Where grab-bars and handrails would help, many people are not permitted to install them (e.g. renters), or are unwilling to do so when the need is expected to be temporary. Instead, many rely on caregiver assistance and/or 'furniture walking'. Technology development: To provide a safer alternative, we are working with potential users, caregivers and manufacturers to develop a modular ''Kit'' of pressure-fit vertical grab poles and horizontal handrails. These can be configured to provide support along common pathways and help people with balance/mobility difficulties to mobilise more safely. The pressure-fit installation is easy and does not permanently modify the home. Research Program: We are running biomechanical studies to estimate ideal safety pole positioning and handrail dimensions. We will investigate how the Kit affects users' lifestyle at home. Feedback from users, caregivers and therapists will help guide the design of additional Kit components that improve its usability and effectiveness. Significance: The biomechanical/field studies will inform further development of the Kit and other mobility aids. We expect that by improving the safety of walking at home, the Kit will encourage users to mobilise more frequently and independently.



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Caregiver techniques for assisting with bathing and toileting in home bathrooms

EC King1,2, R Karkokli1,3, BM Weiss1,4, PJ Holliday1,4, VM Boscart5, GR Fernie1,6 1 Toronto Rehabilitation Institute; 2 University of Toronto, Mechanical & Industrial Engineering; 3 University of Toronto, Institute of Biomaterials and Biomedical Engineering; 4 Utica College, Department of Physical Therapy; 5 Conestoga College; 6 University of Toronto, Department of Surgery

Introduction: Providing care at home can be very physically demanding, and both professional and familial home caregivers experience high injury rates. Professional home caregivers report that assisted bathing and toileting are amongst their most physically challenging tasks. The purpose of this study is to record the techniques used by professional home caregivers to assist with bathing and toileting, and to identify the phases of these tasks that expose the caregiver to the greatest risk of injury. Methods: Bathing and toileting were simulated in a typical home bathroom. Eight practicing personal support workers were invited to assist a patient actor to bathe and toilet using their usual practice. Four lifting-mechanics trainers will participate to represent best practice techniques. Caregiver postures were video-recorded and classified using a posture-matching program. Preliminary results: Caregivers are modifying classically-taught patient handling techniques to cope with the bathroomâ&#x20AC;&#x2122;s tight space constraints. Some of these adaptations were used by multiple caregivers and involve highly non-neutral (risky) postures. Expected Impact: Systematic characterization of the injury risks associated with each phase of assisted bathing and toileting will allow training, research and product development to focus on the aspects of these tasks which are in greatest need of change.


In-Home Biomechanics Using Multiple Kinect Sensors

R Karkokli1,2, T Dutta2, E King2,3, GR Fernie2,4 1 University of Toronto, Institute of Biomaterials and Biomedical Engineering,Toronto Rehabilitation Institute;2 Toronto Rehabilitation Institute;3 University of Toronto, Mechanical & Industrial Engineering Department, Toronto Rehabilitation Institute;4 University of Toronto, Department of Surgery,Toronto Rehabilitation Institute

Caregivers experience musculoskeletal disorders at alarming rates. Most of incidences are low-back related. There is a growing acceptance that these back-injures are largely due to performing patient handling frequently. These injuries are expected to continue to rise mainly due to the rapid growth of our aged population, which has increased the demand for providing care at home. In the home setting, caregivers have to work in difficult confined spaces with little or no equipment providing care alone without the opportunity to ask another caregiver for assistance at key moments, thus increasing their risk of injuries. Understanding the techniques caregivers use to provide care in such challenging spaces and their associated spinal loads is key for developing a solution. Most current biomechanical evaluation tools require large expensive equipment and often entail attaching markers and other instrumentations on the caregiver can lead to unnatural behaviour. This study is focused on developing a portable low-cost biomechanics evaluation tool that can fit in most confined spaces, consisting of a computer and multiple Kinect sensors. The system uses data obtained from the Kinect sensors to track caregiver s joints and calculate spinal loads as they perform patient handling activities.



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Optimizing Stair Design to Prevent Falls

AC Novak1, GR Fernie1 1 Toronto Rehabilitation Institute

Background. Falls on stairs are an endemic issue. Changing environmental codes and practices may be the most effective way to have an impact on falls. However, there is little evidence on the relationship of stair design and precision of construction to user behaviour. This results in difficulty guiding safe stair design. Objective. To assess the risk for missteps and falls with a number of commonly used stair parameters. Three main design features will be studied, including (1) rise/run dimensions, (2) variations in riser height and (3) degree of nosing projections. Methods. Biomechanical data (foot-to-step clearance and variability, postural control measures) will be collected as individuals (young adults, older adults with and without impairment) ascend/descend an instrumented staircase, with systematic modifications in step geometry elements. All outcome variables will be assessed to determine adaptations of gait and movement control strategies in response to variations in step geometry. Progress. Data collection is currently underway in the CEAL. Dissemination of the findings will begin November, 2012. Implications. This study will provide a comprehensive biomechanical analysis of stair ambulation with respect to aging and disability to understand how modifications in step geometry influence user behaviour and risk of falling when ambulating stairs. The results of this research will be used to inform evidence to be presented to support changes in building codes.


Optimal Armrest Design to Maximize Sit-to-Stand Performance

R Leung1,2, D Vena1,2, GR Fernie1,2 1 Toronto Rehabilitation Institute; 2 University of Toronto

Mobility and independence is a growing concern in homecare with the continually increasing aging population. One of the most commonly performed mobility functions performed in the home is the sit-to-stand (STS) movement. The inability to perform such a movement not only indicates poor functional ability of the person but also significantly lowers their quality of life, mobility, and increases caregiver burden. With regards to armrests on chairs, studies have shown the use of armrests to be beneficial to aiding the STS movement; however, no studies have looked at the armrest height, width (w.r.t person), and angle on the STS movement. This study aims to find the optimal armrest variables for the STS movement. An armrest test bed will be designed to determine the optimal armrest variables for STS movement. The biomechanical movements will be studied and compared using a VICON motion capture system and force plates to measure the sway through tracking COP, calculating joint forces/torques, and measuring vertical load forces on the armrests. The results of this study will aid in providing recommendations for optimal armrests relative to the individual to maximize their STS ability and will also form a basis to further work in determining optimal armrest profiles.



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98. Simulator sickness among elderly drivers R Ramkhalawansingh1,2, J Campos2 1 University of Toronto; 2 Toronto Rehabilitation Institute

The risk of being involved in a fatal motor vehicle accident increases substantially as we get older. This signals the need for programs designed to make driving safer for older adults. Driving simulators are instrumental in allowing researchers to assess and train drivers under challenging conditions without endangering them. However, many users and particularly older adults are prone to discomfort and nausea during simulation, a phenomenon known as Simulator Sickness (SS). SS occurs because most driving simulators provide compelling visual input but are devoid of accurate auditory (sound), vibrotactile (touch), and vestibular (motion) input. Our goal is to evaluate the effect of each sensory input on the incidence and severity of SS and driving performance. In this investigation, older (65+) and younger (19-35) adults will embark on a number of simulated drives in our state-of-the-art multisensory simulator, while sequentially experiencing visual input and one other type of sensory input. We predict that driving performance will improve and SS will be reduced under multisensory conditions. This research will inform the design of driving simulators and will elucidate the role that sensory input plays in driving. Ultimately, our goal is to support programming including training and assessment designed to keep older drivers safe for as long as possible.

99. Designing Test Methods for the Evaluation of Scooter Performance in Winter Conditions V Ohri1,2, JA Hsu1,2, Y Li1, PJ Holliday1, C Harry1, T Dutta1, EC King1,2, GR Fernie1,2 1 Toronto Rehabilitation Institute; 2 University of Toronto

Electric mobility scooters are increasing in popularity and already outnumber electric wheelchairs in Canada by almost 2:1. These devices are used extensively year round by individuals with disabilities to conduct various daily activities like attending doctor s appointments and going shopping. However, the body of knowledge on the safety and efficacy of scooters in winter conditions is very sparse. Current technical standards for scooters do not require dynamic tests in winter conditions. This study seeks to develop a test method to evaluate the performance of scooters in a realistic winter environment. To demonstrate the feasibility of the test method, a pilot test with one mobility scooter is also proposed. All tests will be conducted in the climate controlled WinterLab at the Toronto Rehabilitation Institute. There are two expected outcomes of this study: 1) Reproducible methods to create realistic winter surfaces and 2) Performance characteristics of one scooter on these surfaces. The results of this study are significant because this will be the first study to evaluate the safety and efficacy of scooters in winter conditions and moreover, it is the first phase of a larger initiative at Toronto Rehab to systematically raise the bar for scooter safety, performance and design.



ABSTRACTS 92 – 103

100. Comparing the standard method for assessing footwear slip resistance to biomechanical measures while walking on ice J Hsu1,2, Y Li1, K Denbeigh1,2, G Fernie1,2 1 Toronto Rehabilitation Institute; 2 University of Toronto

Slip resistant winter footwear is important for preventing falls in winter. However, footwear deemed slip resistant during standard tests may not reduce the propensity to slip while walking in real winter conditions. This study compares the test parameters and outcomes from standardized slip resistance tests to gait characteristics measured in walking tests on an icy walkway. 12 males participated in biomechanical testing wearing the same model of rubber-soled winter boots. This boot was also tested according to the standard procedures for measuring slip resistance of footwear at an angle of 7.0°, moving at a velocity of 0.3m/s, and at 500N of vertical load. In the biomechanical tests, the foot angle at heel strike, mean horizontal heel slip velocity, and maximum vertical load on the foot during slip were measured at 13.9°±7.0°, 0.12m/s±0.06m/s, and 677N±215N, respectively. The mean coefficient of friction (COF) measured at heel strike during the walking trials on ice was 0.10 while the standard test resulted in a mean COF of 0.40 on wetted steel and 0.62 on wetted quarry tile. These differences are important to understand for improving standard test methods so that they adequately reflect the slip resistant properties of footwear in real-life conditions.

101. Investigating the Optimal Configuration of Spikes in Ice Cleats K Denbeigh1,2, J Hsu1,2, Y Li 1, G Fernie1,2,3 1 Toronto Rehabilitation Institute; 2 University of Toronto, Institute of Biomaterials and Biomedical Engineering; 3 University of Toronto, Department of Surgery

Slips and falls are common for Canadian pedestrians in wintertime, and can result in serious injuries; falls on ice and snow account for over 21,000 emergency room visits each winter in Ontario. As the population ages, it is like that the frequency and severity of winter falls will increase. There are numerous anti-slip devices commercially available for pedestrians to wear over their footwear in an effort to improve traction on winter surfaces, but it has been demonstrated that many of these devices still provide inadequate protection from slipping. Research is needed to determine how different design characteristics of anti-slip devices affect their performance, such as the number of traction elements or their position and properties. Specific to ice cleats - one common type of antislip device - positioning and height of spikes may impact slipping and tripping. This research will investigate optimal characteristics for ice cleats by characterizing how changes in spike position and height on the heel affect slipping, tripping and stability on a variety of winter surfaces. The results from this study will assist in developing general guidelines for the improvement of future winter footwear and anti-slip devices to better protect pedestrians from slip and fall injurie



ABSTRACTS 92 â&#x20AC;&#x201C; 103

Science Outreach at iDAPT

D. Philip1,2 1 University of Toronto, Mississauga; 2 Toronto Rehabiltiation Institute

iDAPT's science outreach program consists of three parts: science outreach to health-care professionals such as hospital workers, science outreach to the general public, and science outreach to schools. The latter two efforts are being done in conjunction with University of Toronto, Mississauga (UTM) undergraduate students taking experiential learning courses. It is their job to create background materials for students and teachers, to create lesson plans for teacher use, and to assist in conducting virtual visits or physical tours of the facility. We describe this program and some current and past efforts.


Moving Students to Knowledge Building Stance

EC King1,3 J Campos2, L Fedoryshin1, A Fuad1, R Gabble1, A Wahid1, DN Philip1, GR Fernie2 1 University of Toronto, Mississauga; 2 Toronto Rehabilitation Institute; 3 University of Toronto, Mechanical and Industrial Engineering

One of the more difficult problems facing students entering graduate school is the transition from undergraduate modes of thought to the modes of thought that characterize the mature researcher. Key among these is to take epistemic agency over their learning and work, and to rely less on directions from their supervisors and instructors. Failure to achieve this can result in failure or leaving the program. We describe work with four undergraduate students to move them from undergraduate thinking types to the knowledge building stance of the researcher. Using both qualitative analysis of online note postings and social network analysis of communication patterns, we found that a key aspect of independent knowledge work, epistemic agency, was present.



ABSTRACTS 104 – 117

104. Development of an affordable clinical toolkit to assess quantitative measures of reactive balance control JE Fraser1,2, S Jones1, A Mansfield1-3, EL Inness1,2, J Wong1, WE McIlroy1-4 1 Toronto Rehabilitation Institute; 2 University of Toronto; 3 Heart and Stroke Foundation Centre for Stroke Recovery; 4 University of Waterloo

Background: As Canada’s population ages, the incidence of falls is expected to rise. As a result, there is an immediate need to invest in affordable methods to identify and assess those at risk. Recently, gaming technology (Nintendo Wii Balance Board; BB) has been shown to provide valid quantitative measures of quiet standing balance control comparable to research-grade forceplates. Unfortunately, the size of the BB limits the capacity to assess more challenging reactive control tasks. Objective: The objective of this study is to develop and validate an affordable toolkit to capture and quantify measures of dynamic balance control using a grid of multiple BBs. Methods: The toolkit will be developed and tested in a sample of healthy young adults (n=15) to ensure feasibility and establish normative data. The toolkit will be validated in a population of sub-acute stroke patients (n=22) against gold standard measures of reactive balance control, as demonstrated by the temporal components of perturbation evoked stepping reactions. Implications: The development of this toolkit may lead to a more comprehensive description of balance and the underlying control systems involved, compared to current subjective clinical scales, leading to more advanced assessment and treatment for those ageing and living with disability.

105. Developing an Android-Based Smartphone App to Reduce Gait Asymmetry in Stroke Patients: the MyWalk App J Chee1,2, TV How1,2, E Wan1,2 1 Toronto Rehabilitation Institute; 2 University of Toronto

Background: Individuals with stroke often develop temporal gait asymmetry, which can lead to negative medical outcomes in the long-run (e.g. musculo-skeletal pain). However, gait-specific biofeedback may prevent this gait characteristic from deteriorating over time. Objective: This study aims to determine the feasibility of developing an Android-based smartphone app that helps its users detect and reduce the occurrence of step-time asymmetry (STA). Methods: The MyWalk app was designed to have three modes of operation: 1) Training: to administer short, repetitive, increasingly challenging gait exercises during which feedback prompts are delivered in real-time to alert its users to walk more evenly (e.g. using sound and vibrational cues); 2) Community Walk: to identify how real-world environments affect STA (e.g. using the smartphone camera); and 3) Progress History: to track the user’s STA changes over time. Preliminary Results and Future Directions: A functional app was developed to handle incoming data from the phone’s sensors (e.g. accelerometer), perform a gait symmetry analysis, and provide user feedback as real-time cues and visual output (e.g. graphs). Future work will involve validating the gait symmetry output in stroke patients. Overall, this app may play a role in disease self-management, remote patient monitoring, and knowledge development for exploratory research.



ABSTRACTS 104 â&#x20AC;&#x201C; 117

106. Environmental Influence on the Upper Trunk Accelerations of Rollator Users with Acquired Brain Injuries J Chee1,2, W Gage1,3, W McIlroy1,4, K Zabjek1,2,5 1 Toronto Rehabilitation Institute; 2 University of Toronto, Graduate Department of Rehabilitation Science; 3 York University, School of Kinesiology and Health Science; 4 University of Waterloo, Department of Kinesiology; 5 University of Toronto, Department of Physical Therapy

Background: Individuals with Acquired Brain Injuries (ABIs) commonly use rollators (i.e. 4-wheeled walkers) to compensate for their mobility impairments. However, the influence of these devices on upper trunk movement during community ambulation has yet to be explored. Objective: This study aims to determine if there is an environmental effect on the upper trunk accelerations of rollator users with ABIs. Methods: Three rollator users with ABIs (n=3) used an instrumented rollator (i.e. iWalker) while walking: 1) in a laboratory; and 2) along a pre-determined outdoor course through an urban downtown environment, which contained everyday mobility challenges (e.g. ramps). Upper trunk accelerations were acquired in both settings using a tri-axial accelerometer attached to C7. Results: Mean root-mean-square (RMS) accelerations of the upper trunk during the course walk were greater in magnitude than those observed in the laboratory (i.e. a 66% and 64% increase in the anterior-posterior and vertical directions respectively) for a large proportion of the course walk time. Conclusions and Implications: The upper trunk accelerations of rollator users with ABIs may differ between controlled settings and walking outdoors. To better understand the mobility challenges of rollator users, it would be helpful to observe how everyday environments affect their upper trunk accelerations.

107. Balance and mobility status among older adults living in congregate care: insights from a newly developed, portable balance and mobility assessment toolkit K Van Ooteghem1,2,3, B Badiuk1, MT Sharratt3, S Brown3, WE McIlroy1,2,3 1 University of Waterloo; 2 Toronto Rehabilitation Institute; 3 Schlegel-UW Research Institute for Aging

Background: We' ve recently developed an assessment toolkit using inexpensive, unobtrusive technologies to provide sensitive indices of balance and mobility. Implementation is underway in collaboration with Schlegel Villages; a group of congregate care facilities in Ontario. Methods: 110 residents have completed an instrumented assessment comprised of tasks that challenge static and dynamic balance, gait, strength, and endurance. Residents wore accelerometers on the ankles and waist, and stood on two Nintendo Wii balance boards during balance tasks. Customized algorithms extracted balance and gait characteristics. Data was aggregated to build a profile of balance and mobility status for older adults in congregate care. Correlational analyses were conducted to examine relationships between task variables. Findings: Measures derived from added technologies revealed balance and gait challenges that would not have been detected by conventional assessment. A significant proportion of residents showed increased risk for negative outcomes such as falls when external norms were applied to the data. Correlational analyses revealed no relationships between variables suggesting independent dimensions of mobility. Implications: The toolkit adds significant utility to conventional assessment. Older adults in congregate care represent a unique cohort and population-specific norms should be considered. The multi-dimensional nature of mobility warrants assessment of individual elements to identify underlying deficits and guide intervention.



ABSTRACTS 104 â&#x20AC;&#x201C; 117

108. Does exposure to aerobic fitness training promote engagement in aerobic exercise post-discharge from stroke rehabilitation? C Brown1,2, JE Fraser2,3, EL Inness2,3, J Wong2, WE McIlroy,1-4, A Mansfield2-4 1 University of Waterloo; 2 Toronto Rehabilitation Institute; 3 University of Toronto; 4 Heart and Stroke Foundation Centre for Stroke Recovery

Background:Stroke patients have low aerobic capacity which impairs activities of daily living. Furthermore, in-patient rehabilitation is too short to cause changes in aerobic capacity. Patients need to engage in long-term aerobic exercise post-discharge. Objective: To assess whether stroke survivors who participated in an inpatient aerobic fitness group met American College of Sports Medicine (ACSM) guidelines for aerobic activity 6 months post-discharge. Method: 31 stroke patients attended a tri-weekly aerobic fitness group during their in-patient stay at Toronto Rehab. A Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) questionnaire was completed 6­ months post-discharge. It was determined from collected information whether patients followed ACSM guidelines. Results: Regardless of the number of fitness sessions attended, participants had low PASIPD scores. When considering walking moderate intensity exercise, 74% of participants met ACSM guidelines 6 months post-discharge; however the intensity of walking was not clear from the questionnaire. Excluding walking, only 23% of participants met ACSM guidelines. Discussion: Exposure to fitness training alone did not promote engagement in planned exercise post-discharge; therefore, a new model of care is required. The potential aerobic benefit of walking post-stroke needs to be determined.

109. Examining the Interrater Reliability of Gait Measures Attained from the GAITRite System H Jasani1,2, EL Inness2,3, V Poon2,3, C Brown1,2, WE McIlroy1-4, A Mansfield2-4 1 University of Waterloo; 2 Toronto Rehabilitation Institute; 3 University of Toronto; 4 Heart and Stroke Foundation Centre for Stroke Recovery

The purpose of this study was to assess the inter-rater reliability of a computerized walkway system (GAITRite) for the temporal and spatial measures of gait in stroke patients. Twenty five subjects (16 men and 9 women) aged between 37 to 94 years (mean 73, S.D. 12.1) were randomly chosen from a pool of 238 stroke inpatients. The patients walked across the pressure sensitive mat at preferred walking speeds with or without a gait aid 2-5 times. The gait trials were then processed separately by two researchers; the Intraclass Correlation Coefficients (ICCs) and 95% confidence intervals (CI) were determined for velocity, step length, step time, and step width. Reliability of velocity and step length was excellent (ICCs > 0.99). However, the ICC values and confidence intervals revealed insufficient reliability for step time (left-0.9 [0.78, 0.96], right-0.8[0.54, 0.91]) and for step width (left-0.7 [0.34, 0.87], right-0.76 [0.46, 0.89]). There was near perfect agreement between the raters for most trials. However, there still remains subjectivity in processing Gaitrite data, resulting in a few trials with poor agreement and lower reliability values. Rater reliability of the Gaitrite should be considered by users.



ABSTRACTS 104 – 117

110. Robotic assessment of post-stroke elbow spasticity during active and passive movement A Centen1,3, WE McIlroy1-4, SH Scott5, G Mochizuki1-3 1 Toronto Rehabilitation Institute; 2 Sunnybrook Research Institute, Heart and Stroke Foundation Centre for Stroke Recovery; 3 University of Toronto, Graduate Department of Rehabilitation Science; 4 University of Waterloo, Department of Kinesiology; 5 Queen’ s University, Centre for Neuroscience Studies

Background and Rationale: Within the first year after stroke, approximately 38% of adults will develop spasticity. Clinical scales for the measurement of spasticity lack the sensitivity required to detect small changes and only measure resistance to passive movement. Robotic technology may provide objective and sensitive measures of spasticity. Objective: Utilize the KINARM™ upper limb robotic exoskeleton to develop objective and sensitive measures of post-stroke spasticity during passive and active conditions. Methods: Kinetic and kinematic data was collected during passive movement at the elbow and during three standard tasks: arm position matching (proprioception), reaching to targets (motor function), and hitting digital objects (selective attention/motor function). Results: Examination of kinematics during passive movement identified features that may be representative of spasticity. The KINARM™ accurately assessed each individual’s performance during active, functional movements. Conclusions: Examination of the kinetic and kinematic features of passive movement may enable the development of objective, sensitive measures of spasticity. Features of active control unique to spasticity may also be effective at monitoring recovery and response to treatment.

111. The Effect Of Depression On Outcome Of Fear Of Falling In A Falls Prevention Program A Iaboni1, R Lam2, C Banez2, BA Liu3, AJ Flint1 1 University Health Network, Department of Psychiatry; 2 University Health Network, Seniors Wellness Centre; 3 Sunnybrook Health Sciences Centre, Regional Geriatric Program

Falls in the elderly are known to be associated with fear of falling and depression. Programs designed to prevent falls are modestly successful at preventing falls, improving balance and gait, and increasing confidence, but have little impact on fear of falling (FOF) or fear-related avoidance of activities. FOF is frequently associated with depression. Our hypothesis is that depression may negatively moderate the potential beneficial effect of a falls prevention program (FPP) on FOF. Participants (n=69, 64% female, mean age 81 ± 7 years) were assessed at baseline, midpoint, and after completing a 12-session FPP at Toronto Western or Sunnybrook hospitals. Nearly half (33/69) met criteria for either a SCID-diagnosed depressive disorder (21/69; 30%) or anxiety disorder (22/69; 32%). In a preliminary analysis, those who were depressed at baseline were significantly more fearful of falling before the FPP (p<0.001), but had greater improvement in FOF (p=0.015) and falls-related confidence (p=0.01) compared to those were not depressed. This improvement was correlated with improvement in depressive symptoms (r=0.47, p=0.049). However, neither the depressed nor non-depressed groups had significant improvement in fear-related avoidance of activities. In this preliminary analysis, improvement in FOF in a FPP was associated with improvement in depressive symptoms.



ABSTRACTS 104 – 117

112. Participant characteristics associated with enrolment in aerobic exercise early after stroke EC Prout1,4, A Mansfield1,4, WE McIlroy4-7, D Brooks1-4 1 University of Toronto, Graduate Department of Rehabilitation Sciences; 2 University of Toronto, Department of Physical Therapy; 3 University of Toronto, Institute of Medical Sciences; 4 Toronto Rehabilitation Institute; 5 University of Waterloo; Faculty of Applied Health Sciences, Department of Kinesiology; 6 Heart and Stroke Foundation Centre for Stroke Recovery; 7 Sunnybrook Health Sciences Centre

Background: Despite the importance of aerobic exercise in promoting stroke recovery and management, opportunities for participation during in-patient rehabilitation have been limited. Understanding the factors that promote or limit enrolment in aerobic exercise early after stroke is important to inform practice. Objective: To determine participant-specific factors that influence enrolment in aerobic exercise during in-patient rehabilitation early after stroke. Methods: Retrospective review of demographics, medical history and stroke-related impairments of individuals admitted to Toronto Rehab over 1 year (n = 120). Comparisons were made between individuals who were and were not enrolled in aerobic exercise. Results: 52% of individuals (62 of 120) were enrolled in the aerobic exercise program. Only three characteristics differed between the two groups; atrial fibrillation (19% vs 9%; p=0.009), arthritis (12% vs 5%; p=0.049) and β-blocker use (28% vs 15%; p = 0.003) were more prevalent in the group that was not enrolled. No differences in stroke-related impairments were found. Conclusion: Non-stroke specific medical reasons appeared to limit enrolment in aerobic exercise to a greater degree than post-stroke changes in cognitive, communication or physical function. Implications/Key Messages: There is a need to better understand non-stroke specific issues to ensure participation in aerobic exercise among in-patient stroke survivors.

113. Temporal profile of alterations to cortical excitability and cognition following a single bout of aerobic exercise MD Sage1,2, L Middleton2,3,4, D Brooks1,2,5, E Roy1,3,4, W McIlroy1,2,3,4 1 University of Toronto, Graduate Department of Rehabilitation Science; 2 Toronto Rehabilitation Institute; 3 Sunnybrook Research Institute, Heart and Stroke Foundation Centre for Stroke Recovery; 4 University of Waterloo, Kinesiology Department; 5 University of Toronto, Department of Physical Therapy

Background: Cortical activity and cognitive function are altered by exercise; however, the persistence post-exercise is relatively unknown. Objective: To examine the temporal profile of alterations in cortical activity and cognitive function after a single bout of aerobic exercise. Methods: Ten healthy adults (age=23.1) performed 20 minutes of aerobic exercise. A modified Flanker task was completed pre-exercise and 5, 15, and 30 minutes post-exercise with concurrent electroencephalography (EEG) recording. A two-minute eyes-closed resting quantitative EEG (qEEG) was recorded before each Flanker task. Behavioural performance (reaction time, accuracy), eventrelated potentials (P300 amplitude & latency), and qEEG power (total & relative bands) were evaluated for change over time. Results: Reaction time was faster at all post-exercise time points (p<.02), with no loss in accuracy (p>.05). P300 amplitude was augmented for 30 minutes post­ exercise (p<.007), while latency was delayed after exercise for incongruent trials only (p<.03). Total qEEG power was increased 5 and 15 minutes post-exercise (p<.035) and returned to pre-exercise levels after 30 minutes. A shift in relative EEG power towards higher frequency bands was also noted (p<.04). Conclusions: The extended influence of a single bout of exercise provides the opportunity to use this approach to prime CNS state prior to rehabilitation sessions.



ABSTRACTS 104 â&#x20AC;&#x201C; 117

114. A Pilot Study on the Usability of Ramps During Rollator-Assisted Ambulation in Persons with Multiple Sclerosis IG Solano1,2, W Gage1,4, G Mochizuki1,3,5, K Zabjek1,2,3, W McIlroy1,2,6 1 Toronto Rehabilitation Institute; 2 University of Toronto, Graduate Department of Rehabilitation Science; 3 University of Toronto, Department of Physical Therapy; 4 York University, School of Kinesiology and Health Science; 5 Sunnybrook Health Sciences Centre, Heart and Stroke Foundation Centre for Stroke Recovery; 6 University of Waterloo, Department of Kinesiology

Background: Multiple sclerosis (MS)1,2 commonly use rollators for mobility. Demand on upper extremities (UE) through rollator use may cause difficulty traversing ramps. Rollators and ramps have been associated with fall risk, however no study has clarified the relationship of MS user with the rollator and built environment. Objective: To clarify the relationship of ramp characteristics, rollator and the MS user with perception of usability and effort during ramp ambulation. Methods: MS subjects walk with an instrumented walker (iWalker) on level ground and ramps. Muscle activity was measured using electromyography (EMG). Effort was measured using Borgâ&#x20AC;&#x2122;s rate of perceived exertion. Ramp usability was measured using usability rating scale. Results: Ramp descent was more challenging in terms of control and balance compared to ascent. Ramp ascent required more physical effort compared to descent. EMG revealed considerable use of UE musculature in descent, which may be a response to control balance and regain stability while trunk and legs continuously propel forward. Conclusion: Initial findings reveal complexity of personenvironment transactions. Results suggest descent may pose a risk for falls if MS clients fail to control rollator. Recommend looking into elderly population and use of additional outcome measures to measure usability. Key Messages: Accessibility standards such as for ramps are not necessarily usable and ergonomic.

115. The Influence of Ankle Stiffness on Balance Control Mechanisms during Quiet Stance M Warnica1, S Prentice1, A Laing1 1 University of Waterloo, Department of Kinesiology

Ankle stiffness plays a significant contribution in the ability to maintain balance during quiet stance. This study systematically altered ankle stiffness across a range of muscle activation levels to test the hypothesis that increased ankle stiffness will not result in a change in the displacement of the COP but will cause an increase in velocity of COP and COG movements. Sixteen healthy participants completed four, thirty second, quiet standing trials at seven conditions (quiet stance, 10, 20, 30, 40 percent of their maximal voluntary contraction level, and wearing an ankle foot orthotic (AFO) with eyes open and eyes closed). Muscle activation levels of muscles at the lower calf were controlled by the participant using a real-time feedback program and recorded using electromyography. The RMS, range and mean velocity of the COP and COG increased with increasing ankle stiffness at 30% and 40% MVC. The 20% MVC condition significantly increased for COP mean velocity. COP and COG RMS, and mean velocity of the COG decrease significantly from the control condition when wearing the AFO. The current study indicates that range of sway increases with increased ankle stiffness for COP and COG except while wearing an ankle foot orthotic.



ABSTRACTS 104 – 117

116. Developing A Strategy: Relationship Between Cadence-To-Step Length Ratio, Velocity, And Impairment Post-Stroke A Jongsma1,2, G Mochizuki1-3, A. Mansfield1-3, WE McIlroy1-4 1 Toronto Rehabilitation Institute, Mobility Research Team; 2 University of Toronto, Graduate Department of Rehabilitation Sciences; 3 Sunnybrook Research Institute, Heart and Stroke Foundation Centre for Stroke Recovery; 4 University of Waterloo, Department of Kinesiology

Background and Rationale: Following stroke, gait velocity is often slower than what is required for independent community ambulation. Velocity is determined by changes in cadence or step length. The choice of using cadence or step length to increase gait speed may be related to impairments associated with stroke and be reflected in the individuals achieved velocity. Objective: To determine the relationship between cadence and step length to velocity as well the underlying impairments relating to the chosen strategy. Methods: A secondary analysis was conducted using data extracted from the Heart and Stroke Foundation Centre for Stroke Recovery Rehabilitation Affiliates Database; 77 participants were included in the analysis. Gait measures were collected using a GAITRite® Walkway. Outcome measures (BBS, CMSA, MAS) and demographics were collected from clinic notes. Results: Statistically significant differences in cadence-to-step length ratio and all outcome measures at both preferred and fast velocity. Statistically significant differences in cadence-to-step length ratio were found between those ambulating at higher gait velocities versus lower gait velocities. Conclusion: Individuals with a higher cadence-to-step length ratio achieve a lower gait velocity and have a higher level of impairment. Research focused on manipulating this ratio to increase gait velocity is warranted.

117. 'Priming' the brain to generate rapid upper-limb reactions B Lakhani1,2, V Miyasike-daSilva3, AH Vette1,3, WE McIlroy1-3 1 Toronto Rehabilitation Institute; 2 University of Toronto; 3 University of Waterloo

Background: In situations where urgent responses are essential, individuals with neurological impairments tend to be slow to react. The present work aims to advance the fundamental understanding of mechanisms that determine rapid reactions. The primary objective of the current study was to temporally pair auditory stimuli with whole-body perturbations to determine if conditioning could prime the central nervous system (CNS) to respond faster to the auditory stimulus alone. Methods: Healthy young participants (n=19) were seated in a custom chair, which tilted backwards upon the release of an electromagnet, and were instructed to reach-to-grasp a handle located in front of their arm as fast as possible following an auditory cue. Three conditions were completed: 1) Baseline: Auditory cue alone (5 trials); 2) Paired: Auditory cue, followed by a chair tilt 110 ms later (20 trials); and 3) Auditory (post-pairing): Auditory cue alone (1 trial). Participants were not informed that the final trial, following the series of paired stimuli, would be Auditory alone. Reaction time was measured using electromyography, and autonomic nervous system activity was monitored via the electrodermal response (EDR). Results: In the Auditory (post­ pairing) condition compared to baseline, the reaction time was significantly faster (Δ=40 ms; p=0.0003) and the amplitude of the EDR was significantly greater (p=0.0159) whereas the amplitude of contraction and overall time to handle contact were not significantly different (p=0.0750 and p=0.5436, respectively). Conclusions: This study demonstrates that the CNS can be primed to generate rapid reactions in the absence of whole-body instability. The ability to reduce the reaction time in response to an auditory stimulus and boost the EDR indicates that the volume of somatosensory information following a whole body disturbance is not the critical determinant of rapid reactions, emphasizing the role of stimulus context on reaction time.



Toronto Rehabilitation Institute â&#x20AC;&#x201C; University Health Network receives funding from the Ministry of Health and Long-Term Care in Ontario. The views expressed herein do not necessarily reflect those of the Ministry. Equipment and space have been funded with grants from the Toronto Rehab Foundation, Canada Foundation for Innovation, Ontario Innovation Trust and the Ministry of Research and Innovation.

Research Day 2012 Conference Program and Abstracts  

Toronto Rehabilitation Institute 8th Annual Research Day November 23, 2012