TRI Research Day 2016 by Toronto Rehab Research Day Abstract Book

Ferocious Innovation Prevent

Restore

Toronto Rehab Research Day 2016

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Congratulations to Kaiyin (Cathy) Zhu for her winning design concept for the front cover!

Message from Institute Director Geoff Fernie, PhD, PEng, CEng, FCAHS Welcome everyone to Toronto Rehabilitation Institute’s 2016 Research Day! We all get excited when our research succeeds in discovering something new but nothing beats the satisfaction of seeing the results of that research being applied to prevent accidents/illness, restore someone’s function to a level where they can play, love and work or enable someone to live in their own homes in harmony with their family for the rest of their life. We can see many examples where our discoveries are now in the early stages of application and can feel the energy being created among our researchers. There is no other centre in the world where we see the research having such broad impact and nowhere else where there is such a shared sense of determination to take the results of research through to broad application. We are entering a period of “ferocious innovation”. We will see more evidence-based guidelines, accessibility codes, safety standards, effective novel treatments, useful products and successful startup companies. I want to recognize our great community of clinicians, researchers, our university partners, community partners, business colleagues, donors, Toronto Rehab Foundation, volunteers and patients for working together so enthusiastically to achieve our vision of solving problems that challenge so many lives. Let us be Ferocious and make it happen soon! All the best

Geoff

Message from the Chair, Research Day Planning Committee Associate Academic Director of Research Susan Jaglal, PhD, FCAHS The theme of this year’s Research Day, “Ferocious Innovation”, captures the spirit and activities led by our scientists and students. It makes us feel proud and sets us apart from other research institutes. As an organization, Toronto Rehab is committed to cultivating the academic and professional development of our trainees while instilling the skillset and mindset of innovation. This means fostering a culture where fully integrative teams with expertise in health and medical sciences, engineering, computer science, and business can flourish. A key determinant of success of an academic organization is career development, so I have developed two mentorship programs: one for junior scientists and one for trainees. The goals of the programs are to advise; provide resources and opportunities to develop; and maintain scientists who are integrative thinkers, innovative, productive, collegial, responsive and socially responsible. One highlight of the program is our newly developed Mentorship Series, featuring panels on: • Enhancing your research visibility • Honorariums and working with companies • What would you do differently if you were • Work-life balance just starting a research career • Appointments with universities • Leading a research team • Research ethics Trainee development is woven into the fabric of Research Day: participation in “Minute Madness” and Mentorship Lunch sessions is reserved for trainees only. To recognize the excellence and commitment of our trainees we sponsor a number of trainee awards, including the new Best Paper Award. I would like to take this opportunity to thank the many trainees and scientists at Toronto Rehab who volunteer to make Research Day and other Mentorship activities a success. Their attitude and commitment to excellence promotes a truly inspiring culture of Ferocious Innovation! Toronto Rehab’s Research Day is a wonderful opportunity to showcase our research, spark new ideas and collaboration in our quest to prevent injury and illness, restore function, enable independence and optimize the rehabilitation system. On behalf of the Research Day Planning Committee we hope you enjoy the day and look forward to seeing you. Warm regards Susan

Message from the Associate Scientific Director of Research Milos Popovic, PhD, PEng This year we focused our efforts on establishing performance expectations for Senior Scientists, Scientists, and Affiliate Scientists. This crystallizes our values and aspirations as a research organization and will provide clear guidelines on how to grow and develop world-class scientists, clinicians and educators in the field of rehabilitation research. We used these performance benchmarks to evaluate our scientists and I am delighted to tell you that our scientists at all levels, from new hires to seasoned scientists, are performing at the levels that undoubtedly merit our ranking as the #1 Rehabilitation Research Institution in the world. TRI scientists make a real difference! The second major thrust of our activities this year was strengthening the culture of scientific integrity. We live in times when the scientific community is under a lot of pressure to publish findings earlier and earlier to meet productivity expectations or to reach a particular h-factor. At TRI we believe that it is our duty to publish our findings with the highest level of integrity. It is only through this attitude towards our research methods, publications and presentations can we maintain leadership in the field of rehabilitation research. The final point I would like to make is that our scientists are leading the creation of new research enterprises that span multiple research organizations and research fields. We have been instrumental in creating international, national and local research hubs that are changing the way rehabilitation research is being conducted. A great example is the Networks of Centres of Excellence(NCE), AGE-WELL (Aging Gracefully across Environments using Technology to Support Wellness, Engagement and Long Life) that has been co-led by our Senior Scientist, Dr. Alex Mihailidis. AGE-WELL consists of 100 funded and affiliated researchers from 29 universities and research centres across Canada, and over 110 industry, government and non-profit partners. AGE-WELL is dedicated to the creation of technologies and services that benefit older adults and caregivers. After only 18 months AGE-WELL has profoundly impacted the research community. Today, AGE-WELL is working on over 75 products, ranging from assistive technologies to new healthcare policies. If only 20% of these products become viable in the next 5 years, which is a conservative estimate, AGE-WELL will become the NCE with the greatest impact on our society. TRIâ&#x20AC;&#x2122;s scientists are encouraged and expected to play these kinds of leadership roles. We are confident that in the years to come TRI will continue to be the major research and commercialization hub in the world of rehabilitation. Sincerely yours

Milos

CONTENTS

PROGRAM OF EVENTS .................................................................................................................................. 7 GUEST SPEAKER – WILLIAM CHARNETSKI..................................................................................................... 9 ABSTRACTS – PREVENT INJURY AND ILLNESS (1-33) .................................................................................. 11

ABSTRACTS – RESTORE FUNCTION (34-61)................................................................................................. 29 ABSTRACTS – ENABLE INDEPENDENCE (62–72).......................................................................................... 43 ABSTRACTS – OPTIMIZE THE REHABILITATION SYSTEM (73-99) ................................................................ 49 TEAMS ......................................................................................................................................................... 63 ACQUIRED BRAIN INJURY & SOCIETY ...................................................................................................... 64 ARTIFICIAL INTELLIGENCE & ROBOTICS IN REHAB (AIRR) ....................................................................... 65 BRAIN DISCOVERY & RECOVERY ............................................................................................................. 66 CARDIORESPIRATORY FITNESS ................................................................................................................ 67 COMMUNICATION .................................................................................................................................. 68 HOME, COMMUNITY & INSTITUTIONAL ENVIRONMENTS ..................................................................... 69 MOBILITY ................................................................................................................................................. 70 NEURAL ENGINEERING & THERAPEUTICS ............................................................................................... 71 OPTIMIZE................................................................................................................................................. 72 SLEEP SCIENCE......................................................................................................................................... 73 SWALLOWING SCIENCE ........................................................................................................................... 74 TEAM EXCELLENCE AWARDS ...................................................................................................................... 76 JOEL VERWEGEN AWARD ........................................................................................................................... 83 TRI BEST PUBLICATION AWARDS ................................................................................................................ 84 MARK ROCHON LEADERSHIP AWARD......................................................................................................... 86 ACKNOWLEDGEMENTS ............................................................................................................................... 88 INDEX BY PRESENTING AUTHOR & ABSTRACT# .......................................................................................... 90

PROGRAM OF EVENTS nd

7:30 – 8:45 am

Registration & Poster Set-up (2 floor foyer)

8:45 – 9:00 am

Welcome & Introduction – Geoff Fernie, Institute Director, Research TRI-UHN

9:00 – 9:15 am

Guest Speaker: William Charnetski, Chief Health Innovation Strategist, Ontario Ministry of Health and Long Term Care OCHIS: Catalyst for Collaboration and Commercialization

9:15 – 10:00 am

Prevent Injury & Illness Theme – Geoff Fernie, Institute Director Introduction & Minute Madness

10:00 – 10:05 am 10.05 – 10:40 am

10:40 – 11:00 am

Fit Break

Restore Function Theme – Milos Popovic, Associate Director, Scientific Introduction & Minute Madness Refreshment and Networking Break

11:00 – 11:15 am

Enable Independence Theme – Susan Jaglal, Associate Director, Academic Introduction & Minute Madness

11:15 – 11:50 am

Optimize the Rehabilitation System Theme – Susan Jaglal, Associate Director, Academic Introduction & Minute Madness

11:50 – 11:55 am 11:55 am – 12:10 pm

12:10 pm

Fit Break

Student Scholarship & Award Presentations • Team Excellence Awards • Joel Verwegen Award • Mark Rochon Leadership Award • TD Announcement Lunch

12:15 – 1:30 pm

Mentorship Lunch – Trainees interact with Scientists they have “pre-booked” (Armoury Room)

1:30 – 3:00 pm

Poster & Interactive Display Sessions (Colony Ballroom, 2 floor foyer, Giovanni Room) • Odd #s (1:30–2:15 pm) • Even #s (2:15–3:00 pm)

3:00 – 3:15 pm

Research Day Award Announcement / Close of Research Day • Best Poster (Undergraduate, Master’s, Doctoral and Postdoctoral) • Best Interactive Display • People’s Choice (Best Minute Madness) • Best Publications • TechnoVation

GUEST SPEAKER â&#x20AC;&#x201C; WILLIAM CHARNETSKI Chief Health Innovation Strategist for Ontario

William Charnetski, is an accomplished national and global executive who has worked in the highest levels of business, law and government. He has a track record of leading transformational change, developing organizations, leading people to realize their potential, fostering internal and external partnerships and collaboration, and delivering results. He has spent more than 10 years working on integrated health solutions in Canada and around the world in the rapidly changing global pharmaceutical industry. Mr. Charnetski most recently worked in the UK with AstraZeneca, one of the world's largest innovative pharmaceutical companies. He led global government affairs and public policy and had responsibilities for corporate social responsibility and regional communications. Mr. Charnetski is the first-ever Chief Health Innovation Strategist for Ontario. His role is to facilitate the uptake of innovation from researchers in the province into the healthcare system and help create a thriving health technology enterprise in Ontario.

PREVENT INJURY AND ILLNESS

ABSTRACTS â&#x20AC;&#x201C; PREVENT INJURY AND ILLNESS (1-33) Research on this topic is not just about preventing the injury or illness from first occurring, but it is also about preventing repeat episodes from occurring after a rehabilitation program is complete. 1. Passive Physiological Monitoring via Ambient Sensors Embedded in a Home Environment 1,2

1,2,6

ISC Chang , H Qiu , J Boger , A Amaya , A Mihailidis 1 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 2 Toronto Rehabilitation Institute; 3 Center for Global eHealth Innovation, University Health Network; 4 Systems Design Engineering, University of Waterloo; 5 Department of Defense, Canadian Government; 6 Intelligent Assistive Technology and Systems Lab, Dept. of Occupational Science & Occupational Therapy, University of Toronto

Issues with current wearable forms of residential medical monitoring devices include forgetting to wear the device and/or using the device incorrectly. One approach to counter these problems is to use ambient monitoring, where sensors embedded into the environment measure signals unobtrusively with little or no effort on the part of the user. Examples of such passive monitoring devices, specifically a floor tile, a chair, a blanket, a bed, and a thermal camera, were evaluated on older adults with heart failure (HF). Preliminary analysis of four subjects showed that the floor tile could measure heart rate (HR) with 5.5% error and the chair could measure the HR with 2.9% error when compared to gold standards-i.e. ECG. Ballistocardiogram (BCG) from the chair was cleaner compared to the tile and thus a better diagnosis tool for older adults with heart failure. The Bed could measure weight with 0.7% error when compared to a gold standard (i.e. digital weight scale) (n = 7), which translates to 500g difference for a person who weighs 70kg. Surface body temperature measured by an off-the-shelf thermal camera was lower than the core body temperature overall with an error of 11.3% (4.13 áľ&#x2019;C). Feedback from older adults with HF on ambient monitoring devices was positive (n = 26). The current study investigated efficacy of ambient monitoring devices with older adults with HF. While physiological signals from older adults with HF were weaker than healthy adults, the monitoring devices could estimate the vital signs of the participants with an acceptable error. Increasing the reliability of the devices and evaluation of the devices in real homes stands as future works.

2. An Automated Monitoring of Gait to Predict Changes in Falls Risk for Older Adults with Dementia 1

1,2,

1,2

E Dolatabadi , A Iaboni B Taati 1 Toronto Rehabilitation Institute-UHN; 2 University of Toronto

Falls represent a major public health problem in older adults with dementia and are associated with an increased risk of dependency, injury, and death. Preventive measures are needed to significantly reduce the frequency of falls in this population. In particular, there is a need for a tool which can identify when there is a change in the risk of falling. Our research aims to combine unobtrusive sensing and predictive analysis to build a system capable of automatically monitoring fall risk in free-living conditions. Toward this goal, we are conducting a systematic review to determine the type of quantitative measures of gait and balance that are related to the prediction of falls in older adults with dementia. We are also in the process of building a vision-based monitoring system, to be installed in the Geriatric Psychiatry unit (TRI5 South) at TRI. This system will automatically capture quantitative measures of gait as residents who 11

PREVENT INJURY AND ILLNESS are part of our study walk by it. For privacy reasons, we are also engineering a solution which prevents the system from recording data when non-participating residents, staff, or family members are within view of the monitoring system. We expect to have this system installed in TRI-5 South by November 2016.

3. Toward the Development of an Artificially Intelligent Computer Vision System for Fall Prediction in the Elderly with Dementia 1,2

Z Hasan 1 Toronto Rehabilitation Institute - UHN; 2 University of Toronto, IBBME

This project proposes the development of an intelligent computer vision system that analyses path trajectory in older adults and predicts the probability of a fall incident occurring by conducting fractal dimension analysis on the trajectory. This project addresses the need of a cost efficient fall predictive/detection system usable by older adults with minimal effort required from both the older adults and their caregivers (zero-effort technology). This technology will look to replace current systems which use RFID sensors that work well but are quite expensive. The technical aspects of this project entail designing and assessing the computer vision capability of a ceiling mounted camera unit to track and collect patient walking patterns, path trajectory, velocity and other variables. These trajectory variables will then be used as inputs to machine learning algorithms that conduct fractal dimensional analysis allowing for the prediction of falls. Clinical studies with healthy participants will also be carried out in order to quantitatively assess and compare the performance of the computer vision solution versus the RFID solution, with the latter as the gold standard.

4. Adaptation and Validation of the Sleep and Concussion Questionnaire© 1,2,3

2,4,5,6

2 7,8,9

10,11,12

1,2,13

C Wiseman-Hakes MC Tartaglia C Tator , D Beaton R Green 1Toronto Rehabilitation Institute-UHN; 2 Canadian Concussion Centre; 3 University of Toronto, Department of Speech Language Pathology; 4 University of Toronto Division of Neurology, Faculty of Medicine; 5 Toronto Western Hospital- Memory Clinic; 6 Toronto Western Hospital, Tanz Centre for Research in Neurodegenerative Diseases; 7 University of Toronto, Division of Neurosurgery, Faculty of Medicine; 8 Toronto Western Hospital, Division of Neurosurgery; 9 Toronto Western Hospital Research Institute; 10 St. Michael’s Hospital , Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute; 11 University of Toronto, Institute of Health Policy, Management & Evaluation; 12 University of Toronto, Institute for Work & Health; 13 University of Toronto, Department of Psychiatry

Rationale: Alterations in sleep are common following concussion, due to biomechanical forces exerted on the head and neck, leading to physiological changes in the brain. Sleep plays an important role in recovery and disturbed sleep can be associated with persistent symptoms and risk of re-injury. Evaluation of sleep has become an increasingly recognized component of concussion assessment, however, tools specific to this disorder are lacking. In particular, there are no tools specific to a history of multiple concussions. Objective: The Sleep and Concussion Questionnaire© (SCQ) was designed to measure sleep disturbance caused by a single concussive event. The objective of the current project is to adapt the SCQ to measure sleep status in those with history of multiple concussions. Methods: Modifications to the original measure were made to capture other clinical and personal history relevant for content validation. Revisions were made based on feedback captured through quality assurance testing. Convergent, discriminant and predictive validity, and internal structure will be evaluated through the validation process. 12

PREVENT INJURY AND ILLNESS Conclusion: Evaluation of sleep is an important component of concussion assessment and management. The outcome of this project will provide an easy-to-administer, patient-report measure that captures sleep disturbances in people with a history of multiple concussions.

5. The Perceived Facilitators and Barriers to Reducing Sedentary Behaviour at an Exercise-based Secondary Prevention Program 12

A Biswas , GE Faulkner , PI Oh DA Alter 1 Institute of Health Policy, Management and Evaluation, University of Toronto; 2 Toronto Rehabilitation InstituteUHN; 3, Faculty of Kinesiology, University of British Columbia

It is important to understand why individuals engage in sedentary behaviour, irrespective of their participation in physical activity, in order to develop effective intervention efforts that encourage reduced sedentary behaviours. This study sought to understand the perceived facilitators and barriers to reducing sedentary behaviours from the perspectives of individuals undertaking an exercise-based cardiac rehabilitation (CR) program, and staff involved in supporting the self-management of these individuals. A descriptive qualitative approach was used. Guided by an ecological framework for sedentary behaviour, semi-structured interviews were conducted with 15 patients, and two focus groups with six staff of a large outpatient CR program in Canada. Patients did not place much importance on reducing their sedentary behaviour, or associated such behaviours with enjoyment and relaxation. Intrapersonal factors (physical and psychosocial health) and environment factors (the information environment, socio-cultural factors, the natural environment) within the behaviour setting contexts of leisure time, the home, and work were common themes identified as influencing patient sedentary behaviour. CR programs may need refinement to increase awareness of the independent health benefits of reducing sedentary behaviour, utilizing existing behaviour change strategies, and use a participatory approach to tailor strategies to individual patients.

6. Uptake of an Incentive-based mHealth Application for the Primary Prevention of Chronic Disease: Process Evaluation of the Carrot Rewards App 1,2

M Mitchell , P Oh1, D Alter , T Leahey , G Faulkner 1 Toronto Rehabilitation Institute-UHN; 2 Carrot Insights Inc.; 3 University of Connecticut; 4 University of British Columbia

Background: Behavioral economics has stimulated renewed interest in financial health incentives worldwide. The Carrot Rewards app was developed to reward Canadians with loyalty points (e.g., groceries) for downloading the app and completing one to two health quizzes per week. Objective: The main objective is to evaluate app uptake during the exclusive 3-month launch period in British Columbia (BC), Canada. Methods: The app was promoted via loyalty program email campaigns (1.64 million emails). Number of downloads and valid registrations were collected. Additional demographics were inferred by linking postal codes with census data at the Local Health Area (LHA) level. Engagement level was collected over three months. Results: In three months, 67,464 individuals downloaded the app. Among active, the majority were female (63%) and aged 18-35yrs (54%). More than half of users (52%) resided in LHAs where the median income is below the provincial average ($28,765 Cnd). The most prevalent risk factors were not meeting physical activity guidelines (73%) and not getting the flu shot last year (68%). Regarding engagement, 13

PREVENT INJURY AND ILLNESS 59% of users were classified as high engagers (completed 75% or more of quizzes). Conclusion: Early results suggest that loyalty points may promote mHealth app uptake and engagement.

7. Selecting Slip-Resistant Footwear for Workers to Use Outdoors in Winter 1,2

1,3,

1,2,4

1,4,5

K Morrone , Y Li , Z Bagheri , S Kong T Dutta , G Fernie 1 Toronto Rehabilitation Institute - UHN; 2 Department of Mechanical and Industrial Engineering, University of Toronto; 3, Department of Electronics, Carleton University; 4 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 5 Department of Surgery, University of Toronto

Outdoor workers experience high injury rates in winter due to slip and fall accidents on ice and snow. Our objective was to determine which winter footwear available to city workers will prevent slips on icy surfaces. We selected 39 of the most popular types of winter footwear worn by city workers and applied our Maximum Achievable Angle (MAA) test method to rate the slip-resistance of the footwear on wetted and un-wetted ice. The MAA test measures the steepest incline that participants can walk up and down without experiencing a slip. A higher MAA value indicates that the footwear is safer to walk on all surfaces, sloped or level. Of the 39 types of footwear, the best performing footwear type achieved an MAA of 8.7°. The second best type obtained an MAA of 5.3° while the remaining 37 types’ MAAs were all below 4.9° which falls below Accessibility Guideline’s maximum allowable slope of 7.1° for a curb ramp. Our results suggested that there is a need to develop a wider selection of footwear with anti-slip characteristics as few are available to city workers. Workers are suggested to select their winter footwear carefully as only one pair possessed reasonable anti-slip properties.

8. Development of Textured Composite Material for Slip-resistant Footwear 1

ZS Bagheri , A Anwer , H Naguib , G Fernie , T Dutta 1 iDAPT Centre for Rehabilitation Research, Toronto Rehabilitation Institute-UHN; 2 Department of Mechanical and Industrial Engineering, University of Toronto

The risk of falling discourages older adults from going outside in winter. As a result, seniors can feel trapped indoors for long periods. The use of composite outsole materials may be able to improve winter footwear and make it safer for older adults to stay active year-round. Ice and snow-covered surfaces are slippery because water molecules produce a liquid-like layer at the surface that acts as a lubricant. We have developed a composite material with microscopic fibers extending out of the surface that provide surprisingly high slip-resistance on a range of surfaces including snow and ice by penetrating and interlocking with the substrate underneath. Our objective is to improve the wear resistance of our composite material to ensure it retains its slipresistance properties over extended use. We evaluated combinations of two abrasion-resistant elastomers as well as five types of fibers with varying stiffness and ductility. The slip-resistance of our composite materials was measured before and after simulated wear. Our results have demonstrated that a number of our new composites have good wear-resistance and therefore have good potential for being incorporated in commercial footwear and may prevent many winter slips and falls.

PREVENT INJURY AND ILLNESS 9. Validity of an Inertial-measurement-based Device for Assessing Slips on Icy Surface 1,2

1,3

1,4

1,5,6

1,2,3

1,4,7

JY Cen , G Wong , Y Li , K Morrone , S Kong , A Novak T Dutta , G Fernie 1 Toronto Rehabilitation Institute-UHN; 2 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 3 Department of Mechanical and Industrial Engineering, University of Toronto; 4 Department of Electronics, Carleton University; 5 Faculty of Kinesiology and Physical Education, University of Toronto; 6 Department of Occupational Science and Occupational Therapy, University of Toronto; 7 Department of Surgery, University of Toronto

Falls in icy winter conditions are a serious problem that can be prevented with slip resistant footwear. However, there is currently no way to test the slip resistance of footwear in real-world winter conditions. We are developing a low cost inertial-measurement-based device, called SlipMeter, to measure slips on icy surfaces. The objective of this study was to evaluate the accuracy of SlipMeter by comparing its performance to a 14-camera motion capture system. Foot velocity was calculated for every stride recorded by the two systems for participant walking up and down various slopes on wet ice in a simulated winter environment. A comparison of the two systems showed a normalized root mean squared error in foot velocity of 5 Âą 4%. No significant differences were found in either the peak or the average stride velocity in the anterior-posterior direction between the two systems (p>0.05). The average and peak stride velocity of the two systems were significantly correlated (r= 0.92 and 0.92, respectively; p= < 0.0001 and < 0.0001, respectively). Our results suggest that SlipMeter can accurately measure foot velocity. We are developing a slip-detecting algorithm for walking on icy surfaces that we hope will lead to safer footwear.

10. Can We Predict Winter Footwear Performance on Level Ground Based on Their Performance on Slopes? 1

1,2

1,3

1,4,5

W Cheng , Y Li , B Westhead , K Morrone , S Kong , G Fernie 1 Toronto Rehabilitation Institute- UHN; 2 Department of Mechanical and Industrial Engineering, University of Toronto; 3 Department of Electronics, Carleton University; 4 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 5 Department of Surgery, University of Toronto

Slips and falls are the leading cause of injuries. Maintaining balance, especially in the winter, is even more challenging due to the presence of snow and ice. To prevent slips in the winter, it is crucial to identify winter footwear that are slip resistant. The maximum achievable angle (MAA) test evaluates the slip resistance of winter footwear. It involves human testers walking on realistic ice surfaces at increasing slope angles. The footwear that allows participants to walk on a higher MAA without slipping was considered more slip resistant. In this study, we compared footwear slip resistance by the MAA test to footwear performance on level ground. Participants were asked to walk as fast as possible on identical hourglass shaped paths on wet ice and concrete, while their level walking speed were measured. The footwear that led to the least slowdown on wet ice compared to speed on concrete was considered the best performing. Our results showed that the footwear's slip resistance ranking determined by the MAA test and the level walking experiment were consistent. Furthermore, the MAA testing was able to differentiate the slip resistance of winter footwear with higher resolution than the level walking experiment.

PREVENT INJURY AND ILLNESS 11. Safety Hazards Encountered by Personal Support Workers in Home Care 1,2,3,

1,2,5,6

1,6

E King P Holyoke , R Hurst , J Del Sole , K Hutchinson , T Kajaks , T Dutta , S Jaglal 1 Toronto Rehabilitation Institute - UHN; 2 Mechanical & Industrial Engineering, University of Toronto; 3 Department of Kinesiology, University of Waterloo; 4 Saint Elizabeth Health Care; 5 Institute of Biomedical & Biomaterials Engineering, University of Toronto; 6 Rehabilitation Sciences Institute, University of Toronto

Introduction: Personal Support Workers provide 70-80% of paid home care. Unfortunately, they are injured at over twice the rate of the average worker. We do not know which activities and situations contribute most to these injuries. This project will identify patterns in personal support work that lead to the highest risk of injury. Methods: More than 900 community-based Personal Support Workers will be followed for one year to track how hours worked and the characteristics of their work activities and clients affect Personal Support Workers' risk of reporting an injury. Further, approximately 190 of these individuals have agreed to provide more detailed information about their past and weekly experiences through a series of surveys. These surveys ask about demographics, personal history, health-related quality of life, prior injuries, working conditions, abuse, available supports, and extra work that they do for their clients. Results: Based on both quantitative and qualitative findings, we will highlight participant's weekly experiences and key safety issues reported to-date including difficult environments, lack of assistance and abuse from clients and families. Impact: The results of this work will inform interventions to reduce injuries to Personal Support Workers.

12. PostureCoach: Posture Prompting Technology for Safer Patient Handling 1

2,4,5,6

D Ford , T Ortega , T Kajaks , A Longfield , T Dutta 1 Occupational Science and Occupational Therapy, University of Toronto; 2 Toronto Rehabilitation Institute-UHN; 3 Saint Elizabeth Health Care; 4 Rehabilitation Sciences Institute, University of Toronto; 5 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 6 Department of Mechanical and Industrial Engineering, University of Toronto

PostureCoach is a wearable device we developed to provide real-time movement-centered feedback to reduce the risk of back injury by prompting caregivers to adopt safer postures. Our objective was to determine if PostureCoach was able to reduce the time participants spent in flexed postures. Eighteen participants (6 novices, 6 student clinicians, 6 professional clinicians) were asked to perform a series of simulated patient handling tasks at Toronto Rehabâ&#x20AC;&#x2122;s CareLab. Both novices and student clinicians had reductions in 90th percentile flexion angle between baseline and coaching but professional clinicians did not. These findings suggest that PostureCoach may be a useful training tool for individuals with limited patient handling experience. This pilot study also identified a number of improvements that will be incorporated in the design of PostureCoach version 2.0. These improvements include designing a more comfortable device harness with less risk for movement over the skin surface, using a more stable inertial motion unit, and simplifying the user-interface with the data acquisition and feedback device. Progress on these improvements is well underway, and we are preparing for a PostureCoach version 2.0 evaluation in clinical and community settings.

PREVENT INJURY AND ILLNESS 13. Methods for Simulating Balance Loss during Stair Descent 1,2

1,6

1,2,5,6

1,3,4

P Gosine , D Houston , D Smyth , S Pong , G Fernie , A Novak 1 Toronto Rehabilitation Institute-UHN; 2 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 3 Faculty of Kinesiology and Physical Education, University of Toronto; 4 Department of Occupational Science and Occupational Therapy University of Toronto; 5 Department of Rehabilitation Science, University of Toronto; 6 Department of Mechanical and Industrial Engineering, University of Toronto; 7 Department of Kinesiology, University of Waterloo

In order to reduce the number of falls on stairs and prevent injury, a greater understanding of the biomechanical demands of recovery reactions following balance loss on stairs is needed. As over 75% of stair-related falls occur during stair descent, the objective of the study is to characterize the recovery reactions following forward and backward falls during stair descent. In order to meet the objective, a repeatable, safe and ecologically valid method must be determined for inducing both forward and backward falls on stairs. Four methods were tested to force the foot to overstep the step or to induce a stumble, simulating different severities of forward falls on stairs. To induce backward falls, platform translation, platform rotation, eight low-friction material interactions, and a motorized slip apparatus were tested. Video analysis was completed to compare falls induced to typical stair fall scenarios. Perturbations and the slip apparatus were selected to induce forward and backward falls respectively. The characterization of the demands of recovery reactions following forward and backward falls on stairs can inform future studies related to environmental design and fall prevention training programs. This process has identified some of the challenges associated with safely simulating situations that result in injury.

14. The Influence of Handhold Heights on the Effectiveness of Reach-to-grasp Balance Recovery Reactions: a Pilot Study 1,2

1,3,

1,2,4

K Nirmalanathan , V Komisar A Novak 1 Toronto Rehabilitation Institute -UHN; 2 Faculty of Kinesiology and Physical Education, University of Toronto; 3 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 4 Department of Occupational Science and Occupational Therapy, University of Toronto

Falls are the leading cause of injuries in all age groups. Well-designed handrails can significantly reduce the incidence and severity of falls. They do so by allowing users to grasp and generate high forces to stabilize their centre of mass (COM). This study investigates how handrail height influences the effectiveness of reach-to-grasp balance reactions, with respect to 1) COM control, and 2) forces applied to handrails following balance loss. Key analysis variables include: 1) peak COM displacement, velocity, acceleration and momentum, and 2) peak handrail forces. Fifteen young adults were destabilized with forward and backward platform perturbations (acceleration: 3.5m/s2) and reached to grasp a handrail to avoid stepping or falling. Three handrail heights were tested: 34â&#x20AC;?/86.5cm, 38â&#x20AC;?/96.5cm and 42â&#x20AC;?/106.5cm. Kinematic and kinetic data were collected. Ongoing analyses will reveal which handrail heights maximize COM control, and characterize the relationship between COM control and applied handrail forces. This will provide an evidence base for informing design guidelines and accessibility standards related to handrail heights. Improved standards can guide safer handrail installations, thereby helping to reduce the risk of falls and associated injuries in the community.

PREVENT INJURY AND ILLNESS 15. Effect of Electronic Prompting on Hand Hygiene Performance in HealthCare Workers 1,2

1,3

S Pong , P Holliday , G Fernie 1 Toronto Rehabilitation Institute-UHN; 2 Mechanical & Industrial Engineering, University of Toronto; 3 Department of Surgery, University of Toronto

Despite the best efforts of frontline staff, infection control practitioners and healthcare institutions, inadequate hand hygiene continues to be the primary cause of healthcare acquired infections (HAI) across North America. It is estimated that up to 5 percent of patients admitted to hospital will contract an HAI. Typical interventions like poster campaigns, intermittent training and observation audits only slightly improve performance temporarily. These preventable infections result in unnecessary illness, lengthened stay and even death of thousands of patients every year. Our team at Toronto Rehab has developed and tested a patented electronic real-time hand hygiene prompting system (HHPS) that discretely reminds healthcare workers to wash their hands when necessary. A smart badge is worn by all staff that quietly vibrates when an opportunity for hand washing has been missed. Our system is the only one in the world that prompts people only when needed and provides a rich individualized audit trail. To determine the effect of the HHPS it has been deployed on numerous clinical units for over a year, sustaining a doubling of hand hygiene performance with over 50,000 hours of user participation. Our system is inexpensive, easy to implement and achieves significant, sustainable results.

16. The Effect of Age on Visual-vestibular Self-motion Perception 1,2

1,2

R Ramkhalwansingh , JS Butler , JL Campos 1 Toronto Rehabilitation Institute-UHN; 2 Department of Psychology, University of Toronto; 3 School of Mathematical Sciences, Dublin Institute of Technology

Walking and driving are contingent upon reliable self-motion perception (Campos & Bülthoff, 2012). Younger adults achieve a robust percept by combing visual and vestibular estimates of self-motion each weighted according to their reliabilities (Butler et al., 2009). However, older adults are more susceptible to gait/posture disturbances when confronted with unreliable cues (Deshpande, 2007). This has led some to posit that they do not weight sensory inputs appropriately (Berard et al., 2012). But to date, no studies have quantified the reliabilities that older adults assign to visual and vestibular inputs. Thus, we employed a 2-alternative forced-choice task in which older adults (age 65+) and younger adults (18-35) were to discern which of two consecutive movements were more rightward. Movements consisted of vestibular cues alone, visual cues alone, or both cues combined. In the combined condition, we introduced intersensory conflicts of 5° and 20° to observe relative cue weightings. At the 5° conflict, both groups weighted optimally. At the 20° conflict, younger adults’ percept was captured by the visuals whereas older adults continued to incorporate vestibular cues into their percept. Older adults may combine visual and vestibular cues mandatorily, despite intersensory spatial conflicts, leaving them vulnerable to performance declines during mobility-related tasks.

PREVENT INJURY AND ILLNESS 17. Investigating Plantar Pressure and Foot Sensitivity of Individuals with Diabetes during Stair Gait 1,2

1,2,3

PJ Antonio , SD Perry 1 Rehabilitation Sciences Institute, University of Toronto; 2 Toronto Rehabilitation Institute-UHN; 3 Department of Kinesiology and Physical Education, Wilfrid Laurier University

Introduction: Diabetic peripheral neuropathy (DPN) is a result of diabetes mellitus. DPN is a dysfunction of the peripheral nerves that restricts sensation from the limbs, which constrain one's mobility and quality of life. Furthermore, the plantar cutaneous sensation of DPN individuals is reduced, compromising their balance. To compensate, they generate greater foot pressures while walking - often leading to tissue ulcerations, or possibly lower-extremity amputations if left untreated. As well, foot pressures during stair gait are greater than level walking. Currently, there are market-available diabetic insole devices that claim to offload foot pressure and limit ulcer formation; however these devices have not been examined. Aims: Investigate plantar pressures of individuals with diabetes during stair walking, while wearing three market-available diabetic insoles (and one normal insole). Methods: Diabetic individuals (n = 4) traverse a staircase while instrumented with pressure sensor insoles to record plantar pressure. Preliminary Results: Diabetic individuals with impaired plantar sensation demonstrated no significant difference of total right foot peak pressures while wearing any of the insoles. This suggests that diabetic insoles may not accurately reduce the pressures while stair-walking. Further analysis of specific foot regions is required.

18. Near-Infrared Spectroscopy During Constant Inspiratory Loading in Young and Middle-Aged Men 1,2,3

4,5,

3,8

TM Saumur , GE Foster J Nakano , AW Sheel , JD Road , WD Reid 1 Rehabilitation Sciences Institute, University of Toronto; 2 Sunnybrook Research Institute; 3 Toronto Rehabilitation Institute-UHN; 4 School of Kinesiology, University of British Columbia; 5 School of Health and Exercise Sciences, University of British Columbia; 6 Graduate School of Biomedical Sciences, Nagasaki University; 7 Department of Medicine, University of British Columbia; 8 Department of Physical Therapy, University of Toronto

Background: Respiratory muscle oxygenation changes during intense exercise are seldom studied despite the vital information it offers related to muscle recruitment and metabolism. Understanding how fatiguing respiratory muscles function in these regards, can further our understanding of how various clinical populations with cardiorespiratory difficulties alter their breathing patterns. Methods: 10 healthy young and middle-aged men were recruited to determine the changes in inspiratory muscle oxygenation that occur during a constant, prolonged inspiratory load. One session of 60-minute inspiratory threshold loading was performed by all participants. During this bout, nearinfrared spectroscopy data were recorded from the sternocleidomastoid, diaphragm, parasternals and vastus lateralis. Results: A significant decrease in oxygenated hemoglobin (O2Hb) concentration was observed in the sternocleidomastoid following completion of inspiratory threshold loading. Diaphragm O2Hb concentration increased significantly in the older men. The young men had vastus lateralis O2Hb concentration decreases that were greater than the older men, potentially due to age-related changes in vasoconstriction. Conclusions: These results suggest that the sternocleidomastoid becomes deoxygenated following prolonged activation and inspiratory muscle recruitment strategies may differ between younger and older men. Understanding physiological properties associated with muscle fatigue or injury is critical when considering physical therapy and rehabilitation techniques using inspiratory muscle training. 19

PREVENT INJURY AND ILLNESS 19. Retrospective Assessment of the Validity and Reliability of the Community Balance & Mobility Scale in Inpatients with Spinal Cord Injury 1,2

1,3

1,4

3,5

1,5

K Chan , K Guy , G Shah , J Golla , HM Flett , J Williams , KE Musselman 1 SCI Mobility Lab, Toronto Rehabilitation Institute-UHN; 2 Rehabilitation Sciences Institute, University of Toronto; 3 Brain & Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-UHN; 4 Department of Neuroscience, University of Toronto; 5 Department of Physical Therapy, University of Toronto,

The Community Balance & Mobility Scale (CB&M) evaluates ambulatory balance, for which there is no validated measure in incomplete spinal cord injury (iSCI). Our objectives were to evaluate convergent validity, use and internal consistency of the CB&M in individuals with iSCI during inpatient rehabilitation. Inpatient charts from 2009 to 2015 were included if the inpatient was aged <65 and had a completed CB&M. Injury-related characteristics, demographics and CB&M score were extracted. If the CB&M was completed within one week of the Berg Balance Scale (BBS), Six-Minute Walk Test (6MWT) and/or Tenmeter Walk Test (10mWT), scores were obtained. We used Chi-Square tests to identify CB&M items with uniform distributions, alluding good discrimination between participants. Thirty individuals were included (23 male, 38.3 ± 15.3 years old, C1-L4, three AIS C, 26 AIS D). All individuals scored ≥51/56 on the BBS, whereas CB&M scores ranged 27-82/96. Six CB&M items showed uniform distributions, suggesting usefulness for discrimination. Scores on the CB&M showed a strong correlation with scores on the 6MWT (r=0.72, p<0.001) and moderately strong correlations with 10mWT and BBS scores (r=0.47-0.59, p=0.004-0.013). Cronbach’s alpha was 0.87. The CB&M shows promise as a valid and reliable ambulatory balance measure for high-functioning iSCI.

20. Clinically-Feasible System Identification Method for Human Balance Control Mechanism 1,2

1,2,

2,3

JW Lee , KL Fok H Rouhani , K Masani 1Division of Engineering Science, University of Toronto; 2Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - UHN; 3Rehabilitation Engineering Laboratory, Institute of Biomaterials and Biomedical Engineering, University of Toronto; 4Department of Mechanical Engineering, University of Alberta

Falling is a serious issue for elderly and people with motor disabilities. Understanding the balance control mechanism during standing is required to assess one's balancing abilities and to propose assistive technologies. By applying system identification, we can quantitatively understand the postural control system. However, the currently accepted system identification method requires laboratoryquality perturbation equipment, which is clinically unfeasible. As an alternative, our lab has proposed a novel system identification method that uses electromyography, kinematics, and kinetics data during unperturbed standing. This eliminates the use of perturbation systems, making it more clinically feasible. Thus, the purpose of this study is to theoretically and experimentally validate our novel method. For the theoretical validation, unperturbed standing is simulated using an established model. For experimental validation, six healthy young participants performed two different tasks: unperturbed standing and perturbed standing. The results of theoretical analyses validated the usefulness of our method. The analyses of experimental data are still ongoing, and we expect that it also will verify our method. The results would suggest that this method can indeed be used as an alternative to identify system parameters of the postural control system, which can help to assess older people’s or patients' abilities to maintain postural balance.

PREVENT INJURY AND ILLNESS 21. Quality Reporting of Carotid Intima-media Thickness Methodology; Current State of the Science in the Field of Spinal Cord Injury 1,2,

1,2, 3

J. Hoskin M. Miyatani , B.C. Craven 1 The Neural Engineering & Therapeutics (NET) Team, Toronto Rehabilitation Institute-UHN; 2 Department of Kinesiology, University of Waterloo; 3 Department of Medicine, University of Toronto

Carotid intima-media thickness (cIMT) may be used increasingly as a cardiovascular disease (CVD) screening tool in patients with spinal cord injury (SCI). However, variation in cIMT acquisition and analysis methods are prevalent in the current published literature. The purpose of this study is to: 1) evaluate the quality of the reported methodology for acquisition and analysis of cIMT values in SCI; and, 2) to discuss the literature regarding cIMT measurement in SCI. Data from 12 studies, which measured cIMT in individuals with SCI, were identified from a systematic search of the Medline, Embase and CINAHL databases. The quality of the reported study methodologies were abstracted and scored based on adherence to methodological guidelines derived from two consensus papers. The overall reporting of quality methodology was poor in the published SCI literature. cIMT values in SCI in studies of at least moderate methodology reporting quality range from 0.46 mm to 0.74 mm (± 0.02 – 0.07). Greater adherence to current methodological guidelines is needed to advance the field of cIMT in SCI. Further research is necessary to refine cIMT acquisition and analysis protocols and aid authors designing research and journal editors in identifying quality cIMT methods.

22. Investigating the Effects of Fluid Overload on the Genioglossus Activity in Anesthetized Rat Model 1

1, 2

1, 3

P Sabetian , A Yadollahi , PB Yoo 1 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 2 Toronto Rehabilitation Institute – UHN; 3 Department of Electrical and Computer Engineering,

Although the precise cause of obstructive sleep apnea (OSA) remains unknown, various anatomical or structural factors (e.g., obesity) are considered as contributing factors in upper airway collapse. Recent clinical studies show that OSA is frequently observed among patients with fluid-retaining states, such as patients with heart or renal failure, and post-surgery. These findings are consistent with previous studies that rostral fluid shift during sleep exacerbated OSA. It is important to note that a cause-effect relationship is not yet established, and our understanding of the effects of fluid overload is limited. To this end, the goal of this study was to develop an animal model that can characterize the physiological changes that occur in response to fluid overload. Our preliminary results in urethane anesthetized rats indicate that acute ‘fluid overloading’ (IV saline infusion rate = 22 ml/Kg, 30 minutes) results in a notable decrease in upper airway dilator muscle activity (i.e., 40% decrease in genioglossus muscle activity from pre- to post- infusion). This change in airway function occurs during infusion and also persists after saline infusion has stopped. Further work is needed to examine the validity of this animal model.

PREVENT INJURY AND ILLNESS 23. Novel Measure to Assess Dynamic Stability during Walking 1

3,4

J Yoo , M Shinya , M Milosevic , K Masani 1 Department of Mechanical and Industrial Engineering, University of Toronto; 2 Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo; 3 Rehabilitation Engineering Laboratory, Institute of Biomaterials and Biomedical Engineering, University of Toronto; 4 Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute-University Health Network

Slips and falls are growing problems among the elderly and patients with motor disabilities. Accurate evaluation of dynamic stability during gait is critical to reducing the risk of falling in these populations. Although current assessments have been focusing on regulating the body's center of mass (COM) within the base of support of the feet, these methods only predict the occurrence of instability without characterizing its nature or severity. Our team has proposed a novel assessment measure involving a desired center of pressure (dCOP), calculated as the location of the body's center of pressure where no moment occurs around the COM. Here we investigated the effectiveness of our method in evaluating the dynamic stability during gait in comparison with other measures. Kinetic and kinematic data were recorded and analyzed for fourteen healthy subjects walking on an instrumented treadmill under four conditions with different dynamic stabilities: (1) naturally, (2) in sync with a metronome, (3) while performing a cognitive task, and (4) with arms restrained. We have found that our measure using dCOP appropriately differentiates the dynamic stabilities among these conditions. This novel measure will contribute to the improvement of fall risk assessment and the development of assistive technologies for vulnerable populations.

24. Animation as an Innovative Knowledge Translation Strategy for Work-related TBI Awareness 1

1, 2

1, 3

1,2

J Gray , A Colantonio , P Kontos , T Mollayeva , M Bayley , A Mihailidis , G Liss , B Gibson , J Lewko , 1 1 B Sharma , B Nowrouzi 1 Research Division, Toronto Rehabilitation Institute - UHN; 2 Rehabilitation Sciences Institute, University of Toronto; 3 Dalla Lana School of Public Health, University of Toronto; 4 Laurentian University

While there is increased attention to the ways traumatic brain injury (TBI) might occur in military, professional sport or paediatric settings, there is significantly less awareness about the ways this injury occurs in work place settings, as well as how work-related TBI might be prevented. Those who have previously sustained a TBI are at increased risk of reinjury at work, and there is little awareness about how injury may occur in â&#x20AC;&#x153;smallerâ&#x20AC;? industries and work places, such as in schools and retail settings. Our team was interested to raise awareness not only of the potential seriousness of even a mild TBI at work, but that there is the potential for such an injury to occur at all. Additionally we were concerned to reach vulnerable stakeholders, such as workers whose first language is not English and may not have networks to navigate injury. Some health researchers are turning to the arts as a knowledge translation strategy to engage stakeholders such as policy makers, administrators and the general public in research, including addressing complexities and raising awareness. This presentation features our animation as an accessible, popular medium to reach out to stakeholders including vulnerable populations to raise awareness about work-related TBI.

PREVENT INJURY AND ILLNESS 25. Effect of Airway Caliber on Sensitivity to Rostral Fluid Shift in Asthma 1

1,2,3

1,3

SA Bhatawadekar , G Keller , A Yadollahi 1 Toronto Rehabilitation Institute- UHN; 2 Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; 3 Institute of Biomaterials and Biomedical Engineering, University of Toronto

When supine, fluid shift from the legs to the thorax may increase airway narrowing, and exacerbate asthma. Our objective was to examine the effect of baseline airway caliber on magnitude of airway narrowing due to fluid shift. While subjects lay supine for 30 min, fluid shift was induced by lower body positive pressure (LBPP). In 17 asthmatic and 17 healthy subjects, airway narrowing was assessed by airway resistance (R5) using impulse oscillometry and changes in thoracic fluid volume (ΔTFV) were estimated by bioelectrical impedance. In asthmatics, increase in R5 after LBPP was correlated with baseline R5 and ΔTFV (r2 =0.68, p < 0.001), and sensitivity to fluid shift (ΔR5/ΔTFV) was correlated with baseline R5 (r = 0.8, p<0.001). No such associations were seen in the healthy subjects (p=0.6). Furthermore in the asthmatics, increase in small airway resistance with LBPP was larger than in large airway resistance (p=0.005). Our results suggest that asthmatics with narrower airways may be at increased risk due to fluid shift. Furthermore, small airways may be more sensitive to the effects of fluid shift than large airways. Future studies should examine the effects of fluid shift in subjects with narrower airways such as women and obese subjects.

26. Development of a Novel Device for Non-Invasive Body Composition Measurements 1,2

1,2

T Cole , B Gavrilovic , M Popovic , A Yadollahi 1 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 2 Sleep Science Team, Toronto Rehabilitation Institute-UHN

Obstructive sleep apnea (OSA) is a chronic sleep disorder which results from the collapse of the upper airway during sleep. Studies have demonstrated that the prevalence of sleep apnea is 10% in adults, and continues to rise as the population becomes more obese and sedentary. Research within our laboratory has demonstrated that larger water content of the pharyngeal tissue is correlated with increased OSA severity, and that a fluid overloaded population is at an increased risk of developing OSA. However, current methods of assessing tissue composition of the upper airway are limited to X-rays and MRI, while simpler and more convenient methods such as bioelectrical impedance analysis (BIA) have not been investigated in this context. BIA is a simple and non-invasive method to assess fluid volumes and body composition. Our objective is to develop a practical clinical tool which utilizes Multi Frequency BIA to accurately monitor and assess the tissue composition and fluid volume of the upper airway concurrently with other body segments. This tool will be validated against X-ray imaging, and clinical measures will be developed to predict the risk of developing OSA.

PREVENT INJURY AND ILLNESS 27. Validating the Patch for Detecting Respiratory Phase and Body Posture during Sleep 1,2

2,3

M. Gonzalez Esquivel , A. Yadollahi 1 Department of Materials Science and Engineering, University of Toronto; 2 Toronto Rehabilitation Institute-UHN; 3 Institute of Biomaterials and Biomedical Engineering, University of Toronto

Rationale: Obstructive Sleep Apnea (OSA) is defined by repetitive non-breathing and shallow breathing during sleep. Moreover, these events are worse while supine; thus, OSA assessment also requires detection of body posture. The Patch is a wearable device that records respiratory sounds and head position. Our objective was to validate the use of The Patch for detecting respiratory phase and posture during sleep. Methodology: Three scenarios were used: only tracheal sounds, only accelerometer data and both. A Butterworth filter was used on the sound signal with a bandpass between 150 and 800 Hz, then the envelope of the signal was estimated using a Hilbert Transform; and the accelerometer data was decomposed into the x, y, and z-axis and filtered to eliminate noise. Results: The y-axis was found to provide the best information for detecting body posture and the z-axis for respiratory phase detection at shallow and normal breathing whereas the tracheal sounds were accurate in normal breathing intensity. Conclusion: The results show The Patch can detect respiratory phase and posture during sleep. This method provides the basis for detecting OSA severity in various body postures during sleep and to find the most advantageous sleeping posture for each patient.

28. Developing a Computational Model of the Upper Airway to Predict the Effectiveness of Mandibular Advancement for Sleep Apnea Treatment 1,2

1,3

1,2

G Gruenspan , T Meisami , A Yadollahi 1 Toronto Rehabilitation Institute-UHN; 2 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 3 Faculty of Dentistry, University of Toronto

Obstructive sleep apnea (OSA) is common in 10% of the population. A common treatment for OSA is mandibular advancement. During mandibular advancement the hyoid bone transfers the load to the other upper airway tissue increasing the caliber of the upper airway, and improving OSA. However, it only has a 50% effectiveness on patients. Previous literature has shown that the difference in position of the hyoid bone between patients can be a predictor for the effectiveness of mandibular advancement in patients with OSA. Our research will involve the development of a subject specific finite element model of the upper airway, which will incorporate the position of the hyoid bone in each subject. Following the development of the model, displacement loads of the hyoid bone which result from mandibular advancement will be applied to the model. The outcome of the model will be the resulting geometry of the upper airway following mandibular advancement. The proposed model will be validated on data of patients with sleep apnea before and after treatment with mandibular advancement. The proposed model will allow us to determine the effectiveness of mandibular advancement and to predict which patients may benefit from mandibular advancement for sleep apnea treatment.

PREVENT INJURY AND ILLNESS 29. Automated Detection of Driver Drowsiness using Machine Learning Techniques 1,2

1,2

AR Hassan , B Keshavarz , A Yadollahi 1 Toronto Rehabilitation Institute-UHN; 2 Institute of Biomaterials and Biomedical Engineering, University of Toronto

Background: 25% of all crashes that lead to injuries and fatalities in Ontario are related to fatigued or drowsy driving. The aim of this research is to develop a wearable device for automatic detection of drowsiness while driving. Method: Twenty subjects will attend the DriverLab. Subjects will stay awake at night, and perform three driving tests at 8PM, 12AM and 4AM. While driving, The Patch, a wearable device, will be used to record respiratory sounds, heart sounds, and head movement. Simultaneously, we will record data from gold standards, including electroencephalogram, eye tracking, and steering pattern. Using data of The Patch, machine learning algorithms will be developed to extract heart rate variability, respiratory rate, and abrupt changes in head position to detect drowsiness. The results will be compared with those from gold-standards. Expected results: We expect that drowsiness will be associated with reduction in respiratory and heart rate, reduction in respiratory and heart rate variability, increase in respiratory intensity, and abrupt movements of the head. We expect the accuracy of our proposed method to detect drowsiness will be comparable to those based on gold-standards. Impact: If successful, this research will develop a reliable, non-intrusive, and convenient device to detect fatigued driving.

30. Effects of Varying Cheyne-Stokes Respiration Maneuver on Stroke Volume in Patients with Heart Failure: Respiratory Cardiac Support 1, 2

1, 2

1, 3

1, 2, 5

T Inami , T Kasai , D Yumino , E Perger , R Hummel , H Alshaer , OD Lyons , JS Floras , TD Bradley 1 Sleep Research Laboratory Toronto Rehabilitation Institute; 2 Centre for Sleep Medicine and Circadian Biology University of Toronto; 3 Department of Medicine, Women's College Hospital; 4 Department of Medicine, Mount Sinai Hospital; 5 Department of Medicine Toronto General Hospital

In patients with heart failure (HF) and reduced left ventricular ejection fraction (HFrEF), stroke volume (SV) decreases during hyperpnea of Cheyne-Stokes respiration (CSR). We have noted 2 patterns of hyperpnea: positive, in which end-expiratory lung volume (EELV) is above functional residual capacity (FRC), and negative, in which EELV falls below FRC. A fall in EELV below FRC implies an increase in positive expiratory intrathoracic pressure. We hypothesized that in HFrEF, the negative CSR pattern might have a self-resuscitation effect and would be associated with a smaller fall in SV and a less increase in cardiac workload than during the positive pattern. HFrEF patients underwent polysomnography to identify CSR and to distinguish the two patterns of hyperpnea. We analyzed hemodynamic data during CSR by digital photoplethysmography and compare data between the two patterns. We found that the negative CSR pattern had a self-resuscitating effect that resulted in a smaller maximal relative fall in SV by 29% and less increase in heart rate and cardiac workload during hyperpnea by 48% and 14%, respectively than during the positive pattern. For the failing heart, it appears that the negative CSR pattern works as a compensatory mechanism in those with severely impaired cardiac function.

PREVENT INJURY AND ILLNESS 31. Effects of Fluid Accumulation in the Neck on the Acoustic Features of Snoring Sounds 1,2,3

2,4

2,3

S Saha , Z Moussavi , TD Bradley , A Yadollahi 1 Department of Biomedical Engineering, University of Manitoba; 2 Toronto Rehabilitation Institute-University Health Network; 3 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 4 Department of Medicine, University of Toronto

Previous studies have shown that rostral fluid shift during sleep from the legs to the neck increases neck fluid volume (NFV). Increases in NFV can narrow the upper airway, increase turbulence of airflow passing in the upper airway and consequently induce snoring. The objective of this study is to investigate whether acoustic features of snoring sounds change with increases in NFV and pharyngeal tissue edema. Twenty men slept supine and we recorded their snoring sounds while sleeping. We obtained the measurement of the NFV and neck circumference (NC) before and after sleep. Spectral features of snoring such as average power, spectral-centroid in several frequency domains were extracted for the sleep stages and entire sleep duration. Our results showed that increases in NFV during sleep were significantly correlated with the decreases in spectral-centroid of snoring sounds in the frequency range of 60-170 Hz (r =-0.46, p=0.048) and 60-200 Hz (r =-0.50, p=0.026) for the Non-REM 2 (N2) sleep stage. Furthermore, we found similar correlations between increases in NC and spectralcentroid in 60-170 Hz (r=-0.57, p=0.009) and 60-200 Hz (r=-0.53, p=0.016). These results showed the potential application of spectral-centroid of snoring sounds to estimate the increases in NFV and NC during sleep.

32. Investigating Signal Quality of The Patch with Different Noise Levels for Drowsy Driving Detection 1,2

2,3

1,2

I Samfira , B Keshavarz , A Yadollahi 1 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 2 Toronto Rehabilitation InstituteUHN; 3 Department of Psychology, Ryerson University

Rationale: Drowsiness is a major driving impairment, causing 20-25% of motor vehicle collisions in Ontario. Physiological measures, like electroencephalography and eye tracking, are the current gold standard to detect drowsiness, but are impractical and cost-intensive. When drowsy, cardiorespiratory signals change. We propose that The Patch, a convenient wearable device that records cardiorespiratory sounds, can be used to predict drowsiness. As the first step, this study investigates quality of The Patch recordings in various environmental conditions. Methods: Three experiments were conducted in 1) SleepLab, 2) DriverLab with operational projector and car, and 3) DriverLab with additional fan noise, representing low, moderate, and high noise levels respectively. Participants wore the Patch, and went through periods of shallow, normal, deep, and no breathing. Signal quality of recorded sounds was validated through accuracy of respiratory and heart rate detection, and comparison of signal to noise ratios for respiratory sounds. Results: Heart rate and respiratory rate detection were reliable for normal breathing, although algorithm sensitivity was modified due to ambient noise in DriverLab. Conclusions: To overcome these challenges, it is necessary to develop robust noise removal algorithms. Implementing the Patch as a detection method has the potential to prevent injury related to drowsy driving.

PREVENT INJURY AND ILLNESS 33. The Clinical and Pathophysiological Features of Dysphagia in Motor Neuron Disease: A Scoping Review 1,2

1,2

AA Waito , TJ Valenzano , M Peladeau-Pigeon , CM Steele 1 Rehabilitation Sciences Institute, University of Toronto; 2 Toronto Rehabilitation Institute-UHN

Introduction: Dysphagia is a highly prevalent in patients with motor neuron disease (MND). We conducted a scoping review of the literature to explore trends in dysphagia assessment and management described within existing research on dysphagia in MND. Materials & Methods: Six search engines yielded 1467 unique articles for review. Abstracts were evaluated for inclusion by two independent raters, using pre-determined criteria. Of the 210 articles accepted for full-text review, 133 articles addressed at least one of the research objectives (67 excluded, 10 unavailable). Relevant keywords from each article were extracted and summarized into themes, for subsequent analysis. Results: Reports of dysphagia in patients with MND patterned into (1) clinical signs/symptoms (e.g., frequent choking/coughing), (2) contributing factors (e.g., orofacial weakness), and (3) functional outcomes of dysphagia (e.g., malnutrition, pneumonia). Observations from instrumental assessment were primarily descriptive in nature, and identified a variety of oral and pharyngeal phase deficits. Primary focus was placed on aspiration. Most commonly reported management strategies included texture modification and non-oral feeding methods. Conclusions: Dysphagia in MND is highly complex and varies between patients, and across disease progression. Further research investigating swallowing pathophysiology would be beneficial to delineate the key contributing factors to impaired swallowing safety and efficiency.

RESTORE FUNCTION

ABSTRACTS â&#x20AC;&#x201C; RESTORE FUNCTION (34-61) Restoring function to those who have had an injury or illness is our second important theme. New techniques for restoring function are showing promise with both acute and chronic injuries. 34. Assistive Technology to Enable Sleep Function in Patients with Acquired Brain Injury: Issues and Opportunities 1,2

1,2

A Biajar , T Mollayeva , S Sokoloff , A Colantonio 1 Toronto Rehabilitation Institute-UHN; 2 Rehabilitation Sciences Institute, University of Toronto

Introduction: Sleep disorders in patients with acquired brain injury (ABI) are highly burdensome and associated with disability. An assistive technology framework emphasizes the need to develop and apply a broad range of devices, strategies, and practices to ameliorate disabilities. This review aimed to summarize scientific evidence regarding the utility of assistive technology in managing sleep disorders in patients with various causes of ABI within the scope of occupational-therapy framework. Methods: We retrieved articles before January 2016, through database search of Medline, Embase, PsycINFO, CINAHL, and various bibliographies. Results: We found 7 assistive technologies (continuous positive airway pressure, adaptive servo ventilator, nasotracheal suction mechanical ventilation, positioning devices, cognitive behavioural therapy, light therapy, and acupuncture) that have been utilized to support patients with ABI in managing various sleep disorders. Conclusion: Assistive technologies demonstrated effectiveness in alleviating and/or managing sleep disorders after injury to the brain. Adherence to using the technology is limited by the level of injuryinduced cognitive and physical impairment, technological regime, and environmental support. Development of user-friendly sleep-assistive technologies that take into consideration functional limitations and practice guidelines on structural communication between the occupational therapist, patient, and caretaker, may facilitate patients' self-determination in managing sleep disorders.

35. Inpatient Rehabilitation in Patients with TBI: Most Frequent Treatments and Functional Outcomes by Age 1,2

1,2

S Zarshenas , A Colantonio , N Cullen 1 Toronto Rehabilitation Institute-UHN; 2 Rehabilitation Sciences Institute, University of Toronto

Introduction: Occupational Therapy (OT) and Physical Therapy (PT) are considered as two key disciplines in inpatient rehabilitation(IR) program for TBI patients. Although numerous epidemiological studies have been conducted on TBI patients, there is a paucity of evidence on the effect of age on components of treatment and outcomes of IR in patients who were treated in Canadian settings. Objectives: Exploring differences in clinical features, OT and PT treatments and functional outcome by age in TBI patients at TRI-UHN. 29

RESTORE FUNCTION Methods: Data on 149 adult TBI patients between 2008 and 2011 were obtained from Practice-Based Evidence project. Patients were stratified by their age. Point of care forms and FIM were used to document activities and Outcome. Results: Cause of injury, length of stay and time from injury to IR admission varied significantly by age (p<0.05). Therapeutic exercise was the most frequent activity in PT for both younger and older adults. In OT, cognitive rehabilitation was the most frequent activity in both younger and older patients. All groups had a significantly higher FIM at discharge (p<0.05) compared with admission. Conclusion: Patients with TBI, all age groups, showed significant improvement at discharge. Compared to younger patients, older adults received more treatment sessions, however they were of shorter duration (e.g. less amount of therapy in each session) with respect to occupational therapy (i.e. cognitive activity, community reintegration) and physical therapy (i.e. therapeutic exercises and stairs training). 36. Development of a Wearable Device to Help Self-Manage Unwanted Behavioural Outbursts for Individuals with Brain Injury 1,2

1,3

1,2,4

TV How , RE Green , A Mihailidis 1 Toronto Rehabilitation Institute-UHN; 2 Institute of Biomaterials & Biomedical Engineering, University of Toronto; 3 Department of Psychiatry, University of Toronto; 4 Department of Occupational Science & Occupational Therapy, University of Toronto

Aggressive and unwanted behavioural outbursts (UBOs) are a common issue after brain injury. In chronic stages after brain injury, this behaviour has been described as being "out of character", an unpredictable occurrence, non-provoked or triggered by trivial matters, persisting to get worse over time, or accompanied with feelings of remorse. UBOs have serious and damaging consequences on relationships and family. As such, various pharmacological and behavioural therapies have been developed to minimize emotional instability. The effectiveness of most behavioural interventions is dependent on teaching an individual to recognize arousal at low level and address it before it becomes unmanageable. New wearable and emotion recognition technologies have the potential to facilitate such behavioural therapy in everyday life by providing real-time feedback that an individual can learn to act on. The goal of this research is to explore the physiological changes related to UBOs in brain injured populations, and to investigate if these changes could be used to predict the onset of UBOs. Specifically, electrodermal activity, blood volume pulse, motion, and skin temperature are recorded using a noninvasive wristband sensor as participants go about their day.

37. Feedback Control of Functional Electrical Stimulation using Mathematical Models of the Human Motor Control System 1

2,3,4

RS Razavian , B Ghannadi , N Mehrabi , J McPhee , A Mihailidis 1 Systems Design Engineering, University of Waterloo; 2 Intelligent Assistive Technology and Systems Lab, Toronto Rehabilitation Institute-UHN; 3 Department of Occupational Science and Occupational Therapy, University of Toronto; 4 Institute of Biomaterials and Biomedical Engineering, University of Toronto

Rehabilitation programs involving functional electrical stimulation (FES) have shown promising improvements in performance index of post-stroke and spinal cord injury patients. The state-of-the-art, however, has one important drawback: the application of the electrical stimulations is independent of the state of the patient---there is no feedback to the FES system. A feedback control scheme measures the patient's posture in real-time, and uses it to modulate the stimulation intensities in order to achieve the desired goal. By including feedback control in the FES 30

RESTORE FUNCTION system, less time is spent on manual system tuning, as the feedback control automatically handles the error. Therefore, more time is left for the exercises. Additionally, the feedback allows for more accurate control of the motion, smaller deviation from the desired target, and more robust behavior in the presence of environment disturbances. The human musculoskeletal system is very complex, requiring a motor controller that mimics the human nervous system. We have developed a mathematical model of the human motor control system based on muscle synergy theory, that is capable of handling the complexities of the human musculoskeletal system. This model is the first of its kind that can be used for the real-time feedback control of the FES system, to control the human arm motion.

38. A Novel Spatial Navigation Memory Intervention for Post-Acute Traumatic Brain Injury: A Pilot Feasibility Study 4

2,5

4,6

A Changoor , Z Belchev , A Baba , M Bray , J Ozubko , B Colella , A Gilboa , R Green 1 Human Biology Program, University of Toronto; 2 Department of Psychology, University of Toronto; 3 State University of New York; 4 Toronto Rehabilitation Institute-UHN; 5 Rotman Research Institute; 6 Rehabilitation Sciences Institute, University of Toronto

A growing number of studies demonstrate evidence of progressive brain atrophy in the post-acute stages of TBI, supporting its reconceptualization as a chronic and neurodegenerative disease process. Particularly vulnerable to this deterioration is the hippocampus, a brain substructure critical in memory and learning. Intensive, allocentric spatial navigation tasks show promise in mitigating neurodegeneration through targeted activation of the hippocampus. The present study involved creating and piloting an online novel memory intervention with the objective to investigate the feasibility of remote delivery of the tasks, retention and compliance. Ten healthy adults and five TBI patients were recruited for a 5-day consecutive series of 1-hour intervention exercises that involved navigating between landmarks of a target city and allocentric learning exercises (e.g. vector mapping; distance judgment). All participants completed the protocol remotely in their homes with minimal experimenter support; retention was 100% as was compliance in the completion of all associated tasks. Pre- vs. post testing after 5 days showed that there was an improvement in drawing maps from memory, and participants could navigate without a map from day 3. These results suggest that this remotely delivered spatial navigation protocol is feasible, and they support a larger-scale feasibility and preliminary efficacy study.

39. Neuroprotective Effect of Spatial Navigation Tasks Following Traumatic Brain Injury: Feasibility of Remote Application 1,2

2,3

M Bray , RE Green 1 Institute of Medical Sciences, University of Toronto; 2 Toronto Rehabilitation Institute-UHN; 3 Department of Psychiatry, University of Toronto

Moderate to severe traumatic brain injury (TBI) is increasingly understood as a progressive neurodegenerative condition. The chronic stage of injury is characterized by progressive brain volume loss as well as decreases in cognitive functioning. Based on previously established work demonstrating the neuroprotective effect of spatial navigation tasks, we developed and successfully piloted an intervention to offset hippocampal degeneration in chronic TBI. This intervention entails challengingbut-enjoyable spatial navigation tasks through virtual environments of increasing complexity. This intervention is self-administered and internet delivered, promoting access for those living remotely or 31

RESTORE FUNCTION with mobility restrictions. With an estimated 2 percent of Canadians suffering chronic disability from TBI, a delivery modality with broad reach and limited therapist support is crucial. A key step in validating this novel tool is a larger-scale assessment of feasibility and preliminary efficacy. Therefore, following discharge, 20 patients with moderate-severe TBI will complete the intervention at home four days/week for one hour/day over 16 weeks. A feasibility study measuring recruitment, retention and adherence, followed by a post-intervention, semi-structured interview to examine barriers to compliance will be undertaken. Should this prove efficacious on an expanded scale, this study represents a crucial first step to ensuring all Canadians access to this promising intervention.

40. Elevated Substance use Impedes Recovery of Attention after Moderate-Severe Traumatic Brain Injury 1,2

1,2

A Tibbles , R Green 1 Toronto Rehabilitation Institute-UHN; 2 Rehabilitation Sciences Institute, University of Toronto

Understanding who is at risk for poor recovery from traumatic brain injury (TBI) is needed to appropriately direct clinical resources. One potential risk factor for poor recovery is past abuse of nonprescription psychoactive substances, such as alcohol and marijuana - there is evidence for the enduring neural and cognitive effects of such substances outside the context of brain injury. While clinicians often caution patients against using non-prescription drugs and alcohol while recovering from traumatic brain injury (TBI), little is known about how past use of these substances may affect recovery. We examined whether elevated substance use, as measured by the Personality Assessment Inventory, was a risk factor for poorer attentional recovery after moderate-severe TBI. Retrospective analysis of 200 patients from the Toronto Rehab TBI Recovery Study comprising moderate-severe TBI patients 18 years of age and older was undertaken. A High Alcohol/Substance Use group, comprising those with T-score of â&#x2030;Ľ60 on the Alcohol Problems and Drug Problems sub-scales of the Personality Assessment Inventory (n=36) was compared to matched TBI controls (n=36) on an attention aggregate comprising measures of attention (Trails A and B, Stroop sub-tests, symbol digit Oral and Written, and Verbal Fluency Phonemic). The High Alcohol/Substance Use Group recovered significantly less on the aggregate of attentional functioning (p<0.05, Cohenâ&#x20AC;&#x2122;s d effect size = 2.78). This study provides the first empirical evidence to our knowledge implicating substance abuse on poorer recovery of attention after TBI using performancebased measures. Further research is needed to determine whether these results are the direct effects of neural consequences to the brain or whether the impact of substance abuse on recovery is mediated by other factors, such as reduced engagement in therapy.

41. The Effect of Semantic Memory Impairment on the Speech of svPPA Patients: A Discourse-Level Analysis 1,2

1,2,

1,3

4,5,6

1,2,5,6,7,8,9,10,11

1,12

5,6,13

B Seixas Lima , N Graham C Leonard , B Levine , S Black , D Tang Wai , M Freedman , 1,2 E Rochon 1 Department of Speech-Language Pathology, University of Toronto; 2 Toronto Rehabilitation Institute-UHN; 3 Audiology and Speech-Language Pathology Program, University of Ottawa; 4 Department of Psychology, University of Toronto; 5 Department of Medicine (Neurology), University of Toronto; 6 Rotman Research Institute, Baycrest Centre, Toronto; 7 Sunnybrook Health Sciences Centre, Toronto; 8 Institute of Medical Science, University of Toronto; 9 L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre; 10 Brain Sciences Research Program, Sunnybrook Research Institute, Toronto; 11 Heart and Stroke Foundation, Partnership for Stroke Recovery; 12 Toronto Western Hospital-UHN; 13 Centre for Memory and Neurotherapeutics, Baycrest Centre, Toronto

RESTORE FUNCTION Semantic variant primary progressive aphasia (svPPA) is a neurodegenerative condition which affects semantic memory and causes language impairment. We hypothesized that deficits in global coherence of discourse could be an issue affecting the speech of svPPA patients. Moreover, it was questioned whether the impairments in semantic memory particularly could be affecting the patients’ discourse. In this study, participants went through an interview and their discourse was assessed by a scale we developed to evaluate discourse coherence (i.e. utterances produced by 18 patients and 14 controls were given a score between A and D according to their relatedness to the topic). The same utterances were categorized as semantic memory or episodic memory details as per the Autobiographical Interview (AI). The results were tallied and it was observed that: a) patients’ discourse was significantly less coherent than controls; b) patients produced significantly fewer episodic details than controls; c) patients’ number of semantic details did not differ significantly from controls; however, d) patients and controls ratio of coherent episodic details was not significantly different, whereas patients’ ratio of coherent semantic details was significantly lower than controls. These results suggest that semantic memory deficits are associated with issues in discourse coherence in this population.

42. A Systematic Review: Is Executive Control a Predictor of Language Recovery after Stroke? 1,2,3,4

1,2,3,4,

1,2

1,2,5,6

T Simic , E Rochon E Greco , R Martino 1 Rehabilitation Sciences Institute, University of Toronto; 2 Department of Speech-Language Pathology, University of Toronto; 3 Toronto Rehabilitation Institute-UHN; 4 Heart and Stroke Foundation Canadian Partnership for Stroke Recovery; 5 Krembil Research Institute-UHN; 6 Department of Otolaryngology-Head and Neck Surgery, University of Toronto

In Canada, someone suffers a stroke every seven minutes; of those who survive, 38% will have aphasia, a difficulty communicating with others. While therapy for aphasia is helpful, some of the factors that make it so are still unclear. One such factor is executive control (EC), which is a person's ability to: pay attention, ignore distracting information, revise existing knowledge, and shift their attention between multiple tasks simultaneously. Research has shown that EC skills are important indicators of how well individuals will recover from stroke in general. The purpose of this study, however, was to review current evidence on the relationship between EC and post-stroke language recovery in particular. Six electronic databases were systematically searched, and abstracts and full-text articles were critically reviewed by two independent raters according to pre-specified inclusion criteria. Initial search results yielded 2676 citations; ultimately 13 studies were accepted. Though based on a small and heterogeneous body of evidence, nine studies demonstrated that patients with higher EC abilities at baseline have significantly better post-treatment language gains. These findings also indicate a need for further research on the benefits of EC in learning, and the effect of treatment intensity on the relationship between EC and language recovery.

43. Game-based Speech Therapy using Visual Feedback in Parkinson's Disease 1,2

2,3

1,2

2,3

1,2

E Kearney , B Haworth , J Scholl , P Faloutsos , M Baljko , Y Yunusova 1 Department of Speech-Language Pathology, University of Toronto; 2 Communication Team, Toronto Rehabilitation Institute-UHN; 3 Department of Electrical Engineering & Computer Science, York University

Background: Parkinson's disease (PD) is a neurodegenerative disease affecting voluntary movement, including speech movements. 45% of individuals with PD experience difficulties with speech articulation, leading to reduced intelligibility. Treatment options that address the underlying movement disorder (i.e. smaller and slower movements) are limited. A recently developed augmented visual feedback system 33

RESTORE FUNCTION showed promise in training larger tongue movements following a single training session (Yunusova et al., 2016). Purpose: To evaluate the effect of a speech therapy program using game-based visual feedback on speech movements and intelligibility in PD. Method: Five participants with PD attended a 10-session program, aimed to increase the size of tongue movements during sentences. Each session involved training 5 sentences, in an acquisition and test phase. During acquisition, participants were instructed to use large tongue movements and were provided with visual feedback relating to the size of their tongue movement for all trials. During the test phase, feedback was provided for 50% of trials. Probe measures for untrained sentences were taken at baseline, and following sessions 5 and 10. Results: All speakers increased tongue movement during therapy sessions. 3/5 speakers demonstrated generalization of treatment effects to probe sentences at sessions 5 and 10. Analysis of intelligibility data is ongoing. Conclusion: This study demonstrated that movement-based therapy using augmented visual feedback may facilitate the treatment of speech impairment in PD.

44. The Effects of Hearing Impairment and Hearing Aids on the Physiological Response to Emotional Speech 1

2,3

1,3

GA Nespoli , G Singh , FA Russo 1 Department of Psychology, Ryerson University; 2 Phonak AG; 3 Toronto Rehabilitation Institute-UHN

Age-related hearing loss negatively impacts the perception of speech. While hearing aids can mitigate these deficits to some extent, it remains an open question as to whether they can support the perception of emotion. In normal hearing adults, characteristic skin conductance responses are triggered in response to the arousal of speech emotion. The current study assessed the extent to which these responses vary across normal hearing, hearing impaired, and hearing aided older adults. Participants were presented with audio-only samples of semantically neutral sentences spoken in a happy, sad, angry, or calm manner, and were asked to respond with the expressed emotion. Normal hearing participants were both faster and more accurate in their responses than the hearing-impaired or hearing-aided groups. Normal hearing participants exhibited an increase in skin conductance in response to negatively-valenced and high-arousal stimuli (i.e. angry, and to some extent happy and sad). This increase was not present in hearing-impaired participants but was recovered in hearing-aided participants. These findings raise important questions about the efficacy of signal processing strategies employed in modern digital hearing aids.

45. The Influence of Selective Attention on Auditory Localization in Younger and Older Adults 1,2,

1,2

S Yung J Campos , I Spence 1 Department of Psychology, University of Toronto; 2 Toronto Rehabilitation Institute-UHN

Auditory localization, the ability to locate sounds, declines with age due to changes in peripheral and central auditory processing. As selective attention is typically preserved in older adults, drawing their attention towards the stimulus before it occurs may improve auditory localization. This study evaluated this hypothesis by precueing younger and older participants towards a likely location of the upcoming target (a broadband noise) with a visual attentional cue. The attentional cues were either congruent with the location of the target (valid), incongruent (invalid), or neutral (no directional information). Participants estimated the target's location on a schematic drawing of the testing environment. Akin to 34

RESTORE FUNCTION younger adults, older adults were found to make less errors, less biases, and faster responses with valid cues. This suggests that older adults can employ selective attention to improve auditory localization, similar to younger adults.

46. Is Faster Always Better? A Description of How Temporal Gait Asymmetry Changes with Increased Walking Speed Following Stroke 1,4

2,3

2,4

L Crosby , A Mansfield , K Patterson 1 Rehabilitation Sciences Institute, University of Toronto; 2 Department of Physical Therapy, University of Toronto; 3 Sunnybrook Research Institute 4 Toronto Rehabilitation Institute-UHN

Temporal gait asymmetry (TGA; gait phase inequality between legs) is common post-stroke. Retraining gait at faster speeds has been recommended. However, how increased speed impacts TGA, a distinct feature from speed, is unknown. This study aimed to describe TGA changes with increased walking speed post-stroke. Demographics, clinical measures (cognitive, motor, and balance) and spatiotemporal parameters of preferred (PP) and maximal pace (MP) gait of 96 people post-stroke were extracted from a database. Further calculations included: swing ratio=paretic : non-paretic swing time, walk ratio=step length/cadence, and change in velocity (MP-PP). People were classified as symmetric (S; swing ratio<1.06) or asymmetric (A; swing ratio>1.06) at PP and then as improved (I), worse (W), or no change (NC) in TGA at MP. Group differences were investigated with one-way ANOVAs. In A group (n=41) there were 31/9/1 people classified as I/NC/W, respectively. There were no betweengroup differences in demographics or clinical measures. Within A, NC participants had faster PP velocity (p<0.01) and higher walk ratio (p<0.05) than I participants. Most individuals with TGA are more symmetric when walking faster, therefore retraining asymmetric gait at faster speeds may be beneficial. Future work will examine changes in gait phases to understand how TGA improvements are achieved.

47. Use of Visual Feedback to Improve Post-stroke Temporal Gait Asymmetry 1

2,3

V DePaul , L Knorr , A Mansfield , G Mochizuki , KK Patterson , J Powers , J Wong 1 School of Rehabilitation Therapy, Queen's University; 2 Mobility Team, Toronto Rehabilitation Institute-UHN; 3 Rehabilitation Sciences Institute, University of Toronto

Temporal gait asymmetry (TGA) is common after stroke (1) and is defined as unequal timing of gait cycle phases between the affected and unaffected limbs. Persistent TGA has long term-consequences: joint degeneration, reduced bone mineral density, increased energy expenditure, and challenges to dynamic balance control(1). TGA is resistant to conventional rehabilitation (2) therefore new approaches are required. One approach may be to apply the principles of motor learning to gait rehabilitation. Aim: Investigate the use of visual feedback to improve TGA in individuals post-stroke. Methods: An acquisition-retention paradigm will be used to examine the influence of visual feedback about TGA on motor learning of symmetrical gait. During acquisition one of three frequencies of visual feedback will be provided: 50%, 100% or no feedback. After 24 hours the overground walking task will be tested with no visual feedback provided in order to measure the amount of learning that has occurred. Expected results: Individuals that receive 100% feedback will show the largest gains in gait symmetry. The results will inform clinical practice about the optimal feedback frequency to improve TGA post35

RESTORE FUNCTION stroke. References: 1) Patterson et al. Arch Phys Med Rehabil 2008;89(2):304;10; 2) Patterson SL J Rehabil Res Dev. 2008;45(2):221;8.

48. Physiotherapy Combined with Deep Brain Stimulation for Improving Balance And Mobility of People with Parkinson's Disease: A Pilot Study 1,2

2,3,4

1,2

1,2,5

R Aryan , A Fasano , CJ Danells , A Aqui , A Mansfield 1 Toronto Rehabilitation Institute-UHN; 2 University of Toronto; 3 Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital-UHN; 4 Krembil Research Institute-UHN; 5 Sunnybrook Research Institute.

Deep brain stimulation (DBS) has been established as a successful procedure to alleviate the symptoms of Parkinson's disease. Tremor, bradykinesia and rigidity are improved following the subthalamic nucleus-DBS (STN-DBS), while minimal or no improvement of postural stability and independent mobility has been demonstrated. We aimed to pilot a physiotherapy intervention for people with STN-DBS in preparation for a larger randomized trial. Participants were recruited from 12 eligible individuals with STN-DBS, and randomly allocated into the physiotherapy (EXE) (n=3) and control (CTRL) (n= 4) groups. CTRL received no training, while participants in EXE completed a 7-week task-oriented exercise program for one hour per session three times per week. Functional balance and mobility, balance confidence, quality of life, and number of falls were assessed pre and post-intervention. One participant withdrew because he was assigned to CTRL. Exercises were tolerated well by participants. Attendance to the exercise sessions was high; two people in EXE attended 18 out of 21 sessions, one completed 16. Post-intervention data collection is ongoing and more complete results will be presented at research day. Given the rate of participation and attendance, optimal adherence to the program has been demonstrated. Preliminary findings support the feasibility of a larger consequent study.

49. Does Blaming Movement Errors on the Environment or Yourself Affect Learning of a Task? 1

1,2,

1,2

L Gill , KK Patterson L Tremblay , RH Wang , A Mansfield 1 Toronto Rehabilitation Institute-UHN; 2 Department of Physical Therapy, University of Toronto; 3 Faculty of Kinesiology and Physical Education, University of Toronto; 4 Department of Occupational Science and Occupational Therapy, University of Toronto

Errors are critical to motor learning. The central nervous system (CNS) estimates the source of these errors. The source can be environmental factors or the CNS' own motor control. If the CNS attributes the cause of the error to poor motor control (i.e., internal credit assignment), adaptations will transfer across situations. In contrast, if the CNS interprets the error as caused by environmental/external factors, motor learning may be specific to that context. Such influence of credit assignment on motor learning processes was directly tested. This study had healthy young adults practice a balance-beam walking task. During the task, two groups of participants experienced subtle postural perturbations. One group was informed of the movements (aware group- external credit assignment). One group was not told (unaware group- internal credit assignment). A control group practiced without postural perturbations. All groups subsequently performed the task unperturbed 24 hours later. The unaware group was expected to exhibit more postural adjustments than the aware group, highlighting the role of credit assignment in motor learning. 36

RESTORE FUNCTION Data from 15 participants will be presented. The results of this study will inform how to leverage error assignment to improve motor learning in rehabilitation settings.

50. Quantifying Change in Function Using Robotic Assessment in Post-Stroke Spasticity 1,2,3

2,3,4,5

MF Resnick , G Mochizuki 1 Rehabilitation Sciences Institute, University of Toronto; 2 Toronto Rehabilitation Institute-UHN; 3 Sunnybrook Research Institute; 4 Canadian Partnership for Stroke Recovery; 5 Department of Physical Therapy, University of Toronto

Background: Spasticity is a common consequence of stroke and can affect the ability to perform volitional movement. Despite this, current assessment methods in the clinic do not measure the effect of spasticity on active movement. Quantitative instrumentation, such as the KINARM robotic exoskeleton, can objectively quantify upper limb function and may provide additional sensitivity to detect change following intervention. Purpose: To determine whether active motor tasks performed on the KINARM robotic exoskeleton can identify change in upper limb function following intervention involving rehabilitation and Botulinum toxin (BoNT-A) injections. Methods: Fifteen individuals with upper limb spasticity after stroke took part in the study. Two weeks after BoNT-A was administered, participants received upper limb rehabilitation 3x/wk for 10 weeks. Assessments were conducted on the KINARM robotic exoskeleton and involved tasks relating to proprioception, reaching, and general motor ability. Assessments occurred at baseline, 4-weeks, and 12weeks post-injection. Results: All 3 tasks revealed a change in key outcome measures at 4 and 12 week assessments. Therapy-specific changes in outcomes were observed. Conclusion: The KINARM was sensitive to changes in upper limb function after intervention for spasticity after stroke. Improvements were observed in outcomes that were most closely aligned with the specific elements of therapy.

51. Next Generation Brain-Computer Interface for Motor Rehabilitation using Functional Electrical Stimulation Therapy 1

2,3

1,2

I BolĂŽvar , MR Popovic , C Marquez-Chin 1 Therapeutic Applications of Complex Systems Laboratory, Toronto Rehabilitation Institute-UHN; 2 Rehabilitation Engineering Laboratory, Toronto Rehabilitation -UHN; 3 Institute of Biomaterials and Biomedical Engineering, University of Toronto

The integration of brain-computer interfaces (BCI) and functional electrical stimulation therapy (FEST) is one of the most recent therapeutic interventions for motor rehabilitation after stroke and spinal cord injury. We have achieved important results with this approach, in which the intention to move, detected through real-time analysis of brain activity, triggers the electrical stimulation to produce the intended movement. Despite our initial positive results, the complexity of the setup and operation of the current system makes the intervention incompatible with a clinical environment. Using experience acquired over the last year, we are implementing a new version of the BCI+FEST system. The updated system will: 1) minimize the need for human intervention, 2) implement improved methods for detecting the intention to move, 3) reduce the required equipment, and 4) automatically adapt to changes in brain activity commonly observed during the intervention. The increased functionality and ease of operation

RESTORE FUNCTION of the new system will facilitate the use of BCI+FEST outside of a research laboratory, making it possible to conduct larger studies and eventual translation to clinical settings.

52. Integration of a Robotic System and Functional Electrical Stimulation for Upper Limb Rehabilitation 1

2,3

S Ali , C Marquez-Chin , MR Popovic 1 Division of Engineering Science, University of Toronto; 2 Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health Network; 3 Institute of Biomaterials and Biomedical Engineering, University of Toronto

In recent years, functional electrical stimulation (FES) therapy has demonstrated superior efficacy over conventional therapy for upper limb rehabilitation after paralysis. As movements generated by FES are imprecise, a therapist guides the patient's limb(s) through the required motions. The therapeutic effects of repeatable high-precision FES-produced movements are currently unknown. We are addressing this knowledge gap by combining FES and robotic systems, the latter having unsurpassed movement precision. We are particularly interested in integrating the strengths of these two technologies incorporating technical, physiological, and clinical considerations. The method proposed by this project is to use an upper limb rehabilitation robot to guide the motion generated by FES as follows: upon the appearance of an onscreen target, (1) sense user intent to move the limb and (2) carry out a limb movement to reach the target. To carry out the limb movement: targeting the deltoid, biceps, and triceps muscles, (1) a model relating relative intensities of muscle activations to torque generation for a representative set of starting positions will be built and (2) an FES controller that replicates the muscle activations needed to reach target positions in the robot workspace will be implemented.

53. Arm Worn Accelerometry: A Valid Measure of Arm Use in Children? 1,2

1,2,3

1,2,4

J Dawe , N Unic , J Zariffa , K Musselman 1 Rehabilitation Sciences Institute, University of Toronto; 2 Toronto Rehabilitation Institute-UHN; 3 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 4 Department of Physical Therapy, University of Toronto

Accelerometry-based data can potentially supplement information that is missing from current assessments for children with hemiparesis, by providing a quantitative measure of affected arm use, relative to non-affected arm use. This information is valuable for treatment outcome evaluation. The objective of this research is to determine whether accelerometry can provide a valid measure of relative arm use in children with hemiparesis. As an initial step, validity testing of arm-accelerometry in a control group was performed. Arm accelerometry data was collected for 20 participants without hemiparesis (ages 3 - 9) in a lab setting, during videotaped play interactions. Observer ratings of movement were compared to accelerometry data as a measure of criterion validity. Findings include agreement scores > 80% for observer vs. accelerometer-based measures of arm use, with greater agreement for dominant vs. non-dominant arm use. The inter-rater reliability of two observers' ratings was high (PrevalenceAdjusted Bias-Adjusted Kappa = 0.83). Accelerometry-based measures of children's arm use had higher sensitivity than specificity. Subsequently, data from participants with hemiparesis will be collected and compared to this control group data. The expected implications of this research include improved evaluation of treatment outcomes for children with hemiparesis.

RESTORE FUNCTION 54. Distinguishing Neural Pathways in Peripheral Nerve Recordings using Spatiotemporal Information 1,2

1,2

RGL Koh , AI Nachman , J Zariffa , 1 University of Toronto; 2 Toronto Rehabilitation Institute-UHN

Improving the ability of neural interfaces to selectively record from different pathways in peripheral nerves has multiple applications in neuroprosthetic and neuromodulation technology, including improving the performance of implanted functional electrical stimulation systems. Novel signal processing algorithms are required to achieve this goal. Recently we showed that the recording selectivity of nerve cuff electrodes could be improved by characterizing spatiotemporal patterns in the recordings produced by different neural pathways. However, cases in which the spatiotemporal patterns from multiple sources overlap in time to produce new patterns are not addressed by our current method, and require further work to correctly interpret. We propose a novel formulation of the problem in which complex recordings must be interpreted by combining a small number of known spatiotemporal templates (i.e. sparse solutions). We identified and tested 13 algorithms in the literature that are compatible with this formulation. A finite element model of the rat sciatic nerve covered by a multi-contact nerve cuff was used to produce simulated recordings. Preliminary results suggest that the orthogonal matching pursuit algorithm shows improvements in classifying signals that overlap in time. This suggests that the use of sparse approximation algorithms may be the next step in solving these issues.

55. Real-Time Phase-Locked Brain Stimulation 1

3,4

1,2

F Mansouri , J Downar , J Zariffa 1 Institute of Biomaterial and Biomedical Engineering, University of Toronto; 2 Toronto Rehab Institute-UHN; 3 MRI-Guided rTMS Clinic-UHN; 4 Department of Psychiatry, University of Toronto

A growing body of research is showing that noninvasive electrical brain stimulation phase-locked to the underlying brain rhythms can effectively modulate neural activity, with a wide range of applications in treating brain disorders. Transcranial alternating current stimulation (tACS) can stimulate the brain inphase to its natural oscillations as recorded by electroencephalography (EEG), but matching these oscillations is a challenging problem due to the complex and time-varying nature of the EEG. This work addresses this challenge by investigating an algorithm to control tACS stimulation in real-time. Our algorithm extracts phase and frequency from a segment of EEG, then forecasts the signal to control the stimulation in real-time. A careful tuning of the EEG segment length and prediction horizon is required and has been investigated here for different EEG frequency bands. The algorithm was tested on EEG from 5 healthy volunteers. The performance of this algorithm was quantified through phase-locking to various EEG frequency bands. The developed algorithm performs faster and provides better phase-locked stimulation compared to the current state-of-the-art. With current parameters, the algorithm performs best when tracking oscillations in the alpha band (8-14Hz). This algorithm will be used in upcoming studies exploring the effects of tACS in psychiatric conditions.

RESTORE FUNCTION 56. Frequency-dependent Effects of Electrical Stimulation in the Subthalamic Nucleus of Parkinson's Disease Patients 1

1,2

1,3

1,2

L Milosevic , S Kalia , M Hodaie , AM Lozano , MR Popovic , WD Hutchison 1 University of Toronto; 2 Toronto Western Hospital-UHN; 3 Toronto Rehabilitation Institute-UHN

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a neurosurgical procedure for the treatment of motor symptoms of Parkinson's disease. Despite the therapeutic benefits of high frequency (130Hz) stimulation, the underlying mechanisms of DBS remain unclear. In order to gain more insight about the physiological mechanisms of action of STN DBS, we examined frequency-dependent effects of microstimulation on 26 STN neurons in 15 patients. One microelectrode recorded individual action potential firing during stimulation from the adjacent microelectrode at different frequencies (1100Hz, 0.3ms pulses, 0.5-10s). With stimulation at 20Hz, firing rates dropped to 71% of baseline, to 58% at 30Hz, 34% at 50Hz, and the firing was silenced at 100Hz. Stimulation frequencies below 20Hz had no effect. Firing rates returned to baseline levels immediately after stimulation, however, at 50 and 100Hz a short latency inhibition of the cell after stimulation train was observed. Additionally, we found tendencies of some cells to increase their firing at 5Hz and 30Hz; two frequencies often described as pathological in Parkinson's disease. Understanding the physiological mechanisms that determine the effects of different stimulation frequencies can help advance efficiency of DBS and improve therapeutic outcomes.

57. Motor Point Stimulation Primarily Activates Motor Nerves 1

1,2

T Yamashita , A Bergquist , T Yoshida , K Masani 1 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 2 Lyndhurst Centre, Toronto Rehabilitation Institute â&#x20AC;&#x201C;UHN

Neuromuscular electrical stimulation (NMES) is a valuable tool for the neurorehabilitation of people with neurological disorders such as spinal cord injury. There are two methods to evoke muscle contraction via NMES including peripheral nerve stimulation (PNS) or motor point stimulation (MPS), delivered to the so-named motor points located at neuromuscular junctions. We hypothesized that, based on the specific location of neuromuscular junctions and the distribution of muscle spindles, MPS would be superior to PNS for selectively targeting motor axons. The study aimed to demonstrate the preferential activation of motor axons by MPS through neuro-electrophysiological examinations including pair-wised stimulations of PNS and MPS. We found: (1) PNS and MPS showed different patterns of recruitment curves, (2) H-reflex elicited by PNS were inhibited by MPS, and (3) PNS induced reciprocal inhibition of the antagonist while MPS did not. These results suggest the distinct differences in motor and sensory recruitment by PNS and MPS, and the preferential activation of motor axons by MPS. Our findings will help to deepen the current understanding on neurophysiology of NMES and hence will contribute to improve the current therapies using NMES.

RESTORE FUNCTION 58. A Garment-based Neuro-orthosis to Help Individuals with Paralysis Standing Independently: Design and Preliminary Results 1

1,3

B Moineau , M Alizadeh-Meghrazi , K Masani , MR Popovic 1 Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute-UHN; 2 MyAnt Corp., Toronto; 3 Institute of Biomaterials and Engineering, University of Toronto

Individuals with neurological paralysis following stroke or spinal cord injury have limitations in moving and maintaining posture. We aim to develop a novel wearable device to assist them to sit and stand. In this presentation, we will introduce the design of this neuro-orthosis with preliminary data. This neuroorthosis, a long tight clothing covering user from the feet to the breast bone, will support and use the remaining muscles and nerves below the injury. The imbedded electrodes will be fabric-based to facilitate putting on and wearing, and optimized to produce strong and comfortable contractions of the paralyzed muscles without use of conductive gel. Small inertial sensors (same as those used to stabilize drones) will track legs and trunk motions to tune in real-time the muscle activations through feedback controls. Sophisticated electrical stimulations patterns will be designed to allow smooth transitions between seated and standing postures, and to limit muscle fatigue. The different aspects of this project are currently tested with healthy individuals and will be refined later with the assistance of individuals with disabilities. This neuro-orthosis could be used by acute and chronic patients, for therapeutic and functional uses, to facilitate their daily activities by enhancing balance in seated and standing position.

59. Operant Conditioning of Neural Activity in a Rat Model 1,2

1,2

M Garcia-Garcia , C Marquez-Chin , M Popovic 1 Institute of Biomaterials and Biomedical Engineering, University of Toronto, 2 Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute

Operant conditioning of neural activity is an alternative approach to control brain-machine interfaces that has recently re-emerged from the need of designing systems that integrate seamlessly with the nervous system, and therefore feel natural and intuitive to the user. This paradigm relies on volitional modulation of neural activity, in which subconscious brain processes are displayed as visual or auditory cues for the user to control. Surprisingly, experiments in humans and animals have demonstrated that it is possible to gain control of the activity of single neurons within minutes of practice. We implemented this paradigm in a rat model, where the animal learned to trigger a food dispenser by completely silencing a neuron for up to 3 s, while simultaneously raising the firing rate of the selected neuron to trigger a liquid dispenser. Using visual biofeedback, the rat quickly gained control over the activity of the selected neurons within minutes with this simple paradigm. In addition to optimizing BMI systems, operant conditioning of neural activity can provide a framework to study basic functions of the nervous system, such as coding and encoding of information in real-time and how these neural circuits are modified as a result of BMI learning.

RESTORE FUNCTION 60. Distinguishing Obstructive from Central Sleep Apneas and Hypopneas Using Linear SVM and Acoustic Features 1,2,

1,2

R Hummel TD Bradley , D Packer , H Alshaer 1 Toronto Rehabilitation Institute-UHN; 2 BresoTec Inc.

Sleep Apnea (SA) is a very common but underdiagnosed respiratory disorder. SA has 2 main types, obstructive and central sleep apnea (OSA and CSA, respectively). The distinction between the 2 types is important for proper clinical management. Our aim in this study was to deploy acoustic analysis of breath sounds to distinguish central from obstructive events. We recorded breath sounds from 29 patients from which 45 segments with obstructive only and 40 segments with central only respiratory events were isolated. Subsequently, 10 acoustic features were extracted and used to identify basic breath sounds: inspiration, expiration, and snoring. A 2nd set of 6 sound-specific features were extracted from the basic sounds, designed based on SA pathophysiology. These 6 features were used to train and test a linear SVM classifier using a leave-one-out cross validation scheme. We achieved an excellent accuracy of 91.8%. In conclusion, this is the first study to demonstrate the ability to distinguish CSA from OSA with high reliability from breath sound recordings during sleep.

61. Precision Matching of the Flow Properties of Barium and Non-Barium Stimuli 1,2

1,2

CEA Barbon , CM Steele 1 Rehabilitation Sciences Institute, University of Toronto; 2 Toronto Rehabilitation Institute-UHN

In order to visualize boluses under videofluoroscopy, radio-opaque contrast media are required. Barium sulfate suspensions/powders are commonly used for this purpose. The addition of barium to a liquid is known to alter viscosity. Recipes are required to achieve a match in the flow characteristics of barium stimuli to the dietary liquids they are intended to represent. The International Dysphagia Diet Standardisation Initiative released a new method for classifying liquid thickness based on flow. We used the IDDSI syringe flow test to measure the stability of flow for barium stimuli prepared in 5 consistencies. Starch and xanthan gum thickeners were included. Repeated flow tests were performed over a 6-hour time frame following mixing. Once the recipes were established, matching recipes for consistencies of lemon-flavored water stimuli were prepared and tested. Acceptable levels of variation in flow results were achieved over time for all stimuli. Amounts of thickener required for barium and non-barium differed. Greater variation in flow was observed over time for the starch-thickened stimuli. The IDDSI flow test was useful for illustrating variations in flow across liquids that are presumed to have similar flow and for guiding the development of recipes to ensure flow similarities between barium and non-barium liquids.

ENABLE INDEPENDENCE

ABSTRACTS – ENABLE INDEPENDENCE (62–72) Advances in medicine have been extending the average life span into the 80’s. As we continue to increase longevity, it is important to also maintain and improve the quality of that life. People like to live at home; we would like to enable that goal to be realized by providing innovations to support aging-in-place without placing financial, time, psychological and physical burdens on family caregivers. We also aim to enable more people to return to work and play following injury and illness 62. Assessing the Effectiveness of Workplace Accommodations in Facilitating Return-To-Work after Brain Injury – Findings of a Systematic Review 1,2

2,3

1,2

R Shafi , B Nowrouzi-Kia , V Chan , A Colantonio 1 Rehabilitation Sciences Institute, University of Toronto; 2 Toronto Rehabilitation Institute-UHN; 3 Laurentian University, Greater Sudbury

Return to work (RTW) post-injury is a primary rehabilitation goal and perhaps the most reliable marker of functional recovery. Returning to work and sustaining employment is a significant challenge for brain injury (BI) survivors. It is estimated that 60% of working-age individuals with BI are unable to RTW postinjury. Within the literature, there is recurring support for the role of workplace accommodations in effective and early RTW. Colantonio and colleagues through a preliminary body of work, have shown that 76% of BI survivors have reported ‘job modifications’ and ‘employers who accommodated treatment needs' as significant factors that facilitated RTW. To date, however, there has been a lack of systematic reviews exploring the specific role of workplace accommodations within the context of RTW after BI. The primary objective of this systematic review was to identify the types of accommodations that facilitate a re-entry and sustenance into the workforce. The systematic review is currently underway and we intend to present our findings at this conference. The information gathered and consolidated by way of this review will help health practitioners, policy makers, researchers and other workforce-related stakeholders to make informed decisions when considering service delivery or future research in RTW with BI survivors.

63. Needs and Preferences of Technology among Chinese Family Caregivers of Persons with Dementia: A Pilot Study 1,2

1,3,4

1,2,5

C Xiong , A Astell , A Mihailidis , A Colantonio 1 Rehabilitation Sciences Institute, University of Toronto; 2 Toronto Rehabilitation Institute-UHN; 3 Ontario Shores Centre for Mental Health Sciences, Whitby, ON; 4 University of Sheffield, Sheffield, United Kingdom; 5 Department of Occupational Science & Occupational Therapy, University of Toronto

Background: Dementia is a major public health concern associated with significant caregiver demands. While technologies such as fall, cooker alarms and home monitoring cameras are available to assist with

ENABLE INDEPENDENCE caregiving, there is a paucity of information on needs and preferences for these technologies, especially among Chinese family caregivers of persons with dementia (PWD). Objective: This studyâ&#x20AC;&#x2122;s purpose was to examine the technology needs and preferences of Chinese family caregivers of PWD in Canada. Methods: A cross-sectional pilot survey was conducted through the Yee Hong Centre of Geriatric Care. Frequency distributions, Wilcoxon Signed Ranks Test and multiple regression analyses were used to examine difference by sex and gender. Results: The majority of the 40 respondents did not demonstrate knowledge about a selection of 12 technologies presented that can assist with caregiving. Ease of installation and reliability were identified as the most important features when installing and using technology. Controlling for age, female respondents were significantly more receptive to technology compared to males. Conclusions: Our findings suggest a need to increase awareness of technology options to assist caregiving in this population. They provide insights for future development of technologies that better align with the needs and preferences of male and female caregivers.

64. Computer Vision Based Facial Expression Analysis for Recognizing Pain in Older Adults 1

A Ashraf , B Taati , T Hadjistavropoulos , K Prkachin , E Browne , A Asgarian , G Marchildon , N Gallant 1 Toronto Rehab Institute-UHN; 2 Department of Computer Science, Universtiy of Toronto; 3 Department of Psychology, University of Regina; 4 Department of Psychology, UNBC; 5 Institute of Health Policy, Management and Evaluation, Universty of Toronto

Older adults living in long term care facilities with advanced dementia are unable to verbally communicate their pain. As a result, their pain condition remains undertreated due to sole dependence on nursing staff. The goal of this project is to develop a computer based system which automatically recognizes the facial expressions of pain. We have gathered videos of 102 elderly people and have coded them for the presence/absence of pain. These ratings are being used for building computer models for automatically detecting pain. We are also gathering perspectives of multiple stakeholders to devise a technology adoption roadmap for our system.

65. Acceptability of Driverless Cars Among Older Adults 1,2,3

S Haghzare 1 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 2 AIRR Team, Toronto Rehabilitation Institute-UHN; 3 AGE-WELL NCE Inc.

The senior population of over 65 could constitute more than one-fourth of the Canadian population by the year 2017, as reported by statistics Canada. Unfortunately, drivers aged 65 and older are more prone to cause accidents by 16% in comparison to adult drivers (25 to 64 years old). In addition, there are those who are not able to drive due to physical restrictions. On the other hand, depriving the elderly of their right to drive can diminish their independence considerably. Accordingly, for this significant fraction of the population, driverless cars can be considered to be a necessity rather than a luxury. The driverless car, however, has a long way to gain the trust of the general population specifically in the case of older adults. Studies suggest that they tend to be more skeptical toward these automated vehicles and prefer to be in control at least to some extent. The ultimate goal of this research is to explore the possible ways to establish a trust between the two. A realization of this goal can be achieved by designing a shared control system which would also have a feedback from a biological signal; however, further studies are needed to confirm the applicability of this idea. 44

ENABLE INDEPENDENCE 66. Development and Evaluation of a User interface for an Intelligent Power Wheelchair to Increase its Usability for Older Adults 1,3,4,

1,2,3,4

T Jose A Mihailidis 1 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 2 Department of Occupational Science and Occupational Therapy, University of Toronto; 3 Toronto Rehabilitation Institute - UHN; 4 AGE-WELL Network of Centres of Excellence

Older adults (individuals > 65) are the most prevalent wheelchair users in North America. Yet, most cannot safely drive a wheelchair due to physical and/or cognitive impairments. Intelligent wheelchairs (IW) have been researched since the 1980s, but focus on this target group/their needs have been largely neglected, resulting in minimally clinically validated or commercialized products. The goals of this study are as follows (given that each user is an older adult with an individual set of impairments/diagnoses that may include, but are not limited, to cognitive impairments): 1. Develop a user interface (UI) for an IW that provides useful feedback to the driver 2. Evaluate whether the UI results in increased usability (effectiveness, efficiency, and satisfaction) of the IW With an Advisory Board of experts and end users, UI prototypes will be developed, based on recommendations from prior research. The final UI will be tested with 5 participants using single-subject research design. Wizard-of-Oz, a technique where the subject believes the system to be autonomous, but is actually operated by a human, will be used to simulate IW autonomy. Quantitative withinparticipant results on the Powered-Mobility Indoor Driving Assessment, NASA Task Load Index and System Usability Scale will be aggregated and evaluated.

67. Detecting unseen falls from wearable devices using channel-wise ensemble of Autoencoders 1

S Khan , B Taati 1 Toronto Rehabilitation Institute-UHN

A fall is an abnormal activity that occurs rarely in comparison to normal activities. In many cases, it is hard to collect sufficient data for falls; so traditional classification algorithms are difficult to be employed. Another major challenge is the extraction of right type and number of features. In this paper, we highlight these two challenges and propose to use auto-encoders to extract generic features from wearable sensor data trained on only normal activities to identify falls that are not present during training phase. While using auto-encoders, we also show that choosing the threshold as maximum of the reconstruction error on the training normal data is not the right way to identify unseen falls. We propose two methods for automatic adjustment of reconstruction error from only the training data comprising of normal activities. We present our results on two activity recognition datasets and show the efficacy of our proposed methods for identifying unseen falls against traditional auto-encoder models and two standard one-class classification methods.

ENABLE INDEPENDENCE 68. Development of a Personal Assistive Robot to Enable Independent Living for Older Adults with Dementia 1,2

1,2

C Moro , A Mihailidis G Nejat 1. Toronto Rehabilitation Institute-UHN; 2. Department of Mechanical and Industrial Engineering, University of Toronto

To assist the increasing number of older adults with dementia (OAwD), we aim to develop a personal assistive robot capable of providing cognitive support for everyday activities in the home. Older adults suffering from dementia face great difficulty in accomplishing basic activities of daily living such as making meals and ensuring proper grooming. The overarching goal is to promote independent living in the long term, increase emotional wellbeing, and provide an additional safety measure. The robot is designed to reduce an older adult's dependence on caregivers by providing multimodal prompts, direction, and encouragement when an OAwD faces difficulty accomplishing an activity of daily living. The challenges in developing such a robot depend firstly on technical barriers, and secondly on developing customized human-robot interactions (HRI). Since little is known about acceptance of robots in this population, we seek to determine those aspects of HRI necessary for such a robot to be accepted by OAwD in their homes. We investigate best practices for a personal assistive robot's embodiment, behavior, and prompting modes through preliminary user studies. Specifically, we aim to develop a design which is customized to the user, thus offering a person-specific combination of cognitive, emotional, and social support in order for them to live independently in their own homes.

69. Development of a Robotic Orthosis and Therapy Program for Finger Assistance and Rehabilitation after Stroke 1,2,3,4

1,3,4

1,2,3,4

A Yurkewich , R Wang , A Mihailidis 1 Toronto Rehabilitation Institute-UHN; 2 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 3 Department of Occupational Science and Occupational Therapy, University of Toronto; 4 AGE-WELL Network of Centres of Excellence

Thesis Proposal: A user-centred inclusive design (UCID) approach will be taken to understand the needs of chronic stroke survivors with severe hand impairments and develop a robotic orthosis with them so the final product is usable by them, useful for integrating into daily life and effective in promoting recovery. The robot will be tested by stroke survivors living at home and in long-term care facilities to assess its usefulness during the execution of daily activities. Therapists and clients will then direct the development of additional control modes into the robotic system to accelerate recovery during in-clinic therapy and at-home use and exercise. The device will be integrated into an intensive rehabilitation program to evaluate its added effect on patient motivation toward the rehab program, use of the affected upper extremity, and functional recovery. From this trial a set of autonomous therapy and communication features will be established to allow more of this therapy to take place independently in the client's home. A tele-rehabilitation program that incorporates these features will then be investigated for its feasibility in delivering highly-accessible low-cost therapy and training to a greater number of stroke survivors to improve recovery and enable their independence in daily tasks.

ENABLE INDEPENDENCE 70. Improving Traction of Mobility Scooters on Icy Conditions 1,2

1,3

1,3,4

1,4,5

S Kong , Y Li , R Montgomery , K Morrone , T Dutta , G R Fernie 1 Toronto Rehabilitation Institute-UHN; 2 Department of Electronics, Carleton University; 3 Department of Mechanical and Industrial Engineering, University of Toronto; 4 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 5 Department of Surgery, University of Toronto

Mobility scooters have been known to improve the quality of life for those with mobility impairments. However, mobility scooters on the market are not designed for travelling on icy and snowy surfaces. The goal of this project was to find an effective method that can improve the traction of mobility scooter's wheels. Two scooters (Fortress 1700DT and Fortress 2000), were tested with two participants (50kg and 100kg) in Winterlab (un-wetted ice) using the original tires, and then tested with modified winter tires. Maximum Achievable Angle (MAA) was determined for each condition by recording the steepest incline that the scooters were able to accelerate and decelerate (in a straight line) and stop at a predetermined position. This occurred for both uphill and downhill in both forward and reverse driving directions. The modified tires increased MAA for both scooters from 0 degrees to 3 degrees. Both scooters had an increase of MAA (in both driving directions) when equipped with the modified tires. However, curb ramps in Toronto are steeper than 3 degrees; this means scooters are still unable to ascend safely. The future goal is to develop a tire that is capable of achieving a much higher MAA to improve safety.

71. Common Gait and Balance Characteristics of Older Adult Users of Wheeled Walkers 1,2

1,2,3,4

I Solano W McIlroy 1 Toronto Rehabilitation Institute-UHN; 2 Rehabilitation Science Institute, University of Toronto; 3 Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Research Institute; 4 Department of Kinesiology, University of Waterloo

Background: Related literature on walker use are sparse particularly in describing rollator users. The aim of this study is to explore common gait and balance characteristics of older adult users of rollators. Methods: Retrospective review was conducted on 139 elderly (69-97 years old, 44 male, 95 female) residents in an assisted living facility in Ontario who could independently walk with or without mobility assistive aids. Balance and mobility of all participants were evaluated based on Schlegel Functional Fitness Assessment. Participants were tested during quiet standing with eyes open and closed, sit-tostand, 6-minute walk, and grip strength. Tri-axial accelerometers and two NintendoÂŽ Wii balance boards were used to measure temporal gait characteristics. SAS 9.4 was used for data analysis. Descriptive statistics were used to describe participants' demographics. Means and standard deviations were used to describe balance and mobility outcomes. Univariate analysis was performed to compare group differences (walker users versus other aid users versus non-aid users) in the outcome measures. Multivariate model was used to determine unique variables that can be associated with aid use. Results and Discussion: Initial analysis indicates a greater number of female walker users in both young to middle old (65-84 years old) and frail old group (85 years old and over). Male walker users are less likely to use the walker in any settings (short hall, long hall, room and outdoor walking) compared to female walker users. Ongoing analysis is aimed at quantifying spatiotemporal gait and balance characteristics. Results of this study could provide concrete information on who is likely to benefit more from the rollator, and lay down initial constructs that could potentially help in formulating an assistive aid or rollator prescription algorithm.

ENABLE INDEPENDENCE 72. Selective Transcutaneous Electrical Nerve Stimulation (TENS) of Lower Leg Afferents 1

1,2

E Sharan , P Yoo 1 Institute of Biomaterials and Biomedical Institute, University of Toronto; 2 Department of Electrical and Computer Engineering, University of Toronto

Background: Percutaneous tibial nerve stimulation (PTNS) is an emerging therapy used to treat overactive bladder (OAB). Pre-clinical experiments conducted in our lab show that, when compared to tibial nerve stimulation, selective electrical activation of the distal branches (medial and lateral plantar nerves) could evoke bladder-inhibitory reflexes in a more consistent manner. More recently, we have also found that saphenous nerve stimulation can also inhibit bladder function. A comparison of the therapeutic efficacy of these neural targets has not been tested in patients. Goal: The goal of this study is to determine the feasibility of using TENS as a means of selectively activating the saphenous, medial plantar, and lateral plantar nerves. Method: In 15 healthy participants, a handheld TENS stimulator was used to target three anatomical sites: knee, medial and lateral sole. The stimulation amplitudes corresponding to the nerve activation threshold and maximum tolerance were recorded. Results: The cutaneous sensory threshold (T) was used to normalize the nerve activation and tolerance thresholds. The tolerance thresholds of the saphenous, lateral plantar and medial plantar nerves were 5.8 ±1.8T, 5.1 ±2.4T and 5.0 ±2.2T respectively. Impact: Our results suggest that selective transcutaneous activation of each neural target is feasible in OAB patients.

OPTIMIZE THE REHAB SYSTEM

ABSTRACTS â&#x20AC;&#x201C; OPTIMIZE THE REHABILITATION SYSTEM (73-99) As our knowledge and understanding of rehabilitation grows, we recognize that parts of our healthcare system require updates, revisions, and reimagining. Our researchers have ideas about how to improve care, access to care, quality of care, and how to accelerate research into clinical practice, even as our rehabilitation challenges become increasingly complex. 73. The Multidimensional Construct of Pain in Males and Females with Persistent Symptoms from Concussion/Mild Traumatic Brain Injury 1,2,

1,3

T Mollayeva JD Cassidy , CM Shapiro , S Mollayeva , A Colantonio 1 Department of Medicine, University of Toronto; 2 Toronto Rehabilitation Institute-UHN; 3 Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto; 4 Toronto Western Hospital-UHN; 5 Department of Biology, University of Toronto-Mississauga

Pain is an unpleasant, complex, and subjective state that places a significant burden on patients and clinicians. It is possible to experience pain in the absence of any apparent injury and its severity may be mediated by emotion, attitude, and environmental influences, expressed differently in males and females. Traumatic brain injury (TBI) is frequently associated with chronic pain, with headaches and neck pain comprising the primary complaint long after the initial injury has resolved. This diagnostic modelling study examines sex differences in the experience of chronic pain in patients with delayed recovery from concussion/mild TBI. Pain intensity/unpleasantness was measured using the Visual Analogue Scale. Univariate and multivariate linear regression models were used to explicate and compare covariates of the experience of pain between males and females. A total of 94 patients (45.20Âą9.94 years; 61.2% male) with an established diagnosis of concussion/mild TBI were included in the analysis. Our results revealed that pain in males and females with concussion/mild TBI is a complex state, in which the variation and covariation can be decomposed into physical/medical and environmental/behavioural sources. Our results support the contention that sex should be considered an important feature in future characterizations of chronic pain in mild TBI. 74. Nonlinear Model Predictive Control of a Two-Dimensional Human-Robot Rehabilitation System 1

2,3,4

B Ghannadi , N Mehrabi , R Sharif Razavian , J McPhee , A Mihailidis 1 Systems Design Engineering, University of Waterloo; 2 Intelligent Assistive Technology and Systems Lab, Toronto Rehabilitation Institute-UHN; 3 Department of Occupational Science and Occupational Therapy, University of Toronto; 4 Institute of Biomaterials and Biomedical Engineering, University of Toronto

Stroke rehabilitation technologies have focused on reducing treatment costs while improving effectiveness. Rehabilitation robots are generally developed for home and clinical usage to: 1) deliver repetitive practice to post-stroke patients, 2) minimize therapists' interventions, and 3) increase the number of patients per therapist, thereby decreasing the associated cost. The control of rehabilitation robots is often limited to black- or gray-box approaches; thus, safety issues regarding the human-robot interaction are not easily considered. A black-box approach includes different variations of admittance and impedance controllers, while gray-box controllers use human biosignals.

OPTIMIZE THE REHAB SYSTEM Though gray-box controllers incorporate feedback from the human body, they require intensive preparation and are therefore not practical for daily usage with multiple post-stroke patients. Moreover, these controllers (i.e. black- and gray-box) require the attachment of additional equipment such as force/torque sensors, which will make the robot expensive and impractical for home rehabilitation. In our research, we integrated a robot computer model with a two-dimensional upper extremity musculoskeletal model to create a nonlinear model predictive control of the stroke rehabilitation robot. This system uses a musculoskeletal model of the upper extremity to predict movements and muscle activations, which are used by the controller to provide optimal assistance to the patient.

75. Impact of Comorbid Conditions on Persistent Concussion Symptoms 1

1,2

L Langer , M Bayley 1 Toronto Rehabilitation Institute-UHN; 2 Department of Medicine, University of Toronto

Background: Concussion is the most common form of brain injury. Most symptoms resolve spontaneously within weeks of the injury however up to 20% of people can have persistent symptoms that require multiple physician visits for treatment. We hypothesized that pre-existing conditions such as migraines, vestibular problems, or mental health problems would increase the likelihood of development of persistent symptoms. Methods: Administrative databases available at the Institute for Clinical and Evaluative Sciences were used to identify residents in Ontario diagnosed with concussion between 2008 and 2013. Comorbid conditions were identified by examining physician and health system utilization for 5 years prior to injury. The cohort was then tracked for 2 years after the index concussion for specialized persistent concussion symptom treatment. Results: People with diagnosed vestibular conditions were the most likely to require specialized care after concussion, and visit multiple types of specialists for their treatment than any other comorbid condition. Other comorbidities that were associated with increased health care utilization were mental health conditions, sleep and pain disorders and prior concussions. Conclusions: These findings identify a high-risk post-concussion group that clinicians can proactively target for earlier intervention to potentially reduce the duration of symptoms.

76. Scaling up: Province-wide Research and Clinical-care for Patients in the Chronic Stages of Traumatic Brain Injury 1

1,2

G Noack , B Colella , RE Green 1 Toronto Rehabilitation Institute-UHN; 2 Department of Psychiatry, University of Toronto

An estimated 12,000 people in Ontario are living with the enduring effects of chronic traumatic brain injury. Our labâ&#x20AC;&#x2122;s basic and applied research has allowed us to develop best-practices for longitudinal assessment of patients in the chronic stages of moderate-severe TBI, and to develop remote delivery interventions to improve clinical outcomes. We are currently developing a research centre for chronic traumatic brain injury in order to continue to research how to improve brain, cognitive, emotional and everyday functioning outcomes. This entails the scaling up of delivery of our interventions across the province to effectively reach the many thousands of patients contending with disability in the chronic stages of TBI. To achieve this new scale of clinical services, the centre will bring together evidence-based interventions from our lab and elsewhere, and will enable patients from across the province to receive the benefits of these interventions through their participation in research. That infrastructure will enable us to collect â&#x20AC;&#x153;bigâ&#x20AC;? data to continue to understand the brain, and how we can better repair it. It 50

OPTIMIZE THE REHAB SYSTEM will also help us to refine our delivery platform, enabling us to the deliver intensive, meaningfully contextualized, and customized interventions to patients on an unprecedented scale.

77. Digitizing Neuropsychological Assessment for Traumatic Brain Injury 1

B Vasquez , L Ruttan , L Klaming , D Van Minde , B Vlaskamp , A Paonessa , L Miguel-Jaimes , B Budisin , M 2 3 3 1 Gillies , C Tartaglia , C Tator , R Green 1 Brain Discovery and Recovery Team, Toronto Rehabilitation Institute-UHN; 2 Philips Health Research; 3 Krembil Research Institute, Toronto Western Hospital-UHN

Background: Chronic Traumatic Brain Injury (TBI) is estimated to affect over 1.1% of the world's population. Cognitive assessments (measuring memory, attention, etc.) are needed to evaluate the type and severity of cognitive impairments, to monitor ongoing recovery, to determine readiness to return to prior activities, or to assess response to treatment. However, many patients do not have access to this important service (e.g. living remotely, are physically immobile, lack resources for travel). Digital approaches will allow for remote assessment to reach such patients and to enhance sensitivity and specificity of existing tests. Objectives: To digitize conventional neuropsychological tests and develop novel outcome measures with increased sensitivity. Methods: Neuropsychological assessments will be conducted in the typical standardized format. A Wacom tablet, positioned beneath paper forms, will digitally record all drawn responses. Precise data including order of lines, timing, pressure, angle, and velocity will be analyzed to determine the most sensitive outcome measures for a given test. Impact: This study will significantly improve cognitive assessment for TBI, and enable access to services by those who are arguably the most vulnerable. Moreover, by digitizing and improving upon existing tools rather than developing new ones, adoption rates by clinicians will be more feasible. 78. Ethnocultural Differences in Cardiac Rehabilitation Barriers 1

1,3

S Ali , G Ghisi , R Britto , SL Grace 1 York University; 2 Federal Universidade of Mimas Gerais; 3 University Health Network

Purpose: To study for the first time and quantitatively compare Cardiac Rehabilitation (CR) barriers by ethnocultural background. Methods: A convenience sample of patients from one of 3 CR programs was approached at their first CR visit, and consenting participants completed a survey which included ethnocultural background categorizations from Statistics Canada. Participants were emailed a survey again 6 months later, including the CR Barriers Scale (CRBS). Results: 198 (48.2%) participants reported their ethnocultural background and completed the CRBS in the follow-up survey. Ethnocultural backgrounds with >10 participants were selected for analysis; these were North American (n=82, 41.4%), British (n=21, 10.6%), Eastern European (n=17, 8.6%), Southern European (n=15, 7.6%), Jewish (n=12, 6.1%), South Asian (n=10, 5.1%), and East or Southeast Asian (n=10, 5.1%). The total mean barriers score was 1.72Âą0.05, and this did not differ by ethnocultural background (F=.88, p=.60). However, there were significant ethnocultural differences for 4 specific barriers (all p<.05), namely distance, cost, wait times, and preference to manage their cardiovascular disease independently. Conclusion: Future research is needed to proactively assess CR barriers in the most under-represented groups. However, offering home-based CR could overcome all 4 barriers where ethnocultural differences were found. 51

OPTIMIZE THE REHAB SYSTEM 79. Depression Screening in a Diabetes Rehabilitation Program; Validity and Correlates of the 14-item CES-D 1,2,5

2,4

1,5

3,5

1,2,5

J Carter , H Cogo-Moreira , N Herrmann , D Merino , P Yang , B Shah , A Kiss , J Reitav ,P Oh , 1,2,5 W Swardfager 1 Cardiac Rehabilitation Program, Toronto Rehabilitation Institute-UHN; 2 Department of Pharmacology and Toxicology, University of Toronto; 3 Department of Health Policy, University of Toronto; 4 Department of Psychiatry, Universidade Federal de São Paulo; 5 Hurvitz Brain Sciences Centre, Sunnybrook Research Institute

Depression is highly prevalent and associated with worse prognoses in patients with Type 2 diabetes mellitus (T2DM).The Center for Epidemiological Studies Depression (CES-D) scale is a widely used 20item self-report instrument. This study aimed to validate the 3-factor solution (negative affective, anhedonic and somatic symptoms) of the 14-item CES-D scale proposed by Carleton et al. (2013) in a T2DM population. The CES-D was administered consecutively to patients with T2DM entering a rehabilitation program. Construct validity was assessed using confirmatory factor analysis. Subscale viability and differential item functioning was tested in bifactor models. Correlations with clinical characteristics was tested using linear regressions adjusting for age, gender, BMI and medications. Among adults with T2DM (n=305, age 56.9±11.1, 44.9% male, duration of diabetes 7.8±7.9 years, HbA1c 0.076±0.014%), the construct validity of Carleton's 3-factor solution was confirmed. The CES-D items can be summed to arrive at a total score but not to produce subscale scores. The CES-D 14 total score increased with BMI (β=0.149, p=0.027), but not HbA1c (β=0.013, p=0.793). In males, the CES-D 14 total score decreased with age (β=-0.366, p=0.012). The 14-item CES-D retained construct validity in adults with T2DM. Depressive symptoms were associated with age, gender and BMI but not glycemic control.

80. Acoustic - Kinematic Relationships in Speech: Improving Assessment and Treatment of Speech Disorder in Parkinson's Disease 1,2

1,2

2,3

1,2

R Giles , E Kearney , MB Haworth , P Faloutsos , M Baljko , Y Yunusova 1 Department of Speech-Language Pathology, University of Toronto; 2 Communication Team, Toronto Rehabilitation Institute-UHN; 3 Department of Electrical Engineering & Computer Science, York University

Identifying an objective measure of speech production that accurately captures the magnitude of speech disorder but minimizes practical limitations for data collection has strong clinical implications. This study investigated the relationship between acoustic and kinematic measures of sentence production with respect to scaled speech intelligibility (a measure of disorder) in patients with Parkinson's Disease (PD). First and second formant frequencies from the acoustic signal were measured along with jaw, tongue tip (TT) and dorsum (TD) amplitude and speed to quantify acoustic and kinematic dimensions of speech production in patients with PD and controls. The analysis revealed a significant reduction in F2 range in the PD group compared to controls, and a correlation between F1 range and speech intelligibility. No kinematic differences were found between groups, however jaw, TT, and TD amplitude correlated positively with speech intelligibility. Pearson's correlations revealed relationships between F1 range with jaw amplitude and speed, and F2 range with TT speed. These data suggest that a relationship between acoustics and kinematics exists, and more importantly, reflects severity of speech disorder. This furthers our knowledge of changes in speech with disease progression, and may be used to guide the selection and optimization of therapeutic techniques to restore function.

OPTIMIZE THE REHAB SYSTEM 81. Can we Objectively Assess the Delivery of Tactile Inputs during Speech Therapy? 1

1,2

3,4

D Rampersaud , A Huynh , A Namasivayam , R Bali , R Ward , T Yan , V Law , D Hayden , 1,2,6,7,8 P van Lieshout 1 Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto; 2 Toronto Rehabilitation Institute-UHN; 3 Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, WA, Australia; 4 Faculty of Medicine, School of Paediatrics and Child Health, Dentistry and Health Sciences, The University of Western Australia; 5 The PROMPT Institute; 6 Department of Psychology, University of Toronto Mississauga; 7 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 8 Rehabilitation Sciences Institute, University of Toronto

The utilization of tactile-kinesthetic-proprioceptive (TKP) input to facilitate improved motor speech control and production is considered an active treatment ingredient within many contemporary motor speech interventions. The delivery of TKP inputs during motor speech intervention requires a speechlanguage pathologist (S-LP) to not only acquire and apply new movement skills but also deliver these skills with accuracy and consistency. We examined the accuracy and consistency of TKP inputs delivered by 3 S-LPs, with differing levels of experience (S-LP 1: novice, S-LP 2: advanced and S-LP 3: expert). Accuracy was derived from confidence interval measures that compare jaw amplitude during active jaw movements of vowel /a/ made by a participant versus jaw movements induced by the S-LPs whilst giving TKP input. The Generalised Orthogonal Procrustes Analysis (GPA) and the cyclic Spatial Temporal Index (cSTI) were used to evaluate consistency. Overall, our findings indicate that S-LPs with more experience are not only more accurate in judging the range of jaw motion of a participant, but are also more consistent in delivering TKP inputs, relative to a S-LP with less experience.

82. Capturing the Challenges of Homecare through Photographs taken by Caregivers 1

1,2

1,4

4,5,6

1,2,7,8

T Kajaks , E King , K Ray , JL Cameron , D Beaton , P Holyoke , T Dutta 1 Toronto Rehabilitation Institute-UHN, 2 Department of Mechanical and Industrial Engineering, University of Toronto; 3 Saint Elizabeth; 4 Occupational Science and Occupational Therapy, University of Toronto 5 St. Michaels Hospital; 6 Institute for Work and Health; 7 Rehabilitation Sciences Institute, University of Toronto; 8 Institute of Biomaterials and Biomedical Engineering, University of Toronto

Our healthcare system is increasingly being challenged to meet the demands of caring for patients in the home rather than in the hospital. This shift places higher demands on personal support workers (PSWs) and family caregivers. More recently, the safety of PSWs and caregivers providing care in the home has been questioned. Our objective was to understand the nature of care provision in the home and identify caregivers' biggest challenges. We used a method called PhotoVoice to capture the challenges faced by home caregivers. Participants were asked to take pictures of at least three home caregiving challenges and to tell us about these challenges. The family caregivers and PSWs discussed different kinds of challenges in providing home care. The family caregivers' themes related to: 1) physical challenges (e.g. bathing, transfers, and fall prevention), 2) need for respite care (a break for the family caregiver), and 3) financial support. PSWs were also concerned with physical caregiving challenges, but additionally identified home accessibility and safety, and care team communication as significant challenges. This research provides important information that will help improve the experiences and safety of home caregivers.

OPTIMIZE THE REHAB SYSTEM 83. A Rehabilitation Goal-Setting Mobile Application (OnMyFeet) in Older Adults: Usability and Acceptability 1,2

1,3

K Chiu , AB Cuperfain , ZB Zhao , SY Zhao , KX Zhu , A Iaboni 1 Toronto Rehabilitation Institute-UHN;; 2 Department of Physical Therapy, University of Toronto; 3 Department of Medicine, University of Toronto; 4 Department of Electrical and Computer Engineering, University of Toronto,

Background: Patient-directed goal-setting is an important practice in physical rehabilitation and it enhances participation and functional outcomes. To facilitate goal-setting, we developed a mobile application called OnMyFeet. OnMyFeet is based on principles of Enhanced Medical Rehabilitation and it assists clients in setting, prioritizing, and personalizing goals. The objectives of this pilot usability study were: 1) assess usability and acceptability of OnMyFeet in older adults and 2) assess effectiveness of OnMyFeet on enhancing client-centredness of goal-setting. Methods: Participants (mean age 70.33 Âą 10.61 years) were two healthy older adults and four inpatients on a MSK rehabilitation unit. The cognitive walkthrough approach was used as the usability evaluation method and qualitative and quantitative measures were collected through usability testing, interviews, and surveys. Results: OnMyFeet scored 65 Âą 27.91 on the System Usability Scale. Users recommended adding clear and visible prompts and more written instructions. Users enjoyed maintaining a diary of their progress and participating in decision-making. On the Client-Centredness of Goal-Setting survey, the application received scores over 90% which indicated high client-centredness. Conclusion: We found that OnMyFeet enhances client-centredness of goal-setting in therapy. The next prototype of the application will aim to improve usability by addressing usability issues specific to older adults.

84. A Mobile Dementia Observation System (DObs): Development and Pilot Usability Testing 1,2

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A Cuperfain , C Marshall , M Tsokas , K Chiu , Q Zhao , D Sheng , A Iaboni 1 Toronto Rehabilitation Institute-UHN; 2 University of Toronto; 3 Regional Geriatric Program, Toronto Rehabilitation Institute-UHN

Responsive behaviours in dementia, such as agitation and aggression, are common and distressing for caregivers and patients. A basic principle of assessment of behavioural symptoms is to chart the behavioural patterns over 24 hour cycles. A widely used tool for this assessment is called the dementia observation system (DOS), which is paper-based and onerous. We have developed a prototype of a mobile application, Dementia Observation (DObs), which integrates information from nursing observations with data from a wearable device on the observed resident with dementia. We conducted usability testing of the DObs mobile application. Both quantitative and qualitative methods of assessment were employed. Six assessors completed a scenario-based usability test with DObs mobile application. On average, users completed 85% of tasks with all components correct. Other clinical considerations were identified through user testing such as: collecting multiple behaviours within a given time interval, clarifying what constitutes an incident, and retroactive charting. Areas of improvement with respect to usability of DObs were explored. The app will be redesigned, and usability testing will be repeated. Future studies will examine feasibility in clinical setting and develop machine learning algorithms to synthesize behavioural, contextual and motion tracking information.

OPTIMIZE THE REHAB SYSTEM 85. Establishing Indicators for Optimal Spinal Cord Injury Care - Phase I: Prioritization of Rehabilitation Domains 1

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1,3

1,4

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SM Alavinia ; BC Craven , H Flett , F Farahani , SL Hitzig , M Bayley 1 Toronto Rehabilitation Institute-UHN; 2 Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto; 3 Department of Physical Therapy, Faculty of Medicine, University of Toronto; 4 School of Kinesiology & Health Science, Faculty of Health, York University

Objective: To prioritize domains of Rehabilitation Care (RC) for Canadians with Spinal Cord Injury (SCI) , from rehab admission to 18 months thereafter. Methods: An advisory committee ranked the priority and feasibility of 15 RC domains using a modified Hanlon method. Domains were rated from 0-10 based on the size of the problem/care domain and effectiveness of interventions. Priority scores (D) were calculated using the formula: D = [A + (2 x B)]x C, where A, B and C are, size, seriousness, and intervention effectiveness, respectively. Members used ‘EAARS’ -Economic, Acceptability, Accessibility, Resources, and Simplicity criteria to rank feasibility on a scale of 0-4. The product of the priority and feasibility scores provided the initial RC domain ranking. A facilitated consensus process was used to modify the priorities based on consumer and stakeholder priorities. Results: In total, 11/15 domains ( total scores from 2183 to 702) in descending order included: Urinary Tract Infection, Community Participation & Employment, Wheeled Mobility, Bladder Continence, Skin Integrity, Informed Self-Management, Cardiovascular Integrity, Emotional Wellbeing, Walking, Grasping and Reaching, and Sexuality. Conclusions: Eleven RC domains were identified to develop specific structure, process and outcome indicators intended to advance the field of SCI care by 2020.

86. pQCT Derived Bone Indicator Discriminates Between AIS Categories Among Individuals With Chronic SCI 1

2,3

1,2,3,4

T Cervinka , LM Giangregorio , BC Craven 1 Neural Engineering and Therapeutics Team, Toronto Rehabilitation Institute –UHN; 2 Department of Kinesiology, University of Waterloo; 3 Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute- UHN; 4 Division of Physiatry, Department of Medicine, University of Toronto

Rittweger et al. reported the ratio of the total bone mineral content (BMC) yielded by peripheral quantitative computed tomography (pQCT) at the tibia mid-shaft (38% site) and above the malleolus (4% site) are altered with neurologic impairment. We hypothesized that this ratio, the “Capozza index” (CzI), may discriminate between ASIA Impairment Scale (AIS) grades among individuals with spinal cord injury (SCI). We performed secondary analyses of pQCT baseline data from two SCI cohorts (N = 90, age 24-77 yrs., C2-T12, AIS A-D, DOI ≥ 2 yrs.) and (N = 77, age 21-80yrs., C2-L4, AIS A-D, DOI ≥ 1 yr.). pQCT images of the proximal and distal tibia (38% and 4%sites) were available for 109/167 participants. To determine BMC, scans were analyzed using the Stratec software (Contour mode 2 – threshold 169 mg/cm3). Descriptive statistics, including the mean and 95% confidence intervals (95%CI) of the CzI in individuals with SCI and AIS A-D subgroups were calculated. The CzI differs between AIS grades D (0.84 ± 0.10), C (0.65 ± 0.09) and A+B (0.54 ± 0.03). The CzI holds promise for explaining the severity of bone deterioration attributable to AIS subgroups, thereby advancing our understanding of the heterogeneity of neuromuscular impairment post SCI.

OPTIMIZE THE REHAB SYSTEM 87. Monitoring Functional Hand Use with Wearable Cameras: Towards a Novel Outcome Measure for Upper Extremity Function 1,2

1,2

J Likitlersuang , J Zariffa 1 Institute of Biomaterials and Biomedical Engineering, University of Toronto; 2 Toronto Rehabilitation InstituteUHN

In order to develop effective interventions to restore upper extremity function in persons with cervical spinal cord injury (SCI), tools are needed to accurately measure hand function. However, there is currently no satisfactory method to collect information about hand function when patients are at home. In this study, a wearable ("egocentric") camera system for the assessment of hand function in the community is presented that can quantify the amount of functional hand use, by detecting interactions of the hand with objects in the environment. The system is based on computer vision techniques, which segment hands from the cluttered background and extract information associated with interactions. Features based on motion and shape descriptors are inputted into a Random Forest classifier to classify video frames as representing interactions or not. The algorithm has been tested using our datasets of egocentric recordings in ablebodied and SCI individuals performing activities of daily living in several environments (F-scores of 0.85 and 0.81, respectively, during leave-one-activity-out cross-validation). It has additionally been validated on a publicly available dataset of able-bodied individuals (F-score of 0.83). These results indicate that egocentric video can form the basis for the first wearable system capable of tracking functional use of the hand.

88. Perspectives on Personalized Adapted Locomotor Training from Canadian Participants with Subacute Spinal Cord Injury 1,2

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1,2,4

H Singh , M Shah , H Flett , B Craven , M Verrier , K Musselman 1 Toronto Rehabilitation Institute-UHNetwork; 2 Rehabilitation Sciences Institute, University of Toronto; 3 Division of Physical Medicine and Rehabilitation,University of Toronto; 4 Department of Physical Therapy, Faculty of Medicine, University of Toronto

Spinal cord rehabilitation employing personalized adaptive locomotor training (PALT) can lead to significant physical and functional improvements. While many studies have examined quantifiable impacts of PALT, limited research has explored the experience of participants. Using semi-structured interviews and conventional content analysis, this research describes the experiences of participants in terms of how participation impacted their lives, the challenges encountered, and how PALT could be improved. Seven individuals with sub-acute SCI (6 AIS-D, 1 AIS-C, C4-T5) participated in PALT for six hours/week for 74-197 hours. Participants highlighted factors that motivated their participation, and perceived benefits and challenges experienced in the program. Factors that motivated participation in PALT included beliefs that higher intensity leads to quicker regain of function. Perceived benefits from PALT included positive health outcomes (e.g. physical and psychological well-being), favorable structure of intensive locomotor training (ILT â&#x20AC;&#x201C; e.g. treadmill), and empowerment to self-manage their rehabilitation. Perceived challenges experienced while in PALT included neglect of other commitments (e.g. no energy for socializing), acquiring services to enable participation (e.g. accessible transportation, bladder care), limited transferability to daily walking, and rigid structure of ILT. Overall, participants described a high level of satisfaction with PALT and challenges outlined by participants will guide future improvements to PALT.

OPTIMIZE THE REHAB SYSTEM 89. Detecting Recurrent Hand Postures of Spinal Cord Injured Individuals in Wearable Camera Video 1,2

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E Sumitro , J Zariffa 1 University of Toronto, Institute of Biomaterials and Biomedical Engineering; 2 Toronto Rehabilitation InstituteUHN

Hand function recovery is crucial for tetraplegic spinal cord injured (SCI) individuals. However, current hand function assessments only occur in a clinical setting. Wearable cameras could enable home monitoring, capturing everyday hand function. While manual analysis of lengthy videos is infeasible, automatic summarization would facilitate interpretation by a clinician. This study seeks to develop a clustering algorithm that can identify recurring hand postures in wearable camera video and create a report summarizing its findings. Clinicians will use the report to efficiently review hand posture quality in a patient's daily life and evaluate hand function recovery. We will adapt a clustering approach based on the Determinantal Point Process that has been shown to work well with able-bodied postures, and validate its use in videos of SCI participants. Clinicians will be consulted to validate the report's usefulness. Preliminary results using data from four SCI participants exhibit a purity of 81.3%. However, 54.5% of clusters were redundant and only 46.1% of postures were detected. Optimizing the algorithm to reduce redundancy and missed postures will enable automatic summarization of lengthy wearable camera video. This will facilitate the evaluation of hand function interventions, thus helping to restore independence to SCI individuals and lowering healthcare costs.

90. The Design of a Novel Assessment Strategy to Study Implementation Fidelity 1

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DC Bentley , KM Sibley 1 Toronto Rehabilitation Institute â&#x20AC;&#x201C;UHN; 2 Department of Community Health Sciences, University of Manitoba

A truly optimal rehabilitation system would be one where there is ongoing translation of evidence-based best practices into clinical practices; a process which is supported using tailored Knowledge Translation (KT) interventions. The REACT study is an example of theory-informed, tailored KT intervention (Sibley et al. 2016), where Cane et al's Theoretical Domains Framework (2012) was used to design a year-long intervention with the goal of increasing the frequency with which physiotherapists assess reactive balance, currently taking place at three Ontario rehabilitation hospitals. In evaluating the effectiveness of REACT it is imperative that there be an assessment of the degree to which the original intervention scheme was followed, referred to as Implementation Fidelity (IF). Using the Conceptual Framework for Implementation Fidelity (Carroll et al, 2007) as a preliminary guide, a novel quantitative assessment of IF was conceptualized and applied. This novel strategy will not only systematically evaluate the IF of the REACT intervention at its three sites, but it will also isolate core moderating factors of the intervention unique to each site. This poster will describe the iterative process by which this novel assessment strategy was created, highlighting the utility of this strategy specific to clinical research environments.

OPTIMIZE THE REHAB SYSTEM 91. Creating and Validating an Algorithm to Identify Non-Traumatic Spinal Cord Injury Patients from CIHI Discharge Abstracts 1

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7,8

1,3,4

SM Cronin , J Voth , S Guilcher , V Noonan , C Ho , N McKenzie , SB Jaglal 1 Institute of Health Policy, Management, and Evaluation, University of Toronto; 2 Department of Physical Therapy, University of Toronto; 3 Toronto Rehabilitation Institute-UHN; 4 Institute of Clinical Evaluative Sciences; 5 St. Michaels Hospital; 6 Rick Hansen Institute; 7 University of Calgary; 8 Foothills Medical Centre

There is little research to estimate the prevalence of non-traumatic spinal cord injury (NTSCI) in Canada, despite the expected rise in prevalence of this diagnosis. The paucity of relevant diagnostic codes and lack of cohort definition have contributed to the challenge of identifying people with NTSCI in administrative health databases. This study aimed to assess the feasibility of identifying cases of NTSCI within Canadian health administrative databases through the creation and validation of an algorithm. Data from the Canadian Institute of Health Information (CIHI) containing acute care discharge records, emergency department visits, and inpatient rehabilitation stays for patients between 2004 and 2011 was used. An algorithm was created using ICD-10-CA diagnostic codes associated with disease aetiology and neurological impairment. A total of 6,362 patients with NTSCI were identified for the cohort dataset. The algorithm was then validated through 281 chart reviews to confirm NTSCI diagnosis. Diagnostic measures of accuracy were computed, resulting in sensitivity of 95% and specificity of 58%. Findings from this study demonstrated the feasibility of identifying people with NTSCI in health administrative databases and will inform future research initiatives on the prevalence, incidence and treatments for people diagnosed with NTSCI.

92. Providing Clients Permission to Discuss Sexuality: A Description of Occupational Therapy Practice 1

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C Cunningham , M Scott , N Paananen , L Schwartz , D Hebert 1 Department of Occupational Science and Occupational Therapy, University of Toronto; 2 Toronto Rehabilitation Institute-UHN

Sexuality can be a significant issue for individuals with disabilities and should be addressed by occupational therapists. Annonâ&#x20AC;&#x2122;s PLISSIT model identifies providing clients with permission to discuss sexuality as the first step in addressing sexuality; it is currently unclear if and how occupational therapists provide this permission. This project describes how and why occupational therapists provide clients permission to discuss sexuality in practice. An anonymous qualitative survey was distributed to a sample of occupational therapists. Participant descriptions of addressing client sexuality were summarized into themes using qualitative content analysis. Themes relating to the environment, therapist attributes, and client interactions were described as factors in how and why permission is provided in occupational therapy practice. Understanding how and why permission is provided to discuss sexuality may inform the development of supportive approaches to addressing sexuality in practice, improving the quality and comprehensiveness of occupational therapy services.

OPTIMIZE THE REHAB SYSTEM 93. Battered & brain injured: Identifying and Supporting Brain Injured Survivors of Intimate Partner Violence 1,3

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3,5,6

H Haag , A Colantonio , N MacGregor , V Green , D Jones , T Joseph , S Sokoloff , N Cullen , 4 S Broekstra 1 Faculty of Social Work, Wilfrid Laurier University; 2 Rehabilitation Sciences Institute, University of Toronto; 3 ABI & Society Team, Toronto Rehabilitation Institute-UHN; 4 WomenatthecentrE, Women’s Centre for Social Justice; 5 Faculty of Medicine, University of Toronto; 6 Physical Medicine and Rehabilitation, West Park Healthcare Centre

Every year thousands of Canadian women experience intimate partner violence (IPV) potentially causing permanent traumatic brain injuries (TBI), a connection left largely unexplored. This pilot project surveyed existing TBI specific knowledge and services in the Toronto IPV survivor support community and developed a knowledge-to-practice network specific to this vulnerable population. Our research question sought to better understand the current knowledge of TBI in the IPV support community and identify ways to improve the health and wellbeing of women survivors. Phase one consisted of an online survey sent out to Toronto based IPV service providers asking about their understanding of TBI in their client population and their ability to offer TBI sensitive services. Phase two expanded the project with a networking/education workshop hosting both provincially and nationally based service providers, brain injured women survivors of IPV, and other key stakeholders to disseminate findings, generate recommendations for ‘next steps’ in research and practice, and offer relevant TBI/IPV education. This project is the foundation for an extensive program of research intended to significantly improve TBI/IPV survivors’ health and wellbeing. Preliminary results from both study phases are presented and recommendations for future research agendas and service development are provided.

94. Development of a Clinically Effective Sensory Screening Tool for Residents with Dementia in Long Term Care (LTC) 1,2

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F Höbler , W Wittich , KS McGilton 1 Department of Research, Toronto Rehabilitation Institute-UHN; 2 Department of Speech-¬Language Pathology, University of Toronto; 3 School of Optometry, University of Montreal; 4 CRIR/Centre de réadaptation MAB-Mackay du CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, Montréal; 5 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto

The prevalence and priority of dementia is widely recognised; however, the incidence of sensory loss in this population frequently goes unnoticed and untreated. In long-term care (LTC), more than half of residents are reported to have dementia, whilst hearing and/or vision loss affects two thirds, and combined dual sensory loss one third. Sensory loss can have profound implications for the functional status, communication abilities, and quality of life of these residents. In this study, we aim to identify effective sensory screening tools suitable for older adults with dementia, adapting their administration if necessary. In phase one, our multidisciplinary team carried out a comprehensive review of available measures to screen for vision and hearing loss with: 1) a scoping review of the literature, 2) environmental scan interviews with LTC nurses and clinical specialists, and 3) consultation with experts in the fields of vision and hearing. In phase two, we aim to pilot the package of screening tools with residents in LTC to determine their feasibility, reliability and construct validity in this population and setting. We outline the benefits of using combined quantitative and qualitative research within a dynamic multidisciplinary framework in response to the complex care needs of our ageing population.

OPTIMIZE THE REHAB SYSTEM 95. Accelerometry and Godin Leisure-Time Questionnaire Relationship in Men on ADT for Prostate Cancer 1,2

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M O'Neill , D Santa Mina , C Sabiston , G Tomlinson , SMH Alibhai 1 Optimize Team, Toronto Rehabilitation-UHN; 2 Institute of Medical Science, University of Toronto; 3 Faculty of Kinesiology & Physical Education, University of Toronto; 4 Dalla Lana School of Public Health, University of Toronto;

Most men with prostate cancer (PC) do not meet recommended physical activity (PA) levels, partly due to side effects from PC and its treatment, although research has shown PA improves multiple side effects. Accelerometry (AC) and the Godin-Shephard Leisure-Time PA (Godin) Questionnaire evaluate Moderate to Vigorous PA (MVPA) levels. However, no study has assessed the agreement between the Godin and AC. AC and Godin measures were obtained during an exercise trial for men on hormone therapy for PC. At each assessment participants completed a Godin questionnaire and wore an AC (Actigraph GT3X) for one week. Statistical analyses included comparing AC and Godin’s median MVPA minutes and Spearman’s correlation coefficient. We analyzed a total of 130 time-points. The median amount of ‘time in MVPA’ was 60 minutes for Godin, and 106.5 minutes for AC. The number of time-points found meeting MVPA from AC and Godin were 44 and 38, respectively. Spearman’s correlation for MVPA minutes between the AC and Godin was poor (0.105). Our preliminary analysis suggests a weak correlation between the two measures; Godin appears to underreport PA verses AC. This discrepancy may be due to patients’ misunderstanding of MVPA. Further analyses are underway to explore agreement of these measures.

96. Discharge Destination Following Hip Fracture: Comparative Effectiveness and Cost Analyses 1

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1,2,3,6

KB Pitzul , WP Wodchis , HJ Kreder , MW Carter , SB Jaglal 1 Institute of Health Policy, Management, and Evaluation, University of Toronto; 2 Institute of Clinical Evaluative Sciences, Toronto; 3 Toronto Rehabilitation Institute-UHN; 4 Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre; 5 Department of Mechanical and Industrial Engineering, University of Toronto; 6 Department of Physical Therapy, University of Toronto

Hip fractures result in a burden on geriatric patients and health systems, which has led to recent focus on the improvement of quality of care for patients experiencing this event. There is currently a gap in evidence for delivery of quality care during the post-acute period. The purpose of this study is to determine the impact on mortality and re-hospitalization, as well as health system cost, of similar hip fracture patients being discharged to an inpatient rehabilitation facility or directly to the community within 1-year in Ontario, Canada. This was a retrospective study of a propensity-matched cohort completed from the health system perspective. Two groups of older adults discharged alive from acute care for hip fracture repair were matched: patients discharged to inpatient rehabilitation (IPR) were matched to patients discharged to the community. The outcomes were death or re-hospitalization within 30 days or 1-year post-acute discharge. A higher proportion of patients discharged to the community died or were re-hospitalized within 30 days of acute-care discharge compared to similar patients discharged to IPR, despite similar costs. This study contributes to the literature surrounding the quality of care for hip fracture patients within the post-acute period.

OPTIMIZE THE REHAB SYSTEM 97. Using Diffusion of Innovations Theory to Understand ECHO Ontario's Effect on Healthcare Providers 1,2

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N Salemohamed , J Zhao , L Carlin , R Dubin , P Taenzer , F Webster , E Seto , J Stinson , A Furlan 1 Department of IHPME, University of Toronto; 2 Toronto Rehabilitation Institute-UHN; 3 Department of Physical Therapy, University of Toronto; 4 Department of Family Medicine, Queen’s University, Kingston; 5 Department of Psychology, University of Calgary; 6 Dalla Lana School of Public Health, University of Toronto; 7 Sick Kids Hospital, Toronto; 8 Department of Medicine, University of Toronto

Background: ECHO (Extension for Community Healthcare Outcomes) is a telemedicine initiative that focuses on teaching primary care health care providers (HCPs) across Ontario how to better manage their chronic pain patients using a hub (experts) and spoke model (learners). Aims: This qualitative study focuses on conducting 10-15 interviews with HCPs to evaluate the impact ECHO has on their confidence levels, their patient's health outcomes, and their comfort with using online platforms to interact with other HCPs. Conceptual Framework: The study is using the diffusion of innovations framework, a theory that explains the process of adopting a new idea (or technology) and the factors surrounding its adoption, to understand the change in behavior and use of the ECHO model in Ontario. Methods: Qualitative descriptive analysis will be used including inductive and deductive strategies. Codes and themes will be generated on an ongoing basis with constant feedback with members of the research team. Results: The semi-structured interview is currently being pilot tested. Significance: Examination of why online communities are successful, how the ECHO model is being accepted in Ontario, and understanding how the knowledge is being diffused outside the ECHO network.

98. Understanding Support Needs in Spouses and Adult Children Caring for Seniors with Major Depressive Disorder 1

CD Wang , B Kirsh , D Conn , JI Cameron 1 Rehabilitation Sciences Institute, University of Toronto; 2 Department of Occupational Science & Occupational Therapy, University of Toronto; 3 Department of Psychiatry, Baycrest Health Sciences

The aging population and increasing diagnoses of seniors with Major Depressive Disorder (MDD) requires family members to take on the role of caregiver to provide support and assist with treatment. The majority of caregivers for seniors consist of offspring (adult children) and spouses, both of whom are often unprepared for their caregiving responsibilities. As a result, many caregivers encounter difficulties and experience depressive symptoms. To date, family members’ experiences and support needs associated with providing care to a senior with MDD is not clear. Therefore, the objectives of this descriptive qualitative study are to: (1) explore the experiences and support needs of being a spouse or adult child caregiver of a senior with MDD, and (2) compare and contrast the experiences and support needs between spouse and adult child caregivers. In-depth interviews will be conducted with family caregivers to depressed seniors, and they will be audiotaped, transcribed, and analyzed using Braun and Clark’s thematic analysis. The results of the study will contribute to our understanding of this caregiving population, and may inform intervention and/or system change for caregivers in need of psychosocial support.

OPTIMIZE THE REHAB SYSTEM 99. Film + Exercise: Changing Attitudes and Practices in the Context of Hemodialysis 1,2

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P Kontos , R Colobong , A Grigorovich , K-L Miller , S Alibhai , D Brooks , T Parsons , SV Jassal , 10,11 3, 4, 12, 13 A Thomas , G Naglie 1 Toronto Rehabilitation Institute-UHN; 2 Dalla Lana School of Public Health, University of Toronto; 3 Department of Medicine, University of Toronto; 4 Institute of Health Policy, Management and Evaluation, University of Toronto; 5 Institute of Medical Sciences, University of Toronto; 6 Department of Medicine, University Health Network; 7 Department of Physical Therapy, University of Toronto; 8 School of Rehabilitation Therapy, Queen's University; 9 Division of Nephrology, University Health Network; 10 St. Michael's Hospital; 11 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; 12 Rotman Research Institute, Baycrest Health Sciences; 13 Department of Medicine, Baycrest Health Sciences.

Background: Exercise improves functional outcomes for hemodialysis patients, yet exercise programs remain rare. We developed a research-based film, Fit for Dialysis, to promote exercise amongst older hemodialysis patients, and exercise encouragement by health care practitioners (HCPs) and family carers (FCs). Objectives: To determine in what ways Fit for Dialysis influences knowledge/attitudes regarding exercise in hemodialysis, and the outcomes that result. Methods: A mixed-methods parallel intervention trial with patients from two hospitals comparing: film+16-week exercise program versus 16-week exercise-only program. The program had an intradialytic and home/community component. We report on qualitative interviews from the intervention site at baseline (10 patients, 10 HCPs, 10 FCs), 8 weeks (8 patients, 6 HCPs, 8 FCs), and 16 weeks (8 patients, 6 HCPs, 6 FCs). Findings: The intervention was successful in: increasing patients', FCs and HCPs understanding of the importance of exercise; increasing encouragement by FCs and HCPs of patient exercise; sustaining patient motivation to exercise and perceived benefits (e.g. improved functioning). Aesthetic components of the film (e.g. storyline) were identified as central to triggering change. Conclusions: Research-based film paired with an exercise program was effective in implementing best evidence in hemodialysis practice. This suggests that the intervention has potential to optimize hemodialysis care.

TEAMS

Toronto Rehabâ&#x20AC;&#x2122;s 11 research teams include 110 scientists with appointments at the University of Toronto and other leading academic institutions. Our investigators bring a rich and varied mix of academic, technical and clinical experience. They collaborate in a multidisciplinary environment where engineers trade ideas with industrial designers, and social scientists work alongside clinicians, patients and an amazing research support staff. Our 200+ graduate students and postdoctoral fellows are members of at least one of these 11 teams that provide them with mentorship, networking and collaboration opportunities. Alums of Toronto Rehab credit our multidisciplinary environment for their success when they graduate.

TEAMS

ACQUIRED BRAIN INJURY & SOCIETY

Team Leader: Dr. Angela Colantonio

The Acquired Brain Injury (ABI) & Society team is a global leader in interdisciplinary research and knowledge exchange that addresses the intersection of brain injury and social variables, such as sex/gender, socioeconomic status, workplace cultures, and exposure to violence. Much of their research explores the impact of brain injury on marginalized populations. They are developing innovative strategies to improve outcomes beyond health indicators, such as employment and social participation, which integrate personal and systemic factors with the latest scientific evidence.

TEAMS

ARTIFICIAL INTELLIGENCE & ROBOTICS IN REHAB (AIRR)

Team Leader: Dr. Alex Mihailidis

The objective of the AI & Robotics in Rehab (AIRR) team is to develop tools that can support the roles and practices of caregivers and clinicians to deliver safe and effective patient care using cutting-edge technologies. The team has particular expertise in selecting, developing and deploying technologies that allow delivery of this care anywhere and at any time, whether in a hospital, clinic, or in the home. Applying techniques and algorithms from the fields of artificial intelligence, robotics, computer vision, and pervasive computing, the AIRR team helps older adults and individuals with disabilities live more independently.

TEAMS

BRAIN DISCOVERY & RECOVERY

Team Leader: Dr. Robin Green

The Brain Discovery & Recovery (BDR) team focuses on the 1.1% of the Canadian population with enduring effects of traumatic brain injury, effects that can be debilitating and last decades. This team has been at the forefront of research that re-conceptualizes moderate-severe TBI as a chronic and progressive disease process rather than a one-time event. Restoring Function: The BDR team has been translating their basic research findings (new brain biomarkers and novel causes of brain decline) into evidence-based treatments designed to restore brain structure and function, and to ameliorate cognitive and emotional functioning. Enable independence: By improving the brain and behaviour, these treatments are designed to help people to get back to more independent lives, back to school, work and an enjoyable social life. Optimize the Rehabilitation System: The BDR team has been developing internet-based therapies, ones that can be delivered by a therapist or self-administered on-line. This allows for significant scaling up of assessment and treatment. The team's approach is to deliver treatment to patients through their participation in research - this is filling a critical gap in both research and care in chronic TBI. Finally, the BD&R team is building a research centre for chronic traumatic brain injury in order to speed up scientific discovery, while scaling up delivery of care province-wide. 66

TEAMS

CARDIORESPIRATORY FITNESS

Team Leader: Dr. Paul Oh

The Cardiorespiratory Team of scientists and trainees comprise a unique mosaic of research interests that transcends multiple disciplines, while maintaining a central ethos of “exercise is medicine”, with the primary goal of improving patient health outcomes. The spectrum of research includes the optimization of rehabilitation programs for not only patients with cardiovascular disease, but for several chronic disease populations that have become increasingly more complex and pervasive in today’s society, locally, nationally, and globally. The team also focuses much of its attention on cardiovascular health services utilization and outcomes, in addition to access to and barriers to cardiac rehabilitation, with particular emphasis on sex-related differences pertaining to these aspects of rehabilitation. Team members conduct research in clinical epidemiology and social determinants, sedentary behavior, cardiac psychology, and equity and continuity in the secondary prevention of chronic disease. At the molecular, mechanistic, and physiological pathway level, they have interests in clinical pharmacology, pharmacoeconomics, lipidomic biomarkers, and other immunological avenues examining the brainheart relationship with respect to cognitive function, mood, and depression in chronic disease populations. This team also addresses several psychosocial aspects of cardiovascular health and chronic disease, with research in areas that include stress and sleep and their effects on cardiovascular morbidity and mortality, the effectiveness of financial health incentives, peer support, and patient education in the rehabilitation setting. Furthermore, the use of technology and music to monitor and promote effective health behavior change in the rehabilitation setting is being investigated.

TEAMS

COMMUNICATION

Team Leader: Dr. Yana Yunusova

The Communication Team undertakes research to restore speech, language and cognitive abilities and enable independence through improved communication in individuals living with dementia, stroke, traumatic brain injury, and Parkinsonâ&#x20AC;&#x2122;s disease. The team members are developing novel therapies to improve naming in those with aphasia, and speech articulation skills and emotional communication in those with Parkinson's disease. They are developing means to maximize communication between individuals with dementia and their caregivers (human and robotic). The team members also enable independent living for those with agerelated hearing loss by improving the design of hearing aids and their acceptability. The members of the team improve our rehabilitation system by participating in large country and province-wide initiatives focused on successful aging and quality of life through improved communication.

TEAMS

HOME, COMMUNITY & INSTITUTIONAL ENVIRONMENTS

Team Leader: Dr. Tilak Dutta

The Home, Community and Institutional Environments Team develops technologies to help older adults and individuals with disabilities live more safely and independently by preventing falls and ensuring safe mobility. They also develop technologies to prevent the spread of infection and to help caregivers avoid back injuries. The team implements their goals by bringing successful new products to the market, making important changes to policy and introducing new therapies to clinical practice.

TEAMS

MOBILITY

Team Leader: Dr. Avril Mansfield

The Mobility Team strives to optimize functional mobility for all. This requires a two-pronged approach: preventing loss of mobility with exercise and innovative interventions; and restoring safe independent mobility to those who have felt it decrease, whether gradually due to aging, or rapidly after a stroke, brain injury, fall, or other life-altering event. They develop and evaluate interventions to prevent falls and reduce secondary stroke, to help people avoid the need to enter a rehab hospital. They research, design and test novel therapies and rehab paradigms to boost recovery efficacy and restore valuable mobility to patients. They empower â&#x20AC;&#x153;rehab graduatesâ&#x20AC;? with skills and tools to maintain physical activity after discharge, enabling their independence from formal rehab and the health care system. Their research results have broad applications in geriatric, neuro-, and pulmonary rehabilitation. Team members have expertise in the study and treatment of human movement (kinesiologists and physiotherapists), structure and design (engineers), and medicine (physicians and nurses). They are a talented and caring unit of transdisciplinary researchers, learning the skills and perspectives of team members outside their primary discipline to become uniquely capable forces within the health care system.

TEAMS

NEURAL ENGINEERING & THERAPEUTICS

Team Leader: Dr. Milos Popovic

The Neural Engineering and Therapeutics (NET) Team is primarily focused on translational research to advance understanding of neurological recovery, neurorehabilitation, and quality of life for individuals with spinal cord injury (SCI). Since its inception, the team has been developing neuroprosthetic systems and assistive technologies, neurorehabilitation tools and interventions, and clinical assessment tools for individuals with SCI and other neurologic impairments. Most of NET Teamâ&#x20AC;&#x2122;s current interventions have potential for immediate clinical application within five years. Besides developing therapies, assessment, and new practices, the NET Team has evaluated the impact of these interventions on patients and their families.

TEAMS

OPTIMIZE

Team Leader: Dr. Kathy McGilton

The goal of Team Optimize research is to prevent cognitive and functional decline of persons requiring rehabilitation by focusing on restoring function and enabling independence for adults through the optimization of the health care system and the home environment. The results of their research will lead to 1) maintaining or improving the ability of patients to function independently, 2) improving health-related quality of life, and, 3) reduce unnecessary service utilization and associated costs. The researchers within this team understand that individuals with these complex conditions require an interdisciplinary solution to their care and deserve access to rehabilitation care so create solutions to improve outcomes such as: a clinic for older adults with complex conditions who have genitourinary cancer, increasing exercise among hemodialysis patients and their caregivers, patient centred rehabilitation models for persons with cognitive impairment, drama-based interventions to address the stigma of dementia and interprofessional clinics using telemedicine focused on chronic pain management. Their research strives to create the most effective health care systems, programs and approaches to caring for patients with complex (i.e. mental, physical, cognitive and social) conditions.

TEAMS

SLEEP SCIENCE

Team Leader: Dr. Doug Bradley

The Sleep Science Team aims to enhance management of sleep disordered breathing through increasing access to diagnosis, determining the causes of airway narrowing during sleep and developing new therapies. Each diagnosis of a breathing disorder during sleep (such as sleep apnea) allows for treatment in a timely manner, improving sleep quality, and preventing injury and poor health outcomes that come with untreated sleep apnea. BresoDx is their at-home sleep apnea diagnosis device that removes barriers to diagnosis; it has received Health Canada Approval and European Commission CE Mark as a medical device. Future generations of the device are in development. The team is developing a new laboratory at Toronto Rehab: SleepdB is a sound-proof laboratory that will help our full spectrum of research, from basic science to prototype development. This basic science research has already made novel observations on the pathogenesis of airway narrowing during sleep. This will lead to new treatments for sleep disordered breathing and help to restore function in patients with comorbidities such as stroke by reducing fluid shifts and their pernicious effects. Treatments can be as simple and practical as exercise, use of compression stockings during the day, diuretics or head elevation at night.

TEAMS

SWALLOWING SCIENCE

Team Leader: Dr. Catriona Steele

The Swallowing Science Team consists of a multidisciplinary group of researchers including speech-language pathologists and engineers whose goal is to optimize outcomes for individuals with swallowing impairment. They study methods to restore optimal swallowing function by tailoring interventions to the specific mechanisms underlying swallowing impairment. There are several foci of research for this team: tongue function; viscosity and texture modification; swallowing accelerometry; treatment studies; and nutrition.

2016 TEAM EXCELLENCE AWARDS TEAM EXCELLENCE AWARDS Toronto Rehabâ&#x20AC;&#x2122;s Team Excellence Awards are granted annually to graduate students from our 11 research teams who have performed exceptionally in the past year. Recipients are nominated by their team leaders.

The 2016 Team Excellence Award winners are:

ACQUIRED BRAIN INJURY (ABI) & SOCIETY TEAM

Sareh Zarshenas

Sareh Zarshenas is an award-winning former occupational therapy faculty member of the Isfahan University of Medical Sciences, Rehabilitation Sciences Department, in Iran. She has 7 published papers and was successful in obtaining 3 grants. As a doctoral student in the Rehabilitation Sciences Institute she has taken leadership roles within a multi-centred international study on rehabilitation outcomes with world renowned rehabilitation research investigators. She recently led a successful symposia submission for an international conference which addresses sex and age among brain injured inpatient rehabilitation patients. She is a recognized leader within the Rehabilitation Sciences Institute and also at the Toronto Rehabilitation Institute-UHN. She is an enthusiastic participant of our Gender Work and Health Journal Club. Outside of academia, she is a member of the Hooshvar Foundation that supports building cultural diversity and the Iranian Women's Association of Ontario.

2016 TEAM EXCELLENCE AWARDS ARTIFICIAL INTELLIGENCE & ROBOTICS FOR REHAB (AIRR) TEAM

Michael Li Michael Li joined the AIRR team in September 2013. At Toronto Rehab, he initially worked as a Research Assistant and worked on the development and evaluation of algorithms to continually estimate breathing and heart rates during sleep. He then started his graduate studies at the University of Toronto in September 2014. He is currently completing his MSc studies in the Institute of Biomaterials and Biomedical Engineering under the supervision of Dr. Babak Taati. In his thesis research, Michael has successfully applied stateof-the-art computer vision techniques to estimate clinical parkinsonism and levodopa-induced dyskinesia scores in individuals with Parkinson’s disease. His work at TRI has resulted in 2 peer reviewed journal publications and 2 peer reviewed conference papers (one of which received an award), all as the first author. Michael has always been happy to help out others at TRI, e.g. with their programming questions, and he has also been a good mentor for an undergraduate thesis student and an undergraduate summer student.

BRAIN DISCOVERY AND RECOVERY TEAM

Alana Tibbles

Alana Tibbles is completing her MSc in rehabilitation sciences at the University of Toronto, supervised by Dr. Robin Green. She is examining how substance misuse affects recovery after brain injury. The interesting and important finding she has uncovered is that the extent of attentional recovery is attenuated by a past (pre-injury) history of substance misuse (both alcohol and marijuana). This may be due to organic effects of substance use on the brain that renders the brain more vulnerable to the effects of brain injury, or to “post-injury” environmental factors, such as less environmental support. Either way, the rehabilitation implications are that this group is a cognitively vulnerable one, even when they are no longer using substances (as was the case for the large majority of participants in Alana’s study). In the short time Alana has been working on the study, she has very effectively disseminated her findings at conferences, including at the Rehabilitation Sciences Institute Research Day (May 2016), where she was invited to give an oral presentation, at the Collaborative Program in Neuroscience Research Day (May 2016), where she was accepted to give an oral presentation, at the 42nd Annual Harvey Stancer Research Day (June 2016,

2016 TEAM EXCELLENCE AWARDS poster presentation), and at Brain Injury Canada, 13th Annual Conference (September 2016) where she gave a very well-received oral presentation to a group or practitioners and researchers.

CARDIORESPIRATORY FITNESS TEAM

Leanna Lee Leanna Lee is in her second year of PhD studies at the Institute of Medical Sciences, University of Toronto. Leanna has a very strong background in exercise sciences and has been outstanding in the role of research coordinator for the cardio respiratory team for a number of years before deciding to resume her academic pursuits. Leanna is also an internationally ranked triathlete and thus brings genuine passion and authenticity to her graduate studies. Her thesis work will examine an innovative higher intensity interval training contrasted with conventional moderate intensity continuous exercise in women with cardiovascular disease. Given that this population has been largely ignored in studies to date, her research work will be quite novel and will have a significant impact on clinical program models at Toronto Rehab and many other cardiac programs nationally and internationally.

COMMUNICATION TEAM

Vina Law

Vina Law is currently a speech-language pathology graduate student working in the Oral Dynamics lab of Dr Pascal Van Lieshout. Vina has a strong academic background in linguistics and neuroscience. She is a lead student researcher on several projects in the lab. Recently, Vina completed a transcranial magnetic stimulation (TMS) study to investigate neural plasticity and motor learning in adults who stutter and co-created an experimental research paradigm to test neural priming effects underlying oro-facial tactile cues in speech rehabilitation. The latter study is in collaboration with the PROMPT Institute, Santa Fe, USA). In the lab, Vina also manages undergraduate research students (within and across disciplines) whom she trains and coordinates in order to support different aspects of a research project, from recruitment and management of human participants, to data collection using different state-of-the-art technologies (e.g. electromagnetic articulography or TMS and), writing software code and analyzing data using specialized statistical software (SPSS and R) as well as research writing. Vina consistently demonstrates exceptional research and leadership skills. In the last year, she was first and co-author 78

2016 TEAM EXCELLENCE AWARDS on conference proceedings as well as a co-author on manuscripts (currently submitted and in preparation) for international peer-reviewed journals. These skills and experience combined with Vinaâ&#x20AC;&#x2122;s strong motivation for leading research show great promise for a future successful career as clinician scientist.

HOME, COMMUNITY & INSTITUTIONAL ENVIRONMENTS TEAM

Robert Ramkhalawansingh

Robert Ramkhalawansingh has been an integral part of the Home, Community & Environments Team since 2012. His research focuses on understanding how the human brain integrates different sources of sensory information (visual, auditory, vestibular) to perceive self-motion through space. For example, Robert recently published some of the first findings to describe how auditory cues during driving (e.g. wind, tire, engine sounds) can be particularly important to support speed control in older drivers (Ramkhalawansingh et al., Frontiers in Psychology, 2016). He has presented his work at international conferences and has two other peer-reviewed publications submitted or in press. Overall Robert has been a key asset to the team through his insightful and valuable contributions to research, through his thoughtful approach to mentorship, and through his infusion of humor into daily team interactions. Robert will be completing his PhD in Psychology (UofT) in January of 2017 and we wish him all the very best.

MOBILITY TEAM

Olinda Habib Perez

Olinda Habib Perez is a PhD student with the Mobility Team. Her doctoral research has expanded our knowledge of balance impairments after traumatic brain injury (TBI) by applying a novel analysis to balance measures. The findings of her research will be valuable to rehabilitation specialists for assessing and creating interventions that address balance specific impairments after TBI. Furthermore, the impact of her doctoral research has influenced scientists and rehabilitation practitioners at TRI in research-clinical balance assessments for a longitudinal concussion study to improve evidence-based practice. She has published three peerreviewed papers as first author in the areas of motor control. Olindaâ&#x20AC;&#x2122;s graduate research has been supported by tri-council, provincial, and regional funding agencies (e.g., OGS, NSERC). She also 79

2016 TEAM EXCELLENCE AWARDS recently received the Best PhD Student Poster award at the Rehabilitation Science Institute Sector Showcase. Olindaâ&#x20AC;&#x2122;s contributes more to the Mobility Team than simply research; she actively plans social gatherings for the team and provides mentorship to new trainees. Additionally, she has contributed to expanding science literacy to youth through Letâ&#x20AC;&#x2122;s Talk Science, planned events for the Rehabilitation Science Graduate Student Union, assisted the RSI in the Programs and Curricula Committee for an external review, reviewed Summer Student applications for the D + H Sunnybrook Research Institute Award, and contributed to the 2015 TRI Research Day as an abstract and poster reviewer. Her academic excellence and other research contributions have recently led to a post-doctoral fellowship award through Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, which she will begin after completing her PhD.

NEURAL ENGINEERING & THERAPEUTICS TEAM

Jirapat Likitlersuang Jirapat Likitlersuang is a PhD candidate at the University of Toronto's Institute of Biomaterials and Biomedical Engineering. He previously received a BASc in engineering science, with a biomedical engineering major at the University of Toronto. Jirapat is currently developing a wearable sensor capable of quantifying functional use of the hand in the home and community. His work has applications in creating outcome measures to gauge the true impact of neurorehabilitation interventions, and in developing more effective strategies to remotely deliver care to individuals with neurological injuries. Jirapat has a passion for rehabilitation engineering. He has previously participated in the development of assistive and evaluation technology with scientists, engineers, and clinicians in multiple projects at the University of Toronto, Toronto Rehab, and the Holland Bloorview Kids Rehabilitation Hospital. He is currently central to multiple collaborations within the NET team, and is always ready to lend a hand with enthusiasm, humour, and talent. Jirapat is a previous winner of the TRI Student Scholarship, the TRI Scholarship in Rehabilitation-related Research for Graduate Students with Disabilities, and the Faculty of Engineering Award at the University of Toronto.

2016 TEAM EXCELLENCE AWARDS OPTIMIZATION OF THE REHABILITATION SYSTEM TEAM

Charlene Chu

Charlene Chu graduated from the Lawrence S Bloomberg, Faculty of Nursing In August 2016. For her PhD thesis, she developed and tested an intervention targeted at maintaining mobility and function of older persons with dementia admitted to long-term care (LTC) facilities. This is an important area of research as almost 40% of older people lose their mobility within the first year of being admitted to LTC.

Charleneâ&#x20AC;&#x2122;s curriculum vitae is a testament to her work ethic and her excellent productivity. She has systematically built her publication record, publishing in premier journals within the field. She has 5 first authored papers published or in press with an additional 12 as a co-author and 4 submitted for review. Over the course of her doctoral program she received 6 scholarships and most notably won the Mark Rochon Leadership award in 2014. With a clinical career in care of older adults, Charlene is optimally placed to identify future knowledge gaps and opportunities for investigation specifically related to care of older persons in acute and long-term care facilities. Charlene is a valuable and outstanding member of Team Optimize and she is being acknowledged for her achievements in what has been a particularly productive year.

SLEEP SCIENCE TEAM

Shumit Saha Shumit Saha is a PhD student at the University of Toronto with the Institute of Biomaterials and Biomedical Engineering. Shumit completed his Bachelor of Engineering at Khulna University of Engineering and Technology and his Masters of Engineering at the University of Manitoba and Toronto Rehab. At Toronto Rehab, Shumit is working on developing an acoustic model of the pharynx to assess pharyngeal anatomy for breathing disorders. Pharyngeal airway narrowing is a major cause of various respiratory disorders, in particular breathing problems during sleep such as sleep apnea. Current methods to assess pharyngeal airway narrowing and collapsibility require expensive and/or invasive measurements based on imaging or measurements of pressure fluctuations within the pharynx. Shumit has developed a novel acoustic model which can be used to estimate pharyngeal airway narrowing based on breathing and 81

2016 TEAM EXCELLENCE AWARDS snoring sounds. This method has the potential to develop novel portable technologies for assessment of pharyngeal airway narrowing during sleep. The result of this research was published in Scientific Reports (IF: 5.57), 2016. Moreover, Shumit has had more than 16 presentations in national and international scientific meetings, and has received highly prestigious scholarships such as Manitoba Graduate Scholarship and Connaught International Scholarship for Doctoral Students.

SWALLOWING SCIENCE TEAM

Ashley Waito

Ashley Waito is a second year doctoral student in Speech-Language Pathology, who came to her degree with an already established track record of publication and research as well as prior clinical experience. Ashley has completed all of her doctoral degree requirements in a single year, in addition to enrolling in the parallel Program in Neuroscience. Ashley’s research focus is on the important topic of swallowing impairment (dysphagia) in Amyotrophic Lateral Sclerosis (ALS). Ashley’s goal is to conduct research that will help us to better understand the nature of progressive swallowing impairments, which are debilitating in the ALS population. Ashley has conducted an extensive scoping review to identify what is known and what gaps in knowledge remain regarding swallowing difficulties in ALS, and she will presented this paper at an international conference in Milan in October 2016. She has outlined a clear plan of study, and already completed some pilot work exploring the pathophysiology of impaired swallowing in ALS through a collaboration with Dr Emily Plowman at the University of Florida. By elucidating the mechanisms by which this disease leads to impaired swallowing function, Ashley will set the stage for more timely identification and the development of effective interventions to restore or maintain swallowing function in people with ALS. Given growing international awareness of ALS through the 2015 ice-bucket challenge initiative, Ashley’s research is timely and has the potential to dramatically influence outcomes for people with this disease. Ashley is an exceptionally hard worker and a critical thinker who is diligent and productive in research tasks. Ashley also displays strong leadership ability, and has volunteered both on academic related committees such as the TRI Trainee Rep committee and in the community.

JOEL VERWEGEN AWARD JOEL VERWEGEN AWARD

The Joel Verwegen Award is given by the Cognitive Neurorehabilitation Sciences Lab at Toronto Rehab in memory of Joel Verwegen. Joel was an undergraduate student researcher in the Cognitive Neurorehabilitation Sciences Lab at Toronto Rehab in 2007 and 2008. He had a passion for learning, with a particular interest in cognitive neurosciences as well as evolutionary biology. Joel had an aptitude for research, and in the short time he worked at Toronto Rehab, he made substantive contributions. Joel possessed an intellect that was not only exceptionally sharp and rigorous, but also creative. He was meticulous and thoughtful in his actions, and he was immeasurably generous and supportive. The purpose of the award is to honour Joel and to inspire other undergraduate students to aim high. The 2016 award is shared by Delaram Dara and Ahmad Kamal. Delaram Dara is a 3rd year, full time undergraduate student, studying Human Biology and Cell and Molecular Biology at the University of Toronto. She is affiliated with UHN through her research at Techna Institute for the Advancement of Technology for Health and she is a former Clinical Support Volunteer at Princess Margaret Cancer Centre. Her goal is to pursue her education by entering a MD-PHD program as she hopes to become a Professor and to have her own laboratory to make life-changing discoveries. Due to cancer affecting the lives of many around her, and her deep passion for research, Delaram becomes more and more motivated to conduct research as she recognizes its essential and influential value. Thanks to Dr Zarrine-Afsar, Delaram commenced her journey in research and is currently continuing as an undergraduate research student.

Ahmad Kamal is in his 3rd year of the University of Torontoâ&#x20AC;&#x2122;s prestigious Engineering Science program and is specializing in Biomedical Systems Engineering with a minor in robotics and mechatronics. With a passion for biomedical research, Ahmad has spent the last two summers as a research trainee through the Institute of Biomaterials and Biomedical Engineering at the University Health Network under Dr Armand Keating and Dr Sowmya Viswanathan. Ahmad is excited to translate his passion for hands-on work into the field of biomedical engineering.

BEST PUBLICATIONS AWARD TRI BEST PUBLICATION AWARDS Sarah Munce Dr Sarah Munce has a PhD from the Institute of Health Policy, Management and Evaluation at the University of Toronto in Health Services Research and Knowledge Translation. She is a post-doctoral fellow at Toronto Rehab with Dr. Mark Bayley. In support of her postdoctoral research, Sarah has received awards from the Heart and Stroke Foundation of Canada, the Canadian Frailty Network, and the Canadian Institutes of Health Research. Broadly, she uses mixed and synthesis methods to develop, implement, and evaluate knowledge translation interventions in stroke, acquired brain injury, and spinal cord injury. She is a member of Team Optimize. Meaning of self-management from the perspective of individuals with traumatic spinal cord injury, their caregivers, and acute care and rehabilitation managers: an opportunity for improved care delivery. Munce SE, Webster F, Fehlings MG, Straus SE, Jang E, Jaglal SB. BMC Neurol. 2016 Jan 23;16:11. doi: 10.1186/s12883-016-0534-2. The trend of decreasing length of stay in rehabilitation facilities has led to individuals with spinal cord injury (SCI) entering the community with unmet needs and fewer self-care skills to prevent secondary complications. The implementation of a self-management program for individuals with SCI for the management of these complex needs, including secondary complications, may be one option to fill these care gaps. A greater understanding of the meaning of self-management may facilitate the development of a tailored selfmanagement program in this population. Thus, the current research aims to understand the meaning of self-management in traumatic SCI from the perspectives of individuals with traumatic SCI and their caregivers as well as acute care/trauma and rehabilitation managers. Interventions that are co-created by users and health care professionals are associated with positive physical and mental health outcomes. The understanding of selfmanagement from these varying perspectives could be applied to the development of a tailored self-management program that is associated with outcomes that are relevant to individuals with traumatic SCI and their family members/caregivers. 84

BEST PUBLICATIONS AWARD Alison Schinkel-Ivy Dr Alison Schinkel-Ivy is an Assistant Professor at the School of Physical & Health Education at Nipissing University in North Bay, Ontario. She obtained her PhD in Kinesiology and Health Science from York University (2014) and was a post-doctoral fellow with the Mobility Team at the Toronto Rehabilitation Institute (University Health Network) from 2014 to 2016 under the supervision of Dr Avril Mansfield. Dr Schinkel-Ivy's work at TRI focused on gaining insight into mechanisms and characteristics of reactive balance control in individuals with stroke, and identifying changes in reactive balance control following perturbation training in this population. Her current research aims to quantify how movement characteristics and strategies change across the older years of the life span, as well as the effects of psychological, cognitive, and environmental factors on these outcomes. The ultimate goal of this work is to develop strategies to better promote function and longevity, independent community living, and work capacity for older adults. Do quiet standing centre of pressure measures within specific frequencies differ based on ability to recover balance in individuals with stroke? Schinkel-Ivy A, Singer JC, Inness EL, Mansfield A. Clin Neurophysiol. 2016 Jun;127(6):2463-71. doi: 10.1016/j.clinph.2016.02.021. The objective was to determine whether quiet standing measures at specific frequency levels (representative of reactive control) differed between individuals with stroke, based on their ability to recover balance (Failed or Successful Responses to external perturbations). Results showed that reduced ability to recover balance among individuals with stroke may be reflected in impaired reactive control of quiet standing. These results provide insight into the mechanism by which reactive control of quiet standing is impaired in individuals with stroke, and may inform assessment and rehabilitation strategies for post-stroke reactive balance control.

BEST P BEST PUBLICATIONS AWARD IONS AWARD MARK ROCHON LEADERSHIP AWARD MARK ROCHON LEADERSHIP AWARD The Mark Rochon Leadership Award in Rehabilitation Sciences was established in recognition and celebration of Mark Rochon, Toronto Rehab’s former CEO. A highly respected and influential health care leader, Mr Rochon was a driving force in the evolution of Toronto Rehab into one of the world’s most prominent health science centres focused on rehabilitation. His passion for, and his belief in, research and the development of the next generation of leaders is the impetus for this important and prestigious award. The goal of establishing this award was to support students in a Master’s or PhD program that aligns with the research mission and goals of the Toronto Rehabilitation Institute. Students need to also demonstrate leadership qualities through extracurricular activities, community service, and/or other personal achievements. We are very pleased to announce this year’s recipients of the Mark Rochon Leadership Award. Aaron Yurkewich won the $10,000 award and very strong runners-up Philippa Gosine and Sareh Zarshenas received $1,000 each. Aaron Yurkewich is a 2nd year PhD Student at IBBME investigating how robots should be designed for upperextremity stroke rehabilitation and daily assistance, and integrated into clinical and home therapy programs. He has actively participated throughout the Toronto Rehab network as a volunteer and representative of its partner associations the Biomedical Engineering Students' Association (BESA), AGE-WELL and the Canadian Partnership for Stroke Recovery (CPSR). He hopes to continue taking on these leadership roles to learn continuously from all stakeholders about the rehabilitation process and create innovative solutions for our healthcare needs. http://www.iatsl.org/people/ayurkewich.html

BEST P BEST PUBLICATIONS AWARD IONS AWARD MARK ROCHON LEADERSHIP AWARD MARK ROCHON LEADERSHIP AWARD: RUNNERS-UP Sareh Zarshenas is a 3rd year PhD student in the Rehabilitation sciences Institute at the University of Toronto. She is part of the Acquired Brain Injury and Society team and is supervised by Drs Nora Cullen and Angela Colantonio. Sareh completed her BSc and MSc in Occupational therapy in Iran and is a registered Occupational Therapist in Ontario. As a doctoral student she is investigating the process and contents of inpatient rehab for patients with Traumatic Brain Injury by conducting a comparison model between TRI and US facilities. Sareh has published numbers of articles and attended national and international conferences to disseminate the primary results of her work. Sareh has recently been awarded the TRI OSOTF Scholarship for 2016-2017. Outside of academia, Sareh is one of the coordinators of mentorship committee at Rehabilitation Science Graduate Students' Union and a liaison between the ABI-society lab and research trainees at TRI.

Philippa Gosine is a 2nd year MASc student in Biomedical Engineering at IBBME, supervised by Drs Alison Novak and Geoff Fernie. She is studying the balance recovery reactions and associated biomechanical demands following balance loss during stair descent. Her project was awarded Best Interactive Display at TRI's 2015 Research Day. For the past five years, Philippa has been involved in various capacities with Engineers Without Borders (EWB). She shares EWB’s systemic, people-centered approach and is striving to be part of sparking passion, changing people’s perception of what engineers can be and inspiring a new generation of engineers with the skills to solve the world’s most complex problems. During her time as President of the Memorial University chapter of EWB, MUN became the first university in Canada to implement the Global Engineering Certificate and worked to support other EWB chapters to do the same as Atlantic Lead of the Global Engineering Initiative. She is the lab representative on the Biomedical Engineering Student Association in Dr Novak’s lab and a student representative on the planning committee for the 2016 Slips, Trips and Falls Conference which will be hosted by Toronto Rehab.

BEST P BEST PUBLICATIONS AWARD IONS AWARD ACKNOWLEDGEMENTS TRI Research Leadership Institute Director, Research Geoff Fernie

Associate Scientific Director Milos Popovic

Associate Academic Director Susan Jaglal

Director of TRI Research Operations and Business Development Catharine Hancharek

TRI Research Team Leaders Angela Colantonio Alex Mihailidis Robin Green Paul Oh Yana Yunusova Tilak Dutta Avril Mansfield Milos Popovic Doug Bradley Catriona Steele Kathy McGilton

Acquired Brain Injury (ABI) & Society Artificial Intelligence & Robotics for Rehabilitation (AIRR) Brain Discovery & Recovery Cardiorespiratory Fitness Communication Home, Community & Institutional Environments Mobility Neural Engineering & Therapeutics Sleep Science Swallowing Science Optimization of the Rehabilitation System

Committee Chairs Geoff Fernie Kathy McGilton Cathy Craven Milos Popovic Susan Jaglal Susan Jaglal

TRI Research Advisory Standard Operating Procedures Central Patient & Subject Recruitment Academic Appointments, Promotions & Productivity Jr. Scientists Support & Mentorship Studentsâ&#x20AC;&#x2122; Support and Mentorship

BEST P BEST PUBLICATIONS AWARD IONS AWARD Research Day Chair

Volunteers

Trainees

Susan Jaglal

Cecilia Campolongo Jennifer Campos Tess Del Mundo Tilak Dutta Gary Evans Susan Gorski Pam Holliday Sanja Hulec Saba Kajaks Emily King Georg Kralik Bart Scieranski

Sanaz Agha Chao Bian Michael Bray Jasmine Carter Genevieve Foley Tuck-Voon How Vicki Komisar Konika Nirmalanathan Teresa Valenzano Ashley Waito Vicky Young-Cherin Aaron Yurkewich

Research Day Team Jessica Hoang Chen Catharine Hancharek Simon Jones Jahvanna Ryan Dan Smyth Shoshana Teitelman Meg Tennant Matt Tran Lois Ward Barry Westhead

(We appreciate the help of all volunteers whose names were not available when we went to print)

A big thank you to the judges! Andrea Bandini, Austin Bergquist, Swati Bhatawadekar, Bojana Budisin, Emilie Jean-Batiste, Jill Cameron, Tracey Colella, Sherry Grace, Andrew Huntley, Behrang Keshavarz, Avril Mansfield, Cesar Marquez-Chin, Kristin Musselman, Alison Novak, Cristina de Oliveira Francisco, Nancy Salbach, Catherine Wiseman-Hakes, Susan Marzolini, Dan Vena, Azadeh Yadollahi, Vicky Young, Yana Yunusova Q:\Research Day\2016 Research Day\Abstract Book\Final Nov 8v1.docx

BEST P BEST PUBLICATIONS AWARD IONS AWARD INDEX BY PRESENTING AUTHOR & ABSTRACT# Alavinia Mohammad, 85 Ali Saba, 78 Ali Saima, 52 Antonio Patrick, 17 Aryan Raabeae, 48 Ashraf Ahmed, 64 Bagheri Zahra, 8 Barbon Carly, 61 Bentley Danielle, 90 Bhatawadekar Swati, 25 Biajar Anmol, 34 Biswas Aviroop, 5 Bolivar Telleria Isabel, 51 Bray Michael, 39 Carter Jasmine, 79 Cen Danny (Jun Yu), 9 Cervinka Tomas, 86 Chan Katherine, 19 Chang Isaac Sung Jae, 1 Changoor Alana, 38 Cheng Weiran, 10 Chiu Karen, 83 Cole Thomas, 26 Cronin Shawna, 91 Crosby Lucas, 46 Cunningham Ceilidh, 92 Cuperfain Ari, 84 Dawe Jaclyn, 53 Dolatabadi Elham, 2 Ford Daniel, 12 Garcia Martha, 59 Ghannadi Borna, 74 Giles Renuka, 80 Gill Laksh, 49

Gonzalez Esquivel Maria del Pilar, 27 Gosine Philippa, 13 Gray Julia, 24 Grigorovich Alisa, 99 Gruenspan Grant, 28 Haag Lin, 93 Haghzare Shabnam, 65 Hasan Zain, 3 Hassan Ahnaf Rashik, 29 Hobler Fiona, 94 How Tuck-Voon, 36 Hummel Richard, 60 Inami Toru, 30 Jose Tricia, 66 Kajaks Tara, 82 Kearney Elaine, 43 Khan Shehroz, 67 King Emily, 11 Koh Ryan, 54 Kong Sean, 70 Langer Laura, 75 Lee Jae, 20 Likitlersuang Jirapat, 87 Mansouri Farrokh, 55 Milosevic Luka, 56 Mitchell Marc, 6 Miyatani Masae, 21 Moineau Bastien, 58 Mollayeva Tatyana, 73 Moro Christina, 68 Morrone Kayla, 7 Nespoli Gabriel, 44 Nirmalanathan Konika, 14

Noack Greg, 76 O'Neill Meagan, 95 Pitzul Kristen, 96 Pong Steven, 15 Powers Jessica, 47 Ramkhalawansingh Robert, 16 Rampersaud Darshani, 81 Razavian Reza, 37 Resnick Myles, 50 Sabetian Parisa, 22 Saha Shumit, 31 Salemohamed Naima, 97 Samfira Ioana, 32 Saumur Tyler, 18 Seixas Lima Bruna, 41 Shafi Reema, 62 Sharan Eshani, 72 Simic Tijana, 42 Singh Hardeep, 88 Solano Ivan, 71 Sumitro Elizabeth, 89 Tibbles Alana, 40 Vasquez Brandon, 77 Waito Ashley, 33 Wang Chen Daniel, 98 Wiseman-Hakes Catherine, 4 Xiong Chen, 63 Yamashita Taro, 57 Yoo Jaeeun, 23 Yung Stephanie, 45 Yurkewich Aaron, 69 Zarshenas Sareh, 35

BEST P BEST PUBLICATIONS AWARD IONS AWARD

From Research to Solutions...

Ferocious Innovation: We are entering an era of Ferocious Innovation - The last ten years have been a decade of discovery for Toronto Rehab. As we emerge from this time with a huge body of knowledge, amazing strategic partnerships, and a global perspective in rehabilitation research, it is now our time to scale up, push even further, to translate this new knowledge into Real Solutions.