Cure and Care Program updates

1. Further our understanding of the biology and physiology of SCI.

• Biobanks are a repository of biological samples that are used as a source for medical research. With support from the Rick Hansen Foundation through the Blusson Integrated Cures Partnership and in partnership with ICORD, a team of researchers led by surgeon-scientist Dr. Brian Kwon is working to establish a SCI biobank which will store biological samples such as cerebrospinal fluid and blood tissue for future investigative purposes and international collaborations on biomarker analysis which researchers believe can play a significant role in predicting the severity of injury and providing insights into the best treatment options for a specific individual.
• Projects supported through RHI’s open funding competitions are well underway and represent a great mix of promising preclinical and clinical therapies that will increase our understanding of how SCI affects the human condition. Learn more about the winning projects here and here.

2. Develop promising therapies for neuro-restoration in acute and chronic SCI.

• RHI is currently supporting three neuro-restorative trials:

1. 1. Led by surgeon-scientist Dr. Michael Fehlings, a study using Magnetic Resonance Imaging (MRI) into the development of MRI-Based Biomarkers in patients with acute SCI is underway to determine if certain MRI techniques are able to capture information that reflect the severity of injury in acute SCI and can offer patients a more accurate prognosis. Based on data from the RISCIS Phase III trial (which addresses the safety and efficacy of riluzole as a neuroprotective agent), the study will look at the use of two specific MRI techniques that may yield valuable imaging biomarkers – i.e. information that correlates with the severity of injury and also predicts functional outcome at six months post injury.
   2. SCI cardiovascular expert Dr. Andrei Krassioukov and team are studying the effects of epidural stimulation on cardiovascular and cognitive health following spinal cord injury. Cardiovascular disease (CVD), which can result in heart attacks and strokes, is a leading cause of death among individuals with SCI. Epidural stimulation of the lumbar spinal cord may offer significant improvements in blood pressure stability by re‐establishing cardiovascular regulation in individuals with SCI. The team is examining the effects of this intervention on blood pressure stability, and the associated clinical consequences including brain blood vessel health, cognitive function and overall cardiovascular risk.
   3. Surgeon-scientist Dr. Andres Lozano and team are studying how deep brain stimulation of the pedunculopontine nucleus (PPN) may improve walking ability after SCI. The PPN is a portion of the brain that is involved in many functions including voluntary limb movements and locomotion. Recent ground-breaking research has already demonstrated that deep brain stimulation improves locomotion in rat models with incomplete SCI and the safety of this method is established in humans with Parkinson’s disease and chronic pain. This study will select five individuals with incomplete SCI and severe gait impairment to examine if bilateral deep brain stimulation of the PPN improves walking ability.

Care Program

RHI’s Care Program focuses on the creation and adoption of best practices to optimize care delivery for people with spinal cord injury and to maximize functional recovery and prevent secondary complications. In addition to well-established projects such as ACT, SCIRE and SCI KMN, here are some activities we are working on towards meeting our Care objectives.

1. Achieve evidence-informed equitable care for Canadians who sustain a SCI.

• A major goal of our Care Program is to have 50% of Rick Hansen SCI Registry facilities in Canada accredited by 2018, according to the SCI Standards developed in partnership with Accreditation Canada. To date, seven of 31 participating RHSCIR facilities have received SCI accreditation through Accreditation Canada’s Qmentum process (see facilities here) with an additional six scheduled for site visits by spring of 2018. To support and help prepare facilities for accreditation visits, RHI has produced a series of tools and resources free of charge. An added bonus is that facilities not associated with RHSCIR are also participating in the SCI Standards with Grace Hospital in Winnipeg becoming an SCI accredited site this past year. For resources on how your facility can become SCI accredited, visit RHI’s clinical resource site http://sci2.rickhanseninstitute.org.

2. Identify and fill important gaps in knowledge that will advance SCI care and facilitate future SCI cure(s).

• RHI and the Ontario Neurotrauma Foundation (ONF) are supporting the development and implementation of a health economics agenda for SCI research in Canada. This agenda will apply health economics research to support existing RHI programs and other national SCI collaborations. In addition to establishing evidence of the economic burden of SCI and secondary complications to encourage action and support research and development initiatives, the health economics agenda will increase the breadth, quality, and applicability of health economic evidence in the field of SCI. The intent is to enhance decision-making in SCI care and the allocation of limited healthcare resources and research funding to support the translation of best practices; avoid excess healthcare costs; and protect and promote the well-being of Canadians who sustain a SCI throughout the continuum. View the report here.
• Pressure ulcers continue to be a serious secondary complications following SCI and are identified as an area of focus in RHI’s Care Roadmap. Therefore, RHI and ONF are supporting the revision of a Canadian SCI Pressure Ulcer Strategy. Led by committee co-chairs Dr. Pamela Houghton and Dr. Chester Ho, and informed by a multidisciplinary expert panel, the strategy outlines the necessary steps to reduce the incidence, prevalence, severity, and improve healing of pressure ulcers following SCI. To establish and operationalize translational research in this area, the strategy will be disseminated to healthcare providers and researchers who participated in an initial strategy summit, other Canadian experts in SCI and/or pressure ulcer prevention and management, as well as key stakeholders and decision-makers. A summary of this agenda will be published on our website - stay tuned! 
  
• In order to provide consistent and standardized clinical assessment and outcome measures, RHI's Clinical Team is working with RHI-affiliated facilities across Canada to implement a number of assessment and outcome measures into clinical practice, including the Spinal Cord Independence Measure (SCIM) and a Standing & Walking assessment protocol. Available as a resource through the International Spinal Cord Society, the SCIM is a measure of function which assesses daily tasks in the areas of self-care, respiration, bowel and bladder management and mobility. The Standing & Walking assessment protocol outlines different stages of standing and walking recovery after SCI, and standardizes measures of standing and walking appropriate for each stage. Standardized assessments and outcome measures provide clinicians and patients with an accurate picture of the progress they are making in reaching their rehabilitation goals and facilitating research.