Clinical

Sponsor:

Duration: 2013 to 2016

Abstract:

Approximately 11,000 individuals in North America sustain a spinal cord injury (SCI) every year and become one of the 300,000 people living with SCI in the US and Canada. A SCI is one of the most debilitating injuries known to humankind. The total annual health cost for Canadians with SCI approaches $3.6 billion, much of these costs are related to the treatment of secondary complications. Cardiovascular disease is the number one cause of illness and death among people with SCI, and people with SCI exhibit cardiovascular risks younger and more frequently than the general population. One of the most serious consequences of injury to the upper spinal cord is an inability to control blood pressure, a complication that is grossly under-recognized and usually poorly treated. The consequences of this are severe, left untreated unstable blood pressure can cause stroke and even death. It is also possible that long term unstable blood pressure causes damage to the heart, which likely contributes to the early onset of cardiovascular disease in this population. An active lifestyle is one of the most effective ways to improve heart health and reduce cardiovascular risk in the able-bodied population; however, exercise options are restricted after SCI and we have limited information on the cardiovascular effects of exercise in people with SCI. The overall question of this research program is: Can exercise improve heart function and reduce cardiovascular complications in individuals with chronic SCI?
To answer this question we will conduct both animal and human studies to investigate how the heart changes over time following SCI and what mechanisms are responsible for the changes. Traditionally, exercise for people with a SCI involved only arm exercise; however, more recently, new and exciting methods of exercise, such as supporting the weight of the individual while they walk on a treadmill, have provided unique methods of exercise. Unfortunately, we do not know whether upper- or lower-body exercise provides sufficient stress to the heart to elicit beneficial changes. Accordingly, we will compare the effectiveness of upper- and lower-body exercise in people with spinal cord injury.
This is a pioneering project that utilizes parallel studies in animal models and human subjects to explore the mechanisms underlying cardiovascular dysfunction and the effects of exercise on the heart after SCI. This overall goal of this research is to provide important information that can help shape rehabilitation strategies and ultimately improve the quality of life in people living with spinal cord injury.

Sponsor:

Duration: 2012 to 2014

Rationale:
A significant number of individuals with spinal cord injury (SCI) require frequent emergency room visits due to episodes of uncontrolled autonomic dysreflexia (AD) originating predominantly from the bladder (up to 90%). Reducing the number of chronic cardiovascular complications of SCI would dramatically improve the health and well-being of Canadians with SCI while positively impacting healthcare costs. The present study will be a first attempt to evaluate the economic impact of using Botulinum toxin A (BOTOX), a naturally occurring potent neurotoxin produced by the Clostridium Botulinum bacteria, to manage the urinary bladder following SCI. Once injected into the detrusor muscle of the bladder we will be able to examine its impact on preventing episodes of life-threatening AD and consequently calculate cost savings for the Canadian healthcare system.

Aims:
1. To assess the effect of BOTOX on blocking AD response during bladder filling through urodynamics procedure.
2. To assess the effect of BOTOX on blocking responses and severity of AD during 24-hour ambulatory arterial blood pressure monitoring with daily catheterizations.
3. To assess the economic implications by undertaking a cost analysis of BOTOX injections on AD care and hospital re-admissions following six months of treatment.
4. To assess the effect of BOTOX and blocking of AD responses on health-related quality of life and incontinence quality of life.

Knowledge Translation Goal:
Education of Urology colleagues on the importance of blood pressure monitoring during urodynamics assessment. This educational aspect will be connected with our previous project titled “ABC of Autonomic Dysreflexia: Translating knowledge into best practice”. Data will be presented to Canadian/US Urological Society meetings as well as national and international conferences. We plan to create clinical practice guidelines for the utilization of BOTOX in the management of both neurogenic bladder and autonomic dysreflexia. The development and dissemination of these guidelines will be part of a Canada-wide Knowledge Translation initiative to improve cardiovascular health in Canadians with spinal cord injury.

Sponsor:

Duration: 2012 to 2013

Abstract:

The goal of this project is to improve knowledge and awareness of autonomic dysreflexia (AD) among individuals with SCI. By educating consumers, family members and caregivers on the timely recognition and management of the condition, we hope to reduce costly and frequently preventable hospital admissions that may result from lack of knowledge of the condition. Ultimately, we hope to empower these individuals to take control of their health and well-being, a confidence often lost due to the debilitating consequences of injury.

Sponsor:

Duration: 2011 to 2016

Abstract:

Exercise training has the potential to improve strength, performance, and well-being among people with SCI. However, we have little information on the CV effects of training in people with SCI. People with SCI respond differently to exercise. This is information that we urgently need to develop exercise programs that will be effective in improving CV health for Canadians living with SCI. The goal of this proposal is to improve CV health for people with chronic SCI through optimized exercise and targeted education. This project gathers a diverse team of 13 prestigious scientists working at 6 Canadian universities. We will use both animal models of SCI and training in people with SCI to examine the effects of exercise on CV risk. We will also determine whether educating health care providers on specific CV problems associated with SCI will help to reduce the financial burden of care, and improve treatment, of people with SCI. For more information, please click here.

Sponsor:

Duration: January to December 2012

Abstract:

A unique disadvantage that athletes with SCI face during competition is unstable blood pressure control. During training and competition, these individuals must deal with extremely low blood pressure, and/or uncontrolled episodes of severe hypertension, known as autonomic dysreflexia (AD). Despite the serious risks associated with AD (stroke, myocardial infarction, death), is it well known that some athletes will self-induce AD to enhance athletic performance, a phenomenon known as “boosting”. While the International Paralympic Committee (IPC) prohibits this practice, it is nearly impossible to reveal the full extent of boosting among Paralympians. As cardiovascular disease represents the primary cause of death and disease in this population, it is essential to increase knowledge and awareness of such risks to athlete’s health and well-being.
Our goal is to establish a Cardiovascular Clinic at the 2012 Paralympic Games. The program will provide athletes and support teams with crucial evidence-based clinical resources, evaluations of blood pressure and heart function, and recommendations for minimizing risks to cardiovascular health during training.

Sponso r:

Duration: 2010 to 2012

Abstract:

The consequences of uncontrolled spikes in blood pressure, known as autonomic dysreflexia (AD), after spinal cord injury (SCI) are extremely severe. People with SCI have a two-fold higher risk of developing heart disease in comparison to non-injured individuals. Furthermore, cardiovascular dysfunction is currently a leading cause of death among people with SCI.

Despite the presence of the published Paralyzed Veterans of America Guidelines on management and prevention of AD, there are obvious gaps in the distribution of this knowledge outside of SCI rehabilitation centers. Therefore, in accordance with the mission of the PVA Education Foundation, the proposed project is designed to improve the knowledge and skills of health care professionals who serve people with SCI in emergency situations. By educating paramedics, ER physicians and nurses with the specifically designed “ABC of AD” course, we anticipate the early prevention of occurrences and complications related to AD in people with SCI.

Sponsor:

Duration: 2010 to 2012

Abstract:

Evidence suggests that the fluctuation of the relatively lower blood pressure of SCI patients than the normal control is likely to be a risk factor of their impeded cognitive function, as well as the mood status. In the SCI patients with autonomic dysreflexia increased blood pressure is common. This study is to investigate the effects of AD on cognitive and mood functions in patients with spinal cord injury. The aim of the study is not to prove the positive/negative effects of AD on cognitive and mood functions, but to gain information in order to plan a larger study in the future.

Sponsor:

Duration: 2010 to 2012

Abstract:

Presently we have well established and detailed criteria for the blood pressure parameters in able-bodied population and guidelines for the monitoring of changes in these parameters². Unfortunately, at the present time we do not have a full clinical picture of the changes in cardiovascular parameters in individuals with SCI. Furthermore, we still do not appreciate the full extent of influence of the changes in arterial blood pressure on extend of neurological recovery following this devastating injury.

Aims:

1. To establish a data base with the natural progression and recovery of cardiovascular parameters in individuals with SCI.

2. To establish the effect of the changes in arterial blood pressure on potential neurological recovery following traumatic SCI.

3. To develop a guidelines on the acute monitoring and management of cardiovascular parameters for individuals with SCI.

Sponsor:

Duration: 2011 to 2012

Abstract:

Knowledge Translation Goal: To improve knowledge and to change practice on management of life-threatening episodes of cardiovascular emergencies among individuals with spinal cord injury (SCI) by educating Canadian paramedics on evidence based clinical guidelines.

Rationale: Our preliminary data demonstrated that there is a lack of knowledge among paramedics on timely recognition and proper management of life-threatening episodes of autonomic dysreflexia (extremely high blood pressure accompanied by pounding headaches, sweating) which could result in stroke, heart attack, and even death. In fact, cardiovascular abnormalities are currently the leading cause of mortality in persons with SCI.

Knowledge Translation Methods: We will develop a web-based education module on the management of AD for paramedics and paramedic students across Canada (three sites).

Main Messages: The goal of this project is to improve knowledge and change the practice of paramedics by enhancing recognition and management of AD. We ultimately aim to improve health care for people living with SCI by reducing costly and frequently preventable hospital admissions that may result from lack of knowledge on management of this condition.

Sponsor:

Duration: 2008 to 2010

Abstract:

Greater awareness and knowledge on management and appropriate actions for the management of these life threatening conditions in this populations by medical personal outside of the SCI rehabilitation centres could prevent episodes of full blown autonomic dysreflexia (AD) and possibly decrease emergency room (ER) and hospital admissions.

This prospective study will focus on needs assessment and knowledge evaluation of ER physicians and nurses as well as paramedics who are the first line of medical practitioners facing the challenges in management of these conditions.

Purpose: This proposal is focused on evaluating the effect of education on issues of management of chronic secondary cardiovascular conditions in SCI population: autonomic dysreflexia, orthostatic hypotension by the medical personnel of ER and paramedics.

Hypothesis:

H 1. There is a lack of knowledge in the management of unstable blood pressure control incuding the episodes of life threatening autonomic dysreflexia among the medical personnel (ER’s MD,RN and paramedics) who are not involved in care of persons with SCI on a daily basis.

H 2. The introduction of the educational tool (ABC course on AD) will improve the early diagnosis and appropriate management of these conditions.

Sponsor: Duration: January to December 2010

Abstract:

The main goal of the proposed project was to bring evidence-based clinical knowledge and crucial practical information on unstable arterial blood pressure control among athletes with spinal cord injury (SCI) to a worldwide athletic community of Paralympic athletes and coaches who will be participating in Vancouver 2010 Winter Paralympic Games. Specifically, we educated athletes, caregivers and coaches on the importance of maintaining good cardiovascular health during exercise and sport. This was achieved by creating awareness and promoting understanding of three major cardiovascular consequences of SCI: autonomic dysreflexia , orthostatic hypotension, and the boosting phenomenon.

Sponsor:

Duration: 2009 to 2011

Abstract:

ASTeP is an online training course for the International Autonomic Standards for the Classification of Spinal Cord Injury. The autonomic standards will allow clinicians and researchers to appreciate possible autonomic dysfunctions and to be able to describe the effects of spinal cord injury on bowel, urinary bladder, sexual, cardiovascular, broncho-pulmonary, sudomotor and other autonomic functions.