On May 26th 2022, the Rehabilitation Sciences Institute (RSI) at the University of Toronto held it’s annual student research day. Each year, RSI Research Day gives students from the department the chance to share their work. While it was virtual again this year (thanks COVID), the day was filled with top notch presentations showcasing the invaluable research being conducted at RSI. With the importance of knowledge translation always top of mind for RSI Research Day, an exciting new collaboration was born. For the first time, rehabINK and the RSI Research Day committee present the winners of each presentation category! This year, we have asked the winners to provide a summary of their prize winning work as a chance to try their hand at writing about their research for the general public. So without further ado, here are the RSI Research Day winners!

We hope that you enjoy this special installment of rehabINK!

Christina Ziebart & Stephanie Cimino, co-Editor-in-Chief, rehabINK, Beatrice Manduchi & Wade Michaelchuk, co-Chairs, RSI Research Day Committee

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People’s Choice Poster PhD Award: Why do some people exercise post stroke by not others?

By: Azadeh Barzideh, PhD Candidate

Background: Less than half of people with stroke participate in aerobic exercise (AE) during rehabilitation. Many studies have explored the reason behind this by searching for barriers and facilitators to AE prescription and participation from the physiotherapists’ perspective only or have examined physiotherapists’ and patients’ perspectives separately, without considering how they may interact. In my study however, not only do we explore the interaction between physiotherapists’ and patients’ interviews, but we also put the patients at the centre of the discussions in physiotherapist’ interviews

Objectives: The purpose of this study is to understand clinical decision making around aerobic exercise prescription and participation in stroke rehabilitation, from both the physiotherapists’ and patients’ points of view combined.

Methodology: A qualitative descriptive approach was adopted. We invited people with stroke at the end of their rehabilitation stay, or soon after discharge.  All treating physiotherapists were invited to take part in the study. All participants completed one-on-one, semi-structured interviews. The final sample size will be determined based on information power. Data are analysed concurrently with data collection. The theoretical domain framework (TDF) is used to guide the deductive part of data analysis.

Preliminary results: Five stroke patients and 5 physiotherapists have been interviewed to date. Patients believed they have poor knowledge of aerobic exercise, its benefits, and how to monitor it. Knowing benefits of exercise, perceived sense of independence, and enjoying exercise were among incentives for aerobic exercise. Physiotherapists mostly believed aerobic exercise is not a priority for patients with numerous impairments and co-morbidities.  Patient related factors such as severe mobility issues, very low endurance and motor control mostly lead to no aerobic exercise prescription. On the other hand, factors such as patient’s interest in aerobic exercise and being physically capable to preform it would lead to aerobic exercise prescription.

Impact: A better understanding of the determinants of participation in AE during stroke rehabilitation will help us develop interventions that can increase AE participation.

People’s Choice Poster PhD Award & Knowledge Translation Competition Award: The Youth Concussion Awareness Network (You-CAN): a pilot study

By: Brynna Kerr, PhD Student

Many Canadian youth suffer from concussions each year, but often these youth do not report their concussions to an adult. This is a concern because youth who do not get the care they need (for example, support from a doctor) after a concussion may take longer to recover, keeping them from the activities they need and love to do. To encourage youth to report their concussions, we must educate them about concussions in a way that is relevant and meaningful to them. Providing youth with this education in their schools using a peer-education model may be beneficial as it can reach all youth. It also allows youth to learn from each other, which may make the information more engaging and memorable. Currently, no researchers have explored if a school-based peer-led education program helps improve concussion reporting in youth. To address this gap, our research team created the Youth Concussion Awareness Network (You-CAN) program. You-CAN is a school-based peer-led concussion education program for Canadian high school students.

To evaluate the You-CAN program, we will invite four high schools from across the country to run the program in their schools. Each school will create a Concussion Council made up of at least two students and one school staff member. These councils will use the evidence-based concussion resources on the You-CAN web portal to create a week-long concussion awareness campaign in their schools. Before and after each school’s campaign, we will ask the entire school to participate in a school-wide survey. This survey will help us learn about what students know about concussions and what they would do if they thought they had a concussion. The findings from this study may help us create concussion education programs that are more meaningful and engaging for youth, which may lead to improved concussion knowledge, attitudes and behaviours in this high-risk population

People’s Choice Poster MSc Award: Gaining insight into gender and Autism shaping mental health experiences of self-diagnosed women.

By: Francis Routledge, MSc Student

The Autism Spectrum, commonly conceptualized as Autism Spectrum Disorder (ASD), has been heavily researched from a biomedical lens. This biomedical way of understanding Autism underpins research focused on genetics and co-morbidities and the search for deficits in behaviours compared to socially accepted behavioural norms. Emphasizing biomedical constructions of Autism directs attention away from other ways of understanding and learning from the lived experiences of Autistic people, in which Autistic ways of being are embraced as a dimension of difference rather than a deficit. Moreover, the profoundly personal experiences of Autistic people related to assessment, diagnosis, community, and being labeled as ‘disordered’ can have significant effects on health, wellbeing, and identity.

Importantly, Autism can present differently in non-male populations. An Autism assessment gap exists where males are two to three times more likely to receive an Autism diagnosis than females. Limited understandings of Autism in women contribute to the discrepancy in diagnosis, significantly impacting women’s health through misdiagnosis, underdiagnosis, or diagnosis later in life. As a result, many adults have relied on or arrived at self-diagnosis. The purpose of this study is: 1) to explore how prevailing ideas about gender and Autism in health sciences intersect and shape the experiences of self-diagnosed Autistic women, and 2) to examine the implications for their mental health.

Guided by a critical social sciences perspective and intersectionality, this qualitative mixed-methods study will involve a critical discourse analysis of health sciences literature on Autism, gender, and mental health and semi-structured interviews with self-diagnosed Autistic women. Results will identify and challenge prevailing ideas about gender and Autism.  Examining the intersection of gender and Autism in the context of self-diagnosis will provide a novel lens to understand the impact of self-diagnosis and the mental health experiences of self-diagnosed Autistic women. 

Best Poster PhD Award: The basic science of patient-provider communication: in theory and practice.

By: Jacquelin Forsey, PhD Student

Health professionals must be expert communicators. However, communicating with patients is challenging and complex because of what is being shared, the health literacy of the patient, and personal values and preferences. To succeed in complex and uncertain scenarios, health professionals must be adaptive communication experts. Adaptive experts can apply their existing knowledge base and create new knowledge as required by the patient needs and context. We can prepare learners to be adaptive experts by providing them with conceptual knowledge integrated into the clinical curriculum, and we call this conceptual knowledge ‘basic science’.

Our first step was to identify the basic science of patient-provider communication. We completed a critical scoping review of the literature that included 271 articles.Our analysis resulted in six conceptual groupings that represent the basic science of communication: (1) clear and explicit language, (2) patient participation and activation, (3) negotiating epistemic knowledge, (4) affiliative language and emotional bonds, (5) role and identity, and (6) managing transactional and relational goals.

The next step towards improving communication training is understanding current educational practices in both the classroom and the clinic. We are currently completing an analysis of communication teaching materials for health professionals. We will analyze the data quantitatively using linguistic software and qualitatively using thematic analysis. The analysis will use our previously identified conceptual groupings to help interpret the data.

To understand clinical teaching, we will observe teaching moments between staff and trainees at Holland Bloorview, followed by interviews with staff to explore their approach to communication teaching. This data will also be analyzed through the lens of our conceptual groupings. This program of work will set the stage for us to move forward with new educational approaches aimed at preparing health professionals to be the adaptive communication experts their patients need and deserve.

Best Poster PhD Award: Exploring the demand for a video gaming, home rehabilitation intervention for children with cerebral palsy in Costa Rica.

By: Daniela Chan Viquez, PhD Candidate

In developing countries like Costa Rica, many children with Cerebral Palsy (CP) face accessibility barriers to rehabilitation services. Home-based therapies can facilitate access to care. Effective and engaging approaches are needed to motivate and support children in practicing motor therapies at home. Bootle Blast (BB) is a low-cost videogame, played through body movements that encourage hand and arm exercises. BB does not need internet or controllers to be played and can be adapted to each child’s abilities & therapy goals.

This project (part of a larger research study) aims to understand the demand for using BB as a family-centred, home based therapy intervention among Costa Rican children with hemiplegic CP. Indicators of a positive demand for the intervention include 1) recruiting more than 3 participants a month, 2) ≥80% of people interested have an appropriate screen and space to play, 3) participants can set a weekly play time goal (PTG) ≥45 minutes and identify at least one hand/arm therapy goal. Participants expectations for the intervention were also explored via interviews.

Five children (7-11 yrs) and their mothers were enrolled in the span of two months. This recruitment rate was mainly affected by limited human resources. Most families in Costa Rica have a flat screen TV. Since BB only requires a 3×3 m² of space to play, these were not barriers for families to participate. The use of a short video showcasing BB (recruitment strategy) made the intervention easy to understand, so all participants could set at least two hand/arm therapy goals, and PTGs ranging from 20-30 min /3-4 days per week. Most children had not received therapy for over a year, and families shared a feeling that “any therapy is better than no therapy”. Children were motivated by the fun component of BB, while parents were interested in its therapeutic value.

Worldwide, children face accessibility barriers to motor therapy services. This study will provide valuable learnings on how therapy gaming interventions can/should be implemented to bridge accessibility gaps, engage children and caregivers, and improve access to care.

Oral Presentation Award: Facilitators and barriers to implementation of swallowing therapies for head and neck cancer patients: preliminary results from a qualitative study.

By: Beatrice Manduchi, PhD Candidate

“The swallowing therapy was working. I needed somebody that knew what might happen to me, to my swallowing. Because nobody else does”. This is a quote from a patient who received radiation treatment to cure throat cancer. People with a tumor in the head and neck region are indeed at high risk of developing swallowing problems (or dysphagia). Dysphagia can have serious medical and psychosocial consequences, including pneumonia, malnutrition, dehydration, depression, and in severe cases it may force patients to be fed with a tube in their stomach, for their entire life. For all these reasons, Speech-Language Pathologists (SLPs) provide swallowing therapy to these individuals, consisting in training their swallowing muscles to prevent the consequences of dysphagia. However, the benefits of providing swallowing therapy during radiation are still unknown. Therefore, a large clinical trial is currently being conducted to test the effectiveness of providing swallowing therapy during radiation from a quantitative standpoint. However, to understand if such therapy can be implemented in real world settings, the opinions of patients involved in this trial need to be explored.

We conducted a qualitative study with these patients with the aim of answering the question: is delivering a swallowing therapy during radiation treatment doable, from a patient perspective?

After interviewing 6 patients using semi-structured interviews, 6 main facilitators and barriers to implementation were identified. Among the facilitators, patients mentioned that receiving constant support and encouragement throughout radiation from the speech pathologist, as well as receiving simple, graphic instructions to complete the exercises, was key to enhance their engagement with the therapy. Among the barriers, patients reported having trouble completing the exercises once they started experiencing acute symptoms of radiation; in addition, patients who ended up being on a feeding tube also reported several barriers related to have to take care of their feeding.

We concluded that patients extremely valued receiving swallowing therapy during radiation, as they felt that someone was taking care of this vital aspect of their life. We also understood that regular clinician support facilitates the implementation of this therapy, and that adjustment of therapy goals may help overcome the most common barriers.

Oral Presentation Award: Therapists’ perspectives on using brain-computer interface-triggered functional electrical stimulation therapy for individuals living with upper extremity paralysis.

By: Hope Jervis Rademeyer, PhD Candidate

Research has shown that brain-computer interface-triggered functional electrical stimulation therapy (BCI-FEST) can improve arm and/or hand use after stroke or spinal cord injury. The next step is to find out if BCI-FEST is a good fit for a larger clinical setting, like a hospital. The purpose of our study was to find out if BCI-FEST could be used in a larger clinical setting to improve arm and/or hand use for people with stroke or SCI.  

We interviewed three physical therapists and three occupational therapists who used BCI-FEST with people who had a stroke or SCI. Interview questions used the COM-B (Capability, Opportunity, Motivation – Behaviour) theory to find out how to change the behaviour of using BCI-FEST in a larger clinical setting. We also used the COM-B to categorize therapists’ quotes before the interviews started. These categories were: (1) Capability (physical, psychological), (2) Opportunity (physical, social), and (3) Motivation (automatic, reflective). Strengths for therapists were: Physical Capability, Automatic Motivation, and Reflective Motivation. Therapists needed more assistance for Physical Opportunity and Social Opportunity. For Psychological Capability, only therapists new to BCI-FEST needed support. Participants found BCI-FEST helpful and worthwhile, but not ready for a larger clinical setting.  

To address future behaviour change to implement BCI-FEST, we matched different approaches to COM-B categories. Department advisors and a larger community could improve Social Opportunity. Next, education on how BCI-FEST works, and therapy results could improve Psychological Capability. Lastly, we could schedule BCI-FEST sessions to improve Physical Opportunity.    There is not a lot of research about the viewpoints of people who use BCI-FEST. Our study speaks to this gap, by providing information for future research. Our findings can help develop new technologies and therapies to improve arm and/or hand use and prepare BCI-FEST for larger clinical settings.

Knowledge Translation Competition Award: Problems with using artificial intelligence to diagnose neurological diseases

By: Chelsea Tanchip, PhD Student

This infographic highlights the dangers of using artificial intelligence (AI) for diagnosing neurological diseases. AI has become a staple in digital healthcare, with many scientists and healthcare professionals relying on it to make complex decisions. In truth, the performance of AI diagnostic systems is highly dependent on factors such as population demographics. In addition, many AI systems use complex algorithms that are not easily interpretable. For these reasons, more research and development is needed to examine the shortcomings of AI and develop solutions for appropriate and widespread use for neurological disease diagnosis.