Susan Pettit, an occupational therapist at Hamilton Health Sciences, performs an assessment on a patient in the Complex Medicine Rehabilitation Unit at Juravinski Hospital.

What are the key indicators of a person’s ability to live and care for themselves independently?

Is it their capacity to dress themselves in the morning? To prepare their own meals? To move about with ease?

Assessment can be a tricky business, and many assessment tools rely heavily on the observations and judgment of the therapist, whose task is challenged by the fact that the abilities and needs of each patient are unique and often quite complex.

It is often the role of an occupational therapist (OT) to make this kind of qualitative assessment of people’s lives to determine what kind of help is needed and to create an action plan. And they often have to take that assessment down to a finer point.

“Often, the role of the OT is quite abstract,” says Susan Pettit, an occupational therapist in the Complex Medicine Rehabilitation Unit (CMRU) at Juravinski Hospital in Hamilton, Ontario. “OTs must take into account what is important to each client before being able to help them overcome or compensate for a change in their abilities.”

Over the last few years, Susan has been a strong advocate for the standardized Assessment of Motor and Process Skills (AMPS), an observational assessment method that allows OTs to measure the quality of an individual’s motor and process performance as they carry out activities of daily living. It’s a comprehensive method that provides the therapist with a more refined, meaningful understanding of an individual’s capabilities.

“The AMPS is unique in that it can be done with persons of all ages, with any diagnosis, in their own language, and it uses activities that are familiar,” says Susan. “Other assessments are often geared to identify a deficit but do not predict how that deficit will affect function.”

AMPS is distinct in that it rates performance of both motor and process skills against an established cutoff point. Raw data is entered into a computer system, which plots the information on a scale that shows whether the individual falls above or below the cutoff for a specific task, and whether they perform within the normative range for healthy people of the same age. The database is comprised of data that has been standardized internationally and cross-culturally on more than 100,000 subjects, providing an objective basis for measuring change over time.

AMPS was developed more than 20 years ago in Sweden, and has since been offered as a course in more than 25 countries around the world. In order to administer AMPS, OTs must complete a five-day training workshop, and are required to administer the test on 10 people following the course. This testing is part of a calibration process that allows assessment scores to be adjusted according to the severity of the rater, reducing bias and allowing for more consistent results.

“The AMPS tool provides the health care team, as well as patients and their families, with valuable information regarding an individual’s motor and processing capabilities,” says Jennifer Henderson, chief of occupational therapy at Hamilton Health Sciences. “It can be a relief for families to have strengths and weaknesses clearly identified, and practical strategies provided that will help them support their loved ones as they transition back into the community.”

At Hamilton Health Sciences, there are more than 85 occupational therapists working in outpatient and inpatient areas. To date, 20 have been trained in AMPS. In an effort to increase uptake of the program, Susan and Jennifer have been successful in bringing the AMPS workshop to Hamilton. The first workshop was offered by Hamilton Health Sciences in October of 2011 to OTs both internal and external to the organization. During the week of April 16-20, 2012, Hamilton Health Sciences hosted its second AMPS course at St. Peter’s Hospital

“To obtain AMPS training, an OT must often travel to another province or even another country,” says Jennifer. “By offering the course right here in Hamilton, OTs are able to enhance their practice at a lower cost and focus on the interventions that they know will make the biggest difference in the lives of their patients and their families.”

Dr. Jon Hummel, Program Chief of Surgery at Rouge Valley Centenary, is a member of the Rouge Valley CIO Day proposal team. The team's winning proposal - a computer program to prioritize surgical wait times - earned them a $10,000 grant from Cancer Care Ontario.

An innovative computer program to prioritize surgical procedures at Rouge Valley Health System (RVHS) has earned the hospital a $10,000 grant from Cancer Care Ontario (CCO).

The winning proposal was submitted as part of CCO’s ‘The Operating Room’ competition, which was held during the organization’s Chief Information Officer (CIO) Day 2012, earlier this month. The contest provided an opportunity to submit an innovative information management or information technology solution addressing a health care need.

“Rouge Valley Health System’s computer program to prioritize surgical wait times for patients exemplifies how we’re evolving the way we use information technology and innovation to improve patient care, safety and access in Ontario,” says Rick Skinner, vice president and chief information officer, Cancer Care Ontario.

“This program will help to ensure that the right patient receives their treatment first,” says Dr. Jon Hummel, program chief, surgery at Rouge Valley Centenary, and a member of the RVHS proposal team. “It will help to address wait list issues, which is great for our patients and community.”

Prior to the final live competition, each submission was reviewed by the CCO selection committee. In the end, Rouge Valley was selected as one of only three hospitals to pitch their solution to a panel of judges at the CIO Day event. This winning proposal was selected by the panel and announced as the winner at the end of the event.

The idea was a collaborative effort by Rouge Valley’s chief information officer, Thodoros Topaloglou, and surgical program leadership of: Renate Ilse, program director, surgery, endoscopy and central processing; and Dr. Hummel.

They identified gaps in the way surgeries are currently booked and how this could be improved for patients. Currently it is the responsibility of a surgeon’s administrative assistant to schedule each patient’s surgery date. It’s quite a challenge, as the assistants need to balance surgeon availability, patient preference, operating room schedules and then apply the Ontario Wait Time priority system rules in order to determine which patient will be operated on first. Each Ontario hospital also has its own provincial wait time targets to meet for different surgical procedures. The current system doesn’t consistently manage how patients can be treated in the best order possible.

There hasn’t yet been a computer program designed to review all of this information and then determine the order in which a patient should be treated. That is what the Rouge Valley team has proposed.

“This product has so much potential. If it is successful, it will give patients better care and ensure that they get a fair booking time, and sooner,” explains Renate Ilse. “It ensures that we are booking people optimally, which will result in shorter wait times. Once this system is in place, it can be shared with other hospitals. And for Rouge Valley to have been the one to develop this improvement is an achievement that we can be very proud of.”

The $10,000 grant will be used to help design the new program, which will be used by Rouge Valley surgeons’ administrative assistants. The proposal team will return to showcase their invention during the CIO Day event next year.

Dr. Robert Ogilvie (second from left) celebrates his retirement from 41 years of Ear, Nose and Throat surgical practice at Toronto’s Humber River Regional Hospital (HRRH) with HRRH Operating Room, Registered Nurses, Cyndi Difilippo (left); Deborah Reccord (second from right) and Corazon Rayos (right) in December 2011.

He’s a surgeon with a song.

And he hasn’t missed a beat in over 41 years; always singing, smiling and whistling while delivering extraordinary care and compassion to patients at Toronto’s Humber River Regional Hospital (HRRH).

Dr. Robert Ogilvie is an Ear, Nose and Throat (ENT) surgeon; a father of four and a grandfather to 10 children.  He credits the “tremendous support” from his wife Hazel and a balanced lifestyle to his long and rewarding surgical career.

“I’ve always paced myself,” says Ogilvie humbly; a Rhodes Scholar who was born and raised in Grenada, studying medicine at both the University of the West Indies in Jamaica and Oxford University in the United Kingdom. “I took work home in the evenings and I worked on the weekends but I made sure that I had an afternoon off in between to spend quality time with my family so I could enjoy all that life has to offer.”

At the beginning of this year, that lifestyle changed.  Dr. Ogilvie – one of Humber River’s longest-serving surgeons and a pioneer of the Hospital – retired from surgery, closing the chapter on an amazing four decades of surgical success and a career that’s shown his remarkable dedication, professionalism and gentle nature in healing others.

“There is no finer gentleman than Bob Ogilvie,” says Dr. Bill Francis, a retired Obstetrician and Gynecologist and the first doctor to work at Humber River Regional Hospital. “I worked with Bob for over 40 years and everyone knows him as a modest, passionate surgeon; supportive, collegial and one of the nicest people around.

“Dr. Ogilvie is one of the kindest and most committed doctors I know,” says Cathie Watts, HRRH operating room Clerical Associate who’s worked alongside Ogilvie for 40 years. “He provided care to all four of my children and his singing and whistling creates a warm and inspiring work environment.”

“No matter the day or time, he always has a wonderful greeting for everyone,” adds Deborah Reccord, HRRH Operating Room Registered Nurse who worked with Ogilvie for the last six years.  “Whether you are colleague, a patient or a student, Dr. Ogilvie takes an invested interest in who you are; where you are from and how you are doing.  His patients love him and he provides remarkable continuity of care, often helping multiple family members, from one generation to the next.”

“Dr. Ogilvie has been caring for me and my family for over 35 years,” says Paul Valenti, a real estate lawyer and a former Vice Chairman of the Board of Humber River Regional Hospital.  “His pleasant bedside manner and respect for his patients is second to none and he always takes the time to explain his treatment practices and procedures,” he adds.  “This outstanding level of care is greatly appreciated.”

In addition to caring for patients, Ogilvie has contributed in many ways to Humber River, its programs and community. He completed a term as Chief of Surgery; he was an Ontario Medical Association Representative and he spent time visiting local schools, talking to children about his role as a surgeon and the hospital experience.

Ogilvie was also a strong supporter for the launch of Humber River’s Parental Presence and Participation for Induction (Hug and Hold) Program – a Child life initiative, in collaboration with HRRH anesthetists, surgeons and nursing staff, that allows a parent to be present in the operating room so they can provide comfort, support and coaching to their child during anesthetic induction.

“With Dr. Ogilvie as a leading supporter we were able to implement this unique and innovative Program, and see the successful results instantly,” says Alexandra Christofides, HRRH Child Life Specialist who works with HRRH surgeons, patient and families to facilitate the operating room experience. “With his warm, friendly approach and his natural ability to make children laugh and feel comfortable, it’s always been easy to see why Dr. Ogilvie is loved and admired by everyone,” she adds.  “I feel honoured to have worked alongside such an accomplished, kind and modest man.”

While Ogilvie will continue to work in his medical practice and in the HRRH surgical clinic doing minor procedures he’s thrilled to be experiencing this new phase in his life.

“I am going to catch up on my sleep after almost 50 years of being ‘on call,’ ” says Ogilvie with his trademark smile. “I have the best of both worlds: continuing to help people feel better in my practice and spending more time with my family and on the golf course. Life is wonderful.”

Dr. John Semple, Chief of Surgery, Women’s College Hospital and Chancellor Crawford, CEO, QoC Health reviewing a mobile app that monitors patients post-surgery.

At Women’s College Hospital (WCH) developing new and innovative ways to diagnose, treat and care for patients is always at the forefront.  The newest example is being led by Dr. John Semple, chief of surgery, who is running a pilot project to test a new mobile app.

Developed by QoC Health, a patient health-care-focused technology company, the app allows doctors to monitor post-operative patients once they’ve been discharged from hospital.

As part of the pilot, 60 orthopedic and breast-reconstruction patients were provided with a smartphone or tablet with instructions on how to file daily reports of their recovery.  The patients take photos of their surgical incisions and answer a series of health questions each day. The surgeons then download the responses for a simple and fast method to keep an eye on their patients’ recovery.

“This app allows patients to receive a quick ‘checkup’ from home. I can keep track of their recovery and hopefully prevent complications before their next scheduled visit,” says Dr. Semple. “Our goal is to decrease emergency room visits by catching problems early and treating them before emergency care is needed – before infections become severe or further complications occur.”

When a surgeon logs into the app, it prioritizes patients who are most in need of care by evaluating their responses to the health questions.

The benefits are numerous. For the patients, it delivers enhanced quality of care, decreased infection rates and potentially a reduction in the number of followup visits. Anxiety levels are also reduced because patients know a doctor is checking in on them daily. For the surgeons, it provides an easy way to monitor their patients, ensuring a safe recovery.

“Technology is changing the way the health-care system offers medical care as smartphones are opening the lines of communication between doctors and patients,” adds Dr. Semple. “Our app is a great example of how technology can improve treatment by adding an extra layer of care. Patients can safely recover in the comfort of home while getting the very best care possible.”

For the pilot project Samsung supplied the enabling mobile technology, tablets and smartphones for doctors and patients, and Rogers supplied SIM cards and airtime enabling QoC to provide its revolutionary technology.

“We are very fortunate and grateful for our partners at Women’s College Hospital, Rogers and Samsung,” says Chancellor Crawford, CEO, QoC Health. “Though we developed the platform and technology, we could not apply it without Women’s College Hospital taking a lead role as the demonstration partner.”

And this is just the beginning.

“These types of innovations will change the future of health care,” concludes Dr. Semple. “Technology is capable of saving health care dollars while providing far better patient care.”

Dr. Jan Andrysek, Scientist at Holland Bloorview Kids Rehabilitation Hospital with the low cost prosthetic knee he developed has received a $100,000 grant to continue his work on the LC Knee joint.

Dr. Jan Andrysek, Scientist at Holland Bloorview Kids Rehabilitation Hospital, has been named rising star in global health by Grand Challenges Canada and received a $100,000 grant to continue his work on the LC Knee joint, a low cost prosthetic knee that has the potential to be mass-produced and distributed to amputees in the developing world.

Countries such as Haiti, Cambodia and Afghanistan have a need for prosthetic devices due to the high number of amputations resulting from natural disasters and land mine injuries, but cost and lack of funding make these devices inaccessible to amputees.  In Canada, where prosthetic devices range from $5,000 – $50,000, Andrysek’s LC Knee joint can be manufactured for approximately $50, because it’s made of low cost thermoplastics and relies on injection molding techniques, but cost is not the only advantage.

“A key component of the limb is its unique knee mechanism that functions much like the human joint. It automatically locks and unlocks itself based on how the person is putting weight on the limb,” Andrysek says. This provides for a natural looking gait.   The plastic knee is also durable and waterproof which will likely make it effective in rough terrain and humidity – the type of environment you would expect to find in developing countries.”

Andrysek has spent about six years developing the knee joint with a team at the Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital. Andrysek says the LC Knee was really the product of their initial work with children, where the key criteria include making the joint functional, for active kids, but also very durable. What developed from these criteria was a knee joint that also fit the needs of developing countries and addressed a gap in global accessibility.

Andrysek plans to use his $100,000 grant to further test the LC Knee in developing countries. Researchers whose ideas prove successful are eligible for another 1 million from Grand Challenges Canada to help get their innovation to the people who need it most.

“As a researcher, one of the most rewarding things is when you can actually take a project from the beginning, with the conceptualization, and actually get to a point where it gets out and starts having an impact on people’s lives and people’s health,” says Andrysek.

The grant is one of 15 that Grand Challenges Canada awards to Canadian researchers that solve some of the most persistent health challenges in the developing world through scientific/technological, business and social innovation.

Recognizing the need for more mixed race stem cell donors in Canada, registrant Jeff Chiba-Stearns offers his final DNA sample during a recent OneMatch swab event.

Each year thousands of Canadians are diagnosed with blood cancers, inherit immune system and metabolic disorders, and blood diseases such as Sickle-Cell and Thalassemia. Many of these same patients may require a stem cell transplant to survive and yet only 30 per cent will find their compatible stem cell donor from an immediate family member. This means that 70 per cent of patients will have to rely on the generosity of a volunteer stem cell donor to survive their illness.  When this happens, patients and their doctors will depend on Canadian Blood Services’ OneMatch Stem Cell and Marrow Network to search both national and international stem cell databases for their match.

With over 950 patients currently being searched by OneMatch, and over 317,000 Canadian registrants on the OneMatch Stem Cell and Marrow Network, there continues to be a significant gap to accurately reflect the changing face of Canada with 76 per cent representing Caucasian and 24 per cent multi-ethnic.

This gap in finding ethnically-diverse matches for ethnically-diverse patients is a significant challenge confirms Canadian Blood Services’ Stem Cells Executive Director, Sue Smith. “The genetic markers used to match donors to patients occur with different frequencies in different ethnic groups.  The best chance of finding a match comes from within a patient’s own ethnic group. In order to better meet the needs of patients, the OneMatch registry must reflect the ethnic composition of the Canadian population.  This is all part of our concentrated effort to build an optimal stem cell network for patients.”

Another key responsibility OneMatch is building leadership within the international stem cell community by providing an ‘optimal’ donor for patients and their physicians.  “As a member of World Marrow Donor Association, our obligation remains to provide both Canadian transplant centres and international registries the best donor available – or, ‘optimal donor’ – for their patients.  The international transplant community has defined an ‘optimal donor’ as young – between the age of 17 and 35 male, and ethnically diverse,” confirms Sue.

This need is bolstered by the fact that many clinicians are finding that younger stem cells from male donors routinely offer patients a better outcome by reducing post-transplant complications such as graft vs. host disease and the reconstitution of the immune system.  “A recruitment strategy defined by a focus on young, ethnically diverse male donors will allow the Network to change the composition of the donor base to better reflect the needs of patients in Canada and around the world.”

The cornerstone to building an optimal stem cell network is the establishment of Canada’s first national public umbilical cord blood bank – Canadian Blood Services’ OneMatch Public Cord Blood Bank.  Starting in the Ottawa area in April 2013, parents will be able to voluntarily donate their babies’ cord blood.  The OneMatch Public Cord Blood Bank will benefit Canadian patients and the country’s health care system, as it will provide those in need of stem cells with an increased opportunity for transplant.  “This is especially important for Aboriginal and Black patients who routinely have difficult searches due to complex alles and haplotypes, informs Sue.  “Equally important is the fact that the public cord bank will decrease our reliance on international sources while creating more transplant opportunities for Canadian patients with a cord blood bank that is reflective of Canada’s ethnic diversity.”  The Ottawa site will be followed by Toronto, Edmonton and Vancouver by the fall of 2014.

Building an optimal Network cannot be done alone implores Sue, “Creating an optimal donor registry for patients requires the generosity and commitment of all Canadians.  As OneMatch continues this journey to building a world-class stem cell network, the participation of our hospital customers is pivotal towards providing better transplant outcomes for all patients”.
For more information or to register as a potential stem cell donor please go to www.onematch.ca.

Jonathan Breslin is Hospital News' new Ethics Columnist who will be contributing a column bi-monthly.

In December, 2005, the Canadian Council for Donation and Transplantation (CCDT) published a report entitled, “Public Awareness and Attitudes on Organ and Tissue Donation and Transplantation Including Donation After Cardiac Death.” The report included the results of a survey of more than 1500 Canadians about their views on organ donation. Although 96 per cent of Canadians surveyed approve of organ donation, only 55 per cent reported having made a decision to be a donor.

This is not surprising – increasing organ donation rates continues to be one of the most significant challenges in healthcare. The most recent data from the Canadian Institute for Health Information indicates that, as of June 30, 2011, there were a total of 1065 organs transplanted across Canada, while there were more than 4500 still waiting for transplants. The waiting list numbers don’t include the 123 patients who died while waiting.

There are several factors that contribute to the continued under supply of transplantable organs but I’m going to focus my first column on one in particular. If you dig into the CCDT report you’ll find an interesting statistic: in response to the statement, ‘Doctors may declare death prematurely in order to get donations,’ a full 20 per cent of respondents said this statement is either probably or definitely true. This is especially relevant to those of you who work in areas in which organs or tissues may be retrieved. It means that one out of every five people you encounter is worried that you or the physicians on your team may prematurely declare them or their loved ones dead in order to obtain their organs. Now let’s talk about what you can do to help address this concern.

First, since this is an ethics column, I want to say a few words about the ethical issue underlying the concern. The ethical issue is a prime example of what we like to call a conflict of interest. A conflict of interest arises when there is potential for a secondary interest to interfere with the pursuit of your primary interest (or responsibility or obligation).

As a health care provider your primary interest (obligation) is to promote the best interests of your patient. It doesn’t matter what kind of professional you are, every professional code of ethics shares this primary interest in common. Of course you also have secondary interests – some of them may be “selfish” interests, such as prestige, reputation, or money, while others may have a basis in your codes of ethics or practice guidelines, such as an interest in promoting organ donation.

So when someone expresses the concern that doctors may declare death prematurely to obtain organs, they are expressing a concern about the doctor being in a conflict of interest – in particular that his or her (secondary) interest in obtaining transplantable organs may interfere with his or her (primary) interest in doing what is best for the patient. Why is this a problem?  Because conflicts of interest, even if they are just perceived conflicts, erode the trust that patients and their family members have in health care professionals. It is also worth noting that this is not just a concern on the part of patients or families but also of health care providers.  I have heard physicians and nurses express discomfort about broaching the subject of organ and tissue donation with family members of a patient in part because they worry that doing so will create the perception of a conflict of interest.

The way to address a potential conflict of interest such as this is to implement safeguards to prevent health care providers from finding themselves in the potential conflict. There are two main safeguards that exist in Ontario to address this issue. One is that the role of the team that retrieves and/or transplants the organs and tissues is separated from the role of the team that is caring for the patient.

This separation enables the team caring for the patient to remain focused on the patient’s interests until death occurs, at which point a different team takes over to retrieve and transplant the organs (assuming consent has been obtained).  Separating the roles in this manner helps reduce the likelihood that individual health care providers will find themselves playing conflicting roles.

The second safeguard that exists, which directly addresses the concern regarding declaration of death, is that the option to donate is raised and discussed with the patient’s next of kin by an external professional, a coordinator from the Trillium Gift of Life Network (TGLN).  Health care providers in Ontario are instructed to call TGLN when a patient has died or meets certain indicators for high risk of imminent death, at which point the TGLN coordinator takes over.  Health care providers who have a close relationship with the patient’s family may choose to remain involved to provide emotional support, but they are not required to do so.  Having the independent TGLN coordinator raise the topic of donation with the next of kin helps separate the conflicting interests even further.

Armed with this knowledge the best thing you can do as a health care provider to help close the gap between the supply and demand for transplantable organs is to help spread the truth about organ donation: that we are in great need of organ donors, that physicians are dedicated professionals who would not prematurely declare death to obtain organs, and that our system is designed to meet the highest ethical standards.

Linda Jean Remmer, 62, diagnosed with Parkinson’s in 2009, enjoys dancing with husband, Ross.

Nora Lea Arcand attends a professionally-led exercise class for people with Parkinson’s twice a week at a recreation centre in her Sudbury, Ontario community. “If I didn’t exercise, I wouldn’t move. I mean that seriously,” says Arcand. “After 20 years of living with Parkinson’s, I know I would seize up. When I walk after supper and when I’m doing the exercises, I move much better during the day.”

Parkinson’s disease is a movement disorder that affects over 100,000 Canadians. With symptoms such as tremor, slow movement, muscle rigidity and walking difficulties, it would not be surprising if people became sedentary. However, research indicates that people with Parkinson’s who exercise fare better over time than those who are inactive.

“When people with Parkinson’s have those really bad days where rigidity is a problem and slow movement makes life difficult, the people who exercise regularly have more resources to draw on because their bodies are stronger,” says kinesiologist Maria Fragapane.

As co-supervisor of the Wellness Centre at the Cummings Centre for Seniors in Montreal, Fragapane has several years’ experience in developing kinesiology-based programs for people with Parkinson’s. She says, “What makes for a good program is to try to target the things that people are having problems with, then train for that with task-specific exercises.”

In addition to tackling the usual Parkinson’s symptoms, her programs address some of the lesser-known areas affected in Parkinson’s.

Dual-tasking. People with Parkinson’s often have difficulty performing activities such as walking and talking at the same time or being able to turn a corner while carrying a parcel. The exercise classes incorporate obstacles courses to train the body and brain.

Proprioception. Some people have trouble sensing where their own bodies are positioned in space. Class facilitators give cues and constant verbal reminders about proper body positioning. Are you stepping with your heel or with your toes? Swing your arms. Keep your head up. Stand straight. Chin up.

Reaction time. Reaction times can be slower in Parkinson’s. The program makes innovative use of boxing exercises to work on coordination and strength. As the instructors constantly switch directions, the participants are forced to react. Fragapane believes that boxing, like dance, offers a combination of focus and rhythm that keeps people moving. “It seems to stop the freezing during the time they’re doing it.” For some participants, the seven-minute boxing segment is the highlight of their day. Fragapane says, “There’s something exhilarating about punching a bag.”

Fragapane is a firm believer in using exercise gadgets such as balance boards and Wii technology and adapting them to suit a person’s mobility level.

For people who want to develop their own exercise routines, Janet Millar, clinical director and physiotherapist at the Maritime Parkinson’s Physiotherapy Clinic in Halifax offers some recommendations:

Exercise regularly, meaning daily. Make it challenging. “Those are the two criteria in which the literature tells us Parkinson’s can be slowed down.”

Focus on five key areas: endurance, flexibility, balance, posture, strength. “Walking is one of the most beneficial activities. It addresses several of those five issues and it provides opportunities to pay attention to stride length, gait pattern and arm swing, which are all affected in Parkinson’s.”

Emphasize the anti-gravity muscle group. “These are the muscles that straighten you or make you taller.” Back extensors, knee straighteners, triceps – the muscles at the back of the elbow that straighten the arms, enabling you to reach up, to the side and behind the back, shoulder blade squeezes. “These work against the typical stooped posture in Parkinson’s.”

Make exercise a lifelong habit. “There is something every single person can do – right from the person who can work out in the gym alongside everyone else to the person who may be confined to a bed and need extra support and intervention.”

Get active and stay active. If you enjoy group exercise, look for classes at community recreation centres. If not, find something you can do on your own or with a buddy. Millar: “Find physical activities that the person likes or will, at least, tolerate. I think that is the secret to compliance.”

Parkinson Society Canada, in partnership with Canadian Physiotherapy Association, has created a new Physical Activity and Parkinson’s Disease information sheet that describes the benefits of aerobic, strengthening, flexibility and balance activities for people with Parkinson’s. It includes a tracking tool to chart and record physical activity and progress. This Physical Activity and Parkinson’s Disease resource is available in English and French, online and in print, and can be downloaded at www.parkinson.ca.

Chris Fraser, centre, leads the OPAN class while Bonnie Chapman, left, monitors the music and Kelly Evoy, right, monitors the broadcast for technical issues. Participants can be seen on the TV screen in the background.

Tucked away in a research lab at St. Joseph’s Parkwood Hospital, an instructor is leading seated aerobics classes for people in Southwestern Ontario with a spinal cord injury (SCI). The instructor is there, but participants are exercising in the comfort of their own homes.

Videoconferencing exercise classes tailored for people with quadriplegia or paraplegia is an innovative research project underway with Lawson Health Research Institute’s SCI Group.  Known as OPAN (Online Physical Activity and Nutrition Counseling Project), the project promotes physical activity and provides one-on-one nutrition counseling for those with a SCI.

For Lora Roch, 37, the classes are making a big difference in her life. “I have more movement, more ambition and energy, and a better take on health and nutrition,” she says. Lora broke her C5 vertebrae in a diving accident in 2003. In the past she tried exercising by watching seated aerobics videos. But she didn’t know if she was doing the exercises right, and wasn’t motivated to work out alone. “I kept saying I’d do it tomorrow – but tomorrow never came.”

Now Lora looks forward to the weekly videoconference.  “The classes are really motivating and it’s great having the instant, specialized feedback,” she says.

Exercise has many benefits for those with a SCI, including preventing secondary health complications and improving well-being. But obtaining these benefits and overcoming barriers such as distance and access to fitness programs can be difficult.  To address these issues, the SCI Research group is making in-home telehealth and ehealth one of its priority research areas.

In the OPAN study, those with a SCI participate in real-time seated aerobics classes using a web cam and videoconferencing from their home computers. “The classes are interactive,” says instructor Chris Fraser, a registered dietician at Parkwood Hospital and avid physical fitness instructor who injured her spinal cord in 1998. “The participants talk to me and to each other during the classes – we have fun and motivate each other.”

Participants’ health is closely monitored during the workout with heart rate and blood pressure monitors provided by the study. They are surveyed regularly to determine if the OPAN classes are increasing their physical activity outside of the classes.

Once the feasibility of OPAN is determined, the SCI group hopes to offer the program to a wider audience.

The SCI Research Group developed the OPAN study in collaboration with SCI Action Canada, and with funding from the Rick Hansen Institute.

The Stroke Support Toolkit, is a step-by-step guide on how to create a stroke support group. The guide includes sample meeting agendas, venue checklists, press releases and evaluation forms that can be printed and used at meetings.

“Before Life After Stroke, there have been too few resources available to people living with stroke,” says Dr. Dale Corbett, Scientific Director and CEO for the Centre for Stroke Recovery. “This website fills an important gap bringing valuable tools together in one place.”

Modeled after the “Getting On With the Rest of Your Life After Stroke” workbook, the new website provides information on living with stroke, rehabilitation, and links to connect with stroke groups across Canada.

To make the website as accessible as possible content is available in both English and French, three different font sizes are available, and free use of a new technology called eSSENTIAL Accessibility that allows users to use head gestures to navigate the website. A nod of the head for example, will click a link on the screen.

In the future, the site will host a forum for stroke patients and their families to gather to share stories and ask questions throughout the recovery process.