Purpose: Traumatic brain injury (TBI) is a disabling neurological condition that can cause substantial cognitive, behavioural, and physical health problems for the individual. Currently, it is a leading cause of death for Canadians. Rehabilitation (particularly specialized rehabilitation) has been shown to promote recovery in those with moderate-to-severe TBI, but not all eligible candidates receive it. We aim to 1) investigate demographic and clinical characteristics of individuals with moderate-to-severe TBI discharged to rehabilitation within 1-year post-injury over a 7-year period, and 2) identify predictors of discharge to specialized rehabilitation for these individuals. Materials and Methods: Patient characteristics were examined by linking their unique health insurance number through databases. Predictors of specialized rehabilitation were determined using logistic regression models. Results: Of 25,095 individuals with moderate-to-severe TBI, 4,748 individuals were admitted to rehabilitation within 365 days of injury between years 2010/2011 and 2017/2018. Most individuals who were admitted to rehabilitation were 64 years old or older (60%). Majority were male (65.6%). The most common cause of injury was related to a fall (61.7%). 13.9% of individuals had a mental health condition at the time of TBI hospitalization. 72.1% were discharged directly to rehabilitation following acute discharge. Mean wait time to rehabilitation was 37.3 (±52.5) days. 7.2% were rehospitalized immediately following rehabilitation discharge. Younger age, male sex, and higher rurality were some significant predictors of receiving specialized rehabilitation. Repatriated patients were less likely to receive specialized rehabilitation. Conclusion: This study identifies key healthcare utilization characteristics of individuals with moderate-to-severe TBI, as well as significant predictors of discharge to specialized rehabilitation for this population. We also highlight potential future research areas relating to these trends. This knowledge will be useful for policy planners and administrators who wish to improve patient access to care, appropriateness of care, and outcomes following moderate-to-severe TBI.
OBJECTIVE:To understand if and how physical therapists (PTs) and occupational therapists (OTs) use activity-based therapy (ABT) and its associated technologies for the rehabilitation of individuals living with spinal cord injury or disease (SCI/D) in Canadian rehabilitation hospital settings. DESIGN:Qualitative study. SETTING:Through rehabilitation hospitals participating in the Rick Hansen Spinal Cord Injury Registry, we recruited licensed OTs and PTs to participate in focus groups. PARTICIPANTS:Twelve PTs and ten OTs from nine sites across eight provinces participated. OUTCOME MEASURES:To inform the development of a semi-structured interview guide, we used the Theoretical Domains Framework. To analyze the data, we used interpretive description. RESULTS:We identified three themes that influenced therapists' use of ABT and associated technologies for SCI/D rehabilitation. (1) Therapists' decision-making approach to ABT and technology. Therapist roles, site-specific dynamics and goal setting influenced decision-making. Assuming roles such as mentor, liaison and advocate led to more ABT use. Site-specific dynamics concerned levels of ABT knowledge, teamwork, and staffing. In hospital rehabilitation, there was competition between discharge and neurorecovery goals. (2) Therapist perceived individual factors. Patient factors either increased (i.e. patients' motivation, self-advocacy) or prevented (i.e. mourning period, tolerance) the likelihood that ABT was introduced by therapists. (3) ABT and equipment access. Technology was used for ABT in a variety of ways. Access was affected by visible (e.g. equipment cost) and invisible barriers (e.g. departmental relations). CONCLUSIONS:The use of ABT and its associated technologies in Canadian rehabilitation hospitals is variable. Ongoing education could be offered, and site-specific implementation strategies could be developed, to promote ABT use.
ABSTRACT: Objective: To examine the use of telemedicine among Canadian concussion providers and clinics before and after the COVID-19 pandemic onset and identify barriers and facilitators for future use. Methods: Ninety-nine concussion clinics and healthcare providers across Canada that offered one or more clinical concussion-related service were identified using standardized online searches and approached to complete a cross-sectional online survey. Results: Thirty clinics or providers completed the survey and two completed subsections of the survey (response rate of 32.3%). Only 28.1% of respondents indicated that they used telemedicine to provide care prior to the COVID-19 pandemic. Providers most commonly using telemedicine prior to the pandemic were occupational therapists and physicians, while the most commonly used services were in-person videoconferencing and eConsultation. Most respondents (87%) indicated their clinic’s use of telemedicine changed following the onset of the COVID-19 pandemic including new use of in-person video-conferencing, telephone calls, and eConsultation. Ninety-three percent indicated that they would consider using telemedicine to provide care to their concussion patients once the pandemic was over. Barriers needed to be overcome to facilitate use or greater use of telemedicine-based services were the inability to conduct a complete physical examination, lack of appropriate reimbursement, lack of start-up, and maintenance funding and medico-legal risk. Conclusion: Telemedicine was used by a minority of Canadian concussion clinics and providers prior to the COVID-19 pandemic but was rapidly adopted by many facilities. This study provides important insight into the factors that must be considered to optimize use of telemedicine in concussion care in the future.
Journal of NeurotraumaVol. 40, No. 9-10 In MemoriamFree AccessDr. Xiao-Ming Xu: A True Gentleman and Scholar in the Field of Spinal Cord Injury and Schwann Cell BiologyPublished Online:28 Apr 2023https://doi.org/10.1089/neu.2023.29136.inmemoriamAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail We have received very sad news that our good friend and colleague, Dr. Xiao-Ming Xu, died peacefully after a long battle with bladder cancer. Xiao-Ming will be remembered for being an exceptional individual who did innovative research and was a leader in the field of Schwann cell biology and spinal cord injury. Over the years, we benefited from his many contributions to science and also his collaborative nature. A truly amazing individual who will be greatly missed. Since we heard the sad news, we have received many communications emphasizing his personal and professional contributions from his scientific community.Dr. James Guest said, “Xiao Ming joined the nascent Miami project in the early 1990s. He was working as a postdoctoral fellow with Dr. Mary Bunge. The Bunges had made significant progress toward the human application of the regenerative potential of Schwann cells, both in tissue culture and in animal models. Purified cells were being derived from whole peripheral nerve segments for use in the central nervous system. One of Xiao-Ming's main projects was to utilize a biocompatible guidance channel in combination with cultured Schwann cells, Matrigel, and exogenous trophic factors to test which classes of brainstem and spinal neurons could respond to this construct. These experiments were cutting edge at the time and brought together important concepts of discoveries in the 1980s that included the finding that central nervous system axons had the potential to regenerate into peripheral nerve grafts. Also, the important role of trophic factors such as BDNF was being elucidated and tested in several paradigms. Xiao-Ming's experiments were characterized by superb technical precision in his handling of the spinal tissues, his ability to perform an anatomic neurotracing, and excellent immunohistochemistry. The sheer beauty of this neuroreconstructive work inspired other scientists to participate in using this model to further knowledge by testing other cell types, matrix materials, and growth-potentiating molecules, such as chondroitinase. In fact, these were among the first combination therapeutics to be tested.”Dr. Martin Oudega said, “With the passing of Xiao-Ming we lost a great scientist, a prominent leader in the SCI field, and a wonderful friend and colleague. I met Xiao-Ming for the first time in 1993. I travelled to Miami to visit the Miami Project for an interview for a postdoc position in Dr. Mary Bunge's laboratory. He picked me up from the airport. On our way back, I recall, we got lost a bit but finally found the hotel. I never felt lost in those first months at the Miami Project because of Xiao-Ming. He told me everything I needed to know about Schwann cells and PAN-PVC tubes, trained me in complex surgeries involving complete spinal cord transections and implantation of Schwann cell bridges, and generously shared his extensive knowledge on SCI and his thoughts on how to achieve repair and recovery. Our career paths were different, but we always kept in contact. I had the privilege to visit Xiao-Ming's laboratory several times, work together on projects, and discuss science and family at meetings. My research over the years has been motivated and shaped by the many interactions with Xiao-Ming. My heart goes out to his family. I will miss him.”Dr. Kook Fai So said, “Xiao-Ming's research in spinal cord repair and regeneration has led the field for many years. He has worked closely with the group led by Professor Zhu Hui in Kun Ming helping many spinal cord injured patients. He and I have been co-editors-in-chief of the journal Neural Regeneration Research (NRR) since 2010. He has been instrumental in establishing the reputation of NRR. Over the last 13 years, Xiao-Ming organized and took part in many INRS (International Neural Regeneration Symposium). The symposia have brought many great scientists worldwide to China, which enhanced exchange and collaboration on neural regeneration and has brought NRR to the international stage. Xiao Ming and I have gone through a lot and spent many happy times together. He is an outstanding scientist, excellent teacher, and good friend. He is our role model, and always our pride. I really miss Xiao-Ming.”Dr. Vance Lemmon said “I first met Xiao-Ming in 2012 at a small meeting in New Orleans on spinal cord injury informatics, which John Bixby and I co-organized with Michihiro Igarashi from Niigata University (Japan). Xiao-Ming was invited because of his well-known technical expertise and impact in the field. This led to a long running collaboration between our labs. He published many high impact papers, two, especially, that really caught our attention involved a kinase inhibitor. When injected at a spinal cord injury site it promoted regeneration of sensory axons but not motor axons. When it was injected into motor cortex it promoted regeneration of the motor axons. This was especially remarkable as it only required a single injection! Although John thinks I am a “wild and crazy guy,” even I would never imagine that such an approach would work. We asked Xiao -Ming to repeat that experiment with another kinase inhibitor we were studying. He and his colleagues did, and when the experiment was complete, he called us and was very excited about the size of the effect of our compound on cortico-spinal tract axon regeneration. Subsequently, Xiao-Ming shared an R01 with John and me and we did many experiments together. Over the years, Xiao-Ming invited me to join the editorial board of Neural Regeneration Research and to organize workshops at the International Regeneration Symposium in China. I was lucky enough to travel with Xiao-Ming to visit beautiful destinations around China. He was always such an amazing host. We would discuss science, as well as Chinese history and culture. He was a teenager during the Cultural Revolution when the Chinese education system nearly collapsed, yet he persevered to become a physician scientist. A colleague said, ‘His spirit reminds me of bamboo, which is soft when there are strong winds, but never broken.’ His humble approach to life made everyone love him. He will be sorely missed.”As for myself, I was first introduced to Xiao-Ming when he was a postdoctoral fellow in Dr. Mary Bunge's laboratory in the Miami Project. Even at that early stage of his career, one could appreciate his clear vision and dedication to advancing discoveries in Schwann cell biology to the clinical setting. More recently I had the opportunity to participate in study sections with Xiao-Ming and frequently had the opportunity to engage in scientific discussions that were always informative and productive. Yes, he will surely be missed by many colleagues and friends around the world.W. Dalton DietrichDeputy EditorJournal of NeurotraumaFiguresReferencesRelatedDetails Volume 40Issue 9-10May 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Dr. Xiao-Ming Xu: A True Gentleman and Scholar in the Field of Spinal Cord Injury and Schwann Cell Biology.Journal of Neurotrauma.May 2023.791-792.http://doi.org/10.1089/neu.2023.29136.inmemoriamPublished in Volume: 40 Issue 9-10: April 28, 2023Online Ahead of Print:February 7, 2023PDF download
