4th National Spinal Cord Injury Conference Program Agenda

Pre-course Agenda

Thursday – October 28, 2010
Fallsview Casino, Niagara Falls

12:00 - 13:00	Registration – Grand Hall Foyer
13:00 - 13:15	Opening Remarks Cathy Craven, BA, MD, FRCP(C), MSc Department of Medicine and HPME, University of Toronto; Toronto Rehabilitation Institute
13:15 - 14:05	Keynote Presentation

Can Pressure Ulcers Be Prevented After Spinal Cord Injury or Has This Battle Been Lost?

Vivian Mushahwar, PhD
Associate Professor and AHFMR Senior Scholar, Department of Cell Biology and Centre for Neuroscience, University of Alberta

This presentation will provide an update on our understanding of the etiology of pressure ulcers and a description of a new clinically viable method for the prophylactic of pressure ulcers in people with reduced mobility and sensation.

Learning Objectives:

Discuss the factors leading to the formation of different classes of pressure ulcers
Describe the state of deep tissue under various loading conditions
Understand the effects of electrical stimulation on muscles trapped between bony prominences and support surfaces
Discuss the use of intermittent electrical stimulation for preventing the formation of pressure ulcers

14:05 - 14:20	Evaluation of Keynote Presentation and Breakout to Concurrent Workshops
14:20 - 15:50	Concurrent Workshops *Workshops 1 to 4 will run concurrently from 14:20-15:50 and again from 16:05-17:35.*

Workshop 1
Finding a Treatment for SCI: Why We Should Still Listen to Basic Science

Serge Rossignol, MD, PhD
Professor, Faculty of Medicine, University of Montreal

Karim Fouad, PhD Neuroscience
Professor and AHFMR Senior Scholar, Faculty of Rehabilitation Medicine, University of Alberta

This workshop will relate recent findings in animal experiments to patients with spinal cord injury. The session will focus on showing that the injured spinal cord is still not sufficiently explored to allow the development of effective treatments, and that animal models are clinically relevant and continually advance the field in the development of meaningful treatments.

Learning Objectives:

Examine the findings from clinically relevant animal studies that are clinically relevant
Understand how basic research is still crucial to find a meaningful treatment for SCI
Discover how plasticity in the spinal pattern generator for locomotion probably plays a major role in rehabilitation of motor function after SCI

Workshop 2
Stimulating Neuroplasticity: Using Afferent Input to Promote Function After SCI

Edelle C. Field-Fote, PhD, PT
Professor, University of Miami Miller School of Medicine

Evidence suggests that spinal cord and brain mechanisms underlying the control of movement adapt in response to afferent inputs such as stimulation and vibration. This beneficial neural adaptation, or adaptive neuroplasticity, is supportive of function and may counter the maladaptive plasticity that is associated with pathology of the nervous system. Using what is known about neural responses to afferent input, treatment strategies can be structured to incorporate stimulation and vibration into training programs to improve motor function.

Learning Objectives:

Describe the mechanisms underlying neuroplasticity and the maladaptive neuroplastic changes that occur in the brain and spinal cord after SCI
Summarize how stimulation and vibration modulate reflex activity and enhance walking function
Discuss how afferent input alters brain mechanisms to promote to adaptive neuroplasticity for improved hand function

Workshop 3
The Neurogenic Bladder: The Role of Anticholinergics

Magdy Hassouna, MD, PhD
Associate Professor of Surgery (Urology), University of Toronto

This presentation will discuss the role of different groups of anticholinergic treatment for the Detrusor Overactivity.

Learning Objectives:

Select the most appropriate anticholinergic to treat the detrusor oveactivity following spinal cord injury
Anticipate the adverse effects of the anticholinergic drugs
Manage the adverse effects of the treatment

The Use of Botulinum Toxin in the Management of Neurogenic Bladder Dysfunction

Sender Herschorn, BSc, MDCM, FRCSC
Professor and Chair, Division of Urology, University of Toronto; Staff Urologist Sunnybrook Health Sciences Centre

Neurogenic bladder dysfunction occurs secondary to a deficiency of nerve supply. The specific deficiency frequently results in failure to store urine, failure to empty and occasionally both. The goals of management are to preserve the upper urinary tract, the kidneys, and to create an acceptable quality of life with the establishment of low pressure storage and emptying system. Botulinum toxin is a new option for improving the storage characteristics of the bladder when other pharmacologic options have been unsuccessful.

Learning objectives:

Understand the current therapeutic options for neurogenic detrusor overactivity and urinary incontinence
Learn the status of Botulinum toxin, a new option for neurogenic detrusor overactivity

Workshop 4
The Development and Application of Evidence-Based Physical Activity Guidelines for the SCI Population

Kathleen Martin Ginis, PhD (Kinesiology)
Professor, Department of Kinesiology, McMaster University

Kelly Arbour-Nicitopolous, PhD (Human Biodynamics)
Post-Doctoral Fellow, Faculty of Physical Education and Health, University of Toronto

Audrey Hicks, PhD (Physiology)
Professor, Department of Kinesiology, McMaster University

Amy Latimer, PhD (Human Biodynamics)
Assistant Professor, School of Kinesiology and Health Studies, Queen’s University

The purpose of this workshop is to introduce newly developed evidence-based physical activity guidelines for people with spinal cord injury, provide stakeholders (e.g., practitioners, consumers) the opportunity to evaluate the guidelines, and describe innovative strategies for promoting active living in the SCI population.

Learning Objectives:

Learn about the newly developed SCI-specific physical activity guidelines
Understand the process used to develop the SCI-specific physical activity guidelines and their implications for clinical practice

15:50 - 16:05	Workshop Evaluation and Breakout to Second Set of Concurrent Workshops
16:05 - 17:35	Concurrent Workshops *Workshops 1 to 4 run concurrently again from 16:05-17:35. See descriptions above.*
17:35 - 17:55	Workshop and Pre-Course Evaluation
17:55 - 18:00	Closing Remarks Milos R. Popovic, PhD, PEng Institute of Biomaterials and Biomedical Engineering, University of Toronto; Toronto Rehabilitation Institute
18:30 - 20:30	Pre-registration for Main Conference at the Fallsview Casino and Resort - Grand Hall Foyer
18:30 - 20:30	Special Registration and Networking Welcome Dinner for Consumers ONF sponsored Fallsview Casino and Resort

Main Conference Agenda

Day 1 – Friday, October 29, 2010
Fallsview Casino and Resort

07:30 - 08:30

Registration and Continental Breakfast – Grand Hall Foyer

08:30 – 08:50

Opening Ceremonies

Welcoming Remarks
Milos R. Popovic, PhD, PEng
Institute of Biomaterials and Biomedical Engineering, University of Toronto; Toronto Rehabilitation Institute

08:50 - 09:40

Keynote Presentation 1

Loss and Gain of Function: Activity-Dependent Plasticity After SCI

David S. K. Magnuson, PhD
Associate Professor, Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center,
University of Louisville

This presentation will describe how swimming, shallow water stepping and wheelchair immobilization in the first few weeks post-spinal cord injury can have dramatic effects on functional recovery. The results presented will support the concept that models of rehabilitation in rodents must deal with a ceiling effect due to in-cage retraining and that wheelchair restriction can have dramatic negative effects on functional recovery.

Learning Objectives:

Explore how different kinds of activity (or inactivity) influence the course of functional recovery in animal models of spinal cord injury
Discuss the relationships between the descending locomotor command circuitry, the central pattern generator for locomotion and the different kinds and patterns of afferent information coming into the spinal cord from the hind limbs
Examine how the capacity of the spinal cord circuitry might change over time post-spinal cord injury

09:40 - 09:50	Evaluation of Keynote Presentation and Break
09:50 - 10:30	Keynote Presentation 2

Muscle – Bone – Fat Interactions

Clifford J. Rosen, MD
Professor of Medicine, Tufts University School of Medicine; Director of Clinical and Translational Research,
Maine Medical Center

Three major tissues control locomotion and energy metabolism in mammalian homeostasis. The muscle - bone interaction has been studied in detail but the interaction of these 3 tissues, particularly relative to fuel utilization, has recently come to light. Two unifying factors link these three organs: Insulin and their common mesenchymal stem cell origin.

Learning Objectives:

Understand the origin of muscle, fat and bone cells
Determine how insulin and its regulation affect function of each tissue
Identify future possible interventions to prevent bone and muscle loss

10:30 - 10:40	Evaluation of Keynote Presentation and Break
10:40 – 11:55	Significant SCI Snippets Each presenter has 10 minutes to present and 5 minutes to discuss with participants

Presentation 1
Evaluating Neuronal Plasticity in the Central Nervous System Following Functional Electrical Stimulation Using a SCI Rat Contusion Model

Eric Beaumont, PhD (Neurophysiology)
Academic Researcher, Department of Surgery, University of Montreal

This presentation will provide an update on the effectiveness of using functional electrical stimulation during the acute phase post SCI, to preserve the neuronal afferent drive across the lesion site. Also, this therapy is beneficial in increasing the neuronal response in the spinal cord below the lesion site when stimulating paralyzed muscles.

Learning Objectives:

Demonstrate how functional electrical stimulation during the acute phase post SCI is beneficial
Demonstrate how functional electrical stimulation preserves the neuronal afferent drive between the paralyzed limbs and the somatosensory cortex
Examine the importance of translating the functional electrical stimulation training on patients during the acute phase post SCI

Presentation 2
Wheelchair Skills Training for People with Spinal Cord Injury – What, Who, When, Where, How and Why?

R. Lee Kirby, MD, FRCPC
Division of Physical Medicine and Rehabilitation, Department of Occupational Therapy, Dalhousie University

Cher Smith, BSc OT, MSc
School of Occupational Therapy, Queen Elizabeth II Health Sciences Centre

Many people with spinal cord injuries use wheelchairs to enhance their mobility. There is accumulating evidence about the safety and superior effectiveness of using a formal approach to wheelchair skills training, as one element in the wheelchair-provision process. In this presentation, we will review the what, who, when, where, how and why of such training and explain how clinicians can refine training in their own settings.

Learning Objectives:

Describe the nature of training, the most receptive learners, the appropriate stages of rehabilitation for training, the setting, how training is performed and the research evidence supporting such training
Refine wheelchair-skills training in their own settings

Presentation 3
Ethics and Professionalism in Rehab

Jeff Blackmer, MD, MHSC, FRCPC
Executive Director, Office of Ethics, Professionalism and International Affairs, Canadian Medical Association

Ethical issues arise commonly in the day to day practice of rehabilitation medicine, from demands for unproven therapies to difficult decisions about a patient's quality of life. Clinicians are faced with more and more therapeutic options and patients, increasingly educated and aware, sometimes make claims to resources that may not be appropriate. During this session, the topic of stem cell therapy for spinal cord injuries will be discussed, with a short review of the science behind the treatment as well as a consideration of the sometimes complex ethical issues underlying its application.

Learning Objectives:

Understand the science of stem cell treatment and the ethical issues surrounding stem cell therapies
Develop an approach to patients requesting stem cell therapy for SCI

Presentation 4
Par-QoL: Guidelines for Evaluating the Impact of Secondary Health Conditions After Spinal
Cord Injury on Participation and Quality of Life

Sander L. Hitzig, PhD, Post-Doctoral Fellow
Toronto Rehabilitation Institute

Although it is recognized that the quality of life (QoL) and participation of persons with spinal cord injury (SCI) are negatively impacted by secondary health conditions, there is a lack of clarity on the theoretical underpinnings, clinical appropriateness and sensitivity of existing QoL and participation measures. This presentation will provide an update on the development of guidelines designed to address these issues.

Learning Objectives:

Provide an overview on conceptualizations of quality of life and the development of the Par-QoL guidelines
Understand the key recommendations on which quality of life and participation measures to use when assessing secondary health conditions

Presentation 5
Two Scientists and a Mystery Talk

Milos Popovic, PhD, PEng
Institute of Biomaterials and Biomedical Engineering, University of Toronto; Toronto Rehabilitation Institute

Cathy Craven, BA, MD, FRCP(C), MSc
Departments of Medicine and HPME, University of Toronto; Toronto Rehabilitation Institute

Co-chairs of the 4th National Spinal Cord Injury Conference Scientific Planning Committee

Learning Objectives:

Present “hot off the press” data
Discuss the associated clinical conundrums and their implications

11:55 to 12:10

Difference Makers Presentation Award Recipient

Charles H. Tator, CM, MD, PhD, FRCSC FACS
Professor of Neurosurgery, University of Toronto; Division of Neurosurgery, Toronto Western Hospital

12:10 - 13:15	Evaluation of Presentations, Networking Lunch and Exhibit Viewing
13:15 - 14:05	Keynote Presentation 3

All Limbs Lead to the Trunk: The Rationale and Methods in the Development of the Thoracic-Lumbar Control Scale

Daniel E. Graves, PhD, FACRM
Director of Spinal Cord Injury Research, Director NeuroRecovery Center,The Institute for Rehabilitation and Research

The function of the trunk musculature has not received the attention given to the extremities over the years. The vital role the trunk plays in many aspects of life following spinal cord injury cannot be ignored.

Learning Objectives:

Describe the important contribution the trunk makes to quality of life, health and participation following spinal cord injury
Discuss the methods utilized to develop the trunk scale as well as the reliability and validity of the scale
Describe the qualitative aspects of recovery of trunk function and how these relate to changes in trunk scale scores

14:05 - 14:15	Evaluation of Keynote Presentation and Break
14:15 - 15:15	Concurrent Workshops *Workshops 1 to 4 and 5A will run concurrently from 14:15-15:15. Workshops 1 to 4 will be repeated again from 16:15-17:15. Workshop 5B will also be held at that time.*

Workshop 1
Posture and Mobility Assessment, Benchmarks and Behavioural Outcomes in the Spinal Cord Injury Rehabilitation

Molly Verrier, Dip P&OT, MHSc (Physical Therapy)
Associate Professor, Department of Physical Therapy, University of Toronto; Toronto Rehabilitation Institute

Andresa Marinho, BSc PT, MSc, PhD candidate (Physical Therapy)
Rehabilitation Science, University of Toronto; Toronto Rehabilitation Institute

Heather Flett, BA, BSc PT, MSc (Physical Therapy)
Advanced Practice Leader, Toronto Rehabilitation Institute

Kristina Guy, BSc (HKin), BSc PT, MSc candidate (Physical Therapy)
Rehabilitation Science, University of Toronto; Toronto Rehabilitation Institute

This workshop will introduce a comprehensive approach to standardized assessment and behavioural outcome measurement for posture and mobility for people with traumatic and non traumatic spinal cord injury.

Learning Objectives:

Understand the rationale for standardized evaluation for posture and mobility and their implications for clinical practice
Learn methods for standardized assessments, and documentation of behavioural posture and mobility outcomes
Discuss the principles and timing for therapeutic interventions for posture and mobility across the recovery profile

Workshop 2
Preventing Back Injury in Caregivers - Understanding the Use of Patient Lift Devices

Geoff Fernie, PhD, PEng
VP Research, Toronto Rehabilitation Institute; Professor, Department of Surgery, University of Toronto

What are the mechanisms of back injury? Is it okay to manually lift patients as long as I use good body mechanics? Is it better to use a floor or overhead lift? The session will explore these questions by reviewing the latest research in nursing biomechanics and patient lift and sling design. It will also introduce some new tools that have been recently developed to help lift and move people more safely.

Learning Objectives:

Understand how to reduce the risk of sustaining a back injury by learning which type of mechanical lift devices should be used
Learn about the current methods researchers use to understand the risks of injury during patient lifting and handling tasks

Workshop 3
Illuminating the Black Box of SCI Rehabilitation Interventions to Describe Services Delivered

Julie Gassaway, MS, RN
Institute for Clinical Outcomes Research

This workshop will introduce the Practice-Based Evidence research methodology used in the SCI Rehab project. We will explore detailed data for 600 rehabilitation patients with traumatic spinal cord injury that included over 115,000 hours of documented treatment by 7 clinical disciplines.

Learning Objectives:

Describe how rehabilitation clinicians spend time treating patients with spinal cord injury (SCI)
Identify patient and injury characteristics that predict time spent in therapy

\Workshop 4
Assessing for SCI Rehabilitation Programming Needs in Low Resources Settings

Colleen O’Connell, MD, FRCPC
Stan Cassidy Centre for Rehabilitation

Joy Wee, MD, MSc, FRCPC
Associate Professor, Queen's University

In the 21st century, rehabilitation challenges for persons with spinal cord injury in low-resource settings remain large, whether in disaster situations or in daily life. Real life experiences in Nepal and post-earthquake Haiti will be incorporated in a review of current epidemiology and outcomes of SCI in the majority world, need for emergent and long term rehabilitation planning and the role of local and international health care providers.

Learning Objectives:

Understand issues encountered by spinal cord injury rehabilitation programs in low-resource settings
Learn about important considerations to guide programming needs for the short, intermediate and long term

Workshop 5A
Planes, Trains and Automobiles: Travel After SCI

Marcie Kern, PT, MS (Physical Therapy)
Senior PT, TIRR Memorial Hermann

Eric Lantz, BSc OT
Senior Occupational Therapist, TIRR Memorial Hermann

Michael Gettleman, SLP
Master of Speech & Hearing Science and Master of Healthcare Administration, Senior Speech Pathologist, TIRR Memorial Hermann

Brenda Lantz, BSc, CTRS
TIRR Memorial Hermann

Travel after SCI can be an overwhelming endeavor and many may just stay at home. We have compiled a significant catalog of travel tips and information for people with disabilities and health care providers to empower people to travel again.

Learning Objectives:

Describe the education class developed for teaching patients how to prepare for travel by air, land or sea after discharge from hospital
Understand Project Airport, a specialized outing to the airport to prepare patients for airline travel
Learn information regarding barriers to travel, resources for travelers with mobility limitations, and tips for successful travel

Workshop 5B
Goal Attainment Scaling in the Spinal Cord Injury Pilot (SCI-Pilot) Program

Jeffrey Jutai, PhD (Psychology)
Professor, Interdisciplinary School of Health Sciences, University of Ottawa

This presentation will describe the use of Goal Attainment Scaling (GAS) to evaluate a new program to support individuals with spinal cord injury to navigate the health care system.

Learning Objectives:

Describe the methodology for doing GAS
Discuss the role for GAS in program evaluation in regard to other methods for outcome measurement
Discuss challenges for implementing GAS within a program like the SCI-Pilot

15:15 - 15:25	Evaluation of Workshops and Break
15:25 - 16:15	Exhibit and Poster Viewing: Odd Numbered Posters
16:15 - 17:15	Concurrent Workshops *Workshops 1 to 4 and 5B will run concurrently from 16:15-17:15. See descriptions above.*
17:15 - 17:25	Evaluation of Workshops
17:25 - 18:15	Top 6 Articles You Need to Readation of Workshops

Moderator: Colleen McGillivray, BSc, MD, FRCPC
Assistant Professor, Department of Medicine, University of Toronto, Toronto Rehabilitation Institute

Panel:
Jeff Blackmer, MD, MHSC, FRCPC
Executive Director, Office of Ethics, Professionalism and International Affairs, Canadian Medical Association

Cathy Craven, BA, MD, FRCP(C), MSc
Departments of Medicine and HPME, University of Toronto, Toronto Rehabilitation Institute

Christine Short, BSc, MD, FRCPC
Assistant Professor, Department of Medicine, Dalhousie University; QEII Health Sciences Centre

Karen M. Smith, MD, FRCPC
Associate Professor, Department of Physical Medicine and Rehabilitation, Queen's University; Providence Care

Karen Ethans, MD, FRCPC (PM+R)
Associate Professor, University of Manitoba; Health Sciences Centre

Denise C. Hill, MD, FRCP(C), CSCN (EMG)
Clinical Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Calgary; Foothills Hospital

The “Top 6 Articles You Need to Read” session will be led by a group of physiatrists. The intent is to supplement the busy clinician’s learning with six succinct presentations of key articles published in the last two years. Each presentation will highlight the article’s utility and discuss its implications for clinical practice in a journal club format. Discussion and debate is encouraged.

Learning Objectives:

Become familiar with some of the most significant recent publications in the field of SCI research
Identify areas of strength/weakness in the current SCI literature
Discuss differences in current regional practices

18:15 - 19:30	Cocktail Reception
19:30 – 21:30	Consumers, Scientists and Keynotes Dinner – Sponsored by Rick Hansen Institute

Day 2 – Saturday, October 30, 2010
Falls View Casino and Resort

07:45 – 08:30	Continental Breakfast
08:30 – 08:50	Welcome and Announcements Moderator: Molly Verrier, Dip P&OT MHSc (Physical Therapy) Associate Professor, Departments of Physical Therapy and Rehabilitation Science, University of Toronto; Toronto Rehabilitation Institute
08:50 – 09:40	Keynote Presentation 4

Clarity During Challenging Conversations

John Flannery, MD, FRCPC
Associate Professor, Division of Physiatry, University of Toronto; Toronto Rehabilitation Institute

During challenging conversations, outcomes are important as emotions are peaked and stakes are high. This is particularly important in SCI where challenging conversations can be part of everyday patient care. The ability to master challenging conversations and be clear during communication is important for long term relationships and patient care.

Learning Objectives:

Recognize key components of challenging conversations
Describe at least three steps involved in mastering challenging conversations

09:40 - 09:50	Evaluation of Keynote Presentation and Break
09:50 - 12:00	Scientific Poster Presentations by Award Winning Recipients The top three award winners in each of the categories of Patient Care, Education, Research and Students will present their posters. Awards will be presented by: Anthony Burns, MD Toronto Rehabilitation Institute Molly Verrier, Dip P&OT MHSc (Physical Therapy) Associate Professor, Departments of Physical Therapy and Rehabilitation Science, University of Toronto; Toronto Rehabilitation Institute
12:00 – 13:00	Special Working Lunch for Consumers: Evaluation of the Conference Consumers will complete written evaluations and discuss the conference with representatives of the Planning Committee. Moderator: Anthony Burns, MD Toronto Rehabilitation Institute
13:00 – 13:50	Keynote Presentation 5

Nutrition, the Missing Link: The Role of Nutrition in Rehabilitation
Joanne Smith, BA, BRT Dip, CNP
Holistic Nutritionist

This presentation will provide insight into the role that nutrition can play in the rehabilitation process. It will demonstrate how food can be used as a preventative medicine for many of the secondary health complications people with spinal cord injuries face, and reveal how this holistic approach can help empower people to live independently.

Learning Objectives:

Understand why nutrition has not historically been a significant part of the rehabilitation process
Learn what nutrition is and its critical role in healing the body and maintaining one’s overall health
Demonstrate how nutrition can be used in conjunction with traditional allopathic therapies in treating people with spinal cord injuries

13:50 - 14:00	Evaluation of Keynote Presentation and Break
14:00 - 14:50	Exhibit and Poster Viewing: Even Numbered Posters
14:50 - 15:50	Concurrent Workshops *Workshops 6 to 9 will run concurrently from 14:50-15:50.*

Workshop 6
Upper Limb Sensorimotor and Functional Assessment for Individuals with Tetraplegia - Graded Redefined Strength, Sensibility and Prehension (GRASSP)

Sukhvinder Kalsi-Ryan, BSc BSc PT MSc (Physical Therapy), PhD (Candidate)
Research Physical Therapist, Krembil Neuroscience Centre; University Health Network

Molly Verrier, Dip P&OT MHSc (Physical Therapy)
Associate Professor, Departments of Physical Therapy and Rehabilitation Science, University of Toronto;
Toronto Rehabilitation Institute

Naaz Kapadia, BSc PT MSc (Physical Therapy)
Research Coordinator, Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute

Jennifer Holmes, BSc MSc OT
Professional Practice Leader Occupational Therapy, Toronto Rehabilitation Institute

The purpose of this workshop is to understand how measurement of upper limb impairment and function contributes to rehabilitation outcome measurement for clinical practice and clinical research.

Learning Objectives:

1. Understand the conceptual framework for development and the psychometric properties of the GRASSP
2. Become proficient in GRASSP assessment and scoring
3. Learn the methodology of GRASSP documentation for clinical practice and clinical trials
4. Discuss the timing of assessments and approaches to therapy across the recovery profile based on GRASSP scores

Workshop 7
SCI Outcome Measures Toolkit: Clinical Use of Outcome Measures in SCI Rehabilitation

Amira Tawashy, MSc (Rehabilitation Sciences)
University of British Columbia

Bill Miller, PhD, OT
Associate Professor, University of British Columbia

Dalton Wolfe, PhD
Assistant Professor, University of Western Ontario

Vanessa Noonan, PhD, PT
Post-doctoral fellow, University of Washington (Seattle)

The purpose of this workshop is to introduce the Outcome Measures (OM) Toolkit for clinicians working in SCI rehabilitation. This toolkit was created by a large Pan-Canadian panel and covers a broad range of clinical areas ranging from pressure sores to community participation.

Learning Objectives:

1. Identify the key elements required for selecting outcome measures for use in clinical practice
2. Evaluate and critically appraise the outcome measures selected for the toolkit
3. Apply information from the OM Toolkit into clinical practice by working through case study examples

Workshop 8
Improving Diagnosis of Mild Traumatic Brain Injury in People with Traumatic Spinal Cord Injury

Cheryl Bradbury, PsyD, C Psych
Assistant Professor, Department of Psychiatry, University of Toronto; Psychologist, Toronto Rehabilitation Institute

Robin Green, PhD., C. Psych.
Associate Professor, Department of Psychiatry, Graduate Department of Rehabilitation Sciences, University of Toronto; Toronto Rehabilitation Institute

Yuko Koshimori, BA, MSc. Candidate
Rehabilitation Sciences, University of Toronto

In this workshop, we will discuss novel neuroimaging and behavioural approaches for improving the diagnosis mild traumatic brain injury (mTBI) in people with spinal cord injuries. We will discuss findings from our lab on diffusion tensor imaging for single case diagnosis of mTBI in people with spinal cord injury (SCI), and present a set of neuropsychological tests tailored for the diagnosis of mTBI in SCI. We will also discuss recent findings from our lab on the prevalence of brain injury in SCI, utilizing the diagnostic approaches above.

Learning Objectives:

1. Understand the clinical challenges of diagnosing brain injury (especially milder ones) in people with SCI
2. Understand how we can use diffusion tensor imaging to diagnose milder brain injuries in people with SCI
3. Understand how a neuropsychological test battery can be tailored and validated for people with SCI and to be able to better identify SCI patients who may be at risk of mTBI

Workshop 9
Respiratory Aids in Tetraplegics: From Tracheostomies with Mechanical Ventilation to Diaphragm Pacing: What You Need to Know in 2010

Raymond Onders, MD
Margaret and Walter Remen Chair of Surgical Innovation, University Hospitals Case Medical Center

MaryJo Elmo, ACNP
University Hospitals Case Medical Center

The need for mechanical ventilation drastically changes the management for high quadriplegics. This session will outline respiratory management of tracheostomies, mechanical ventilation, suctioning, cough assist device, and diaphragm pacing to optimize the care and quality of life of tetraplegics.

Learning Objectives:

1. Learn how diaphragm and ventilation is affected by spinal cord injury
2. Identify ways to improve tracheostomy management and decrease secretions
3. Identify how to overcome loss of control of respiratory muscles with functional electrical stimulation

Workshop 10
Get Ready, Get Set, You Have Been Called as an Expert Witness

Roger Oatley
Oatley, Vigmond LLP

James Vigmond
Oatley, Vigmond LLP

John McLeish
McLeish Orlando LLP

Dale Orlando
McLeish Orlando LLP

In a court action for damages arising out of an injury, judges and juries will rely upon the opinions of health professionals in order to understand and interpret the facts of a plaintiff’s claim. However, many health professionals are understandably hesitant to express their opinions within this context. This workshop is intended to assist health professionals in this regard, through a discussion of such topics as the legal ramifications of the choice of words in a medical legal report and the Rules with respect to document production and trial attendance, as well as what a health professional may expect and how best to prepare if called to appear as a witness at trial. There will also be a witness demonstration.

15:50 - 16:00	Evaluation of Workshops
16:00 - 16:15	Closing Ceremonies Moderator: Cathy Craven, BA, MD, FRCP(C), MSc Departments of Medicine and HPME, University of Toronto; Toronto Rehabilitation Institute