Physical rehabilitation plays a critical role in the health-care journeys of patients who have had life-altering experiences. Physiatrists at Sunnybrook Health Sciences Centre and St. John’s Rehab Hospital work tirelessly to support patients along this journey, offering unique skills and expertise.

So, what exactly is a physiatrist? We sat down with Sunnybrook physiatrist Dr. Amanda Mayo to learn more about her role and how the work of physiatrists like her is helping support patients throughout the care continuum.

What is a physiatrist?

A physiatrist is a medical specialist in Physical Medicine and Rehabilitation who evaluates and treats patients whose functional abilities have been impaired.

Physiatrists focus largely on optimizing patient function after they have suffered from illness, injury, or surgery. Their goal is to help patients regain independence and the ability to return to daily activities as they once did.

“The most rewarding part about my job is seeing patients regain use of their limbs,” says Dr. Amanda Mayo, Amputee Physiatrist and Program Chief at St. John’s Rehab Hospital. “Seeing patients walk again for the first time with a prosthetic leg, pick something up with a prosthetic hand or return to an activity that’s meaningful to them is truly special.”

Physiatrists often lead a team of health-care professionals in their daily work, including occupational therapists, physiotherapists, speech-language pathologists, and social workers. This team of specialists works in concert to address a variety of patient needs through various methods of physical and cognitive rehabilitation.

Dr. Amanda Mayo walking with an amputee patient at St. John’s Rehab Hopsital. 

What kinds of conditions do physiatrists treat?

Physiatrists work with a wide variety of patients with unique needs and challenges, providing care in the following areas:

• Amputations: This includes patients who have lost a limb due to illness, injury, or congenital limb differences.
• Neurorehabilitation: This includes patients who have experienced an injury or illness which affects their brain, such as a spinal cord injury, traumatic brain injury, Parkinson’s Disease or Multiple Sclerosis.
• Pain medicine: This includes patients who experience chronic pain, such as arthritis, chronic pain syndrome, carpal tunnel, and more.
• Musculoskeletal care: This includes patients experiencing bone-related issues such as Osteoarthritis, Osteoporosis, Rheumatoid Arthritis and others.
• Sports injuries: This includes patients with a variety of sports injuries, including Achilles Tendonitis, stress fractures, and concussions.
• Post-operative care: This includes patients who have recently undergone surgery for treatments related to joint replacements, organ transplantation and more.

How do physiatrists support patients along their health-care journey?

Physiatrists care for patients along the entirety of the care continuum, supporting them throughout their journey. “Whether pre-surgery, in acute care, within a rehab hospital setting, or in outpatient clinics, we, as physiatrists, help address various issues to support recovery at every stage,” says Dr. Mayo.

Their proactive approach often involves seeing patients before functional problems escalate. This includes patients who require rehabilitation, those in need of assistive devices to prevent further weakness, pain, and falls, or who need to offload wounds to prevent limb loss and enhance their overall quality of life.

In the early stages of care, physiatrists are instrumental in helping prepare patients for pre-planned surgeries. This support often involves ensuring patients are physically strong and ready to use assistive devices post-surgery.

Physiatrists are also essential in acute care settings, working with patients who may have rehabilitation needs. In these cases, physiatrists work with other physicians from across Sunnybrook to advise on treatment and discuss prognosis and recovery outcomes with patients and their families.

In the midst of the care continuum, physiatrists assist patients in rehabilitation settings after initial acute or surgical care.  Rehabilitation may include helping patients learn how to walk, use mobility aids, regain their speech or motor function, and re-acquire day-to-day skills.

Finally, physiatrists continue to support patients toward the end of their care journey through outpatient clinics. They work with patients who have transitioned from rehabilitation facilities, providing ongoing assessments and care as part of outpatient rehab programming and to patients in the community.

Dr. Amanda Mayo tending to the wound of an amputee patient during clinic at St. John’s Rehab Hopsital.

Physiatrists like Dr. Mayo are critical in guiding patients through every stage of their health-care journey. Their expertise ensures that individuals facing significant health challenges receive comprehensive, personalized care that extends from pre-surgery preparations to long-term rehabilitation and outpatient support.

By addressing each individual’s unique needs, they work towards improving patients’ overall quality of life and assisting them in regaining their independence. This tailored approach is essential for effective rehabilitation, underscoring their commitment to improving patient outcomes across the care continuum.

The post How physiatrists are supporting patients throughout the care continuum appeared first on Your Health Matters.

The toolkit was uniquely co-designed by an interprofessional group of researchers, allied health professionals, stroke organizations and people with lived stroke experience, to create a person-centred, inclusive experience for users to learn about and access aquatic therapy.

“STARRT is the first aquatic therapy toolkit developed at Sunnybrook,” explains Dr. Marinho Buzelli, STARRT project lead. “This unique toolkit will help deliver a more specialized aquatic therapy experience to persons with stroke experience across Canada.”

The need for a stroke toolkit for aquatic rehabilitation

Stroke is a medical emergency resulting in a sudden loss of brain function and is often caused by an interference with blood flow to the brain. In Canada, stroke is the leading cause of adult disability as it can result in restricted movement, paralysis and impaired speech even after medical intervention. For many persons with stroke experience, the road to recovery is long and filled with many challenges. Aquatic therapy, which involves exercise in water, has been shown to have several benefits for people recovering from a stroke.

“I’ve had the chance to observe how aquatic therapy has changed the lives of so many with stroke experience,” says Shaylene Leibl-Smith, a recreation therapist at Saskatchewan Health Authority and a member of the STARRT advisory team. “From stress and pain management, freedom of movement, confidence building and connecting with others, it’s rewarding to see the progress individuals can make participating in aquatic therapy.”

Sharing lived experience to empower survivors

Danny Foran is the patient partner that is sharing his own stroke journey to help and empower other survivors. As a member of the STARRT co-design team, Danny’s experience using aquatic therapy informed some of the benefits, exercises and caregiver supports identified in the toolkit.

Dr. Marinho Buzelli, STARRT project lead, and Danny Foran, transferring his experience with stroke to help design the toolkit.

In 2012, Danny suffered a serious stroke that left him paralyzed on the left side of his body. In addition to different on-land rehabilitation exercises like physiotherapy, Danny joined an aquatic therapy club for stroke survivors. Since pursuing aquatic therapy, Danny has felt an improvement in his balance, strength and endurance, and has even learned how to swim using his right arm.

“Not only has swimming helped me physically, but it’s also supported my mental health since suffering my stroke,” explains Danny. “Swim clubs like the Oakville Strokers allow survivors to meet with each other in and outside the pool, which is a very empowering and motivating experience.”

Rehabilitation can be a frustrating experience for persons with stroke experience, who struggle with movements and activities that they could do before having a stroke. Danny hopes that sharing his experience to design resources like STARRT, will help survivors on their rehabilitation journey, and provide them with both physical and mental benefits and comfort.

“It’s been rewarding to participate in the design process of STARRT,” adds Danny, “I’ve been able to transfer my knowledge of aquatic therapy into an accessible tool for others.”

Danny participating in aquatic rehabilitation after suffering a stroke that left him paralyzed in one side of his body.

Optimizing recovery through aquatic therapy

STARRT is designed to teach persons with stroke experience, caregivers and health care professionals about the benefits of aquatic therapy, answer questions about what to expect from an aquatic therapy class and showcase aquatic therapy pool locations across Canada via an interactive map.

There are currently over 700 pools in Canada that patients and caregivers can explore in the STARRT toolkit. From swimsuits to medications to snacks, STARRT also provides a list of what you might need at an aquatic therapy session, as well as different strengthening, balance, aerobic exercises and games you can try in the pool.

“When designing STARRT we wanted persons with stroke experience to inform the foundation of the toolkit,” adds Dr. Marinho Buzelli. “The goal of this project is to help persons with stroke experience reap the physical benefits from aquatic therapy, and feel more confident and independent in their functional ability by providing them with all the information they might need in one location.”

If you or someone you care for is interested in learning about the rehabilitation benefits of aquatic therapy post-stroke, or would like to learn about aquatic therapy facilities near you, visit STARRT.ca.

The post Let’s get STARRT-ed: Empowering stroke survivors with access to aquatic therapy appeared first on Your Health Matters.

What are my rehab goals? 

Whether it is going back to work, starting to drive again, or returning to other daily activities, it is important to think about what you would like to accomplish in rehab. This can sometimes be difficult, so you may want to talk about your goals with your current health-care team before choosing your rehab provider.

Does the provider have experience with my health condition(s)? 

Ask about the qualifications of providers and ensure that the facility has experience providing care for people with condition(s) similar to yours. For example, if you have a burn or an amputation as a result of your motor-vehicle collision, or have complex cognitive needs, choose a rehab provider that has experience in providing treatment for these conditions.

What services are available at the clinic?

Find out if the clinic offers services that fit your rehab goals and needs, and what to expect from a typical appointment. You may want to ask about:

• The different types of services offered at the clinic: Usually, treatment services available for people who have had an MVC includes physiotherapy, occupational therapy, massage therapy, social work, and/or psychology.
• How the treatment will be provided: How long are your appointments? How much individual time will you have with your therapist? Group-based treatment options can help give you social support as you work on your recovery. Some providers can offer treatment virtually, depending on your needs.
• Other services available at the clinic that are important to you: Does the clinic have other services such as pool therapy, chiropractic, or acupuncture? Talk to your current health-care team about which services and therapies can help you.

How does the clinic communicate with my insurance adjuster?

Your rehabilitation costs are covered under your insurance accident benefit claim. There is a limit to the amount of money available for rehab and you will need to keep track of how much you are using for your therapy services. You can ask about the clinic’s process for submitting information about your rehab services to your adjuster. Never sign a blank treatment plan and always make sure that you will have the chance to review and ask questions before the clinic submits your treatment plan.

How will my care be coordinated?

Do you have someone that can help you coordinate your rehab services? Does the clinic have a team that works together with you to achieve your rehab goals? How does the clinic regularly communicate with insurance adjustors, lawyers, and others involved in your care? Communication between everyone on your team is important in helping to make sure you are getting the care you need.

How far am I willing to travel for my rehab care? 

You might need to go for your appointments for a few weeks or months. It is important that you go to all your appointments so that you reach your rehab goals. Don’t let distance or transportation be a barrier and plan accordingly. Think about other ways to get to your appointments, such as a family member, public transit or insurance-funded taxis.

Visit the GTA Rehab Network Rehab Finder to find a facility that’s right for you. You could also go to professional regulatory websites – such as the College of Physiotherapists of Ontario or College of Occupational Therapists of Ontario – to find licensed health-care professionals near you.

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The post How to choose your outpatient rehab provider after a motor vehicle collision appeared first on Your Health Matters.

When George’s symptoms began, they were initially very mild. “After isolating myself for about a week, I started to feel worse. My muscles ached, I couldn’t concentrate on simple tasks, and I felt very winded after the slightest movement,” explains George.

Primarily dealing with the cognitive and physical symptoms associated with Long COVID, George worked virtually with clinicians at St. John’s Rehab to build his mental and physical strength. Through the St. John’s Rehab Outpatient Post-COVID Rehab Program, Sunnybrook patients who experience lingering or residual deficits from COVID-19 infection are enrolled in an active rehabilitation program to manage their recovery.

When patients who have been diagnosed with COVID-19 continue to experience symptoms, it becomes an issue of Long COVID. This is where a rehabilitation consult may be beneficial and can be conducted as early as 4 weeks after COVID-19 diagnosis.

“When we are presented with a patient that has continued symptoms, it’s important for us to work with them to figure out their rehab focus. It helps us organize their care plan and tap into additional supports, when needed,” explains Dr. Melody Nguyen, physiatrist in the division of physical medicine and rehabilitation. She adds, “It’s not just physiotherapy – we’re looking at the whole person.”

Current research emphasizes the importance of a personalized approach to rehab given the many areas of the body that can be impacted by the virus. Dr. Marina Wasilewski, a scientist at St. John’s Rehab recently published a scoping review evaluating the current research on rehabilitation for COVID-19. “We know a range of respiratory, physical, psychosocial, cognitive and cardiovascular complications can persist following COVID-19,” says Dr. Wasilewski. “Our review underscored the importance of individualized rehabilitation programs provided across the care continuum by an interdisciplinary team of professionals.

For George, the personalized goals he set for rehabilitation included activities that are often taken for granted such as remembering names, making his bed, and participating in light gardening. “They were simple activities that I wanted to be able to do again and my care team helped me along the way to build my endurance,” shares George. 

Regaining functional independence through occupational therapy

Sarah Rockman is an occupational therapist and was on George’s care team. “I was looking to help George regain his functional independence at home, in the community and at his place of work,” says Sarah.

Patients with Long COVID have been reported to experience symptoms like brain fog or mental fatigue. “When it comes to long-term recovery, we want to make sure everyone has the necessary education and resources to get back to their pre-COVID functional ability,” explains Sarah. She adds, “Rehabilitation can be vital for this patient group.”

This meant focusing George’s treatment on some of the cognitive aspects of Long COVID. “George expressed some cognitive challenges, especially at work. He noted that he was having difficulty focusing on tasks, forgetting people’s names, and was mentally and physically exhausted after just a few hours of work,” explains Sarah.

In occupational therapy, Sarah worked with George on the importance of pacing and working with external aids to assist with scheduling and monitoring his activities. Over time, George was able to learn effective memory and energy conservation strategies that could be easily incorporated in his day-to-day activities at home and at work.

“We slowly and gradually increased George’s mental and physical endurance to work in larger chunks of time and re-adjusted his goals as needed. With this plan in place, George was able to return to work and noted improvements in his cognitive abilities,” shares Sarah.

COVID rehabilitation and virtual care

The St. John’s Rehab Outpatient Post-COVID Rehab Program uses a hybrid model of in-person and virtual appointments. For some patients, having treatment sessions in-person meant they could access equipment that may not be available at home. For others, virtual treatments were more appropriate. Depending on the patient, this model of care is adjusted to better serve the rehabilitation goals of each patient.

All of George’s appointments were conducted virtually. “Based on George’s needs and goals, we were able to provide treatment successfully via Zoom. We were able to implement the treatment and strategies he needed at a distance,” explains Sarah. She adds, “Virtual care is appropriate for some patients, and is always dependent on their needs and goals. Some patients might need a more hands-on approach which we are able to provide at St. John’s Rehab.”

“My experience with the program was amazing,” shares George. In addition to working with Sarah on building his cognitive strength, he worked with physiotherapist, Jean Yee, to build his physical strength.

He explains, “I was progressing pretty well but had a few bad days here and there. Jean was able to help me adjust my treatment plan to something that was better suited for me.”  The skills that George learned with the experts at St. John’s Rehab benefitted him at the time of his treatment and still benefit him today.

George clears snow from the sidewalk at his home

George explains, “There’s not a lot of information about Long COVID right now, and at times, it felt like I was alone or that it was never ending. My care team was really supportive of my journey and if I stumbled or needed help, they were only an e-mail away.”

Rehabilitation experts can provide the patient with a connection to their community, especially during this significantly isolating time.

“There is a lot of anxiety attached to recovering from COVID-19. Seeing other people or going back to work can be some very real barriers for some patients and rehabilitation acknowledges those barriers,” explains Dr. Nguyen.

She stresses, “It’s so vital to recognize that if something doesn’t feel right, you can and should advocate for yourself. Get in touch with your family physician and see what kinds of resources or educational opportunities are available so you can get back to your usual day to day activities.”

The post Recovering from Long COVID: How rehab is helping patients like George regain independence appeared first on Your Health Matters.

Long COVID and Sunnybrook’s COVIDEO

COVIDEO, funded in part by Ontario Health, is a program at Sunnybrook that has helped patients with mild to moderate cases of COVID recover at home with consultations over video or phone. Dr. Daneman is the co-lead of COVIDEO, along with Drs. Philip Lam, Nisha Andany and Adrienne Chan.

The doctors have now seen 9,000 patients through COVIDEO, and they are beginning to analyze some of the data. Patients diagnosed with COVID-19 at Sunnybrook are offered a 90-day in-person follow-up visit. Of the first 995 patients, 506 didn’t respond to the invitation, 266 responded and declined, saying they were back to health, and there were 206 patients who came in for the 90-day follow up. From that data, Dr. Daneman says they have been able to look at which symptoms are most persistent and how common they are.

He did caution these numbers are likely overestimates, and also says these are symptoms seen in individuals who were not hospitalized with COVID-19; hospitalized and critically ill patients would have a different recovery than people who had a mild to moderate case of the virus.

“Generally, if you read about long COVID in the news, people are going to be worried that everyone is left with terrible after effects, but the vast majority of people are back to normal health way before the three-month mark.”

Most common “long COVID” symptoms

Dr. Daneman says the most common symptoms seen in COVIDEO patients are similar to what is being seen elsewhere.

“Fatigue, number one,” he says. “Some kind of anxiety, depression, insomnia [is] pretty common. Headache.”

He also says some patients still experience loss of smell at 90 days and temporary hair loss, known as telogen effluvium, was common, although it’s a condition known to happen sometimes after an acute illness.

Some patients still had a cough or some muscle and joint aches. 

Recovery from long COVID

For people still battling COVID-19 symptoms months after their initial infection, they may understandably wonder when they will feel well again, and what they can do to help the process.

“One of the biggest things is time,” says Dr. Daneman. “We see this after almost any type of infection. That some people, a minority of people, can end up with some residual symptoms.”

He gives the example of a chronic cough following influenza or chronic fatigue after a bout of mono. And he says while it may be tempting to hunt for an “active, ongoing infection,” most often there is no infection remaining; the body simply needs time to recover.

“The trigger’s already gone and the body just hasn’t turned off the light switch that’s been turned on,” Dr. Daneman says.

Adopt healthy coping strategies

While Dr. Daneman is not a rehabilitation specialist, he says it’s important for people to find ways of coping and to find a “happy medium where they’re getting energizing activity, but not overdoing it.”

The COVIDEO program has some multi-disciplinary collaborations with the physiatry and rehabilitation departments to provide rehabilitation for Sunnybrook patients who are experiencing long COVID symptoms.

It might be difficult, but Dr. Daneman also recommends people don’t withdraw from their family, friends, work or hobbies because that could make mood or anxiety symptoms, or even physical symptoms, worse.

“It’s important to try as best as possible to find coping strategies and work toward the recovery because it will come with time,” he says.

The post When COVID-19 lingers: symptoms and recovery tips for COVID long haulers appeared first on Your Health Matters.

People may not associate speech-language pathologists with COVID-19 recovery, but these health care professionals have a critical role with COVID patients, from the ICU to acute care to rehab, and three of Sunnybrook’s speech-language pathologists shared how they support COVID patient recovery and why their role is so important.

Speech and swallow therapists

Nabil Jabbour is a speech-language pathologist at Sunnybrook who works with ICU patients and he says he and his colleagues are really “speech and swallow therapists,” so when COVID-19 patients who have been on ventilators for a prolonged period of time, or on high-flow oxygen experience dysphagia, or difficulty swallowing, it’s speech-language pathologists who provide assessment and treatment to help these patients transition from tube feeding to eating and drinking by mouth.

“These patients have had no airflow through the throat for a long time and have not used their muscle to swallow, so their muscle … becomes weak,” says Nabil. “Not only that, but the vocal cords get weak, the voice is hoarse, there is swelling in the throat, reduced sensation, etc.”

It can take a lot of time and therapy for patients to regain the ability to swallow, especially if there are other health conditions present.

“The recovery is hard,” says Zubeen Dharshi, a speech-language pathologist who works in acute and transitional care at Sunnybrook’s Bayview and Holland Centre campuses. She says COVID patients are more complex, and if there is an underlying condition such as MS or Parkinsons, “their deficits, such as muscle weakness or incoordination, get amplified even more.”

Communication skills post-COVID

At St. John’s Rehab, speech-language pathologist Stephanie Durocher-LeBlanc works with patients who are well enough to have been discharged from the hospital, but could still use support in their recovery. Sometimes she’ll continue swallowing therapy, but Stephanie also sees patients who are having trouble recovering their communication skills after being ill with COVID-19.

“They’re foggy, they have delirium, they’re just not as quick, not as sharp,” she says. And since the onset of the pandemic, the demographic of her patients has trended younger, in the 30-50 age range, which means these are people who need to return to full and busy lives.

“It’s not enough that they can functionally get by,” Stephanie says. “They have to run their kids’ lives over Zoom and do their own job; it’s not good enough to be foggy all day.”

She helps patients with their “cognitive communication” by practicing everyday tasks such as setting up a schedule or a calendar, or reading a map and plotting out directions to a location.

“[They’re] literally practicing skills they should be able to do much easier, and it just takes them longer,” Stephanie says. “You kind of retrain their brain to do it at a better speed, a better rate and with more confidence.”

Speech-language pathology is key to COVID recovery

Nabil, Zubeen and Stephanie all say their caseloads have become more challenging during the pandemic, either with more patients, or sicker patients with more complex care needs, or both. And while they may not be first to mind when thinking of a COVID patient’s care team, their role is critical to recovery.

“Without speech pathology these patients will not be able to eat,” says Nabil. “It’s that simple. We are the ones who assess the swallowing and get people off the feeding tubes most of the time and get them back to what they enjoy the most, which is eating and drinking.”

And that, in addition to the work of helping people regain communication skills, has highlighted for Stephanie how necessary this work is.

“I have come to realize just how imperative speech pathologists really are to our patients and to COVID recovery.”

The post The role of speech language pathology in COVID-19 recovery appeared first on Your Health Matters.

Mark Opauszky exercising on the streets of Toronto (photograph by Kevin Van Paassen)

In February 2019, Mark Opauszky flew down to New York for what he thought would be a quick business trip. The Toronto-based CEO and founder of a rapidly growing marketing automation company was scheduled to present at a conference and take in a few sales meetings.

Two days in, Mark fell suddenly, severely ill. With a fever spiking and on the brink of losing consciousness, his business partner rushed him to a Manhattan hospital. Mark emerged several weeks later from a medically induced coma to discover he had developed necrotizing fasciitis, more commonly known as “flesh-eating disease,” and it had brought him to the brink of death.

“I found out later that my probability rate of survival had been in the 5 per cent range,” says Mark, now 51.

The full extent of Mark’s ordeal reads like the plot of a horror movie. Necrotizing fasciitis is a disease in which bacteria infects the connective tissue, or fascia, under the skin. The disease rapidly kills the tissue, causing it to peel, blister and turn black as it dies. Most often caused by Group A streptococcus bacteria (the same bacteria that causes strep throat), it usually enters the body through a break in the skin like a cut or scrape.

Mark’s strain of necrotizing fasciitis resulted in septic shock, a worst-case scenario where the major internal organs begin to shut down and blood pressure dips dangerously low. In order to save his life, surgeons were forced to cut away a vast quantity of Mark’s muscle and flesh to remove damaged tissue, exposing some limbs down to the bone.

The New York team had saved Mark’s life. But by the time he arrived via air ambulance at Sunnybrook’s Ross Tilley Burn Centre four weeks later, Mark says he was in extremely rough shape.

“They did what they did [in New York] and then they sort of shipped me back to Toronto in pieces,” he says.

Mark in his room at Sunnybrook’s Ross Tilley Burn Centre, a few days after his arrival.

THE JOURNEY BEGINS

Mark’s arrival at Sunnybrook was the beginning of a long healing process that would involve multiple surgeries on his limbs, extensive rehabilitation and an extreme level of determination. Mark went through eight surgeries over four weeks at the Ross Tilley Burn Centre, including the amputation of several fingers and toes. He was then transferred to Sunnybrook’s St. John’s Rehab to begin the next phase of recovery.

St. John’s Rehab is renowned in Canada for its personally tailored programs that incorporate multidisciplinary teams to treat complex medical traumas, such as burns, falls, limb loss and vehicular accidents.

Multidisciplinary teams at St. John’s Rehab include physicians, nurses, physical and occupational therapists, prosthetists, speech-language pathologists and dietitians to support patients back to previous daily functioning. Equally important are psychologists, social workers and spiritual care providers to support the mental and emotional aspects of recovery.

“We use a holistic approach to care that focuses on the mind, body and spirit of each person,” says Dr. Amanda Mayo, physiatrist (rehab specialist) at St. John’s Rehab. “It’s one thing to save a life, and it’s another to rebuild that life in a way that is meaningful for that person.”

Mark’s program involved a rigorous schedule of cardio and calisthenics designed to rebuild atrophied muscle. Physiotherapy and occupational therapy helped him start walking again and learn how to use his injured hands. He also required regular massage and stretching for his limbs due to the volume of skin grafts he’d received – an extremely painful procedure.

For the entire duration of his stay at Sunnybrook, Mark says he didn’t once turn on his phone or watch TV. A tech entrepreneur who had previously been perpetually plugged in, Mark transitioned to a near meditative state that allowed him to focus on healing.

“It was me and my brain and my time, and that’s all I did,” he says. “I would spend hours just picking one body part at a time to concentrate on. Or I would open and close my fist because I was trying to get my fingers to work again.”

Doctors anticipated Mark’s in-patient stay at St. John’s Rehab would take eight weeks. He walked out the front door two weeks later. Mark says his quick recovery time was a combination of the outstanding care he received and the extreme discipline he had maintained in his previous life as a high-functioning CEO.

“I would get up in the middle of the night, get my walker and do laps around the nurses’ station at 2 a.m.,” Mark says of his time in rehab, noting that he was motivated by his desire to get back home to his wife, Danielle, and his two children.

ONE MORE STEP

In October, Mark returned to the Ross Tilley Burn Centre for a final amputation of his lower left leg. He had a bone infection, his left foot wounds weren’t healing and despite a top-of-the-line orthotic to offload his painful foot, he was in constant pain.

Dr. Mayo says she recognized that Mark’s left leg below the knee might need to be amputated due to the extensive damage back when he first arrived at the Ross Tilley Burn Centre. But she also understood how important it was to his emotional recovery to give him the opportunity to make that decision on his own time.

“Limb loss is a life-changing event. A lot of patients with chronic infections have to go through this journey and they go through multiple treatments or surgeries that can become quite draining,” says Dr. Mayo, who led Mark’s limb-loss rehabilitation team. “And then they realize, ‘I’m actually better off not having the foot. The foot is painful. This foot has wounds. I can’t walk on this foot.’ And Mark came to that decision.”

The left below-knee amputation surgery, led by plastic surgeon Dr. Alan Rogers, proved successful and has improved his quality of life, Mark says.

He began outpatient rehab at St. John’s Rehab to learn how to use his new prosthesis. Esther Chung, Mark’s physiotherapist, says that Mark’s dedication was a key factor in his specific recovery.

“Mark is very strong mentally, and I think it helped him progress,” she says. “He also had a strong support network of family and friends, which is important to maintain motivation over the long run.”

Dr. Mayo agrees that mindset and attitude are crucial aspects of the rehab process at St. John’s Rehab.

“A patient’s perseverance is very important,” she says. “Somebody who’s very active and doesn’t have any other medical comorbidities should be going back to most of the activities they did before, [only now] wearing a prosthesis or maybe [using] some adaptive equipment.”

Today, Mark is thriving. He is adjusting to a new normal that seems much closer to his previous life than he had initially imagined.

“I lift weights. I have a treadmill. I started [martial art] Muay Thai again. I’ve been learning to be a bit more agile on my limb,” he says. “I don’t even walk with a limp anymore. Some people can’t even tell that I’ve lost a leg.”

Feeling immense gratitude to his Sunnybrook team, Mark says he is inspired to give back.

“I would very much like to transition from just being a patient to being somebody who can contribute to the [organization] in some way, shape or form,” he says.

HEALING THROUGH MINDFULNESS

How much does your state of mind dictate how well you heal?

At his Sunnybrook lab, physiatrist and researcher Dr. Robert Simpson develops mindfulness and yoga programs for patients with disabling long-term conditions, including multiple sclerosis, stroke and amputations.

“There’s now robust, high-quality evidence for mindfulness improving mental health outcomes – mainly stress, anxiety and depression. There’s also fairly robust evidence that it leads to beneficial changes in cognitive function and probably pain,” says Dr. Simpson, who is trained to teach both mindfulness and Hatha yoga.

Mindfulness can be defined as the act of paying attention to the present moment, non-judgementally. It is often taught through guided meditation practices that focus on the breath and sensations within the body.

The concept hit the North American mainstream in the late 1970’s when a program called Mindfulness-Based Stress Reduction (MBSR) began to infiltrate medical and wellness circles as a treatment for chronic pain and stress. The program had been adapted from Buddhist and Yogic principles by U.S. medical professor Jon Kabat-Zinn.

Dr. Simpson says he considers a host of factors when deciding who might benefit from a mindfulness-based intervention (MBI). For example, someone with an amputation who also has conditions like diabetes, high blood pressure and depression may face more challenges with rehab than someone without these conditions.

That’s why a combination of personalization, education and support are key to improved results, he says.

“Humanistic factors like encouragement, empathy, compassion, understanding – I think these are all really important factors, and different people likely need different ‘doses’ of these things.”

The post One man’s journey after a battle with ‘flesh-eating disease’ appeared first on Your Health Matters.

Julian was talking to his wife on their family room couch before taking on an afternoon of housework. When he stood up, he felt a strange sensation in his left eye and sat back down. Then, all his strength drained from his body. Thinking little of it, he dragged himself to the bedroom to sleep it off. It wasn’t until hours later that he called 911 and was rushed to the emergency room at Sunnybrook Health Sciences Centre.

“Life suddenly changed. Everything changed,” says Julian.

Julian suffered a stroke that weakened the entire left side of his body so much so that he was virtually bedridden for more than a month. He couldn’t sit up or even raise his arm. Doctors said his stroke was likely caused by high blood pressure and his 30-year history of heavy smoking.

“I didn’t pay much attention to my blood pressure. Sometimes I didn’t take my medicine. I didn’t eat right. I smoked one-and-a-half packs every day,” he admits. “Now, all of my mind is on exercise, getting back my health and my capability of daily life.”

Julian rebuilds his strength and balance with physiotherapist Chaya Plonka at Sunnybrook’s St. John’s Rehab.

Since April, Julian has been working with a multidisciplinary team at St. John’s Rehab, including nurses, physicians, physiotherapists and occupational therapists, to regain his strength, balance and mobility.

“After a month, something in me changed. I tried to adjust my psychology to think in a positive way,” he says. Soon after, he made the decision to quit smoking and became determined to get moving.

“Every day I exercised,” he says proudly. “Eventually, I was able to stand up by the side of my bed. Then, I took a couple of steps. Gradually, a couple more. Then I pushed the wheelchair outside the room and walked down the corridor.”

Julian was still dependent on a wheelchair when he was discharged as an inpatient but continued his rehabilitation through the hospital’s outpatient program.

“About a week after discharge, I got rid of my wheelchair,” he says. “Now I barely use a cane. I’m almost back to normal.”

Back at home, Julian insists on going for walks in his neighbourhood every day and is determined to prevent a second stroke.

“The stroke was very bad for me and in a way it’s good for me,” he says. “After the stroke, I quit smoking and a lot of bad habits. On the whole, my body and health is much better.”

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Most well-intentioned siblings (usually a daughter) take on the caregiving role expecting the responsibilities to be equal or shared, but that isn’t always the reality. A recent study we conducted at the University of Toronto suggests that in many cases, geographic proximity to the parent, individual expertise or skillset, and work schedules can cause an imbalance in caregiving responsibilities, leaving one sibling to take on more than their share. This can lead to feelings of resentment.

While sharing caregiving responsibilities with a sibling (or multiple siblings) can be challenging, it’s not impossible. As you embark on this journey with your family, consider the following five questions:

1. How will you maintain open communication with your sibling(s)?

Clear and consistent communication between siblings will make it easier to divide tasks and discuss expectations of how each of you wants to share care. If you need help in a particular aspect of care, discuss this with your sibling(s) rather than assuming they will know. Check-in with each other regularly and discuss personal plans, such as travelling, to make sure someone is available to take care of your parent’s needs.

2. How will you balance responsibilities with siblings further away?

Long-distance caregivers can provide important emotional support to the sibling who lives closest to their parent. Just calling your sibling and listening may not sound like much help, but a “listening ear” is often just what they need. Caregivers further away can also offer valuable support with managing finances, booking appointments, arranging services, or gathering information about health services and medications. Online shopping for the parent is also a great option given the many delivery options available.

3. How can you break down stereotypical gender roles?

Rather than dividing roles based on gender, have an open discussion about the types of tasks you think are best-suited to you and your siblings’ skills (while keeping practical issues such as geographic distance and availability in mind). If you feel that your sibling unfairly expects you to do certain things because of your gender, have an honest conversation with them about why you feel this way and how they can be more involved in sharing those responsibilities.

4. Who can take on what based on their expertise or skillset?

Discussing your strengths, interests, and weaknesses can help to guide the division of caregiving responsibilities in a way that avoids resorting to stereotypical gender norms. For example, if a sibling excels at money management, let them be in charge of the finances; if cooking is a strength, have them take-on meal preparation. Of course, there will inevitably be some tasks that neither you nor your sibling(s) want to do. In these cases, it is important to keep the lines of communication open to understand and address the reason that nobody wants to complete a particular task. This can help you and your siblings reach a compromise that is acceptable to everyone involved.

5. How will you manage with your work schedule(s)?

Discussing your caregiving duties with your employer may be a good place to start, even if caregiving accommodations are not in your employee handbook. As caregiving becomes more common, employers are often willing to accommodate.  You may also wish to explore all available community supports and services to help care for your parent while you and your sibling(s) are at work. Despite your best efforts, unforeseen issues may arise, so it is important to be patient with your sibling(s) and accommodate as you’re able. Developing a contingency plan, such as knowing a neighbour you can call for help or where local day programs are for when such situations arise, could also help ensure your parent is always cared for.

Remember, you are not alone. Caring for a parent with health complications is a journey many of us will take in our lives. Conflicts are likely to arise and it will be important for you and your family to know how to work through them.

This article was co-authored by Kristina Kokorelias, primary author of the study cited in this posting and a postdoctoral fellow in the St. John’s Rehab Research Program. Her research aims to help older adults and their families navigate the health care system. Follow her on Twitter @kmkokorelias.

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Gerry Banks has built his life in the Toronto Community Housing Corporation (TCHC) building he’s called home for the past 30 years. But now, at age 72, Gerry worries about his future as an older person living in social housing.

“I think about things like falling in the bathtub, and no one hears me. Or what if I need to move some furniture around – how will I do that with my bad back?” says Gerry, who shares his apartment with a dog and a cat. “There are a lot of things I have a hard time doing now, because I’m old.”

Health and safety become greater concerns for most people as they get older. But for senior tenants of social housing – who tend to be especially disadvantaged by poverty, health problems, social isolation and mobility barriers – these concerns are often magnified and, in many cases, left untended.

Sunnybrook scientists are stepping up to build and implement solutions to these urgent problems, in order to help seniors like Gerry remain in their homes safely and comfortably.

Gerry Banks in front of his home in Toronto.

In a joint project that started almost two years ago, TCHC, the City of Toronto and the Toronto Central Local Health Integration Network (LHIN) have launched an “integrated services model” that addresses the issues faced by older Canadians living in government-supported housing. Key features of this new model include greater engagement of tenants in building affairs, on-site staff dedicated to each building, access to social and wellness programs and care coordinators who connect tenants to support services.

While these features are novel for Toronto Community Housing, what’s especially unique about its development is the application of implementation science – a field of expertise at Sunnybrook that uses carefully designed frameworks to translate research into strategy, actions and, ultimately, success.

FROM ANALYSIS TO EXECUTION

“Basically, it’s the study of how to get research evidence into practice and on to the front lines,” says Sander Hitzig, PhD, a scientist at the St. John’s Rehab Research Program, a Sunnybrook Research Institute program focused on advancing rehabilitation sciences to improve patient recovery.

“We often see great ideas for a new intervention or model of care that works really well under a controlled setting, but that doesn’t work as well when you try to implement it in the real world,” Hitzig says. “By applying implementation science, you can create and put into action the best possible model based on real world evidence.”

Hitzig says the successful implementation of any project depends on five key factors: characteristics of the intervention, project setting, stakeholders’ needs, the people involved and the process for executing and evaluating the intervention.

“Without this framework, you risk looking at the trees and missing the forest,” says Hitzig, who has used implementation science to develop and launch new models of care at Sunnybrook. As an example, he cites the decision to expand the work of physiatrists (specialists in physical medicine and rehabilitation) at St John’s Rehab to include consultations in acute care.

“Everyone liked the idea, because we knew it would lead to better outcomes for patients, such as a lower need for pain medications, but there was confusion around what physiatrists should do, and whether they should be at various sites or dedicated sites,” recalls Hitzig. “We used implementation science to determine the best model and the best way to implement it.”

For the senior housing project, Hitzig and post-doctoral research fellow Christine Sheppard, PhD, worked with a team to analyze 34 social housing models in Canada, the United States and Europe. They then narrowed their investigation to five models that aligned most closely with what TCHC, the city and Toronto Central LHIN wanted to accomplish.

They also interviewed 58 senior-aged community housing residents (including Gerry Banks) and consulted with 132 diverse stakeholders who included health-care providers, social workers, geriatricians, city hall officials and community advocates.

“We learned a lot,” says Sheppard. “For instance, how [to] empower tenants by helping them improve their financial literacy in things like everyday banking, setting up direct deposits and filling out forms. Because when tenants are empowered, they feel more free to ask for help.”

A BOLD NEW MODEL OF CARE

Andrea Austen, head of seniors, services and long-term care for the City of Toronto, says that having access to Sunnybrook’s experts in implementation science has made a big difference. Their work has led to key findings that shaped the integrated services model for TCHC’s 83 seniors-designated buildings.

“Under this new model, we will have these integrated teams of care coordinators, dedicated building staff and service providers like social workers and personal support workers working together to coordinate their services and to flag any issues,” says Austen.

“We will also be upping training in many different areas related to seniors, including how to identify and support cases of elder abuse, and how to communicate with people who have mild cognitive impairment.”

In addition to conducting research and presenting their findings and recommendations, Hitzig and Sheppard created a “logic model” that outlines goals and how various actions would affect outcomes for the short, intermediate and long term. They also created a dashboard to present a visual overview of 26 indicators for a healthy building.

“We are lucky to have access to experts like Christine and Sander,” says Austen. “Through the framework they’ve created, we will be able to closely monitor this new integrated services model and see the intended impact and outcomes.”

COMMUNITY HOUSING THAT WORKS

Here are some of the elements identified by Sunnybrook researchers Christine Sheppard, PhD, and Sander Hitzig, PhD, that indicate a healthy building:

CLEANLINESS: Buildings are clean, free of pests and repairs are completed in a timely manner

ACCESS: Tenants have access to health services, social supports and community agencies right in their buildings

SAFETY: Tenants feel safe in their homes and community, resulting in reduced safety incidents and reduced calls to police and fire departments

COMMUNICATION: Frequent, proactive and respectful communication from housing staff to tenants

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