Personalised tools and stimulations in rehabilitation: linking clinical measures of motor recovery and mobility post-stroke with gait performance and functional outcomes of an intervention

Stroke is the leading cause of disability in Canada with more than 400,000 Canadians living with long-term disorders due to stroke. Hence, whilst challenging, it is critical to restore mobility to these individuals such as independent walking; the most frequently stated goal of individuals post-stroke. However, achieving this goal is hindered by motor impairments, including muscle weakness and spasticity, yet we still do not understand how these impairments influence walking post-stroke. This lessens the efficacy of emerging innovative treatments such as the use of botulinum toxin or Botox to suppress spasticity and improve walking. Computer simulations are powerful tools to uncover how muscles coordinate movement and predict the functional gains following a personalised treatment plan.

This research aims to develop diagnostic tools that can be used in clinical practice to identify movement deficiencies during walking post-stroke and associate them with clinical measures of function and spasticity before and after an intervention. These tools will facilitate greater use of personalised therapies, one of the primary goals of stroke recovery in Canada, and ultimately give people with strokes the ability to walk independently.

The effects of 60% oxygen during exercise training in patients with fibrotic interstitial lung disease

Breathing discomfort is common in patients with interstitial lung disease (ILD) and often results in an inability to perform physical activity, leading to a poor quality of life. Exercise training can reduce breathing discomfort and enable ILD patients to perform physical activity. However, severe breathing discomfort makes it challenging for these patients to withstand the amount of training they need to get the most benefit. A recent study showed that ILD patients breathing supplemental oxygen had less breathing discomfort and were able to exercise for longer compared to breathing room air. Another study showed that breathing supplemental oxygen was safe for patients with ILD for a single exercise session. However, we still do not know if these findings can be applied to a long-term exercise program.

Therefore, the purpose of this study is to determine if using a higher amount of oxygen during a rehabilitation program is a safe intervention that translates to greater benefits from training compared to the same regimen without the additional oxygen. We are also interested in examining if higher intensity training sessions with added oxygen affects every day physical activity levels.

Improving sepsis outcomes with anti-PCSK9 monoclonal antibody therapy

Sepsis is a severe disorder that occurs when human defense cells fight off an infection in an uncontrolled manner that can cause organ damage and death. Unfortunately, there is no specific treatment for sepsis, and there is a limited understanding of the mechanisms driving this deadly disorder.

During infection, toxins are released in the blood and carried inside cholesterol particles, which are removed from the blood by the liver. People with decreased levels of PCSK9 (proprotein convertase subtilisin/kexin type 9), a protein that normally regulates cholesterol particle levels, seem to have an increased ability to clear toxins from their blood. This project aims to test if inhibiting PCSK9 increases the removal of toxins from blood during sepsis and reduces organ damage and mortality. The findings of this research can lead to improved understanding and management of sepsis, and potentially a new treatment for sepsis that could save thousands of lives every year in the future.

Protein-energy wasting: prevalence and treatment outcomes among patients with advanced chronic kidney disease in British Columbia

People with or approaching kidney failure requiring dialysis often develop protein-energy wasting (PEW), which is characterized by loss of body stores of protein and energy fuels, and is associated with increased risk of death, heart disease, infections, and poor quality of life. The extent of PEW, its consequences, and its management have not been previously characterized among kidney patients in Canada, yet nutritional management remains a top research priority from the patient perspective.

Utilizing an existing database of chronic kidney disease patients in BC, the aims of the proposed study are:

  1. to determine the number and characteristics of adult kidney patients with PEW in BC, using several nutritional parameters and their changes over time to define PEW;
  2. to assess the impact of PEW treatment with nutritional supplementation (according to the BC Renal Nutritional Supplement Policy) on outcomes, including death, hospitalizations, nutritional lab parameters, and patient-reported functional status.

This research will:

  1. identify patients at risk of adverse outcomes from PEW in order to improve treatment policy and resource allocation, and
  2. inform future studies of dietary/self-management strategies for kidney patients

Balancing act: Measuring and optimizing the challenge point in rehabilitation to improve walking balance after stroke

Up to 73% of people who are able to walk post-stroke suffer a fall, commonly within the first few months after discharge home. Optimizing the approach to rehabilitation of walking balance remains vital to long-term outcomes post-stroke.  A fall poses a significant risk of injury and erodes confidence. The loss in confidence alone can lead to decreased activity levels, loss of independence and social isolation that affect quality of life and overall health, even hastening death.

After stroke, much of the focus of rehabilitation is on improving balance and walking. However, no objective measures are available to assist clinicians in making important treatment decisions such as walking balance task type or intensity of the challenge.  Unlike retraining of walking endurance that uses established measures such as heart rate to monitor and plan progression of walking endurance, there are no objective measures to guide progression of rehabilitation of walking balance.

To address this issue I am working with clinicians and people with stroke to:

  1. develop clinically useful balance measurement technology for use during rehabilitation;
  2. better understand the interaction between physical ability and confidence during rehabilitation of walking post-stroke; and
  3. incorporate this new technology together with algorithms that model rates of change to personalize the level of challenge of walking interventions and assure the best outcome for each individual with stroke.

Identity in mental health: A focus for early intervention and improving social functioning

Personal identity–one's psychological sense of personal continuity–is an important aspect of mental health, informing one's motivations, behaviours, and social relations. Disruptions in identity can contribute to prevalent conditions such as personality disorders. Indeed, distorted identity is a core aspect of personality dysfunction and disorder, contributing to considerable negative health and social outcomes–and a prominent challenge for health care providers and systems. Interventions that strengthen identity during young adulthood may be a potent way to mitigate personality dysfunction, preventing entrenched impairment and setting a course for positive mental health.

This proposal features a novel psychosocial intervention aimed at strengthening identity and reducing personality-related dysfunction among vulnerable young adults–tested in a randomized controlled trial. The intervention is designed for use by non-specialists to maximize transferability and impact on access and quality of care. Building on the applicant's work in maladaptive personality and identity, the project is set within a broader program of research on identity-focused intervention, including within early psychosis and recovery from alcohol misuse.

Incorporating practical, high-intensity interval training (HIIT) into the workplace: Examining the impact on physiological and psychological health, absenteeism, and work productivity

Among office workers, physical activity has been shown to have the potential to improve absenteeism, work productivity and psychological and physical health.

Dr. Stork’s research will incorporate physical activity into the workplace using high-intensity interval training (HIIT) – short-duration exercise that consists of multiple brief, high-intensity efforts, separated by periods of rest.

In Phase 1, physically inactive office employees will undergo an 8-week HIIT program of either one daily HIIT session completed during lunch break, or brief exercise bouts dispersed throughout the workday as 'exercise snacks.' Phase 2 will deliver an 8-week optimized HIIT program designed for sustainability based on a process evaluation of Phase 1. Dr. Stork will measure physical and psychological health, physical activity behaviour, absenteeism and work productivity immediately and up to six months following the program.

The HIIT programs will be implemented in Kelowna's Landmark Centre office towers. Community partners will be engaged early on in the research process to work together to successfully ensure that the program is evidence-based and implemented in a sustainable manner that adequately serves the community. The HIIT programs implemented will undergo a process evaluation to better understand the barriers and facilitators and to optimize and tailor the design and delivery of future programs.

Cerebrovascular burden and cognitive impairment after spinal cord injury

Spinal cord injury (SCI) is a complex pathophysiology, characterized not only by paralysis but also severe autonomic cardiovascular dysfunction. After SCI, strokes are 300 – 400% more likely to occur compared to non-disabled individuals.

One potential explanation for this is autonomic dysreflexia (AD), a life-threatening condition whereby persons experience sudden, transient episodes of high blood pressure. Such volatile swings in blood pressure in individuals with SCI result in structural and functional changes within peripheral blood vessels and lead to the deterioration of peripheral organs, including the brain. In the general population, chronic hypertension is a key risk factor for cerebrovascular dysfunction (increased stroke-risk and cognitive impairment). However, it is currently unclear whether the cumulative load of AD plays a similar role in cerebrovascular and cognitive impairment in persons with SCI.

Using the latest technological advances in magnetic resonance imaging, Dr. Nightingale’s research will examine differences in the structure and function of micro-vessels in the brain between two groups of SCI participants with different durations of SCI (and thus AD exposure), relative to an able-bodied age-matched control group. The results of this research will lead to a better understanding of AD in SCI individuals, and potentially improve treatment to better prevent the occurrence of stroke.

Targeting the complement system in Alzheimer’s disease

Many seniors aged 65 or older experience “age-associated memory impairment,” a normal aging process. However, Alzheimer’s disease is different, and not a normal part of aging. Alzheimer’s is a progressive brain disease with gradual loss of nerve cells and resulting problems with thinking, memory, and movement. Changes in the brain can start to happen 20 years before any memory problems appear.

Currently, no treatments are available to cure Alzheimer’s disease; however, if the disease is diagnosed and treated at an early stage, patients have a greatly improved quality of life.

Measurement of some proteins in a body fluid found in the brain and spinal cord has been used to aid in diagnosis. The sample collection is performed by inserting a needle into the spinal canal. People are usually reluctant to take the test, which causes a delay in diagnosis.

Dr. Shi’s research aims to develop a new test that could help doctors diagnose Alzheimer’s disease at an early stage. This new test is different from the current tests in two ways in that it uses blood instead of spinal fluid, which is much easier to get through venipuncture; and uses a new technique that is more sensitive and specific.

The resulting blood test could be a convenient and accurate way of diagnosing Alzheimer’s disease at an early stage.

Investigating the role of skeletal muscle dysfunction on dyspnea and exercise intolerance in interstitial lung disease

Interstitial lung disease (ILD) is a group of disorders characterized by fibrosis and inflammation of the lungs. Dyspnea (i.e., breathlessness) is the most common symptom in ILD. To minimize dyspnea, ILD patients commonly avoid physical activity, leading to a progressive decline in exercise capacity, and eventually the inability to perform daily activities. Maintaining exercise capacity is important, given that ILD patients with the lowest physical activity levels have the lowest quality of life and the highest mortality.

Unfortunately, treatment options for improving dyspnea and exercise tolerance in ILD patients are limited. It is thought that skeletal muscle dysfunction, which appears to be common in ILD patients, may contribute to dyspnea and exercise intolerance. However, few studies have adequately investigated skeletal muscle dysfunction in patients with ILD.

Relative to the inexorable damage to the lungs, the skeletal muscles could be an important site by which to therapeutically reduce dyspnea and improve exercise tolerance. Dr. Molgat-Seon’s research aims to determine the role of skeletal muscle dysfunction on dyspnea and exercise intolerance in ILD. The results of this research could lead to improved functional capacity and quality of life in ILD patients.