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Mild traumatic brain injuries (mTBI), including concussions, may come with lasting effects that can alter a person’s life.  Although a person with a mTBI may appear fine on the outside, many have to pace their day-to-day activities in order to allow the time needed for the brain to properly heal. 

For 42-year-old Cindy Vanderveen who lives with post-concussion syndrome, every day tasks can become quite a challenge. Cindy who had multiple concussions over the years, experienced her mTBI symptoms in July of 2020 after an intense workout. Not knowing what was happening, she assumed she was having a stroke or seizure. 

“I had issues with my vision; everything looked distorted. I had problems speaking (aphasia) and couldn’t eat or drink without choking on my food,” explains Cindy. “Everything I used to enjoy doing, gardening, cycling, working, it just stopped and my entire life was put on hold.”

Cindy was referred to the Acquired Brain Injury (ABI) program at St. Joseph’s Health Care London where she was encouraged to try a new research tool called MyBrainPacer™App, created to help those living with an mTBI.

The app was created at Lawson Health Research Institute – the institute of St. Joseph’s Health Care London – a team looking to better assist and treat those living with a mTBI. It was made possible by funding provided by the Cowan Foundation and other community supporters through St. Joseph’s Health Care Foundation. 

“By documenting activity levels over time, patients and their clinicians can better understand what activities are linked to worsening symptoms, which they can therefore avoid,” explains Dr. Dalton Wolfe, Lawson Scientist.

The online application is part of a study which allows Dr. Wolfe and his team to track the efficacy of the app. Much like point tracking used by dieters to monitor food choices, through MyBrainPacer™ App, users can assign values to tasks like driving, grocery shopping, screen use and exercise so they can plan and pace their daily activity. Individual users are given a total number of points per day that will keep their persisting symptoms in the ‘safe range’. As users track their symptoms through the app, the app adjusts the daily point value to what is best for the user. The app is based on St. Joseph’s Pacing and Planning Program, which has helped hundreds of concussion patients achieve their recovery goals. 

“By putting the app in the hands of patients and the clinicians who treat them, the app has the potential to give us data that traces the recovery patterns of patients and how that relates to the activities that they participate in over time,” adds Dr. Wolfe. “This will enable us to document safe levels of activity for persons with specific characteristics or symptom profiles, which could be the key to unravelling better treatment strategies.” 

After using the app for some time, Cindy has noticed a positive change. “In the beginning I wasn’t able to drive farther than five minutes at a time,” remembers Cindy. “Once I began to use the app to plan and track my activities, my symptoms dramatically decreased.”

Currently anyone with a mTBI can enroll as a study participant on the MyBrainPacer™ App and use the tool. The research team is hoping to enroll approximately five-thousand users over time to allow for a large evaluation population.

“Without the app, there is no way to keep track of the hundreds of trajectories of patient recoveries,” says Dr. Wolfe. “This information is vital to understand what is working in terms of future therapeutic approaches.” 

“I still have bad days, and some tasks are harder than others,” adds Cindy. “But through using the MyBrainPacer™ App I am able to do more activities independently and I’m 90 per cent back to who I was.”

Anyone interested in enrolling to use the app can do so by visiting mybrainpacer.ca
 

Transitional aged youth in Middlesex County now have access to a free transportation resource to access mental health services. Called the County Transport initiative, it will help youth ages 16 to 25 in Lucan, Parkhill, Exeter and Strathroy-Caradoc get the mental health care they need, when they need it. 

County Transport is being coordinated by MINDS of London-Middlesex, a program of Lawson Health Research Institute, in partnership with the Canadian Mental Health Association (CMHA) of Elgin-Middlesex, Star Taxi and Middlesex County through the Lucan and Parkhill Libraries. 

“Through our collaborative work, we’ve heard from many youth that transportation is a barrier for them when trying to access mental health services when in crisis. Youth in rural areas find this very challenging since most services are not close to their location,” says Romaisa Pervez, Research Assistant at MINDS of London-Middlesex. 

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MINDS, a Mental Health INcubator for Disruptive Solution, is a social innovation lab with a mission to address the complexity of the mental health care system. Youth with lived experience, community members and researchers work together to understand and help those living with mental health challenges in London-Middlesex by designing, piloting and testing innovative solutions developed locally. 

“We do not have the exact numbers of transitional aged youth living in rural Middlesex who would benefit from access to the County Transport Initiative, but we know that mental health services in rural communities are limited and that access to the services available in larger city centres is challenging due to transportation difficulties,” explains Cathy Burghardt-Jesson, Warden for Middlesex County.

“Transportation from Middlesex to London, where the majority of mental health resources are located, is underdeveloped as there are limited bus routes and schedules. This leaves little in the way of affordable transit options for youth in crisis.”  

Youth in crisis who connect with CMHA’s Reach Out 24/7 line at www.reachout247.ca or by phone at 519-433-2023 will be supported and assessed by the Crisis Line staff. If it is determined that a visit to the London Crisis Centre is needed, the CMHA Crisis worker will ensure a smooth transition from the Crisis Line to the Star Taxi Service. The youth will be provided with free transportation to and from CMHA’s Mental Health and Addictions Crisis Centre located at 648 Huron Street.  

To ensure the safety and wellbeing of the youth accessing this service, Star Taxi drivers have received training developed by CMHA regarding mental health and crisis de-escalation, as well as suicide prevention training by Living Works. 

Funding for the initiative has been provided by St. Joseph’s Health Care Foundation and the generous support of individual donors in the community. 

“With additional funding, the initiative could be scaled up to reach as many youth as possible in Middlesex County and beyond. We want to see all youth in rural areas who want to access mental health services able to do so, by removing the barriers of location and transportation,” adds Pervez.

They will be collecting information regarding use of the transportation service and youth experience to refine and improve the initiative.

For patients with kidney stones, ureteral stents (hollow devices placed in the ureter – the tube between the kidney and bladder) can be used temporarily to relieve urinary obstruction. Despite the use of antibiotics, ureteral stents often become encrusted with minerals and coated with bacteria. This can lead to complications like infection and the need for replacement surgery. 

Published today in Cell Reports Medicine, researchers at Lawson Health Research Institute and Western University conducted a novel microbiome study to examine bacteria associated with ureteral stents. They found that nearly all the stents, whether visibly coated or not, had unique bacterial profiles that were most associated with a patient’s medical condition rather than antibiotic use. For patients with ureteral stents, they may benefit from a personalized approach to care and antibiotic treatment. 

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The study included 241 patients from St. Joseph’s Health Care London. The research team collected and analyzed patient urine samples and ureteral stents following surgical removal, as well as relevant patient information such as antibiotic use and history of infections.  

“We wanted to know which bacteria were present and whether the bacteria found in urine samples corresponded to the bacteria found on a patient’s stent,” explains Dr. Kait Al, Postdoctoral Fellow at Lawson and at Western’s Schulich School of Medicine & Dentistry. “We found that there was a bacterial community present on almost all stents, even if they were not visibly affected, and that it differed from the bacterial community found in a patient’s urine.”

These findings challenge long-held beliefs that the urinary tract is a sterile environment devoid of bacteria.

The study revealed that the bacteria present were determined by an individual patient’s medical condition. They differed significantly based on comorbidities like irritable bowel syndrome, obesity and hypertension. Antibiotic use within the past 30 days did not seem to have an effect on the types of bacteria detected on the stents. 

“While more research is needed, our study suggests that antibiotic use during the placement of these stents could one day be more conservative or targeted based on each patient’s condition,” says Dr. Jeremy Burton, Lawson Scientist and Associate Professor at Schulich Medicine & Dentistry.

The team also discovered that in patients needing multiple stents, the bacterial community remained stable over time, suggesting that infections on a patient’s previous stent could direct the course of treatment for their future device placements. 

“This is the largest study of its kind, investigating bacteria both in urine and adhered to ureteral stents,” states Dr. Hassan Razvi, Urologist at St. Joseph’s, Lawson Associate Scientist and Professor at Schulich Medicine & Dentistry. “We hope this will be the first step towards personalized care, ultimately leading to fewer stent-associated infections.” 

The study was made possible through the generous support of The W. Garfield Weston Foundation and St. Joseph’s Health Care Foundation.

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Dr. Kait Al, Postdoctoral Fellow at Lawson and Schulich Medicine & Dentistry