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A new study aims to assess the use of functional near-infrared spectroscopy (fNIRS), a type of imaging, to provide neurofeedback during stroke rehabilitation with a goal of eventually improving patient outcomes.

fNIRS is used to detect changes in brain oxygen levels using light. More recently it has also been used to develop brain-computer interfaces (BCIs), which allow patients with brain injuries to control devices like robotic arms with their thoughts.

Dr. Sue Peters, a Scientist at Lawson Health Research Institute and Director of the Neurorehabilitation Physiology Lab at St. Joseph Health Care London’s Parkwood Institute, was one of the recipients of the Spring 2022 Lawson Internal Research Fund (IRF) Awards. 

The funds will go towards a new study to assess whether fNIRS can be used to direct neurofeedback in stroke survivors – helping them with rehabilitation.

“Currently, there's no real measure of brain activity that is used in stroke rehabilitation to help make clinical decisions,” says Dr. Peters, who is also a Professor at Western University.

Over 400,000 Canadians live with the effects of a stroke, according to the Heart and Stroke Foundation, and there’s hope that fNIRS could make a big difference by eventually improving movement and independence.

“We're going to use the device in some common tasks that people might do with their arm and determine whether we can use this device reliably and accurately in a stroke-related context,” Dr. Peters explains. 

Participants in the study will imagine moving while remaining still. This activates very similar parts of the brain to when people actually move. If done correctly, patients will see a visual cue generated through measurement using fNIRS.

“We know from MRI studies that when I move my right hand, the left side of my brain is activated,” notes Dr. Peters. “We think we can use this concept in stroke rehab.”

Dr. Peters is recruiting 40 people from the community who are at least six months post stroke and 40 healthy adults of all ages. They will first participate in motor assessment with a physiotherapist and then wear an fNIRS cap while thinking about moving their wrist to measure brain activity.

Previously, there were a lack of methods to image the brain during real-life movement.

“The hope is to eventually conduct a clinical trial where we're testing motor interventions to see whether some things are more effective than others at activating the regions of the brain that were impacted by the stroke.”

Dr. Peters believes the study has the potential to have a big impact on the future of rehabilitation for stroke patients, leading to lasting changes in quality of life.

Multiple studies are reporting the pandemic’s impact on the mental health of Canadians, but what effect is it having on our nation’s Veterans and their spouses? 

“With concerns about COVID-19 infection and drastic changes to everyday life, the pandemic is taking a toll on the health of Canadians,” explains Dr. Don Richardson, Associate Scientist at Lawson Health Research Institute and Director of the MacDonald Franklin Operational Stress Injury (OSI) Research Centre, located at St. Joseph's Health Care London's Parkwood Institute. “And it may be particularly distressing for those vulnerable to mental illness.”

Population studies show that Veterans are at double the risk of mental illness when compared to the rest of the population. They experience higher rates of depression, anxiety and loneliness. Spouses of Canadian Veterans are also at higher risk of distress, as they may sometimes undertake significant caregiving responsibilities that that require significant emotional and time investments.  

“It’s currently unknown how the pandemic will impact Veterans and their spouses, but it could result in particularly serious outcomes,” says Dr. Anthony Nazarov, Associate Scientist at Lawson and the MacDonald Franklin OSI Research Centre. 

In a new project from Lawson and the Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), researchers will seek answers to these questions by partnering with up to 1,000 Canadian Veterans and 250 spouses of Canadian Veterans. Through online surveys, the project will hear directly from Veterans and their spouses to assess the pandemic’s effects on their well-being over time. The team hopes results can be used by health care workers and policy-makers to support Veterans and their families during both the current pandemic and future public health emergencies. 

“We want to hear from all Canadian Veterans and their spouses, whether they’re doing well or not and whether they’re seeking care or not,” explains Dr. Nazarov. 

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From left: Drs. Don Richardson and Anthony Nazarov

Participants will complete online surveys, available in both English and French, once every three months for a total of 18 months. They will be asked questions about their psychological, social, family-related and physical well-being, and any relevant changes to their lifestyle and health care treatment. 

“Veterans who regularly access health care services could encounter significant changes, including a move to virtual care appointments. This could lead to increased caregiving responsibilities for spouses,” says Dr. Nazarov. “Given the uncertainty surrounding the pandemic, these changes may persist well into the future, mandating a thorough assessment of patient satisfaction and treatment outcomes.”

The team hopes results can be used to support the wellness of Veterans and their families during public health emergencies. This includes providing health care professionals and policy-makers with information to guide emergency preparedness policies and health care delivery models. They hope results can also be used to recognize early signs of distress in order to target with early interventions.

“We are seeking to understand the impact of COVID-19 on Veterans and their families to identify if this global pandemic is leading to psychological distress or triggering historical traumas,” says Dr. Patrick Smith, CEO of the Centre of Excellence on PTSD. “The Centre’s primary goal is to increase Canadian expertise related to military and Veteran mental health, suicide prevention and substance use disorders. This study can help us understand if the pandemic is having debilitating and life-altering effects, and help us address a potential mental health crisis.”  

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Dr. Patrick Smith

The following column was provided to Hospital News by Dr. David Hill, scientific director, Lawson Health Research Institute. 

Dedicated health researchers across the country are working every day to make discoveries that improve patient outcomes and support a higher quality of life. Our research hospitals have a mandate to develop and test new treatments, technologies and procedures that address our most pressing health challenges.

There is a cycle of health innovation that is supposed to happen – scientific discoveries are made, they transition to clinical trials and then are adopted as an improved standard of care. This is followed by evaluations of the new method and moving along to the next cycle of refinements and improvements. But the reality in Canada is that gaps, in some cases chasms, disrupt the creation and adoption of evidence-based health innovations.

This starts with discovery. The research funding climate in Canada continues to be extremely difficult. Despite the Federal Government outlining substantial new investments in discovery research in Budget 2018 much of that money will not be available to researchers until 2020 and beyond, and the Canadian Institutes of Health Research (CIHR) continues to be limited by a low funding rate of around 14 per cent. Funding for large, definitive clinical trials is especially difficult to support with public funds. Too many good ideas are left unfunded, and in that environment researchers can feel it’s wiser to propose incremental and ‘safe’ science that avoids controversy and the risk of losing support for experienced research teams built up over many years.

Yet researchers are persistent and manage to secure funding from a range of smaller agencies. Unfortunately, many of these do not fund the indirect costs of research necessary to cover administration, infrastructure, equipment maintenance and upgrades, and the investigator’s salaries. Indirect costs are estimated to be approximately 40 per cent on top of direct study costs. In research hospitals these costs generally fall on the institutions to find funding outside of the provincial government budget that covers the costs of hospital care. This is a negative spiral whereby the more successful a hospital becomes in attracting research funds, the bigger the gap in finding the resources to support that research.

When innovative solutions to health care problems are delivered, backed by solid evidence, adoption into our hospital-based care is often far from rapid. Currently, in most provinces, there is no funding mechanism to translate health innovation to the ‘real world’ setting of our front-line care. Yet, such a mechanism is crucial to the translation of science. Clinical trials are carefully designed with strict protocols and criteria for a highly specific population of patients. Innovations that work in a clinical trial do not always work in the real world where patient populations and settings are much more complex.

Following a clinical trial, innovation needs to be tested at the point of care. Without funding to do this, research innovation hits a roadblock. Scientists are left waiting and hoping that one day their provincial government might look to incorporating their innovations into the health system funding schedule. Meanwhile, their work may be used to inform health care improvements in other nations.

An example can be found in medical imaging research. Canadian scientists, including those at Lawson Health Research Institute, are leaders in the development of positron emission tomography (PET) biomarkers to improve diagnosis and understanding of disease using PET scans.  PET biomarkers are successfully created and then validated in clinical trials across our nation, but there is little funding to translate them back in a timely fashion to patient care in our hospitals. While countries like the US and Europe readily adopt these innovations, Canada lags behind.

This gap was addressed in a report to the Federal government by the Advisory Panel on Healthcare Innovation entitled “Unleashing Innovation: Excellent Healthcare for Canada” and published in 2015. The panel recommended the formation of a Healthcare Innovation Agency of Canada open to hospitals and other care providers in order to evaluate health innovations in the real-world setting of our health system. Scientists would apply by putting forward evidence from their research, including that collected from clinical trials. They would then design a new translational study to test their innovation at the point of care, with the goal of building evidence for presentation to provincial government.

Will everything tested at the point of care succeed? No; some things will fail in the real world. This is why such a fund is so important. It will show whether or not an innovation truly benefits patients and if it’s ready for wider adoption. If successful, the evidence will highlight the right time to bring innovations into the mainstream standard of care. By bridging this gap in the system, we can improve patient care and ensure a timely return on the investment in science.

Dr. David Hill is scientific director at Lawson Health Research Institute, the research institute of London Health Sciences Centre and St. Joseph’s Health Care London.

Researchers at Western University and Lawson Health Research Institute continue to make important contributions to help mitigate the spread of COVID-19 and its negative consequences. Two projects in London will address virus transmission during surgery and pandemic planning for COVID-19, thanks to new funding announced by the Government of Canada, through the Canadian Institutes of Health Research (CIHR), along with provincial partners.

Researchers in London received more than $400,000 in funding through this latest round.

“Accelerating high-quality research and real-time evidence is a priority for Canada in its fight against COVID-19. I congratulate the successful teams for their essential work aimed at better preventing, detecting and treating COVID-19 at the individual and population levels,” said Patty Hajdu, Minister of Health in a press release. “Our government believes that it’s through collaboration and data sharing that we will respond efficiently to this global health emergency.” 

Virus transmission in surgical smoke

In an effort to perform surgery during the pandemic as effectively and safely as possible, Dr. Leigh Sowerby, Associate Professor at Schulich Medicine & Dentistry and Associate Scientist at Lawson, will be investigating whether or not the virus that causes COVID-19 can be transmitted in surgical smoke. Surgical smoke is the aerosol produced by an essential surgical tool called electrocautery. 

“Electrocautery is a ubiquitous tool for surgery, and is known to generate aerosol and smoke. We do not know if the SARS-CoV-2 virus can be transmitted in this plume, and this is important to answer for all surgeons, but in particular, for surgeons working in the respiratory and aerodigestive tract,” said Dr. Sowerby, who is also a head and neck surgeon at London Health Sciences Centre and St. Joseph’s Health Care London. “CIHR funding will allow us to rapidly execute this project. Without this funding, the project would not be possible.”

Dr. Sowerby says the results from this study, whether positive or negative, will have important implications. If positive, it will have a critical and direct impact on ensuring the safety of health care workers performing procedures on patients. Procedures using cautery will continue to require high level protection if the COVID-19 status of the patient is unknown. If negative, it will allow these surgical procedures to continue safely and effectively while conserving critical protective equipment for cases that need it.

The family physician’s role in pandemic plans

Maria Mathews, PhD, Associate Professor at Schulich Medicine & Dentistry, is investigating how the role of family physicians can be better incorporated into pandemic plans. Family physicians play important roles during a pandemic, from detecting potential outbreaks and screening and testing patients to providing care to infected patients and contributing to surge capacity in hospitals. 

“During the early stages of the COVID-19 pandemic, family physicians had concerns about roles they were asked to fill for a variety of reasons, including the lack of appropriate personal protective equipment, availability of tests, and concerns about infection risks to other patients and staff in a family practice clinic,” said Mathews.

Mathews will examine the experiences in four regions in Canada – Newfoundland and Labrador, Nova Scotia, Ontario and British Columbia – to identify key roles, supports and best practices. The results will provide government ministries, public health units, and other health organizations with evidence and tools in order to incorporate family physicians in the response to a potential second COVID-19 wave and plan for future pandemics.