With an aging population, neurological conditions like stroke, brain injury and multiple sclerosis (MS) are on the rise in Canada. Those living with neurological conditions face many long-term challenges that can affect both their physical and cognitive functioning. They are also at an increased risk for mental health challenges such as depression and anxiety.

“While mental health challenges are common for those with neurological conditions, they often go untreated for a number of reasons,” says Dr. Swati Mehta, Scientist at Lawson Health Research Institute. “For example, those living in remote areas often do not have access to specialized services and many patients are concerned about stigma.” 

Yet seeking mental health care is critically important for patients with neurological conditions. “Research suggests that depression among these patients can impair recovery, leading to decreased quality of life and increased health care costs.”

To improve patient outcomes, Dr. Mehta and a collaborative research team are developing an internet-delivered cognitive behavioural therapy (ICBT) program.

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Cognitive behavioural therapy (CBT) is a specialized type of therapy that involves patients learning strategies and skills to self-manage mental health symptoms. It’s one of the most widely used therapies for the treatment of depression and anxiety. 

A panel of researchers, persons with lived experience of neurological conditions and community organizations are working collaboratively to develop an accessible ICBT program that meets the needs of persons with neurological conditions and mild cognitive impairment who are also experiencing symptoms of depression or anxiety. The program, called The Neuro Course, will be a modified version of an existing course developed in Australia by the eCentreClinic.

“Through co-development with patients and experts in the field, the ICBT program will meet the specific needs of persons with neurological conditions who are also experiencing mental health challenges,” explains Dr. Mehta. “With online delivery, it can provide personalized treatment while being flexible and easily accessible.”

The Neuro Course will be piloted with a small group of research participants, including patients from Parkwood Institute, a part of St. Joseph’s Health Care London. Eligible participants can sign up to be notified of the course’s availability at https://www.onlinetherapyuser.ca/neuro. 

The free online course consists of six easy-to-understand CBT lessons and will take approximately 10 weeks to complete. In addition to the six lessons, participants will be encouraged to work through various activities during the week.

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Participants will also receive regular support from a designated online guide. Guides will be health educators who are certified providers or graduate students working under the supervision of certified providers. All guides will have training in psychology or social work. The participant’s guide will review the participant’s progress and answer any questions or comments through a secure messaging system.  

Participants in the study will be asked to complete brief questionnaires before they begin the course, on a weekly basis throughout the course and then again three months after treatment ends. The research team will use the questionnaires to assess patient outcomes and improve future versions of the course.

The goal of the program is to overcome barriers to face-to-face therapy, such as limited access to specialized care and concerns about stigma related to seeking care, by providing an effective online alternative. By reaching those in need, the research team hopes to improve patient outcomes and overall wellbeing. 

“The long term goal would be to implement the ICBT program into clinical practice to provide increased access to mental health services among this population,” says Dr. Mehta. “The program could be used to provide care to those with mild to moderate mental health concerns or those waiting to access face-to-face programs.”

The team is being funded for this project through Lawson’s Internal Research Fund (IRF) competition. “As an early career researcher, receiving funding from Lawson’s IRF is a great honour. It’s a great opportunity to help researchers obtain funding for small feasibility studies to develop evidence for larger grants that can be used to translate knowledge across the community,” states Dr. Mehta.

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