A spinal cord injury diagnosis is life-changing for patients and their families. In acute care, beyond surgery and cardiovascular support, clinicians have limited tools to improve outcomes. Current guidelines recommend increasing blood pressure during the first three to seven days post-injury to enhance spinal cord blood flow. However, it remains unclear whether this approach improves oxygen delivery to the injured spinal cord or risks further damage at the injury site. To address this, we have developed a near-infrared spectroscopy (NIRS) sensor to measure oxygenation and blood flow to the injured spinal cord in real time. Implanted during spinal surgery, the sensor emits near-infrared light into the spinal cord, assessing oxygen delivery based on light absorption. This BC-based study, conducted at Vancouver General Hospital under the leadership of principal investigator Dr. Brian Kwon, aims to recruit six patients with acute spinal cord injuries undergoing surgical repair. The sensor will be implanted during surgery, remain in place for up to seven days post-injury, and then be removed. Our primary objectives are to evaluate the safety, feasibility, and effectiveness of this novel monitoring approach in a clinical setting. Ultimately, our goal is to provide clinicians with real-time information about spinal cord oxygenation and blood flow, enabling personalized care to improve patient outcomes.
Program: CAN TAP TALENT
What is the baseline of Total Oxygenation Index (TOI) in transplanted tissue after Free Tissue Transfer (FTT) surgery
Head and neck cancer is the seventh most common cancer worldwide, with over 660,000 new cases and 325,000 deaths each year. After removing a tumor, a common reconstructive method called Free Tissue Transfer (FTT) is used. This involves transplanting skin, muscle, or bone, along with its blood supply, from one part of the body to the surgical site.
A proper blood supply to the transplanted tissue is crucial. If blood flow is inadequate, complications or tissue death can occur, which may require further surgery or even lead to death. Early detection of changes in blood flow and oxygen levels is key to preventing these issues.
Currently, FTT monitoring relies on hourly visual checks by trained medical staff, which are subjective and not continuous. To address this, our team has developed an optical non-invasive sensor using near-infrared spectroscopy (NIRS). This technology uses light to measure blood flow and oxygen levels in the tissue. It provides a metric called Tissue Oxygenation Index (TOI), which reflects the health of the transplanted tissue.
Initial testing on four patients showed the sensor could monitor tissue oxygenation continuously for 72 hours after surgery. Amir’s project aims to enhance this technology by creating a wireless, non-invasive sensor. It will transmit data to a monitor and remote systems, allowing doctors to track patient status and receive alerts if TOI changes.
The next steps include clinical trials with 60 FTT patients to establish TOI baselines and improve the sensor’s hardware and software. The device recently received approval from Health Canada and Clinical Trial governments body. This innovation aims to reduce FTT failures, improve patient outcomes, and lower healthcare costs.
Non-invasive spinal cord stimulation for cardiovascular recovery following spinal cord injury: A pilot clinical trial
Blood pressure dysfunction following spinal cord injury (SCI) decreases quality of life, delays rehabilitation, and is rated as a top priority for recovery for individuals with SCI. Non-invasive spinal cord stimulation (SCS) is a promising treatment to improve BP control. However, the best position to deliver this therapy along the spine, and the physiological mechanisms behind this therapy, remain unclear.
This study aims to compare the effects of mid-back and lower-back SCS on BP regulation in real time and after long-term stimulation (3x/week for 8 weeks). We will also investigate the mechanisms by which both real-time and long-term stimulation improves BP control. We will do this by performing analysis on heart rate and BP signals, and measure blood biomarkers. The results from this pilot clinical trial will provide the necessary evidence to conduct a larger multi-center clinical trial.
This award is co-funded by the Canadian Training Platform for Trials Leveraging Existing Networks (CAN-TAP-TALENT) and is a part of the Canadian Clinical Trials Platform competition.
SuPA Mobility: Supporting Physical Activity for Older Adults with Limited Mobility
Health Research BC is providing match funds for the Canadian Training Platform for Trial Leveraging Existing Networks (CAN-TAP-TALENT) Post-Doctoral Fellowship Award 2023.
Dr. Jordyn Rice, PT, DPT, PhD is a post-doctoral fellow in the Aging, Mobility, and Cognitive Health Lab, working under the supervision of Professor Teresa Liu-Ambrose, Tier 1 Canada Research Chair in Healthy Aging.
The SuPA Mobility Trial is a Vancouver based randomized controlled trial using a health coaching intervention aimed to promote physical activity in older adults with limited mobility.
As individuals age, they have a greater risk of limited mobility, or difficulty in getting around safely in one’s environment. Limited mobility is linked to illness, disease, and decreased quality of life in older adults. Supervised group exercise that increases physical activity by only 6 minutes per day has been shown to have beneficial effects on mobility. However, supervised exercise programs may be difficult to accomplish on a large scale due to the significant resources needed to manage such programs.
This research will evaluate: 1) the effectiveness of a 26-week health coaching program to increase physical activity in older adults with limited mobility by at least 50 minutes per week; and 2) differences between health coaching compared to a control group on overall activity level, walking speed, cognition or thinking ability, mood, and quality of life.
Increasing physical activity through the use of health coaching has the potential to improve mobility in aging adults with limited mobility. The results of this study will be used to provide future guidance on physical exercise programs for older adults that may be deliverable on a broader scale.
End of Award Update – February 2025
Results
This project began enrolment in September 2023 and is still ongoing. One of the most exciting milestones of 2024 was crossing the threshold of enrolling 100 participants (out of 290) and completing the intervention and final assessments for 60 participants. In the first year of the study, we were able to use participant feedback to improve their experiences and fine–tune our study procedures, which has led to an increased recruitment rate and improved efficiency within our team.
Impact
The impacts of this project cannot be fully determined as data collection is still ongoing. The funding from CAN-TAP-TALENT and MSHR BC have greatly impacted my development as a postdoctoral researcher as I was able to present this project at the Clinical Trials Training Summit in Montreal, complete the Clinical Trials Training Program, present related research at international conferences, and network with other researchers throughout this fellowship. The funding and training I received in 2024 was instrumental in helping me to secure additional fellowship funding from MSHR BC to complete the SuPA project in its entirety over the next few years. In addition to securing additional fellowship funding, I had a first authored manuscript, related to my current research project, accepted for publication in the Physical Therapy Journal. This study demonstrated that in people who have previously fallen and have slower walking speeds, 6-months of exercise reduced subsequent falls and improved mobility and cognitive function.
Potential Influence
The potential influence of this study cannot be fully determined as we are still completing data collection. Participants who have completed the study have shared positive feedback regarding their experiences in the study. We hope that the results of this study can allow us to make better recommendations to improve mobility in older adults with limited mobility through increasing their physical activity.
Next Steps
This is project is still actively recruiting, with the goal of completing enrollment by September 2026 and concluding study interventions by March 2027. We are continually performing quality assessment checks to ensure participant satisfaction throughout the trial and guarantee data integrity. While working to complete the SuPA Mobility project, I am continuing to work with secondary data analyses that are exploring the impact of exercise interventions on people with mobility limitations and a high risk of falls.
CAN TAP TALENT & Michael Smith Health Research BC Post-Doctoral Fellowship 2023 award
Health Research BC is providing matching funds for this postdoctoral fellowship, which is funded by the CAN-TAP-TALENT clinical trials training program.
Approximately 15-20% of patients who have COVID-19 will develop long-term symptoms as part of what is now known as post-COVID-19 condition (PCC) or ‘long COVID’. Those suffering from PCC can experience debilitating fatigue that can last for over 18 months. The pattern of fatigue experienced by some PCC patients is similar to what has been experienced by patients with myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS). This subtype of PCC can be called post-COVID fatigue syndrome (PCFS). Currently there are no medications that have been proven to be helpful for fatigue in patients with PCC or ME/CFS. However, a low dose of the medication naltrexone (low dose naltrexone, LDN) has been prescribed off-label.
In this randomized controlled trial (Principal Investigator: Dr. Luis Nacul), we will investigate whether LDN is able to reduce fatigue severity in patients with PCFS. We will recruit patients from the Post-COVID-19 Interdisciplinary Clinical Care Network (PC-ICCN) directory and REACH BC platform. We have made in-person participation optional so that patients from throughout BC (and not just Vancouver) will be able to participate. Participants will be randomized to receive LDN or placebo capsules. We will follow participants for 16 weeks and determine whether they have improvement in their fatigue severity, as well as other outcomes such as quality of life and step count. This is one of the first clinical trials for PCC in Canada, and the results could inform treatment for the millions of individuals struggling with this illness.