Accelerometers worn on the ankles can provide information about daily walking activity.

Personalized feedback within rehabilitation programs is important for achieving goals because it enables people to adjust their behaviours, gauge their progress and stay motivated. For those recovering from a stroke, the most common goal is to improve walking ability. While affordable technologies exist that could provide detailed feedback, rehabilitation programs do not currently take advantage of them.

TRI Scientist Dr. Avril Mansfield tested whether the use one of these technologies—a motion sensing technology known as an accelerometer—could enhance rehabilitation programs for those recovering from a stroke.

A selection of participants wore accelerometers on each ankle for up to 12 hours a day while they were enrolled in the program. The information recorded by the accelerometer was compiled and shared with participants by their physiotherapist in the form of daily walking activity reports and incorporated into standard goal setting approaches.

The research team found that patients' walking speeds and consistency of step speed improved when they received the added feedback. Dr. Mansfield comments, “These results are encouraging because gains in walking speed enable patients to better carry out daily tasks. Also, the more consistent steps taken by patients within the study group may indicate enhanced walking stability. Taken together, integrating this type of personalized feedback into rehabilitation may to help speed up recovery and lead to better quality of life.”

This work was supported by the Ontario Ministry of Health and Long-Term Care, the Ontario Stroke Network, the Canada Foundation for Innovation, the Ontario Innovation Trust, the Ministry of Research and Innovation, and the Toronto Rehab Foundation.

Use of accelerometer-based feedback of walking activity for appraising progress with walking-related goals in inpatient stroke rehabilitation: a randomized controlled trial. Mansfield A, Wong JS, Bryce J, Brunton K, Inness EL, Knorr S, Jones S, Taati B, McIlroy WE. Neurorehabilitation and Neural Repair. 2015 Jan 20. [Pubmed abstract]

During ex vivo lung perfusion, the lungs' blood vessels are flushed with a solution containing complex sugars, an antibiotic and a medication to block inflammation.

For people with severe lung disease, a lung transplant can be a life-saving treatment. Unfortunately, not all patients who need a new pair of lungs will receive them: the demand for healthy lungs far exceeds availability.

To increase the number of lungs suitable for transplantation, TGRI Senior Scientist Dr. Shaf Keshavjee and his team developed a new technique that better preserves the lung during its transit from the donor to recipient. The technique —known as ex vivo lung perfusion—involves storing the donor lung in conditions that mimic the body: the lungs are ventilated, maintained at normal body temperature and a fluid is circulated through the lung’s blood vessels (follow this link to watch a video of the ex vivo lung perfusion technique).

Recently, Dr. Keshavjee’s team demonstrated that a detailed examination of the fluid circulated through the lung could reveal which lungs may be less suitable candidates for transplantation. After four hours in the ex vivo system, researchers detected high levels of two proteins—interleukin-8 and growth-regulated oncogene-α—in the fluid of lungs that performed poorly after transplantation.

“We hope that measuring the levels of these proteins during ex vivo lung perfusion will allow clinicians to safely expand the current donor pool and improve outcomes after lung transplantation” says Dr. Keshavjee.

This work was supported by the Canadian Institutes of Health Research and the Toronto General & Western Hospital Foundation. M Cypel holds a Tier 2 Canada Research Chair in Lung Transplantation.

Protein expression profiling predicts graft performance in clinical ex vivo lung perfusion. Machuca TN, Cypel M, Yeung JC, Bonato R, Zamel R, Chen M, Azad S, Hsin MK, Saito T, Guan Z, Waddell TK, Liu M, Keshavjee S. Annals of Surgery. 2015 March. [Pubmed abstract]

Surgery is the only curative treatment for pancreatic cancer but only 20% of patients are surgical candidates as most have advanced disease at diagnosis.

Pancreatic cancer is devastating—most patients with this disease suffer from symptoms that require hospitalization and the disease is associated with high mortality rates. For this reason, their quality of life near death and the quality of care that they receive is important. Aggressive care near death for patients with incurable cancers is an important indicator of end-of-life quality; it has been linked with worse quality of life for patients and worse bereavement adjustment for their caregivers.

A study by a team led by PM Cancer Centre’s Dr. Raymond Jang examined whether palliative care (PC) impacts the aggressiveness of the medical care that patients with advanced pancreatic cancer receive near death. By conducting a retrospective population-based cohort study using data from Ontario patients, they analyzed measures of aggressive care, including: chemotherapy within 14 days of death; intensive care unit admissions, and multiple emergency department admissions and hospitalizations, all within 30 days of death. The results showed that patients who received a PC consultation experienced significantly less aggressive care—this was consistent across all four measures.

“More intensive PC follow-up was also associated with fewer instances of aggressive care near death,” says Dr. Jang. “These results emphasize the benefits of PC for these patients and hopefully provide motivation for increasing its availability worldwide.”

This work was supported by the Conquer Cancer Foundation of the American Society of Clinical Oncology, the University of Toronto Medical Oncology Postgraduate Ontario Student Opportunity Trust Funds, the Division of Medical Oncology and Hematology at the Princess Margaret Cancer Centre, and The Princess Margaret Cancer Foundation.

Palliative care and the aggressiveness of end-of-life care in patients with advanced pancreatic cancer. Jang RW, Krzyzanowska MK, Zimmermann C, Taback N, Alibhai SMH. Journal of the National Cancer Institute. 2015 January 20. [Pubmed abstract]