SCI Care: What Really Matters
SCI Care: What Really Matters
Perspectives of a New Associate Editor of Spinal Cord - Professor Chester Ho on “Time is Spine” and other hot topics in Spinal Cord Injury
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Dr. Michael Fehlings is joined by Dr. Chester Ho – one of the new Associate Editors at Spinal Cord. The conversation covers Dr. Ho’s perspectives on the current state of spinal cord injury research and opportunities for implementing evidence-based approaches in the clinic.
Learning goals:
- The concept of early surgical intervention for acute spinal cord injury was discussed
- The Canadian knowledge translation efforts to implement Time is Spine were reviewed
- Other key areas in spinal cord injury treatment were discussed
The opinions of our host and guests are their own; ISCoS does not endorse any individual viewpoints, given products or companies.
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Welcome And Who We Are
SPEAKER_01Hello and welcome to our uh ISCOS podcast. I'm Professor Michael Failings. Uh I'm the editor-in-chief of Spinal Cord. I'm a professor of neurosurgery at the University of Toronto. And we've been having these uh periodic um podcasts that are um uh sponsored by by ISCOS and in my role as editor-in-chief of a spinal cord, which is the signature uh uh journal uh for uh for for ISCOS and the leading uh spinal cord injury um uh uh uh uh uh journal. And we have these periodic podcasts to um have conversations with um uh leading
Meet Chester Ho And His Focus
SPEAKER_01lights in the field of uh spinal cord injury, and it's a particular pleasure for me uh today uh to welcome Professor Chester uh uh uh Ho uh to the podcast. I'll briefly um uh uh introduce Professor Ho, who is a um a professor in the Department of Medicine, the Division of Physical Medicine Rehabilitation uh at the University of Alberta. And uh Chester has had um uh an active uh interest in uh uh uh health service delivery and areas of research related uh uh uh to this. He and I are currently uh collaborating on a time as spy knowledge translation uh program. And in another um uh role, um uh Professor Ho has uh in the past year uh joined our team at Spinal Cord as an associate editor. So uh Chester, so welcome to this uh uh to this podcast.
SPEAKER_00Thanks for having me.
SPEAKER_01Um so I might sort of just begin by
Clinician Researcher Administrator View
SPEAKER_01uh perhaps if you could um maybe uh just talk a little bit about yourself, about your areas of um research interest in the area of spinal cord injury.
SPEAKER_00Uh sure, thanks, um Dr. Phoenix. My uh special interest is in spinal cord injury as a physiotrist. And uh basically I have um two particular interests. One is to look at the rehabilitation issues related to spinal cord injury. And then, as you mentioned, I'm also very interested in the healthcare delivery for um people with spinal injury. And to that end, basically, I have our three main roles in my um current position at the University of Alberta. Um, I am a clinician, I'm also a researcher, and I'm also an administrator. So I feel that I can combine all of those together in a very integrated manner to actually do my uh research and do my clinical practice to have the maximum impact.
SPEAKER_01Very good. So um can you uh perhaps talk to us a little bit about a knowledge
Why Time Is Spine Matters
SPEAKER_01translation project that you and I and our teams are collaborating on related to the concept of time as spine. So the the idea that uh the early uh acute care for patients with a spinal cord injury can have have a beneficial effect for outcome.
SPEAKER_00Absolutely. Um so in my administrative role for the province of Alberta, I'm a medical co-lead for the uh Neurosciences Care Alberta provincial program. It's one of our uh provincial programs that basically oversee um the um strategic planning and also um the implementation of evidence-based practice into our province. And um, so within Neurosciences Care Alberta, yeah, uh last year we actually conducted a uh review of the care of uh people with spinal clear injury in our province, and that was actually by the request of our hospital administrators. And from that, we reviewed the current evidence and also um determined together with our stakeholders what would be actually um the thing that would make a big change that would actually um have a big impact in the care of people with spinal injury. And then we selected um time spine as actually our key project there. And so basically, uh throughout the journey, um over the last year or so, uh, we gathered a um provincial uh group of stakeholders together. And that included uh surgeons and other clinicians involved, as well as um researchers, um, healthcare administrators, and also people with lived experience with spinal injury, um, to try to understand um how we can implement time in spine in Alberta, and also to um really try to identify the key factors that are barriers as well as facilitators to make it happen. And so, if there are barriers, then we are going to try to address those barriers to try to make that work. And so um we are now uh at a point that we are actually implementing this uh uh project here in Alberta, and it's very exciting because we have um really strong buy-in by our clinician colleagues, such as our spine surgeons and um also our healthcare administrators are very excited about it. And uh, so our team is now working um collaboratively, also with your team as well, because your team has got um such a wealth of information and evidence for this work. And um, so we're hoping that uh by this time next year we'll actually have some uh outcomes to show as well.
SPEAKER_01Yeah, very good.
Modeling Speed After Stroke Care
SPEAKER_01And we've certainly seen an evolution in awareness related to the role and timing of early surgical intervention. And in parallel with some of the changes we've seen in stroke care, you know, the um the implementation of you know early intervention protocols has had a beneficial effect right along the continuum of care of stroke. Do you see similar potential benefits for people with spinal cord injury?
SPEAKER_00Yes, I'm so glad you brought that up. Because um in Alberta, we are very strong in stroke care. And um, in fact, um the daughter needle time for stroke was actually what we modeled this after. Because we see the parallel and we see that sure, for stroke, we have done such a great job, and we see the benefits of really timely early um intervention. And so we believe that for spine we can achieve the same, and that's exactly why uh we have selected um Time Based SPINE to be our signature project for our neurosciences care Alberta program.
SPEAKER_01Yeah, very good. Now, you know, ISCOS is a very international uh organization, and we have many, many uh people from uh countries that are working in in um
Challenges In Low Resource Settings
SPEAKER_01low and middle income settings. Do you see that there are potentially opportunities to apply this knowledge around time as spine uh to um settings with lower resources?
SPEAKER_00Yes, I think that we certainly uh need to consider all of the different factors that may affect time as spine. And um I think that if I um just recall some of the factors that we have explored in Alberta and how they may apply to an international context, I think that we have to think about, for instance, um how we actually get uh people with spinal uh a new spinal coating to the first um uh emergency center. That's a big factor. And also uh the time to get um diagnostic imaging studies done, and then the availability of operating rooms. And um, so all of these system factors need to be thought about. Now, how do they apply to an international context? I think that's a really good question. Because if I actually think about, for instance, um I had a master's student um a couple of years ago, and she's actually a physiotherapist from Nepal. And so our project was about um the experience of people with spinal clear injury um in Nepal. And I heard about stories such as how people um uh how they're being carried actually to the um emergency center, right? And uh on a stretcher. And so then I think about okay, um, is that applicable? So I think that um this project will actually highlight some of the key factors that may need to be um worked on by people across around the world to make it happen. So I think that the effects of that is not just to um achieve the time a spine concept, but it's also to highlight what needs to be done locally in the center to really achieve um that standard of um excellent acute care.
SPEAKER_01Yeah, very good. I see you know many, many opportunities to really to facilitate care um you know around the world, including in low and middle-income um
Early Rehab And Health Equity Goals
SPEAKER_01uh countries. So so just to shift gears, um so uh you know, I've had the pleasure of welcoming you as an associate editor to um you know uh to the spinal uh uh cord. And you know, part part of your role is that you have, I think, a vision uh related to spinal cord injury that goes beyond your own personal areas of clinical and research expertise. So um what what do you see as some of the um exciting emerging areas of new development in spinal cord injury?
SPEAKER_00Um I think that um from my standpoint, um there are several really exciting areas to um to look at in spinal cord injury that will actually really impact on the lives of people with um spinal cord injuries. And uh I think we've already talked about um early decompression, and that's one thing that's really important. And um, then I'm also um really interested in the impact of potentially early rehabilitation intervention, because if you look at the studies around the world, there are lots of excellent studies, but they're mostly done on people with chronic spinal injuries. So, what about if we actually deliver rehabilitative interventions really early on, just like how we do acute interventions earlier? Would that make a big difference in the um neural recovery? I'm very interested in that. So that's the second area. Then the third area that I'm really excited about is to look at the um healthcare delivery for people with spinal injury, because I think that uh we again have really uh pockets of excellence for that. However, um, even if I look at um you know our country um in Canada, we do have multiple ways of doing things around different jurisdictions. And to me, um the health equity piece is quite important. And also, how do we actually um make sure that we elevate our standard to a common high level? I think that um we need to look at that more um uh seriously, and um I think that's a great opportunity.
SPEAKER_01Yeah, yeah, thank you. So, you know, I I think we have a lot of very uh exciting opportunities, you know, in the area of um of spinal cord injury, and you know, to come back to the concept, you know, that um health systems may learn from conditions such as the management of stroke, which I think is a very relevant analogy, to enhance the overall care for individuals with spinal cord injury and to also to facilitate their integration into the community and and and long-term health, I think is extremely you know important. And I, you know, I want to thank you and your team for really um really I think a landmark effort. Um and uh you know, in putting them on my editor-in-chief hat, I I hope that a publication will emerge from this exciting um knowledge translation effort.
SPEAKER_00Thank you. We are actually working on that, so um that is some S3.
SPEAKER_01Yeah. I I want to also have a shout out to the Praxis Institute for for their support of of these uh knowledge translation efforts, and you know they've been a very active contributor uh for sure, in particular for us as uh Canadian clinicians and researchers, but I think they've also been very heavily engaged with um uh other uh uh funding bodies um uh around around the world. Um before we uh uh close close it out, um uh uh uh uh Professor Ho, perhaps you could, as the uh associate editor of Spinal Cord, articulate what you feel the importance of the journal is and and why clinicians and scientists should be um thinking about uh spinal cord as their number one choice when they're submitting their articles.
Why Publish In Spinal Cord
SPEAKER_00Yeah, thank you. Well, um I joined your team um just last year. I think that it was very exciting um to be working with you and also the excellent team of associate editors. I think that's um, you know, it's apparent from the meetings that we've had um for the associate for the editorial team that everybody's really on board, really excited, with full of energy. So I think that's excellent. I think that it's such an up-and-coming journal. Um, you know, it's already in a good place, but um I think that you and the team will take it up to an even higher place. And um I believe that um we should uh consider the journal Spinal Cord as the journal of choice uh when submitting our manuscripts, because we have a very strong and dedicated team of uh um editors, um well, editorial team, and um I think that um it's good well it's also its very international flavor, gives it really an advantage because we receive um submissions from all over the world, and um it's also associated with ISCOS, which is such a strength. So I think for those reasons, um we should uh really uh look at this journal as the premier journal.
SPEAKER_01Very well said, and thank you for for you know for those comments. Uh so I'm gonna close
Closing Thoughts And What’s Next
SPEAKER_01things out. This is um our um uh our spinal cord uh podcast through uh ISCOS. I'm uh Michael Phalings, professor of neurosurgery, University of Toronto, editor-in-chief of spinal cord. And we've been having a conversation with Professor Chester uh Ho uh from the University of Alberta, who is an associate editor in uh in spinal cord. And uh Chester, thank you so much for uh joining us. On that note, we'll um uh we'll close out and we'll encourage all of you to um to have a careful look at at some of the uh uh upcoming um uh journal issues from Spinal Cord. We have a lot of very exciting uh uh research that will be uh coming forward. Thank you.