Virtual Rehabilitation | Pi Day Speaker Series - March 2, 2021
Jodi Cowan: Good afternoon, everybody and welcome to our Pi day of giving virtual speaker series event today's topic is virtual rehabilitation of promising way forward. Jodi Cowan: Before we start, I’d like to start with a land acknowledgement of the traditional territory in which we are gathering today. Jodi Cowan: Our university campus is situated on the traditional territory of the Mississaugas, a branch of the greater Anishinaabeg nation, which includes Algonquin, Ojibwe, Odawa, and Pottawatomi. Jodi Cowan: Because, everyone is turning in with us remotely across a variety of cities, I don't want to forget this important element of reconciliation. Jodi Cowan: So, I’d like to ask everyone take a moment to reflect on the traditional territory on what you're on the Treaty that it's covered under and your own personal relationship with the land. Jodi Cowan: As a university community we're dedicated to increasing our awareness, understanding and gratitude for the lands in which we share.
Jodi Cowan: My name is Jody Cowan and I’m the Community engagement coordinator here at Ontario tech university, thank you for joining with us for today's session. Jodi Cowan: Today is with Dr Pierre Côté from our faculty of health sciences it's a second 10 sessions, where we're hosting with Ontario tech experts to share the research and to spread the word about our pi day of giving. Jodi Cowan: This will help raise funds for our student relief fund which helps our students who are experiencing financial need to cover 19.
Jodi Cowan: Now, there will be time for Q&A following the presentation so use the Q&A function at the bottom of your screen at any point during. Jodi Cowan: today's presentation and we'll do our best to get to your questions. Jodi Cowan: This session is being recorded and we will be posting it on our website so you can watch it again or share with your friends who are unable to make it with us to make it work last life today I’d now like to introduce Dr Peter coyote from the Faculty of health sciences. Jodi Cowan: Dr containers to Canada research chair and disability prevention and rehabilitation his research interests include the study the management and prognosis of musculoskeletal pain mental health and disability. Jodi Cowan: His work aims to identify modifiable risk factors and design interventions that will reduce the burden of chronic pain and disability and our population.
Jodi Cowan: He is also interested in the translation of scientific evidence into policy now I’d like to turn it over to you, Dr. Côté, for your presentation on virtual rehabilitation a promising way forward take it away Pierre. Pierre Côté: Thank you very much Julie.
Pierre Côté: I will share my screen and good afternoon everyone, and thank you so much for sharing your lunch hour with us. Pierre Côté: I have to tell you that, as someone who's been interacting with students over the past year, I am amazed every day by the resiliency. Pierre Côté: That the students at our university have shown, and I am truly impressed by how they've adapted to this challenging situation, so I thank you very much for supporting our student body.
Pierre Côté: And for contributing to their future success, I’d like to talk to you today about a topic that is very close to. Pierre Côté: My heart and that I’m very passionate about which is the world of rehabilitation and I’d like to use the lens of an epidemiologist I know most of you will I heard that term a lot during the pandemic. Pierre Côté: To look at how we can actually move the world or the field of rehabilitation forward, given what we've experienced in the past week, and how our university can really play a role, nationally and globally in influencing rehabilitation and people helping people with disabilities. Pierre Côté: I think it's important to first define rehabilitation in in because there's been a lot of misconception about what rehabilitation is.
Pierre Côté: rehabilitation is really a set of interventions that are designed to improve or optimize function and disability with health conditions in relationship and interaction with the environment. Pierre Côté: So, although rehabilitation has been traditionally defined as caring for individuals with severe conditions or severe injuries. Pierre Côté: rehabilitation is much broader than that, in fact, if some of you today are wearing glasses hearing aids or you're wearing some kind of support to help with your back pain.
Pierre Côté: These interventions are all part of rehabilitation. Pierre Côté: So, rehabilitation is really part of our daily life, whether we seek healthcare or whether we interact with the environment in, in fact, there are two main buckets. Pierre Côté: of interventions or things that are done to ensure that our public our patients have access to appropriate rehabilitation. Pierre Côté: The first one is you know is clinical rehabilitation, which will consist of providing individuals will need them with healthcare interventions. Pierre Côté: And this can range from seeing a physical therapist a chiropractor in the Community to having access to very significant in advance.
Pierre Côté: Intervention interventions in tertiary care hospitals, but the other bucket of interventions that is really important rehabilitation is what we call Community based we have. Pierre Côté: How do individuals with disability with impairments can actually contribute and live an active life in society, how do we adapt our workplace, how do we adapt our sidewalk. Pierre Côté: These things, called Community based rehabilitation are essential to ensure that people with disabilities, a whole range of disabilities can actually contribute. Pierre Côté: So today I’m going to navigate between the fields of clinical rehabilitation and community-based rehabilitation and offer some thoughts about how we and the university and can really contribute to advance in this field. Pierre Côté: This very important study published in The Lancet in at the end of 2020 in December of 2020 by the World Health Organization. Pierre Côté: had a very strong message for the global community, what we've learned from this paper is that today globally around the world.
Pierre Côté: There are 2.41 billion individuals who are in need of rehabilitation services and often cannot access them. Pierre Côté: Because of funding, because of access, because they live in remote areas or because they live in low- and middle-income countries. Pierre Côté: And what does also is also surprising for a lot of us is that the main reason why people need. Pierre Côté: Rehabilitation services is musculoskeletal disorders or pain or disorders that affects your bones your joints or muscles your ligaments. Pierre Côté: Such as your spine, in fact, low back pain is the single most condition the similar condition for which there is the highest need of rehabilitation services throughout the world.
Pierre Côté: And that is the case for 134 of 204 countries in the world, so low back pain is the main reason why people experience disability in their life. Pierre Côté: what's so surprising is that this problem is not only an issue in the low- and middle-income country, but in fact low back pain is the main reason for needing rehabilitation services. Pierre Côté: in Canada in our country in our province and where we live and, as you can see, this is also true in South America in Africa in part of the Middle East and Southeast Asia.
Pierre Côté: So, disability related to low back pain in the need to provide rehabilitation services for these individuals is the main reason for lost productivity or loss of functioning in our communities. Pierre Côté: No back and neck pain, in fact, are the main cause of disability in Canada and try the wall, as I just mentioned, and they are the most common cause of medically certified six absence. Pierre Côté: sickness and certification and they have led to the opioid epidemic that has been plaguing our nation, for the past decade. Pierre Côté: In fact, people with low back pain and neck pain, or very likely to use healthcare services. Pierre Côté: Roughly about half of individuals who experienced something in their back will consult the healthcare providers and half of the costs are related to direct patient visits. Pierre Côté: The costs are rising exponentially in fact just completed an analysis of the cost of low back pain, you know Ontario and the cost annually or close to $1 billion.
Pierre Côté: depend them, it did not help with the situation last March, as you well know, and you're seeing me my Home Office, we have to change our lifestyles. Pierre Côté: And our lifestyles change I’ve led to the way different ways in which we live, we had to take care of children at home, we had to take care. Pierre Côté: of our elderly parents, we had to adapt our workplaces, to be able, that we function make times to actually deliver on our work outputs while taking care of our loved ones. Pierre Côté: And these lifestyle changes have led to an impact on our health, our cemetery the prevalence of sedentary lifestyle has greatly increase in our communities.
Pierre Côté: Our sleep as nothing prove it has gone down in terms of quality, a large segment of the population is now experiencing stress anxiety and depression. Pierre Côté: Because we're less active and more sedentary we have gained some weight and also, we have suffered, or we are suffering from social isolation, these are not new things for you, I knew, you are well aware of these changes that we had to adapt to. Pierre Côté: But what's also very important to consider is that those individuals in our Community will live with long term conditions, these would be chronic diseases and disability.
Pierre Côté: reported to a statistics Canada survey conducted last summer that their health and actually deteriorated more than 50%. Pierre Côté: Of these individuals reported that their health is worse that has been made worse by the pandemic 61% are now reporting to have worse mental health. Pierre Côté: But what is also very important, is that about 53% of these individuals with chronic conditions needed medical treatment, but could not access it. Pierre Côté: So there has been a real challenge for individuals with long term conditions and disability to access their appropriate health care. Pierre Côté: And this is also through for those who needed rehabilitation services such as physical therapy chiropractic and massage about 42% of those cannot access their treatments and therefore help with their disabilities.
Pierre Côté: So, what did people do and what how did our society in our healthcare system react to this to this side effect of the pandemic. Pierre Côté: Well, we saw an increase in the use of telehealth and virtual health services internationally, in fact, the World Health Organization. Pierre Côté: reported that 63% of countries that are Members States of the who reported disruption in this in rehabilitation services. Pierre Côté: And 58% of these countries had to replace in person consultation with Tele health during the pandemic. Pierre Côté: Now telehealth is not new, it was its origin date back to the 1960s, but there has been a slow evolution of telehealth and virtual health and virtual rehabilitation really until the pandemic, which has led to a really rapid evolution of services in the United States, compared to. Pierre Côté: 50 but there has been a 50% increase in synchronous Tele health visits in 2020.
Pierre Côté: This is basically you need to consult your general practitioner your doctor, you cannot go to the office, so therefore you're likely to pick up the phone or engage with your physician. Pierre Côté: To a zoom conferences, this is what synchronous Tele health is, and this has increased by 50% compared to last year in the United States. Pierre Côté: And what was really noticeable is that in the early phases of the pandemic there was 154% increase in telehealth utilize a synchronous Tele health utilization in the United States, and I would assume that we are, we have faced a similar type of issue here in the country. Pierre Côté: Fortunately, most Canadians did not get infected with the coronavirus but one of the side effects of the pandemic again was the reduced access to health care and, in fact.
Pierre Côté: telehealth was used not primarily to treat covert patients, but it was used to treat the people's heart disease arthritis depression, diabetes and other chronic health disorders. Pierre Côté: So, what is tilly rehabilitation and what is virtual rehabilitation well tilly rehabilitation is really the delivery of professional rehabilitation services at a distance using technology like we are doing right now. Pierre Côté: And this has rapidly evolved more so recently, but over the past 1015 years into virtual reality rehabilitation and this is what I’m really excited about. Pierre Côté: And where I think our university can play a great role in the future.
Pierre Côté: virtual reality rehabilitation is really using technology to allow users to interact with a multi-sensory simulated environment. Pierre Côté: and receive real time feedback on performance and I’ll give you an example of that in a minute so it's really about changing behaviors adapting lifestyle using virtual reality visitation. Pierre Côté: gaming is a key component of these technologies, now I do the work to people benefit from using 20 rehabilitation and virtual we have station. Pierre Côté: So, some of the work that we've engaged with in starting with. Pierre Côté: In last spring at the Center for disability prevention and rehabilitation, where I am the director.
Pierre Côté: The stretching looked at the overall body of knowledge, the overall body of science to understand whether or not patients, we use these technologies these services actually benefit from them from a health perspective. Pierre Côté: And the evidence is quite clear, and this is very, very important that synchronicity rehabilitation. Pierre Côté: Being in contact with your physical therapist during his session for whatever health problem you have such as non-acute headaches neurological disorders low back pain, are still are try this of the knee and the hip.
Pierre Côté: is actually similar in benefits to seeing a healthcare provider in person. Pierre Côté: So, the idea that timmy rehabilitation is not as good as being with a clinician in their office is actually not supported by the evidence people benefit from these interventions. Pierre Côté: Now, what about 3D virtual rehabilitation, we are virtual reality rehabilitation. Pierre Côté: Well, again looking at the seven that's, it is clear that there was this is a promising and viable options for rehabilitation of musculoskeletal disorders neurological disorders and even mental health and cardiovascular disease. Pierre Côté: And this is really where I think the future of rehabilitation is going to be evolving in the next 10 to 20 years.
Pierre Côté: It was an example of the delivery of virtual rehabilitation intervention, which was just recently tested for people with chronic low back pain. Pierre Côté: Now, chronic low back pain is a really challenging disorder condition to treat because once you've had pain for more than six months. Pierre Côté: The course is really challenging for individuals that pain tends to become chronic, and it has lasting consequences on the ability of individuals to engage in their daily activities. Pierre Côté: So, I was really excited when I saw this new intervention, which is basically using virtual reality. Pierre Côté: With the goggles that individuals put on their face for a period of eight weeks, and they were shown little videos and.
Pierre Côté: and music that emphasize the concepts of cognitive based rehabilitation. Pierre Côté: And provided messages about education relaxation mindfulness escaping the stress of the daily lives. Pierre Côté: pain distraction gains and dynamic breathing so individuals that were randomly assigned to receive the ease Dr X device received these virtual reality interventions. Pierre Côté: And it was compared to a sham interventions people got the same goggle, but they were just provided with low key videos and random music in their in their device, and the results were very exciting. Pierre Côté: The use of the virtual reality virtual reality rehabilitation really had an impact on pain and disability and as individuals, so this graph shows the course the progression of pain overtime.
Pierre Côté: Since the beginning of the trial for a period of about a year following the intervention. Pierre Côté: In what you can see is that there has been a constant decline in the pain reported by the individuals that was much more improved. Pierre Côté: In those who received the virtual reality intervention compared to those who receive the Shan intervention in this was also true for a range of other outcomes, such as mental health outcomes and also the activity their ability of individuals to engage in their daily activities. Pierre Côté: So, the future is there for us, and this is an area of research that we will be that we are engaged in at the Center for disability prevention and rehabilitation at the university. Pierre Côté: And there are some important unanswered questions that I hope I’ll be able to tackle with my colleagues and graduate students over the next in the near future. Pierre Côté: And these questions are not necessarily related to the medical interventions related to the patients but they're also in related issues related to equity and access.
Pierre Côté: Is this technology, easily accessible by all by individuals in all socio-economic status in the population. Pierre Côté: What about individuals will live in remote areas where the technology may be harder to get this is an important area of. Pierre Côté: Research that we need to involve them what do we do with the rapid evolution of technology, how do we adapt current technology with current with very quickly evolving advancement.
Pierre Côté: The concept of patient centered care and shared decision making, which is now part of evidence-based practice will need to be adapted. Pierre Côté: To the delivery of virtual reality rehabilitation simply often because we cannot touch patients, we cannot establish the necessary contact to engage with patients in in a in a shared decision making. Pierre Côté: Well, we find ways to deliver these services and a cost effectiveness way so that can provide value-based care to our population. Pierre Côté: And finally, is it going to be safe for patients will increase the rate of miss diagnosis or promote over medicalization by that I mean will it be a technology that will be used.
Pierre Côté: For people to actually access services when they may not necessarily need them, so I think that Ontario tech. Pierre Côté: is very well positioned to tackle these issues because six of our faculties can actually join forces, this is a challenging issue. Pierre Côté: That needs more than healthcare intervention, it needs collaborations with our colleagues and the Faculty of education issues obviously related to equity. Pierre Côté: Human rights need to be tackled with our colleagues and social medicine sciences and humanities computer engineering technology with science. Pierre Côté: And in business its artificial intelligence and robotics, so I think it's our challenge. Pierre Côté: to your rehabilitation virtual rehabilitation is not going anywhere, and I think that we can make a difference, so thank you so much for sharing a few minutes of your time with me today, and I hope we can engage in a Q&A Thank you very much, God back to you.
Jodi Cowan: Thank you so much, Pierre I’m sure I speak for all of us today when I say that we all learned a lot, and we will keep these tips in mind, especially when working from home and. Jodi Cowan: You mindful of our ergonomic setup so we can eliminate that lower back problem that you talked about so much, I do have a couple great questions from the audience today and the first one would be. Jodi Cowan: Do you think that VR rehabilitation will help expand the range of in-home services that can be offered. Pierre Côté: Yes, I think that this is one of the goals of virtual rehabilitation. Pierre Côté: Especially in populations that are either live in remote areas in rural areas or in individuals that have issues such as mobility problems they cannot easily get to a clinic. Pierre Côté: or even busy parents nowadays that have to double tasks with their work, the children Educating the children, so if they can take a few minutes in their home use VR rehabilitation, then I think that this is a promising avenue to improve their chronic health conditions.
Jodi Cowan: And as a really awesome follow up question Dr Côté, we were wondering what the VR rehabilitation will help sorry, what kind of access, do you need for bandwidth for those in remote areas to offer these kind of services as. Jodi Cowan: Virtual rehabilitation okay. Pierre Côté: I must admit, God that this is beyond my knowledge, expertise I’m not well versed in the technology requirements for this, but I know. Pierre Côté: having discussions with my colleagues and the Faculty of business and information technology at the university that's really, they are focusing on making sure that these are accessible, so therefore using cell phone or other devices could be an avenue that is used to deliver these interventions.
Jodi Cowan: awesome now we both can agree that the mental and physical health of our students is of paramount importance to all of us, so what would you like to see the university adopt a virtual rehabilitation to best enhance our services that we provide here. Pierre Côté: I think that I would start by focusing obviously on the mental health of our students now, and I know that the University has done. Pierre Côté: tremendously tremendous efforts and it's very conscious of these, and I think that developing virtual rehabilitation or virtual reality interventions. Pierre Côté: With the students understanding their needs is really the way to move forward, so I would focus on mental health in them on promoting exercises and physical activity, because that is really the key. Pierre Côté: To help with a lot of the issues that I've mentioned about today. Pierre Côté: From pain to sleep to sedentary lifestyle.
Jodi Cowan: This is very exciting now can this be offered in in care settings ltc age by the staff there do they need specialized training, how do you see this working in conjunction with primary healthcare, such as chiropractors and physiotherapist. Pierre Côté: yeah, so obviously it would have to be a bit of a learning curve, with the staff but I’m sure that that can be managed well and, in fact, some of these interventions have been delivered or used. Pierre Côté: In clinical setting on long term care homes to compliment the services that are provided to elderly populations or individuals who need rehabilitation for.
Pierre Côté: Their musculoskeletal neurological deficit, so this is also another, this is a very good question and there another avenue for these technologies is that they can complement what is currently provided in clinics and hospitals. Jodi Cowan: Great well, I must admit we're so lucky to have someone with your expertise as part of our Ontario tech family and the support that you give for our students is amazing, so thank you again so much PR for joining us today. Jodi Cowan: This is our fourth annual pi day of giving her we're celebrating the infinite possibilities for our students here at Ontario tech.
Jodi Cowan: it's been a difficult year for everyone, as we all can imagine and I’m glad that we're able to switch to virtual learning within one day we're really looking forward to being back on campus with our students. Jodi Cowan: However, our students need help, more than ever, so I really hope that everyone joining us today will make a gift and supportive our student really fun to help students. Jodi Cowan: who are experiencing their financial need that were unexpected do to reduce their last part time jobs and all donations to the student Relief Fund are going to be matched dollar for dollar. Jodi Cowan: For those of you who didn't make a gift when registering today we do, thank you. Jodi Cowan: I’m pleased to share that we've already given out nearly $400,000 to students in addition to our regular scholarship and bursary program which is just amazing. Jodi Cowan: And I in saying that I would really like to also thank camp travel group for their generous sponsorship today for our pi day of giving.
Jodi Cowan: I hope those of you joining us today will spend your lunch hour with us for the remaining of our speaker series sessions. Jodi Cowan: You can find more details on the topics and speakers on our website on Ontario tech you dot slash Ontario tech you.ca backslash pi day. Jodi Cowan: Thank you for joining us again thank you so much to our Ontario tech expert Dr Peter conte before we say goodbye today, I’d like to share a short message with you from our students here in Ontario tech, thank you, thank you. Jodi Cowan: On March 14 you can help support my dreams knowledge is infectious and my dream is to teach. Jodi Cowan: My dream is to educate young students about the benefits of physical activity, so they can adopt these practices into their daily lives. Jodi Cowan: And also contribute to innovative technologies that leave a lasting impact on society on pi day join our circle and support students like me.
Jodi Cowan: I want to help save people from natural disasters; I want to be part of engineering projects that to help make tech be your best friend. Jodi Cowan: I want to develop technology to aid in space exploration I aspired to design aerodynamic race cars to shape the future Formula one racing, just like the value of pie opportunities, like me, are endless to join us.