Canadian Military Family Services Program (MFSP) Run by the Military Family Services

As you begin working with Canadian Forces military personnel you develop a picture of not just the member’s occupational needs, strength and deficits but, often, the needs of spouse, caregiver, children and even friends and extended family. We all know that the needs of the family (in whatever form) can directly impact on the military member – this is true for all the populations occupational therapists work with.

As you develop your assessment plan pre-first-visit or organize your thoughts as you write your plan forward, we invite you to consider the excellent programs and services offered by the Canadian Military Family Services Program (MFSP) Run by the Military Family Services [https://www.cfmws.com/en/AboutUs/MFS/Pages/default.aspx], MFS are located across Canada.

The MFSP offers programs and services around

  • Deployment, departures and reunions
  • Children’s deployment support
  • Education and training for family members
  • Assistance locating and re-establishing medical services
  • Self-help groups, short term intervention and crisis support and mental health resources for children and youth
  • Postings for volunteering and community involvement opportunities
  • And so much more …

Go here to find the nearest MFSP to you: https://www.familyforce.ca/sites/AllLocations/EN/Pages/default.aspx

What is your experience with the MFSP?

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Volunteering with Veterans in Extreme Sports: An Occupational Therapist’s Account from the UK

A virtual interview with guest poster Deborah Harrison, MSc, BA, Dip COT: Dr. Harrison is a UK occupational therapist with extensive experience working in the NHS, higher education and third sector organizations (the focus of the post). Her focus of research and lecturer at the University of East Anglia, School of Health Sciences is mental health, combat injury and occupational science. [https://www.uea.ac.uk/health-sciences/people/profile/deborah-harrison]

We asked her: “How did you begin volunteering with wounded veterans?”

Mrs. Harrison: I began my journey working with veterans in 2011 by being part of a motorsport team. Race2Recovery [http://race2recovery.com/r2r/ ] came about when two friends, having been through their rehabilitation, were wondering what to do next with their lives. They decided that their recovery would be helped by being involved in motorsport; but not just any motorsport, the most challenging race in the World, the Dakar Rally. The desire to face the most difficult and extreme goals is not unusual, Walking with the Wounded [weblink] and Row2Recovery [weblink], both UK based charities, being further examples.

“How do occupational therapists work with veterans in these types of charities?”

Mrs. Harrison: Occupational therapists work with people to enable them to participate fully in life and to make the most of every opportunity. For people recovering from combat injury there is a sense of loss of previous occupational roles and identity; it is important to support the creation of a life that has new meaning and purpose. Activities have to be relevant and appropriate to the individuals in recovery; sport has many features which appeal to the younger and often male participant (although not exclusively of course).

“Why motorsports?”

Mrs. Harrison: Motorsport has some advantages over other forms of sport because it does not have a special category for people with disabilities. The amputee drivers, with their race suits on, look like any other driver or co-driver. It is a physically and mentally challenging sport that earns respect and therefore brings status. Veterans with a disability do not want to be defined by that disability and a positive self-image and self-esteem are vital to successful functioning and full recovery. In motorsport, integration and social inclusion are possible. A huge difficulty with motorsport however is the cost and the lack of an evidence base for its efficacy; many of the benefits can be achieved in other ways.

“What are some exceptional experiences you have had volunteering?”

Mrs. Harrison: One of the most significant experiences of being a part of Race2Recovery was the close team work, often in difficult and challenging situations. This is a vital element for people who have been in the military when they are recovering. The team work in Race2Recovery provided a bridge from the military and helps veterans to adjust to working in close proximity with civilian team members (not always easy). Team activities forge lasting friendships with other veterans and civilians, even when separated by thousands of miles, thanks to social media connections.

I have seen first-hand that wounded veterans often overcome multiple and ongoing problems. Recovery is a long haul when you’ve had long periods as an inpatient, multiple injuries including amputation, brain injury and mental health problems. It is important to take into account not only the physical aspects of rehabilitation and but also the psychological and social aspects. The combat injured veterans need support over an extended period of recovery. Many kinds of help are needed with relationships, finances, finding work, management of pain and mental health problems. If any one aspect of the rehabilitation goes wrong then life can come to a complete halt. Participating in a sport might give everyone a happy feeling, but there needs to be other help available and readily accessible.

“What are some current authors, researchers and or occupational therapists readers can draw on regarding overcoming combat related injury?”

Mrs. Harrison: Having noted the need for signposting to further help, overcoming huge challenges and excelling at a sport or in a particular event can be hugely rewarding and transforming. Dr Mick Collins (2014) discusses this peak experience in his book ‘The Unselfish Spirit’; from the lowest point in your life, which might be seen as a spiritual emergency or complete loss of meaning and purpose, you can be ‘re-born’ and reach self-actualisation and a new sense of self. Occupational therapists believe that this has to be achieved through ‘doing’ (engagement with activity) to achieve our full potential. Those of us who were a part of the team during the Dakar Rally in 2013 will never forget the intense emotions of that moment when the race car, called Joy, crossed the finish line against the most extraordinary odds (see Colene Evans-Allen’s blog for the full story).

Nick Caddick (2014) whilst working in the Peter Harrison Centre for Disability Sport at Loughborough University published a literature review demonstrating the value of sport and physical activity for supporting the well-being and rehabilitation of veterans with disabilities and those with Post Traumatic Stress Disorder (PTSD). His findings have a strong resonance for occupational therapists. His themes include (among others): focus on ability, identity and self-concept, a sense of achievement and accomplishment. The evidence reviewed by Nick demonstrates clear physical, psychological and social benefits of sport (Caddick 2014).

Nick has also published research about veterans who are finding that surfing can play a part in recovery from PTSD. In addition to the benefits discussed above, surfing has the transformative element of being an activity in nature, or ecotherapy. The ‘spiritual awareness of a connection with the natural world’ (Dustin et al 2011 cited in Caddick & Smith 2014) is also a key message in ‘The Unselfish Spirit’ (Collins 2014).

In the United States an occupational therapist has been delivering ‘Ocean Therapy’ for veterans from the conflicts in Iraq and Afghanistan with PTSD to facilitate their transition to civilian life (Rogers et al 2014). She used quantitative methods in a small study and demonstrated that a 5 week surfing programme had a positive impact on PTSD and depression symptom severity. Although Nick and colleagues reject medical model concepts of PTSD, there are many similarities in their findings. The interaction with the ocean was found to be an important part of developing coping strategies; storytelling and relationship building were key positive factors in the efficacy of the programme. The veterans developed a new kind of brotherhood with its own language and culture, similar to being in the military, which aided transition. There were aspects of surfing that appealed to male participants, also a benefit of motorsport previously mentioned. Rogers et al (2014) concluded that surfing and other high impact sports could be incorporated into occupational therapy programmes with veterans but that more research is needed. The charity in the UK providing ocean therapy is Surf Action and I provide free consultancy to the team working as a non-executive director on the board of trustees.

“So what’s in store for you now?”

Mrs. Harrison: Since leaving Race2Recovery in 2014 I have become involved with supporting a number of small charities and organisations that provide opportunities for veterans to become engaged in challenging activities as part of their recovery, usually outdoors in the natural environment. I have been inspired by a growing evidence base to support this work.

I am also facilitating volunteering for occupational therapy and physiotherapy students from the University of East Anglia with the Re-Org Trust who support veterans living with PTSD. I was deeply moved by Jonathan Weaver, representing the Re-Org Trust, when he spoke at a student seminar ‘Actively Supporting Veterans’. He bravely shared his story and reminded our healthcare students that they have precious skills, pleading with them not to forget our veterans. Students are now going out to France to work alongside veterans on the Re-Org Trust farm and are learning a huge amount from the experience.

Finally, I also volunteer my time to The Baton. This is a charity with the primary mission to raise and maintain awareness within the British public and our Allies about the reality of life for Armed Services personnel and their families. It exists to ensure that they are given the level of support that they are rightfully due. People carry The Baton around the world to share the message; we must never forget.

MAVAN would like to thank Mrs. Harrison for her time with responding to our request to gather information from her about experiences working with veterans in the UK.

Further information:

www.surfaction.co.uk

http://thereorgtrust.org

www.thebaton.co.uk

For a first person account of Tony Harris’ recovery through motorsport in Race2Recovery and a good account of Dakar Rally 2013 read this blog from Colene Evens-Allen: http://inspirationatspeed.blogspot.ca/p/race2recovery.html

Carly Rogers’ TED Talk on Ocean Therapy: https://youtu.be/Wfb8tHn8Xv4

References:

Caddick N & Smith B (2014), The impact of sport and physical activity on the well-being of combat veterans; A systematic review. Psychology of Sport and Exercise 15, 9-18.

Collins M (2014), The Unselfish Spirit. Permanent Publications, Hampshire.

Rogers C, Mallinson T, Peppers D (2014), ‘High-Intensity Sports for Posttraumatic Stress Disorder and Depression: Feasibility Study of Ocean Therapy With Veterans of Operation Enduring Freedom and Operation Iraqi Freedom’, American Journal of Occupational Therapy 68, 395-404.

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The Canadian Forces Spectrum of Care: Implications for Occupational Therapist

Purpose of the Canadian Forces Spectrum of Care

Canadian Force (CF) members are entitled to receive health benefits and services through Canadian Forces Health Services Group (CF H SVCS GP) in accordance with specific regulations (Queen’s Regulations and Orders Chapters 34 and 35 found here).

The benefits and services are comparable to those provided to other Canadians through their respective provincial health care plans.

The CF Spectrum of Care (SoC) provides direction to CF health care providers, Base/Wing Surgeons, Clinic Managers and Dental Detachment Commanders. QR&O 34.07 Entitlement to Medical Care are the authority for utilization of public funds to ensure CF members have access to a range of medical benefits and services similar to those Canadians receive through provincial health care plans.

What is placed in the SoC health services and benefits for CF members?

Recommendations for inclusion of health benefits and services in the CF SoC are based on the following principles:

  1. The benefit/service is necessary for the purpose of maintaining health and mental well-being or preventing disease; diagnosing or treating an injury; illness or disability;
  2. The benefit/service sustains or restores a serving member to an operationally effective and deployable member of the CF;
  3. The benefit/service adheres to the scientific principle of evidence-based medicine. (This principle would eliminate any new procedures or remedies that have not been thoroughly and scientifically investigated (e.g. homeopathic remedies); and
  4. The benefit/service is not for purely experimental, research or cosmetic purposes.

The benefit/service is funded by at least one provincial health care plan or federal Agency (this principle is in keeping with Public Service Health Care Plan criteria).

Implications for occupational therapists working with CF members:

  1. Occupational therapy referrals: Canadian Forces Health Services (CFHS) will make referrals regarding a number of different CF member issues. Most often CFHS are interested in assessment and treatment of injuries that are causing issues living in the home and community; however, more recently CFHS are referring specifically to OT assess and treat in the area of return to duty and return to work. The idea of assessment and treatment in the area of return to duty draws on processes and concepts regarding “operational effectiveness”, “universality of service” and “deployability” often not seen in other industries. These CF process and concepts will be explored in-depth in a later post.
  2. Occupational therapy and military duty: For OTs working with CF members who are not transitioning out of the CF, an understanding of the member’s return to duty plan should be considered within the OTs approach. In dialogue and partnership with the CFHS team, OTs will want to consider the members current function and their work status and position. If the CFHS team plan intents to send the member back to full time military duty, consider your role to assist and, if you have the skills and experience, speak with the CFHS team. If the CF member has a long term disability, is still in the military but transitioning slowly to civilian work / community, the member still has expectations to engage in work or health work. It is critical to understand what the CFHS expectations are for the member and integrate these expectations within the OT rehabilitation plan and recommendations.
  3. Occupational therapy CF recommendations: When an OT assesses a CF member an OT report (either  must be written and provided to the CFHS team. The recommendations within in the report are recommendations for the CFHS to consider in light of the CF funding criteria, the medical needs of the member and over arching rehabilitation and health care plan for the member. Each recommendation is reviewed in light of the SoC #3 and #4 criteria above. Because of this OTs must communicate to the CF member that their recommendations are not “set in stone” but are reviewed by the CFHS care team first. Further, OT recommendations must (a) be based on assessment findings / medical needs (outcome measures, assessments, expert observations rounded out with member’s subjective, voiced concerns) and (b) treatment recommendations are are to have evidence of effectiveness.

Have you had to work with CFHS at any point? What great experiences have you had with the CFHS team?

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Mindfulness: Current evidence and its implications for the Canadian Forces

GUEST POST

Written by Calvin Yip, Canadian Forces Physical Rehabilitation Research Student (Federal Student Work Experience Program- FSWEP)

“[Mindfulness is] the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment”

(Kabat-Zinn, 2003)

What is mindfulness and why should Canadian Forces Health Services care?

Mindfulness has been defined as “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment” (Kabat-Zinn, 2003). In 1982, Jon Kabat-Zinn authored one of the first articles documenting the use of a mindfulness-based therapy for clinical purposes. He found the intervention to be associated with marked decreases in the severity of chronic pain (Kabat-Zinn, 1982). Since then, the body of literature on mindfulness-based health interventions has grown substantially, with a review of systematic reviews identifying 81 systematic reviews (including hundreds of studies in total) in this topic area (Shekelle et al., 2014). Overall, the evidence implicated a potential positive effect of mindfulness-based interventions for 10 health conditions including depression, chronic illness and pain (Shekelle et al., 2014). In the U.S. military, many positive health impacts have been reported following mindfulness training including decreases in pain, stress and anxiety (Stanley et al., 2011; U.S. Army, 2015).

Mindfulness 1.png

Why conduct additional reviews?

Despite the growing evidence suggesting that mindfulness-based interventions are likely beneficial for health in general, the information is insufficient to guide decision making within the Canadian Forces. Conclusions cannot be drawn from an individual study, and existing systematic reviews do not provide findings pertaining to a specific mindfulness-based intervention for a specific health condition. To address this knowledge gap, separate reviews were conducted for each of the 4 conditions of interest identified by mental health professionals in the Canadian Forces. These conditions were depression, post-traumatic stress disorder (PTSD), substance use disorders (SUDs) and traumatic brain injury (TBI).

The Good

Findings were promising and consistent for depression, where all 14 randomized control trials (RCTs) described the intervention as a variation of mindfulness-based cognitive therapy (MBCT), an intervention previously developed by Segal et al. (2002). All but one of the RCTs reported significant improvements in at least one main outcome, two found MBCT to be as effective as antidepressant medication, and two others found MBCT to be as effective as cognitive behavioural therapy (CBT). Results were also positive for PTSD, with all 7 RCTs reporting significant improvements in at least one main outcome attributable to the intervention. Multiple RCTs reported significant improvements in PTSD symptoms and quality of life measures. Interestingly, 6 of the RCTs were conducted in a veteran population, and every one of them used an intervention reminiscent of the mindfulness-based stress reduction (MBSR) program originally developed by Kabat-Zinn (1982).

The Unclear

Findings were less consistent for SUDs and TBI. Of the 9 RCTs that investigated SUDs, 8 reported significant improvements in at least one main outcome attributable to the intervention. Although mindfulness-based interventions may be beneficial for SUDs in general, conclusions cannot be drawn from the available evidence due to the heterogeneity in the type of intervention, outcome measures, and specific SUD. The review for TBI proved to be a challenge, as the limited size and scope of the existing literature made it infeasible to limit the review to only RCTs as with the other 3 reviews. Seven studies were retrieved and 6 of these reported improvements in at least one main outcome attributable to the intervention, though several key limitations must be considered. These include the particularly small sample sizes (the largest study included only 76 participants, and the mean number of participants for all studies was only 31) and concerns of methodological weakness (4 out of the 7 studies reviewed were not RCTs). Three studies lacked a control group and one lacked random assignment to conditions.

Preliminary Implications

In light of the positive and consistent findings from the aforementioned reviews, MBCT-based interventions are recommended for depression and MBSR-based interventions are recommended for PTSD. Stemming from inconclusive and insufficient evidence, no recommendations can be made at the present time regarding the use of mindfulness-based interventions for individuals experiencing SUDs or TBI. Instead, further research on the impact of mindfulness on SUDs and TBI is recommended.

References

  • Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry 1982;4:33-47.
  • Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. Clin Psychol Sci Pract 2003;10:144-156.
  • Shekelle PG. Evidence map of mindfulness (2014). retrieved from http://www.hsrd.research.va.gov/publications/esp/cam_mindfulness-report.pdf
  • Segal ZV, Williams JMA, Teasdale ID. Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse (2002). Guilford Press: New York.
  • Stanley EA, Schaldach JM, Kiyonaga A. Mindfulness-based mind fitness training: a case study of a high-stress predeployment military cohort. Cogn Behav Prac 2011;18:566-576.
  • U.S. Army. Mndfulness-based stress reduction finds a place in the military (2015). retrieved from http://www.army.mil/article/151787/mindfulness_based_stress_reduction_finds_a_place_in_the_military/

So tell us: Are you using a mindfulness approach in your everyday practice?

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Virtual Reality Research and Rehabilitation in the Canadian Forces: Part 3

GUEST POST

Written by Emily Sinitski, Canadian Forces Health Services CAREN Coordinator

Recap from Part 1 post: The Computer Assisted Rehabilitation Environment (CAREN) is located in The Ottawa, Ontario and Edmonton, Alberta Centres of Excellence. The CAREN is a virtual reality environment that allows clinicians and researchers to systematically manipulate the walking surface and/or visual field to address patients’ treatment needs for physical, cognitive and mental health rehabilitation. Get all the information from last weeks post here. Part 2 can be found here.

Current CAREN research areas

Several research studies have been completed since the opening of the CAREN facilities in 2011, which were led by teams from Defence Research & Development Canada, Canadian Forces Health Services, The Ottawa Hospital Rehabilitation Centre, Glenrose Rehabilitation Hospital, and Center for Interdisciplinary Research in Rehabilitation and Social Integration in Quebec. Current research areas include non-level gait biomechanics, assistive device evaluation, and use of the CAREN system for chronic low back pain, and lower limb amputee gait training. Results from our research studies will be instrumental in directing future research to the efficacy of the CAREN in rehabilitation programmes and optimising therapeutic protocols, making informed decisions related to the future use of the CAREN, and providing a scientific basis for moving forward with the possible use of this system for other disorders.

Simulator sickness and postural stability after immersion in the CAREN

Although the CAREN is a valuable tool for rehabilitation, simulator sickness can cause feelings of discomfort and unwanted side effects that limit the effectiveness of training. The purpose of this research was to establish a baseline of simulator sickness symptoms and postural stability after immersion in the CAREN system, for a non-injured military population (n=30). Results from this research demonstrated participants experienced “slight” symptoms of simulator sickness and greater postural instability after moderate activity in the CAREN. The data reported support our current guidelines to assess simulator sickness during CAREN sessions, even for a non-injured population. This information will be used as a comparative dataset for CAREN-based clinical assessments and future studies with CAF patient populations.

Evaluation of a CAREN-based gait training protocol for lower limb amputees

This research evaluated a structured CAREN gait training protocol used to improve gait performance for individuals with a lower limb amputation (n=8). Participants’ walking performance was assessed on days 1 and 8, and 20 minute training sessions were provided on days 2-7. A matched control group was also used for comparisons (n=8). The functional training sessions were individualized to participant’s needs by establishing a Lower Extremity Prosthetic Training Consideration framework to ensure therapeutic education and activities were delivered consistently to participants in the CAREN system. The largest improvements in walking performance were observed in symmetry of standing balance, step length, toe load and arm swing; upper body gait variability; and self-report measures of confidence and perceived exertion. The findings in this research suggested that the therapeutic education and functional strengthening throughout the six gait training sessions resulted in gait patterns closer to able-bodied.

Upcoming research areas

A preliminary investigation of a Motion-Assisted, Multi-Modal Memory Desensitization and Reconsolidation virtual reality based treatment for individuals with chronic combat-related post traumatic stress disorder will commence in early 2016. This treatment incorporates elements of Virtual Reality Exposure therapy and Eye Movement Desensitization and Reprocessing, while adding a motion-based component (e.g, walking). In this combination, members are challenged to optimally approach their traumatic memories for exposure.

CAREN scientific literature for 2015

Summary of scientific literature using the CAREN system for 2015:

  • Collins JD et al. A systematic literature review of the use and effectiveness of the Computer Assisted Rehabilitation Environment for research and rehabilitation as it relates to the wounded warrior. Work 2015; 50(1):121-129.
  • Hebert JS et al. Use of the CAREN system as a treatment adjunct for Canadian Armed Forces members with chronic non-specific low back pain: a pilot study. Journal of Military, Veteran and Family Health 2015; 1(1):47-58.
  • Plotnik M et al. Self-selected gait speed – over ground versus self-paced treadmill walking, a solution for a paradox. Journal of NeuroEngineering and Rehabilitation 2015;12:20.
  • Roosink M et al. Assessing the Perception of Trunk Movements in Military Personnel with Chronic Non-Specific Low Back Pain Using a Virtual Mirror. PloS One 2015; 10(3):e0120251.
  • Sessoms PH et al., 2015. Head stabilization measurements as a potential evaluation tool for comparison of persons with TBI and vestibular dysfunction with healthy controls. Military Medicine 2015; 180(3):135-142.
  • Sessoms PH et al. Improvements in gait speed and weight shift of persons with traumatic brain injury and vestibular dysfunction using a virtual reality Computer-Assisted Rehabilitation Environment. Military Medicine 2015; 180(3):143-149.
  • Sheehan RC et al. Mediolateral angular momentum changes in persons with amputation during perturbed walking. Gait & Posture 2015; 41:795–800.
  • Sinitski EH et al. Fixed and self-paced treadmill walking for able-bodied and transtibial amputees in a multi-terrain virtual environment Gait & Posture 2015; 41:568–573.

So how are you using technology in your everyday practice? Have you ever participated in research within the military or veteran populations? We would love to hear and share your story.

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OTNow: SnapShot of Occupational Therapy Leadership in Military, Veteran and Family Health

We wanted to highlight a special publication from CAOT’s Occupational Therapy Now journal speaking to military and veteran occupational therapy work in Canada. Enjoy!

VOLUME SEVENTEEN ISSUE FIVE September / October 2015.

OVERVIEW ARTICLE

Find it here: Occupational therapy leadership in military, Veteran and family health

Authors: Megan Edgelow and Heidi Cramm

“In this special issue, several best practices and service delivery models are shared. Guidelines for trauma-informed care, useful with this population, but also with other groups who have experienced trauma, serve to sensitize therapists to the need for physical and emotional safety as a cornerstone of a therapeutic relationship (Kitchen & Hosegood, p. 24). The role of service providers within Veterans Affairs Canada, and the focus of occupational therapists, is detailed by Card (p. 25). The specific work of occupational therapists with military personnel and Veterans at an OSI clinic, including intervention models, is shared by Beauchesne and Jacques (p. 26). Finally, the unique role of occupational therapists within the Canadian Armed Forces in a rehabilitation program shows the opportunities for holistic work with military personnel (Brown & Marceau-Turgeon, p. 25). These four articles offer concrete examples of occupational therapists as change agents for military personnel and Veterans” (Edgelow & Cramm, 2015, p. 23).

SNAP SHOT ARTICLES

Find it here: Snapshots of occupational therapists as change agents: Military and Veterans

  • Joining forces: Occupational therapists as change agents with military personnel and Veterans using trauma-informed care

Katie Kitchen, O.T. Reg. (MB) and Alana Hosegood, O.T. Reg. (MB), are both occupational therapists from Winnipeg, Manitoba. For more information, contact: kkitchen@hsc.mb.ca

  • Canadian Armed Forces occupational therapy

Helen Brown, OT Reg. (Ont.), is the Canadian Forces national occupational therapy coordinator working for the Canadian Forces Health Services. She may be reached at: Helen.Brown@forces. gc.ca

Mireille Marceau-Turgeon, M.Erg., is a Canadian Forces occupational therapist working out of Canadian Forces Base Valcartier.

  • Occupational therapists working with Veterans Affairs Canada

Patti Card, OT Reg. (NS), is an occupational therapist working as a case manager for Veterans Affairs Canada. She may be reached at: patricia.card@vac-acc.gc.ca

  • From combat to compassion: Enabling change in Veterans

Julie Beauchesne, erg., and Chantal Jacques, erg., work for Veterans Affairs at St-Anne’s Hospital near Montreal, QC. For more information, contact: Julie.Beauchesne@vac-acc.gc.ca

About OTNow: http://www.caot.ca/default.asp?pageid=7

 

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Virtual Reality Research and Rehabilitation in the Canadian Forces: Part 2

GUEST POST

Written by Emily Sinitski, Canadian Forces Health Services CAREN Coordinator

Recap from last week’s post: The Computer Assisted Rehabilitation Environment (CAREN) is located in The Ottawa, Ontario and Edmonton, Alberta Centres of Excellence. The CAREN is a virtual reality environment that allows clinicians and researchers to systematically manipulate the walking surface and/or visual field to address patients’ treatment needs for physical, cognitive and mental health rehabilitation. Get all the information from last weeks post here.

New CAREN Applications

  1. Smooth Pursuit: The Smooth Pursuit application displays a single moving tracking object with or without multiple moving distracter objects. This application can simulate standing or walking in a busy environment and can be used for sensory desensitization. The clinician can customize the field of view, number of distracter objects, shape and colour, and if the tracking object path is continuously or intermittent.CAREN 2.pngFigure 1. The Smooth Pursuit application displays a single moving tracking object (sphere) and 5 moving distracters (cube).
  2. Train: The Train application allows a person to walk or stand in a virtual moving train that can be used to provide conflicting visual-vestibular information as well as the addition of cognitive and balance tasks. The clinician can customize visual flow or train speed, direction of visual flow (e.g., forward or backward), and environmental distracters inside and outside the train.CAREN 3.pngFigure 2. This figure demonstrates the virtual train scenario with multiple objects inside the train (passenger, brief case, and bicycle) and objects outside the train (trees, telephone poles, highway, and vehicles). Objects outside the train can be displayed one or both sides.

What information can you obtain from the CAREN?

The CAREN system consists of measurement devices, including a motion capture system and a multi-axis tilting platform embedded with a treadmill and two force plates. The motion capture system is used to capture how a person moves by recording 3D positions of reflective markers that are attached to the body with double sided tape. Marker positions are used to create a unique subject model and allow us to obtain movement in three dimensions. The treadmill force plates are used to record ground reaction forces, which can be translated into joint torques and powers at the ankle, knee, and hip. The data capture using this system can also be used to quantify centre-of-mass movement, centre-of-pressure progression, or temporal-spatial information such as step length and step time. This information can be used to quantify deviations in walking patterns, which can be used to guide rehabilitation.

So what CAREN research is currently happening at Canadian Forces Health Services Physical Rehabilitation Program? See next weeks Part 3!

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