The philanthropic contributions of the Spinal Cord Injury Treatment Centre Society (SCITCS), led by visionaries Louise and John Miller, have helped make it possible to recruit and appoint Chester Ho, one of North America’s premier spinal cord injury researchers, as the first Spinal Cord Injury Research Chair at the University of Alberta and new director of the Division of Physical Medicine & Rehabilitation in the Department of Medicine.
“I am really grateful, not just for the funding of the endowed chair, but also to the Millers for their vision, enthusiasm and persistence―their tenacity―because they have been working on this for a long time,” said Ho, whose previous work at the Louis Stokes Department of Veterans Affairs Medical Center in Cleveland, Ohio, was instrumental in the development of an innovative telehealth program now used across the United States for rehabilitating injured American veterans.
“The Millers really had a great vision to create this chair position in spinal cord research and I hope to use the resources of this chair to give back to the community with my work. It is a great time for rehab,” said Ho.
Ho joins the U of A from the Cumming School of Medicine at the University of Calgary where he was an associate professor and division head, Physical Medicine and Rehabilitation, for the Department of Clinical Neurosciences and Alberta Health Services.
What drew you to the University of Alberta?
The endowed chair in spinal cord injury was very attractive and it allowed me to pursue my research which has two main arms. One is actually looking at the health-care delivery for people with spinal cord injury because it is a very complex, lifelong―and I would even say chronic―condition. The other research interest is the complications of spinal cord injuries such as pressure ulcers.
Pressure ulcers are one of the most common complications of a spinal cord injury and despite the fact that we have known about that for years, decades, centuries, the incidence is not decreasing. Despite all the advances in medicine, despite all the equipment we now have, despite all the efforts we have made, the incidence is not decreasing. That is a big problem. Apart from causing morbidity, it can cause mortality. People like Christopher Reeve, Superman, he died from a pressure ulcer. It affects the patient and his or her family members and caregivers.
Given those interests, I already have many collaborators at the U of A. The Smart-e-pants system that was developed at the U of A, I had the pleasure of working with Vivian Mushahwar when I was in Calgary, engaging in the design and clinical studies associated with that technology.
Your medical education was pursued at the University of Cambridge in England. What was that ‘a-ha’ moment in your internal medicine training that led you to specialize in rehabilitation medicine?
There are three particular moments, one was in medical school. I was at Cambridge and one of our required rotations as a med student was to follow a rehab patient throughout their stay in the hospital. I got to work with a stroke patient and that really opened my eyes. I started to realize that after the diagnosis and the initial treatment, there is actually a lot more we can do in rehab to help people regain their function and improve their quality of life. That was my first exposure that got me really interested in rehab.
My second ‘a-ha’ moment was when I was still in England, doing my houseman training (postgraduate medical training phase similar to internship in Canada) I took care of a gentleman with a spinal cord injury. I thought it was fascinating. Obviously it wasn’t good that he had a spinal cord injury but in terms of the physiology and all the things we could potentially help him with, I think that was really interesting to me and very satisfying work.
What is telehealth?
Telehealth is a variety of methods for enhancing health care, public health and health education delivery and support using telecommunications technologies.
Telehealth includes video conferencing or two-way audiovisual communications that allow for interaction between a patient, caregivers and health-care providers for counseling or a range of diagnosis and management discussions in chronic disease monitoring.
Remote patient monitoring using digital technologies to collect health data from an individual and electronically transmitting that information to a health-care provider in a different location for assessment, is another example of telehealth. It can help individuals manage their health at home in their own community, without physically needing to travel to a provider’s location.
Telehealth also includes applications of mobile health such as broadcasting physical or occupational therapy exercises or public health educational programs that can be accessed through mobile communication devices such as cell phones and tablets.
See Alberta Health Services website for more information about telehealth.
During my Physical Medicine and Rehabilitation residency at Harvard Medical School, my first rotation was in spinal cord rehab and it was clear to me that I wanted to focus my career in that direction.
What potential do you see in the application of telehealth to spinal cord rehabilitation with the delivery of care to Alberta patients?
I see telehealth as a great tool to provide better access to the specialists for people that do not live in urban centres. For instance, here in Alberta, we know that two-thirds of people with spinal cord injuries live around Calgary and Edmonton but the other third live in rural areas. That’s a sizable population and yet we don’t really have much in terms of specialized care and programs for people with spinal cord injuries living outside of urban centres.
Telehealth can provide better access but it also can be used to broadcast mass education to various sites simultaneously and be used as a way to connect and interact during consultations and facilitate discharge. Telehealth does transition the care more easily and allow the patients and family members to be brought together in conversation.
In the United States, we used telehealth a lot in Veteran Affairs medical centres. In Alberta, we have great telehealth infrastructure through Alberta Health Services and I can totally see us taking advantage of that and building from it to benefit our patients even more. In fact, that is one of my main interests, to develop a network system of care for people with spinal cord injury in the province.