July 22, 2018 was one of those magical summer Toronto evenings, perfect for enjoying a meal or having a drink outdoors. It was also supposed to be a night of celebration for Danielle Kane, a 31-year-old nursing student who was at a friend’s birthday at 7Numbers, a popular restaurant on the always busy Danforth Avenue.
Kane and her friends were on the patio, like countless other people that night, when they heard a bang – it sounded like a car backfiring or fireworks going off. Almost immediately, she rushed inside the restaurant where she ran into another reveler, yelling hysterically, who said she saw someone get shot nearby.
Alarmed, Kane and her boyfriend, Jerry Pinksen, an emergency room nurse, rushed out to see if they could help. “I have always cared deeply about others,” she says. But Kane was scarcely out the door when a bullet struck her, too, shattering a vertebra in her lower back. She screamed, fell to the ground and thought about how she didn’t want to die. Pinksen carried her back inside the restaurant and helped stabilize her until paramedics arrived.
Kane soon learned that a disturbed gunman shot and killed two young people that night, and that she was one of 13 others who were wounded.
“All it takes is one accident, one instance of being in the wrong place at the wrong time, and everything changes,” she says.
As bad as the shooting was, the nightmare was just beginning. Kane spent two weeks in an induced coma, underwent four surgeries, then spent several more weeks in the neuro trauma unit at St. Michael’s Hospital. She was eventually transferred to Toronto Rehab’s Lyndhurst Centre, where she discovered her diagnosis was permanent paraplegia – motor complete spinal cord injury at the T11 level, which means the 11th of 12 thoracic vertebrae located in the mid-back was damaged – which left her with no sensation and no ability to move from the belly button down.
“I was devastated,” she recalls. “I just cried. It was so hard to imagine how I would get through life this way.”
Fortunately, Lyndhurst specializes in caring for patients with spinal cord injuries (SCI) resulting from trauma (car accidents, falls and gunshot wounds) or disease to recover and adjust to their new circumstances.
In operation since 1945, Lyndhurst is Canada’s largest freestanding spinal cord injury rehabilitation facility, admitting more than 300 in-patients each year, and supporting more than 20,000 outpatient visits across 17 outpatient clinics.
“The centre’s interprofessional teams provide a wide range of therapies and services to help patients learn to compensate for any motor function they may have lost, psychologically reframe their lives with new goals or life objectives, and, in some cases, repair neurological damage,” says Dr. Cathy Craven, medical lead for Toronto Rehab’s Spinal Cord Rehabilitation Program and a senior scientist and leader of the Neural Engineering and Therapeutics (NET) team at KITE, the Toronto Rehabilitation Institute’s research arm.
Depending on their rehabilitation needs, Lyndhurst patients may see physiotherapists, occupational therapists, recreational therapists, psychologists, social workers, respiratory therapists, dietitians, and speech language pathologists, in addition to physiatrists (doctors who specialize in rehabilitation medicine), family doctors, and other specialists (such as urologists). “We tailor the services we offer to provide personalized rehab care,” explains Dr. Craven.
It’s a tall order, but necessary, due to the many bodily systems that can be affected by spinal cord injury (SCI). While most of us think of the motor and sensory problems that accompany SCI, such as losing the use of one’s arms or legs or not being able to feel sensations on the skin, there is also often significant autonomic impairment. This means the control systems that regulate body temperature, heart rate, blood pressure, bowel, bladder and respiratory systems may no longer operate properly, which can lead to a wide range of complications.
“For example, patients with SCI at the T5 level or above [an injury to the thoracic nerves that affects the upper chest, mid-back and abdominal muscles] can no longer sweat, so going out in the summer can be dangerous if they don’t monitor their temperature and fluid intake,” says Dr. Craven.
For Kane, it’s these “hidden” challenges that have been the most difficult. “The hardest thing has been learning how to manage my bladder,” she admits. For example, when an old high school friend invited her to a party, she decided to go, have a beer and try to recapture some of her old life. But she couldn’t sense when she needed to urinate. “I wet the couch in front of all of these people I didn’t know,” she says. “I never thought bladder control was something I’d have to worry about in my 30s. People need to understand the scope of the difficulties SCI patients are facing.”
Given the broad range of challenges, KITE’s applied clinical researchers are looking into new devices and treatments to improve the quality of care for SCI patients.
For example, KITE’s clinical studies on functional electrical stimulation helped bring a device to market that uses surface electrodes and an electrical current to get compromised muscles to contract, which retrains a patient’s body to perform movements it previously knew how to do.
An ongoing clinical trial is investigating whether the use of supplements or existing drugs – such as calcium, vitamin D, co enzyme q-10 and some cholesterol-lowering medications – may reduce the risk of heart disease or leg fractures in SCI patients.
And a recently completed trial compared different methods of balance training to see if new techniques could reduce the number of falls patients experience.
“In a previous study, we found that 70 per cent of patients in a wheelchair, and 80 per cent of ambulatory patients [those who are able to walk with a cane, walker or other assistive device], fell at least once a year,” says Dr. Kristin Musselman, a physical therapist and award-winning scientist at KITE. “That can really affect their confidence, and we don’t want people to stay home in fear.”
In the yet-to-be published study, one group of patients received traditional balance training, which alters vision and other sensory information to challenge a patient’s sense of balance, while another group of patients were repeatedly pushed or pulled and forced to regain their balance. While both groups saw improvements to their balance, patients in the second group experienced fewer falls during the six-month follow-up period, and were willing to take on a wider range of activities as a result. “Because they were repeatedly exposed to losing their balance [and had to react by stepping forward or backward to keep from falling] it may have strengthened the connections within their nervous system to take the appropriate action to stabilize themselves,” explains Musselman.
She hopes these results will encourage healthcare workers to do more reactive balance training with patients. “What distinguishes us from other centres internationally is that our scientists and clinicians work beside each other,” notes Dr. Craven. “With that increased knowledge sharing, we can make sure to get new solutions deployed to patients on the front lines much faster.”
After the initial shock of her diagnosis, Kane soon realized she was in excellent hands at Lyndhurst. “They kept reassuring me, saying, ‘I know this is devastating news, but you will be fine.’ They had no doubt I’d have a good, independent life,” she says. “They helped me get stronger and showed me how to use my body even though it doesn’t work the way it used to.”
Kane got a schedule with all her appointments, including sessions with a psychologist and social worker, where she could discuss any fears or anxieties she had, and learn techniques and coping strategies to manage her mood.
The main parts of her therapy were physical (pulling exercises for her shoulders and back to keep her from hunching forward, standing in a frame to maintain bone density, and strapping her feet into the pedals of a “passive bike” to maintain flexibility); occupational (how to dress, open doors, navigate her wheelchair on various surfaces); and recreational (Wii-style active video games like golf or baseball, wheelchair basketball and hand-pedal bikes). “There was someone there to take care of every aspect of my life – all the bases were covered,” she explains. “I even had someone help me get signed up with the TTC Wheel-Trans service, and apply for interest-free status on my student loan. I felt so supported.”
As much as the clinical staff helped her recover, Dr. Craven adds that patients can help themselves improve. “The clinical staff is not solely responsible for each patient’s recovery, but rather the patient’s own resilience and determination plays a big role,” she says.
After about two months, Kane, who now uses a wheelchair to get around, completed her in-patient stay at Lyndhurst, although she continued on with outpatient care services. “By the end, I truly felt I was part of a community, which really helped with the healing process,” she says.
She and Pinksen bought a house in Oshawa, which they began renovating to make fully accessible. While she’s on the fence as to whether or not to return to nursing school, in part because she still experiences debilitating pain in her legs and lower back – another symptom of SCI that many are not aware of – she is grateful for all the help she received at Lyndhurst.
“My wish is that anyone who has the misfortune of experiencing a spinal cord injury gets the same support I did at Lyndhurst,” she says. “My life would have been really hard without it.”