'Where I'm supposed to be': Manitobans head to Saskatchewan for spinal cord rehabilitation

Manitobans are picking up their lives and setting up in Regina for spinal cord rehabilitation they can't get in their home province.

Growing stream of Manitoba patients at Regina First Steps centre over past 3 years, executive director says

Danique Dupuis, right, and her mom, Gaetane, moved from Lorette, Man., to Regina for spinal cord rehabilitation. (Kim Kaschor)

Three months after a snowmobile accident left her paralyzed from the chest down, Danique Dupuis left Winnipeg's Health Sciences Centre rehabilitation facility with a modified wheelchair, some functional movement in her upper body and a large backrest she thought she'd need her whole life.

It wasn't until she went to a rehabilitation centre in Saskatchewan that she realized she had more movement to gain, she said.

"I used to need a big backrest that would hold me up, and now I barely have any support," said Dupuis, who's 19, referring to the reduced backrest on her current wheelchair.

In summer 2017, Dupuis started therapy at First Steps Wellness Centre, a charitable not-for-profit facility in Regina that focuses on spinal cord injury rehabilitation. Her family pays for the expensive therapy, which is not covered by medicare.

When Dupuis rolled into the facility with her high backrest, the therapists immediately recommended cutting the backrest down and focusing on developing her core muscles.

"I kind of feel like that's where I'm supposed to be," she said, "or it's like the best place to be after something like a spinal cord injury."

In Manitoba, patients with spinal cord injuries go to Health Sciences Centre, which has the province's only publicly funded rehabilitation facility. After they're discharged, most continue to get a blend of physiotherapy, occupational therapy and nursing care on an outpatient basis, usually with two or three hours of physiotherapy per week.

But Danique is one of several Manitobans with spinal cord injuries who have gone to the clinic in Saskatchewan for services they feel they aren't receiving in their home province.

Executive director Owen Carlson said a steady stream of Manitoba clients has increased over the past three years.

This year, he's typically had around five or six patients from Manitoba at a time, he said.The majority of them, including Danique, receive about 15 hours a week of exercise-based therapy.

"We had had a few one-off people [before that]," Carlson said. "But when you have your first person, that sort of reaches back to all of the people that they were going to rehab with and starts telling them — and that chain has never been broken."

'Less alone'

First Steps offers exercise-based therapy led by kinesiologists who have done extra training to become exercise physiologists, Carlson said.

The facility uses therapies such as pneumatic training and gait training that assist the body with movement and help it relearn movement patterns.

Other therapies, such as vibration therapy and functional electrical stimulation, cause muscles in the body to relax and contract, encouraging muscle development and helping the nervous system grow and reconnect to different parts of the body.

The centre's focus is on neuroplasticity, which he described as the ability of the brain to rewire itself after an injury.

The centre isn't a replacement for inpatient care in a hospital setting, he said.

He'd like to see the provincial governments in Saskatchewan and Manitoba fund two or three months of care at the centre following discharge from hospitals, and to work with hospitals to more fully integrate the therapies into outpatient plans.

An entrepreneur in Winnipeg hopes to open a centre in the city in the future, Carlson said.

When Danique left the hospital in Winnipeg, she was offered two hours a week of physiotherapy. It focused on the mobility she still had — using her arms to transfer in and out of her wheelchair, for example — rather than working on her lower body, she and her mom, Gaétane, said.

But Gaétane said her family had researched other people with spinal cord injuries who improved their quality of life by working on muscles below their level of injury, even if it didn't mean walking.

"That's what we were looking for a bit more than just, 'OK, well you're confined to your chair for the rest of your life, get used to it,'" Gaétane said. "Those were the exact words that they were using for us."

Danique's work at First Steps has included strengthening her core muscles to improve stability, time on an exercise bicycle and work on crawling. She's also continued to strengthen her arm muscles.

She's hit a series of small milestones that add up to major progress, including the ability to pedal on a spin bike, her mom said.

While many of her fellow patients in Winnipeg were elderly or recovering from amputations, at First Steps, Danique has met people like her with spinal cord injuries.

"I didn't really get to meet people my age, or people that were going through, like, similar things as much as I do here," she said.

"It means a lot. I guess you feel a little less alone."

'Much more than walking'

Rudy Niebuhr, clinical advisor in physiotherapy at Health Sciences Centre's Rehabilitation Hospital, said outpatient services for patients in the program are determined based on patients' individual needs. There's no cap on how many hours a patient may get.

The Rehabilitation Hospital sees roughly 50 to 60 patients a year, with inpatient stays averaging from three to six months, he said.

Comparing the number of physiotherapy hours somebody might get as an outpatient in Winnipeg to the number of hours they'd be getting at First Steps is an incomplete picture, he said, because it doesn't include occupational therapy, community therapy and nursing care hours also offered by Health Sciences Centre.

It also leaves out the expectation that patients will do exercises on their own time, as guided by staff at the hospital.

"Rehab is the whole thing — so it's 24 hours. It's not just what happens during a physio session," he said.

"You've got home care attendants that are coming and doing your stretches. You might have a piece of equipment that you're using at home. You might have some exercises that your family member helps you with. You might be going to a gym."

Without the specifics of Danique's case, Niebuhr couldn't comment on the changes made to her bracing, he said. But seating and backrests should be reassessed frequently, and it's not uncommon for a brace to be reduced as a person's needs change, he said.

Dr. Karen Ethans, a physiatrist at Health Sciences Centre with a subspeciality in spinal cord injury, said the hospital's outpatient services are interdisciplinary, offering patients access to physiotherapy and occupational therapy but also treatment for related health concerns, such as bowel and bladder control, muscle spasticity and neurogenic pain.

Those elements are important parts of recovery, too, she said.

"I would hope that if there's a private clinic that's geared towards people with spinal cord injury, it would actually have that interdisciplinary spinal cord expertise, meaning that there would physiotherapists and occupational therapists and nurses and physicians that at least can consult on patients, that can help deal with everything else," she said.

"Because like we have said, rehab is about much more than just walking."

'No limits'

Niebuhr and Ethans said they'd support a First Steps centre opening in Winnipeg as another option for the right patients, as long as it lived up to standards including offering interdisciplinary care from people trained in spinal cord management, and working on obtainable, evidence-based goals. With First Steps in the city, patients could go to the centre while continuing to access care at the Health Sciences Centre, Ethans said.

It would also mean less displacement for patients and would save people money, they said. Niebuhr added he supports the idea of any fully accessible exercise facility as a choice for people with spinal cord injuries trying to stay fit.

Danique and her mom plan to stay in Regina for the next couple of months but think they'll be able to move back to Winnipeg in the new year.

Right now, Danique is focused on continuing her rehab, but her life goals are largely the same as before her injury.

"You never know what gains you will get, but I'm fully expecting to have my life back to normal. Work, get married, kids, there's no limits," Danique said. "I still have a ways to go but it's all good things, things I'm looking forward to."

With files from Aidan Geary