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Select Papers, Reports & Presentations

RHI is strongly committed to sharing details of the great work that is taking place throughout the SCI field—from promising translational research to inspiring solutions that are improving the quality of life of people with SCI.

We believe strongly in the power of knowledge and are pleased to present a variety of reports and presentations contributed by members of RHI's clinical research network. Also, be sure to check out our Youtube page for interviews with RHI network members.

Accessing Research

Many of the papers below are available from the publisher's website. However, some publishers may charge access fees to view the entire article. For tips on how to access and find the research you are looking for, download these fact sheets (finding SCI research news and accessing SCI research articles) to help get you started!

If you would like access to any of the publications below and cannot find the full paper, please contact us for more information.

Peer-Reviewed Scientific Papers

Clinical studies

Facilitators and Barriers to International Collaboration in Spinal Cord Injury: Results from a Survey of Clinicians and Researchers

Noonan VK, Chan E, Bassett-Spiers K, Berlowitz DJ, Biering-Sørensen F, Charlifue S, Graco M, Hayes KC, Horsewell J, Joshi P, Markelis D, Smith V, Waheed Z, Brown DJ. 

Journal of Neurotrauma. 2017 doi: 10.1089/neu.2017.5036. [Epub ahead of print].

Summary: This paper presents findings from an international survey conducted with SCI clinicians and researchers that identifies barriers and facilitators to international SCI clinical research, potential initiatives for future international collaboration and the use of SCI-specific data sets and standards. The study identified several opportunities for greater collaboration and many of the top barriers (e.g. funding availability, funding timelines, research capacity) can be potentially offset by SCI study initiatives currently underway. One example is the International Spinal Data Network (ISDN) workshop held in 2015 which explored how SCI registries can partner to align data standards and share data.

A priority of RHI’s Care Program is to identify gaps in knowledge and the requirements to fill them. The findings from this survey, as well as its companion survey on the perspectives of people living with SCI and the barriers and facilitators to their participation in clinical studies (Anderson et al., 2016), state the challenges that often prevent progression of important SCI clinical studies and provide insight into how to reduce this gap through international collaboration. Findings from both surveys will also support studies that are part of RHI’s Cure Program by informing the design of SCI clinical trials.

Predicting Recruitment Feasibility for Acute Spinal Cord Injury Clinical Trials in Canada Using National Registry Data

Thibault-Halman G, Rivers CS, Bailey CS, Tsai EC, Drew B, Noonan VK, Fehlings MG, Dvorak MF, Kuerban D, Kwon BK, Christie SD. Summary: Research in spinal cord injury is challenging given the small population numbers and differences in the type of injury (severity and location on the spinal cord). The study group investigated whether a national registry (Rick Hansen SCI Registry) of individuals with a new traumatic spinal cord injury is useful for researchers to determine whether there are enough potential participants for their studies. The study team counted the number of people in the registry that would be eligible for five existing research studies. The study found that RHSCIR can support the design of studies to ensure there are enough potential participants. J Neurotrauma. 2017 Feb;34(3):599-606. doi: 10.1089/neu.2016.4568. Epub 2016 Oct 24.


The Validity of Administrative Data To Classify Patients with Spinal Column and Cord Injuries

Noonan VK, Thorogood NP, Fingas M, Batke J, Bélanger L, Kwon BK, Dvorak MF.  J Neurotrauma. 30:173–180, February 1, 2013.

Meeting the Privacy Requirements for the Development of a Multi-Centre Patient Registry in Canada: The Rick Hansen Spinal Cord Injury Registry

Noonan VK, Thorogood NP, Joshi PB, Fehlings MG, Craven BC, Linassi G, Fourney DR, Kwon BK, Bailey CS, Tsai EC, Drew BM, Ahn H, Tsui D, Dvorak MF. Healthcare Policy. 8(4) May 2013: 87-99.doi:10.12927.hcpol.2013.23397.

The Rick Hansen Spinal Cord Injury Registry (RHSCIR): a national patient-registry

Noonan VK, Kwon BK, Soril L, Fehlings MG, Hurlbert RJ, Townson A, Johnson M, Dvorak MF, RHSCIR Network. Spinal Cord. Jan 2012; 50 (1): 1 - 85


The Economic Burden of Traumatic Spinal Cord Injury in Canada

Krueger H, Noonan VK, Trenaman LM, Joshi P, Rivers CS.  Chronic Diseases and Injuries Canada. 33(3), June 2013.

Forecasting Financial Resources for Future Traumatic Spinal Cord Injury Care Using Simulation Modeling

Ahn H, Lewis R, Santos A, Cheng CL, Noonan VK, Dvorak MF, Singh A, Linassi AG, Christie S, Goytan M, Atkins D. J Neurotrauma. 2017 Aug 24. doi: 10.1089/neu.2016.4936. [Epub ahead of print] View summary on the ACT Focus Issue page 

The Economic Burden of Urinary Tract Infection and Pressure Ulceration in Acute Traumatic Spinal Cord Injury Admissions: Evidence for Comparative Economics and Decision Analytics from a Matched Case-Control Study

White BAB, Dea N, Street JT, Cheng CL, Rivers CS, Attabib N, Kwon BK, Fisher CG, Dvorak MF. J Neurotrauma. 2017 Sep 18. doi: 10.1089/neu.2016.4934. [Epub ahead of print] View summary on the ACT Focus Issue page

Long-term health

Quality of life and adaptation in people with spinal cord injury: Response shift effects from one to five years' post-injury 

Schwartz CE, Stucky B, Rivers CS, Noonan VK, Finkelstein JA; RHSCIR Network.

Arch Phys Med Rehabil. 2018 Aug;99(8):1599-1608.e1. doi: 10.1016/j.apmr.2018.01.028.

Summary: Following a spinal cord injury, a 'response shift', or adjustment to life following SCI may improve quality of life as an individual adjusts their standards and values regarding their health, post-injury. This shift has been found in those with other chronic health conditions, but is not commonly studied in SCI. In this study, we found that individuals with SCI had significant improvement in their self-reported physical and social functioning and life satisfaction over time. By understanding which factors contribute to this shift, rehabilitation care planning can target these factors to support an individual's adjustment to life following SCI. 

Rural and Urban Living in Persons with Spinal Cord Injury and Comparing Environmental Barriers, Their Health, and Quality-of-Life Outcomes

Glennie RA, Batke J, Fallah N, Cheng CL, Rivers CS, Noonan VK, Dvorak MF, Fisher CG, Kwon BK, Street JT. J Neurotrauma. 2017 May 18. doi: 10.1089/neu.2016.4931. [Epub ahead of print] View summary on the ACT Focus Issue page

Community Needs and Outcomes in Long-standing Spinal Cord Injury: Results from the Canadian SCI Community Survey

Noreau L, Noonan VK, Cobb J, Leblond J and Dumont F, Giangregorio L, Craven BC, Jetha A, Sweet S, Park S, Fallah N and Pelletier C. Topics in SCI Rehabilitation. 2014;20(4): 249-345. This issue includes a number of articles resulting in the work from the RHI-funded study, the SCI Community Survey - the largest of its kind ever conducted on the needs of Canadians with SCI. Topics include secondary complications, employment, quality of life and health care utilization.

Optimized care

Entire continuum

The Application of Operations Research Methodologies to the Delivery of Care Model for Traumatic Spinal Cord Injury: The Access to Care and Timing Project

Noonan VK, Soril L, Atkins D, Lewis R, Santos A, Fehlings MG, Burns AS, Singh A, Dvorak MF.

J Neurotrauma. 29:2272–2282, September 1, 2012.

Spinal Cord Injury Clinical Registries: Improving Care across the SCI Care Continuum by Identifying Knowledge Gaps

Dvorak MF, Cheng CL, Fallah N, Santos A, Atkins D, Humphreys S, Rivers CS, White BAB, Ho C, Ahn H, Kwon BK, Christie S, Noonan VK. J Neurotrauma. 2017 Jul 26. doi: 10.1089/neu.2016.4937. [Epub ahead of print]

Methodology of the Access to Care and Timing Simulation Model for Traumatic Spinal Cord Injury Care

Santos A, Fallah N, Lewis R, Dvorak MF, Fehlings MG, Burns AS, Noonan VK, Cheng CL, Chan E, Singh A, Belanger LM, Atkins D. J Neurotrauma. 2017 Mar 12. doi: 10.1089/neu.2016.4927. [Epub ahead of print] View summary on the ACT Focus Issue page

Understanding Length of Stay after Spinal Cord Injury: Insights and Limitations from the Access to Care and Timing Project

Burns AS, Santos A, Cheng CL, Chan E, Fallah N, Atkins D, Dvorak MF, Ho C, Ahn H, Paquet J, Kwon BK, Noonan VK. J Neurotrauma. 2017 Mar 29. doi: 10.1089/neu.2016.4935. [Epub ahead of print] View summary on the ACT Focus Issue page

Modeling the Patient Journey from Injury to Community Reintegration for Persons with Acute Traumatic Spinal Cord Injury in a Canadian Centre

Santos S, Gurling J, Dvorak MF, Noonan VK, Fehlings MG, Burns AS, Lewis R, Soril L, Fallah N, Street JT, Bélanger L, Townson A, Liang L, Atkins D.  PLoS ONE. 8(8): e72552. doi:10.1371/journal.pone.0072552.



An analysis of ideal and actual time to surgery after traumatic spinal cord injury in Canada

Glennie RA, Bailey CS, Tsai EC, Noonan VK, Rivers CS, Fourney DR, Ahn H, Kwon BK, Paquet J, Drew B, Fehlings MG, Attabib N, Christie SD, Finkelstein J, Hurlbert RJ, Parent S, Dvorak MF. Summary: It is believed that the less time between when a person sustains a spinal cord injury and when he or she receives surgery leads to the best outcomes. However, surgeons may have different opinions or face challenges in operating in the time period they think is best. This study found that the majority of surgeons thought surgery within 24 hours of injury is the best. However, some surgeons reported difficulties operating as early as they would like because of delays in getting an operating room or experienced staff. This study uses data from the Rick Hansen SCI RegistrySpinal Cord. 2017 Jun;55(6):618-623. doi: 10.1038/sc.2016.177. Epub 2017 Apr 18.

Optimizing Clinical Decision Making in Acute Traumatic Spinal Cord Injury

Fehlings M, Noonan V, Atkins D, Burns AS, Cheng CL, Singh A, Dvorak MF. J Neurotrauma. 2017 Jan 5. doi: 10.1089/neu.2016.4926. [Epub ahead of print]

Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Propensity Score-Matched Cohort Study from a Canadian Multi-Center Spinal Cord Injury Registry

 Evaniew N, Noonan VK, Fallah N, Kwon B, Rivers CS, Ahn H, Bailey CS, Christie SD, Fourney DR, Hurlbert RJ, Linassi AG, Fehlings MG, Dvorak MF, and The RHSCIR Network.Journal of Neurotrauma. November 1, 2015 doi:10.1089/neu.2015.3963. Summary: In a matched case-control analysis using national RHSCIR data, no evidence was found that methylprednisolone improves neurologic outcome following traumatic spinal cord injury as found in the controversial and much criticized 1990 NASCIS-II trial. This supports the downgrade of methylprednisolone as a treatment recommendation to a treatment option, and the evidence that it may increase odds of complications.

Effect of older age on treatment decisions and outcomes among patients with traumatic spinal cord injury

Ahn H, Bailey CS, Rivers CS, Noonan VK, Tsai EC, Fourney DR, Attabib N, Kwon BK, Christie SD, Fehlings MG, Finkelstein J, Hurlbert RJ, Townson A, Parent S, Drew B, Chen J, Dvorak MF, and The RHSCIR Network.  Canadian Medical Association Journal. July 6, 2015 cmaj.150085 Summary: More people over the age of 70 are incurring spinal cord injuries given the changing population demographics. It is not clear if there are differences in management of these older patients. We found that older patients with traumatic spinal cord injuries are less likely to receive surgery compared with younger patients and they experience a significant lag between both injury and acute admission to a specialized centre, and between admission and surgery. Future work will look at differences in outcome and advise treatment guidelines.

Minimizing errors in acute traumatic spinal cord injury trials by acknowledging the heterogeneity of spinal cord anatomy and injury severity: an observational Canadian cohort analysis

Dvorak MF, Noonan VK, Fallah N, Fisher CG, Rivers CS, Ahn H, Tsai EC, Linassi AG, Christie SD, Attabib N, Hurlbert RJ, Fourney DR, Johnson MG, Fehlings MG, Drew B, Bailey CS, Paquet J, Parent S, Townson A, Ho C, Craven BC, Gagnon D, Tsui D, Fox R, Mac-Thiong JM, Kwon BK.  J Neurotrauma. 2014 Sep 15;31(18):1540-7. 

The Influence of Time from Injury to Surgery on Motor Recovery and Length of Hospital Stay in Acute Traumatic Spinal Cord Injury: An Observational Canadian Cohort Study

Dvorak MF, Noonan VK, Fallah N, Fisher CG, Finkelstein J, Kwon BK, Rivers CS, Ahn H, Paquet J, Tsai EC, Townson A, Attabib N, Bailey CS, Christie SD, Drew B, Fourney DR, Fox R, Hurlbert RJ, Johnson MG, Linassi AG, Parent S, Fehlings MG, and The RHSCIR Network. J Neurotrauma. doi:10.1089/neu.2014.3632.* *Named as a High-Impact Article (top-cited) on September 22, 2016.

The impact of spine stability on cervical spinal cord injury with respect to demographics, management, and outcome: a prospective cohort from a national spinal cord injury registry

Paquet J, Rivers CS, Kurban D, Finkelstein J, Tee JW, Noonan VK, Kwon BK, Hurlbert RJ, Christie S, Tsai EC, Ahn H, Drew B, Bailey CS, Fourney DR, Attabib N, Johnson MG, Fehlings MG, Parent S, Dvorak MF; RHSCIR Network. Summary: One of the most common types of spinal cord injury is known as central cord syndrome, which is traditionally described as a cervical (neck) injury that results in more weakness in the arms than in the legs. It is often seen in people who are injured by falling and hitting their head, and over-extending their neck. However, doctors often have differing views on how to diagnose central cord syndrome. The study found that using spinal column stability to classify central cord syndrome is more accurate than traditional rules. This study uses data from the Rick Hansen SCI RegistrySpine J. 2017 Jul 1. pii: S1529-9430(17)30306-6. doi: 10.1016/j.spinee.2017.06.032.


Predicting rehabilitation length of stay in Canada: It's not just about impairment

Catharine Craven B, Kurban D, Farahani F, Rivers CS, Ho C, Linassi AG, Gagnon DH, O'Connell C, Ethans K, Bouyer LJ, Noonan VK; RHSCIR Network. Summary: Funding for rehabilitation and planning for length of hospital stay of an individual with a spinal cord injury is currently based on severity of injury. However, this is not always an accurate predictor for length of stay. Using data from the Rick Hansen SCI Registry, this study found that patients with a breathing tube or a bladder catheter had longer hospital stays. This information can help rehab facilities more accurately predict length of hospital stay and ensure adequate funding and resourcing.  J Spinal Cord Med. 2017 Sep 12:1-15. doi: 10.1080/10790268.2017.1368962. [Epub ahead of print]

Does Specialized Inpatient Rehabilitation Affect Whether or Not People with Traumatic Spinal Cord Injury Return Home?

Cheng CL, Plashkes T, Shen T, Fallah N, Humphreys S, O'Connell C, Linassi AG, Ho C, Short C, Ethans K, Charbonneau R, Paquet J, Noonan VK. J Neurotrauma. 2017 May 24. doi: 10.1089/neu.2016.4930. [Epub ahead of print]

Perinatal Care for Women with Spinal Cord Injuries: A Collaborative Workshop for Consensus on Care in Canada

Hocaloski S, Elliott S, Hodge K, McBride K, Hamilton L, McBride C, Basso L Summary: There are currently no standards of care for women with SCI during pregnancy and labour & delivery in North America. To address this, a one day workshop was held in Vancouver in November 2013. The workshop addressed issues of care providers' lack of knowledge of non-medical issues during pregnancy, physical and attitudinal barriers to access to care for women with SCI, and the need for better collaboration and communication between care providers. Recommendations for knowledge generation and research priorities were made during the workshop. Since the workshop, two information sources for women have been developed and are available online. Topics in SCI Rehabilitation. 2017;23(4): 386-396.

Outcome measures

A simplified clinical prediction rule for prognosticating independent walking after spinal cord injury: a prospective study from a Canadian multicenter spinal cord injury registry

Hicks KE, Zhao Y, Fallah N, Rivers C, Noonan V, Plashkes T, Wai EK, Roffey DM, Tsai E, Paquet J, Attabib N, Marion T, Ahn H, Phan P; RHSCIR Network.

Spine J. 2017 Jul 14. pii: S1529-9430(17)30329-7. doi: 10.1016/j.spinee.2017.05.031. [Epub ahead of print]

Summary: Severity of damage following a traumatic SCI is highly variable, which hinders the ability to accurately predict the extent of recovery. This has sparked much interest in developing better ways to predict long-term walking ability following SCI, with the hope of giving patients more informed recovery expectations. The paper found that three factors (age, motor function at L3 and sensory function at S1) found within 24 hours of injury could predict walking function, as measured by the Functional Impairment Measure at least one year after injury, with 89% accuracy. This was quite accurate when considering all patients, but less so for patients with ASIA Impairment Scale B and C injuries. Future work is focusing on B and C injuries using new statistical methods. This work is part of RHI's cure strategy to give better information to patients, families and clinicians about recovery of function after SCI.

Policy and advocacy

Using Evidence To Inform Practice and Policy To Enhance the Quality of Care for Persons with Traumatic Spinal Cord Injury

Fehlings MG, Cheng CL, Chan E, Thorogood NP, Noonan VK, Ahn H, Bailey CS, Singh A, Dvorak MF. J Neurotrauma. 2017 Aug 2. doi: 10.1089/neu.2016.4938. [Epub ahead of print]

Incidence and Prevalence of Spinal Cord Injury in Canada: A National Perspective

Noonan VK, Fingas M, Farry A, Baxter D, Singh A, Fehlings MG, Dvorak MF. Neuroepidemiology. 2012;38:219–226, April 27, 2012. 

Secondary complications


Evaluation of a Clinical Protocol to Assess and Diagnose Neuropathic Pain During Acute Hospital Admission: Results from Traumatic Spinal Cord Injury

Bélanger LMA, Umedaly HS, Noonan VK, Park SE, Prince J, Thorogood NP, Shen T, Townson AF, Street JT, Dvorak MF, Negraeff M. Clin J Pain. 2017 Jun 12 doi:10.1097/AJP.00000000000 00523. [Epub ahead of print] Summary: The purpose of this study was to find out how common neuropathic pain is and when it first occurs in patients who have recently sustained a spinal cord injury and are in the hospital. The occurrence of neuropathic pain in the Acute Spine Unit at Vancouver General Hospital was 56% of patients and the onset was first identified an average of 8 days following injury. Patients with incomplete spinal cord injuries were diagnosed with pain earlier than those with complete injuries. A new pain screening method decreased the time it took for patients to be assessed. Neuropathic pain is a secondary complication identified as an area of focus under RHI’s Care Program. This study uses data from the Rick Hansen SCI Registry. 

Incidence, Risk Factors and Impact of Delirium in Patients with Traumatic Spinal Cord Injury

Cheung A, Thorogood NP, Noonan VK, Zhong G, Fisher CG, Dvorak MF, Street JT.  J Neurotrauma. 2013 Nov 1;30(21):1824-9. doi: 10.1089/neu.2013.2975.

Previously Identified Common Post-Injury Adverse Events in Traumatic Spinal Cord Injury-Validation of Existing Literature and Relation to Selected Potentially Modifiable Comorbidities: A Prospective Canadian Cohort Study

Marion TE, Rivers CS, Kurban D, Cheng CL, Fallah N, Batke J, Dvorak MF, Fisher CG, Kwon BK, Noonan VK, Street JT. J Neurotrauma. 2017 Jun 28. doi: 10.1089/neu.2016.4933. [Epub ahead of print] View summary on the ACT Focus Issue page


Secondary Complications in SCI Across the Continuum: Using Operations Research to Predict the Impact and Optimize Management Strategies

Atkins D, Noonan VK, Santos A, Lewis R, Fehlings MG, Burns AS, Dvorak MF. Topics in Spinal Cord Injury Rehabilitation. 2012;18(1):57–66, Winter 2012.

Treatment patterns of in-patient spasticity medication use after traumatic spinal cord injury: a prospective cohort study

Holtz Kaila A, Szefer Elena, Noonan Vanessa K, Kwon Brian K, Mills Patricia B. Spinal Cord. 2018 Jun 14. doi: 10.1038/s41393-018-0165-0. [Epub ahead of print].

Summary: Muscle spasms are a major secondary complication of SCI, affecting 60-70% of injured individuals. Those with spasticity report difficulties with other complications following SCI like pain, bladder problems, sleep, and overall quality of life. There are several types of treatment used, but little high-quality information about their effectiveness. Our aim is to build on this information by tracking 'real world' treatment both in the hospital and what is prescribed as individuals return home. The study found that a third of individuals were prescribed in-patient and discharge treatment for spasticity. However, as spasticity develops over time, 70% were receiving treatment one year after injury. This information will help clinicians and researchers determine 'real world' treatment and develop new studies to optimize treatment for spasticity to help improve the lives of those affected.


Impact of bladder, bowel and sexual dysfunction on health status of people with thoracolumbar spinal cord injuries living in the community

Park SE, Elliott S, Noonan VK, Thorogood NP, Fallah N, Aludino A, Dvorak MF.J Spinal Cord Med. 2016 Aug 31:1-12. [Epub ahead of print]. Summary: Bowel, bladder and sexual problems are common after traumatic SCI and are among the highest priority to improve an individual’s life. We looked at these problems in individuals living with injuries to their thoracolumbar region, as the location of this type of injury corresponds to the nerves that control bowel, bladder and sexual function. Of the 51 individuals who participated in the study, 59% had bladder incontinence, 54% bowel incontinence, and 61% had sexual dysfunction – almost 30% had all three problems. This is the first study looking at the combination of these problems on overall health in this population. Importantly, it showed that these problems often occur together and that care providers need to have standard tests for individuals with SCI to identify these problems in order to help optimize care and improve overall health status. We plan to study these problems in a larger group of people using new standard tests to confirm our results.

The influence of depression on physical complications in spinal cord injury: behavioural mechanisms and health-care implications

Krueger H, Noonan VK, Williams D, Trenaman LM, Rivers CS.  Spinal Cord. (2013) 51, 260–266; doi:10.1038/sc.2013.3; published online 18 February 2013.

Publications and Reports

Health Economics: Agenda for SCI Research in Canada. This RHI report presents a detailed agenda for establishing evidence of the burden of SCI and the costs and consequences of initiatives aimed at mitigating the burden.

SCI Community Survey: Prelimary Results. This participants' report is also the first activity within a comprehensive knowledge translation plan. In addition to academic journal articles, knowledge translation activities include providing data and support to SCI advocacy groups and its Canadian branches to ensure that results from the survey can be used for advocacy, nationally and in provincial jurisdictions.

Rehabilitation Environmental Scan Atlas: Capturing Capacity in Canadian SCI Rehabilitation. This first atlas of Canadian SCI rehabilitation enables rehabilitation providers, people with SCI and their caregivers with evidence-based data to advocate for preventive care, improved clinical care services and a reduction in regional service disparity.

Spinal Cord Injury: Progress in Care & Outcomes in the Last 25 years. This report was commissioned by RHI to review the gains made in SCI care and outcomes over the last 25 years, and in this way, help commemorate the historic Man In Motion World Tour that was launched by Rick Hansen in 1985. RHI wishes to thank H. Krueger & Associates Inc., the authors of this report.

The State of Spinal Cord Injury in Canada. This report, jointly released by RHI and Urban Futures, estimates the incidence and prevalence of SCI in Canada and has found that there are close to 86,000 Canadians currently living with SCI and that an estimated 4,300 new cases of SCI occur in Canada each year. This ground-breaking report provides a baseline measurement of the extent of SCI in Canada, a measurement that was previously unknown.


Browse the links below to view a selection of presentations from RHI's research network presented at Interdependence 2012.