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How the Rehabilitation Virtual Reality Laboratory helped an injured Canadian diplomat return to normal life

Canadian diplomat Bushra Saeed was 25 years old when an improvised explosive device (IED) ripped through the light-armoured vehicle (LAV) she was travelling in, in Kandahar City, Afghanistan.

“When I woke up… I knew immediately my legs weren’t really working,” she says, adding that after the explosion, soldiers pulled her to a safe area, placed tourniquets on her legs and stayed with her to provide some much-needed comfort.

“I remember looking up in the sky and making sure not to look down, because I knew it was bad,” she says.

“For two years I was in and out surgeries,” Saeed says of the injuries that spanned her whole body. “It was very hard on the soul.”

Saeed’s right leg was amputated through the knee and her lower left leg, broken in two places, had much of the flesh torn from it – losing 50 per cent of its mobility.

“My biggest fear was not knowing where I would be in a year, or even two, five or 10 years,” says Saeed. “I was concerned about being able to have a family, or being dependent on a walker, cane or wheelchair.”

With the support of a dedicated rehabilitation team, it was the leading-edge virtual reality technology at The Ottawa Hospital Rehabilitation Centre (TOHRC) that made all the difference in Saeed’s rehabilitation.

Today, Saeed says, “It’s a shock that I’m able to do as much as I can.”

Virtual Reality Lab provides TOH patients with invaluable rehab tools

In June 2011, TOHRC treated its first patient in the Rehabilitation Virtual Reality Laboratory (RVR Lab). The first of its kind in Canada, the RVR Lab came to TOHRC through a partnership between The Ottawa Hospital and the Canadian Forces Health Services Group.

At the heart of the RVR Lab is a Computer Assisted Rehabilitation Environment system, better known as the CAREN system. The CAREN system allows patients, such as those learning to walk with a prosthetic device, to improve their mobility, balance, and ability to move within complex environments. It is also used for cognitive rehabilitation for patients who have suffered a brain injury, or those with post-traumatic stress disorder.

Using room-size 3D graphics and a moving platform with treadmills, the CAREN system simulates walking in a range of different environments – from a sidewalk, to bumpy park path, or a bridge swaying in the wind.

“Patients feel protected and safe here, so they actually take more risks than they might if we were doing what we used to do, which is take someone outside onto the hills behind the General Campus to walk down the uneven slopes and grass,” says Dr. Nancy Dudek, physiatrist, who specializes in working with amputees. “That can be a bit scary.”

Using world-class motion-analysis technology, the CAREN system has a rigorous safety system.

“Patients are attached to a harness while they are working, testing their balance, and pushing their limits,” says Marie-Andrée Paquin, senior physiotherapist. “Because it is such a safe environment, we can try things earlier, things we may not have taken the chance on before.”

A strong multidisciplinary team is required to make the CAREN system a success for patients, including a system operator, medical staff, physiotherapists, psychologists, occupational therapists, researchers, and technical engineers.

At The Ottawa Hospital Rehabilitation Centre, researchers use data gathered from the CAREN system and in their laboratory to develop tailored virtual environments. For example, in partnership with the City of Ottawa, they’ve created a full 3D model of the city.

“We’re at the cutting edge, providing the best care, treatment and access for people in our area,” says Edward Lemaire, research associate at TOH and clinical investigator at the Ottawa Hospital Research Institute.

“Of course this isn’t in isolation,” he adds. “Patients do a full rehabilitation program here, with the CAREN system being a very strong part of that full continuum of care.”

How TOHRC’s team used CAREN to help Saeed run again

“The good thing about the CAREN system is I was able to practice and build not only my confidence, but also my capacity,” says Saeed, adding that it was an incredible achievement the first time she was able to run on the system.

“To know that if I needed to run quickly I could, was such a relief,” she says. “It brought tears to my eyes.”

Every day Saeed witnesses the benefits of her rehabilitation program as she continues treatment with her dedicated TOHRC team.

“This weekend I was at Dow’s Lake and I was on the dock,” she says. “A year and a half ago, I would have been on my hands and knees afraid of falling, but we had a program on the CAREN system where I was able to practice my balance.”

Her entire team is impressed and inspired by her progress.

“I am proud to be part of the team that helped her get to where she is today and keep encouraging her to move further. Today, at 28 years old, her life is not over,” says Paquin. “She has the ability to attain her goals.”

Saeed believes that too – both for herself and for others.

“I’ve been at the rehab centre for over two years now, and I’ve seen people come in a wheelchair and leave walking without a cane,” says Saeed. “It’s such a nice feeling to know that it is doing such positive work.”