Bringing the Outdoors In

As you walk down the street of any Canadian city, often you take small things for granted - parking your car and getting out of it or crossing the street. For many amputees, orthopedic and geriatric rehabilitation patients and individuals recovering from strokes and other neurological disorders, performing these tasks can be daunting and they may resist going outside.

A Toronto clinic has brought the streets indoors complete with a crosswalk, traffic light, wheelchair ramp and a mix of outdoor surfaces in a controlled environment. It's here that rehab patients from Providence Healthcare are able to get ready for life again by readapting to everyday activities.

Shawn Brady, Director of Inter-Professional Practice at Providence Healthcare said the idea for the facility stemmed from a clinical need identified by patients, therapists and clinicians to carry out such things as getting into and out of a vehicle safely, which can pose a challenge during inclement weather.

The Toyota Canada Motor Skills Clinic allows patients to work at repetitive acts in a safe, controlled environment. "If one patient is in the room using it there's no one else there, so they can build up that confidence and feel secure and at ease about practicing these things that they might otherwise feel too shy or too timid to really try," says Mr. Brady.

Mr. Brady continues, "(For) a lot of our patients, their ultimate goal is to go home. Not only do we want them to go home; we want them to go home feeling confident and having a really high quality of life, and for a lot of people that involves outings."

With one of the biggest challenges patients face being mobility, the opportunity to rehearse how to get in and out of a vehicle is immensely important. Especially since the alternative modes of transportation of wheelchair taxis or buses are expensive and not always convenient.

It was fortuitous for the patients that one of Providence's Foundation board members worked for Toyota Canada. It was important to have access to a car and other vital resources. A proposal for funding was made to the automaker for the motor skills clinic and the company donated $300,000 to build the 80 square metre facility, purchase the equipment and operate it for the first year - and they got their car.

Now, three years later the facility has served more than 700 people with many success stories. One such story is Kathe Akbar's. She arrived at Providence in April, a month after she underwent a neurosurgical procedure leaving her with the left side of her body numb along with having a broken foot.

Over the past six months, Kathe has made significant progress. Though she still needs someone nearby, she can now get out of bed and transfer in and out of a wheelchair, along with using a walker.

One of the goals for the wife and mother of two was to be able to increase her mobility enough to transfer in and out of her car. Ms. Akbar saw it as a sign of independence and proof of being active. Physiotherapist Angela Gliatta, was able to help the 47-year improve her car transition technique.

"Basically, my husband was always helping me out there, but when I did it myself, the way Angela showed me, it made more sense, and I can do it better now. I can almost do it myself as long as there's a person standing near me," beams Kathe. Ms. Akbar has been quite busy over the last month. She has been out to a movie, gone shopping and she had her first haircut in six month.

It's not uncommon for family members to try to help a loved one, but for them to end up doing a lot more than they should, says Ms. Gliatta. "While every case may differ slightly," she said, "the best way to help someone get into a vehicle is to stand facing them while they hold on to the car for support."

Although the goal may be the same - to get into the vehicle - the strategy may require some adjustment to the way that the individual may have done it before surgery.

"When we get into a car, we just kind of put in the one foot and duck in. But when your legs are weak, or your balance is an issue, or you've had a stroke, that strategy is a potential for a mishap to happen or a fall," she said.

Ms. Gliatta elaborates, "Generally, we think about sitting down first on the seat and then bringing the legs over, swiveling your bottom so the legs kind of go in. Getting out is just the opposite."

The Toyota Canada Motor Skills Clinic focuses on other types of mobility too. It provides the patients the opportunity to train their body to walk on different surfaces found in parking lots and driveways, like interlocking brick and gravel.

There is also a walking path with slight inclines and declines to allow them to learn to adjust accordingly. They can even practice walking at night with the aid of dimming lights that create the effect. A crosswalk with a working stoplight helps the patient check their reaction times.

Mr. Brady says, "It builds up their confidence so when they do this outdoors they feel more comfortable."

While the clinic brings the outdoors inside for the patients, they look forward to stepping outside again to strut their stuff.

Source: La Rose, Lauren. "Indoor facility helps disabled get outdoors." The Canadian Press. June 13, 2009. Retrieved from