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Indoor facility helps disabled get outdoors

Physiotherapist Angela Gliatta, right, helps teach rehab patient Kathe Akbar how to safely enter a vehicle in the Toyota Canada Motor Skills Clinic at the Providence Healthcare facility in Toronto on Wednesday, June 3, 2009.

Darren Calabrese

A short distance from a bustling east-end Toronto street where pedestrians amble along sidewalks and cars and buses zoom by in either direction lies a tranquil little slice of roadway heaven.

A gleaming sedan sits parked mere steps from a cozy, inviting wooden bench. The crosswalk lines are freshly painted, the lawn neatly trimmed.

There are no traffic jams or wailing horns. And you won't ever need a car brush or umbrella - or to check the forecast for that matter - since it never rains or snows.

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Within the confines of this streetscape, rehabilitation patients at Providence Healthcare are able to get ready for life beyond the facility's walls by readapting to everyday activities.

The Toyota Canada Motor Skills Clinic recreates central elements of the outside world, including a wheelchair ramp, crosswalk, traffic light and a mix of outdoor surfaces in a controlled indoor environment.

Amputees, orthopedic and geriatric rehab patients and individuals recovering from neurological disorders, usually strokes, are among those who use the clinic, said Shawn Brady, director of interprofessional practice at Providence Healthcare.

Mr. Brady said the idea for the facility stemmed from a clinical need identified by patients, therapists and clinicians to practise such things as getting into and out of a vehicle safely, which can pose a challenge during inclement weather.

"(For) a lot of our patients, their ultimate goal is to go home," Mr. Brady said. "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."

Without the opportunity to practise getting in and out of a vehicle, for example, patients may be limited to using modes of transport such as wheelchair taxis or buses, which can be expensive and not always the most convenient way to get around, he said.

The clinic enables patients to practise repetitive acts in a safe, controlled environment.

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"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 feel at ease about practising these things that they might otherwise feel too shy or too timid to really try," Mr. Brady said.

One of Providence's foundation board members had worked for Toyota Canada, and the idea came up to present a proposal to the automaker for the motor skills clinic.

The company donated $300,000 to build the clinic, which covers more than 80 square metres, to provide equipment, and to operate it for the first year. In addition, a car was donated.

Since opening nearly three years ago, the clinic has served more than 700 people.

After a neurosurgical procedure in March, Kathe Akbar said, she could hardly move her legs when she arrived at Providence in April. Six months ago, the whole left side of her body had been numb and she had a broken foot.

While she still needs someone nearby, the wife and mother of two said she can now get out of bed and transfer in and out of a wheelchair, and has been using a walker for a couple of weeks.

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Many people likely don't think twice about the ease with which they can transfer in and out of a vehicle. But for Ms. Akbar, 47, such movement and the ability to be more active and independent marks significant progress.

In the past month, she's been out to a movie, gone shopping and had her first haircut in six months.

And under the care and guidance of physiotherapist Angela Gliatta, Ms. Akbar said, she's been able to improve her car transition technique.

"Basically, my husband was almost 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."

Ms. Gliatta said it's not uncommon for family members trying to help a loved one to end up doing a lot more than they should, such as lifting that perhaps isn't appropriate.

She said the strategies taught at the clinic aren't typically what individuals may have done prior to surgery, and as a result require adjustment.

"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.

"The end goal is the same: you want to get into a car because you want to get to some place, but you just might have to modify in a different way to achieve that same goal, but in a way that's safer and that maximizes your ability to participate in that activity."

While every case might be slightly different, Ms. Gliatta said, the best way to help someone getting into a vehicle is to stand facing them while they hold on to the car for support.

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

The clinic also gives patients the chance to test out walking on different surfaces, including interlocking brick, typically found in parking lots and driveways, and gravel.

A crosswalk with a working stoplight helps patients practise reaction times, while the walking path features slight inclines and declines allowing them to learn to adjust to such subtleties. Dimming lights help to simulate nighttime.

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

"It's almost like a snowball effect: As they become more confident in their abilities, they'll reach higher levels of independence."

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