When Alisha-Yonette Punjani was discharged home from Toronto Rehab's Lyndhurst Centre with incomplete paraplegia, she knew she'd be facing a new normal – even though she's on track to make a full recovery.
She was prepared to set up a home-base on the main floor, and knew she’d have to rely on the help of others, for anything she couldn't do from her wheelchair.
What she wasn't prepared for was the anxiety that set in, as the reality of her limitations became clearer.
"Second to suffering a spinal cord injury, coming home was the lowest of the low," Alisha-Yonette says. "It forced me to face the issue, which was that I couldn't function as I had once been able to.
"It was humiliating having a personal support worker – a virtual stranger – come to my house to help me shower, using a bench, or asking my daughter to change my catheter bottle."
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It was Toronto Rehab's Let's Connect Program that taught her the emotional tools she needed to cope with her challenges and take control of her feelings.
"I learned how to deal with my anxiety, so I could start shutting out my negative feelings and stop feeling like a lesser version of myself," says Alisha-Yonette.
Learning how to cope
Let's Connect is a 10-week group program designed to support spinal cord outpatients who are adjusting to life back in their community – a vulnerable time in their recovery journey.
"When a patient is in the hospital, and dealing with grief around their injury and loss of independence, they're cared for 24/7," explains Dr. Martha McKay, a clinical psychologist at Toronto Rehab.
"But those feelings don't necessarily go away upon discharge. In fact, returning to the community can be even more challenging, and impact mood, anxiety, and stress."
With a focus on coping strategies that are based in cognitive behavioural therapy, sessions cover a range of topics, from pain, to relationships, to self-compassion.
"One of my biggest wins was learning how to breathe," says Alisha-Yonette.
She achieved this by learning to breathe in for a count of three and out for a count of six, which can activate the parasympathetic nervous system and lower your heart rate.
"Now, I engage in this breathing technique all the time," says Alisha-Yonette.
"For example, it can be frustrating waiting for help when I need it most. Practicing my breathing helps calm me down."
Trial and error – finding a model that works
Let's Connect allows patients to join at any time within one year of discharge. But it wasn’t always structured this way.
In fact, when the program was first introduced in 2018, it started toward the end of a participants inpatient stay, and extended through the early weeks of post-discharge.
But a high dropout rate of 44 percent led the team to reconsider the model.
“From a logistical perspective, when patients first transition home, they have a lot of competing priorities – from setting up care schedules to arranging transportation – that can interfere with attendance,” says Dr. McKay.
Patients may also be feeling hopeful when they leave the hospital, and only start experiencing adjustment symptoms down the road, when they don’t necessarily see the changes they expected.
The newer, more flexible model allows patients to access intervention when they need it most.
Intervention that is otherwise hard to tap into.
"Mental health resources can be hard to access in the community, so we’re 100 per cent filling a gap for our patients," says Dr. McKay.
"Because our population continues to come to Lyndhurst for outpatient care, offering the program here creates a seamless patient experience."
Building capacity by training tomorrow's leaders
Along with filling a gap in the community, Let's Connect also increases capacity, by inviting psychology residents to co-facilitate the program.
"Not many learners have an opportunity to get training on how to support individuals with spinal cord injuries," says Dr. McKay.
"As more and more learners take this experience with them, we’re building capacity beyond our walls."
Psychology resident Samantha Fashler says that co-facilitating the program has given her a deeper awareness of just how hard it can be to transition home after a spinal cord injury.
"By gaining a better understanding of their unique challenges, and how they can impact day-to-day life, I'll be better able to engage and help future patients struggling with similar difficulties."
Proven success
The new Let's Connect model appears to be a more patient-centred approach.
Dropout rates have decreased to 14 per cent, and patients say the flexible start time allows them to find help when they need it most.
"In a way, I needed to experience the struggles first, in order to understand what areas I needed help in," says Alisha-Yonette.
If funding continues to be made available, the team hopes to explore virtual intervention as an alternative delivery method, to help increase accessibility and expand reach beyond the Greater Toronto Area.
Funding for the Let's Connect program has been generously provided by Bell Let's Talk Community Grants, through the Toronto Rehab Foundation.
