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Bloorview 2008/09 Annual Report
BLOORVIEW KIDS REHAB 08 – 09 HOSPITAL & RESEARCH REPORT

A world of possibility
For helping us make our
vision a reality, we thank
Bloorview Kids Foundation,
Bloorview Children’s Hospital
Foundation, the Ontario
Ministry of Health and Long-
Term Care, the Toronto
Central Local Health
Integration Network, our
academic partner – the
University of Toronto – and
the many community
agencies who work with us.
We couldn’t do it without you!
Bloorview 2008/09 Annual Report

Dear friends
Wonder.
It’s a spirit that permeates Bloorview
Kids Rehab.
It starts with a deep reverence and
respect for every child, a fascination
with growth and development, and the
belief that all children deserve to
participate fully in life.
It’s the curiosity and imagination that
bring Bloorview clinicians and
scientists together to develop
breakthrough treatments and
technologies that improve the lives of
children with disabilities.
Wonder motivates us to question, study
and change a world in which
environments and attitudes too often
exclude children with disabilities.
It opens our eyes to multiple ways of
seeing, and explains the unique
integration of care, research and
education at Bloorview.
Wondrous are the deeds of our
volunteers and donors.
We’re pleased to bring you the first
joint report of Bloorview Kids Rehab
and the Bloorview Research Institute.
We call it small wonder because our
focus is children and youth. And while
our size is modest, our work has an
international impact in the field of
childhood disability that’s astonishing.
On many levels, Bloorview is truly a
small wonder.
Sheila Jarvis Peter Fullerton Colin Macarthur
President and CEO Chair, Board of Trustees Director, Bloorview Research Institute

Bloorview big picture
Vision: A world of possibility for kids with disability
STRATEGIC PRIORITIES
•
Establish centres of leadership in child
development and participation
•
Enhance the impact of research
•
Innovate in teaching and learning
•
Create a knowledge hub for
childhood disability
•
Lead system change and integration
and improve access to services
BLOORVIEW RESEARCH 2008-09
Scientists: 19
Trainees: 92
Total external funding:
$4.8 million
Peer-reviewed funded projects: 56
Peer-reviewed publications: 37
Ratio of external to internal funding: 2:1
Peer-reviewed publications per full-time scientist: 3.4
Peer-reviewed grants per full-time scientist: 5.9
Graduate students per full-time scientist: 5
RESEARCH FUNDING BY SOURCE 2008-09
BLOORVIEW KIDS REHAB 2008-09
Outpatient visits: 53,600
Inpatient visits: 644
Average length of stay:
32 days
Total clients: 7,000
Employees: 875
Student doctors, nurses, therapists, teachers,
engineers, psychologists and social workers: 300
Volunteer hours: 44,000
7%
Industry
13%
International
13%
Other national funding agencies
9%
Federal/Provincial
government 5%
7%
Donations
26%
CIHR/NSERC/SSHRC
4%
Other
10%
Provincial funding
agencies
Royalties
6%
Research
endowments

Bloorview 2008/09 Annual Report

In this lab, science is a calling
In February, a study that could unlock
the world of choice to children who
can’t speak or move through optical
brain imaging – a kind of ‘mindreading’
– was published in the Journal
of Neural Engineering and reported
around the world.
It’s no surprise that the study
emanated from Tom Chau’s rehab
engineering lab at Bloorview.
The biomedical engineer has a
fundamental belief that guides the
training program he’s built for top
graduate students with scholarships
from around the world.
“Each child is irreplaceable, unique
and precious,” he says.
Given this premise, Tom and his
students are developing body-machine
interfaces to give children who can’t
speak or move a way to communicate
their intentions through brain waves,
breathing patterns and heart rate. The
goal is to translate a child’s physiological
signals into control of a voice-output
device or computer.
‘Each child is irreplaceable,
unique and precious.’
“My students approach their work as
a vocation, not just a degree or job,”
Tom says.
“Vocation comes from the Latin word
‘vocare’ – to call. Applying scientific
skills to create possibilities for children
with disabilities is a personal calling to
each. Many volunteer in other areas of
the hospital. They want to be a living
part of the journey that families take.”
Shining a light, unlocking a mind
In February’s Journal of Neural
Engineering, University of Toronto PhD
student Sheena Luu decodes a person’s
preference for one of two objects with
80 per cent accuracy by measuring the
intensity of near-infrared light
absorbed in brain tissue.
Wearing a headband fitted with fibreoptics
that emit light into the pre-frontal
cortex of the brain, adults were shown
two drinks on a computer monitor, one
after the other, and asked to make a
decision about which they liked more.
“When your brain is active, the oxygen
in your blood increases and depending
on the concentration, it absorbs more
or less light,” Sheena says. She was able
to teach a computer to recognize the
unique pattern of brain activity associated
with preference for each subject.

A child’s best friend
was lift her shoulders off the pillow,”
Kim says. She was receiving nutrition
through a nasal feeding tube and the
trauma of her illness and hospitalization
had left her anxious and withdrawn.
For the next couple of months
Samantha participated in intensive
physical, occupational and speech
therapy and never missed a weekly
pet session.
A brain tumour the size of an apple
turned Kim Burke’s active, exuberant
toddler Samantha into a child she
didn’t recognize.
“First she got lethargic, then she
stopped walking and standing up and
when she crawled, she fell on her face,”
Kim recalls. “By the time we got the
diagnosis, she was barely eating and
limp as a rag doll, lifeless.”
Samantha had surgery to remove the
tumour – which was benign – and
spent two-and-a-half months at
SickKids. When she came to Bloorview
for inpatient rehab “all she could do
It wasn’t until Samantha participated
in a pet visiting program at Bloorview
that Kim says she saw the daughter she
knew return.
“As soon as she saw the dogs, I saw the
sparkle in her eye and the excitement
and the smiles and she started to say
‘doggie’ again, which she’d lost at
SickKids. When I put her on the
ground, she started bouncing around
like crazy and touching the dogs.
“I can’t even explain in words how
important it was,” Kim says. “It gave
me a sense of hope, of seeing a light at
the end of the tunnel: my daughter was
coming back.”
The pet visiting program is run by
therapeutic recreation and volunteer
resources staff and made possible by 27
volunteers and their dogs and cats.
Samantha’s now eating on her own,
walking with support, cruising on
furniture, “and laughing and chatting
like there’s no tomorrow,” Kim says.
“When we first came to Bloorview, I
never could have imagined her doing
so well.”
Wondrous works
Over 1,000 Bloorview volunteers
contributed 44,000 hours in 2008-09.
When surveyed, 100 per cent said they
would recommend the experience to
friends and family.

Bloorview 2008/09 Annual Report

A machinist and his magic wand
In January, Sarah Doherty climbed
Africa’s highest peak on high-tech
crutches she developed with Bloorview
prototypist Bill Johnson.
The 49-year-old lost her right leg at age
13 when she was hit by a drunk driver.
But she never lost her love of the
outdoors and adventure.
Bill machined the crutches with shock
absorbers to make her dream possible.
“They slowly uncoil, like your joints do,
giving a nice cushion in each step,
instead of jarring your joints,”
Sarah says.
He also suggested ball joints in the
attachable feet to mimic the rotation
you get in your ankle.
Bill had used a similar joint in a hockey
stick he designed for a girl with an arm
amputation who wanted to play
Canada’s game. It gave her the multidirectional
movement of a wrist.
‘When they bring their child to
Bloorview, they’re going to get
hope and compassion.’
With Bill’s machine-shop wizardry, kids
and adults with disabilities are scaling
their own mountains.
Children with arm prostheses play
baseball, climb rocks and paddle
canoes. One of Bill’s clients, Adrian
Anantawan, is a classical violin soloist.
He was born without a right hand. Bill
designed a metal piece that attaches to
his bow and slides onto a small paddle
he wears on a cuff on his right forearm.
The metal piece acts as a “hand,”
allowing Adrian to hold the bow and
position it on the paddle.
Bill’s work was inspired by another
Bloorview client, his sister Anne.
“When my sister was born, the
specialists told my parents ‘she’ll never
amount to anything. Put her in an
institution.’”
With the help of braces, a guide dog
and seizure medication, Anne
graduated from university.
“That’s why I want parents to know
that when they bring their child to
Bloorview, they’re going to get hope
and compassion. What I usually say
when I first talk to a client is: “If I had a
magic wand, and could make anything,
what would you like to be able to do?”

The power of one
Who: Vito Bigioni, father to Emily, 13,
who has disabilities, uses a wheelchair
and doesn’t speak. Emily is an artist
who loves to paint and work with clay.
What: Vito’s dream to save Bloorview’s
March Break Creative Arts Respite
Camp for children with complex needs.
The program provides a creative, social
and safe environment for Emily while
giving her parents a break from roundthe-clock
care. In 2007 Vito learned the
camp was being cancelled due to a
change in government funding
allocations. Vito, who owns a
construction company, set out to raise
money to ensure its survival.
Why: “I’ve seen changes to other
programs, but I couldn’t swallow this
one. I can’t get that arts programming
in a respite service anywhere. Raising
money gives us a sense of giving back
for what we’ve received from Bloorview.
It’s a way of thanking the staff for
running a great program. For Emily’s
brother Max, it’s an important life
lesson. He sees that we’re helping and
that we don’t have to just sit on the
sidelines and take whatever is given to
us. We can be out in the community
and make a difference.”
How: Vito met with Bloorview Kids
Foundation and developed a plan to
raise enough money to keep the
program running for five years –
$250,000. Then he went to family and
business associates to ask them to
support him. Within three months he’d
reached his five-year goal and set a new
target of raising $1 million for the Emily
Bigioni Endowment Fund, to keep the
program going forever. The foundation
provided a personal fundraising page
on its web site; support when Vito
presented to potential donors; and
organized special events, including a
gala reception. Vito has raised over
$750,000 to date.
To find out more, visit
www.bigioni.giftsofpossibility.ca

Bloorview 2008/09 Annual Report

Bloorview 2008/09 Annual Report

Bridging research and clinical care
‘There has to be a constant back and forth – a marriage’
Dr. Evdokia Anagnostou is a child
neurologist and scientist recruited to
Bloorview from the Mount Sinai School
of Medicine in New York to develop a
clinical research program in autism.
Evdokia’s clinician scientist position is
a new one that reflects the hospital’s
goal to better bridge the worlds of
research and care.
What brought you to Bloorview?
Dr. Anagnostou: There were a number
of pluses to building a clinical research
lab here: access to children with
autism; our link with SickKids, which
allows me to collaborate with
geneticists and basic scientists; and a
well-organized research institute with
huge potential to grow. I like the
philosophy that disability is where you
start and not where you end. It doesn’t
become who you are, but is just one
aspect of you. That attitude is very
promising for children with autism.
One part of your research focuses on
testing alternative compounds like fish
oil. Why is this important?
Dr. Anagnostou: There are limited
medications available to children with
autism. As a result, parents and
physicians have started using
alternative compounds without any
evidence that they are safe or effective.
We need to test the compounds
scientifically. And because we’ll be
treating many people with autism over
their lifetime, if there are natural
substances that have better safety
profiles than the current drugs we’re
using, we need to know that.
What are the advantages of being a
clinician scientist?
Dr. Anagnostou: The risk, if you’re just a
researcher, is that you get caught up in
asking questions you think you can
answer, instead of what’s relevant and
will have impact for families living with
autism. Seeing children keeps me
grounded in what needs to be asked.
Research keeps us up to date on the
newest treatments. There has to be a
constant back and forth – a marriage –
between the clinical and the research in
order to provide excellent care.
How do you bring a sense of wonder to
your work?
Dr. Anagnostou: My patients bring me a
sense of wonder. What’s special about
children with autism is that their brain
is wired differently, so they have an
alternative view of the world that
challenges our perceptions. They have
the ability to see things from a completely
different view.

Artists visit inpatients at bedside
When children are hospitalized, they’re
cut off from regular activities, friends
and the outside world, and lose a sense
of control.
Not ideal conditions for healing.
So Bloorview brings art and gardening
to the bedside to help inpatients
reconnect with their creativity and
the natural world.
Artists and gardeners visit children
one-on-one with trolleys packed with
paints, brushes and clay, baskets of soil
and seeds for planting, cut-flowers,
water and watering cans.
The program is called ARTery because
the art trolley run through the core of
the hospital, restoring children’s
metaphorical hearts.
“It can be transformative,” says Sarah
Dobbs, director of Bloorview’s Centre
for the Arts. “It’s an opportunity for the
children to create and contribute again,
and that leads to a sense of wellbeing
and self-esteem.”
“I love it,” says Crystal Brown, 16, who’s
spent half a year in hospital recovering
from surgery to remove a brain tumour.
“On my first day at Bloorview I got to
make a wonderful bamboo flute in
ARTery.”
Crystal has spent three months in
inpatient rehab receiving physical,
speech and occupational therapies,
going to school, and choosing a new
hot pink wheelchair.
“ARTery is relaxing and it takes away
stress,” she says – key ingredients in a
hospitalized child’s recovery.

Bloorview training draws pediatricians worldwide
University of Toronto’s training program in developmental pediatrics is based at Bloorview and prepares
pediatricians to assess and treat children with developmental disabilities as part of a multi-disciplinary rehab
team. The program draws clinical fellows from around the world. We asked a few why they chose Bloorview.
“Bloorview is a big hospital with a denselypopulated
catchment area, so my chances of
seeing a large volume of patients, which is
very important during a limited, two-year
fellowship, were better. The academic and
research parts of the program are excellent.”
“As a pediatrician, I’m trained to know
concrete pathology. But kids with
disabilities are so intricate. No two are
the same. You can’t learn about them in
a textbook or in medical school. You
need hands-on interaction in a rehab
hospital like Bloorview.”
Dr. Sharon Smile
Kingston, Jamaica
Dr. Michal Begin
Jerusalem, Israel

“Canada has an excellent reputation
internationally for training doctors in
many specialties. The developmental
pediatrics program at Bloorview is one
of the few programs that offer training in
neurodevelopment anywhere in the
world. I was unable to find such a
training program in Ireland or Britain,
where I had previously trained.”
“Bloorview’s developmental pediatrics
program has many renowned experts in
developmental and behavioural fields,
especially in autism and cerebral palsy at
Bloorview, and neurology at SickKids. The
program gave me rich experiences in
clinical, research and academic activities.
I learned a lot in the area of autism and
how to assess children with unique tools.
That’s been very useful when I returned
to my country.”
Dr. Kay Lekagul
Bangkok, Thailand
Dr. Siobhan Gallagher
Limerick, Ireland

Building the case for Botox, step by step
Like any five-year-old, Chantel Azevedo
likes to be on the move.
But until recently, getting around was
difficult. That’s because cerebral palsy
made her right leg muscles stiff, pulling
her heel off the floor. “You can imagine
how hard it would be to walk everywhere
on tip-toe,” her mom Vicky says. “It
knocked her balance off and made
her fall.”
That changed dramatically when
Chantel had Botox injections to treat
the stiffness – known as spasticity – at
Bloorview. “She was able to put her foot
flat on the ground, which meant she
could walk and run better, play jumprope
better, alternate her legs climbing
stairs, and do all the things five-yearolds
like to do.”
Bloorview was one of the first hospitals
in North America to use Botox to treat
spasticity in children, conducted one of
the first randomized trials to show its
efficacy, and uses the treatment in over
400 children each year. The drug
temporarily blocks abnormal brain
signals that cause muscles to contract.
Dr. Darcy Fehlings, physician director
of Bloorview’s child development
program and head of the University of
Toronto Division of Developmental
Pediatrics, has just embarked on the
first study to look at the long-term
impact of Botox on motor function and
participation.
“We want to see if the short-term gains
we see in function translate into a
richer, everyday quality of life over the
long-term,” says Darcy. “Are kids able
to take more steps, participate in more
recreation activities, and move around
in the community more easily?”
About 180 children, aged two to five,
will be followed over three years.
Dr. Darcy Fehlings is part of an
international group of specialists who
developed a consensus statement on
the medical uses of botulinum toxin
based on an extensive review of the
scientific literature. Findings of the
review on treating upper-limb
spasticity in children – which Darcy led
– will be published in the European
Journal of Neurology.

Access study looks to kids as experts
The challenge: Participating in everyday
activities helps children develop skills,
interests and friendships that promote
physical health and emotional
wellbeing. But children who use
wheelchairs or walkers face barriers.
That’s because most houses,
communities and schools aren’t built
with their needs in mind. Stairs, narrow
doorways and standard furniture
separate these kids from their peers.
Sometimes buildings are technically
accessible, but convey the message that
children with disabilities don’t belong.
For example, a ramp may be added to a
school, but if it's located at the back of
the building and everyone else goes in
at the front, it implies second-class
treatment. Little is known about how
children with disabilities navigate and
evaluate their built environments.
The solution: A three-year study led by
Bloorview scientist Patricia McKeever
asks children to rate the accessibility
and inclusiveness of their homes,
communities and schools.
How it works: In the first phase –
underway now – 12 children aged 10-14
from urban, suburban, rural and
northern Ontario communities are
interviewed about each environment.
Kids draw maps on a tablet PC, take
photos and talk about how they get
around and how included they feel in
each setting. Outside, they carry a
blackberry that generates a real-time
map of their whereabouts. Later, using
Google Earth, they discuss the places
they went, barriers faced and what
could be improved. Researchers assess
five locations chosen by the child,
including a nearby park, movie theatre,
restaurant, doctor’s office and store.
Based on case study findings, a survey
of about 1,000 Ontario children aged
six to 14 will be conducted in the fall.
The impact: The goal is to develop
scientific evidence that will influence
building codes and place-based
interventions so that kids with
disabilities have the same
opportunities as their peers to
participate in childhood activities.

Making the system work
Making it easier for children and
families to obtain services by
partnering with other players in the
health system is a strategic priority
for Bloorview.
2008 was a banner year for
partnerships and collaboration that
improved the speed at which children
and youth received inpatient
rehabilitation care and services for
children diagnosed with autism.
Speeding transition to
inpatient rehab
Problem: Children with brain injuries
who were ready to be transferred to
Bloorview for inpatient rehab spent on
average nine days more than needed
in SickKids’ trauma unit in 2006. A
cumbersome Bloorview referral form
was identified as the challenge, causing
273 medically-unnecessary days.
Partnership: Managers and frontline
staff at Bloorview and SickKids worked
together to simplify and improve the
referral process, as part of the Ontario
Health Ministry’s Flo Collaborative.
Solution: A new, concise two-page
referral form. What originally took four
people three days to complete can now
be filled out by one person in an hour.
An up-to-date clinical overview is sent
48 hours before transfer. Staff agreed on
common definitions of “medicallystable
and rehab-ready.” Visual icons
that describe steps in the referral
process were developed and are posted
beside the child’s name on an
information board at SickKids. This
helps staff identify what stage the child
is at and minimizes duplication of tasks.
Impact: Unnecessary days were cut
from nine to three, and incomplete
referral forms from 50 per cent to less
than five per cent. Bloorview is using
the process-improvement knowledge it
gained to improve referral practices on
other units.

Linking families to
autism services
Problem: Over 100 children are
diagnosed with autism at Bloorview
each year. For ongoing treatment, we
refer families to agencies like the
Geneva Centre for Autism. In 2006-07,
only 63 per cent of the families
diagnosed successfully made the
transition. Community services for
autism are complicated and can be
difficult for families to access.
Partnership: Bloorview and the
Geneva Centre partnered to ensure
families make the transition from
one organization to the other
and get the services their
children need.
Solution: A new social work position
was created to ensure families are
successfully bridged from Bloorview to
the Geneva Centre. The social worker
meets with parents to discuss their
goals, initiates the referral, explains
services available at Geneva and
elsewhere in the community, and
provides emotional support.
Impact: In 2007-08, 86 per cent of
children diagnosed with autism at
Bloorview were bridged to the Geneva
Centre. In 2008-09 it was 87 per cent.
The Impact on Family Scale – which
measures the impact of a child’s
disability on the family – shows an
overall decrease in family stress
following transfer to the Geneva
Centre.

The wonder year
BLOORVIEW BUILDS RESEARCH TALENT
BLOORVIEW SHEDS LIGHT ON HOUSING
FUNDING TARGETS SOCIAL INCLUSION u
Bloorview recruited five top clinical
and social scientists to build our
leadership in participation and child
development programs. Two positions
combine clinical and research work
and reflect our plan to more closely
integrate research, clinical and
teaching efforts.
Bloorview submitted a report to the
City of Toronto – which is developing a
10-year affordable housing plan –
outlining the challenges families of
children with disabilities face in finding
accessible and affordable housing. We
were delighted that the City
subsequently identified families with
children with disabilities as a priority
group for new affordable housing.
Almost $4 million in funding for
childhood disability research was
announced by the federal government
at Bloorview. Five teams of Canadian
scientists will conduct research to
improve the social inclusion and
participation of children with severe
disabilities. The funding is a partnership
between the Canadian Institutes of
Health Research and Bloorview
Children’s Hospital Foundation.

t EARLY RESEARCHER AWARDS
SHEILA JARVIS LEADS MISSION TO CHINA
Ontario Research and Innovation
Minister John Wilkinson announced
funding of 22 Toronto research projects
worth over $3 million through the Early
Researcher Awards program at
Bloorview. Tom Chau, who leads a team
of scientists developing assistive
technologies at Bloorview, was one of
the recipients. “We don’t have to look
any further than Bloorview to find
extraordinary examples of inspirational
and pioneering innovators,” Minister
Wilkinson said.
Bloorview President and CEO Sheila
Jarvis represented the Council of
Academic Hospitals of Ontario on a
visit to China to pursue health research
partnerships between China and
Ontario. Universities in Hong Kong,
Shanghai and Beijing are keen to
explore joint grant applications,
research projects and publications, and
exchange of post-doctoral students.
Bloorview will host two students this
summer. Next steps include a scientific
symposium in Ontario.
NEW TAX-FREE SAVINGS PLAN
CANADA’S CHEFS SHARE SECRETS
Canada’s new Registered Disability
Savings Plan was launched by Minister
of Finance Jim Flaherty and Minister
of Human Resources and Skills
Development Diane Finley at Bloorview.
The plan is a tax-free option to help
parents save for the long-term needs of
children with severe disabilities.
A gala dinner to launch the third
annual Recipes for Possibility Calendar
drew over 200 business and community
leaders and raised more than $425,000
for Bloorview. The calendar features
recipes from 13 of Canada’s top chefs,
and was sponsored by BMO Financial
Group.

No wonder we’re the best!
W hy do you work at Bloorview?
“I have a sister with special needs who
has greatly inspired me to work in the
field of disability. I did my masters
placement at Bloorview and after
meeting the fabulous staff and social
work colleagues, I was hooked. It was
my dream to work here and here I am!”
Stephanie Willison
Social Worker
Complex Continuing Care,
Family Support Services
“Because of the children and families.
We have to find ways to understand the
causes of autism and we have to find
better ways to provide integrated and
comprehensive care that relieves the
burden and stressors for caregivers and
kids. It's listening to what parents are
struggling with everyday that keeps us
going in trying to make changes.”
Dr. Wendy Roberts
Developmental Pediatrician
Child Development Program
“I love working at the Bloorview School
because every day is a great
adventure.”
Paul Alcamo
Teacher
Integrated Kindergarten Program

“I like my job. I have fun meeting
different people from all cultures. I like
to be friendly with everyone.”
Maggie Rodrigues
Dietary Aid,
Cafeteria
“I want to make a difference in
children’s lives. The children at
Bloorview inspire me in all realms of
my life. Bloorview has a friendly
atmosphere that always makes me feel
welcome.”
Jorge Santos
Registered Nurse
Complex Continuing Care
“It’s nice to have a workplace that is so
aligned with my personal values. I feel
great about the work I do everyday,
even though I’m not on the front lines.”
Kathy Foisey
Executive Assistant
Human Resources

In case you wondered
Peer-Reviewed Publications
Alves N, Chau T. Testing the
Stationarity of Mechanomyographic
Signals from Extrinsic Hand
Muscles During Isometric
Contractions. Journal of
Electromyography and
Kinesiology 2008;18(3):509-515.
Alves N, Chau T. Vision-based
Segmentation of Continuous
Mechanomyographic Grasping
Sequences for Training
Multifunction Prostheses. IEEE
Transactions on Biomedical
Engineering 2008;55(2):765-773.
Andrysek J, Redekop S, Matsui N,
Kooy J, Hubbard S. A method to
measure the accuracy of loads in
knee-ankle-foot orthoses using
conventional gait analysis, applied
to persons with poliomyelitis.
Arch Phys Med Rehabil
2008;89(7):1372-79.
Biddiss E, Chau T. Dielectric
elastomers as actuators for upper
limb prosthetics: challenges and
opportunities. Medical
Engineering & Physics
2008;30(4):403-418.
Biddiss E, Chau T. Multivariate
modeling for prediction of
prosthesis use or rejection.
Disability and Rehabilitation.
Assistive Technology
2008;3(4):181-192.
Blain S, Chau T, Mihailidis A.
Body language: the untapped
potential of the autonomic
nervous system. Open
Rehabilitation 2008;1:27-37.
Blain S, Mihailidis A, Chau T.
Assessing the potential of
electrodermal activity as an
alternative access pathway.
Medical Engineering & Physics
2008;30(4):509-515.
Brian JA, Bryson SE, Garon N,
Roberts W, Smith I, Szatmari P,
Zwaigenbaum L. Clinical
assessment of autism in high-risk
18 month olds. Autism
2008;12(5):433-456.
Brooks D, Gibson BE, Dematteo
D. Perspectives of Personal
Support Workers and Ventilator-
Users on Training Needs. Patient
Education and Counseling
2008;71:244-250.
Carnevale FA, Macdonald ME,
Bluebond-Langner M, McKeever
P. Using Participant Observation
in Pediatric Health Care Settings:
Ethical Challenges and Solutions.
Journal of Child Health Care
2008;12(1):18-32.
DeMatteo CA, Cousins MA, Lin
CY, Law MC, Colantonio AC,
Macarthur C. Post- injury living
environments for children and
youth with acquired brain injury.
Arch Phys Med Rehabil
2008;89:1803-10.
Di Rezze B, Wright FV, Curran CJ,
Campbell K, Macarthur C.
Individualized outcome measures
for evaluating life skill groups for
children with disabilities. Can J
Occup Ther 2008;5:282-287.
Epstein I, Stevens S, McKeever P,
Baruchel S. Using a puppet to
elicit talk with children. Nursing
Inquiry 2008;15(1):49-56.
Fernandes D, Chau T. Fractal
dimension of pacing and grip
force in handwriting stroke
production. Journal of
Biomechanics 2008;41:40-46.
Gibbins S, Stevens S, McGrath P,
Yamada J, Beyene J, Breau L,
Camfield C, Finley A, Franck L,
Johnston C, Howlett A, McKeever
P, O’Brien K, Ohlsson A.
Comparison of pain responses in
infants of different gestational
ages. Neonatology 2008;93:10-18.
Guerriere D, Wong A, Croxford R,
Leong V, McKeever P, Coyte P.
Costs and determinants of
privately-financed home-based
health care in Ontario, Canada.
Health and Social Care in the
Community 2008;16(2):126-136.
Guiqing C, Edelmann L,
Goldsmith JE, Cohen N,
Nakamine A, Reichert JG,
Hoffman EJ, Zurawiechi DAM,
Silverman JM, Hollander E,
Soorya L, Anagnostou E,
Betancur C, Buxbaum JD.
Multiplex ligation-dependent
probe amplification for genetic
screening in autism spectrum
disorders: efficient identification
of known microduplications and
identification of a novel
microduplication in ASMT.
Medical Genomics 2008;16:1-50.

King G, Bartlett D, Currie M,
Gilpin M, Baxter D, Willoughby C,
Tucker MA, Strachan D.
Measuring the expertise of
pediatric rehabilitation therapists.
International Journal of Disability,
Development and Education
2008;55(1):5-26.
King G, Batorowicz B, Shepherd
TA. Expertise in researchinformed
clinical decision
making: Working effectively with
families of children with little or
no functional speech. Evidence-
Based Communication
Assessment and Intervention
2008;2(2):106-116.
King G, Currie M, Smith L, Servais
M, McDougall J. A framework
of operating models for
interdisciplinary research
programs in clinical service
organizations. Evaluation and
Program Planning 2008;31:160-173.
Kolski HK, Hawkins C, Zatz M, de
Flavia P, Biggar WD, Alman B,
Vajsar J. Diagnosis of limb-girdle
muscular dystrophy 2A by
immunohistochemical
techniques. Neuropathology
2008;28(3):264-268.
Lee J, Steele C, Chau T. Time and
Time-Frequency Characterization
of Dual-Axis Swallowing
Accelerometry Signals.
Physiological Measurement
2008;29(9):1105-1120.
Missiuna C, Moll S, King G,
Stewart D, Macdonald K. Life
experiences of young adults who
have coordination difficulties.
Canadian Journal of Occupational
Therapy 2008;75(3):157-166.
Murphy A, Milo-Manson G, Best
A, Campbell K, Fehlings D. The
impact of modafinil on spasticity
reduction and quality of life in
children with cerebral palsy.
Developmental Medicine and
Child Neurology 2008;50:510-514.
Narayanan U. Multiple
Collaborators from American
Academy of Pediatrics
Orthopaedic Section and Pediatric
Orthopaedic Society of North
America: Management of
Pediatric Trauma. Pediatrics
2008;121(4):849-54.
Redekop S, Andrysek J, Wright V.
Single-Session Reliability of
Discrete Gait Parameters in
Ambulatory Children with
Cerebral Palsy based on GMFCS
level. Gait Posture 2008;28(4):627-33.
Silva J, Torres J, Chau T, Mihailidis
A. A novel asynchronous access
method with binary interfaces.
Journal of Neuroengineering and
Rehabilitation 2008;5:24.
Stevens B, McGrath P, Dupuis A,
Gibbins S, Beyene J, Breau L,
Camfield C, Finley A, Franck L,
Howlett A, Johnston C, McKeever
P, O’Brien K, Ohlsson A, Yamada J.
Indicators of pain in neonates at
risk for neurological impairment.
Journal of Advanced Nursing
2008;65(2):285-296.
Tai K, Blain S, Chau T. A review of
emerging access technologies for
individuals with severe motor
impairments. Assistive
Technology 2008;20:204-219.
Tam C, Teachman G, Wright V.
Pediatric Application of
Individualized Client-Centered
Outcome Measures: A Literature
Review. British Journal of
Occupational Therapy
2008;71(7):286-296.
Thompson P, Beath T, Bell J,
Jacobson G, Phair T, Salbach NM,
Wright FV. Test-retest reliability of
the 10-metre fast walk test and
6-minute walk test in ambulatory
school-aged children with
cerebral palsy. Dev Med Child
Neurol 2008;50:370-376.
Wiles R, Cott C, Gibson BE.
Understanding hope and illness:
A narrative literature review of
qualitative research on hope,
expectations and recovery, Journal
of Advanced Nursing
2008;64(6):564-573.
Wright JG, Smith PL, Owen JL,
Fehlings DL. Assessing functional
outcomes of children with
muscular dystrophy and scoliosis:
the muscular dystrophy spine
questionnaire. Journal of
Pediatric Orthopaedics
2008;28(8):840-845.
Wright JG, Smith PL, Owen JL,
Fehlings DL. Simple Bone Cyst
Trial Group: A randomized clinical

trial comparing intralesional bone
marrow and steroid injections for
simple bone cysts. The Journal of
Bone & Joint Surgery (A)
2008;90(4):722-30.
Wright V, Rosenbaum P,
Goldsmith C, Fehlings D, Law M.
How do changes in body
functions/structures, activity and
participation relate to each other
in children with cerebral palsy.
Dev Med Child Neurol
2008;50:283-289.
Young S, Pratt J, Chau T. Choosing
the fastest movement: perceiving
speedaccuracy tradeoffs.
Experimental Brain Research
2008;185(4):681-688.
Zabjek KF, Leroux MA, Coillard C,
Prince F, Rivard CH. Postural
characteristics of adolescents with
idiopathic scoliosis. J Pediatric
Orthop 2008;28(2):218-24.
Peer-Reviewed Funding
fMRI for the study of response
inhibition, and face and linguistic
processing in autism, Seaver
Foundation, (2 Years), $28,687,
Anagnostou, E (PI)
fMRI study of the effect of
intravenous oxytocin vs placebo
on response inhibition and face
processing in autism, Seaver
Foundation, (3 Years), $10,625,
Anagnostou, E (PI)
A double blind placebo controlled
trial of memantine targeting
motor skills in autism, Autism
Speaks, (2 Years), $54,493,
Anagnostou, E (Co-PI)
Brain glutamate concentrations in
autistic adolescents by magnetic
resonance spectroscopy,
NARSAD - Young Investigator
Award, (2 Years), $30,000,
Anagnostou, E (PI)
Brain glutamate concentrations in
autistic children by magnetic
resonance spectroscopy, Autism
Speaks, (2 Years), $54,791,
Anagnostou, E (PI)
Clinical trial network;
infrastructure grant to do multisite
pilot studies in autism, Autism
Speaks, (3 Years), $114,483,
Anagnostou, E (PI)
Refinement of prototype for
self-energizing prosthetic knee
damper, Ontario Centers of
Excellence CCIT Market
Readiness, (1 Year), $50,000,
Andrysek, J (PI)
Further development of a
stance-phase controlled kneeankle-foot-orthotic,
Proof of
Principle Fund of the Ontario
Research Commercialization
Program (ORCP - POP), (1 Year),
$50,000, Andrysek, J (PI)
Swing-phase controller for a lowcost
prosthetic knee joint, Proof of
Principle Fund of the Ontario
Research Commercialization
Program (ORCP - POP), (1 Year),
$49,000, Andrysek, J (PI)
Effect of the Wii Fit video game as
a therapeutic intervention in
promoting dynamic balancecontrol
among paediatric
amputees, Bloorview Research
Institute Seed Grant Competition,
(1 Year), $24,525, Andrysek, J (Co-PI)
Design of a Novel, User-centred
Prosthetic Sleeve, Medicork Ltd.,
(1 Year), $21,000, Biddiss, E (PI)
Longitudinal study of the
relationship between impairment,
activity limitation, participation
and quality of life in persons with
Duchenne muscular dystrophy- a
five-year study, CINRG, (5 Years),
$8,395, Biggar, D (PI)
Enhancing Inter-subjectivity in
Infants at High-Risk for Autism,
Autism Speaks Canada, (3 Years),
$212,668, Brian, J (Co-PI)
Canada Research Chair in
Intelligent Systems in
Multidisciplinary Paediatric
Rehabilitation, Canada Research
Chairs, (5 Years), $143,500,
Chau, T (PI)
Intelligent systems in paediatric
rehabilitation, Natural Sciences
and Engineering Research
Council, Discovery Grants-
Individual, (5 Years), $31,768,
Chau, T (PI)

Combining musical training
through VMI and Smart Kids
Learning Software, Ministry of
Research and Innovation, Ontario
Research Commercialization
Program, (1 Year), $50,000,
Chau, T (PI)
Advanced body-machine
interfaces for voiceless
communications, Principal
Investigator (with E. Bouffet and
Panacis Medical) Ontario Centres
of Excellence, Biomedical
Collaborative Research Program,
(3 Years), $80,000, Chau, T (PI)
“Body talk”: access technologies
for voiceless communication and
interaction, Ministry of Research
and Innovation, Early Researcher
Award, (5 Years), $38,000, Chau, T (PI)
Development of a proof-ofconcept
medical device: the
aspirometer, Ministry of Research
and Innovation, Ontario Research
Commercialization Program, (1
Year), $50,000, Chau, T (PI)
Development of a commercial
prototype of a device to assist
aspiration detection, Precarn,
Small Company Research
Program, (1 Year), $276,770,
Chau, T (Co-PI)
Access innovations for individuals
without a voice, REMAD
Foundation (Hong Kong),
Operating Grants for Scientists of
Chinese Descent, (3 Years),
$50,000, Chau, T (PI)
An Evaluation of the Long-term
Effectiveness of Botulinum Toxin
in Children with Spastic Cerebral
Palsy, CIHR, (4 Years), $106,489,
Fehlings, D (PI)
Cerebral Palsy Outcomes Project
(CPOP), American Academy for
Cerebral Palsy and Developmental
Medicine, (1 Year), $25,000,
Fehlings, D (PI)
There’s no place like home: What
constitutes an “adequate” home
environment for younger disabled
adults? CIHR Catalyst Grant:
Ethics, (2 Years), $46,072,
Gibson, B (Co-PI)
Assessment of Children’s Capacity
to Consent for Research: A
Descriptive Qualitative Pilot Study
of Researchers’ Practices and
REBs’ Expectations, Bloorview
Research Institute Seed Grant,
(1 Year), $24,926, Gibson, B (PI)
WALK: Why Ambulation Learning
for Kids? Social Science and
Humanities Research Council
(SSHRC) Research Development
Initiatives, (1 Year), $35,351,
Gibson, B (PI)
School role participation:
Perspectives of the child, the
parents, and the teachers, Social
Sciences and Humanities
Research Council of Canada, (3
Years), $36,666, King, G (Co-PI)
Facilitating the development of
professional expertise in
children’s mental health,
rehabilitation, and education
services, Social Sciences and
Humanities Research Council of
Canada, (1 Year), $18,210, King, G (PI)
Inclusion in the environments
and activities of childhood: A
focus on optimal environments
and the experience of meaningful
participation, Canadian Institutes
of Health Research, (1 Year),
$9,937, King, G (PI)
An evaluation of an occupational
therapy mentorship program:
Effects on therapists’ skills and
family-centred behaviour,
Bloorview Research Institute Seed
Grant Competition, (1 Year),
$24,783, King, G (PI)
Facilitating optimal life
experiences and environments for
children with disabilities and their
families, Ontario Mental Health
Foundation, (3 Years),
$29,840, King, G (PI)
Communication competencies in
children who use augmentative
and alternative communication
(AAC): A multi-site and crosscultural
investigation, Ontario
Federation for Cerebral Palsy, (1
Year), $39,648, King, G (Co-PI)
From Knowledge Generation to
Knowledge Translation: A Systems
Approach to Reducing the Burden
of Injury in Canada, Canadian
Institutes of Health Research,
(5 Years), $188,472, Macarthur, C (PI)

A longitudinal evaluation of The
LIFEspan Model of linked
healthcare, Ontario Neurotrauma
Foundation, (4 Years), $76,750,
Macarthur, C (Co-PI)
Outcomes Research in Paediatrics,
Hospital for Sick Children
Foundation, (5 Years), $150,000,
Macarthur, C (Co-PI)
The Lived Experiences of Mothers
of Children with Autism, Social
Sciences and Humanities
Research Council of Canada, (3
Years), $18,000, McKeever, P (Co-PI)
School, Home and
Neighbourhood Accessibility:
Physically Disabled Children’s
Assessments (The ScHaN Project),
Canadian Institutes of Health
Research, (3 Years), $120,256,
McKeever, P (PI)
The Lived Experiences of Mothers
of Children with Autism, The
Hospital for Sick Children
Foundation, (2 Years), $64,910,
McKeever, P (Co-PI)
Identity, Embodiment and Heart
Transplantation: A
Phenomenologically-Informed
Exploration, Advanced Heart
Failure Fund, University Health
Network, (1 Year), $75,000,
McKeever, P (Co-PI)
From fixing to function: exploring
opportunities for the
development of a functional
optimization model for
intervention for children with
disabilities, Social Sciences and
Humanities Research Council of
Canada (SSHRC), (1 Year),
$10,000, Narayanan, U (Co-PI)
Functional Outcomes Following
Orthopaedic Surgery Based On
Gait Laboratory Versus
Observational Gait Analysis In
Ambulatory Children With
Cerebral Palsy: A Randomized
Controlled Trial, Zimmer of
Canada, (2 Years), $4,250,
Narayanan, U (PI)
Functional Outcomes Following
Orthopaedic Surgery Based On
Gait Laboratory Versus
Observational Gait Analysis In
Ambulatory Children With
Cerebral Palsy: A Randomized
Controlled Trial, Pediatric
Orthopaedic Society of North
America (POSNA), (2 Years),
$15,500, Narayanan, U (PI)
Safety and efficacy of botox
injection in alleviating postoperative
pain & improving
quality of life in lower extremity
limb lengthening, Clinical
Outcomes Studies Advisory Board
(COSAB) of Shriners Children’s
Hospitals, (3 Years), $73,333,
Narayanan, U (PI)
Development of a Computer
Adaptive Test - Patient Reported
Outcome Measure for Children
with Physical Disabilities,
AACPDM Planning Grant, (1 Year),
$22,325, Narayanan, U (Co-PI)
Collaborative Community-Based
Complex Care Coordination,
Norman Saunders Complex Care
Grant, Sick Kids Foundation, (2
Years), $23,725, Narayanan, U
(Co-PI)
Globus Pallidus Deep Brain
Stimulation in Children with
Dystonia, New Investigator Grant,
Sick Kids Foundation (2 Years),
$59,308, Narayanan, U (Co-PI)
Concerns, needs and expectations
of parents and caregivers of
children with severe cerebral
palsy, Ontario Federation for
Cerebral Palsy, (2 Years),
$16,017, Narayanan, U (PI)
Implementation of Low Risk Ankle
Rules, PSI Foundation, (2 Years),
$80,500, Narayanan, U (Co-PI)
The Establishment of a Patient
Registry for the Autism Treatment
Network, Autism Treatment
Network (ATN), (3 Years),
$150,000, Roberts, W (PI)
Development of an Indicator of
the Impact of Assistive Devices on
Children with Disabilities and
Their Families, Canadian
Institutes of Health Research, (3
Years), $70,833, Ryan, S (PI)
1Q4All.com – One Q for All,
HTX-OCE-IRAP Business
Partnership Program, (1 Year),
$243,875, Shein, F (PI)

Focus on the Outcomes of
Communication Under Six (the
FOCUS): Evaluating validity and
responsiveness to change,
Canadian Institutes of Health
Research, (3 Years), $74,563,
Thomas-Stonell, N (PI)
Evaluating the validity and
responsiveness of the FOCUS:
Focus on the Outcomes of
Communication Under Six,
Canadian Institutes of Health
Research, (3 Years), $58,333,
Thomas-Stonell, N (PI)
A comparison of the WeeFIM and
PEDI questionnaires for
measuring change in functional
status of young children with
cerebral palsy or developmental
delay, Canadian Institutes of
Health Research, (3 Years),
$58,333, Wright, V (PI)
Functional Status Outcome
Indicators for Young Children with
Cerebral Palsy: Evaluation of the
Comparative Abilities of Two
Internationally-recognized
Measures to Detect Change, and
Determination of Benchmarks for
Clinically Important Change,
Canadian Institutes of Health
Research, (2 Years), $87,282,
Wright, V (PI)
Evaluation of quality of movement
in ambulatory children with
cerebral palsy: Validity and
Sensitivity to change of the
Quality FM, Physicians Services
Inc. (PSI), (2 Years), $62,500,
Wright, V (Co-PI)
Awards and Honours
Tom Chau
Early Researcher Award, Ontario
Ministry of Research & Innovation
Sandi Cox
Canadian Nursing Association
Centennial Award – honouring
exceptional registered nurses.
Unni Narayanan
Robert Salter/Orthopaedic
Resident Teaching Award
Distinction, University of Toronto
Patty Rigby
Circle of Honour Award in
Education from Bloorview
Kids Rehab
Patty Rigby
Research Supervision Award from
the Department of Occupational
Science and Occupational
Therapy, Faculty of Medicine,
University of Toronto
Steve Ryan
Whittaker Memorial Award from
the Ontario Association of
Children's Rehabilitation Services
(for outstanding achievement in
rehabilitation research and
development for children with
cerebral palsy).
Fraser Shein
WordQ, SpeakQ, ThoughtQ were
voted as one of the Brightest Ideas
of 2008 in the National Center for
Technology Innovation Tech Expo,
Washington.
Virginia Wright
Exceptional Achievement Award
in Research. Department of
Physical Therapy. University
of Toronto
Bloorview also received the
Canadian Nurses Association 2008
Employer Recognition Award.

How we measure up
Fair ★ Good ★★ Excellent ★★★
Bloorview is always looking for better ways to track our performance and communicate how we are doing. Here is an at-a-glance report on our performance. To determine our ratings,
Bloorview invited representatives from the Provincial Council for Maternal, Newborn, Child and Youth Health Care, Grandview Children’s Centre, Toronto Central Local Health
Integration Network, Child Health Network, Ontario Association of Children's Rehabilitation Services and Bloorview's Board of Trustees and Family and Youth Advisory Committees.
GOAL MEASURE BENCHMARK ACTUAL SCORE
CARE
Improve inpatient rehab
outcomes
Rate of improvement in children’s functional abilities from
admission to discharge using WeeFIM
10% improvement
16% average
improvement *
★★★
Improve participation for
kids with disabilities
Rate of improvement in performance after intervention using the
Canadian Occupational Performance Measure
2 point improvement
3 point average
improvement *
★★★
Achieve outpatient rehab
therapy goals
Achievement of goals set by the client and/or therapist using
Goal Attainment Scaling
A score between 44-55
Average score
is 55.4 *
★★
Provide client and family
centered care (CFCC)
Number of CFCC domains that achieve or exceed average scores
found in literature**:
Enabling and partnership
Providing general information
Providing specific information
Coordinated and comprehensive care
Respect and supportive care
5.46 / 7
4.28 / 7
5.54/ 7
5.49/ 7
5.72/ 7
3 out of 5 domains
achieve or exceed
average scores
5.70/ 7
4.91/ 7
5.78/ 7
5.27/ 7
5.35/ 7
★★
Improve the client
experience
Percentage of clients and families who rate Bloorview excellent or good
95%
94%
★★★
Ensure timely access to
inpatient care
Percentage of clients admitted within 4 days of being ready
80%
77%
★★
Ensure timely access to
effective diagnosis from a
developmental pediatrician
Average wait from date of referral to date seen
180 days
272 days
★
Improve access to
communications and
writing aids services
Rate of change in wait times from 2007-08 to 2008-09
50% wait time reduction
from 696 to 348 days
47% reduction to
368 days
★★
Reduce the rate of hospital
acquired infections
Overall infection rate compared to Bloorview’s average rate
for the previous 36 months
4.9 per 1000
inpatient days
3.3
★★★

GOAL MEASURE BENCHMARK ACTUAL SCORE
RESEARCH
Enhance the output and
impact of research
Number of peer reviewed grants per full time employee (FTE)
compared to other clinical research institutes
2
5.9
★★★
Number of peer reviewed publications per FTE compared to other
clinical research institutes
2
3.4
★★★
TEACHING
Lead interprofesional
education (IPE) in
childhood disability
Number of IPE placements compared to Bloorview’s performance
last year
Number of professional groups involved in IPE compared to
Bloorview’s performance last year
2
9
3
11
★★★
★★★
HUMAN RESOURCES
Offer staff a satisfying,
healthy and safe workplace
Staff turnover rate compared to 2007-08 Ontario Hospital Association
(OHA) data
11.6%
9.5%
★★
Staff average sick time compared to 2007-08 OHA data
10.3 days
6.2 days
★★★
FINANCE
Ensure a sound financial
position
Current ratio of short-term assets and liabilities based on the Toronto
Central Local Health Integration Network (TC LHIN) standards
0.8 – 2.0
1.3
★★★
Year end financial position based on TC LHIN standards
TC LHIN target
$227,521
(595,000)***
★★
*Bloorview also looks at the percentage of clients who meet targets to better understand the full scope of Bloorview’s performance. **Measure of Process of Care, CanChild Centre for
Childhood Disability Research. ***Without the realization of investment losses due to a change in investment managers we would have shown an operating surplus of $804,671.

wonder: verb, to be filled with admiration or awe
wonder: verb, to feel curiosity, to query in the mind
A teaching hospital
fully affiliated with
150 Kilgour Road, Toronto, ON M4G 1R8
T 416-425-6220 | E info@bloorview.ca | www.bloorview.ca
Principal photography: www.williamsuarez.ca