Virtual Rehabilitation Services for Individuals with Spinal Cord Injury

Abstract

Spinal cord injury (SCI) results in significant motor, sensory, and psychological impairments that can persist throughout an individual’s life. Rather than being a one-time or acute incident, SCI often leads to long-term challenges that affect both personal well-being and place ongoing demands on healthcare systems. In Canada, over 86,000 individuals live with SCI, many experiencing considerable barriers in accessing in-person rehabilitation due to geographic and financial barriers further exacerbated by events such as the COVID-19 pandemic. This thesis explores the role of virtual rehabilitation in supporting individuals with SCI. Rather than serving solely as an alternative to in-person services, virtual rehabilitation may complement and enhance traditional care delivery, by offering additional flexibility, accessibility, and ongoing engagement for individuals with SCI. Through a two-pronged approach, this thesis first describes a scoping review of 80 studies which was used to synthesize existing evidence on the characteristics and outcomes of virtual rehabilitation interventions for individuals with SCI. These interventions commonly included exercise training, cognitive-behavioral therapy, and educational components. The findings highlight strong feasibility, safety, and adherence rates, with positive impacts on quality of life and functional outcomes. Building on these insights, a qualitative descriptive study was conducted with 15 individuals living with SCI to capture their firsthand experiences and perspectives on the use of virtual rehabilitation in their recovery. Four categories emerged related to the need for virtual rehabilitation, essential design features (e.g., real-time feedback and interactivity), feasibility considerations, and contextual factors influencing use. Participants emphasized that while virtual rehabilitation enhances access and continuity of care, it cannot fully replace in-person interactions and must be thoughtfully integrated into hybrid care models. Together, the findings underscore the potential for virtual rehabilitation to transform post-SCI care, especially when grounded in user-centered design and flexible delivery models. The discussion emphasizes the need for equitable access, which ensures all individuals regardless of geography, socioeconomic status, or digital literacy can engage in virtual care; robust technological support, encompassing accessible hardware, user-friendly software platforms, and training for both clinicians and patients; and comprehensive policy frameworks that establish standards for safety, reimbursement, and integration into existing healthcare systems. These components are essential to embedding virtual rehabilitation within mainstream practices in an inclusive, sustainable, and scalable way.