National Defence Committee on Nov. 26th, 2013

[Dr. Anne Germain]

Absolutely. Think about it. If you have a bad night of sleep, typically the next day your mood may be altered; you may be a little bit more irritable, and not as pleasant as usual. That's after one night. If you multiply that by thousands of nights of many years of service, you are going to have some impairments or difficulties in facing the world, in getting out of the basement.

The other truth is that when we have chronic sleep problems, it's just hard to handle things that are coming at us, so instead of exploding or having an argument with somebody outside in the street, people will oftentimes choose to stay in their basement. They use it as one of their avoidance strategies, to avoid arguments, avoid being hyperreactive.

Yes, if we start with sleep, not only can we improve sleep, but we can make people feel better, and make them feel that they are better prepared to handle what's coming up on a regular day-to-day basis.

[Jack Harris, NDP, St. John's East, NL]

Thank you.

I need to ask Helen Zipes one question. A million dollars for this. Is that what you're saying? Did I hear you correctly? You said that you have 60,000 outpatient visits a year. That's about 160 a day for 365 days year.

[Helen Zipes]

Yes. Our outpatient program is huge.

[Jack Harris, NDP, St. John's East, NL]

You seem real busy.

How many of these do we need across the country to be able to make a real difference in the problems we have?

[Helen Zipes]

Well, we have waiting lists for all our programs. We try to minimize the waiting times for our in-patients. For someone coming from acute care to an in-patient bed, we try to get them in as fast as possible, but—

[Jack Harris, NDP, St. John's East, NL]

Is it the only one in the country?

[Helen Zipes]

No. There are rehab centres throughout the country.

[Jack Harris, NDP, St. John's East, NL]

No, for this machine, I mean.

[Helen Zipes]

For this machine, there are two: ours and one in Edmonton at the Glenrose. There are other similar smaller units, but we were the first with the extended system.

[Jack Harris, NDP, St. John's East, NL]

Thanks.

I have one last question for Dr. Germain.

In looking at “Sleep Across the Deployment Cycle”, on page 3 or 4, when I'm looking at the right-hand side and the sleep duration in hours, it looks dramatically different on the scale, but when you look at the numbers, we're looking at 6.46 hours to 6.56 hours being the big difference between the lowest and the highest. Is that significant?

[Dr. Anne Germain]

It is. This is self-reporting, so usually you have people overestimating how much sleep they get. The absolute difference does not look that dramatic, but I would suspect that in reality it's.... Well, 30 minutes of sleep is significant, so if it translates to 20 to 30 minutes and that's an underestimate of what really happens, you're thinking about a significant sleep loss during deployment.

[Jack Harris, NDP, St. John's East, NL]

All right. Those are my questions.

[The Chair, Conservative, Peter Kent]

Thank you, Mr. Harris.

Mr. Norlock.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you very much, and through you, Chair, to the witnesses, thank you for appearing today.

I'll start with a quick question for Dr. Germain.

Pharmacological sleep aids are good, but I know a lot of folks who prefer herbal or natural medicines...well, so-called natural medicines or natural products. Have you utilized those as sleep aids—because they tend not to have a lot of side effects like the traditional pharmacological medicines used—and what's the success rate?

[Dr. Anne Germain]

It's very low. That's the problem.

The primary difficulty with natural products is that there's no control for quality. Three milligrams of melatonin from one brand can be very different from three milligrams of melatonin from another brand. That's the primary difficulty.

Overall, the studies that have been done tend to be negative or to show very small effects.

Anecdotally, there are people who swear by these products, and it may very well work for people, but we don't have the science to determine the quality of different natural products or to be able to identify who is more or less likely to respond to any of these products.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you very much.

With regard to the CAREN system, it's very interesting for the folks who have physical disabilities, but how does the CAREN system work for people with PTSD and other psychological injuries?

[Helen Zipes]

What we do is evaluate each patient and see what their needs are. Then we work on specific goals. We can alter the environment. We can alter the program.

For instance, for someone who has trouble concentrating, we would maybe have them in an easy environment, and then little tasks will come up on the screen that they have to attend to, or signs, so that they have to look at signs. There's one program in which you give someone a shopping list. They feel like they're in a store with a shopping cart. They have to reach for and look for different things. They have to be able to identify what's on their list and where to find it.

In Israel, they're using this system to work with children with autism. For instance, they have a streetscape, and they're teaching them how to cross the street safely and be aware and be safe in public.

Depending on what the issues are, we tailor the environment to the individual.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you very much.

With respect to the CAREN system's potential for research, what research information have you been able to glean from the utilization of the system?

[Helen Zipes]

I'm glad you asked that.

I brought with us our package from our centre for rehab research and development. There are several experiments and studies using the CAREN system shown here. I can leave this with you to look over.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Would you do that, please, because our researchers would be able to make use of that as part of our study.

[Helen Zipes]

The great thing about the system is that we can get objective measurements from it, so we can put markers on the patient depending on what part or what we're looking at. We can get objective data, so you can see how much force they're putting through their prosthetic limb, you can see what they're attending to, and you can see what they're recognizing, what they're not recognizing. We get objective data.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

I'm a great believer in customer satisfaction. What kind of feedback have you received from your patients in regard to their utilization of the system and how they feel after they've had the treatments?

[Helen Zipes]

They love it. Because it's realistic, it's exactly what rehab should be. You're making the person more functional in a normal environment, in a real environment. The men and women of the forces, especially, they really love it.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Commodore Hans Jung, former Canadian Forces surgeon general, has said it really pushes the envelope both in terms of the circumstances you can get into, but also the pace of advancement. His indication was this is truly a transformative technology.

Can you tell us about the speed of recovery with this equipment compared to other forms of rehabilitation?

[Helen Zipes]

That's what's so wonderful about this piece of equipment. For instance, the sergeant I showed you has an upper amputation, above the knee. Normally we'd work with someone like that for probably at least a good month before we'd take them outside on uneven ground. Now with this system, two weeks after he got used to his prosthetic limb, we had him using the system, getting the platform to go back and forth and in different directions. It sped it up by months. It gives them the confidence and they realize, “Gee, I can do this”.

The sergeant, for instance, mentioned to me one day that he used to be a golfer before his injury. My husband and I belong to a golf course here in town, so we invited him to come with us and try it. I said that if he could do that, I thought he could golf, and he did wonderfully; he really did.

Interestingly enough, the thing he had the most trouble with is that at our course the tee boxes are a little bit raised. Where there were steps, he was fine, but where there was just incline, he had a lot of trouble going up it. That was something we could go back and work on with him.