By Larissa Fong, Research Team Member
On January 16, 2025, I had the privilege of touring the KITE Research Institute, guided by two knowledgeable KITE tour guides and joined by fellow University of Toronto students from the University Research Students Association. This extraordinary institute is at the forefront of complex rehabilitation research, aiming to improve the lives of individuals living with disabilities, illnesses, and aging-related challenges. KITE is part of the University Health Network (UHN), Canada’s leading medical research hospital network, which boasts over $539 million in annual research expenditures and 1,194 principal investigators as of 2023. Affiliated with the University of Toronto, KITE is home to over 100 scientists committed to advancing rehabilitation science.
CEAL Labs: Simulating Real-Life Challenges
The Challenging Environmental Assessment Laboratory (CEAL) at KITE is dedicated to developing and testing innovative solutions for individuals to live independently. With four simulation laboratories — StreetLab, DriverLab, StairLab, and WinterLab — researchers can test products such as assistive devices, pharmaceuticals, and smart clothing in controlled environments. Dr. Jennifer Campos, Chief Scientist of CEAL, highlighted the significance of simulation labs in studying human abilities and performance in realistic settings, ensuring the safety and efficacy of emerging technologies.
First Stop: Perception Lab:
Perception Lab provides a temperature-controlled environment equipped with state-of-the-art hardware to support research on human perception and performance in virtual environments. This space is designed to create ideal conditions for investigating phenomena such as visually induced motion sickness, a common side effect of visual devices, and virtual environments. Users of Virtual Reality (VR) systems frequently report symptoms like disorientation, headache, drowsiness, and nausea. Research in PerceptionLab focuses on understanding the mechanisms behind these side effects and developing strategies to mitigate them effectively.
Given the growing integration of technological devices like smartphones, tablets, and VR systems into daily life, the lab’s work addresses increasingly relevant issues. VR systems, now widely used for applications in rehabilitation, education, training, and research, require careful study to optimize user experiences. Perception Lab is equipped with tools such as a stereoscopic projector, various VR headsets, such as the Oculus Rift, a three-monitor setup, and advanced neurophysiological devices to explore perceptual phenomena like VR sickness, illusory self-motion, and presence.
Second Stop: KITE Workshops:
The KITE Workshops offer a dynamic environment for designing, building, developing, and testing prototypes and products. Equipped with skilled staff, the workshops provide workspace, tooling, and expert assistance in design and fabrication, catering to the needs of both internal and external clients. Supporting the broader KITE Labs and Facilities, the workshops play a crucial role in the development and maintenance of research devices, equipment, and environments. With the capability to produce specialized, high-precision, low-volume parts, they are integral to creating custom laboratory and research instrumentation tailored to specific scientific and technical requirements.
Third Stop: Motion Base:
One of the highlights of KITE’s CEAL is its advanced 6-degree-of-freedom motion platform. This system operates using six independently controlled hydraulic actuators, allowing precise movements that enhance the capabilities of CEAL’s labs: DriverLab, StairLab, StreetLab, and WinterLab. Originally designed for airline flight simulators, this motion system boasts remarkable versatility, supporting studies on human interactions in a wide variety of settings.
The platform's innovative design features a flying frame capable of accommodating four interchangeable lab pods, which are mounted onto the motion base using a large crane. Switching between labs is a meticulous process, requiring an entire day to complete. The motion system is synchronized with visual scenes to mimic vehicle movement, creating an immersive driving simulation experience. Additionally, WinterLab’s icy floor can tilt incrementally to test winter boots, tires, or mobility devices on complex slopes.
Fourth Stop: Stair Lab:
Scientific research on gait and balance plays a crucial role in improving the independence of individuals, particularly those facing aging-related challenges or disabilities, while also helping to prevent injuries. Such studies contribute to the development of clinical recommendations, more effective building codes, and stronger safety standards, which collectively enhance public safety. One prime example of this research is StairLab, a specialized facility that enables scientists to study how the human body interacts with various environments, such as stairs, ramps, and bathrooms.
StairLab's innovative motion tracking and video capture systems are pivotal for biomechanical studies. These technologies allow for precise measurement of how individuals move and respond to different challenges, such as navigating stairs or facing obstacles. The lab has led to the creation of better-designed handrails, updated building codes, and new mobility aids that directly benefit individuals in real-world settings.
A particularly notable feature of StairLab is its robotic safety harness. This system enables participants to safely maneuver through the lab while researchers simulate various challenges, such as navigating a soapy bathtub or experiencing a sudden shake to test balance. The harness can be programmed to adjust the level of body weight support, assisting if a participant starts to lose balance or a fall is detected. The safety harness is a critical component of the research, and its cost is said to be around one million dollars.
The findings from this research are not just academic—they have real-world applications. For example, in Canada, the combined social and healthcare costs of falls are estimated to be a staggering $8.8 billion annually. In the United States, injuries related to falls on home stairs have been increasing at a rate of 6 percent per year between 1997 and 2009. In Ontario alone, an estimated 3,800 individuals are hospitalized annually due to stair-related falls.
One of the key outcomes of StairLab’s research was the modification of the 2015 National Building Code for Canada, particularly regarding the design of stairs. The step depth in homes was increased from a minimum of 8.25 inches to 10 inches, a change informed by the lab's findings. During the study, participants were asked to mount stairs while researchers monitored their movements, they were then exposed to motion. When participants began to lose their balance, the researchers tracked their foot placement and analyzed how they landed. These findings demonstrated that stairs with a depth of 10 inches could reduce the risk of falls by as much as three times, according to Alison Novak, a scientist at KITE.
Fifth Stop: WinterLab
The Winter Lab plays a crucial role in understanding how extreme cold, icy conditions and snow affect mobility and safety. This facility allows scientists to simulate typical Canadian winter conditions, including sub-zero temperatures, snow-covered surfaces, and winds exceeding 70 km/h. By recreating these challenging environments, the Winter Lab provides a safe space for researchers to study the impact of winter weather on people’s movement and safety, particularly focusing on winter slips, falls, and the use of mobility devices.
One of the lab’s unique features is its ability to replicate the difficulties faced by individuals during the winter months. The lab’s motion platform can be tilted to create slopes, mimicking icy or snow-covered surfaces, which allows scientists to observe how people navigate these conditions and identify ways to reduce risks. This research has led to the development of new winter footwear and improvements to mobility aids like scooters and crutches, making them more effective on slippery, inclined surfaces.
WinterLab also conducts testing for the RateMyTreads initiative, a program that objectively evaluates winter footwear sold in Canadian stores. Every year, the lab releases a new report to inform consumers about the best winter boots to help avoid slips and falls.
The lab also investigates how different walking surfaces affect individuals with various disabilities, taking into account factors such as surface texture, stability, and the ability to maintain balance. This research is crucial because it highlights the challenges that many Canadians face, particularly seniors. It is estimated that 43.4% of seniors report a disability that limits their daily activities, and 56.3% of individuals aged 75 and older face similar challenges. For many of these individuals, the winter months can lead to increased isolation, as they may feel unsafe leaving their homes due to the risk of slipping and falling.
The safety risks are significant, as over 21,000 Ontarians visit emergency rooms each year due to slips and falls on ice and snow. This statistic underscores the importance of WinterLab’s work, which is dedicated to improving safety and mobility during the colder months. By studying the effects of winter conditions on individuals' mobility, the lab plays a vital role in developing solutions to help people stay safe, active, and independent throughout the winter season.
Sixth Stop: StreetLab
StreetLab is a cutting-edge multi-sensory, immersive VR lab that enables scientists to simulate realistic scenarios, providing valuable insights into how individuals navigate the sensory and cognitive challenges encountered in everyday life. By recreating both indoor and outdoor environments, StreetLab offers a safe platform for studying how sensory and cognitive impairments affect mobility, particularly in real-life contexts. This innovative space allows for the development of screening tools, interventions, and improvements in the design of the built environment to enhance mobility and safety for individuals with various challenges.
A significant area of research in StreetLab involves the development of tools for detecting cognitive decline, especially in the early stages, which is crucial for effective intervention. The lab’s ability to simulate real-world tasks that require multitasking helps scientists understand how cognitive decline can impact an individual’s ability to navigate complex environments. For instance, individuals with cognitive decline, such as those with dementia, often struggle with multitasking, which can affect their mobility and safety. Additionally, the lab explores ways to optimize mobility aids, such as visual and hearing devices, to facilitate smoother navigation and support independent living.
StreetLab is also at the forefront of research on perceptual phenomena, such as self-motion perception, and its impact on daily functioning. One particular area of focus is the role of hearing loss, an often overlooked but significant risk factor for falls. People with hearing loss typically exert more cognitive effort to process sounds, which may drain resources needed for other tasks like walking. This cognitive load could increase the risk of falls, as it diverts attention from the immediate physical environment. Sensory loss, including both hearing and vision impairment, is also a key risk factor for the development of dementia. Hearing loss has been identified as the top modifiable risk factor for dementia, surpassing even smoking, diet, and exercise in its potential to affect cognitive health.
In terms of practical applications, StreetLab provides a type of "brain stress test"—similar to a cardiac stress test for the heart—that challenges participants with progressively complex multisensory and multitasking scenarios. This test can help detect early signs of cognitive decline that may not be identifiable through traditional office-based cognitive assessments. Identifying these signs at an earlier stage can lead to more effective interventions and improved long-term outcomes for individuals at risk.
The lab also plays an essential role in improving the design of accessible public spaces, particularly regarding pedestrian infrastructure. For example, pedestrian signals at intersections are typically designed to assist individuals with visual impairments, but older adults often have both vision and hearing impairments. StreetLab has been instrumental in testing and optimizing auditory signals at street crossings to accommodate this dual sensory loss, ensuring that all pedestrians, including those with hearing loss, can navigate safely. This kind of research is vital, as individuals with even mild age-related hearing loss are at three times greater risk of falling than those without hearing loss.
Seventh Stop: DriverLab
DriverLab is a pioneering simulation facility that plays a critical role in assessing driving fitness and safety, particularly the effects of health conditions and medications on driving abilities. As the only one of its kind in Canada, DriverLab is on par with the most sophisticated driving simulators globally, offering an immersive environment that replicates the sights, sounds, and physical motions of real-world driving. This advanced simulator allows researchers to evaluate driving abilities under controlled conditions, unlike traditional on-road tests that typically occur during clear, daytime conditions. With DriverLab, evaluations can also take place under more challenging circumstances such as nighttime, poor weather, and high-risk situations like heavy traffic, aggressive drivers, and in-car distractions.
Motor vehicle trauma is a significant public health issue, and DriverLab's research aims to mitigate this by reducing both the frequency and severity of collisions. The outcomes of this research help lower the emotional, physical, and financial costs associated with vehicle accidents in Canada. Furthermore, DriverLab supports the goal of healthy aging by enabling older adults to continue participating in essential activities that typically require driving, such as attending medical appointments, working, volunteering, and engaging in social events. This research also plays a role in optimizing vehicle designs and in-car devices to ensure they are safe and accessible for a variety of populations, including those with sensory, cognitive, or physical impairments.
The lab’s research objectives are vast, including the development of sensitive assessment methods for driver fitness, improved driver training techniques, recommendations for vehicle design improvements, and strategies to mitigate drowsy or distracted driving. It also examines the impact of prescription and illicit drugs on driving performance, as well as evaluating the interactions between drivers and integrated vehicle technologies. Researchers at DriverLab evaluate driving performance across a diverse range of populations and scenarios, working with partners such as the Ontario Ministry of Transportation, driver examiners, clinicians, automobile manufacturers, and simulation developers.
One critical focus of the lab’s research is the impact of medications on driving safety. For example, one in five older adults are prescribed psychotropic medications, and nearly half of Canadians who experience chronic pain use analgesics. These medications often have side effects, such as sedation, agitation, and memory issues, that can significantly impair driving abilities. Additionally, DriverLab investigates the safety of drivers with monocular vision, who may face challenges when driving compared to those with full binocular vision. Another important area of research is developing reliable methods to assess fitness-to-drive in individuals with mild cognitive impairment or dementia. With an aging population, Canada is expected to have 1.4 million people with dementia by 2031, many of whom may continue to drive despite cognitive decline. Research at DriverLab aims to help determine when it is safe for these individuals to continue driving and when driving restrictions should be implemented.
One of the significant contributions of DriverLab is its work on developing customized licensing programs that could impose specific driving restrictions based on an individual’s abilities. For instance, people with certain impairments might be allowed to drive during the day on local roads but not at night or on highways. This kind of personalized approach to licensing can help individuals maintain their independence while also ensuring public safety. Additionally, DriverLab explores how cognitive and physical training programs might improve safe driving outcomes, potentially offering a way to enhance driving skills and reduce risks for those with age-related or health-related challenges.
Eighth Stop: CareLab:
CareLab is a state-of-the-art simulated hospital room designed to test and develop technologies aimed at improving patient care, safety, and outcomes. By replicating a typical hospital single-patient room, CareLab provides a controlled environment where products and techniques can be tested in conditions similar to those found in real hospital settings. The lab’s primary focus is on the development of innovations that reduce caregiver and patient injuries, enhance patient outcomes, and minimize the spread of infections within healthcare facilities.
One of the significant concerns in patient care is preventing pressure injuries, which can result from prolonged bed rest without repositioning. Pressure injuries are a common issue for patients who spend extended periods in bed, and when not addressed, they can lead to serious complications. Caregivers often struggle to follow repositioning schedules, and many do not fully understand the long-term effects of pressure injuries until it is too late. To address this, CareLab has contributed to the development of the Pressure Injury Management and Education System (PrIME). This system incorporates sensors placed under the legs of the bed to monitor a patient’s position and detect when repositioning is necessary. The system uses artificial intelligence to accurately track the patient’s position with 94% accuracy and provides caregivers with educational prompts and reminders to prevent pressure injuries. In addition to PrIME, CareLab also explores other preventive measures, such as in-bed monitoring to identify when repositioning is required.
Caregiver injury prevention is another key focus of research in CareLab. Lifting patients, especially those who require mechanical lifting devices, can lead to injuries among healthcare workers. To make this process safer, CareLab has tested products designed to assist caregivers, such as devices that facilitate the placement of slings under patients. In addition, CareLab has tested an overhead fall detection system for use in hospital and nursing home settings, including a specialized dementia unit at Toronto Rehab. These innovations help to reduce the physical strain on caregivers and prevent injuries associated with patient handling.
Infection control is another critical area of research in CareLab. Hospital-acquired infections (HAIs) are a significant concern, with improper hand hygiene being a leading cause. To combat this, CareLab has been instrumental in the development of the Buddy Badge System or Hygienic Echo. This system consists of a small wearable badge that discreetly reminds healthcare workers to wash their hands when entering or leaving patient areas. The Buddy Badge works in conjunction with motion sensors and hand hygiene stations, ensuring that healthcare workers are reminded to perform hand hygiene before interacting with patients. This system has been tested in various hospital environments, including emergency rooms and nursing homes, where it has shown promise in improving compliance with hand hygiene protocols and reducing the risk of HAIs.
Another important innovation developed and tested in CareLab is the Easy Range (ER) StandEasy Pole System, designed to help patients get in and out of bed independently. The ER StandEasy system is a support pole that attaches to the wall, making it suitable for facilities with false ceilings. This product promotes patient independence and mobility, reducing the need for caregiver assistance and enhancing patient autonomy.
Ninth Stop: SleepdB:
SleepdB is a state-of-the-art soundproof laboratory designed to explore sleep-disordered breathing using innovative and non-invasive acoustic monitoring technologies. It focuses on the complex relationship between sleep, body fluid shifts, and respiratory conditions, such as obstructive sleep apnea, asthma, and chronic obstructive pulmonary disease (COPD). These respiratory disorders share common risk factors, including advanced age, physical inactivity, smoking, and obesity. Symptoms like shortness of breath and coughing often worsen during sleep, and understanding the mechanisms behind this exacerbation is a central goal of SleepdB's research.
One of the main hypotheses being studied is that sleep, which induces various physiological changes in respiration, may contribute to the worsening of these symptoms. During sleep, there is a reduction in respiratory muscle tone and lung volume, as well as changes in humoral factors that influence breathing. Additionally, when a person lies down to sleep, gravity causes fluids from the lower body to shift toward the chest, lungs, and neck. This fluid accumulation can lead to airway narrowing, potentially aggravating respiratory conditions. Despite these theories, the connection between sleep, fluid shifts, and the intensification of respiratory diseases remains poorly understood.
SleepdB is one of the few laboratories in the world dedicated to investigating these interactions. The research at SleepdB utilizes both physiological experiments involving human participants and an artificial intelligence-driven approach to examine the pathophysiological mechanisms behind the exacerbation of respiratory diseases during sleep. The laboratory is focused on developing new technologies to monitor physiological signals during both sleep and wakefulness. These advancements aim to improve the management of respiratory diseases and prevent exacerbations that could lead to hospitalization.
The lab is equipped with advanced tools to conduct comprehensive studies. It features a large acoustic chamber that houses a bed and monitoring equipment capable of assessing sleep and respiratory function. Techniques such as polysomnography, which records brain waves and other physiological parameters during sleep, are employed to gain insights into sleep patterns and related respiratory issues. Additionally, the lab uses respiratory function assessment equipment, as well as ultrasound imaging with elastography, to visualize cardiopulmonary function and tissue stiffness—critical factors in understanding the impact of fluid shifts on the respiratory system.
A crucial component of SleepdB’s research is the fluid measurement and data acquisition module. This technology integrates and synchronizes various measurements taken during sleep studies, including respiratory function, body fluid dynamics, and tissue stiffness. The goal is to create a comprehensive understanding of how fluid shifts during sleep contribute to the worsening of chronic cardio-respiratory conditions.
Last Stop: HomeLab:
HomeLab is a unique research facility designed to explore and test new technologies that can help older adults and individuals with disabilities remain in their homes longer, more safely, and with greater independence. The lab is designed to resemble a typical single-story home, complete with functional plumbing and wiring, creating a real-life environment where innovations can be tested under everyday conditions. This “home within a lab” setup allows study participants to occupy the living space and experience new technologies firsthand, while researchers can observe and gather data from an overhead catwalk.
The primary vision of HomeLab is to create an integrated platform of technologies that provides a safe and supportive environment for people to age in place. These technologies include sensors embedded throughout the home, wearable devices integrated into clothing, and domestic robots that assist with daily activities. The goal is for these technologies to not only help with daily tasks but also to monitor health and safety, supervise treatments related to nutrition and exercise, and offer cognitive and social support. By seamlessly combining these technologies, HomeLab aims to improve the quality of life for individuals, enabling them to remain in their homes for as long as possible while maintaining their independence.
A key area of research in HomeLab is the development of intelligent home systems. These systems are designed to provide reminders for daily tasks, respond to emergencies, and offer social and cognitive support. As part of future research, scientists are working to enhance these systems so they can detect early changes in a person’s health and send warnings before a decline in their condition occurs. This proactive approach aims to prevent health issues from escalating and help individuals stay healthier for longer.
In addition to supporting individuals, HomeLab is also focused on developing technologies that assist caregivers. Caring for a loved one at home can be physically and emotionally demanding, and many caregivers report high levels of stress and physical pain due to tasks such as lifting, bathing, and toileting. To address these challenges, researchers are creating affordable and practical products that can help caregivers manage these tasks more easily. These innovations are designed to be easy to install and use, without requiring major modifications or renovations to the home.
The impact of these innovations extends beyond improving the quality of life for individuals with disabilities and older adults. By developing products that assist both the people receiving care and their caregivers, HomeLab aims to reduce the burden of caregiving. It is estimated that nearly half of the family caregivers experience high levels of physical and mental stress and 14% report physical pain from their caregiving responsibilities. By creating practical solutions, HomeLab strives to reduce these stresses and make home caregiving more manageable.
In conclusion, the KITE Research Institute has broadened my perspective and inspired me and others to care deeply about the well-being of others. It has highlighted the transformative power of research in improving lives, reinforcing the importance of innovation, curiosity, and empathy in creating meaningful change.
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