“My journey in the field of physiotherapy began in 1999, when I recognized how many patients were living with pain and disability without timely access to proper care,” says Venkadesan (Ven) Rajendran. “This observation motivated me to pursue a 4½-year Bachelor of Physiotherapy program at The Tamil Nadu Dr. MGR Medical University, which I completed in 2003.”

After graduating, Ven began his career working in rehabilitation settings treating patients with complex medical conditions. It didn’t take long before he identified a significant gap in care: “Within two years, I noticed that individuals with neurological conditions, especially those who had experienced a stroke, faced significant challenges in accessing specialized rehabilitation and assessments. That led me to pursue a master’s degree in advanced physiotherapy in neurology (MPT).”

Ven’s training in the MPT program deepened his expertise in neurological rehabilitation and introduced him to specialized clinical practices. “As part of the program, I gained experience conducting electromyography (EMG) and nerve conduction velocity (NCV) studies and worked closely with neurologists to triage patients with stroke and spinal injuries, bridging the gap between acute care, outpatient clinics, and community rehabilitation,” Ven explains.

Ven eventually brought this expertise to Canada. He joined Health Sciences North (HSN) in Sudbury and began conversations about the possibility of expanding physiotherapy’s role in stroke care, which the leadership team supported. “This role emerged from the unique convergence of personal vision and institutional strategy,” Ven says. Because of Ven’s efforts, Health Sciences North was the first academic hospital in Canada to implement an Advanced Practice Physiotherapist (APP) role specifically for stroke, which has allowed him to extend the boundaries of physiotherapy practice while directly addressing system-level challenges to improve patient outcomes.

Continuing Professional Development

“My professional advancement happened gradually and strategically within the same healthcare system” says Ven. He notes that continuity within Health Sciences North allowed him to build institutional knowledge, trust, and strong interprofessional relationships. Building on these foundations, Ven has continued to pursue ongoing professional development to adapt to the ever-changing Canadian healthcare landscape.

“Even after completing my PhD in Rehabilitation, I felt it was important to stay current” he explains. “I completed a one-year graduate certificate in stroke rehabilitation from the University of Alberta to better understand stroke rehab practices in Canada.”

Evolution of the Role

Over time, the APP role has grown beyond its original scope. “It started with a focus on direct clinical assessment and research, but now it includes leadership responsibilities and managing system-level triage pathways for stroke patients.”

He has also led initiatives that challenge traditional care models. One of these is the ‘MObile TIA and Stroke with AdaptiVE Workflow (MOTIVE)’ project, which utilizes an expert stroke team that tends to patients throughout every area of the hospital setting, not just in the stroke unit.

One of the most innovative aspects of our MOTIVE project involves rehabilitation triage of mild stroke patients in collaboration with stroke neurologists and other interdisciplinary members, ” Ven said. “We were able to triage patients with rehabilitation needs within hours or on the same day, which significantly reduced delays and facilitated faster discharge of patients with TIA/minor stroke.“

Advocacy and System-Level Approaches

To further support this shift, Ven has begun advocating for legislative and regulatory changes.

“I’ve had preliminary discussions with the leadership team at HSN about implementing Bill 179 for stroke care” he explains. “If adopted, physiotherapists could use diagnostic tools like X-rays, CT scans, and MRIs to identify red flags and triage patients for rehabilitation and treat them more effectively. This wouldn’t replace physicians; it would enhance system efficiency and stroke care.”

In addition to his clinical expertise, Ven brings a systems-thinking approach to his role. “I completed Lean Six Sigma Green Belt certification and gained knowledge in Implementation Science. These tools have helped me move beyond individual treatment plans and look at redesigning entire clinical workflows.”

The APP role has proven especially impactful for patients with acute stroke and TIA, where rapid decision-making can dramatically influence outcomes. “This patient group really benefits from quick triage and early discharge planning” says Ven. “By addressing initial system inefficiencies, we can reduce length of hospital stays and direct patients to the right rehab pathway once they’re medically stable.” Ven points to the MOTIVE Project as a clear example of success: “We were able to triage patients within hours or on the same day. Working collaboratively with stroke neurologists, physicians, Occupational Therapists, and Speech Language Pathologists allowed us to significantly reduce delays and support faster discharges.”

Health System Impacts

Ven has seen the significant impacts of his role within the hospital system:

“My role helps reduce hallway medicine by preventing unnecessary admissions and ensuring timely discharges. That improves patient flow, optimizes bed use, and reduces re-admissions.”

Ven believes strongly that the value of APP roles needs to be communicated in system-level terms. “There’s already strong evidence that APPs in musculoskeletal care are a cost-effective way to assess and manage patients. The same applies to stroke. Investing in APPs isn’t just about staffing, it’s an economic strategy. These roles help improve patient flow, reduce hospital admissions, and deliver advanced care at a lower cost compared to relying solely on physicians for triage.”

He emphasizes that APPs are intended to work alongside and not in place of physicians.

“It’s important for other health professionals to know that APP roles are designed to complement, not compete” Ven explains. “In stroke care, our involvement enables timely assessments and planning, so that neurologists and physicians can focus on high-acuity medical needs.”

When asked how the profession can better advocate for APP roles, Ven stresses the importance of aligning with system priorities. “Advocacy needs to go beyond individual clinical outcomes. We need to show the impact on things like ALC days, and length of hospital stays. For example, our MOTIVE project focused on reducing length of stay and readmission risk for stroke patients. If we can connect physiotherapy to government goals like improved flow and reduced wait times, we’ll have a much stronger case.”

For others looking to replicate this model, Ven offers some clear advice: “Effective advocacy for an APP role has to be tied to a specific system issue, not just professional ambition. Focus on solving inefficiencies, like long waits for specialist consults. Use quality improvement methods to measure outcomes and back up your work with data. To ensure sustainability, the role should include clinical practice, leadership, research, and education.”

Ven’s work offers a compelling example of how physiotherapists, when supported to work at full scope, can play a transformative role in patient care and health system design.

Members of the leadership team at Health Sciences North share their perspectives on the importance of the APP role:

“Allowing physiotherapists to order diagnostic tests within their professional scope can enhance patient care by minimizing delays associated with waiting for physician assessments and orders. Advanced Practice roles in internal medicine and stroke care further facilitate collaboration with stroke neurologists and physicians, thereby promoting timely and efficient triage for rehabilitation” – Lisa Zeman, Clinical Manager of Internal Medicine and Acute Stroke, Health Sciences North.

“Advanced Practice Physiotherapist (APP) play a vital role in stroke care, partnering with stroke neurologists to provide expert functional assessments and guide timely, and evidence-based rehabilitation decisions.” – Dr. Ravinder-Jeet Singh, Stroke Neurologist, Health Sciences North; Medical Director, NEO Stroke Network.

“Integrating Advanced Practice Physiotherapy (APP) into our stroke team has greatly enhanced both patient care and system performance. At Health Sciences North, we’ve seen measurable improvements in research, clinical outcomes, access to care, and interdisciplinary collaboration. Our APP has demonstrated exceptional clinical leadership and has been instrumental in strengthening the overall effectiveness of our stroke program” – Chantal Liddard, Administrative Director Medicine Program, Health Sciences North.

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