SPIN Clinic

The SPH Immunotherapy in Neurology clinic provides comprehensive diagnostic and treatment for people with autoimmune conditions affecting the peripheral nervous system: the nerves, neuromuscular junction and muscle.  This multidisciplinary clinic provides education and support to patients over the course of their journey which often requires immunosuppressive medication or immunemodulating treatment as well as a focus on lifestyle to maintain optimal health.

The clinic is also the home of the home Immunotherapy (SCIg) - subcutaneous Immune globulin - program for the region.

SPH Immunotherapy in Neurology Clinic - (Also known as the  SPIN clinic)

For most healthy people, the immune system helps protect the body from infection and cancer cells. But for people with autoimmune diseases, their immune systems attack their bodies, causing a huge range of symptoms.

To help people with autoimmune neuromuscular disorders, a team at St. Paul’s Hospital has launched the St. Paul’s Immunotherapy in Neurology (SPIN) Centre. A first in BC, the centre aims to unify the treatment of inflammatory disorders of the muscle and nerve.

With the SPIN Centre, we  bring a coordinated approach to caring for people with auto-immune neuromuscular diseases. We  review all treatments and work with our patients to respond to what matters most to them, like issues of fatigue and quality of life, in addition to neurologic symptoms of weakness or loss of feeling.

The SPIN Clinic was established initially as a pilot project supported by the Dept of Medicine Innovation Platform.   Funding from the PQI.   Support from the PHC Value Team.   Building on the success of the pilot phase, we were able to expand and secure funding for a regional program

Clinic goals:

  • Early Diagnosis and Treatment
  • Outcome Measurement to Optimize Patient Care
  • Multidisciplinary Care “One Stop Shop”
  • Transition to home based SCIg Treatments whenever possible
  • Participation in novel clinical research for patients with autoimmune neurological disorders

Wrap around care for patients with complex, chronic neuromuscular conditions.

What is Value Based Health Care?

Value Based Health Care (VBHC) emphasizes organizing and delivering care in a way that improves health outcomes that matter to patients.  By improving outcomes that patients care about (the “3Cs”: calm, comfort, capability) we  add value from the patients’ perspective.

Key components of VBHC include:

  1. Team based care by an Integrated Practice Unit (IPU)
  2. Measuring outcomes that matter to patients
  3. Collaboration between  family doctors and specialists over the full cycle of care – from initial recognition of the pinched nerve through  diagnostic testing to successful treatment or surgery if needed. 

To learn more, visit the PHC Department of Medicine website on VBHC 


Good paper about VBHC: 


These articles are a great introduction to Value Based Healthcare:

1. Porter ME. What is Value in Health Care?

2 Teisberg E, Wallace S. Creating a High Value Delivery System for Health Care


3. Stowell C, Akerman C. Better Value in Health Care Requires Focusing on Outcomes: Harvard Business Review


4. Porter ME. Measuring Health Outcomes: The Outcome Heirarchy


What is an Integrated Practice Unit? (IPU)

A team that provides coordinated care to a group of patients with shared medical needs over the full cycle of care, from diagnosis to resolution.

The “3 C’s” of outcome measurement:
Capability, Comfort and Calm


The ability to carry on with life while receiving care


Minimizing physical and psychological pain


Improving the ability to function and do the things that let me be me

ICHOM (International Consortium for Outcome Measures). Please visit ICHOM.org.

Hand and Wrist Data Set


Dr. Kristine Chapman (Co-Director)

Director, Vancouver Centre for Neuromuscular Disease, Vancouver Hospital
Head, Division of Neurology, Providence Health Care
Physician Lead, Innovation and Quality, Dept. of Medicine, PHC
Clinical Professor, University of British Columbia

Dr. Chapman is a Clinical Professor of neurology at the University of British Columbia. She completed her undergraduate degree in Occupational Therapy, and Neurology training at UBC followed by a Neuromuscular and Neurophysiology Fellowship at Harvard. Her interests include autoimmune neuropathies and complex nerve injuries.
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Dr. Katie Beadon (Co-Director)

Dr. Katherine Beadon MD, FRCPC, CSCN (EMG)
Clinical Assistant Professor, UBC
Co-Director, St. Paul’s Immunotherapy in Neurology Clinic

Dr. Beadon is an Assistant Clinical Professor at the University of British Columbia. She completed a masters in biomedical engineering and neurology residency and neurophysiology training at UBC and a fellowship in inflammatory and hereditary neuropathies at the Centre for Rare Neuromuscular Disorders at the Salpetriere in Paris, France. She has an interest in inflammatory conditions affecting the neuromuscular system.
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Stacey Cave

B.A.Sc., MPT

Stacey has been working for Providence Health Care since the fall of 2012 in a variety of areas including acute, rehab, outpatients and geriatrics. Before her current role with the Adult Bleeding and Red Blood Cell Disorder Programs, she worked with the Complex Pain Outpatient Program where she spent several years supporting patients with an assortment of multifaceted pain conditions. She also helped develop the pain self-management program with her coworkers. She graduated from the University of British Columbia’s Master of Physical Therapy program in 2012 and has returned as a Clinical Assistant Professor with the program to continue to support the MPT students in their learning process.
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Occupational therapist
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Michelle Garabb


Michelle is the registered nurse for the SPIN clinic. She has a background working in neuroscience/neurosurgery and experience in nurse educator roles. Michelle has a passion for providing patient teaching, promoting autonomy, and focusing on patient and family centered care.
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Medical Office Assistant
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Peripheral Nervous System conditions that are treated at the SPIN Clinic.

Guillain-Barré Syndrome
Learn more
Multifocal Motor Neuropathy
Learn more
Myopathy/Muscular Dystrophy
Learn more
Chronic Inflammatory Demyelinating polyradiculoneuropathy
Learn more
Myasthenia Gravis
Learn more


Immune Modulating therapies

1. IVIg

IVIg Provincial Task force

Chair - Dr. Kristine Chapman
Dr. Katie Beadon
Dr. Nadim Jiwa

Dose Calculator

IVIg for Neurology Program Provincial Blood Coordinating Office

Recommended titration schedule for IVIg in Neurologic Disease
2. Home Subcutaneous Immunoglobulin Therapy

What is SCIg?

Information for referring physicians:

  • Referral criteria:  Patients in the Vancouver Coastal region, who have demonstrated a robust response to a three month trial of IVg or longer, are eligible for consideration of SCIg.   You must have adequate hand dexterity or someone who is able to help you on a regular basis.
  • Referral form - link
  • What to do  if you aren’t in the catchment

Information for patients

  • What to expect from the IVIg → SCIg transition sessions
  • How to get started
  • Trouble shooting
  • ?Contact info for nurse? Will need to decide how to manage “cold calls” if we put the phone number on the website

3. Plasma exchange (PLEX)

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How to monitor

Depending on which medication you are on, you may need to have regular (monthly, for example) bloodwork done to ensure there it is not affecting your liver, kidneys or blood counts.   Your doctor will review the results and contact you if the medication needs to be adjusted. 

Immunotherapy can impact your body’s ability to fight off infections so it is important that you see your family physician if you develop signs of infection such as a fever. 

Other interventions:  Optimizing function:  

More general information for practitioners

List of outcome measures



10m walk

Grip strength

Peg Board





Example case (with permission)

Research Abstracts

1. Smith CB, Ashe M, Ogalo E, Mezei MM, Jackson S, Beadon K, Chapman KM.
Optimizing Value-Based Outcome Measures in Inflammatory Neuropathy: Patient Perspective Regarding Timing, Rationale, and Data Sharing. 2024 PNS Annual Meeting; June 22-25, 2024; Montreal QC. (submitted for review).

2. Beadon K, Ashe M, Barr S, Carr A, Jackson S, MacLeod M, Monteiro A, Yoon P, Ebel E, Au C, Smith C, Ho K, Chapman KM.
Quantifying the Opportunity Cost of Transitioning Patients from IVIg to SCIg. 2024 PNS Annual Meeting; June 22-25, 2024; Montreal QC. (submitted for review).
3. Smith CB, Beadon K, Ogalo E, Ashe M, Mezei MM, Chapman KM.
Provider and Patient Perspectives on Outcome Measure Use in Clinical Care for Chronic Inflammatory Neuropathy. 2024 Canadian Neurological Sciences Federation Congress; May 21-24, 2024; Toronto, ON. (submitted for review).
4. Chapman KM, Yuan Y, Little B, Cave S, Smith C, Ashe M, Jackson S, Beadon K, Berger M, Ogalo E.
Implementation of Patient Reported Outcome Measures for Neurology : At-Home VS. In-Clinic Completion. ICHOM 2023, Barcelona, Spain.

View Poster
5. Smith CB, Gorham RB, Beadon K, Mezei MM, Banah A, Lambertson E, Huffman J, Berger M, Hoffman A, Chapman KM.
Outcome Measures for Patients with Chronic Inflammatory Neuropathy: Lessons from Patient Focus Groups. 2023 PNS Annual Meeting; June 17-20, 2023; Copenhagen.

View Poster
6. Ogalo E, Smith C, Ashe M, Beadon K, Chapman KM.
 P.029 Relevance and home completion rate of patient reported outcome measures set in chronic inflammatory neuropathies. Canadian Journal of Neurological Sciences. 2023;50(s2):S65-S65. doi:10.1017/cjn.2023.133.

View Poster
7. Beadon K, Smith C, Ashe M, Ogalo E, Barr S, Carr A, Jackson S, MacLeod M, Monteiro A, Ho K, Chapman KM.
Implementing Outcome Measures: From Research to Operations in the St. Paul’s Immunotherapy in Neurology Clinic. 2023 CHSPR Health Policy Conference.

View Poster
8. Smith C, Beadon K, Chapman KM.
Evaluation of the use of Objective Outcome Measures for Inflammatory Neuropathies in Clinical Practice. Peripheral Nerve Society 2022. Poster No 23a. https://onlinelibrary.wiley.com/doi/full/10.1111/jns.12506

View Poster
9. Smith C, Tse E, Jiwa N, Chapman KM, Beadon K.
Immunoglobulin Use for Neuromuscular Conditions: Updating provincial guidelines for British Columbia, Canada. Peripheral Nerve Society 2022. Poster No 103b. https://onlinelibrary.wiley.com/doi/10.1111/jns.12506

View Poster
10. Smith CB, Beadon K, Berger M, Carpenter M, Washbrook C, Chapman KM.
P.048 Objective measures of balance deficits in sensory ganglionopathy. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques. 2022;49(s1):S20-S20. doi:10.1017/cjn.2022.149.

View Poster
11. Smith CB, Chapman KM, Mezei M, Beadon K.
P.040 Value-based approach to the management of Inflammatory Neuropathies: Incorporating objective outcome measures in clinical care. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques. 2022;49(s1):S18-S18. doi:10.1017/cjn.2022.141.

View Poster
12. Chapman KM, Gorham RB, Huffman J, Banah A, Lambertson E, Smith C, Beadon K.
Value-based Approach to the Management of Inflammatory Neuropathies: Incorporating Objective Outcome Measures in Clinical Care. ICHOM 2022, Boston, United States.

View Poster
13. Gorham RM, Chapman KM, Huffman J, Banah A, Lambertson E, Smith C, Jackson S, Beadon K, Berger M, Hoffman A.
Listening to Patient Perspectives: Improving Outcome Measures for Inflammatory Neuropathy. ICHOM 2022, Boston, United States.

View Poster
14. Chapman KM, Huffman J, Banah A, Lambertson E, Smith C, Beadon K, Boaz R (2022).
Value-based Approach to the Management of Inflammatory Neuropathies: Incorporating Objective Outcome Measures in Clinical Care. Health Care Transformation ​Project Symposium, The University of Texas at Austin, 2022 August 4.

View Poster
15. Tse E, Smith C, Chapman K, Beadon K.
P.060 Immunoglobulin Use for Neuromuscular Conditions: Updating British Columbia Provincial Guidelines Through Focused Literature Review. Canadian Journal of Neurological Sciences / Journal Canadien Des Sciences Neurologiques. 2021;48(S3), S35-S36. doi:10.1017/cjn.2021.340


For Inquiries and donations, please contact:

Tracie Watson
Manager, Major Gifts
St. Paul's Foundation