May 11 – 07:00-12:30 - 9th World Congress for NeuroRehabilitation

Transcription

May 11 – 07:00-12:30
WCNR-0046
BOARD NUMBER: 001
A. TREATMENT/PHARMACOTHERAPY/PT
DEVELOPING A LONGITUDINAL PROFILE OF IMPAIRMENT AND DISABILITY IN
PEOPLE WITH NON-FUNCTIONAL ARM IN THE FIRST YEAR POST-STROKE
R. Allison1, C. Kilbride2, J. Chynoweth3, S. Creanor3, J. Picken1, I. Frampton4, J. Marsden5
1Torbay & South Devon NHS Foundation Trust, Stroke Service, Newton Abbot,
United Kingdom
2Brunel University, Department of Clinical Sciences, London, United Kingdom
3Plymouth University Peninsula Schools of Medicine & Dentistry, Centre for BiostatisticsBioinformatics & Biomarkers, Plymouth, United Kingdom
4University of Exeter, Centre for Clinical Neuropsychology Research, Exeter, United Kingdom
5Plymouth University, School of Health Professions, Plymouth, United Kingdom
Aims
There is a lack of evidence on how to treat people who do not recover active function of the
arm post-stroke. This study aimed to establish the longitudinal profile of impairment and
disability in people with a non-functional arm in the first year after stroke.
Method
In a prospective cohort study, 155 adults identified as being unlikely to regain functional use of
the arm, based on Fugl-Meyer Assessment upper limb scores, were recruited at 2-4 weeks
post-stroke, and followed up at 3, 6 and 12 months. Measures included within the profile were
of pain, spasticity, range of movement, skin condition, a self-reported measure of difficulty
caring for the arm (Leeds Arm Spasticity Impact Scale) and carer burden.
Results
One hundred and ten participants (71%) were reviewed over the year. There was a large
variation in the profile of disability even within this targeted group. At one year 77% of
survivors had developed some spasticity, with severe spasticity present in 25%. Pain was
reported by 65% and 58% had lost more than half of the available range of passive movement
in the shoulder. 30% were unable to care for their arm themselves or described severe
difficulty, and 6% developed macerated skin in the hand or elbow-crease. These incidences
are higher than those reported in studies with more general populations of people after stroke.
Conclusion
There was a high incidence of spasticity, pain and loss of passive movement in people with
non-functional arm up to one year post-stroke. There was also a high incidence of difficulty
caring for the arm and some changes in skin condition. This group warrant targeted treatment
to address these difficulties.
WCNR-0033
BOARD NUMBER: 002
TRANSCRANIAL DIRECT CURRENT STIMULATION OF THE PARIETAL-INSULARVESTIBULAR CORTEX VERSUS TRANS-MASTOIDAL GALVANIC VESTIBULAR
STIMULATION FOR TREATMENT OF LATEROPULSION FOLLOWING STROKE
S. Babyar1, T. Santos-Pontelli2, T. Lemos2, M. Bikson3, D. Truong3, M. Reding1, D. Edwards4
1Burke Rehabilitation Hospital, Stroke Unit, White Plains, USA
2Ribeirao Preto Medical School, Department of Neuroscience and Behavioral Sciences,
Ribierao Preto Sao-Paulo, Brazil
3City College- City University of New York, Grove School of Engineering, New York- NY, USA
4Burke Rehabilitation Hospital, Burke Medical Research Institute, White Plains, USA
Aims
To assess the effects of Transcranial Direct Current Stimulation (tDCS) of the Parietal-InsularVestibular-Cortex (PIVC) vs. Trans-Mastoidal Galvanic Vestibular Stimulation (GVS) for treatment
of lateropulsion due to stroke.
Method
Nine in-patients in a rehabilitation unit, with Burke Lateropulsion Scores of 2 or greater,
consented to this IRB-approved protocol. Saline-soaked 25cm 2 sponge electrodes delivered 2mA
trans-cranial or trans-mastoidal tDCS current using 4 montages: A) anode over ipsilesional
PIVC/cathode over opposite PIVC; B) anode over ipsilesional PIVC/cathode over opposite prefrontal region; C) anode over ipsilesional mastoid/cathode over opposite mastoid; D) sham
condition with 30-sec current ramp up and immediate 30-sec ramp down, randomized for
condition A through C. A force plate beneath a specialized chair measured seated center of
pressure in the medial-lateral plane (COP-X): 1 min before stimulation (T0); after 5 (T1), 10 (T2),
and 15 (T3) min of stimulation followed by 30-sec ramp down; then 5 min after stimulation (T4).
Data analysis used a linear mixed-effect model (p=.05).
Results
A significant Time by Montage effect was observed: COP-X deviation was significantly better for
Montage A at T3 and T4 compared to Sham (X̅diff = -0.30, 95% CI –0.58 to –0.03, p = 0.03; and
X̅diff = –0.32, 95% CI –0.60 to –0.05, p = 0.02, respectively). COP-X was also significantly better
for Montage B at T3 and T4 vs. Sham (X̅diff = -0.28, 95% CI –0.55 to –0.01, p = 0.04; and X̅diff = –
0.32, 95% CI –0.59 to –0.05, p = 0.02, respectively). COP-X did not differ significantly for
montages C and D.
Conclusion
Anodal stimulation of PIVC but not bi-mastoidal GVS produced a small but significant change in
COP-X.
WCNR-0195
BOARD NUMBER: 003
AN APPLICATIVE ON-LINE EEG TOOL FOR ENHANCING TREATMENT EFFICACY IN THE
REHABILITATION SETTING
G. Bartur1, K. Joubran2, S. Peleg-Shani2, J.J. Vatine1, G. Shahaf1
1"Reuth" Rehabilitation Hospital, Rehabilitative psychobiology LaboratoryReuth Research and development institute, Tel Aviv, Israel
2"Reuth" Rehabilitation Hospital, Physiotherapy, Tel Aviv, Israel
Aims
To investigate the efficacy of a simple and easy to use tool that can extract relevant attentionrelated markers - Brain Engagement Index (BEI) from ongoing EEG.
Method
First part: thirteen control subjects underwent BEI monitoring during motor exercise with varying
levels of difficulty. Second part: fourteen sub-acute stroke patients were treated with and without
utilization of feedback regarding their level of engagement. Engagement levels were provided by
a simple-to-use on-line EEG based tool. Single session treatment outcomes were evaluated
according to videos taken before and after training a specific task. Two assessors blinded to
whether feedback was used or not, assessed the positive/negative change following single
session treatments.
Results
A relation between exercise difficulty and BEI was demonstrated. Positive clinical outcomes were
obtained when the BEI index was high and it seems possible to harness the feedback for better
outcome in the majority of patients.
Conclusion
In this work we show that it is possible to extract an attention related biomarker from a simple-touse EEG system during a standard motor rehabilitation sessions in a manner, which can guide
the treatment and lead to improved clinical outcome.
WCNR-0076
BOARD NUMBER: 004
QUANTIFYING CHANGE DURING OUTPATIENT STROKE REHABILITATION: A
RETROSPECTIVE REGRESSION ANALYSIS
M. Bland1, K.R. Lohse2, C.E. Lang1
1Washington University School of Medicine, Physical Therapy, St. Louis, USA
2Auburn University, School of Kinesiology, Auburn, USA
Aims
Examine overall change and individual trajectories for balance, upper extremity motor capacity,
and mobility in people post-stroke receiving outpatient therapies.
Method
Multi-level linear modeling was used to quantify changes across activity domains for 366 poststroke patients admitted to outpatient therapy: Berg Balance Scale (BBS), a measure of balance;
Action Research Arm Test (ARAT), a measure of upper extremity motor capacity; and walking
speed, a measure of mobility. Additional variables modeled as fixed-effects were: Duration
(months of outpatient therapy), Time (days post-stroke at the start of outpatient therapy), Age
(years), and Inpatient status (if the patient went to an inpatient rehabilitation facility (IRF)) as a
proxy for functional severity. Initial scores at the start of outpatient therapy (intercepts), rate of
change during outpatient therapy (slopes), and the covariance between slopes and intercepts
were modeled as random-effects.
Results
A patient with average Age and Time started at 37 points on the BBS with a change of +1.8
points per month, at 35 points on the ARAT with a change of +2.0 points per month, and with a
walking speed of 0.59 m/s with a change of +0.09 m/s per month. When controlling for other
variables, patients started with lower scores on the BBS and ARAT or had slower walking speeds
at admission if they started outpatient therapy later than average or went to an IRF.
Conclusion
Patients generally improved during outpatient therapy, but there was considerable variability in
individual trajectories. The average rates of change across all three domains were small.
WCNR-0655
BOARD NUMBER: 005
IDENTIFICATION OF THE SIMILARITIES AND THE VARIABILITIES IN THE MANAGEMENT
OF SPASTICITY
R. Singh1, J. Soon2, M. DER NIGOGHOSSIAN2
1northern general hospital, neurorehabilitation, sheffield, United Kingdom
2Merz Pharma, Medical Affairs, borehamwood, United Kingdom
Aims
Spasticity is a complex disease and its management is multifactorial, involving physical as well as
pharmacological interventions.
There is currently no standard for best practice and a wide variation in spasticity service set-ups
and the clinicians’ background. This could potentially cause large differences in practice.
The aim of this study was to try to identify some of the common elements of service delivery as
well as to highlight any significant variations in service models. It was hoped that the survey
would assist healthcare professionals working in spasticity to gauge or improve their own service
provision in the light of any findings.
Method
A survey of 40 spasticity experts was undertaken at a national conference in the United Kingdom.
Questions included (i) numbers of patients referred and diagnostic groups, (ii) staff composition of
each clinic, (iii) methods of spasticity assessment, (iv) outcome measures and treatment goals
commonly used, (v) follow-up arrangements including community follow-up.
Results
There were broad areas of agreement between experts such as methods of assessment of
spasticity, treatment, injection guidance and follow-up arrangements. However there were
differences in diagnostic groups seen and outcome measurement across a wide range of clinical
settings.
Conclusion
There are considerable variations in practice between spasticity experts. This survey may help
practitioners identify areas of improvement in their services or explore alternative service
arrangements.
WCNR-0150
BOARD NUMBER: 006
DUAL-TASK GAIT SPEED IS STRONGLY RELATED TO PHYSICAL ACTIVITY IN THE REAL
WORLD FOR COMMUNITY-DWELLING INDIVIDUALS POST STROKE
J.A. Feld1, L.A. Zukowski1, D. Fletcher1, C.A. Giuliani1, P. Plummer1
1University of North Carolina at Chapel Hill, Department of Allied Health Sciences, Chapel Hill,
USA
Aims
The real world is considerably more complex than both the clinical and laboratory settings in
which gait is typically evaluated. Ambulation in the community requires negotiation of complex,
dynamic environments, often while simultaneously performing cognitive tasks (dual-tasking).
Thus, difficulty with dual-tasking may contribute to restrictions in community mobility and
participation among community-dwelling stroke survivors. Moreover, dual-task walking may be a
better representation of walking in the real world than traditional clinic-based gait assessments.
The purpose of this study was to examine the relationships between single-task and dual-task
gait speed in the laboratory and physical activity measures in the real world.
Method
Fifteen community-dwelling individuals with stroke (age 59.9±12.9 years, 15.9±10.6 months post
stroke) participated. We measured gait-speed in single-task and dual-task conditions (auditory
Stroop task) in the laboratory, and calculated the relative dual-task effect (DTE) on gait speed.
Daily physical activity in the real world was captured over two days using a physical activity
monitor. Relationships between gait measures and real world activity were analyzed using
Spearman’s rho correlation coefficients.
Results
There were moderate positive correlations between dual-task gait speed and maximum and
average walking duration (seconds), total number of steps, and maximum and average number of
steps per episode of walking (rho=.511 to .629, p≤.05). DTE on gait speed was positively related
to average number of steps per episode (rho=.511, p≤.05) and average walk duration (rho=.546,
p≤.05). Single-task gait speed was not significantly related to any measure of physical activity.
Conclusion
Dual-task gait speed is more strongly related to physical activity in the real world than typical
(single-task) measures of gait speed in community-dwelling stroke survivors. These findings have
important implications for clinical assessment of gait. Specifically, traditional, single-task gait
speed assessments in the clinic may be inadequate to assess real world walking function after
stroke.
WCNR-0054
BOARD NUMBER: 007
IMPLEMENTATION OF A TECHNOLOGY-ASSISTED PROGRAM TO INTENSIFY UPPER
LIMB REHABILITATION IN NEUROLOGICALLY IMPAIRED PARTICIPANTS
M. Galea1, F. Khan2, B. Amatya2, M. Klaic3, A. Elmalik2, G. Abbott2
1The University of Melbourne, Medicine Royal Melbourne Hospital, Parkville, Australia
2Royal Melbourne Hospital, Department of Rehabilitation Medicine, Parkville, Australia
3Royal Melbourne Hospital, Department of Occupational Therapy, Parkville, Australia
Aims
Although most patients regain walking ability, 30%-60% of stroke survivors fail to regain
functional use of their upper limb. Rehabilitation of the arm is frequently given a lower priority.
Advances in robotics, sensor and game technology now provide a means of enabling patients to
undertake intensive structured practice of upper limb tasks with minimal supervision. The aim of
this study was to evaluate the effectiveness of a technology-assisted program - the 'Hand Hub', to
intensify upper limb rehabilitation after stroke and other neurological conditions in an Australian
community cohort.
Method
A ‘Hand Hub’ was established in a tertiary hospital, comprising several workstations of relatively
inexpensive devices to facilitate activities via computer games that are appropriate for patients
with varying levels of severity of upper limb impairment. Intervention was delivered via individual
or group sessions for a period of a period of six weeks, additional to the patients’ regular therapy.
Patients were assessed before and after the program using validated measures.
Results
Ninety-two participants completed the ‘Hand Hub’ program. Mean age of the participants’ was
57±17 years, over half (58%) were male and majority (88%) were with stroke. Post-intervention,
participants showed significant improvement in arm function and strength (p <0.001, with large
effect sizes (r) = 0.5-0.7), Wolf Motor Function Test score (p <0.05, r = 0.2-0.4), improved muscle
tone on the Modified Ashworth Scale (p <0.001, r = 0.4), Functional Independence Measure
(locomotion, mobility and psychosocial subscales (p <0.05, r = 0.2-0.3). Quality of life (EQ-5D)
and overall health also improved significantly (p <0.01 for all, r = 0.3-0.6).
Conclusion
The ‘Hand Hub’ program is feasible and showed promising results for upper limb function in
persons with neurological disorders. The findings need to be further confirmed in a larger study
sample, with a longer follow-up.
WCNR-0695
BOARD NUMBER: 008
ELECTROTHERAPY IMPROVES MOTOR FUNCTION IN AN ADOLESCENT WITH TYPE III
SPINAL MUSCULAR ATROPHY: A CASE REPORT
M. GOBBO1, S. Lazzarini1, P. Gaffurini2, L. Bissolotti3, A. Padovani1, M. Filosto1
1University of Brescia, Dept. of Clinical and Experimental Sciences, Brescia, Italy
2Teresa Camplani Foundation, Laboratory of Neuromuscular Rehabilitation, Brescia, Italy
3Teresa Camplani Foundation, Service of Functional Rehabilitation, Brescia, Italy
Aims
This case report describes the effects of a rehabilitation program based on electrotherapy aimed
at improving muscle function and physical fitness of an adolescent with type III Spinal Muscular
Atrophy (SMA).
Method
The subject (male; 14 y.o.; walker) was provided with a portable stimulator (Globus Genesy 600)
and was given instructions for proper electrode placement (Gobbo et al., 2014, JNER) and
stimulation intensity (i.e., enough to induce visible strong contractions without discomfort/pain).
The program initially consisted of a home-based treatment with neuromuscular electrical
stimulation (NMES) using a conventional protocol for quadriceps muscle strengthening (30
min/day; 5 days/week). Tele-assistance/monitoring was provided. After 8 weeks, in addition to the
ongoing strengthening program, the subjects underwent a systemic conditioning program based
on sustained (25 min) cycling exercise assisted by functional electrical stimulation (FES-cycling)
with the Biotech Pegaso Clinic cycle-ergometer.
Outcomes: quadriceps strength through maximal isometric voluntary contraction (MIVC); exercise
intensity during FES-cycling expressed as metabolic equivalents (METs; multiples of basal
oxygen consumption); Tinetti Scale; Expanded Hammersmith Functional Motor Scale for SMA
(HFMSE); minimal clinically important difference through the Goal Attainment Scale (GAS) for
measuring treatment effectiveness perceived by the subject (range: from -2, outcomes lower than
expected, to +2, outcomes higher than expected).Results
The patient showed very good treatment compliance and adherence. All outcomes measures
improved substantially during the 18-week program (Table 1) and, through the GAS scale, the
subject reported to perceive meaningful changes due to the intervention.
Conclusion
This report indicates, for the first time to our knowledge, great potential for NMES/FES to
strengthen skeletal muscles and improve motor abilities and fitness status in subjects with SMA
type III.
This preliminary experience could represent an important contribution to the development of new
and affordable rehabilitation approaches for SMA by adding electrotherapy to conventional care.
WCNR-0196
BOARD NUMBER: 009
COMPARISON OF RECOVERY IN BALANCE AND ACTIVITIES OF DAILY LIVING
FOLLOWING RIGHT AND LEFT CEREBRAL INFARCT USING OCCUPATIONAL THERAPY
P. Gokhale1
1, Dombivali, India
Aims
To study the effect of Occupational Therapy on Balance and Activities of Daily Living
Performance & compare it in patients with Right and Left cerebral infarcts respectively.
Method
11 patients with Right Middle cerebral artery Cerebrovascular accident (MCA CVA) in Group A
and 09 patients with Left MCA CVA in Group B, in age group 40-60 years were subjected to 12
week OT intervention inclusive of ADL & static and dynamic balance training. In this Prospective
Interventional study, outcome measures were Berg Balance scale and Functional Independence
Measure-Functional Assessment Measure (FIM-FAM) Scale.
Results
There was increase in Berg Balance Scale Score from baseline (27.45 ± 5.373) to 12th week
(44.09 ± 5.166) in Group A & from (27.22 ± 7.014) to (44.00 ± 6.946) in Group B. There was
increase in FIM-FAM Total score from baseline (181.18 ± 22.351) to 12th week (211.36 ± 21.205)
in Group A & from (177.78 ± 29.731) to (209.78± 28.556) in Group B. Difference was statistically
significant at P< 0.01 within group; but was statistically insignificant in intergroup comparison.
Conclusion
Recovery in balance and ADL performance seems to be independent of side of brain lesion but
pattern of recovery varies slightly as
represented in above data analysis.
WCNR-0099
BOARD NUMBER: 010
PRISM ADAPTATION DURABLY REDUCES POSTURAL ASYMMETRY AFTER RIGHT
HEMISPHERIC STROKE WITHOUT NEGLECT
A. Hugues1,2,3, J. DI MARCO4, M. LUNVEN5, S. JACQUIN-COURTOIS1,2,3, Y. ROSSETTI2,3,
I. BONAN6, G. RODE1,2,3
1Hopital Henry Gabrielle- Hospices Civils de Lyon, Medecine Physique et de Réadaptation, SaintGenis Laval, France
2Hôpital Henry-Gabrielle- Hospices Civils de Lyon, Plate-forme « Mouvement et Handicap »,
Lyon, France
3Inserm UMR-S 1028- CNRS UMR 5292- impAct-,
Centre de Recherche en Neurosciences de Lyon- université Lyon 1, LYON, France
4Hôpital Tenon- Assistance Publique des Hôpitaux de Paris, Service de Neuro-urologie-, Paris,
France
5Inserm U1127- UPMC-Paris 6- CNRS UMR 7225-, Brain and Spine InstituteGroupe Hospitalier Pitié-Salpêtrière, Paris, France
6Centre Hospitalier Universitaire de Rennes, Service de médecine physique et de réadaptation-,
Rennes, France
Aims
Right brain damage (RBD) after stroke involves postural asymmetry and spatial frames disorders.
In acute RBD patients, postural asymmetry is immediately reduced after one single session of
prism adaptation (PA), without assessment of effects on spatial frames.
The aim is to assess long-term effects of PA on posture and spatial frames in chronic RBD
patients, without neglect.
Method
Six chronic RBD after stroke patients without neglect (mean delay: 45 months) were included.
Each patient sustained 10 PA sessions of 20 minutes during 2 weeks. Outcome measures were:
i) posturographic analysis (mediolateral position of center of pressure (X cop), ii) subjective straight
ahead (SSA) and perception of longitudinal body axis (LBA). Each parameter was assessed by 3
pre-tests and 3 post-tests (+2h, Day+3 and Day+7).
Results
In pre-tests, patients showed a shift of the Xcop and SSA. In post-tests, results displayed i) a
significant reduction in mediolateral postural asymmetry at D+7; ii) a significant left deviation of
SSA at D+3 and enduring at D+7; and iii) no significant modification of LBA. The mean curves of
Xcop and SSA between pre- and post-tests were similar.
Conclusion
PA involves persistent reduction in postural asymmetry in RBD patients without neglect. These
findings were obtained at a chronic stage. This new effect cannot be explained by reduction in
spatial attentional shift. Improvement may be explained by an action of extra personal space
frames used for posture, without effect on personal space frame. Findings argue in favour of a
bottom-up effect of PA on mechanisms underlying spatial cognition.
WCNR-0166
BOARD NUMBER: 011
EFFICIENCY OF PHYSICAL REHABILITATION ON POSTURAL IMBALANCE AFTER
STROKE: A META-ANALYSIS
A. Hugues1,2,3, J. Di Marco4, P. Janiaud5, I. Bonan6, F. Gueyffier5,7, G. Rode1,2,3
1Hopital Henry Gabrielle- Hospices Civils de Lyon, Medecine Physique et de Réadaptation, SaintGenis Laval, France
2Hôpital Henry-Gabrielle- Hospices Civils de Lyon, Plate-forme « Mouvement et Handicap »-,
Lyon, France
3Inserm UMR-S 1028- CNRS UMR 5292- impAct,
Centre de Recherche en Neurosciences de Lyon- Université Lyon 1, LYON, France
4Hôpital Tenon- Assistance Publique des Hôpitaux de Paris, Service de Neuro-urologie-, Paris,
France
5UMR 5558 CRNS Lyon, Université de Lyon 1, LYON, France
6Centre Hospitalier Universitaire de Rennes, Service de médecine physique et de réadaptation,
Rennes, France
7Centre d’Investigation Clinique- EPICIME-, INSERM CIC 1407/UMR 5558 CNRS, LYON, France
Aims
Balance disorders are frequently seen after stroke and remain a cause of disability. Different
methods aim at reducing postural imbalance The level of evidence is actually weak and debated.
The aims are: i) to determine whether physical rehabilitation methods are effective in recovery of
postural imbalance in patients with unilateral stroke; ii) to assess if any one method is more
effective than any other one.
Method
Search strategy: Search terms were defined and the following electronic databases were
searched from inception to august 2015: Medline, Embase, Pedro, Cochrane central register of
controlled trials, Pascal and Francis.
Selection criteria: Randomised controlled trials, which assessed the effects of physical
rehabilitation methods on the recovery of postural imbalance in adults with stroke, were included.
Outcome measures were the Berg Balance Scale (BBS), the Postural Assessment Scale for
Stroke (PASS) and posturographic parameters. Outcomes also included measures of
independence in activities of daily living (ADL) and quality of life.
Data collection and analysis: Two authors (AH and JDM) independently screened the article titles,
then abstracts and finally the whole study reports, according to the selection criteria for inclusion
in the review. The methodological quality of studies was evaluated and the data were extracted.
The standardised mean difference and its confidence interval (95%) will be calculated for each
comparison of approaches. Subgroup analyses were planned according to the overall time of
rehabilitation, the side of lesion, the expansion and duration of effects, the type of method (topdown or bottom-up) and the methodological quality.
Results
0
Conclusion
0
WCNR-0117
BOARD NUMBER: 012
THERAPEUTIC TABLET APPLICATION FOR POST-STROKE MOTOR REHABILITATION:
DEVELOPMENT AND USABILITY
S. Jax1, A. Packel2, G. Curtis1, J. Detre3
1Moss Rehabilitation Research Institute, MRRI, Elkins Park, USA
2MossRehab, PT, Elkins Park, USA
3University of Pennsylvania, Neurology, Philadelphia, USA
Aims
One of the most common post-stroke disabilities is impairment in upper extremity movement
production. The use of traditional methods for treatment of this impairment is expensive and labor
intensive. As a consequence, many patients receive insufficient treatment, which in turn results in
incomplete recovery. Recent innovations in computer tablet technology and application-based
therapies (“therapeutic apps”) offer the potential for expanded rehabilitation opportunities due to
their low cost, ease of use, and widespread availability. The objective of this initial phase project
was to test the usability of a tablet-based upper extremity motor rehabilitation app we developed,
prior to additional research examining the app’s efficacy.
Method
Ten individuals in the chronic phase following stroke with a range of motor abilities completed the
study. Participants were first given verbal and written instructions on how to access and use the
app. Following use of the app for approximately 10 minutes, participants completed a survey
about their experience (the System Usability Scale). Then, participants were evaluated and timed
in their ability to restart the app without any experimenter assistance. Finally, we asked
participants about their interest in participating in future research involving longer-term use of the
app to improve their arm functioning.
Results
Participants with a wide range of motor abilities reported enjoying using the app. The System
Usability Scale survey and timed app restarting results indicated the technology was easy to use
without assistance. Participants indicated strong interest in long-term therapeutic use of the app.
Conclusion
Our results indicate that therapeutic app use has potential for use in the post-stroke population,
and that technological barriers do not prevent app use. The authors will discuss their plans for the
pilot efficacy study as well as their experience in developing the app and suggestions for others
considering similar projects.
WCNR-0118
BOARD NUMBER: 013
WHOSE STROKE IS IT? EXTERNAL VALIDITY AND CLINICAL RELEVANCE OF POSTSTROKE GAIT REHABILITATION STUDIES. A SYSTEMATIC REVIEW
M. Kafri1, R. Dickstein1
1University of Haifa, Physical Therapy, Haifa, Israel
Aims
Gait rehabilitation is a major component of stroke rehabilitation, with plentiful research dedicated
to remediating gait problems. Despite wide recognition of the importance of such research, the
definition of the target population for which this body of research is aimed is not unequivocal.
Furthermore, the clinical relevance of this body of research might be limited by the distinct
characteristics of the post-stroke individuals included in the studies, as defined by the
inclusion/exclusion criteria. Accordingly, three questions were posed: What are the characteristics
of populations that are excluded from the reviewed intervention studies? Is the development of
strategies for post-stroke gait rehabilitation exclusive to a specific section of the stroke
population? and, are major limitations to external validity are reflected in the titles/abstracts?
Method
We systematically researched PubMed for intervention studies to improve gait post-stroke,
working backwards from the beginning of 2014. Eligible studies were examined for
inclusion/exclusion criteria and for feasibility of the subjects to participate in the studies based on
the nature of the intervention (high-tech versus low-tech). The description of the target population
in the titles/abstracts was further reviewed.
Results
Altogether, 52 studies were examined. Many prevailing characteristics of the stroke population
served as exclusion criteria (e.g. cognitive decline, severe gait impairment). The feasibility of
individuals post-stroke to participate in a study was limited by the frequent use of high-tech
interventions (N=27, 52%), that were confined to research centers. It was found that major and
significant characteristics of the studies' population were not declared in the title or abstract
sections.
Conclusion
The external validity and clinical relevance of a substantial number of intervention studies is
limited by the exclusivity of the samples. The exclusive nature of the studied population cannot be
inferred from the titles/abstracts and therefore the actual clinical relevance of the study might be
concealed.
WCNR-0057
BOARD NUMBER: 014
FIXED-PACE VERSUS SELF-PACED TREADMILL TRAINING IN PEOPLE WITH STROKE: A
PILOT STUDY
A. Kerr1, R. Stockley2, G. Donaldson2, Y. Minxiang3, J. Cunningham4, S. Moss4
1University of Strathclyde, Biomedical Engineering, Glasgow, United Kingdom
2Manchester Metropolitan University, Department of Health Professions, Manchester,
United Kingdom
3University of Strathclyde, Electrical and Electonic Engineering, Glasgow, United Kingdom
4Brain And Spinal Injury Centre, CAREN, Salford, United Kingdom
Aims
Treadmills provide a convenient method for practicing walking after a stroke. Self-paced
treadmills, where belt speed adjusts automatically to body movement, may offer a more suitable
learning environment for recovering walking function than traditional fixed pace treadmills. This
pilot study aimed to compare outcomes from self-paced and fixed pace treadmill training.
Method
Ambulant stroke patients attending a rehabilitation centre were invited to participate in a training
programme of 16 sessions over 8-10 weeks. Participants were randomised to either fixed or selfpaced training using the ReGait (MotekForcelink) treadmill. Walking speed and activities of daily
living (Nottingham Extended Activities of Daily living (NEADL) were recorded at baseline and
outcome.
Results
Ten participants of weight 76.7Kg (SD 13.8), height 1.75m (SD 0.11), 35.62 months post ictus
(SD 3.2) were recruited, nine fully completed the training. There were no statistical differences
between the groups at baseline (p>0.05). Both groups showed improvement post training,
however, there was a better response from the self-paced group, see table 1.
Table1: Response to self–pace and fixed-pace treadmill training among
Conclusion
In a group of people with long term stroke treadmill training produced modest and variable
improvement in walking speed (treadmill and overground) and ADL. This is consistent with
existing literature; however the better response from individuals trained in a self-paced mode is
worth further investigation. The data from this pilot suggests a sample of around 70 (p<0.05)
would be necessary for a definitive, statistically powered (90%), trial.
WCNR-0060
BOARD NUMBER: 015
THE NUMBER OF DAILY SIT-TO-STAND TRANSITIONS PERFORMED BY ACUTE STROKE
PATIENTS UNDERGOING REHABILITATION
A. Kerr1, J. Dawson2, P. Rowe1, T. Quinn2
2University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow,
United Kingdom
Aims
The sit-to-stand (STS) transition is a frequently performed task which is key to independent living
and frequently affected by a stroke. Practicing this movement during rehabilitation is therefore
recommended. The current practice intensity of STS during rehabilitation is unknown. This
observational study aimed simply to count STS repetitions during the rehabilitation period of
acute stroke patients.
Method
Participants were medically stable stroke patients referred for rehabilitation. An accelerometer,
with established validity in stroke populations, (Paltechnologies, Glasgow, UK) was applied to the
thigh of each participant. After 14 days of continuous wear the accelerometer was removed, the
data downloaded and processed with proprietal software using changes in thigh inclination to
count STS events.
Results
A heterogeneous group (n=37) were recruited; they were aged 68.4 years (sd 13.15), weight
77.12Kg (sd 22.73), height 1.67m (sd 0.1), 9 days (sd 9) post ictus and with a NIHSS (stroke
severity) score of 6.4 (sd 3.3). When separated into two groups, according to the level of
assistance required to perform the STS movement at baseline, statistically significant (p=0.000)
differences were evident, table 1.
Table 1: STS repetition by acute stroke patients during 14 days of the rehabilitation period
Conclusion
The average number of daily STS repetitions, for the whole group, is lower than published reports
for frail older people receiving rehabilitation, (36, sd 16) and substantially below community living
older adults (71, sd 25). While perhaps not surprising, these very low levels of STS repetition
recorded during the rehabilitation period raises questions on whether a training effect is being
achieved, particularly for individuals requiring assistance.
WCNR-0075
BOARD NUMBER: 016
DETERMINING OPTIMAL POST-STROKE EXERCISE (DOSE): STUDY PROTOCOL FOR A
RANDOMIZED CONTROLLED TRIAL INVESTIGATING EXERCISE INTENSITY DURING
INPATIENT REHABILITATION
T. Klassen1, J. Eng1, M. Bayley2, O. Benavente3, J. Bennett4, A. Krassioukov5, M. Piitz6,
E. Reimer7, S. Rowe4, J. Yajure6, J. Yao4, M. Hill6, S. Dukelow6
1University of British Columbia, Department of Physical Therapy, Vancouver, Canada
2University of Toronto, Toronto Rehabilitation Institute, Toronto, Canada
3University of British Columbia, Department of Neurology, Vancouver, Canada
4GF Strong Rehabilitation Centre, Rehabilitation Research Program, Vancouver, Canada
5University of British Columbia, Department of Medicine, Vancouver, Canada
6University of Calgary, Department of Clinical Neurosciences, Calgary, Canada
7Carewest, Dr. Vernon Fanning Centre, Calgary, Canada
Aims
A top priority in stroke rehabilitation research is determining the appropriate exercise dose to
promote optimal recovery. Recent scientific findings suggest that higher exercise dose in the
acute stage post-stroke is deleterious to functional recovery. Inpatient rehabilitation, occurring
after acute care, may be a more appropriate setting to assess the effect of greater intensity
exercise interventions to maximize post-stroke recovery. This study will examine the feasibility
and effectiveness of exercise intensity and dose in the inpatient rehabilitation setting in individuals
post-stroke.
Clinical Trial Registration Number: NCT01915368
Method
75 individuals across Canada, admitted to inpatient stroke rehabilitation, will be recruited for this
single-blind, randomized controlled trial. Participants will be randomized into 1 of 3 treatment
programs. Each program is 4 weeks duration and conducted 5 days/week.
Group 1: Usual physical therapy (PT) care
Group 2: Usual PT care replaced by a 1 hour/day high intensity exercise program
Group 3: Usual PT care replaced by a 2 hour/day high intensity exercise program
Heart rate monitors and pedometers will measure activity during the treatment sessions.
Outcome data will be assessed at four time points. The primary outcome measure is the 6
minute walk and secondary outcomes include cognitive, functional independence, and quality of
life measures.
Results
We hypothesize that the higher intensity exercise programs will yield greater improvements in
walking ability (6 minute walk) and secondary measures (cognition, functional status and quality
of life) over usual physical therapy care.
Conclusion
This well designed randomized controlled trial has the potential to improve walking ability,
functional status, cognition, and quality of life at a very important stage of rehabilitation and neural
recovery post-stroke.
WCNR-0190
BOARD NUMBER: 017
SHOELESS OR SHOED DURING POSTUROGRAPHY IN PATIENTS AFTER STROKE?
EFFEKTS OF FOOTWEAR ON POSTURAL PARAMETERS DURING QUIET STANDING
C. Krewer1,2, J. Bergmann1,2, K. Rauen3,4, K. Jahn2,3, F. Müller2,3
1Schön Klinik Bad Aibling, Motor Research Department, Bad Aibling, Germany
2Ludwig-Maximilians University of Munich,
German Center for Vertigo and Balance Disorders DSGZ, Munich, Germany
3Schön Klinik Bad Aibling, Neurology, Bad Aibling, Germany
4UniversityHospital, Department of Psychiatry and Psychotherapy, Zurich, Switzerland
Aims
Balance deficits are common in individuals after stroke increasing the risk of falls. Center of
pressure (COP) parameters recorded via posturography are often used as a measure for postural
stability. Although there are some recommendations to increase reliability, there is lack of
evidence regarding footwear during posturography. Thus, the goal of this study was to investigate
the influence of footwear on COP parameters.
Method
COP signals were obtained from 21 patients (age 67 ± 11 years; 9 male, 12 female) with
hemiparesis 9 ± 5 weeks after a stroke. Data were collected during 90 seconds of quiet standing
in both, shoeless and shoed conditions, each with and without visual input, on a single session
using the force measuring plate (FDM-S, zebris Medical GmbH, Germany). Subjects wore their
own daily footwear. Foot positioning between conditions was standardized throughout using
individual foot templates. Condition sequence was randomized. Paired-samples t-tests were used
to analyze length of COP displacement, area of sway, and mean COP velocity between
conditions.
Results
Analyses of those parameters showed significant differences between the eyes open and closed
conditions (p<0.007), i.e., when eyes were closed patients had a longer COP displacement, an
increased area of sway, and a faster COP velocity. But there were no significant differences
between the conditions with and without shoewear (p>0.429).
Conclusion
Our current findings suggest that footwear does not significantly affect postural stability in quit
standing in eyes-open and eyes-closed conditions in patients with hemiparesis, who are able to
perform these standing tasks.
WCNR-0174
BOARD NUMBER: 018
FATIGUE, PERCEIVED EXERCISE BARRIERS AND EXERCISE BEHAVIOR AFTER STROKE
Y.C. Lee1, S.C. Wu2, Y.J. Lee1, Y.J. Chen3, T.W. Chen1
1Kaohsiung Municipal Ta-Tung Hospital, Department of Rehabilitation, Kaohsiung, Taiwan
2Kaohsiung Veterans General Hospital, Center of medical qaulity management, Kaohsiung,
Taiwan
3Kaohsiung Medical University Chung-Ho Memorial Hospital, Department of Rehabilitation,
Kaohsiung, Taiwan
Aims
To assess the relation between fatigue, perceived exercise barriers and exercise behavior in
subjects with stroke.
Method
We recruited a total of 50 subjects(66% male;age:56.1±8.06 years;6 to 45 months post stroke)
with regular rehabilitation therapy in hospital. The inclusion criteria were:(1) a minimum of 6
months post stroke; (2) without cognitive dysfunction, neglect, visual deficit, or other physical
disease that could impact on regular rehabilitation exercise; (3) ambulate with or without advice.
A structured questionnaire was used to assess post-stroke fatigue, perceived exercise barriers
and behaviors, which were used to quantify stroke patients’ perceptions about fatigue, exercise
barriers on the day of encounter. These items were scored on a 5-point Likert scale from 5
(limited all of the time) to 1(limited none of the time). The relation between fatigue, perceived
exercise barriers and behavior were tested with the Pearson correlation coefficients. All
calculations were performed using SPSS 18.0. The significance levels less than 0.05 represented
statistical significance.
Results
There was a significant correlation between fatigue and perceived exercise barriers(r=0.525,
p<0.01). The result also found negative correlation between patients’ perceived exercise barriers
and exercise behavior(r=－0.291, p<0.05). The exercise behavior and fatigue score were
significantly different in various motor function of affected lower extremity (p<0.05).
Conclusion
Fatigue is a common and disabling symptom that affects over half of stroke survivors. This study
was showed that the motor deficit of lower extremity may impact the severity of fatigue and
perceived exercise barriers after stroke. The perceived exercise barriers in stroke patients were
related to the safety during exercise, such as falling, environment. Encouraging stroke patients to
exercise actively and regularly is also important to reduce their disabling pattern of reduced
physical activity.
WCNR-0175
BOARD NUMBER: 019
EFFECTS OF COGNITIVE AND MOTOR DUAL TASK ON GAIT PERFORMANCE AND BRAIN
ACTIVITIES IN INDIVIDUALS WITH STROKE
Y.C. Liu1, R.Y. Wang1, C.F. Lu1,2, Y.R. Yang1
1National Yang-ming University, Department of Physical Therapy and Assistive Technology,
Taipei, Taiwan
2Taipei Medical University, Translational Imaging Research Center, Taipei, Taiwan
Aims
The purpose of this study was to investigate the effects of cognitive and motor dual task on gait
performance and brain activities in individuals with stroke.
Method
Twenty-three stroke subjects performed the normal-pace walking (NW), walking with cognitive
task (WCT), and walking with motor task (WMT) in their self-selected speed. The gait
performance including speed, cadence, stride time and stride length was measured by GAITRite
system. The dual task cost (DTC) was also calculated for the interference of dual task as
compared with the single task. Brain activities in prefrontal cortex (PFC), premotor cortex (PMC)
and supplemental motor areas (SMA) were measured by functional near-infrared spectroscopy
(fNIRS). The repeated one way ANOVA was used to analyze the effects of dual task on gait
performance and brain activities. The significant level was set at p<0.05.
Results
Significant decrease in speed, cadence, stride length, and increase in stride time were noted
during both WCT and WMT as compared with NW. The DTC was 17.96% and 18.35% in WCT
and WMT respectively with no significant difference between two dual task walking conditions.
Regarding the brain activities, the bilateral PFC, posterior SMA and most part of PMC were
significantly activated during WCT, and the non-affected PFC, bilateral posterior SMA and most
part of PMC were significantly activated during WMT compared with NW. Comparing the WCT
and WMT, the bilateral PFC and most part of non-affected PMC were more activated during
WCT, however, the bilateral SMA and affected PMC showed greater activation during WMT.
Conclusion
For individuals with stroke, executing cognitive and motor dual task deteriorated gait
performance, and no significant difference was noted between the two dual tasks on gait
performance. However, the brain areas may activate differently in response to different dual task
walking challenges.
WCNR-0034
BOARD NUMBER: 020
POWERED ROBOTIC EXOSKELETONS IN POST-STROKE GAIT REHABILITATION: A
SCOPING REVIEW
D. Louie1, J. Eng1
1Vancouver Coastal Health Research Institute, Rehab Research Program, Vancouver, Canada
Aims
Newly developed powered robotic exoskeletons were originally designed to allow paraplegic
individuals with spinal cord injury to walk. They have recently gained attention as a potential
rehabilitation intervention for stroke patients.
The aim of this scoping review was to map the current literature surrounding the use of robotic
exoskeletons for gait rehabilitation in adults post-stroke.
Method
Five databases (Pubmed, OVID MEDLINE, CINAHL, Embase, Cochrane Central Register of
Clinical Trials) were searched for articles from inception to 2015. Reference lists of included
articles were reviewed to identify additional studies. Articles were included if they utilized a robotic
exoskeleton as a gait training intervention for adult stroke survivors and reported walking
outcome measures.
Results
Of 441 records identified, 11 studies involving 212 participants met the inclusion criteria. The
studies ranged from case series and prospective cohorts to randomized controlled trials (n=3); 5
of the studies utilized a robotic exoskeleton device unilaterally, while 6 used a bilateral design.
Participants ranged from subacute (<7 weeks) to chronic (>6 months) stroke. Training periods
ranged from single-session to 8-week interventions. Main walking outcome measures were gait
speed, 10-Meter Walk Test and 6-Minute Walk Test; 9 studies showed varying degrees of
positive results in these parameters of walking ability.
Conclusion
Currently, there are only a handful of clinical trials suggesting powered robotic exoskeletons as
an effective gait training intervention for stroke. Efforts should be invested in designing rigorous,
appropriately powered controlled trials before it can be translated into a clinical tool for gait
rehabilitation post-stroke.
WCNR-0097
BOARD NUMBER: 021
FUNCTIONAL DEFICITS IN NON-PARETIC ARM DEPEND ON HEMISPHERE OF DAMAGE
AND EXTENT OF PARETIC ARM MOTOR IMPAIRMENT
C. Maenza1,2, D.C. Good1, C. Winstein3, R.L. Sainburg1,2
1Penn State College of Medicine, Neurology, Hershey, USA
2Pennsylvania State University, Kinesiology, University Park, USA
3University of Southern California, Biokinesiology and Physical Therapy, Los Angeles, USA
Aims
We previously detailed the hemisphere dependence and specific behavioral nature of non-paretic
arm motor deficits in patients with unilateral stroke. We now examine whether these deficits
depend on hemisphere of damage and severity of contralesional paresis by quantifying the effect
of unilateral stroke on clinical tests of motor function.
Method
We have, thus far, recruited 34 left hemisphere damaged (LHD) patients, 49 right hemisphere
damaged (RHD) patients, 54 age and gender matched control subjects (27 using right arm, 27
using left arm). Measures of motor function included: 1) Jebsen-Taylor Hand Function Test
(JTHFT), 2) Slotted pegboard test, and 3) Finger tapping test. We measured the extent of
contralesional impairment with the upper extremity component of the Fugl-Meyer (UEFM)
assessment of motor impairment.
Results
Non-paretic arm motor deficits depended strongly on hemisphere of damage and on severity of
contralesional arm impairment. LHD patients with severe paresis (UEFM < 35) took 300% more
time to complete the JTHFT than control subjects, and RHD patients with severe paresis took
150% more time.
Conclusion
Thus, stroke survivors with the most severe paretic arm impairment, who must rely on their
ipsilesional arm for daily activities, have the greatest motor deficit in the non-paretic arm. The fact
that these stroke survivors were tested 1.8 years (±0.3 SE) on average post-stroke suggests that
these deficits do not spontaneously improve over time, emphasizing the need for remediation of
this arm in chronic stroke survivors.
WCNR-0019
BOARD NUMBER: 022
TRAINING OF THE NON-PARETIC ARM IN UNILATERAL STROKE IMPROVES ARM
FUNCTION AND PERFORMANCE
C. Maenza1,2, D.C. Good1, C. Winstein3, W. David4, R.L. Sainburg1,2
1Penn State College of Medicine, Neurology, Hershey, USA
2Pennsylvania State University, Kinesiology, University Park, USA
3University of Southern California, Division of Biokinesiology and Physical Therapy, Los Angeles,
USA
4Pennsylvania State University, Department of Human Development and Family Studies,
University Park, USA
Aims
We previously elaborated hemisphere specific motor deficits in the non-paretic, ipsilesional arm of
chronic unilateral stroke patients. We have demonstrated that these deficits can be associated
with substantial limitations in functional performance, especially in patients with moderate to
severe contralesional paresis. In this pilot feasibility study, we ask whether intense training of the
ipsilesional arm can lead to substantial and durable improvements in functional performance.
Method
Non-paretic arm training employed both virtual reality (VR) tasks and challenging real-life
activities involving resistive exercise, rapid and accurate object placement, object manipulation,
tracing, cutting, and targeted throwing tasks. Eight patients with moderate to severe paresis
engaged in a 4 week intervention, involving 3 sessions per week, which lasted for 2 hours each.
For 30 minutes, patients focused on VR activities involving rapid accurate motions of the arm,
followed by real-life activities for the remaining 1.5 hours. Dependent measures included: 1)
Jebsen-Taylor Hand Function Test (JTHFT), 2) Slotted Pegboard test, 3) Kinematics during a
center out reaching task, and 4) a modified version of the Functional Independence Measure
(FIM). These tests were given twice prior to training, separated by a 1 week interval, immediately
following training, and 1 month after training.
Results
Improvements were made on measures of unilateral function, activities of daily living, and
functional tasks, including substantial improvements on the JTHFT, a test of unimanual functional
performance. Reaching Kinematics were also assessed, but trends toward improvement were not
significant.
Conclusion
We conclude that training of the non-paretic arm in unilateral stroke improves arm function and
functional independence.
WCNR-0126
BOARD NUMBER: 023
SOMATOSENSORY IMPAIRMENTS IN THE UPPER LIMB POST STROKE: DISTRIBUTION,
IMPACT OF VISUO-SPATIAL NEGLECT AND ASSOCIATION WITH MOTOR FUNCTION
S. Meyer1, N. De Bruyn1, C. Lafosse2, M. Van Dijk3, M. Michielsen4, L. Thijs4, V. Truyens5,
K. Oostra6, L. Krumlinde-Sundholm7, A. Peeters8, V. Thijs9, H. Feys1, G. Verheyden1
1KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
2Rehabilitation Hospital RevArte, Rehabilitation, Edegem, Belgium
3University Hospitals Leuven, campus Pellenberg, Leuven, Belgium
4Jessa Hospital, Rehabilitation Centre Sint Ursula, Herk-de-stad, Belgium
5Rehabilitation & MS centre Overpelt, Rehabilitation, Overpelt, Belgium
6Ghent University Hospital, Department of Physical and Rehabilitation Medicine, Ghent, Belgium
7Karolinska Institutet - Department of Women's and Children's Health,
Astrid Lindgren Children's Hospital - Neuropediatric Unit, Stockholm, Sweden
8Cliniques Universitaires Saint-Luc, Department of neurology, Brussels, Belgium
9KU Leuven, Department of Neurosciences, Leuven, Belgium
Aims
To investigate the distribution of upper limb somatosensory impairments and the association with
uni- and bimanual motor outcome and visuo-spatial neglect.
Method
A cross-sectional observational study was conducted including 122 patients within the first six
months after stroke (median 82 days, IQR 57-133 days). Somatosensory measurement included
the Erasmus modified Nottingham sensory assessment (Em-NSA); perceptual threshold of touch
(PTT); thumb finding test; two-point discrimination, and stereognosis subscale of the NSA. Upper
limb motor assessment comprised the Fugl-Meyer assessment, motricity index, action research
arm test and adult-assisting hand assessment stroke. Screening for visuo-spatial neglect was
performed using the star cancellation test.
Results
Upper limb somatosensory impairments were common, with prevalence rates ranging from 2154%. Low to moderate Spearman rho correlations were found between somatosensory and motor
deficits (r=.22-r=.61), with the strongest associations for PTT (r=.56-r=.61) and stereognosis
(r=.51-r=.60). Visuo-spatial neglect was present in 27 patients (22%). Between-group analysis
revealed significantly more often and more severe somatosensory deficits in patients with visuospatial neglect (p<0.05). Results showed consistently stronger correlations between motor and
somatosensory deficits in patients with visuo-spatial neglect (r=.44-r=.78) compared to patients
without neglect (r=.08-r=.59).
Conclusion
Somatosensory impairments are common in sub-acute patients post stroke and related to motor
outcome. Visuo-spatial neglect was associated with more severe upper limb somatosensory
impairments.
WCNR-0128
BOARD NUMBER: 024
LONGITUDINAL EVOLUTION OF SENSORIMOTOR IMPAIRMENTS IN THE UPPER LIMB
POST STROKE
S. Meyer1, N. De Bruyn1, L. Krumlinde-Sundholm2, A. Peeters3, H. Feys1, V. Thijs4,
G. Verheyden1
2Karolinska Institutet - Department of Women's and Children's Health,
Astrid Lindgren Children's Hospital - Neuropediatric Unit, Stockholm, Sweden
3Cliniques Universitaires Saint-Luc, Department of Neurology, Brussels, Belgium
Aims
The aim of this prospective cohort study was to map the evolution in extent and distribution of
somatosensory deficits, and to determine associations over time between somatosensory deficits
and motor impairment and activity limitations.
Method
We recruited 32 participants who were assessed four to seven days post stroke, and at six
months. Somatosensory measurements included the Erasmus-modified Nottingham sensory
assessment (Em-NSA); perceptual threshold of touch (PTT); thumb finding test (TFT); two-point
discrimination, and stereognosis subscale of the NSA. Evaluation of motor impairment comprised
the Fugl-Meyer assessment, motricity index and action research arm test. Additionally, at six
months, activity limitation was determined using the adult-assisting hand assessment stroke, the
ABILHAND, and hand-subscale of the stroke impact scale.
Results
Somatosensory impairments were common, with 41-63% experiencing a deficit in one of the
modalities within the first week and 3-50% at six months. In the acute phase, there were only very
low associations between somatosensory and motor impairments (r=0.03-0.20), whereas at six
months, low to moderate associations (r=0.32-0.69) were found for PTT, TFT and stereognosis
with motor impairment and activity limitations. Low associations (r=0.01-0.29) were found
between somatosensory impairments in the acute phase and motor impairments and activity
limitations at six months.
Conclusion
This study showed that somatosensory impairments are common and suggests that the
association with upper limb motor and functional performance increases with time after stroke.
WCNR-0015
BOARD NUMBER: 025
JSU-DIAGRAM: A GUIDELINE FOR TREATMENT OF THE UPPER LIMB IN STROKE
PATIENTS
M. Michielsen1, E. Janssens2, M. Bossuyt2, K. Cypers2, G. Daems2, L. Thijs2, E. Schruers2
1Jessa Hospital, Rehabilitationcampus Sint Ursula, Hasselt, Belgium
2Jessa Hospital, Rehabilitationcampus Sint Ursula, Hasselt/Herk-de-Stad, Belgium
Aims
Recovery of efficient, functional use of the upper limb post stroke can contribute to an increased
quality of life.
Early implementation of well-structured upper limb treatment after stroke may affect recovery of
upper limb function
and dexterity. The JSU (Jessa Sint-Ursula) diagram should be considered a guideline to work on
the objectives
needed to shape the rehabilitation of the upper limb at various stages of recovery. The diagram
starts with upper
limb rehabilitation from day one, even in the absence of sufficient trunk control and aims at
offering a logical
theoretical strategy for improving the recovery of function of the upper limb.
Michielsen M, Janssens E, Bossuyt M, Cypers K, Daems G, et al. (2015) JSU-Diagram: A
Guideline for Treatment of the Upper Limb in
Stroke Patients. Int J Phys Med Rehabil 3: 280.
doi:10.4172/2329-9096.1000280
Method
A diagram is presented offering guidelines to direct clinical reassoning and clinical decision
making in upper limb treatment in stroke patients.
Results
Exemples of treatment decisions are presented
Conclusion
Recovery of efficient, functional use of the upper limb post stroke
can contribute to an increased quality of life. After a stroke, the
literature suggests immediate implementation of therapy for the upper
limb may reduce the risk of secondary dysfunction related to non-use
of the arm/hand. The JSU diagram offers a guideline for implementing
upper limb treatment at various stages of recovery after stroke.
Prerequisites for efficient voluntary reach and grasp skills require
adequate postural control, core stability, scapula setting and selective
recruitment of reach-related musculature. Objectives must be defined
on an activity level. The choices of rehabilitation environment, task,
starting positions and handling techniques may influence the
maximum level of functional levels of voluntary movement recovery.
Further research on the effectiveness of the treatment strategy, which
is described in the JSU-diagram, is needed.
WCNR-0062
BOARD NUMBER: 026
THE SIDEWAY WALK TEST FOR ASSESSING PEOPLE WITH CHRONIC STROKE
S.S.M. NG1, B.K.C. Lau1, G.T.C. Law1, C.W.K. Wom1, S.S.M. Fong2
1The Hong Kong Polytechnic University, Department of Rehabilitation Sciences, Hung HomKowloon- Hong Kong, Hong Kong- China
2The University of Hong Kong, Institute of Human Performance, Pokfulam- Hong Kong,
Hong Kong- China
Aims
To investigate (1) the intrarater, interrater, and test-retest reliability of Sideway Walk Test (SWT)
time and counts in individuals with stroke; (2) their correlations with stroke-specific impairments;
(3) the cut-off SWT times and counts that discriminate individuals with stroke from healthy
controls; and (4) the minimal detectable changes (MDC) in SWT time and counts of individuals
with stroke
Method
A cross-sectional study targeted at stroke patients (n = 29) and healthy control subjects (n =32) in
a university-based rehabilitation center setting. The SWT was conducted along with Fugl-Meyer
Motor assessment of the Lower Extremities (FMA-LE), lower limb muscle strengths, the FiveTime-Sit-To-Stand Test (FTSTST), the Berg Balance Scale (BBS), Timed Up-and-go Test (TUG),
Activity-based Confidence (ABC-C) and Community Integration Measure (CIM-C).
Results
The SWT times and counts demonstrated good to excellent intrarater, interrater, and test-retest
reliabilities in individuals with stroke. The SWT times and counts were significantly correlated with
FMA-LE scores, muscle strengths of lower limbs, FTSTS completion times, BBS scores, and
TUG test times. The cut-off affected SWT time and count were 10.74s and 8.83 steps
respectively, while unaffected SWT time and count were 10.19s and 8.17 steps respectively. The
MDC for the affected and unaffected SWT time were 1.85 and 2.13s respectively while the
affected and unaffected SWT counts were 1.12 to 1.48 steps respectively.
Conclusion
The SWT is a reliable and easy-to-administer clinical test for assessing dynamic walking balance
in sideway walking.
WCNR-0063
BOARD NUMBER: 027
ACCELERATION AND DECELERATION DISTANCES FOR MEASURING WALKING SPEED
IN STROKE REHABILITATION
S.S.M. NG1, K.K.C. Au1, E.L.W. Chan1, D.O.M. Chan1, G.M.Y. Keung1, J.K.Y. Lee1,
P.W.H. Kwong1, S.S.M. Fong2
1The Hong Kong Polytechnic University, Department of Rehabilitation Sciences, Hung HomKowloon- Hong Kong, Hong Kong- China
2The University of Hong Kong, Institute of Human Performance, Pokfulam- Hong Kong,
Hong Kong- China
Aims
To examine the effect of acceleration and deceleration distance (0m, 1m, 2m, 3m) on comfortable
and maximum walking in 5-meter walk test (5mWT) and 10-meter walk test (10mWT) for people
with chronic stroke.
Method
A cross-sectional study targeted at patients with chronic stroke (n = 30) in a university-based
rehabilitation center setting. Participants performed a timed 5m and 10m walking test with
different acceleration and deceleration distance (0m, 1m, 2m, 3m).
Results
There was no significant difference between conditions of acceleration and deceleration distance
in 5mWT with maximum speed (P=0.122), 10mWT with comfortable (P=0.225) and maximum
speed (P=0.052). In 5mWT, the comfortable speed with 0m acceleration and deceleration
distance was significantly slower than other conditions of acceleration and deceleration distance
(1m, 2m, 3m) (P<0.0083). No significant difference was found between 1m, 2m, 3m acceleration
and deceleration distance in 5mWT with comfortable speed.
Conclusion
Adoption of 1m acceleration and deceleration distances is recommended in 5mWT with
comfortable speed. Neither acceleration nor deceleration distance is needed in 5mWT with
maximum speed, 10mWT with both comfortable and maximum speed.
WCNR-0110
BOARD NUMBER: 028
HOW TO AUGMENT EXERCISE THERAPY AFTER STROKE?
R. Nijland1, J. Vloothuis1, M. Mulder2, E. van Wegen2, G. Kwakkel2
1Amsterdam Rehabilitation Research Centre- Reade, Department of Neurorehabilitation,
Amsterdam, Netherlands
2VU University Medical Center- Amsterdam, Department of Rehabilitation Medicine, Amsterdam,
Netherlands
Aims
Several systematic reviews have shown that more exercise therapy can lead to better functional
outcome after stroke. A resource efficient method to increase intensity of training could be to
involve caregivers in exercise training. This has the potential to augment the intensity of practice
without increasing health care costs and could improve outcomes in terms of body function,
activities and participation in people with stroke. In addition, caregivers are more actively
involved, which may increase feelings of empowerment with reduced levels of caregiver burden.
All this could lead to early supported discharge and a reduced length of stay.
The aim of this poster is to give an overview of the available evidence for the effectiveness of
caregiver-mediated exercises (CME) after stroke with respect to motor impairment, activities of
daily living (ADL) and quality of life (QoL) of patients and caregivers.
Method
A systematic review and meta-analysis was performed. Randomized controlled trials comparing
CME to usual care, no intervention, or another intervention as long as it is not caregivermediated, were included.
Results
Six randomized controlled trials about CME involving 216 participants were included. Significant
differences in favor of CME were found for basic ADL, balance and patients’ QoL post
intervention and for extended ADL and walking distance at follow up.
Conclusion
CME can be a valuable intervention to augment the pallet of therapeutic options for rehabilitation
after stroke towards living at home. Future research should determine whether CME is costeffective. Therefore, a randomized controlled trial (CARE4STROKE+) will be conducted in the
Netherlands. Eighty-eight patients are randomly assigned to either 8 weeks of CME in addition to
usual care or 8 weeks of usual care. CME is combined with e-health support to increase
adherence and enable monitoring by the rehabilitation team. The primary outcome is the Stroke
Impact Scale and length of inpatient stay.
WCNR-0036
BOARD NUMBER: 029
EVALUATION OF PREDICTIVE FACTORS INFLUENCING COMMUNITY REINTEGRATION IN
ADULT PATIENTS WITH STROKE
O. Olawale1, J. Usman1
1College of Medicine University of Lagos/Lagos University Teaching Hospital -Lago,
Physiotherapy, Lagos, Nigeria
Aims
Patients with stroke are faced with gait, balance and fall difficulties which could impact on their
community reintegration. The objective of this study was to evaluate the predictors of community
reintegration in adult patients with stroke.
Method
Study participants were 91 adult patients with stroke. Gait variables, balance self-efficacy,
community balance/mobility and fall self-efficacy were assessed using Rivermead Mobility Index,
Activities-specific Balance Confidence (ABC) Scale, Community Balance and Mobility (CB&M)
Scale, and Falls Efficacy Scale-International (FES-I) respectively. The Reintegration to normal
Living Index (RNL-I) was used to assess satisfaction with community reintegration. Pearson
product-moment correlation coefficient was used to determine the relationship between
community reintegration and gait spatiotemporal variables, balance performance and risk of fall.
Multiple regression analysis was used to determine the predictors of community reintegration (p≤
0.05).
Results
Participants’ mean age was 58.21±10.53 years. There was significant positive relationship
between community reintegration and cadence (r=0.250, p=0.017), functional mobility (r=0.503,
p=0.001), balance self-efficacy (r=0.608, p=0.001), community balance/mobility (r=0.586,
p=0.001) and duration of stroke (r=0.220, p=0.036). Stride time (r=-0.282, p=0.073) and fall selfefficacy (r=0.566, p=0.001) were negatively correlated with community reintegration. Duration of
stroke, balance self-efficacy, community balance/mobility and fall self-efficacy (52.7% of the
variance) were the significant determinants/predictors of community reintegration.
Conclusion
Community reintegration is influenced by cadence, functional mobility, balance self-efficacy,
community balance/mobility and duration of stroke. The less the stride time and fall self-efficacy,
the better the community reintegration. Hence, improving balance during rehabilitation is
important in enhancing community reintegration in adult patients with stroke.
WCNR-0121
BOARD NUMBER: 030
EFFECTS OF AEROBIC EXERCISE ON COGNITIVE IMPAIRMENTS IN SUBACUTE STROKE
SURVIVORS - A RANDOMIZED CONTROLLED TRIAL
H. Pallesen1, M. Bjerk2, L. Christensen1, L.B. Lund3, L.B. Sørensen1, A.R. Pedersen1,
J.F. Nielsen1
1Hammel Neurorehabilitation Centre and University Research Clinic, Research Unit, Hammel,
Denmark
2Plymouth University, Faculty of Health- Education and Society, Plymouth, United Kingdom
3University College, VIA- Aarhus, Aarhus, Denmark
Aims
The central aim was to assess the effects of aerobic exercise on cognitive impairments in
subacute stroke survivors. We hypothesized that cognitive impairments in subacute stroke
survivors assessed by neuropsychological measurements would improve more with high-intensity
aerobic exercise compared to low-intensity general exercise.
Method
A pilot randomized controlled trial (RCT) on the effects of aerobic exercise on cognitive
impairments in a group of stroke patients was initiated in November 2012. Thirty patients will be
included in the study and randomly assigned to either the intervention group performing highintensity aerobic exercise or the control group performing low-intensity general exercise. The
patients are referred from three different rehabilitation units within the same hospital and are all in
the subacute phase and with moderate cognitive impairments. Patients in both groups exercise
twice weekly for four weeks. Before, after and at three months follow-up, physical and
neuropsychological measurements are conducted. Aerobic capacity and endurance: ÅstrandRhyming cycle ergometer test and 6 Minute Walk Test (6MWT). The neuropsychological
measurements: Wechsler Adult Intelligence Scale (WAIS), Trail making test part A and B, Serial
subtractions, Rey Complex Figure Test and Recognition Trial (RCFT), Rey Auditory Verbal
Learning Test (RAVLT), Word Association Test, The Tower of London Test (TOL) and the
Subscales Anxiety (SCL-ANX) and Emotional disorder (SCL-8) from Symptom Check List 90-R
(SCL-90). Additionally, Patients´ Global Impression of Change scale (PGIC) is performed at
follow-up.
Results
The inclusion of patients is finished january 2015 and the final results to be presented early spring
2016. The preliminary results (ten patients) showed that the high-intensity group achieved
significant improvements (p<0.05) on Trail making B testing processing speed and WAIS digit
span testing working memory and attention.
Conclusion
Forthcoming
Implications: Procedures of both the high-intensity training and the low-intensity training seemed
to be feasible for subacute stroke patients who were hospitalized at a rehabilitation unit.
WCNR-0016
BOARD NUMBER: 031
DISTRIBUTION OF SPASTICITY IS INVERSELY ASSOCIATED WITH WALKING SPEED IN
ADULTS WITH NEUROLOGICAL DISORDERS
C. Phadke1, F. Ismail1, C. Boulias1
1West Park Healthcare Centre, Spasticity Research Program, Toronto, Canada
Aims
To assess the relationship between the distribution of spasticity in the upper and lower limbs, and
gait speed in adults with neurological disorders.
Method
In this prospective cross-sectional study, 43 participants (24 males 19 females; mean age 52 ±19
years) with various neurological disorders such as - stroke (n=21), multiple sclerosis (n=7),
acquired brain injury (n=4), spinal cord injury (n=3), cerebral palsy (n=4), other (n=4) were
recruited. Main Outcome Measures: a) Spasticity distribution: We calculated the number of
muscles in the upper and lower limbs with modified Ashworth scale (MAS) score >2, b) Gait
speed. Participants completed 2 walking trials at preferred speed on a GAITRite walkway. A
Pearson’s correlation coefficient was used to assess the association between spasticity
distribution and gait speed.
Results
Results: We found a significant negative association between spasticity distribution and gait
speed (r= - 0.36; p<0.01).
Conclusion
Higher number of muscles with moderate to severe spasticity may impair gait kinematics and
lower gait speed. Future studies should examine the impact of multiple muscles rather than one
or two muscle groups on gait speed.
WCNR-0026
BOARD NUMBER: 032
EFFECTS OF BOTULINUM TOXIN INTRAMUSCULAR INJECTIONS ON SPINAL
EXCITABILITY AFTER STROKE
C. Phadke1, A. On2, F. Ismail1, C. Boulias1
1West Park Healthcare Centre, Spasticity Research Program, Toronto, Canada
2Ege University, Physical Medicine and Rehabilitation, Izmir, Turkey
Aims
To assess the effect of botulinum toxin type-A (BoNTA) on spinal excitability post-stroke.
Method
We applied new methods to isolate central effects of BoNTA using maximum H-reflex (Hmax) and
M-wave (Mmax) amplitudes assessed in ten patients post-stroke at: pre-, 2, 4, and 12-weeks
post-BoNTA collected in our previous study. In order to understand the central effects using Hreflex, it is important to isolate the central effects on spinal synapses from the peripheral effects
on the neuromuscular junction. We subtracted the %change in Mmax from baseline (representing
extrafusal effects only) from the %change in Hmax from baseline (representing extrafusal and
central effects) at 2, 4, and 12-weeks post-BoNTA. We compared the central effects at different
time-points, and association between central effects and change in modified Ashworth Scale
(MAS) for spasticity using non-parametric tests.
Results
Our results show a trend that BoNTA induces central effects starting with inhibition at 2-weeks
post-BoNTA switching to excitation at 12-weeks post-BoNTA (p=0.09). Central effects were
greatest at 2-weeks (inhibition), but tapered off resulting in decrease in inhibition at 4 weeks, and
eventually switched to excitation at 12-weeks post-BoNTA. We found no correlation between the
central effects of BoNTA and changes in MAS.
Conclusion
These results are in line with the intrafusal effects and clinical experience that many patients
return for treatment 3 months post-BoNTA with return of the signs of spasticity. The lack of
correlation between MAS and reflex excitability could be because of poor sensitivity of MAS or
small magnitude of central effects.
WCNR-0129
BOARD NUMBER: 033
WHAT ARE THE BARRIERS AND FACILITATORS TO GOAL-SETTING DURING STROKE
REHABILITATION? A SYSTEMIC REVIEW AND META-SYNTHESIS
S. Plant1, S. Tyson1, J. Parsons2, S. Kirk1
1University of Manchester, School of Nursing- Midwifery and Social Work, Manchester,
United Kingdom
2The University of Auckland, School of Nursing, Auckland, New Zealand
Aims
Goal setting is recommended in national clinical guidelines for stroke however many clinicians
report difficulty implementing it. We systematically reviewed the barriers and facilitators to goal
setting with people with stroke to make practice recommendations.
Method
Electronic searches using keywords relating to goal setting, acquired brain injury and
rehabilitation were completed. Two reviewers independently screened the papers, extracted data
and assessed trial quality and undertook thematic content analysis.
Results
Nine qualitative papers were selected. The selected papers involved 202 participants in total: 88
patients, 89 health care professionals and 25 relatives of participating patients. All but one
selected paper involved in-patient rehabilitation on specialist stroke or rehabilitation units,
although two studies interviewed patients after their discharge. Semi-structured interviews were
most frequent means of data collection although focus groups; mixed methods using interviews,
observations and document analysis and an email questionnaire were also used. Main barriers
were: a mismatch between staffs’ and patients’ perspective of goals and recovery; lack of
expertise (by patients, families and staff); patients’ stroke-related impairments; and organisational
pressures (lack of time and team cohesion). Goal setting can be facilitated by tailoring the goals
to individuals’ needs and preferences; providing support material; education (for staff, patients
and families) to build goal setting skills and confidence, and appropriate resourcing.
Conclusion
The main barriers and facilitators to goal-setting during stroke rehabilitation have been identified.
They suggest that current methods are not fit for purpose. The challenge is to develop a more
sophisticated and nuanced model of goal setting that enables goal-setting to be tailored to
individual patients’ needs and preferences.
WCNR-0170
BOARD NUMBER: 034
EFFECTS OF ELASTIC TAPE ON JOINT POSITION SENSE OF SHOULDER IN CHRONIC
HEMIPARETICS: A RANDOMIZED SHAM-CONTROLLED CROSSOVER STUDY
G. Lopes dos Santos1, M. Bragança de Souza1, T. Luiz Russo1
1Universidade Federal de São Carlos, Department of Physiotherapy, São Carlos, Brazil
Aims
To evaluate the immediate effects of elastic tape placed to the paretic shoulder (anterior, middle,
and posterior deltoid) on the joint position sense of shoulder. Furthermore, to verify if this possible
effect (difference pre and post intervention) are correlate with sensorimotor impairment and
shoulder subluxation grade.
Method
The research activities of this study was registered in the Clinical Trials (NCT02390115).
Crossover sham-controlled trial where participants were assigned at random to two condition:
elastic tape (ET) followed by sham tape (ST- strapping) or ST followed by ET. One month of
washout period was considered. Thirteen individuals with chronic hemiparesis due to ischemic
stroke and thirteen healthy subjects matched for gender and age. The joint position sense was
evaluated using dynamometer. Absolute error for shoulder abduction and flexion at the 30° and
60° was calculated. Sensorimotor impairment was determined by Fugl-Meyer, and shoulder
subluxation was measured with caliper. To verify the effects of tape, repeated measures analyses
of variance two-way, with condition (ET or ST) as the repeated measure and order of condition
(ET then ST or ST then ET). A significance level was set at p less than 0.05. Spearman’s test
was used for correlations.
Results
Order effect was not observed. No differences were observed between conditions before
intervention for all movements and angles (p>0.05). Repeated-measures analysis showed
significant interaction between condition and order of condition for both movements and angles
(p<0.001), indicating that absolute error were significantly decreased by ET compared with ST.
This reduction was, an average, 8.18° for 30° of abduction, 4.55° for 60° of abduction, 5.86° for
30° of flexion, and 5.72° for 60° of flexion. No correlations with clinical measures were observed.
Conclusion
ET improved joint position sense for abduction and flexion shoulder, regardless of the sensorymotor impairment and the degree of subluxation. Financial support: CNPq and FAPESP
(2014/25845-6).
WCNR-0156
BOARD NUMBER: 035
DEVELOPMENT OF AN INTERVENTION TO INCREASE AFFECTED UPPER LIMB USE
POST STROKE
L. SIMPSON1, J. Eng2
1University of British Columbia, Graduate Program in Rehabilitation Sciences, Vancouver,
Canada
2University of British Columbia, Physical Therapy, Vancouver, Canada
Aims
Despite gains made during rehabilitation, many people do not go on to use their affected upper
limb after stroke. Use of the affected arm in natural settings is being recognized as an important
primary outcome for rehabilitation and clinical trials. The purpose of this project is to describe the
development of an intervention which focuses on increasing affected upper limb use post stroke.
Method
The intervention was developed using: theories and evidence from the behavioural change and
self-management literature, principals of experience-driven neuroplasticity and evidence from
clinical trials that aimed to increase use of the upper limb post stroke.
Results
The intervention incorporates a capacity building exercise program in combination with a
behavioural change protocol that includes goal setting, self-monitoring, feedback on performance
and a new wearable sensor that provides objective feedback about participants’ arm and hand
activity.
Conclusion
This theoretically-derived intervention has the potential to increase affected upper limb use
following stroke. We plan on assessing the feasibility and efficacy of the intervention in an
upcoming clinical trial.
WCNR-0107
BOARD NUMBER: 036
IMPACT OF INTEGRATED UPPER LIMB SPASTICITY MANAGEMENT INCLUDING BoNT-A
ON PATIENT-CENTRED GOAL ATTAINMENT: METHODOLOGY FOR ULIS-III AND INITIAL
GOAL-SETTING DATA
L. Turner-stokes1, S. Ashford2, J. Jacinto3, P. Maisonobe4, J. Balcaitiene4, K. Fheodoroff5
1Cicely Saunders Institute, Palliative Care- Policy and Rehabilitation, London, United Kingdom
2King's College London School of Medicine, Palliative CarePolicy and Rehabilitation and Regional Rehabilitation Unit, London, United Kingdom
3Centro de Medicina de Reabilitaçãode Alcoitão, Serviço de Reabilitação de Adultos, Estoril,
Portugal
4Ipsen Pharma, Medical Affairs, Boulogne-Billancourt, France
5Gailtal-Klinik, Department of Neurorehabilitation, Hermagor, Austria
Aims
To outline the methodology for the Upper Limb International Spasticity study (ULIS)-III, and
describe an initial evaluation of goal-setting.
Method
ULIS-III is a 2-year longitudinal cohort study evaluating patient-centred function-related goal
attainment following repeated botulinum toxin A (BoNT-A) injections as part of integrated upper
limb spasticity (ULS) management in real-life clinical practice. ULIS-III is expected to enrol >1000
subjects in 70 centres worldwide.
The ULS-Index and Goal Attainment Scaling─Evaluation of Outcome for ULS (GAS-eous) tool
will be utilised to evaluate functional changes following BoNT-A treatments. GAS-eous provides a
structured framework for application alongside standardised outcome measures in a clinical
setting. Additionally, ULIS-III will record economic and quality-of-life data, as well as concomitant
therapy use.
Results
Recruitment began in January 2015; as of June 2015, initial goal-setting data had been collected
for 79 patients across 13 sites in 3 countries. Centres were awarded a rating based on the quality
of goal statements set. Overall, 12/13 centres achieved the highest rating (A++).
One primary goal and ≥one secondary goals were set for each patient. The most common
primary goal areas identified were passive function (38.0%), active function (21.5%) and pain
(17.7%). Overall, 128/129 of all set goals fit within the eight specified goal areas of the GAS-eous
toolConclusion
ULIS-III will implement novel approaches for evaluating patient-centred goal attainment and a
structured and consistent method of recording data. Initial goal-setting data supported the validity
of the goals classification underpinning the GAS-eous tool and high-quality goal-setting was
demonstrated in the majority of centres.
WCNR-0024
BOARD NUMBER: 037
WHICH IS THE BETTER TYPE OF ANKLE FOOT ORTHOSIS FOR PEOPLE WITH STROKE?
RESULTS OF THE AFOOT TRIAL
S. Tyson1, N. Thomas1, P. Tyrrell2, K. Woodward-Nutt1, S. Plant1, A. Vail3
1University of Manchester, School of Nursing- Midwifery & Social Work, Manchester,
United Kingdom
2University of Manchester, Stroke Research Centre, Manchester, United Kingdom
3University of Manchester, Centre for Biostatsitics, Manchester, United Kingdom
Aims
An ankle foot orthosis (AFO) can improve mobility after stroke, but there is little research
comparing orthoses to inform clinicians which to use. This trail compared the effects of the two
most commonly used types of AFO (off-the-shelf or bespoke)
Method
Community-living stroke survivors with limited mobility were randomised to receive either an offthe-shelf or bespoke AFO. The effects of the AFO on the following were evaluated





patient satisfaction (questionnaire)
functional mobility (Walking Handicap Scale)
gait (10m walk test)
falls risk (Falls Efficacy Scale)
adverse events (self-report).
Assessments were made at baseline, 6 and 12 weeks after the AFO was fitted.
Results
139 participants were recruited. Overall, there were no differences between groups at either time
point in any outcomes (p<0.005) except that falls risks was lower in the off-the-shelf AFO group
(33.7 vs 39.2 respectively; p=0.003 95% CI 7.65, -1.648). 59 (63%) participants were satisfied or
very satisfied with their AFO at short–term follow up but only 53 (50%) held this view at long term
follow up (p=0.640 (95% CI = -0.619, 1.007) and p=0.415 (95% CI= -1.007, 0.415)) respectively.
There were 11 serious adverse events; 7 injurious falls, pain (n=2) and skin break-down (n=2) but
no difference between groups.
Conclusion
No differences in mobility, patient satisfaction or adverse events between an off –the-shelf AFO
and bespoke AFO were found. Thus we recommend that the cheaper, off-the-shelf design used
in this trial should be prescribed in the 1st instance. Further research into AFO design to improve
user satisfaction is needed.
WCNR-0025
BOARD NUMBER: 038
PATIENTS’ SATISFACTION WITH ANKLE-FOOT ORTHOSES AFTER STROKE. RESULTS
OF THE AFOOT TRIAL
S. Tyson1, N. Thomas1, K. Woodward-Nutt1, S. Plant1, P. Tyrrell2, A. Vail3
1University of Manchester, School of Nursing- Midwifery & Social Work, Manchester,
United Kingdom
2University of Manchester, Stroke Research Centre, Manchester, United Kingdom
3University of Manchester, Centre for Biostatsitics, Manchester, United Kingdom
Aims
An ankle foot orthosis (AFO) can improve mobility after stroke, but there is little research
considering patients’ experience of using them although satisfaction plays an essential role in
adherence. Here, we report on patients’ satisfaction with the two most commonly used types of
AFO (off-the-shelf or bespoke)
Method
114 community-living stroke survivors with limited mobility were randomised to receive an off-theshelf or a bespoke AFO and completed assessment of their satisfaction (using a face-to-face
questionnaire with open and closed questions)12 weeks after fitting.
Results
Only 2/3 (n=73, 68%) of participants’ were satisfied or very satisfied with their AFO. Participants
reported that the main benefit of the AFO was improved alignment of their foot and ankle which
stopped their foot inverting and toes catching, and thus improved their mobility. They felt steadier,
more confident and less likely to fall. 52 (48%) felt the AFO caused a problem. The main
complaints were discomfort; skin rubbing, chafing or breaking down; difficulty doffing and
donning; poor fit; restricted choice of clothes and shoes, and excessive rigidity and bulkiness
making it difficult to fit in to shoes and cumbersome to wear. Where differences between groups
were found, participants tended to view the off-the-shelf AFOs more positively.
Conclusion
Patient satisfaction with AFOs is sub-optimal. Further research is needed to develop AFOs that
meet patients’ needs
WCNR-0192
BOARD NUMBER: 039
FALLING AFTER STROKE: HOW IS IT RELATED TO QUALITY OF LIFE?
E. van der Kooi1, S. Schiemanck2, F. Nollet1, G. Kwakkel3, J.W. Meijer4, I. VAN DE PORT4
1Academic Medical Centre- University of Amsterdam, Rehabilitation, Amsterdam, Netherlands
2Leiden University Medical Centre, Rehabilitation, Leiden, Netherlands
3MOVE Research Institute AmsterdamVrije Universiteit Medical Center and Department of NeurorehabilitationReade Center for Rehabilitation and Rheumatology, Neurorehabilitation, Amsterdam,
Netherlands
4Revant, Rehabilitation, Breda, Netherlands
Aims
To evaluate the impact of falling on health related quality of life (HRQoL) in the subacute phase
after stroke during outpatient rehabilitation.
Method
A total of 199 patients with stroke were included after discharge home after inpatient rehabilitation
in nine rehabilitation centers in the Netherlands. At inclusion participants needed to be able to
walk 10 meters independently and they all needed further neurorehabilitation and specifically
physiotherapy. They were measured at discharge and 12 weeks later. Primary outcome was the
difference in Stroke Impact Scale (SIS)-16, the physical domain of the SIS. Falling was
determined by using a falls dairy. Participants were classified as fallers if they reported one or
more falls during these 12 weeks. The impact of falling on change in HRQoL was measured using
multiple regression analysis. Data were collected as part of the FIT stroke trial, a randomized
clinical trail (RCT) investigating the effect of circuit class training after stroke.
Results
Of the 199, 55 patients (28%) reported one or more fall(s) during 12 weeks of observation. Mean
age was 58 years, 63% was male and mean time after stroke was 94. Falling was negatively
associated with the change in HRQoL as assessed with the SIS-16 (p=0.008). Also after
correcting for potential confounders which were significantly different between fallers and non
fallers, ie Motricity Index and Mini Mental State Examination, and group allocation.
Conclusion
Almost 30% of our mildly impaired stroke population reported fall(s). Falling was significantly
associated with less improvement in the physical domain of HRQoL. Therefore, it is important to
identify patients at risk for falling and subsequently reduce falls. We are now developing a
treadmill based fall prevention intervention using perturbations which is studied in an RCT. In
April 2016 I will be able to present on this intervention as well.
WCNR-0141
BOARD NUMBER: 040
OBSERVED CHANGES IN UPPER EXTREMITY FUNCTIONAL CAPACITY AND DAILY
PERFORMANCE DURING OUTPATIENT OCCUPATIONAL THERAPY FOR PEOPLE WITH
STROKE
K. WADDELL1, C. Doman2, R. Bailey1, J. Moore2, C. Lang1
1Washington University, Program in Physical Therapy, St. Louis, USA
2Rehabilitation Institute of Chicago, Allied Health, Chicago, USA
Aims
To explore how upper extremity (UE) functional capacity and daily performance change during
the course of routine outpatient rehabilitation in individuals with stroke.
Method
Complete data were available for thirteen participants. UE motor capacity was measured with the
Action Research Arm Test (ARAT) and UE performance was measured using bilateral, wrist-worn
accelerometers. Measurements were taken at or near the start of therapy, every 10th visit or 30
days throughout the duration of services, and at discharge.
Results
Three patterns were observed:
(1) increase in ARAT scores and improved accelerometry profiles (n=2), (2) increase in ARAT
scores but no change in accelerometry profiles (n=4), (3) no change in ARAT scores or in
accelerometry profiles (n=7). The figure displays an example of second-by-second
accelerometry data for 24 hours for one participant with the second observed pattern. The
intensity of activity (Bilateral Magnitude, y-axis) and the contribution from each UE (Magnitude
Ratio, x-axis, negative and positive values reflect increased unaffected and affected UE activity,
respectively) do not change over time despite increased ARAT scores.
Conclusion
UE performance in daily life was highly variable, with inconsistencies between change in UE
capacity and UE performance. Measurement of UE capacity and performance are important
constructs to assess separately during rehabilitation.
WCNR-0095
BOARD NUMBER: 041
SINGLE TO MULTI-USER TELE-REHABILITATION SERVICE DELIVERY FOR ACQUIRED
BRAIN INJURY
P.L. Weiss1,2, R. Kizony1,2,3, S. Harel1, Y. Feldman1, O. Elion1, A. Obohov4, G. Zeilig4, M. Shani1
1Gertner Institute for Epidemiology and Health Policy Research, ReAbility Online, Ramat Gan,
Israel
2University of Haifa, Occupational Therapy, Haifa, Israel
3Sheba Medical Center, Occupational Therapy, Ramat Gan, Israel
4Sheba Medical Center, Neurological Rehabilitation, Ramat Gan, Israel
Aims
To present a retrospective study on clients with Acquired Brain Injury (ABI) enrolled in a telemotion-rehabilitation service program for 2 ≥ months.
Method
The Kinect-based ReAbility Online Tele-Motion system (Kizony et al., IJDHD, 13, 361-368.2014)
provides services ranging from full 1:1 synchronous care to interventions provided via other
paradigms when the client does not require 1:1 support (e.g., a clinician treats two clients
simultaneously or offline treatment for up to 45 min/day is supplemented with scheduled
synchronous sessions. The goal is to improve or maintain function of the weak upper extremity
for clients with ABI if they have intact sitting balance, mild-moderate upper extremity impairment,
mild cognitive impairment and Internet accessibility at home. They were evaluated prior to and
two months following the commencement of service with clinical assessments.
Results
Fifty-eight people (M ± SD = 56.4 ± 14.8 years, 72.4% with stroke) were included in the study.
Initially, most had intact or mild cognitive impairment, mild-moderate motor impairment but little
use of their weak upper extremity for daily activities. Forty-two clients underwent a second
assessment after two months. No adverse events were reported and client feedback showed that
they enjoyed the service. They had a significant improvement in their active movements of the
weak upper extremity as assessed by Fugl-Meyer Assessment (Fugl-Meyer et al., SJRM,7,13-31,
1975) and shoulder flexion and abduction range of motion.
Conclusion
The service appears to be feasible for people with ABI and effective in important clinical
outcomes related to improvements in upper extremity function.
WCNR-0068
BOARD NUMBER: 042
CONVENTIONAL PHYSIOTHERAPY VS VIRTUAL REALITY EXERGAMES IN SUBACUTE
PATIENTS UNDERGOING STROKE REHABILITATION IN A COMMUNITY HOSPITAL: THE
FIRST PILOT ASSESSOR BLINDED RANDOMIZED CONTROLLED TRIAL
L. Yong Joo1, Z. Shan Yong1
1Tan Tock Seng Hospital, Rehabilitation Medicine, Singapore, Singapore
Aims
The aim of this non-inferiority pilot assessor blinded randomized controlled trial is to compare
functional mobility gains after conventional physiotherapy vs after virtual reality exergames.
Method
60 suitable patients admitted for inpatient rehabilitation in a community hospital will be
randomized into 2 equal groups. Each group will undergo 3 weeks of additional mobility training,
with the conventional group having physiotherapy for 9 sessions, 3 sessions per week and 30
minutes per session and intervention group having the same intensity of virtual reality exergames.
Both groups will continue their daily customary individual or group physical therapy sessions.
Results
The primary outcome measure is 10 metre walk test to assess patients’ mobility status and
secondary outcome measures Berg Balance Test, Timed Up and Go Test and a questionnaire at
the end of the intervention on users’ experiences, attitudes, potential benefits and adverse effects
if any
Conclusion
The results of this study will help the investigators design further efficacy studies and conduct
multi-centre trials in other healthcare facilities. The objective data mining of individual diagnostics
will be refined for transition to home use with tele-rehabilitation capabilities. There is also vast
potential to extend to other functional and cognitive activities with specified exergames and
making it a cost-effective augmentative rehabilitation tool.
WCNR-0602
BOARD NUMBER: 043
TREATMENT/PHARMACOTHERAPY/FES
THE INVESTIGATION OF THE EFFECTS OF REFLEXOLOGY WITH
NEURODEVELOPMENTAL TREATMENT APPROACH ON GROSS MOTOR FUNCTION AND
CONSTIPATION CHILDREN WITH CEREBRAL PALSY
B. Elbasan1, S. Bezgin2
1Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, ANKARA, Turkey
2Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, KIRIKKALE,
Turkey
Aims
To investigate the effects of reflexology with neurodevelopmental treatment approach on gross
motor function and constipation children with cerebral palsy.
Method
Forty children,diagnosed with cerebral palsy between the ages 3- 15, whose gross motor function
classification system (GMFCS) levels are 3/4/5, took part in study. The participants randomly
divided two groups which contents 20 children. The first group took 45 minute sessions twice a
week for eight weeks. The program consist of neurodevelopmental treatment approach
physiotherapy sessions. The second group took 20 minute foot reflexology after the
physiotherapy program. Gross motor function assessed with gross motor function measure
(GMFM) and constipation with modified constipation assesment scale (MCAS) both before and
after the study.
Results
After the study significant positive changes were observed both of groups on gross motor
function. The change were not significiant between groups. Significant positive changes were
observed in the constipation scores in the group that took reflexology after the study (p<0,05). No
change in the group which treated only neurodevelopmental treatment on constipation (p>0,05).
Conclusion
It is concluded that neurodevelopmental treatment approach physiotherapy program is singlehanded effective on gross motor function on children with cerebral palsy. The result is
unprecedented contribution to the gross motor function however effective positively on
constipation reflexology.
WCNR-0304
BOARD NUMBER: 044
EFFECTS OF TRANSCUTANEOUS NEUROMODULATION OF THE POSTERIOR TIBIAL
NERVE ON DETRUSOR OVERACTIVITY: A RETROSPECTIVE STUDY
I. Fodor1
1, Lausanne, Switzerland
Aims
The aim of the study was to define the effect of transcutaneous neuromodulation of the posterior
tibial nerve on detrusor overactivity.
Method
After urodynamic and mictionary calendar, we taught patients affected by neurological diseases
to apply 1x/day, during a period of minimum 2 months, an electrostimulation device on their
posterior tibial nerve. This study is retrospective and based on 3 years.
Results
More than half of the patients described positive results. We noticed an improvement in their
bladder capacity and the micturition urgencies decreased. There is no visible change for patients
with important cognitive and/or too much sensitive impairments.
Conclusion
Transcutaneous neuromodulation of the posterior tibial nerve in detrusor overactivity is a good
alternative or an additional treatment to the actual solutions. It’s a non-invasive and nonexpensive therapy without side effect.
WCNR-0207
BOARD NUMBER: 045
ANALYSIS OF PHARMACOLOGICAL MANAGEMENT OF PAROXYSMAL SYMPATHETIC
HYPERACTIVITY (PSH) IN ACUTE BRAIN INJURY
K. Mitton1, M. Sivan2, K. Walton2
1, Manchester, United Kingdom
2Salford Royal NHS Foundation Trust, Rehabilitation Medicine, Manchester, United Kingdom
Aims
To analyse the pharmacological management of PSH in acute brain injury in a tertiary care
hyperacute neurorehabilitation unit.
Method
A retrospective case review of all consecutive admissions to the hyperacute neurorehabilitation
unit in a 2-year period was performed. All patients with a clinical diagnosis of PSH had
retrospective completion of the PSH – Assessment Measure that categorised symptom severity
as mild/moderate/severe and the likelihood of diagnosis as unlikely/possible/probable.
Pharmacological agents used in management were recorded. Average pharmacological dose
changes (APC) was defined as the number of pharmacological changes needed to achieve
symptom control.
Results
Out of the 173 cases reviewed, 19 patients (11%) were diagnosed with PSH. The mean age was
37 years (SD18).There were 12 males and 7 females.
PSH diagnostic likelihood was scored at: possible 6 patients (32%), probable 13 patients (68%)
and unlikely no patients. PSH clinical feature scale was scored as: mild – patients, moderate –
patients and severe – patients.
The mean APC was 4.7 (range 1 – 10). No significant correlation was found between APC and
PSH diagnostic likelihood score (Possible PSH 4.1 APC and Probable PSH 5 APC). In clinical
feature scale, severe PSH had higher APC than mild or moderate PSH (Mild 4 APC, Moderate
4.4 APC, Severe 6.2 APC).
Symptom control was achieved in 10 patients (53%) with a combination of Pregabalin and
Betablocker (Propanolol n=9, Atenolol n=1), 4 patients (21%) with Pregabalin alone, 2 patients
with Gabapentin alone, 1 patient with combination of Gabapentin and Propanolol, 1 patient with
Propanolol alone and 1 patient with Oxycodone alone.
Conclusion
Symptom control in severe PSH involves greater number of changes in agents and/or doses
when compared to mild or moderate PSH. The combination of Pregabalin and Propanolol was the
most effective management to achieve symptom control in this cohort of patients.
WCNR-0091
BOARD NUMBER: 046
BASIC SCIENCE
THE COOKING TASK: MAKING A MEAL WITH COGNITIVE DEFICITS
L. Barker1, T. Doherty1, R. Denniss1, A. Jalil2, M. Beer2
1Brain Behaviour and Cognition Group, Department of Psychology- Sociology and PoliticsSheffield Hallam University, sheffield, United Kingdom
(2Communication and Computing Research Centre (CCRC), Sheffield Hallam University,
Sheffield, UK
Aims
The act of cooking a meal requires several cognitive functions including multitasking, planning,
sequencing, prospective memory, and maintaining and completing sub-goals and overall goals
within a defined timeframe. These (executive functions) are often diminished after brain injury.
Cooking can provide a sensitive and reliable measure of executive function ability in a ‘real-world’
context. However, ‘real’ cooking tasks require elaborate setup, are time consuming and require
ongoing monitoring of the individual’s progress that is not easily standardised, for later follow-up
or across group comparisons. Current standardized neuropsychological tests may fail to
accurately capture real-world executive deficits.
Method
We developed a computer-based Cooking Task (CT) assessment of executive functions based
on the cooking task developed by Craik and Bialystok (2006) and Kerr (1991), and trialed the
measure with a normative group before use with a head-injured population (Doherty, Barker,
Denniss, Jalil & Beer, 2015, Frontiers in Behavioral Neuroscience). Forty-six participants
completed the computerized CT and subtests from standardized neuropsychological tasks,
including the Tower and Sorting Tests of executive function from the Delis-Kaplan Executive
Function System (D-KEFS) and the Cambridge prospective memory test (CAMPROMPT), in
order to examine whether standardized executive function tasks, predicted performance on
measurement indices from the CT.
Results
Findings showed that verbal comprehension, rule detection and prospective memory contributed
to measures of prospective planning accuracy and strategy implementation of the CT. We also
found that functions driving cooking efficacy differed on the basis of task demands indexed by
levels of increasing difficulty on the CT.
Conclusion
The CT shows promise as an ecologically valid measure of executive function for future use with
a head-injured population and indexes selective executive functions captured by standardized
tests. The task was winner in a recent Medipex NHS Innovation and Showcase Awards Mental
Health and Wellbeing category (2015).
WCNR-0113
BOARD NUMBER: 048
BASIC SCIENCE
GESTURE PRODUCTION IN APHASIC PATIENTS
N. Eggenberger1, B. Preisig1, R. Müri1
1Perception and Eye Movement Laboratory, Neurology and Clinical Research, Bern, Switzerland
Aims
Aphasia – an acquired impairment in speech production and / or comprehension – is a common
consequence after left hemispheric brain damage (e.g. stroke). The influence of aphasia on
gesturing as means of nonverbal communication remains unclear. Some aphasic patients use
gestures as a compensation for impaired verbal capacities, however, in others, the gestural
outputs seems to parallel the language disorder, leading to impaired gesturing. In the present
study, we tested spontaneous gesture production in aphasic patients in different conditions.
Method
25 aphasic patients and 25 matched healthy controls participated in this study. Participants
watched video excerpts in two conditions: either action-loaded (e.g. a cartoon sequence with
characters chasing each other) or language-loaded (e.g. an excerpt from a talk show with several
interlocutors discussing an abstract topic). After watching each sequence, participants were
asked to retell it to the experimenter while being videotaped. All gestures produced by the
participants were recorded and coded by means of an adapted version of McNeill’s gesture
classification system.
Results
On a quantitative level, repeated measures ANOVAs revealed that patients did not gesture more
or less compared to controls. Looking at qualitative aspects, however, patients produced more
semantic gestures compared to controls, while controls displayed more (self-)regulatory gestures.
Within the patient group, we found that overall, more gestures were produced in the action-loaded
condition compared to the language-loaded condition. Furthermore, in the action-loaded
condition, patients displayed more semantic gestures compared to the language-loaded
condition.
Conclusion
Gesturing in aphasic patients did not quantitatively differ compared to controls, but patients
produced different gestures. While controls used gestures primarily to regulate themselves,
aphasic patients displayed more representational and semantically meaningful gestures,
particularly when retelling action-loaded contents. We interpret these preliminary results in terms
of compensational mechanisms for impaired verbal capacities in aphasic patients.
WCNR-0202
BOARD NUMBER: 049
BASIC SCIENCE
DOES HAVING ACCES TO EARLY NEUROREHABILITATION IN A NEURO INTENSIVE
STEPDOWN UNIT (NISA) INFLUENCE THE PROGNOSIS OF PATIENTS WHO HAVE
EXPERIENCED SEVERE BRAIN INJURIES
M. From1, M. Hoff1
1regional hospital off Silkeborg, Neuro Intensive Step Down unit, Silkeborg, Denmark
Aims


To ensure the best possible prognosis for severely brain-damaged patients
To reduce complications related to patient immobility and critical illness
Method
Patients are assessed and referred by HNC. The NISA patients are generally unstable and
require respiratory assistance/intensive care and have severe brain injuries.
The multi-disciplinary team work together using their combined field specific knowledge and skills
to continuously monitor, observe and evaluate the patient and their progress.
The patient’s family/support network will need to be incorporated into the patient’s care as their
involvement increases patient confidence and provides support with the neurorehabilitation
therapy.
The observations are supported by scores. RLAS used to assess cognitive function. (2) In
addition, the FIM, EFA, fois, GOS-E and ABS to assess the patient's development.
Scores are made interdisciplinary to achieve the most valid results, the basis for future planning.
Rehabilitation is expected to take place 24-7 if the patient's condition allow it.
Results
It is difficult to measure the effect the NISA model of care has on the prognosis of a brain injury
patient.
A retrospective survey was carried out in 2012, unfortunately no clear results where able to be
obtained to ascertain whether the NISA model of care affects the prognosis of brain injury. This is
because the two groups of patients sampled had different levels of severity in regards to their
brain injuries. The NISA patients had suffered more severe brain injuries (4).
Conclusion
It is the assumption that patients did benefit greatly from the early neurorehabilitation, but it is
difficult to provide quantifiable indicators for this. This is because it would be ethically
irresponsible to do a randomized study. There is a need for further studies to describe research
areas for the comparison of the patient's progress through NISA, opposite scenario without the
NISA to HCN.
WCNR-0228
BOARD NUMBER: 050
BASIC SCIENCE
FORMATION OF COGNITIVE FUNCTION IN CHILDREN AFTER MILD TRAUMATIC BRAIN
INJURY
S. Pervichko1, I. Gorina1, E. Fufaeva2, Y. Mikadze1, Z. Semenova2
1Lomonosov Moscow State University, Psychology, Moscow, Russia
2Clinical and Research Institute of Emergency Children's Surgery and Trauma, Neurosurgical,
Moscow, Russia
Aims
This work focused on study of the violations and a follow the dynamics of recovery of higher
mental functions (HMF) after mTBI through the lens of neuropsychological syndrome / symptom
in the range of up to six months in adolescents 10-14 years.
Method
The research was conducted by using the Luria method of neuropsychological syndrome
analysis, aimed at complex research cognitive, structural and dynamic components of HMF. The
experimental group consisted of 31 adolescents with mTBI, which examined three times (at 3-5
days after injury, 1 month, 6 months). The control group consisted of 20 healthy adolescents 1014 years with good academic performance and without CNS pathology.
Results
Analysis of the results indicated that violations of HMF in the acute period were represented by
three types of syndromes in which the leading place occupied by non-specific symptoms of
deficiency of brain structures, especially the lower parts of the trunk. Although violations of HMF
were not generally rough nature, is necessary to note that with the growth of the severity of
functional deficiency of the trunk-diencephalic brain structures observed involvement in the
pathological process of cortical regions of the hemispheres, mainly the front. Study of the
dynamics recovery HMF showed that for the first month there is a reduction of symptoms
belonging primarily to the deficiency of the parietal-temporal-occipital area, as well as a range of
symptoms from the front of the brain. Six months following TMI of mild severity leveling of all
observed symptoms of cortical structures, but the symptoms persist in the form of fatigue,
reducing the rate of mental activity, difficulty concentrating, which once again demonstrates the
continued dysfunction of stem-diencephalic structures.
Conclusion
Thus, the current data indicate the presence of so-called "nuclear" neuropsychological symptom,
most of whose components is stored in adolescents distant from TBI in life.
WCNR-0674
BOARD NUMBER: 051
BASIC SCIENCE
Assessment of interhemispheric cooperation in language functions during the
performance of verbal cognitive tasks with the use of blood flow velocity indicators
E. Lysenko1, Y. Mikadze2, M. Bogdanova3, S. Abuzaid4, A. Shakhnovich4
1Lomonosov Moscow State University, Faculty of Psychology, Moscow, Russia
2Lomonosov Moscow State University- Pirogov Russian National Research Medical University,
Faculty of Psychology, Moscow, Russia
3Center of Speech Pathology and Neurological Rehabilitation, Children's department, Moscow,
Russia
4Burdenko Neurosurgery Institute, Pathology of cerebral vasculation, Moscow, Russia
Aims
There are preliminary results of the research which devoted to identification the interhemispheric
cooperation during the performance of different types of verbal cognitive tasks in auditory
modality in healthy subjects and patients with brain lesions.
Method
The aim of the experiment was to analyze the effect of interhemispheric cooperation during the
memorizing and then recognizing cognitive tasks (concrete nouns, abstract nouns, verbs) which
presented in auditory modality to healthy subjects. Then to select the most effective one to apply
it to group with organic brain lesions. The study involved 20 healthy right handed subjects and 20
patients with unilateral organic brain lesions (tumors) - 10 in left hemisphere and 10 in right
hemisphere.
Results
The results showed the blood flow velocity increases in left and right hemispheres
simultaneously. All types of cognitive tasks demonstrated statistically significant changes in blood
flow velocity during their performance with most increased in arteries of left hemisphere. This
effect showed expressed cooperation of two hemispheres for all types of verbal cognitive tasks.
At the same time the highest blood flow velocity indicators both in left and right hemispheres were
observed while performing tasks with concrete nouns in healthy subjects. So, this type of
cognitive task was selected to apply it to patients to understand if the tendency of increased blood
flow velocity the same or not.
Conclusion
There were observed the same tendency of increased blood flow velocity in healthy group and in
patients with brain organic lesions during the performance the task with concrete nouns, but the
indicators between groups were different.
The study performs with the support of Russian Humanitarian Scientific Fund (project № 15-0610636 “The research of functional specialization of brain hemispheres with the use of
neuropsychological and ultrasonic methods in norm and pathology”)
WCNR-0039
BOARD NUMBER: 052
BASIC SCIENCE
UTILITY OF NEUROPSYCHOLOGICAL ASSESSMENT & REHABILITATION IN
NEUROLOGICAL CONDITIONS: AIIMS EXPERIENCE
A. Nehra1
1ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi, India
Aims
(1) the role and importance of neuropsychological assessment in neurological conditions
including stroke, dementia/pseudo-dementia; Traumatic Brain Injury, Epilepsy & Subarachnoid
Haemorrhage and other neurological conditions (e.g. assessment of aphasia & hemi-neglect,
cognition, intellectual ability along with other behavioral and ADLs, etc).
(2) To discuss neuropsychological rehabilitation procedure and its effectively
Method
The assessments are patient specific, localized & lateralized depending upon severity of the
injury, dominant & non dominant hemisphere. All the assessment procedures follow flexible and
fixed approach depending upon the patients needs & neuropsychologist training and
competence. The neuropsychological rehabilitation procedure where restorative &
compensatory techniques are used following an eclectic approach, depending upon patient’s
strengths & weaknesses, at home- based, computer based and hospital based level to help a
patient acquire the knowledge and skills needed for optimal physical, psychological, vocational,
cognitive and social functioning. CNP, Neuro Sciences Centre, AIIMS, New Delhi, India, is using
evidence based assessment and rehabilitation techniques (using A-B-A format) based on national
& international literature.
Results
The interventions done on various neurological conditions have shown their effectiveness in
improving the Neuropsychological functioning and quality of life, AIIMS, New Delhi, India,
experience will be discussed. Neuropsychological rehabilitation has also helped in ameliorating
the co-morbid conditions e.g. depression, post concucussive syndrome, anxiety and improvement
in social, vocational, personal wellbeing.
Conclusion
Clinical Neuropsychology is a super- specialization which is grounded in
the neurosciences with a strong focus on evidence-based practice including diagnostics (using
standardized tests), prognostics and interventions for various neurological conditions. In India it is
a challenge evaluating patients with diverse languages and mixed educational status (low literate
to highly literate). The paper would also highlight personal experiences in sharing the knowledge
about intervention results, which would strengthen the interdisciplinary approach in healthcare
sector lending to a better and improved quality of life of patient populations, worldwide.
WCNR-0684
BOARD NUMBER: 053
BASIC SCIENCE
Transcranial Direct Current Stimulation in Post Stroke Aphasia: Unpacking spontaneous
speech
C. NORISE1, D. Sacchetti1, R. Hamilton1
Aims
Emerging evidence suggests that transcranial direct current stimulation(tDCS) can improve
aspects of language production in persons with chronic non-fluent aphasia due to left hemisphere
stroke. We previously reported a study in which tDCS was employed to improve spontaneous
speech and reduced overall aphasia severity in post-stroke aphasic patients (Shah-Basak et.al.,
2015). This current study aims to elucidate whether there are specific elements of spontaneous
speech that can be identified to drive language recovery.
Method
We report eight patients who demonstrated deficits in fluency as assessed using the Cookie Theft
picture description task of the Boston Diagnostic Aphasia Examination. In the treatment condition,
subjects received a 2.0mA current through 5cmx5cm electrodes for 20min at a site previously
shown to elicit a patient-dependent optimal response to tDCS. They were then tested 2-weeks
and 2-months after treatment. In the sham condition, a subset of these subjects were tested on
the same protocol with sham instead of real tDCS.
Results
For measures of fluency, including the usage of hesitation markers, extraneous words, speech
errors, pause rate and speech rate, subjects improved 2months after tDCS. However, these
improvements were not observed in the sham stimulation condition. Additionally, we found that
improvements in spontaneous speech are driven by multiple factors.
Conclusion
The results suggest that tDCS of an individually predetermined optimal site may improve
language fluency in patients with chronic non-fluent aphasia, and that these benefits may persist
after discontinuation of tDCS treatment. Distinguishing which factors of spontaneous speech are
enhanced, allows us to better characterize the pattern of language response after tDCS.
WCNR-0382
BOARD NUMBER: 054
BASIC SCIENCE
ARCS: ASSESSMENT AND RECOVERY OF COMPREHENSION POST STROKE
H. Robson1, T. Griffiths2, M. Grube2, A. Woollams3
1University of Reading, Clinical Language Sciences, Reading, United Kingdom
2Newcastle University, Institute of Neuroscience, Newcastle, United Kingdom
3University of Manchester, School of Psychological Sciences, Manchester, United Kingdom
Aims
WA is thought to manifest in approximately 20% of acute aphasia and 5% of chronic aphasia
cases (Pedersen, et al., 2004). Recent investigations in chronic WA have found a relationship
between the language comprehension impairment and phonological and auditory processing
impairments (Robson, et al., 2014; Robson, et al., 2013). This study explores whether factors
associated with chronic WA auditory comprehension impairments predict or support recovery
from the acute phase.
Method
Twelve individuals with acute WA and 8 individuals with chronic WA were recruited from hospitals
in South England. All participants underwent a battery of neuropsychological assessment
including:
Language: single word comprehension, repetition and reading aloud.
Auditory-phonological processing: word, non-word and pure tone discrimination, frequency
modulation and dynamic modulation detection
Cognitive-semantic processing: nonverbal reasoning, nonverbal semantic association and
phonological short term memory.
Participants with acute aphasia were assessed at three time points post-stroke: T1: 2.5months,
T2: 5 months and T3: 9 months. Individuals with chronic aphasia were assessed once (min 12
months post onset).
Acute and chronic participants were compared across all measures using t-tests. Cross-lagged
correlations were used to explore the relationship between language comprehension at T2 and
T3 and neuropsychological measures at T1 and T2.
Results
Individuals with acute and chronic WA did not significantly differ on measures of language
comprehension but individuals with acute WA were significantly better at non-verbal auditory
processing (dynamic modulation detection, t(19) =-3.6, p=0.002, Figure 1) and verbal auditory
discrimination (t(18)=3.4, p=0.003).
Single word comprehension at T3 showed a boarderline relationship with word discrimination at
T1 (Spearmans rho = 0.64, p=0.09).
Figure 1
Conclusion
Despite similar levels of auditory comprehension impairment, individuals with acute and chronic
aphasia show differences in underlying neuropsychological profile. A limited relationship between
speech perception at an acute stage and language comprehension at a chronic stage is
observable.
WCNR-0201
BOARD NUMBER: 055
BASIC SCIENCE
BEWARE..CAN CHRONIC ALCOHOLISM LEAD TO COGNITIVE DECLINE..?
P. Sawant1, P. Gokhale2
1Kokilaben Dhirubhai Ambani Hospital, Physical medicine and Rehabilitation, Mumbai, India
2Vasant Vihar Counselling Centre, Occupational Therapy, Mumbai, India
Aims
Chronic Alcoholics suffer from cognitive impairment,thereby affecting their ADL and work
performance. The objective was to screen chronic alcoholics for cognitive impairment &
assessing affectations in various components of MoCA. Early screening to help them from further
deterioration in ADL and work.
Method
In this case control study, 50 Chronic Alcoholics, Males, age group 30-50 years, abstaining for
more than two months, referred to outpatient De-addiction Occupational Therapy department of
K. E. M Hospital, Mumbai were screened using MoCA (Hindi)&compared with their age matched
control group.
Results
All patients showed mild cognitive impairment on MoCA; irrespective of pattern and frequency of
drinking. Their average mean score in MoCAin test and control group was 21.02and 26.03
respectively.The domains more affected were language, abstraction and memory; thus affect
their performance in ADL and work. Results were analysed using Unpaired 't' test and were
statistically significant at the level of P<0.05 and 95% Confidence level.
Conclusion
Screening of Chronic Alcoholics using MoCA showed mild cognitive impairment with varying
degree of affectations in the sub components of the test.
WCNR-0401
BOARD NUMBER: 056
BASIC SCIENCE
VISUAL ATTENTION REDIRECTION DISRUPT SACCADIC PERFORMANCE
J. Torres1, P. Maldonado2
1BNI- Faculty of Medicine- Universidad de Chile, Physical Therapy Department, Santiago, Chile
2ICBM- BNI- Faculty of Medicine- Universidad de Chile., Physiology and Biophysics, Santiago,
Chile
Aims
Some neurological conditions show associated disorders of eye movements, which negatively
impact on perceptual, attentional and motor skills. In the present pilot study, we aimed to examine
the functional relationship between saccadic accuracy and the orienting of attention during a task
that requires visual redirection during a saccade execution.
Method
Fifteen healthy subjects (8 males) performed a dual task in order to track the location of an
attentional focus by discriminating the identity of a peripheral target which is indicated by a central
cue, while they have to perform a saccade to a target that is indicated by the color and direction
of the same central cue (figure). Saccade targets are directed towards the same location of the
primary task (congruent trials), or to a neighboring site (incongruent). 25% of the trials were
“invalid” because we presented the discrimination target on the opposite side of the one indicated
by the central cue. The saccade has to be withheld for a variable time until a GO signal appeared.
Results
We found significant differences in saccadic performance between invalid trials, depending if the
trial was congruent or incongruent. Invalid-congruent trials showed significant higher percentage
of hits to the cued location (39.32%, SD 19.84) versus invalid-incongruent trials (22.9%, SD
10.27), (p=0.03; F= 4.62).
Conclusion
These results suggest that during invalid trials, the absence of the discrimination target in the
cued side triggers an attentional reorienting, interfering the execution of the current saccade.
However, oculomotor programs can resist changes in spatial attention when saccade is directed
to the same location than the potential discrimination target (congruent trials). The existence of
shared resources between attentional orienting and oculomotor planning could explain this
phenomenon, causing structural interference between these two processes when attention is
reoriented.
WCNR-0671
BOARD NUMBER: 057
BASIC SCIENCE
Cognitive decline and associations with personality traits among independent elderly
A. WALDMAN-LEVI1, A. Bar Haim Erez2, J. Stancanelli3, N. Katz4
1, Cresskill, USA
2Ono Academic College, Occupational Therapy, Kiriat Ono, Israel
3Mercy College, Occupational Therapy, Dobbs Ferry, USA
4Ono Academic College, The Research Institute for the Health Professions, Kiriat Ono, Israel
Aims
Background and aims: The intersection of neurological function and affective goals in aging
indicates that cognitive functions are critical factors in promoting emotional wellbeing (WB) and
participation later in life. However, it is imperative to gain a broader perspective of the potential
effect of personality traits, such as, sense of hope and playfulness on healthy aging.
Method
Method: The study is cross-sectional and cultural with connivance sampling of 81 independent
elderly who live in the community, 57 resided in Israel and 24 in the US (at this point).
Instruments included: participation (RNL); wellbeing (PWI); playfulness (APTS); hope (AHS);
emotional status (PHQ); and cognitive status (MoCA).
Results
Results: Although data was collected from elderly who live independently in the community we
found variability in cognitive status, 56.8% showed mild cognitive impairment (MCI) and 16%
showed significant decline. Individuals with cognitive decline (mild and moderate) were older,
more depressed, less satisfied with life and reported decrease in participation in activities of daily
living, as compared with elderly with intact cognitive status. ANOVA model was significant for
participation and WB. A non-parametric analysis of correlations between participation and WB to
Hope and Playfulness for each cognitive group separately, revealed significant correlations
between WB and sense of hope in the intact group; between sense of hope and participation and
WB for the MCI group (p<0.05); no correlations were found for the impaired group.
Conclusion
Conclusions: In this cross-cultural study of independent elderly we found that both participation
and WB were negatively affected by a person’s cognitive decline. Worth noting is the possible
role of sense of hope to level of participation and WB. It appeared that elderly with intact cognition
or those with a mild cognitive decline, had a better sense of hope, were more engaged in the
community, and felt satisfied in their life.
WCNR-0550
BOARD NUMBER: 058
DIAGNOSIS
ELECTROMYOGRAPHY REFERRAL PATTERN: PILOT STUDY FROM THE FIRST CENTER
FOR NEUROREHABILITATION IN EAST, WEST AND CENTRAL AFRICA
P. Adebayo1, M. Owolabi2, O. Ogunremi3
1Ladoke Akintola University/WFNR_Blossom Medical Centre, Faculty of Clinical Sciences,
Ogbomoso, Nigeria
2University of Ibadan/University College Hospital/WFNR-Blossom Medical Centre,
faculty of Clinical Sciences/Department of Medicine, Ibadan, Nigeria
3Monitor Healthcare Limited, Clinical Services, Lagos, Nigeria
Aims
Electromyography (EMG) is one of the diagnostic tools most commonly requested in neurology. It
is important for the assessment of muscles, peripheral nervous system as well as neuromuscular
junction disorders. EMG laboratories in Nigeria are few. In May 2014, EMG services were
introduced to the WFNR/Blossom Medical Centre by the Monitor Healthcare Clinical Service Unit.
This study aims to determine the 18 months (May 2014-October 2015) referral pattern for a new
EMG service at WFNR/Blossom Medical Centre,Nigeria.
Method
Data of consecutive patients who underwent EMG for the first time at the WFNR/Blossom
Medical Centre were retrospectively analysed. Direct referrals to the electromyographer were
also included. Patients demography, type of referring physician, suspected diagnosis,
congruence of clinical and electrophysiological diagnosis as well as need for neurorehabilitation
were reviewed and analyzed
Results
Thirty-four referrals were received during the period in review (referral rate < 2 /month).The mean
age ± SD of the patients was 43.12±15.54. Male: Female ratio; 1.13:1. Twenty-five (73.5%) of the
referrals were from neurologists while the other referrals were either from orthopaedic surgeon or
other specialist. Polyneuropathy was the commonest referral diagnosis 8(23.5%), 5(14.7%) did
not have a referral diagnosis, 4(11.7%) had mononeuropathies, 5(14.7%) had myopathies,
2(5.8%) had myasthenia gravis. The clinical diagnosis was congruent with electrodiagnosis in 19
(55.8%) patients while it was incongruent in 15(44.1%). EMG provided additional prognostic
information for two patients with Bell’s palsy. EMG referral was appropriate in 33(97.0%) patients.
Thirty patients (88.2%) needed neurorehabilitation.
Conclusion
Referral rate to this new EMG service is low and they are predominantly from neurologists. More
than half of the patients had their diagnosis confirmed by EMG while a new diagnosis was
provided in the rest. The referrals were largely appropriate. Education of primary care providers
and other healthcare professional on the usefulness of EMG should be reinforced.
WCNR-0620
BOARD NUMBER: 059
DIAGNOSIS
STAR PROTOCOL -A DIAGNOSTIC TOOL FOR PROLONGED DISORDER OF
CONSCIOUSNESS (PDOC)
M.A. Ali1, D. Badwan2, V. Stokes1
1Central England Rehabilitation Unit, Neuro-Rehabilitation, Leamington Spa, United Kingdom
2Central England Rehabilitation Hospital, Neuro-rehabilitation, Leamington Spa, United Kingdom
Aims
To develop a protocol for performing the STAR (Sensory Tool for the Assessment of
Responsiveness) assessment for establishing the level of awareness in individuals diagnosed
with an acquired brain injury resulting in a low level arousal .
Method
We as a Multidisciplinary team at CERU extended our Sensory Stimulation Assesent Programme
(SSAP) , which was originated at CERU in 1992 previously known as Royal Leamington Spa
Regabilitation Hospital (RLSRH) and incorporated this SSAP with a Modality Focussed Patient Centred Assesment Programme (MFPCAP) which allows the multidisciplinary team to tailor
assessment stimuli bespoke to each Client. The programme provides various forms of stimuli
(e.g, visual, auditory and tactile stimuli ) on a daily basis in order to provide multiple opportunities
to stimulate responses. It also allows for further opportunities I.e cause/effect switch activation to
be explored. Thus STAR provides us an accurate record of behaviours to inform diagnosis of a
disorder of consciousness and establish any means of communication with the client.
Results
STAR Assesment for three sensory modalities ; auditory, visual and motor functions , in addition
to communication and emotional responses administered in a hierarchical order, reflexive ,
withdrawal,brief localisation , localisation and discrimination , distinguishing the level of responses
expected in each condition , I.e, vegetate time state (VS), minimally conscious state (MCS) and
emerging from the minimally conscious state (EMCS).
Conclusion
Thus STAR , Sensory Tool for the Assessment of Reponsiveness Protocol at CERU which
comprises of a total 10 week programme with STAR assessments initilly followed by an initial
diagnosis, with a written report/review with a Multidisciplinary Team Approach followed by a
Modality Focused Patient Centred Assessment Programme (MFPCAP), followed by
reassessments finally leads to MDT confirmation of diagnosis in Prolonged Disorder of
Consioussness (PDOC) .
WCNR-0209
BOARD NUMBER: 060
DIAGNOSIS
PHYSICAL HEALTH IN THE FIRST 5 YEARS AFTER MODERATE-TO-SEVERE TRAUMATIC
BRAIN INJURY
N. Andelic1, P.B. Perrin2, M.V. Forslund1, H.L. Soberg1, S. Sigurdardottir3, U. Sveen1, T. Jerstad4,
C. Roe1
1Oslo University Hospital- Ulleval, Dept. of Physical Medicine and Rehabilitation, Oslo, Norway
2Virginia Commonwealth University, Department of Psychology, Richmond, USA
3Sunnaas Rehabilitation Hospital Trust, Research Department, Nesoddtangen, Norway
4Oslo University Hospital- Ulleval, Department of Neuroradiology, Oslo, Norway
Aims
Because of the paucity of research examining the longitudinal trajectories of health related quality
of life (HRQL) after traumatic brain injury (TBI) and its physical components, this study
investigated the trajectories of physical HRQL in patients with moderate-to-severe TBI through 1,
2, and 5 years post-injury.
Method
A longitudinal cohort study was conducted with 97 individuals with moderate-to-severe TBI
(Glasgow Coma Scale score 3-12) who had been admitted to a Trauma Referral Centre in
2005/2007. Patients were followed up at 1, 2 and 5 years post-injury. Physical HRQL (i.e.,
physical health) was measured by four subscales of the Medical Outcomes 36-Item Short Form
Health Survey (SF-36): Physical Functioning, Role - Physical, Bodily Pain and General Health.
Four hierarchical linear models (HLMs) were performed to examine whether linear trajectories of
Physical HRQL could be predicted by: time, gender, age, relationship status at admission,
education, employment status prior to admission, occupation prior to admission, acute GCS
score, cause of injury, length of post-traumatic amnesia (PTA), CT head Marshall score, and
Injury Severity Score (ISS).
Results
Only the Physical Functioning domain showed statistically significant improvements across time
(p=0.006). Women had lower scores on Role - Physical, Bodily Pain (more pain) and General
Health (p= 0.014, p= 0.043 and p= 0.037, respectively). Unemployment prior to injury was
associated with lower Physical Functioning (p=0.014) and General Health (p<0.001), while
greater TBI severity was associated with lower Physical Functioning (p=0.049), but better Role Physical (p=0.020).
Conclusion
Bodily Pain, Role - Physical and General Health remained fairly stable over time, despite the
improvement in Physical Functioning. There were a number of significant injury-related and
demographic predictors across the four trajectories of physical health. A better understanding of
factors influencing these domains over the first five years after TBI and effective pain reducing
rehabilitation strategies are needed.
WCNR-0579
BOARD NUMBER: 061
DIAGNOSIS
IS AGE AN FACTOR IN THE OCCURANCE OF SPATIAL NEGLECT AFTER TBI?
P. Chen1, I. Ward2, K. Hreha2
1Kessler Foundation, Research, West Orange, USA
2Kessler Institute for Rehabilitation, Clinical Research, West Orange, USA
Aims
To explore the effect of age on the prevalence of spatial neglect following traumatic brain injury
(TBI) in the setting of an inpatient rehabilitation facility. In this secondary analysis of published
data, we examined the prevalence of spatial neglect across different age groups.
Method
The sample’s age spanned over 75 years, from 19 to 93 years old. Thus, we separated patients
into three groups using 25 year increments: 19–43 (n=28); 44–68 (n=46); 69–93 (n=82).
Following the same criteria used in the published study, patients who had a positive score on the
Catherine Bergego Scale or an abnormally biased left-versus-right omission on the Star
Cancellation test were considered having spatial neglect.
Results
17.9% of the youngest group, 23.2% of the mid-age group, and 35.4% of the oldest group had
spatial neglect. However, the 2x3 Exact Test revealed no significant difference among the three
age groups (p = .204). Post hoc logistic regression using age as a continuous variable to predict
the presence of spatial neglect also showed results not reaching significance: odds ratio of age =
1.02 (SE= .01, 95%CI=[1.00, 1.03], p= .093).
Conclusion
When our manuscript was reviewed for journal publication (Chen et al., Neurorehabil Neural
Repair, 2015), one critique was about the age (median= 69.5 years; IQR= 50-81) of our sample. It
was older than the mean age reported in the TBI Model Systems (mean age = 40.8 years, who
received inpatient rehabilitation). Although there was a trend suggesting a positive association
between age and the presence of spatial neglect in the TBI population, our data did not provide
conclusive information. Nonetheless, spatial neglect occurred in 17.9% of the youngest group
(similar to the age of the TBI Model Systems), which calls for attention on systematic assessment
and treatment for spatial neglect in inpatient rehabilitation.
WCNR-0585
BOARD NUMBER: 062
DIAGNOSIS
THE SUBJECTIVE EXPERIENCE OF MILD TRAUMATIC BRAIN INJURY IN PEDIATRIC
PATIENTS
R. Clair1, S. Allen1, K. Tresco1, M. Henigan1
1Philadelphia College of Osteopathic Medicine, Psychology, Philadelphia, USA
Aims
Mild Traumatic Brain Injury is a neurologic insult that impacts a child’s functioning across
domains. Risk factors include previous concussion history, force of impact, and gender. Current
research regarding return to school following a brain injury suggests the need for
accommodations in a number of areas of learning including changes in schedule, reduced
exposure to screens and text, limitations to classroom expectations for tasks such as reading and
note-taking, and modified testing. A one-size-fits-all approach to accommodations is problematic
as recovery rates vary widely. Studies have also suggested that mood symptoms are comorbid
with concussion recovery. Further, pediatric concussion patients who suffer from anxiety and
depression symptoms while recovering may have extended recovery periods with more
debilitating symptoms. Students must balance their recovery, school demands, and changes in
their activities. School professionals are often uncomfortable managing students with brain
injuries leading to further stress for the recovering student.
Method
This study sought to explore patient perspectives regarding return to learning and functional
activity. Participants included pediatric patients seeking treatment at a regional concussion clinic.
Seventy participants have submitted data, with data collection ongoing. A patient recovery profile
was compiled including perspectives on the level of disruption the brain injury has caused to
learning, social interactions, and activities. The patients completed a survey with a 6 point Likert
scale at each visit.
Results
The extent to which the concussion was impairing, concerns with post injury recovery, support
from school, and the impact of the concussion on mood was analyzed. The impact of gender,
age, and time post injury on recovery profile were also explored.
Conclusion
Variables related to the level of disruption by the concussion and perception of school support
were related to perception of impairment. Concussion impacts mood, cognition, social interaction,
and sense of efficacy.
WCNR-0632
BOARD NUMBER: 063
DIAGNOSIS
INABILITY TO REWEIGHT SENSORY INFORMATION REDUCES POSTURAL BALANCE IN
PATIENTS WITH MULTIPLE SCLEROSIS
B.A. Da Fonseca1, C.B. Pereira1, D. Callegaro1
1University of São Paulo Medical School, Department of Neurology, São Paulo, Brazil
Aims
Balance and mobility limitations are a hallmark of patients with multiple sclerosis (PWMS),
independent of disability level. Adequate balance relies on accurate perception of sensory
information by somatosensory, vestibular and visual inputs. The process of adjusting the sensory
contributions to postural balance is referred to as sensory reweighting; this means that when one
sensory cue is absent or inappropriate, the Central Nervous Systems (CNS) uses other more
reliable cues. Thus, our aim was to investigate if PWMS can correctly reweight sensory
information during different sensory conditions to maintain balance control.
Method
Methods: We evaluated 70 PWMS (EDSS 0 – 4.5). They were divided into two groups according
to their self-report about postural balance problem: without balance problem (w/oBP, n=38)
and with balance problem (wBP,n=32). We excluded patients with other neurological diseases,
dizziness, cognitive, vestibular and visual impairment. Balance was tested with the modified
Sensory Organization Test (mSOT) of Computerized Dynamic Posturography, which was
developed to identify the relative contribution of the 3 main sensory systems involved in balance.
Statistical analysis was performed by the Mann-Whitney test, Kruskal Wallis test and logistic
regression, as appropriate.
Results
Results: EDSS was significant different between groups (p<0,01), wBP group showed poorer
balance performance across all conditions tests with significant group differences (p<0,01).
Conclusion
Conclusion: Inefficient central processing and integration of sensory input may contribute to poor
balance in MS, probably due to MS-related lesions in the cerebellum and brainstem, leading to
difficulties in the integration of sensory inputs. SOT allows us to detect patients with imbalance
and those unable to reweight sensory inputs when environment changes. It is important for
physicians and rehabilitation professionals to understand the underlying sensorimotor
mechanisms related to postural instability and initiate appropriate evidenced-based treatments
that can improve balance and enhance quality of life in PwMS.
WCNR-0335
BOARD NUMBER: 064
DIAGNOSIS
LANGUAGE ASSESSMENT IN THE ACUTE PHASE OF POST-STROKE APHASIA
ASSOCIATED WITH CLINICAL OUTCOME
B. Glize1, M. Villain1, M. Vellay1, L. Richert2, I. de Gabory3, J.M. Mazaux1, P. Dehail1, I. Sibon3,
P.A. Joseph1
1University of Bordeaux, EA 4136, Bordeaux, France
2University of Bordeaux, ISPED, Bordeaux, France
3Bordeaux Universitary hospital, Stroke unit, Bordeaux, France
Aims
The aphasia recovery remains difficult to predict initially for the most severe cases. The aim of
this study was to determine whether some components of language evaluated in the acute phase
of stroke could be prognostic factors for aphasia recovery, and if these components could predict
the clinical pattern of aphasia in the chronic phase.
Method
All consecutive right-handed patients with aphasia, were included after a first stroke, lefthemisphere injured. Assessment performed at the acute phase: LAnguage Screening Test
(LAST) and Aphasia Severity Rating Scale (ASRS) of the Boston Diagnostic Aphasia
Examination (BDAE). Three months after: LAST, ASRS and BDAE. Good recovery was defined
as an ASRS score of 4 or 5.
Results
Eighty-six patients (21-92 years) were included. LAST Total, all the items of the LAST, and ASRS
were significantly associated with good recovery from aphasia at 3 months (p<0.01) for all
aphasic patients and for the most severe cases. In multivariable analyses including ASRS and all
the items of the LAST, LAST word repetition was significantly associated with good recovery for
patients with severe aphasia initially (OR=0.058, p<0.001). Furthermore, all the items of the LAST
assessed in the acute phase and the corresponding BDAE subtests assessed 3 months after,
were correlated (p<0, 01).
Conclusion
For patients with severe aphasia initially, the LAST word repetition seems to be even more
relevant than initial ASRS for predicting severity of aphasia 3 month after. Thus, the motor
component of aphasia (here LAST word repetition) seems to underscore the importance of
language deficit and it shows the importance of production systems in the recovery of language. It
is also interesting to note that the pattern of aphasia 3 months after a stroke could be defined by
the initial assessment.
WCNR-0337
BOARD NUMBER: 065
DIAGNOSIS
PREDICTING APHASIA RECOVERY WITH MOTOR EVOKED POTENTIALS
B. Glize1, M. Villain1, I. Sibon2, P. Dehail1, P.A. Mazaux1, D. Guehl3
1University of Bordeaux, EA 4136, Bordeaux, France
2Bordeaux Universitary Hospital, Stroke unit, Bordeaux, France
3University of Bordeaux, CNRS UMR 5293, Bordeaux, France
Aims
Aphasia is the main cause of communication disorders following stroke. The individual prognosis
of aphasia recovery remind difficult to establish in the acute phase. The aim of this study was to
investigate whether the motor evoked potentials (MEP) of the hand and the orbicularis oris in the
acute phase of stroke could predict aphasia recovery.
Method
This study is ongoing at the University Hospital of Bordeaux. All consecutive patients with
aphasia, first left hemispheric stroke confirmed by imaging, right-handed, non-demented, have
been proposed for inclusion. MEPs were collected after stimulation of M1 the abductor pollicis
and the orbicularis oris, right and left. The assessment of language performed in the acute phase
was composed of: Language Screening Test (LAST) and the aphasia severity rating scale
(ASRS) of the Boston Diagnostic Aphasia Examination (BDAE). Three and six months later, the
language assessment was composed by: LAST, ASRS and BDAE. Good recovery from aphasia
was defined as a score of ASRS 4 or 5. The association between the presence of a MEP after
stimulation and good recovery was studied by Fischer exact tests.
Results
In our interim analysis, 58 patients were followed. The presence of MEP of the right hand (left
cortical stimulation) was significantly associated with good recovery 6 months (p<0.001) after a
stroke, even for patients with severe aphasia (ASRS≤2) initially (p=0,005). The results are similar
for MEP of the right orbicularis oris (left cortical stimulation) (p=0,004).
Conclusion
MEP of hand and lips predict recovery from aphasia. These results suggest the importance of
production systems in the recovery of language, suggesting a new approach compared semantic
core highlighted in the old classic models such as Lichtheim.
WCNR-0221
BOARD NUMBER: 066
DIAGNOSIS
NEURALGIC AMYOTROPHY WITH PHRENIC NEUROPATHY: A DIFFICULT DIAGNOSIS
BUT NOT INVARIABLY A BAD OUTCOME.
J. Groothuis1, N. van Alfen2, J. Doorduin2, Y. Heijdra3, A. Boon4, P. Wijkstra5
1Radboud University Medical Centre, Rehabilitation, Nijmegen, Netherlands
2Radboud University Medical Centre, Neurology, Nijmegen, Netherlands
3Radboud University Medical Centre, Pulmonary diseases, Nijmegen, Netherlands
4Mayo Clinic, Physical Medicine and Rehabilitation, Rochester, USA
5University Medical Centre Groningen, Pulmonary diseases- Centre for home ventilation,
Groningen, Netherlands
Aims
Neuralgic amyotrophy (Parsonage Turner syndrome) is a distinct peripheral nervous system
disorder with acute severe upper limb pain, multifocal paresis and complicated recovery. It is
caused by an acute inflammation and classically affects the upper trunk of the brachial plexus,
with involvement of the long thoracic, suprascapular and anterior interosseus nerves. A
considerable proportion has phrenic nerve involvement with accompanying respiratory
complaints.
Method
We performed a prospective cohort study to describe these patients, focusing on their symptoms,
treatment and outcome. Patients with an established diaphragm dysfunction or phrenic
neuropathy were included.
Results
96 patients (8% of neuralgic amyotrophy population) had a phrenic neuropathy, in 87% combined
with brachial plexus involvement. Phrenic neuropathy was unilateral (55%), bilateral (31%) or
unclear (14%). Male to female ratio was 7:1, mean age 51 years. Common symptoms were
orthopnea (87%), exertional dyspnea (90%), sleep disturbances (89%) and fatigue (84%). The
median time to diagnosis was 33 weeks. Median follow-up was 19 months, within this period 32%
reported no recovery, 43% an improvement and 25% a good recovery.
One-third started non-invasive mechanical ventilation. 71% reporting an improvement and 12%
no effect and 15% were unable to comply.
The difference between supine and sitting vital capacity seem to be the most sensitive diagnostic
test. Remarkably, in one-third no supine vital capacity was measured.
Conclusion
These results indicate that besides severe symptoms and complaints one. Therefore, an early
diagnosis of phrenic neuropathy in neuralgic amyotrophy with focused history taking and sitting
and supine vital capacity measurements is essential.
WCNR-0510
BOARD NUMBER: 067
DIAGNOSIS
CONCURRENT VALIDITY OF THE KING-DEVICK, SENSORY ORGANIZATION TEST, HEAD
SHAKE-SENSORY ORGANIZATION TEST, AND DYNAMIC VISUAL ACUITY TEST IN
HEALTHY INDIVIDUALS
J. Heick1, C. Bay2, T. McLeod3, T. Dompier4
1A. T. Still University, Physical Therapy, Mesa, USA
2A. T. Still University, Interdisciplinary Health Sciences, Mesa, USA
3A. T. Still University, Athletic Training, Mesa, USA
4Datalys Center for Sports Injury and Prevention- Inc., President, Indianapolis, USA
Aims
OBJECTIVES: Visual system disruption is frequently observed following concussion, and 65% to
90% of patients show oculomotor disruption. This visual system disruption also affects postural
stability. The objective of the current study was to evaluate the concurrent validity between the
King-Devick (K-D) and the Sensory Organization Test (SOT), the Head Shake-Sensory
Organization Test (HS-SOT), and the Dynamic Visual Acuity (DVA) Test in healthy individuals
aged 14 to 24 years.
Method
METHODS: Participants were 14 to 24 years oldand had no lower extremity injuries in the past 3
months; head injury in the past year; or diagnosis of a visual, vestibular, or balance disorder.
Sixty participants (30 males, 30 females; mean age =19.9±3.74 years) completed the K-D, SOT,
HS-SOT, and DVA in one session. The mean value from each of three testing sessions was
used to assess concurrent validity of the K-D test. Intraclass correlation coefficients (ICCs) were
calculated using a 2-way, random-effects model.
Results
RESULTS: Our results did not support concurrent validity between the K-D composite score
(ICC=0.97), and SOT (ICC=0.83), HS-SOT (ICC=0.81), or DVA (ICC=0.83). Reliability across the
3 trials of the K-D was excellent, ICC=0.97 (95% CI, 0.96-0.98). The SOT correlated highly with
the HS-SOT for condition 2, ICC=0.84 (95% CI, 0.77-0.89). The SOT correlated highly with HSSOT condition 5, ICC=0.81 (95% CI, 0.73-0.88). The DVA test had excellent reliability
(ICC=0.83; 95% CI, 0.74-0.89).
Conclusion
CONCLUSIONS: Each of the tests assessed have been studied as concussion assessment
tools, and our results suggest that the K-D test is not measuring the same aspects of vestibular
function as the others. Rather, it seems to complement other tests of vestibular function, and
must be investigated further in a concussed population.
WCNR-0053
BOARD NUMBER: 068
DIAGNOSIS
APPLICATION OF ACTION POTENTIAL PARAMETERS ON SPINAL CORD INJURY USING
THE TELEMETRIC SYSTEM IN LUMBRICUS TERRESTRIS
A. Hwang1
1, Florham Park, USA
Aims
This project investigated the applicability of the L. terrestris as a model for the diagnosis of
pressure-related spinal cord injuries (SCI) in the human spine.
Method
Single action potentials were evoked by controlled electrical impulses and simultaneously
recorded with the telemetric system. A set of weights positioned in the center of the dorsal side of
the body mimicked the stress caused by spinal tumor development. Four waveform parameters,
the peak, trough, width, and area under the curve (AUC), were compared across differences in
electric stimulation voltage level and weight of pressure.
Results
Resulting patterns suggested proportional relationships among pressure, peak, and width and
inverse relationships among pressure, trough, and AUC. Furthermore, linear relationships (R 2 >
0.82) between pressure and each parameter were found under constant electric stimulation
voltage level.
Conclusion
The differences in parameter outputs varied per pressure modality, suggesting the presence of a
characteristic waveform in accordance to the amount of pressure exerted on the nerve cord. The
existence of such characteristic waveforms implies the possibility of using recorded patterns to
diagnose the magnitude of spinal tumors. More research is needed to replicate and extend these
results.
WCNR-0702
BOARD NUMBER: 069
DIAGNOSIS
VOLUNTARY CONTROL OF BALANCE AND ASSOCIATIONS WITH WHITE MATTER
INTEGRITY IN TRAUMATIC BRAIN INJURY
J. LEARY1, C. Zampieri1, J. Row1, C. Shenouda2, D. Pham3, J. Dsurney2, L. Chan1
1NIH Clinical Center, Rehabilitation Medicine, Bethesda, USA
2Center for Neuroscience and Regenerative Medicine, Phenotyping Core, Bethesda, USA
3Center for Neuroscience and Regenerative Medicine, Imaging Core, Bethesda, USA
Aims
To determine whether voluntary balance control abilities are associated with white matter integrity
following traumatic brain injury (TBI). We hypothesized that the Limits of Stability (LOS) Test
(NeuroCom, Natus Inc.) balance measures would be significantly associated with Diffusion
Tensor Imaging (DTI) measures in brain regions of interest.
Method
Individuals who had sustained a non-penetrating TBI underwent LOS testing and a magnetic
resonance imaging (MRI) scan. LOS variables included: reaction time (RT), movement velocity
(MVL), and maximum excursion (MXE) composite scores. DTI was conducted to quantify white
matter fractional anisotropy (FA) on bilateral corticospinal tract (CST), posterior thalamic radiation
(PTR), and superior longitudinal fasciculus (SLF). Pearson's correlation was used to relate
outcomes (p<0.05).
Results
Forty-six subjects (31 M/15 F; average age: 42.8; severity: 21 mild, 17 moderate, 8 severe) were
included in this analysis. Significant inverse correlations were found between RT and FA of the
left CST (r = -.42, p<0.01), left and right SLF (r = -.53, p<0.01, and r = -.50, p<0.01, respectively),
and left and right PTR (r = -.37, p = 0.01, and r = -.46, p<0.01, respectively). Significant positive
correlations were identified between MVL and FA of the left and right SLF (r = .38, p<0.01, and
r = .30, p = 0.04, respectively). No significant correlations were observed involving MXE and DTI.
Conclusion
Reduced white matter integrity in CST, SLF, and PTR following TBI appears related to deficits in
voluntary balance control, specifically in speed-related tasks. Neuroimaging using DTI may help
to identify individuals potentially at risk for balance impairments after injury. Future work should
examine the contribution of white matter integrity in the context of other injury factors to determine
the degree to which voluntary balance impairments are attributable to axonal damage after TBI.
WCNR-0136
BOARD NUMBER: 070
DIAGNOSIS
NEW SCORING SYSTEM FOR THE COMA RECOVERY SCALE-REVISED FOR
ASSESSMENT OF PATIENTS WITH DISORDERS OF CONSCIOUSNESS
M. Leonardi1, D. ROSSI2, V. COVELLI1, L. MINATI3, A.M. GIOVANNETTI1, C. ROSAZZA3,
A. BERSANO4, A. NIGRI5, S. FERRARO5, S. FRANCESCHETTI2, E. VISANI2, D. DURAN2,
F. PANZICA2, D. SATTIN1
1Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurology- Public Health- Disability Unit,
Milan, Italy
2Fondazione IRCCS Istituto Neurologico Carlo Besta,
Neurophysiology and Diagnostic Epileptology Unit, Milan, Italy
3Fondazione IRCCS Istituto Neurologico Carlo Besta, Scientific Directorate, Milan, Italy
4Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurology Unit- UCV, Milan, Italy
5Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroradiology Unit, Milan, Italy
Aims
Differential diagnosis between Vegetative State and Minimally Conscious State is still complex
and the development of a reliable evaluation systems is one of the challenging tasks for
researchers and professionals. The Coma Recovery Scale-Revised (CRS-R) is considered the
gold standard for clinical/behavioural assessment and for differential diagnosis of patients with
Disorder of Consciousness. However, the scale presents some limitations in that i) scores may
partially overlap between different diagnoses, and ii) there is an underlying assumption that if a
patient is able to demonstrate higher-levels of behavior, he is also able to demonstrate lowerlevel responses.
Method
In the present study a procedure to calculate a modified CRS-R score is presented which
attempts to avoid these problems. To exemplify this new scoring approach, 60 patients with
Disorder of Consciousness were studied at Coma Research Centre Besta, and the results
showed usefulness of the modified score.
Results
Pilot results show that the CRS-R MS avoids the overlapping of scores in respect to the 32% of
patients reported using standard CRS-R total score. Moreover, for 6%of patients, for whom the
originally assumption of CRS-R implies scores for lowest behaviorsif a patient shows an higher
response category in the same item, the CRS-R MS highlighted that patients did not show lowest
response categories for visual or motor function items although they presented cognitively
mediated behaviors.
Conclusion
The possibility to fully describe behavioral functioning of a patient with DOC, allows the
achievement of a more tailored and accurate clinical management for each patient.
WCNR-0662
BOARD NUMBER: 071
DIAGNOSIS
Hand and digits dexterity and grip strength in individuals with diabetic peripheral
neuropathy
K. LIMA1, S. JARIC2, M. UYGUR3, P.B. DE FREITAS1
1Cruzeiro do Sul University, Institute of Physical Activity and Sport Sciences Motion Analysis Lab,
Sao Paulo, Brazil
2University of Delaware, Departament of Kinesiology and Applied Physiology, Newark, USA
3Rowan University,
Department of Health & Exercise of the Science School of Biomedical Science & Health Professio
ns, Glassboro, USA
Aims
The diabetic peripheral neuropathy (DPN) impairs function of both lower and upper extremities,
mainly due to the reduction of sensory input from feet and hands. The most frequently test used
to assess hand function in DPN and other clinical populations is the hand grip strength (GS Max).
However, our previous studies with non-neuropathic diabetic individuals showed that strength and
dexterity tests might not be sensitive to detect differences between diabetic and healthy
individuals. Thus, the aim of this study was to compare the sensitivity of the GSMax with the handdigits dexterity tests for evaluation of hand function in individuals with DPN.
Method
Ten DPN (58.29±3.95 years-old) and 10 healthy age and sex-matched healthy individuals were
evaluated regarding the cutaneous sensitivity of their fingers using Semmes-Weinstein
monofilaments test. Thereafter, the nine-hole peg test (9-HPT) and the Jebsen-Taylor hand
function test (JTHFT) were applied to evaluate the digits and hand dexterity, respectively, while
the grip strength was assessed through a standard GS Max test (Jamar® dynamometer).
Results
Thus, Semmes-Weinstein monofilaments test showed a reduced cutaneous sensitivity of
individuals with DPN as compared with controls (p<0.005). DPN performed the 9-HPT and
JTHFT test at a slower rate than controls with both dominant (9-HPT: 19.38±1.94s vs.
15.73±1.29s, p<0.001 | JTHFT: 33.63±4.73s vs. 26.56±1.71s, p<0.001) and non-dominant hand
(9-HPT: 20.61±2.37s vs. 17.72±1.97s, p<0.01 | JTHFT: 35.70±5.65s vs. 29.41±3.23s, p<0.01).
However, GSMax of DPN was not different than healthy individuals (dominant hand:
2.51±0.45N/kg vs. 2.78±0.39N/kg, p=0.165 | non-dominant hand: 2.44±0.45N/kg vs.
2.65±0.33N/kg, p=0.256).
Conclusion
The results strongly suggest that the 9-HPT and JTHFT could be more sensitive to detect the
deficits in hand function than GSMax. Therefore, GSMax should be used for the assessment of
muscle strength per se, rather than for the assessment of the overall hand function.
WCNR-0423
BOARD NUMBER: 072
DIAGNOSIS
MATADOC: A DIAGNOSTIC MEASURE FOR AWARENESS OPTIMISING THE AUDITORY
MODALITY IN DISORDERS OF CONSCIOUSNESS
W. Magee1, R. Siegert2, B. Daveson3, G. Lenton-Smith4, S. Taylor2
1Temple University, Boyer School of Music and Dance, Philadelphia, USA
2Auckland University of Technology,
School of Rehabilitation and Occupation Studies and School of Public Health and Psychosocial S
tudies, Auckland, New Zealand
3Kings College London, Cicely Saunders Institute, London, United Kingdom
4Ealing Music Therapy, Music Therapy, London, United Kingdom
Aims
Diagnosis, assessment, and intervention planning for Prolonged Disorders of Consciousness
(PDOC) is complex due to motor, sensory, and cognitive impairments. Developing reliable and
valid measures that meet evidence-based recommendations is a priority (Seel et al., 2010). The
auditory modality is the most sensitive for identifying awareness (Gill-Thwaites & Munday, 1999),
however, current standardised behavioural measures fail to provide adequate measurement of
auditory responsiveness (Magee et al., 2015). The Music Therapy Assessment Tool for
Awareness in Disorders of Consciousness (MATADOC) was developed for diagnosis and
intervention planning for PDOC. We aimed to examine the psychometric properties and
characteristics of the MATADOC and its validity against a standardised external reference
standard.
Method
A prospective study with 21 patients examined inter-rater and test-retest reliability for the 14-item
MATADOC using repeated measures. The protocol involves tasks utilising live music. Trained
MATADOC assessors were blinded to the diagnostic outcomes of an external reference standard.
Reliability was assessed using the intraclass correlation coefficient with random effects. Rasch
analysis examined the internal structure and consistency of the 5-item principal subscale.
Results
The principal subscale had good inter-rater and test-retest reliability (α =0.76) using evidencebased criteria for DOC measures (Seel et al., 2010) with satisfactory internal consistency (interrater ICCs: 0.65–1.00; test-retest ICCs: 0.77–0.90). Diagnostic outcomes agreed 100% with the
external reference standard suggesting excellent concurrent validity. Calculated intra-class ICCs
for the remaining subscales had mixed results: reliability for most items fell within the adequateacceptable range with the exception of one item.
Conclusion
The MATADOC is a reliable and valid tool demonstrating diagnostic utility for assessing
awareness in patients with PDOC. MATADOC holds greater sensitivity for assessing auditory
responsiveness than other standardized tools currently available. Thus, it is useful for
interdisciplinary assessment of awareness in PDOC and complements existing PDOC measures
that may be less sensitive to assessing the auditory modality.
WCNR-0087
BOARD NUMBER: 073
DIAGNOSIS
CLINICAL EFFECTIVENESS OF A NEW QUANTITATIVE METHOD USING SEMMESWEINSTEIN MONOFILAMENT TEST IN CARPAL TUNNEL SYNDROME
M. Muraoka1, K. Watanabe2, K. Imai2
1Kameda-Daiichi Hospital, Rehabilitation, Niigata, Japan
2Kameda-Daiichi Hospital, Orthopedic Surgery, Niigata, Japan
Aims
We present a new approach to quantitative sensory evaluation using Semmes-Weinstein
monofilament test (SWT) in patients with carpal tunnel syndrome (CTS). We investigated the
utility of SWT by comparing with the results of nerve conduction study (NCS), both preoperatively
and postoperatively.
Method
A total of 90 hands, including 27 operative cases, which were clinically compatible with carpal
tunnel syndrome were examined. For SWT scoring, we divided the median nerve-dominated area
into 11 segments based on distal / proximal interphalangeal, and metacarpalphalangeal joints of
the thumb through ring finger. Each segment was scored from 0 to 3 based on minimum pressure
sensation. In each hand, we calculated the sum of those score (0 to 33) and comparatively
performed NCS.
Results
The sensitivity was 88 % using SWT scoring, and 89 % in NCS. In 32 hands which showed no
sensory nerve action potentials (SNAPs) in NCS, SWT score was high of 19.3±6.8. The SWT
score was 14.3±6.9 in non-operative cases, while high of 18.2±5.7 in operative cases. In 16
operative cases, SWT score clearly improved postoperatively (pre 18.2±5.7; post 15.4±6.7), while
SNAPs were undetectable except for 2 cases.
Conclusion
A newly quantitative method using SWT score proved to be effective for evaluating the condition
in CTS both preoperatively and postoperatively. Our approach will be capable of assessing CTS
simply and accurately.
WCNR-0096
BOARD NUMBER: 074
DIAGNOSIS
THE MEDICAL ACTIVITY ASSESSMENT IN SPECIALIST REHABILITATION: A
PROSPECTIVE COHORT STUDY
M. Nayar1, A. Pick2, H. Williams3, L. Turner-Stokes2
1Kings College Hospital, Cicely Saunders Institute, London, United Kingdom
2Kings College London, Cicely Saunders Unit, London, United Kingdom
3Hyperacute rehabilitation unit, Northwick park hospital, London, United Kingdom
Aims
Hyper-acute rehabilitation services are increasingly developed in the UK to take patients directly
into rehabilitation from intensive care settings, so relieving pressure on acute care services. This
prospective cohort study was carried out to quantify and describe the resource requirements to
manage unstable patients in a single tertiary hyper-acute rehabilitation service in London, UK
Method
Medical Activity Assessment (MAA) data were recorded at weekly intervals over 1 year to
characterise the co-dependencies of hyper-acute services, alongside Rehabilitation complexity
scores (RCSEv13) medical scores to describe and quantify medical resource requirements in
rehabilitation settings.
RCSE-M subscale scores of 3-4 identified patients with potentially unstable medical conditions.
Medical input (hours/week) was recorded through the Northwick Park Therapy Dependency
Assessment Medical Score.
Results
1209 parallel data points were recorded from 101 patients (mean age 43.5 (SD=13) and mean
length of stay 106 (SD=51) days). Diagnosis: 93% acquired brain injury. 37% of patients were in
continued vegetative or minimally conscious state.
Overall, specialist input was required from 36 different medical specialties (commonest
ENT/tracheostomy team 29%, Neurology 13%, Neurosurgery 7%, Radiology 7%). The RCS-M
scores in 27% of data-points specified the need for hyper-acute care. The hyper-acute patients
required on average 3-4 hours/week of medical care, compared with 2-3 hours in non-hyperacute
patients. The commonest reasons for requiring medical intervention were complex tracheostomy
management (143 (76%)), desaturation (30 (16%)), sympathetic storming (26 (14%))
respiratory/acute distress (29 (15%)), acute sepsis 22 (12%), and decline in consciousness level
(25 (14%)).
Conclusion
Hyper-acute rehabilitation services require an extensive range of on-site specialist medical and
emergency services. Our findings suggest that hyper-acute needs should be staffed with
approximately twice the allocation of routine direct medical care, as well as the consistent
availability of around the clock emergency medical and surgical care.
WCNR-0523
BOARD NUMBER: 075
DIAGNOSIS
THE RELATIONSHIP BETWEEN ANGER AND NEGATIVE ATTRIBUTION BIAS AFTER
BRAIN INJURY
D. Neumann1, J.F. Malec2, F. Hammmond2
1Indiana University, Physical Medicine and Rehabilitation, Indianapolis, USA
2Indiana University, PMR, Indianapolis, USA
Aims
Negative attributions pertain to judgments of intent, hostility, and blame that one makes regarding
other people’s behaviors. Negative attribution bias is when someone has the tendency to
perceive actions significantly more negative than the general population, especially when actions
are ambiguous or benign. The aim of this study was to examine if people with traumatic brain
injury (TBI) make stronger negative attributions than healthy controls (HCs), and explore the
relationship of these attributions with situational anger.
Method
Forty-eight adults with moderate to severe TBI and 49 HCs who were frequency matched for age
and gender, participated in the study. Participants were presented with hypothetical scenarios
describing characters’ behaviors that ultimately resulted in hypothetically negative outcomes for
the participant. Actions described in the stories were clearly hostile, ambiguous, or benign,
resulting in three story types. Participants rated characters’ behaviors for intent, hostility, and
blame, as well as how angry they would be in response to each scenario.
Results
Participants with TBI rated characters’ behaviors to be significantly more intentional, hostile, and
blameworthy than healthy controls for all three scenario types (benign, ambiguous, and hostile).
Negative attributions significantly predicated 73.6% of anger variance for participants with TBI,
and 65.3% of variance for HCs.
Conclusion
People with TBI appear to be biased in judging others’ behaviors as more intentionally hostile and
blameworthy. Furthermore, it appears that these negative attribution biases are contributing to
anger problems after TBI. These findings have important clinical implications, which will be
discussed. Future studies investigating factors that contribute to negative attribution biases are
critical to understanding and treating anger deficits in the TBI population.
WCNR-0524
BOARD NUMBER: 076
DIAGNOSIS
THE INFLUENCE OF ALEXITHYMIA, DEPRESSION AND ANXIETY ON AGGRESSION
AFTER BRAIN INJURY
D. Neumann1, J. Malec2, F. Hammond2
Aims
The aims of this study were twofold: 1) To determine differences in aggression severity and
prevalence in people with traumatic brain injury (TBI) and healthy controls (HC), and 2) examine
the influence of alexithymia (blunted emotional insight), depression, and anxiety on aggression.
Method
Forty-eight participants with moderate to severe TBI and 49 age and gender matched HCs.
Participants with TBI were a minimum of 3 months post-injury. Participants completed measures
of trait aggression (Buss Perry Aggression Questionnaire); depression (Patient Health
Questionnaire-9); trait anxiety (State Trait Anxiety Inventory (STAI); and alexithymia (Toronto
Alexithymia Scale-20).
Results
Participants with TBI had significantly higher aggression (physical aggression, verbal aggression,
anger and hostility) than HCs. Significantly more participants with TBI were classified as having
higher than average verbal aggression (42% vs 18%), anger (42% vs 20%), and hostility (48% vs
20%). Together alexithymia, depression and anxiety accounted for 35.2% of the adjusted
aggression variance for participants with TBI, and 45.7% for HCs. The largest unique contributor
to these models was alexithymia for participants with TBI, and depression for HCs.
Conclusion
Aggression is more severe and prevalent in people with TBI than HCs. It appears that alexithymia
is a major contributing factor to aggression after TBI. Since people with alexithymia have poor
emotional insight, they may not have the awareness needed to properly regulate escalating
feelings of anger and aggression. Clinical implications for the treatment of aggression will be
discussed.
WCNR-0308
BOARD NUMBER: 077
DIAGNOSIS
REHABILITATION AND OUTCOME MEASURES IN CHARCOT-MARIE-TOOTH
L. Padua1, C. Pazzaglia2, D. Coraci3, G. Vita4, D. Pareyson5, A. Schenone6, G.M. Fabrizi7,
F. Gemignani8, L. Santoro9, A. Quattrone10
1Università Cattolica del Sacro Cuore- Rome - Don Gnocchi Foundation- Milan,
Department of Geriatrics- Neurosciences and Orthopaedics - Department of neurorehabilitation,
Rome - Milan, Italy
2Don Gnocchi Foundation- Milan, Department of neurorehabilitation, Milan, Italy
3Don Gnocchi Foundation - Milan, Department of neurorehabilitation, Milan, Italy
4University of Messina, Clinical and Experimental Medicine, Messina, Italy
5IRCCS Foundation- "C. Besta" Neurological Institute, Clinical Neurosciences, Milan, Italy
6University of Genoa, Neurosciences- Rehabilitation Ophthalmology- Genetics and MaternalInfantile Sciences DINOGMI and CEBR, Genoa, Italy
7University of Verona, Neurological- Neuropsychological- Morphological and Motor Sciences,
Verona, Italy
8University of Parma, Neurosciences, Parma, Italy
9University Federico II of Naples, NeurosciencesReproductive and Odontostomatological Sciences, Naples, Italy
10University Magna Græcia, Medical and Surgical Sciences, Catanzaro, Italy
Aims
The aim of the current study was to evaluate the reliability and validity of 6MWT and SAM. These
measures have never been used in CMT patients and appear to be promising for future
therapeutic trials. Moreover the information provided by these tools may be useful to identify the
walking features more related to better QoL hence to design a tailored rehabilitation program for
CMT patients.
Method
We performed a prospective multicenter study by administering 6MWT and SAM to CMT patients
enrolled in specialized Italian center for inherited neuropathies in order to validate them and to
evaluate their reliability. Validation statistical process was applied.
Results
180 CMT patients were consecutively enrolled. The mean age of sample was 44.4 yrs (range: 1873, SD: 13.7; 52% female, 48% male). Distribution of age was normal. The current study showed
that 6MWT and SAM are a valid tool but it provides perhaps too many outcome measures: the
more meaningful, from clinical and Quality of life point of view, are the average of maximal speed
in 1 and 5 minutes, the index of peak activity and the average of number of steps and minutes
walking at high speed.
Conclusion
The current study demonstrated the validity of the studied outcome. SAM, besides being a valid
and reliable tool is able “explode” the walking pattern into several items providing useful
information to address future research on rehabilitation.
WCNR-0659
BOARD NUMBER: 078
DIAGNOSIS
INFERRING HIDDEN BRAIN STATES FROM EEG SIGNALS USING TOPIC MODELLING
K. PRABHUDESAI1, L. Collins- Ph.D.1, C. Throckmorton- Ph.D.1
1Duke University, Electrical and Computer Engineering, Durham, USA
Aims
Although electroencephalography (EEG) has been suggested as a means of tracking changes in
brain state, e.g. the development of complications after brain injury, assessing EEG currently
requires manual analysis by trained experts, making continuous bedside monitoring unfeasible.
This research aims to automatically detect changes in EEG signals using an unsupervised
learning technique to infer hidden brain states.
Method
Labeling brain states is confounded by multiple states occurring simultaneously, e.g. brain injury
and sedation. To address this, we propose using a technique typically used to define topics in
documents; documents may contain multiple topics just as the brain may be in multiple states.
Topic models provide a distribution of key word occurrences within a document that are used to
infer the applicable topics. For EEG, the frequency content of two-second segments were treated
as key words, and the distributions of the frequency content were assessed using the latent
Dirichlet allocation (LDA) topic model to infer the brain states and their occurrences in the EEG
signal. Stochastic processes were used to allow for infinite brain states to be present in the
model, and the correct number of brain states was inferred automatically by selecting the finite
set that best described the data.
Results
We used continuous EEG recordings from ten subjects with brain injury of which five developed
vasospasm during recording. The topic model successfully discriminated between vasospasm
and non-vasospasm EEG signal characteristics thereby detecting separate brain states in the two
conditions. The topic model performed better than a supervised classifier trained to discriminate
between vasospasm and non-vasospasm subjects.
Conclusion
Our method has the potential to detect brain states without labelled data and without the number
of states specified a priori. This could provide a method to monitor brain state continuously
without requiring neurologists to manually analyze and annotate data.
WCNR-0031
BOARD NUMBER: 079
DIAGNOSIS
THE STRUCTURE OF THE DEPRESSION ANXIETY AND STRESS SCALES (DASS-21) IN
AUSTRALIAN ADULTS WITH TRAUMATIC BRAIN INJURY
M. Thomas1, D. Randall1, D. Whiting2, A. McGrath1
1Charles Sturt University, School of Psychology, Bathurst, Australia
2Ingham Institute of Applied Medical Research, Brain Injury Rehabilitation Research Group,
Liverpool, Australia
Aims
The DASS-21 is a widely used measure of psychological distress in clinical practice (Lovibond &
Lovibond 1995). A 3-factor structure for the DASS-21 has been supported in both healthy and
clinical populations. Although limited by small sample sizes, recent research has raised questions
as to whether the original structure of the DASS-21 was valid for the TBI population. The
objective of the present study was to compare the published factor structures of the DASS-21 in a
large sample of adults with severe TBI.
Method
The sample consisted of 504 adults with severe TBI (PTA > 1 day). Archival data was utilised
from Liverpool Hospital Brain Injury Rehabilitation Unit in Australia.
Results
Several published structures were compared using confirmatory factor analysis (CFA). The
results showed the data fitted Lovibond & Lovibond’s (1995) original 3-factor model adequately.
However, the data best fit Henry and Crawford’s (2005) quadripartite model, in which items
loaded onto the three factors, as well as a general distress factor. The internal consistencies of
each factor were good (alphas =.82 to .90).
Conclusion
The data fitted Lovibond & Lovibond’s (1995) original three factor model adequately and
appeared to best fit Henry and Crawford’s (2005) quadripartite model. These results suggest the
DASS-21 three factor model can be used with confidence in the TBI context.
WCNR-0594
BOARD NUMBER: 080
DIAGNOSIS
COMMUNICATION ASSESSMENT THROUGH THE APPLICATION OF THE LA TROBE
QUESTIONNAIRE IN PATIENTS WITH TBI AND HIS/HER FAMILY
M. Toloza Dauvergne1,2, R. Tobar Fredes1,2, N. Salazar Beltrami2, J. Urzúa Retes3
1Universidad de Chile, Departamento de Fonoaudiología, Santiago, Chile
2Hospital del Trabajador, Servicio de Otorrinolaringología - Departamento de Salud Ocupacional,
Santiago, Chile
3Universidad Mayor de Temuco, Escuela de Fonoaudiología, Temuco, Chile
Aims
The assessment of communication is still a challenge for the speech pathologist, because the
communication is dynamic, and vary in context and communication partners.
Therefore the information of the family or people who knew the patient before the TBI is very
important for the clinician. The apply of La Trobe Questionnaire to the patient and his/her family
give us information about the communication as well as the cognitive disorders of the patient.
In this context, our aim is describe the communication and cognitive disorders through the
application of the La Trobe Questionnaire in TBI patients of the Hospital del Trabajador.
Method
A sample of 45 patient with TBI were considered for this study. All of them diagnosed with
cognitive-communication disorder, between march and october of 2015.
The Speech Pathologist applied the La Trobe Questionnarie to the patient and his/her relative –
family or friend who knew the patient before the TBI.
The variables of the study considerer: a) TBI diagnoses, b) time lapse from the accident, c) time
lapse between the accident and the communication assessment, and d) the results in the La
Trobe Questionnarie
Results
All the patients were diagnosed with TBI –close or open injury-.
The average of time lapse between accident and communication assessment was 3 weeks.
The results of application of the La Trobe Questionnaire to the patients showed more difficult in
the quantity and quality constructs of communication. Also, the results showed more memory
deficit and tangentiality in the discourse.
All of this results also were reported for the family and friends of the patients.
Conclusion
The early assessment of the cognitive-communication disorders, using the La Trobe
Questionnaire, in TBI patients benefit the clinical decisions and the communication treatment in
the patient, increasing the person (and his/her family) quality of life.
WCNR-0575
BOARD NUMBER: 081
DIAGNOSIS
GERIATRIC SPINAL CORD INJURY REHABILITATION AND FUNCTIONAL OUTCOME IN A
TERTIARY CARE REHABILITATION HOSPITAL IN SAUDI ARABIA
S. ULLAH1, I. Qamar1, A. Niaz2
1King Fahad Medical City, Physical Medicine and Rehabilitation, Riyadh,
Kingdom of Saudi Arabia
2King Abdulaziz medical city.National guard Health affairs., Physical medicine and rehabilitation,
Riyadh, Kingdom of Saudi Arabia
Aims
To describe rehabilitation and functional outcome in geriatric
spinal cord injury (SCI) patients.
Method
Retrospective study using medical charts (electronic and paper)
Inclusion criteria: Spinal cord injury Patients with age above 65 admitted for Inpatient
Rehabilitation.
Results
We identified 24 patients (one female and 23 male) which fulfill the inclusion criteria, The mean
age of the 24 patient was 72.3 years SD±6.3 (Range 66–90). The most common cause of injury
was Cervical Myelopathy: 8 patients (33%). The second most common cause of injury was
lumbar canal stenosis 7 (29%) patients and the motor vehicle accident constitute only 4 (16%) of
the patients. The Hypertension in 18 (75.0%) patients and Diabetes Mellitus in14 (58.3%) patients
was most common pre morbid conditions.
The urinary tract infection in 8 (33.4%) patients was most common complication encounter during
inpatient rehabilitation. The second most common complication encounter during inpatient
rehabilitation was surgical site infection in 2 (8.4%)pts.
The median hospital stay was 66.0 days'± 13.9(14-360). All patients were discharged home.
Patients without complication during inpatient rehabilitation have short length of stay (P<0.021)
Higher score for FIM at admission (P<0.021) and FIM at discharge( P<0.035).
Patients without complication during inpatient rehabilitation also achieve their FIM score which
was set as their goal (P<0.055Conclusion
In geriatric population cervical myelopathy and lumbar canal stenosis are the major cause of
spinal cord injury leading to disability. Urinary tract infections and surgical site infections are the
most common complication during inpatient rehabilitation. Preventing these complications by
appropriate measure, higher functional independence can be achieved with shorter length of stay
WCNR-0576
BOARD NUMBER: 082
DIAGNOSIS
AN UNUSUAL CERVICAL SPINAL CORD INJURY AND REHABILITATION: A CASE REPORT
FROM SAUDI ARABIA
S. ULLAH1, A. Niaz2
1King Fahad Medical City, Physical Medicine and Rehabilitation, Riyadh,
Kingdom of Saudi Arabia
2King Abdulaziz medical city.National Guard health affairs., Physical Medicine And Rehabilitation,
Riyadh, Kingdom of Saudi Arabia
Aims
To understand the rare clinical presentation of spinal cord injury resultant from sudden neck
movement and to appreciate the benefit of acute inpatient rehabilitation program for the functional
improvement.
Method
18-year-old male patient developed neck pain shortly after he abnormally rotated his neck
voluntarily for stretching. On arrival to the hospital, he developed left hemiplegia. As per patient
it was told to him by spine surgeons of his local hospital that He had cervical cord contusion on
MRI done at that time with no other abnormalities found, but no official report or evidence was
with patient when patient admitted in KFMC .Apart from some traditional therapy outside KSA
patient not received any rehabilitation since 3 years. Patient weakness persists and along with
weakness he developed spasticity and ROM restrictions due to lack of proper rehabilitation.
Results
The patient admitted in spine rehab unit for intensive rehabilitation. As diagnosis was not clear so
during rehab process patient also investigated by neurology and rheumatology team to rule out
cervical myelopathy, vertebral artery dissection and any immunological disease.
MRI, MRA scan and Immunological workup was unremarkable. Patient received four weeks of
intensive inpatient spine rehabilitation with improvement in his ROM and decrease in
spasticityConclusion
1. Spinal cord injury can result from abnormal neck movements, which is common practice in
community to stretch the neck. Education should be done on spine care and work ergonomics.
2. Conditions like cervical myelopathy, vertebral artery dissection and immunological disease
should be rule out if no evidence of trauma available.
3. Timing is important in spinal cord injury rehabilitation, earlier rehabilitation prevents
complication and result in better functional outcome
WCNR-0270
BOARD NUMBER: 083
ORTHOTICS
TABLET-BASED APPLICATIONS FOR TRAINING SOCIAL SKILLS OF CHILDREN WITH
AUTISM SPECTRUM DISORDERS: IMPACT ON ADAPTATIVE BEHAVIORS IN
MAINSTREAM SCHOOL
C. Fage1,2, C. Consel1, P.A. Joseph2, H. Sauzéon1,2
1Inria, Equipe Phoenix, Talence Cedex, France
2Université de Bordeaux, Laboratoire Handicap & Système Nerveux EQ-4136, Bordeaux, France
Aims
Mainstream inclusion of children with ASD is notably hampered by limited social skills, resulting in
difficulties on adaptive behaviors in school settings. By adopting an inclusive approach involving
all stakeholders of the children with ASD (families, school staffs, therapists), we developed three
training applications to be used at home: 1) emotion identification (photos and videos) ; 2) Gaze
Orientation (attentional focus in classroom context) and 3) Self-emotion regulation (self-emotion
identification and regulation). Contents of these three applications have been adapted to the
school context; typically, each exercise involved members of school staff pictures. We conducted
a field study to assess our applications in situ.
Method
Our applications have been deployed and used 15 min per day during three months by children
with disabilities who attended mainstream classrooms for the first time. A total of 48 children
participated to our study separated into three groups: 14 equipped children with, 19 equipped
children with ID and 15 non-equipped children with ASD. We conducted pre- post comparisons to
assess benefits from using our applications. Moreover, we collected and analyzed interaction
data recorded by the tablet.
Results
First we showed that social skills have been improved among equipped children with ASD
(Ekman Faces test, Sarfati test, NEPSY, LEAS-C). Second, teachers reported improvements also
on adaptive behaviors inside mainstream classrooms. Log data gave insights on differences
between our two different populations.
Conclusion
Training applications we developed give assistance to both children with ASD and children ID to
promote their school inclusion. They allowed participants to improve their social skills as well as
their adaptive behaviors inside mainstream classrooms. Further work will be related to improving
contents to meet the changing needs of children across time and enlarging the spectrum of skills
targeted by developing and deploying new applications.
WCNR-0330
BOARD NUMBER: 084
ORTHOTICS
DEVELOPMENT AND EVALUATION OF AN ITERATIVE LEARNING ORTHOSES IN
PATIENTS WITH A CENTRAL PARETIC DROP-FOOT
C. WERNER1, S. Mareike2, D.S. Thomas3, S. Thomas3, S. Prof. Hesse4
1Medical Park Berlin, Neurological Rehabilittaion, Berlin, Germany
2Charite-University Medicine Berlin, Center of Stroke Research Berlin, Berlin, Germany
3TU Berlin, Control Systems, Berlin, Germany
4Medical Park.de, Neurological Rehabilitation, Berlin, Germany
Aims
Objective was to evaluate the effect of a newly developed iterative learning orthosis (ILO) in
patients with a central paretic drop-foot. Conventional functional electrical stimulation (cFES)
provides a destinct amount of stimulation to the muscle in order to facilitate the peroneal nerve or
muscle. This ILO provides in addition not only EMG-triggered information but also with the help of
an inertia sensor the position of the foot while walking. Every step and every support made is
implemented in the ILO and uses the information for the stimulation amount for the next step.
Method
20 ambulatory patients with a central paretic drop-foot were either walking without any orthosis
(WO), cFES or the ILO on even and uneven ground as well as on stairs. Under all nine conditions
the gait quality, -velocity and endurance was assessed.
Results
No side effects occurred with the cFES or ILO. All patients showed a significantly higher
symmertry ratio while walking on even ground with the ILO compared to WO (p=0,008) and to
cFES (p=0,016). Similar effects were seen for the gait velocity, walking on uneven ground and
stairs. The gait endurance increased in most of the patients (n=14) with the help of the ILO. 18
patients rated the ILO as their best option for supporting the drop-foot, 2 rated it similar to cFES.
Conclusion
The use of the ILO seems to be feasible in supporting the central paretic drop-foot. The muscle
fatigue and habituation to the electrical stimulation seemed to be less as compared to cFES. A
long term study will be the next step.
WCNR-0637
BOARD NUMBER: 085
C. TREATMENT/PHARMACOTHERAPY/PT - PART 1
EFFECT OF COMBINING DIFFERENT VISUAL FEEDBACKS ON HAND CONTROL IN
HEMIPARETIC CHILDREN
M. Gamal1, A.A.N. Asmaa2, E.E.N. Emam3
1, Giza, Egypt
2Faculty of Physical Therapy- Cairo University, Pediatric Departement, Cairo, Egypt
3Faculty of Physical Therapy - Cairo University, Pediatric Departement, Cairo, Egypt
Aims
The purpose of this study was to determine the effect of combining different visual feedback on
hand control in hemiparetic children.
Method
thirty hemiparetic children divided randomly into two groups (A and B) of equal number, fifteen
patients each. Eligibility criteria to our study were age ranged from 4-8 years, quality of upper
extremity skills test and manual ability classification system, assessment done by baseline hand
held dynamometer for hand palmar grasp and pinch grasp strength, Tardieu scale and
geniometer for elbow flexors and wrist extensors spasticity before starting the treatment protocol,
reassessed at 4 weeks and 8 weeks of the treatment program.
The treatment protocol used for the two groups include: Children in children in study group (A)
received an occupational therapy program with modified mirror apparatus while children in control
group (B) without modified mirror apparatus. The treatment protocol was conducted for two
successive months at frequency of three sessions per week (1.5 hours/session) for the two
groups.
Results
The results of this study revealed non-statistically significant differences in the palmar, pinch
grasp strength, wrist extensors angle of spasticity and elbow flexors angle of spasticity in study
group (A) than control group (B) due to short duration of application , short duration of home
program and (combining of uni-manual and bi-manual rehabilitation improved hand control in 2
groups).
Conclusion
From the obtained results of this study, it can be concluded that combining different visual
feedbacks could help in improvement of hand control in hemi paretic children.
WCNR-0633
BOARD NUMBER: 086
EFFECT OF COMBINED PERIPHERAL MOTOR ELECTRICAL STIMULATION AND
TRANSCRANIAL DIRECT CURRENT STIMULATION TO FINGER MOVEMENT IN PATIENTS
WITH HEMIPARESIS
Y.H. LEE1, S.H. Kim2, A. Ko2
1, Wonju, Republic of Korea
2Yonsei University Wonju College of Medicine, Department of Rehabilitation Medicine, Wonju,
Republic of Korea
Aims
To evaluate the combining peripheral motor stimulation to the hemiparetic hand with tDCS to the
ipsilesional M1 would facilitate beneficial effects of motor training more than each intervention
alone.
Method
Six patients with hemiparesis trained finger sequence task three times per week for 30 minutes,
and participated in 4 experimental sessions separated by 6 days (Table 1). Each session started
with baseline determination of motor performance followed by stimulation of corresponding day,
and motor practice. Post-training assessments were done 30 minutes after the end of training.
Anodal tDCS was applied over the ipsilesional M1 for 20 minutes. Peripheral motor stimulation
was applied on the EDC.
Table 1. Experimental sessions
Session
Stimulation
S0
No stimulation
S1
tDCS
S2
Peripheral motor stimulation
S3
tDCS + Peripheral motor stimulation
Subjects typed keyboard containing 4 keys using four digits of the paretic hand. Subjects
repeated the 5 elements sequence for a period of 3 minutes, which constituted 1 block. A
computer displayed the sequences, and recorded the time and accuracy of each key press.
Subsequently, they practiced 4 blocks of 3 minutes each, separated by 2 minutes rest for a total
of 18 minutes.
Finger performance was evaluated by score and response time of typing in respond to a random
number on the screen. Performance was tested at baseline, after each form of stimulation and
after motor training. Subjects performed 1 block of 3 minutes in each test.
Results
The mean time of key presses increased significantly after electrical stimulation of S1, but
decreased after finger motor training. The mean time of key press improved significantly in S3
compared to S0, S1 and S2.
Conclusion
These findings indicate that combining peripheral motor stimulation with anodal brain polarization
before physical practice could represent a better adjuvant than application of each intervention
alone.
WCNR-0609
BOARD NUMBER: 087
NEUROREHABILITATION IN DEVELOPING COUNTRIES - PART 1
MDT Spasticity Assessment
M.A. Ali1, D. Badwan1
1Central England Rehabilitation Unit, Neurorehabilitation, Leamington Spa, United Kingdom
Aims
To improve the In-patient Spasticity services at CERU (Central England Rehabilitation Unit),UK
We do inject our patients with Botulinum Toxin for their spasticity in upper and lower limbs
following their neurological illness, (e.g., following traumatic brain injury, stroke, Multiple Sclerosis
other neurological illnesses). To improve the communication among the multidisciplinary team
and to improve the functional outcome of the spasticity management, now we developed a
multidisciplinary approach for these patients which includes them being seen in the ward round
by the multidisciplinary team and assess them for their spasticity together and make a
management plan accordingly keeping their goals in mind. We designed a Performa for each
patient who needs spasticity management to be filled via MDT approach and be reviewed
accordingly.
Method
We developed a multidisciplinary approach for these patients which includes them being seen in
the ward round by the multidisciplinary team and assess them for their spasticity together and
make a management plan accordingly keeping their goals in mind. We designed a Performa for
each patient who needs spasticity management to be filled via MDT approach and be reviewed
accordingly.
The timescale for this project was from October 2015 to January 2016 followed by an audit to
make sure we achieved the goals and made the service improvement plan implemented
accordingly.
Results
This service development plan improved our patient’s management for their spasticity as was
measured through feedback and an audit. The multidisciplinary approach for the spasticity
management showed an improvenment in our patients spssticity management with a better
review plan in place as well with a better written communication.
Conclusion
This altered muscle tone assessment and Evaluation clearly showed that the multidisciplinary
appraoch as per Guidelines for the spasticity management improves the outcome of the
management of spasticity in patients with Acquired or Traumatic brain Inury.
WCNR-0608
BOARD NUMBER: 088
SOCIAL COGNITION, EXECUTIVE FUNCTIONS AND BASIC EMOTIONS IN TRAUMATIC
BRAIN INJURY
F. Deschle1,2,3, R.G. Espindola2,3, E. Tabernero2,3, W.D. Toledo1,3, H.M. Pavón1,3, J.A. Saggese3,4,
J.J. Cancino1,3
1Clinica Santa Catalina, Neurology, Buenos Aires, Argentina
2Clinica Santa Catalina, Neuropsychology, Buenos Aires, Argentina
3Clinica Santa Catalina, Neurorehabilitation, Buenos Aires, Argentina
4Clinica Santa Catalina, Education and research, Buenos Aires, Argentina
Aims
To study facial recognition of basic emotions (FRBE), executive functions (EEFF) and its relation
to Social Cognition (SC), in patients with moderate and severe traumatic brain injury (TBI) to
improve their rehabilitation and development.
Method
We include two different groups, one diagnosed with moderate TBI, the other diagnosed with
severe TBI. All of them adults between 18 and 60 years of age. A control group of the same age
and educational level was used for testing FRBE and SC.
Instruments: 60 photographs of Ekman’s pictures of facial affect where selected, and three tasks
were created. Assessment of SC includes: Reading the mind in the eyes as an emotional Theory
of Mind (ToM) task, First and second-order false-belief reasoning as a cognitive ToM task, Faux
Pas, and Game of Dice Task (GDT) as a social decision making task. EEFF assessment includes
the following tests: Wisconsin Card Sorting Test, Rey Complex Figure organizational strategy
score, Phonological verbal fluency test – P, M, R –, Digit span backward test, Trail Making Test A
and B, and Stroop Test.
Results
There is evidence of FRBE and SC impairment in TBI patients, but their frequency and relevance
with EEFF remains under discussion. Based on the literature, it is expected to find EEFF changes
in patients with moderate and severe TBI, and also higher alterations in FRBE and SC in patients
with severe TBI. We studied the presence of dissociations between emotional and cognitive ToM,
in order to acknowledge the differential pattern of alteration for each group, and the relation
between FRBE, SC and EEFF.
Conclusion
We believe that the assessment and early diagnosis of these impairments are essential to
propose a suitable rehabilitation plan. We know that an appropriate approach would impact on
the development of these patients, improving behavioral changes and social reintegration.
WCNR-0698
BOARD NUMBER: 089
GOAL SETTING PRACTICE IN NEUROREHABILITATION: HOW MANY GOALS AND WHICH
DOMAINS SHOULD WE CHOOSE?
K. Fheodoroff1, M. Freimueller2, V. Tomantschger2
1, Austria
2Gailtal-Klinik, Neurorehabilitation, Hermagor, Austria
Aims
Goal setting is considered 'best practice' in neurorehabilitation; however, there is no consensus
regarding numbers and content of goals to be set/agreed for in-patient rehabilitation.
The ICF offers an accepted framework to classify goals alongside the main categories of body
functions and life domains.
Here we report the number of goals for in-patients in each ICF main category related to the
Barthel-Index (BI) at admission.
Method
Descriptive statistics of all goals for all in-patients discharged between 2013 and 2014. A
subgroup analysis according to BI at admission was performed.
Results
Of 2672 in-patients, 357 (13%) had a BI of 0-30 at admission (Austrian phase model: phase B),
801 (30%) had a BI of 35-80 (phase C) and 1514 (57%) had a BI >85 (phase D). Average stay
was 37.7 (SD 25) days.
The average number of goals for each patient was n=8.8 (SD 4.5). In phase B, n=12.6 (SD 5.8);
in phase C, n=10.0 (SD 4.8) and in phase D n=7.2 (SD 3.1) goals were set.
In phase B, goals related to Body Functions (b [n=1.9; SD 1.0]), Mobility (d4 [n=4.4; SD 2.0]) and
Self Care (d5 [n=3.3; SD 1.7]) were more frequent than in phase C and D.
The percentage of goals related to General Tasks and Demands (d2) was high in all 3 groups (B:
70.9%, C: 65.9%, D: 73.8%).
The percentage of patients with goals related to Interactions (d7) was highest in group B (41.2%
vs 21.6% in C and 18.8% in D)
Conclusion
Depending on level of independence at admission, a total of 7-13 individual goals seems to be
appropriate for goal setting in in-patient neurorehabilitation.
Beyond mobility and self care, goals related to interaction (d7) and general tasks and demands
(d2) should be considered as relevant for individual goal setting practice.
WCNR-0618
BOARD NUMBER: 090
Analysis of the clinical characteristics of children with cerebral palsy caused by human
CMV infection
J. Qiu1, X. Chen2, C. Xu1
1Zhejiang Provincial Rehabilitation Guidance Center for Disabled Persons,
Rehabilitation Medicine, Hangzhou, China
2Zhejiang Minzheng Rehab Center, Pediatric Rehabilitation, Hanghzou, China
Aims
To Analyze the clinical characteristics of children with cerebral palsy caused by human
CMV(HCMV) infection
Method
Fifty-one cases of HCMV infection were studied by analyzing related clinical symptoms of
cerebral palsy, finding its characteristics, and analyzing its causes.by comparing with control
group of 50 patients with cerebral palsy caused by other causes
Results
The clinical symptoms of cerebral palsy caused by HCMV infection were similar to those of
cerebral palsy caused by other reasons, However ,the clinical symptoms of cerebral palsy
caused by other reasons were more severe.37.25% of cerebral palsy caused by HCMV infection
showed damage to liver function. Brain CT and MRI for cerebral palsy caused by other
reasons showed that 30% of alba was damaged with local cyst. Developmental quotient
determination of cerebral palsy caused by HCMV infection showed 90.20% of the patients was in
moderate to severe defects,whereas the percentage of patients with cerebral palsy caused by
other causes was 52.6% .There was a significant difference between the two groups with
respect to their developmental quotient. The motor function in 88.23% of patients with cerebral
palsy caused by HCMV infection was class II-III, which was mainly in slight to moderate damage
Conclusion
The movement function of cerebral palsy caused by HCMV was mostly in the slight to moderat
damage ,however the mental development obviously was mostly in moderate to severe defects,
which showed the mental damage was much greater than the motor function damage. In patients
with cerebral palsy caused by other causes, the degree of motor function damage was greater
than the degree of intelligence damage.Besides, The children with cerebral palsy caused by
HCMV infection were easy to suffer multiple organ injury such as liver damage. The brain CT and
MRI showed 30% of the brain damage caused by other reasons of cerebral palsy was in the
alba.
May 11 – 12:45: 17:00
WCNR-0386
BOARD NUMBER: 001
B. TREATMENT/PHARMACOTHERAPY/PT
LONGITUDINAL STUDY INVESTIGATING THE ASSOCIATION BETWEEN SEVERITY,
DISABILITY AND PHYSICAL FUNCTION AT BASELINE WITH WALKING SPEED SIX
MONTHS POST-STROKE
M.K. Aaslund1,2, R. Moe-Nilssen1, B.B. Gjelsvik2, B.E. Bogen3, H. Næss4,5,6, H. Hofstad1,7,
J.S. Skouen1
1University of Bergen, Department of Global Public Health and Primary Care, Bergen, Norway
2Haukeland University Hospital, Department of Physiotherapy, Bergen, Norway
3Bergen University College, Department of Occupational TherapyPhysiotherapy and Radiography, Bergen, Norway
4Haukeland University Hospital, Department of Neurology, Bergen, Norway
5University of Bergen, Institute of clinical medicine, Bergen, Norway
6Stavanger University Hospital, Centre for age-related medicine, Stavanger, Norway
7Haukeland University Hospital, Department of Physical Medicine and Rehabilitation, Bergen,
Norway
Aims
To investigate whether stroke severity, disability and physical function the first week post-stroke
are associated with walking speed (WS) at six months.
Method
Participants were recruited from a stroke unit and tested within the first week (baseline) and at six
months post-stroke. Participants had to live at home prior to the stroke. Outcome measures were
the NIHSS, Barthel Index, modified Rankin Scale, preferred walking speed (PWS), Postural
Assessment Scale for Stroke (PASS) and the Trunk Impairment Scale. Linear multiple regression
models were used to explore which variables that best predicts PWS at six months, and Receiver
Operating Characteristics (ROC) curves to determine cut-offs.
Results
In total, 132 participants post-stroke were included; mean age 69 years (SD 12), 58 percent male,
and mean NIHSS score of 4.5 (SD 3.8). At baseline, mean WS was 0.73 m/s (SD 0.49) and at six
months post-stroke 1.03 m/s (SD 0.41). PASS, PWS, gender and age at baseline predicted
walking speed at six months with an explained variance of 0.63. Cut-offs of these measures to
predict long-term walking speed will be presented at the conference.
Conclusion
Six months post-stroke 75 percent of the participants had a PWS faster than 0.8 m/s and 58
percent walked faster than 1 m/s. The score on the PASS, PWS, gender and age at baseline
predicted PWS at six months post-stroke, and the four variables explained 63 percent of the
variance in PWS.
WCNR-0351
BOARD NUMBER: 002
STROKE REHABILITATION WITH BRAIN-COMPUTER INTERFACE (BCI) TECHNOLOGY
B. Allison1, R. Ortner1, N. Sabathiel1, C. Guger1,2
1Guger Technologies OG, Research Dept., Schiedlberg, Austria
2g.tec medical engineering GmbH, Engineering Dept., Graz, Austria
Aims
The primary objective was to explore a new approach to movement therapy based on paired
associative stimulation (PAS).
Method
Three subjects each performed several hand movement therapy sessions lasting about 30
minutes each. The methods were similar to conventional therapy in terms of the subject’s task
and the type of feedback. Feedback was provided via a functional electrical stimulator (FES) and
a first-person view of an avatar. However, we also recorded each patient’s motor imagery (MI) via
the EEG. We used the MI to influence both types of feedback in a closed-loop fashion, in which
patients received positive feedback only when they correctly performed the imagined movement.
This novel method is called “Paired Associative Stimulation” or PAS, since it pairs each patient’s
MI with feedback. The figure below presents RecoveriX, the real-time closed-loop BCI system
used here.
Results
We present results in terms of BCI classification accuracy, MI maps, and functional improvement.
Patient P1 was completely unable to move the affected hand before the experiment, and
regained limited movement after ten training sessions. Patients P2 and P3 participated in 21 and
14 sessions, respectively, and showed improvement in 9-hole PEG test (9-HPT) performance.
Conclusion
Initial results with three subjects suggest that the closed-loop feedback presented here can lead
to encouraging outcomes. Future R&D with this PAS approach is warranted.
WCNR-0340
BOARD NUMBER: 003
PERCEPTUO-MOTOR PLANNING DURING FUNCTIONAL REACHING AFTER STROKE
M. Alt Murphy1,2, M.F. Levin2,3
1Neuroscience and physiology, Rehabilitation Medicine, Gothenburg, Sweden
2McGill University, Center for Interdisciplinary Research in Rehabilitation CRIR, Montreal,
Canada
3McGill University, School of Physical and Occupational Therapy, Montreal, Canada
Aims
Healthy young people adjust their grasp position on an object depending on the future position of
the object, a phenomenon described as the end-state comfort effect. This aspect of motor
planning may be affected by stroke, especially in the presence of perceptual deficits. Thus, the
aim of the study was to determine to what extent motor planning for reaches to different heights is
affected by stroke.
Method
Thirty-three adults (18 healthy, 15 chronic stroke with mild/moderate motor impairment)
performed a functional goal-directed task, which included reaching, grasping and transporting a
cylindrical object (a plunger) from a standard height to 4 different target heights, relative to the
body. The relationship between grasp heights on the object shaft and the heights of target
shelves was the primary outcome. This relationship, expressed as a slope, signifies the degree of
perceptuo-motor coupling. An optoelectronic camera system recorded kinematics of the endpoint,
arm and trunk. Sensorimotor impairment and perceptual deficits were measured with
standardized validated clinical measures.
Results
A clear and strong linear relationship between grasp height and the target height was found in
both groups. The mean values of the slopes for the affected and less-affected arm in stroke (53.1 and -42.2) were not statistically different from healthy controls (-60.0). However, for the lessaffected arm in the subgroup with visuo-perceptual impairments, the slopes were significantly
lower than in healthy controls, indicating deficits in perceptuo-motor planning.
Conclusion
Results suggest that perceptuo-motor planning is relatively preserved in people with mild and
moderate stroke, although visuo-perceptual impairment may influence this planning as indicated
by the smaller end-state comfort effect in this subgroup of patients. In those without visuoperceptual impairment, the system may preserve end-state comfort by incorporating
compensations for the existing movement deficits.
WCNR-0300
BOARD NUMBER: 004
AN INTERNATIONAL, MULTICENTER, PROSPECTIVE, RANDOMIZED, EVALUATORBLINDED STUDY COMPARING DIFFERENT BOTULINUM TOXIN INJECTION STRATEGIES
FOR TREATMENT OF UPPER LIMB SPASTICITY
T. Dalager1, B. Biering-Sörensen2, J. He3, O.J. Vilholm4, P. Brøgger Christensen5, T. Ulfarsson6,
T. Rekand7, T. Ström8, P. Myrenfors8, P. Maisonobe9, R. Belusa8
1Bispebjerg Hospital, Clinic of Dystonia, Copenhagen, Denmark
2Glostrup Hospita, Dept. of Neurology, Glostrup, Denmark
3University Hospital of Copenhagen- Roskilde Sygehus, Dept. of Neurology, Roskilde, Denmark
4Vejle Hospital, Dept. of Neurology, Vejle, Denmark
5Aarhus University, Inst. of clinical medicine, Aarhus, Denmark
6Sahlgrenska University Hospital, Dept. of Rehabilitation Medicine, Gothenburg, Sweden
7Haukeland Unversity Hospital, Dept. of Neurology, Bergen, Norway
8Institut Produits Synthèse Ipsen AB, Medical department, Stockholm, Sweden
9IPSEN Pharma S.A.S, Medical department, Paris, France
Aims
To evaluate non-inferiority between two different injection strategies incorporating different
numbers of injection points and concentrations/volumes of abobotulinumtoxinA (ABO, Dysport ®).
Method
Patients (Nordic) who had previously received ≥2 cycles of ABO and with satisfactory efficacy
(per investigator’s judgment) were randomized (1:1) to two groups. G1: ≥2 injection points per
muscle, 0.1-0.7ml per muscle (ABO concentration 300 U/ml), G2: 1 injection point per muscle,
0.4-2.0ml per muscle (ABO concentration 100 U/ml) and according to a predefined
neuromuscular junction targeting technique. Electromyography or ultrasound was used to guide
the injections. Total dose administered at Visit 1 (baseline) were per investigator’s judgment and
remained unchanged. The primary endpoint (PE) was the percentage of patients with at least 1
level improvement in MAS at elbow flexors at 4 weeks post Visit 1 injection.
Results
The study was closed before full recruitment due to slow recruitment. The study was planned to
include 272 patients. Non-inferiority in PE was not shown in the intention to treat (ITT) (n=88) or
in the per protocol (PP) (n=54) population. ABO units administered (mean±SD) were 537.8±130.2
for G1 and 579.4±180.5 for G2. The ITT population displayed a numerical favoring towards G1
(72.7 vs 56.8%, p=0.0986). The proportion of patients with at least 1 level decrease in MAS in PP
was 69% for G1 and 68% for G2. Injection pain (VAS±SD) was not different between the groups
(G1: 30.68±27.33 vs G2: 25.67±25.37). Over all the treatments was well tolerated.
Conclusion
In the PP population similar efficacy was observed while the ITT population indicated a trend
favoring G1. However, since the study had to be closed before full recruitment, non-inferiority
could not be concluded.
WCNR-0241
BOARD NUMBER: 005
THE INFLUENCE OF PHYSICAL ACTIVITY AND LEAN MASS ON VOLUMETRIC BONE
DENSITY AT THE TIBIA TWO YEARS AFTER STROKE
K. Borschmann1,2, S. Iuliano3, A. Ghasem-Zadeh3, M.Y. Pang4, J. Bernhardt1,2
1La Trobe University, Department of Physiotherapy, Melbourne, Australia
2The Florey Institute of Neuroscience and Mental Health, Stroke Division, Heidelberg, Australia
3University of Melbourne, Department of Medicine- Austin Health, Melbourne, Australia
4Hong Kong Polytechnic University, Department of Rehabilitation Sciences, Hung Hom,
Hong Kong- China
Aims
Accelerated bone loss associated with immobility and muscle atrophy contributes to increased
fracture risk of paretic limbs. The aim of this study was to observe changes in the magnitude of
side-to-side difference (STS-diff) in volumetric bone mineral density (vBMD) between paretic and
non-paretic legs from early after stroke and its relationships to physical activity and lean mass.
Method
Prospective observational study. Participants unable to ambulate were recruited within week of
first stroke, and assessed 6-monthly for two years. Primary outcome: vBMD at bilateral distal
tibiae, derived using high-resolution peripheral quantitative computed tomography (HR-pQCT);
analysed by generalised estimating equation, controlling for age and stroke severity (National
Institutes of Health Stroke Scale, NIHSS). Secondary outcomes: physical activity (accelerometer
recorded proportion of time standing, and number of transitions between lying, sitting and
standing), serum markers of bone resorption (carboxyterminal crosslinked telopeptide of type 1
collagen, CTX) and formation (N-terminal propeptide of type 1 procollagen), dual energy X-ray
absorptiometry (DXA) derived lean mass.
Results
16 participants aged 65.3±10.2 years, NIHSS 12.8±5.4 (n=7 females). Between baseline and two
years, the STS-diff in vBMD increased (p=0.01) from 1.0% (95%CI -1.3,2.4) to 2.9% (-1.6, 9.0); a
monthly change of 0.17% (95%CI 0.04, 0.30). STS-diff in lean mass increased monthly by 0.09%
(95%CI 0.01, 0.17; p=0.03), from -2.35% (-3.97, 1.40) to 0.69% (-2.43,4.02). Between baseline
and two-years, proportion of time standing increased (p<0.01) from 1.22% (0.27, 4.8) to 23.46%
(15.33, 32.67) and transitions from 58.5 per day (33, 75) to 71 (58, 108). STS-diff in vBMD was
not associated with STS-diff in lean mass or physical activity. Proportion of time standing was
inversely associated with CTX (-2.86, 95% CI -5.2, -0.6; p=0.01).
Conclusion
The magnitude of the difference in vBMD between paretic and non-paretic legs increased within
two years of stroke. Increasing time standing may reduce bone resorption after stroke.
WCNR-0379
BOARD NUMBER: 006
THE CORRELATION OF NUTRITIONAL STATUS WITH FUNCTIONAL OUTCOME IN
STROKE
B. Celik1, B. Erhan1, B. Gunduz1, N. Paker1, C. Atalay1
1Istanbul Physical Medicine Rehabilitation Training and Research Hospital,
Physical Medicine&Rehabilitation, Istanbul, Turkey
Aims
Malnutriton is a serious condition which could interfere with immunity and functional recovery
following stroke. The aim of this study was to evaluate the effects of nutritional status on the
functional recovery after stroke.
Method
The study included 64 patients with stroke (42 female, 22 male) with a mean age 64.89±11.80
yrs (min-max, 34-91). Time since injury was 22.92±40.15 months (1-228). A full physical
examination was performed. Patients were administered Mini Nutritional Assesment Scale
(MNAS) to evaluate nutritional status and Mini Mental Test (MMT) , Modified Rankin Scale,
Functional Ambulation Scale to evaluate functional status.
Results
The mean MNAS and MMT were 21.39±4.30 (min-max, 7-29) and 19.21±6.83, respectively. The
frequencies for Modified Rankin Scale was as follows: 1-7.8%, 2-9.4%, 3-40.6%, 4-31.2% and 510.9%. The frequencies for Functional Ambulation Scale was as follows: 0-18.8%, 1-12.5%, 226.6%, 3-12.5%, 4-21.9%, 5-7.8%. A significant correlation was found between MNAS with MMT,
Modified Rankin Scale and Functional Ambulation Scale (p= 0.000, r=0.447; p=0.001, r=0.418;
p=0.001, r=0.393 respectively).
Conclusion
Our findings suggest that protein-energy malnutrition following stroke could be a risk factor for
poor functional status and motor recovery.
WCNR-0294
BOARD NUMBER: 007
THE MANAGEMENT AND REHABILITATION OF PATIENTS WITH ACUTE ISCHEMIC
STROKE
I.D. Cuciureanu1, I.S. Stratulat2
1Prof. Dr. N. Oblu Clinical Emergency Hospital, Neurolgy, Iasi, Romania
2Clinic Railroads Hospital - Rehabilitation Department"Gr. T. Popa" University of Medicine and Pharmacy, Medical Rehabilitation, Iasi, Romania
Aims
Introduction: Ischemic stroke represents the second cause of death worldwide, after
cardiovascular disease, and the first cause of death in Romania. Also, stroke is cited as the
second leading cause for dementia, the first cause of epilepsy and a common cause for
depression. It’s most important complication is related to loosing the ability for work and dailyliving activities with increased costs for society, therefore an appropriate management of the
patient with stroke (neurological treatment and rehabilitation) is needed.
Objectives: Our goals were to quantify the number of cases with stroke and their most efficient
treatment, based on the time of arrival at the hospital, but also the impact of different complex
treatment in the rehabilitation phase (acute, post acute and chronic).
Method
Methods: We analyzed 14 patients that underwent emergency thrombolysis after ischemic
stroke, in the periods june-october 2015, in the Neurology Department of the Regional Clinic
Emergency Hospital “Prof. N. Oblu” Iasi, Romania.
Results
Results: There was 1 patient between 50-60 years, 4 patients between 60-70 years, 6 patients
between 70-80 years and 3 patients between 81-85 years. The most frequent co-morbidities
encountered were arterial hypertension (31%), high cholesterol levels (27%) and arterial
fibrillation (15%). The majority of patients suffered a stroke in the carotidian system (79%) and
only 21% were in the vertebro-basilar system. The results were excellent in terms of recovery for
the patients that underwent arterial thrombolysis.
Conclusion
Conclusions: Admission to a stroke unit is recommended for acute stroke patients, included in
thrombolysis treatment; post-acute these patients need to receive coordinated multidisciplinary
rehabilitation in order to prevent complications. The early discharge is recommended for
neurologically stable patients with mild or moderate impairment so that rehabilitation can be
delivered by a multidisciplinary team.
WCNR-0290
BOARD NUMBER: 008
CORRELATIONS BETWEEN REDUCED SPASTICITY, GOAL-ATTAINMENT AND GLOBAL
ASSESSMENT OF BENEFITS IN PATIENTS WITH UPPER LIMB SPASTICITY TREATED
WITH BOTULINUM TOXIN-A
K. Dashtipour1, J. Balcaitiene2, S. Ashford3, J. Jacinto4, K. Fheodoroff5, P. Maisonobe2, L. TurnerStokes3
1School of Medicine- Faculty of Medical Offices- Loma Linda University,
Department of Neurology/Movement Disorders, Loma Linda, USA
2Ipsen Pharma, Medical Affairs, Boulogne-Billancourt, France
3King’s College London School of Medicine- Palliative Care- Policy and Rehabilitation and,
Regional Rehabilitation Unit- Northwick Park Hospital, London, United Kingdom
4Centro de Medicina de Reabilitaçãode Alcoitão, Serviço de Reabilitação de Adultos, Estoril,
Portugal
Aims
To analyse the correlation between Modified Ashworth Scale (MAS) change scores and
investigator or patient global assessments of benefits following botulinum toxin-A (BoNT-A)
treatment, for upper limb spasticity (ULS) in the Upper Limb International Spasticity (ULIS)-II
study.
Method
ULIS-II was an 18-month, international, non-interventional study in 456 post-stroke adults with
ULS receiving BoNT-A treatment. Muscle tone in upper limb joints was evaluated using the MAS
(no increase to rigid joint) and MAS composite change scores were calculated from baseline to
follow-up (at 3-5 months). Global assessment of benefits were rated by investigators and patients
as great, some or no change/worsening. Correlations were determined between MAS, reported
benefit and the primary outcome measure, Goal Attainment Scaling (GAS) T-scores, using
Spearman’s rank correlation coefficient.
Results
Weak but significant correlations were observed between MAS change scores and investigatoror patient-assessed benefit (rho=0.28 and 0.20, respectively; P<0.01). Investigator-reported
benefits correlated better with MAS change score than patient-reported benefits; although, a
correlation was demonstrated between investigator and patient assessment of benefit (rho=0.66;
P<0.01). Significant correlations were observed between GAS T-scores and investigator- or
patient-assessed benefit (rho=0.39 and 0.47, respectively; P<0.01). Additionally, a marked
correlation was shown between MAS change score and GAS T-score (rho=0.28; P<0.01).
Conclusion
In ULIS-II patients receiving BoNT-A treatment, MAS change scores at follow-up correlated with
investigator and patient global assessment of benefits, as well as GAS T-scores. Better
correlations between MAS and investigator-assessed benefits compared with patient-assessed
may suggest that MAS change is not necessarily translated into patient benefits, whereas goalattainment may provide more person-centred reflection of outcome.
WCNR-0306
BOARD NUMBER: 009
THE PHYSICAL ACTIVITY LEVEL IN SUBACUTE AMBULATORY STROKE PATIENTS
B. Ersoz Huseyinsinoglu1, G. Kuran Aslan2, D. Tarakci3, H. Kucukoglu4, S. Baybas4,
A. Razak Ozdincler2
1Istanbul University, Department of Neurological Physiotherapy and Rehabilitation, Istanbul,
Turkey
2Istanbul University, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
3Medipol University, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
4Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases,
Neurology, Istanbul, Turkey
Aims
Physical inactivity is an important risk factor for stroke and stroke recurrence. Increased
dependence level in ambulation reduces the physical activity level after stroke. Our aim was to
determine the physical activity level in subacute ambulatory stroke patients and compare with age
matched healthy subjects.
Method
Thirty subacute stroke patients who fulfilled the following criteria were included in the study: (1)
<3 months after stroke (2) >3 according to Functional Ambulation Category (3) no pain of lower
extremity related to musculoskeletal dysfunctions which limits the level of ambulation (4) has no
additional systemic diseases (COPD, hearth failure etc.) which causes dyspnea at >3 level
according to Modified Medical Research Council Dyspnea Scale (5) having no discharge
proposal by the doctor providing treatment for a while due to some ongoing systemic problems.
The physical activity level was assessed by “International Physical Activity Questionnaire Short
Form” (IPAQ) and pedometer (OMRON Walking style II). The pedometer tripped for 48 hours for
determine average number of steps and, walking distance.
Results
International Physical Activity Questionnaire (IPAQ) score, daily number of steps and walking
distance were significantly less than healthy subjects in subacute stroke patients (respectively, p
= 0.003, p = 0.001, p = 0.02). While females’ IPAQ scores and number of steps were lower than
male in stroke patients, there was found no difference according to demographic characteristics
(age, education level, body mass index, and smoking status) between two groups.
Conclusion
Subacute stroke patients had lower physical activity level despite being ambulatory in early stage
of stroke. Also step counts which was an important mode of physical activity were less in women
compared to men after stroke. While building up strategies for stroke patients to prevent from
recurrence the physical activity level should taken into consideration.
WCNR-0318
BOARD NUMBER: 010
THE EFFECTS OF KINESIOTAPING ON UPPER EXTREMITY OF A STROKE PATIENT
ACCORDING TO THE INTERNATIONAL CLASSIFICATION OF THE FUNCTIONING,
DISABILITY AND HEALTH
E. Onder1, B. Ersoz Huseyinsinoglu2
1Istanbul University, Instıtute of Health Sciences, Istanbul, Turkey
2Istanbul University, Department of Neurological Physiotherapy And Rehabilitation, Istanbul,
Turkey
Aims
The aim of our study was to examine the effects of upper extremity kinesiotaping (KT) which was
applied to a stroke patient addition to the physiotherapy intervention.
Method
51-year-old male patient with stroke was undertaken physiotherapy sessions two times per week
for eight weeks. KT was performed on affected shoulder and scapula in each session. Body
function and structure (posture, trunk control, proprioception), activity (independence in personal
care, skill) and participation (amount of use on affected side) domains of International
Classification of Functioning, Disability and Health (ICF) were assessed before and after the
treatment. Posture Screen Mobile (PSM- iPad app), Trunk Impairment Scale (TIS), Forward
Reach Test (FRT), measurements with inclinometer for analysing proprioception of shoulder and
trunk were used for body function and structure area of ICF. FIM-Self Care and Nine-hold peg
test (NHP) were used to determine activity. Participation was measured with Motor Activity Log28.
Results
The results of outcome measurements were shown in Table 1.
Table 1. The results of outcome measurements
Before
Treatment
After
Treatment
2.23 (right)
0.42 (right)
5.1° (right)
1.2° (right)
17
23
PSM Posture displacement (cm)
(Shoulder posterior translation)
PSM Posture displacement (degree)
(Shoulder posterior angulation)
TIS (max. 23)
Angles of proprioception deviation for 45° shoulder flexion-45°
2°- 13°
abduction
0°- 8°
Angles of proprioception deviation for 30° forward flexion of
trunk
11°
4°
FIM-Self Care (max. 42)
25
39
NHP (sc.)
60
13
MAG-28 Amount of Use (max. 5)
Conclusion
2.3
4.2
The number of researches which examine the effects of KT on posture, trunk control and
proprioception in neurological disorders are insufficient. Our study showed that applying KT in
addition to the physiotherapy program leads to improvement in all areas of the ICF. For accurate
results, randomized controlled studies are needed.
WCNR-0338
BOARD NUMBER: 011
THE EFFECTS OF PATIENT-RELATED AND CAREGIVER-RELATED VARIABLES ON
CAREGIVER BURDEN OF ACUTE STROKE PATIENTS: PRIMARILY RESULTS FROM
TURKEY
B. Ersoz Huseyinsinoglu1, E. Zirek2, H. Kucukoglu3, S. Baybas3
Turkey
2Istanbul University, Institute of Health Sciences, Istanbul, Turkey
Department of Neurology, Istanbul, Turkey
Aims
The aim of this study was to determine the effects of patient related factors and caregiver related
factors on the level of caregiving burden in acute stroke patients.
Method
35 pairs of stroke patients/caregivers were included and analyzed in terms of demographic
characteristics. Modified Motor Assessment Scale, Barthel Index and Standardized Mini-Mental
Test was used to assess the level of motor-cognitive-functionality respectively. Caregiver Burden
Scale (CB) was used to determine the burden. Hospital Anxiety and Depression Sale (HADS),
World Health Organization of Life Assessment- Short Scale (WHOQQL-BREF), Multidimensional
Scale of Perceived Social Support (MSPSS), and Family Sense of Coherence Scale- Short Form
(FSOC-S) were applied to assess caregivers’ depression, quality of life, social and family support
respectively. All assessments were performed at discharge from hospital.
Results
The mean age of patients was 62.8 ±13.1; the main age of caregivers was 42.4 ±14.6. There was
significant relation between CB and MSPSS special and total scores. Also caregiver burden
related with caregivers’ quality of life (environment subscore; 0.001, physical subscore; <0.001).
Level of independence in ADL and cognitive status were nearly statistically significant with CB
(p= 0.05; p=0.07).
Conclusion
There are insufficient researches which examine caregiver burden of stroke patients with all
aspects in Turkey. Our trial indicated that caregiver burden could be affected by both patient and
caregiver-related factors. Advanced analysis methods with more participants and follow-up
results are needed to determine strategies for reducing caregiver burden level.
WCNR-0283
BOARD NUMBER: 012
THE BRIDGES SELF-MANAGEMENT PROGRAM FOR AUSTRALIAN COMMUNITY STROKE
SURVIVORS: A FOCUS GROUP STUDY
S. Lennon1, T. Alder1, L. Pearce1, C. Smith1, A. Vanderzon1, F. Jones2
1Flinders University, Physiotherapy, Adelaide, Australia
2St George’s University of London and Kingston University,
Faculty of Health and Social Care Science, London, United Kingdom
Aims
Self-management programs (SMP) have been identified as a way to support individuals coping
with chronic disability. Bridges is a UK developed stroke – specific program which aims to
enhance self efficacy in stroke survivors through strategies such has problem-solving and goal
setting. This study investigated whether the Bridges self-management program was appropriate
for Australian community stroke survivors.
Method
Ethics approval was obtained from the Southern Adelaide Clinical Human Research Ethics
Committee (Project Number: 225.14). Two focus groups were conducted in a sample of
community stroke survivors in a rehabilitation setting. Open-ended questions explored their
understanding of self-management, and their opinions of the different components embedded in
Bridges such as reflection, peer stories, managing their stroke, keeping active, planning for the
future and taking control. The digital recording was transcribed verbatim, then analysed
independently by two researchers for underlying themes.
Results
Twelve community-dwelling stroke survivors who had completed their inpatient rehabilitation
participated in two focus groups. The Bridges SMP was found to be a useful and informative tool
for Australian community stroke survivors. Participants identified the following core themes
related to self-management: challenges/unmet needs, triggers for motivation, the power of
confidence, and accepting / adapting to life after stroke. The main recommended changes
included the addition of stories that focused on emotional changes especially those relating to
relationship issues, and more space for documentation.
Conclusion
Stroke survivors supported the need for developing self management skills. The Bridges SMP
was considered acceptable and beneficial, requiring only required minimal adaptation for
Australian stroke survivors.
WCNR-0347
BOARD NUMBER: 013
EFFECTS OF EARLY MOBILISATION ON FUNCTIONAL OUTCOME IN STROKE PATIENTS:
A SYSTEMATIC REVIEW
C. Jeanrenaud1, M. Wacker1
1Centre Hospitalier Universitaire Vaudois, Clinical Neurosciences, Lausanne, Switzerland
Aims
The aim of the systematic review was to determine the effects of early mobilisation in the medium
and long term on functional outcome in stroke patients and to identify whether other factors are
associated with a good outcome.
Method
A systematic review was performed in PubMed, CINAHL and PEDro between january 2013 and
july 2015. Inclusion and exclusion criterias were predefined. Outcome measurements were
extracted and analyzed in order to define the effects of early mobilization on functional outcome.
Results
Six studies were included. Three studies have shown a positive trend towards early mobilization,
while the other three showed a negative trend. There was no other factor correlated to a good
functional outcome.
Conclusion
The effect of early mobilization on functional outcome in stroke patients is rather controversial.
Most of the results were not significative due to the small sample size. One study with a larger
sample size and significative results showed an odds reduction of a favourable outcome with the
early mobilization protocol. Further studies are still needed to identify the elements correlated to a
good functional outcome, such as intensity, in order to establish an optimal protocol of
mobilization for stroke patients.
WCNR-0321
BOARD NUMBER: 014
THE RELATION BETWEEN ICF CATEGORIESS AND QUALITY OF LIFE IN TURKISH
STROKE SURVIVORS: A PRELIMINARY REPORT
G. Kara1, F. Yarar1, E. Baskan1, U. Cavlak1
1Pamukkale University, Physiotherapy and rehabilitation, Denizli, Turkey
Aims
A stroke can cause lasting brain damage, long-term disability, or even death. The time it takes to
recover from a stroke varies. It can take weeks, months, or even years. Some people recover
fully, while others have long-term or lifelong disabilities. Ongoing care, rehabilitation, and
emotional support can help the survivors recover. Due to all these reason stroke leads a
decreased quality of life. WHO defines The International Classification of Functioning, Disability
and Health (ICF) as ‘a comprehensive classification system for how health- related conditions,
including disabilities, affect people’s lives. The pragmatic aim of this study was to determine the
relation between ICF core set and quality of life in stroke survivors.
Method
21community-dwelling stroke survivors (12 males and 9 females; mean age = 56.3±18.3 yrs.)
were evaluated in the cross-sectional study. The Stroke Impact Scale (vr.3.0) was used to define
the level of quality of life of the sample. An ICF core set for the stroke survivors was used to
define disability level. 12 items in body functions, 4 items in body structures, 13 items in activity
and participation, and 11 items in environmental factors were considered for this study.
Results
A significant moderate inverse relation between the two ICF categories, including body functions
and activity and participation, and quality of life scores (p≤0.005).
Conclusion
The results indicate that a structured core set for the stroke survivors can be used to show the
impact of the stroke on the Turkish survivors.
WCNR-0266
BOARD NUMBER: 015
COMBINED VIRTUAL REALITY-BASED REHABILITATION AND FUNCTIONAL ELECTRICAL
STIMULATION (FES) SYSTEM FOR DISTAL UPPER EXTREMITY FUNCTION: A
RANDOMIZED, SINGLE BLINDED CONTROLLED TRIAL
J.Y. Lee1, M.Y. Kim1, Y.J. Jeon1, J.H. Shin1
1National Rehabilitation Center, Ministry of Health and Welfare, SEOUL, Republic of Korea
Aims
Recovery of wrist and hand function is important for function and quality of life among stroke
survivors. Virtual reality (VR)-based rehabilitation and functional electrical stimulation (FES) have
been used to improve upper extremity function in stroke patients, however, there are lack of
studies combining those two interventions. The purpose of the present study was to investigate
the effects of VR-based rehabilitation combined with FES on distal upper extremity function, and
compare the findings to those of FES rehabilitation in stroke survivors.
Method
Randomized controlled trial including 20 patients with subacute or chronic stroke was performed.
Experimental group received 30 minutes of FES plus VR-rehabilitation system (SMART glove
intervention; SG group) and control group received 30 minutes of FES. Both groups participated
in total 20 sessions over four weeks. Wolf Motor Function Test was measured as a primary
outcome measurement and Jebsen-Taylor hand function test, and Box and Block test were also
done as a secondary outcome. All of the measurements were obtained at baseline, two and four
weeks after intervention and after 1 month. The changes of those variables were compared
between the two groups using the RM ANOVA.
Results
Both group showed improvements of whole variables (P < 0.05). SG group showed better
improvement of whole variables; however changes did not reach statistical significance level.
Conclusion
VR-based rehabilitation combined with FES showed possibility as a rehabilitation intervention in
stroke survivors; however, it is difficult to make definite conclusions compared to FES alone
because of small participants. Further results will be followed in the near future, as this trial is still
ongoing.
WCNR-0264
BOARD NUMBER: 016
BALANCE YOURSELF! WALKING-AIDS THAT DON’T USE HANDS. ORTHOTIC-GARMENT
IMPROVES GAIT AND BALANCE IN CHRONIC, PREVIOUSLY CANE USING STROKEPATIENTS
C. Maguire1, J. Sieben2, J. Romkes3, H. Scheidhauer4, G. van der Weijden5, R. de Bie2
1Bildungszentrum Gesundheit Basel Stadt, Munchenstein, Switzerland
2Maastricht University, Department of Anatomy and Embryology, Maastricht, Netherlands
3University Childrens Hospital Basel, Movement and Gait Laboratory, Basel, Switzerland
4Bildungszentrum Gesundheit Basel Stadt, Physiotherapy, Munchenstein, Switzerland
5REHAB Clinic for Neurorehabilitation and Paraplegia, Physiotherapy, Basel, Switzerland
Aims
Activity of the hemiplegic-side with high repetition increases ipsilesional cortical-plasticity and
improves function following stroke. Normal hip-joint-loading facilitates normal Central-PatternGenerator activity. Canes held in the non-hemiplegic hand reduce hemiplegic muscle-activity and
unload the hip. An orthotic-garment TheraTogs increases muscle-activity during gait and allows
normal joint-loading. This study investigates the effect of TheraTogs on gait and balance when
replacing canes in chronic stroke-patients.
Method
Multiple, single-subject ABC experiment with 4 subjects. Outcomes 1)Functional Gait
Assessment(FGA) 2)Trunk-sway in walking. All measured weekly. Phase-duration randomized.
PhaseA:Cane-walking as normal 9-12 weeks. PhaseB:TheraTogs-walking applied to facilitate
hip-extensor and abductor activity worn throughout the day 15-17 weeks. PhaseC:Follow-up
walking either 1.with no walking-aid 2.continued with TheraTogs or 3.returned to cane 9-10
weeks.
Results
FGA score(*MCID=5), p-wert(Friedmans-Anova) and phaseC condition. Subject 1: A10, B13,
C12 p=0.05 and returned to cane-use. Subject 2: A13, B16, C20* p= 0.001 and walked without
cane. Subject 3: A12, B15, C11 p=0.03 and returned to cane-use. Subject 4: A8, B13*, C12
p=0.022 and remained using TheraTogs. Trunk-sway during walking measured as Total-AngleArea (TAA) in degrees in the frontal and sagittal-planes, reduced in two patients from phaseA to
B and in three patients from A to C indicating increased stability. Improvements were maintained
or continued in all subjects in phaseC although no TAA changes were statistically significant.
TAA mean(SD) Subject 1: A161.9°(42.4), B137.3°(41), C117°.38(32.4); Subject 2: A223.4°(32.2),
B216.5°( 30.5), C207.70(38.88); Subject 3: A116.9°(25.7), B121.8°(28), C116°(12.22); Subject 4:
A166.2°(29.6), B169.15°(28.26), C151.25°(39.14).
Conclusion
One previously cane-using patient became independent without aids. This clinically-significant
improvement may indicate that walking-aids decisively impact gait and balance-ability. Other
subjects showed similar tendencies but effect-sizes were smaller. Walking-aids which increase
muscle-activity, allow normal joint-loading and do not require hands may be more effective than
canes for gait rehabilitation. Further research is needed to confirm these results and to identify
which patients may benefit.
WCNR-0385
BOARD NUMBER: 017
AN IMPLANTED MULTI-JOINT NEUROPROSTHESIS FOR GAIT ASSISTANCE AFTER
STROKE CONSISTENTLY IMPROVES WALKING SPEED: A CASE REPORT
N. Makowski1, R. Kobetic1, L. Lombardo1, K. Foglyano1, G. Pinault2, S. Selkirk3,4, R. Triolo1,5,6
1Louis Stokes Cleveland Veterans Affairs Medical Center, Research, Cleveland, USA
2Louis Stokes Cleveland Veterans Affairs Medical Center, Surgery, Cleveland, USA
3Louis Stokes Cleveland Veterans Affairs Medical Center, Neurology, Cleveland, USA
4Case Western Reserve University, Neurology, Cleveland, USA
5Case Western Reserve University, Biomedical Engineering, Cleveland, USA
6Case Western Reserve University, Orthopaedics, Cleveland, USA
Aims
Post-stroke gait is compromised by limitations in voluntary control of the hip, knee, and ankle.
Implanted neuroprostheses targeting the nerves and muscles responsible for hip, knee, and ankle
movements have the potential to improve mobility during activities of daily living. To be clinically
useful, such devices need to operate consistently over time. This case study evaluates the
consistency of clinical outcomes of a multi-joint neuroprosthesis with respect to post-stroke gait.
Method
The participant sustained a hemorrhagic stroke two years prior to inclusion in the study. Gait was
limited by decreased strength, limited joint coordination, and moderate hypertonia. He received
an 8-channel implanted pulse generator (IPG) and intramuscular stimulating electrodes targeting
hip, knee, and ankle flexors and extensors on the paretic side. After implantation, a stimulation
pattern was customized to assist hip, knee, and ankle movement during gait.
During eleven over ground gait training sessions over two months, we measured average gait
speed at two minute intervals to assess the consistency of walking with stimulation. A linear
model with interactions was fit to the data to evaluate gait speed based on: 1) time within a walk,
2) walk sequence within a session, and 3) session order.Results
Walks ranged from 6-40 minutes. Although average gait speed had a relatively low standard
deviation (0.53m/s ±0.04m/s), the model reveals a gradual decrease in speed during walks
(p<0.001) that is reduced during later walks and sessions (p<0.001).
Conclusion
Walking speed was generally consistent, but reductions in speed during walks may have resulted
from fatigue. Differences were statistically significant, but not clinically relevant (i.e. <0.16m/s).
Interaction effects suggest fatigue decreased with additional use as the subject’s endurance
improved. These results imply that implanted neuroprostheses provide consistent improvements
to post-stroke walking and are suitable for clinical application.
WCNR-0366
BOARD NUMBER: 018
SINGLE-SESSION RESPONSE TO REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION
RELATES TO MOTOR CONTROL GAINS OVER AN INTERVENTION IN STROKE
SURVIVORS
C. Massie1
1School of Health and Rehabilitation Science- Indiana University Indianapolis,
Occupational Therapy, Indianapolis, USA
Aims
The aim of this study was to evaluate the relationship between the neurophysiological changes
within an acute session of repetitive transcranial magnetic stimulation (rTMS) with motor control
changes after multiple sessions of rTMS.
Method
Chronic survivors of stroke participated in this study as part of a larger randomized control trial
(n=9, 2 female, mean age 67±11 years, mean post-stroke 4.4±3.8 years). Participants completed
an initial acute session with measures recorded prior to and immediately following the rTMS
session. Participants then completed 10 sessions of rTMS over the course of 5 days with a posttest the last day. The outcomes included TMS at 120% of resting motor threshold (rMT) and force
steadiness at 10 % of the maximum voluntary contraction during a lateral pinch task. The rTMS
stimulation was 10Hz, 3 second train, 30 second inter-train interval at 70% rMT delivered over the
hotspot for an intrinsic hand muscle. The rTMS was delivered either at rest or during a light
isometric contraction. Data analysis included an average of 12 peak-to-peak TMS amplitudes and
coefficient of variation (CV) of the force steadiness data. Change scores and correlation
coefficients were calculated.
Results
TMS amplitudes changed 0.02±0.52mV following the acute session with a range of -0.8 to 0.8mV.
Average CV improvement was 0.3±2.4% with a range from -3.3 to 3.7mV. Figure 1 illustrates a
significant correlation between acute TMS changes with motor control after the intervention
(r=0.7, p = 0.03).
Conclusion
The strong relationship between the degree of neuromodulation achieved during an acute
session with longer-term changes in motor control suggests that trying to maximize acute session
changes could lead to better outcomes with rTMS interventions delivered over multiple days.
These preliminary results support the need to study individualized rTMS protocols.
WCNR-0254
BOARD NUMBER: 019
EFFECT OF ORAL BACLOFEN ON INCREASED MUSCLE TONE FOR PERSONS
POSTSTROKE
S. Mizuno1, S. Sonoda1, Y. Tomita2, K. Takeda2
1Fujita Health University, Rehabilitation medicine II, Tsu, Japan
2Fujita Health University, Fujita Memorial Nanakuri Institute, Tsu, Japan
Aims
Baclofen is commonly prescribed for the management of persons with spasticity. Its efficacy is
questionable.
The objective of the current study was to assess an efficacy of oral baclofen for persons with
increased muscle tone after stroke.
Method
Twenty nine persons who were with increased muscle tone of ankle plantar flexion and ankle
clonus by clinical assessment participated in the study. Baclofen was administrated 20 mg/ day
for a week. Muscle tone of ankle plantar flexion was quantitatively measured pre and post
administration of baclofen by the custom built device. Ankle joint was passively dorsiflexed at
angular velocity of either 5 °/sec (slow stretch) or 90 °/sec (fast stretch). Ankle joint angle and
resistive plantar flexion torque were measured during ramp and hold stretch. Electromyograms
from gastrocnemius and tibia anterior were recorded simultaneously. The torques at 10 ° of
ankle dorsiflexion in slow stretch (T-slow) ,fast stretch (T-fast), ⊿T-velocity dependent (T-fast-Tslow), and ankle clonus during hold were compared pre and post oral baclofen.
Results
Remarkable reduction of ankle clonus during hold was accompanied with velocity dependent
torque reduction in three persons. T-slow, T-fast, and ⊿T-velocity dependent did not show
significant differences between pre and post administration of baclofen. Adverse effects were
seen in 5 persons.
Conclusion
Limited persons well responded to oral baclofen, whereas most did not. Short term trial
administration of baclofen, assessments of muscle tone and ankle clonus are recommended
before regular administration is considered.
WCNR-0373
BOARD NUMBER: 020
THE RELATIONSHIP BETWEEN FUNCTIONAL PERFORMANCE, CONTROL OF BALANCE
AND FEAR OF FALLING IN STROKE PATIENTS: A CROSS-SECTIONAL STUDY
R. Mustafaoglu1, I. Yeldan2, B. Gunduz3, B. Erhan4
1ISTANBUL UNIVERSITY, Faculty of Health ScienceDivision of Physiotherapy and Rehabilitation, ISTANBUL, Turkey
2ISTANBUL UNIVERSITY, Faculty of Health ScienceDivision of Physiotherapy and RehabilitationDepartment of Neurologic Physiotherapy and Rehabilitation, ISTANBUL, Turkey
3Istanbul Physical Medicine and Rehabilitation Training Hospital, Physical Medicine, ISTANBUL,
Turkey
4ISTANBUL AYDIN UNIVERSITY, Health Services Vocational School of Higher EducationIstanbul Physical Medicine and Rehabilitation Training Hospital, ISTANBUL, Turkey
Aims
Stroke survivors often have significant walking limitations and impaired balance and consequently
they are at high risk for falling. This study aimed to determine the relationship between functional
performance, balance and fear of falling in patients with stroke.
Method
Fourty-three subjects with stroke, (range of age; 34-77 years), who treated in-patient rehablitation
unit, after 3 months from stroke, participated in this cross-sectional study. Functional Ambulation
Scale (FAS), 10-meter Comfortable and Fast Gait Speed Tests (CGST-FGST), 6-minute walk test
(6MWT), and stair climbing test were measured to determine fuctional performance. The Single
Leg Stance Test (SLST), the Timed Up and Go (TUG) and the Berg Balance Scale (BBS) were
used to measure balance ability. Fear of falling was assessed with the Falls Efficacy ScaleInternational (FES-I) using face-to-face interviews and a self-reported questionnaire. Linear
regression analysis was used to elucidate the explanatory factor associated with falling. Statistical
significance was accepted for values of p < 0.05.
Results
Mean age of the patient was 52.8±13.1 years. Significant correlations were found between the
FES-I and all outcome measures except that unaffected limb SLBT (p<0.05). Also, significant
relationships were observed between the FES-I with 10-meter CGST (p=0.021), FGST (p=0.007),
stair climbing test (p=0.005, p=0.006), TUG (p=0.000), BBS (p=0.019), FAS (p=0.007) and
affected limb SLST (p=0.006).
Conclusion
The results indicate that the fear of falling was related with both decreased functional
performance and balance deficit in stroke patients. Furthermore, it is sugessted that the patients
who can accomplish 6MWT may feel comfortable in terms of the fear of falling risk. The
assessment of shorter distance performance may be stronger determinants to identify falling risk
in stroke patients.
WCNR-0381
BOARD NUMBER: 021
THE EFFECTS OF ROBOT-ASSISTED GAIT TRAINING ON MOBILITY AND GAIT
PARAMETERS IN COMMUITY-DWELLING PEOPLE WITH STROKE: SINGLE-BLINDED,
RANDOMIZED CONTROLLED STUDY
B. Erhan1, R. Mustafaoglu2, I. Yeldan3, B. Gunduz4, A. Razak Ozdincler2
4Istanbul Physical Medicine and Rehabilitation Training Hospital, Physical Medicine, ISTANBUL,
Turkey
Aims
Mobility and gait deficits may determine patients’ community integration after stroke. Recently,
robot-assisted gait training (RAGT) has been suggested as a useful option for gait rehabilitation
after stroke. The purpose of this study was to investigate the effects of RAGT on mobility and gait
parameters in patients with stroke.
Method
Thirty-three (11 women, 22 men with an age range: 19-77 years) patients, 3 months after stroke,
were randomized into 3 treatment groups. Group 1 (n=11): 45 minutes daily, 5 days a week for 6
weeks duration conventional stroke rehabilitation, Group 2 (n=11): only RAGT. Group 3 (n=11):
conventional stroke rehabilitation plus RAGT. Locomat (Hocoma AG, Volketswil, Switzerland)
was used in RAGT with 20 % body weight reduced, and 1.8 km/h (0.5 m/sec) velocity, 45
minutes/session, 2 times a week, for 6 weeks duration. The Comfortable and The Fast Gait
Speed Tests, Rivermead Mobility Index (RMI), the 6 minute walk distance (6-MWD), cadance and
step length were evaluated before and after the treatment. For comparison of change in outcome
measures, the repeated-measure analysis of variance (ANOVA) was used, and p ≤0.05 was
considered statistically significant.
Results
There was no significant difference in baseline values between groups except that step length.
When the three groups were compared after treatment, the improvements in RMI (p=0.036), the
6-MWD (p=0.037), cadance (p=0.011) and step length (p=0.023) were statistically beter in Group
3 than the other groups. In terms of differences, all outcome parameters showed significant
improvements (p<0.05) in favor of conventional rehabilitation plus RAGT.
Conclusion
RAGT added to conventional gait training has improved gait parameters and increased gait
speed in stroke patients. The content of rehabilitation program may affect different parameters of
gait and these parameters will have favorable effects on functional status and quality of life of the
patient.
WCNR-0355
BOARD NUMBER: 022
STANDING AND SIT-TO-STAND WEIGHT BEARING ASYMMETRY CHANGES WITH
REHABILITATION IN SUBACUTE POST-STROKE INDIVIDUALS
S. Nadeau1, A. Boukadida2, F. Piotte1, S. Mesure3
1University of Montreal, School of Rehabilitation, Montreal, Canada
2Pathokinesiology laboratory- CRIR, Rehailitation, Montreal, Canada
3Université Aix Marseille-, CNRS- ISM UMR 7287, Marseille, France
Aims
It is well known that people with hemiparesis after stroke have asymmetric weight bearing (WB)
when standing and during sit-to-stand (STS). However, few studies have quantified the evolution
of WB with rehabilitation and assessed if WB asymmetry of standing is comparable to STS. The
main purpose of this study was to assess the changes, with rehabilitation, in WB distribution
during standing and STS. A secondary objective was to identify the factors that characterize the
asymmetrical behavior.
Method
Sixteen participants (8 females, 9 right lesions; 52.0 years, 52.6 (± 23) days post-stroke) admitted
in a stroke unit agreed to participate. The first assessment (admission) was performed when they
could stand alone 10 s and rise from sitting, and the second (discharge) within a week before
discharge from in-patient rehabilitation. Their physical therapist performed the clinical tests. They
were then assessed in the laboratory with AMTI force plates to characterize their WB distributions
during three trials of standing and STS tasks. Multivariate (two-way ANOVAs) and correlational
analyses allowed comparison of WB while standing and rising (at seat-off) at admission and
discharge, and identification of factors related to the level of WB asymmetry.
Results
The results showed that asymmetric WB was present in the first months after stroke and
persisted despite rehabilitation. For individuals who had severe impairment of motor function, WB
was more symmetrical during STS than standing. Overall, data at admission and discharge from
the study were not different. Furthermore, the motor function of the paretic lower limb and the
strength of knee extensors were the most determinant factors of WB asymmetry in both tasks.
Conclusion
Findings revealed that it is important to assess WB asymmetry in various tasks. Moreover, since
WB asymmetry did not improve during intensive rehabilitation, future studies will be needed to
identify specific rehabilitation approaches to improve this motor behavior.
WCNR-0240
BOARD NUMBER: 023
CORRELATION BETWEEN INDICATOR OF CONTROL OF THE OSCILLATORY DYNAMICS
OF THE CENTER OF MASS AND CLINICAL SCALE OF BALANCE IN HIGH POSITIONS IN
STROKE SUBJECTS
A. Quezada Pineda1, G. Varas1, F. Balbontin1
1Clínica Los Coihues, Terapia, Santiago, Chile
Aims
The functional scales are important for the clinical practice, in the same way the use of
technology in rehabilitation is a reality nowdays. For this reason, the aim of the present work is
correlate the indicator of the oscillatory dynamics of the center of mass, Jerk, with the clinical
scale of balance sheet in high positions, Berg Balance Scale, in stroke subjects and in addition to
compare the achieved results of the Jerk indicator in stroke subjects with the obtained ones in
healthy people.
Method
There were recruited 15 healthy adult subjects without previous history of critical illnesses related
to the Nervous Central System and 9 subjects with stroke and the inclusion criteria for supporting
independent biped. There was in use the APDM system as a whole with MobilityLab software, for
targeting the changes in acceleration and deceleration of the center of mass with an OPAL
sensor located in L5 (lumbar zone). Every OPAL sensor is composed of an accelerometer,
gyroscope and magnetometer which will register the changes of acceleration of the center of
mass. The subjects realized the ISway test (to support independent biped during 30 second) for
three times. The software leaks and analyzes the signal sent by the sensors across a Wireless
system, which compare the performance of the evaluated subject with reference parameters and
to generate the record of the Jerk indicator.
Results
The results suggest that Jerk indicator is significantly high in population of stroke subjects
compared with a group of healthy people (p = 0.0006). In addition, it is possible to establish a
statistically significant correlation between this indicator (Jerk) and BBS in stroke subjects
(p=0.0025; r= 0.86).
Conclusion
It is possible to establish that Jerk indicator is sensitive to changes in the performance of balance
sheet in subjects with sensorimotor alterations.
WCNR-0277
BOARD NUMBER: 024
REHAB-LET: EFFECTIVNESS OF A TABLET-BASED SELF-TRAINING PROTOCOL FOR
IMPAIRED DEXTERITY AFTER AQUIRED BRAIN INJURY; A PILOT RANDOMIZED
CONTROLLED TRIAL
K. Rachel1,2, G. Zeilig3,4, S. Barzilay2,5, I. Sharony-Zukerman6,7, M. Arad5, D. Rand7
1Sheba Medical Center Tel hashomer, Center of Advanced Technologies in Rehabilitation,
Ramat Gan, Israel
3Sheba Medical Center Tel hashomer, Neurological Rehabilitation, Ramat Gan, Israel
4Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
5Sheba Medical Center Tel hashomer, Geriatric Rehabilitation, Ramat Gan, Israel
6Sheba Medical Center Tel hashomer, Head Trauma Rehabilitation, Ramat Gan, Israel
7Tel Aviv University, Occupational Therapy, Tel Aviv, Israel
Aims
1. To compare the effectiveness and satisfaction from Rehab-let (a self-training protocol utilizing
game apps on a touchscreen for practicing finger movement of the weaker upper extremity) to a
traditional self-training program for improving dexterity of the weaker upper extremity following an
acquired brain injury (ABI). 2. To examine relationships between satisfaction and total selftraining time.
Method
Twenty-one individuals with subacute ABI (aged 29.5 to 83 years) were randomized to Rehab-let
or traditional self-training program. All participants were requested to self-train for 60 minutes/day,
5Xweek for 4 weeks. Participants met with the therapist weekly and were asked to log their daily
training time. Upper extremity assessments were administered pre and post the self-training
intervention by assessors blind to group allocation using the following tools; The Nine Hole Peg
Test (NHPT), The Fugl-Meyer Motor Assessment (FMA) and the Action Research Arm Test
(ARAT). A satisfaction questionnaire was administered post-intervention.
Results
Seventeen individuals completed the self-training. Dexterity improved significantly in both groups
[from 70 to 43.15 seconds for Rehab-let (z=-2.19,p<0.05), and 85 to 38.92 seconds for traditional
(z=-2.43,p<0.01)]. Significant improvements in motor (z=-2.82,p<0.01) and functional abilities (z=1.83,p<0.05) were found for the traditional group. Participants in both groups were satisfied from
the protocol (median score 4.2/5 for Rehab-let and 4/5 for traditional), with no significant
differences between groups. The rehab-let group trained significantly longer (22.5±7.4 and
15.2±4.8 hours, respectively; t=2.5,p<.05). A significant strong correlation between training time
and satisfaction was found in the rehab-let group (r=.80,p<.01).
Conclusion
Self-training using a tablet is feasible, safe and effective for improving dexterity of individuals with
subacute ABI. It has the potential to increase treatment intensity and therefore improve
satisfaction with the rehabilitation process. Potentially, Rehab-let can be used also after
discharge to maintain the function of the weaker hand. Larger studies are needed.
WCNR-0258
BOARD NUMBER: 025
HOME-BASED VIDEO-GAME SELF-TRAINING PROGRAM FOR INDIVIDUALS WITH
CHRONIC STROKE; A PILOT RANDOMIZED CONTROLLED TRIAL
D. Rand1, H. Weingarden2, A. Yacoby1, R. Weiss1, S. Reif1, R. Malka1, G. Zeilig2
1Tel Aviv University, Occupational Therapy, Tel Aviv, Israel
2The Chaim Sheba Medical Center at Tel-HaShomer, Neurological Rehabilitation, Tel-HaShomer,
Israel
Aims
Video-games enhance repetitive upper extremity and trunk movement in a challenging and fun
manner therefore might be suitable for self-training. We aimed to compare compliance,
satisfaction and effectiveness of a self-training protocol using video-games compared to a
traditional self-training program.
Method
This pilot single-blind randomized controlled trial included assessments pre, post and 4-week
follow-up by assessors blind to group allocation. Participants randomized to video-game or
traditional self-training program were requested to perform self-training (one hour/day, 6times/week for 5-weeks). Daily-self-training was logged by participants to calculate total training
hours, satisfaction was rated. Self-training during follow-up was optional. The Action Research
Arm Test (ARAT) and the Motor Activity Log (MAL) assessed upper extremity function. Functional
Reach Test (FRT) assessed standing balance and the Trail Making Test (TMT-B) assessed
executive functioning.
Results
Thirteen participants (mean±SD age 59.1±10.5, 19.6±11.3 months poststroke) took part in the
video-game self-training [standing (N=10), Xbox-Kinect (N=9), PlayStation-EyeToy (N=4)] and
eleven participants (mean±SD age 64.9±6.9, 13.0±6.0 months poststroke] performed traditional
exercises and activities of the upper extremity while seated. Two participants per group stopped
self-training following 2-3 weeks. Participants performed 18.8±8.0 hours playing video-games and
27.4±5.6 hours of traditional-self-training during the 5-weeks. During follow-up, 9/13 and 4/11
participants continued to play video-games and perform traditional self-training, respectively.
Satisfaction was highly rated for each group (3.9±1.0 and 3.6±0.7/5). ARAT and MAL significantly
improved for both groups. Balance improved (non-significantly) and executive functioning
improved significantly from pre to follow-up only for the video-game group. Training time in the
video-game group was significantly correlated to executive functioning (TMT-B) (r=-0.7, p<0.05),
and need for family support while training (r=-0.5, p<0.05).
Conclusion
Self-training using video-games results in high compliance, satisfaction and improves upper
extremity function, balance and executive functioning of individuals with chronic stroke. This may
be a solution for maintaining active life-style poststroke.
WCNR-0307
BOARD NUMBER: 026
THE AWARENESS OF CARE-GIVERS ON STROKE PATIENTS
A. Razak Ozdincler1, E. Zirek2, B. Ersoz Huseyinsinoglu3, S. Baybas4
1Istanbul University, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
2Istanbul University, Instıtute of Health Sciences, Istanbul, Turkey
Turkey
Department of Neurology, Istanbul, Turkey
Aims
Generally caregivers accompany with stroke patients while they are staying at hospital in Turkey.
Caregivers take care of patients for daily routine care because of insufficient number of health
care professionals in neurology departments. The aim of this study is to investigate the
knowledge of caregivers about their patients' disease and to compare with reel condition for
understanding the awareness of caregivers.
Method
33 caregivers who took out their patients in neurology department attended in this study. Their
mean age was 43.06+14.46 years. They filled in a questionnaire which was established by the
authors. The same questionnaire was filled in by patients’ physiotherapists, too. The
questionnaire was divided in 3 main parts: disease knowledge, patients’ cognitive status and
patients’ motor status. For cognition, there were questions about localization and time, for motor
evolution, bed mobility, sitting balance, standing, walking, arm function and grip ability, speech
and swallowing functions were asked. Two questionnaire results for one patient were compared
with right and wrong answers.
Results
The rate of caregivers living with the patient in the same house was 57.6%. 51.5% of them had
experienced for the patient care before. 36.4% was low educated. In general 91% of caregivers
answered the questions rightly. The rate of right answers for disease knowledge was 94%, for
cognition part 81%, and for motor part 95%.The highest rate of the wrong answer was about the
understanding question (33%). The rate of right answer about swallowing was 100%. For most
difficulty in daily routine care activities, 36.4% announced standing from bed, 27.3%
communication with patients and 18% feeding activities.
Conclusion
Caregivers have got awareness on their patients. We want to think this as high degree of
awareness contribute to positive effects for patient care in Turkey.
WCNR-0391
BOARD NUMBER: 027
ARMin, BEAM ME IN! IMPLEMENTATION OF A TELEASSESSMENT BATTERY FOR
ROBOT-ASSISSTED NEUROREHABILITATIVE THERAPY OF THE ARM
N. Rohrbach1, K. Baur2, V. Klamroth-Marganska2, J. Hermsdörfer1, R. Riener2
1Technische Universität München, Chair of Human Movement Science, Munich, Germany
2Swiss Federal Institute of Technology Zurich, Sensory-Motor Systems Lab, Zurich, Switzerland
Aims
Spasticity and a loss of interjoint coordination in the upper extremity are often present after
stroke. New technologies such as robots or telerehabilitation are promising concepts to improve
recovery. Although robots can provide repetitive high-intensive training, objective therapy and
assessment they limit therapy by restraining the therapist to feel the patient. However, this
interaction is seen as prerequisite for the neurorehabilitative process. The “Beam me In” concept
aims for combining the advantages of both robot-assisted and manually-assisted therapies. It is
realized through ARMin, an exoskeleton robot for neurorehabilitation of the arm. A master-slave
teleoperation system with two connected ARMin robots (one for the patient, one for the therapist)
may enable the therapist to put himself in the position of the patient by experiencing a motion
initiated by the patient and transferred via the robots. This single-case study investigated whether
a therapist can use ARMin to assess a patient´s motor condition, i.e. spasticity and interjoint
coordination, remotely.
Method
Fifteen therapists were positioned in ARMin to assess three prerecorded stroke patients.
Therapists rated i)the resistance to passive movement of the elbow flexor muscles by applying
the Modified Tardieu Scale (MTS) and ii)the interjoint coordination in the shoulder on a Likert-type
scale. Additionally, a questionnaire evaluated the “Beam me In” approach.
Results
We found significant inter-rater reliability for both the MTS scores and the interjoint coordination
(ICC=0.995, 95% CI:0.98-1.0). The analysis of the questionnaire revealed that 93% of therapists
judged “Beam me In” as an enriching concept to experience movements and the clinical condition
of a patient.
Conclusion
To date, the inability to assess a patient’s status remotely has been a major limitation in
telerehabilitation. ARMin can be used for teleassessment. It was shown that therapists can feel
and rate spasticity and abnormal interjoint coordination by means of the ARMin robot without
directly placing hands on.
WCNR-0687
BOARD NUMBER: 028
IMPROVED COGNITION AND FATIGUE IN A PATIENT WITH MULTIPLE SCLEROSIS AFTER
tDCS: A CASE REPORT
D. SACCHETTI1, S. Chahin1, J. Gill1, R. Hamilton1
Aims
A majority of patients with multiple sclerosis (MS) experience cognitive deficits (40-70%) and
excessive physical or mental fatigue (80%). The most common cognitive deficits in MS patients
relate to executive dysfunction. Previous studies have suggested that transcranial direct current
stimulation (tDCS) may be beneficial in ameliorating these symptoms of MS. We hypothesized
that common neural substrates may underlie both executive impairments and mental fatigue, and
therefore hypothesized that enhancement of neuroplasticity in the prefrontal cortex (a region
frequently associated with a variety of executive functions) could ameliorate both of these
symptoms.
Method
In this proof-of-concept study, we employed a sham-controlled, double-blind intervention protocol
in a 51-year old woman with relapsing-remitting MS and symptoms of cognitive dysfunction and
fatigue which did not respond to traditional treatment. tDCS was applied over the left prefrontal
cortex (2.0 mA; 20 min) for 5 consecutive days (Monday-Friday) for two weeks. During each of
the 10 visits, the participant performed a 2-back N-Back task during stimulation and an adjusting
(Paced Serial Addition Task) PASAT task pre- and post- stimulation. At the baseline and 1-month
follow-up visits, the Repeatable Battery for the Assessment of Neuropsychological Status
(RBANS) and modified fatigue impact scale (MFIS) were administered.
Results
Accuracy on the PASAT task was greater during real stimulation (t=-4.558 p=.001) than sham.
Additionally, compared to sham stimulation, the patient’s performance on the RBANS improved
after real tDCS, including attention, delayed recall, language, and visuospatial construction.
Fatigue levels decreased after real tDCS, but increased after sham. Notably, improved fatigue
was primarily driven by changes in the cognitive fatigue subscale of the MFIS.
Conclusion
This promising case study suggests that prefrontal tDCS may be a valuable tool in treatment of
not only cognitive dysfunction in MS, but also mental fatigue symptoms.
WCNR-0263
BOARD NUMBER: 029
COOPERATIVE HAND MOVEMENT TRAINING IN POST-STROKE SUBJECTS
M. Schrafl-Altermatt1, V. Dietz1
1Balgrist University Hospital, Spinal Cord Injury Center, Zurich, Switzerland
Aims
Cooperative hand movements have been shown to be controlled by a specific ‘neural coupling’
mechanism which is defective after stroke. However, a strengthening of ipsilateral pathways
between the unaffected hemisphere and the affected arm seems to be induced by the
performance of such movements. Therefore, the aim of this pilot study was to investigate the
effect of training of cooperative hand movements on the outcome of hand function and compare it
to conventional occupational therapy.
Method
The study was conducted in two chronic post-stroke patients (S01 and S02). Cooperative arm
training (COOP) and conventional occupational therapy (OT) were applied in two blocks each
over a total of 16 weeks of therapy with four training sessions every week. Assessments including
Fugl-Meyer upper limb score (FM), Chedoke arm and hand activity inventory (CAHAI), Box and
Block test (BBT) and electromyographic reflex responses reflecting neural coupling were
performed four times at baseline (BL) and every two weeks during the intervention sessions.
Results
Improvement in the BBT of the impaired hand was greater in the COOP compared to OT (S01:
10.75 BL, 16.0 COOP, 16.5 OT; S02: 36.25 BL, 42.0 COOP, 36.75 OT). Performance in Patient
S01 was better during both therapies compared to BL, while S02 improved only during COOP. In
the CAHAI, an improvement was obtained during both therapies only in patient S01 (S01: 35.5
BL, 42.25 COOP, 42.1 OT). The FM did not change over the course of training. A modulation of
the ‘neural coupling’ occurred over the course of therapy in S02.
Conclusion
In this pilot study, cooperative hand training seems to positively influence outcome of hand
function in post-stroke subjects.
WCNR-0380
BOARD NUMBER: 030
THE UTILITY OF H-REFLEX FOR DETECTING INTRATHECAL BACLOFEN SYSTEM
INTEGRITY: A THREE-STEP VALIDATION PROCEDURE
D. Stokic1, S. Yablon1, A. Hayes1
1Methodist Rehabilitation Center, Center for Neuroscience and Neurological Recovery, JacksonMS, USA
Aims
To determine changes in H-reflex (H/M ratio) at different doses and modes of intrathecal baclofen
(ITB) administration before and after surgical revision for confirmed ITB system malfunction.
Method
We reviewed 117 H-reflex studies in 19 pump recipients performed shortly before and after ITB
system revision. To derive H/M ratio, H-reflex recruitment curve was recorded in the soleus
muscle, bilaterally, during a continuous ITB (CITB) mode of administration (mean CITB dose
before revision: 501 mcg/day; after revision: 157 mcg/day) and hourly after a pump bolus
programmed over CITB dose (before revision: mean 65 mcg bolus + 521 mcg/day CITB; after
revision: mean 50 mcg bolus + 75 mcg/d CITB). This allowed validation of H/M ratio for
assessing ITB system integrity in 3 sequential steps under the hypotheses of 1) no difference in
H/M ratios between CITB and Bolus+CITB modes before revision; 2) significantly decreased H/M
ratios for both CITB and Bolus+CITB modes after revision; and 3) significantly lower H/M ratio for
Bolus+CITB vs. CITB only mode after revision.
Results
Before revision (hypothesis 1), H/M ratios were not significantly different (p=0.61) between the
two modes of ITB administration (CITB=57±25%, Bolus+CITB=54±21%), suggesting a system
malfunction. After revision, H/M ratios decreased significantly (p<0.001) for both Bolus+CITB
mode (4±6%) and CITB mode (9±11%), consistent with post-surgical system integrity (hypothesis
2). Also, H/M ratio for Bolus+CITB was significantly (p<0.001) lower than for CITB alone
(hypothesis 3).
Conclusion
These results validate H-reflex (H/M ratio) as a sensitive marker of both failed and successful ITB
delivery to the neuroaxis. Systematic H-reflex monitoring, starting with the screening trial,
continuing during early dose titration, and augmented with programmed boluses in cases of
suspected malfunction, provides a simple and sensitive adjunct method for detecting ITB system
malfunction more rapidly and at lower doses than typically achieved by currently recommended
troubleshooting procedures.
WCNR-0212
BOARD NUMBER: 031
HOME-BASED NEUROLOGIC MUSIC THERAPY FOR UPPER LIMB HEMIPARESIS: A PILOT
STUDY
A. Street1
1, St Neots, United Kingdom
Aims
Upper limb hemiparesis following stroke is more common and resistant to treatment than in the
lower limbs. Motivating, repetitious, task-driven interventions are needed for acute and
community stage patients, with rehabilitation increasingly taking place in the home. Research has
produced statistically significant gains following musical instrument playing and rhythmically cued
exercises. This pilot study builds on previous research, investigating a musically synchronized,
home-based exercise protocol. The study examines three new aspects: 1) home-based, 2)
facilitating music, 3) twice weekly dosage.
Method
11 of a projected 14 NHS stroke patients with hemiparesis who had completed their community
rehabilitation were recruited into a crossover design. Participants all received treatment,
randomized into either treatment (n=6) or waitlist (n=5) groups. The neurologic music therapy
intervention was delivered twice weekly over 6 weeks in each participant’s home and
assessments taken at five timepoints. A blind assessor conducted pre and post treatment
measures. A lab based EEG case comparison study was projected but not completed due to
ethical and time constraints. Qualitative data informed on participant compliance, motivation and
tolerance.
Results
10 participants completed the study. There was no statistical significance found between early
and delayed intervention. Whilst statistical significance was found between time point means,
there was no correlation between the groups and so no statistical significance in treatment
effects. Qualitative data indicates that participants clearly perceived the facilitating musical
structures as helping their movement synchronization, and that the intervention was motivating.
Conclusion
The emphasis of this pilot study was on testing the TIMP protocol, the feasibility and effects of
home delivery at this dosage, and informing on motivation and tolerance. Statistical significance
was not predicted, however data analysis indicates that time since stroke may not be a factor
influencing response to this protocol for patients matching this study cohort. A larger RCT would
help to substantiate this.
WCNR-0232
BOARD NUMBER: 032
ADAPTIVE PHYSICAL ACTIVITY FOR STROKE
M. Stuart1,2, A. Dromerick3
1University of Maryland- Baltimore County, Health Administration and Policy Program, Baltimore,
USA
2Veterans Affairs Maryland Health Care System, Research Service, Baltimore, USA
3Georgetown University/Medstar National Rehabilitation Hospital,
Rehabilitation Medicine and Neurology, Washington- D.C., USA
Aims
(1) Test safety, feasibility, sustainability, and effectiveness of the Italian Adaptive Physical Activity
(APA) for stroke survivors in a US community setting; (2) Obtain pilot data in preparation for a
phase 3 US clinical trial of APA.
Method
This was a phase 2 randomized clinical trial (RCT) comparing two exercise interventions (APA
and Sittercise) for stroke survivors in a community setting. APA, a progressive protocol involving
walking and balance exercises, was developed in Italy. Previous studies demonstrated significant
improvements in walking speed and balance, compared to usual care. Sittercise, a seated
aerobic upper body exercise program, was developed by the Office on Aging (OoA) in Howard
County, Maryland. Both classes were offered for one hour, three times a week, in community
locations. Study subjects were at least 6 months post stroke and had a hemiparetic gait deficit. A
total of 73 subjects were randomly assigned to APA or Sittercise. Approximately 2/3rds
completed the 6 month intervention.
Results
Preliminary findings indicate: 1) Randomization was effective; 2) No significant between group
differences in change for major study outcomes; 3) Both groups demonstrate significant before
and after improvements on some outcomes, differing by group; 4) Neither group declined on any
study outcome; 5) Both interventions proved safe, feasible, and sustainable in a community
setting; 6) Both exercise protocols continue to be offered at Senior Centers by the Office on
Aging.
Conclusion
Stroke is a leading cause of disability with persistent declines in function for usual care patients
post-discharge. At the end of the research study, protocols for screening participants, training
instructors, and monitoring treatment fidelity were adapted for local OoA staff use. This study
provides valuable lessons in community sustainability of exercise programs for stroke survivors.
WCNR-0387
BOARD NUMBER: 033
REACHING PERFORMANCE SCALE FOR STROKE: TEST-RETEST RELIABILITY AND
CONCURRENT AND DISCRIMINANT VALIDITY IN INDIVIDUALS WITH CHRONIC STROKE
S. Subramanian1,2, M. Banina2,3, G. Chilingaryan2,3, M. Levin2,3
1Université de Montréal, Département de neurosciences, Montreal, Canada
2Jewish Rehabilitation Hospital site of Centre for Interdisciplinary Research in Rehabilitation of Gr
eater Montreal, Feil-Oberfeld Research Centre, Laval, Canada
Aims
Descriptions of movement patterns characterizing movement quality and use of compensations
can help better quantify motor impairment and recovery in individuals with stroke. Movement
patterns can be described using both kinematic and clinical outcomes. One clinical outcome that
assesses movement quality and compensations used for reaching a close (18 pts) and a far
target (18 pts) is the Reaching Performance Scale for Stroke (RPSS). The study objective was to
estimate the reliability (test-retest) and validity (concurrent, discriminant) of the RPSS in
individuals with chronic stroke.
Method
A retrospective study of clinical (Fugl-Meyer Assessment- upper limb, FMA and RPSS scores close and far targets) and kinematic outcomes (sagittal trunk displacement, shoulder flexion,
shoulder horizontal adduction, elbow extension, trajectory straightness) from subjects with
chronic stroke performing pointing tasks was done. Test-retest reliability (n=14) was assessed
using intraclass correlation coefficients (ICCs). Concurrent validity was assessed using both FMA
(n=102, correlations) and kinematic outcomes (n=51, multiple regression analyses). Logistic
regression analyses between two groups determined discriminant validity. For this analysis
subjects were divided into two groups based on the amount of trunk movement during reaching
(permissible = ≤4.9 cm and excessive = ≥5 cm).
Results
The RPSS had excellent test-retest reliability for both close (ICC(2,1)=0.979) and far
(ICC(2,1)=0.984) targets. Concurrent validity with the FMA was high for close (r=0.91) and far
(r=0.92) targets. The majority of the variance in RPSS scores was explained by a combination of
trajectory straightness and elbow extension for both close (51.3%) and far targets (50.6%). The
RPSS scores discriminated between individuals using permissible and excessive trunk
displacement for both close (ExpB=0.915, p<0.001) and far targets (ExpB=0.916, p<0.001).
Conclusion
The RPSS is a reliable and valid clinical measure of movement patterns and compensations used
for reaching which can complement assessments of motor recovery in individuals post-stroke.
WCNR-0334
BOARD NUMBER: 034
MOVEMENT ADAPTABILITY DURING REACHING FROM STANDING IN INDIVIDUALS WITH
STROKE
Y. Tomita1,2, A. Feldman2,3, M. Levin1,2
2Center for Interdisciplinary Research in Rehabilitation CRIR, Jewish Rehabilitation Hospital,
Montreal, Canada
3Université de Montréal, Département de neuroscience, Montreal, Canada
Aims
According to the threshold control theory of motor control, reaching is organized by minimizing
the difference between actual and centrally specified referent body configurations. The
minimization process may lead to the movement being accomplished by different combinations of
joint movements (adaptability). We investigated movement adaptability ability in patients with
stroke when postural stability is challenged during standing reaches.
Method
Patients with mild/moderate stroke and healthy controls reached from standing toward a
remembered target placed beyond the arm’s reach (130% arm length). Reaching the target
required combining arm motion with hip flexion (free-hip trials; FH). In 30% of randomly chosen
trials, hip flexion was unexpectedly prevented, forcing the subject to take a step to prevent falling
while reaching the target (blocked-hip trial; BH). Reaching was repeated when the subject took an
intentional step (intentional-step trial; IS). Arm path, upper/ lower limb and trunk kinematics were
recorded.
Results
The direction and shape of the arm trajectory during reaching was similar between BH and FH
conditions in control subjects and subjects with mild stroke. When extra trunk displacement
occurred because of taking a step, it did not affect the accuracy of the arm movement.
Maintaining the arm trajectory and accuracy was achieved by appropriately adapting elbowshoulder interjoint coordination. In contrast, subjects with moderate stroke had more variable
reaching trajectories in all conditions and used a different arm path in BH and FH conditions,
which was manifested after the stepping reaction occurred.
Conclusion
Our results suggest that the ability to appropriately adapt interjoint coordination to changing task
conditions is impaired in individuals with moderate stroke. This also suggests that there may be
deficits in the specification of referent body configuration for control of reaching. Training requiring
patients to adapt movement to different situations may improve motor control in patients with
stroke.
WCNR-0350
BOARD NUMBER: 035
THE EFFECT OF BIONESS ON THE RECOVERY OF DORSAL FLEXION AND DECREASE
OF SPASTICITY AFTER A STROKE
K. Van Den Keybus Déglon1
1Centre Hospitalier Universitaire Vaudois, Neuroscience Clinique, Lausanne, Switzerland
Aims
Introduction
Miss A. had a front-temporo-parietal stroke on July 2012. When she left rehabilitation at the end
of the year, even if she had a muscle activity in the Tibialis anterior, she walked with a Tamarac
orthesis to limit the spasticity of the Gastrocnemius and Solaris. Miss A. received injections of
botulinum toxin every 4 months in the triceps surae.
Objectives
The aim of this case was to determine if there is a decrease of spasticity and a recovery of the
dorsal flexion by using a Bioness NESS L300® after 2 years stroke.
Method
16 months after the stroke, we changed the Tamarac orthesis for a Bioness NESS L300®. She
walked every day with it and trained her Tibialis anterior and Peroneus by electrostimulation.
Results
After one year, we noticed an improvement of the muscle strength from M2 to M4 in the dorsal
flexion. We also observed a complete decrease of the spasticity of the triceps surae and she
doesn’t need botulinum toxin anymore.
Conclusion
In this case, the use of the Bioness NESS L300® helped to decrease spasticity and improved
muscles strength. Miss A. can now move her ankle freely and walk without any support.
WCNR-0259
BOARD NUMBER: 036
THE ADULT ASSISTING HAND ASSESSMENT STROKE: PSYCHOMETRIC PROPERTIES OF
AN INNOVATIVE OBSERVATION-BASED ASSESSMENT IN STROKE REHABILITATION
A. Van Gils1, S. Meyer1, L. Krumlinde-Sundholm2, D. Kos1, G. Verheyden1
2Karolinska Institutet, Department of Women’s and Children’s Health, Stockholm, Sweden
Aims
The Adult-Assisting Hand Assessment (Ad-AHA) Stroke is an observation-based instrument
assessing the effectiveness of the spontaneous use of the affected hand when performing
bimanual activities in adults after stroke. Internal scale and concurrent validity have been
demonstrated (Krumlinde-Sundholm, 2013). This study investigates concurrent and discriminant
validity and interrater and intrarater reliability of Ad-AHA Stroke.
Method
Stroke survivors are recruited within the first six months post stroke. Concurrent validity is
appraised by calculating correlations between Ad-AHA Stroke and ABILHAND Questionnaire,
Action Arm Research Test (ARAT) and Upper Extremity Fugl-Meyer assessment (UE-FM).
Differences in Ad-AHA Stroke scores for distinctive levels of motor impairment evaluated
discriminant validity. Reliability is examined using intraclass correlation coefficients (ICC),
standard error of measurement (SEM), and minimal detectable change (MDC).
Results
Data of 118 stroke survivors is analyzed (mean age 66±12.3 years; mean time post stroke 92±52
days; mean UE-FM 35 points (±24 points). Correlations between Ad-AHA Stroke and clinical
assessments is high (r=0.8–0.9), supporting concurrent validity. Significant differences in Ad-AHA
Stroke scores are found for different levels of motor impairment, suggesting discriminant validity.
ICC for interrater agreement is 0.99 (95% CI=0.98-0.99) and for intrarater 0.99 (95% CI=0.990.99). SEM is 2.36 for interrater and 2.15 for intrarater reliability, MDC is 6 for both interrater and
intrarater reliability.
Conclusion
The Ad-AHA Stroke is a novel test offering an innovative and relevant approach on upper limb
assessment post stroke. Results of Ad-AHA Stroke may guide occupational therapy goals and
interventions that target effective bimanual task performance. Psychometric properties for the AdAHA Stroke are further underpinned by the results of this study, and support use of the Ad-AHA
Stroke in clinical practice and research.
References
Krumlinde-Sundholm, L., and Lindquist, B. (2013). Ad-AHA Stroke. Adolescent/Adult Assisting
Hand Assessment Stroke. English B version 1.0. Stockholm: Handfast AB.
WCNR-0313
BOARD NUMBER: 037
DOES LOCATION MATTER? COMPARING RECOVERY AFTER STROKE IN A BRITISH AND
SOUTH AFRICAN SETTING
G. Verheyden1, A. Werbrouck1, Y. Herremans1, S. Rouillard2, E. Dejaeger3, W. Jenni4,
N. Lincoln5, W. Schupp6, K. Putman7, L. De Wit7,8
2University of Cape Town, Department of Health and Rehabilitation Sciences, Cape Town,
South Africa
3University Hospitals Leuven, Department of Geriatrics, Leuven, Belgium
4RehaClinic Zurzach, Department of Neurology- Physical Medicine and Rehabilitation,
Bad Zurzach, Switzerland
5University of Nottingham, School of Medicine, Nottingham, United Kingdom
6Fachklinik Herzogenaurach, Department of Neurology and Neuropsychology, Herzogenaurach,
Germany
7Vrije Universiteit Brussel, Department of Public Health Sciences, Brussels, Belgium
8Vrije Universiteit Brussel, Department of Physiotherapy- Human Physiology and Anatomy,
Brussels, Belgium
Aims
The global burden of stroke is high. Literature comparing recovery post stroke in various locations
is scarce, but there is belief that recovery in high income countries is better compared to middle
or low income countries. The purpose of this study was to compare motor and functional outcome
after inpatient stroke rehabilitation between a British and South African setting.
Method
In this study, patients were included from one middle (South Africa) and one high income (United
Kingdom) setting. The UK setting was part of the Collaborative Evaluation of Rehabilitation in
Stroke aross Europe (CERISE). Motor and functional recovery was assessed on admission and
discharge of inpatient rehabilitation, and at six months post stroke, using the Rivermead Motor
Assessment of Gross Function (RMA-GF), Leg/Trunk function (RMA-LT) and Arm function (RMAA) and the Barthel Index (BI). We statistically compared matched patient pairs made based on
age, gender and initial severity.
Results
The investigated sample comprised 20 matched pairs. No significant differences were found
between settings for age, gender, stroke severity, length of stay and time between stroke onset
and admission, although the latter had a greater range in South Africa (3-69 days) compared to
the UK (1-35 days). When comparing motor and functional recovery within settings over time,
results showed significant improvements in both settings. When comparing between settings,
recovery between admission and discharge was significantly greater for BI (p=0.017) and for
RMA-GF (p=0.025) in the British compared to the South African setting. However, no differences
were found between settings at six months.
Conclusion
This exploratory study revealed differences in motor and functional recovery between a high and
middle income setting after inpatient rehabilitation but not at six months after stroke. Future
studies should determine recovery in larger samples and investigate determining factors between
settings such as amount and content of rehabilitation and post-discharge care.
WCNR-0220
BOARD NUMBER: 038
A HYBRID EXOSKELETON FOR TRAINING OF GAIT AFTER STROKE
A. Wall1, J. Borg2, S. Palmcrantz2, V. Katarina2
1Karolinska Institutet Danderyds Sjukhus- KIDS, Department of Clinical Sciences, Stockholm,
Sweden
2Karolinska Institutet, Department of Clinical Sciences, Stockholm, Sweden
Aims
Impaired gait after hemiparetic stroke remains a challenge and may be approached by use of
novel technology. Hybrid Assistive Limb (HAL) is an exoskeleton allowing both autonomous and,
by use of surface electromyography, also a voluntary mode of action. The operator adjusts the
support for each joint separately. Here we report on phase I-III studies using HAL.
Method
Phase I: Safety and feasibility: 8 patients with severely impaired gait function included < 8
weeks after stroke performed HAL training 5 days per week during in mean 3 weeks.
Phase II: Randomized controlled study: 36 patients with severely impaired gait function < 8
weeks after stroke are randomized to conventional gait training or to training with HAL in addition
to the conventional program, 4 days/week for 4 weeks.
Phase III: Multicentre, randomized, controlled studies. A total of 270 patients with severely
impaired gait function <7 weeks after stroke (Study I) or with impaired gait function 1-10 years
after stroke (Study II) will be included.
Results
Phase I: The HAL system was feasible and safe to use for gait training in a rehabilitation setting
and allowed intensive, task specific training also in patients with severe paresis after stroke.
Phase II: Until November 2015, 23 patients have completed the training protocol, 10 with HAL.
All have improved walking ability. 6 months follow-up of 17 patients indicates that training with
HAL might be superior.
Phase III: Multicenter, randomized, controlled studies of training early and late after stroke
respectively will run 2015-2017.
Conclusion
The HAL system enables gait training in patients with severe lower limb paresis and such training
may have beneficial effects on gait function and independence in walking after stroke. The
multicenter randomized controlled trials may provide confirmatory data, inform about responders
and also allow other potential effects on health to be explored.
WCNR-0271
BOARD NUMBER: 039
INSTANTANEOUS EFFECTS OF CEREBELLAR TDCS ON BALANCE PERFORMANCE IN
PATIENTS WITH CHRONIC STROKE
S. Zandvliet1, C. Meskers1, G. Kwakkel1, E. van Wegen1
1VU medical center, rehabilitation medicine, Amsterdam, Netherlands
Aims
Restoration of standing balance performance in the early phase after stroke is crucial for clinical
outcome and self-dependence.¹ Transcranial direct current stimulation (tDCS) is a novel
technique that may improve motor function and enhance learning dependent plasticity post stroke
when applied to the motor cortex.² Cerebellar tDCS can potentially enhance the function of this
specific brain region, as it is highly involved in standing balance control and motor learning. In
addition, inter-hemispheric inhibition could be influenced via cerebellar brain inhibition. The aim of
the present study is to investigate if tDCS has an added instantaneous effect on performance of
standing balance when compared to balance training alone.
Method
Nine chronic stroke patients performed three sessions minimally one week apart. Center of
pressure (COP) data was collected in three different conditions (eyes open, eyes closed and
tandem stance) before and after a lateral balance training session.
During the training, cerebellar stimulation was applied for 20 minutes using either anodal tDCS
(1.5 mA) on the ipsilesional side, contralesional side or sham in randomized ordered between
sessions. The COP velocity (VCOP) was calculated and a repeated measures ANOVA was
applied to analyze differences between the pre-post measurements and stimulation conditions.
Results
A significant lower VCOP was found during the post-measurements in tandem stance compared
to the pre-measurements, F(1,8)=5.3, p=.005, ηp2=.40. VCOP decreased the most in the
contralesional stimulation session (mean decrease of 6.4 mm/s, sham: 2.7mm/s, ipsilesional: 2.9
mm/s), however these differences were not statistically significant.
Conclusion
Current results suggest a positive effect of the training task on reducing VCOP in a group of 9
stroke patients. These first results hint towards contralesional stimulation being the most effective
method to improve balance control. Measurements will continue for the upcoming months to
determine the effects of cerebellar tDCS on balance control in a larger sample size.
WCNR-0253
BOARD NUMBER: 040
TREATMENT/PHARMACOTHERAPY
SLEEP EFFICIENCY IS ASSOCIATED WITH DUAL-TASK WALKING AMONG COMMUNITY
DWELLING OLDER ADULTS
M. Agmon1, T. Shochat2, R. Kizony2
1, Haifa, Israel
2University of Haifa, School of Nursing, Haifa, Israel
Aims
Over a third of people over 70 and the majority of older adults over 85 have a clinical diagnosis of
gait abnormalities. Gait abnormalities can lead to loss of independence, increased risk of falls,
increased mortality and mobility. Dual-task (DT) interference during walking is widely recognized
as a functional mobility concern among older adults. Adding a cognitive task to walking may lead
to decreased walking distance and increased stride to stride variability, which associates with
increased risk for falls and cognitive decline. Although sleep problems are common among older
adults, few studies addressed associations between sleep disturbance and gait abnormalities.
The aim of this srudy is to examine associations between objective sleep/wake measures and
gait with DT walking in community dwelling older adults, hypothesizing that reduced sleep
efficiency during the nighttime sleep period is associated with increased gait abnormalities during
a daytime DT challenge.
Method
Thirty-two (65.6% women) independently functioning community dwelling older adults (mean age
71.0±5.9, Montreal Cognitive Assessment mean score 24.4 ± 2.3) participated. Sleep efficiency
(percent of sleep of the time-in-bed interval) was objectively assessed by seven-day wrist
actigraphy monitoring. Measures of gait were walking distance (meters) and stride to stride
variability as a single task (ST), and with an additional cognitive task as DT, subtraction by 3 from
a random number, both during 1-min periods. Hierarchical linear regression model was
performed to assess relationships between sleep efficiency and ST/DT measures and to control
for important covariets.
Results
Higher sleep efficiency was associated with increased walking distance under the ST condition
(r=0.45, p=0.01), and as a DT with subtraction (r=0.39, p=0.03). Moreover, reduced sleep
efficiency was the strongest predictor of increased stride-time variability under DT (β=-0.59,
p=0.002) after controlling for age and cognition.
Conclusion
These findings point to the importance of the diagnosis and treatment of these two conditions
concomitantly.
WCNR-0685
BOARD NUMBER: 041
PHYSIOLOGICALLY-ENHANCED VIRTUAL REALITY FOR PAIN TREATMENT
J. BELLO RUIZ1, M. Solcà1, R. Mange1, B. Herbelin1, O. Blanke1
1Ecole Polytechnique Federale de Lausanne EPFL, EPFL SV BMI LNCO, Geneva, Switzerland
Aims
Based on our work on neuroscience of embodiment, we propose a new approach to Virtual
Reality (VR) combining mixed virtual and real environments, integrating physiological and
multisensory bodily signals, aimed to enhance the analgesic effects of VR for chronic pain
treatment.
Method
We developed our own software, ExpyVR, to present and control stimuli in VR. It allows 3D visual
and audio stimuli display, tactile stimulation and integration of multiple devices, physiological
signals recording and real-time data processing to administer fully controlled experiments.
Our innovative approach to VR, the Reality Substitution Machine, allows us to create content
based on spherical audio-visual recording of the real world. It provides full immersion into the
scene by the use of a head-mounted display and sensors for the integration of the participant’s
own body into the virtual environment.
Results
We exploited recent findings suggesting that visuo-tactile stimulation (Rubber Hand Illusion)
might reduce pain perception in complex regional pain syndrome patients. To provide
multisensory bodily stimulation without touching the painful hand, we created a VR environment
in which patients see a virtual hand being illuminated synchronously with their heartbeat. See
Solcà et al. “Alleviate pain by showing the heart” poster for the results.
In a second application, we extend the use of cardio-visual stimulation for chronic pain treatment
in paraplegic patients due to spinal cord injury. Instead of presenting virtual body parts, we project
an illumination synchronously with their heartbeat directly on their legs in order to promote leg
embodiment and reduce pain.
Conclusion
By exploiting insights from neuroscience of embodiment together with cutting-edge technology,
physiologically-enhanced VR can be applied as long-term treatment for chronic pain, potentially
leading to new non-invasive and analgesic rehabilitation programs for different pain conditions.
WCNR-0435
BOARD NUMBER: 042
RESTORATION OF BOTH CONCEPTUAL KNOWLEDGE AND WORD FORM RETRIEVAL IN
A CASE OF SEMANTIC DEMENTIA IN TWO COMPARED TREATMENTS
P. D'honincthun1, C. Charpié Gambazza1, S. Clarke1
1Centre Hospitalier Universitaire Vaudois, Department of Clinical Neurosciences, Lausanne,
Switzerland
Aims
Research on the efficacy of treatment for anomia in semantic dementia has demonstrated that
word retrieval could be improved (see Suarez-Gonzalez et al., 2015). However, since the
reported improvements only concerned naming tasks, which cognitive processes have been
restored remains unclear: semantic representations, access to word forms, or both ? In our
single-case study (DP), we addressed this issue by investigating whether both comprehension
and naming can be improved with an errorless anomia treatment recruiting remaining personal
semantic memories. We also compared the treatment efficiency (immediate benefits,
generalisation, maintenance) when the patient was trained with a therapist all along versus half
by himself.
Method
Two lists (L1, L2) of 32 personally familiar items matched for word frequency, concept familiarity
and initial performance were constituted.
Two types of 16 sessions-intensive training were sequentially proposed to DP: training (L1) fully
with a therapist followed by training (L2) alternatively with and without the therapist.
The (computer) training procedure was an errorless lexical and conceptual enrichment training
(ELCOENT) in 5 steps adapted from Savage et al. (2013) and Suarez-Gonzalez et al. (2015).
The effectiveness of the two types of training was measured with cognitive baselines (naming and
property verification tasks) and a generalisation task administered immediately and after 1-3-6
months.
Results
The two types of training had equivalent immediate benefit, significant in naming and
comprehension tasks. However, the first type of training was more efficient both in terms of
generalisation and maintenance of the improvement at the follow-up naming baselines (Figure
1).
Conclusion
This seems to be the first empirical evidence of (1) the effectiveness of an ELCOENT on
comprehension and naming in semantic dementia, suggesting a restoration of both semantic and
word form retrieval processing, (2) advantages of a fully-accompanied training.
WCNR-0315
BOARD NUMBER: 043
MILD COGNITIVE DISORDER RELATED TO ASYMPTOMATIC LACUNARS STROKE - IS
POSSIBLE TO RECOVER?
I.D. Cuciureanu1,2, A. Cuciureanu3, C. Tudor4
1University of Medicine “Gr. T. Popa” Iasi, Neurology, Iasi, Romania
2Emergency Hospital “Prof.dr. N. Oblu” Iasi, Neurology, Iasi, Romania
3CMI of neurology "Cuciureanu Adina", Neurology, IASI, Romania
4University of Medicine “Gr. T. Popa” Iasi, Gastroenterology, Iasi, Romania
Aims
Purpose: to investigate the relationship between mild cognitive disorder and risk factors for
chronic asymptomatic cerebrovascular disease in middle age patients and to estimate the
possibility of recover.
Method
Method: A sample of 92 consecutively evaluated subjects with MCD was follow-up for 2 years
after a recruitment period of 3 years, in our neurological service. The patients, aged 50 – 70, had
memory complaints, no stress, anxiety, depression or causal medication, but 60 of them had
vascular risk factors. All meet the operational criteria for MCD.
Patient were investigated by clinical examination, neuropsychological test, brain computed
tomography, vascular related blood tests. After 1 year of outpatient follow up 46 of them received
in addition to medication psychological recovering techniques.
Results
Results: the 92 patients were divided in 3 groups according to existing risk factors: 36 with
hypertension, 24 other vascular risk factors and 32 without vascular risk factors. All patients had a
Mini-Mental State Examination score greater than or equal to 24. Neuropsychological
examination by “Repeatable Battery for the Assessment of Neuropsychological Status” (RBANS)
revealed in the third group a predominant memory impairment with relative sparing of other
cognitive domains and and in 2 other groups multiple domain non amnesic MCD. Combined
analyze of cerebral computed tomography and neuropsychological examination concluded that
hypertension group has white matter ischemic changes (leukoaraiosis) in 25 %, and
asymptomatic lacunars stroke in 88 % cases. After 2 years follow-up neuropsychological test
were made again. For both categories the recovering rates were between 10 to 18%.
Conclusion
Conclusion: asymptomatic ischemic brain damage can lead to MCD. We speculate that every
patient with long term or incontrolated vascular risk factors and minimal complain of memory loss
must promptly be investigated with neuroimagistic techniques. The rehabilitation psychological
techniques may lead to a partial recovery
WCNR-0267
BOARD NUMBER: 044
NEUROANATOMICAL BASIS OF PRISM ADAPTATION THERAPY ON PREMOTOR
NEGLECT
M.F. Gutierrez Herrera1, S. Saevarsson2
1Faculty for Sports and Health Sciences- Technical University Munich,
Department of Human Movement Science, Munich, Germany
2Bogenhausen University Hospital Munich, Clinical Neuropsychology Research Group, Munich,
Germany
Aims
The present study assessed to what extent having premotor neglect (PMN) increases the
chances of patients to benefit from prism adaptation therapy (PA). Furthermore, with the aim of
elucidating the neuroanatomical correlates of PMN, still unclear to date, the lesion patterns of
patients displaying premotor deficits (PMD) were compared to those without them.
Method
Eight neglect patients underwent a four session protocol, including two sessions of
neuropsychological assessment each followed or preceded by PA therapy, and two follow-up
sessions consisting of assessment only. PMN was evaluated with a modified landmark task
designed to explore the presence of perceptual and intentional motor biases, by asking the
patients to either bisect lines (i.e. manual condition) or verbally judge whether similar lines had
been correctly bisected (i.e. verbal condition). After comparing patient’s performance on both
conditions, two groups were defined (i.e. patients with predominant perceptual symptoms vs.
patients with accompanying PMD). Linear regression analyses were conducted to test for
influences of PMN on the performance on the different assessment tasks. Those tasks that
showed to be significantly predicted by PMD were selected as dependent variables to follow the
effects of PA across sessions (i.e. line bisection, star cancellation, letter cancellation, and
straight-ahead pointing tasks).
Results
A mixed design ANOVA revealed a significant interaction between session and patient group.
This interaction was given by a significant performance improvement in the fourth session
compared to the first one, for the group of patients with PMD, F(3, 18) = 4.45, p < .05. As to the
neuroanatomical basis of PMN, the right caudate nucleus and the putamen were found to be
significantly related to the presence of PMN.
Conclusion
Our findings provide evidence for the involvement of subcortical regions in PMN. Furthermore,
they suggest that neglect patients with PMD profit more from PA than patients without them.
WCNR-0309
BOARD NUMBER: 045
MNEMONIC STRATEGY TRAINING ENHANCES MEMORY AND LATERAL
FRONTOPARIETAL ACTIVATION IN COGNITIVELY INTACT OLDER ADULTS
B. Hampstead1,2, A.Y. Stringer3, R.F. Stilla4, K. Sathian5,6
1University of Michigan, Psychiatry, Ann Arbor, USA
2VA Ann Arbor Health System, Mental Health Service Line, Ann Arbor, USA
3Emory University, Rehabilitation Medicine, Atlanta, USA
4Emory University, Neurology, Atlanta, USA
5Atlanta VAMC, RR&D Center of Excellence, Decatur, USA
6Emory University, Neurology, Atlanata, USA
Aims
This single-blind, randomized controlled trial examined whether 1) training with mnemonic
strategies (MST) improved memory for face-name associations relative to training with vanishing
cues (VCT) and 2) whether training modulated the blood oxygen level dependent (BOLD) signal
in a treatment-specific manner.
Method
Cognitively intact older adults (mean age=69, SD=7.9) were randomized to MST or VCT of facename associations. During three training sessions, MST participants learned to 1) identify a
salient facial feature, 2) develop verbally-based reason(s) linking the feature and name, and 3)
create a mental image. VCT participants recalled the targeted name across a series of trials.
Specifically, a letter of the name was removed for each trial following a correct response whereas
a letter was added on trials following an incorrect response. This process was repeated until
participants were able to recall the name, without cues, on 10 consecutive trials. A total of 30
participants (15 MST) underwent pre- and post-training functional magnetic resonance imaging
(fMRI) while encoding face-name associations. Different stimuli were used pre- and post-training.
Long-term retention was assessed at 1-month.
Results
Compared to VCT, MST improved memory for trained stimuli both post-training (p=0.006) and 1month later (p=0.003). Additionally, fMRI revealed increased activation in the intraparietal sulcus
bilaterally and left lateral occipital cortex in the MST group whereas the VCT group demonstrated
increases in the left retrosplenial cortex and angular gyrus. While encoding novel stimuli, the MST
group demonstrated robust increases in bilateral frontoparietal network regions while the VCT
group showed a more restricted pattern of change, primarily in the left frontoparietal network.
Both groups demonstrated repetition suppression effects in right hemisphere and “default mode
network” areas.
Conclusion
MST is superior to VCT for enhancing long-term retention of face-name associations in healthy
older adults and appears to enhance use of the lateral frontoparietal cognitive control network.
WCNR-0691
BOARD NUMBER: 046
Remote neuropsychological rehabilitation
S.H. HIEKKALA1, T. Kaitaro2, A.L. Salminen3
1The Finnish Association of People with Physical Disabilities, Research, Helsinki, Finland
2Validia Rehabilitation, Neuropsychological services, Helsinki, Finland
3The Social Insurance Institute of Finland, Research, Helsinki, Finland
Aims
The purpose of this literature review was to investigate types of remote technologies used in
neuropsychological rehabilitation of disabled people.
Method
The review was conducted on all types of studies. The search words included neuropsychology
and neuropsychological rehabilitation with different types of digitized methods. Melinda, the
Cochraine Library, Embase, PubMed, PychINFO and CINAHL, were searched for articles
published in English, Finnish and Swedish from January 2000 to January 2015.
Results
40 articles out of 239 were included in the review. Articles varied from cross-sectional studies to
clinical trials and reviews. Acquired brain trauma (brain trauma, stroke), Parkinson, Multiple
Sclerosis, Cerebral Palsy, and ADHD were the most common patient groups in the studies. The
technologies used were videoconferences, telephone contacts, text messages, web-based or cdrom –based computer/tablet/mobile applications and virtual reality. Neuropsychological
assessment and rehabilitation occurred in attention and executive functions (sharing of attention,
impulsivity), linguistic functions (production and comprehension of speech), sensorimotor
functions (control and sensing movements), visuospatial functions (perception and spatial
visualization), memory and learning. Only in few studies rehabilitation was performed on-line
from the distance, whereas in most of the cases patients used applications alone without on-line
connection to the therapist. Overall, neuropsychological assessment and rehabilitation was easily
performed with aforementioned methods and patients. Different applications showed positive
effects on mainly in the parameters of applications itself, but generalized improvement of
functional ability was less seen.
Conclusion
Remote neuropsychological rehabilitation includes wide variety of technological methods which
mostly are performed by patients themselves with no connection to the therapists. Results were
promising, but more studies using on-line neuropsychological rehabilitation, where patients and
therapists are remotely connected are needed.
WCNR-0064
BOARD NUMBER: 047
EVALUATION OF TBI PATIENTS' HIGHER COGNITIVE FUNCTION IN PERFORMANCE THE
FUNCTIONAL LOWENSTEIN OCCUPATIONAL THERAPY COGNITIVE ASSESSMENT
N. Katz1, A. Sagive2, S. Averbuch2, Y. Schwartz3
1Ono Academic College, Research Institute for Health and Medical Professions, Kiryat Ono,
Israel
2Loewenstein Rehabilitation Hospital, Occupational Therapy, Raanana, Israel
3Lowenstein Rehabilitation Hospita, Occupational Therapy, Raanana, Israel
Aims
Objectives: Impairments of cognitive function are a significant cause of disability and of low
participation in the community after Traumatic Brain Injury (TBI). Deficits in performance of higher
level integrative cognitive functions in simulated daily activities are evaluated with the Functional
Lowenstein Occupational Therapy Cognitive Assessment (FLOTCA). The purpose of this study
was to obtain reliability and validity of the FLOTCA evaluating TBI patients' higher cognitive
functions compared to a matched control group.
Method
Methods: Participants consisted of 25 patients with severe TBI, ages 18-49 consecutively
accepted to the hospital. Glasgow Coma Scale (GCS) scores and number of days unconscious
were recorded. A control group of 25 healthy individuals matched by age, gender and years of
education was also tested. Both groups underwent the FLOTCA evaluation that consists of 3
tasks: navigating on a map; organizing a toolbox; and planning a daily schedule; filled out the
MPAI-4 questionnaire to determine the ecological validity; and patients' cognitive scores on the
FIM & FAM questionnaire was evaluated as well.
Results
Results: The FLOTCA internal consistency reliability between the tasks and the total score was
high (α = .82). Moderate ecological validity with the FIM/FAM was obtained (r(19) = .44, p < .05);
and with MPAI-4 (r(50) =.51, p < .01);. Furthermore, severity of injury, Glasgow Coma Scale
(GCS) and Length of Unconsciousness, were both significantly correlated with the total FLOTCA
(r(19) =-.69 p<.01). Significant differences between the patient group and the control group were
found on the total FLOTCA (t(48) = -5.48, p<.01) and total MPAI-4 (t(48) = -4.69, p<.01)
supporting construct validity.
Conclusion
Conclusions: The FLOTCA was found to be reliable and valid, it can identify higher cognitive
impairments of TBI patients and serve as the basis for building appropriate treatment plans.
Nonetheless, further research is needed on a larger and more varied population.
WCNR-0074
BOARD NUMBER: 048
INTENSIVE POST-INPATIENT BRAIN INJURY REHABILITATION RESULTS IN
SUBSTANTIAL FUNCTIONAL CHANGE IN A LARGE NATIONAL U.S. SAMPLE
J. Malec1, J. Kean2, P. Monahan3
1Indiana University, PM&R, Indianapolis- Indiana, USA
2Unversity of Utah, Health Science, Salt Lake City- Utah, USA
3Indiana University, Biostatistics, Indianapolis- Indiana, USA
Aims
To evaluate outcomes for intensive post-inpatient brain injury (BI) residential and
outpatient/community-based rehabilitation programs relative to supportive living programs.
Method
OutcomeInfo is a web-based database system for tracking progress and outcomes in postinpatient BI rehabilitation programs primarily with the Mayo-Portland Adaptability Inventory
(MPAI-4). Four major program types were identified through expert opinion: (1) Intensive
Residential Rehabilitation: daily goal-directed therapies for individuals with behavioral problems
requiring a structured environment and 24-hour-a-day supervision; (2) Intensive Outpatient and
Community-based Rehabilitation: daily to weekly goal-directed therapy for individuals living in
private residences; (3) Long-term Residential Supported Living: supervised residential services
designed to preserve optimal health and assist participants to care for themselves and participate
in a stable activity plan; (4) Long-term Community-based Supported Living: ongoing support and
structure for individuals living in private residences with similar goals to Residential Supported
Living. Demographic and Rasch-adjusted MPAI-4 data obtained from 2008-2014 from 11
provider organizations offering programs in 29 facilities throughout the U.S. were examined.
Results
Controlling for age at injury, time in program, and time since injury on admission (chronicity),
both Intensive Residential (n=205) and Outpatient/Community-based (n=2781) programs resulted
in significant (approximately one standard deviation) functional improvement on the MPAI-4 Total
score compared to Supported Living (n=101) programs (F=18.184, p<.001). Outcome was
moderated by time since injury and level of initial disability. Examination of more chronic cases
(>1 year post-injury) showed significant, but smaller (approximately ½ standard deviation) change
on the MPAI-4 relative to Supported Living Programs (F=17.562, p<.001). Derivation of the
Minimal Clinically Important Difference (MCID) will also be briefly described; similar results were
obtained using the MCID.
Conclusion
Compared to supported living programs with a primary goal of preservation of function, Intensive
Residential and Community-based BI rehabilitation programs result in substantial positive
functional changes moderated by chronicity and initial level of disability.
WCNR-0048
BOARD NUMBER: 049
DISSOCIATING THE CAUSAL CONTRIBUTIONS OF THE DLPFC TO EXECUTIVE
FUNCTIONS AND WORKING MEMORY WITH REPETITIVE TRANSCRANIAL MAGNETIC
STIMULATION
E.M. Marron1, R. Sober-Viejo1, M. Palaus1, M. Boixados2, A. Valero-Cabre3, D. Redolar-Ripoll1
1Cognitive NeuroLab Open University of Catalonia, Psychology, Barcelona, Spain
2Open University of Catalonia, Psychology, Barcelona, Spain
3Université Pierre et Marie Curie, Centre de Recherche de l'Institut du Cerveau et la Moelle ICM,
Paris, France
Aims
Thanks to its ability to modulate cortical excitability and improve cognitive performance, repetitive
transcranial magnetic stimulation (rTMS) holds high promise in neuropsychological rehabilitation.
Yet to date, few studies have evaluated the effects of a well-established rTMS protocol such as
TBS (theta burst stimulation) known for its ability to induce a lasting inhibition (cTBS, continuous
stimulation) or facilitation (iTBS, intermittent stimulation) of regional brain function, and assessed
its impact on neuropsychological clinical tests. We aimed to explore the ability of cTBS and iTBS
protocols to modulate performance in four neuropsychological clinical tasks evaluating working
memory and executive functions.
Method
Thirty-three participants were evaluated in four tasks: backward digit span, 3-Back task, Stroop
test and Tower of Hanoi. Subjects were assessed twice, first as a baseline prior to rTMS and a
week later, immediately following a single session either active cTBS, active iTBS or sham TBS,
always delivered to the left dorsolateral prefrontal cortex (DLPFC).
Results
Immediately following stimulation, iTBS improved performance in backward digit span, reaction
time in 3-Back and reduced interference in Stroop test, with respect to pre rTMS performance.
Both cTBS and sham TBS reduced the time necessary to complete the Tower of Hanoi. In sum, a
single session of an iTBS excitatory protocol over DLPFC improved working memory and
reduced interference, whereas planning did not reach the expected performance due to practical
effect. Conversely, the application of the cTBS inhibitory protocol over DLPFC showed no
significant impact, with task performance changes being similar to those of the sham TBS group.
Conclusion
The DLPFC has a differential role in working memory and planning. Moreover, rTMS-driven
excitability increases in this area could be beneficial for performance in some tasks but not
others. A single session of iTBS improved performance, making it a particularly promising tool for
the rehabilitation of cognitive functions.
WCNR-0079
BOARD NUMBER: 050
PERSONALITY TRAITS INFLUENCE TRAJECTORIES OF MENTAL HEALTH-RELATED
QUALITY OF LIFE, ANXIETY, AND DEPRESSION IN CAREGIVERS OF PATIENTS WITH
SEVERE BRAIN INJURY
A. Norup1, M.A. Trujillo2, P.B. Perrin2, K. Doser3
1Rigshospitalet, Department of Neurology, Glostrup, Denmark
2Virginia Commonwealth University, Department of Psychology, Richmond- Virginia, USA
3Danish Cancer Society Research Center, Survivorship Unit, Copenhagen, Denmark
Aims
As a result of the lack of research examining the connections between severe brain injury
caregiver personality traits and mental health, the purpose of the current study was to use
hierarchal linear modeling to examine whether Danish severe brain injury caregivers’ personality
traits could predict their trajectories of mental health-related quality of life (HRQoL), anxiety, and
depression beginning at the patient’s stay in a neuro-intensive care unit through one year after
injury.
Method
Fifty-two Danish family members of individuals with severe brain injury completed the Vitality,
Social Functioning, Role Limitations – Emotional, and Mental Health subscales of the Short Form36, and the anxiety and depression subscales of the Symptom Checklist-90-Revised, at five
different time points during the first year after injury.
Results
All mental HRQoL, anxiety, and depression variables improved significantly over time. Caregivers
who were less neurotic and less conscientious tended to have higher longitudinal trajectories of
Vitality, Social Functioning, and Mental Health. Additionally, caregivers with higher
Agreeableness had higher trajectories of Social Functioning. All caregivers experienced a
decrease in anxiety and depression over time, but caregivers with low Neuroticism improved
more quickly in both depression and anxiety.
Conclusion
Caregivers’ personality traits were strongly associated with their longitudinal trajectories of
HRQoL, anxiety, and depression. These results suggest that personality assessments for
caregivers of individuals with severe brain injury could help identify those most at risk for poor
mental health over the course of their family member’s recovery.
WCNR-0505
BOARD NUMBER: 051
CHARACTERISTICS OF INDIVIDUALS WITH ACQUIRED BRAIN INJURY AND NICOTINE
USE
J. Podcasy1, A. Hartwig Tverdov2
1, Philadelphia, USA
2Bancroft NeuroRehab, Neuropsycology, Mt. Laurel, USA
Aims
Objectives: In 2010, an estimated 2.5-6.5 million Americans lived with traumatic brain injury (TBI).
Comorbid conditions such as alcohol and substance use disorders are also prevalent in TBI
populations. Chronic cigarette smoking is associated with significant neurocognitive abnormalities
in non-clinical samples. In individuals with mild TBI (MTBI), smoking contributes to slow
improvement in multiple cognitive domains. Previous literature focuses on health outcomes and
recovery time in individuals that smoke and have TBI. Limited emphasis has been placed on the
establishment of effective interventions. A specific post-acute rehabilitation day treatment
program in New Jersey became a smoke free campus; however, efforts to maintain a smoke-free
environment were ineffective. This study aimed to describe a sample of individuals with severe
acquired brain injury (ABI) with the intention of designing smoking cessation interventions.
Method
Design: In a retrospective design, matched pair t-tests were used to compare cognitive,
psychological, and emotional functioning in individuals with severe ABI. Participants: participants
in the smoking group were matched with non-smoking participants based on age and level of
functioning. Cognitive measures included attention, processing speed, and executive functioning.
Psychological and emotional measures included self-ratings on quality of life (QoL), depression,
anxiety, and anger.
Results
Results: Findings did not reach clinical significance. However, trends revealed that the smoking
group performed better on selective attention and processing speed tasks, had higher ratings of
anger, and higher ratings of social quality of life.
Conclusion
Conclusions: The use of nicotine in this population was associated with differences in emotional
functioning, QoL, and attention and processing speed scores when compared to non-smokers.
This study suggests there was some benefit to continued smoking despite health risks and
neurocognitive slowing in a ABI population. Results indicate that techniques targeting the
reduction of anger and increase in attentional skills could assist individuals with smoking
cessation or reduction.
WCNR-0281
BOARD NUMBER: 052
BODY-CONTROLLED VIRTUAL REALITY TRAINING FOR IMPROVING EXECUTIVE
FUNCTIONS OF INDIVIDUALS WITH ACQUIRED BRAIN INJURY: PRELIMINARY RESULTS
PROM ACUTE REHABILITATION AND COMMUNITY SETTINGS
S. Preminger1,2, R. Eliav3,4, Y. Swartz4, B. Blumenfeld1, S. Maoz1, D. Rand3, Y. Sacher4
1Intendu Ltd, Intendu Ltd, arsuf kedem, Israel
2Interdisciplinary Center Herzliya, School of Psychology, Herzliya, Israel
3Tel Aviv University, Department of Occupational therapy, Tel Aviv, Israel
4Lowenstein Rehabilitation Center, Traumatic Brain Injury department, Raanana, Israel
Aims
Deficits in executive functions (EF) are common following an Acquired Brain Injury
(ABI). Computerized cognitive training is becoming more popular, however their usability is low
for individuals with cognitive impairments, and the transfer of performance to real-life is unclear.
Cognitive training using virtual reality environments using body movement for interaction offers a
more realistic training, therefore may facilitate transfer to everyday function. Software that adapts
in real-time to patient’s cognitive behavior may potentially enhance patients' usability. Our goal
was to assess the experience of training with dynamically-adaptive motion-interaction cognitive
training and its potential benefits in improving EF for individuals with ABI.
Method
Experimental group included seven participants from Lowenstein inpatient wards with moderate
to severe TBI and two individuals with ABI living in the community, all were screened for EF
dysfunctions. Intervention included 4-9 computerized training sessions over a 2-3 week period
using motion-based adaptive video games designed to train behavioral control, initiation, working
memory and attention (Intendu Functional Brain Trainer®). Control group included 4 individuals
with TBI from Lowenstein inpatient playing commercial iPad games.
The following assessments were administered pre and post intervention; the Dysexecutive
Questionnaire (DEX), computerized neuropsychological EF assessment (WebNeuro), functional
assessments, and a satisfaction questionnaire. Performance during training was also analyzed.
Results
Participants from experimental group were gradually able to perform games involving higher EF
challenge, task difficulty in the last session was significantly higher than in the first session and
response time significantly decreased. Participants reported enjoying the training and feeling
successful in it. Preliminary analysis shows trend of improvement in EF assessments following
training.
Conclusion
These findings demonstrate the potential of using motion-based adaptive cognitive training for
individuals with ABI. Currently more participants are recruited to assess effectiveness of this
training for improving EF and the transfer of training into everyday functioning.
WCNR-0654
BOARD NUMBER: 053
Alleviate pain by showing the Heart: Treatment of CRPS through physiologically-enhanced
virtual reality
M. SOLCÀ1, R. Ronchi1, J. Bello Ruiz1, T. Schmidlin1, F. Luthi2, M. Konzelmann2, J.Y. Beaulieu3,
F. Delaquaize3, A. Schnider4, A.G. Guggisberg4, A. Serino1, O. Blanke1
1Ecole Polytechnique Federale de Lausanne EPFL, Center for neuroprostheticsLaboratory of Cognitive Neuroscience, Geneva, Switzerland
2Clinique romande de réadaptation suvacare, Department for Musculoskeletal Rehabilitation-,
Sion, Switzerland
3University Hospital, Department of Orthopeadic Surgery, Geneva, Switzerland
4University Hospital, Division of Neurorehabilitation, Geneva, Switzerland
Aims
Complex regional pain syndrome (CRPS) is a chronic painful condition, whose mechanisms are
poorly understood and which difficult to treat. Recent work suggest that manipulating body related
signals may alleviate pain in different pathological conditions. Here we manipulated cardiac and
visual bodily signals to reduce chronic pain in CRPS patients.
Method
24 orthopedic patients with CRPS were tested. We briefly exposed them (90’ repeated 3 times) to
cardio-visual stimulation through a physiologically-enhanced virtual reality system, in which we
presented with a virtual hand flashing in synchrony (or our of synchrony in the control condition)
with their own online-detected heartbeat. We assessed pain, grip strength and heart rate
variability (HRV, which is known to be reduced in chronic pain) to measure the analgesic effects
of cardio-visual stimulation.
Results
Our data show that pain rating was significantly reduced in the synchronous cardio-visual as
compared to the control (asynchronous) condition. Grip strength on the affected hand also
selectively increased after exposure to the synchronous condition. Importantly, HRV was
significantly higher during synchronous cardio-visual stimulation, similarly as previously reported
after analgesics administration.
Conclusion
This study represents a proof-of-concept demonstrating through subjective (i.e. pain rating),
functional (i.e. force strength) and physiological (i.e. HRV) measures that exposure to a bodilyspecific cardio-visual stimulation can reduce chronic pain in CRPS patients. The use of this
physiologically-enhanced virtual reality approach can be applied as long-term treatment of CRPS
symptoms, potentially leading to new non-invasive, analgesic rehabilitation programs for different
pain conditions.
WCNR-0320
BOARD NUMBER: 054
NON-INVASIVE BRAIN STIMULATION TO PROMOTE ALERTNESS AND AWARENESS IN
CHRONIC PATIENTS WITH DISORDERS OF CONSCIOUSNESS: LOW-LEVEL, NEARINFRARED LASER STIMULATION VS. FOCUSED SHOCK WAVE THERAPY
C. Werner1, B. Manuela2, P.H. Stefan1
1Medical Park Berlin, Neurological Rehabilitation, Berlin, Germany
2Haus Havelblick, Nursing Home, Berlin, Germany
Aims
Objective:
The promotion of alertness and awareness is a challenging issue in the neurological rehabilitation
of patients with disorders of consciousness (DOC). Casusitic reports were positive regarding the
non-invasive brain stimulation with either frontal near infrared laser stimulation (N-LLT) or focused
shock wave therapy of the cranium (F-SWT). The study intended to compare both techniques in
chronic DOC patients, either classified as patients in the syndrome of unresponsive wakelfulness
(UWS) or minimal conscious state (MCS).
Method
Methods: The randomised baseline-treatment study included 16 DOC patients, allocated to two
groups ( A and B). A three week baseline either followed a frontal N-LLT (10 mW / cm2, 10 min
per session), five times a week over four weeks (group A), or a F-SW (10 mW / cm2, 4000 stimuli
per session) three times a week over four weeks (group B). The primary variable was the revised
Coma Recovery Scale (r-CRS, 0-23), blindly assessed.
Results
Results: Both groups were comparable at study onset. Over ther period of the interventions the rCRS of both groups improved over time. Between group differences did not occur at any of the
measurement points. One patient of group B had a focal seizure in the third therapy week. Merely
one patient with an akinetic mutism improved her competence in the activities of daily living.
Three UWS-patients, who had suffered from global cerebral damage due to hypoxia, did not
improve their r-CRS scores at all. Care-takers of 11 patients rated the interventions positively as
the interactions had improved.
Conclusion
Conclusion: Both options are an interesting and equipotent tool to increase the alertness and
awareness of chronic DOC patients. An akientic mutism seems to be a positive and a global brain
damage due to hypoxia a negative predictor. Epileptic seizures are a potential unwanted side
effect. More clinical studies are warranted.
WCNR-0599
BOARD NUMBER: 055
MOTION LAB KINEMATIC FINGER TAPPING TEST
L. Willadino Braga1
1SARAH Network of Rehabilitation Hospitals, Presidency, Brasilia, Brazil
Aims
Purpose: The Halstead Finger Tapping Test (HFTT), which has been widely used to assess
motor control and severity of brain injury, although very effective, may involve a degree of
subjectivity during data collection. The aim of this study was to standardize kinematic analysis of
the Finger Tapping Test (KFTT) and develop a data collection and analysis model for the Motion
Laboratory.
Method
Methods: One hundred forty-five healthy participants, 15 to 85 years old, were assessed. All
underwent the HFTT as well as the KFTT, the new Kinematic Method of the Finger Tapping
Test. The statistical analysis of the data included comparison to the HFTT, as well as
participant’s performance, gender, age and educational level.
Results
Results: The General Linear Model revealed better performance, taking into account age
(younger), educational level (higher) and gender (male), similar to the results found in the
literature for HFTT. Comparing the HFTT to the KFTT revealed that the new method allowed for
greater precision, more control of the testing rhythm, fatigue analysis, and differences between
dominant and non-dominant hand. KFTT was more precise and accurate than the previous one
(HFTT) and permitted generating a kinematic data collect and analysis model for the motion
laboratory.
Conclusion
Conclusion: The data obtained from the movement lab using KFTT were more diagnostically
precise with regards to motor control, cognitive problems and lesion severity, and enabled the
development of a motion laboratory data collection and analysis model that can be used all over
the world.
WCNR-0600
BOARD NUMBER: 056
NEUROREHABILITATION OF EXECUTIVE FUNCTIONS IN ADOLESCENTS WITH ABI
L. Willadino Braga1
1SARAH Network of Rehabilitation Hospitals, Presidency, Brasilia, Brazil
Aims
Purpose: Adolescence in an individual with ABI is a complex stage during which behavioral
problems may arise, especially due to the frontal lobe's lack of maturation and the teenager's
problems with executive functions and, consequently, self-monitoring. The aim of this randomized
clinical trial study was to evaluate the efficacy of an intervention program based on executive
functions and metacognition (Metacognitive Dimension) in preadolescents with acquired brain
injury (ABI).
Method
Participants/Methods: Participants were 29 ABI preadolescents: 14 in the experimental group and
15 in the control group (average age, 10.4 y.o.; average time of lesion, 5.3 years). Evaluations
were conducted 3 months after the start of the intervention, using the Evaluation Scale of
Elementary School Learning Strategies (ESESLS) to assess metacognitive strategies, SelfConcept Scale for Children (SCSC) and Behavioral Rating Inventory of Executive Functions
(BRIEF).
Results
Results: The experimental group had superior outcomes to the control. The results of
metacognitive strategies (ESESLS) and self-concept (SCSC) were better in the experimental than
in the control group (p < 0.05). BRIEF did not reveal any significant differences between the
groups, although we observed better results in the experimental group for 5 sub items of the
scale, in the broader index and global executive composite score.
Conclusion
Conclusion: Three months of an intervention based on executive functions helped
preadolescents with acquired brain injury develop metacognitive strategies and improve selfconcept and self-monitoring, thereby helping empower the preadolescents in their social
relationships.
WCNR-0250
BOARD NUMBER: 057
DIAGNOSIS/IMAGING
THE EFFECT OF SENSORY PROCESSING ON GAIT IN ECOLOGICAL CONDITIONS
M. Agmon1, T. Bar-Shalita2, R. Kizony3
1, Haifa, Israel
2Tel- Aviv University, Occupational Therapy and Sagol School of Neuroscience, Tel-Aviv, Israel
Aims
The world's population aged 60 years and older is set to rise from 841 million in 2013, to more
than 2 billion by 2050. Falls are very common among this aging population. They dramatically
reduce quality of life and their cost to society lies in the range between 64.4- 85.4 billion dollars in
the US. Understanding risk factors associated with falls is therefore an absolute public health
priority.
Ample studies have demonstrated the effect of a single sensory system (i.e., vision, hearing,
tactile and proprioception) on walking deterioration in older adults. Yet, the effect of sensory
processing (i.e. modulation across several sensory systems) on walking among the elderly is yet
to be identified.
The objective of this study is to explore the effect of sensory processing on gait with dual-task in
ecological conditions in community older adults.
Method
24 community dwelling older adults (mean age 69.9, SD-4.9) carried out a one minute walk, both
with and without a cognitive arithmetic task (i.e., dual-task paradigm) on a flat surface in
laboratory conditions and also outside the laboratory in a crowded area. Gait speed and gait
variability were evaluated using the APDM motion analysis system. Sensory processing was
evaluated with the Questionnaire-Intensity Scale (SRQ-IS)
Results
Sensory processing was associated with gait speed under both single and dual-task in ecological
conditions outside the laboratory (p=0.006; p=0.001 respectively) but not in a laboratory setting
after controlling for age.
Conclusion
sensory processing may help to understand the risk of falls in daily life situations and should be
incorporated into fall examination and treatment.
WCNR-0402
BOARD NUMBER: 058
DIAGNOSIS/IMAGING
INFLUENCE OF AUDITORY STIMULI ON A VIRTUAL NAVIGATION TASK (IN THE VIRTUAL
ACTION PLANNING-SUPERMARKET VAP-S) MADE BY BRAIN-INJURED PATIENTS
M. Cogné1, J.F. Knebel2, E. Klinger3, C. Binschaedler4, P.A. Rapin5, P.A. Joseph1, S. Clarke2
1CHU Bordeaux, Service de Médecine physique et de Réadaptation, BORDEAUX, France
2Neuropsychology and Neurorehabilitation ServiceCentre Hospitalier Universitaire Vaudois CHUV, CHU, Lausanne, Switzerland
3Digital Interactions Health and Disability Lab- ESIEA, ESIEA, Laval, France
4Neuropsychology and Neurorehabilitation ServiceCentre Hospitalier Universitaire Vaudois CHUV, CHUV, Lausanne, Switzerland
5Institut de Lavigny, 1010, Lavigny, Switzerland
Aims
Introduction : Topographical disorientation is a frequent issue among patients
suffering from brain injury. Virtual reality environments present many advantages
for estimating spatial navigation in this population. Furthermore, stimuli can be
integrated to the software. E. Klinger created the Virtual Action Planning
Supermarket (VAP-S) in 2003. Then, some contextual (“sonar effect” and “name of
product”) and non-contextual (“periodic randomized noises”) auditory stimuli
were added to the VAP-S software. The use of these stimuli notably involves
attentional and executive processes.
Objective : In this study, we aim at investigating how these auditory stimuli
influence the performance and the spatial learning of brain-injured patients over a
navigation task in the supermarket VAP-S.
Method
Methods : Thus, we included 22 patients with brain injury and 17 healthy subjects.
After a software-familiarization, they were estimated without auditory stimuli, with
a sonar effect or periodic random sounds whose order is randomized, and with
the stimuli “name of product”.
Results
Results : The results showed that patients’ performance was improved by
contextual auditory stimuli, more than the control group (with “sonar effect”:
H(1)=5.93, p≤0.05 ; with “name of product”: H(1)=6.94, p≤0.05). Contextual stimuli
were most helpful for patients with large dysexecutive disorders or with severe
unilateral neglect.
Conclusion
Conclusion : These results give important insights for the rehabilitation of
patients with topographical disorientation.
WCNR-0208
BOARD NUMBER: 059
DIAGNOSIS/IMAGING
UNEVEN LINGUISTIC OUTCOME IN EXTREMELY PRETERM CHILDREN
P. De Stefano1, G. Cossu2, M. Marchignoli3, F. Pisani4
1Service de Neuropsychologie et Neuro-réhabilitation,
Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
2Unit of Cognitive Neurorehabilitation for Children, Centro Medico di Foniatria, Padova, Italy
3AUSL Sud-West district and Fidenza, Child neuropsychiatric Unit, Parma, Italy
4Child Neuropsychiatric Unit, Department of Neurosciences, Parma, Italy
Aims
Premature birth often leads to neurodevelopmental impairment.One primary problem in
extremely-preterm children is the occurrence of atypical language development.This study
investigates the impact of extremely-preterm birth on language acquisition.
Method
We selected a sample of 20 extremely-preterm monolingual Italian children (GA < 28 weeks) at
pre-scholar age free from significant neurological sequels (high grade IVH, PVL, genetic disease,
or malformation),and compared them with a group of 40 full-term children, matched for age and
IQ.Extremely-preterm children had a normal non-verbal and verbal IQ. Language comprehension
was fully efficient in all of the components that we assessed.
Extremely-preterm children had a normal non-verbal and verbal IQ.The language assessment
was conducted by means of the TNP (Preschool Neuropsychological Test), whereby we explored
lexical comprehension and lexical production, morphosyntactic comprehension and production
and the circuit of articulatory phonology by means of non-word repetition.
The language assessment was conducted by means of the Preschool Neuropsychological Test,
whereby we explored lexical comprehension and production, morphosyntactic comprehension
and production and the circuit of articulatory phonology.
Results
Our findings show that in extremely-preterm children the language function can be selectively
impaired in some components, whereas other components follow regular developmental
trajectories. In particular, the integrity of the lexical-semantic system stands in contrast with an
impaired output phonology.Likewise, the efficiency of morphosyntactic comprehension is
contrasted by a marked impairment in morphosyntactic production.
Conclusion
These findings outline that language and general cognitive intelligence can follow largely
discrepant trajectories,thus suggesting the computational fractionability of these different
cognitive domains.It also appears that the fractionability of cognitive systems can occur within the
faculty of language itself. We have theoretically principled reasons for assuming that the
occurrence of an early impairment in articulatory phonetics may reverberate in the subsequent
acquisition of literacy,thus suggesting the importance to detect it at an earlier stage to provide a
neuro-rehabilitative therapeutic program.
WCNR-0586
BOARD NUMBER: 060
DIAGNOSIS/IMAGING
CORTICOSPINAL TRACT LESION LOAD: AN IMAGING BIOMARKER FOR STROKE MOTOR
OUTCOMES
W. Feng1, J. Wang2, P. Chhatbar1, C. Doughty2, D. Landsittel3, V.A. Lioutas2, S. Kautz4,
G. Schlaug2
1Medical University of South Carolina, Neurology, Charleston, USA
2Beth Israel Deaconess Medical Center, Neuroimaging and Stroke Recovery Laboratory, Boston,
USA
3University of Pittsburgh, Department of Medicine, Pittsburgh, USA
4Medical University of South Carolina, Dept of Health Sciences & Research, Charleston, USA
Aims
The aim of this work was to investigate whether an imaging measure of corticospinal tract (CST)
injury in the acute phase can predict motor outcome at 3 months in comparison to clinical
assessment of initial motor impairment.
Method
A two-site prospective cohort study followed up a group of first-ever ischemic stroke patients
using the Upper-Extremity Fugl-Meyer (UE-FM) Scale to measure motor impairment in the acute
phase and at 3 months. A weighted CST lesion load (wCST-LL) was calculated by overlaying the
patient’s lesion map on magnetic resonance imaging with a probabilistic CST constructed from
healthy control subjects. Regression models were fit to assess the predictive value of wCST-LL
and compared with initial motor impairment.
Results
Seventy-six patients (37 from cohort 1 and 39 from cohort 2) completed the study. wCST-LL as
well as assessment of motor impairment (UE-FM) in the acute phase correlated with motor
impairment (UE-FM) at 3 months in both cohort 1 (R250.69 vs. R250.67; p50.43) and cohort 2
(R250.69 vs. R250.62; p50.25). In the severely impaired subgroup (defined as UE-FM10 at
baseline), wCST-LL correlated with outcomes significantly better than clinical assessment
(R250.47 vs. R250.11; p50.03). In the nonseverely impaired subgroup, stroke patients recovered
approximately 70% of their maximal recovery potential. All stroke patients in both cohorts had
poor motor outcomes at 3 months (defined as UE-FM25) when wCST-LL was7.0 cc (positive
predictive value was 100%).
Conclusion
wCST-LL, an imaging biomarker determined in the acute phase, can predict poststroke motor
outcomes at 3 months, especially in patients with severe impairment at baseline.
WCNR-0580
BOARD NUMBER: 061
DIAGNOSIS/IMAGING
ALTERED MOTOR AND SENSORY THALAMOCORTICAL PATHWAYS IN CHRONIC
STROKE AND TYPE-2 DIABETES: PRELIMINARY ANALYSIS
J. Ferris1, S. Peters1, K. Brown1, K. Tourigny2, L. Boyd1
1University of British Columbia, Rehabilitation Sciences, Vancouver, Canada
2University of British Columbia, Psychology, Vancouver, Canada
Aims
There is a high prevalence of type-2 diabetes (T2DM) in stroke populations, and previous
research suggests that T2DM reduces brain health and neuroplasticity. It is unclear how known
neurological changes in T2DM interact with patterns of recovery from stroke. Here we explore
alterations to white matter pathways between the thalamus and the primary motor (M1) and
sensory (S1) cortices and grey matter thickness of M1 and S1 in chronic stroke and T2DM.
Method
Nine individuals with chronic stroke and T2DM were pair-matched with nine non-diabetic
individuals by age, time since stroke, and upper limb impairment based on Fugl Meyer score.
With the thalamus as a “SEED” region and M1 (thal-M1) or S1 (thal-S1) as an “AND” region,
fractional anisotropy (FA) of tracts between these regions were extracted bilaterally using
constrained spherical deconvolution (CSD) tractography in ExploreDTI. Parcellation of T1 scans
was performed using Freesurfer to quantify mean cortical thickness for M1 and S1 bilaterally.
Differences between group (diabetic/non-diabetic) and hemisphere (ipsilesional/contralesional) in
FA and cortical thickness were examined using 2-way ANOVAs.
Results
Thal-M1 FA showed a trend towards a decrease in the ipsilesional hemisphere (p = 0.089) and a
bilateral decrease in diabetics (p = 0.195). M1 thickness did not differ between hemispheres, but
was significantly lower bilaterally in diabetics (p = 0.002). Thal-S1 FA did not differ between
hemisphere or group. S1 thickness showed a trend towards being reduced in the ipsilesional
hemisphere (p = 0.069) and being reduced in diabetics (p = 0.100).
Conclusion
These data suggest altered thalamocortical white matter pathways and reduced grey matter
thickness in individuals with chronic stroke and T2DM. Alterations to motor and sensory pathways
in the brains of individuals with T2DM may impact the potential for full recovery after stroke, which
has implications for neurorehabilitation interventions and the clinical management of diabetes.
WCNR-0142
BOARD NUMBER: 062
DIAGNOSIS/IMAGING
TRUNK CONTROL AND LESION LOCATIONS: RELATIONSHIP AND HEMISPHERIC
DIFFERENTIATION IN ACUTE STROKE
B. Gjelsvik1, L.I. Strand2, H. Næss3, H. Hofstad4, J.S. Skouen4, G.E. Eide5, T. Smedal1
1Haukeland University Hospital, Physiotherapy Department, Bergen, Norway
2University of Bergen, Department of Global Public Health and Primary CarePhysiotherapy Research Group, Bergen, Norway
3Haukeland University Hospital, Department of Neurology, Bergen, Norway
4Haukeland University Hospital, Department of Physical Medicine and Rehabilitation, Bergen,
Norway
5Haukeland University Hospital, Centre for Clinical Research, Bergen, Norway
Aims
Stroke is a leading cause of disability in elderly people. Trunk control is an important aspect of
postural control, and has been found to be impaired after stroke. Lesion location and trunk control
early after stroke have been found predictive of functional outcome. A hemispheric difference in
the regulation of postural control has been suggested, and a hemispheric asymmetry for trunk
control has been described.. We aimed to explore whether single middle cerebral artery (MCA)
lesion locations affected trunk control after stroke, and to compare trunk control between left and
right hemispheric lesions.
Method
We used a cross-sectional design, and patients were recruited consecutively from a hospital
stroke unit. Trunk Impairment Scale–modified Norwegian version (TIS-modNV) is a 6 item scale
(0-16) by which trunk control in sitting was evaluated, and Alberta Stroke Program Early CT
Score (ASPECTS) were used. Results were analyzed by descriptive statistics, independent t-test,
Mann-Whitney’s U-test, and the Chi-Squared test.
Results
Thirty-eight patients with single ASPECT lesion locations due to first time MCA infarctions were
included. Over all, the scores on TIS-modNV indicated reduced trunk control (median 11.0, range
2-16). The most common single lesion locations were M5 (50 percent) and internal capsule (18.4
percent). M5 is situated in the anterior parts of the MCA territory and hypothesized to represent
sensory and motor areas of the cortex. Patients with lesions of M5 locations in the right
hemisphere achieved poorer scores on trunk control than patients with left sided locations
(p=0.030), with poorest scores for testlets 1: side flexion to most affected side; 4: lifting nonaffected pelvic half off the plinth; and 6: rotation of lower trunk.
Conclusion
The results indicate that therapists should have specific attention towards trunk control in
rehabilitation of patients with MCA lesions. A possible hemispheric difference in the regulation of
trunk control needs further investigation.
WCNR-0153
BOARD NUMBER: 063
DIAGNOSIS/IMAGING
THE CONTRALESIONAL HEMISPHERE MAY PLAY AN IMPORTANT ROLE IN SUPPORTING
MOTOR RECOVERY OF PEOPLE WITH SEVERE UPPER LIMB IMPAIRMENT AFTER
STROKE.
K.S. HAYWARD1,2, J.L. Neva1, S. Peters1, J.K. Ferris1, K.P. Wadden1, C.S. Mang1, L.A. Boyd1
2Florey Institute of Neuroscience and Mental Health, Stroke, Melbourne, Australia
Aims
Explore potential biomarkers of recovery derived from transcranial magnetic stimulation (TMS)
and diffusion-weighted imaging (DWI) in a group of individuals with severe and chronic upper limb
(UL) impairment after stroke.
Method
Individuals completed a clinical assessment of paretic UL impairment (Fugl Meyer UL, FM-UL)
and performance (Wolf Motor Function Test rate, WMFT-rate). TMS characterised the presence
of ipsi- and contralesional motor evoked potentials and transcallosal inhibition (TCI); and DWI
indexed fractional anisotropy of ipsi- and contralesional corticospinal (CST) and prefrontal corpus
callosum (PF-CC) tracts, and contralesional tracts extracted from a constrained motor
connectome (CMC). Correlations (p <0.1) informed a stepwise regression model to identify key
biomarkers of paretic WMFT-rate.
Results
Fifteen individuals (mean 58±12 years old; 62±47 months post stroke) with severe impairment
(mean FM-UL 17±7) were included. Age (rho=-0.682), PF-CC (rho=0.609) and contralesionalCMC (rho=0.582) were significantly correlated (p<0.05) with WMFT-rate; while contralesionalCST (rho=0.486) and ipsilesional-TCI (rho=0.447) showed a trend (p<0.1) towards significance.
The stepwise regression model identified ipsilesional-TCI (R2 change 0.342, p = 0.028) and age
(R2 change 0.202, p = 0.05) to explain 54.4% (p=0.013) of the variance in WMFT-rate. The same
model was performed in a cohort comprised of 14 individuals (mean 68±9 years old) with mildmoderate (mean FM-UL 58±4) and chronic (mean 80±71 months post stroke) UL impairment.
However, no variables emerged to significantly explain WMFT-rate variance in the mild-moderate
group.
Conclusion
This study suggests that the contralesional hemisphere supports motor recovery in people with
severe, chronic UL impairment after stroke; a pattern unique to this cohort. These findings
advance our understanding of the role of the contralesional hemisphere as a potential target
when designing interventions to promote recovery after severe stroke and highlights key
biomarkers to explore (e.g., TCI, PF-CC, contralesional-CMC) in clinical trials of people with
severe impairment.
WCNR-0185
BOARD NUMBER: 064
DIAGNOSIS/IMAGING
SEVERE UPPER LIMB IMPAIRMENT AFTER NEUROLOGICAL INJURY: A SYSTEMATIC
REVIEW OF INDIVIDUAL DATA OF BRAIN-DERIVED BIOMARKERS.
K.S. HAYWARD1,2, J.Y. Schmidt1, K.R. Lohse3, S. Peters1, K.P. Wadden1, J. Bernhardt2,4,
N.A. Lannin5,6, L.A. Boyd1
2Florey Institute of Neuroscience and Mental Health, Stroke, Melbourne, Australia
3Auburn University, School of Kinesiology, Auburn, USA
4La Trobe University, Department of Physiotherapy, Melbourne, Australia
5La Trobe University, Department of Occupational Therapy, Melbourne, Australia
6Alfred Health, Occupational Therapy Department, Melbourne, Australia
Aims
Clinical outcomes are inadequate in identifying the recovery potential of people with severe upper
limb impairment after neurological injury. Brain-derived biomarkers are possible alternatives to
explain residual function. This systematic review and meta-analysis aims to: 1) explore brainderived biomarkers in people with severe upper limb impairment as a result of a neurological
injury; 2) compare biomarkers between phases of recovery (acute/subacute/chronic), and 3)
compare biomarkers between populations (stroke/traumatic brain injury/acquired brain injury).
Method
Three electronic databases will be searched (MEDLINE, EMBASE and CINAHL) up to October
2015 to identify studies that evaluated brain-derived biomarkers indexed from anatomical,
diffusion, resting and functional magnetic resonance imaging; transcranial magnetic stimulation;
electroencephalography; and positron emission tomography. In addition, eligible studies will
include a cohort of adults with severe upper limb impairment (or at least 50% or individual data on
at least two individuals) with a neurological injury. Studies will be excluded based on study type
(i.e., reviews or single case designs). Two reviewers will independently screen titles and
abstracts, followed by full text articles. Individual data will be extracted by two reviewers. Study
authors will be contacted for individual data if not provided in the paper. Meta-analysis of
individual data will be performed using mixed-effects and logistic regression modelling in R, using
the ‘lme4’ package.
Results
This will be the first systematic review with meta-analysis using a large sample of individual data
to explore brain-derived biomarkers in people with severe upper limb impairment after
neurological injury.
Conclusion
The outcomes of this systematic review using individual data will uniquely advance our
understanding of brain-derived biomarkers and their impact on upper limb recovery. Not only will
it provide data to more effectively guide researchers undertaking future studies, but also offer
clinically meaningful outcomes for clinicians treating individuals with severe upper limb
impairment after neurological injury.
PROSPERO: CRD42015026107.
WCNR-0065
BOARD NUMBER: 065
DIAGNOSIS/IMAGING
PHANTOM LIMB PAIN AND MEMORY OF PREAMPUTATION PAIN EXPERIENCE IN ADULT
TRAUMATIC LIMB AMPUTEE
W. Kusumaningsih1
1, Jakarta, Indonesia
Aims
To identify the relation between phantom limb pain with pain experience in the same limb before
amputation.
Method
Fifty single limb amputee subjects without stump pain, man and women, between 17 to 55 years.
By consecutive random sampling were allocated into two independent group, prosthetic group (P)
and nonprosthetic group (NP). Phantom pain (PP) is measured using visual analoug scale with
range from zero (0) to ten (10) and subjects answer a questionare for preamputation pain
experience (PNPA).
Results
Independent t test show significance difference in both group (p<0,0001) in the distribution of
preamputation pain experience (PNPA+) and incidence of phantom pain (PP+). Also significance
difference in both group (p<0,0001) without preamputation pain experience
(PNPA-) and
no phantom pain incidence (PP-).
Subjects with preamputation pain experience in group NP and group P have phantom pain score
above zero. Mean score of phantom pain in group NP is 6,16 (SD 1,96) and mean score of
phantom pain in group P is 5,26 (SD 1,47). Subjects without preamputation pain experience has
no phantom pain.
Conclusion
Preamputation pain experience will develop into phantom pain. Loss of ascending impuls caused
by amputation will disinhibit cortical somatosensory pain memory. Without preamputation pain
experience, there will be no painfull memory to built and no phantom pain. However phantom
sensation is still there, since memory of self body perception was already there from birth
(Melzack Neuromatrix Theory).
WCNR-0372
BOARD NUMBER: 066
DIAGNOSIS/IMAGING
POST-STROKE INTER-HEMISPHERIC MYELIN ASYMMETRY AS AN INDICATOR OF
IMPAIRMENT BUT NOT FUNCTION
B. Lakhani1, K. Hayward1, L. Boyd1
Aims
The level of impairment following stroke is commonly attributed as the primary predictor of longterm functional outcome. However, the relationship between impairment, function and underlying
brain structure following stroke remains unclear. The integrity of white matter tracts in individuals
with stroke strongly correlates with residual motor impairment. Although tractography analysis is
useful in broadly assessing white matter structure, it has limited utility in identifying specific
underlying components, such as myelin. Thus, the purpose of the present study was to explore
the relationship between myelination, motor impairment and functional outcomes in individuals
with stroke.
Method
Assessments of paretic upper limb (UL) impairment (Fugl-Meyer; FM-UL) and function (Wolf
Motor Function Test rate; WMFT-rate) were administered to 10 individuals with chronic stroke (>6
months post-stroke). Participants also completed a magnetic resonance imaging protocol that
included a high resolution T1 anatomical scan and a multi-component T2 relaxation imaging scan
to quantify myelin water fraction (MWF), a histopathologically validated measure of myelin in vivo.
Thirty-four white matter regions of interest were parcellated using Freesurfer and MWF was
quantified from these regions as an asymmetry ratio (contralesional/ipsilesional). Stepwise
multiple linear regression was used to quantify MWF regions that significantly predicted paretic
FM-UL and WMFT-rate.
Results
The stepwise multiple linear regression model identified 3 out of 34 regions of interest whose
asymmetry ratio significantly predicted FM-UL score (R2=0.998, p=0.004). These regions were
the precentral gyrus (β=-1.273), supramarginal gyrus (β=0.481) and pericalcarine gyrus (β=0.227). However, none of the 34 regions of interest predicted WMFT-rate.
Conclusion
Our preliminary results suggest that asymmetric myelination in sensorimotor specific brain
regions is a significant predictor of UL impairment, but not function, in individuals with chronic
stroke. As such, myelination may be utilized as a more specific marker of the neurobiological
changes that predict long term impairment and recovery from stroke.
WCNR-0345
BOARD NUMBER: 067
DIAGNOSIS/IMAGING
FUNCTIONAL CONNECTIVITY IN SENSORIMOTOR BRAIN NETWORKS AND THE
DEVELOPMENT OF SPASTICITY AFTER STROKE
A. Eriksson Duva1, J. Plantin1, J. Borg1, E. Laurencikas1, P. Lindberg2
1Karolinska Institutet, KIDS, Stockholm, Sweden
2Karolinska Institutet- INSERM U894, KIDS, Paris, France
Aims
The mechanisms underlying spasticity development after stroke remain unclear. The aim here is
to explore whether early changes in functional connectivity (FC) in sensorimotor networks after
stroke relate to the development of spasticity in the hand.
Method
41 stroke patients with upper limb paresis, admitted to inpatient rehabilitation, underwent restingstate functional MRI at 2-6 weeks (T1) after stroke. Spasticity in wrist and finger flexor muscles
was quantified with NeuroFlexor® at T1and at 3 and 6 months post stroke (T2, T3). Resting-state
functional MRI analysis includes conventional pre-processing using SPM12b and calculation of
FC using the Connectivity toolbox. FC is evaluated between regions of interest (ROIs) in ipsi and
contra-lesional sensorimotor areas known to be important for hand movements. Motor cortex
(M1) FC maps are calculated. Three types of network FC were calculated: inter-hemispheric
homotopic FC, intra-hemispheric homotopic FC and inter-hemispheric heterotopic FC. Planned
analyses include (i) a comparison of M1 and network FC in patients with and without spasticity at
T1 and (ii) a correlation analysis of M1 and network FC with change of spasticity over time (T3T1). We control for potential confounds such as cortical lesion and initial motor function.
Results
Data from some patients were excluded due to excessive head motion in scanner. Preliminary FC
results reproduced the known default mode network in patients validating the data quality and the
analysis approach. Average FC is highest in supplementary motor area and inter-hemispheric FC
in M1s was reduced in some patients as in previous studies. Spasticity developed in about 30%
of patients and relation to FC is being studied.
Conclusion
Analysis is ongoing and complete results will be reported. This is the first study relating functional
connectivity early after stroke and development of spasticity.
WCNR-0509
BOARD NUMBER: 068
DIAGNOSIS/IMAGING
THE PSYCHOMETRIC PROPERTIES OF ACTIVLIM SCALE IN PATIENTS WITH
PARKINSON'S DISEASE
M. Madan1, S. Aksu YILDIRIM2, M. Kılınç2
1Afyon Kocatepe University, Atatürk High Vocational School of Health Services, Afyon, Turkey
2Hacettepe University, Faculty of Health SciencesDepartment of Physiotherapy and Rehabilitation, Ankara, Turkey
Aims
The aim of this study was to investigate whether ACTIVLIM scale a valid and reliable scale for
activity limitations of patients with parkinson's and to investigate sensitivity to changes in the
activity limitations.
Method
The study was carried out with 94 voluntary patients with Parkinson's disease who have been
directed to be given home exercises or for physiotherapy. Patients between the ages of 35-95
years, without any orthopaedic problems that affect activities of daily living, without any serious
neurological disease other than Parkinson's disease, Modified Hoehn&Yahr score ≤4and who
agreed to participate in the study were included. Patients first was evaluated by both ACTIVLIM
and UPDRS, two weeks later just with ACTIVLIM, 8 weeks later by both of them by the same
physiotherapist. Internal consistency, test-retest reliability, content validity (Comparing with the
UPDRS-ADL), construct validity and responsiveness of ACTIVLIM scale were investigated by the
data obtained in patients with Parkinson's.
Results
ACTIVLIM has been found to be highly reliable and valid instrument for measuring activity
limitations in Parkinson patients (ICC=0.998, Cronbach α=0.938, Content validity rs= -0.719).
ACTIVLIM wasn't sensitive to the changes in activity limitations compatible with UPDRS-ADL
subsection that we accepted as a reference scale for changes.
Conclusion
Because of the resulting changes in activity limitations were very low (UPDRS-ADL Cohen’s
d=0.07), in future studies it is needed to investigate the sensitivity of ACTIVLIM scale again by
obtaining clinically significant effect size on the UPDRS-ADL subsection. "Sit toilet bowl" item was
in the structure of the 18-item ACTIVLIM scale translated into Turkish shows incompatibility with
lifestyle and architecture of our country, it should be kept in the scale with a more appropriate
translation. "Get out of the bath tub" item should be replaced with a new item that has similar
level of difficulty for social adaptation.
WCNR-0125
BOARD NUMBER: 069
DIAGNOSIS/IMAGING
LESIONS UNDERLYING SOMATOSENSORY DEFICITS IN THE UPPER LIMB AFTER
STROKE: A VOXEL-BASED LESION-SYMPTOM MAPPING STUDY
S. Meyer1, S.S. Kessner2, B. Cheng2, M. Bönstrup2, R. Schulz2, F.C. Hummel2, N. De Bruyn1,
A. Peeters3, V. Van Pesch3, T. Duprez4, S. Sunaert5, M. Schrooten6, H. Feys1, C. Gerloff2,
G. Thomalla2, V. Thijs6, G. Verheyden1
2University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany
3Cliniques Universitaires Saint-Luc, Department of Neurology, Brussels, Belgium
4Cliniques Universitaires Saint-Luc, Department of Radiology, Brussels, Belgium
5KU Leuven, Department of Imaging and Pathology, Leuven, Belgium
Aims
The aim of this study was to investigate the relationship between stroke lesion location and the
resulting somatosensory deficit in the upper limb.
Method
We studied exteroceptive and proprioceptive somatosensory symptoms and stroke lesions in 38
patients with first-ever acute stroke. The Erasmus modified Nottingham Sensory Assessment was
used to clinically evaluate somatosensory functioning in the arm and hand within the first week
after stroke onset. Additionally, more objective measures such as the perceptual threshold of
touch and somatosensory evoked potentials were recorded. Non-parametric voxel-based lesionsymptom mapping was performed to investigate lesion contribution to different somatosensory
deficits in the upper limb. Additionally, structural connectivity of brain areas that demonstrated the
strongest association with somatosensory symptoms was determined, using probabilistic fiber
tracking based on diffusion tensor imaging data from a healthy age-matched sample.
Results
Voxels with a significant association to somatosensory deficits were clustered in two core brain
regions: the central parietal white matter, also referred to as the sensory component of the
superior thalamic radiation, and the parietal operculum close to the insular cortex, representing
the secondary somatosensory cortex. Our objective recordings confirmed findings from clinical
assessments. Probabilistic tracking connected the first region to thalamus, internal capsule, brain
stem, postcentral gyrus, cerebellum, and frontal pathways, while the second region demonstrated
structural connections to thalamus, insular and primary somatosensory cortex.
Conclusion
This study reveals that stroke lesions in the sensory fibers of the superior thalamocortical
radiation and the parietal operculum are significantly associated with multiple exteroceptive and
proprioceptive deficits in the arm and hand.
WCNR-0215
BOARD NUMBER: 070
DIAGNOSIS/IMAGING
TRANSCALLOSAL INHIBITION ELICITED FROM NON-PRIMARY MOTOR CORTEX IN
INDIVIDUALS WITH CHRONIC STROKE
J.L. Neva1, K.S. Hayward1, K.E. Brown1, N.H.M. Ledwell1, C.S. Mang1, L.A. Boyd1
Aims
To investigate potential functional interhemispheric interactions between non-primary motor areas
to contralateral primary motor cortex (M1) in individuals with chronic stroke. Although
interhemispheric interactions of non-primary motor regions has been demonstrated in healthy
individuals, this functional connectivity and its importance to motor recovery has not been studied
in individuals with stroke.
Method
Five individuals with chronic stroke (mean Fugl-Meyer upper-limb (UL)=20±9) participated in the
study. Transcranial magnetic stimulation (TMS) was used to quantify transcallosal inhibition (TCI)
elicited from M1, primary somatosensory (S1), and dorsal premotor (PMd) cortex. TCI was
evoked from the non-lesioned (NL) and lesioned (L) cortices, and quantified via the ipsilateral
silent period recorded from the extensor carpi radialis. Additionally, associations between all
cortical regions (i.e. M1, S1 and PMd) of bilaterally evoked TCI and Wolf Motor Function Test rate
(WMFT-rate) scores were explored.
Results
Preliminary individual data demonstrated unique patterns of TCI evoked from M1 and non-M1
areas. Firstly, there was an increased L-TCI (more inhibition) from all cortical regions (i.e. M1, S1
and PMd) compared to NL-TCI. Secondly, there was comparable TCI elicited from S1 and PMd
as evoked from M1, suggesting that these non-primary motor regions play an important role in
interhemispheric connectivity. Finally, our data suggest an association between TCI elicited from
non-M1 areas with WMFT-rate of the paretic UL (rho=0.90, p=0.037).
Conclusion
Our preliminary results are the first demonstration of interhemispheric connectivity between nonprimary motor regions and contralateral M1 after stroke. Critically, altered interhemispheric
connectivity from non-primary motor regions could be indicative of individualized cortical
reorganization following stroke and may be a potential factor supporting motor recovery. This
information may be particularly relevant to inform non-invasive cortical stimulation targets to
optimize rehabilitation therapies.
WCNR-0466
BOARD NUMBER: 071
DIAGNOSIS/IMAGING
DETECTING AWARENESS IN PROLONGED DISORDERS OF CONSCIOUSNESS:
ADAPTING ADULT MEASURES FOR USE WITH CHILDREN AND YOUTH
J. Pool1, W. Magee2, M. Johnson3, H. Gill-Thwaites4
1The Childrens Trust, Research, London, United Kingdom
2Temple University, Music Therapy, Philadelphia, USA
3The Childrens Trust, Occupational Therapy, London, United Kingdom
4Royal Hospital for Neuro-disability, Occupational Therapy, London, United Kingdom
Aims
Prolonged disorders of consciousness (PDOC) have persisted for four weeks minimum following
acquired brain injury. Rehabilitation with PDOC aims to provide accurate diagnosis to identify the
patient’s current level of awareness, influencing effective management of family expectations
around planning care, treatment and palliative decisions. Adult measures for PDOC exist.
However, none have been validated for the paediatric population. Two main issues arise when
considering assessment of consciousness with youth. First, the model of consciousness is based
on the adult (developed) brain. Second, behavioural assessments of consciousness are
vulnerable to neurodevelopmental differences at various stages of development. This affects
language comprehension, movement, and cognitive processes such as attention and memory.
We aim to refine two existing adult PDOC measures for children and youth: the Music Therapy
Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) and the Sensory
Modality Assessment and Rehabilitation Technique (SMART). Both are validated measures for
detecting awareness in PDOC optimising sensory assessment.Method
Content validity of the MATADOC and SMART were assessed through a review of the evidence
and focused group discussions with selected health professionals experienced in PDOC.
Recommendations for adaptations to the adult measures accounted for expected
neurodevelopmental differences between adults and children in specific areas: language,
attention, memory, and biography. Variables considered included salient and standardised stimuli
and dosage. Content validity and clinical utility were assessed.
Results
At the time of abstract submission, this study is seeking ethical approval . A minimum age of two
years is recommended considering verbal commands and language development. Salient,
familiar stimuli are essential but challenging depending on the age of acquired brain damage.
Guidelines will be provided around the standardisation of stimuli.
Conclusion
When considering adaptation of adult measures for use with children, it is important to consider
known neurodevelopmental differences and the implications for developmental milestones and
biographical capacity.
WCNR-0567
BOARD NUMBER: 072
DIAGNOSIS/IMAGING
DIAGNOSTICS OF TOOL-USE APRAXIA
J. Randerath1, I. Buchmann1
1Clinical Neuropsychology, Psychology, Konstanz, Germany
Aims
Tool-Use Apraxia is an oftentimes underestimated but frequent impairment after brain damage.
Typically the disorder is assessed by pantomime tests: without really having the object in hand
many patients with left brain damage have difficulties to demonstrate its correct use. Many
studies confirm the observation that patients’ performance improves significantly when they are
allowed to really grasp and use the objects instead of merely pantomiming the movement.
Clinicians therefore oftentimes do not regard the disorder as relevant for activities of daily living
(ADL), despite an increasing number of studies from the last decade revealing its relationship to
reduced ADL-independence.
Our goal was to provide clinicians with a diagnostic tool that measures real use of familiar tools
and objects and may demonstrate better ecological validity.
Method
Based on the Novel Tool-Use Test by Goldenberg and Hartmann (1998) we developed a test with
familiar tools and objects. We applied the test in a group of healthy adults as well as typical left
brain damaged stroke patients with and without aphasia or hemiparesis, who were admitted to a
German rehabilitation clinic. Patient-selection was based on weekly screenings of clinical records.
They were tested if they had unilateral left-brain-damage, the ability to participate in 30 minute
sessions, were right handed and consented to participate in our study.
Results
We calculated Cut-Off values based on the normative data of the healthy adults group. About
39% of the tested left-brain-damaged patients demonstrated difficulties with real familiar tool-use.
Conclusion
The Familiar Tool-Use Test provides a sensitive measure for tool-use apraxia. It better
approaches real life actions than the typical pantomime tests, and it is simple to administer in
stroke patients.
Goldenberg, G., & Hagmann, S. (1998). Tool use and mechanical problem solving in apraxia.
Neuropsychologia, 36(7), 581-589.
WCNR-0500
BOARD NUMBER: 073
DIAGNOSIS/IMAGING
LESION LOAD OF THE ARCUATE FASCICULUS PREDICTS POST-STROKE APHASIA
G. Schlaug1, E. Pani1, J. Wang1, A. Norton1
1BIDMC/Harvard Medical School, Neurology, Boston, USA
Aims
Making accurate predictions about a stroke patient’s language outcome and recovery potential
continues to be challenging. In the current study, we compared a new variable, the Arcuate
Fasciculus Lesion Load (AF-LL) as a structural lesion marker with a functional lesion marker, the
functional grey matter (fGM) lesion load in its value to predict speech fluency outcome.
Method
A group of 50 chronic stroke patients with left hemisphere lesions and varying levels of
impairment of speech fluency were included. The white matter canonical map consisted of the
Arcuate fasciculus which was derived from high resolution DTI scanning of a group of elderly
normal controls. The functional Gray Matter map was derived from activation patterns of overt
rate-controlled speaking tasks in a group of elderly healthy controls. Furthermore, fGM and sWM
maps were summed into a combined sWM-fGM map. Each canonical map was overlaid with
lesion masks derived from the 50 chronic stroke patients to calculate a lesion load for each
patient. Lesion loads were then regressed with measures of speech fluency (by quantitatively
assessing spontaneous speech) and naming ability (using the Boston Naming Test).
Results
Regression analysis revealed that sWM and fGM lesion loads predicted CIUs/min (Adjusted
R2=0.624, p<0.01). sWM lesion load explained more variance in CIUs/min than fGM lesion load
(sWM partial R2=0.09, p<0.01; fGM partial R2=0.01, p>0.05). Combined sWM-fGM lesion load
significantly predicted in CIUs/min (Adjusted R2=0.542, p<0.01), but did not predict more of the
variance than individual sWM and fGM lesion load models. Naming ability was predicted
significantly by sWM, fGM, and Combined sWM-fGM lesion loads (Adjusted R2=0.472, p<0.01;
Combined sWM-fGM R2=0.388, p<0.01). Naming was best predicted by sWM lesion load (partial
R2=0.06, p<0.05)..
Conclusion
The consistent importance of AF lesion load in predicting speech fluency and naming in chronic
stroke patients is replicated in this current study’s large patient sample.
WCNR-0428
BOARD NUMBER: 074
DIAGNOSIS/IMAGING
STROKE UPPER LIMB CAPACITY SCALE CORRELATES WITH UPPER EXTREMITY FUGLMEYER ASSESSMENT AND ELBOW MUSCLE STRENGTH IN SUBACUTE AND CHRONIC
STROKE
J. Sivak1, J. Chow1, D. Stokic1
Aims
Stroke Upper Limb Capacity Scale (SULCS) has been recently validated against the Action
Research Arm Test early after stroke and for predicting long-term recovery of initially paralyzed
hand. However, the relationship of SULCS with the more commonly used upper extremity FuglMeyer Assessment (FMA-UE) and the strength in elbow flexors and extensors has not been
examined early and late after stroke.
Method
SULCS and FMA-UE (reflex scores excluded) were administered to 39 subacute subjects (19
men, 61±13 years, 22±12 days post-stroke, 23 right paretic) and 34 chronic subjects (13 men,
61±11 years, 11±6 months post-stroke, 21 right paretic) able to voluntarily flex elbow to >90°
against gravity. Maximal isometric strength in elbow flexors (EF) and extensors (EE) was
assessed bilaterally using isokinetic dynamometry and expressed as the ratio between the paretic
and non-paretic sides (EFR, EER). The Pearson’s correlation coefficient was calculated between
SULCS, FMA-UE (total score; upper extremity, wrist, hand, coordination/speed subscores), EF R,
and EER for each group. Floor/ceiling effects were also assessed.
Results
In subacute subjects, SULCS showed significant moderate-to-strong correlations with FMA-UE
(total score: r=0.80; subscores: upper extremity, r=0.73; wrist, r=0.66; hand, r=0.62;
coordination/speed, r=0.78; all p<0.001) and moderate correlations with EF R (r=0.50, p=0.001)
and EER (r=0.55, p<0.001). In chronic subjects, the correlations of SULCS with FMA-UE were
similar to subacute subjects (r=0.63-0.80, p≤0.001) and higher for EFR (r=0.60, p<0.001), but not
for EER (r=0.55, p=0.001). Markedly greater ceiling effect was found for chronic SULCS (50%)
than FM-UE (9-18%).
Conclusion
For subjects able to flex elbow to >90°, SULCS and FM-UE provide closely related information
about arm motor function after stroke, however, SULCS seems more appropriate in the subacute
phase than chronic phase due to the ceiling effect. Strength ratio for elbow flexors and extensors
may increase sensitivity of SULCS and FM-UE in both subacute and chronic phases of stroke.
WCNR-0569
BOARD NUMBER: 075
DIAGNOSIS/IMAGING
TEST D’ÉVALUATION DES MEMBRES SUPÉRIEURS DE PERSONNES ÂGÉES TO ASSESS
UPPER LIMB ACTIVITY IN PARKINSON’S DISEASE
A. Swarowsky1, P.R. Freitas1, A.E. Lemos2, J. Ilha1, C.L. Corrêa2, S.M. Michaelsen1
1Universidade do Estado de Santa Catarina, Physical Therapy, Florianópolis, Brazil
2Universidade Federal do Rio de Janeiro, Physical Therapy, Rio de Janeiro, Brazil
Aims
Motors classic symptoms of Parkinson's disease (PD) like bradykinesia, rigidity and tremor may
be related to manual dexterity deficits, digital and strength modulation changed in upper limb (UL)
of individuals with PD. This study aims to assess the UL activity level through the Test
d'Evaluation des Membres Supérieurs Des Personnes Agées (TEMPA) in individuals with PD and
verify some psychometric properties.
Method
The following psychometric properties of the TEMPA Brazilian version were evaluated in 52
subjects, accordingly to COSMIN: inter-rater and test-retest reliability; the concurrent validity
assessed by the correlation of the TEMPA with sections (II, III) of the Unified Parkinson's Disease
Scale (UPDRS); the convergent validity, between correlation of TEMPA and Nine Hole Peg Test
(NHPT); discriminant validity, verified by comparing the TEMPA and Hoehn and Yahr scale, and
the relationship of UL activity level with the the presence of freezing of gait.
Results
Excellent reliability and inter-rater agreement (intraclass correlation coefficient - ICC = 0.99 and
weighted kappa - k = 0.92) and test-retest reliability (ICC = 0.97) for TEMPA. It was found a
negative moderate correlation between the TEMPA and section II of the UPDRS (ρ = -0.58; p =
0.000), moderate correlations between the test and NHPT values of the right and left UL (ρ = 0.56
and ρ = 0.41; p = 0.000) (ρ = 0.52 and ρ = 0.51; p = 0.000 and p = 0.002), respectively. There
was no significant relationship between the group that presented freezing episodes (p = 0.057).
Conclusion
TEMPA is an instrument that contains unilateral and bilateral tasks that represent daily activities
for assess the activity level of upper limbs in PD. It presents suitable psychometric properties and
was able to capture the influence of disease signs being useful for physical therapy practice.
WCNR-0574
BOARD NUMBER: 076
DIAGNOSIS/IMAGING
COMPARISON BETWEEN TWO FUNCTIONAL MOBILITY SCALES FOR PARKINSON'S
DISEASE DIRECTLY APPLIED TO PHYSICAL THERAPY PRACTICE: CROSS-CULTURAL
ADAPTATION AND MEASUREMENT PROPERTIES
A. Swarowsky1, M.P. Santos1, B.A. Silva1, J. Siebra1, A.C. Ovando1, J. Ilha1
Aims
The Modified Parkinson Activity Scale (PASm) and Lindop Parkinson's Disease Mobility
Assessment (LPA) scales were developed to assess the functional mobility in patients with
Parkinson's disease (PD) being directly applied to physical therapy practice. The previous falls
and freezing of gait events are considered the main risk factors for further declines in the PD and
have direct influence on functional mobility. To translate and perform the cross-cultural adaptation
(CCA) of PASm and LPA scales to Portuguese-Brazil, and to analyze some psychometric
properties.
Method
The study consisted of two stages: 1) CCA process; 2) evaluation of psychometric properties.
Results
Considering the total score, the interrater and test-retest reliabilities showed a coefficient of intraclass correlation that ranged between 0.97 and 0.98. Both scales showed excellent internal
consistency (α=0.83 and 0.94). Positive correlations were obtained between the Brazilian
versions of the LPA and PASm and PAS (ρ= 0.63 and 0.92). The concurrent validity between
scales and part III of UPDRS, established a moderate negative correlation, (ρ=-0.54 and -0.65).
The one way ANOVA showed that LPA - Brazil discriminates the individual with PD between all
stages according HY, and the PASm- Brazil between mild and severe stages, and moderate and
severe. The MDC of scales ranging from 1 to 2 points. There was Ceiling effect only for the LPA Brazil.
Conclusion
Brazilian versions of PASm and LPA are valid and reliable instruments to assess the functional
mobility in patients with PD, the major goal of physical therapy. The results of study are relevant
and could improve the physical therapy practice in Brazil, since it provides the Brazilian version of
two mobility scales (one of them recommended by the European Guidelines for Physical Therapy
Practice in patients with Parkinson disease).
WCNR-0090
BOARD NUMBER: 077
DIAGNOSIS/IMAGING
DUAL-TASK RELATED FUNCTIONAL CONNECTIVITY ALTERATIONS IN PATIENTS WITH
PARKINSON&RSQUO;S DISEASE AND FREEZING OF GAIT
G. Vervoort1, E. Heremans1, A. Bengevoord1, C. Strouwen1, E. Nackaerts1, W. Vandenberghe2,
A. Nieuwboer1
1KU Leuven, Rehabilitation Sciences, Leuven, Belgium
2University Hospitals Leuven, Neurology, Leuven, Belgium
Aims
Dual-task (DT) gait impairment in people with Parkinson’s disease (PD) and specifically in those
with freezing of gait (FOG), reflects attentional dependency of movement. This study aimed to
elucidate resting-state brain connectivity alterations related to DT gait abnormalities in PD with
and without FOG.
Method
PD patients (n=73) and healthy age-matched controls (n=20) underwent DT gait analysis and
resting-state functional MRI while ‘off’ medication. Patients were classified as freezer (n=13) or
non-freezer (n=60). Functional connectivity (FC) alterations between PD and controls and
between patient subgroups were assessed in regions of interest (ROIs) within the fronto-parietal
and motor network.
Results
PD had longer stance times, shorter swing times and more step length asymmetry during DT gait
and needed more time and steps during DT turning compared to controls. Additionally, freezers
showed similar impairments and longer double support times compared to non-freezers during
DT gait. PD demonstrated hyper-connectivity between the inferior parietal lobule and premotor
cortex (PMC) and between the cerebellum and the PMC and M1. FOG-specific hypo-connectivity
within the striatum and between the caudate and superior temporal lobe and hyper-connectivity
between the dorsal putamen and precuneus was correlated with worse DT performance.
Conclusion
PD showed FC alterations in DT-related networks, which were not directly correlated to DT
performance. However, FOG-specific FC alterations in DT-related regions involving the
precuneus and striatum were correlated to worse DT performance, suggesting that the balance
between cognitive and motor networks is altered in people with FOG.
WCNR-0104
BOARD NUMBER: 078
DIAGNOSIS/IMAGING
ECOLOGICAL ASSESSMENT OF NUMERICAL SKILLS IN CEREBROVASCULAR DISEASE
M. Villain1, H. Robert1, C. Tarabon-prevost1, M. Cocquelet-bunting1, O. Pomme2, B. Glize2,
P. Pradat-diehl1
1GH Pitié-Salpêtrière, Physical and Rehabilitation Medicine, Paris, France
2CHU Bordeaux- Hôpital Pellegrin, Physical and Rehabilitation Medicine, Bordeaux, France
Aims
Number-processing may be altered following brain injury and might affect the everyday
life of patients. Yet few studies aimed on assessment of these disorders, especially in everyday
life. We developed the first French ecological test to evaluate the number processing and
calculation skills: Ecological Assessment Battery for Numbers (EABN).
The purpose of this study was to assess calculation skills and number processing in
cerebrovascular disease patients, using EABN. Another aim was to establish lesion profiles, to
evaluate links with an analytical reference test: Evaluation Clinique des Aptitudes Numériques
(ECAN), and with routine assessments of brain-damaged patients.
Method
Patients were included after cerebrovascular disease. Inclusion criteria were first stroke patients,
older than 18, with no neurologic or psychiatric antecedent. An evaluation of language functions,
cognition and independence was also executed. We studied the link between variables through
multivariate analysis. Non parametric group comparisons were also conducted.
Results
Forty eight patients were included, of which 36 left brain-damaged (LBD) and 10 right braindamaged. 62.5 % of them presented with a pathological score on EABN. LBD patients were
significantly impaired and slower than RBD patients especially for transcoding tests (reading
numerical data, make a digicode, make a payment in cash). The total score for EABN was
significantly correlated to the ECAN, showing good concurrent validity. Language functions,
MOCA and MIF were also highly correlated with the total score of the EABN.
Conclusion
The EABN seems to be a good tool for promoting more systematic screening for calculation
impairment in brain-damaged patients, as its consequences are a major disability in everyday life
activity. This tool allowed us to distinguish profiles performances according to location of the brain
lesion. In clinical practice, it would therefore be advisable to assess the number processing and
calculation skills of all left side brain-damaged patients, in addition to the routine cognitive
assessment.
WCNR-0112
BOARD NUMBER: 079
DIAGNOSIS/IMAGING
SOCIAL SUPPORT DURING HOSPITALIZATION FOR STROKE AND THREE-MONTH
OUTCOMES
M. Villain1, I. Sibon2, P. Renou2, M. Poli2, J. Swendsen1
1Université de Bordeaux- INCIA, CNRS UMR5287, Bordeaux, France
2CHU Bordeaux- Hôpital Pellegrin, Pôle de Neurosciences Cliniques, Bordeaux, France
Aims
The high rates of depression following stroke are associated with worsened clinical outcomes and
greater functional impairment. While social support has generally been shown to improve
depressive symptoms and functioning in this population, previous investigations have measured
support only in the weeks or months following hospital discharge. The impact of support received
immediately following stroke is largely unknown, despite indications that early intervention
following medical or psychological crises is an important determinant of later outcomes. In order
to facilitate the earliest identification of vulnerable individuals, this investigation examined whether
social contact and support received at initial hospitalization for stroke predicted depression levels
and daily life functioning three months later.
Method
Using Ecological Momentary Assessment (EMA) to avoid memory biases, 34 patients with firstever mild to moderate ischemic stroke were evaluated concerning their daily life experiences.
EMA was first administered within 24 hours following hospitalization to assess the number of
social contacts and quality of social support received from family, friends and medical staff. Three
months later, EMA was again administered over a one-week period to assess depression
symptoms as well as the frequency of leisure activities and tasks necessary for autonomous
living. Multilevel modeling was used to account for the repeated-measure design.
Results
The number of social interactions experienced at hospitalization did not predict depression
symptoms or functional activities at follow-up. However, the quality of emotional support from
friends and family were predictive of both depression levels (γ=-0.097, t=-2.141, p=0.041) and
functional behaviors (γ=0.367, t=2.783, p=0.011) at three months. The role of support was
specific to the patient’s personal relationships, as no effect was observed for support received
from medical staff.
Conclusion
Patient perceptions of support immediately following stroke provide important information for the
identification of vulnerable individuals and for the development of the earliest possible prevention
strategies.
WCNR-0647
BOARD NUMBER: 080
BASIC SCIENCE/REGENERATIVE THERAPY
Silent lesions diminish cognitive and motor outcome after stroke
A. Auriat1, J. Ferris1, S. Black2, J. Claudia3, L. Boyd1
2Sunnybrook Research Institute, Canadian Partnership for Stroke Recovery, Toronto, Canada
3Pacific University Oregon, Psychology, Portland, USA
Aims
In addition to the primary stroke lesion the co-occurrence of ‘silent lesions’, which include white
matter hyperintensities (WMH) and black holes (BH), may contribute to post-stroke outcome. We
sought to determine if ‘silent lesions’, independent of stroke volume, affect outcome.
Method
Volumetric quantification of stroke, WMH, BH, ventricular and sulcul CSF, and normal appearing
white and gray matter was completed based on magnetic resonance imaging. ‘Silent lesions’
were classified as periventricular if they touch the ventricle, all other lesions were considered
deep. Motor impairment and function, as well as memory and non-memory cognitive functions
were assessed. The impact of WMH and BH on outcome when controlling for stroke volume was
assessed. Multivariate stepwise regressions, which included stroke volume and any correlated
MRI parameters, were used to identify which factors have the greatest impact on outcome.
Results
Stroke volume correlates with motor outcomes, and non-memory cognitive function. However,
after controlling for stroke volume silent lesions have a significant impact on outcome. Nonmemory cognition correlate with periventricular BH (r=-0.649, p=0.001) and periventricular WMH
(r=-0.555, p=0.002), whereas memory performance correlates with periventricular WMH (r=0.416, p=0.028). Motor outcome relates to the volume of periventricular WMH (impairment: r=0.417, p=0.024; function: r=-0.418, p=0.024), and deep WMH (function: r=-0.488, p=0.007).
Regression analysis identified periventricular BH and normal appearing gray matter as
accounting for 43% of the variance of non-memory cognitive outcome. Ventricular CSF accounts
for 24% of the variance of memory outcome. Stroke volume and periventricular WMH accounts
for 37% of the variance in motor impairment, and deep WMH accounts for 48% of the variance in
motor function.
Conclusion
The co-existence of ‘silent lesions’ and stroke significantly impacts cognitive and motor outcomes.
The type and location of ‘silent lesions’ are important and must be considered when evaluating
stroke recovery.
WCNR-0694
BOARD NUMBER: 081
Preliminary study about prognostic value of biochemical markers in cerebrospinal fluid for
the functional outcome in patients with traumatic SCI
R. Capirossi1, G. Ferrara1, M. Fernandez2, L. Calzà2, R. Montevecchi3, M. Merafina1, J. Bonavita1,
G. Belloni1, T. Giovannini1, G. Gordini3, S. Ferro4, F. De Iure5
1Montecatone Rehabilitation Institute, Spinal Cord Unit, Imola, Italy
2University Bologna, CIRI - Health Science and Technologies, Bologna, Italy
3Maggiore Hospital Bologna, Trauma Centre, Bologna, Italy
4Emilia Romagna Region Health Authority, Department of Hospital Services, Bologna, Italy
5Maggiore Hospital, Spine Surgery, Bologna, Italy
Aims
Objectives: to identify potential prognostic biomarkers for functional outcome after spinal cord
injuries (SCI) through the analysis of molecular markers in the cerebrospinal fluid (CSF) in the
context of primary care. The identification of such factors would facilitate the formulation of early
diagnosis, would improve the therapeutic-protective strategies and the clinical-care setting and
identify new potential therapeutic targets.
Method
Methods: the prospective trial is still in progress. It is expected to enroll 30 SCI patients (9
recruited) with indication to spinal stabilization. As controls, 10 CSF samples of healthy subjects
(4 recruited) will be included. CSF obtained by lumbar puncture performed within the first 24
hours after injury is processed using the high-throughput protein multi-parametric quantification
technology. Three magnetic bead panels were used for biomarker testing: cytokine/chemokine
21-plex, 4-plex Neurological Disorders and Neurodegenerative Diseases 10-plex, so that 35
protein markers were studied. The sensory-motor function and disability were evaluated with
ASIA standards, Ashworth and SCIM III scale. Neurophysiological and neuroradiology
investigations have been also carried out.
Results
Results: among cytokines/chemokines, we found an increase in GRO-A (Chemokine C-X-C Motif
Ligand 1) and MIF (Macrophage/microglia migration inhibitory factor) in SCI patients compared to
controls; HGF, SDF1a, SCGF-B, IL16, MIG and CTAK were unchanged. P-tau increases, such as
RANTES (Chemokine C-C motif ligand 5), BDNF, platelet-derived growth factor, siCAM (soluble
Intercellular Adhesion Molecule 1) and PAI-1 (Plasminogen activator inhibitor-1). IL2Ra, INFa2,
SDF1a, MCP3, IL12, LIF, TNFb, IL18, IL1a, IL3, SCF, TRAIL, M-CSF resulted undetectable in
both control and lesioned patients.
Conclusion
Conclusions: the study is still underway and correlation analysis with clinical results not yet
possible: these preliminary results indicates that high-throughput technologies seems to be a
promising approach for the discovery of prognostic markers of clinical and functional outcome of
SCI patients.
WCNR-0645
BOARD NUMBER: 082
HETEROTOPHIC OSSIFICATION FOLLOWING SEVERE ACQUIRED BRAIN INJURY-AUDIT
OF CURRENT PRACTICE
A.M. Cortese1, K. Yelden2, A. Mumin2
1, Lido di Venezia, Italy
2Royal Hospital for Neurodisability, Brain Injury Service, London, United Kingdom
Aims
Neurogenic heterotopic ossification (NHO) is a disorder of aberrant formation of mature lamellar
bone in extra-skeletal soft tissues. NHO is largely described after traumatic and vascular damage
of the CNS. It can be associated with significant morbidity including pain and loss of motion
especially around joints. In addition, NHO increases the risk of complications such as urinary tract
infections and pressure ulcers, which can significantly impair quality of life.
We are presenting a retrospective study to define the incidence of HO in our population of
patients, to study the HO distribution according to the aetiology of the acquired brain injury ( ABI)
and the clinical risk factors, the correlation with gender, age, and the association with the time
from the ABI. Furthermore our aim is to review our service in order to understand if it is
appropriate to screen all the new admissions or if the practice should be changed.
Method
Our specialist rehabilitation hospital admit a varied population of patients affected from severe
ABI of several aetiology. On admission every patient is screened for NHO with X-Rays of the
main sites of possible NHO formation (shoulders, elbows, hips, knees).
We analysed retrospectively the huge amount of data collected in the last two years, resulting
from the XRays reports, in order to have a picture of the HO incidence and distribution in our
population of patients.
Results
Data analysis is in progress, however preliminary results show that the overall prevalence of
NHO is minimal compared to the whole population and that he NHOs are mainly detected where
mostly expected such as brain tumour and moya-moya disease patients.
Conclusion
Although preliminary, our results indicate that screening all admissions may not be necessary.
We aim to present a concise clinical guideline/ pathway for screening and diagnosis of NHO
following severe acquired brain injuries.
WCNR-0605
BOARD NUMBER: 083
Clinical and neuroimaging parallels in patients with vascular dementia
F. Gumerova1, G. Rakhimbaeva1
1Tashkent Medical Academy, Neurology Department, Tashkent, Uzbekistan
Aims
To make correlates between clinical data and results of MRI images in patients with vascular
dementia.
Method
The study involved 24 patients(18 men,6 women)with vascular dementia.Average age was 55,1.
It was conducted MRI with use of T1-WI ,T2-WI and T2-FLAIR modes and MRI angiography on
scanner 0.35 tesla capacity.Evaluation of cognitive functions was performed by MOCA and
MMSE tests.
Results
Patients were divided into 2 groups.In group I 4 patients had mild cognitive impairments
according to MOCA(MMSE score-27.5),20 in group II- moderate (MMSE -22.9).In group I it were
revealed multiple small plots 1-3 mm size with indistinct profiles,hyperintensive signal
characteristics on T2-WI and T2 FLAIR located periventricular (50% with 24 points in MOCA and
29 in MMSE) and periventricular and subcortical (in 50%,with 23 in MOCA and 26 in MMSE).In
group II the same spots were located subcortical and periventricular in 100%, 20% had lacunar
infarctions and 10%(with the lowest results in MOCA and MMSE) had cystic glial areas in the
thalamus.Ventricular system:the sizes of the 4rd ventricle and Silvio aqueduct are without
changes in both groups,in group I the lateral ventricles are not increased, the 3rd ventricle is 6.5
mm.In group II 60% of patients had enlargement of lateral ventricles,the 3rd ventricle was 6.0
mm. In group I subarachnoid space was enlarged diffuse(50%) and in frontoparietal
regions(50%). In group II the expansion was in fronto-parietal areas in 10%,in fronto-parietaltemporal areas with depletion of peripheral blood flow-40%, in fronto-temporal-20% and wasn`t
extened- 20%.
Conclusion
Subcortical leukoaraiosis,areas of encephalomalacia in the thalamus and increased sizes of
lateral ventricles leads to a more emphasized cognitive impairments.The sizes of the 3rd, 4rd
ventricles and Silvio aqueduct don`t reflect cognitive disturbances.Cognitive decline correlates
with the presence of brain atrophy in fronto-temporo-parietal lobes,expansion of subarachnoid
space and depletion of peripheral blood flow in cerebral vessels.
WCNR-0708
BOARD NUMBER: 084
COMBINATION OF DEEP BRAIN STIMULATION AND STEM CELL ENGINEERING FOR
PARKINSON’S DISEASE
J.W. KIM1, H.C. Jung1, S.A. Lee1, I.H. Song1, S.K. Yoo1, J.H. Moon1
1OSONG Medical Innovation Foundation, Medical Device Development Center, Cheongju-si,
Republic of Korea
Aims
Regenerative therapy using neuronal stem cells has been expected to be a fundamental therapy
for progressive nervous system diseases including Parkinson’s and Alzheimer’s diseases.
Chemical stimulations with bioactive compounds have been assumed to yield defined
differentiation pathways of stem cells and other stimulations such as electrical and mechanical
stimulations may bring synergistic effects. We hypothesize that precisely defined electrical
stimulations can be a new strategy for stem cell engineering and combination of DBS which is
based on electrical stimulations and stem cell engineering can become a unique therapy for
Parkinson’s disease. In this presentation, we introduce the neuronal differentiation of electrically
stimulated human adult neural stem cells and DBS system in which injection pathway for stem
cells and bioactive compounds is embedded.
Method
To investigate the improvement of neuronal differentiation capacities of human adult stem cells by
electrical stimulation, an experimental set-up comprising electrode-embedded culture slides and
an electrical stimulator was developed. ReNcell CX and VM (Millipore, Inc.) were utilized as adult
neural stem cell sources and the charge balanced biphasic current stimulations with various
parameters were applied. The cell death and pH change of the maintenance medium containing
bFGF and EGF by electrical stimulations were tested and proliferation and cellular differentiation
of neural stem cells were monitored based on the modulated electrical stimulation parameters.
And injection pathway was embedded in the center of the DBS lead by injection molding and
injection of bioactive compounds was investigated.
Results
No significant cell death and pH change were observed in the presence of applied electrical
stimulations but electrical parameters had effects on synaptic vesicle protein expression levels
and beta 3 tubulin expression. Chemical injection through injection pathway of DBS lead worked
well.
Conclusion
The combined stimulation of chemical injection and electrical stimulation as a unique therapy for
Parkinson’s disease will be investigated.
WCNR-0660
BOARD NUMBER: 085
DRIVING POSITIVE PLASTICITY THROUGH COMPUTER-BASED INTERVENTION IN
PARKINSON’S DISEASE
H. NGUYEN1, C. Reynolds2, E. Dressler3, J. Ross4, E. Disbrow1
1LSU Health Sciences Center Shreveport, Pharmacology- Toxicology- and Neuroscience,
Shreveport- LA, USA
2LSU Health Sciences Center Shreveport, Neurology, Shreveport- LA, USA
3EchoUser, Research, San Francisco- CA, USA
4University of California- Merced, Center for Neuroscience, Merced- CA, USA
Aims
Evaluate the effects of computerized neuro-rehabilitation on cognitive and motor performance.
Method
Subjects (19 PD and 16 age-matched controls), ages 50-85 Participants completed a pre-training
evaluation, 30 training sessions a post-training test of the same program. Subjects were also
assessed with neuropsychological and motor tests including symbol digit modality test (SDMT),
functional dexterity test (FDT), Delis Kaplan Executive Function Systems (DKEFS), and falls
efficacy scale (FES) before and after training. Computer-based rehab program: Participants
viewed a blank screen divided down the middle. A cue appeared (a combination of numbers on
the right, left or both sides of the screen), and they entered the cue combination. Cued trials were
followed by un-cued trials consisting of a green dot, signaling the participant to re-enter the cue
combination. The training component of this program is adaptive, beginning with easier (shorter)
combinations followed by longer combinations based on performance.
Results
Participants with PD were divided into two groups: Impaired (IPD) versus unimpaired (UPD),
according to their performance compared to the mean performance of the control group.
Improved performances specific to the IPD group included: un-cued reaction time, DKEFS Trailmaking, and FES. Each group (IPD, UPD, and control) displayed improved performance in the
SDMT, FDT, DKEFS Verbal Fluency, and the number of errors during the computer testing.
Conclusion
Improved reaction time on internally generated trials and trail-making suggests improved
cognitive flexibility. Lowered FES scores suggests the participants were less worried about falling
during day-to-day activities.
WCNR-0616
BOARD NUMBER: 086
TUMOR SUPPRESSOR LKB1 IS CRITICAL FOR REGULATING AXONAL REGENERATION
AFTER CNS INJURY
Y. Ohtake1, U. Hayat1, N. Serradj1, S.I. Muramatsu2,3, S. Li1
1Temple University School of Medicine, Shriners Hospitals Pediatric Research CenterDepartment of Anatomy and Cell Biology, Philadelphia, USA
2Jichi Medical University, Division of Neurology, Shimotsuke, Japan
3The University of Tokyo, Center for Gene & Cell Therapy- The Institute of Medical Science,
Tokyo, Japan
Aims
Central nervous system (CNS) axons in adult mammals fail to regenerate after lesions, including
spinal cord injury (SCI). A number of signaling proteins and transcription factors have been
shown to regulate the intrinsic growth capacity of adult neurons. Recently, the liver kinase B1
(LKB1), a tumor suppressor, has been reported to mediate neuronal polarization during
development. In this project, we studied the role of LKB1 for regulating neurite outgrowth in adult
neuronal cultures and axon regeneration in adult rodents with SCI.
Method
To determine whether up-regulation of LKB1 overcomes suppression of inhibitory substances, we
transfected adult dorsal root ganglion (DRG) neurons with AAV2-LKB1 and measured neurite
outgrowth of DRGs on CNS myelin or aggrecan spotted coverslips. To assess the role of LKB1
for regulating axon regeneration in vivo, we systemically injected AAV9-GFP (control) or AAV9LKB1 into adult mice and transected the dorsal spinal cord at T7 two weeks after the viral
injections. We evaluated the integrity of multiple descending axonal tracts in the spinal cord,
including corticospinal tract (CST), serotonin axons and tyrosine hydroxylase fibers in the injured
spinal cord. We also monitored locomotion function recovery for 8 weeks by measuring the BMS
locomotor scores, grid walk and footprints of hindpaws.
Results
Up-regulation of LKB1 significantly enhanced neurite extension in adult neurons cultured on both
inhibitory substrates, CNS myelin and aggrecan. Systemic application of AAV9-LKB1
considerably stimulated regrowth of multiple descending fiber tracts in the caudal spinal cord,
including CST, 5-HT and dopamine axons. The analysis of locomotor function recovery in these
SCI mice is still ongoing.
Conclusion
Our findings demonstrate that LKB1 is critical for regulating growth capacity of mature neurons
and that this kinase may become an important molecular target for treating CNS injuries,
including SCI.
WCNR-0614
BOARD NUMBER: 087
THE CHANGES OF CORTICAL ACTIVATION IN SWALLOWING AFTER THE APPLICATION
OF HIGH FREQUENCY RTMS IN OLDER ADULTS
J.W. Park1, B.S. Kwon1
1Dongguk University Ilsan Hospital, Physical Medicine and Rehabilitation, Goyang,
Republic of Korea
Aims
Presbyphagia refers to characteristic changes in the swallowing mechanism of healthy older
adults. With age, the area of cortical activation was reduced and becoming more symmetrical. On
the other hand, non-invasive cortical stimulation could modulate cortical activity and give the
improvement in swallowing function. Therefore, we wondered if the high frequency rTMS can
make the changes of activity in swallowing cortical area in older adults and stop the functional
decrement of swallowing.
Method
Ten healthy elderly volunteers (≥65years) with right handedness were attended and 18F-labelled
FDG-PET scans were obtained in all subjects on three separate occasions (rest, swallowing and
swallowing after rTMS). During swallowing study, water was infused orally via a fluid delivery
catheter connected to a fluid reservoir at a rate of 600mL/h and subjects swallowed following
every 20 sec light flash for 30 min. During rest study, the light source was active but subjects
were requested not to swallow. 5Hz rTMS was applied on right pharyngeal motor hot spot for 10
min every weekday for 2 weeks. The intensity of stimulation was set at 90% of the thenar motor
threshold of the same hemisphere. The differences between each patient’s active image and the
control images (t statistic for p<0.05) on a voxel-by-voxel basis were examined to find significant
increases in metabolism using Statistical Parametric Mapping (SPM12).
Results
The cortical areas activated by swallowing before rTMS included the bilateral sensorimotor cortex
(Brodmann’s areas (BA) 3, 4) and showed symmetricity. The cortical areas activated by
swallowing after rTMS were same as the area before rTMS. There was no statistical difference
between two swallowing activation areas.
Conclusion
Unfortunately, high frequency rTMS did not affect the activation in swallowing sensory motor
cortex in elderly people. It seemed to be impossible to change the aging process related to
swallowing using rTMS.
May 12 – 07:00-12:30
WCNR-0590
BOARD NUMBER: 001
TREATMENT/PHARMACOTHERAPY/DBS/PT
ROBOT-ASSISTED GAIT TRAINING IN INDIVIDUALS WITH PRIMARY LATERAL
SCLEROSIS: A CASE SERIE
C. Adans-dester1, A. Scarton1, S. Paganoni1, J.F. Daneault1, A. O'Brien1, G. Severini1, P. Bonato1
1Spaulding Rehabilitation Hospital, Physical Medicine & Rehabilitation - Harvard Medical School,
Charlestown, USA
Aims
This pilot study investigated the suitability of robotic-assisted gait training (Lokomat, Hocoma AG)
in individuals with primary lateral sclerosis (PLS), a progressive motor neuron disease affecting
upper motor neurons (UMN). Based on evidence from research in other patient group with UMN
dysfunction, we hypothesized that robot-assisted gait training would improve gait coordination
and functional capability during walking.
Method
Four subjects with PLS (age 56.5±4.2) were recruited and underwent robotic-assisted training
3x/week, for 6 weeks. Gait analysis was performed at self-selected speed with a 10 cameras
motion capture system (Vicon) synchronized with 2 force plates (AMTI) embedded in the
walkway. Lower-limb joint kinematics was estimated using the Plug-in-Gait model. In addition, the
10-meter walk test and 6-minute walk test were administered in order to assess walking speed
and endurance. Data was collected pre-intervention, post-intervention and one month following
the end of training.
Results
Given the heterogeneity of the symptoms, we analyzed data on a subject-by-subject basis. We
attempted to characterize the gait patterns considering the disease stage in each subject. Modest
changes in walking speed and endurance were observed pre- vs. post-intervention. Limited
changes were also observed in the kinematics and kinetics of motion, mostly related to
improvements in the quality of movement. More severely affected subjects showed decreased
velocity, step and stride length. Less impaired subjects increased their step and stride length.
Conclusion
Gait training was well tolerated with no adverse events. Patients appeared to be more aware of
their gait characteristics after training. Robot-assisted gait training is focused on achieving good
quality of movement and it appears to be a good complement to an exercise-based program. The
latter could help to improve long-term management of patients with PLS. Subjects showed no
indication of physical decline during the period of observation.
WCNR-0296
BOARD NUMBER: 002
SWALLOWING CHANGES IN PEOPLE WITH PARKINSON’S IN SAUDI ARABIA:
PERCEPTIONS AND PRACTICES
K. Alhussain1, L. Pennington1, K. Britton1, N. Miller1
1Newcastle University, Institute of Health and Society- Faculty of Medical Sciences,
Newcastle upon Tyne, United Kingdom
Aims
The impact of swallowing changes in neurological conditions has been neglected for people living
in Saudi Arabia. We aimed to explore the experience of swallowing changes in people with
Parkinson’s (PwP) in Saudi Arabia and their impact on both PwP and their families.
Method
This was a qualitative, interview based study. A preliminary topic guide was developed through
pilot interviews and focus groups. The main study comprised 33 semi-structured interviews with
PwP (n17) and their caregivers (n16). Participants were recruited from two medical sites in Saudi
Arabia’s capital. Interviews focused on perceptions of changes in eating and drinking and their
effect on daily life.
Results
Main themes emerging included isolation, embarrassment and feelings of uselessness. There
existed a close link between culture and how the swallowing changes manifested and impacted
on individuals and families. The role of the older person in Saudi culture during meals strongly
influenced how PwP felt due to their restricted eating abilities. The influence of Islamic beliefs was
obvious in both the PwP and the caregivers’ interviews. It shaped how they dealt with the
disease, how they interpreted symptoms and change, beliefs around rehabilitation and their
willingness to discuss the impact of swallowing changes with the interviewer.
Conclusion
Saudi Arabian society has traditional mealtime customs for families and for older people in
particular. Swallowing changes due to Parkinson’s challenge and restrict these customs resulting
in themes that speech and language therapists should be aware of when working with PwP.
WCNR-0122
BOARD NUMBER: 003
THE ‘SYSTEMATIC SCREENING OF HANDWRITING DIFFICULTIES’ (SOS-TEST):
VALIDATION FOR PATIENTS WITH PARKINSON’S DISEASE
S. Broeder1, A. Nieuwboer1, E. Heremans1, M. Pinto Pereira1, B. Smits-Engelsman2,
E. Nackaerts1
2KU Leuven, Department of Kinesiology, Leuven, Belgium
Aims
Handwriting in Parkinson’s disease (PD) features specific abnormalities which are difficult to
assess since no specific assessment tool is currently available. The objective of this study was to
validate the ‘Systematic Screening of Handwriting Difficulties’ (SOS-test) in patients with PD and
to evaluate the responsiveness of this test to medication.
Method
Handwriting performance of 25 PD patients and 15 healthy age-matched controls was repeatedly
examined by using the SOS-test. Participants were asked to copy as much as possible of a
standard text within 5 minutes, with the instruction to write as neatly and quickly as in daily life.
Writing speed, mean size and quality of handwriting (i.e. writing fluency, letter connections,
regularity of letter height, space between words and straightness) were determined. Inter-rater
and test-retest reliability were assessed using the intraclass correlation coefficient (ICC). In
addition, medication effects (ON versus OFF differences in PD) were investigated.
Results
The SOS-test scores were found to have excellent inter-rater and between test-retest reliability
(ICC>0.845 for both). Analysis of subjects’ handwriting performance, showed deficits in PD
handwriting compared to healthy controls. A significant slower writing speed (p=0.016) and a
trend towards smaller writing amplitudes (p=0.078) and worse quality of writing (p=0.061) was
found for patients with PD. No significant differences were shown for ON versus OFF medication
states.
Conclusion
The SOS-test is a short and effective instrument to detect handwriting problems in PD patients
with excellent reliability. It can therefore be recommended as a clinical instrument for
standardized screening of handwriting deficits in PD patients. The lack of medication effects is
however surprising. It may indicate that the test is not responsive to treatment effects or that
Levodopa was not effective in ameliorating micrographia during spontaneous writing.
WCNR-0189
BOARD NUMBER: 004
CO-CREATING KNOWLEDGE IN NEURO-REHABILITATION BETWEEN PHYSICAL
THERAPISTS AND PATIENTS WITH PARKINSON'S DISEASE
W. Buated1, U. Katsuhiro1, P. Lolekha2
1Japan Advanced Institute of Science and Technology, School of Knowledge Science, Nomi,
Japan
2Thammasart University, Internal Medicine, Pathumthani, Thailand
Aims
To propose a theoretical model of Knowledge Co-Creation between Physical Therapists (PTs)
and Patients with Parkinson's disease (PD) in Neuro-Rehabilitation approach.
Method
60 patients with PD were recruited from Thammasart University hospital, Thailand. General
demographic data and clinical scores were recorded. PTs and PD co-create new knowledge by
(1) reviewing literature in PD, Neuro-Rehabilitation for PD and clinical practice particularly
regarding gait and balance disturbances; (2) interviewing the patients with questionnaires; ABC
scale and FOG-Q and face-to-face meetings; (3) assessing their physical conditions and testing
balance with mini BESTest score; and (4) systemizing all of the information gathered and then
created a model co-created by the PTs and PD Patients.
Results
The knowledge in theories and in practice of PTs and the experiences of the PD patients in terms
of explicit and bodily tacit knowledge are significantly ground-breaking knowledge. The theoretical
model for co-creating knowledge can be drawn which will be able to apply in practice as well as
will be benefit for improving PTs treatments and PD patients' qualities of life.
Conclusion
A theoretical model of knowledge co-creation between PTs and PD patients can be considered to
convey some clarifications of knowledge from the 2 sides which will be advantageous for PTs in
applying the knowledge in to practice.
References:
[1] Bowen SJ, Graham ID. From Knowledge Translation to Engaged Scholarship: Promoting
Research
Relevance and Utilization. Archives of Physical Medicine and Rehabilitation. 2013; 94(1):
S3–S8.
[2] Nudo RJ. Neurorehabilitation and Neural Repair: An International Journal of Translational
Science
for Researchers and Clinicians. SAGE 2014.
[3] Rappolt S, Tassone M. How rehabilitation therapists gather, evaluate, and implement new
knowledge.
Journal of Continuing Education in the Health Professions. 2002 Summer; 22(3):170-80.
WCNR-0542
BOARD NUMBER: 005
INFLUENCE OF NEUROLOGIC MUSIC THERAPY TO IMPROVE LOCOMOTION IN A GROUP
OF PATIENTS WITH IDIOPATHIC PARKINSON'S DISEASE
A. Bukowska1
1University of Physical Education, Department of Occupational Therapy, Krakow, Poland
Aims
The main hypothesis of this research assumes the major role of sensorimotor techniques of
Neurologic Music Therapy (NMT) in improving spatial and temporal gait parameters and
kinematics of gait in a group of patients with Idiopathic Parkinson’s Disease (PD).
Method
The 55 PD-diagnosed subjects invited to the study were randomly assigned into two groups:
experimental (n=30) and control (n=25). To evaluate the influence of NMT procedure on the
locomotion, the 3D Movement Analysis System BTS Smart was utilized. Participants from the
experimental group attended NMT sessions 4 times a week for 4 weeks. Participants from the
control group got the recommendations for daily life activities. The measures were taken twice,
both before and after 4 weeks of therapeutic program.
The study was approved by the Bioethical Committe of The Supreme Medical Council in Krakow,
Poland. This research was supported by the National Science Center, Poland under Grant no.
2012/05/N/NZ7/00651.
Results
The results demonstrated significant improvement in the spatial and temporal gait parameters
and in the kinematics of gait in comparison between I and II trial in the experimental group. Both
groups were significantly differentiated in terms of changes in measured parameters.
Conclusion
The confirmation of research hypothesis might be used to develop therapeutic strategy based on
music and rhythm for improve and maintain locomotion and help this group of patients come back
to social activity.
WCNR-0100
BOARD NUMBER: 006
ABOBOTULINUMTOXINA INJECTION PATTERNS IN PATIENTS WITH CERVICAL
DYSTONIA FROM THE ANCHOR-CD REGISTRY STUDY
C. Comella1, D. Truong2, A. Espay3, D. Snyder4, D. Marchese4, R. Trosch5
1Rush University Medical Center, Department of Neurological Sciences, Chicago, USA
2The Truong Neuroscience Institute, The Parkinson and Movement Disorder Institute,
Fountain Valley, USA
3University of Cincinnati College of Medicine,
Department of Neurology and Rehabilitation Medicine, Cincinnati, USA
4Ipsen Biopharmaceuticals, Medical Affairs, Basking Ridge, USA
5Millennium Medical Group, The Parkinson's and Movement Disorders Center, Farmington Hills,
USA
Aims
To assess usage patterns of abobotulinumtoxinA (Dysport®) from the ANCHOR-CD registry of
patients with cervical dystonia (CD). AbobotulinumtoxinA is indicated for treatment of adult upper
limb spasticity and CD. ANCHOR-CD is a prospective, open-label, non-interventional, "real-world"
post-marketing registry study of CD patients treated with abobotulinumtoxinA.
Method
BoNT-naive and non-naive patients ≥18 years of age with a diagnosis of idiopathic CD were
eligible. Patients were treated according to the investigator's usual medical practice. The muscles
injected, dose per muscle, number of sites into the muscle, and use of guidance technique were
at the investigator's discretion. Patients continued in the study for ≤4 treatment cycles.
Retreatment intervals were scheduled according to the investigator's usual practice.
Results
347/350 patients from 41 sites completed the study. 75% were female, mean age 59.0±13.6
years, and mean age at symptoms onset 48.9±15.6 years. 73% had previous treatment with
BoNT. The most common types of CD treated were mixed postures (68%). The most frequent
single predominant posture was torticollis (25.6%); other forms accounted for <5% each. Median
abobotulinumtoxinA dose was 500U (range 100U-2000U) during 4 cycles. Median time between
retreatment intervals was 14 weeks, with 25% having been reinjected >14 weeks. 4-5 muscles
across 11-12 injection points were injected during each cycle. Almost half of the investigators
used electromyography (EMG) for injection guidance. The most frequently injected muscles
across cycles included splenius capitis (91.6%-92.5%), levator scapulae (68.8%-71.5%),
trapezius (68.0%-70.4%), and sternocleidomastoid (56.2%-61.4%). The most common adverse
events (AEs) included dysphagia and muscle weakness. Five patients discontinued due to AEs.
Conclusion
This study demonstrates the usual clinical practice of botulinum toxin injectors across multiple
sites and demonstrates a consistent approach to abobotulinumtoxinA injection patterns and
doses. Use of EMG guidance was variable, with less than half of the injections using this
technique.
WCNR-0101
BOARD NUMBER: 007
COMPARISON OF METHODOLOGY, PATIENT CHARACTERISTICS, AND TREATMENT
RESULTS FROM ANCHOR-CD AND OTHER REGISTRY STUDIES OF BOTULINUM TOXIN
TYPE A IN CERVICAL DYSTONIA
R. Trosch1, C. Comella2, A. Espay3, D. Snyder4, D. Marchese4, D. Truong5
1Millennium Medical Group, The Parkinson's and Movement Disorders Center, Farmington Hils,
USA
2Rush University Medical Center, Department of Neurological Sciences, Chicago, USA
3University of Cincinnati College of Medicine,
Department of Neurology and Rehabilitation Medicine, Cincinnati, USA
5The Truong Neuroscience Institute, The Parkinson and Movement Disorder Institute,
Fountain Valley, USA
Aims
To assess similarities and differences between
methodology, patient characteristics, and treatment results from
registry studies of different formulations of botulinum toxin type A
(BoNT-A) in cervical dystonia (CD). AbobotulinumtoxinA (Dysport®) is indicated for
the treatment of adult upper limb spasticity and CD. ANCHOR-CD
is a real world, prospective, open-label registry study designed to
collect patient response and health economics data in patients with
CD who were treated with abobotulinumtoxinA in the US.
Method
We examined ANCHOR-CD and 2 other
open-label registries: CD-PROBE (onabotulinumtoxinA) and
XCiDaBLE (incobotulinumtoxinA; CD patients only [n=145], study
also included blepharospasm patients), focusing on similar efficacy
assessments (eg, Toronto Western Spasmodic Torticollis Rating
Scale [TWSTRS], patient and clinical global impression of change
[PGIC and CGIC], and CD impact profile [CDIP-58]).
Results
The mean (±SD) age (59.0±3.6 years), % of females
(75%), and mean (±SD) age of onset (49±15.6 years) were
comparable among CD registries. More patients in ANCHOR-CD
(73%) and XCiDaBLE (77%) had previously received BoNT
treatment vs CD-PROBE (36.5%). Changes in TWSTRS total scores
were similar in ANCHOR-CD (-12.1, n=304, baseline-week 4 of
cycle 1) and CD-PROBE (-11.8, n=479, baseline-visit 3, >4-6 weeks
after second injection), as were changes in TWSTRS severity,
disability, and pain subscales. TWSTRS was not assessed in
XCiDaBLE. Much improved or very much improved ratings on
CGIC were similar in ANCHOR-CD (62.7%; n=316, week 4/cycle
1) and CD-PROBE (61.4%; n=479, visit 2, >4-6 weeks after first
injection). Changes in CDIP-58 subscale scores were similar
between ANCHOR-CD (cycle 1/day 1-cycle 3/day 1) and
XCiDaBLE (CD patients; baseline-cycle 1/week 4), but larger in
CD-PROBE (baseline-final visit, >4-6 weeks after cycle 3), possibly
due to a higher proportion of BoNT-naive patients.
Conclusion
Patient characteristics and response patterns were
generally similar across BoNT-A registries, supporting their
individual effectiveness in CD.
WCNR-0102
BOARD NUMBER: 008
EFFICACY AND SAFETY OF A 2 mL DILUTION OF ABOBOTULINUMTOXINA COMPARED
WITH PLACEBO IN ADULT PATIENTS WITH CERVICAL DYSTONIA
M. Lew1, P. Maisonobe2, D. Snyder3
1University of California, Keck Medical Center, Los Angeles, USA
2Ipsen Biopharmaceuticals, Biostatistics, Boulogne-Billancourt, France
Aims
To determine efficacy and safety of a 500 unit, 2 mL
dilution of abobotulinumtoxinA (Dysport®) vs placebo in cervical
dystonia (CD) patients. CD is characterized by involuntary cervical
muscle contractions leading to sustained and painful head and neck
postures. Botulinum toxin is FDA approved for the treatment of CD,
and abobotulinumtoxinA is effectively administered in solutions up
to 1 mL to affected muscles. Off-label 2 mL dilutions have been
reported in the US and trials supporting this dilution would support
dosing flexibility.
Method
In this 12-week, phase 3b, double-blind study, CD
patients were randomized (2:1) to abobotulinumtoxinA or placebo.
Toxin-naive abobotulinumtoxinA patients received 500 units/2 mL
in ≥2 affected neck muscles. AbobotulinumtoxinA CD subjects who
had previously received botulinum treatment (non-naive) received
250-500 units/2 mL (2.5:1 abobotulinumtoxinA: previous
onabotulinumtoxinA [Botox®] dose) into muscles injected during
prior treatments. The primary endpoint was change from baseline to
Week 4 (W4) in Toronto Western Spasmodic Torticollis Rating
Scale (TWSTRS) total score. Safety was assessed over the 12-week
study period.
Results
A total of 134 patients (abobotulinumtoxinA, n=89;
placebo, n=45) were randomized and 129 (abobotulinumtoxinA,
n=84; placebo, n=45) completed the W4 primary endpoint
evaluation. Versus placebo, abobotulinumtoxinA patients
experienced significantly greater changes from baseline in TWSTRS
score at W4 (-2.5 versus -10.8, P<0.001; based upon the modified
intent-to-treat population). Adverse events (AEs) occurred in 41%
and 22% of abobotulinumtoxinA and placebo patients, respectively.
Dysphagia was reported in 9% of treated patients. Other AEs in
treated patients were muscle weakness, neck pain, and headache,
none of which were reported with placebo.Conclusion
Data from this study indicate a 2 mL dilution of
abobotulinumtoxinA was significantly more effective than placebo in
CD patients. No unexpected AEs were observed relative to previous studies
that used the 1 mL dilution volume in this patient population.
WCNR-0593
BOARD NUMBER: 009
MUSIC AND THE MIRROR SYSTEM: A VIDEO TRAINING TO IMPROVE MOTOR SKILLS IN
EARLY PARKISNON'S PATIENTS
B. Colombo1, S. Herman1, A. Antonietti2
1Champlain College, EHS, Burlington, USA
2Catholic University if the Sacred heart, Psychology, Milano, Italy
Aims
A previous study (Colombo et al. 2013) highlighted how observation promoted the activation of
Mirror Neurons System (MNS), which led to a more deep and adequate processing of the
stimulus during the learning of motor sequences. Music enhanced this effect, and should hence
be considered as a valid support to motor rehabilitation based on the activation of MNS. Recently,
music has been shown to be very effective in aiding Parkinson's treatment. A large advantage of
the use of background music is its ability to subconsciously combine training for balance, reaction
time, movement speed and verbal/non-verbal cueing techniques while providing a light physical
exercise.
For these reasons we develop a video training targeting Patients with early stages of Parkinson’s,
aiming at improving quality of movements, coordination, and fluidity. We also aim at improving
overall self-confidence.
Method
We selected classes of actions linked to everyday motor activities and subdivided each action
into sub-movements, presented to the patients in a video format, with a rhythmic background
music.
Patients assigned to experimental group (n = 20) and to control group (n =20) were assessed
using the Unified Parkinson Disease Rating Scale (UPDRS). Precision of the specific movements
targeted by the training has been assessed by the way of using a Kinect equipment.
Patients in the experimental group used the video program for 3 weeks. Both groups had been
re-tested after 4 weeks.
Results
Data analysis is undergoing, but feedback received from patients and caregivers, plus qualitative
observation show a very positive trend.
Conclusion
This study presents a simple approach to support people in the early stages of Parkinson disease
in improving their everyday movements, using the activation of the MNS and the support of
background music.
WCNR-0123
BOARD NUMBER: 010
VIRTUAL REALITY FOR REHABILITATION IN PARKINSON'S DISEASE
K. Dockx1, E. Bekkers1, P. Ginis1, L. Rochester2, J.M. Hausdorff3, A. Mirelman3, A. Nieuwboer1
2University of Newcastle, Institute for Aging and Health, Newcastle, United Kingdom
3Tel Aviv Sourasky Medical Center, Department of Neurology, Tel Aviv, Israel
Aims
To summarize the best evidence for effectiveness of virtual reality (VR) exercise interventions for
rehabilitation in patients with Parkinson’s disease (PD). Primary outcomes included balance and
gait outcomes. Secondary outcomes entailed global motor function, activities of daily living,
quality of life, adverse events, and therapy adherence.
Method
Relevant articles were identified by electronic searches of CENTRAL, MEDLINE, EMBASE,
CINAHL, PEDro, online trials registers and by hand searching reference lists on August 20 th
2015. We included RCTs of VR exercise interventions in patients with PD. Only trials related to
motor rehabilitation as the primary goal were included. Two review authors independently applied
the pre-defined inclusion criteria, extracted the data and assessed the methodological quality. A
meta-analysis according to the Cochrane methodology and GRADE guidelines was conducted.
Results
Nine trials involving 263 patients with PD were included. Sample sizes were small, and a large
amount of heterogeneity existed between trials with regards to study design and outcome
measures used. As a result, the quality of the evidence was low when judged by the GRADE
system. VR interventions were found to be more effective compared to conventional
physiotherapy for step/stride length (standardized mean difference (SMD)=0.69; 95% confidence
interval (CI): 0.30–1.08) and balance performance (SMD=0.41; 95% CI: 0.05–0.77). VR
interventions demonstrated no added value with regards to global motor function, activities of
daily living, quality of life, cognitive function, adverse events, or therapy adherence.
Conclusion
This review illustrates that VR technology provides a useful alternative for conventional
rehabilitation in patients with PD. We found evidence of a surplus value of VR interventions with
regards to balance and gait. However, due to small sample sizes and considerable risk of bias in
some of the trials, these results should be interpreted with care. Additional high quality studies
are needed to confirm these findings.
WCNR-0514
BOARD NUMBER: 011
DEVELOPMENT AND PRELIMINARY TESTING OF AN INNOVATIVE THORACOLUMBAR
BRACE FOR INDIVIDUALS WITH PARKINSON'S DISEASE
E. Donoso Brown1, S. Bleakley2, G. Vojcsik2, E. Boring1, J. Moon1
1Duquesne University, Occupational Therapy, Pittsburgh, USA
2Healthsouth Sewickley, Physical Therapy, Sewickley, USA
Aims
It is common for individuals with Parkinson’s disease (PD) to experience postural dysfunction.
Postural dysfunction, including instability can contribute to a higher risk for falls, pain, visual
problems, and depression. One method for addressing postural instability is the use of external
support through bracing. While there is limited research on the use of bracing in PD
management, a novel dynamic back brace for people who need lower, middle, and upper back
support has been developed. The objective of this preliminary investigation was to identify the
immediate effects of this brace on posture for individuals with PD.
Method
This preliminary investigation utilized a single subject randomized A-B design. Participants were
included if they were between 50-80 years of age, had a diagnosis of PD, self-identified issues
with posture, and had the ability to ambulate in the community without an assistive device. Each
phase included multiple photographic measurements of posture in both the left and right sagittal
planes. Primary variables of interest included: a) head position, b) shoulder position, and c)
hip/trunk position as measured through both angulations and translations of body segments.
Results
Photographs were digitized and variables were viewed as time series graphs. Then
autocorrelations and C-statistics were run to determine if any visual trends were statistically
significant. The first participant demonstrated statistically significant changes (p= 0.02) in
shoulder position, while the second demonstrated statistically significant changes (p= 0.01) in hip
position.
Conclusion
Preliminary analyses of the initial participants suggest that the brace could impact posture for
individuals with PD, although the nature and strength of this impact may vary by individual and
characteristics of postural dysfunction.
WCNR-0305
BOARD NUMBER: 012
THE EFFECT OF PHYSIOTHERAPY ON QUALITY OF LIFE AND COGNITIVE LEVELS IN
PARKINSON PATIENTS
A. Fil Balkan1, Y. Salci1, H. Keklicek Hotaman1, B. Çetin1, K. Armutlu1, H. Kayıhan2, B. Elibol3
1Hacettepe University, Health Sciences Faculty Physiotherapy and Rehabilitation Department,
Ankara, Turkey
2Hacettepe University, Health Sciences Faculty Occupational Therapy Department, Ankara,
Turkey
3Hacettepe University, Medicine Faculty Neurology Department, Ankara, Turkey
Aims
Motor symptoms such as postural instability, gait problems and posture problems adversely affect
quality of life of patients with Parkinson disease (PD). Similarly, the cognitive level of patients
indirectly affected depending on these symptoms. Physiotherapy is important to manage motor
symptoms in PD. The aim of this study is to investigate the indirect effect of physiotherapy on
cognitive levels and quality of life in Parkinson patients.
Method
22 patients with Parkinson (10 female, 12 male) disease who were the stage 2-3 according to
Modified Hoehn & Yahr Rating Scale received physiotherapy 2 times per week for 6 weeks. The
patients assessed with UPDRS, SF 36 and Loewenstein Occupational Therapy Cognitive
Assessment (LOTCA) before and after treatment.
Results
UPDRS total, motor and activities of daily living subgroup scores increased (respectively from
39.18±13.64, 21.23±7.74, 13.00±6.04 to 29.22±13.29, 16.27±8.16, 8.81±5.29). LOTCA total (from
95.95±5.01 to 97.23±4.33) and visual motor organization (VMO) subgroup score ( from
25.18±2.53 to 25.77±2.05 ) improved but SF36 points ( Physical Component Summary from
40.75±9.42 to 42.14±8.04, Mental Component Summary from 46.10±9.36 to 47.95±8.16) did not
change.
Conclusion
It was observed that physiotherapy reduced the severity of the disease and improved cognitive
function. VMO evaluates the patients' ability to transform perception into a motor response on
spatial zone. These results showed that physiotherapy could affect cognitive process as well as
motor symptoms. However it was ineffective to develop quality of life. Quality of life affected by a
lot of factors did not change our study. SF36 includes last one month. This time period is located
in treatment period. It is possible that to assess patient’s end of treatment could not be enough to
determine the change in quality of life.
WCNR-0312
BOARD NUMBER: 013
THE EFFECT SENSORY INTEGRATION TRAINING ON THE OBJECTIVE AND SUBJECTIVE
FUNCTIONAL ACTIVITIES IN PATIENTS WITH PARKINSON DISEASE
A. Fil Balkan1, Y. Salci1, H. Hotaman Keklicek1, B. Çetin1, K. Armutlu1, H. Kayıhan2, B. Elibol3
Ankara, Turkey
2Hacettepe University, Health Sciences Faculty Occupational Therapy Department, Ankara,
Turkey
3Hacettepe University, Medicine Faculty Neurology Department, Ankara, Turkey
Aims
Parkinson patients have difficulty some very important daily life activities such as to standing up,
turning in bed and walking. These activities require to manage combination of sensory -motor
process and balance. Aim of our study is to investigate the effect of the sensory integration
training (SIT) combined with physiotherapy based on balance training on the functional activity of
patients
Method
18 patients with Parkinson disease (9 women 9 men, 72.94±8.19 years) who were the stage 2-3
according to Modified Hoehn & Yahr Rating Scale divided into two groups as control and study.
The control group received conventional physiotherapy based on balance training; the study
group received sensory integration training combined with conventional physiotherapy based on
balance training 2 times per week for 6 weeks. Objective functional activities was assessed with
UPDRS II, Parkinson Activity Scale (PAS), balance with staying in tandem position (STP) and
Time Up and Go Test (TUG). Subjective functional activity level was evaluated with visual analog
scale (VAS) (the difficulty in functional activities 0: so easy, 10: very difficult). The assessments
were repeated before and after the treatment.
Results
Objective level assessed by UPDRS II and PAS and subjective functional activity level assessed
by VAS improved in groups (p<0.05). But the groups were similar according to these results
(p>0.05). On the other hand balance in study group was developed more than control group
(p<0.05).
Conclusion
While combined SIT improved balance, it did not sufficiently affect functional activity level. These
results were thought that the patient's functional activities were affected by different factors as
well as the balance. Because balance problem was compensated by other mechanisms in daily
life, its real impact did not arise on functional activities.
WCNR-0367
BOARD NUMBER: 014
BEAT VARIABILITY MAY OPTIMIZE THE EFFECTS OF RHYTHMIC AUDITORY CUEING ON
GAIT IN PARKINSON'S DISEASE
E. Guettard1,2,3, D. Dotov1, S. Bayard1,2, V. Cochen de Cock1,4,5, C. Geny1,6, B. Bardy1,
S. Dalla Bella1,7,8
1University of Montpellier, EuroMov, Montpellier, France
2CHU of Montpellier, Clinical Investigation Center, Montpellier, France
3Clinique Beau Soleil, Rehabilitation Unit, Montpellier, France
4CHU Montpellier, Clinical Investigation Center, Montpellier, France
5Clinique Beau Soleil, Neurology, Montpellier, France
6CHU of Montpellier, Neurology, Montpellier, France
7International Laboratory for Brain- Music and Sound Research, BRAMS, Montreal, Canada
8Institut Universitaire de France, -, Paris, France
Aims
The goal of this study was to test the effects of beat variability of rhythmic auditory cueing on gait
in patients suffering from idiopathic Parkinson’s disease (IPD). Cueing typically improves gait
spatio-temporal parameters in patients with IPD. A particular statistical parameter expressing
long-range corrections of the inter-stride-intervals (the α-exponent) has been proposed as an
index of healthy variability in physiological gait control. Interestingly, this parameter is known to
decrease with PD, thus indicating non-optimal gait.
Method
Participants: 19 IPD patients (HαY= 2) and 19 age-matched controls.
Design: In a quiet hospital, participants walked with auditory cues (a metronome or music), in
three conditions. The inter-beat-intervals were either fixed (no variability), with physiological
variability, or with non-physiological variability. Stimulus rate was set 10% faster than each patient
preferred cadence as assessed in a pre-test. Participants did not receive any explicit instruction
to synchronize to the beat of auditory stimuli.
Data: Gait parameters were measured by wireless IMU sensors using Mobility Lab recording
system. Synchronization between heel strikes and stimulus beats was also computed using a
measure ranging from 0 to 1 based on circular statistics (1 = perfect synchronization, 0 = lack of
synchronization).
Results
Gait parameters as a function of stimulus variability are presented in Table 1. Stride length was
shorter in patients than controls, irrespective of stimulus variability. α was larger when the
stimulus presented physiological or non-physiological variability as compared to no variability.
Synchronization to the beat was higher in patients than in controls but no correlations were found
between synchronization and clinical characteristics (disease severity, duration or
treatment).
Conclusion
Rhythmic auditory cueing in rehabilitation programs for IPD should take into account the
variability of the stimulus in order to foster the natural variability of gait, which is an optimal
compromise between flexibility and stability.
WCNR-0582
BOARD NUMBER: 015
EXERCISE TARGETING COGNITIVE IMPAIRMENT IN PARKINSON'S DISEASE
L. Hawthorne1, M. Gomez1, J.V. Filoteo2, A. Petkus3, B. Jarrahi4, Y.L. Kuo5, E. Zelinski3,
S. McEwen4, B. Fisher1,5, G. Petzinger1
1University of Southern California, Department of Neurology, Los Angeles, USA
2University of California San Diego, Department of Psychiatry, San Diego, USA
3University of Southern California, Department of Psychology, Los Angeles, USA
4University of California Los Angeles, Department of Psychiatry and Behavioral Sciences,
Los Angeles, USA
5University of Southern California, Division of Biokinesiology and Physical Therapy, Los Angeles,
USA
Aims
Mild cognitive impairment, particularly of the executive function (EF) subtype, is common in
Parkinson’s Disease (PD) and frequently transitions to dementia. There are no effective
interventions to alleviate or slow these cognitive declines. EF processes are needed to learn and
optimize performance of complex cognitive and motor skills. Our studies in PD demonstrate that
exercise facilitates neuroplasticity of the basal ganglia, supporting the hypothesis that exercise
will reverse EF deficits in PD. Our translational animal studies and recent studies in aging and
exercise have suggested that skill-based exercise may facilitate cognitive circuitry to a greater
extent than aerobic exercise. The aim of this study is to compare and elucidate the effects of
skill-based exercise versus aerobic exercise versus control on mild cognitive impairment in
Parkinson’s disease.
Method
Patients will be randomized into 1 of 3 groups (N=20/group) to participate in either:(i) skill-based
exercise; (ii) aerobic exercise or (iii) social-engagement (control) for 36 hours across 12 weeks.
Patients assigned to either exercise group will complete 3 one-hour, individual sessions per week
in a neurologic physical therapy practice. Blinded evaluators will conduct all assessments at preintervention, post-intervention and 3-month follow up visits. Patients will be examined for
changes in neurocognitive measures and changes in the connectivity and function of the brain
circuits sub-serving executive function seen during an fMRI scan. These outcomes will be
compared to changes in measures of cardiovascular and motor/skill-related fitness and body
composition.
Results
Findings from this clinical
study could help elucidate the role of exercise in restoring cognitive function in PD and the
parameters of exercise that may be important for facilitating neuroplasticity and repair.
Conclusion
If our hypotheses are supported, we will be able to ascertain the role of exercise in modifying
Parkinson’s disease through the alteration of brain circuitry relevant for cognitive and motor
function.
WCNR-0083
BOARD NUMBER: 016
MOTOR LEARNING OF HANDWRITING IN PATIENTS WITH PARKINSON'S DISEASE WITH
AND WITHOUT FREEZING OF GAIT
E. Heremans1, E. Nackaerts1, S. Broeder1, G. Vervoort1, S.P. Swinnen2, A. Nieuwboer1
1KULeuven, Department of Rehabilitation Sciences, Leuven, Belgium
2KULeuven, Department of Kinesiology, Leuven, Belgium
Aims
Handwriting is a highly automatic movement which is often impaired in patients with Parkinson’s
disease (PD). The basal ganglia dysfunction underlying PD may also contribute to reduced motor
learning and even more so in patients with freezing of gait (FOG) who have greater automaticity
deficits. Hence, this study investigated the effect of a six week intensive training program of
handwriting in PD patients with and without freezing of gait.
Method
The handwriting performance of 35 PD patients, including 16 with and 19 without FOG (PD+FOG,
PD-FOG) was examined during three test sessions. Tests sessions were performed (a) before
and (b) after six weeks of handwriting training, consisting of 30 minutes per day during five days
per week, and (c) after a six week retention period. Testing consisted of the writing of trained and
untrained sequences on a digital writing tablet at small (0.6 cm) and large (1.0 cm) size.
Results
For writing at small size (0.6 cm), a significant group by time interaction was found (p=0.03). The
PD patients without freezing had a significantly larger writing amplitude during the retention test
compared to baseline (p=0.04), while the patients with FOG did not show any learning effect. In
contrast, writing at large size (1 cm) significantly increased after the intervention in both groups
(p<0.01 for both groups).
Conclusion
Motor learning of handwriting significantly differs between PD patients with and without FOG.
Whereas PD-FOG learned in both conditions, the PD+FOG did not show any learning effect
when writing at small size, which may be more freezing-provoking. It is hypothesized that the
diminished learning potential in this group is related to the increased automaticity deficits
associated with freezing of gait. These differences in motor learning between PD-FOG and
PD+FOG point to the need for designing individualized rehabilitation programs for PD subgroups.
WCNR-0030
BOARD NUMBER: 017
DUAL-TASK BALANCE TRAINING TO PREVENT FALLS IN COMMUNITY-DWELLING
OLDER ADULTS WITH MILD TO MODERATE ALZHEIMER’S DISEASE: A PILOT STUDY
S. Hunter1, M. Montero Odasso2
1University of Western Ontario, School of Physical Therapy, London, Canada
2University of Western Ontario, Schulich School of Medicine & Dentistry- Geriatric Medicine,
London, Canada
Aims
To determine the effect of physical and cognitive (dual-task) training on gait, balance, and
cognitive function in community-dwelling older adults with Alzheimer’s disease (AD).
Method
Pilot study of community-dwelling older adults with mild/moderate AD. The outcomes were gait
(single and dual-task) and balance (Timed Up & Go, Functional Reach Test, Berg Balance
Scale). The intervention was an individualized 12-week graded strengthening and balance homebased exercise program (3x/per week) with the caregiver as coach; dual-task training combined
cognitive tasks with balance exercises. Paired t-tests for comparison of pre and post intervention
scores were performed.
Results
Fifteen people were enrolled, seven completed the study (age 77.9±4.1, MMSE=21.75±4.74).
Drop-outs were the result of dementia progression in people with moderate AD at baseline who
became unable to participate. All people were able to perform the dual-task exercise program.
There were no significant changes on balance or mobility measures, though each participant was
performing a more challenging exercise routine (more repetitions and more complex dual-task
exercises) at the end. Caregivers reported an improvement in participant functional mobility and
no added burden assisting with the exercise program. Recruitment was <10%, reasons included
high caregiver burden and not interested in exercise.
Conclusion
Older adults with mild/moderate AD can perform complex and functionally relevant exercises.
Reports of improved mobility in conjunction with exercise progression over the duration of the
study suggest functional gains that could not be quantified and may require new balance
measures. Potential for improvement versus maintenance of function needs further evaluation for
fall prevention.
WCNR-0437
BOARD NUMBER: 018
INDIVIDUAL WITH PROGRESSIVE SUPRANUCLEAR PALSY DEMONSTRATES
IMPROVEMENTS IN WALKING DISTANCE AND EFFICIENCY FOLLOWING A MOTORASSISTED ELLIPTICAL TRAINING INTERVENTION
J.M. Burnfield1, S.L. Irons1, T.W. Buster1
1Madonna Rehabilitation Hospital- Institute for Rehabilitation Science and Engineering,
Movement and Neurosciences Center, Lincoln, USA
Aims
Individuals with Progressive Supranuclear Palsy (PSP) typically develop gait disturbances. Two
promising case studies have been published describing improvements in walking function
following intensive body weight support treadmill training (BWSTT). Unfortunately, many clinics
and fitness facilities lack the resources to provide BWSTT or robotic therapy due to the need for
multiple clinicians to assist patients while training and/or the expense associated with purchasing
the technology. A recently created motor-assisted elliptical trainer that promotes repetition of
walking-like movements and physically assists users with weakness, movement control or
endurance challenges could provide an affordable alternative for intensive gait-like cardiovascular
training. This study highlights changes in function in one individual with PSP following a
structured 24-session motor-assisted elliptical training intervention. We hypothesized that the
individual’s walking speed, distance and efficiency would improve following a motor-assisted
elliptical training intervention.
Method
A 67 year-old gentleman diagnosed with PSP 1.5 years prior to study initiation participated in 24
motor-assisted elliptical training sessions (Madonna ICARE by SportsArt; 3 days/week; Figure 1).
At baseline, he had difficulties with walking, balance, freezing of gait, and movement initiation. He
was not engaged in rehabilitation. Therapeutic challenge was increased across sessions by
manipulating training parameters (i.e., speed, motor assistance, body weight support, and total
training time) in an effort to achieve ≥30 minutes training at a Borg Perceived Exertion of 12-14
each session. Training capacity on the motor-assisted elliptical (first and last training session),
and walking and energy cost were quantified (pretraining, posttraining, and 1-month follow-up).
Results
(Table 1): Motor-assisted elliptical training capacity improved across 24 sessions. The participant
walked farther and more efficiently post-training. Unfortunately the gains were not sustained at 1month follow-up.
Conclusion
Intensive motor-assisted elliptical training can be used to improve walking and fitness in
individuals with PSP; however it is critical that the program is sustained to mitigate functional
decline.
WCNR-0492
BOARD NUMBER: 019
REAL-TIME FEEDBACK IMPROVES GAIT AND POSTURE IN PARKINSON'S DISEASE
N. Krishnamurthi1, J. Jellish2, T. Ingalls3, P. Mahant4, J. Samanta4, M. Ospina4, J. Abbas5
1ASU, College of Nursing and Health Innovation, Phoenix, USA
2ASU,
Center for Adaptive Neural Systems at ASU and College of Nursing and Health Innovation at AS
U, Tempe, USA
3ASU, School of Arts Media and Engineering, Tempe, USA
4Banner Good Samaritan Medical Center, Movement Disorders, Phoenix, USA
5ASU,
Center for Adaptive Neural Systems and School of Biological and Health Systems Engineering,
Tempe, USA
Aims
In people with Parkinson’s disease (PD), studies have shown that presentation of audio cues
(e.g. metronome) can improve gait regularity and that visual cues (e.g. lines on the floor) can
improve step length. However, the effects are limited and these techniques provide only preprogrammed cues that are independent of task performance. In this work, we developed a
treadmill-based experimental paradigm to determine if people with PD can utilize real-time
feedback (RTFB) of step length and back angle (uprightness) to improve gait and posture.
Method
Eleven subjects (mean age 67 ± 8 years) with mild to moderate PD (Hoehn and Yahr stage I-III)
were evaluated during medication-on state regarding their ability to successfully utilize RTFB of
back angle or step length during quiet standing and treadmill walking tasks during a single
session. Changes in back angle and step length due to RTFB were compared using Friedman
nonparametric tests with Wilcoxon Signed-Rank tests for post hoc comparisons.
Results
Improvements in gait were observed as an increase in step length (p < 0.01) during step length
feedback compared to tasks without feedback. Improvements in uprightness were also observed
as an increase in back angle during quiet standing (p < 0.01) and during treadmill walking (p <
0.01) with back angle feedback when compared to corresponding tasks without feedback. In
addition and importantly, although people with PD display difficulty with dual tasks, the RTFB
presented in this study improved step length and uprightness without adversely affecting
variability in step length and step time.
Conclusion
These results indicate that the immediacy of the feedback facilitated favorable modulation of
performance in real-time resulting in significantly improved step length and uprightness. Future
work will investigate the long-term effects of this RTFB paradigm and the development of systems
for clinical or home-based use.
WCNR-0173
BOARD NUMBER: 020
A CASE ANALYSIS OF A MULTIPLE SYSTEM ATROPHY PATIENT BY USING THE
INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH
FRAMEWORK DURING MULTIDISCIPLINARY PATIENT MANAGEMENT
Y.J. Lee1, Y.C. Lee1, Y.J. Chen2, T.W. Chen1
1Kaohsiung Municipal Ta-Tung Hospital, Department of Rehabilitation, Kaohsiung, Taiwan
2Kaohsiung Medical University Hospital, Department of Rehabilitation, Kaohsiung, Taiwan
Aims
Physical therapists require a comprehensive assessment of patient’s functioning status to
address multiple problems in patients with severe conditions. The International Classification of
Functioning, Disability and Health (ICF) is provided a common language in order to improve
communication among people with disabilities, health care providers and researchers. The
purpose of this case report are (1) to apply ICF-based documentation tools to the care of a
patient with multiple system atrophy and (2) to illustrate the use of ICF-based decision making
tools during multidisciplinary patient management.
Method
An 50-year-old male experiencing general weakness and abnormally increased muscle tone over
four limbs within past 5 years and diagnosed as multiple system atrophy (MSA). MSA is a
unifying term brings together a group of neurodegenerative syndromes. With similar brain
pathology that are characterized by various degree of autonomic dysfunction, cerebellar
abnormalities, atypical parkinsonism, and corticospinal degeneration. His main problems included
paralysis over four limbs, postural instability, functional limitations, ADL and wheelchair
dependent. Physical therapy intervention is important for fall prevention, reduction on
contractures and maintenance of mobility while possible.
Results
The patient’s comprehensive functioning status at the beginning of the program, the rehabilitation
goals, the intervention plan, and his improvements in functioning following rehabilitation and the
according goal achievement were illustrated with physical therapy-specific and multidisciplinary
ICF-based decision making tools.
Conclusion
The case report illustrated how the ICF-based template for physical therapists summarizes all
relevant information to aid the physical therapist’s patient management and how ICF-based tools
used to enhance multidisciplinary patient management. In addition, the ICF assists in clarifying
clinician roles as part of multidisciplinary team. This case report demonstrates that the ICF can be
a viable framework for clinical documentation.
WCNR-0522
BOARD NUMBER: 021
REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (RTMS) CAN IMPROVE
OLFACTORY DYSFUNCTION IN NEURODEGENERATIVE DISORDERS: CASE STUDY
A. Marei1, H. Rashed1
1Brains' clinic, neuropsychiatry, cairo, Egypt
Aims
To investigate the possible effect of rTMS in improving anosmia associated with
neurodegenerative disorder.
Method
A middle aged male patient with the diagnosis of symptomatic parkinsonian syndrome (tremors,
rigidity, bradykinesia, frequent falls and insomnia ), referred to our lab for brain stimulation
sessions after failure of his dopaminergic medications to improve his symptoms. On further
evaluation, patient reported anosmia. 3 protocols were done every session: (a) 30 pps,100
pulse/train, 20 trains, 2 sec inter train interval, intensity 8% (all over the cortex, stroking AnteroPosterior (AP), sagittal and parasagittal planes) , with total number of pulses 2000, using circular
coil, followed by (b) 5 pps, 100 pulse/train, 20 trains, 20 sec inter train interval, intensity 45% with
total number of pulses 2,000 over the left dorsolateral prefrontal cortex (LDLPFC) (F3), using 8
shaped coil, then (c) 10% (all over the cortex, AP, sagittal and parasagittal), with total number of
pulses 2000, using circular coil.
Patient received the fore-mentioned protocols for 10 sessions (5 consecutive sessions and 2
days off). TMS machine used was MagVenture Pro 30
Results
Along with improvement of the motor symtoms and non motor symptoms, there was also a
significant improvement in the olfactory functions. Our patient was able to identify cumin on the
fourth day from a distance of 1 meter after his brother open its jar. The next day, the patient
identified type of breakfast his brother was cooking while residing in his own apartment (one floor
above his brother’s)
Conclusion
Extensive investigations have confirmed the association between neurodegenerative diseases
and olfactory impairment.Medical dopaminergic treatment seems to have no effect. In our current
case, rTMS didn't only improve motor dysfunction, it also improved non motor dysfunctions as
sleep disturbance and anosmia, which was an annoying symptom for the patient. Further
researches are needed to confirm our results.
WCNR-0697
BOARD NUMBER: 022
Evaluation of a Wearable “Smart Socks” Gait Monitoring System for Improving
Rehabilitation Through Remote Gait Monitoring
S. ROSENBERG1, J. Yeung1, D. Catolico1, N. Fullmer1, R. Lovell1, E. Pearson1, R. Daniel1,
R. Tang1
1Casa Colina Hospital and Centers for Healthcare, Research Institute, Pomona, USA
Aims
Identifying and monitoring gait abnormalities and changes in gait-related symptoms is an
important component of optimizing rehabilitation for patients with neurological conditions.
However, measurements taken in the clinic only provide a brief snapshot of a patient’s gait
patterns. Our ultimate goal is to identify an effective method for monitoring gait remotely when a
patient is away from the clinic and participating in activities of daily life, in order to enhance
rehabilitation by providing a more accurate picture of a patient’s gait. Our main goal for this study
was to evaluate Sensoria Smart Socks, a new commercially available wireless technology, as a
feasible tool for monitoring gait. We compared the data output from the Smart Socks to the
GAITRite system, a standard tool for monitoring gait in the clinic. Because the GAITRite facilitates
continuous gait measurements of approximately 5 meters distance at a time, this study was used
to determine the Smart Sock’s ability to accurately depict gait measured over short distances.
Method
20 participants with neurological conditions were enrolled. Participant ages ranged from 29 to 89.
Each participant wore the Smart Socks and walked across the GaitRite mat to allow simultaneous
data collection from both gait monitoring systems. Four gait variables were compared: pace
(min/mile), foot contact time (ms), step count and cadence (step/min).
Results
Preliminary results from t-test analysis indicate that the measurement of pace, foot contact time,
and step count were comparable between the Smart Socks and GAITRite systems (p > 0.05).
Bland-Altman plots were used to further compare the two systems.
Conclusion
Initial results suggest that the Smart Socks system may be a feasible wearable tool for wireless
gait monitoring. Further investigation is warranted to determine the efficacy and clinical value of
using the Smart Socks system for monitoring gait over longer distances during daily activity
outside of the clinic.
WCNR-0200
BOARD NUMBER: 023
FUNCTIONAL APPROACH IN SPINOCEREBELLAR ATAXIA- OCCUPATIONAL THERAPY
PERSPECTIVE
P. SAWANT1, P. Gokhale2
1Kokilaben Dhirubhai Ambani Hospital, Physical Medicine and Rehabilitation, Mumbai, India
2Vasant Vihar Counselling Centre- Mumbai, Occupational Therapy, Mumbai, India
Aims
The cerebellum is known to play a strong functional role in both motor control and motor learning.
Diseases of cerebellum like Spinocerebellar Ataxia (SCA) leads to functional limitations leading to
activity restriction. Ataxia following degenerative cerebellar disease becomes a major cause of
disability. Literature talks about effectiveness of Occupational Therapy in rehabilitation of these
patients but not much work is been documented on it. Objective of the study was to rate ataxia
and assess the Functional Independence and Balance in the context of Occupational Therapy.
Method
3 male patients with diagnosis of Spinocerebellar ataxia, in the age group of 20- 30 years were
screened on MMSE to rule out cognitive impairment and ensure the utility of intervention. Ataxia
was rated using Scale for Assessment and Rating of Ataxia (SARA). The subjects underwent 3
months of Occupational Therapy (OT) intervention including physical exercises, therapeutic
activities, Intensive coordination training, prescription of adaptive aids, Balance retraining and
functional retraining using Top Down Approach and were assessed on Functional Independence
Measure Functional Assessment Measure FIM FAM Activities of Daily Living (ADL) scale and
Berg Balance Scale (BBS) pre and post intervention and statistically analysed using paired’t’ test.
Results
Pre intervention mean score on FIM FAM scale was 199 ± 5.57 which increased to 202.66 ± 6.03
post intervention and was statistically significant at t = 11, P< 0.01.The mean score on BBS
increased from 38 ± 2 to 39.66 ± 2.08 ; post intervention and was statistically significant at t= 5,
P< 0.05. Scores on SARA were also maintained which shows there was no worsening of
symptoms.
Conclusion
The results were statistically significant it can be concluded that OT intervention was effective in
improving functional independence in Patients with SCA in the selected study population. Further
research is recommended with larger sample size.
WCNR-0682
BOARD NUMBER: 024
CLOSED-LOOP OPTIMIZATION OF DBS PROGRAMMING: A COMPUTATIONAL STUDY
R. SINGH1, J. Kim1, J. White2, S. DeWeerth2
1Georgia Institute of Technology, Electrical Engineering, Atlanta, USA
2Georgia Institute of Technology, Biomedical Engineering, Atlanta, USA
Aims
The current deep brain stimulation (DBS) programming procedure can be time consuming and
error prone. A closed loop optimization (CLO) approach for DBS programming using response
surfaces is presented in simulation that can improve upon the current procedure and move closer
to automation of DBS programming.
Method
A model of the basal ganglia originally published by Rubin and Terman is used to model
Parkinson’s disease and DBS. Key aspects of the model are described in figure 1. The CLO
procedure used here is based on the efficient global optimization (EGO) algorithm and is depicted
in figure 2. The response surface is a prediction of the optimization space built using the DACE
model (figure 3). A parameter test is the evaluation of a set of DBS parameters.
Results
The DACE model fit can be seen in figure 3. The CLO scheme successfully found effective
parameters that restored thalamic fidelity in 54-94 parameter tests in 100 simulations.
Conclusion
Due to recent advances in quantitative assessment metrics, the capability to translate a CLO
procedure from simulation to clinic is possible. A CLO procedure for DBS that requires less
parameter tests than previously published method was presented. This CLO procedure requires
far less parameter tests because it approximates the optimization space using a response
surface. This method is computationally expensive but is frugal in its parameter tests. In DBS,
parameter tests are costly because of the amount of time it can take to assess a set of DBS
parameters and due to patient fatigue. Therefore, it is essential for a CLO scheme for DBS to be
frugal in the number of DBS parameters evaluated.
WCNR-0577
BOARD NUMBER: 025
RESPONSIVENESS OF THREE FUNCTIONAL MOBILITY TESTS TO PHYSICAL THERAPY
INTERVENTION IN GROUP FOR INDIVIDUALS WITH PARKINSON'S DISEASE
A. Swarowsky1, G. Spagnuolo1, H.D.O. Braga1, J. Siebra1, J. Ilha1, S. Cardoso1
Aims
Patients with Parkinson's disease (PD) experience a variety of deficits in structure and body
function and activity limitations, making more complex the kinetic-functional evaluation. Thus, it is
important that the physiotherapist use appropriate tools to quantify these changes with good
psychometric properties and responsive to possible improvement of his patient. The aim was
verify if Bed mobility test (BM) , Sitting to standing test (STS) and Timed up and Go test (TUG)
are responsive to physical therapy intervention in group (PtIG) in patients with Parkinson's.
Method
15 patients were evaluated (Unified Parkinson's disease ratting scale - section III, Mini Mental,
Hoehn & Yahr stage, BM, STS, TUG) and attended 16 physiotherapy sessions in group twice a
week, for 45 minutes. After treatment the subjects were re-evaluated, and responded to a Likert
scale to analyze if the response to intervention were considered clinically significant for PD
patients. Ethics Committee: 1.251.231.
Results
For TUG test: area under the curve = 0.72; IC 95% 0.43-0.91; p=0.1976; BM: area under the
curve = 0.58; IC 95% 0.31-0.82; p=0.6093 and STS: area under the curve = 0.55; IC 95% 0.280.80; p=0.7353, (Figure 1 and 2). The Analysis of ROC curves showed a poor diagnostic
accuracy for the TUG, STS and BM in their ability to be responsive or not for this sample size.
The established cutoff points, the sensitivity and specificity of each variable are shown in table 2.
In relation to minimal clinical important difference, the table 3 showed the dichotomized Likert
scale values for each functional test/participant.
Conclusion
The Analysis of ROC curves showed a poor diagnostic accuracy for the TUG, STS and BM in
their ability to be responsive or not for this sample size. However, more studies are needed to
confirm this hypothesis since functional tests are widely used in clinical practice.
WCNR-0230
BOARD NUMBER: 026
VIRTUAL REALITY IN NEUROREHABILITATION
A. Switonski1, H. Josinski1, R. Mucha2, K. Wojciechowski1
1Polish-Japanese Academy of Information Technology-, Research and Development Center,
Bytom, Poland
2Medical University of Silesia, Clinical Department of Internal MedicineAngiology and Physical Medicine, Bytom, Poland
Aims
The system named Virtual Physiotherapist (VPh) is designed. It supervises a rehabilitation
process by analyzing and comparing movements performed by a skilled trainer and a patient. The
online feedback is activated in case of improperly performed exercises and differences are
explained. What is more, because of defined rule based relationships between exemplary
exercises, the VPh is able to modify the training depending on the obtained progress. The
rehabilitation is captured and recorded in database. The motion data are accessible for medical
expert, they can be analyzed and assessed offline.
Method
The crucial choices for the effectivity of VPh are motion acquisition technique and the method
which compares exemplary training and an one performed by a patient. Wearable inertial
measurement units (IMU) are chosen to capture motion data. Thus, it is possible to prepare any
configuration of the sensors in respect to body segments involved in a rehabilitation. On the basis
of our previous experiences on motion analysis, dynamic time warping technique is used to
compare captured motion data.
Results
The prototypes of IMU suit were constructed – the one with IMU sensors incorporated with textile
material and a configurable one with wearable straps. The validation experiments with the
reference optical Vicon system were carried out. The estimated mean error calculated across
skeleton joints is less than two degrees. Moreover, DTW was applied to evaluate performance of
a training for selected rehabilitation exercises. Once again results are satisfactory. DTW
determines similar improperly performed movements as a human expert.
Conclusion
The proposed VPh system is mobile, scalable and precise enough. Thus, rehabilitation with
reliable assessments can take place even in home environment. The prototype of VPh is
currently being developed.
Acknowledgement: The work is supported by The Polish National Centre for Research and
Development, the project is named “Virtual physiotherapist”.
WCNR-0496
BOARD NUMBER: 027
IMPROVING WALKING IN INDIVIDUALS WITH PARKINSON’S DISEASE THROUGH
WEARABLE TECHNOLOGY
E. Thompson1, P. Agada2, J.H. Reimann2, W.G. Wright3, J. Jeka2
1Temple University, Kinesiology- Physical Therapy Departments, Philadelphia, USA
2Temple University, Kinesiology Department, Philadelphia, USA
3Temple University, Physical Therapy- Bioengineering Departments, Philadelphia, USA
Aims
Parkinson’s disease (PD) leads to gait deficits including decreased and asymmetrical arm swing
and small steps, possibly due to the effects of impaired proprioception on motor output.
Rehabilitation approaches that attempt to address this deficit to correct movement are not well
understood. Our purpose was to explore the effects of a new wrist-based vibratory feedback
device, ArmSense, designed to improve walking characteristics through larger arm swing.
Method
Twelve individuals with PD and four healthy individuals participated in trials where gait changes
were elicited by visual targets at 120% of baseline step length or ArmSense vibration cues at
110-140% of baseline arm swing. Additionally, two individuals with PD and ten healthy
individuals participated in trials where gait initiation changes were elicited by galvanic vestibular
stimulation. Arm swing was measured by the ArmSense device, step length was measured by
video analysis, and foot placement and center of pressure were measured during gait initiation
with a forceplate. Bonferroni-corrected t-tests were used to detect any differences.
Results
Visual cues led to increased step length and lateral trunk sway in both groups, but only those with
PD showed increased step length when using the ArmSense devices. The group with PD
retained longer step length for over five minutes after Armsense cuing was withdrawn, but the
effects following visual cuing dissipated almost immediately. Evidence from gait initiation trials
indicated that center of pressure modulation and step width were reduced in people with PD, or
were near-normal in magnitude but temporally delayed.
Conclusion
Visual or vibratory cues led to larger steps in people with PD (with longer retention following
vibratory cues), but the mechanisms by which these adjustments are made may be different in
PD.
WCNR-0343
BOARD NUMBER: 028
TREATMENT/PHARMACOTHERAPY/PT
THE DETAILED INVESTIGATION OF PHYSICAL ACTIVITY LEVEL IN MUSCLE DISEASES
S. Aksu Yildirim1, F. Avcu1, E. Ayvat1, C. Demirci1, Ö. Onursal1, M. Kılınç1
1Hacettepe University, Physiotherapy and Rehabilitation, Ankara, Turkey
Aims
It is well known that physical activity level decreases in patients with Neuromuscular disease
(NMD). The aim of this study is to examine the physical activity levels of individuals with NMD
and to investigate the factors that may have an effect on physical activity levels.
Method
24 individuals with NMD (IwNMD) and 10 healthy subjects were included to the study. Physical
activity levels of participants were evaluated with Sense-Wear Armband Pro 3 device.
Participitans were used the device 5-days of week and total numbers of steps and energy
consumption were recorded. Total physical activity MET scores were calculated by the
International Physical Activity Questionnaire. Also muscle strength, pain, activity limitation,
fatigue, balance, functional mobility level and quality of life were assessed with the hand held
dynamometer, McGill Pain questionnaire, Activlim questionnaire, fatigue severity scale (FSS),
timed up and go test (TUG) 6 minute-walk and SF-36 questionnaire respectively.
Results
The mean age of the IwNMD was 32.41±6.86 while healthy individuals’ was 25.50±1.90 in the
study. Individuals with NMD had 28.865±158.39,97 steps and 11.903.70±2861.07 kcal energy
expenditure while healthy individuals had 49236.70±22110.61 steps at similar energy expenditure
(12.866.50±3.484.11 kcal). There was a significant relationship between energy expenditure
levels; the number of steps and lower extremity muscle strength of individuals with NMD (p
<0.05) . Also there were significant correlation between energy consumption levels and total
Activlim points, TUG, a 6-minute walk test, physical functioning and physical role subparameters
of SF-36 (p <0.05).
Conclusion
The most important result of present study is that IwNMD have engaged in similar activity
performance by spending approximately doubled energy. Because of that situation, increasing
the energy expenditure may be the major cause of reduction in physical activity of the IwNMD.
Another important result is the relationship between physical activity level and muscle strength of
lower extremities.
WCNR-0199
BOARD NUMBER: 029
MANAGEMENT OF CHALLENGING BEHAVIOUR IN PATIENTS WITH TBI
M.A. Ali1
1Central England Rehabilitation Unit CERU previously named as Royal Leamington Spa Rehabilit
ation Hospital, Neuro-Rehabilitation, Leamington Spa, United Kingdom
Aims
Estimates of the prevalence of challenging behaviours among the survivors of Traumatic Brain
Injury (TBI) vary considerably in the literature from 10-96%. Behavioural disturbances may
include inappropriate vocalisation , intolerance of medical management or equipment , directed or
diffuse aggressive and disinhibition. Such abnormal behaviours could lead to limitations of the
physical safety of the person or others.This review is for the optimisation of the management of
patients prescribed as aggressive or disruptive secondarily to a traumatic brain injury.
Method
Methodology::Patients identified as having difficult behaviour based on the Emerson 1995
definition (April to November 2014).The questions addressed included age, behaviour charts
completion , clinical presentation , attempt of non pharmacological therapy first, pharmacological
therapy , use of one or more pharmacological agents, improvement of challenging behaviour and
the adverse effects.
Results
Results:The most commonly seen patterns of challenging behaviour , was agitation (100%),
followed by restlessness and verbal aggression (57%) each , refusal of medications (43%). 29%
exhibited delusions, sexual inappropriateness and physical aggression .Behavioural charts were
only properly completed in 40% of the cases. In 62% of the cases (n=10), pharmacological
therapy was commenced without trying non pharmacological methods first or concomitantly. Drug
management was effective in improving behaviour in 70% of the case with less than 30% of the
patients suffering from minor adverse side effects.
Conclusion
Overall the lack of high quality evaluations of medications for the management of agitation and /
or aggression in patients with ABI. Beta blockers were found useful for both agitation and
aggression with no difference between early or late post injury . Recommendations are
completeness of behavioural charts is essential not only to aid in the evaluation but also to
document response to interventions. Non pharmacological measures remains the priority but
monitoring of drug side effects is essential with pharmacological intervention.
WCNR-0511
BOARD NUMBER: 030
DEVELOPMENT OF A PATIENT REPORTED EXPERIENCE MEASURE OF THERAPY
PROVISION FOR REHABILITATION OF THE PARETIC LOWER LIMB - THE LOWER
EXTREMITY THERAPY RECORDING SCHEDULE (LegTS)
S. Ashford1,2, D. Jackson2, L. Turner-Stokes1,2
1London North West Healthcare NHS Trust, Regional Hyper-acute Rehabilitation Unit, London,
United Kingdom
2King's College London, Department of Palliative Care- Policy and Rehabilitation, London,
United Kingdom
Aims
In studies of physical therapy rehabilitation it is critical to understand the intervention provided for
patients, to both enable replication of the work and clearly identify what treatments work best.
This study reports the development a patient reported experience measure (PREM) of therapy
provision during rehabilitation of the paretic lower limb in the context of focal spasticity
management.
Method
Potential intervention categories for inclusion were identified from; a) evaluation of intervention
used in conjunction with botulinum toxin administration for lower limb spasticity (n=62) and b)
cognitive de-briefing with a Project Advisory Group (PAG) consisting of patient and carer dyads
(n=6). Item reduction was achieved through consultation with a, purposively-selected group of
experienced physiotherapists and occupational therapists (n=16) in a 2-round Delphi process.
This was followed by review of Delphi consultation findings by the same Project Advisory Group
(PAG) members and one of the researchers in the wider study who was a ‘patient expert’.
Results
A list of 23 possible therapy categories were identified from evaluation of therapy intervention
applied alongside BoNT. All therapy categories identified through cognitive de-briefing were also
present in the list of therapy interventions actually applied in practice. Two rounds of Delphi
consultation were undertaken. Further rounds of consultation were not required due to the high
degree of agreement between respondents for inclusion of items in LegTS. The LegTS was
subsequently refined in terms of wording and presentation for clinical and research use.
Conclusion
The LegTS is designed to record focal therapy interventions for the paretic lower limb in the
context of spasticity intervention. Content and face validity have initially been addressed within
the development process.
WCNR-0420
BOARD NUMBER: 031
COMPUTERIZED DYNAMIC POSTUROGRAPHY DETECTS BALANCE DEFICITS AND IS
ROBUST TO CEILING EFFECTS FOR INDIVIDUALS WITH CHRONIC SEVERE TRAUMATIC
BRAIN INJURY
T.W. Buster1, B.R. Lowndes1,2, J.M. Burnfield1
1Madonna Rehabilitation Hospital, Institute for Rehabilitation Science and Engineering, Lincoln,
USA
2University of Nebraska-Lincoln, Biological Systems Engineering, Lincoln, USA
Aims
Individuals recovering from traumatic brain injuries (TBI) self-report balance problems that are
difficult to substantiate with clinical measures due to documented ceiling effects. Computerized
Dynamic Posturography (CDP) has been used as an evaluation and training tool for individuals
with a wide variety of conditions. However, CDP’s effectiveness for detecting balance deficits in
those recovering from brain injuries is unclear. This study compared CDP balance scores from
individuals with chronic severe TBI to matched controls. We hypothesized that participants
recovering from TBI would score more poorly than matched controls. We also hypothesized that
no participants would reach a ceiling score (i.e., zero) on CDP but they would on the Berg
Balance test.
Method
Ten individuals with history of severe TBI (initial loss of consciousness greater > 6 hours;
currently ≥ 5 FIM locomotor score; and currently ≥ 6 on the Rancho level of cognitive function)
and ten individuals that served as matched (i.e., age, height, and weight) controls without history
of injury participated in three sessions (spaced 24 to 72 hours apart). Participants performed
three CPD (Proprio 4000, Perry Dynamics, Decatur, IL) tests and a Berg Balance test during
each session. Dynamic Movement Analysis scores (DMA) were recorded by the CDP system’s
ultrasound sensor. Given failed normality assumptions, the Mann-Whitney Rank Sum test
evaluated differences between TBI and comparison participants.
Results
TBI participants scored significantly higher on the CDP test than comparison participants across
all three days of testing. Additionally, no participants reached a ceiling score on CDP while nearly
half of the TBI group scored perfectly on the Berg.
Conclusion
CDP is able to detect balance deficits and is robust to ceiling effects when evaluating individuals
with chronic severe TBIs.
WCNR-0433
BOARD NUMBER: 032
MOVEMENT VARIABILITY DURING WALKING AND ELLIPTICAL EXERCISE FOR
INDIVIDUALS WITH CHRONIC SEVERE TRAUMATIC BRAIN INJURIES
T.W. Buster1, A.P. Taylor1, J.M. Burnfield1
USA
Aims
Regaining walking skill is often a high priority after a severe traumatic brain injury (TBI). It has
been suggested that rehabilitation should incorporate movement strategies with complex
variability in order to encourage highly adaptable functional recovery. Elliptical exercise is
increasingly being used in rehabilitation to address cardiovascular deconditioning and gait
challenges simultaneously given the documented similarities to gait. Unclear is whether an
elliptical allows for more complex variability compared to treadmill walking given the elliptical’s
varying constraints (e.g., sustained double limb support, static and moving hand holds).This study
compared TBI participants’ movement variability during elliptical exercise to that occurring during
walking. We hypothesized that elliptical exercise would constrain movement variability as
evidenced by more stereotypical (i.e., more closely overlapping) movement trajectories.
Method
Ten individuals with history of severe TBI (initial loss of consciousness greater > 6 hours;
currently ≥ 5 FIM locomotor score and ≥ 6 Rancho level of cognitive function) participated. Threedimensional lower extremity kinematics were recorded while participants treadmill walked and
elliptical trained. Maximum Lyapunov exponents (LyE) were calculated from 30 consecutive
strides of joint motion profiles at the hip, knee and ankle for each condition. Independent t-tests or
Mann Whitney Rank Sum test evaluated differences between walking and elliptical training.
Results
Only ankle joint motion profiles demonstrated significantly altered variability during elliptical
exercise compared to walking.
Conclusion
Contrary to our hypothesis, the elliptical did not overly constrain variability compared to walking.
Instead, ankle movement variability/complexity was actually enhanced. Continuous double limb
support and multiple hand hold positions may have allowed participants to explore varying
movement strategies while dynamically moving. Elliptical exercise should be considered if
incorporating complex variability is a goal of rehabilitation.
WCNR-0534
BOARD NUMBER: 033
NEUROREHABILITATION IN PATIENTS WITH MYASTHENIA GRAVIS AFTER
THYMECTOMY
Y. Bykov1, A. Smolin1
1Irkutsk State Medical University, Neurology, Irkutsk, Russia
Aims
Myasthenia gravis (MG) is an autoimmune disease manifested by muscle weakness and
fatigability. Thymectomy has become increasingly accepted as an efficacious procedure for MG.
The aim of this study is to investigate a long-term neurorehabilitation period after thymectomy and
the quality of life in a patients with MG.
Method
A total of 103 patients (mean age 36,2 ± 2,4; male – 28,8; female – 71,8%) was divided into two
groups, first group with 67 patients after extended trans-sternal thymectomy (TY) and second one
is consisting of 36 patients submitted to conservative treatment (CT) according to age and
gender. The following data were analyzed: gender, age, and age at the beginning of symptoms,
illness duration, follow-up time and type of medical treatment. The patients were evaluated
clinically using a quantified MG clinical score (QMGS) and tested by SF-36 self-reported.
Results
Severity of disease in 1 and 2 groups: mild (32,8% and 44,4%), moderate (52,2% and 41,6%),
sever (14,9% and 13,8%). Clinical forms of myasthenia: ocular (0 and 33,3%), cranial (0 and
30,5%), bulbar (0 and 19,4), generalized (100 and 16,6%).
Quality of life:
1 group. Physical component - 72 (48; 87). Mental component - 75 (55; 100).
2 group. Physical component - 55 (25; 75). Mental component - 72 (61; 88).
Four clinical types were revealed: 1) remittent; 2) stable; 3) progressive; 4) malignant.
Conclusion
Different types of rehabilitations were revealed in patients with MG. Four groups were defined
(remittent, stable, progressive, malignant). Obtained data demonstrates that thymectomy has
advantages over conservative treatment in rehabilitation process and quality of life. There were
statistical differences between the conservative treatment and thymectomy groups. Best quality of
life was registered in patients after thymectomy.
WCNR-0181
BOARD NUMBER: 034
EFFECT OF SPINAL STABILIZATION EXERCISES ON BALANCE, GAIT AND QUALITY OF
LIFE IN PATIENTS WITH MULTIPLE SCLEROSIS
B. Çetin1, Y. Salci1, A. Fil Balkan1, K. Armutlu1
1Hacettepe University, Health Sciences Faculty- Physiotherapy and Rehabilitation Department,
Ankara, Turkey
Aims
Multiple sclerosis(MS) is chronic inflamatuar and otoimmun disease that affects the central
nervous system. MS is characterized with demyelinite placs and it can spread to different
anatomical structures through time. Balance and gait problems that reveal with early stage of MS,
affects daily living acitivities and quality of life negatively. And we know that especially trunk
stabilization is very important for balance and gait function. Our purpose was to research the
effect of spinal stabilization exercises on balance, gait and quality of life.
Method
This study inluded the patients that their edss scores were between 3 – 5,5 , not having MS
attack in last 3 months, walking independently and not having any other sistemic or orthopedic
problems. MS patients participated in a program that was three times a week and during six
weeks. This program was applied as group therapy and included spinal stabilization exercises.
The measurements we used in this study were mini-bestest, dynamic gait index, six minutes walk
test and MSQOL-54 test for quality of life.
Results
This study included 20 patients (13 female, 7 male). Mean age of these patients was 37,1±9,5 .
The mean scores of dynamic gait index increased from 18,4 to 21,4 , mini-bestest increased from
19,3 to 23,5 , six minutes walk test increased from 485,9 m. to 535,1 m. , MSQOL-54 increased
from 61,5 to 72,4. We found statistically significant improvements in all evaluations (p<0,05).
Conclusion
As a result, we think that the exercise program especially focusing on improvement of trunk
stabilization is effective on gait, balance and quality of life in MS patients. Spinal stabilization
exercises should take place in exercise programs of patients having gait and balance problems.
WCNR-0224
BOARD NUMBER: 035
CORRELATION BETWEEN THE BALANCE COMPONENTS AND WALKING PERFORMANCE
IN PATIENTS WITH MULTIPLE SCLEROSIS
B. Çetin1, Y. Salci1, A. Fil Balkan1, K. Armutlu1
1Hacettepe University, Health Sciences Faculty- Physiotherapy and Rehabilitation Department,
Ankara, Turkey
Aims
Balance and gait problems that are seen frequently in patients with Multiple Sclerosis(MS),affect
their quality of life negatively. Our purpose was to research the correlation between different
components of balance and walking performance in MS patients.
Method
This study inluded the patients that their edss scores were between 3 – 5,5 , not having MS
attack last 3 months, walking independently and not having any other sistemic or orthopedic
problems. Mini-bestest and 6 minutes walk test(6mwt) were the measurements that we used in
our study.
Results
This study included 44 patients(28 female and 16 male). The mean age of these patients was
39,1±10,1 years. The correlation between mini-bestest and 6mwt was evaluated with Spearman
correlation analyse. The relations between 6mwt and mini-bestest subcomponents: anticipatory
balance and reactive postural control were mid range(respectively r:0,541; p:0,001, r:0,572;
p:0,001). On the other hand, the relations between 6mwt and mini-bestest subcomponents:
sensory orientation and dynamic gait were weak range(respectively r: 0,373; p:0,013 , r: 0,474;
p:0,001). And the correlation between mini-bestest total score and 6mwt was mid range(r: 0,578,
p: 0,001).
Conclusion
These results make us think that anticipatory balance and reactive postural control problems
directly affect walking performance and the patients can not compensate these problems easily
while walking. On the other hand, about low correlation of sensory integration, we think that MS
patients who have balance problems can compensate sensory problems with using visual system
and adjusting their support surface efficiently. And the weak correlation result of dynamic gait
subcomponent which includes daily life walking activities like turning around and stepping over an
obstacle, make us think that 6mwt can be insufficient for evaluation walking within community in
daily life in MS patients.
WCNR-0326
BOARD NUMBER: 036
EFFECTS OF TRUNK STABILIZATION EXERCISES ON TRUNK CONTROL AND UPPER
EXTREMITY FUNCTION IN ADULT MUSCLE DİSEASES
C. Demirci1, F. Avcu2, E. Ayvat2, Ö. Onursal2, M. Kılınç2, G. Baltacı2, S.A. Yıldırım2
1Kirikkale University- Faculty of Health Science, Department of Physiotherapy and Rehabilitation,
Kirikkale, Turkey
2Hacettepe University- Faculty of Health Science, Neurological Rehabilitation, Ankara, Turkey
Aims
Trunk stabilization decreases in muscle diseases because of progressive muscle weakness. Also
trunk has an important role because of providing proksimal stability for distal mobility. This study
was planned to investigate the effects of trunk stabilization exercises on trunk control and upper
extremity functions in adult muscle diseases.
Method
In the study, 16 muscular dystrophy patients with a mean age of 33,25 ±12,99 years were
included to the trunk stabilization exercises. Individuals were taken into the trunk stabilization and
strenghtening exercise program 3 days per week for 8 weeks. Patients were assessed three
times; pre-treatment, 4th week and in post-treatment. After the demographic data were recorded,
pain and fatique severity were assessed with visual analog scale, muscle strength of trunk and
hip muscles with manual muscle test, trunk control with trunk impairment scale, balance with
functional reach test, lower trunk stabilization with bridging test, activity limitations with activlim
questionnaire, manual ability with abilhand questionnaire and upper extremity stabilization with
Minnesota manual hand dexterity test (MHDT).
Results
According to the 4th week evaluations only trunk control, balance, lower trunk and upper extremity
stabilization results improved significantly (p<0.05). However, when we compared the pre-post
treatment results there has been significant improvements additionally in pain, fatique, trunk
control, balance, lower trunk stabilization, activity limitations and upper extremity stabilization
(p<0.05). There has been improvement in all muscle strength (p<0.05) except back extensors,
trunk lateral flexors and left hip extensors (p>0.05) in study.
Conclusion
Muscular dystrophies are chronic and progressive diseases and patients were doing the same
exercises for a long time. This causes both physiological and motivational problems in this
patients. Trunk stabilization exercises should take place in routine management of muscle
diseases. These exercises offered as an option for muscular dystrophies will make a significant
contribution to physiotherapists working in these field.
WCNR-0295
BOARD NUMBER: 037
IS THERE ANY RELATIONSHIP BETWEEN MULTIPLE SCLEROSIS PATIENTS BETWEEN
VESTIBULAR DYSFUNCTION AND SUBJECTIVE FATIGUE? A PILOT STUDY
K. Unal1, A. Fil Balkan2, Y. Salcı2, K. Armutlu2, A. Tuncer3
1Bezmialem University, Physiotherapy and Rehabilitation, Istabul, Turkey
2Hacettepe University Faculty of Health Science, Physiotherapy and Rehabilitation, ankara,
Turkey
3Hacettepe University Faculty of Medicine, Neurology, ankara, Turkey
Aims
Fatigue and loss of postural control is among the most common symptoms often leading to
limitations in daily activities in patients with Multiple Sclerosis (MS). According to our
observations when patients get tired they have a difficulty to protect their balance. The aim of this
study is to investigate the relationship between fatigue and postural control in MS patients.
Method
20 MS patients without peripheral vestibular disease (8 male, 12 female, and Expanded Disability
Status Scale scores ranging from 2.5 to 4) were included in the study. Postural control was
evaluated with Sensory Organization Test (SOT), fatigue with Fatigue Impact Scale (FIS),
disability connected to dizziness with Dizziness Handicap Inventory (DHI).
Results
Composite balance score was 62.65±12.57 points and vestibular system score was
43.35±26.81. Furthermore average DHI and FIS score were 30.90±19.46 and 52.80±27.70
points, respectively. FIS scores correlated with balance composite score (r=-0.59, p<0.05) and
vestibular system scores (r=-0.51, p<0.05). In addition, the composite balance scores correlated
with only vestibular system score (r=0.82, p<0.05) not other system scores (p>0.05).
Conclusion
The results of our study showed that there was vestibular dysfunction in our patients and
composite balance scores were determinated by vestibular system scores. Also the correlation
has been found between the balance composite score, the vestibular system score and fatigue.
The correct processing of the visual, proprioceptive and vestibular information is immensely
important to maintain postural control. MS often affect brain stem and cerebellum essential
central sensory integration areas. Patients might have had to spend extra energy to provide
sensory integration because of these affected centers and this condition might cause
symptomatic fatigue. Further studies are needed to clarify the effect of vestibular disorders to
sensory integration and the relationship between fatigue and vestibular dysfunction
WCNR-0299
BOARD NUMBER: 038
THE KINESIOTAPING AND POSTURAL CONTROL IN MULTIPLE SCLEROSIS PATIENTS: A
PILOT STUDY
E. Ayvat1, A. Fil Balkan1, Y. Salci1, H. Hotaman Keklicek1, K. Armutlu1, A. Tuncer2, S. Aksoy3
Ankara, Turkey
2Hacettepe University Faculty of Medicine, Neurology, Ankara, Turkey
3Hacettepe University Faculty of Helath Science, Audiology, Ankara, Turkey
Aims
Proprioceptive, visual and vestibular systems provide sensory information to maintain postural
control. Multiple sclerosis (MS) can cause balance disturbances by affecting these three sensory
systems. The cervical region is a rich proprioception area in point of proprioceptors. Therefore, an
application such as Kinesiotape faciliting muscles can increase the sensory output of the
proprioceptive system and contribute to postural control. The aim of this study is to investigate the
effect of the kinesiotape applied to cervical region on postural control with multiple sclerosis
patients.
Method
Expanded Disability Status Scale (EDSS) scores ranging from 2 to 4 , 16 MS patients (relapsingremitting type, 6 males, 10 females, mean age 36.81 ± 10.50) were divided into two groups, the
control and study groups. Postural of patients was evaluated with Sensory Organization Test
(SOT). After initial assessment, the kinesiotape was applied to the cervical region to facilitation of
the vertebral muscles and taping with correction technique to normalizate of the cervical lordosis.
Postural control was evaluated again after 15 minutes following application.
Results
The composite balance scores insignificantly increased from 56.25±16.10 to 59.25±18.23 and the
proprioceptive system scores from 90.50±7.36 to 91.38±7.04 in study group (p>0.05) . In control
group the composite balance scores insignificantly increased from 62.25±8.41 to 66,63±9.55 and
proprioceptive system scores were compared each other from 93.88±3.27 to 94.50±2.33
(p>0.05). In comparison with study group and the control group, there was no difference in
composite balance and proprioceptive system score, before and after the application (p> 0.05).
Conclusion
Kinesiotape application was not effective on postural control system via propriceptive system. We
believe that the kinesiotape application being able to stimulate only superficial muscle is
insufficient to provide desired proprioceptive stimulation level considering the complex
anatomical structure of the cervical.
WCNR-0303
BOARD NUMBER: 039
MULTIPLE SCLEROSIS AND POSTURAL CONTROL: MAY CERVICAL MOBILIZATION BE
AN OPTION?
A. Fil Balkan1, H. Hotaman Keklicek1, Y. Salci1, K. Armutlu1, A. Tuncer2
Ankara, Turkey
2Hacettepe University Faculty of Medicine, Neurology, Ankara, Turkey
Aims
Disability in postural control is one of the most common problems causing disability in patients
with multiple sclerosis (MS). Proprioception is an important sensory component of the postural
control and cervical region is very rich with regard to proprioceptive receptors. Therefore, the
applications in this area could positively affect postural control. The aim of this study is to
investigate the acute effect of neck mobilization on postural control in MS patients.
Method
23 patients (8 male, 15 female, EDSS score 2-4) with relapsing-remitting type MS were divided
into two groups as control (n=11)) and study (n=12). The control group (no application group) was
created in order to eliminate the learning effects of the dynamic posturography. Postural control in
patients was evaluated by Sensory Organization Test (SOT). Joint and soft tissue mobilization
were performed on the upper and lower cervical region for 10 minutes in the study group. The
study group patients were evaluated after cervical mobilization and control group patients 10
minutes after the initial assessment.
Results
The composite balance scores and vestibular system scores significantly increased in study
group after application (p<0.05) while there was no change in control group. The proprioceptive
system scores did not change in both groups (p>0.05). In study group high correlation was found
between the composite balance scores and the vestibular system score (r=0.94, p<0.01).
Conclusion
The results of this study demonstrated the acute effect of cervical mobilization on postural control.
Although it was expected that the mobilization techniques applied to cervical area by stimulating
the proprioceptors would contribute to postural control, there was not any change in this system
score. On the other hand the high correlation between composite balance and vestibular system
scores was the applications via the cervico-colic reflex by regulating the vestibular system
responses could be due to the contributing to postural control.
WCNR-0021
BOARD NUMBER: 040
THE USE OF STANDARDIZED PATIENTS TO PORTRAY TRAUMATIC BRAIN INJURY IN
PHYSICAL THERAPY EDUCATION
S. Fishel1, L. Gras1
1Ithaca College, Department of Physical Therapy, Ithaca, USA
Aims
Physical therapy (PT) educators are responsible for preparing students to provide patient
centered care for individuals with traumatic brain injury (TBI). However, in the educational setting
it is often not possible to safely expose PT students to patients who have acute or complex
injuries. A standardized patient (SP) is an individual who is trained to represent a patient case.
Using SPs in PT education can bridge the gap between didactic coursework and clinical
experiences in a safe and nonthreatening environment. The purpose of this study was to describe
the student perception of the use of SPs to simulate traumatic brain injury (TBI) in neurological
rehabilitation coursework.
Method
Doctor of PT students at Ithaca College (n=85) participated in this experience. SPs were theatre
arts students at the same college and were trained to portray individuals with TBI at various
stages of recovery on the Rancho Los Amigos Scale of Cognitive Functioning (II, IV, VI). Led by
the faculty facilitator, the students performed a PT examination and provided PT interventions
with the SP. After the experience, an anonymous and voluntary online survey was distributed to
the students to understand their perspective of the experience.
Results
Forty students completed the survey. Students agreed or strongly agreed that the experience was
enjoyable (93%), allowed them to develop their ability to solve problems (90%), and allowed them
to use the knowledge they learned in the course (98%). Ninety six percent of the students agreed
that SPs should be further used in the PT program. Students comments included “I felt I was in
the clinic,” “the experience seemed real,” and “it was clinically applicable.”
Conclusion
Students perceived this experience positively and felt that it contributed to their learning. PT
educators can use actors to portray patients with TBI to foster student learning and student
engagement.
WCNR-0288
BOARD NUMBER: 041
A FALLS PREVENTION PROGRAM FOR PEOPLE WITH MS WHO FALL: A PRE-POST
INTERVENTION FEASIBILITY STUDY
S. Lennon1, L. Anthony1, S. Burnell1, C. Hutchins1, S. Mackenzie1, T. Schubert1, S. Ventoruzzo1,
L. Bradnam2
1Flinders University, Physiotherapy, Adelaide, Australia
2University of Technology, Physiotherapy, Sydney, Australia
Aims
Preventing falls in people with Multiple Sclerosis (PwMS) is important with falls prevalence
estimated to be between 50% to 63%. This study examined the feasibility of delivering a falls
prevention program using a group exercise and education format with self-management specific
to PwMS, who fall.
Method
Ethics approval was obtained from the SAHREC (Project Number: 226.13). PwMS participated in
a group program for 2 hours per week over 6 weeks. The impact on balance (Berg Balance
Scale-BBS) and a range of secondary measures related to mobility, number of falls, self-efficacy,
fatigue and quality of life was measured. Exercises targeted strength, balance, walking practice
through obstacle courses, getting on and off the floor and dual tasking. Education focused on
falls risk factors, action planning, balance and mobility, and fatigue management.
Results
Twenty one participants were recruited to three groups in the community. Feedback was positive
with high attendance. Changes in self- reported confidence levels in balance (p=0.007) and
mobility (p=0.001) were significant. There was a marked reduction in the number of falls (Mean
falls pre= 8.81 ± SD 10.79; Mean falls post = 0.90 falls ±SD 1.58). There was no significant
difference on the BBS (Wilcoxon test; p=0.420). Thirteen participants reported a reduction in
fatigue on the Modified Fatigue Impact Scale (mean difference= 11.67; p=0.000). The MS Impact
Scale (MSIS-29) improved by 9.29 points (p=0.003).
Conclusion
The MS falls prevention intervention was feasible and acceptable to participants. Delivering group
circuit training for PwMS in the community may be a resource efficient way to improve
accessibility to therapy in order to reduce falls.
WCNR-0341
BOARD NUMBER: 042
INEQUALITY IN TRAUMATIC BRAIN INJURY REHABILITATION - A CASE STUDY
R. Guldager1, I. Poulsen2
1Rigshospitalet/Aalborg University, Clinic of Neurorehabilitation- TBI UnitRigshospitalet Satellite Department on Hvidovre Hospital., Lejre, Denmark
2Rigshospitalet, Clinic of Neurorehabilitation- TBI UnitRigshospitalet Satellite Department on Hvidovre Hospital., Copenhagen, Denmark
Aims
This case study aims to explore the process of rehabilitation related to professionals in
healthcare. Focus is on how a high status patient and family is perceived and handled
by professionals.Furthermore, how strategies are applied by the patient and family.
Method
Observations and qualitative interviews have been conducted though different phases of the
rehabilitation trajectory during admission at one TBI Unit. Interdisciplinary meetings are regarded
as key elements of the empirical attention. The sociology of Pierre Bourdieu constitutes the
theoretical framework. Bourdieu’s concepts of economic, cultural, social, health and symbolic
capital are used to categorize and analyze the patient positions and strategies in the field. The
concept of strategy is used to understand how the agents (patient and family) perform to optimize
their position in general and also as a ‘good’ patient and family.
Results
The presented case is a 60 year old female (MK) admitted to rehabilitation after a major car
accident. MK suffers from severe physical and cognitive deficits. MK is married and has one
daughter, is an academic and is acknowledged within the field, as well as her husband is. At the
admission interview, the husband argues for examinations using the biomedical concepts,
classifications and logic and the examinations are accepted by the professionals. Consequently, it
seems to be crucial to act pro-active. As well as it seems as the patient and family have the ability
to use and convert capitals into real life.
Conclusion
Denmark as part of the Nordic welfare states is relatively equal in access to treatment in health
care, but inequality is increasing. The case study shows how one high status couple with many
resources uses capitals and strategies in order to optimize their oveall situation.
Especially cultural and social capital seems to be usefull when interacting with the health and
welfare professionals in rehabilitation.
WCNR-0650
BOARD NUMBER: 043
Fitness training for cardiorespiratory conditioning after traumatic brain injury: Cochrane
systematic review update
L. Hassett1, A. Moseley2, A. Harmer3
1The University of Sydney, Clinical and Rehabilitation Sciences Research GroupFaculty of Health Sciences and Musculoskeletal division- The George Insitute for Global Health,
Sydney, Australia
2The University of Sydney, Musculoskeletal division- The George Institute for Global Health,
Sydney, Australia
3The University of Sydney, Clinical and Rehabilitation Sciences Research GroupFaculty of Health Sciences, Sydney, Australia
Aims
To evaluate whether fitness training is safe and improves cardiorespiratory fitness (CRF) and
psychosocial functioning in people after traumatic brain injury (TBI).
Method
Only randomised controlled trials were included. Ten electronic databases, one clinical trials
registry and the reference lists of included studies were searched. Two authors independently
screened the search output, extracted data and assessed quality. Mean difference and 95%
confidence intervals (CI) were calculated for continuous data. Data were pooled when there were
sufficient studies with homogeneity.
Results
Eight studies, incorporating 399 participants, were included. The participants were primarily
males in their mid-thirties with severe TBI. No studies included children. Three of the eight studies
(67 participants) indirectly assessed change in CRF immediately after fitness training using the
peak power output obtained during cycle ergometry. Using the GRADE criteria, the quality of the
evidence for this outcome was rated as "low" due to risk of bias of study methods and imprecision
of the estimate. There was a mean difference in improvement of 36 watts (95% CI 3 to 68 watts)
in favour of fitness training compared to the control interventions. Post-hoc analysis for
Depression including only sub-acute and chronic participants (3 studies; 178 participants, “low”
quality evidence) showed a moderate effect of fitness training on depression (standardized mean
difference = -0.61; 95% CI -1.1 to -0.11). No adverse events were reported in any study.
Conclusion
There is low quality evidence that fitness training is effective at improving CRF. There is
insufficient evidence to draw any definitive conclusions about secondary outcomes. Whilst fitness
training appears to be a safe intervention for people with TBI, more adequately powered and welldesigned studies are required to determine a more precise estimate of the effect on CRF, as well
as the effects across a range of important secondary outcome measures and in different subgroups (e.g. children).
WCNR-0617
BOARD NUMBER: 044
Munch your Lunch!: An innovative interdisciplinary bespoke intervention for
eating/drinking problems
H. Hitchen1, J. Jim2, E. Wallace3
1The Children's Trust, Music Therapy, Tadworth, United Kingdom
2The Children's Trust, Psychology, Tadworth, United Kingdom
3The Children's Trust, Speech and Language Therapy, Tadworth, United Kingdom
Aims
To increase the food and drink intake of an 8 year old boy who had sustained a severe acquired
brain injury.
To avoid the need for surgical intervention via PEG insertion
Method
A song was composed to compensate for cognitive and emotional barriers to eating and drinking.
Specifically, extreme difficulties focusing & sustaining attention and the child's need for control &
autonomy were taken into account throughout the whole process of the intervention.
The song provided the following functions:
- auditory cueing for the child to attend to eating, initiate chewing, swallowing etc.
- lyrics (co-constructed with the child) containing embedded instruction to sustain these
behaviours
- musicality imbueing a sense of fun, excitement and enjoyment to mealtimes
Careful implementation of the song maximised choice and control for the child.
8 x 30 min lunch sessions over a course of 3 weeks were delivered involving family and nursing
staff.Results
Clinically significant weight gain was achieved, averting the need for surgery.
The child displayed increased enjoyment and reduced anxiety around mealtimes.
Positive Collaborative relationships between child, parent and staff.
Conclusion
Improvement in functional abilities has been observed when music therapy has been used as part
of an inter-disciplinary program
WCNR-0169
BOARD NUMBER: 045
FATIGUE, PHYSICAL ACTIVITY, QUALITY OF LIFE AND FALL RISKS IN PEOPLE WITH
MULTIPLE SCLEROSIS
P. Hoang1, E. Vister2, M. Tijsma3, S. Lord1
1Neuroscience Research Australia, Sensation- Movement- Balance & Falls,
Randwick NSW 2031, Australia
2Radboud University Nijmegen, Nijmegen Medical Centre, Nijmegen, Netherlands
3Radboud University Nijmegen, Medical Centre, Nijmegen, Netherlands
Aims
To examine the extent to which fatigue and low physical activity reduce quality of life and
increase fall risks in people with multiple sclerosis (MS)
Method
Community-dwelling people with definite diagnosis of MS (any type), able to stand unsupported
for 30 seconds and walk 10 meters with or without mobility, were recruited. Fatigue was assessed
with the Fatigue Severity Scale (FSS) and physical activity was assessed using items from the
IPEQ questionnaire1. Other measures included quality of life (WHODAS scores), proprioception,
gait speed, standing and leaning balance, Choice Stepping Reaction Time (CSRT) and upper
limb fine motor control (9-hole peg test). Participants were categorized as having either high or
low reported fatigue and walking activity levels and then followed up for falls using monthly fall
diaries for 6 months.
Ref: 1 Delbaere K, et al. (2010). Evaluation of the incidental and planned activity questionnaire
(IPEQ) for older people. Br J Sports Med. 1029-34.
Results
The mean age of participants (n= 210) was 50.8 years (±11.1) and 152 (72.4%) were women. A
high level of fatigue (FSS > 45) was significantly associated with higher MS severity, worse
balance, greater fear of falling, lower WHODAS scores and more prospectively recorded falls.
Low walking activity (≤1h/week) was significantly associated with higher MS severity, reduced
proprioception, worse standing and leaning balance, slow stepping, slow gait speed, worse fine
motor control, greater fear of falling and lower WHODAS scores.
Conclusion
Increased fatigue and low physical activity levels were significantly associated with several
indicators of fall risk and lower quality of life in people with MS. High fatigue levels were
associated with higher incidents of prospectively falls.
WCNR-0171
BOARD NUMBER: 046
A SIMPLE TEST OF CHOICE STEPPING REACTION TIME FOR ASSESSING FALL RISKS IN
PEOPLE WITH MULTIPLE SCLEROSIS
P. Hoang1, M. Tijsma2, E. Vister2, S. Lord1
1Neuroscience Research Australia, Sensation- Movement- Balance & Falls,
Randwick NSW 2031, Australia
2Radboud University Nijmegen, Nijmegen Medical Centre, Nijmegen, Netherlands
Aims
To determine a) the discriminant validity for established fall risk factors and b) the predictive
validity for falls of a simple test of Choice Stepping Reaction Time (CSRT) in people with Multiple
Sclerosis (MS).
Method
People with MS (n=210, 21-74y) performed the CSRT. Other measures included quality of life
(WHODAS scores), neuropsychological assessment (Trail Making Test –TMT - including Part A
that tests simple attention and Part B that tests complex attention), proprioception, knee
extension strength of affected leg, gait speed, standing and leaning balance and upper limb fine
motor control (9-hole peg test). Participants were followed up for falls using monthly fall diaries for
6 months.
Results
The CSRT test had excellent discriminant validity with respect to established fall risk factors.
Multiple fallers (≥3 falls) performed significantly worse in the CSRT test than non-multiple fallers
(0-2 falls). With the odds of suffering multiple falls increasing 69% with each SD increase of
CSRT (OR= 1.69, 95% CI 1.27-2.26 P = <0.001). In regression analysis, CSRT was best
explained by sway, time to complete the 9-Hole Peg test, knee extension strength of the weaker
leg, poorer proprioception and the time to complete the Trail A & B test (multiple R 2 = 0.449,
P<0.001).
Conclusion
A simple low tech CSRT test has excellent discriminative and predictive validity in relation to falls
in people with MS. This test may prove useful in documenting longitudinal changes in fall risk in
relation to MS disease progression and effects of interventions.
WCNR-0265
BOARD NUMBER: 047
THE EFFECTS OF EXERGAMES ON BALANCE AND MOBILITY PERFORMANCE IN ATAXIC
PATIENTS
M. Kilinç1, E. Ayvat1, F. Avcu1, Ö. Onursal1, E. Gürses2, C. Demirci1, S. Aksoy2, S. Aksu Yıldırım1
2Hacettepe University, Audiology, Ankara, Turkey
Aims
The use of the commercial video games as rehabilitation tools, such as Microsoft Kinect, has
recently gained much interest in the physical therapy area. The aim of this study was to
investigate the effects of Kinect games as a physiotherapy application on disease severity,
balance, mobility performance, trunk control and dual task on ataxic patients.
Method
10 ataxic patients (7F/3M) were included to the study. Severity of diseases, trunk control,
balance, gait, risk of falling and walking speed was evaluated with ataxia rationing scale (ARS),
trunk impairment scale (TIS), berg balance scale (BBS), dynamic gait index (DGI), time up and go
(TUG), 10 meters walk test (10mwalk), respectively. In order to observe the effect of dual task,
TUG was reassessed with additional cognitive and motor tasks. Also anteroposterior and
mediolateral stability limits were evaluated with Computerized Posturography. A pre-posttreatment design was used. Cases were treated 8 weeks /3 days per week / 40 minutes per day
with Kinect-based games. In these physiotherapy sessions, 3 standart games were chosen for
the improvement of weight shifting to all directions, stepping, reaction time and coordination.
Results
The mean age of patients were 32.40±10.98 years. After treatment, there were significant
improvements in scores of TIS, ARS, DGI, TUG and TUG+ additional cognitive task (p<0.05).
Additionally, after treatment, there were statistically significant differences in backward weight
shifting, end point excursion, and weight shifting to the right side parameters on limits of stability
measurements of Computerized Posturography (p <0.05).
Conclusion
The results of present study offers a new treatment option to clinicians in the physiotherapy
application of ataxic patients who need long-term rehabilitation process. Ataxic patients usually
have anterior balance and they have difficulty in weight shifting to the backward. Therefore,
significant improvements in weight shifting to the backward obtained from our results is
promising.
WCNR-0106
BOARD NUMBER: 048
BRAIN INJURY AND SEVERE EATING DIFFICULTIES AT ADMISSION - PATIENT
PERSPECTIVE NINE TO FIFTEEN MONTHS AFTER DISCHARGE: A PILOT STUDY
A. Kjaersgaard1, H. Kaa Kristensen2,3
1Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel,
Denmark
2Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
3Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
Aims
The aim: The aim of this pilot study was to explore and interpret the way that individuals with
acquired brain injury, admitted to inpatient neurorehabilitation with severe eating difficulties,
experienced eating nine to fifteen months after discharge.
Method
Methods: Four individuals with acquired brain injury were interviewed via qualitative semistructured interviews. An explorative study was conducted to study eating difficulties. Qualitative
content analysis was used.
Results
Results: Four main themes emerged from the analysis: personal values related to eating,
swallowing difficulties, eating and drinking, meals and social life. Three predominating
experiences were: fed by tube, ‘relearning’ to eat, and eating meals together.
Conclusion
Conclusions: The preliminary results regarding the four participants suggest that the meaning of
food and being able to eat and take part in meals may be nearly the same as before the injury,
however, having the ability to eat reduced or lost completely, even temporarily, was unexpected
and difficult, and caused strong emotional reactions, even 18 months after injury. Time spent
using a feeding tube had a negative, but not persistent, impact on quality-of-life. The preliminary
findings provide knowledge regarding the patient perspective of adapting to and developing new
strategies for activities related to eating, however, further prospective, longitudinal research in a
larger scale and with repeated interviews is needed.
WCNR-0216
BOARD NUMBER: 049
FACTORS ASSOCIATED WITH DIZZINESS AND BALANCE PROBLEMS FOLLOWING
TRAUMATIC BRAIN INJURY (TBI)
I. Kleffelgaard1, B. Langhammer1, T. Hellstrom2, M. Sandhaug3, C. Roe2, H.L. Soberg2
1Oslo and Akershus University College, Intstitue of Physiotherapy, Oslo, Norway
2Oslo University Hospital, Department of Physical Medicine and Rehabilitation, Oslo, Norway
3Statped, Head Office, Oslo, Norway
Aims
To describe and explore socio-demographic, injury-related and post-injury functioning factors
associated with dizziness and balance problems in a TBI population.
Method
An RCT with baseline assessments of 65 patients admitted to Oslo University Hospital 3.5
months after a TBI. Thirty-nine (69.2 %) were women. Mean age was 39.8 (SD: 13.1) years.
Socio-demographic factors, injury related factors and outcome measures of functioning and
health related quality of life (HRQL) were registered. Univariate regression analyses were
performed to test the associations between these factors and the main outcome measure
Dizziness Handicap Inventory (DHI).
Results
The patients had mild/moderate TBI (Mean GCS: 14.4). 71 % had a higher education (>12
years), and 83% were on partial/complete sick leave. Results on the outcome measures are
presented in mean (SD): The patients reported moderate to severe dizziness: DHI 45.1 (18.1),
Vertigo Symptom Scale-sf (VSS-sf):18.4 (9.8), considerable post-concussion symptoms:
Rivermead post-concussion symptoms questionnaire (RPQ): 32.9 (9.9), and some psychological
distress: Hospital anxiety and depression scale 15.5 (7.9). HRQL on the Quality of life after brain
injury(QOLIBRI) was 53.1 (17.3). Performance based scores on balance and mobility were below
norms: Balance error scoring system (BESS): 28.9 (10.1) and High mobility assessment tool for
TBI (HiMAT) 40.1 (10.6). Sick-leave (p=0.012), pre-injury co-morbidity (p=0.008) and neck pain
(p=0.033) showed significant associations with DHI at baseline. All outcome measures showed
significant associations with DHI: VSS-sf (p<0.001), RPQ (p<0.001), HADS (p<0.001), QOLIBRI
(p<0.001), BESS (p<0.002) and HiMAT (p=0.001).
Conclusion
Dizziness reported on the DHI was associated with neck-pain, sick leave, pre morbid comorbidities, psychological distress, post-concussion symptoms and self-reported and
performance based measures of dizziness and balance/mobility. Further analyses are needed,
but clinicians should pay attention to complaints of dizziness and their relations to return to work,
psychological distress, post-concussion symptoms and quality of life.
Clinical Trials # NCT01695577
WCNR-0664
BOARD NUMBER: 050
PRELIMINARY STUDY FOR CRITERION VALDITY OF THE JAPANESE VERSION OF THE
QOLIBRI (QUALITY OF LIFE AFTER BRAIN INJURY).
I. Kondo1, M. Suzuki2, K. Ota3, M. Naito4, E. Saitoh5, N. von Steinbüchel6, K. Von Wild7,
H. Poinstingl1
1National Center for Geriatrics and Gerontology, Rehabilitation medicine, Obu, Japan
2Fujita Health University- School of Health Sciences, Faculty of Rehabilitation, Obu, Japan
3International University of Health and Welfare Hospital, Department of Rehabilitation Medicine,
Nasushiobara, Japan
4Nagoya University Graduate School of Medicin, Department of Preventive Medicine, Nagoya,
Japan
5Fujita Health University School of Medicine, Department of Rehabilitation Medicine 1, Toyoake,
Japan
6University Medical Center Göttingen, Institute of Medical Psychology and Medical Sociology,
Göttingen, Germany
7Medical Faculty Munster University, Neurosurgery, Munster, Germany
Introduction: The Quality of Life after Brain Injury (QOLIBRI) questionnaire is a cross-culturally
developed instrument to assess HRQoL of individuals after TBI. However the self-reported
health-related quality of life (HRQoL) measure has not yet been introduced to Japan. This study
was performed to assess the reliability and validity of the Japanese version of the QOLIBRI. It
was compared with the generic SF-36 (PCS and MCS).
Methods: Participants were 82 Japanese after TBI（68 male, 14 female, average age: 41.9, SD:
19.5. They completed the QOLIBRI, the Short Form (SF-36) version 2 and the Hospital Anxiety
and Depression Scale (HADS). With the Glasgow Outcome Scale-Extended (GOS-E) recovery
from disability was assessed. We examined how the QOLIBRI total and subscores performed and
were related to the SF-36. In order to determine the reliability, Cronbach’s alpha and ICC were
examined.
Results: 5% of the subjects were classified by GOS-E as good recovery, with 44% and 38%
classified as moderate and severe disability, respectively. Mean scores of the Japanese QOLBRI
scales were lower than those reported in Australia. The Total QOLIBRI score positively correlated
with PCS and MCS (r=0.46 and r=0.45, respectively; P
Conclusion: The classification of the Japanese subjects by GOS-E showed different proportions
from previous studies, which might lead to their lower QOLIBRI scores. Although QOLIBRI and
SF-36 differ in approach, their results were comparable as reported previously. QOLIBRI scores
negatively correlated with HADS, suggesting that higher HRQoL scores leads to less anxiety and
depression.
WCNR-0504
BOARD NUMBER: 051
THE EFFECTS OF ELECTROMAGNETIC FIELD THERAPY IN THE MANAGEMENT OF
COMPLEX REGIONAL PAIN SYNDROME TYPE I
A. Küçükdeveci1, I. Cömertoglu1, A. Elhan2, S. Kutlay1
1Ankara University, Department of Physical Medicine and Rehabilitation, Ankara, Turkey
2Ankara University, Department of Biostatistics, Ankara, Turkey
Aims
Complex regional pain syndrome (CRPS), usually initiated by exposure to a harmful stimulus, is
characterized by pain, vasomotor/sudomotor abnormalities, and sensory, motor and trophic
changes. The goal of therapy is to reduce pain and provide functional recovery of the affected
extremity. Electromagnetic field therapy (EMT) is commonly used in the management of various
musculoskeletal disorders with its anti-inflammatory, anti-edema and tissue healing effects. The
aim of this randomized, controlled, open study was to investigate the effects of EMT prescribed in
addition to routine physical therapy and exercise program in patients with CRPS.
Method
32 patients with CRPS type I of the hand participated. Patients were randomized into EMT (n=16)
and control (n=16) groups. Hot pack, TENS, desensitization and exercises were given to both
groups. While control group received only this therapy, 10 Hz, 40% intensity electromagnetic field
was applied to EMT group as add-on therapy. All patients received 20 therapy sessions (5
sessions per week, total 4 weeks), and were assessed before and after the therapy as well as at
the first month follow-up. Assessment parameters were pain intensity by 0-10 Numeric Rating
Scale, grip/pinch strength, hand circumference, hand dexterity by Moberg pick-up test, hand
activities by Duruoz Hand Index, and ultrasonographic measurement of subcutaneous tissue
thickness.
Results
Both groups showed significant improvements in all assessment parameters (p<0.05) after the
therapy and at the first month follow-up. When 2 groups were compared regarding the
improvements (percentage of change) in assessment parameters, no statistically significant
difference was found between the EMT and control groups in any of the parameters (p>0.05).
Conclusion
EMT applied in addition to routine physical therapy and exercise program did not provide extra
benefit in the treatment of CRPS type I.
WCNR-0703
BOARD NUMBER: 052
Go Baby Go Cafe: Use of a Low Technology Immersive Rehabilitation Environment to
Promote Functional Recovery in Traumatic Brain Injury Survivors
D. KUMAR1, J.C. Galloway1
1UNIVERSITY OF DELAWARE, PHYSICAL THERAPY, NEWARK, USA
Aims
Treatment for brain injury survivors involves two general phases: physical, occupational and
speech therapy within a clinical setting followed by vocational training.Two issues are addressed
here: 1) the potential advantage of co-treating within a complex, real world environment which in
this case is functioning business, and 2) use of technology to allow participants to be functionally
mobile before they can walk independently within that environment.
Method
Participant was a 34 year old with a history of a severe head injury 17 years ago. Intervention
was provided within the Go Baby Go Café at the University of Delaware.The Café is a functioning
eatery that serves snacks and beverages. Within the Café is a 10’ x 10’ mechanical structure
equipped with an overhead harness.This allowed the participant to freely move throughout the
café performing various tasks during two-hour shifts, three times a week for 2 months. Clinical
outcome measures like Jebson Hand Taylor Function Test (JHFT), 10 M walk test, Trail Making
Test B (TMT B) and Neuro QOL were used at baseline, 1 and 2 months of intervention.
Results
The subject improved by 1.54 minutes with the left hand and 1 minute with the right of the JHFT.
The 10 M walk test showed an improvement in walking speed by 55% at 2 months of intervention.
TMT B showed improvement by 54% indicating twice as fast processing speed.The Neuro QOL
showed positive changes in various social activities, feeling of well being, and gross motor
function domains.
Conclusion
Participation in the café was associated with wide spread gains in a variety of physical, cognitive,
quality of life outcomes. Our focus is now on conducting group studies that build on this initial
report to test specific hypotheses about the effect of this novel immersive environment to address
comprehensive interventions and job training for various patient populations.
WCNR-0678
BOARD NUMBER: 053
FUNCTIONAL OUTCOMES AFTER INTENSIVE REHABILITATION IN SUBACUTE AND
CHRONIC ACQUIRED BRAIN INJURY: COMPARATIVE ANALYSIS BETWEEN TRAUMATIC
BRAIN INJURY AND STROKE
H. LEE1, T.W. KIM1
1National Traffic Injury Rehabilitation Hospital, TBI rehabilitation centerDepartment of Rehabilitation Medicine, Yangpyeong-Gun, Republic of Korea
Aims
To evaluate the effects of intensive rehabilitation on the functional outcome of patients who were
in subacute and chronic stage of recovery after traumatic brain injury (TBI) and stroke
Method
A retrospective study was performed on 62 patients of moderate to severe brain injury (37 with
cerebrovascular and 25 with traumatic) who received 3 months inpatient rehabilitation program
(more than 5-hour/day) among all 151 inpatients attending TBI rehabilitation center of National
Traffic Injury Rehabilitation Hospital during the period 2014-2015. Each TBI and stroke patients
was divided into 3 groups according to the stage of recovery (1~6months, 7~12 months, >12
months after brain injury). The clinical features and outcomes based on the Modified Barthel
Index (K-MBI), Berg Balance Scale (BBS), Manual Muscle Testing (MMT), Global Deterioration
Scale (GDS) and Mini-Mental State Examination (MMSE-K) on admission and discharge were
compared.
Results
Subacute stroke and TBI patients showed significant improvement all outcome measures.
Subacute TBI patients showed significantly more improvement after 3 months rehabilitation
compared to stroke patients in BBS, hemiplegic shoulder MMT, and urinary incontinence score
(p-value 0.0368, 0.0219, 0.0365 respectively). Both stroke and TBI patient groups at chronic
(7~12months) recovery stage showed significant advance in MMSE-K, total, dressing, and
transfer variables of K-MBI, and BBS. TBI group documented significantly more enhancement in
dressing than chronic stroke group (p-value 0.0145). In stroke and TBI patient groups at more
chronic (>12months) stage, MMSE and total K-MBI were significantly advanced but the extent of
improvement was not significantly comparable between the groups.
Conclusion
Patients with TBI are likely to continue recovering to higher levels of activities of daily living than
patients with stroke, though significant enhancement in the stroke group is still possible. High
intensity rehabilitation including activities of daily living program is encouraged for patients of
moderate to severe TBI, even in initial chronic recovery stage.
WCNR-0333
BOARD NUMBER: 054
SPECIALIZED CROSS-DISCIPLINARY REHABILITATION PROGRAM REDUCES
PERSISTENT SYMPTOMS IN POST-CONCUSSIVE SYNDROME - A RANDOMIZED
CONTROLLED PHASE I-II STUDY
H. Malá Rytter1, K. Nielsen2, F. Humle2
1University of Copenhagen, Department of Psychology, Copenhagen K, Denmark
2Center for Rehabilitation of Brain Injury, Center for Rehabilitation of Brain Injury, Copenhagen S,
Denmark
Aims
To evaluate the effectiveness of a specialized, cross-disciplinary rehabilitation program with
standard care for people suffering from persistent post-concussive syndrome.
Method
Design: Randomized controlled trial. Setting: Specialized post-acute brain injury rehabilitation
center. Participants: Participants suffering persistent symptoms after concussion (chronicity > 6
months) were recruited via referrals from the community. Eighty-nine participants who met
inclusion criteria were randomly allocated to treatment conditions. Interventions: The specialized
rehabilitation program (S-REHAB) consisted of a 22-week long treatment combining individual
and group-based neuropsychological treatment with physical therapy and coaching within a
therapeutic environment. The treatment emphasized the cognitive and educative aspects
together with counselling regarding the management of physical and mental energy (n=45). The
standard care (STAND) was the usual treatment offered by the public services and ranged from
no treatment at all to a referral to individual, discipline specific therapies (n=44). Outcome
Measures: The outcome measures elucidated the persistent physical, cognitive and emotional
symptoms and were assessed immediately after completed treatment and at 6 month follow-up.
They included The Headache Impact Test (HIT 6), Rivermead Postconcussion Symptoms
Questionaire (RPSQ), Multidimensional Fatigue Inventory (MFI-20), and Major Depression
Inventory (MDI).
Results
Regarding HIT-6 and MDI, there was a significant (p<0.05) reduction in the symptoms in the SREHAB group at 6-month follow-up compared to the STAND group. The RPSQ showed a
significant reduction in symptoms in the S-REHAB group both immediately after treatment and at
6-month follow-up. Regarding MFI-20, the S-REHAB group reported significantly improved scores
at 6-month follow-up on dimensions ‘reduced activity’, ‘reduced motivation’ and ‘mental fatigue’.
Conclusion
The specialized rehabilitation program is an effective instrument to reduce the persistent
symptoms after concussion and mild head injury. Improvements seen after specialized
intervention can greatly impact the general functioning of these individuals. The results show the
feasibility and effectiveness of a comprehensive, individually tailored rehabilitation.
WCNR-0274
BOARD NUMBER: 055
TREATING MCARDLE PATIENTS BY IMPROVING EXERCISE AND DIET
A. Martinuzzi1, M. Vavla1, D. Berto1, E. Carraro1, E. Trevisi1, E. Russo1, S. Modolo1, A. Amadio1
1E. Medea Scientific Institutte, Conegliano-Pieve di Soligo Research Centre, Conegliano, Italy
Aims
Exercise may be one of the most effective interventions for patients with various forms of
myopathies. Patients with McArdle’s disease (MCA) benefit from aerobic training and diet
manipulation. In spite of this the translation of these indications into day to day practice is difficult
for the need to individually tailor the exercise program and to assure compliance. In the context of
the activities of EUROMAC, the European registry for muscle glycogenoses
(www.euromacregistry.eu), we tested an individualized and supervised training program for MCA
patients.
We aimed at establishing and experimenting an individualized supervised training program for
MCA patients.
Method
We structured a one-week protocol for MCA consisting in: presentation meeting, blood tests,
functional tests, evaluation of the psychological profile and of dietary habits. Patients attended
three day exercise training including aerobic and strengthening exercises. There was a mix of
individual and group activities. Patients were given instruction for home activities and were
monitored for compliance via regular phone calls. Functional tests were repeated at 6 and 12
months. A structured questionnaire investigated the patients’ perception of the program.
Results
We recruited 13 patients. Age range 22-60.
The baseline assessment confirmed the functional heterogeneity among the MCA patients and
the poor adherence to previous medical instructions about dieting and exercise.
The protocol was well tolerated. Phone monitoring was successful in improving compliance with
exercise and diet indications.
Motor performance after the exercise training improved in over 50% of patients. Patients felt very
positive being attended from a specialists and being able to share their experiences with other
patients. The need to take leave from work was seen as a relevant obstacle to
participation.Conclusion
Transferring the indications for exercise and diet for MCA patients into a structured supervised
group protocol improves acceptance, safety, compliance and efficiency.
WCNR-0071
BOARD NUMBER: 056
NONPHARMACOLOGIC THERAPIES FOR LUMBOSACRAL RADICULAR SYNDROME: A
REVIEW OF THE LAST TEN YEARS EVIDENCE
A. Musumeci1, U. Carraro2, S. Masiero3
1Physical Medicine and Rehabilitation, Orthopedic Rehabilitation Unit, Padova, Italy
2IRCCS Fondazione Ospedale San Camillo, Carraro- UgoInterdepartmental Research Center of Myology- University of Padova, Venice, Italy
3Physical Medicine and Rehabilitation, Orthopedic Rehabilitation Unit, Padua, Italy
Aims
The lumbosacral radicular syndrome(LRS), also called sciatica, is a disorder with radiating leg
pain below the knee with or without neurological deficits.Many non-pharmacological therapies for
LRS are available.
Purpose:To assess the benefits of physical therapies for LRS in the last ten years studies.
Method
Only English-language Clinical Trials were identified through searches of MEDLINE(from January
2005 until September 2015) and selected.
We abstracted information about study design, population, interventions, duration of treatment
and follow-up,outcomes.To grade methodological quality, we used the Cochrane Back Review
Group criteria.
Results
584 abstracts were identified by searches. Of these, 28 seemed potentially relevant: 21
Randomized Clinical Trials (RCT), 7Observational Studies ( 5Prospective Cohort Studies [PCS],
1Retrospective, 1Quality Research Study [QRS]).(see Table on Exercise versus other
interventions).
Exercise also improved symptoms in 1Large Retrospective study and 1QRS.
Other interventions produced effective results: Spinal Manipulation (SM) (2RCTs, 1 PCS), Lowlevel laser therapy (2RCTs without follow-up, 1PCS [associated to TECAR therapy]), Mechanical
Traction (MT) combined to interferential therapy and hot packs (1RCT), TENS (1RCT),
Acupunture(1RCT),Yoga and Ayurvedic medicine (1Low-quality RCT), Massage (1PCS),Spinal
Cord Stimulation (1PCS). 2RCTs on Magneto-therapy produced inconsistent results.
INTERVENTION
VS
INTERVENTION
BENEFIT
QUALITY OF
METHODOLOGY
STUDY
Nonoperative
Surgery
Uncertain
6/9
Weinstein,2006
Nonoperative
Percutaneous
surgery
Percutaneous
Surgery
6/9
Erginousakis,2011
Exercise
Active life after
surgery
Uncertain
7/9
Donaldson,2006
Exercise(general)
Exercise(specific)
Specific
8/10
Hebert,2015
after surgery
Exercise
Exercise(general)
Exercise(specific)
Specific
Exercise
8/9
Albert,2012
Exercise+GP
advice
GP advice
Exercise+GP
advice
9/9
Luijsterburg,2008
Exercise
Epidural injection
Epidural
injection
2/9
Vihelmann,2006
Exercise + Epidural
Epidural injection
injection
Epidural
injection
5/9
Tackeray,2010
Exercise
SM
SM
8/9
Gudavalli,2006
Exercise ±
MT
Exercise+MT
6/9
Prasad,2012
Exercise ±
Conclusion
MT
Exercise+MT
8/10
Fritz,2007
There is good evidence on the efficacy of the exercise in LRS. The evidence for SM and MT
associated to exercise is fair.There is currently limited information available from RCTs to assess
the role of the other therapies.
WCNR-0525
BOARD NUMBER: 057
ENHANCING EMOTIONAL INSIGHT AFTER TRAUMATIC BRAIN INJURY: A TREATMENT
FOR ALEXITHYMIA
D. Neumann1, T. Langston2, J. Malec3, F. Hammond3
2University of Indianapolis, Psychology, Indianapolis, USA
Aims
Alexithymia (poor emotional insight) is a common problem after traumatic brain injury (TBI),
ranging between 30 and 60%. The purpose of this study was to explore the feasibility and
preliminary effectiveness of an intervention designed to improve emotional insight in people TBI.
Method
Eight adults who had a moderate to severe TBI, were a minimum of one year post-injury, and had
moderate to severe alexithymia (poor emotional insight) completed an intervention to improve
their emotional awareness. Participants were pre- and post-tested on two main outcome
measures of emotional awareness: the Toronto Alexithymia Scale-20 (TAS-20) and the Levels of
Emotional Awareness Scale (LEAS). The intervention consisted of eight 60-90 minute sessions
(2 per week) for one month. Sessions were one-on-one between a therapist research assistant
and participant, in which a web-based training program was used to deliver structured content
and exercises aimed at enhancing participants’ emotional vocabulary, emotional insight, and
interoceptive awareness.
Results
Participants' scores showed significant improvements post-intervention on both the TAS (p=.014,
dCohen =1.15 ) and the LEAS (p=.006; dCohen =1.55 ). Post-treatment satisfaction scores showed
strong satisfaction for the program.
Conclusion
These preliminary findings suggest that alexithymia can be reduced after TBI with treatment.
More research needs to be conducted using a randomized controlled trial and a larger sample.
WCNR-0487
BOARD NUMBER: 058
SHORT AND LONGER TERM OUTCOMES OF EXECUTIVE FUNCTION TRAINING IN
VETERANS WITH CHRONIC TBI
T. Novakovic-agopian1, G. Abrams2, A. chen3, G. Carlin4, J. Burciaga5, M. madore6, E. kornblith7,
F. Loya8
1San Francisco Veterans Affairs - UCSF, Mental Health, San Francisco, USA
2San Francisco Veterans Affairs - UCSF, Neurology, San Francisco, USA
3VA Northern California, Neurology, Martinez, USA
4San Francisco Veterans Affairs, Rehabilitation, San Francisco, USA
5San Francisco Veterans Affairs, Research, San Francisco, USA
6palo alto VAMC, Mental Health, palo alto, USA
7San Francisco Veterans Affairs, Mental Health, San Francisco, USA
8VA Northern California, Research, Martinez, USA
Aims
Deficits in executive control function are some of the most common and disabling consequences
of brain injury. Goal-Oriented Attentional Self-Regulation (GOALS) training was designed to
target these deficits with attention regulation training applied to participant-defined goals. In initial
study individuals with chronic brain injury significantly improved post GOALS on measures of
attention/executive function, functional task performance, and goal-directed control over neural
processing on fMRI (Novakovic-Agopian, 2011; Chen, Novakovic-Agopian et al 2011). The
objective of this study is to assess immediate and long term effects of GOALS training in
Veterans with chronic TBI
Method
32 Veterans with chronic (6+months) TBI and mild-moderate executive dysfunction were
randomized to start with either 5 week of GOALS or control Brain-Health (EDU) training matched
in time and intensity. Participants that started with EDU switched to GOALS during second 5
weeks. Assessments at baseline, weeks 5, 10 and 6 months included neuropsychological,
complex functional task performance and self-report measures of emotional regulation
Results
Post GOALS, but not EDU training, participants significantly improved from baseline on:1) overall
neuropsychological attention/executive function domain score, and following subdomain scores:
mental flexibility, inhibition, generative ability; 2) overall complex functional task performance
score, and following subdomains: planning, self-monitoring, execution, switching, maintenance of
attention; and 3) on emotional regulation self-report measures: Profile of Mood States - total
mood disturbance, depression, tension, confusion, anger; and BDI-II depression. At follow-up
evaluation 6+ months post GOALS training, participants maintained significant improvements in
most of the above domains, and majority reported incorporating trained strategies into their daily
life
Conclusion
GOALS training may be promising in Veterans with chronic TBI. Improving cognitive control
functioning may also improve functioning in other domains such as emotional regulation and
functional performance. The challenges and importance of using participant-defined goals applied
to relevant training and assessing change in functioning at different levels will be discussed
WCNR-0293
BOARD NUMBER: 059
THE MEASUREMENT OF SCAPULA MOVEMENTS WITH ELECTROMAGNETIC TRACKING
SYSTEM IN PATIENTS WITH FACIOSCAPULOHUMERAL MUSCULAR DYSTROPHY
O. Onursal1, C. Demirci1, E. Turgut1, E. Ayvat1, F. Avcu1, M. Kilinç1, I. Düzgün1, S. Aksu Yildirim1
1Hacettepe University Faculty of Health Sciences, Physiotherapy and Rehabilitation, Ankara,
Turkey
Aims
Facioscapulohumeral muscular dystrophy (FSHD) is a complex inheritable muscle disease. Many
newer studies reported that FSHD as the most prevelant type of muscular dystrophy. The usual
location of weakness at onset is shoulder girdle and upper arm. These weakness causes the
reduction of scapular stabilisation and scapular winging. Because of these stabilisation problems
patients usually can not elevate and abduct his arms above nineteen degree. Although it is known
that there is a problem in stabilizing the scapula, there is no detailed information about the
scapular movement in FSHD. The aim of this study was to analyze the scapular motion of FSHD
patients and compare this motions with healthy control group with electromagnetic tracking
system.
Method
Eight patients with FSHD (4M/4F) who has scapular stabilization problems and eight healthy
subjects were included to the study. Three-dimensional scapular kinematics were analyzed with
electromagnetic tracking system for all participants. Kinematic recording of scapular internalexternal rotation, upward-downward rotation and anterior-posterior tilt were assessed during
scapular plane 30°, 60°, 90° and 120° elevation when available. Mann- Whitney U test used to
compare pooled data from bilateral shoulders.
Results
Comparisons between FSHD and health shoulders indicated that scapula was more intenally
rotated at 30 (Median (IQR); 41.2(18.9), 23.6(8.3), relatively) and 60 (45.1 (12.9), 27.5(11.2),
relatively) of humerothoracic elevation and more downwardly rotated 30 Humerothoracic
elevation (12.5 (26.8), -1.14 (3.6), relatively) in FSH. Average of the maximal humerothoracic
elevation in degrees was 67.04 (minimum 37.5, maximum 107.82).
Conclusion
The detail analysis of scapula movement will be able to give accurate knowledge to training these
group of patients.With these individually measurements clinicans will able to know how much the
scapula need stabilisation training in which positions.
WCNR-0418
BOARD NUMBER: 060
INTERIM RESULTS OF LONG-TERM SAFETY ANALYSIS OF 3 MG/ML OF BACLOFEN
INJECTION ADMINISTERED THROUGH INTRATHECAL ROUTE
T. Patel1
1, New York, USA
Aims
To assess the rate of granuloma formation and to demonstrate the safety of 3mg/mL baclofen
(Mallinckrodt Pharmaceuticals, Inc., St. Louis, MO) administered through intrathecal route using a
SynchroMed® II (Medtronic Inc., Minneapolis, MN) pump over a 9-month treatment period.
Method
A prospective, open-label, single-arm, long term safety study. Multi-center trial conducted across
13 centers within the United States.
Results
Of the 153 enrolled subjects (age range 4-69 years old), 108 (70.6%) completed their 9-month
follow-up at the time of this safety analysis. A total of 50 serious adverse events (SAEs) were
reported in 29 subjects (19%), of which 4 events (n=3; 2.0%) in 3 subjects (2.0%) were reported
to be related to the study medication. None of the reported SAEs were considered unexpected
based on the safety profile of intrathecal baclofen. Among the 97 (63.4%) study subjects who
experienced at least one TEAE, 13 (8.5%) adverse events were considered treatment related by
the investigator. Overall, seven subjects presented with clinical signs and symptoms suggesting
further evaluation to rule out granuloma. Results from MRI in 6 subjects and CT scan in one
subject confirmed absence of any masses or catheter tip granulomas in all seven subjects.
Conclusion
No confirmed masses or catheter tip granulomas were seen in subjects who were administered
GMP-manufactured 3 mg/mL baclofen via intrathecal pump during the 9-month duration. The 3
mg/mL concentration of GMP-manufactured baclofen appears to be safe and well-tolerated in the
study population.
WCNR-0571
BOARD NUMBER: 061
INDIVIDUALIZED QUALITY OF LIFE OF SEVERELY AFFECTED MULTIPLE SCLEROSIS
PATIENTS: PRACTICABILITY AND VALUE IN COMPARISON TO STANDARD INVENTORIES
E. Pietrolongo1, A. Giovannetti2, A. Giordano3, V. Cimino4, A. Campanella2, G. Morone5,
A. Fusco5, A. Lugaresi1, P. Confalonieri2, F. Patti4, M. Grasso5, M. Ponzio6, S. Veronese7,
A. Solari on behalf of the PeNSAMI project3
1G. d'Annunzio University of Chieti-Pescara, Department of Neuroscience Imaging and Clinical Sciences, Chieti, Italy
2Foundation IRCCS Neurological Institute C. Besta, Unit of Neuroimmunologyand Neuromuscular Diseases, Milan, Italy
3Foundation IRCCS Neurological Institute C. Besta, Unit of Neuroepidemiology, Milan, Italy
4University Hospital Policlinico Vittorio Emanuele, Neurology Clinic- MS Centre, Catania, Italy
5Foundation IRCCS S. Lucia Rehabilitation Hospital-, Multiple Sclerosis Unit, Rome, Italy
6Fondazione Italiana Sclerosi Multipla FISM, Departmentof Research, Genova, Italy
7FARO Charitable Foundation, FARO Charitable Foundation, Torino, Italy
Aims
Individualized quality of life (QoL) measures differ from traditional inventories in that QoL
domains/weights are not predetermined,but identified by the individual. We assessed
practicability and worth of the Schedule for the Evaluation of Individual QoL-Direct Weighting
(SEIQoL-DW) in severelyaffected multiple sclerosis (MS) patients, and correlation of the SEIQoLD Windex score with standard patient-reported outcome measures (PROMs).
Method
The SEIQoL-DW and other PROMs were administered at PeNSAMI trial
(ISRCTN73082124)baseline visit. Participants were non-institutionalized MS adults withsevere
MS (Expanded Disability Status Scale [EDSS] score ≥ 8.0) [Trials 2015; 16:184. DOI:
10.1186/s13063-015-0695-0.1]. Patients then received the Core-Palliative careOutcome Scale
(Core-POS), the Palliative care Outcome Scale-Symptoms-MS (POS-S-MS), the European
Quality of Life Five Dimensions, theHospital Anxiety and Depression Scale, and theFunctional
Independence Measure (FIM).
Results
Of 59 enrolled patients, 11 (19%) did not receive the SEIQoL-DW(and the other PROMs)
because of severe cognitive compromise or inabilityto communicate. SEIQoL-DW administration
was completed and deemedvalid in all 48 cases (mean age 60 years, 58% women, median
EDSS score8.5, mean FIM 56.1 [SD 16.1]). Mean SEIQoL-DW index score was 59.1 (SD 25.5).
The most commonly nominated SEIQoL-DW areas were family (94% of the
patients),relationships and leisure activities (both 65%). Core-POS and POS-S-MScontained 80%
of the SEIQoL-DW nominated areas. Nevertheless, correlations between SEIQoL-DW index,
Core-POS, POS-S-MS (and the other PROMs) were negligible. Correlation with FIM was
moderate (Spearman’s rho 0.35; p=0.01).
Conclusion
Individualized QoL can be reliably assessed in severelyaffected MS patients, providing
information that is not tracked by standard PROMs. Appraisal of QoL via an interview in which the
patient identifies his/her ownpriorities is key for the patient-provider communication and goal
setting.
WCNR-0146
BOARD NUMBER: 062
CHANGES IN NEURAL NETWORK RESPONSE AFTER PROPIOCEPTIVE STIMULATION IN
PATIENTS WITH DISORDERS OF CONSCIOUSNESS
G. Rivera1,2, J. Egaña3, M. Pedro4
1Universidad de Chile, Department of Kinesiology, Santiago, Chile
2Clínica Los Coihues, Department of Neurorehabilitation, Santiago, Chile
3Universidad de Chile, Department of Anesthesiology, Santiago, Chile
4Universidad de Chile, Department of Physiology- Biomedical Neuroscience Institute, Santiago,
Chile
Aims
Vegetative state is a disorder of consciousness (DOC) characterized by lack of a sustained,
reproducible or voluntary behavioral responses to stimulation. Previous reports have showed that
propioceptive stimulation in those subjects induce an increment in the excitability across different
cortical and subcortical areas. The purpose of this study is evaluate the capacity of propioceptive
stimulation in modify the activity of neural network associated with the processing of auditory
stimuli. We propose that proprioceptive stimulation affects the pattern of neural activity, reflected
in changes in the oscillatory activity of delta/theta and alpha band.
Method
We recorded data from twelve subjects with conscious disorders and ten control subjects. We
measured the oscillatory activity (24-Channel EEG) related to auditory stimuli using a classical
oddball paradigm where the deviant stimulus was the patient's own name pronounced by a family
member. This paradigm was presented before and after fifteen minutes of 110Hz mechanical
stimulation at neck muscles.
Results
Previous to propioceptive stimulation was possible to observe significant changes in delta, theta
or alpha band power spectrum in response to deviant and standard stimuli in the most of
conscious disorders patients. Similar to previously reported in normal subjects, most of patients
showed a increase in delta/theta and change in alpha power after the deviant stimuli, mostly
seen in Cz, around 200-900ms. This changes in neural oscillatory activity was severely
diminished after fifteen minutes of propioceptive stimulation.
Conclusion
These results may be related to the capacity of the proprioceptive stimulation to modify the
dominant activity pattern of the neural network. Changes in the excitability induced by
proprioceptive stimulation could favor the participation of areas that typically remain inhibited,
affecting the limited neural organization and response related to information processing.
WCNR-0325
BOARD NUMBER: 063
REHABILITATION IN SEVERE HEAD INJURY: MIXED CHALLENGES, OPPORTUNITIES
AND STRATEGIES
D. Sadana1, J. Rajeswaran1
1National Institute of Mental Health and Neurosciences, Clinical Psychology, Bangalore, India
Aims
Traumatic brain injury (TBI) is a complex injury with a broad spectrum of symptoms and
disabilities. Persisting disability after brain damage usually comprises both cognitive and physical
handicap. The cognitive component is often the more important in contributing to overall social
disability. The challenges in rehabilitation of such patients are unique as the basic capacities for
attention, orientation and comprehension are compromised.
Method
An intensive case series design was followed for this study. 5 cases (young males in the age
range of 24-26 years who sustained severe head injury after RTA) were referred for
Neurorehabilitation. Neuropsychological assessment and cognitive rehabilitation were attempted
through holistic rehabilitation techniques.
Results
Patients were not amenable for a comprehensive neuropsychological assessment. Personality
attributes such as low frustration tolerance, irritability, aggression were major challenges in
initiating rehabilitation. With EEG Neurofeedback training cooperation and motivation for recovery
were enhanced but the improved insight opened the gateways for a wide array of existing
cognitive dysfunction.
Conclusion
Most patients with severe head injury are managed only on pharmacotherapy and are a daunting
challenge for the caregivers as well as rehabilitation specialists. This paper would highlight
challenges, opportunities for rehabilitation and provide suggestions for including this population in
mainstream cognitive rehabilitation.
WCNR-0198
BOARD NUMBER: 064
FATIGUE AND ITS IMPACT ON QUALITY OF LIFE IN PATIENTS WITH GUILLAIN BARRE
SYNDROME: OCCUPATIONAL THERAPY PERSPECTIVE
P. SAWANT1
1, Mumbai, India
Aims
To study the effect of Occupational therapy intervention on fatigue levels & quality of life and
understand the impact of fatigue on quality of life.
Method
23 randomly selected patients in the age group 20-50 years, diagnosed with GBS, were
subjected to 8 weeks Occupational Therapy programme in this Prospective Interventional study.
Outcome measures were Fatigue severity scale and WHO Quality of Life- BREF.
Results
Statistical analysis was done using Repeated measure ANOVA.
There was decrease in Fatigue Severity Scale mean score from baseline (46.57 ± 4.785) to 8 th
week (25.26 ± 1.137) and increase in WHO QOL Physical Domain mean score from baseline
(44.83 ± 5.416) to 8th week (73.22 ± 10.475) of therapy, Psychosocial domain mean score from
baseline (44.52 ± 2.502) to 8th week (72.57 ± 10.500) , Social Relationship Domain mean score
from baseline (44.52 ± 5.984) to 8th week (73.61 ± 9.787) , Environmental Domain mean score
from baseline (44.26 ± 1.251) to 8th week
(64.78 ± 8.174).
Results were statistically significant at P< 0.01 (95% confidence level)
Conclusion
The changes in the outcome variables indicate the effectiveness of the Occupational Therapy
intervention programme in terms of reduced Fatigue and improved Quality of life in above
represented data.
WCNR-0551
BOARD NUMBER: 065
PATIENT AND FAMILY PERSPECTIVES OF GOAL SETTING AFTER SEVERE ACQUIRED
BRAIN INJURY
J. SCHMIDT1, N.A. Lannin2, K. Roberts3, C. Unsworth2, K. D’Cruz3, J. Morarty3
2LaTrobe University, Occupational Therapy, Melbourne, Australia
3Alfred Health, Occupational Therapy, Melbourne, Australia
Aims
There is limited research exploring the concept of patient-centred goal setting from the
perspectives of the person with an ABI and their family. This study explored how in-patients with
severe ABI and their families experienced goal setting during hospitalisation, and aimed to
produce recommendations for clinicians working with this population.
Method
Eleven dyads were interviewed (including the person with ABI and their family member/s) using a
semi-structured questionnaire. Interviews were audio-taped, transcribed verbatim and reviewed to
develop a coding scheme and definitions. Researchers conducted line-by-line review of
transcripts (with double coding of 25% of interviews) to identify themes and sub-themes that
emerged. Additional notes were made throughout the analysis to document further ideas and
assumptions held.
Results
Four themes emerged from that encapsulated the reflections of people with ABI and their families
about goal setting during hospitalisation: 1) “Not Knowing”, which identified that the injury is new
for the patient and their family, and they are reliant on hospital staff for understanding not only
impairments but also rehabilitation trajectory; 2) “Imposing Therapist/Controlling Therapist”, which
identified that the goal-setting process is susceptible to being overtaken by the clinician in the
hospital setting; 3) “Building Trust”, which identified that patients and their families need to be
able to trust that the clinician team are ‘experts’ and that they will listen to their goals and
aspirations without imposing their own goals; and finally 4) ‘Sharing Power’, which identified the
importance of feeling part of a bigger team when you commence rehabilitation after severe ABI,
that rehabilitation is driven by the patient themselves and their family, but that the power in the
relationship is shared.
Conclusion
Findings will assist rehabilitation professionals to understand the need to share power during
goal-setting in order to develop trust with adults with severe ABI.
WCNR-0552
BOARD NUMBER: 066
PATIENTS WITH MILD TRAUMATIC BRAIN INJURY THREE MONTHS AFTER INJURY:
FUNCTIONAL AND PSYCHOSOCIAL OUTCOMES
J. Schmidt1, R. Cooksley2, E. Maguire3, N. Lannin2, B. Mitra4, M. Farquhar3
2LaTrobe University, Occupational Therapy, Melbourne, Australia
3Alfred Health, Occupational Therapy, Melbourne, Australia
4Alfred Health, Emergency and Trauma Service, Melbourne, Australia
Aims
Approximately 80% of traumatic brain injuries are considered mild in severity. Mild traumatic brain
injury (mTBI) may cause temporary or persisting impairments that can adversely affect an
individual’s ability to participate in daily occupations and life roles. This study sought to identify
the prevalence of symptoms and the functional and psychosocial outcomes of participants with
mTBI three months following injury.
Method
Patients discharged from the Emergency Department of a major metropolitan hospital with a
diagnosis of mTBI were contacted by telephone three months post injury. Two questionnaires
were administered: The Concussion Symptom Inventory (CSI) Scale and the Rivermead Head
Injury Follow-Up Questionnaire (RHFUQ). Data obtained in the interviews were used to determine
the type and prevalence of post-concussion symptoms, and their impact on functional and
occupational performance.
Results
Sixty-four people with mTBI participated in the study. The majority of participants (81%) reported
that all symptoms had resolved within the three month time frame. Of those still experiencing
problems three months post mTBI, problems with workplace fatigue (23%), and an inability to
maintain previous workload/standards (13%) were reported.
Conclusion
There is a small, but clinically significant, subgroup of patients who continue to experience
cognitive, physical and behavioural symptoms three months post-mTBI. Symptoms experienced
beyond the expected three-month recovery timeframe have the potential to adversely affect an
individual’s ability to participate in daily occupations and return to work and as such, occupational
therapists should ensure accurate discharge information and follow-up support is provided post
mTBI.
WCNR-0556
BOARD NUMBER: 067
DETERMINANTS OF TRAUMATIC BRAIN INJURY PATIENTS AT KENYATTA NATIONAL
HOSPITAL, KENYA
J. Shisoka1, L. Omondi2, S. Kimani2
1University of Nairobi, School of Nursing Sciences, Nairobi, Kenya
2University of Nairobi, School of Nursing, Nairobi, Kenya
Aims
Traumatic brain injury (TBI) is a leading cause of hospital admissions associated with significant
morbidity, mortality and disability globally. TBI represent a significant growing disease burden and
a cause of death among economically active adults in developing countries. TBI as a
neurosurgical emergency, timely and rigorous intervention is critical for favorable outcome. We
sought establish the determinants of traumatic brain injury patients at Kenyatta National Hospital.
Method
A descriptive cross-sectional study utilizing purposive sampling method was used to collect data
on patients, clinical care and systems factors affecting the outcome of TBI from A&E, CCU and
surgical units of Kenyatta National Hospital. The study involved (n=91) TBI patients admitted
within 72 hours, aged 18-65 years. Data was abstracted and analyzed descriptively and
inferentially using SPSS.
Results
Study participants who were casual laborers were more at risk (p=0.043) of TBI, those above 40
years (p=0.042) and with poly-trauma (p=0.042) had poor outcome, respectively. The time lapse
from trauma to hospitalization significantly (p=0.051) impacted on TBI outcome, while the
condition improved with hospital stay (p=0.05). The TBI care factors namely timely diagnosis and
medication (p=0.001), Nursing care (p=0.055) and admission to A&E (p=0.051) and CCU
(p=0.032) influenced the patients outcome. However, admission of TBI patients to surgical wards
resulted in significantly (p<0.05) poor outcome.
Conclusion
Age, poly-trauma and timely acute intervention are important patients determinants of TBI
outcome. In addition, timely diagnosis and specific medication, nursing support and admission to
specialized units (A&E, CCU) are critical factors for survival and improved TBI outcome.
Specialized ward setup, staff training and neuro-team formation in hospital units that handle
patients with TBI should be considered as a policy and practice issue.
WCNR-0223
BOARD NUMBER: 068
THE EFFECT OF SPECIFIC GROUP BALANCE TRAINING ON BODY STRUCTURES,
ACTIVITIES AND PARTICIPATION IN AMBULANT INDIVIDUALS WITH MULTIPLE
SCLEROSIS
A.S. Smaradottir1,2, G. Karlsdottir1, J. Jonsdottir3, T. Gudjonsdottir2
1Reykjalundur, Neurorehabilitation, Mosfellsbær, Iceland
2University of Iceland, Physical Therapy, Reykjavik, Iceland
3Foundation Don Gnocchi IRCCS, Neurorehabilitation, Milan, Italy
Aims
To explore the effectiveness of 5 weeks of task-oriented balance training on all aspects of the
International classification of functioning, disability and health (ICF) in people with moderate to
severe disability.
Method
Six individuals with MS participated in 15 sessions of group training. The intervention was
focused on all aspects of balance within a task oriented approach. A single subject design was
used for two primary outcomes: Timed up and go with cognitive task (TUG cogn) and single leg
stance (SLS). Visual analysis and two standard of deviation band method were used for the
single subject design. The primary outcomes were also used for group level data analyses (quasiexperimental design) in addition with 10 m walk test, functional reach, reactive balance, modified
clinical test of sensory integration test, functional strength of abductor muscles at the hip, the
ABC Scale and Multiple Sclerosis Impact Scale (MSIS-29).
Results
Visual analysis of variability, trend, level and slope demonstrated improvement in four participants
in TUGcogn. This was confirmed with two standard of deviation band method analysis for two
measures in the withdrawal phase. Visual analysis of the SLS test showed improvement in three
participants in right SLS and two participants in left SLS. Friedman´s analysis of variance
(ANOVA) revealed a significant difference between measurements before, after and three weeks
after the intervention for right SLS (p=0,0388), right lateral functional reach (LFR) (p=0,0388) and
right hip abduction strength (p=0,0363). Post hoc analysis did not demonstrate difference
between any pair of the measures.
Conclusion
This study provides preliminary evidence of the effectiveness of 5 weeks of balance exercise
group training in improving static-and dynamic balance and functional strength in ambulant
people with MS. Thus, significant improvements were seen in two aspects of the ICF model. The
balance group training did not significantly alter participation and balance confidence.
WCNR-0521
BOARD NUMBER: 069
REHABILITATION PATHWAYS, FUNCTIONAL INDEPENDENCE AND SATISFACTION WITH
REHABILITATION SERVICES ONE YEAR AFTER SEVERE TRAUMATIC BRAIN INJURY
U. Sveen1, C. Røe2, S. Sigurdardottir3, T. Skandsen4, N. Andelic2, U. Manskow5, S.A. Berntsen6,
H.L. Soberg2, A. Anke7
1Oslo University Hospital, Physical Medicine and Rehabilitation, Oslo, Norway
2Oslo University Hospital, Department of Physical Medicine and Rehabilitation, Oslo, Norway
3Sunnaas Rehabilitation Hospital, Department of Research, Nesoddtangen, Norway
4Norwegian University of Science and Technology NTNU, Department of NeuroscienceFaculty of Medicine, Trondheim, Norway
5University of Tromso, Faculty of Health Sciences- Department of Health and Care Sciences,
Tromso, Norway
6Sorlandet Hospital, Department of Physical Medicine and Rehabilitation, Kristiansand, Norway
7University of Tromso, Faculty of Health Sciences- Department of Clinical Medicine, Tromso,
Norway
Aims
To study the pathways within rehabilitation services in a Norwegian national cohort with severe
traumatic brain injury (TBI) and the association to functional independence and satisfaction with
health care 12 months post-injury.
Method
A total of 163 adults, age 16-85 years [median 36], with severe TBI participated in a prospective
national multicentre study. The main variables were: transfer between acute care and
rehabilitation, type of rehabilitation services, functional independence, and satisfaction with health
care.
Results
75% of the patients received specialized TBI rehabilitation, 11% non-specialised and 14% no inpatient rehabilitation. In total, 48% of the patients were transferred directly to specialized
rehabilitation from acute wards in regional trauma centres. There were no differences in injury
severity between patients transferred directly and non-directly, but the direct-transfer patients
were younger. At 12 months post-injury 71% of the participants were functionally independent,
90% lived in their home. Younger age, fewer days of ventilation and shorter post-traumatic
amnesia were associated with independence. Among patients treated with specialized
rehabilitation, direct transfer to rehabilitation was associated with functional independence (OR:
4.3, p<0.01). Overall, 70% of patients were satisfied with their health care; those transferred
directly to specialized rehabilitation reported higher satisfaction.
Conclusion
A direct clinical pathway including specialized rehabilitation in dedicated units was associated
with independence and satisfaction with treatment.
WCNR-0649
BOARD NUMBER: 070
CHINESE HERBAL MEDICINE AIDED TO REHABILITATION AFTER TRAUMA BRAIN
INJURY. LATE BREAKING REPORT OF TWO CASES
D. Szabela1, Ś. Sikorska1, M. Preś-Jachimowska1, U. Lach1, J. Żyłka1, E. Paprot1, L. DardaLedzion1
1Comprenhensive Rehabilitation Centre, Department of Neurorehabilitation, Konstancin-Jeziorna,
Poland
Aims
The aim of the study was to present our experiences and the conclusions of the literature on the
subject of mechanisms of action and effects of aiding neurorehabilitation after TBI by NurAiD®
preparation derived from traditional Chinese medicine (MLC 601 and MLC 901).
Method
Neurological and functional condition of two TBI patients treated with NurAiD® II (MLC601) in
addition to rehabilitation and basic drugs were assessed before and after completing the
treatment and 18 month later. Both TBI patients were originally hospitalised in Intensive Care
Unit. On admission to our Neurorehabilitation Department both were conscious without verbal or
logical contact presenting severe pyramidal quadriparesis and severe cognitive disorder Barthel
Scale and Disability Rating Scale were assessed in both patients during hospitalisation. In
addition Coma Recovery Scale - Revised was assessed in one patient whereas Benton Visual
Retention Test and Addenbrooke's Cognitive Examination were assessed in the other.
Publications describing the neuroprotective and neuroregenerative effects of NurAiD®, especially
the effects of MLC901 in a rat model of TBI and a series of cases reports were analyzed.
Results
The description of cases shows that in the presented patients there were no side effects and
there was improvement in neurological and functional condition in measured end-points. The
animal study has been shown that MLC901 reduces infarct volume and cell death, reduces
activation of astrocytes and harmful M1 subtype microglia, prevents oedema formation and
assists resolution by modulating AQP4 expression, enhances neurogenesis and gliogenesis,
stimulates VEGF expression and improves cognitive and neurological recovery.
Conclusion
1. Neuroregenerative and neuroprotective mechanism of NeurAiD® application is multimodal.
2. NurAiD® is a safe drug
3. Neurological and functional improvement was noted in 2 described TBI patients treated
with rehabilitation and NurAiD®
4.The above-mentioned findings encourage the continuation of research on NurAiD® in TBI
in form of clinical study
WCNR-0310
BOARD NUMBER: 071
EXPERIENCES OF TREADMILL WALKING WITH AUDIO-VISUAL FEEDBACK AFTER BRAIN
INJURY
K. Törnbom1, A. Danielsson2
1Neuroscience and physiology, Section of rehabilitation and medicine, Gothenburg, Sweden
2Neuroscience and physiology, Section of rehabilitation medicine, Gothenburg, Sweden
Aims
To motivate persons with neurological impairments to be physically active is highly important. It is
central to promote neuro plasticity and physical functioning as well as general health and wellbeing. Persons with brain injuries are less physically active compared to healthy peers, and
inactivity is a major risk factor for a new cardiovascular event.
The use of virtual technology in rehabilitation has shown positive effects on the level of physical
activity as well as endurance. The purpose of this study was to explore participants’ experiences
of treadmill walking with audio – visual (AV) feedback after brain injury.
Method
Three woman and seven men, with a median age of 51, undergoing rehabilitation after stroke
(n=7) and other brain injury (n=3) were interviewed about their experiences of treadmill walking
with AV feedback. The semi structured interviews were analysed, using qualitative content
analysis. Interviews were read several times by the authors and a coding scheme based on key
concepts related to the research questions was developed. All codes retrieved from the
interviews were grouped into categories. To catch the latent meaning, categories were formulated
into themes.
Results
Themes that appeared in the interviews comprised positive and negative experiences, as well as
suggestions about how to enhance the treadmill experience. The visual feedback was mainly
considered pleasurable and exiting. However, participants who suffered from mental weariness
were ambivalent and often found the AV feedback disturbing to some extent. Several felt dizzy or
nauseas, and in some cases even panic, and therefore considered the experience as too
exhausting.
Conclusion
In general, participants enjoyed the AV feedback, and the exercise form was considered to be
safe. Participants also found it motivating and more exciting than ordinary treadmill walking.
However, to avoid negative feelings, the amount of audio - visual stimuli should be adjusted to the
capacity of each individual.
WCNR-0453
BOARD NUMBER: 072
IMPROVEMENT IN NEUROBEHAVIORAL AND PHYSICAL FUNCTION IN THE PRISM II
TRIAL OF DEXTROMETHORPHAN/QUINIDINE FOR PSEUDOBULBAR AFFECT
FOLLOWING TRAUMATIC BRAIN INJURY
F. Hammond1, W. Sauve2, F. Purayidathil3, A. Formella3, F. Ledon3, P. Shin3, C. Yonan3
1Indiana University School of Medicine, Neurology, Indianapolis, USA
2TMS NeuroHealth, Neurology, Richard, USA
3Avanir Pharmaceuticals- Inc., Health Economics and Outcomes Research, Aliso Viejo, USA
Aims
Pseudobulbar affect (PBA), a neurologic condition characterized by sudden, frequent, and
uncontrollable outbursts of laughing and/or crying, is a potential consequence of traumatic brain
injury (TBI). PRISM II, a 90-day, open-label, multicenter study measured effectiveness, safety
and tolerability of dextromethorphan/quinidine (DM/Q) for PBA following dementia, stroke or TBI.
Changes in neurobehavioral and physical function, assessed using the Neurobehavioral
Functioning Inventory (NFI) for enrolled patients with TBI are reported.
Method
PRISM II included persons with PBA secondary to nonpenetrating TBI and a Center for
Neurologic Study-Lability Scale (CNS-LS) score ≥13. Participants received DM/Q 20/10 mg twice
daily. Outcomes including the CNS-LS (primary) and NFI were assessed at Baseline and Day
90/endpoint.
Results
Of 120 enrolled participants with TBI, 87 were evaluable for effectiveness. Mean (SD) CNS-LS
improved by -8.5 (5.2) points, from 20.5 (4.3; n=87) at Baseline to 11.9 (4.4; n=67) at Day
90/endpoint (P<0.001 vs. Baseline; [1-sample t-test]). At Baseline, standardized NFI T-scores
ranged from 51.1 (10.6) for the Motor domain to -55.7 (10.9) for the Aggression domain. At Day
90/endpoint, all 6 NFI domains improved significantly vs. Baseline [P<0.001 (n=49) each]. Mean
(SD) domain T-score changes were: depression -7.1 (11.0); somatic -4.8 (9.4); memory/attention
-5.4 (9.7); communication -5.6 (9.8); aggression -5.7 (9.5); motor -4.8 (9.3).
Conclusion
Persons with TBI taking DM/Q experienced reduced PBA episode frequency and improved
neurobehavioral and physical function in this open-label study. Further evaluation of the
relationship between changes in PBA and functional measures will help clarify the impact of PBA
treatment.
WCNR-0448
BOARD NUMBER: 073
ROBOTIC ASSISTED ARM TRAINING IN A CASE WITH TRAUMATIC BRAIN INJURY
N. Yozbatiran1, Z. Keser1, M. Mas1, G. Francisco1
1University of Texas Medical School at Houston, Physical Medicine and Rehabilitation, Houston,
USA
Aims
To report the effect of robotic-assisted arm training in an adult with chronic (>12 years) traumatic
brain injury (TBI) with spastic hemiparesis
Method
Most published trials in upper limb robot-assisted therapy is in the stroke population. We describe
the case of a 51 yo right-handed male with an 18 year history of TBI secondary to a motor vehicle
crash. Robotic-assisted training with MAHI Exo-II robotic exoskeleton device was delivered for 12
sessions over 4 weeks (3 times/ week). Training included elbow flexion/extension, forearm
pronation/supination, wrist flexion/extension and radial/ulnar deviation in active mode. Upper limb
motor function and strength were tested with Jebsen Taylor Hand Functions Test (JTHFT) and
grip strength, and muscle tone was assessed with Modified Ashworth Scale at baseline and
immediately after completion of treatment.
Results
After 12 sessions of treatment JTHFT scores have changed from 0.027 items/sec to 0.044
items/sec whereas grip strength from 8.66 kg to 15.17 kg. No change was observed in muscle
tone. The only adverse event related with study intervention was moderate fatigue of the trained
arm that resolved the following day after the invention and with no lasting consequence. The
fatigue was not any different from what he had experienced with other forms of exercise or
activity. The subject reported that he gained new functions including turning the steering wheel,
turning on/off the light with light switch after the study intervention with the affected hand. Daily
robotic measurements of the impaired arm such as normalized average speed, mean arrest
period ratio, and number of speed peaks were in line with behavioral assessments.
Conclusion
This case report suggested that robot-assisted arm training is safe, feasible and induce some
functional improvement even in the chronic stages of TBI, and has laid the groundwork for larger
studies investigating safety and efficacy, and potential mechanisms for late recovery.
WCNR-0643
BOARD NUMBER: 074
EFFECTIVENESS OF A VERY EARLY STEPPING VERTICALIZATION PROTOCOL IN
SEVERE BRAIN INJURIED PATIENTS: A RANDOMIZED TRIAL IN ICU
I. Zivi1, R. Valsecchi2, S. Bonini1, S. Maffia1, K. Molatore1, L. Bettiga1, A. Zarucchi1, D. Matteri1,
G. Ercoli1, L. Sebastianelli1, R. Maestri3, L. Saltuari4, G. Frazzitta1
1"Moriggia-Pelascini" Hospital, Brain Injury and Parkinson Disease Rehabilitation,
Gravedona ed Uniti, Italy
2"Moriggia-Pelascini" Hospital, Intensive Care, Gravedona ed Uniti, Italy
3Scientific Institute of Montescano- Fondazione S. Maugeri IRCCS, Biomedical Engineering,
Montescano, Italy
4Landeskrankenhaus Hochzirl-Natters, Research Unit for Neurorehabilitation South Tyrol,
Hochzirl, Austria
Aims
Verticalization was reported to improve the level of arousal and awareness in patients with severe
acquired brain injury (ABI) and to be safe in ICU. We evaluated the effectiveness of a very early
stepping verticalization protocol on their functional and neurological outcome.
Method
Consecutive patients with Vegetative State or Minimally Conscious State were enrolled in ICU on
the third day after an ABI. They were randomized to undergo conventional physiotherapy alone
(60 min/day, 5 days/week) or associated to fifteen 30-minute sessions of verticalization (5
sessions/week, three consecutive weeks), using a tilt table with robotic stepping device (Erigo.
Hocoma AG, Switzerland) located in the ICU room. In the verticalization days the patients
received conventional physiotherapy for only 30 minutes. Once stabilized, patients were
transferred to our neurorehabilitation unit for a six-month individualized treatment. Outcome
measures (Glasgow Coma Scale, Disability Rating Scale –DRS-, Coma Recovery Scale revised CRSr- and Levels of Cognitive Functioning) were assessed on the third day from the injury (T0),
at ICU discharge (T1) and at Rehab discharge (T2).
Results
15 patients completed the study in the verticalization group and 16 in the conventional
physiotherapy one, without adverse events. Early verticalization started 12±7 days after ABI. All
outcome measures significantly improved in both groups after ICU stay (T1 vs T0, p<0.004 all),
after Rehab (T2 vs T1, p<0.004 all) and after the overall period (T2 vs T0, p<0.001 all). The
improvement was significantly better in the experimental group only for CRSr (T1-T0 p=0.006;
T2-T0 p=0.032) and DRS (T1-T0 p=0.055; T2-T0 p=0.039).
Conclusion
A stepping verticalization protocol started since the acute stages of a severe ABI improves the
short-term and long-term functional and neurological outcome of patients with disorders of
consciousness. We therefore propose its use since the first days of hospitalization in ICU, upon
the reaching of hemodynamic, respiratory and intracranial stability.
WCNR-0339
BOARD NUMBER: 075
TREATMENT/PHARMACOTHERAPY/SPEECH THERAPY - PART 1
ESTABLISHMENT OF A RESEARCH AND TRAINING NETWORK FOR APHASIA AFTER
STROKE
M. Ali1, K. VandenBerg1, M. Brady1
1Glasgow Caledonain University, NMAHP Research Unit, Glasgow, United Kingdom
Aims
Aphasia research faces methodological and infrastructural challenges, often remaining language,
region, and discipline-specific, limiting the efficiency, strength, and broader relevance of individual
research. Funded by the European Cooperation in Science and Technology (COST), the aim of
the Collaboration of Aphasia Trialists (CATs) is to enhance knowledge, skills and methodology in
aphasia research on an international level.
Method
We established a memorandum of understanding; two individuals represent each participating
country on a management committee. We established working groups to investigate (i)
assessment and outcome measures for aphasia research, (ii) prognosis and predictors of
recovery, (iii) effectiveness of interventions, and (iv) societal impact and re-integration. We
collated aphasia trial datasets to facilitate novel exploratory and secondary analyses to address
gaps in knowledge and inform trial design. We facilitated knowledge exchange across our
network through training visits at participating institutions within CATs.
Results
Our network includes more than 100 multidisciplinary members, across 22 European countries, in
addition to Australia, New Zealand and South Africa. Our active research programmes include
systematic reviews, meta-analyses, improvements in the quality of aphasia research
methodology & reporting, development of primary international aphasia research, and translation
of language assessment tools across multiple languages. We have also facilitated annual
research training visits across the collaboration, developed and informed international aphasia
research grant applications and established annual training schools, including master-classes for
aphasia researchers.
Conclusion
Expansion and integration of trial networks is essential to facilitate research translation. CATs
facilitates high-quality, synergistic international research, dissemination and training opportunities.
We welcome additional participation in this Collaboration by the aphasia research community.
Information can be found at www.aphasiatrials.org.
WCNR-0331
BOARD NUMBER: 076
EFFECTS OF TWO INTENSIVE LANGUAGE AND COMMUNICATION THERAPIES ON
SENTENCE PRODUCTION: A MULTIPLE SINGLE CASE STUDY
C. Charpié Gambazza1, L. Schneider1
1Centre Hospitalier Universitaire Vaudois, Neuropsychology and Neurorehabilitation ServiceClinical Neurosciences Department, Lausanne, Switzerland
Aims
Since 10 years constraint induced language therapy is widely used for aphasia rehabilitation.
Numerous studies have investigated the effect of this therapy using various measures such as
naming, grammatical production, generation of verbs, number of content informative units (CIU)
however the efficacy of this therapy on the quality of sentence production remains unclear, as
well as the contribution of the main variables of the protocol (intensity, constraint, setting).
This study compares the efficacy of two treatments, namely ‘Promoting Aphasics' Communicative
Effectiveness (PACE) vs. Constraint Induced Aphasia Therapy (CIAT), practiced individually and
intensively. Its goal is to determine if one therapy is more efficient than the other on the different
modalities of language (naming, comprehension…) measured by traditional standardized tests,
on specific measures of sentence production, and on informativeness.
Method
Among 4 patients with chronic Broca aphasia, 2 patients started their treatments with therapy A
(CIAT) followed by therapy B (PACE) and vice versa for the two others. The duration of treatment
was 1.5 hour per day during 10 days for each therapy. The assessments were done 5 times
(base lines 1 and 2, post treatment A, post treatment B and 1-month follow-up).
Results
For standardized tests, only 1 significant change was shown for only 1 patient (noun and action
naming test) after both therapies. For sentence production, the percentage of syntactically correct
utterances improved in 3 patients after CIAT only. For informativeness measures (CIU and
referential communication task analyzes) the scores of the same 3 patients improved after PACE
therapy.
Conclusion
Specific measures of sentence production seem more sensitive than standardized tests to
measure progress post treatment. Each therapy showed effects on different measures (sentence
production for CIAT and informativeness for PACE). Further studies using a larger sample of
patients are necessary to confirm these findings.
WCNR-0412
BOARD NUMBER: 077
COMPUTER SPEECH PRACTICE FOR DYSARTHRIA IN EARLY AND LATE POST- ONSET
TRAUMATIC BRAIN INJURY
S. Fager1
USA
Aims
Computer speech practice may be a beneficial tool to supplement speech therapy and provide
long-term speech practice support. This project compared the impact of computer speech
practice using speech recognition technology on speech performance between two individuals
with dysarthria and TBI at different stages post-onset.
Method
Two individuals with TBI (Participant 1: 2 years post-onset and Participant 2: 12 years post-onset)
who had mixed spastic-flaccid dysarthria participated in the project. Both demonstrated similar
error patterns (voicing errors) that significantly impacted their intelligibility. Ten sessions using
customized speech recognition software targeted the accurate production of final consonants in
20 words produced 5 times each. Measures were taken pre and post intervention and included
speech intelligibility and acoustic analysis using zero-crossing rate to assess voicing.
Results
Participant 1demonstrated a substantial increase in speech intelligibility pre and post intervention
(15% to 28%). Participant 2’s speech intelligibility remained unchanged pre and post intervention
(29%). On an acoustic measure of voicing for voiceless consonants, Participant 1 increased from
40.61 on the first session to 173.80 by the last session (higher zero-crossing rate indicates
voiceless consonants). Participant 2 increased from 46.53 on the first session to 132.93 by the
last session.
Conclusion
A brief stint of intense speech practice promoted speech improvement for an individual who was
relatively early in his recovery process. While the same changes in speech intelligibility were not
noted for the participant who was 12 years post-onset, it was interesting to note that intense
practice did improve his performance on acoustic measures. What remains unknown is whether
continued practice would eventually result in generalized improvements to his speech
intelligibility. These results indicate that computerized speech practice using speech recognition
may hold promise as a long-term speech practice support system for some individuals with
dysarthria regardless of time post-onset.
WCNR-0124
BOARD NUMBER: 078
BE CLEAR: A NOVEL INTENSIVE SPEECH TREATMENT FOR DYSARTHRIA FOLLOWING
STROKE AND TRAUMATIC BRAIN INJURY
D. Theodoros1, E. Finch1, S. Park1, E. Cardell2
1University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
2Griffith University, School of Allied Health Sciences, Gold Coast, Australia
Aims
Dysarthria, a motor speech disorder characterised by slurred, indistinct speech, is highly
prevalent following stroke and traumatic brain injury. The decreased speech intelligibility in
dysarthria can cause difficulties with everyday participation, resulting in significantly decreased
quality of life. Neither the effectiveness of traditional speech pathology management techniques
nor the ideal treatment intensity for non-progressive dysarthria has been rigorously investigated.
To meet this need, a novel intensive treatment (Be Clear) has been developed for nonprogressive dysarthria guided by the principals of motor learning and neuroplasticity.The aim of
the current study was to determine the feasibility of Be Clear as an intensive treatment for nonprogressive dysarthria compared to traditional dysarthria therapy.
Method
The feasibility and outcomes of Be Clear were examined in two participants matched for stroke
location, dysarthria severity and subtype, and cognitive function. P1 received Be Clear, while P2
received traditional dysarthria therapy. Both participants attended intensive therapy involving 1hour therapy sessions 4 times per week, for 4 weeks (16hrs total). Assessment of Intelligibility in
Dysarthric Speech (ASSIDS), Dysarthria Impact Profile (DIP), and paired comparison ratings
were conducted across three assessment phases; prior to treatment, immediately post treatment,
and 3 months post-treatment.
Results
Improvements varied across the assessment measures and participants. P1’s intelligibility on the
ASSIDS improved for sentences but not for words following the Be Clear treatment. In contrast,
P2’s performance on the ASSIDS improved at the word level, but not for sentences. Both
participants reported improvements on the DIP immediately following treatment. Paired
comparison ratings will also be discussed.
Conclusion
Be Clear has potential as a new treatment approach for non-progressive dysarthria, however,
further investigation is required.
WCNR-0302
BOARD NUMBER: 079
SUPPORTED CONVERSATION FOR HOSPITAL STAFF - A QUESTIONNAIRE STUDY OF
SELF-EVALUATED OUTCOME
H.B. Forchhammer1, A.P. Løvholt1, L.L. Mathiesen1, H.K. Iversen1, L.S. Larsen1, A. Norup1,
L.R. Jensen1
1Rigshospitalet, Department of Neurology, Glostrup, Denmark
Aims
It is a challenge for health professionals to involve patients with aphasia (PWAs) in their own
treatment, care and rehabilitation. Disrupted communication may also influence patient safety and
lead to social isolation.
In order to increase health care professionals’ ability to engage PWAs in communication and
interaction, Supported Conversation for Adults with Aphasia (SCA) was adapted and
implemented in a large neurological department at Rigshospitalet-Glostrup in Copenhagen.
Method
152 staff members representing different health professionals were assigned to one of eleven
courses during a six month period. Each course had 10-12 participants and lasted 6 hours,
including instruction in the SCA principles, video analysis, interdisciplinary group work, and
practice sessions with PWAs. Self-assessed learning outcomes were evaluated with a brief
questionnaire filled out by staff members immediately before course attendance and 3-6 months
afterwards.
Results
Self-rated knowledge of aphasia had significantly improved when assessed 3-6 months after the
course and improvement was seen for all groups of health professionals. Comfort and ease in
communicating with PWA and ability to solve problems in communication, also showed significant
improvements across all staff groups. After the course, more time to spend with patients was
perceived as the most important factor to further increase communication success with PWA.
Conclusion
The results show that interdisciplinary SCA-courses successfully increase hospital staff’s
confidence and self-assessed ability to communicate with PWAs.
WCNR-0256
BOARD NUMBER: 080
BRAIN PLASTICITY AND RECOVERY OF AUDITORY COMPREHENSION IN CHRONIC
POST-STROKE APHASIA
J. Hurtado1
1Universidad Mayor, Escuela de Fonoaudiología, Temuco, Chile
Aims
To confirm the efficacy of intensive language treatment in the recovery of the auditory
comprehension in a patient with chronic aphasia.
Method
A 73 year-old, right-handed man, native Spanish speaking with severe aphasia and right
hemiparesis resulting from a cerebral ischemia in the left frontal, parietal and temporal lobes. The
patient showed severe non-fluent aphasia 28 years after onset with an auditory comprehension
percentile of 37 on the Boston Diagnostic Aphasia Examination. The patient received language
treatment 1 hour a day, 3 days a week for 36 weeks which included word-level auditory
comprehension tasks. During the treatment, a follow-up of the skills was made through some of
the tasks described in the Western Aphasia Battery.
Results
After 36 weeks of language therapy, his auditory comprehension improved to 57 percentile on the
Boston Diagnostic Aphasia Examination.
Conclusion
This study reports on the auditory comprehension recovery in a chronic post-stroke aphasic
patient by intense language treatment. This significant improvement suggests brain plasticity and
functional reorganization in chronic post-stroke.
WCNR-0072
BOARD NUMBER: 081
VOICE-TRAINING-INDUCED PLASTICITY IN CHRONIC NONFLUENT APHASIA AND
APRAXIA OF SPEECH
M. Jungblut1, W. Huber2, C. Mais3, R. Schnitker4
1Interdisciplinary Institute for Music- and Speech -Therapy, Director, Duisburg, Germany
2RWTH Aachen, Cognitive Neurology, Aachen, Germany
3Interdisciplinary Institute for Music- and Speech -Therapy, Speech Terapy, Essen, Germany
4RWTH Aachen, Cognitive Neuropsyhology, Aachen, Germany
Aims
Difficulties with temporal coordination or sequencing of speech movements are frequently
reported in aphasia patients with concomitant apraxia of speech (AOS).
Evidence-based rhythmic-melodic voice training SIPARI® which was developed for language
rehabilitation focuses specifically on these problems by training rhythmic singing with differently
demanding complexity levels.
Our objective was to investigate how potential therapy-induced improvements in language and
speech-motor performance correlate with changes in brain activation.
Method
3 patients with severe chronic nonfluent aphasia and AOS were included in this therapy study.
Changes in language and speech-motor performance were examined by combining cognitive and
neural methods.
Patients underwent the same fMRI-procedure as 30 healthy control subjects in our pre-study
(Jungblut et al. 2012) in order to investigate if changes in brain activation occur due to improved
temporal sequencing.
The experiment was conducted in an event-related design. Imaging data were analyzed using
SPM8. Functional data were derived from random effects analysis with an FDR-corrected p-value
of p=0.05.Results
A main finding was that post-minus pre-treatment imaging data yielded peri-lesional activations in
all patients e.g. in the left superior temporal gyrus, whereas the reverse subtraction revealed
either no significant activation or right hemisphere activation.
A correlation could be found between improvements in temporal sequencing, intensity of
activation and recruitment of a neural network that we previously found in our study with healthy
control subjects e.g. inferior frontal gyrus, insula, and basal ganglia.
For all patients clinically significant improvements could be assessed in final language and motorspeech tests.
Conclusion
Functional reintegration of the left superior temporal gyrus is often mentioned in connection with
language improvement.
Our results suggest that especially in the treatment of severely impaired chronic aphasia patients
with concomitant AOS the applied rhythmic-melodic voice training SIPARI® can be very effective
because it targets specific language deficits but also cognitive function.
WCNR-0291
BOARD NUMBER: 082
INTENSIVE NEUROPSYCHOLOGICAL REHABILITATION IMPROVES POST STROKE
DEPRESSION & QUALITY OF LIFE IN PATIENTS WITH POST STROKE APHASIA: A PILOT
STUDY
H. Kaur1, R. Bhatia2, R. Pandey3, S. Chopra1, A. Nehra1
1All India Institute of Medical Sciences, Clinical Neuropsychology, New Delhi, India
2All India Institute of Medical Sciences, Neurology, New Delhi, India
3All India Institute of Medical Sciences, Biostatistics, New Delhi, India
Aims
Depression is a common complication post-stroke affecting approximately one-third of patients
thereby impairing their functional recovery. Hence, the objective was to evaluate the effects of 8
weeks of intensive neuropsychological rehabilitation on post stroke depression and quality of life
(QOL) in patients with Post-Stroke Aphasia.
Method
Design: An open-label, before-after pilot study.
Setting: Outpatient Stroke clinic patients referred to Clinical Neuropsychology Unit.
Participants: Fifteen patients with Post-stroke aphasia with no previous history of psychiatric or
neurological disorder, education > 10 years & mean age 49.93±15.01 years were included.
Patients had mild to moderate aphasia.
Interventions: Intensive Neuropsychological Rehabilitation comprised of home based exercises
focused on retraining attention and working memory along with aphasia therapy targeting
acoustic, speech & language, simple mathematical problems. 8 weekly follow ups were
maintained where the caregiver was trained and tasks were based on Standard Operating
Procedures. The weekly follow ups also included psycho education and supportive family
therapy. Each session lasted 1 to 1.5 hours.
Main Outcome Measures: Pre to post assessment of patients was done by the Indian Aphasia
Battery (IAB), Stroke Specific Quality of Life (SSQOL), and Stroke Aphasia Depression
Questionnaire (SADQ-10).
Results
A comparison of the measures taken before and after the intervention indicates general
improvement of language functions. QOL, as measured by the SSQOL, was increased
(improved) (P<.001). Depression symptoms, as measured by the SADQ-10, decreased
(improved) (P<.02). Interestingly, many of the improvements persisted even 4 weeks later.
Conclusion
These results show the potential to enhance quality of life and depression in patients with Poststroke Aphasia and suggest that a progressive and intensive neuropsychological rehabilitation
can be used to minimize impairments in language, depression and increase QOL in these
patients, thereby reducing the caregiver burden.
WCNR-0465
BOARD NUMBER: 083
UNDERSTANDING AND FACILITATING INDIVIDUAL RESPONSIVENESS TO APHASIA
REHABILITATION
S. Kiran1
1Boston University, Speech Language and Hearing Sciences, Boston, USA
Aims
Objective: While the evidence for efficacy of rehabilitation of language disorders is fairly robust
(Allen, et al., 2012; Brady, et al., 2012; Kelly, Brady, & Enderby, 2010; Cherney, et al., 2008), it is
difficult to understand individual responsiveness to rehabilitation and how factors such as severity
of impairment impact treatment outcomes. In previous study, we reported data examining the
effectiveness of software platform (Constant Therapy®) to deliver, monitor and analyze treatment
for individuals with aphasia (Des Roches et al., 2015). In this study, we examine individual
responsiveness to rehabilitation in closer detail.
Method
Methods. Fifty one individuals with language and cognitive deficits were administered
standardized tests (Western Aphasia Battery, Boston Naming Test, Pyramids and Palm Trees,
and Cognitive Linguistic Quick Test) prior to initiation and following completion of therapy. Thirtyeight therapy tasks were divided into language and cognitive activities that were developed (Des
Roches et al., 2015), 28 of these tasks included buttons that revealed a hint to assist the patient
answer the item. The assigned therapy tasks were tailored to that individual’s language and
cognitive impairment profile based on an initial baseline assessment.
Results
Results: In general, the more severe patients benefited from the simpler language and cognitive
tasks whereas the less severe patients improved on tasks that required a combination of
language/cognitive processing. In addition, because participants were able to self-administer the
hints for individual items, correlations between frequency of hint use and participant
language/cognitive impairment profiles showed significant negative relationships between hint
use and performance on standardized tests indicating that the more severe the participants the
more often they utilized hints to complete the therapy tasks.
Conclusion
Conclusions: Results showed that more severe patients showed more gains in treatment and
standardized tests, but were also more reliant on self-administered hints, which were not always
beneficial in terms of accuracy.
WCNR-0316
BOARD NUMBER: 084
AWAKE CRANIOTOMY AND REHABILITATION IN TUMORS OF ELOQUENT AREA: OUR
EXPERIENCE
L. Ortiz-fernandez1, A. Gutierrez-Ruiz1, P. Abaitua-Ezquerra1, I. Galarza-Ibarrondo1,
E. Santisteban-Leguina1
1Cruces University Hospital - Osakidetza, Physical Medicine and Rehabilitation, Barakaldo, Spain
Aims
The increasing prevalence of brain tumors and longer survival achieved by treatment advances
provoke a decrease on quality of life (QL). Language sites in the cortex vary among patients.The
aim is to show our experience of the multidisciplinary team of awake-craniotomy of tumors in the
eloquent area.
Method
The multidisciplinary team of our tertiary hospital has 1 rehabilitation doctor, 1 speech therapist, 2
neurosurgeons, 2 neuroanesthesiologists, 1 radiologist, 1 neuropsychologist.Neurosurgeon and
rehabilitation doctor have the ability to use brain mapping techniques to identify and avoid
injuries. Previously functional MRI and specific tests have been performed. Awake speech
mapping consists on assessing specific areas of languages by individualized tests.We assess the
patient the day before, 72 hours later, 1 month postsurgery and periodical reassessments
depending on needs.
We report a prospective descriptive serial of patients who have undergone awake-craniotomy
during the last 18 months. Barthel-index, Boston and SF 36 was performed.
Results
5:3 (M:F). Average age: 48 years (26-69). 5 started with crisis. 4 bi-trilingual. No intraoperative
complications.20% worsening at 72hours, 5% 1 month postsurgery3 needed speech-language, 1
physiotherapy.All were discharged home.5 coadjutant treatment. Excellent QL in 6. Barthel:100.
Conclusion
According to reviewed literature, although the path toward perfecting a system to treat brain
tumors in critical regions without morbidity has been long studied, presurgical and
intraoperatorive mapping presents a unique opportunity to obtain individualized information for
the surgery and for avoiding posterior rehabilitation needs. In our experience, this technique
decreases the neurological deficit, the need of speech therapy, improves QL of patients and
relatives. The role of rehabilitation doctor specialized in speech and coordination of
multidisciplinary team is essential for optimal results and uses of medical resources.More studies
should be performed to obtain further insight into neuroplasticity potential and refine our methods.
WCNR-0360
BOARD NUMBER: 085
VIGILANCE AND COGNITIVE PERFORMANCE IN APHAISA THERAPY: RESULTS FROM A
COHORT OF AGE-MATCHED CONTROLS
E. Riley1, J. Hylkema1
1Syracuse University, Communication Sciences and Disorders, Syracuse, USA
Aims
Individuals with aphasia often report increased fatigue following stroke, which may negatively
affect progress in speech and language treatment. Speech-language pathologists report that
decline in session performance is frequently observed as an indicator of client fatigue; however,
these reports are based on subjective judgments that do not clearly establish a relationship
between fatigue and cognitive performance. The objective of this experiment was to identify the
relationship between vigilance, an objectively measurable fatigue-related variable, and cognitive
performance in a group of age-matched control participants during simulated language therapy.
Method
In this experiment, we collected continuous EEG, accuracy, and reaction time data for 7
participants without neurological impairment (age 40-70 years) during a control condition (onehour non-verbal Stroop task) and during one hour of computer-simulated language therapy. The
EEG data for each experimental trial was classified into one of four cognitive state conditions 1)
high vigilance, 2) low vigilance, 3) distraction, and 4) sleep onset using each individual’s
performance on a baseline vigilance task.
Results
Participants demonstrated an overall increase in low vigilance and distraction trials over the
course of both experimental conditions, although performance accuracy remained high
regardless of EEG-detected cognitive state. Reaction time was much more variable, with
participants demonstrating patterns of increased reaction times for low vigilance and distraction
trials as compared to high vigilance trials.
Conclusion
Results of this study demonstrated that declines in EEG-detected cognitive vigilance are
associated with slowed reaction times in age-matched participants without neurological
impairment. Considering these findings, we expect to observe more pronounced performance
declines during simulated language therapy in subsequent experiments focused on participants
with stroke-induced aphasia.
WCNR-0369
BOARD NUMBER: 086
MaLT: MOTOR AND LANGUAGE TRAINING: DEVELOPMENT OF A MULTIDISCIPLINARY
MOTOR AND PHONOLOGICAL REHABILITATION TOOL
M. Wairagkar1, H. ROBSON2, L. Meteyard2, M. Pugh3, A. Smith4, M. Sperrin5, R. McCrindle1
1University of Reading, School of Systems Engineering, Reading, United Kingdom
2University of Reading, Clinical Language Sciences, Reading, United Kingdom
3Royal Berkshire Hospital, Physiotherapy and Occupational Therapy, Reading, United Kingdom
4Royal Berkshire Hospital, Clinical Engineering, Reading, United Kingdom
5Royal Berkshire Hospital, Medical Physics, Reading, United Kingdom
Aims
Home-based rehabilitation tools are requires to meet the dosage requirements of evidence based
therapy (Bhogal, et al., 2003). Motor and language impairments are frequently co-morbid in
neurological conditions such as stroke because of the proximal nature of aspects of the motor
and language network. By contrast, physiotherapy and speech and language therapy (SLT)
almost universally occur in isolation. This project aimed to develop and test a multidisciplinary
home-based impairment-level therapy tool for simultaneous upper limb and phonological
awareness rehabilitation.
Method
A multidisciplinary team of expert service users, SLTs, occupational therapists, medical engineers
and systems engineers developed three novel rehabilitation games targeting gross upper-limb
movement, single-word comprehension and phonological awareness. Games were developed
using the Microsoft Kinect2 motion sensor technology to incorporate motion and language goals
into the same task.
A small trial of n =3-5 stroke patients with co-morbid language and upper limb weakens is
ongoing. This trial uses a single subject multiple-baseline design with pre and post measures of
language, phonological awareness, upper limb movement and a control visual attention task.
Results
Three language and motor games were developed (1) spoken word picture matching, (2) initial
phoneme detection and (3) rhyme detection. Responses are made by moving the affected hand
in space to a target picture on a screen following a prompt question (see, Figure 1). Games have
three levels of difficulty based on language properties.
Feedback from user groups indicates that the games are more motivating than traditional ‘pen
and paper’ activities, however, simplicity of set-up and use is key to wide-spread uptake.
Figure 1: A Rhyme Detection Trial
Conclusion
This prototype rehabilitation tool indicates that motor and language goals can be simultaneously
targeting in a home-environment. More dynamic language exercises may be more engaging for
the patient.
Bhogal, S.K., Teasell, R., Speechley, M. (2003) Intensity of aphasia therapy, impact on recovery.
Stroke, 34:987-993.
WCNR-0161
BOARD NUMBER: 087
COMPARE: A RANDOMISED CONTROLLED TRIAL COMPARING CONSTRAINT-INDUCED
AND MULTI-MODAL APHASIA THERAPY TO USUAL CARE IN PEOPLE WITH CHRONIC
APHASIA
M. Rose1, D. Copland2, L. Nickels3, L. Togher4, M. Meinzer5, E. Godecke6, T. Rai7, J. Pierce8,
A. Foster8, M. Hurley8
1La Trobe University, Allied Health, Bundoora, Australia
2University of Queensland, Health and Rehabilitation Sciences, Brisbane, Australia
3Macquarie University, Cognitive Science, Sydney, Australia
4University of Sydney, Health Sciences, Sydney, Australia
5Univeristy of Queensland, Centre for Clinical Research, Brisbane, Australia
6Edith Cowan University, Psychology and Social Science, Perth, Australia
7University of Technology Sydney, Mathematical and Physical Sciences, Sydney, Australia
8La Trobe University, Allied Health, Melbourne, Australia
Aims
Chronic post-stroke aphasia directly impacts 30% of stroke survivors. This study aims to
determine whether two intensive and contrasting treatments Constraint Induced Aphasia Therapy
(CIAT) and Multi-Modal Aphasia Therapy (M-MAT) for chronic post-stroke aphasia are superior
and cost saving when compared to usual care treatment. Participant response to these therapies
has been found to be highly variable, with aphasia severity and co-occurring cognitive problems
likely to be key factors in treatment response. This study will be the first to fully address the
factors predicting treatment response providing better evidence for effective treatment
prescription.
Method
This is a 3-arm prospective, single-blinded, randomized controlled trial with an end point at three
months post treatment. Participants (n=198) will be randomised to CIAT, M-MAT or usual care
(UC). Both CIAT and M-MAT focus on intensive speech practice (30 hours in 2 weeks) using
interactive game formats, however M-MAT also involves gesture, writing, and drawing cues. UC
is usual health service-based aphasia therapy. The primary outcome immediately post treatment
is the Aphasia Quotient of the Western Aphasia Battery. Secondary outcomes at 3-month follow
up include measures of connected speech, multi-modal communication, and quality of life. In
addition, we will identify participant cognitive and linguistic predictors of treatment response. Rerandomised UC participants will undertake a less intense schedule (30 hours in 5 weeks) in a
nested sub-study to explore the impact of intensity of treatment on outcomes. A full cost
effectiveness analysis will be undertaken.
Results
The trial is underway with ethics approval, trial registration, and data base all established.
Recruitment from five Australian states commenced in February 2016.
Conclusion
This trial will determine the therapeutic effect of and variable response to different treatment types
in chronic aphasia. It will provide vital economic evaluative information regarding the service
delivery standards of aphasia rehabilitation.
WCNR-0164
BOARD NUMBER: 088
OBJECTIVE AND SUBJECTIVE ASSESSMENT OF LANGUAGE TELE-REHABILITATION
SYSTEM FOR PEOPLE WITH APHASIA
K. Rosen1, N. Vered1, I. Feldman2, G. Kavé3, Y. Feldman1, M. Shani1
1Sheba Medical Center, Gertner Institute for Epidemiology and Health Policy Research,
Tel Hashomer, Israel
2Sheba Medical Center, Rehabilitation Hospital, Tel Hashomer, Israel
3The Open University, Department of Education and Psychology, Ra'anana, Israel
Aims
Tele-rehabilitation has been proven to be an appropriate mode of speech and language treatment
for people with aphasia (PWA). The current study aims to compare language performance of
PWA before and after enrolling in a computerized language treatment. Practice on the system
was directed primarily at word retrieval, and participants received personally tailored feedback
through a virtual clinician, guided by a human clinician.
Method
54 PWA participated in the study, 22 of them women, ages 24-82 (M = 59.0, SD = 13.6). All
participants suffered from brain damage at least 3 months prior to treatment entry (M = 29.2
months, SD = 35.8) and were treated for at least two months (M = 13.7, SD = 3.4), twice weekly.
The Western Aphasia Battery (WAB) and a written naming test (PALPA53) were administered
before and after treatment. Participants evaluated their communication abilities before and after
treatment. Upon treatment completion, participants filled a satisfaction questionnaire.
Results
A significant before-after improvement was found in WAB oral naming and in PALPA53 written
naming scores. No difference was found in WAB measures of spontaneous speech, auditory
comprehension, or repetition. A significant before-after improvement was found in self-reported
written language skills, with no difference in spoken language skills or in general well being.
Overall satisfaction was high.
Conclusion
The study demonstrated the feasibility and effectiveness of tele-rehabilitation for treatment of
retrieval difficulties in aphasia. With advances in technology, tele-rehabilitation carries much
promise. It is especially advantageous for clients who live far from large medical centers. It can
also help reduce the financial burden of one-to-one therapy by allowing one clinician to treat more
than one client simultaneously.
WCNR-0009
BOARD NUMBER: 089
REHABILITATION OF READING COMPREHENSION IN SUB-ACUTE CARE: FEASIBILITY OF
IMPLEMENTING A NEW TREATMENT DURING INPATIENT BRAIN INJURY
REHABILITATION
K. Watter1, E. Finch1, A. Copley2
1Princess Alexandra Hospital, Speech Pathology, Brisbane, Australia
2University of Queensland, Health and Rehabilitation Sciences, Brisbane, Australia
Aims
Current research into cognitive-communication reading comprehension (CCRC) typically involves
people with chronic, longterm acquired brain injury (ABI). However, CCRC deficits impact
participation during rehabilitation and upon return home. Providing early CCRC rehabilitation may
improve patient outcomes. An evidence-based intervention for CCRC deficits was developed for
Australian subacute ABI rehabilitation, utilising survey findings on Speech Pathology (SP) service
delivery and CCRC management during subacute ABI rehabilitation, a systematic review,
advisory group feedback and evidence-based reading interventions from other populations.
The study objectives were to:
(i)
Investigate the effectiveness of the CCRC intervention during sub-acute ABI
rehabilitation, and report preliminary results
(ii)
Investigate barriers and facilitators to implementing the intervention and service delivery
model in a clinical setting
Method
A multiple-baseline single case experimental design was employed to investigate the
effectiveness of a multiple-strategy reading intervention for people with ABI. The three (baseline)
conditions were functional, longer factual and inferential reading. The intervention involved
multiple reading strategies (visual, content and metacognitive strategies) taught via direct
instruction. Treatment dosage involved 3-4 sessions per week over 4-6 weeks. Outcome data
(quantitative and qualitative) was collected pre-, post and at 2 months follow up, with probe and
treatment data collected within each treatment condition.
Results
Preliminary study data and outcomes will be reported, including clinician feedback regarding
barriers and facilitators for implementing the treatment.
Conclusion
The feasibility and impact of providing a structured strategy-based intervention in subacute
rehabilitation will be discussed.
WCNR-0486
BOARD NUMBER: 090
COMBINED MUSICAL SPEECH STIMULATION (MUSTIM) AND CONVENTIONAL SPEECHLANGUAGE THERAPY INTERVENTIONS: EFFECTS ON THE WAB-R AND SONG PHRASE
PRODUCTION IN ADULTS WITH APHASIA
E. Wegener1, S. Jacobsma2, A. Hindman2, R. Green2, E. Norris3, L. Hill4
1Spectrum Health, Music Therapy, Grand Rapids, USA
2Spectrum Health, Speech & Language Pathology, Grand Rapids, USA
3Spectrum Health, Music Therapy- Intern, Grand Rapids, USA
4Music Therapy, Speech & Language Pathology, Grand Rapids, USA
Aims
Purpose: Musical Speech Stimulation (MUSTIM), a Neurologic Music Therapy technique using
overlearned song phrases to stimulate nonpropositional speech (Thaut, 2005), has demonstrated
successful initial findings as a compensatory strategy for language recovery post-stroke (Schlaug
et al., 2008, Brown et. al, 2006), but overall evidence with both stroke and traumatic brain injury
populations remains limited.
Method
Method: Twelve total participants (n=12: 9 with L CVA, 3 with TBI) participated in this study.
Subacute Rehabilitation (SR) participants were <1-month post-TBI or L CVA and were given
experimental MUSTIM treatment + conventional speech-language therapy 3-5 times per week,
for 4-6 weeks. Long Term Care (LT) participants, at least 1-year post injury and all L CVA
diagnoses, were given only MUSTIM. Functional language change was measured pre and posttest with the WAB-R Bedside and Cookie Theft Picture. Additionally, total song phrase
completions were collected at baseline and post-test.
Results
Results: Of the SR participants able to complete the post-treatment WAB-R, 80% demonstrated
functional gains. 33% of LT participants also made small gains on the WAB-R given MUSTIM
alone. 92% of total participants (both SR and LT participants) achieved ability to complete at
least 80% song phrase completions at post test.
Conclusion
Conclusions: Musical Speech Stimulation (MUSTIM) served as a compensatory language
treatment approach in conjunction with conventional speech-language therapy interventions for
several participants with aphasia. MUSTIM alone also showed initial gains for one long term care
participant. Many participants experienced an improvement in mood and overall motivation for
therapy through participation in music therapy treatment.
WCNR-0067
BOARD NUMBER: 091
CASE REPORT: A SEVERE LOCKED IN SYNDROME PATIENT WHO CANNOT
COMMUNICATE
L. YONG JOO1, Y.M. Soh1
1Tan Tock Seng Hospital, Rehabilitation Medicine, Singapore, Singapore
Aims
In this case report, we present a challenging patient who developed severe Locked in Syndrome
with inconsistent blinking eye movements and the strategies in management of trying to establish
a reliable communication channel between the patient and his family in order to improve his
quality of life.
Method
The patient, Mr NYS, initial presentation to the development of complications will be first
described. It will be followed by his subsequent rehabilitation plans and the challenging
communication difficulties the rehabilitation team faced and the solutions to solve these problems
to establish consistent communication strategies with his family.
Results
As described above, the detailed rehabilitation plans and the use of appropriate Augmentative
and Alternative Communication (AAC) Devices will be illustrated in the case report presentation.
Conclusion
This case illustrates a difficult case of locked in syndrome. The difficulties faced in this case were
in establishing a consistent means of communication between him and his family. Commercially
available AAC systems are often expensive and hence potentially dissuade patients and/or their
family from getting them. In this world of advancing technology, there are now more tools in the
mainstream society with the potential to enable people to communicate and express themselves.
Occupational and speech therapists need to familiarize and update themselves with affordable
AAC apps, apps with switch accessibility options and use these readily available products along
with their knowledge on seating, positioning and adaptations to empower their patients with a
“voice”.
May 12 – 12:45: 17:00
WCNR-0668
BOARD NUMBER: 082
ENVIRONMENTAL ENRICHMENT FOLLOWING PREFRONTAL CORTEX STROKE: GOOD
OR BAD?
A. Clarkson1,2, T. Wright1
1University of Otago, Anatomy, Dunedin, New Zealand
2The University of Sydney, Faculty of Pharmacy, Sydney, Australia
Aims
Depression and anxiety have been reported to have a negative impact on stroke recovery.
Experimental models of stroke appear to replicate clinical findings concerning the negative impact
of stress on stroke recovery. Current models of stress, however, fail to emulate what happens to
humans after stroke. Accordingly, we established a model of distress that involves removing
animals from an enriched to an impoverished environment after stroke.
Method
Adult 6-month old C57Bl/6J male mice were housed for 3-months in a standard environment (SE
- group housing; toys changed once / week), prior to receiving a photothrombotic stroke to the
prefrontal cortex (PFC). Immediately post-stroke mice were split into three groups (n=15 / group):
SE ; enhanced enrichment (EE – group housing; toys changed 3-4 times / week); and Deenriched (DE – individual housing without toys). Infarct volume and behavioural assessments
(motor skills; activity and anxiety; and learning and memory) were carried out one and four weeks
post-stroke.
Results
DE animals had smaller lesion volumes one week after stroke; however no differences in stroke
volume between all groups were observed at 4-weeks. Assessment of sham animals confirms
that DE induces anxiety at one and four weeks (P<0.05). Interestingly, assessment of stroke
animals revealed the opposite effect: DE animals were less anxious whereas EE animals were
more anxious and were less active. We also show that animals in DE perform better on the object
location recognition task, whereas animals in EE showed no recovery.
Conclusion
These data indicate that PFC strokes maybe interfering with the hypothalamic stress axis and EE
maybe acting as an added stressor. We have reliably set up a model to induce stress and
assess its impact on stroke recovery; however, our data indicates caution should be taken
depending on stroke location so as to not impair recovery.
WCNR-0689
BOARD NUMBER: 083
LONGITUDINAL STUDY OF INTEGRATIVE VIRTUAL REHABILITATION FOR THE
MAINTENANCE OF SKILLED NURSING FACILITY RESIDENTS WITH CHRONIC STROKE
G. HOUSE1, G. Burdea1, K. Polistico1, N. Grampurohit1, D. Roll1, F. Damiania2, S. Keeler3,
J. Hundal4
1Bright Cloud International Corp, Technology, Highland Park- NJ, USA
2Roosevelt Care Center, Administration, Edison- NJ, USA
3JFK Hartwyck Nursing & Rehabilitation Centers, Quality & Service Delivery, Edison- NJ, USA
4Hundal Neuropsychology Group, Administration, Watchung- NJ, USA
Aims
This longitudinal controlled trial investigated the effects of integrative training with an
experimental virtual reality (VR) system for the maintenance of upper extremity (UE) function,
cognition and emotive state in elderly skilled nursing facility (SNF) residents with chronic stroke.
Method
The BrightArm Duo system (Figure 1) enabled the experimental group, seated at a low-friction
robotic table with gravity modulating capability, to interact with custom adaptable VR games. The
system automatically tracked both UE supported movements and grasps. The 8-week intensive
training (16 sessions), was followed by 3 boosters (4 sessions/ 2 weeks) at 8-week intervals,
supervised by an occupational therapist. The final booster was a tournament, where pairs of
residents from two SNFs played collaboratively. Standardized assessments were used pretraining (A0), post-training (A1), and pre- (A2, A4, A6) and post- (A3, A5, A7) each booster period
for experimental (N=7) and control (N=3) group
subjects.
Results
The experimental group subjects totaled an average of 19,020 UE repetitions, and 12,540 hand
grasps at study completion. The experimental group showed statistically significant improvements
over controls (A0 – A7) in UE range of motion (p=0.04), strength (Figure 2) and function
(p=0.035) (Figure 3), and for cognitive and emotive (p=0.0006) measures. The boosters
successfully maintained the effects of intensive therapy significantly above pre-training levels.
The technology was well-rated on subjective evaluation questionnaires. The control group scores
worsened for UE function, depression, verbal learning and
memory.
Conclusion
Integrative rehabilitation with the experimental system was well-accepted by the SNF residents
and was effective in improving and maintaining UE range of motion, strength and function along
with reducing depression and improving memory. The control group showed continued decline.
WCNR-0657
BOARD NUMBER: 084
High-frequency repetitive transcranial magnetic stimulation effects functional recovery
and neurogenesis possibly via BDNF signaling pathways in a rat model of MCAO
J. Luo1, L. Zhang1, X. Hu1, Q. Zhang1, H. Zheng1, L. Li1
1the Third Affiliated Hospital- Sun Yat-sen University, Rehabilitation Medicine, Guangzhou, China
Aims
This study was performed to investigate whether high-frequency rTMS can improve functional
recovery or promote neurogenesis, and to examine the role of BDNF-TrkB pathways in highfrequency rTMS-induced effects in a rat model of middle cerebral artery occlusion (MCAO).
Method
A total of 56 adult wistar rats after MCAO were randomly divided into four groups: 20Hz group
(n=16), iTBS group (n=16), control group (Sham stimulation group, n=16) and sham-operated
group (n=8, filament was not inserted into the artery). The rats were sacrificed on the 7 and 14
days after evaluating the neurological function. And neurogenesis around the peri-infarction
region were checked with the specific marker Ki67、Nestin、DCX、CD31 and NeuN.
Results
The results showed that 20Hz rTMS and 50Hz iTBS significantly improved neurological function
and reduced infarct volume. Moreover, they promoted neurogenesis as evidenced by the
increased Ki67/Nestin-positive and Ki67/DCX-positive cells in ischemic hemisphere. These
beneficial effects were in conjunction with the elevated BDNF and TrkB proteins.
Conclusion
High-frequency rTMS improves functional recovery and promotes neurogenesis possibly through
BDNF signaling pathways in ischemic rats.
WCNR-0676
BOARD NUMBER: 085
ENDOTHELIN-1 BRAIN ISCHEMIA INDUCES EARLY FORELIMB DISABILITY AND
SELECTIVE MUSCLE ATROPHY IN RATS
T. Russo1, F. Faturi1, A. Tanan1, A.C. Gianlourenço1, P. Castro1
1Universidade Federal de São Carlos, Physical Therapy, São Carlos, Brazil
Aims
To assess reach performance and muscle adaptation (atrophy) on paretic forelimbs 4 days after
focal brain ischemia induced by endothelin-1 in Wistar rats.
Method
The study was approved by the local animal ethics committee (AEC 6299090615). Twenty one
Wistar rats had their dominance determined by 20 consecutives trials of reaching a pellet in a
cage. Then, 20 min of reaching task training were performed daily during 10 days. At the end of
this period, all animals reached the criteria of 40% of successes (grasp and bring the food to the
mouth). Trained animals were then divided into control (CG), sham or ischemia 4 days (S4d or
I4d) groups. Endothelin-1 was used to induce brain ischemia on the sensoriomotor cortexes from
dominant brain hemisphere. Sham group was submitted to the same surgical procedures of I4d,
but salin solution was used instead of endothelin-1. Success rate (ration between total number of
successes reach and total number of trials) was quantified during reach task test 3 days after
surgery. Four days after lesion, the brachii biceps, triceps, fingers flexors and extensors muscles
were removed and weighted from dominant forelimbs. The one-way ANOVA followed by Tukey
post-hoc was used.
Results
There was a decrease of reaching performance at 3 days in I4d compared to S4d and CG. The
extensor muscle weight was reduced in I4d versus S4d and CG. Biceps, triceps and flexors
muscles did not change their weights among groups.
Conclusion
Endothelin-1 brain ischemia induces early forelimb disability and selective muscle atrophy in
Wistar rats.
WCNR-0663
BOARD NUMBER: 086
EVIDENCE OF INTRINSIC MECHANISM ON FLEXION AND EXTENSION ALTERNATIVE
ACUPOINT ELECTRICAL STIMULATION: A FMRI STUDY
D. WANG1, R. ZHANG1
1Heilongjiang University of Chinese Medicine, Department of Acupuncture and Moxibustion,
HARBIN, China
Aims
This study that we focused on using fMRI to reveal the relationship between central nerve system
and acupoints and explore the intrinsic mechanism of flexion and extension alternative acupoint
electrical stimulation (FEAAES).
Method
The study was performed in 12 healthy volunteers. They were undergoing two scans. The typical
block design was chosen. The fisrt scan was stimulated by FEAAES, and after one week
performed the manual acupuncture (MA). FEAAES chose the acupiont Waiguan (SJ-5),
Shousanli (LI-10), Neiguan (PC-6), Ximen (PC-4) on the left upper. The frequency of FEAAES
therapeutic device was 50Hz. The stimulation intensity was produced wrist flexion and extension.
Acupuncture was performed at SJ-5 and LI-10 on the left upper. The stimulation consisted of
rotating the needle clockwise and counterclockwise for 1 minate at a rate 60 times per minute.
MRI was performed on a 3.0T system. The fMRI data were analyzed by SPM 12 .
Results
In FEAAES and MA, the same brain activations were observed in ipsilateral SMA and
contralateral cerebellum, primary motor cortex (MI) and pre-supplementary motor areas (PM).
However, the difference between them was that FEAAES activated ipsilateral PM while MA
activated marginal lobe. And the activated brain regions (including the number of voxels and
extent) of FEAAES in MI, SAM and PM were larger and more intensity than that of MA.
Conclusion
FEAAES may be more effective for the motor areas of brain activation than MA.
WCNR-0611
BOARD NUMBER: 087
The effectiveness in functional MRI-based therapeutic high-frequency repetitive
transcranial magnetic stimulation strategy for aphasic stroke patients
M. Abo1, S. Watanabe2
1The Jikei University School of Medicine, Department of Rehabilitation Medisine, Tokyo, Japan
2The Jikei University School of Medicine, Department of Rehabilitation Medicine, Tokyo, Japan
Aims
We reported potential usefulness in functional MRI-based therapeutic repetitive transcranial
magnetic stimulation (rTMS) strategy for aphasic stroke patients, first in the world. This time, we
consider the effectiveness of high-frequency repetitive transcranial magnetic stimulation (HFrTMS) strategy for aphasic stroke patients.
Method
Six poststroke patients with history of left hemispheric stroke and with aphasia were studied.
During 13-day hospitalization, each patient received 12 treatment sessions consisting of 2400
pulses of stimulation followed by 10-Hz HF-rTMS to the right cerebral hemisphere and intensive
ST for 60 min daily. HF-rTMS were applied to the inferior frontal gyrus or the superior temporal
gyrus, the most activated area on functional MRI performed prior to rTMS.
Results
This protocol was successfully completed by all patients without any adverse effects. Each
patient showed an increase in the correct answer rate after the intervention. Improvement was
found in both expressive and recessive language modalities in all patients.
Conclusion
We think that our therapeutic rTMS strategy is a clinically feasible neurorehabilitative approach
for poststroke aphasic patients. There are no conflicts of interest. The authors declare no conflict
of interest. Funding for this study was provided by a Grant-in-Aid for Scientific Research from the
Japan Society for the Promotion of Science.
WCNR-0693
BOARD NUMBER: 088
TRANSCRANIAL DIRECT CURRENT STIMULATION AS A POTENTIAL THERAPY FOR
SYMPTOMS OF PRIMARY PROGRESSIVE APHASIA
N. WHITE1, F. Gervits1, S. Ash1, H.B. Coslett1, M. Grossman1, R.H. Hamilton2
2University of Pennsylvania, Neurology, Neurology, USA
Aims
Primary Progressive Aphasia (PPA) is a neurodegenerative condition characterized by insidious
irreversible loss of language abilities. Prior studies suggest that transcranial direct current
stimulation (tDCS) directed toward language areas of the brain may help to ameliorate symptoms
of PPA, but have only focused on a narrow range of language deficits. This sham-controlled study
aimed to assess whether tDCS may be used to treat a variety of PPA-related language
difficulties.
Method
Participants were recruited from the Penn Frontotemporal Dementia Center to receive 10
consecutive days of both real and sham tDCS (counter-balanced, full-crossover design;
participants naïve to stimulation condition). A battery of language tests was administered at
baseline, immediately post-tDCS (real and sham), and six weeks and twelve weeks following
stimulation. The language battery included the Boston Naming Test (BNT), a measure of ability to
read, write and repeat sentences and lists of words (from the NACC-UDS FTLD Module),
Pyramids and Palm Trees (PPT; words and picture categorization), a sentence-picture matching
test of grammatical comprehension (L-TROG Short), FAS Verbal Fluency and Category Fluency
assessment. Data for each battery item for participants (n=6) were blind-coded and submitted to
linear mixed-effects analysis to assess whether real and sham tDCS are associated with changes
in performance relative to baseline.
Results
Real tDCS was associated with a marginally significant increase in performance on measures of
sentence writing and the picture version of the PPT. Promising trends were also demonstrated for
BNT and L-TROG Short performance. In reading from a list of words, performance accuracy
tended to increase following sham tDCS. Data collection is ongoing.
Conclusion
Real tDCS may improve language performance on some measures but not others. There is no
evidence to suggest that sham tDCS improves language performance relative to baseline, with
the possible exception of word reading.
WCNR-0444
BOARD NUMBER: 089
IS ADDING AMPHETAMINE TO NON-INVASIVE BRAIN STIMULATION SAFE FOR POSTSTROKE SPEECH RECOVERY?
N. Yozbatiran1, Z. Keser1, M. Weber-Dehgan2, S. Shadravan2, K. Shaw2, M.M. Morrow3,
A. Marroquin3, L. Maher4, G. Francisco1
USA
2The Institute for Rehabilitation and Research at Memorial Hermann, SpeechLanguage Pathology, Houston, USA
3The Institute for Rehabilitation and Research at Memorial Hermann, Music Therapy, Houston,
USA
4University of Houston, Department of Communication Sciences and Disorders, Houston, USA
Aims
Aphasia is a common result of stroke. There is a growing need for various effective adjunctive
treatment options for speech recovery after stroke.
In this “proof of concept” study, we aimed to test the safety of a triple combination therapy of
dextroamphetamine (D-AMP), transcranial direct current stimulation (tDCS) and melodic
intonation therapy (MIT) in the patients with chronic non-fluent aphasia due to stroke.
Pharmacological agent combined with non-invasive brain stimulation has never been reported for
post-stroke aphasia recovery.
Method
In our double-blinded placebo-controlled experimental study, ten native English speaker subjects
with chronic non-fluent aphasia underwent two experiments where they received 10 mg of D-AMP
(active experiment) or placebo (placebo experiment) along with 1.5 mA anodal tDCS to right
inferior frontal gyrus and MIT at two separate days. Bedside form Western Aphasia BatteryRevised ® (WAB-R) was used to monitor changes in the speech performance.
Results
No serious adverse events are observed. There was no significant increase in blood pressure
with amphetamine and deterioration in speech and language performance. WAB-R ® Aphasia
Quotient (AQ) (36.13±18.23 TO 38.60±19.33; p=0.04) and Language Quotient (LQ) (32.41±14.93
TO 35.03±15.10; p=0.02) showed statistically significant increase in the active experiment. No
significant change in AQ and LQ was observed in placebo experiment. Comparison of
proportional changes of AQ and LQ in active experiment to AQ and LQ in placebo experiment
showed significant difference (p=0.02 for AQ; p=0.008 for LQ).
Conclusion
We have shown that the triple combination therapy is safe and induces positive changes in
speech and language performance of the patients with chronic non-fluent aphasia due to stroke.
We believe our pilot study will shed the light to future clinical trials of combination therapies with
bigger sample size and more intervention sessions.
WCNR-0704
BOARD NUMBER: 001
TRIAGE ALGORITHM FOR THE REHABILITATION PATHWAYS OF STROKE PATIENTS
R. ALAERTS1, R. lemmens2, D. michiels3
1KU Leuven - UZ Leuven, neurology/physiotherapy, Leuven, Belgium
2KU Leuven - UZ Leuven, neurology, Leuven, Belgium
3KU Leuven - UZ Leuven, management, Leuven, Belgium
Aims
In the acute stroke unit of the university hospitals Leuven, we introduced a triage system to
determine in witch rehabilitation trajectory our patients need to be assigned. As we know that
resources for the rehabilitation of stroke patients is limited, and considering the impact of early
rehabilitation, it is important to choose the appropriate pathway.
Method
Based on the evaluation of the present state of the patient by the rehabilitation team, and what
we know about his premorbid functional and cognitive state, together with concurrent items e.g.
comorbidity and being medically stable, the patient will be allocated to one out of 8 pathways,
suggested by the algorithm we developed. Known scales and assessments are used to feed the
algorithm, and this information has to be delivered by the end of day 2, and repeated each week
during the team meeting.
Results
following profiles are generated:
GR
1A
no need for rehabilitation
GR
1B
GR 2
need for but no potential for rehabilitation GR 3
GR
4A
need for physical rehabilitation
GR
4B
need for psychological rehabilitation
GR 5
high need and potential for intensive
rehab
GR 6
need for and potential for cognitive
rehab
GR 7
need for specific rehab e.g.vegetative
state
GR 8
palliative care
need for monotherapy
need for but low potential for
rehabilitation
The different patient groups according to the rehabilitation profiles are quantified,
and will be linked to process- and outcome measures in further studies:
Conclusion
This triage tool gives us the opportunity to prepare patients and their family for well-known
rehabilitation paths, and prevents thereby prolonged stay in acute care-units. An even bigger
advantage is the possibility to develop new trajectories for patient profiles that are more
customized to patients needs, e.g. those patients with low potential but existing rehabilitation
needs or combinations between in-hospital and out-hospital treatment.
WCNR-0450
BOARD NUMBER: 002
CRYOTHERAPY DECREASES PLANTAR FLEXORS SPASTICITY WITHOUT CHANGES IN
ISOMETRIC STRENGTH IN CHRONIC STROKE SUBJECTS: A PILOT STUDY
C. Alcantara1, L. Garcia1, E. Herrera2, S. Michaelsen3, J. Blanco1, L. Oliveira1, P. Ribeiro1,
T. Russo1
1Federal University of Sao Carlos, Department of Physical Therapy, Sao Carlos, Brazil
2Industrial University of Santander-Colombia, Faculdade de Saúde, Bucaramanga, Colombia
3Santa Catarina State University, Department of Physical Therapy, Florianópolis, Brazil
Aims
To evaluate the immediate effects of cryotherapy (ice pack) on plantar flexors spasticity and
strength in subjects post-stroke.
Method
Chronic hemiparetic subjects following ischemic stroke were included in this study (n=13 for
spasticity outcome; n=9 for strength outcome). Tardieu Scale was used to clinically measure
spasticity. An isokinetic dynamometer was used to measure the plantar flexors maximum
isometric voluntary contraction (peak torque). All measures were performed before and after 20
minutes of cryotherapy (ice pack) treatment on calf muscles or placebo treatment (sand pack),
using a crossover design. The order of intervention (cryotherapy or placebo) was randomized.
An ANOVA two-way with repeated measures was used to identify differences for peak torque
(mean values). For category outcomes (Tardieu Scale scores), Wilcoxon test was applied
(median values). This study has been approved by the Ethics committee (number 732.652).
Results
No changes were observed in plantar flexors peak torque following both cryotherapy and placebo
interventions (p>0.05). Regarding spasticity measure, there was a significant decrease in Tardieu
Scale score following cryotherapy (p=0.014) but not following placebo intervention (p=0.317).
Figure 1 presents Tardieu Scale outcomes before and after placebo/cryotherapy
interventions.
Conclusion
Cryotherapy (ice pack) applied on calf muscles is capable of decreasing plantar flexors spasticity,
without changes in isometric strength, in chronic stroke subjects.
WCNR-0641
BOARD NUMBER: 003
THERAPEUTIC PATIENT EDUCATION (TPE) IN STROKE SURVIVORS: DEFINING USUAL
CARE AND PRELIMINARY DATA OF A SELF-MANAGEMENT PROGRAM (LAY – LOOK
AFTER YOURSELF)
R. Bardelli1, S. Fugazzaro1, M.A. Accogli1, M. Denti1, A. Altavilla1, M. Piccinini1, G. Maisto1,
E. Cavalli2, D. Pagliacci3, S. Calugi2, S. Costi1, S. Cavazza4, C. Tedeschi1, M. Taricco2
1Azienda Ospedaliera IRCCS S.Maria Nuova, Department of Neuromotor Physiology,
Reggio Emilia, Italy
2Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Neuromoto department, Bologna, Italy
3Azienda Sanitaria di Livorno, Distretto Val di Cornia, Livorno, Italy
4Nuovo Ospedale Civile S.Agostino Estense, Neuromotor department, Baggiovara MO, Italy
Aims
To define usual care (UC) in inpatient stroke rehabilitation and to develop a standardized TPE
program for stroke survivors to empower self-management (SM) and facilitate social
reintegration.
Method
Design: controlled clinical trial in 3 rehabilitation centers: S.Orsola Bologna (BO), Reggio Emilia
(RE), Baggiovara (MO).
Patients: UC phase: 10+10 RE, MO; 20 BO. Intervention phase: 120 intervention group (RE,
MO); 120 control group (BO).
Inclusion criteria: first stroke, >18 ys, presence of a caregiver, moderate-severe disability (MBIModified Barthel Index<70), no severe communication disability and cognitive impairment
(MMSE-Mini Mental State Evaluation>15).
Primary outcome: patient perceived self efficacy (SSEQ-Stroke Self Efficacy Questionnaire)
Assessments: T0 (enrollment), T1 (inpatient rehabilitation discharge), T2 (50-60 days after
discharge): SSEQ, MBI, Short Physical Performance Battery, Geriatric Depression Scale, SF-12,
patient and caregiver’s satisfaction, Caregiver Strain Index. At T2 also: % of homecoming, lenght
of stay, territorial services use.
Results
In the first 6 months, 56 patients recruited (19F, 37M). Statystical analisys confirmed the
omogeneity of UC in the 3 centers: all patients showed significant improvement (p < 0.001) at
discharge (T1-T0) in self-efficacy, functional status (BIM), in SF-12 physical component, and
balance (SPPB).
A structured TPE intervention was set up, defining contents, timing, modality (6 group and 3
individual sessions directed by rehabilitation specialists). The program is an adaptation of the
Chronic Disease Self Management Program (CDSMP Stanford) for stroke patients and
caregivers. The focus is the training on goal setting and problem solving.
Conclusion
We defined UC in the 3 centers and we standardized the TPE Intervention which is ongoing. The
compliance to the program is very high (90.2% patients participated to all sessions), and the core
instrument of goal-setting (Action Plan) is widely used: weekly action plans were completed in
99.8% of the cases. We’ll present preliminary data.
WCNR-0442
BOARD NUMBER: 004
APPLICATION OF COMPUTERIZED NEUROPSYCHOLOGICAL COGNITIVE TEST BATTERY
FOR DUAL-TASK PARADIGMS: TEST-RETEST RELIABILITY AND VALIDITY IN YOUNG,
OLD AND STROKE SURVIVORS
T. Bhatt1
1University of Illinois at Chicago, Physical Therapy, Chicago, USA
Aims
Computerized neuropsychological testing is an emerging area in cognition testing. The traditional
paper-pencil tasks although valid and reliable, require specialized training, are prone to manual
error and are not feasible to use in a dual task paradigm, limiting its overall usability in clinical
settings. This study thus aimed to establish the test- retest reliability and validity of a
computerized, custom-designed cognitive test battery in young, older adults and chronic stroke
survivors.
Method
Healthy young (n=10), older (n=12) adults and adult chronic stroke survivors (n=12) performed
the cognitive test battery that was custom-designed using DirectRT™, Empirisoft. This battery
included tasks that measured 1) visuo-motor function (SC); 2) associated memory, (NP); 3)
phonemic memory (AN) and verbal fluency task (WLG); 4) executive function, via the congruent
and incongruent visual stroop tasks (CN); 5) discriminant decision-making (US) and 6) visual
working memory, via n-back tasks (TR); 7) problem solving, (PG) 8) Information processing
speed (LN).The outcome variables consisted of reaction time(SC task) and accuracy for all
others. Criterion validity was studied against the Delis Kaplan Executive Function System™ (DKEFS™). The intraclass correlation coefficient (ICC) was used to determine reliability and
Pearson-product moment correlation to measure the criterion validity.
Results
There was a good to excellent reliability for all the eight tasks (p<0.05) for each of the three
groups. The criterion validity for the AN and WLG tasks showed good correlation, whereas the LN
task had moderate correlation when compared to the D-KEFS. It was observed that stroke
survivors performed worse followed by older adults and finally young, especially in the AN and
WLG tasks.
Conclusion
The computerized cognitive test used in this study was highly reproducible and reliable for
several domains of cognitive function. Such testing could be easily implemented by clinicians for
assessing cognition and could also be incorporated in dual-task testing and training paradigms.
WCNR-0578
BOARD NUMBER: 005
THE EFFECTS OF INPATIENT REHABILITATION PROGRAMS ON FUNCTION AND LENGTH
OF STAY AMONG OLDER ADULTS WITH STROKE: A SYSTEMATIC REVIEW AND METAANALYSIS
S. Bindawas1, V. Vennu1, E. Moftah1
1King Saud University, Rehabilitation Sciences, Riyadh, Kingdom of Saudi Arabia
Aims
Stroke is a main source of functional impairments. Rehabilitation interventions are important to
maximize functions for patients with stroke. The purpose of this study was to examine Inpatient
Rehabilitation Programs (IRPs) effects on functions and Length of Stay (LOS) in older patients
with stroke.
Method
We searched for published randomized controlled trials (RCTs) about the IRPs effects on
functions as measured by Functional Independence Measure (FIM) and LOS as measured by
days. The Cochrane library, Physiotherapy Evidence Database (PEDro), PubMed, MEDLINE,
and CINAHL were used to identify related RCTs; including published full-text articles written in the
English language with no time limit. The selected studies were assessed for quality by using the
PEDro Scale and the risk of bias was assessed by using the Cochrane collaboration’s tool. Effect
sizes (ES) and confidence intervals (CIs) were estimated using fixed-effect models.
Results
Eight RCTs involving 1,910 patients were included in the review. Meta-analysis showed that
patients after receiving the IRPs had significantly higher FIM score (5 RCTs, 1,797 participants;
ES = 0.10; 95% CI = 0.01, 0.22, p = 0.016), and shorter LOS (5 RCTs, 1,187 participants; ES =
0.14; 95% CI = 0.03, 0.22; p = 0.006).
Conclusion
This systematic review provided evidence that IRPs have beneficial effects on improving function
and reducing LOS for older adults with stroke. However consensus on IRB definition and
component is lacking.
WCNR-0502
BOARD NUMBER: 006
IDENTIFYING FACTORS OF INDIVIDUAL POTENTIAL FOR MOTOR RECOVERY AFTER
STROKE IN MEXICAN POPULATION. PROSPECTIVE COHORT
L.R. Castrejon Juarez1, O.V. Norma Gabriela1, S. Labastida Gutierrez1, E. Gallardo2
1Hospital General Dr. Eduardo Vazquez Navarro, Physical Medicine & Rehabilitation, Puebla,
Mexico
2Benemerita Universidad Autonoma de Puebla, Medicine School, Puebla, Mexico
Aims
It is considered that stroke is the third cause of mortality and the first cause of disability in adults.
Objectives. Identify determinants factors for an adequate development of a Rehabilitation
program, optimize financial and human resources as possible as well as empower patients for
they are the central part of the rehabilitation process
Method
Method. Prospective cohort study (two years), evaluating clinical and neurophysiological
variables.
Data will be obtained from patients who income the Emergency Room. Premorbid factors:
sedentary lifestyle, muscular strength, functional independence, general state of health,
pharmacologic treatment. Morbid factors: damage topography, level of reflex activity of
corticospinal via, visual state, set up time of pathological reflexes, muscle tone grade, perimeter
of paretic limbs, shoulder articular space (risk of subluxation), limb perimeter (edema and
trophism), residual motor activity (shoulder abduction, carpal extension, hip extension) reflex and
voluntary, peripheral sensory state, strength and coordination of the healthy hemibody, among
others.
For inferential statistics, it is used central tendency measures for quantitative variables and U of
Mann Whitney for qualitative variables.
Results
In development.
Conclusion
In development.
WCNR-0503
BOARD NUMBER: 007
NEUROMOTOR REEDUCATION SYSTEM FOR UPPER LIMB AFTER NEUROLOGICAL
DAMAGE BASED ON COMBAT SPORTS
L.R. Castrejon Juarez1, S.P. Marisol1, S. Labastida Gutierrez1, N.G. Ortiz Velazquez1,
L.C. Bautista Justo2, A.K. Caballero Lazaro2
1Hospital General Dr. Eduardo Vazquez Navarro, Physical Medicine & Rehabilitation, Puebla,
Mexico
2Benemerita Universidad Autonoma de Puebla, School of Medicine, Puebla, Mexico
Aims
Determine the utility of a Neuromotor Reeducation Programme designed at the Physical Medicine
and Rehabilitation Department of Hospital General Dr. Eduardo Vázquez Navarro for functional
imrpovement.
Method
It has been evaluated that certain combat techniques and martial arts can combine different basic
motor patterns that may help to improve muscular strength, coordination and an adequate motor
control. It was stablished a coordinating basic movements for the upper limb (shoulder flexion and
horizontal abduction, elbow extension, wrist extension and maximal grade of supination).
The patients were trained to improve the following: 1)speed of movement, 2) coordination
between both upper limbs, 3) visual and space training and self image, 4) execution and reaction
of unexpected movements. The programe was executed for 8 weeks.
The program was executed in 3 stages: 1) consciousness of healthy side: observe, repeat and
execution of motor programs versus punch stimulus (premeditated), 2) try to repeat movement
patterns with the paretic side, 3) start bilateral motor activity with predetermined sequences
(basic motor patterns with low speed and logical sequences), 4) bilateral motor patterns without
logical sequences seeking response to high velocity frequency and direction
Results
In development.
Conclusion
In development
WCNR-0488
BOARD NUMBER: 008
INDEPENDENT HOME-BASED THERAPY AFTER STROKE USING THE HAND SPRING
OPERATED MOVEMENT ENHANCER (HANDSOME)
J. Chen1,2, D. Nichols2,3, E. Brokaw1,2, P. Lum1,2
1The Catholic University of America, Biomedical Engineering, Washington- DC, USA
2MedStar National Rehabilitation Hospital,
Center for Applied Biomechanics and Rehabilitation Research, Washington- DC, USA
3National Rehabilitation Hospital, Physical Therapy, Washington- DC, USA
Aims
Stroke commonly results in abnormal muscle tone in the affected hand. Our previous work
showed that HandSOME, a spring-powered hand exoskeleton that compensates for flexor tone in
the fingers and thumb, improves range of motion (ROM) and function while worn. This study aims
to investigate if an independent home therapy program using HandSOME can improve
unassisted ROM and functional grasp of the affected hand.
Method
Individuals with chronic stroke completed a 4-week home intervention with a data logger
recording the number of movements completed. Outcome measures were collected before and
after the intervention and in a 3-month follow up. Changes in Fugl-Meyer Assessment (FMA) and
Action Research Arm Test (ARAT) were used as primary outcome measures. Kinematic data
were also collected to evaluate changes in ROM of the fingers and thumb, and hand movement
efficiency (measure of proximal arm control).
Results
Seven individuals with chronic stroke completed the home therapy program. Five responded well
to the intervention with gains of 6 or more on the ARAT or the FMA. During the training, the five
responders performed an average of 11,519 total repetitions of finger extension, whereas the two
non-responders performed <1500 total repetitions. The five responders had significant
improvements in finger ROM (14.3±5.0deg, p = 0.04) and hand movement efficiency (p = 0.02).
Thumb ROM also increased although not significantly (16.4±6.5deg, p = 0.07). At the 3-month
follow up, ROM gains were no longer significant and clinical score improvements were partially
lost.
Conclusion
Most individuals showed significant improvements after the intervention. The reduced
performance at the 3-month follow up suggests that a longer training period might be needed.
However, these preliminary results are promising, given the low cost of the device and treatment.
WCNR-0707
BOARD NUMBER: 009
VIRTUAL REALITY BASED REHABILITION IMPROVES POSTSTROKE ACTUAL ARM USE
IN DAILY LIFE – A PILOT STUDY
S. Chen1, C.M. Lin2, S. Hsu1, C.H. Ho1, S.C. Yeh3
1China Medical University, Department of Physical Therapy, Taichung, Taiwan
2Asia University, Department of Psychology, Taichung, Taiwan
3Fudan University, School of Information Science and Technology, Shanghai, China
Aims
Virtual reality (VR) based gaming programs have been used to increase the motivation for longterm poststroke rehabilitation. Previous studies showed the VR-based rehabilitation was useful
for enhancing upper extremity capability after stroke. However, the training effects which transfer
to real life use still remained unclear. Therefore, this study aimed to examine the effect of VRbased rehabilitation on actual arm use in daily life for people with chronic hemiparesis.
Method
Three participants (53.67 ± 11.15 y/o) recruited and completed the VR-based rehabilitation for 36
hours (3 hours * 12 weeks). The contents of VR-based rehabilitation were designed to emphasize
the proximal stability of upper extremity. The upper extremity subscale of Fugl-Meyer assessment
(FMA-UE), the motor activity log (MAL), and the stroke impact scale (SIS) were used to examine
the effects of VR-based training for upper extremity function. Among these outcomes, MAL is to
detect actual arm use in daily life.
Results
Three participants were all right hand dominant before stroke, with one right hemiparesis and two
left hemiparesis. The average time after stroke was 2.67 ± 1.53 years. The following table
showed the effect of VR-based training.
FMA-UE (0-66) MAL-aou (0-5) MAL-qom (0-5) SIS (0-5)
SIS-R (0-100)
Pre
34.00 ± 14.00
1.65 ± 1.65
1.69 ± 1.61
4.04 ± 0.65 55.00 ± 32.79
43.00 ± 14.42
2.03 ± 1.45
2.16 ± 1.59
4.12 ± 0.53 62.67 ± 24.11
23.36 %
27.87 %
1.96 %
VR training
Post
VR training
% of change 26.47 %
13.94 %
MAL-aou, MAL-qom: "amount of use", "quality of movement" in the motor activity log
SIS-R: perceived recovery of affected hand in the stroke impact scale
Conclusion
The results from this pilot study showed there is a tendency of improvement by adapting the VRbased rehabilitation. The future work could focus on the dexterity VR training in order to obtain
more actual use.
WCNR-0706
BOARD NUMBER: 010
VENTRICULOPERITONEAL SHUNT COMBINED AMANTADINE IN REHABILITATION
TREATMENT ON DISORDER OF CONSCIOUSNESS: CASE REPORT
Z. CHEN1, Y. Liu1
1Beijing United Family Rehabilitation Hospital, High Dependent Unit, beijing, China
Aims
Patients with severe cerebral hemorrhage and hernia may lost consciousness and end up in a
state of disorder of consciousness. Clinical rehabilitation treatments of those patients aim to
improve arousal levels and recovery of consciousness.
Method
This case study described the change in consciousness on one vegetative state patient with
severe cerebral hemorrhage and hernia after treatment of ventriculoperitoneal shunt (VPS)
combined Amantadine. The 80 years old male with vegetative state received VPS at 3 months
because of chronic normal pressure hydrocephalus as well as amantadine at 4 months after
severe basal ganglia hemorrhage (broke into ventricular and caused cerebral hernia). Coma
Recovery Scale and the Disability Rating Scale as well as Glasgow Coma Scale were used to
measure the change of consciousness. Electroencephalogram was used to monitor the change of
brain electrophysiology (prior to VPS, 1 month as well as 2 months after shunting and
rehabilitation).
Results
His consciousness regained gradually, and started to follow instructions intermittently at 5 months
after cerebral injury, from vegetative state transited to minimally consciousness state.
Conclusion
Further randomized, double-blind, placebo-controlled experimental study is required to confirm
the mechanism of VPS and amantadine for the recovery of consciousness regarding the patient's
etiology, diagnosis, time since injury and overall condition.
WCNR-0429
BOARD NUMBER: 011
INTRATHECAL BACLOFEN BOLUS REDUCES EXAGERRATED EXTENSOR
COACTIVATION DURING PRE-SWING AND EARLY SWING PHASES OF GAIT AFTER
ACQUIRED BRAIN INJURY
J. Chow1, S. Yablon1, D. Stokic1
Aims
To compare the coactivation of knee and ankle extensors during gait between patients with
pronounced resting hypertonia due to acquired brain injury (ABI) and healthy controls and to
examine changes in the extensor coactivation after intrathecal baclofen (ITB) bolus injection in
ABI patients.
Method
Temporospatial gait parameters and bilateral surface EMG of rectus femoris (RF) and medial
gastrocnemius (MG) were assessed during gait in 17 healthy controls walking at a self-selected
very slow speed and in 18 ABI patients (9 stroke, 9 TBI, 33±12 years old, 48±41 months postABI) before and at 2, 4, and 6 hours after a 50-µg ITB injection via lumbar puncture. The
coactivation index (CoI) was calculated by dividing the area of overlap between RF and MG
muscles by the overlap duration after normalizing EMG to their respective average amplitude
over the entire gait cycle. The duration of coactivation (CoD) was calculated as the time (%
phase duration) when both RF and MG muscles were active (>3SDs above resting EMG).
Results
Compared to controls, both the more-affected and less-affected leg of patients showed
significantly increased CoI in all phases of gait except the single support (P≤0.044) and longer
CoD throughout (P≤0.007). After ITB bolus, only CoD significantly decreased in the moreaffected leg, specifically during the pre-swing (late double-support) and the early (knee flexion)
portion of the swing at ≥4-hour post-injection (P≤0.026). The decrease in CoD was independent
of changes in gait speed.
Conclusion
Both magnitude and duration of coactivation in the leg extensor muscles are bilaterally
exaggerated during gait in patients with resting hypertonia after ABI. ITB bolus may effectively
reduce the exaggerated extensor coactivation in the more-affected leg during the pre-swing and
early swing phases of gait.
WCNR-0403
BOARD NUMBER: 012
DIFFERENTIAL MOTOR RECOVERY PATTERN IN ARM AND LEG AFTER MIDDLE
CEREBRAL ARTERY STROKE SYNDROME
W. Feng1, P. Chhatbar1, S. Kautz2, J. Wang3, G. Schlaug3
1Medical University of South Carolina, Neurology, Charleston, USA
2Medical University of South Carolina, Health Sciences and Research, Charleston, USA
3Beth Israel Deaconess Medical Center, Neurology, Boston, USA
Aims
It is not clear whether arm and leg follow the same recovery pattern after middle cerebral artery
(MCA) stroke syndrome. In this study we aimed to investigate if leg recovery is better than arm
recovery.
Method
Patients with MCA stroke syndrome were identified from AHA sponsored “Prediction and Imaging
Biomarker for Post-Stroke Motor Recovery” study database where Fugl-Meyer upper extremity
(FM-UE) and lower extremity (FM-LE) scale are the primary outcome variables. Patients with firstever ischemic stroke were assessed between 2-7 days after stroke and ~90 days after stroke.
Patients with both FM-UE≤10 and FM-LE≤10 at baseline were included for analysis. A
proportional recovery score was calculated by relating the actual change score in the FM-UE or
(FM-LE) between baseline and 3 months to the maximal recovery potential. Maximal recovery
potential was defined as the difference between the maximal possible score (66 and 34 for FMUE and FM-LE, respectively) minus the baseline score.
Results
We found no difference in baseline severity of motor function between arm and leg in included 38
subjects (FM-UE at baseline is 7.7 vs. FM-LE is 8.1, P=0.56). Although both arm and leg
recovered similar points on each scale at 3 months (10.0 vs. 10.0, p=0.99), the proportional
recovery score was significantly different between arm and leg (17.2% vs. 38.2%, p<0.05). 50.0%
of patients still had NIHSS arm motor score ≥3 compared with only 18.4% of patients with NIHSS
leg motor score ≥3 (p<0.05). This translated to 44.7% of patients being able walk without
assistance (i.e., mRS≤3) at 3 months.
Conclusion
We observed a differential recovery pattern between arm and leg after first-ever MCA stroke
syndrome. Better understanding the mechanism of difference may help lead to a better recovery
of motor function after stroke.
WCNR-0520
BOARD NUMBER: 013
ASSESSMENT TRUNK CONTROL IN CLINICAL SETTING FOR ACUTE STROKE PATIENTS
A. Fil1, Y. Salci1, C. Turkmen2, B. Çetin1, K. Armutlu1, M.A. Topçuoğlu3
Ankara, Turkey
2Osmangazi University Hospital, Physical Medicine and Rehabilitation, Eskişehir, Turkey
3Hacettepe University, Medicine Faculty Medicine Neurology Department, Ankara, Turkey
Aims
Trunk impairment is a major problem in acute stroke patients. Assessment of trunk impairment
effectually in short time is important in clinical settings. There are lots of scales to evaluate trunk
control. Our purpose is to find out which the scale is more feasible in terms of time and efficiency
in clinical settings.
Method
The present study included acute 64 patients (26 female and 24 male). The mean age of these
patients was 61.72±11.16, onset 4.04±2.71 days. Trunk Impairment Scale (TIS-V) by Verheyden
was identified as the gold standard. Patients were assessed with Motor Assessment Scale (MAS)
subgroups for trunk control, Trunk Impairment Scale (TIS-F) by Fujiwara, Trunk Control Test
(TCT). The correlations between the scales were analyzed with Spearman Correlation Test.
Results
There were statistically significant high correlations between Trunk Impairment Scale by
Verheyden and Motor Assessment Scale subgroups, Trunk Impairment Scale by Fujiwara, Trunk
Control Test (Respectively r: 0.871, p: 0.001; r: 0.895, p: 0.001; r: 0.722, p: 0.001).
Conclusion
Despite Trunk Control Test had lower correlation with Trunk Impairment Scale by Verheyden than
other tests, this correlation level was situated in the “high correlation category”. Therefore, we
think that using Trunk Control Test in clinical setting is more practical in terms of its having less
items and requiring shorter time in acute stroke patients.
WCNR-0692
BOARD NUMBER: 014
ACTIVE VIDEO GAME TECHNOLOGY INCREASES ENERGY EXPENDITURE OF
STATIONARY CYCLING PERFORMED BY STROKE PATIENTS: A CROSSOVER STUDY
M. GOBBO1, M. Lo2, D. Putrino3, C. Orizio1, L. Bissolotti4, P. Gaffurini5
1University of Brescia, Clinical and Experimental Sciences, Brescia, Italy
2Victoria University, Institute of Sport- Exercise and Active Living ISEAL, Melbourne, Australia
3Burke Medical Research Institute, Department of Telemedicine and Virtual Rehabilitation,
New York, USA
4Teresa Camplani Foundation, Functional Rehabilitation Service, Brescia, Italy
Aims
To compare levels of metabolic adaptations and muscle activation in stroke patients performing
seated stationary cycling with or without interactive active video game (AVG) feedback.
Method
Eighteen outpatients (12M; 14 ischemic; 28-78 years) with post-stroke chronic hemiparesis (years
since stroke: 1-11; mean=3.5) performed stationary seated cycling on a motorized cycleergometer (MOTOmed-Viva1).
The AVG modality was provided with a Nintendo® Wii console (game: JoggingPlus®). The WiiRemote® controller was fixed on the patient's thigh, allowing the user to control the game through
leg movements during pedaling (the greater the cycling power, the higher the avatar running
speed).
The therapy session consisted of: 5-min warm-up (passive cycling; 30 rpm); basal assessment
(1-min rest); 10-min cycling in either standard (ST) or AVG conditions (order assigned with block
randomization); 5-min rest (enough to reach basal values); 10-min cycling under the remaining
condition.
Oxygen consumption (ΔVO2) and heart rate (ΔHR) deviations from basal values were assessed
with a Cosmed K4-b2 metabolimeter. Energy expenditure (EE) was expressed in metabolic
equivalents (METs; multiples of the individual basal VO 2).
We assessed pedaling asymmetry (higher values = more asymmetry) by comparing the force
applied to each pedal.
The level of paretic quadriceps activation was quantified with EMG-RMS calculation.
Results
The measured physiological parameters resulted significantly higher (p<0.05; paired t-test) during
AVG compared to ST trial (Table 1).
In the AVG modality, mean EE reached 3 METs, i.e. the recommended exercise intensity for
health promotion, and patients cycled in a more symmetrical manner due to enhanced activation
of paretic quadriceps.
Conclusion
Seated cycling combined with AVG interaction is more likely to induce greater conditioning effects
in chronic stroke patients compared to conventional training. The achieved exercise intensity in
AVG condition is therefore more likely to promote health-related benefits associated with this type
of adapted physical activity, and could more readily result in lower limb functional gains.
WCNR-0661
BOARD NUMBER: 015
FRONTAL LESIONS PREDICT RESPONSE TO PRISM TREATMENT IN SPATIAL NEGLECT:
A RANDOMIZED CONTROLLED STUDY
K. GOEDERT1, P. Chen2, A.M. Barrett2
1Seton Hall University, Psychology, South Orange, USA
2Kessler Foundation, Stroke Rehabilitation Research, West Orange, USA
Aims
Prism adaptation treatment (PAT) is a promising rehabilitation for left spatial neglect, a debilitating
disorder characterized by difficulty attending to, or performing actions towards, contralesional
space. However, not all individuals respond to PAT. Our goal was to investigate brain-based
predictors of PAT response in a randomized controlled study. In particular, we investigated
whether integrity of frontal or medial temporal regions were critical for PAT response, as
suggested in our previous study (Chen et al., Brain Imaging and Behavior, 2014).
Method
We recruited participants with suspected right-brain stroke and left spatial neglect from inpatient
rehabilitation settings and randomized individuals who met the screening criteria for spatial
neglect [Behavioral Inattention Test (BIT) < 129 or Catherine Bergego Scale (CBS) > 5] to a 10day course of once-daily PAT (n = 8) or to a control group receiving standard care (n = 9). We
assessed neglect with the CBS (higher scores indicate greater severity) weekly for six weeks.
Results
Mixed effects regression modeling revealed that response to PAT depended on the presence of
frontal cortical lesions [t(56) = -2.27, p = .027 for the treatment group by frontal integrity by time
interaction]. Integrity of medial temporal regions did not predict response to PAT. As seen in
Figure 1, among individuals receiving prism treatment, only those with frontal lesions improved
(bottom right graph). The opposite pattern was observed in the control group: those with frontal
cortical integrity experienced more spontaneous recovery of neglect symptoms (upper left graph).
Conclusion
Consistent with our previous study, the current findings suggest that prism adaptation treatment
may best-serve individuals with frontal cortical lesions. More work should explore the
mechanisms by which frontal cortical lesions are associated with, or induce, neural network
changes that support beneficial effects of PAT.
WCNR-0479
BOARD NUMBER: 016
FUNCTIONAL RECOVERY AFTER STROKE: FAVOURABLE RESULTS OF A FIRST TIME
INPATIENT SPECIALIZED REHABILITATION PROGRAM IN PORTUGAL
M. Gorayeb1, J. Pimenta1, J. Jacinto1
1Centro de Medicina de Reabilitação de Alcoitão, Serviço de Reabilitação de Adultos 3, Cascais,
Portugal
Aims
The aim of this study was to evaluate the results of an inpatient rehabilitation program through the
functional independency outcomes at discharge from the rehabilitation center, in a population of
stroke survivors.
Method
Data from 119 stroke patients in their first inpatient rehabilitation period during the year of 2014
were prospectively collected in a specifically designed instrument, at the beginning and end of the
rehabilitation program, and retrospectively analyzed. Stroke was classified by aethiology
(ischemic versus hemorrhagic), localization (right or left hemispheres, or sub-hemispheric),
impairment (right or left hemiparesis, tetraparesis and double hemiparesis). Functionality was
measured by total and specific subscores of the Functional Independence Measurement (FIM).
Results
Mean age was 63 years, with 27.7% in young age (<55years) and 22.7% aged 75 or older.
Overall 56.3% were females. The most frequent aethiology was ischemic (72.3%). The right
hemisphere was affected in 46.2%, the left in 39.5% and sub-hemispheric in 13.5%. Impairment
was left hemiparesis in 51.26% and right hemiparesis in 41,18%. Mean interval between stroke
and admission was 77 days and mean length of stay was 67days. Mean FIM score at admission
was 65.76 and 83.43 at discharge, with a mean evolution of 17.67 (18%) (p<0.05). The efficiency
of the rehabilitation program was 0.26/inpatient per day. Subscores analysis showed an
improvement of 18 % in self-care, 19% in tranfers and locomotion, and 8% in communication and
social cognition.
Conclusion
The favourable evolution of patients treated shortly after a stroke, as measured by the FIM, and
the high overall efficiency observed, confirm the benefits of an adequate inpatient rehabilitation
program in a specialized rehabilitation center. Furthermore, it illustrates how the efficiency of a
rehabilitation program/facility can be demonstrated and even benchmarked.
WCNR-0483
BOARD NUMBER: 017
PREDICTORS OF EFFICACY AND UTILITY OF GAIT, AFTER INPATIENT REHABILITATION
IN STROKE SURVIVORS
M. Gorayeb1, J. Pimenta1, J. Jacinto1
1Centro de Medicina de Reabilitação de Alcoitão, Serviço de Reabilitação de Adultos 3, Cascais,
Portugal
Aims
Our purpose was to evaluate if total scores of the Functional Independence Measurement (FIM),
Berg Balance Scale (BBS) and Functional Ambulatory Categories (FAC) at admission in an
inpatient rehabilitation program can be prognostic predictors of ambulation independence in a
cohort of stroke survivors.
Method
Data from 119 stroke patients in their first inpatient rehabilitation period, during the year 2014, in
an adult neuro-rehabilitation service. Data were prospectively collected in a custom designed
instrument at the beginning and end of the inpatient rehabilitation program and were
retrospectively analyzed. Total FIM, BBS and FAC at admission were correlated to FIM walk
score, FAC, gait velocity (10 meter walk test) and 6 minutes walk test, at discharge.
Results
We included 119 stroke cases. Stroke occurred at a mean age of 63 years, 27.7% in young age
(<55years) and 22.7% aged 75 and above. 56.3% of cases were female. The most frequent
mechanism was ischemia (72.3%) and the right hemisphere was affected in 46.2%. Impairment
was left hemiparesis in 51.26% and right hemiparesis in 41.18% of patients. Mean interval
between stroke and admission was 77 days and length of stay was 67 days. Mean FIM improved
from 65.76 at admission to 83.43 at discharge, with a change of 17.67 (18%) (p<0.05). Total FIM
score, locomotion-FIM sub-score, BBS and FAC at admission positively correlated with better
results upon discharge, in gait velocity (10m walk test) and 6-minute walk test (efficacy and
efficiency/utility of gait).
Conclusion
In our cohort of 119 stroke survivors the outcome measures routinely used by the
multidisciplinary team allow us to expect that patients with better FIM global and locomotion
scores, better BBS and FAC scores on admission are more likely to have better results in gait
autonomy, efficacy and utility, after their first inpatient rehabilitation period.
WCNR-0426
BOARD NUMBER: 018
INDIVIDUALS POST STROKE IMPROVED WALKING ENDURANCE AND EFFICIENCY
FOLLOWING MOTOR-ASSISTED ELLIPTICAL TRAINING INTERVENTION
J.M. Burnfield1, T.W. Buster1, S.L. Irons1
1Madonna Rehabilitation Hospital- Institute for Rehabilitation Science and Engineering,
Movement and Neurosciences Center, Lincoln, USA
Aims
Robotic and body weight support treadmill training systems used to help individuals relearn to
walk post stroke are infrequently available in rehabilitation and fitness settings due to the
technologies’ expense and/or need for multiple clinicians to assist patients while training. To
address the need for affordable technology to improve walking and fitness across the care
continuum from inpatient to community settings, our team developed a motor-assisted elliptical
trainer that is now being used in clinical and medical fitness environments. The device’s motor
provides customized physical assistance to help users with weakness, movement control, and
endurance challenges perform repetitive gait-like movements in the forward and reverse direction
at speeds up to 65 cycles/minute. To date, the impact of extended training interventions on
individuals post-stroke has not been explored. We hypothesized that stroke-survivors’ walking
distance, speed, and efficiency would improve following a motor-assisted elliptical training
intervention.
Method
Four community dwelling adults previously hospitalized for unilateral strokes (mean age=59
years; mean years post injury=5.7; 3 right, 1 left MCA), classified as limited community
ambulators, and no longer engaged in rehabilitation, participated in 24 motor-assisted elliptical
training sessions (Madonna ICARE by SportsArt; 3 days/week; Figure 1). Challenge was
increased across sessions by manipulating training parameters (i.e., speed, motor assistance,
body weight support, and total training time) in an effort to achieve ≥30 minutes training at a Borg
Perceived Exertion of 12-14 each session. Paired t-tests evaluated changes in training
parameters (first vs. last training session) and walking (pre- vs. post-training).
Results
(Table 1): Motor-assisted elliptical training capacity improved across 24 sessions. Participants
walked farther and more efficiently post-training.
Conclusion
Intensive motor-assisted elliptical training can be used to improve walking and fitness in
individuals post stroke.
WCNR-0441
BOARD NUMBER: 019
ASSESSMENT OF STROKE REHABILITATION EXERCISES FOR THE PURPOSE OF
VIRTUAL REHABILITATION
H. Josinski1, A. Switonski1, R. Mucha2, A. Michalczuk3, A. Szczesna3
1Research and Development Center, Polish-Japanese Academy of Information Technology,
Bytom, Poland
2Medical University of Silesia, Clinical Ward of Internal DiseasesAngiology and Physical Medicine of the Chair of Internal Diseases, Bytom, Poland
3Institute of Informatics, Silesian University of Technology, Gliwice, Poland
Aims
The concept of virtual rehabilitation assumes remote automatic control of rehabilitation exercises
based on comparison of recording of patient’s completion of given exercise with a pattern
recording. This report relates to the initial phase of the project which aims to create virtual
physiotherapy system based on inertial measurement units (IMU). The inertial sensors, each
made of accelerometer, gyroscope and magnetometer, are part of the Human Motion Suit (HMS)
which is a hardware and software system for indoor and outdoor motion capture measurements.
At the moment, our research aims to propose and verify diagnostic correctness of quality
assessment of completion of stroke rehabilitation exercises based on motion data obtained from
the HMS.
Method
We carried out experiments during which we registered the course of assisted rehabilitation
exercises performed by both stroke patients and control group. Exercises were chosen according
to [1]. Additionally, simultaneous video recording provided the referential information.
Results
We compared the registered time series by means of the recurrence plots (RP) and recurrence
quantification analysis (RQA) [2] revealing the difference between stroke patients and control
group.
Conclusion
We found the possibility of detection of differences in the quality of performed exercises based on
motion capture recordings. In this regard selected RQA measures could be helpful in virtual
rehabilitation. It opens the possibility of correct assessment of exercises performed in the HMS
without the necessity of leaving the house.
Acknowledgment. The work is supported by The Polish National Centre for Research and
Development as part of the project “Virtual Physiotherapist”.
References
1. Mirelman, A., Patritti, B., Bonato, P., Deutsch, J.: Effects of virtual reality training
on gait biomechanics of individuals post-stroke. Gait & Posture, 31(4), pp. 433437, 2010.
2. Webber Jr., Ch.L., Zbilut, J.P.: Dynamical assessment of physiological systems
and states using recurrence plot strategies. Journal of Applied Physiology, 76(2),
pp. 965-973, 1994.
WCNR-0541
BOARD NUMBER: 020
FUNCTIONAL ELECTRICAL STIMULATION IMPROVES ACTIVITY PERFORMANCE AFTER
STROKE: A SYSTEMATIC REVIEW WITH META-ANALYSIS
N. Lannin1, O. Howlett2, L. Ada3, C. McKinstry2
1La Trobe University, Occupational Therapy, Melbourne, Australia
2La Trobe University, Occupational Therapy, Bendigo, Australia
3University of Sydney, Physiotherapy, Sydney, Australia
Aims
Rehabilitation professionals perceive that functional electrical stimulation (FES) is able to facilitate
practice of motor activities that would not otherwise occur because of hemiparesis following
stroke; however, the benefits of FES over standard motor training is not yet clear. This systematic
review determined whether functional electrical stimulation (FES) is more effective in improving
activity performance after stroke than motor training alone.
Method
Systematic review methodology, searching seven electronic databases up to June 22, 2014.
Randomized and controlled trials were included if they included stroke survivors undergoing
motor training rehabilitation which included FES (electrical stimulation used during activity
performance). Methodological quality was rated using PEDro scale.
Results
Eighteen trials met inclusion criteria. FES was determined to have a moderate effect on activity
(standardized mean difference [SMD], 0.40; 95% confidence interval [CI], 0.09 - 0.72) compared
with no or placebo intervention. FES had a moderate effect on activity (SMD, 0.56; 95% CI, 0.29 0.92) compared with training alone. Subgroup analyses showed that FES had a large effect on
upper-limb activity and a smaller effect on walking speed compared with control groups.
Conclusion
Published clinical trials were found to show the benefits of FES on meta-analysis. Specifically,
FES appears to moderately improve activity compared with both no intervention and training
alone. These findings suggest that FES should be used routinely in stroke rehabilitation and
translation of findings from published trials is recommended.
WCNR-0688
BOARD NUMBER: 021
BACLOFEN USE FOR PERSISTENT HICCUPS IN STROKE PATIENTS
A. LARIK1
1Singapore General hospital, Rehabilitation Medicine, Singapore, Singapore
Aims
Pharmacological treatment of persistent hiccups is generally unsatisfactory, as evidenced by the
myriad of pharmacological agents available. The case reports given here aim to highlight the
effectiveness of baclofen in the treatment of persistent hiccups relating to stroke.
Method
Persistent hiccups are uncommon but can result in psychological distress, feeding difficulties,
sleeping problems and even aspiration pneumonia.
This is a report of two patients who experienced persistent hiccups that were refractory to
common pharmacological agents, related to lateral-medullary syndrome. There was no relief in
symptoms with usual ward medications such as domperidone, metoclopramide, chlorpromazine
and haloperidol. In both patients, hiccups were persistent and resulted in sleep disturbances and
difficulty with participation in therapy.
Results
Baclofen use resulted in rapid and complete resolution of hiccups. Both patients had a maximum
dose of oral baclofen 10 mg up to three times a day for five days period. There were no side
effects reported.
Conclusion
This report suggest baclofen can be used effectively as a first line pharmacological agent
especially in patients with lateral-medullary syndrome and serve to strengthen the limited
evidence base for baclofen use for hiccups.
WCNR-0634
BOARD NUMBER: 022
FUNCTIONAL ELECTRICAL STIMULATION TO ANKLE DORSIFLEXOR AND
PLANTARFLEXOR USING SINGLE FOOT SWITCH THE EFFECT ON KNEE AND ANKLE
ANGLE IN PATIENTS WITH HEMIPLEGIA
Y.H. LEE1, S.H. Kim2, S.Y. Yong3
1, Wonju, Republic of Korea
2, Rehabilitation Medicine, Wonju, Republic of Korea
3Wonju Severance Christian Hospital, Rehabilitation Medicine, Wonju, Republic of Korea
Aims
To evaluate the effects of delivering Functional Electrical Stimulation(FES) to ankle dorsiflexor
during the swing phase, and ankle plantarflexor during the stance phase using single switch on
hemiplegic gait.
Method
Fourteen patients with hemiparesis, who can walk independently more than 5 minutes, has
sufficient passive range of motion of ankle. Two sets of surface electrodes were located on the
ankle dorisflexor and plantarflexor respectively. Portable FES equipment used single foot switch,
and was programmed to deliver electrical stimulation to one channel while foot switch is open,
and to the other channel while foot switch is closed. Ankle plantarflexors were stimulated by heel
contact and dorsiflexors were stimulated by heel off. Computerized motion analysis system with 6
cameras collected data. Patients were asked to ambulate three sessions, 6 meters per session.
Firstly subject ambulated without any stimulation (NS). Secondly subject ambulated with ankle
dorsiflexor stimulation during the swing phase (DS). Lastly patient ambulated with additive ankle
PF stimulation during the stance phase (DPS). Each session was composed of 5 trials. Knee
flexion, ankle dorsiflexion and plantarflexion angle in sagittal plan during the gait cycle were
compared among NS, DS and DPS groups.
Results
In addition to the usual FES application stimulating ankle DF only during the swing phase,
stimulation of ankle PF during stance phase can help to increase peak knee flexion during the
swing phase (Table 1).
TABLE I.
Comparison of Group-pairs of Knee Angle During Gait.
Group-pairs, Angle (degree)
Groups
Mid-stance Knee
Extension
Swing Phase Peak Knee
Flexion
Toe-off Knee
Flexion
No-stimulation (NS)
-5.27±8.87
30.78±13.64*
-8.55±7.87
Dorsiflexor only (DS)
-5.24±9.27
32.83±13.07‡
-4.53±5.46
Plantarflexor and
Dorsiflexor (DPS)
-5.49±9.34
34.12±13.77*‡
-5.20±6.01
*. NS and DPS, p < 0.05
‡ DS and DPS, p < 0.05
Conclusion
This study shows the advantages of stimulating the ankle dorsiflexor and plantarflexor using
single foot switch for post-stroke gait.
WCNR-0665
BOARD NUMBER: 023
NEUROMUSCULAR PATTERN OF THE LOWER LIMBS OF HEMIPARETIC STROKE
PATIENTS DURING OVER-GROUND GAIT TRAINING: ACUTE CHANGES INDUCED BY A
WEARABLE EXOSKELETON
F. MOLTENI1, G. Gasperini1, M. Gaffuri1, M. Colombo1, C. Giovanzana1, N. Farina1,
C. Lorenzon1, S. Scarano1, E. Guanziroli1
1Valduce Hospital, Villa Beretta Rehabilitation Center, Costa Masnaga, Italy
Aims
In stroke patients gait control is impaired. Interlimb coordination associated with abnormal timing
and intensity of recruitment of lower limb muscles are key factors for gait pattern. Surface
ElectroMyoGraphy (sEMG) can be used to identify the neuromuscular pattern of the lower limbs
during over-ground gait training.Rehabilitation targeting coordination impairments using new
wearable exoskeletons may be a way to improve walking ability. The aim of this work is to
evaluate acute changes of neuromuscular pattern of the lower limbs in acute and chronic post
stroke patients during over-ground gait training using a wearable exoskeleton (EksoTM).
Method
51 stroke patients, 25 Acute and 26 Chronic, were enrolled. A sEMG of muscles rectus femoris,
hamstrings, tibialis anterior and soleus of both limbs was collected during over-ground walking 1)
in standard condition and 2) with Ekso. A clinical classification of the neuromuscular patterns of
the lower limbs in terms of 1) timing for distal and proximal lower limb muscles; 2) muscular
activity of the whole lower limbs according to Knutsson’s classification was performed.
Results
Acute Patients with Ekso: 64% restored proximal timing, 44% the distal one for both affected and
non-affected side. Chronic Patients with Ekso: 81% restored proximal timing and 50% the distal
one for the non-affected side; 54% restored proximal and distal timing for the affected side.
According to Knutsson's classification lower limbs neuromuscular pattern was classified as Type
II for 84% of non-affected and 96% of affected sides in acute patients, and for 73% of nonaffected and 85% of affected sides in chronic patients.
Conclusion
Over-ground gait training using wearable robotic exoskeleton induces a timing/intensity
modulation of the neuromuscular pattern of the lower limbs both in acute and chronic stroke
patients. Further studies are needed to demonstrate the long-term effects.
WCNR-0672
BOARD NUMBER: 024
AN ART BASED CREATIVE ENGAGEMENT INTERVENTION FOR IN-PATIENT STROKE
REHABILITATION: HOW DOES PARTICIPANT PREFERENCE INFLUENCE RETENTION
AND OUTCOMES IN A RANDOMISED CONTROLLED FEASIBILITY TRIAL?
J. MORRIS1, C. Kelly2, T. Kroll3, S. Joice4, G. Mead5, P. Donnan6, B. Williams7
1Nursing- Midwifery and Allied Health Professions Research Unit,
School of Health and Life Sciences, Glasgow, United Kingdom
2NHS Tayside, Tayside Healthcare Arts Trust, Dundee, United Kingdom
3University of Dundee, Social Dimensions of Health Institute, Dundee, United Kingdom
4Massey University, School of Psychology, Palmerston North, New Zealand
5University of Edinburgh, Geriatric Medicine, Edinburgh, United Kingdom
6University of Dundee, Population Health Sciences, Dundee, United Kingdom
7University of Stirling, Nursing.Midwifery and Allied Health Professions Research Unit, Stirling,
United Kingdom
Aims
Art participation during rehabilitation may improve psychosocial outcomes after stroke, but does
not appeal to everyone. Within a feasibility randomised controlled trial (RCT) investigating an arts
based creative engagement intervention (CEI), we aimed to explore whether preference for art
participation influenced study retention and CEI group outcomes.
Method
Stroke survivors receiving in-patient rehabilitation were randomised to receive CEI (n=41): 4-8
art-making sessions with trained artists; or usual care including an art portfolio to view (n=40).
Preference was measured using a simple question after randomisation to indicate preference for
art participation, art viewing or no preference. Study Retention and CEI group descriptive data for
mean change (T1) baseline to (T2) end of intervention in Stroke Impact scale (SIS) sub-sections
emotion and social participation; Positive and Negative Affect Scale; Recovery Locus of Control
are presented.
Results
44% (n=18) of the CEI and 38% (n=15) of controls preferred art participation; 22% (n=9) CEI and
22% (n=9) of controls preferred art viewing; 34% CEI (n=14) and 40% (n=16) controls expressed
no preference.
Study Retention: At T2, 33/41 (80%) CEI and 38/40 (95%) control participants remained. Of CEI
withdrawals (n=8), six expressed no preference or preference was not met. Of those, five
declined the intervention and one declined T2 assessment. Of control withdrawals (n=2), one
whose preference was not met declined assessment, the other withdrew because of illness.
CEI group participants whose preference was met demonstrated higher change T1-T2 compared
to those whose preference was not met in SIS emotion (12.7±18.2 vs -0.6±27.4), positive affect
(6.3±8.8 vs 4.4±9.8) and recovery locus of control scales (2.0±3.2 vs -0.1±5.8).
Conclusion
Conclusion: Findings suggest preference for art participation may be an important consideration
for retention to studies evaluating this type of intervention. Preference may also be important in
determining study outcomes and its role should be more fully explored.
WCNR-0673
BOARD NUMBER: 025
IS EVALUATION OF PSYCHOSOCIAL EFFECTS OF AN ARTS BASED CREATIVE
ENGAGEMENT INTERVENTION DURING IN-PATIENT STROKE REHABILITATION
POSSIBLE? A FEASIBILITY RANDOMISED CONTROLLED TRIAL
J. MORRIS1, C. Kelly2, T. Kroll3, S. Joice4, G. Mead5, P. Donnan6, B. Williams7
1Glasgow Caledonian University, Nursing.Midwifery and Allied Health Professions Research Unit,
Glasgow, United Kingdom
2NHS Tayside, Tayside Healthcare Arts Trust, Dundee, United Kingdom
3University of Dundee, Social Dimensions of Health Institute, Dundee, United Kingdom
4Massey University, School of Psychology, Palmerston North, New Zealand
5University of Edinburgh, Geriatric Medicine, Edinburgh, United Kingdom
6University of Dundee, Population Health Sciences, Dundee, United Kingdom
7University of Stirling, Nursing.Midwifery and Allied Health Professions Research Unit, Stirling,
United Kingdom
Aims
Qualitative studies suggest art participation in rehabilitation may improve post-stroke
psychosocial outcomes. This study examined feasibility of conducting an RCT to evaluate such
an art intervention
Method
Design: Feasibility randomised controlled trial
Population: Stroke survivors admitted for in-patient rehabilitation
Intervention Group (n=41): 4-8 Creative Engagement Intervention (CEI) sessions with trained
artists with trained artists to create a piece of artwork
Control Group: (n=40) usual care and art portfolio to view.
Outcomes: Stroke Impact Scale - Social Participation, Communication, Emotion; Positive and
Negative Affect Schedule (PANAS); Visual Analogue Self-Esteem Scale (VASES), Trait Hope
Scale; General Self-efficacy Scale (GSES), Self-Efficacy for Art (SEfA); Recovery Locus of
Control.
Blinded assessment: Baseline (T1); end of intervention (T2); three months (T3)
Results
Of 198 admitted stroke survivors, 81 (41%) were recruited. 88% (n=71) completed T2 and 77%
(n=62) completed T3 assessments. CEI mean change was greater than controls between T1-T2
and T1-T3 for Emotion, PANAS and SEfA. CEI mean change T1-T2 was also higher than controls
for Social Participation. At T2, after adjusting for baseline covariates, estimated between group
differences for SEfA (p<0.001) and VASES (p=0.01) significantly favoured intervention and
control groups respectively. At T3 after adjusting for baseline covariates estimated between
group difference for SEfA (p<0.001) and GSES (p<0.04) significantly favoured intervention and
control groups respectively.
Conclusion
An RCT testing art participation in rehabilitation was possible and indicates art participation may
benefit social participation, emotion, positive affect and self-efficacy for art after stroke. These
potential effects warrant investigation in a fully powered RCT.
WCNR-0425
BOARD NUMBER: 026
MOTOR-COGNITIVE DUAL TASKING DURING REACHING IN PATIENTS WITH CHRONIC
STROKE
A.A. Mullick1,2, Y. Tomita1,2, M.C. Baniña1,2, M.F. Levin1,2
2Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, FeilOberfeld Research Centre- Jewish Rehabilitation Hospital, Laval, Canada
Aims
It has been observed that even if motor recovery is scored highly in test situations, people with
stroke do not spontaneously use their paretic arms in daily life situations. Real world
environments are often unpredictable and require the ability to multitask and make rapid and
accurate arm movement adjustments. The goal of this study was to identify whether and to what
extent cognitive-motor deficits in people who have had a stroke, particularly those who are
considered to be well-recovered, affect their ability to interact effectively with objects in the
environment by adapting their upper limb movements rapidly when environmental conditions
change.
Method
Well-recovered post-stroke individuals (Chedoke arm scores >5/7) and healthy controls
performed an obstacle avoidance task (OA) while standing in a 3D virtual environment Subjects
reached for a virtual juice bottle on a refrigerator shelf with their hemiparetic arm as quickly as
possible. In random trials, a sliding glass door partially obstructed the reaching path from the right
or the left side. A successful trial was one in which the subject touched the bottle without their
arm or hand hitting the door. Subjects then performed the OA task while also performing an
auditory n-back task (AT).
Results
Stroke and control subjects reached with similar velocities and decreased their speed similarly in
the presence of an obstacle (p<0.001). When performing the AT, unobstructed reaching was
significantly slower in the stroke (p<0.05) but not the control group. When performing AT and
avoiding obstacles, half the stroke subjects further decreased their reaching velocity. All stroke
subjects made a greater proportion of errors in the AT when also carrying out the OA task,
compared to performing the AT alone.
Conclusion
Preliminary results indicate that even in well-recovered patients, movement deficits may be
identified when individuals have to perform more complex, real-life tasks.
WCNR-0393
BOARD NUMBER: 027
THE EFFECT OF ROBOTIC TRAINING ON LOCOMOTION AND HEALTH RELATED
QUALITY OF LIFE IN STROKE PATIENTS
I. Yeldan1, R. Mustafaoglu2, B. Gunduz3, B. Erhan4
3Istanbul Physical Medicine and Rehabilitation Training Hospital- Istanbul-, Physical Medicine,
ISTANBUL, Turkey
Aims
Walking impairments have been considere done of the most devastating disabilities of poststroke.
Individuals may limit their mobility for safety reasons and consequently not accomplish
community ambulation. Therefore, improving walking for individuals after stroke remains a major
component of poststroke rehabilitation. The aim of this study is to investigate the effect of robotic
training on locomotion and quality of life in patients with stroke.
Method
Subacute and chronic 43 (12 women, 31 men) stroke patients older than 18 years, who can
cooperate and have 3 or higher grade in Functional Ambulation Scale were included in the
study.They were randomized into 3 groups. Group 1 (n=17): 45 minutes daily, 5 days a week for
6 weeks duration conventional stroke rehabilitation, Group 2 (n=11): only RAGT. Group 3 (n=15):
conventional stroke rehabilitation plus RAGT. Locomat (Hocoma AG, Volketswil, Switzerland)
was used in RAGT with 20 % body weight reduced, and 1.8 km/h (0.5 m/sec) velocity, 45
minutes/session, 2 times a week, for 6 weeks duration. The stair ascend and descend tests, the
6-Minute Walk Test (6-MWT) and Stroke Specific Quality of Life Scale (SSQOL) were used to
evaluate before and after the treatment. For comparison of change in outcome measures, the
repeated-measure analysis of variance (ANOVA) was used and p ≤0.05 was considered
statistically significant.
Results
When the three groups were compared after treatment, statistically significant improvements
were found in stair descend, 6-MWT and SSQOL in all groups (p=0.041, p=0.045, p=0.000;
respectively). In terms of differences, all outcome parameters showed significant improvements
(p<0.05) in favor of conventional rehabilitation plus RAGT.
Conclusion
Robotic gait training added to conventional gait training enhance locomotion, functional capacity
and quality of life in stroke patients. These improvements will have favorable effects on
participation of daily life specifically requiring outside participation of the patient.
WCNR-0529
BOARD NUMBER: 028
INVERSE RELATIONSHIP BETWEEN DEPRESSION, ANXIETY, STRESS AND FUNCTIONAL
INDEPENDENCE AMONG STROKE SURVIVORS IN NIGERIA
K. Nwankwo1, M. Owolabi2
1WFNR-Blossom Specialist Medical Centre, Physiotherapy, Ibadan, Nigeria
2WFNR-Blossom Specialist Medical Centre, Medicine, Ibadan, Nigeria
Aims
Cognitive and motor impairment in stroke
survivors often results in depression, anxiety,
stress and functional decline. Though these
characteristics have been studied individually, the
extent of functional impairment that could occur
as a result of their coexistence has not been
adequately investigated. We investigated the
relationship between existing co-existing
psychological disorder (depression, anxiety and
stress) and functional independence among
stroke survivors in this pilot study.
Method
We evaluated 30 consecutive stroke survivors who presented at the Physiotherapy clinic of the
University of Nigeria Teaching Hospital with first- ever stroke and no cognitive impairment (based
on the Mini Mental State Examination). Functional independence was assessed using the 10-item
Barthel index while depression, anxiety and stress were assessed using the Depression, Anxiety
and Stress Scale-21 (DASS-21). Data was analyzed using descriptive statistics, independent
sample test and Pearson moment correlation.
Results
30 stroke survivors with mean age 50.4±9.8 years participated in the study.There was a
preponderance of males (53.3%). All of depression, anxiety and stress were present in 56.7% of
the participants, 13.3% had depression and anxiety, 20% had anxiety and stress, 3.3% had
depression and stress while 6.7% had anxiety only. We observed that patients who had all the
three conditions coexisting had more functional impairment (t= -4.32; p<0.001) compared to those
who had one or two of the conditions alone. We found a significant negative correlation between
depression and functional independence (r= -0.61, p<0.001) while a non-significant negative
correlation existed between stress and functional independence (r = -0.180, p=0.341) and anxiety
and functional independence (r = -0.330, p=0.341).
Conclusion
Coexisting depression, anxiety and stress was
common and had more impact on functional
independence of stroke survivors. Psychological
dysfunction had an inverse relationship with
functional independence which was strongest
between depression and functional
independence.
WCNR-0607
BOARD NUMBER: 029
WRIST WORN ACCELEROMETERS WITH VIBRATING-ALERT TO PROMPT EXERCISES
AFTER STROKE (WAVES)
C. Price1, R. Da Silva1, S. Moore1, D. Jamieson2, D. Jackson2, M. Balaam2, K. Brittain3, L. Brkic1,
T. Ploetz2, H. Rodgers1, L. Shaw1, F. van Wijck4
1Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom
2Newcastle University, School of Computing Science, Newcastle upon Tyne, United Kingdom
3Newcastle University, Institute of Health and Society, Newcastle upon Tyne, United Kingdom
4Glasgow Caledonian University, Institute for Applied Health Research, Glasgow,
United Kingdom
Aims
Recovery of arm function after stroke is optimised through frequent repetition of functional
movements. We explored the feasibility of using a wrist-worn tri-axial accelerometer with vibrating
alert (the CueS wristband) to prompt impaired arm use when activity levels fall below a
personalised threshold, thereby encouraging movement and discouraging learned non-use.
Method
Adults ≤28 days post-stroke with new motor impairment completed a four week upper limb
rehabilitation programme wearing a CueS wristband for 12hours per day. Patients and therapists
reviewed twice weekly report of prompts and movement activity data (signal vector magnitude) to
agree personalised prompt thresholds (median baseline activity + 5%, 15%, 25% or 50%) and
maximum frequencies (every 1-4 hours).
Results
Seven patients completed the programme (age 65 ± 4; males 4; days post-stroke 13 ± 7; baseline
Action Research Arm Test 31 ± 19; 4 week ARAT 42 ± 24). Table 1 shows the activity response
to prompts for individual patients. The mean activity per minute during 60 minutes before/after all
prompts is displayed in Figure 1 and shows a post-prompt activity increase of +21% (p=0.04).
Conclusion
Stroke patients increased upper limb activity following personalised prompts by the CueS
wristband.
WCNR-0533
BOARD NUMBER: 030
FEASIBILITY OF ELICITING LOWER EXTREMITY MOTOR EVOKED POTENTIALS WITH
TRANSCRANIAL MAGNETIC STIMULATION IN CHILDREN WITH STROKE
L.A. Prosser- PT- PhD1, H.L. Atkinson- PT- NCS2, C. Gorman- BA3, R.N. Ichord- MD3,
S.K. Kessler- MD- MSCE3
1The Children's Hospital of Philadelphia, Division of Rehabilitation Medicine, Philadelphia, USA
2The Children's Hospital of Philadelphia, Physical Therapy, Philadelphia, USA
3The Children's Hospital of Philadelphia, Division of Neurology, Philadelphia, USA
Aims
Transcranial magnetic stimulation (TMS) is a useful biomarker of cortical excitability, but its use in
elucidating neural control of lower extremity muscles in children has been limited. The objective of
this pilot feasibility study was to determine the response patterns of tibialis anterior (TA) muscles
to TMS in children with a history of stroke during an episode of rehabilitation.
Method
Seven children and adolescents (mean age 10.7 years) with hemiplegia and a history of unilateral
supratentorial stroke at least 6 months prior participated in an 8-week rehabilitation program.
Cortical excitability was measured bilaterally, during resting state and active TA contraction, by
the stimulation threshold needed to elicit a motor evoked potential (MT, motor threshold) of the
contralateral TA using single-pulse TMS. These data were collected monthly from one month
prior to one month after therapy, for a total of 5 sessions.
Results
There was wide variability in the patterns of muscle responses observed among participants, but
these patterns were largely consistent session to session within participants. Three participants
demonstrated MTs only with active contraction on the nonparetic side. Four other distinct patterns
were observed in the other 4 participants, as presented in Table 1. Younger participant age
appears to limit the feasibility of eliciting MTs on the paretic side. To date, we have not observed
a pattern by stroke type or location.
Conclusion
The variability in motor patterns observed likely reflects increased variability in neuronal
maturation and cortical organization in children with stroke compared to more predictable patterns
of reorganization in adults after stroke. This variability may require the design of individualized
rehabilitation programs to target neural reorganization – with one treatment unlikely to be optimal
for all. Continued investigation of the influence of cortical organization on rehabilitation outcomes
is warranted.
WCNR-0710
BOARD NUMBER: 031
Human Recombinant Hyaluronidase Injections for Upper Limb Spasticity
P. RAGHAVAN1, M. Shalwala1, Y. Lu2, A. Stecco1
1New York University School of Medicine, Rusk Rehabilitation, New York, USA
2New York University, Steinhardt School of Education- Culture and Human Development,
New York, USA
Aims
Spasticity is a common impairment after injury to the central nervous system, but the neural and
biomechanical contributions to it are still poorly understood. Here, we propose a novel
hypothesis, the hyaluronan hypothesis, to explain the development of muscle stiffness and its role
in the exacerbation of spasticity, and provide the first evidence for a new treatment of spasticity
using the enzyme hyaluronidase.
Method
Between May 2014, and September 2015, twenty patients with moderately severe unilateral
upper limb spasticity in more than one joint, received multiple intramuscular injections of human
recombinant hyaluronidase with saline. The safety, tolerability, and efficacy of the injections on
upper limb spasticity, passive, and active range of motion for shoulder flexion and abduction,
elbow flexion and extension, forearm pronation and supination, and wrist flexion and extension
were assessed over the short-term (within 2 weeks) and long-term (up to 4 months).
Results
All subjects tolerated the procedure without clinically significant adverse effects. The mean
Modified Ashworth score across all movements decreased from 2.39 (SD 0.12) to 0.77 (SD 0.24)
in the short-term, and persisted at 0.58 (SD 0.35) over the long-term. The mean passive range of
motion increased significantly for all joints in the short-term and persisted over the long-term,
except for elbow flexion and forearm supination. The mean active range of motion showed more
variability across patients, but increased significantly for all movements over the short-and longterm, except for elbow extension and forearm pronation which increased only over the long-term,
and for wrist extension where the increase was not statistically significant in both short and longterm.
Conclusion
The results suggest that hyaluronidase injections offer a safe and potentially effective treatment
for upper limb spasticity, and may facilitate functional recovery when the neural capability exists.
These results must be confirmed in blinded placebo-controlled clinical trials.
WCNR-0410
BOARD NUMBER: 032
ROLE OF VISION AND HAPTIC FEEDBACK ON REACHING ACCURACY IN SUBJECTS
WITH CHRONIC STROKE
M. R.M. Rodrigues1,2, M. Slimovitch2,3, A. K. Blanchette4, M. F. Levin1,2
1McGill University, School of Physical and Occ. Therapy, Montreal, Canada
2Center for Interdisciplinary Research in Rehabilitation of the Greater Montreal CRIR,
Feil and Oberfeld Research Center- Jewish Rehabilitation Hospital, Laval, Canada
3McGill University, Faculty of Medicine, Montreal, Canada
4Laval University, Department of Rehabilitation, Quebec, Canada
Aims
Accuracy of upper-limb (UL) reaching movements is commonly affected after stroke. We
hypothesize that reaching accuracy is related to altered processing of sensory (visual, haptic)
input after stroke. The goal of this study was to identify the role of visual and haptic feedback on
maintaining movement accuracy in subjects with stroke.
Method
Two trials of 10 movements each were done in which subjects (stroke/control; n=20 each)
alternatively touched their nose (ReachIn) and a target (ReachOut) located at 90% arm-length, as
fast as possible, and at matched speeds with each arm. The task was performed in four
conditions: a) eyes open, haptic feedback (EOHF), b) eyes closed, haptic feedback (ECHF), c)
eyes open, no touch (EONT), and d) eyes closed, no touch (ECNT). UL and trunk kinematics
were recorded (Optotrak: 30s,100Hz).
Results
When reaching with both visual and haptic feedback, subjects with stroke made more curved and
less accurate endpoint trajectories compared to controls. Movement accuracy was lower with
eyes closed compared to eyes open without touch compared to with touch in both groups.
Subjects with stroke had larger errors than controls without vision and without touch. Movement
accuracy was worse when movements are performed in ReachOut direction in both groups in all
conditions.
Conclusion
Absence of vision and haptic feedback decreased task performance more in stroke compared to
healthy individuals. The results of this study will inform practitioners about the extent to which the
disruption of the task is related to the integrity of visual and haptic information.
WCNR-0631
BOARD NUMBER: 033
The effect of hyperbaric oxygen therapy on functional impairments caused by ischemic
stroke
E. Rosario1, S. Kaplan1, S. Khonsari1, G. Vazquez1, N. Solanki1, M. Lane1, G. Kerry1,
H. Brownell1, S. Rosenberg1
1Casa Colina Hospital and Centers for Healthcare, Research Institute, Pomona, USA
Aims
While research suggests a benefit of hyperbaric oxygen therapy (HBOT) for neurologic injury,
controlled clinical trials have not been able to clearly define the benefits. The objective of this
study was to investigate the mechanistic and functional effects of hyperbaric oxygen therapy
(HBOT) in the treatment of ischemic stroke.
Method
Subjects were included in this study if they had suffered an ischemic stroke approximately 12month ago and exhibited some functional impairments. Using a within subject design a baseline
for current functional abilities was established over a 3-month period for all subjects. Each subject
then received two 4-week periods of HBOT for a total of 40, 90-minute treatments over a 12-week
period. Subjects completed a battery of assessments including cognitive, physical, speech, and
quality of life measures, and had blood drawn for biochemical analysis of biomarker expression
levels six times over the 9-month total duration of the study.
Results
We found improvements in cognition and executive function as well as physical abilities
specifically, improved gait. Participants reported improved sleep and quality of life following
HBOT treatment. We also saw changes in serum levels of biomarkers for inflammation and
neural recovery. In the functional domains where improvement was observed following HBOT
treatment, the improvements were maintained up to 3 months following the last treatment.
However, the physiological biomarkers showed a pattern of more transient changes following
HBOT treatment.
Conclusion
Findings from this study support the use of HBOT as a potential intervention following stroke,
even after patients have plateaued in recovery. In addition these finding suggest the potential
value of monitoring blood based inflammatory and neural markers as indicators of a physiological
response to treatment.
WCNR-0597
BOARD NUMBER: 034
RELATIONSHIP BETWEEN SUB-SECTIONS OF UPPER EXTREMITY FUGL-MEYER SCORE
AND REACHING PERFORMANCE IN CHRONIC STROKE SURVIVORS
A. Rounds1,2, C. Wutzke2,3, R. Harrington2, E. Chan2, M. Harris-Love1,2
1George Mason University, Rehabilitation Science, Fairfax, USA
2Medstar National Rehabilitation Hospital, Neuroscience Research Center, Washington- DC, USA
3Veteran Affairs Medical Center, U.S Dept Of Veterans Affairs, Washington- DC, USA
Aims
Arm impairment is a major contributor to post-stroke disability. Impaired reaching ability is
particularly devastating for performance of activities of daily living. Objectives To identify
relationships between impairments characterized by the proximal-arm sub-sections of the Upper
Extremity Fugl-Meyer (UEFM) and reaching performance.
Method
27 people with chronic stroke participated in the study (UEFM =33.48±19.59; range: 0-66).
Participants performed a reaching response time task. The components of response time,
Reaction Time (RT) and Movement Time (MT) were calculated, in addition to the sub-sections of
the UEFM that focus on proximal-arm function (Flexor synergy, Extensor Synergy, Movement
Combining Synergies and Movement Out of Synergy). We calculated the correlation between
reaching components (RT and MT) and UEFM sub-sections and total score.
Results
Total UEFM Score correlated negatively with both reaching RT (r=-.615, p=.001) and MT (r =.455, p=.017). The sub-sections of the UEFM, Flexor Synergy and Extensor Synergy scores,
correlated negatively with RT(r=-.604, p=.001 and r=-.508, p=.007, respectively), but not MT. In
contrast, the Movement Combining Synergies and Movement Out of Synergy scores were not
only significantly correlated with RT (r=-489, p=.010 and r=-527, p=.005, respectively), but also
with MT (r=-.443, p=.021 and r=-.493, p=.009, respectively).
Conclusion
While the Flexor and Extensor Synergy sub-scores of the UEFM were related to RT, they were
not significantly related to MT (i.e. execution of the reaching task). However, UEFM sub-scores
related to Movements Combining Synergies and Movements Out of Synergy were related to both
reaching RT and MT. This suggests that the UEFM sub-sections for movements combining
synergies and out of synergy may be more closely related to proximal-arm function than those for
Flexor and Extensor Synergy.
WCNR-0417
BOARD NUMBER: 035
FEASIBILITY OF A SELF-MANAGEMENT TELEHEALTH INTERVENTION TO IMPROVE RISK
FACTOR CONTROL IN STROKE PATIENTS: THE STROKE COACH
B. Sakakibara1, J. Eng1, S. Barr2, O. Benavente3, C. Goldsmith4, S. Lear4, N. Silverberg5, J. Yao5
2University of British Columbia, Food- Nutrition- and Health, Vancouver, Canada
3University of British Columbia, Neurology, Vancouver, Canada
4Simon Fraser University, Health Sciences, Vancouver, Canada
5University of British Columbia, Physical Medicine and Rehabilitation, Vancouver, Canada
Aims
Stroke risk factors are controllable by improving lifestyle behaviours. We have developed the
Stroke COACH, an evidence-based self-management telehealth program to promote healthy
lifestyle behaviours after stroke. This multi-site randomized controlled trial will determine the
feasibility and effect of self-management support in patients within 1-year post stroke.
Method
In this study, participants are assigned to either the: 1) Stroke COACH program; or 2) Memory
training attention control program. The Stroke COACH is delivered by trained ‘lifestyle coaches’
who utilize self-management support techniques, such as motivational interviewing and the 5A
Interview Model, to facilitate the engagement of patients in their care, and management of healthy
lifestyle behaviours. In seven 30 to 60 minutes telephone sessions over 6-months, participants
collaboratively work with their coach to identify goals and develop action plans to better manage
their lifestyle behaviours.
Results
35 participants have been enrolled in this study. Sixteen participants have completed their
program; eight in the Stroke COACH program. The most frequently identified goals were to
increase physical activity (n=8), followed by eating healthier (n=7), and improving stress
management (n=7). For physical activity, participants developed action plans to walk more (alone
or with their friends and family) (n=8), cycling (n=4), and join a community exercise program
(n=3). For eating healthier, participants developed plans to eat more fruits and vegetables (n=6),
reduce sodium intake (n=4), and monitor food consumption (n=2). For stress management, action
plans were developed to seek social/peer support (n=5), participate in leisure activities (n=4), and
better manage work related stress.
Conclusion
The Stroke Coach program has enabled participants to successfully identify lifestyle behaviours
to self-management, and develop goals and action plans to follow to potential improve risk factor
control. Subsequent analyses will determine the efficacy of the Stroke COACH at improving risk
factor control in stroke patients using standardized outcome measures.
WCNR-0416
BOARD NUMBER: 036
COMPENSATION VERSUS MOVEMENT ADAPTABILITY DURING REACHING IN PATIENTS
WITH STROKE
K. Sambasivan1,2, S.K. Subramanian2,3, S. Khanafer4, M.C. Banina1,2, H. Sveistrup5, M.F. Levin1,2
2Center of Interdisciplinary Research in Rehabilitation, Jewish Rehabilitation Hospital, Montreal,
Canada
3University of Montreal, Department of Neuroscience, Montreal, Canada
4University of Ottawa, Department of Human Kinetics, Ottawa, Canada
5University of Ottawa, Department of Rehabilitation Sciences, Ottawa, Canada
Aims
Trunk recruitment to assist reaching has been described as a motor compensation in patients
with stroke. This is an example of the ability of patients to use kinematic redundancy for reaching.
Our goal was to determine the extent to which the ability of arm joints to compensate for
intentional trunk movement is affected by stroke.
Method
13 patients with stroke (60.9±10.3yrs, Composite Spasticity Index (CSI): 6.5±3.2/16; Fugl-Meyer
Assessment (FMA): 53.0±11.7/66; Reaching Performance Scale for Stroke (RPSS):
far=15.8±2.7/18 target and Chedoke Arm and Hand Activity Inventory (CAHAI): 44.4±15.0/63)
and 9 healthy controls (63.7±12.4yrs) participated. Kinematics for two arm tasks (40 trials/task)
were recorded for both arms in sitting without vision: Stationary-task: maintaining finger above a
target at 66% arm’s length; Reaching-task: reaching to target. Tasks were performed with and
without trunk leaning. In 40% of trials, trunk movement was unexpectedly blocked. Postural
control (sitting) was assessed with the Limits of Stability (LoS) test. The primary outcome for the
stationary-task was gain (g) quantifying the compensatory arm-trunk synergy (g=1: complete
compensation, g=0: no compensation); and for the reaching-task was the endpoint position
difference. Secondary outcomes were correlations between clinical measures and endpoint
performance measures.
Results
Gain was lower for the more-affected compared to the less-affected arms of stroke patients and
the non-dominant arms of controls (F3,40=9.54, p=0.004). The endpoint differences for both arms
of the stroke group were lower than controls (F3,40=10.27, p=0.003). Clinical scores were
correlated with g and endpoint differences of the more-affected arm.
Conclusion
Patients with stroke had decreased ability to adapt their arm movements to maintain endpoint
accuracy when intentionally moving their trunk. Our results may inform clinicians of which motor
control deficits may be targeted in upper limb rehabilitation of patients with stroke.
WCNR-0622
BOARD NUMBER: 037
PERCEPTIONS OF INDIVIDUALS WITH STROKE REGARDING THE USE OF WALKING
STICKS: A QUALI-QUANTITATIVE ANALYSIS
A. Scianni1, L.R. Nascimento1, G.M. Rocha1, L.F. Teixeira-Salmela1
1Universidade Federal de minas Gerais, Physical Therapy, Belo Horizonte, Brazil
Aims
To comprehend how people after stroke perceive the use of walking sticks, by identifying their
positive and negative perceptions. The specific research questions were: (i) what was the
percentage of positive perceptions regarding the use of walking sticks after stroke? Were the
positive perceptions related to participants’ walking abilities? (ii) How people after stroke, who
were naïve to the use of walking sticks, perceive the use of walking sticks?
Method
A secondary study, based upon a mix-method approach was conducted with 20 adults with
stroke. Participants, naïve to the use of walking sticks, received instructions on how to walk with a
single-point cane and their perceptions were registered. A quantitative analysis was used to
classify the participants’ perceptions into “positive” or “negative”. The percentage of positive
perceptions was calculated with all participants analyzed together and separated into functional
levels based upon their walking speeds (slow, intermediate, and fast walkers). A qualitative
analysis was used to comprehend the participants’ perceptions regarding the use of walking
sticks, by analysis of their discourse (content analysis).
Results
Individuals with severe and moderate gait disabilities i.e., slow and intermediate walkers, reported
more positive perceptions regarding the use of walking sticks (100% and 50%, respectively), in
comparison with those with mild disabilities, i.e., fast walkers (30%). The qualitative analysis
revealed that two categories with positive perceptions and two categories with negative
perceptions emerged from the content analysis.
Conclusion
People after stroke with severe and moderate disabilities tended to have more positive
perceptions regarding the use of walking sticks. The benefits were associated with improvements
in mobility and functional independence, as well, as in safety and balance during walking.
Negative perceptions were associated with lack of social confidence and/or limitations regarding
the use of their non-paretic upper limb during daily activities.
WCNR-0623
BOARD NUMBER: 038
CROSS-CULTURAL ADAPTATION OF THE BRAZILIAN VERSION OF THE EXERCISE
PREFERENCE QUESTIONNAIRE (STROKE)- BRASIL FOR INDIVIDUALS WITH STROKE
A. Scianni1, L.C.G. Caetano1, J.C. Polese1, L.F. Teixeira-Salmela1
1Universidade Federal de Minas Gerais, Physical Therapy, Belo Horizonte, Brazil
Aims
To perform the cross-cultural adaptation of the Exercise Preference Questionnaire (EPQ stroke) to
the Brazilian Portuguese language and evaluate its measurement properties.
Method
The EPQ(stroke) was submitted to translation, synthesis, back-translation, expert committee
review, and pre-testing, applied to 30 individuals with stroke. After the final version of the
EPQ(stroke)-Brazil was created, its test retest reliability was verified using Kappa index and
Intraclass Correlation Coeficcient (ICC) (n=50), and internal consistency was assessed by
Cronbach's alpha coefficient (n=101). Construct validity was assessed by the Confirmatory
Factorial Analysis (n=101), content validity, by the content validity index (CVI) (n=8), and face
validity, by the rate of agreement regarding the clarity, wording, ability to answer the questions
and layout and style in two groups including individuals with stroke (n=81) and multidisciplinary
health professionals (n=32).
Results
The pre-final version required review (items 9, 29, and 30) and, after another pre-test, it showed
to be appropriate. The Kappa index was 0,58; the ICC values ranged from 0,35 to 0,93, and the
Cronbach's alpha coefficient was 0,82. The Confirmatory Factorial Analysis and the CVI
confirmed the validity of the EPQ(stroke)-Brazil. The rate of agreement was greater than 80% for
both groups.
Conclusion
The EPQ(stroke)-Brazil showed to be a valid and reliable measure for Brazilian individuals with
stroke, considering the personal factors described by the International Classification of
Functioning, Disability and Health.
WCNR-0624
BOARD NUMBER: 039
CROSS-CULTURAL VALIDITY OF THE BRAZILIAN VERSION OF THE ABILOCO
QUESTIONNAIRE FOR INDIVIDUALS WITH STROKE, BASED UPON RASCH ANALYSIS
A. Scianni1, P.R. Avelino1, I. Faria-Fortini1, M.L. Basílio1, K.K.P. Menezes1, L.C. Magalhães2,
L.F. Teixeira-Salmela1
2Universidade Federal de Minas Gerais, Occupational Therapy, Belo Horizonte, Brazil
Aims
To evaluate the cross-cultural validity of the Brazilian version of the ABILOCO (ABILOCO-Brazil)
questionnaire for stroke individuals.
Method
Firstly, the process of cross-cultural adaptation of the ABILOCO was conducted, following
standardized procedures. The measurement properties of the ABILOCO-Brazil were investigated
using Rasch analysis. Cross-cultural validity was verified by differential item functioning (DIF)
analyses.
Results
The adapted version was applied to 136 sub-acute and chronic stroke survivors and
demonstrated satisfactory performance. Only one item exhibited misfit to the Rasch model’s
expectations. Principal component analysis showed that the variance explained by the first
dimension was 45%, however, the eigenvalue was 1.92, showing unidimensionality. The
ABILOCO-Brazil was able to divide the sample into two levels of ability and the items into seven
levels of difficulty, leading to reliability indices of 0.65 and 0.95 for subjects and items,
respectively and internal consistency of 0.76. The item-person map showed some gaps and
ceiling effect was observed for 21 participants (15.4%). Analysis of cultural invariance showed
that although there were found differences in calibrations in five items across the countries, these
differences did not impact the estimates of locomotion ability (Figure 1). These results indicated
that both the ABILOCO-Original and ABILOCO-Brazil calibrations can be used
interchangeably.
Conclusion
The ABILOCO-Brazil demonstrated satisfactory measurement properties for use within both
clinical and research contexts in Brazil and cross-cultural validity for use in
international/multicentric studies between Belgium and Brazil.
WCNR-0625
BOARD NUMBER: 040
LOWER LIMB MOTOR COORDINATION IS SIGNIFICANTLY IMPAIRED IN AMBULATORY
PEOPLE WITH CHRONIC STROKE: A CROSS-SECTIONAL STUDY
A. Scianni1, K.K.P. Menezes1, L.R. Nascimento1, P.R. Avelino1, I. Faria-Fortini1, C.D.C.M. Faria1,
J.C. Polese1, L.F. Teixeira-Salmela1
Aims
To quantify the extent of loss of motor coordination of the lower limbs in people with chronic
stroke, in comparison with healthy individuals and the magnitude of the deficits, according to
participant’s motor recovery levels.
Method
Motor coordination was measured by the Lower Extremity Motor Coordination Test (LEMOCOT)
and reported as number of taps/sec. The LEMOCOT scores of the individuals with stroke were
compared to those of healthy subjects, matched by age and gender. The results were also
provided according to participants’ motor recovery levels, measured by the Fugl-Meyer lower limb
motor section scores.
Results
Ninety-seven participants, with a mean age of 58 years (SD 12) participated. Significant
differences in the LEMOCOT scores were found between stroke and healthy subjects for both the
paretic (MD -22 taps/sec; 95% CI -25 to -19) and non-paretic lower limbs (MD -7 taps/sec; 95%
CI -9 to -4). Individuals with stroke showed deficits of 59% and 17% for the paretic and nonparetic lower limb, respectively. Significant differences in the LEMOCOT scores of the paretic
lower limb were found between motor recovery levels (p<0.01) (Figure 1), except between the
participants with marked and moderate impairment
levels.
Conclusion
The findings suggested that motor coordination of the paretic lower limb is significantly impaired
after stroke, and should be target during interventions. Motor coordination of the non-paretic
lower limb is also reduced. Although the deficit may not be clinically relevant, the scores of the
non-paretic lower limb should not be considered as references for rehabilitation purposes, since it
has the potential for improvement. Individuals with greater motor impairments may benefit more
from motor coordination exercises.
WCNR-0627
BOARD NUMBER: 041
ENERGY EXPENDITURE AND ENERGY COST OF STAIR ASCENT AND DESCENT IN
INDIVIDUALS WITH CHRONIC STROKE
A. Scianni1, J.C. Polese1, L.F. Teixeira-Salmela1
Aims
To compare energy expenditure (EE) and energy cost (EC) during stair ascent and descent
(SAD) between individuals with chronic stroke and healthy controls.
Method
For this cross-sectional study, 18 individuals with stroke and 18 healthy controls, matched by age
and sex, were assessed during SAD. EE (VO2), in ml∙kg-1∙min1, was measured using a portable
monitoring system. EC was reported in ml∙kg-1∙m-1. Individuals with stroke were classified into
community (walking speed ≥0.8m/s) or limited-community (<0.8m/s) ambulators.
Results
ANOVA revealed between-group differences for both the EE (F=15.94;p<0.0001) and EC
(F=61.92,p<0.0001) (Table 1). Both stroke sub-groups demonstrated lower EE values, compared
to healthy controls. However, the limited-community ambulators demonstrated the highest EC,
followed by the community ambulators, and healthy controls during SAD.
Table 1: Descriptive data (means ± standard deviations) and ANOVA results (F and p values)
regarding the between-group comparisons during the performance of stair ascent and descent.
Limited-community Community
Healthy Controls
Variable
ambulators
ambulators
F (p) values
(n=18)
(n=8)
(n=10)
11.24±3.10a
16.10±3.50a 22.73±5.96b
15.94 (<0.0001)
0.64±0.15a
0.51±0.09b
61.92 (<0.0001)
Energy expenditure
(ml∙kg ∙min )
-1
-1
Energy cost
0.17±0.08c
(ml∙kg ∙m )
-1
-1
Different letters indicate significant differences between the groups (p<0.05).
Conclusion
Both stroke sub-groups demonstrated lower EE during the performance of SAD, compared to
healthy controls. The limited-community ambulator sub-group demonstrated the highest EC,
followed by the community ambulators, and controls.
WCNR-0642
BOARD NUMBER: 042
Peroxynitrite could be critical drug target for preventing delayed thrombolysis-induced
hemorrhagic transformation in ischemia-reperfused rat brains
J. Shen1, H. Chen1, X. Chen1, J. Feng1
1The University of Hong Kong, School of Chinese Medicine, Hong Kong, Hong Kong- China
Aims
Tissue plasminogen activator (t-PA) is the only FDA approved drug for acute ischemic stroke but
has narrow therapeutic time window. Hemorrhagic transformation (HT) is a major complication of
delayed t-PA treatment. We aimed to test the hypothesis that peroxynitrite, a representative of
reactive nitrogen species, plays critical roles in HT and peroxynitrite decomposition catalyst
(PDC) could prevent such complication. Furthermore, we tested whether baicalin, a natural
antioxidant, could scavenge peroxynitrite and prevent t-PA-induced HT in ischemic stroke.
Method
Male Sprague-Dawley (SD) rats were subjected to middle cerebral artery occlusion (MCAO) with
t-PA (10 mg/kg) or t-PA plus FeTMPyP (3 mg/kg, a representative PDC) or Baicalin (10, 25, 50
mg/kg) at MCAO for 2 or 5 h and reperfusion for 22 or 19 h, respectively. HT was assessed with
hemoglobin assay. Neurological deficit was evaluated with Modified Neurological Severity Score
(mNSS). Peroxynitrite was examined by detecting 3-nitrotyrosine (3-NT) and HKYellow1, a newly
developed high sensitive and selective fluorescent probe. The expression and activity of MMP9/MMP-2 and iNOS were assessed by Western blotting and gelatin zymography.
Results
t-PA treatment at 2 h of MCAO attenuated neurological deficit without inducing HT but at 5 h
significantly induced HT and worsened neurological outcome. Such complications were
prevented by FeTMPyP co-treatment. Early t-PA treatment inhibited iNOS activity, peroxynitrite
production, MMP-9/MMP-2 expression and activity, whereas delayed t-PA treatment up-regulated
iNOS activity, increased peroxynitrite formation, and downregulated MMP-9/MMP-2 expression
and activity. Interestingly, co-treatment of FeTMPyP significantly revised those changes. Baicalin
revealed strong peroxynitrite-scavenging activity and co-treatment of Baicalin protected the
neuronal cells from peroxynitrite-induced neurotoxicity, reduced infarct size and attenuated
apoptotic cell death and prevented HT.
Conclusion
Peroxynitrite could be a critical therapeutic target for preventing hemorrhagic transformation and
improving neurological outcome in ischemic brains with delayed t-PA treatment.
WCNR-0406
BOARD NUMBER: 043
SENSORY RETRAINING OUTCOMES FOLLOWING STROKE: IMPACT OF SEVERITY OF
SOMATOSENSORY IMPAIRMENT AND FUNCTIONAL ARM USE
M. Turville1,2, T. Matyas1,2, J. Blennerhassett1,3, L. Carey1,2
1The Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery,
Heidelberg, Australia
2La Trobe University, Community and Clinical Allied Health, Melbourne, Australia
3Austin Health, Physiotherapy, Melbourne, Australia
Aims
Somatosensation and motor capacity are inherently linked in functional use of the upper limb
following stroke. However, it is unknown the extent to which individual differences in severity of
somatosensory impairment and functional arm use impact on ability to benefit from treatment for
somatosensory loss. The aim was to investigate if initial severity of somatosensory impairment
and functional arm use is associated with somatosensory retraining outcomes following stroke.
Method
Data will be pooled from two randomised control trials (RCT) of somatosensory discrimination
retraining. At baseline, initial somatosensory impairment was measured using standardised
sensory assessments of: (1) texture discrimination (Tactile Discrimination Test and Fabric
Matching Test); (2) wrist proprioception (Wrist Position Sense Test); and (3) haptic object
recognition (functional Tactile Object Recognition Test). Arm functioning was measured using the
Motor Activity Log (MAL) at baseline, end of treatment, and 3 or 6 month follow-up. Outcomes of
somatosensory retraining, using the above sensory assessments, were measured pre-treatment,
post-treatment, and follow-up 3 or 6 months post-treatment.
Results
Data sample (n=78) will be available in January 2016. Regression modeling will analyse the
relationship between: (1) initial severity of somatosensory impairment and (a) post-treatment
sensory outcomes (b) follow-up treatment outcomes; (2) initial levels of functional arm use and (a)
post-treatment sensory outcomes (b) follow-up treatment outcomes. Relationship between
somatosensory functioning, post-treatment functional arm use and follow-up outcomes will be
analysed. Clinical significance of sensory outcomes will be investigated for a sub-group of
participants using Canadian Occupational Performance Measure (COPM).
Conclusion
Results will inform debate on whether initial severity of hemiparesis and/or somatosensory
impairment is associated with specific treatment outcomes. It will be determined if it is necessary
to target sensory retraining treatment according to individual differences in initial severity of
hemiparesis and somatosensation.
WCNR-0419
BOARD NUMBER: 044
IMPROVED STEP QUALITY AFTER PERTURBATION-BASED BALANCE TRAINING IN
PERSONS WITH CHRONIC STROKE
H.J.R. Van Duijnhoven1, J.M.B. Roelofs1, J. den Boer1, G. van Bon1, A.C.H. Geurts1,
V. Weerdesteyn1
1Radboudumc - Donders institute for Brain - Cognition and Behaviour, Rehabilitation, Nijmegen,
Netherlands
Aims
To investigate whether perturbation-based balance training improves step quality in persons with
chronic stroke.
Method
Twenty persons with chronic stroke were randomized to an intervention (n=10) or waiting-list
control group (n=10). The intervention studied was a 5-week perturbation-based balance training
on a moveable platform (10 sessions of 45 minutes). The control group received the same
intervention after a 5-week waiting period. Step quality was assessed during a lean-and-release
task in backward and forward direction at pre intervention, post intervention and six weeks after
the intervention (retention) for the study population at large. For the control group, step quality
was additionally assessed six weeks prior to training. Leg angles at foot contact, a strong
indicator of step quality, were calculated. Group differences between the study population at large
and the control group were estimated at post intervention and retention, using linear mixed
models for repeated data with adjustment for baseline values.
Results
After training, leg angles were significantly increased in the study population at large, compared
to the control group (table 1: mean difference (95% CI) backward 4.8°(1.2-8.5) p=0.013; forward
2.5° (0.3-4.7) p=0.03). These improvements were retained (backward p=0.016; forward p=0.02).
Conclusion
This small-sized RCT shows that 10 sessions of perturbation-based balance training improves
step quality in persons with chronic stroke, immediately and six weeks after training.
WCNR-0449
BOARD NUMBER: 045
IMPROVEMENT IN NEUROBEHAVIORAL AND PHYSICAL FUNCTION IN THE PRISM II
TRIAL OF DEXTROMETHORPHAN/QUINIDINE FOR PSEUDOBULBAR AFFECT
FOLLOWING STROKE
R. Zorowitz1, D. Alexander2, F. Purayidathil3, A. Formella3, F. Ledon3, P. Shin3, C. Yonan3,
J. Siffert3
1MedStar National Rehabilitation Network, Neurology, Washington, USA
2David Geffen School of Medicine at UCLA, Neurology, Los Angeles, USA
3Avanir Pharmaceuticals- Inc., Health Economics and Outcomes Research, Aliso Viejo, USA
Aims
Pseudobulbar affect (PBA), a neurologic condition characterized by sudden, frequent, and
uncontrollable outbursts of laughing and/or crying, is commonly reported following stroke. PRISM
II was a 90-day, open-label, multicenter study measuring dextromethorphan/quinidine (DM/Q)
effectiveness, safety and tolerability for PBA following stroke, dementia, or traumatic brain injury.
Neurobehavioral and physical function outcomes related to stroke were assessed using the
Stroke Impact Scale (SIS) and are reported.
Method
Enrolled patients had PBA secondary to stroke and a Center for Neurologic Study-Lability Scale
(CNS-LS) score ≥13. Patients received DM/Q 20/10 mg twice daily. Outcomes including the CNSLS (primary) and SIS were assessed at baseline and Day 90/endpoint.
Results
Of 113 enrolled stroke survivors, 103 were evaluable for effectiveness. Mean (SD) CNS-LS
scores improved -7.6 (6.7) points from Baseline score 20.7 (4.7; n=103) to Endpoint 13.1 (5.4;
n=92; P<0.001 vs. Baseline, [1-sample t-test]). Baseline SIS scores ranged from 45.4 (34.4) for
hand function to 68.2 (21.6) for communication. All SIS domains improved significantly vs.
Baseline [P<0.001 for all]. Changes were generally larger for neurobehavioral [memory 8.3
(23.0); emotion 11.0 (20.4); communication 5.3 (20.4); social participation 12.4 (23.2)] than
physical domains [strength 4.2 (17.1); hand function 5.0 (19.5); mobility 6.0 (16.5); ADL/IADLs 5.7
(17.7); physical dimension 5.2 (12.9)]; overall stroke recovery assessment improved 8.1 (19.8).
Conclusion
Stroke survivors treated with DM/Q showed reduced PBA episodes and improved functional
outcomes related to stroke recovery. Further analysis of the relationship between PBA symptom
reduction and stroke recovery will help clarify the impact of DM/Q.
WCNR-0561
BOARD NUMBER: 046
RELATIONSHIP BETWEEN TRUNK CONTROL AND RECOVERY OF UPPER EXTREMITY IN
SUBACUTE STROKE PATIENTS
S.K. Wee1, J.H. Burridge2, A.M. Hughes2, M.B. Warner2, S. Brown2, D.S.C. Yeo1, K.H. Kong1,
K.F. Chan1
1Tan Tock Seng Hospital, Rehabilitation Centre, Singapore, Singapore
2University of Southampton- United Kingdom, Faculty of Health SciencesRehabilitation and Health Technologies Research Group, Southampton, United Kingdom
Aims
Background:
Impaired trunk control is commonly observed following a stroke. The trunk is considered an
important postural stabilizer which enables dissociation of upper extremity (UE) from the trunk for
function. Our recent cross-sectional study1 has demonstrated a strong association between trunk
control and UE function in stroke patients. However, the relationship between trunk control and
recovery of UE over time has not been investigated yet.
Aim:
To evaluate the relationship between trunk control and recovery of UE in the first 6 months post
stroke.
Method
Forty-five subacute stroke patients were recruited for this longitudinal study. Trunk control was
assessed using the Trunk Impairment Scale (TIS). UE impairment and function were assessed
with Fugl-Meyer (FMA) and Streamlined Wolf Motor Function Test (SWMFT) respectively. The
SWMFT consists of the performance time (SWMFT-Time) and functional ability scale (SWMFTFAS). Participants were assessed once a month till 6 months post stroke. The individual growth
curve (IGC) modeling technique was used to analyse intra-individual and inter-individual changes
over time.
Results
The IGC results demonstrated that the most rapid recovery of trunk control and UE occurred in
the first 3 months followed by a deceleration in the rate of recovery from 4th to 6th month post
stroke. The rate of change of the recovery curves of trunk control and UE impairment was found
to be similar over time. As TIS scores improved over time, both the UE impairment (FMA) and UE
function (SWMFT-Time and SWMFT- FAS) improved almost in parallel with the TIS increase. A
better degree of trunk control was associated with a better recovery of UE.
Conclusion
Trunk control has an association with the recovery of UE impairment and function in the first 6
months post stroke. Hence, improving trunk control has the potential to facilitate better recovery
of the UE in stroke patients. *1 Physical Therapy 95(8):1163-1171
WCNR-0681
BOARD NUMBER: 047
EFFECTS OF SENSORY CUEING ON PARETIC UPPER EXTREMITY IN SUBACUTE
STROKE PATIENTS: A SHAM RANDOMIZED CONTROLLED TRIAL
X. Wei1, K.N.K. FONG1
1The Hong Kong Polytechnic University, Department of Rehabilitation Sciences, Kowloon,
Hong Kong- China
Aims
Remind-to-move is an emerging concept of reducing non-use of paretic upper extremity after
stroke. This study was to investigate the effects of Remind-to-move by means of sensory cueing
for promoting upper extremity recovery in subacute stroke patients.
Method
Fifty-one subacute patients recruited from 3 hospitals, were randomly allocated to experimental,
placebo, and control groups at the time when they were discharged from the hospital. The
patients in both experimental or placebo groups would need to wear a wristwatch cueing device
on their affected wrist 3 hours per day for 4 weeks, with a vibration cue emitted from the device
every 10 mins. Only patients in the experimental group had to follow customized upper extremity
movement exercise upon every cue. All patients were assessed by a blinded rater at four
occasions (pre, 4-week, 8-week, 12-week). The assessments included: Fugl-Meyer Assessment
(FMA), Action Research Arm Test (ARAT), Box and Block Test (BBT), Motor Activity Log (MAL),
and Functional Independent Measure (FIM).
Results
The study was on-going and we have recruited 15 patients in the experimental, 15 in the placebo,
and 21 in the control group. All the baseline characteristics were comparable among groups. All
groups showed significant improvement immediately after treatment. The patients in the
experimental and placebo groups presented relative more recovery than these allocated to the
control group, however, there were no significant differences between-group in the outcomes.
Our findings showed that placebo effect of remind-to-move by means of sensory cueing is
stronger especially increasing movement control , whereas sensory cueing itself prompt more
hand use daily life.
Conclusion
Placebo effect is strong in remind-to-move treatment. However, both experimental and placebo
treatment cannot reduce disability in terms of ADL. Further investigation of the benefits of using
different protocols in sensory cueing for various arm impairments is recommended.
WCNR-0430
BOARD NUMBER: 048
MUSCLE SELECTION PATTERNS FOR INJECTION OF ONABOTULINUMTOXINA IN ADULT
PATIENTS WITH POST-STROKE LOWER-LIMB SPASTICITY INFLUENCE OUTCOME:
RESULTS FROM A DOUBLE-BLIND, PLACEBO-CONTROLLED PHASE 3 CLINICAL TRIAL
T.H. Wein1, A. Esquenazi2, A.B. Ward3, C. Geis4, C. Liu5, R. Dimitrova6
1McGill University, Neurology and Neurosurgery, Montreal, Canada
2MossRehab Gait and Motion Analysis Laboratory, Physical Medicine & Rehabilitation,
Elkins Park, USA
3Staffordshire University, North Staffordshire Rehabilitation Centre, Stoke on Trent,
United Kingdom
4Halifax Health- Brooks Rehabilitation, Department of Rehabilitation Medicine, Daytona Beach,
USA
5Allergan- Inc., Biostatistics, Bridgewater, USA
6Allergan- Inc., Neurology and Pain Clinical Development, Irvine, USA
Aims
OnabotulinumtoxinA (300U–400U) is being investigated for the treatment of post-stroke lower
limb spasticity (PSLLS) in the ankle. The objective of this analysis is to identify an optimal muscle
selection pattern for onabotulinumtoxinA injection for the treatment of PSLLS.
Method
Adults with PSLLS (Modified Ashworth Scale [MAS] ≥3 in the ankle) were enrolled in a
multicenter, phase 3, placebo-controlled study. The 12-week double-blind phase randomized
patients to onabotulinumtoxinA (300U, mandatory muscles [gastrocnemius, soleus, tibialis
posterior] and ≤100U, optional lower limb muscles [flexor digitorum longus (FDL), flexor digitorum
brevis, flexor hallucis longus (FHL), extensor hallucis, rectus femoris]) or placebo. The primary
endpoint, MAS change from baseline, and a secondary endpoint, physician-assessed Clinical
Global Impression of Change (CGI), were each reported as the average score of weeks 4 and 6.
Results
In the intent-to-treat group (n=468), onabotulinumtoxinA significantly improved ankle MAS (–0.81
vs –0.61; P=0.01) and CGI (0.86 vs 0.65; P=0.012) versus placebo. 211 patients received
treatment in the mandatory muscles only; 119 received treatment in the mandatory muscles plus
FHL and FDL muscles. Injection of the mandatory muscles alone was insufficient for improving
ankle MAS (P=0.255) or CGI (P=0.576) in all patients, however, it was adequate among those ≤2
years post-stroke (MAS, –1.13 vs –0.62, P=0.019; CGI, 1.24 vs. 0.68, P=0.006). Additional
injections into FDL and FHL muscles significantly improved ankle MAS (–0.98 vs –0.52; P=0.002)
and CGI (0.80 vs 0.38; P=0.023) versus placebo regardless of their time since stroke.
OnabotulinumtoxinA 300-400 U was well tolerated with no new safety findings
Conclusion
Additional injections of onabotulinumtoxinA into the toe flexors (FDL, FHL) significantly improved
ankle MAS and CGI scores compared with injections into the mandatory muscles alone,
particularly when treatment was initiated >2 years post-stroke.
Study Supported by: Allergan, Inc.
WCNR-0414
BOARD NUMBER: 049
DEVELOPMENT OF A BIMANUAL ASSESSMENT MEASURE (BAM) TO ASSESS FUNCTION
AFTER STROKE
B. Johnson1, S. McCombe Waller1, J. Whitall1, K. Westlake1
1University of Maryland- Baltimore, Physical Therapy and Rehabilitation Science, Baltimore, USA
Aims
Challenges in bimanual function can be found above and beyond unimanual deficits after stroke
and can lead to role reversals of both hands. In these cases, the previously dominant hand acts
as a stabilizer rather than manipulator and vice versa for the non-dominant hand. Despite the
emerging understanding of bimanual impairments and rehabilitation, the majority of clinical
outcome scales have essentially omitted an assessment of bimanual function whereby the
specific role of each hand is evaluated. The aim of this study is to develop a brief mobile appbased bimanual assessment measure (BAM) that incorporates common functional tasks with the
hands in both pre- and post-morbid roles, if different.
Method
Phase 1: Individuals with chronic stroke (>6 months) and licensed and practicing occupational
therapists from a local hospital were invited to focus group discussions regarding test item
selection and refinement as well as the overall layout and script of the BAM. Reliability and
validity testing will be conducted in Phases 2 and 3.
Results
BAM items related to independent community functioning supported the initial item selection of 11
current functional tasks that include specific components of bimanual coordination (i.e. common
and parallel goals, asymmetrical and symmetrical force, timing, and trajectory requirements).
Example items include cutting food, writing, opening container, lifting a large box, and catching a
falling box. A web-based version has been developed that includes consideration of dominant
and non-dominant hands as well as functional hand role (i.e. stabilizer or manipulator).
Conclusion
As a first step towards development, BAM demonstrates face and content validity. Further
validity, reliability, and usability testing are underway.
WCNR-0461
BOARD NUMBER: 050
NEURAL SUBSTRATES FOR THE EFFECTS OF UNIMANUAL AND BIMANUAL TRAINING
ON MOTOR RECOVERY AFTER STROKE
E. Woytowicz1, S. McCombe Waller1, J. Whitall1, K. Westlake1
1University of Maryland School of Medicine - Baltimore,
Physical Therapy and Rehabilitation Science, Baltimore, USA
Aims
Evidence from basic science supports both unimanual and bimanual task-oriented practice to
alter and improve how the brain controls movement. In theory, these protocols offer great promise
for stroke rehabilitation. However, clinical trials often result in marked variability of upper extremity
function with similar inconsistencies with respect to the associated cortical reorganization. The
goal of this pilot study was to investigate the relationship between group differences in neural
connectivity at baseline with responsiveness to training that differs only with the use of number of
arms. We hypothesized that 1) a preferential response to bimanual training, defined by improved
affected arm function, will be predicted by a greater bihemispheric coupling of sensorimotor areas
at baseline, and 2) a preferential response to unimanual training, defined by improved affected
arm function, will be predicted by reduced coupling between bihemispheric sensorimotor brain
networks at baseline.
Method
Using functional magnetic resonance imaging (fMRI) of paretic hand movements, we used dual
regression to compare functional connectivity of the sensorimotor and cognitive networks
between chronic (> 6 month) stroke patients who underwent unilateral (n=10) or bilateral (n=8)
training at baseline, mid-training (6 weeks), and post-training (12 weeks). As a next step, dynamic
causal modeling (DCM) will be used to investigate effective connectivity within and between these
regions at baseline in relation to changes in outcomes after training.
Results
Preliminary analysis revealed no significant differences in functional connectivity of the
sensorimotor or cognitive networks between time points or groups. Results from DCM will be
presented and discussed.
Conclusion
Although functional connectivity with dual regression did not illustrate any significant differences,
effective connectivity measures are expected to provide a more dynamic characterization of the
interaction between brain regions. These results have potential to guide the matching of
rehabilitation to the neural capacity after stroke.
WCNR-0639
BOARD NUMBER: 051
Effect of Transcranial Direct Current Stimulation on Upper Limb Function in Subacute
Stroke: a Double-blind Randomized Controlled Trail
W. XIA1
1Hubei Province Hospital of the Intergrated Chinese and Western Medicine,
Department of Physical Medicine and Rehabilitation, Wuhan, China
Aims
Objective To evaluate the effectiveness of combined transcranial direct current stimulation
（tDCS） and standard rehabilitation training in treating stroke patients with upper motor
dysfunction in.
Method
Methods In a double-blind randomized controlled trial, 124 patients with hemiplegia after stroke
were randomly divided into two groups: experimental and control. In experimental group, the
patients received tDCS and standard rehabilitation training treatment, and those in control group
received sham tDCS and standard rehabilitation training treatment. Participants in both groups
received therapy of 5 days per week for 4 weeks. The primary endpoint including the upper limb
motor function test of Fugl-meyer assessment (U-FMA) and wolf motor function test (WMFT), and
the secondary endpoint including modified Barthel index (MBI) and 36-item Short Form Health
Survey Questionnaire (SF-36) were assessed before and 4 weeks after treatment.
Results
Results Totally, 113 subjects completed the study. After 4-week treatment, the U-FMA scores (
P<0.01), WMFT scores (P<0.01), MBI scores (P<0.05) and SF-36 (P<0.01) were significantly
increased in the experimental group as compared with the control group. After 3 months of followup, the U-FMA scores, MBI scores and SF-36 scores were significantly increased in the
experimental group as compared with the control group (P＜0.05, P＜0.01).
Conclusion
Conclusions The combined use of tDCS with standard rehabilitation training could effectively
improve the upper limb function, the living activity, and the quality of life in patients with
hemiplegia following subacute stroke, which may provide a better rehabilitation treatment for
subacute stroke.
WCNR-0436
BOARD NUMBER: 052
DIAGNOSTIC UTILITY OF DIFFUSION TENSOR IMAGING IN STROKE REHABILITATION: A
REPORT OF THREE CASES
N. Yozbatiran1, Z. Keser1, K. Hasan2, D. Phillips3, G. Francisco1
USA
2University of Texas Medical School at Houston, Radiology, Houston, USA
3The Institute for Rehabilitation and Research at Memorial Hermann, Occupational Therapy,
Houston, USA
Aims
To describe diagnostic utility of diffusion tensor imaging in subacute subcortical ischemic stroke
with moderate to severe upper extremity motor impairment.
Method
We describe two cases (Subject 1(S1) = 40, F and Subject 2 (S2) = 34, M) having ischemic
stroke respectively 3 months and 5 months prior to the study secondarily to uncontrolled
hypertension. They underwent upper-extremity Fugl-Meyer (UEFM) motor and sensory
assessments, magnetic resonance (MRI) and diffusion tensor imaging (DTI) of brain exams. In
both subjects stroke lesions were found to be at corona radiate level; at right in S1 and at left in
S2. The ratios of lesion volume to total intracranial volume (ICV) were 0.02 % and 0.01 %
respectively. S1 scored 20/66 in UEFM motor and 12/12 in UEFM sensory whereas S2 scored
32/66 in UEFM motor and 11/12 in UEFM sensory. We used unaffected side as a control in the
DTI and we have computed the ratio (affected side/unaffected side) of DTI derived values.
Volume of corticospinal tract on the affected side found to be ten and three times smaller
compared to unaffected side in S1 and S2 respectively whereas volumes of spinothalamic tract
were found to be similar bilaterally on both subjects. The other DTI derived values showed similar
trend in both motor and sensory tracts.
Results
Although MRI showed very tiny lesions (0.01- 0.02 % of total ICV), DTI has showed specifically
affected pathway, which was CST in our study, with a huge volume loss (70-90%) at corona
radiate level where all ascending-descending fibers intermingle. It was interesting to observe the
correlation of lesion severity of CST in DTI with motor impairment in our subjects.
Conclusion
DTI is a powerful tool to assess the white matter integrity of brain and to correlate with functional
measurements in stroke rehabilitation.
WCNR-0187
BOARD NUMBER: 053
THE USE OF LOW-COST ADAPTATION TO PROMOTE ACCESSIBILITY IN COUNTRYSIDE
CITIES IN BRAZIL - A MODEL FOR MULTIPROFESSIONAL TEAM
F. Albieri1, P.H. Mota2, L.F.F. Silva3, P. Bandeira Cientifica4
1, Boston, USA
2University of Sao Paulo - Medical School, Preventive Medicine, Sao Paulo, Brazil
3University of Sao Paulo - Medical School, Pathology, Sao Paulo, Brazil
4University of Sao Paulo, Pathology, Sao Paulo, Brazil
Aims
Promoting low coast adaptations for disabled people aiming accessibility and quality of life
improvement during a Health Care Extension Program in poor cities in Brazil.
Method
A team including students and Physical, Occupational and Speech Therapists, Engineer and
volunteer citizens took part in two editions of a ten days expedition to the countryside cities of
Pedra Azul (Dec 2013) and Ibatiba (Dec 2014) to select the patients, execute of the adaptations
and evaluate the intervention. The selection criteria included economic vulnerability, costs and
real possibilities of intervention for the people. To select the material the team considered the
cost-benefit ratio, local availability of needed materials and reproduction feasibility by local
volunteers.
Results
Twelve patients were selected and received the adaptations (six per year) including seven wheel
chairs, three bath chairs, two bath stages, one lower limb orthesis, one access ramp and two
communication boards. The team encouraged the volunteers to move forward with this project
and teach other volunteers how to select the materials and make the adaptations.
Figure legend: A - The team working in a bath stage; B - The process of wheel chair adaptations;
C - An adapted shower chair
Conclusion
The use low cost adaptations is a feasible alternative to promote accessibility and improve the
quality of life of disabled people in poor countryside communities. The participation of local
volunteers is a strategy to promote the citizens involvement and to stimulate the maintenance and
propagation of such activities.
WCNR-0188
BOARD NUMBER: 054
A DAILY LIFE ACTIVITY AND ACCESSIBILITY SCREENING IN DISABLED PATIENTS FROM
A NEGLECTED BACKLAND BRAZILIAN CITY
F. Albieri1, P.H. Mota2, L.F.F. Silva3, P. Bandeira Cientifica4
1, Boston, USA
2University of Sao Paulo - Medicine School, Preventive Medicine, Sao Paulo, Brazil
3University of Sao Paulo - Medicine School, Pathology, São Paulo, Brazil
4University of Sao Paulo, Pathology, Sao Paulo, Brazil
Aims
The main purpose of this study was identify some characteristics of a disabled population in a
neglected Brazilian countryside and the impact in their lives to demonstrate the necessity of
rehabilitation policies.
Method
Physical Therapist group conducted a 8-day disability screening in Afogados da Ingazeira
(32,000 inhabitants city in Brazilian northeast backlands) through of patient and/or caregivers
interviews. To select the participants the snowball sampling was used by the group. Eighty-five
people were indicated by the method. Two were excluded for having fractures, one old man was
excluded because didn’t have disabilities, two people didn’t want to take part on the study and
one person wasn’t found. The group was restricted to urban area. All data were analyzed by the
Physical Therapists and reported to the city authorities.
Results
Seventy-nine patients were identified in this study (47% male / 53% female). The mean age was
34.5±26.4. Four kinds of disabilities were identified: motor (68.4%), cognitive (30.4%), visual
(22.8%) and hearing (15.2%). The most important cause of disabilities was genetic and
congenital disease (59.5% of cases) yet there were secondary causes and traumatic causes too
(24.3% and 16.2% respectively). The results regarding daily life activity (A), locomotion (B) and
accessibility structure in frequent environments (C) are presented in the graphs below.
Conclusion
The studied city has a poor integrated health care and accessibility structure resulting in impaired
patients’ independence. Rehabilitation policies and accessibility structures should be
implemented to improve disabled patient’s quality of life.
WCNR-0092
BOARD NUMBER: 055
OUTCOMES OF POST-STROKE NEUROREHABILITATION THERAPY AT THE ELDERLY
A. Capisizu1, S.M. Aurelian1, A.S. Nica2, R. Dascalescu1, A. Mirsu-Paun3, A. Zamfirescu1
1Hospital "Sf Luca", Geriatric UMF "Carol Davila", Bucharest, Romania
2National Institute of Rehabilitation ”Filantropia", Rehabilitation Department UMF "Carol Davila",
Bucharest, Romania
3University of Medicine and Pharmacy “Carol Davila “, Geriatric Department- “St. Luca“ Hospital,
Bucharest, Romania
Aims
Neurorehabilitation helps the patients to become as independent as possible and to obtain a
better quality of life. Stroke is frequent in elderly population and a leading cause of disability.
Rehabilitation post stroke at the elderly is long process.
Method
A prospective-cross-sectional study 1 year in Geriatric Department“St.Luca” Bucharest. 119
inpatients(62, 2% female, mean-age 79.03±7.13) with one first unilateral stroke and no severe
cognitive impairment were enrolled. Functionality was assessed by Barthel Index of Daily
Activities of Living[BIDAL], Tinetti Balance Assessment Tool[TBAT](Romanian-version) and
Reisberg Global Deterioration Scale[RGDS]. Data were collected twice, at inclusion(T1) and after
1 month(T2) of daily physical exercises(practicing isolated movements, repeatedly changing from
one kind of movement to another, complex movements that require a great deal of coordination
and balance). Statistical multivariate analyses were made by SPSS 22.0. The study was
approved by the Ethical Committee. Informed consent was obtained from all individual
participants included.
Results
Paired sample t-tests were conducted to examine group differences. RGDS and TBAT scores
were improved statistically significant. For BIDAL the scores were improve overall with
time[F(1,112)=93.08,p<0.0001, partial h2=0.45],but no statistically significant time by treatment
differences were found although the mean scores show a trend. The outcomes obtained: TBAT
t(36)=3.78, p<0.0001, scores decreased 1,40 units; BIDAL t(36)=11.79, p<0.0001, scores
increased 7.16 units; RGDS t(36)=- 7.61, p<0.0001, scores decreased 0.54 units.
Tinetti
PRE
Tinetti
POST
Barthel
PRE
Barthel
POST
Reisberg
PRE
Reisberg
POST
Mean
11.81
10.41
50.68
57.84
3.68
3.14
N
37
37
37
37
37
37
2.901
16.209
15.747
1.375
1.337
.477
2.665
2.589
.226
.220
Std. Deviation 2.942
Std. Error
Mean
Conclusion
.484
Physical exercises had a positive impact on functional capacity after one month of treatment. The
repetitive physical therapies encourage brain plasticity and helps reduce disabilities. Physical
therapists and physicians establish exercise programs, compensatory strategies to reduce the
effect of remaining deficits.
WCNR-0147
BOARD NUMBER: 056
BOBATH CONCEPT APPROACH IN PATIENTS WITH INTRACRANIAL TUMORS: RESULTS
OF EARLY STAGE REHABILITATION
H. Çetin1, C. Turkmen1, E. Dulger1, S. Bilgin1, N. Kose1
Aims
The aim of this study was to research the effect of neurodevelopmental Bobath Treatment that
applied in early stage on functional capacity and mobility of adult patients with brain tumors(BT).
Method
This study was performed retrospectively on 30 hemiparesis patients who had operation because
of BT at Hacettepe University Hospital neurosurgery department between the years 20132015.The rehabilitation program had been started when medical status of patients were stabil.
Demografic informations,localization of tumor,surgical technics, time between surgery and start of
rehabilitation and time of hospital stay. Neurodevelopmental Bobath Treatment was applied on
patients 5 days a week. The effect of treatment was measured with Karnofsky Performance
Scale, Stroke Rehabilitation Assessment of Movement, Mini Mental Test, Acut Hemiplegia
Mobility Scale and Functional Independent Measurement.
Results
This study included 30 patients(16 women,14 men). The mean age of patients was 52.4±11.7.
Patients who have tumors at supratentorial area,had surgical technics like this;8 grosstotal,10
total,12 subtotal. Respectively, time of between surgery and start of rehabilitation,rehabilitation
and stay at hospital were 5.7±4.6, 12.2±9.4, 24.4±11.6. As a result of this study, we found
statistically significant improvement in all evaluation results (p<0,001).
Conclusion
This study revealed positive effect of Bobath neurodevelopmental treatment on early stage in
patients with brain tumors. As a result, we emphasise that rehabilitation program in addition to
surgery and medical treatment is a necessity. Also our study revealed that increased studies that
applied Bobath treatment approaches which contribute to formation correct plastic process are
needed in early stage.
WCNR-0384
BOARD NUMBER: 057
EARLY PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF) EXERCISES AND
QUALITY OF LIFE IN PATIENTS WITH ACUTE STROKE WITH COMPARISON IN STROKES
OF DIFFERENT HEMISPHERES
P. Chaturvedi1, A.K. Singh2, D. Kulshreshtha3, P.K. Maurya2, A.K. Thacker2
1, Lucknow, India
2Ram Manohar Lohia Institue of Medical Sciences, Neurology, Lucknow, India
3Ram Manohar Lohia Institute of Medical Sciences, Neurology, Lucknow, India
Aims
Objectives: To assess quality of life after PNF in stroke patients with acute stroke and to
compare the quality of life in patients with stroke of different hemisphere
Method
Methods: In this prospective cohort study total 45 patients were recruited and divided into left
and right hemiplegic group. PNF exercises were given from first day of their admission to the
hospital. Intervention was given twice daily for 30 minutes 5 days a week until patient was able to
stand independently. Quality of life and Modified Rankin scales were assessed at the time of
admission and at 6 months. It was assessed by stroke specific quality of life scale (SSQOL).
Patients were followed up in IPD on monthly basis upto 6 months. Patients with right and left
hemispheric stroke were analyzed separately.
Results
Results: Mean age of the patients was 55.80±12.53, Glasgow coma scale=14.93 ±0.066,
NIHSS= 7.53 ±0.747 with maximum score 15, MRS= 3.53±0.157. Twenty nine patients suffered
from left and 16 from right hemispheric stroke. Independent t- test was applied for statistical
significance. For SSQOL t(44)= - 9.91, p= .026. Results were highly significant which shows that
there was significant improvement in functional activities of daily living and patients were having
better quality of life. However, there was no significant change in different hemispheric
involvement (t(43)= -0.168 and p= 0.168 (two tailed).
Conclusion
Conclusion: PNF exercises improved the quality of life in patients with stroke however no
significant difference was observed in relation to the two hemispheres. The quality of life appears
to be independent of cortical functions.
WCNR-0272
BOARD NUMBER: 058
DEVELOPMENT & STANDARDIZATION OF A LITERACY FREE COGNITIVE INTERVENTION
AFTER BRAIN INJURY TARGETING ATTENTION, MEMORY & EXECUTIVE FUNCTIONS
S. Chopra1, S. Sinha2, R. Pandey3, H. Kaur1, A. Nehra1
2All India Institute of Medical Sciences, Neurosurgery, New Delhi, India
Aims
As people with low literacy levels represent a significant proportion of the world, specific cognitive
rehabilitation modules for such populations are indispensable. Literacy is significantly associated
with all neuropsychological measures and retraining programs widely use techniques which
essentially require the individual to read or write. The aim was to develop a literacy free
intervention for improving cognitive functioning in patients after mild to moderate Traumatic Brain
Injury (TBI).
Method
The development consisted of planning, preparing, analyzing and revising the modules for
immediate and delayed visual memory; planning; focussed and divided attention; concentration
and colouring (for relaxation; to control irritability and aggression). 98 home based modules were
prepared using visual item memorization, stick constructions, symbol cancellations, and colouring
tasks (42: memory, 42: executive functioning, 7: attention & 7: colouring). The standardization
was done on 20 healthy controls to review, select and edit items. For each module, time, errors
made & errors per second were noted to establish the difficulty level of each module and were
arranged in increasing level of difficulty over a period of 6 weeks. The retraining tasks were then
administered on 11 brain injured individuals (5= Mild TBI and 6= Moderate TBI).
Results
Education was divided into illiterates, up to 10, 10-15, and >15 years. Between group and within
group analysis was done using t-test. The performance of 20 healthy controls was analyzed and
only a significant difference was observed on the time taken for the attention tasks and all other
domains had non-significant differences in performance between different education levels. There
was a significant improvement in cognitive functioning in the patient group after 6 weeks.
Conclusion
This intervention is feasible to administer and may help alleviating cognitive complaints after brain
injury in low literate or mixed cultural populations. Further study of its efficacy in a randomized
trial is already underway.
WCNR-0280
BOARD NUMBER: 059
EFFECTIVENESS OF A LITERACY FREE COGNITIVE INTERVENTION ON COGNITION &
POST CONCUSSIVE SYMPTOMS: AN ONGOING SINGLE BLIND RANDOMIZED STUDY
S. Chopra1, S. Sinha2, R. Pandey3, H. Kaur1, A. Nehra1
2All India Institute of Medical Sciences, Neurosurgery, New Delhi, India
Aims
There are nearly 1.5 to 2 million survivors of Traumatic Brain Injury (TBI) in India. There is a
paucity of literacy and cost effective cognitive interventions for developing nations which can be
used as home-based retraining programs. The effectiveness of a new cognitive intervention
developed in India which was education and culture free was studied.
Method
Thirty four consenting individuals in an ongoing clinical trial (CTRI/2014/04/004555), between 1845 years, educated from 0-17 years, within one month of Mild (n=26) or Moderate TBI (n=8); with
cognitive complaints and/or PCS, were randomized and assigned to the control group (CG)
(Mean Age 30.8±9.2 S.D. Years) or the intervention group (IG) (Mean Age 32.3±10.2 S.D.
Years). They were evaluated using standardized neuropsychological tools for cognition, anxiety,
depression, Post Concussive Symptoms (PCS) and Quality of Life (QOL). The 6-week, homebased Neuropsychological Rehabilitation included intervention for focussed and divided attention;
short term and long term visual memory; visuo-spatial and planning ability; and relaxation
techniques.
Results
Within group analysis using paired t-test/ Wilcoxon signed-rank test showed improvement in both
groups. There were significant improvements in the IG as compared to the CG after 6 weeks, in
episodic memory (p =0.030); working memory (p=0.016); short term verbal memory (p=0.007);
paired associate learning (p=0.050); new learning, anxiety (p=0.007); depression (p=0.032); PCS
(p=0.050); and QOL (0.005). PCS still persisted in the CG on follow up (p=0.300).
Conclusion
Frequently used cognitive interventions have been found to be non-reproducible in developing
nations like India, as literacy rates can affect task performance. This intervention can be used
with patients with low education levels or from lower socio-economic status who cannot afford
daily visits to the Neuropsychologist or a tertiary care centre. Long term benefits of this
intervention are being followed up to study its effectiveness 3 months, 6 months and 1 year post
rehabilitation.
WCNR-0516
BOARD NUMBER: 060
FACILITATORS AND BARRIERS FOR USING VALID AND RELIABLE OUTCOME
MEASURES IN NEUROLOGICAL REHABILITATION IN HIGH AND LOW-INCOME
COUNTRIES
M. Demers1,2, A. Blanchette3,4, K. Woo1,2, A. Mullick1,2, A. Shaw5, J.M. Solomon5, M.F. Levin1,2
1McGill University, School of Physical and Occupational therapy, Montreal, Canada
2Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal,
Feil and Oberfeld Research Center- Jewish Rehabilitation Hospital, Laval, Canada
3Université Laval, Department of Rehabilitation, Quebec, Canada
4Center for Interdisciplinary Research in Rehabilitation and Social Integration, IRDPQ, Quebec,
Canada
5Manipal University, Department of Physiotherapy, Manipal, India
Aims
To compare the factors influencing the use of standardized outcome measures for physical (PT)
and occupational therapists (OT) working with neurological populations in India and Canada.
Method
A self-administered web-based questionnaire (cross-sectional design) was sent to PTs and OTs
working in neurology across Canada and India. The questionnaire, developed by experienced
researchers and clinicians, contained questions related to socio-demographics, work
environment, patient characteristics and factors influencing the use of standardized neurological
assessments. Frequencies and proportions (%) of responses were computed. Two-proportion ztests were used to compare the responses between both countries.
Results
A total of 450 clinicians completed the questionnaire (133 Indians and 317 Canadians). The most
often cited facilitators and barriers to using standardized outcome measures were similar for India
and Canada. The main facilitators were: rapidity and ease of administration (India: 18.4%,
Canada: 17.1%), known reliability and validity of the measure (India: 16.1%, Canada: 15.9) and
recommendation of the measure in clinical practice guidelines (India: 16.1%, Canada: 14.7%).
Lack of time (India: 22.6%, Canada: 25.2%) and the preference to rely on clinical judgment to
assess change and identify impairments (India: 17.8%, Canada: 18.7%) were identified as
important barriers for using standardized outcome measures in both countries.
Conclusion
Despite differences in the healthcare systems between India and Canada, factors influencing the
use of standardized outcome measures for PTs and OTs working in neurology are similar. The
identification of these factors is the first step in tailoring strategies to increase the use of
standardized outcome measures in neurological rehabilitation.
WCNR-0108
BOARD NUMBER: 061
NEUROLOGICAL REHABILITATION IN COLLECTIVE MODE IMPROVES SOCIAL SUPPORT
TO PEOPLE WITH STROKE, AFTER APPLICATION OF CONSTRAINS INDUCED OF
MOVEMENT THERAPY
A. Doussoulin1, J. Najum2, J.L. Saiz3, F. Molina4
1Universidad de La Frontera, Temuco, Chile
2Hospital Hernán Henriqueza Aravena, UCI, Temuco, Chile
3Universidad de La Frontera, Psychology, Temuco, Chile
4Universidad de La Frontera, Kinesiology Program, Temuco, Chile
Aims
Social and family support is crucial after a stroke, considering that prevents the occurrence of
psychopathology and helps support the sensory-motor complications that generate a neurological
disease.
To determine whether the neurological rehabilitation in collective mode improves social and
family support users with stroke, after application of Constraint-Induced Therapy of Movement
(CIMT).Method
A randomized controlled trial of 36 patients (table 1) that had a stroke were divided into two
intervention groups. The independent variable was the implementation of collective or individual
therapy for 3 hours for 10 consecutive days (figure 1) and the dependent variable was social
perception evaluated by Medical Outcomes Study-Social Support Survey (MOS-SSS), at baseline
(pre-test) and end (post-test).
Results
Results: By controlling the pre-test scores, an analysis of covariance indicate that the dependent
variable presented significant differences in favor of the collective modality (table 2).
Conclusion
Both types of intervention generated increases in social perception, however these increases
being higher in the collective modality.
WCNR-0311
BOARD NUMBER: 062
DEVELOPMENT OF A MUSIC THERAPY PROJECT IN A NEUROLOGICAL
REHABILITATION SETTING IN TURKEY
B.M. Dursun1, T. Gokbel2, C. Karacan2, B.C. Tayyare2, S. Akyel3, E. Dursun2
1Istanbul University National Music Conservatory, Department of Piano, Istanbul, Turkey
2Kocaeli University Faculty of Medicine, Department of Physical Medicine and Rehabilitation,
Kocaeli, Turkey
3Dance Teacher, Kocaeli, Kocaeli, Turkey
Aims
Music therapy (MT) can be motivating and elating, enhance self esteem, help to reach patients`
full potential, and provide opportunities to bolster social skills. The aim of this project was to
develop a profound MT program as an adjunctive modality in a multimodal neurologic
rehabilitation setting for children with cerebral palsy (CP) and patients with stroke; to accomplish
clinical research studies about MT; and to generalize the its use.
Method
A music conservatory student, a Turkish classical music conductor, a tango dance teacher
voluntarily worked exhaustively with the medical rehabilitation team including physiatrist,
occupational therapist, special educator, recreational sportist within the project. Specific
objectives are set for each patient and musical activities such as listening, singing, playing
instruments (simple percussion instruments like maracas, tambourine, drum, spoons, triangle),
and moving to music (simple steps to salsa and tango basic steps) are used to reach these goals.
Musical activities were applied as single and group therapy sessions.
Results
69 patients with CP and 65 with stroke received MT. Clinical research studies on effectiveness of
playing percussive instruments on hand function of CP, effectiveness of salsa/tango on gait and
balance of CP and stroke, effects of MT on attention, memory, and quality of life of CP patients
were started and preliminary reports of two were made in an international congress. Group
therapy sessions came about CP children percussion band, CP teenagers salsa group, stroke
patients tango group, and stroke patients Turkish Classical Music Choir. A patient performance
show with the participation of 25 patients occurred on 23rd of February 2015 in Süleyman
Demirel Cultural Center with the immense attention of media.
Conclusion
This is the first MT program in a neurologic rehabilitation setting in Turkey. MT can be a useful
adjunctive modality in neurological rehabilitation settings which requires scientific proof by
prospective randomized controlled trials.
WCNR-0194
BOARD NUMBER: 063
SOCIAL SKILLS- A MILESTONE IN MILD AUTISM SPECTRUM DISORDER:
OCCUPATIONAL THERAPY PERSPECTIVE
P. Gokhale1, P. Sawant2
1Vasant Vihar Counselling centre, Occupational Therapy, Mumbai, India
2Kokilaben Dhirubhai Ambani Hospital, Physical medicine and Rehabilitation, Mumbai, India
Aims
Aim of the study was to improve the social interaction skills in children with mild Autism Spectrum
Disorder (ASD) and to reduce the abnormal behaviours in high functioning autistic children.
Method
Children, in age group of 6-8 years, both males and females; with diagnosis of Autism Spectrum
Disorder were screened using Autism Spectrum Disorder assessment scale (ASD AS) to rule out
moderate & severe impairment. Those with Mild ASD were subjected to 8 weeks of Occupational
Therapy intervention focussing on social skills training (Group Therapy) along with Sensory
integration therapy. In this observational cohort study; social skills assessment was done using
ASD Social skills profile (ASD SSP); pre and post intervention.
Results
Post intervention, there was an improvement in Social skill areas as reflected in the scores of
ASD SSP. The pre-intervention mean score was (91.67 ± 0.97) which increased to (96.88 ±
0.97). This result was statistically significant at P < 0.01
Conclusion
Thus, it can be concluded that there was improvement in social interaction skills with reduced
abnormal behaviours post therapy in children with mild Autism Spectrum Disorder. The children
were more comfortable in consecutive group therapy sessions.
WCNR-0539
BOARD NUMBER: 064
MIRROR THERAPY IN IMPROVING HAND FUNCTION OF A HEMIPARETIC CHILD WITH
BRAIN ABSCESS AND TETRALOGY OF FALLOT: A CASE REPORT
A.R. Hebreo1, M. Lim-Dungca1
1Philippine General Hospital, Rehabilitation Medicine, Manila, Philippines
Aims
This case aims to explore the effects of mirror therapy in early phase of neuro-rehabilitation in a
pediatric patient with hemiparesis.
Method
An 8-year-old female, right-handed, diagnosed with Tetralogy of Fallot since 5 years old,
presented with left hemiparesis and was referred for rehabilitation in August 2014. Cranial CT
scan showed an abscess at the right parietal area. On initial evaluation she presented with
weakness of the left upper extremity, manual muscle test (MMT) grade of 2/5 on the proximal
muscles and 3/5 on distal muscles. Weak grip and pinch strength were also noted. Jebsen Test
of Hand Function showed incoordination and impairments in dexterity and hand function. Four
days after surgery she started 30-minute mirror exercises in addition to 30-minute conventional
occupational therapy (OT), completing six sessions for two weeks, and another two weeks of
conventional OT only. MMT, grip and pinch strength test, Jebsen Test of Hand Function and
WeeFIM were performed at the beginning and end of each two-week intervention.
Results
There was increase in handgrip strength from 0.24 to 1.28 kg. Improvements were noted on
strength of muscles of the paretic upper extremity, from 2/5 to 4/5 MMT grade. There was
improvement in the components of the Jebsen Test of Hand Function, manifested as decrease in
time it takes to complete the tasks. WeeFIM (Functional Independence Measure) score showed
improvements in bimanual self-care activities from 16 to 23 post-treatment with conventional OT
and mirror therapy. Pinch grip strength did not show any change from baseline. No adverse
effects were noted.
Conclusion
Improvements in hand function were seen following early initiation of mirror therapy with
conventional OT in the management of hemiparesis in children with brain abscess and Tetralogy
of Fallot. Mirror therapy may be prescribed as an affordable and readily available adjunct to
conventional OT, thus warranting further investigation.
WCNR-0287
BOARD NUMBER: 065
DEVELOPMENT & STANDARDISATION OF A COMPREHENSIVE NEUROPSYCHOLOGICAL
REHABILITATION WITH APHASIA THERAPY FOR POST STROKE APHASIA: A HOME
BASED APPROACH
H. Kaur1, R. Bhatia2, R. Pandey3, S. Chopra1, A. Nehra1
2All India Institute of Medical Sciences, Neurology, New Delhi, India
Aims
India not only possesses racial diversity but also linguistic diversity, therefore, rehabilitation
becomes challenging. As adaptations and translations are not easy to work with in rehabilitation,
our objective was to develop and standardize a Comprehensive Neuropsychological
Rehabilitation (CNR) for post stroke aphasia in India.
Method
The CNR is weekly home based rehabilitation program which included retraining tasks for
attention, executive functioning, response inhibition comprehension, naming, fluency and simple
mathematical problems with a total of 509 worksheets. These were standardized and task
analysis was done on 42 healthy controls where the tasks were found to be free from the
influence of age and education. The effectiveness of the same was tested on 20 stroke survivors
suffering from aphasia with no previous history of psychiatric or neurological disorder, education
> 10 years & mean age 49.93±15.01 years. Patients had to maintain 8 weekly follow ups and do
the tasks in their home environment in the supervision of the caregiver. A new module was
introduced after attaining the flooring effect by the patient. Pre Post outcome measure was the
Indian Aphasia Battery (IAB) for the severity of aphasia.
Results
Wilcoxon sign rank test shows that the neuropsychological assessment post rehabilitation shows
a marked improvement in the Global Aphasia Quotient (GAQ) (p=<0.001) along with significant
results in the individual domains. More number of sessions shows favorable improvement in the
test scores with a mean change of scores maximum when more than 5 sessions are held.
Conclusion
Using a home based CNR programme can help in ameliorating the language and cognitive
deficits in post-stroke aphasia & can come as aid in developing countries where it becomes
difficult for patients for routine travel to the hospital due to financial constraints. RCTs are
necessary to see its efficacy.
WCNR-0043
BOARD NUMBER: 066
NEURO-REHABILITATION IN THE ERA OF NEW GLOBAL HEALTH
F. Khan1, B. Amatya1, F.A. Rathore2
1Royal Melbourne Hospital, Department of Rehabilitation Medicine, Parkville, Australia
2CMH Lahore Medical College- University of Health Sciences,
Department of Rehabilitation Medicine, Lahore, Pakistan
Aims
The prevalence of disability due to neurological conditions are escalating worldwide. These add
to the economic burden for healthcare systems (particularly low-resourced countries), where
despite improved acute health care systems, health policies have not extended to include
rehabilitation. The aim is to provide an overview of neurorehabilitation in developing countries
Method
Narrative review of the literature was conducted to provide an overview current status of
neurorehabilitation in developing countries and to highlight some of the challenges in
implementation of the WHO’s Global Disability Action Plan (DAP), within context of neurological
conditions, with a focus on rehabilitation (Objective 2).
Results
Neurorehabilitation is interdisciplinary and cross-sectorial, requiring collaborative coordinated
effort of diverse sectors, professions, patients and community to manage the biopsychosocial
challenges due to complex disability. Several issues related to neurorehabilitation are discussed
for a systematic approach to build horizontal health care systems that are sustainable and
responsive; involvement of bilateral agencies using multi-sectorial approach, new partnerships,
strategic collaboration; provision of technical assistance, research and development; and
capacity-building for a strong interdisciplinary workforce. Other factors that need to be addressed
include governance for strengthening health care systems through logistics, surveillance and
service delivery; and adequate scaling.
Conclusion
The DAP provides comprehensive summary actions to tackle global disability, including
neurological disorder related disability, and offers governments, policy makers, and other relevant
stakeholders a blueprint for implementing the recommendations of the World Disability Report
and Convention on the Rights of Persons with Disabilities, and facilitate social inclusion of
persons with neurological conditions, in countries at all stages of development.
WCNR-0186
BOARD NUMBER: 067
CHANGE PSYCHOMOTOR DEVELOPMENT IN PREMATURE WITH BRONCHOPULMONARY
DYSPLASIA UNDER SENSORIMOTOR STIMULATION WITHIN FIRST 12 MONTHOF LIFE
M.A. Marin1, I. Geraldine1, A. Paulina1
1Universidad de Chile, Kinesiology, Santiago, Chile
Aims
The purpose of this study was to assess the effects of early sensorimotor stimulation on
extremely premature with Bronchopulmonary dysplasia (BPD) as a potential additional key risk
factor for psychomotor development disorder within the first year of life(adjusted).
Method
Anon-experimental case-control, study was conducted,. 55 preterm infants (≤32 weeks of
gestation) from a governmental physical rehabilitation unit were reviewed, out of which 40% had
BPD. Basic data under assessment comes from clinical records and results from a local
standardized psychomotor development test (“EEDP”) taken at 6 and 12 months (adjusted
age).All cases received sensorimotor stimulation along theadjusted first year.
Results
The analysis shows that the prevalence of delayed psychomotor development in preterm infants
was 34.5% and increases to 40% in preterm infants with BPD. However, based on results from
an Adjusted Logistic Regression model (OR= 2.809 and p=0.248), BPD shows no statistical
materiality as an independent key risk factor for psychomotor development disorder in the first
year of life.
Conclusion
Results suggest that BPD will not act as a significantrisk factor on motor development in the first
year of life on children benefited by early sensorimotor stimulation.
WCNR-0226
BOARD NUMBER: 068
EVALUATION OF KINEMATIC AND SPATIAL-TEMPORAL CHANGES DURING GAIT WITH
THE USE OF FUNCTIONAL ELECTRIC STIMULATION IN PEOPLE WITH AFFECTED LIMB
DUE TO BRAIN INJURY
M. Rodrigo1, G. Varas1, F. Covarrubias1
1Clinica los Coihues, Terapia, Santiago, Chile
Aims
To describe the effect of funcional electric Stimulation (FES) in spatial-temporal and kinematic
parameters of gait in subjects with affected lower limb as a result of brain injury.
Method
In this study, kinematic and spatial-temporal parameters were compared during the walking test
in 12 subjects with paretic lower limb due to brain injury, with and without the use of the FES
(Neuroprosthesis L300® System). This system selectively activated the dorsiflexor muscles
during the swing phase of walking. The spatial-temporal and kinematic parameters were
registered by the APDM system. Data was analyzed by Mobility Lab and Matlab. The research
was approved by the University of Chile ethics committee. Were all subjects previously evaluated
with Berg Balance Scale (BBS)
Results
In subjects with scores in the functional balance assessment, Berg Balance Scale, of less than 45
points, selective use of FES in dorsiflexor muscles during the swing phase of walking had
significant improvements in kinematic and spatial-temporal parameters (p=0.004 cadence, step
length p=0.025; percentage of the gait cycle in double support p=0.045). However, in subjects
with BBS scores higher than 45 points, no significant differences were observed with the use of
FES during walking, in comparison with no use of FES.
Conclusion
Selective use of FES in dorsiflexor muscles during the swing phase of walking was effective only
in subjects with medium and low motor functions and balance.
WCNR-0546
BOARD NUMBER: 069
ROLE OF DXA DENSITOMETRY IN REHABILITATION OF BACK PAIN CAUSED BY
OSTEOPOROSIS IN UZBEKISTAN
E. Mirdjuraev1, D. Akilov1
1Tashkent Institute of Postgraduate Medical Education, Neurorehabilitation, Tashkent, Uzbekistan
Aims
One of the most common causes of back pain is osteoporosis, which is now according to the
WHO ranks, is third in the list of medical and social problems of our time, after cardiovascular
disease and diabetes. Back pain is main cause of patients arrival to neurologist in Uzbekistan.
In recent decades, significant progress in the development of noninvasive assessment of the
skeleton. The "gold standard" of bone densitometry at the present stage of medical science is the
method of dual energy X-ray absorptiometry (DXA). This study work of this type is based on the
transmission of X-rays through the bone. The detection system detects the intensity of the bone
passed through two narrow X-ray beams one of high-energy and one low-energy, which greatly
increases the accuracy of the study. DXA can test various portions of the skeleton, depending on
the capabilities of the device.
Method
As a method of studying the state of bone tissue of lumbar spine, we have used dual energy
absorptiometry. The objects of the study were 63 patients aged 40 to 65 years (42 women and 21
men) with low back pain of varying severity.
Results
DXA revealed the following violations of bone mineral density: 32 (50.7%) patients after a study in
the area of the lumbar spine was diagnosed with osteoporosis in 19 (30.2%) - osteopenia and
only 12 (19.1 %) patients had normal BMD detected;
Conclusion
This method of study is very effective and should be applied in a comprehensive examination of
patients with back pain for further correction treatment for osteoporosis or osteopenia identify. It is
clear that early diagnosis of osteoporosis will help to further rehabilitation of back pain.
WCNR-0452
BOARD NUMBER: 070
PROFILE OF THE CARE RECEIVED BY STROKE PATIENTS TREATED AT THE
CATARINENSE REHABILITATION CENTER - CRC, FLORIANÓPOLIS, SANTA CATARINA
(SC), BRAZIL
S.P.B.O. Nogueira1, C. Dadalt2, S.C.M. Lacerda1, A.M.N. Batista1, D.A. Dunzer1, B.D. Rangel3,
A.D. Costa3, F. Romaguera3, P. Khan1
1Catarinense Rehabilitation Center, Adult Neurorehabilitation Program, FLORIANOPOLIS, Brazil
2Catarinense Rehabilitation Center, Adult Neurorehabilitation Program, Florianópolis, Brazil
3Universidade do Estado de Santa Catarina, Departamento de Fisioterapia, FLORIANOPOLIS,
Brazil
Aims
To describe the profile of the care received by stroke patients treated in the Adult
Neurorehabilitation Program (ANP) at the Catarinense Rehabilitation Center (CRC), located in
Florianópolis (SC).
Method
Retrospective study based on medical records of patients with stroke diagnosis treated between
November 2014 to April 2015, through register of any health care specialty they received in this
period.
Results
During the study period 80 patients with stroke were treated in the program : 88.75% attended
physiotherapy, 78.75% speech therapy, 76.25% psychology, 75% occupational therapy, 73.75%
nutrition, 67 5% social services, 42.5% nursing and 23.75% physical education. In addition to the
program ´s team, the patients were also attended by medical specialists: neurologist (85%),
cardiologist (63.75%), physical medicine and rehabilitation (52.5%), urology (15%), orthopedic
(10%) and general practitioner(12.5%). Support services like Prosthetics and Orthotics
Department, botulinum toxin and acupuncture were also part of the care provided to patients
(26.25%, 26.25%, 1.25% respectively). The need of professional assistance of various specialties
resulted from disabilities either due or already present prior to the stroke, which included loss of
strength and muscle tone changes, perceptual changes, balance, motor coordination; changes in
instrumental activities of daily living, self-care, work, study, entertainment and social participation;
swallowing disorders, speech, language, nutrition, cognitive and cardiorespiratory complications.
Conclusion
Interdisciplinary teamwork provides a comprehensive approach in the health context, promoting
the rehabilitation process and quality of life.
WCNR-0456
BOARD NUMBER: 071
EXPANSION OF ATTENTION TO CAREGIVERS OF PATIENTS ATTENDED IN THE ADULT
NEUROREHABILITATION PROGRAM OF THE CATARINENSE REHABILITATION CENTER,
BRAZIL: CARING OF WHO CARES GROUP
S.P.B.O. Nogueira1, A.M.N. Batista1, S.C.M. Lacerda1, F. Romaguera2, P. Khan1
1Catarinense Rehabilitation Center, Adult Neurorehabilitation Program, FLORIANOPOLIS, Brazil
2Universidade do Estado de Santa Catarina, Departamento de Fisioterapia, FLORIANOPOLIS,
Brazil
Aims
A health promotion group was offered to caregivers to increase their understanding about
psychological aspects, the feelings involved in care giving activities and proposed therapeutic
activities for them, expanding their social and occupational role.
Method
A group of 15 caregivers of patients enrolled in Adult Neurorehabilitation Program of the
Catarinense Rehabilitation Center participated in this study (indicated by a team member or from
spontaneous demand). They used expressive, interactive and educational techniques in four
weekly meetings of an hour and-a-half , coordinated by an occupational therapist and a
psychologist. Theory and technical approaches of the two areas fomented the project. A semistructured questionnaire was applied as an evaluation tool.
Results
The main results were: facilitation of the rehabilitation process, expansion of coping resources of
caregivers, strengthening of social bonds and practice of interdisciplinarity. It was observed that
this group could carry out the development and implementation increasingly for broad settings of
care, through taking care of themselves, their families and the community where they live.
Conclusion
This project demonstrated to be a tool that enable caregivers to exercise their role with better
terms of confront, less physical and emotional stress, resulting in higher quality of life for
everyone involved.
WCNR-0458
BOARD NUMBER: 072
INTERDISCIPLINARY ACTIVITIES: IMPROVING TEAMWORK OF AN ADULT
NEUROREHABILITATION PROGRAM AT A REHABILITATION CENTER
S.P.B.O. Nogueira1, S.C.M. Lacerda1, A.M.N. Batista1, D.A. Dunzer1, F. Romaguera2, P. KHAN1
1CATARINENSE REHABILITATION CENTER, Adult Neurorehabilitation Program,
FLORIANOPOLIS, Brazil
2UNIVERSIDADE DO ESTADO DE SANTA CATARINA, DEPARTAMENTO DE FISIOTERAPIA,
Aims
Improve technical planning for the work through reflections and elaborations raised by the topics
covered in the proposed activities, to strengthen the actions of interdisciplinary teamwork, to
increase the closeness and harmony between professionals with direct impact on the quality of
the services provided, foster awareness of the interdependence between the various professional
fields and their relationship with the environment and culture.
Method
The study was coordinated by a psychologist and two occupational therapists. Four meetings of
four hours eachwere promoted along the year, which included the participation of the team.
Artistic resources were used (films, workshops) in order to raise issues related to work:
individuals, families, disability, group phenomena. During discussion, links between the themes,
clinical cases and the performance of the teamwere set up.
Results
It was observed both increase of the interdisciplinary teamwork and awareness of the
interdependence of technical fields, which reflected in harmony and technical/relational
improvementsamong the team members.
Conclusion
The rehabilitation is a multifaceted process that requires the team to design and to reflect
constantlyabout the aspects involved in this area, both personal and professional, and their
interrelations, reflecting in the quality of work with patients, caregivers/family members.
WCNR-0462
BOARD NUMBER: 073
THE PROFILE OF CAREGIVER IN A ADULT NEUROREHABILITATION PROGRAM: THEIR
EMOTIONAL AND PHYSICAL BURDENS
S.P.B.O. Nogueira1, S.C.M. Lacerda1, A.M.N. Batista1, C. Dadalt1, C.G.D. Santos1, D.A. Dunzer1,
E.M.R. Spinelli1, J. Heidrich Junior1, M.M. Oki1, F. Romaguera2, P. KHAN1
Aims
To describe the profile of the patient’s caregivers participating in the Third Meeting of Patients
and Caregivers of the Catarinense Rehabilitation Center what happened in April 2015.
Method
A descriptive and qualitative study was conducted through a questionnaire applied to 13
caregivers of patients who are in the rehabilitation program. The questions addressed issues of
their routine and health care.
Results
It was observed that 69.2% caregivers (n = 9) were female. 84.6% (n = 11) had some degree of
family relationship with the patient who they took care of (n = 3 son, brother and wife n = 3 n = 3;
n = 1 mother, granddaughter n = 1). Most caregivers (61.5%, n = 8) assumed this role after the
family member had neurological deficits . They accumulated more than one function, such as
caring and working out or taking care of the house (69.2%, n = 9). Health problems such as
gastritis and anxiety were reported by 30.7% of caregivers (n = 4), and encountering difficulties in
everyday life such as physical fatigue (69.2%, n = 9) and activity overload ( 30.7%, n = 4).
Despite these problems, they assess themselves as good carers (30.7% great and 46.1% good
caregivers) and recognize this role and an opportunity to become more patient and tolerant
(69.2%, n = 9). They also recognized the importance of family (61.5%, n = 8) and felt more
prepared for new situations, changes and difficulties (61.5%, n = 8).
Conclusion
In addition to the attention given to the patient, the family also needs support from the
interdisciplinary team in order to be able to effectively participate in the rehabilitation process. The
family approach aims at the distribution of tasks among members, so that there is no emotional
and physical burden on a single family member.
WCNR-0467
BOARD NUMBER: 074
THE EFFECTS OF ORIENTATION AND PHYSIOTHERAPY AFTER TREATMENT WITH
BOTULINUM TOXIN IN STROKE PATIENTS - PRELIMINARY RESULTS
S.P.B.O. Nogueira1, M. Schmoeller1, D. Peres2, F. Romaguera2, P. Khan1
Aims
To evaluate the effects of orientation and physiotherapy after treatment with BoNT A
Method
In this descriptive, observational, cross-sectional study , 12 patients with stroke were included.
The patients included had upper limb spasticity and no previous treatment with botulinum toxin.
The subjects were separated into two groups. Group 1 (G1) received verbal and demonstrative
physical therapy orientation about exercises, emphasizing the muscles that were treated . They
also receivedan illustrative folder of exercises. Group 2 (G2) received verbal orientation and an
illustrative folder with physiotherapy exercises. Both groups had to perform exercises twice daily
for 30 days. Patients were assessed pre- and post application of the protocol for: passive range
of motion (pROM) of the shoulder, elbow and wrist; functionality (Barthel Index); muscle tone
(Modified Ashworth Scale); and pain (Visual Analogic Scale).
Results
For pROM, the G1 improved an average of 120,2oin the four analyzed movements and the G2
improvement was 162,2o. For function, , the G1 had an average of 68.3 in the evaluation and G2,
43 points. At the moment of revaluation, G1 evolved to 73.8 points while G2 improved to 66.6
points on average. It was observed that spasticity of the wrist and elbow musculature responded
better to the toxin (80% to G1 and 100% to G2) than the proximal muscles (45% and 50% G1
G2). Pain improved 50% in G1 and 57.1% in G2. Adherence to prescribed exercises was 88.8%
in G1 and 100% in G2.
Conclusion
Regardless of the type of exercises given, it is important for patients to do exercises to get better
results in aspects such as spasticity, pROM, pain and function after treatment with BoNT A .
WCNR-0470
BOARD NUMBER: 075
ACTIVITIES OF DAILY LIVING TRAINING GROUP: OCCUPATIONAL THERAPY
INTERVENTION IN STROKE PATIENTS– CASE REPORT
S.P.B.O. Nogueira1, A.M.N. Batista1, D.A. Dunzer1, F. Romaguera2, P. Khan1
Aims
To promote a meeting among patients presenting difficulties in ADL so that they can share and
perform ADL tasks,benefiting from other experiences, on how adaptations can be made,
contributing to learning new ways to perform them. The group is also intended to appraise the
potential of each participant, regarding aspects of social, emotional and occupational
development.
Method
A group with four weekly meetings of ninety minutes , coordinated by two occupational therapists
was conducted in the ADL room of a rehabilitation center. Four patients recruited from
occupational therapy services participated in the group, three of them had stroke and one had
Traumatic Brain Injury sequelae. Each meeting was structured contemplating a category of ADL:
clothing, personal care and food. In this last one, the feeding training was associated with a
Culinary Workshop.
Results
One participant reported that adopted the other suggestions for cleaning her dental prosthesis
and the technique suggested to haircombing. This same participant showed her adapted use for
dental floss, with good adhesion of the group. Other participant reported that he began to dress
himself (top). Two of them for the first time practiced knife use (peel and cut fruit), with
satisfactory performance. For another participant, the group provided more confidence in their
own skills, as their way of performing the ADL inspired and motivated others.
Conclusion
The ADL training group made it possible for patients to find their skills at the various levels of
restrictions imposed by the deficits, which favors individual perception of their capabilities,
triggering a greater engagement in the rehabilitation process.
WCNR-0474
BOARD NUMBER: 076
PROFILE OF STROKE PATIENTS TREATED BY THE ADULT NEUROREHABILITATION
PROGRAM AT CATARINENSE REHABILITATION CENTER – FLORIANÓPOLIS, SANTA
CATARINA, BRAZIL
S.P.B.O. Nogueira1, C. Dadalt1, S.C.M. Lacerda1, A.M.N. Batista1, D.A. Dunzer1, B.D. Rangel2,
A.D. Costa2, F. Romaguera2, P. Khan1
FLORIANÓPOLIS, Brazil
Aims
To describe the profile of stroke patients treated at the Adult Neurorehabilitation Program (ANP)
at the Catarinense Rehabilitation Center.
Method
Retrospective study based on medical records of stroke patients treated between November
2014 to April 2015.
Results
80 patients were treated, 39 men and 41 women, 70 of them coming from the metropolitan area
of Florianópolis. Fifty-five patients enrolled due to their first stroke. The ischemic stroke
corresponded to 77.5% and 56.25% with right hemiparesis. Hypertension was the major risk
factor found in 86.2% patients (n = 69), dyslipidemia, in 56.2% patients (n = 45). Regarding
mobility, 35% of patients arrived in a wheelchair (n = 28), 32.5% walked with assistance , 32.5%
were independent in walking(n = 26). The average time of admission at the rehabilitation center
after stroke was 69 months, varying from 1 month to 535 months, although a third of these
patients arrived within 6 months after the event. From the 17 medical and paramedical specialties
offered by the rehabilitation center, an average of 48.1% of the professionals provided care to
stroke patient . Taking part in care were physical therapy, speech therapy, psychology,
occupational therapy, nutrition, neurology and cardiology the specialties of higher prevalence.
Conclusion
Most patients were from the great Florianópolis area, there was a balance in relation to gender
and mobility at the admission, most of patients suffered ischemic stroke and were assisted by an
interdisciplinary team of ANP program. The knowledge of patient profile provides adequate
preparing to the rehabilitation team in order to provide a global approach, to the rehabilitation
process for stroke patients.
WCNR-0481
BOARD NUMBER: 077
CARE FOR WHO CARES PROJECT: GROUPS AND WORKSHOPS EXPANDING THE
ATTENTION TO PATIENTS AND CAREGIVERS IN AN ADULT NEUROREHABILITATION
PROGRAM AT THE CATARINENSE REHABILITATION CENTER
S.P.B.O. Nogueira1, S.C.M. Lacerda1, A.M.N. Batista1, D.A. Dunzer1, P. Khan1
Aims
Prevention of physical and emotional exhaustion of the participants; exchange of experiences,
recognition of investment and effort involved in the relationship between caregiver / patient /
professional; therapeutic use of the skills and interdisciplinary practice
Method
Expressive, interactive and educational techniqueswith four weekly meetings ninety minutes long,
coordinated by a psychologist and two Occupational Therapists. Open groups of caregivers,
coordinated by a psychologist and one of the Occupational Therapists occurred simultaneously to
workshops with thepatientscoordinated by another Occupational Therapist. Caregivers
participated in educational workshops, with the contribution of Physiotherapists and a
Neurologist. The themes were related to transfer techniques, positioning, posturesof caregivers
during patient care and orientation on diagnosis / prognosis . Emotional aspects brought by the
participants as impediments in their role as caregivers was addressed by the psychologist . In
the patients workshops they elaborated a poster and participated in the adapted sitting dance.
The poster was presented to their caregivers when the two groups united in the second meeting
and at the last meeting with the theme , retribution and gratitude of the care received .
Results
Expanding coping skills in the relationship between patients / caregivers, recognition of skills
and potentials despite the shortcomings, highlight the uniqueness of participants through
different experiences. The representation of the chance of patients to provide care for their
caregivers reversing the usual roles, strengthening the links between participants.
Conclusion
The new learning and reflection facilitated overcoming the everyday barriers in caregiving
activities. Inversions of care roles during the course of the project and the preparation of these
aspects have facilitated the recognition of the difficulties and potentials of the participants.
Interdisciplinary actions expanded technical resources and therapeutic applications in the
rehabilitation of people with disabilities.
WCNR-0344
BOARD NUMBER: 078
PROFILE OF CRITICALLY ILL NEUROLOGICAL PATIENTS REFERRED FOR
PHYSIOTHERAPY IN A TERTIARY HOSPITAL IN SOUTHWEST NIGERIA
K. Nwankwo1, O. Adejare2, M. Owolabi3
1WFNR-Blossom Specialist Medical Centre, Physiotherapy, Ibadan, Nigeria
2University College Hospital- Ibadan, Physiotherapy, Ibadan, Nigeria
3WFNR-Blossom Specialist Medical Centre, Medicine, Ibadan, Nigeria
Aims
The pattern of neuro-critical conditions requiring physiotherapy in low and middle income
countries have not been adequately characterized particularly in Africans. This is necessary to
enable proper planning, and better outcomes. We determined the profile of critically ill
neurological patients referred to the neurophysiotherapist.
Method
Data from the hospital records using the ICD-10 classification of 218 critically ill neurological
patients referred for Physiotherapy from the Intensive Care Unit (ICU) of the University College
Hospital, Ibadan, Nigeria over a five-year period (2008 to 2012) was reviewed retrospectively.
Results
Of the 2966 patients admitted in the intensive care unit of our hospital within the study period,
only 13.22% was referred for Physiotherapy.Neurological referrals accounted for (55.6%) of the
total referrals to Physiotherapy. The mean age of patients was 39.61±19.37 years with a
preponderance of male (60.1%). External causes of mortality and morbidity (Chapter XX)
(53.2%), neoplasm (Chapter II) (22%) and diseases of the circulatory system (Chapter IX)
(12.4%) were top reasons for referral with traumatic head injury (50.5%), brain tumor (22.9%) and
stroke (12.8%) being the top three diagnoses. Passive movements, percussion, and chest
vibration were the most common physiotherapeutic intervention. Six percent of the patients were
discharged from physiotherapy while 44% were discharged to the ward and 45.4% died.
Conclusion
Traumatic head injury is the commonest reason for neurocritical referral to the
neurophysiotherapist in a low and middle income setting.
WCNR-0370
BOARD NUMBER: 079
GAIT PROFILE SCORES (GPS) AND GAIT VARIABLE SCORES (GVS) AFTER MOTOR
TRAINING AND tDCS IN CHILDREN WITH CEREBRAL PALSY
C. Oliveira1, L. Grecco2,3, C. Cosmo2, N. Duarte3, N. Zanon2, M. Galli4,5
1, São Paulo, Brazil
2Pediatric Neurosurgery Center CENEPE, Pediatric Neurosurgery Center CENEPE, São Paulo,
Brazil
3Universidade Nove de Julho, Rehabilitation Sciences, São Paulo, Brazil
4Politecnico di Milano, Department of Electronics- Information- and Bioengineering- DEIB, Milan,
Italy
5IRCCS San Raffaele Pisana, IRCCS San Raffaele Pisana, Rome, Italy
Aims
This study performed a retrospective analysis of studies that evaluated the effects of transcranial
stimulation by direct current (tDCS) over the primary motor cortex in order to identify whether this
could enhance gait learning with improved kinematic parameters in children with spastic,
hemiparetic, or diparetic cerebral palsy
Method
The data of 42 patients who were participants in parallel, controlled and randomized studies,
were analyzed. The study protocols comprised two weeks (5 sessions per week) of intensive
intervention including treadmill training or virtual reality training associated with anodal
transcranial direct current stimulation over the primary motor cortex (active or sham; 1 mA; 20
minutes). The three-dimensional gait was evaluated, and the data analysis included gait variable
scores (GVS) and gait profile scores (GPS).
Results
The results showed that the improvement in kinematic gait parameters was dependent on the
type of gait training simultaneously performed with anodic stimulation. Only individuals in the
active tDCS group associated with gait training on a treadmill showed improvement in the GPS
data (p <0.05). Spastic diparetic children showed improvement in the angular data of joints in the
pelvis, hip, and knee while children with spastic hemiparesis showed improvements only in the
angular data of the pelvis.
Conclusion
There were no isolated effects of anodal tDCS on improving gait kinematics, however, individuals
in the active tDCS group showed improvement in the kinematic gait data when associated with
gait training on a treadmill, especially children with spastic diparesis. Therefore, the use of a
treadmill for training can lead to improved gait kinematics.
WCNR-0205
BOARD NUMBER: 080
PROFILE OF PATIENTS SEEKING NEUROREHABILITATION IN A DEVELOPING COUNTRY:
REPORT FROM THE FIRST CENTRE FOR NEUROREHABILITATION IN EAST, WEST AND
CENTRAL AFRICA
M. Owolabi1, E. Uvere2, K. Nwankwo3, E. Awoniyi4, O. Olukolade5, T. Hamzat6, K. Moranti7,
A. Philip8, B. Owolabi9, M. Barnes10
1University of Ibadan, Ibadan, Nigeria
2Blossom Specialist Medical Center, Research- Training and Advocacy, Ibadan, Nigeria
3Blossom specialist Medical Center, Physiotherpay, Ibadan, Nigeria
4Blossom Specialist Medical Center, Speech Therapy, Ibadan, Nigeria
5Blossom Specialist Medical Center, Psychotherapy, Ibadan, Nigeria
6University of Ibadan, Physiotherpay, Ibadan, Nigeria
7Blossom Specialist Medical Center, Physiotherapy, Ibadan, Nigeria
8Blossom Specialist Medical Center, Neurology- Electrophysiology, Ibadan, Nigeria
9Blossom Specialist Medical Center, Management, Ibadan, Nigeria
10Hunters Moor Neurorehabilitation Ltd- UK and Christchurch Group, Clinical Director,
North Shields, Nigeria
Aims
To delineate the pattern of neurological diseases managed in the first and leading holistic neurorehabilitation Centre in East, West and Central Africa.
Background: The burden of neurological disease in East, West and Central Africa is growing at
an alarming rate but the pattern of disorders requiring holistic neurorehabiltation care has not
been previously described. There is a need to appreciate the scope of neuro-rehabilitation in the
management of neurological diseases in this region.
Method
Data from the hospital records of 340 neurologically ill patients managed at the Blossom
Specialist Medical Centre, an affiliate of World Federation for Neuro-rehabilitation from 2011 to
2015 was retrospectively reviewed and analysed using descriptive and inferential statistics.
Results
There were more males than female (56.8% vs 43.2%) with over half (54.7%) of the patients
being within the middle age range (41-70 years). 14.7% of the patients, had a family history of
neurological disease. Of this proportion, 83.7% of such illnesses were cardiovascular diseases.
At least 68.2% of patients had a form of cardiovascular risk factor with hypertension being the
most prevalent (50.9%). These factors were more common among males and the middle-aged.
Stroke related disorders accounted for most neurological visits (27.9%) while tremors accounted
for the least (1.5%). More than half of the patients managed (52.4%) received at least a form of
neuro-rehabilitative therapy which included speech (10.9%), physical (39.7%), psychological
(12.1%) and cognitive (5.6%) solely or in various combinations (5 to 10%).
Conclusion
Conclusion: Non-communicable disorders predominate and are associated with significant
patient and family history of cardiovascular diseases. There is the need to foster sustainable
collaborative efforts and scaling up of capacity building strategies towards the adoption of best
practices for holistic management of neurological disorders in this region.
WCNR-0560
BOARD NUMBER: 081
INTELLIGENT GAMES AND SENSOR FEEDBACK INTERFACE FOR NEUROREHABILITATION THERAPY
K. Vemuri1, R. Singla1, A. Agarwal1, J. Ahmed1, D. Kukar1, R.K. Elluri2
1International Institute of Information Technology- Hyderabad, Cognitive Science/Game Lab,
Hyderabad, India
2Anuragh Rehabilitation Center, Rehabilitation, Hyderabad, India
Aims
Biofeedback controlled immersive game interaction for rehabilitation therapy of stroke/spinal cord
injury patients
Method
A running track game controlled by signals from load sensor embedded into a floor mat to
estimate shift in weight, step forward and back was designed. Random sudden events in the
game ‘force’ the patient to change state. A second game using ultrasonic and pressure sensors
collect arm swing and pressure applied by the fingers. Eight patients with injury to spinal cord or
stroke induced paralysis from accidents took part in the testing. Four were able to play for 7 days
and the play time, leg movement/weight, finger pressure and response time to an event in the
game were recorded.
Results
The total game play time per session by each patient was compared to similar traditional
exercises used in daily therapy sessions. The play time increased from 200 – 500 seconds in the
leg movement game (figure 1) for two patients with spinal cord injury and paralysis. For the arm
movement game (figure 2), a paralysis effected patient from a stroke due to binge drinking played
for 800secs. While a second patient with cervical spinal cord injury leading to hand motor control
problem played for 400 seconds. In the traditional hand exercise therapy the duration was 2-3
minutes at a stretch and only with constant monitoring.
Conclusion
The results from 2 preliminary game systems are encouraging and indicate that immersiveness of
a game interaction makes the patients exercise longer with minimal assistance. The data helped
the doctor to monitor progress. The cost (<$200) and ease to setup at home with the therapy
monitored remotely can reduce patient expenses in countries like India.
May 13 – 07:00 - 12:30
WCNR-0182
BOARD NUMBER: 001
TREATMENT/PHARMACOTHERAPY/PT/FES
A NEUROPROSTHESIS FOR CORONAL PLANE TRUNK CONTROL
M. Audu1, R. Triolo1
1Case Western Reserve University, Biomedical Engineering, Cleveland, USA
Aims
The objective was to explore the design of a feedback control system for ensuring trunk stability
in the coronal plane using an implanted neuroprosthesis targeting the otherwise paralyzed
muscles of the trunk and hips.
Method
A neuroprosthesis to keep the trunk of an individual with spinal cord injury (SCI) in an erect
stable posture was tested in a series of coronal plane experiments. Five volunteers with thoracic
level SCI participated. The volunteers sat in their wheelchairs placed in the work volume of a 16camera motion capture system. A wireless sensor containing an accelerometer was employed to
measure trunk tilt from the component of the acceleration due to gravity in the lateral direction.
The sensor was strapped to the sternum on the chest of the volunteers below the clavicle. The
sensor streamed the x, y and z components of gravitational acceleration wirelessly to a receiver
board built into the neuroprosthesis that generated additional stimulation to the implanted
muscles of the volunteer whenever trunk tilt exceeded a set threshold so as to return the trunk to
erect. The muscles stimulated were Erector Spinae, Quadratus Lumborum, Gluteus Maximus,
Posterior Adductors and Hamstrings. The volunteers used voluntary effort to bend their trunk in
the coronal plane mimicking picking up an object on the floor.
Results
Preliminary results of tests with the volunteers show that appropriate stimulation of trunk and hip
muscles can restore the trunk to an erect posture from a coronal plane posture bent up to 37o
both to left and right with overshoot not exceeding 5o in all cases.
Conclusion
The ability to control trunk movement effectively in the coronal plane along with a previously
successful control system for sagittal plane movements implies that the design of a
neuroprosthesis for trunk control in all planes is nearing a transfer from laboratory to a home
environment.
WCNR-0686
BOARD NUMBER: 002
ENHANCED MODULATION OF TRAINING EFFECTS ON SPINAL CORD EXCITABILITY BY
TRANSCUTANEOUS SPINAL DIRECT CURRENT STIMULATION
O. AWOSIKA1, N. Fishman1, M. Sandrini1, R. Volochayev1, M. Hallett2, L. Cohen1, M.K. Floeter3
1NIH/NINDS, Human Cortical Physiology and Stroke Neurorehabilitation Section, Bethesda, USA
2NIH/NINDS, Human Motor Control Section, Bethesda, USA
3NIH/NINDS, Human Spinal Physiology Unit, Bethesda, USA
Aims
Locomotion is often impaired in individuals with brain and spinal cord injury. Circuits underlying
the lower extremity Hoffman reflex (H-reflex), a measure of excitability of the alpha motoneuron
pool, contribute to spasticity and often results in difficulty with locomotion. Previous work in
stroke and cerebral palsy patients have suggested that backwards locomotion training (BLT) can
improve forward locomotion (Yang et al 2005 and Kim et al, 2013); however the mechanism of
action is unknown. Here, we evaluated the effects of BLT on modulation of the soleus H-reflex in
healthy individuals, and investigate whether anodal transcutaneous spinal direct current
stimulation (a-tsDCS) could enhance these effects.
Method
In this double-blinded randomized controlled study, 36 untrained healthy subjects (n=18/group)
aged 19-39 yr., underwent backwards-locomotor training (20 min/day), while concurrently
receiving sham transcutaneous spinal direct current stimulation (s-tsDCS) or anodal (a-tsDCS),
over three consecutive days. Resting H-reflex data was collected at baseline, immediately, and at
30 minutes post training. We measured soleus H-reflex amplitude (H/Mmax), slope and the
stimulus intensity needed to achieve 50% of the maximum H-reflex amplitude (S-50).
Results
We found that backwards locomotion training resulted in transient down regulation of H-reflex
amplitude (H/Mmax) in both groups. Additionally, concurrent application of a-tsDCS with BLT
elicited a longer lasting effect than s-tsDCS+BLT. No group differences were seen for H-reflex
slope and S-50.
Conclusion
We show for the first time that BLT downregulates resting soleus H-reflex excitability and is
enhanced by concurrent a-tsDCS. Given the association of alpha-MNP suppression and
improved locomotor performance (Thompson et al, 2013) it is conceivable that a-tsDCS+ BLT
could be an effective approach to reduce spasticity and ultimately improve locomotion in patients
with brain and spinal cord injury.
WCNR-0130
BOARD NUMBER: 003
EFFECTS OF BODY WEIGHT-SUPPORTED TREADMILL TRAINING ON CENTER OF MASS
CONTROL IN SPINAL CORD INJURY, MEASURED WITH INERTIAL SENSORS
F. Covarrubias1, G. varas1, R. torres1, G. rivera1, A. navarrete2
1clínica los coihues, terapia, Santiago, Chile
2Instituto de Rehabilitación Infantil. Teletón, fisiatria, santiago, Chile
Aims
The purpose of this study was to evaluate the effectiveness of body weight-supported treadmill
training (BWSTT) on static balance impairment in adults with incomplete spinal cord injury (SCI)
in chronic stage.
Method
The individuals who participated in this study were subjects with SCI with more than twelve
months of evolution. All were classified as incomplete injury class C or D according to the
American Spinal Injury Association.
Each received training on a treadmill with the use of body weight support for six weeks.
Two measures of stance balance were performed during the training protocol. The first measure
was made before entering the training protocol; the final measure was performed once the gait
training on body weight support treadmill protocol was completed.
For instrumented stance balance testing, small wireless inertial motion sensors (OPAL sensors,
APDM Inc., Portland, OR) were placed on the subjects’ waist. Subjects performed instrumented
stance with their eyes opened (iSway). Outcome measures were recorded and automatically
generated using Mobility Lab software (APDM Inc., Portland, OR). Measures included the root
mean square of sway and jerk (normalized to the range of acceleration amplitude).
Results
For this research, 17 subjects with SCI were measured. The outcomes showed significantly
decreased values of normalized jerk after gait training protocol (p = 0.0174). Also, a statistically
significant correlation was observed between the initial Jerk indicator and the level of
Independence in gait measured through the WISCI scale (p = 0.0315; r = 0.522).
Conclusion
Gait training with BWSTT was shown to have a beneficial impact on postural control in people
with incomplete spinal cord injury. These results suggest that sensorimotor learning achieved
through gait training impacts center of mass control in people with incomplete spinal cord injury.
WCNR-0540
BOARD NUMBER: 004
FUNTIONAL RANGE OF MOTION NORMS FOR INDIVIDUALS WITH CHRONIC
TETRAPLEGIA
P. Geigle1, S.K. Frye1, H. York1, H. Goodin1
1University of Maryland School of Medicine - Baltimore, Neurology, Baltimore, USA
Aims
Aims: To determine what range of motion measurements are typical for individuals with chronic
tetraplegia and to determine the minimum upper and lower limb range of motion necessary to
successfully complete functional mobility and self-care tasks.
Method
Participants/Methods: A convenience sample of 30 individuals with chronic tetraplegia (C5-8)
who are wheelchair dependent completed the survey instruments including a demographic
questionnaire, the Spinal Cord Independence Measure 3 (SCIM-3), and Spinal Cord Injury
Functional Index (SCI-FI) as well as upper and lower limb range of motion (ROM) assessments.
Results
Results: Typical or greater shoulder extension, wrist extension, and hip external rotation showed
the strongest relationship with activities of living independence. The most commonly seen
contractures were hip flexion and ankle plantarflexion. Contrary to popular belief, full elbow
extension was not a prerequisite for individuals with C6 tetraplegia to achieve transfer
independence. Data analysis also examined demographic data and relationships between subcategories of the SCIM-3, SCI-FI, and ROM classifications of no, mild, moderate, and major
restrictions.
Conclusion
Conclusion: Clinicians should be aware of range of motion relationships to functional abilities in
individuals with chronic tetraplegia. Knowledge of specific joints at increased contracture
risk and subsequent reduced function is essential to develop effective range of motion programs
for clinical and home use.
Support: This project did not receive financial support.
WCNR-0460
BOARD NUMBER: 005
BODY MASS, METABOLIC, CARDIOVASCULAR IMPACT OF AQUATIC EXERCISE AND
NUTRITION GUIDANCE FOR INDIVIDUALS WITH CHRONIC MOTOR INCOMPLETE SPINAL
CORD INJURY
P. Geigle1, W. Scott1, P. Gorman1, J. Smith2, K. James3
1University of Maryland School of Medicine - Baltimore, Neurology, Baltimore, USA
2Fruitfull Elements, Fruitful Elements, Toronto, Canada
3Koru Nutrition, Koru Nutrition, Toronto, Canada
Aims
Assess dosed group aquatic exercise at 70-75% of heart rate reserve (HRR) and nutritional
guidance upon body mass, glucose, insulin, A1C, peak VO 2, and resting metabolic rate (RMR) for
three individuals with CMISCI and fasting glucose greater 100 mg/dL.
Method
Design: Pilot study, clinical case series.
Participants/methods: Three men: 63 yo, AIS D, body mass index (BMI) 31.9; 34 yo who is non
ambulatory, AIS C, BMI of 31.6; and 58 yo, AIS D, BMI 27.4. We prescribed dosed aquatic
exercise program 3 times per week for 10 weeks, and a weekly phone nutritional consult by
phone. Nutritional guidance included reducing refined carbohydrates and processed food,
limiting high glycemic fruits, and increasing vegetable, fluid and lean protein intake. Outcome
measures (pre/post) included: three day electronic food logs, weekly hard copy food logs,
glucose, insulin and A1C (via standard fasting venipuncture), peak VO 2 and RMR.
Results
Results: Participant one decreased glucose, 20% (132 to 106 mg/dL); A1C, 11% (6.3-5.6);
weight, 10%, (11.9 kg); RMR, 13%; and peak VO2 , 12%; participant two increased glucose, 9%;
A1C, no change; decreased weight, 3% ( 3.3 kg); decreased peak VO2, 18.5; increased RMR,
4.5%; participant three decreased: glucose, 14%, (126 to 108 mg/dL); A1C, 5% (7.5 to 7.1);
weight, 6% (88.9 to 83.8 kg); RMR, 12.5%,and increased peak VO 2, 8% (21.9 to 23.7).
Conclusion
Conclusion: Moderate exercise with weekly nutritional guidance decreased body mass in all 3
participants, and glucose, and A1C in two out of three. Further examination of the impact a low
cost intervention of combined aquatic exercise with nutritional guidance exerts upon body mass,
metabolic status, and cardiovascular fitness for individuals with CMISCI is indicated.
Support: Aquatic Section, American Physical Therapy Association.
WCNR-0392
BOARD NUMBER: 006
MIDODRINE ADMINISTRATION REDUCED THE FALL IN CORE TEMPERATURE AND
IMPROVED COGNITIVE PERFORMANCE DURING COLD EXPOSURE IN PERSONS WITH
TETRAPLEGIA
J. Handrakis1,2, O. Tascione1, C. Barton1,2, J. Bart1,2, S. Kahal1, W. Bauman1
1James J Peters VA MC, National Center of Excellence for the Medical Consequences of SCI,
Bronx, USA
2New York Institute of Technology, Department of Physical TherapySchool of Health Professions, Old Westbury, USA
Aims
Core temperature (Tcore) maintenance in response to cold exposure has been shown to be
dysfunctional in persons with tetraplegia, increasing their vulnerability to hypothermia
(Tcore<35°C). Sympathetic decentralization limits effective increases in insulation and
thermogenesis. Recent investigation supports the association between reduction in Tcore and
declines in cognitive performance (Pcog). Midodrine administration was tested to induce
peripheral vasoconstriction during cold exposure in an effort to stabilize Tcore during cold
exposure and mitigate the decline in Pcog.
Method
Tcore was measured at baseline after 30 minutes of 27°C (thermoneutral) and during up to 120
minutes of 18°C exposure (cold) during two laboratory visits, one without drug and one after
administration of midodrine (10 mg). Pcog was assessed using the Wechsler Adult Intelligence
Scale IV (WAIS IV) at end of baseline and again at end of cold.
Results
Six individuals with tetraplegia (C4-T1; AIS A & B; age 42±3 years; BMI 25±3 kg/m2) completed
the study. After cold exposure without midodrine, Tcore declined 2.86±0.84% from 37.3±0.4°C to
36.2±0.5°C. WAIS IV Forward and Total scores declined 28±22% and 19±30%, respectively.
After administration of midodrine with the same duration of cold, Tcore declined 1.90±0.74% from
37.0±0.4 to 36.3±0.4°C. WAIS IV Forward and Total scores increased 3±33% and 3±19%,
respectively. The percent change of Tcore (p=0.006) and WAIS IV Forward score (p=0.011) and
Total score (p=0.052) differed between study days. The percent change in peripheral skin
temperatures (baseline to the end of cold) and blood pressure (at time of testing) were not
different between days.
Conclusion
Our findings suggest that midodrine attenuated the percent decline in Tcore and Pcog by
mechanisms other than vasoconstriction and/or increased blood pressure. We speculate that the
improvements observed may be due to increased thermogenesis secondary to increased
spasticity after midodrine administration, as reported to the investigator by the subjects.
WCNR-0648
BOARD NUMBER: 007
CERVICAL TRANSCUTANEOUS STIMULATION TO INCREASE CORTICAL TRANSMISSION
TO HAND MUSCLES
N. Harel1,2, L. Yung3, A. Romero1, T. Santiago1, K. Guber1, S. Kastuar4, N. Nguyen1, Y.K. Wu1,
J. Carmel5, A. Spungen1,6, W. Bauman1,7
1James J. Peters VAMC, SCI Research, New York, USA
2Icahn School of Medicine at Mount Sinai, Neurology- Rehabilitation Medicine, New York, USA
3James J. Peters VAMC, Medicine, New York, USA
4Icahn School of Medicine at Mount Sinai, Medical School, New York, USA
5Burke Medical Research Institute, Brain and Mind Research Institute, White Plains, USA
6Icahn School of Medicine at Mount Sinai, Rehabilitation Medicine, New York, USA
7Icahn School of Medicine at Mount Sinai, Medicine- Rehabilitation Medicine, New York, USA
Aims
We aim to use a novel combination of non-invasive cervical and transcranial stimulation to
strengthen connections between motor cortex and hand muscles in subjects with cervical SCI or
ALS.
Method
Individuals with incomplete cervical SCI, definite or probable ALS, and able-bodied volunteers
participate in this ongoing pilot study (clinicaltrials.gov NCT02469675). Stimulation modalities
include transcranial magnetic stimulation (TMS), median nerve electrical stimulation, and a novel
form of transcutaneous cervical electrical stimulation (CES). Baseline testing evaluates CES
safety and tolerability, as well as acute effects of CES on TMS motor-evoked potentials to the
hand. Subsequent sessions test the effect of different combinations of repetitive paired or
unpaired stimulation modalities (0.1 Hz x 120 pulses). Paired stimulation is timed for TMS pulse
arrival at cervical motor neurons either 1.5 ms before or 10 ms after electrical pulse arrival.
Results
To date, seven subjects have undergone >40 CES sessions without any safety or tolerability
issues. CES induces action potentials across multiple muscles in both arms simultaneously. At
peri-threshold intensity, CES activates cervical motor neurons trans-synaptically via sensory
afferents. At higher intensity, CES directly activates efferent cervical nerve roots. Single pulses of
subthreshold CES acutely facilitate TMS-induced motor evoked potentials to the abductor pollicis
brevis. Repetitive paired pulses of TMS with electrical stimulation preliminarily increase TMSinduced motor evoked potentials to hand muscles for at least 15 minutes post-stimulation.
Conclusion
Cervical electrical stimulation delivers several benefits as an approach to neural stimulation: it is
non-invasive, it activates multiple levels and both sides simultaneously, and it has the ability to
target novel interaction sites for convergent peripheral and corticospinal input onto cervical motor
neurons. These features offer the potential to strengthen cortical control over arm and hand
muscles.
WCNR-0056
BOARD NUMBER: 008
NOVEL SENSORY INTERVENTION TO PROMOTE LATE MOTOR RECOVERY IN AN
INDIVIDUAL WITH INCOMPLETE SPINAL CORD INJURY; A CASE REPORT
J. Hastings1, A. Muller1
1University of Puget Sound, School of Physical Therapy, Tacoma, USA
Aims
Objective: With a case report we add to the evidence of sensory stimulation to facilitate motor
recovery. We will illustrate a novel treatment combination of progressive sensory activation and
motor level electrical stimulation which promoted meaningful motor recovery in one patient.
Method
Case Description: 19 year old participant presented to our student physical therapy clinic with
incomplete Brown Sequard syndrome ASIA D SCI since age 12 with L sensory and R motor
impairment. This young woman was ambulatory and independent in all ADL and IADL and a full
time student at our intuition. Referral to our clinic was precipitated after a L foot fracture and the
treating therapist noting trace activity in the R triceps. Upon examination weak triceps activation
was confirmed with absent wrist and finger extrinsic activity. R UE had dystrophic signs and was
held in a protective posture of shoulder internal rotation and adduction and forearm pronation.
This arm was used for writing with a gross grip but otherwise intentionally neglected. Tactile
sensation was intact in the R hand.
Intervention: Progressive stereognosis training followed by electrical stimulation to wrist
extensor and finger extrinsic muscular followed by full body functional strengthening activities. 6
one hour session over 11 weeks.
Results
Results: Progressively refined stereognosis ability, improved fine motor ability, anti-gravity triceps
with increased endurance, wrist extension activation during functional activity and decreased
dystrophic signs in hand with more natural engagement of arm including arm swing during gait.
Conclusion
Conclusion: 7 years after SCI it is unlikely that we facilitated new neural connections and SC
recovery. More likely this case illustrates and example of reversing learned disuse and
maladaptive neuroplasticity. The progressive sensory challenges to her UE appear to have
reactivated volitional pathways that had been latent.
Support: none.
WCNR-0409
BOARD NUMBER: 009
THE EFFECTS OF BALANCE AND COORDINATION TRAINING AND GAIT TRAINING IN
FUNCTIONAL RECOVERY AND NEUROPLASTICITY IN AN INCOMPLETE SPINAL CORD
INJURY MODEL
J. Ilha1, A. Meireles1, C.C.D.E.S. Do Espirito Santo2, I.S. Coelho2, G.R. Freitas1,
N.A.M.D.M.M. Pereira1, J.V. Dos Santos1, L. Rosa1, A. Swarowsky1, A.R.S. Santos2
1Santa Catarina State University, Physical Therapy, Florianópolis, Brazil
2Federal University of Santa Catarina, Neuroscience, Florianópolis, Brazil
Aims
Verify the effects of two training protocols in sensorimotor recovery and neural plasticity in an
experimental model of incomplete SCI.
Method
Thirty two (32) adult Wistar rats divided into four groups: Sham, NT, BCT and GT, subject to
weekly reviews of locomotor and sensory-motor recovery of the hind limbs. Brain structures and
lumbar spinal cord were dissected and processed for biochemical analysis of the BDNF, MAP-2
and Synaptophysin expressions.
Results
In the motor cortex, for synaptophysin the NT showed lower rates compared to the sham group.
The BCT showed higher rates compared to the GT and NT group. For MAP-2 NT showed lower
rates compared to the sham group and BCT showed higher rates compared to the NT group. For
BDNF, BCT and GT groups showed higher rates compared to the NT and SHAM group. In the
cerebellum for synaptophysin GT group showed higher rates compared to the NT and SHAM
group, BCT showed higher rates compared to the NT. For MAP-2 the BCT group showed higher
rates compared to the NT. In the SC, for synaptophysin the NT, BCT and GT showed lower rates
compared to the sham group.
Conclusion
Gait training played key role in sensory-motor recovery of the hind limbs. Moreover, both training
modulate synaptic and structural proteins, playing an important role in exercise dependent
plasticity after experimental spinal cord injury.
WCNR-0432
BOARD NUMBER: 010
IMPROVING COMMUNITY AMBULATION IN INCOMPLETE SPINAL CORD INJURY WITH A
NEUROPROSTHESIS
L. Lombardo1, S. Bailey1, K. Foglyano1, R. Kobetic1, G. Pinault1, R. Triolo1
1Louis Stokes Cleveland VA Medical Center, Research, Cleveland, USA
Aims
Objective: Ambulation continues to be a high priority for increasing number of individuals with
incomplete SCI (iSCI). The objective of this case study was to evaluate an implanted
neuroprosthesis in an individual with iSCI to determine its effect on walking.
Method
Methods: The subject was a 52-year-old female with C6 iSCI, ASIA Impairment Scale C, with
significant lower extremity weakness and moderate weakness of trunk and upper extremities,
who was a limited community ambulator. Informed consent was obtained prior to implantation of
a pulse generator (IPG) with electrodes controlling hips, knees and ankles bilaterally. Gait speed
and distance were measured at baseline, discharge from gait training, and after 21 months of
home use to evaluate the effect of stimulation on ambulation. Upper extremity support and
energy consumption were also measured during walking tests.
Results
Results: Stimulation resulted in a 139 and 413% increase in walking distance at discharge and
follow-up, respectively, over volitional walking. At discharge, the volitional and stimulated walking
speeds were the same (0.2m/s). At follow-up her volitional speed decreased to 0.12 m/s (from
0.22 m/s at baseline) while the speed with stimulation remained the same 0.22 m/s. In addition,
there was a significant reduction in the upper extremity support and metabolic energy
consumption when walking with stimulation.
Conclusion
Conclusion: Walking with stimulation allowed this individual to walk 488m compared to 95m
without stimulation. In addition, she was able to maintain her baseline walking speed with the
neuroprosthesis despite the fact that her volitional walking has declined over time. These result
demonstrates how a neuroprosthesis can be used to improve walking ability in iSCI ambulators.
WCNR-0346
BOARD NUMBER: 011
INTRATECHAL DELIVERY OF BDNF VIA IMPLANTED MINI-PUMP PROMOTES HINDLIMB
STEPPING IN A LARGE ANIMAL MODEL OF SPINAL CORD INJURY
F. Marchionne1, A.J. Krupka1, M.A. Lemay2
1Temple University College of Engineering, Bioengineering, Philadelphia, USA
2Temple University College of Engineering, Bioegineering, Philadelphia, USA
Aims
Evaluate if BDNF delivery to the locomotor centers using a clinically translational delivery method
does promote recovery of stepping in a large animal model of spinal cord injury.
Method
Seven adult female cats were used for this study. Animals were acclimated to treadmill walking
for 3-8 weeks prior to spinal transection at the T11/T12 level. In three cats, a 50 ng/day dose of
BDNF was delivered intrathecally to the lumbar spinal cord for 48 days post-transection through a
programmable mini-pump implanted subdermally. The catheter was implanted at the L7/S1 level
and inserted subdurally until reaching approximately the L3 spinal segment level. The remaining
four animals underwent spinal transection and pump implant as well but the pump was filled with
0.9% NaCl and those animals served as controls.
Results
Kinematic evaluation was conducted before, 3 and 5 weeks after injury/pump implant. Results
show that treated cats are able to bipedally step at all velocities tested, although stance length
and swing height decreased after injury. Untreated spinal cats did not recover stepping ability,
especially at higher velocities. Control cats tend to drag their hind paws on the treadmill after
injury, and show dorsal foot placement during stance. Histological analysis is undergoing and
gross examination of the spinal cord post-mortem shows no damage to roots and cord with
minimal to no-encapsulation of the catheter and pump.
Conclusion
Constant infusion of BDNF to the locomotor centers stimulates and promotes locomotor recovery
after SCI. Intrathecal delivery by an implantable and programmable pump is a safe and effective
method for SCI treatment, posing minimal risk to the cord. Delivery of a controlled dosage of
BDNF using a commonly used method for drug delivery to the spinal cord makes this study
significant for future clinical applications.
WCNR-0375
BOARD NUMBER: 012
HOW TO CONTROL THE MOTOR IMAGERY TRAINING IN GRASPING REHABILITATION
AFTER TETRAPLEGIA
S. Mateo1,2,3, K.T. Reilly3, A. Metahni1, V. Bergeron1, F. Di Rienzo4, A. Guillot4, C. Collet4,
G. Rode2,3
1Ecole Normale Supérieure, Laboratoire de Physique, LYON, France
2Hospices Civils de Lyon- Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap, Lyon,
France
3INSERM U1028- CNRS UMR5292- Lyon Neuroscience Research Center, ImpAct Team, LYON,
France
4Centre de Recherche et d’Innovation sur le Sport- Equipe d’Accueil 647,
Laboratoire Performance Motrice- Mentale et du Matériel, Villeurbanne, France
Aims
Motor Imagery (MI) has been shown to be effective for grasping rehabilitation after C6-C7 spinal
cord injury (SCI). This requires high MI quality that can be assessed using both self-ratings of
vividness, and mental chronometry (based on the principle of temporal equivalence between MI
and physical practice (PP)). However, it is unknown whether tetraplegia and/or MI training during
grasping rehabilitation affect the MI quality. The aims are to i) measure the impact of tetraplegia
on MI quality by comparing kinesthetic imagery (KI) to visual imagery (VI) respectively, ii)
determine whether MI training influences MI quality.
Method
6 chronic C6-C7 SCI inpatients performed 15 MI training sessions over 5 weeks (3 sessions per
week). During each 45 minute-session, first they performed PP then MI (successively VI and KI)
with a ratio from 1:6 to 1:9. Participants trained both single-joint movement (e.g. wrist extension
or tenodesis grasp) and multiple-joint movements (e.g. reach-to-grasp). Actual (PP) and mental
(MI) durations were measured. Participants self-rated MI vividness using a visual-analog scale.
Paired t-test and linear mixed models were applied for the statistical analysis.
Results
For single- and multiple-joint movements, i) VI duration was significantly shorter than KI by 12%,
ii) VI and KI vividness significantly increased by 7% and 32% respectively while MI/PP time ratio
decreased across the 15 MI training sessions, approaching 1. However, only VI/PP during
multiple-joint movements was statistically significant.
Conclusion
C6-C7 SCI participants slow down KI as compared to VI, probably to maintain imagery vividness
despite partial sensorimotor upper limb impairment. MI training improves MI quality by increasing
MI accuracy and improving its temporal organization for both VI and KI. Hence, measuring
vividness and movement duration during MI training is recommended after tetraplegia to control
MI quality and ensure MI effects on motor performance.
WCNR-0051
BOARD NUMBER: 013
TRPV1 AND TRPA1 ACTIVATORS DEMONSTRATE EFFICACY ON HUMAN MUSCLE
CRAMPING. POTENTIAL NEW TREATMENT FOR MUSCLE CRAMPS AND SPASTICITY
R. Sutherland1, E. Solberg1, A. Tornblom1, T. Wessel1, C. Westphal1, J. Cermak1
1Flex Pharma, R&D, Boston, USA
Aims
Based on a general property of neuronal circuits, whereby strong excitatory input increases
inhibitory tone and reduces responsiveness to excitation, we hypothesized that transient receptor
potential channel (TRP) activation could yield sufficient excitatory input to dampen α-motor
neuron hyperexcitability in humans. The purpose of the study was to evaluate the effect of highly
pure activators compared to a vehicle control, in preventing muscle cramps.
Method
Flexor hallucis brevis muscle cramping was elicited through external stimulation of the abductor
hallucis brevis muscle and medial plantar nerve in healthy normal volunteers. The intensity and
duration of the cramp was recorded by EMG for each subject in timecourse studies.
Results
An oral solution containing highly pure, synthesized TRP activators prevented cramps with
duration of activity lasting for several hours. This blinded clinical study showed significantly
increased cramp reduction compared to a control group.
Conclusion
These results suggest that chemical neuro stimulation through synthetic TRP activators may be
an effective new treatment for individuals suffering from cramps/spasticity associated with motor
neuron disease, in addition to other disorders. Flex Pharma is evaluating starting studies exUSA, multi-center, randomized, blinded, cross-over study to investigate the effects of Flex's
proprietary product in patients with symptoms of spasticity and cramps due to MS and other
motor neuron diseases. Patients will be assessed for changes in their cramps, measures of
spasticity, quality of life, and sleeping patterns with safety/tolerability monitored. The results from
pre-clinical and ongoing clinical research will be presented.
WCNR-0485
BOARD NUMBER: 014
KINEMATICS OF THE LIMB AND PELVIS DURING LOCOMOTION IN THE NEONATALLY
SPINALIZED RAT
J. Vanloozen1, S. Giszter1
1Drexel University College of Medicine, Neurobiology and Anatomy, Philadelphia, USA
Aims
Spinal cord injury (SCI) is a debilitating injury resulting in profound loss of sensory and motor
activity below the site of injury that affects upwards of 10,000 people each year. Recovery of
locomotion after this type of injury has been associated with overall systemic health
improvements in patients being treated with locomotor rehabilitation. Here we use a neonatally
spinalized rat model that shows autonomous stepping (with and without weight-support) during
adulthood to investigate how the hindlimbs and pelvis interact in animals throughout robot-based
locomotor rehabilitation.
Method
In the neonatal SCI (NTX) model, animals undergo a complete spinal transection at T9/10 on
post-natal day 5. As adults these animals show a recovery of stepping behavior and in around
20% of cases animals demonstrate recovery of autonomous weight-supported locomotion.
Animals were surgically implanted with a pelvic orthosis for interfacing with our robot system and
treadmill trained for 20 minutes, 5 days a week for 30 days. Kinematics were collected at the
ankle (3DOF) and pelvis (6DOF) throughout the training period.
Results
Using a polar representation of the limb we were able to show that across rehabilitation there is
an increase in both angular excursion of the limb and an increase in limb length indicating that
training on the treadmill increases the animal's ability to utilize the limb in the task space. In an
animal that transitions from a low-level of weight-supported stepping to a higher level of weightsupport there was stabilization of the pelvis across the step cycle as training progressed that
corresponded with increasing excursion of the limb.
Conclusion
These preliminary findings demonstrate that the role of pelvic rotation may be important in the
development of weight-supported stepping and recovery of locomotion in NTX animals
undergoing our robot-based locomotor rehabilitation.
WCNR-0069
BOARD NUMBER: 015
MECHANISMS OF AUTONOMIC REGULATION DURING SOCIAL COGNITION TASK IN
SUBJECTS WITH SPINAL CORD INJURY
G. Varas1, P. Maldonado2
1Clinica Los Coihues, Terapia, Santiago, Chile
2Universidad de Chile, Physiology, Santiago, Chile
Aims
Demonstrate the differences of the mechanisms of regulation of the autonomic activity during
social cognition task between a group of patients with spinal cord injury and a group of healthy
subjects.
Method
We measured Heart rate variability (HRV), as autonomic marker, in healthy subjects and in
subjects with Spinal cord injury (SCI), diagnosed with paraplegia, who were pursuing a period of
adaptation and socio-labor integration. A 5 min. quiet sitting period at the beginning of the
assessment was used to collect baseline HRV. Than HRV was measured during performance of
the The Reading the Mind in the Eyes Test (RMET), which assesses the affective component of
the theory of mind. Interbeat intervals were measured via the Polar RS800CX . Raw data was
extracted as a text file and imported into Kubios (version 2.2, Biosignal Analysis And Medical
Imaging Group, University of Kuopio, Finland, MATLAB). Kubios was then used to calculate high
frecuency HRV (0.15–0.4 Hz) using the Fast Fourier transform, and root mean squere of the
differences between interbeat intervals. This study has been approved by the Ethics committee
of Chile University.
Results
We measured HRV in 18 healthy subjects and 10 subjects with SCI. Based on our results it was
observed that the group of subjects with SCI had a worse performance in RMET (p=0.001), a
significantly lower level of security on responses compared with the group of healthy people
(p=0.002), lower HRV at rest (p=0.005), and a smaller increase in the HRV during the task
relative to the baseline condition (p=0.007).
Conclusion
These results suggest that there be alterations in social cognition in subjects with SCI, diagnosed
with paraplegia, who were pursuing a period of adaptation and socio-labor integration. Our results
also confirm a positive correlation between limitations in autonomic flexibility and worse
performance in social cognition tasks.
WCNR-0284
BOARD NUMBER: 016
EFFECTS OF A TILT TABLE INTEGRATING FUNCTIONAL ELECTRICAL STIMULATION
AND PASSIVE STEPPING ON SPASTICITY AFTER SPINAL CORD INJURY
G. Verheyden1, C. Borghgraef2, L. Van Bosch2, S. Maas1, W. van den Hout1, E. Roels2,3,
C. Kiekens2
2University Hospitals Leuven, Department of Physical Medicine and RehabilitationCampus Pellenberg, Leuven, Belgium
3University Medical Center Groningen- University of Groningen,
Department of Rehabilitation Medicine, Groningen, Netherlands
Aims
Tilt table training is a common part of rehabilitation after spinal cord injury (SCI). This study
investigated whether tilt table integrating functional electrical stimulation and passive stepping
showed a reduction in spasticity when compared to traditional tilt table training.
Method
A single subject design with repeated measures was conducted in a spinal cord injury inpatient
rehabilitation unit. After a one-week baseline including three measurements, the participant
(male, 56 years), with a spinal cord injury level T9 (AIS A, sustained seven months earlier),
underwent four weeks (three times per week) of integrated tilt table training (iTTT; ErigoPro,
Hocoma AG, Switzerland), followed by four weeks (three times per week) of traditional tilt table
training (tTTT). For measuring spasticity the Modified Ashworth Scale (MAS) was used before
and after each training session. Before and 24 hours after each training session, the Penn Spasm
Scale was collected.
Results
After four weeks of iTTT, mean MAS score decreased with at least one point for the left leg in
three muscle groups (hip flexors and extensors and gastrocnemius) and for the right leg in two
muscle groups (hip flexors and adductors). After four weeks of tTTT, mean MAS score decreased
with a maximum of 0.54 for the left leg in one muscle group and 0.75 for the right leg in one
muscle group. The results of the Penn Spasm Scale showed a small and similar decrease for
mean self-reported frequency of spasticity. Mean self-reported severity of spasticity showed a
slight increase after iTTT and slight decrease after tTTT.
Conclusion
Our study suggests a positive effect for iTTT and tTTT in terms of spasticity reduction. MAS
scores decreased after both interventions, slightly more in favour of iTTT, warranting further
exploration in larger studies.
WCNR-0261
BOARD NUMBER: 017
HEALTH RELATED QUALITY OF LIFE FOLLOWING TRAUMATIC TETRAPLEGIA: FINDINGS
FROM THE SPINAL CORD INJURY PHYSICAL ACTIVITY (SCIPA) 'HANDS ON'
RANDOMIZED TRIAL
A. Yates1, Y.S. Hsueh1, M. Galea2, D. Dunt1
1The University of Melbourne, Centre for Health PolicyMelbourne School of Population and Global Health, Parkville, Australia
2The University of Melbourne, Department of Medicine, Parkville, Australia
Aims
To report the utility and quality adjusted life year (QALY) outcomes from the ‘Hands On’ RCT
comparing standard therapy (ST) with ST plus eight weeks of FES-assisted hand therapy (IN) for
recently injured tetraplegic patients.
Method
Utility and dexterity attribute values were assessed at baseline, post-intervention, and six-months
post-randomization using Health Utilities Index Mark 3 (HUI-3®). QALYs to six months were
computed using the ‘area under the curve’. Treatment arm mean utility and QALYs were
calculated as per intention to treat. Mean QALY difference was calculated using linear regression
to adjust for baseline differences
Results
33 and 37 participants were randomized to ST and IN respectively: 87% male; mean age 35
years; 54% had C4 injuries; 47% had AIS C/D injuries; no between-group baseline differences.
Mean utility and dexterity values improved in both groups overall, but between-group differences
were not significant. Adjusted mean QALY difference was 0.01 (95% CI:-0.03-0.06, p=0.586).
There was however a significant post-intervention between-group utility difference among AIS
C/D participants (mean difference=0.23, 95% CI:0.03-0.42, p=0.024); the six-month difference
approached significance (mean difference=0.22, 95% CI:-0.002-0.45, p=0.052). The adjusted
mean QALY difference was non-significant (mean difference=0.07, 95% CI:-0.02-0.15, p=0.118).
The post-intervention mean dexterity score difference was significant (IN mean 0.87,SD:0.09; ST
mean 0.79,SD:0.12, p=0.044).
Conclusion
Although IN showed no advantage over ST alone for recent tetraplegia injuries overall, it shows
promise for AIS C/D tetraplegia patients. Further research with larger samples is recommended.
WCNR-0683
BOARD NUMBER: 019
EPILEPSY
Antiepileptic activity of the peptide Neurovespina in a model of chronic Temporal Lobe
Epilepsy
L. Carneiro dos Anjos1, M. MORTARI2
1Biology, Phisiology, Brasília, Brazil
2Biology, Phisiology, BRASILIA, Brazil
Aims
This work aims to evaluate the activity of Neurovespina (2014, Brazil, Patent: BR1020140047280,
INP), a new peptide similar to one found in a social brazilian wasp Polybia occidentalis in a
pilocarpine model of chronic temporal lobe epilepsy (TLE).
Method
The pilocarpine model of SE is one of the well-established animal models for SE and shares
many of the characteristics of human TLE. Swiss mice (n=8) were injected with methylscopolamine (1 mg/kg, i.p) 30 min prior pilocarpine injection (210 mg/kg, i.p) to minimize
peripheral cholinergic effects. Control mices received saline instead of pilocarpine. Three hours
after developed status epilepticus (SE) all animals received tiopental administration (single 40
mg/kg i.p. injection) in order to standardize the duration of seizure activity. Fifteen days after SE
animals developed a chronic condition determined by spontaneous recurrent seizures. After two
weeks of the pilocarpine/saline injection, animals received i.p. injections of Neurovespina (doses:
1, 2 or 4 mg/kg) or saline (control groups) to evaluate the behavioral effectiveness antiepileptic
effect. The occurrence of seizures (Racine scale) and time spent in seizures was evaluated
during two weeks (video recorded 9 hours/day).
Results
Our results showed that Neurovespina reduced the time and number of spontaneous recurrent
seizures in all doses evaluated and in the highest dose (4mg/kg) animals have no seizure after
treatment.
Conclusion
These data indicate that Neurovespina has potential for the development of novel drugs for
neurological diseases or as pharmacological tools for the study of normal
and pathological functioning of the CNS, both to reduce the seizures frequency and to minimize
the neuronal damage associated with seizures (data not show). Further research is in course in
order to elucidate the mechanism of action of the Neurovespina. Histopathological data and EEG
recording are still in evaluation phase.
WCNR-0636
BOARD NUMBER: 020
EPILEPSY
INTRANASAL MIDAZOLAM VERSUS INTRAVENUS LORAZEPAM IN CONTROL OF ACUTE
SEIZURES IN CHILDREN
A. Thingal1
1, Alappuzha, India
Aims
Primary Objective
To determine the efficacy of intranasal midazolam against intravenous
lorazepam in control of acute onset seizures in children aged 6 months to 15 years.
Secondary Objective
To study adverse effects .Method
Methods, type of study and design: .
Setting: Emergency department
SubjectsAll children presenting in the emergency room with active seizures in the
age group of 6 months to 15 years
Outcome measures- time to cessation of seizures
Results
65.2% 15) of the children in whom intranasal midazolam was
given, seizures were controlled within 5 minutes from ER presentation, where as in
lorazepam group only 34.8% (8) children ceased to seizure within 5 minutes. Of that
17.4%(4) in the midazolam group and 56.5% (13) lorazepam group ceased to
seizure in 5to 10 minutes. More than 10 minutes were required for the control of
seizures in 17.4% (4) of children in the midazolam group as compared to
8.7%(2)children in the lorazepam group. the time to
cessation of seizures from ER,65.2%in the midazolam group stopped seizuring within
5 minutes, whereas majority (65.2%)of children in the lorazepam group required
more than 5 minutes for seizure controlThis was statistically significant,
hence time to cessation of seizures after arrival at hospital was faster with
midazolam .
Time to cessation of seizures from drug administration:
,73.9%(17) children in the intranasal midazolam group and
78.3%(18) in lorazepam group stopped seizuring within 5 minutes of administration
of the respective drugs, whereas 26.1% (6) in the midazolam group and
21.7%(5) in the lorazepam group took more than 5 minutes for control of seizures
after administration of the drugs Only 8.5%(2) children in both the groups
required more than 10minutes for seizure control
Conclusion
Primary outcome
•
The overall time to cessation of seizure after arrival at hospital was
faster with intranasal midazolam
The time to cessation of seizures after drug administration was almost
similar
The time from arrival at hospital to starting treatment was significantly
shorter in the intranasal midazolam group.
SECONDARY OUTCOME
No untoward adverse effects
WCNR-0677
BOARD NUMBER: 021
KINESIOLOGY
PARETIC ARM PERFORMANCE AFTER STROKE: ANALYSIS OF CYCLIC AND DISCRETE
MOVEMENTS
S. Alouche1, P.M. Dib1, J.V. Fandim2, S.M.S.F. Freitas1
1Universidade Cidade de Sao Paulo, Master's and Doctoral Program in Physical Therapy,
Sao Paulo, Brazil
2Universidade Cidade de Sao Paulo, School of Physical Therapy, Sao Paulo, Brazil
Aims
Discrete and cyclic movements are differentially controlled by the central nervous system, which
influences the performance of aiming movements. Direction of movement also influences
performance. Cyclic and ipsilateral movements are faster and smoother than discrete and
contralateral movements. The effects of task constraints over paretic arm performance were less
explored. This study analyzed the influence of the task constraints in paretic arm performance
after stroke.
Method
A cross-sectional study was conducted with 10 post-stroke (with left or right unilateral hemisphere
damage) and 10 healthy individuals. Participants performed aiming movements over a digitizing
tablet in different ways: discrete and cyclic movements and for ipsilateral and contralateral
direction of the moving limb. The paretic arm was used by all patients. Temporal (reaction time,
movement time and peak velocity) and spatial (smoothness, trajectory length and resultant
constant error) variables were analyzed. The initial and final cycles of the cyclic movements were
also compared for both groups. Analysis of variance was used considering a significance level of
5%.
Results
Individuals post-stroke were slower to react and less smooth and accurate than the healthy
group. Cyclic and ipsilateral movements were faster and less accurate than the discrete and
contralateral movements for both groups. Additionally, participants with impairment could not
reach the same trajectory length of the healthy group in cyclic movements. There were
differences between initial and final movement' cycles for both groups.
Conclusion
Individuals after stroke modulate the paretic arm performance according to the task constraints
similarly to that of healthy individuals. Both groups prioritized accuracy in discrete movements
and speed in cyclical movements and were faster and smoother in the ipsilateral direction. Cyclic
movements were, however, more difficult to be initiated and completed by the paretic arm.
WCNR-0670
BOARD NUMBER: 022
KINESIOLOGY
ASSESSMENT OF THE IPSILESIONAL HAND FUNCTION IN STROKE SURVIVORS: THE
EFFECT OF LESION SIDE
B. CUNHA1, S. Freitas2, G. Gomes2, P. de Freitas3
1Cruzeiro do Sul University, Institute of Sciences of Physical Activity and Sport, São Paulo, Brazil
2Cidade de São Paulo University, Physical Therapy, São Paulo, Brazil
3Cruzeiro do Sul University, Cruzeiro do Sul University, São Paulo, Brazil
Aims
Examine the effect of the side of brain lesion on the function of ipsilesional hand of stroke
survivors
Method
Twelve left and 12 right chronic stroke survivors and 12 sex- and age-matched controls
performed the Jebsen-Taylor Hand Function Test (JTHFT), the nine hole peg test (9HPT), the
maximum power grip strength (PwGS) test, and the maximum pinch grip strength (PcGS) test.
Stroke survivors performed the task with their ipsilesional hand while controls performed with
both, right and left hands. The order of execution of dexterity tests (JTHFT and 9-PnB) was
randomized. After, maximal strength tests were performed also in a randomized order
Results
PwGS and PcGS were similar among the three assessed groups. Performances in JTHFT and
9HPT were impaired by the stroke. In addition, individuals who suffered a left stroke showed
better performance in 9HPT than right stroke survivors, but their performances in JTHFT were
similar
Conclusion
Stroke survivors have their capacity to produce hand and digits maximum force preserved when
they use their ipsilesional hand. However, the hand and digit dexterity are affected by the stroke,
in particular, for individuals who suffered a right stroke. These findings indicate that the
ipsilesional hand also needs to be rehabilitated, and that the intervention plan should also
emphasize the execution of sensorimotor tasks rather than only muscle strength and power.
These findings also suggest that individuals who suffered a stroke in the right brain hemisphere
need additional attention during the rehabilitation process
WCNR-0699
BOARD NUMBER: 023
KINESIOLOGY
ASSESSMENT OF NEUROMUSCULAR QUICKNESS THROUGH ISOMETRIC FORCE
PULSES: COMPARISON BETWEEN RATE OF FORCE-DEVELOPMENT AND -RELAXATION
SCALING FACTORS
L. Funk1, K. Haberland2, M. Uygur1
1Rowan University, Health and Exercise Science, Glassboro, USA
2Rowan University, Mechanical Engineering, Glassboro, USA
Aims
The ability to generate a quick muscle contraction to produce a submaximal force and relax
immediately is a quality of movement that is highly related to falls and could be deteriorated both
in aging and neurological populations (e.g. Parkinson’s and multiple sclerosis). Recently,
neuromuscular quickness has been assessed from the kinetic analysis of isometric force pulses
performed to various submaximal levels under the instructions to produce each pulse as fast as
possible. The slope of the regression line drawn to the relationship between peak force (PF) and
its peak rate of force development (RFD) is named as rate of force development scaling factor
(RFD-SF) and is regarded as a measure of neuromuscular quickness. Along with RFD-SF, R2
(indicating how firmly CNS controls this relationship) and intercept (together with RFD-SF it
indicates quickness) are also assessed as indices of neuromuscular quickness. Considering the
importance of muscle relaxation in tasks that require switching from one level of muscle activation
to another, the assessment of how quickly one can relax their muscle is also crucial for daily
activities.The aim was to assess the indices of the quickness during relaxation and to compare
them with those measured in force generation.
Method
Thirteen healthy young adults performed rapid contractions to varying force levels and relaxed
immediately in isometric elbow extension and flexion tasks. The indices of neuromuscular
quickness of both force generation and relaxation were compared in both directions.
Results
Results indicated a similar R2 and quicker force generation values than those values in relaxation
periods of isometric force pulses in both force directions.
Conclusion
Similar to those obtained during force generation, indices of neuromuscular quickness could also
be assessed during force relaxation. Future studies that compare those indices between healthy
and neurological populations could be of importance for rehabilitative and clinical purposes.
WCNR-0658
BOARD NUMBER: 024
KINESIOLOGY
EFFECTS OF DUAL TASK ON THE GRIP FORCE CONTROL IN STROKE INDIVIDUALS
G. GOMES1, P. de Freitas2, B. Cunha2, S. Freitas1
1Cidade de São Paulo University, Physical Therapy, São Paulo, Brazil
2Cruzeiro do Sul University, Institute of Sciences of Physical Activity and Sport, São Paulo, Brazil
Aims
The aim of the study was to examine how individuals whom suffered a stroke control grip force
(GF) during an object lifting-holding task with the ipsilesional hand when this task is performed
along with a cognitive task.
Method
Eight right-handed stroke individuals between 50 and 70 years-old performed a motor task
consisting in grasping, lifting and holding, as stable as possible, an object of 214g for 10s and
replace it on the table. This motor task was performed either alone (MT) or simultaneously with a
cognitive task (dual task, DT). Also, the cognitive task was also performed alone to test if its
performance was affected by the MT. The cognitive task was to memorize the number of images
of houses with both stair and garage, or with both stair and car and report the number of such
images at the end of trial. Five images were presented per trial. The dependent variables were
the time from contact to liftoff, the maximum GF during the lifting phase, and GF mean and
coefficient of variation of GF (CV_GF) during the holding phase.
Results
The results revealed that the DT led to increased GF and reduced CV_GF, indicating that stroke
individuals increased the safety margin but reduced GF variability while holding an object and
performing simultaneously a cognitive task. Yet, there was an increase of the number of errors in
the DT.
Conclusion
Therefore, the findings of this study suggested that stroke individuals present alterations on the
performance of both motor and cognitive tasks when they are performed simultaneously. The
interference of the cognitive task on the magnitude of GF should be considered in counseling and
rehabilitation of stroke individuals as performing such tasks for a long time could anticipate
muscle fatigue in such situations.
WCNR-0667
BOARD NUMBER: 025
KINESIOLOGY
The effect of deliberately light interpersonal contact on head stability during walking in
children and adolescents with cerebral palsy
L. JOHANNSEN1
1Technische Universität München, Department of Sport and Health Sciences, München,
Germany
Aims
Individuals with cerebral palsy (CP) show extreme trunk instability and poorly articulated head-ontrunk orientation during walking which might pose a fall risk. In mature walkers, head-on-trunk
articulation minimizes head motion and resulting vestibular stimulation during a gait cycle. We
aimed to improve the stability of head orientation during locomotion in CP by the application of
‘deliberately light’ interpersonal touch (IPT).
Method
In this quasi-experimental study, IPT was applied in three contact conditions at the back between
the shoulder blades, the occiput and the apex of the head. In self-paced walking, head and trunk
stability as well as gait variability were assessed by an inertial motion capture system in children
and adolescents with CP and age-matched typically developed (TD) participants.
Results
IPT at the occiput and apex reduced head sway and tended to reduce trunk sway despite
increased stride rate in the CP group. In contrast, thoracic IPT increased head and trunk sway in
combination with increased stride rate. The TD group, however, responded differently to the CP
group. Reductions in head and trunk sway with the tendency to reduce stride rate were seen in all
testing conditions compared to walking alone. Analysis of the residual variance in the head and
trunk accelerometry indicated that the CP individuals depended more on current sensory
feedback during a stride cycle than the TD individuals. Nevertheless, this component of locomotor
control was not altered by any IPT condition.
Conclusion
Deliberately light IPT at the head results in a reduction of head and trunk sway in children and
adolescents with CP. Increases in stride rate may indicate assured confidence during locomotion
with IPT. The effect of IPT, however, varies as a function of contact location and may be
qualitatively different in TD individuals. IPT may be a strategy in gait training to establish an
optimized habitual locomotor pattern.
WCNR-0397
BOARD NUMBER: 026
KINESIOLOGY
COMPARING THE CONTRIBUTION OF LENGTH AND FORCE FEEDBACK TO ANKLE
EXTENSION DURING STANCE IN THE TREADMILL TRAINED SPINAL CAT
A. Krupka1, D. Higgin2, B. Prilutsky3, A. Klishko3, I. Rybak4, M. Lemay1
1Temple University, Bioengineering, Philadelphia, USA
2Delaware State University, Department of Biological Sciences, Dover, USA
3Georgia Institute of Technology, School of Applied PhysiologyCenter for Human Movement Studies, Atlanta, USA
4Drexel University College of Medicine, Neurobiology & Anatomy, Philadelphia, USA
Aims
The purpose of this study was to investigate the contribution of length versus force-feedback and
cutaneous afferents to the recovery of stepping in spinalized cats. We assessed the kinematic
capabilities of spinalized cats before and after reinnervation or deafferentation on flat and sloped
treadmill surfaces.
Method
Eight female cats were used in this study. Cats were separated into two groups: those
undergoing spinal transection at T11-T12 followed by unilateral deafferentation of the L7-S1
roots, and cats who underwent section and reinnervation of the LGS nerve before T11-T12 spinal
transection. After transection, cats were trained to step on a treadmill at speeds from 0.3-0.8m/s.
Spinalized cats underwent deafferentation after fully recovering plantar weight-bearing stepping.
Kinematic recordings were taken for all cats after recovery of stepping.
Results
Recovery of stepping in reinnervated and spinalized cats is comparable to spinalized cats,
despite the loss of Ia afferents from reinnervation. Spinalized and reinnervated cats readily
adapted to stepping on 10° inclined and declined surfaces. However, after unilateral
deafferentation, cats were no longer capable of locomotion on a sloped surface and showed a
persistent yield of the ankle during stepping.
Conclusion
Our results show that spinalized cats will readily adapt to stepping on a sloped surface, even if
trained only to step on a flat surface. Furthermore, our results show that the contribution of Ib and
footpad cutaneous, but not Ia ankle afferent input, is critical for the maintenance of a normal
locomotor rhythm, and is also critical for the execution of locomotion on a sloped surface. These
results provide experimental support for a model proposed by Rybak and Prilutsky.
WCNR-0301
BOARD NUMBER: 027
KINESIOLOGY
SOUND ACTION OBSERVATION THERAPY: EFFECTIVENESS IN UPPER LIMB STROKE
REHABILITATION
A. Levantesi1, F. Morsut2, A. Giattini2, C. Annarita2, S. Cocci Grifoni2
1, Ascoli Piceno, Italy
2Santo Stefano Institute, Acute rehabilitation center, Ascoli Piceno, Italy
Aims
.Different studies show the effectiveness of the neuron mirror system and of its application in
neurological rehabilitation. The background is the positive role of AOT in upper limb rehabilitation
stroke and the relationship between the observation of movements sonified with the activation of
the basal ganglia. The aim of this study is to verify the influence of sound stimulus in functional
recovery accompanied with action observation therapy.
Method
We enrolled 10 patients affected by ischemic or hemorrhagic strokes, within 60 days from the
acute event, with the involvement of their upper limbs. Participants watched a video footage of
movements (actions) carried out with the upper limb in order to prepare to imitate the presented
action. The video was accompanied by sounds in the protocol group. The control group was
submitted to a treatment without sounds stimuli. Outcome measures were: Functional
Independence Measure, Modified Ashworth Scale, Motricity Index, Wolf Motor Test, Nine Hole
Peg Test. General motricity must be maintained, and serious cognitive deficits must not be
present (apraxia, neglect, attentive deficit, memory deficits and visual impairments) The treatment
is planned for 20 applications, for 20 minutes each, and three assessments were carried out per
patient. The final assessor will be blind. The study received the approval of the Ethics Committee.
Results
Data were analyzed with paired t-test and gave a significant results of effectiveness in
improvement of motor learning in the protocol group, more than in the control group.
Conclusion
Protocol group patients showed a better improvement in motor learning of the upper limb than
control group patients who were submitted to a treatment without sounds stimuli. This small
sample encourages us to continue observation of a larger group of patients.
WCNR-0377
BOARD NUMBER: 028
KINESIOLOGY
MOTOR CONTROL STRATEGIES FOR UPPER LIMB MOVEMENTS AFTER TETRAPLEGIA.
A KINEMATIC REVIEW
S. Mateo1,2,3, A. Roby-Brami4, K.T. Reilly2, A. Metahni1, V. Bergeron1, Y. Rossetti2,3, C. Collet5,
G. Rode2,3
1Ecole Normale Supérieure, Laboratoire de Physique, LYON, France
2INSERM U1028- CNRS UMR5292- Lyon Neuroscience Research Center, ImpAct Team, Lyon,
France
3Hospices Civils de Lyon- Hôpital Henry Gabrielle, Plateforme Mouvement et Handicap, Lyon,
France
4UPMC, Institut des systèmes intelligents et de robotique, Paris, France
5Centre de Recherche et d’Innovation sur le Sport- EA 647, Laboratoire Performance MotriceMentale et du Matériel, Villeurbanne, France
Aims
The aim of this literature review is to provide a clear understanding of motor control and kinematic
changes during open-chain upper limb (UL) movements after tetraplegia and state the implication
for rehabilitation.
Method
Using data from MEDLINE between 1966 and August 2014, we investigated kinematic UL studies
after tetraplegia.
Results
We included fourteen control-case and three series-case studies with a total of 161 spinal cord
injury (SCI) and 126 healthy control participants. SCI individuals planned UL movements
according to two kinematic invariants that are endpoint accuracy and economy. Furthermore,
motor slowing is a clear kinematic characteristic, caused by (i) decreased strength, (ii) accuracy
requirements at movement endpoint, (iii) triceps brachii paralysis disrupting normal agonistantagonist co-contractions (above C7 SCI), and (iv) grasping (C6-C7 SCI). Below C5 SCI, these
individuals can still achieve a broad range of tasks reflecting effective scapulothoracic and
glenohumeral compensations that provide a dynamic mechanical coupling between the shoulder
and elbow joints thus palliating elbow extension despite triceps brachii paralysis. However this
mechanism is incomplete since C5-C6 SCI individuals reduce overhead workspace to keep the
elbow extended and to maintain the mechanical dynamic interaction between the shoulder and
elbow. Surgical restoration of active elbow extension causes increased elbow stiffness resulting
in increased movement velocity, reduced glenohumeral compensation, and overall improved
motor control. After C6-C7 SCI, grasping requires prolonged deceleration phase during transport
to ensure hand placement with respect to the to-be-grasped object then wrist extension during
grasping to elicit either whole hand or lateral grip. Contrary to the normal pattern, where grasping
is prepared during the transport phase, C6-C7 SCI individuals perform reaching and grasping
consecutively indicating that reaching is independent from grasping.
Conclusion
Rehabilitation and surgical restoration of UL should take these kinematic findings into account to
favor greater autonomy of individuals after SCI.
WCNR-0527
BOARD NUMBER: 029
KINESIOLOGY
CORTICAL REPRESENTATION OF PRECISION MOTOR CONTROL IN ADULTS WITH
MAJOR DEPRESSION
R. Mehta1
1Texas A&M University, Environmental and Occupational Health, College Station, USA
Aims
An estimated 18.8 million American adults experience depression each year, and ~80 percent of
those with depression have some level of functional impairment. Neuroimaging data point to a
depression-specific neuropsychological dysfunction in the prefrontal and limbic cortices, however
very little is known regarding brain-behavior relationships with depression during precision motor
control. The purpose of this study was to determine the brain imaging correlates of precision
motor control in adults with depression.
Method
Upon informed consent, participants (10 adults with major depression disorder (MDD) and 10
age-matched healthy control adults), completed ten force control trials at 30% of their maximum
voluntary contraction, for both handgrip and knee extension. Dependent variables included motor
control (measured as fluctuations in force control) and neural activation (measured using
functional near infrared spectroscopy; fNIRS) bilaterally from the prefrontal cortex (PFC) and the
supplementary motor areas and the primary motor cortex.
Results
A 2 (group: control vs MDD) x 2 (task: handgrip vs knee) x 6 (brain regions) mixed-effects model
was employed to investigate the main and interaction effects of these factors on oxygenated
hemodynamic (HbO) response levels. Both PFC regions exhibited higher HbO levels than the left
Motor regions (P<0.0001), and the control group exhibited greater cortical activation than the
MDD group (P=0.03). A significant group, task, and brain region interaction was found (P=0.01);
the MDD group exhibited lower activation during the handgrip task than the knee extension task
in the right PFC region, however, no such differences were found in the control group.
Conclusion
These results indicate that hypofrontality during handgrip in MDD adults plays a major role in
functional decrements of the upper extremity but not with lower extremity motor control. These
findings may guide specific neurorehabilitative strategies to improve PFC functioning that in turn
aid in recovering upper extremity functional outcomes in individuals with depression.
WCNR-0445
BOARD NUMBER: 030
KINESIOLOGY
INCIDENCE OF HEAD DEFORMITIES ASSOCIATED TO POSTURAL MANAGEMENT IN
NEWBORN INFANTS FROM A NEONATAL INTENSIVE CARE UNIT IN SANTIAGO DE CHILE
A. Pedrero1, E. Alvear1
1Clinica Alemana Santiago, medicina fisica y rehabilitacion, santiago, Chile
Aims
Due to increasing number of head deformities in newborns during the last decade that is
associated with developmental and cognitive delay, there has been a rising interest in non
synostotic head deformities. There is also information available about preterm infants and their
risk of developing symmetrical and asymmetrical head deformities. In the Neonatal Intensive
Care Unit (NICU) of Clínica Alemana Santiago, we implemented a postural management based
on the analysis of posture and general movement of newborn, which allows us to take specific
measures to prevent hospital stay complications. In the present study we aim to obtain
quantitative data about head shape of newborn infants at the time of discharge from hospital who
received this postural management.
Method
189 infants were included. Cranial measurements were made as a routine procedure by qualified
staff using a craneometer. Cranial Vault Asymmetry (CVA) and Cranial Index (CI) was calculated.
Head shape was described by CVA and CI for each subject, during initial evaluation and at the
time of discharge.
Results
Initial CVA showed normal (85%), mild (14%), moderate (0.5%) and severe (0.5%) deformational
plagiocephaly (DP). CVA at discharge showed an incidence of normal (82%), mild (18%),
moderate (0%) and severe (0%) DP.
IC results shown during the initial measurement were normal (58%), brachycephaly (28%) and
dolichocephaly (14%). At discharge there was normal (56%), brachycephaly (18%) and
dolichocephaly (26%).
Conclusion
These preliminary data obtained in this study shows that most of the subjects obtain a normal
initial evaluation and at the time of discharge remains normal. These data needs to be compared
with similar studies like the one published by Ifflaender S. et al., 2013 and provide important
information to develop prevention strategies and clinical decision algorithm focus on decrease the
number of cranial deformities.
WCNR-0476
BOARD NUMBER: 031
KINESIOLOGY
COMPARISON OF CONSTANT AND VARIABLE PRACTICE CONDITION OF A BALANCE
TASK USING THE WII BALANCE BOARD
G. Pino1
1Universidad de Chile, departaento de kinesiologia, Santiago, Chile
Aims
COMPARISON OF CONSTANT AND VARIABLE PRACTICE CONDITION OF A BALANCE
TASK USING THE WII BALANCE BOARD
Objectives: Practice conditions can improve the motor learning in healthy subjects. However, in
subjects with neurologic diseases, and using more ecological or functional tasks, the benefits of
practice conditions are not completely understood. Particularly, the variable and constant practice
does not have a strong support in functional tasks such as balance tasks. Therefore, the objective
here was to compare the performance of two groups of healthy subjects learning a postural task
in a variable or constant practice condition.
Method
Method: Twenty six healthy adults were randomly assigned in two groups, constant and variable.
Both groups were trained to follow, with the center of pressure (CoP), three different paths
(images with C, D and S shapes showed in a screen) in a standing position on a wii balance
board. The training was conducted in two sessions with a difference of 24 hours between them.
The constant group performed 36 times just the C image while the variable group practiceds with
a random order the C, D and S images. The second day both groups performed the first 18 trials
with the same image, while in the last 18 trials the subjects practiced all the pathswere randomly
trained.
Results
Results: The constant group do not show significant differences between the two days of training
(p=0.064), while the variable group show a significant difference (p=0.049). The interaction
between both groups and days do not show a significant difference (p=0.86).
Conclusion
Conclusion: The advantages of the variable practice for the postural task learning are consistent
with the previous literature. Nevertheless the effects size of the differences are not strong to
predict if the variable practice condition is more benefitial than the constant practice in healthy
subjects.
WCNR-0548
BOARD NUMBER: 032
OTHER - PART 1
FUNCTIONAL ELECTRICAL STIMULATION, IMPAIRED GROSS MOTOR CONTROL AND
MOBILITY IMPROVEMENT
K. BO1
1Northern Lincolnshire and Goole NHS Foundation Trust, Rehab Medicine Service, Brigg,
United Kingdom
Aims
Heel strike is a result of push off force (POF, Fig 1a), delivered by calf muscles, has two vectors,
lift vector (vPOF) and linear progression vector( hPOF) acting on the foot. During swing phase,
calf muscles should be silent (fig,2), to allow vPOF lifting the forefoot up giving rise to heelstrike.
In a variety of conditions there is Impaired Gross Motor Control, the calf muscles fail to relax
during the swing phase generating the push down force (PDF) and this will oppose the vPOF,
interfering the heel strike. In those situations, variety of interventions can control the PDF. As
shown in Fig 2, by applying AFO, a reaction force (AFORF in Fig.2b) can be generated
neutralising the PDF and heelstrike can be restored as in Fig.2b. In children with Motor Coordination Disorder or Impaired Gross Motor Control , they do not out grow their motor difficulties
and physiotherapy, orthoses and drugs are not always the solution.
To study if Functional Electrical Stimulation (FES) can control the Push Down Force of Cocontraction of calf muscles during swing phase allowing heel strike to happen.
Method
Single case prospective study from 27 02 13 to 12 01 15. An eighteen-year gold girl with difficulty
to make right heel strike due to Impaired Gross Motor Control, was trained to use ODFS III to
control PDF during swing phase.
Results
At the end of the study period, patient can make heel strike with good foot clearance and safer
mobility.
Conclusion
FES can be a useful tool in retraining people with Impaired Gross Motor Control.
WCNR-0061
BOARD NUMBER: 033
OTHER - PART 1
REMOTE LIMB ISCHEMIC CONDITIONING ENHANCES LEARNING IN ADULT HUMANS
K. Cherry-allen1, J. Gidday2, J.M. Lee3, T. Hershey4, C. Lang5
1Washington University in St. Louis School of Medicine, Physical Therapy, St. Louis, USA
2Washington University in St. Louis School of Medicine, Neurological SurgeryCell Biology and Physiology- Ophthalmology and Visual Sciences, St. Louis, USA
3Washington University in St. Louis School of Medicine, Neurology, St. Louis, USA
4Washington University in St. Louis School of Medicine, Neurology- Psychiatry- Radiology,
St. Louis, USA
5Washington University in St. Louis School of Medicine, Physical TherapyOccupational Therapy- Neurology, St. Louis, USA
Aims
To test if: 1) remote limb ischemic conditioning (RLIC) enhanced motor and cognitive learning in
human adults compared to sham conditioning and 2) RLIC at lower pressures would yield
equivalent results as RLIC at higher pressures. We hypothesized that learning would be greater
in those who received RLIC vs. sham.
Method
48 adults participated in a 7-day protocol of RLIC/sham conditioning followed by motor and
cognitive training, to induce learning. In Experiment 1, RLIC was achieved via cuff inflation to
200mmHg; sham conditioning was achieved via cuff inflation to 10mmHg under diastolic blood
pressure. Experiment 2 tested lower cuff inflation pressures to 20mmHg above systolic blood
pressure against pressures used in Experiment 1. Learning was assessed on day 7 and retention
was evaluated at 2 and 4 weeks. Data were analyzed using repeated measures ANOVAs with
planned post-hoc comparisons to analyze group-by-time interaction effects.
Results
RLIC groups had greater motor learning compared to sham groups (Figure). RLIC groups also
had a trend toward enhanced cognitive learning in Experiment 2 (p = .07), but not Experiment 1
(p = 0.33). RLIC at lower cuff inflation pressures was equally effective in enhancing motor (p =
0.98) and cognitive (p = 0.97) learning.
Conclusion
RLIC had a robust effect on learning and could be harnessed as a low-cost and clinically-feasible
neurorecovery agent to increase learning and enhance rehabilitation following neurological injury.
WCNR-0572
BOARD NUMBER: 034
OTHER - PART 1
TEAMS THERA IN THE NEUROREHABILITACIÓN, WORK EXPERIENCES, HOSPITAL JULY
DÍAZ, HAVANA, CUBA
V. Cisneros1
1hospital julio diaz, vicedireccion de rehabilitacion, La Havana, Cuba
Aims
to expose the experiences of work of the hospital Julio Díaz González National Center of
Rehabilitation, with the teams THERA TRAINER TIGO 510 and THERA TRAINER BLEATS 524.
Method
experimental explanatory study, universe constituted by all the patients with affections of
neurological origin (injured medullary, ataxias and patient with ictus sequels and children with
cerebral paralysis) that enter in the institution, the sample conformed it 434 patients assisted
consecutively during the period understood between September of the 2011 and September 2015
and that they fulfilled the inclusion approaches.
Results
talked 270 patients to the team Thera tigo and 164 made it in the Thera I bleat, alterations of the
muscular tone, mainly the espasticity for medullary damage was the affection that showed better
results inside the treaties with thera tigo, 98,3% I diminish the espasticity in at least a degree, as
long as they responded well to the I bleat the ataxias with 68% of the patients reaching the
maximum of space dimensions what a good evolution, 27% is considered they were evaluated of
regulating and 5% didn't achieve improvement, the children with operated cerebral paralysis of
knee flexus also responded favorably to the I bleat, it was possible to enlarge the arch to
articulate for the extension of knees of 160°-180° in more than 50% of these children.
Conclusion
the teams Thera constitutes an excellent work tool for the neurorehabilitacion
WCNR-0507
BOARD NUMBER: 035
OTHER - PART 1
THE PLATFORM COBS LIKE INSTRUMENT TO IMPROVE THE QUALITY OF LIFE OF
PATIENT WITH SEQUELS DE STROKE
V. Cisneros1
1Hospital Julio Diaz, Vicedireccion de Rehabilitacion, la Havana, Cuba
Aims
Objective to evaluate effectiveness of the Platform Cobs in the Quality of Life of patient with ictus
sequels, he/she was carried out an explanatory, experimental, longitudinal, prospective study and
applied in patient with sequels of Illness Cerebrovascular assisted in the Hospital Julio Díaz
during the period September 2012-diciembre2014.
Method
The universe was constituted by the entirety of patients entered in the service of Cerebral Lesion
with diagnosis of Illness Cerebrovascular. The sample belonged to 50 patients that were
distributed in group estudio(A) and group control (B) applying simple aleatory method. The
rehabilitation program was used according to the protocol of performance of the service for the
group control and to the patients of the group study they were added program of training with
Platform Cobs. The scales NIHSS and FIM were applied to measure discapacidad, the ECVI-38
for Quality of Life to the beginning and final
Results
the NIHSS in the group TO with a stocking of 6 and the group B with a stocking of 9 at the end of
the treatment, the FIM with the degree of without help 21 patients in the group TO and 11 in the
group Concluded B. the rehabilitative treatment the domain more beneficiary was the sociofamiliar Operation with OF: 8.64
Conclusion
the platform improved the quality of life of patients with hemiplegia from stroke.
WCNR-0249
BOARD NUMBER: 036
OTHER - PART 1
TRAINING CARERS TO USE TECHNOLOGIES MAY BE MORE IMPORTANT THAN
TRAINING PATIENTS IF YOU WANT UPTAKE OF TELEREHABILITATION AFTER STROKE
M. Crotty1, M. Van Den Berg2, E. Liu1, M. Killington1, G. Kwakkel3,4,5, E. Van Wegen6
1Flinders University, Rehabilitation- Aged and Extended Care, Adelaide, Australia
2Flinders University, Rehabilitation- Aged and Extended Care- Flinders University- Australia,
Adelaide, Australia
3Centre of Rehabilitation and and Rheumatology READE, Neurorehabilitation, Amsterdam,
Netherlands
4MOVE Research Institute, 2VU University Medical CenterDepartment of Rehabilitation Medicine, Amsterdam, Netherlands
5Department of Physical Therapy and Human Movement Sciences, NorthWestern University,
Chicago IL, USA
6VU University Medical Center- MOVE Research Institute, Rehabilitation, Amsterdam,
Netherlands
Aims
To describe the factors associated with higher levels of uptake of a telerehabilitation exercise
practice approach in patient and carer dyads after stroke.
Method
In a post hoc analysis of data from a randomised controlled trial (n=63) we investigated factors
associated with higher levels of self reported practice using telerehabilitation.
In the trial we provided one group of stroke patients and carers with an 8 week structured carer
mediated exercise program using a telehealth approach and another with general advice, We
provided a customised exercise training app and other "off the shelf " commonly available
equipment (tablet loaded with video app, activity monitors)
We assessed the carer’s self efficacy and symptoms of anxiety, depression and fatigue. We also
examined the familiarity of patients and carers with technology using the Modified Computer Self
Efficacy questionnaire. In those who received the telehealth intervention (n=31) the need for
technical support was assessed and at the completion of the program individuals were asked
about their experience using the System Usability and whether they would recommend a
telehealth approach to others
Results
Higher levels of practice were reported by those who received telerehabilitation. At 8 weeks, no
relationship between exercise practice time and patient’s age or baseline computer self efficacy
was found. However, in a general linear regression model we found that carer’s baseline
computer self-efficacy (β=4.9, p=0.0451) was significantly associated with exercise practice time.
High levels of satisfaction were reported with telerehabilitation regardless of age. On average
those who received the tele-rehabilitation received 19.3 minutes of technical support over 8
weeks (SD9.6 range 0, 40) and most were happy to recommend the approach to others.
Conclusion
Incorporating telerehabilitation into post hospital recovery could be an important part of self
management after stroke but addressing carer confidence with technology will promote the
chances of uptake.
WCNR-0032
BOARD NUMBER: 037
OTHER - PART 1
THE CHALLENGES OF EDUCATING STUDENT NURSES TO NEUROREHABILITATION
C. Farnan Kennedy1
1Thomas Jefferson University Hospital, Nursing/rehabilitation, Philadelphia, USA
Aims
THIS POSTER WILL DESCRIBE THE CHALLENGES FACED BY NURSING EDUCATORS TO
EXPOSE STUDENT NURSES TO NEUROREHABILITATION. CURRICULUMS ARE
EVOLVING SUCH THAT THIS TYPE OF KNOWLEDGE AND EXPOSURE IS CONSIDERED
SPECIALIZED.THIS POSTER WILL DESCRIBE BARRIERS BUT ALSO SOLUTIONS FOR
IMPROVEMENT.
Method
Educator feedback and students' curriculum barriers.
Results
Neuro rehabilitation pts and issues will be vital for the future
Conclusion
THere are barrriers for nursing students to learn neurorehabilitation with their patients. Despite
the expense ,time and testing barriers neuro rehabilitation offers an invaluable learning exposure.
WCNR-0297
BOARD NUMBER: 038
OTHER - PART 1
MODULATION OF THE CORTICOSPINAL EXCITABILITY IN THE ANKLE MUSCLE JUST
BEFORE POSTURAL PERTURBATION
K. Fujio1,2, H. Obata3, T. Kitamura2, N. Kawashima2, K. Nakazawa1
1University of Tokyo, Graduate School of Arts and Sciences, Tokyo, Japan
2Research Institute- National Rehabilitation Center for Persons with Disabilities,
Department of Rehabilitation for the Movement Functions, Tokorozawa, Japan
3Univercity of Tokyo, Graduate School of Arts and Science, Tokyo, Japan
Aims
The aim of this study was to clarify how the corticospinal excitability in the ankle muscles would
be modulated when subjects can anticipate the upcoming perturbations.
Method
Fifteen participants stood on the movable platform which could be translated anteriorly in
horizontal plane (6cm, 25 cm/sec). The electromyographic activities were recorded from the right
tibialis anterior (TA) muscle. Motor evoked potentials (MEPs) using single-pulse transcranial
magnetic stimulation were induced during quiet standing (Control) and 50ms before the
perturbations during conditions with and without an acoustic warning signal (No-cue / Cue).
To evaluate the input-output relation between the stimulus intensities and the size of the MEP,
the stimulus intensity was increased by 10 % steps of the motor threshold (MT) from 80% to
130% MT. All MEPs were normalized to the maximum M-wave.
Results
The results showed that the slope of the TA-MEP had a significant main effect of the conditions
(F14,2 = 11.3, p < 0.001). A post hoc test revealed that the slope of the TA-MEP in No-cue and
Cue conditions were significantly higher than that in Control condition (0.023±0.004 vs
0.042±0.007, p = 0.01, 0.023±0.004 vs 0.050±0.008, p = 0.01). No significant differences
between in the No-cue and the Cue conditions were observed (0.042±0.007 vs 0.050±0.008, p =
0.17).
Conclusion
Our results showed that the corticospinal excitability of the TA was facilitated when subjects could
predict perturbations, while information of their timing did not have an effect. Therefore, our
results suggest that the cortical contribution is higher not only when standing posture is unstable
but also when postural instability can be expected.
WCNR-0489
BOARD NUMBER: 039
OTHER - PART 1
INFLUENCE OF FEEDBACK AND DIRECTED ATTENTION ON CYCLING IN A VIRTUAL
ENVIRONMENT: HEALTHY OLDER ADULTS AND PEOPLE WITH PARKINSON’S DISEASE
R. Gallagher1, W.G. Werner1, H. Damodaran2, J.E. Deutsch3
1New York Institute of Technology, Physical Therapy, Old Westbury, USA
2Rutgers University, Rehabiliatation and Movement Sciences, Newark, USA
3Rutgers University, Rehabilitation and Movement Sciences, Newark, USA
Aims
In PD, an inability to utilize intrinsic feedback to correct and modify motor behavior results in
increased reliance on external feedback. In addition, abnormalities in sensorimotor processing
adversely affect motor performance, particularly with the presentation of simultaneous cues.
Focusing attention on a specific cue may alleviate this problem. Virtual environments (VE)
present complex multimodal sensory information to the user that may augment motor
performance in cycling VEs. Previously, we showed that visual and auditory cueing modulated
pedaling speed in a VE. Here we report on the responses of older adults and persons with PD to
feedback and directing attention to increase pedaling speed in a VE.
Method
Healthy older adults (n=13) and persons with PD (n=15, H&Y stage 2-3) 50-85 years and
cognitively intact (MoCA >/=24). Participants cycled on a stationary bicycle while interacting with
a VE under 4 conditions: auditory cueing, visual cueing, feedback, and directed attention. Data
were analyzed using separate RM factorial ANOVAs. Post-hoc analyses were conducted using
Bonferonni corrected paired t-tests
Results
Feedback resulted in between group differences (F=7.50, p=0.01). Older adults pedaled faster
compared to persons with PD (t=-2.44, p=0.01). Both groups significantly increased their cycling
speed in the feedback (F=71.38, p<.000), and directed attention (F=18.08, p<.00) conditions.
Conclusion
Embedding feedback and directing attention in a cycling VE can be used to promote short-term
changes in motor behavior for both older adults and persons with PD. These results suggest that
incorporating these techniques into a rehabilitation program would be a strategy to increase
exercise intensity.
WCNR-0396
BOARD NUMBER: 040
OTHER - PART 1
HOW TO DESIGN PRACTICE SCHEDULES IF SEVERAL TASKS HAVE TO BE LEARNED
SIMULTANEOUSLY? THE CONTEXTUAL INTERFERENCE EFFECT IN CHILDREN
J.V. Graser1, H.J. Van Hedel1
1Rehabilitation Centre for Children and Adolescents Affoltern am AlbisUniversity Children's Hospital Zurich, Paediatric Rehab Research Group, Affoltern am Albis,
Switzerland
Aims
When several motor tasks are practiced together they can functionally interfere with each other.
This contextual interference (CI) effect has been examined mainly in healthy adults and suggests
a benefit of high CI (tasks in random practice order) over low CI (blocked practice order). Since CI
has to be considered also in paediatric neurorehabilitation, we aimed to evaluate the evidence on
whether high or low CI should be preferred in healthy children and children with congenital or
acquired brain lesions. Therefore, we performed a systematic review with consecutive metaanalysis.
Method
A systematic search was conducted in 7 databases. Two researchers are independently scoring
each paper concerning the in- and exclusion criteria (e.g. controlled, peer reviewed, published
studies, field of motor learning). Overall effects of grouped studies (according to factors such as
similar training duration, tasks, population) were calculated in a meta-analysis (random effects
model).
Results
Preliminary results are based on the analyses from 1 researcher only. From the 502 hits, 25 full
text papers were included in the systematic review (figure 1).
Methodological quality ranged from low to moderate. In general, high CI did perform similar to low
CI. A first meta-analysis of studies examining the CI effect with volleyball tasks came to the same
conclusion (figure 2). Final and more extensive results will be presented at the WCNR 2016.
Conclusion
The preliminary systematic review and meta-analysis lead to no clear preference of either low or
high CI. High-quality research, especially in the field of paediatric neurorehabilitation, is needed to
generate sound knowledge about CI and about the ideal order of practice schedules to gain the
best therapeutic outcome.
WCNR-0197
BOARD NUMBER: 041
OTHER - PART 1
AFFORDABLE TECHNOLOGIES TO IMPROVE MOBILITY AND PHYSICAL ACTIVITY IN
REHABILITATION: PATIENT EXPERIENCES IN THE AMOUNT REHABILITATION TRIAL
C. Hamilton1, A. McCluskey1, L. Hassett2, M. Lovarini1
1The University of Sydney, Faculty of Health Sciences, Sydney, Australia
2The George Institute for Global Health- Sydney Medical School- The University of Sydneyand The University of Sydney, Faculty of Health Sciences, Sydney, Australia
Aims
To explore adult patients’ experiences of using affordable technology to improve mobility and
physical activity in rehabilitation.
Method
A qualitative study using a grounded theory approach within a multicentre randomised controlled
trial (n=300). The trial is investigating the effectiveness of using affordable technologies in
addition to usual care to improve mobility and physical activity for patients in aged care and
neurological rehabilitation. Technologies included commercially available videogames,
rehabilitation-specific devices and android/iOS applications (Nintendo Wii, Xbox Kinect, Fitbit,
Fysiogaming, Humac, Stepping Tiles, exercise iPad apps).
Seventeen inpatients in the experimental arm of the trial (11 male, 6 female; mean (SD) age 65
(24) years). Of these participants, 59% had mobility limitations from a neurological condition.
Participants used an average of five technologies during the 6-month intervention.
Two semi-structured interviews were conducted with each participant, one during their hospital
admission and another in the community following discharge. Interviews were transcribed
verbatim and data were analysed in parallel with data collection. Data were coded in two phases,
initial coding and focused coding to explore and understand technology use. Memo-writing and
constant comparison methods were utilised to guide the analysis.
Results
The use of technology in rehabilitation involved a process with a number of steps, with varying
levels and type of support needed by patients. The steps include: trialling and matching the
technology to each patient, minimising risks and optimising safety, training and education to
understand the purpose and functions of the technology, overcoming barriers and establishing
routines, providing the ‘just right’ level of challenge for benefit and feedback about performance or
dose of practice.
Conclusion
Supporting patients through each step appears to be important for ongoing and successful
technology use and therapeutic benefit during rehabilitation. Therapists need to identify the
support required by individuals, to help improve technology use and potentially improve mobility
and physical outcomes.
WCNR-0239
BOARD NUMBER: 042
OTHER - PART 1
AMOUNT (Activity and MObility UsiNg Technology) REHABILITATION TRIAL:
TECHNOLOGIES UTILISED IN THE FIRST SIX MONTHS OF RECRUITMENT
L. Hassett1,2, M. van den Berg3, S. Chagpar1, H. Weber3, S. Wong4, A. Rabie4, E. Lynch3,
K. Schurr5, A. McCluskey6, S.T. Smith7, B. Bongers8, R. Lindley9, M. Crotty3, C. Sherrington1
1George Institute for Global Health- The University of Sydney, Musculoskeletal division, Sydney,
Australia
2Faculty of Health Sciences- The University of Sydney, Discipline of Physiotherapy, Sydney,
Australia
3Repatriation General Hospital and Flinders University,
Department of Rehabilitation and Aged Care, Adelaide, Australia
4Liverpool Hospital- South Western Sydney Local Health District, Brain Injury Rehabilitation Unit,
Sydney, Australia
5Bankstown-Lidcombe Hospital- South Western Sydney Local Health District, Physiotherapy,
Sydney, Australia
6Faculty of Health Sciences- The University of Sydney, Discipline of Occupational Therapy,
Sydney, Australia
7University of the Sunshine Coast, Faculty of Arts and Business, Sunshine Coast, Australia
8University of Technology Sydney, School of Design, Sydney, Australia
9George Institute for Global Health- The University of Sydney,
Neurological & Mental Health division, Sydney, Australia
Aims
Which technologies were used in an inpatient setting during the first six months of the AMOUNT
rehabilitation trial (n=300)? Did participants perceive the technologies to be enjoyable and easy to
use?
Method
Design: Intervention process evaluation from a randomised controlled trial. Participants: Forty
participants, predominantly male (65%) with a mean (SD) age of 72 (17) years; 53% with mobility
limitations from neurological conditions. In the month prior to their hospitalisation, 48% of
participants had used a computer, 25% had used a tablet and 28% a Smartphone, and few had
used pedometers (3%) or gaming consoles (8%). Intervention: The intervention is additional to
standard care, and prescribed according to a protocol which matches games/exercises from eight
technologies to the participant’s current mobility limitations. The eight technologies are
commercially available devices and android/iOS applications (Nintendo Wii; Xbox kinect; Fitbit;
Runkeeper app) and rehabilitation-specific devices (Humac; Fysiogaming; Stepping Tiles;
exercise iPAD apps). Outcome Measures: Technology use data, Physical Activity Enjoyment
Scale (PACES; 18-126) and the System Usability Scale (SUS; 0-100) with higher scores
indicating more enjoyment and better usability.
Results
Seven of the eight included technologies were used (Runkeeper app was not used) with the
Humac as the technology introduced first for 50% of participants. A mean (SD) of 3 (1) different
technologies per participant were used with the Humac and Fitbit used most for participants
(73%), and the commercial gaming systems used least (Xbox kinect 18%; Nintendo Wii 20%). At
3 weeks, participants perceived using the technology as very enjoyable (mean (SD) PACES= 101
(17.3)) and they rated the usability as above average (mean (SD) SUS= 71(19)).
Conclusion
Thus far, rehabilitation-specific devices are preferred over commercially available devices in
inpatient rehabilitation. Tailored prescription of technologies appears to enable enjoyment and
ease of use of technology for people participating in inpatient rehabilitation despite previous
limited exposure.
WCNR-0243
BOARD NUMBER: 043
OTHER - PART 1
SENSOR ADEQUACY AND ARM MOVEMENT ENCODING FOR AUTOMATIC ASSESSMENT
OF MOTOR DEXTERITY FOR VIRTUAL REHABILITATION
P. Heyer1, L.R. Castrejón2, F. Orihuela-Espina1, J. Hernández-Franco3, L.E. Sucar1
1Instituto Nacional de Astrofísica - Óptica y Electrónica, Computer Sience, Puebla, Mexico
2Benemérita Universidad Autónoma de Puebla, Hospital Universitario, Puebla, Mexico
3Instituto Nacional de Neurología y Neurocirugía,
Instituto Nacional de Neurología y Neurocirugía, Mexico, Mexico
Aims
Home deployment of virtual rehabilitation [1] benefits from automatic assessment of motor
dexterity. We aim at automatically perform the Fugl-Meyer assessment (FMA). Here we question
the adequacy of different sensing and analytical configurations, and compare two analytical
approaches.
Method
Data was acquired from 6 patients with motor impairment while undergoing FMA. To complement
algorithm training, data from 15 healthy participants simulating three levels of dexterity on FuglMeyer exercises -5 times each- was further acquired . Motor response is sensed with (a) a pair of
inertial sensors, and (b) a Kinect sensor. The arm segments rotation is encoded using
quaternions. Automatic recognition of patient movements is attempted using (i) naive Bayes
classifier over PCA and (ii) random forest classifier over t-SNE [2]. Classifiers were validated with
10 cross-folding. For the patients, the scores assigned by the expert were used as ground truth.
Results
Figure 1 summarizes the area under the curve (AUC) of the ROC analysis for the recognition of
scores of individual exercises of the FMA for different configurations. Neither the sensing setup
(ANOVA: p=0.682), nor the classification strategy (MWU, 1-tailed: p=0.500) are currently making
a significant difference.
Figure 1. ROC-AUC (mean+\-std) of the recognition scores of individual exercises of the FMA for
healthy participants (left) and patients (right).
Conclusion
Recognition rates of individual exercises scores is high for healthy and moderate (but above from
random) for patients under the current analysis. Alternatives to boost current recognition include
finding an alternative representation and increasing data from patients.
References
[1] Sucar et al (2014) IEEE TNSRE, 22(3):634-642
[2] Maaten, L. & Hinton, G. (2008). JoMLR, 9:2579-2605
WCNR-0535
BOARD NUMBER: 044
OTHER - PART 1
COMBINING TRANSCRANIAL DIRECT CURRENT STIMULATION AND BRAIN
CONNECTOME: A NOVEL TECHNIQUE TO INCREASE THE SIZE AND LASTING OF
CORTICOSPINAL EXCITABILITY
S. Jaberzadeh1, M. Zoghi2, B. Vasegi3
1Monash University, Physiotherapy, Melbourne, Australia
2The University of Melbourne, Medicine, Melbourne, Australia
3Monash University, Physioltherapy, Melbourne, Australia
Aims
Transcranial direct current stimulation (tDCS) is a technique with therapeutic potential to
modulate corticospinal excitability for different therapeutic purposes. New evidences indicate that
functional connectivities exist between different cortical sites of the brain such as primary motor
cortex (M1) dorsolateral prefrontal cortex (DLPFC), primary sensory cortex (S1) and primary
visual cortex (V1). Therefore the main aim of this study is to compare the effects of conventional
single site anodal (a)-tDCS of M1, with concurrent dual site stimulation of these functionally
connected sites on the size and lasting of M1 corticospinal excitability. The secondary aim is to
investigate the mechanisms behind the induced changes.
Method
Twelve healthy, right-handed volunteers received a-tDCS (0.3 mA, 20 min) under the following
conditions: 1. Conventional a-tDCS of M1, concurrent a-tDCS of, 2. M1-DLPFC, 3. M1-S1, 4. M1V1, and 5. sham a-tDCS. The corticospinal excitability of first dorsal interosseous muscle was
assessed by single-pulsed transcranial magnetic stimulation (TMS) before, immediately, 30 min,
60 min and 24 hours after completion of the interventions. Short-interval intracortical inhibition
(SICI) and intracortical facilitation (ICF) were also assessed, using TMS paired-pulse paradigm.
Results
Compared to conventional single channel a-tDCS of M1, the new technique induced larger CSE.
The level of M1 CSE changes in M1-DLPFC stimulation was significantly higher than other
conditions following a-tDCS of M1-DLPFC compared to other concurrent a-tDCS conditions (P<
0.05), which lasted at least for 24 hours. Paired pulsed TMS assessments revealed that the
induced changes were mediated by decrease in SICI and increase in ICF.
Conclusion
The novel technique could be used as a safe and effective neuromodulatory technique to
significantly increase the induced CSE and also prolong the lasting of these effects up to 24
hours. This could be used as an adds-on technique to prime the effects of other therapeutic
techniques.
WCNR-0120
BOARD NUMBER: 045
OTHER - PART 1
QUALITY OF MOTOR IMAGERY AND PRIMARY MOTOR CORTEX CONNECTIVITY ARE
ASSOCIATED WITH THE EMOTIONAL CONTEXT OF THE IMAGERY
M. Kafri1, S. Stringham2, J. Deutsch2
2Rutgers, Department of Rehabilitation and Movement Sciences, Newark- NJ, USA
Aims
Motor imagery (MI) is a commonly used technique in neurorehabilitation. Gains in motor
performance after MI practice might be influenced by the quality of the imagery. The aim of this
study was to test the association between the emotional context (valence and arousal levels) in
which MI is performed and the quality (vividness) of the imagery, and to explore the associated
brain connectivity.
Method
Twelve healthy individuals participated in a single session which included a computerized test of
MI. This test was consisted of imagery scripts divided into 3 conditions: MI of walking, MI of
walking integrated with positive emotion cues (e.g. "happily walk"), and MI of walking integrated
with positive emotion cues and subject-centered goal (e.g. walking to buy a present to a love
one). After performing each imagery condition the participants were asked to rate their level of
emotion and arousal, and rate the vividness of the image of walking. A sub-set of six participants
underwent a functional MRI evaluation using the same MI protocol. Psycho-physiologic analysis
was done to detect interactions between the emotional content and the connectivity of the primary
motor cortex.
Results
The emotional and arousal levels were significantly higher for MI that involved emotional cues
and was subject-centered (p<0.001) when compared to standard MI. Vividness of imagery was
significantly associated with the level of emotion (X2=26.85, p<0.001), and with the level of
arousal (X2=33.27, p<0.001). There was a significant interaction effect between emotional context
and the connectivity of the primary motor cortex with the dorso-lateral prefrontal cortex (DLPFC).
Conclusion
The quality of MI is associated with its emotional context, which can be enhanced by integration
of emotional cues and subject-centered goals. This might be mediated by increased connectivity
between the primary motor cortex and the DLPFC, area that is involved in attention and working
memory.
WCNR-0049
BOARD NUMBER: 046
OTHER - PART 1
INVOLVING END-USERS IN THE DESIGN OF A SIT-TO-STAND TRAINING SYSTEM FOR
STROKE REHABILITATION
A. Kerr1, A. Thomson2, S. Ho1
2University of Strathclyde, Design- Manufacture and Engineering Management, Glasgow,
United Kingdom
Aims
Engaging users in the process of designing new rehabilitation technology is crucial to increasing
the adoption of these much needed technologies through greater understanding of user
preferences as well as individual and institutional barriers. The aim of this study was to acquire
user (patients, carers, therapists and managers) input in the design of a new system for training
the sit-to-stand (STS) movement, a key functional task for independent living often affected by
neurological conditions such as stroke.
Method
A user centered approach was undertaken. Initially user needs and design specifications were
obtained through observation of stroke rehabilitation sessions (n=6) and individual interviews
(n=3) with therapy staff. These data contributed to the design of two questionnaires; 1) healthcare
professionals (n=27) and 2) stroke survivors (n=6) as well as generating initial concepts for the
STS trainer. Finally, evaluation of the generated concepts was carried out with focus groups of a
different set of stakeholders (stroke survivors and therapists).
Results
Data from the interviews, observations, questionnaires and focus groups were pooled and
analysed using a thematic analysis approach. Along with general concerns around safety, easeof-use and clinical evidence, four key features for the design of a sit-to-stand trainer were
identified: 1) performance feedback, 2) friendliness of the user interface, 3) mechanical supports
and 4) visual appearance of the system.
Conclusion
These findings are an important contribution to understanding the user requirements of
rehabilitation technologies and a sit-to-stand trainer in particular. They will be incorporated into
the production of a prototype trainer for further user evaluation.
WCNR-0059
BOARD NUMBER: 047
OTHER - PART 1
ADAPTATION TO WALKING ON A SPLIT BELT TREADMILL IN HEALTHY ADULTS
A. Kerr1, A. Booth2, C. Childs1, P. Rowe1
2Motekforcelink, Research, Amsterdam, Netherlands
Aims
Recovering functional walking is a priority for many rehabilitation programmes. The use of split
belt (SB) treadmills has been suggested as a rehabilitation tool for addressing gait asymmetry
resulting from stroke induced hemiplegia. The aims of this study were to test an experimental
protocol for split belt training in healthy adults, identify common adaptation strategies and assess
the influence of the length of exposure.
Method
Healthy adults (n=10), aged 23 years (SD 0.7) and a BMI of 24.8 (2.5) experienced two randomly
allocated blocks of SB walking (5 and 10 minutes) using the Computer Assisted Rehabilitation
Environment (Motekforcelink) while an optoelectronic system (Vicon) tracked the 3D trajectories
of body segments. Split belt sessions were separated by a period (30 minutes) of rest and normal
walking. Belt speeds were calculated from preferred treadmill walking speed, the slower belt
being adjusted to 50% of this preferred speed.
Results
Initially SB walking created step length asymmetry (left/right step length) which persisted for 13
strides, on average. To achieve this correction a distinct strategy was observed in some
participants; foot contact on the faster side was delayed at the end of swing by momentarily
holding the foot’s vertical position, a strategy we termed “heel hang”. On return to normal walking
conditions this gait adaptation persisted, causing a short period of step length asymmetry. Motor
strategies learnt in the first block were applied within three strides during the second block.
Conclusion
The results show that young healthy adults can quickly modulate their walking to accommodate
right/left differences in treadmill belt speed and that, once learned can be applied within 3 strides.
The learned adaption of “heel hang” may be a useful strategy to correct gait asymmetry.
WCNR-0133
BOARD NUMBER: 048
OTHER - PART 1
OPPORTUNITIES OF MARKERLESS MOTION DETECTION SYSTEMS FOR USE IN
NEUROLOGICAL REHABILITATION: A QUALITATIVE STUDY ON PATIENT AND
THERAPIST PERSPECTIVE
E. Knippenberg1, A. Spooren1
1PXL University College, Healthcare, Hasselt, Belgium
Aims
Markerless motion detection systems such as Microsoft Kinect® are promising systems in clientcentred task-oriented training in central nervous disorders, but therapists and patients have
specific expectations and requirements for use in neurological rehabilitation. Therefore the aim of
this study is to assess expectations and requirements of therapists and patients towards the use
of Microsoft Kinect® in neurological rehabilitation.
Method
A qualitative design was used in which seven focus groups were performed with patients with
neurological disorders (n = 15) and physio- and occupational therapists (n = 22) in four
rehabilitation centres. The grounded theory was used to analyse the data.
Results
Two main themes were identified: knowledge-use-experience and expectations and
requirements. It was found that knowledge, use and experience cannot be separated as they are
connected. Therefore, to use Microsoft Kinect® in rehabilitation, people need knowledge and
experience with the system. In order to be useful in rehabilitation, Microsoft Kinect® system
needs to be easy to use independently, easy to set up, low cost and small. The system should
also provide patients and therapists with feedback of their performance and/or results.
Conclusion
As knowledge and experience with Microsoft Kinect® are very important before and during first
use, it seems important to inform therapists and patients about the advantages of Microsoft
Kinect® as opposed to robotic devices or marker-based motion detection systems. By integrating
the expectations and requirements in future research, opportunities are created for using
Microsoft Kinect® into a new client-centred task-oriented system in upper limb neurological
rehabilitation.
WCNR-0354
BOARD NUMBER: 049
OTHER - PART 1
MOTION DETECTION SYSTEMS IN NEUROLOGICAL REHABILITATION: A SYSTEMATIC
REVIEW
E. Knippenberg1, J. Verbrugghe2, I. Lamers2, A. Spooren1
1PXL University College, Healthcare, Hasselt, Belgium
2Hasselt University, Rehabilitation Research Center, Diepenbeek, Belgium
Aims
Motion detection systems are promising in neurological rehabilitation, but knowledge and
evidence of training is scarce. The present review aims to investigate which motion detection
systems are used in training in neurological rehabilitation, what their content and outcome of
training is.
Method
A computerized systematic literature review was conducted in four databases (PubMed, Cinahl,
Cochrane Database and IEEE). The following MeSH terms and key words were used: Motion,
Movement, Detection, Capture, Kinect, Rehabilitation, Nervous System Diseases, Multiple
Sclerosis, Stroke, Spinal Cord. The Van Tulder’s Quality assessment was used to score the
methodological quality of the selected studies. The descriptive assessment is reported by patient
group, training parameters and ICF level of training and outcome.
Results
Nineteen studies were selected (mean Van Tulder score = 7.84 ± 4.00), six of which are RCT and
one CCT. Fourteen studies included persons with stroke. Microsoft Kinect was used in thirteen
studies. Twelve out of nineteen studies trained the upper limb, four studies the upper limb and
three the whole body. Intervention and outcome measures focused mainly on ICF activity level.
The combination of visual and auditory feedback was most commonly used. None of the studies
reported an individualized training program. Most prevailing combination of training parameters is
four weeks of training, three training sessions per week, training for one hour per day. All but one
study reported improvement on one or more ICF levels.
Conclusion
Motion detection systems are promising tools in neurological rehabilitation to increase intensity of
treatment and may assist improvement on ICF level of function, activity and/or participation.
However, more research is needed to explore the use of motion detection systems in clinical
practice by performing larger multicenter RCTs with long-term follow-up using an individualized
task-oriented approach.
WCNR-0140
BOARD NUMBER: 050
OTHER - PART 1
MONITORING EVERYDAY LIFE MOTOR ACTIVITY IN CHILDREN WITH NEUROMOTOR
DISORDERS
R. Labruyère1,2, J. Fritschi1,3, H.J. van Hedel2
1University Children's Hospital Zurich, Rehabilitation Center for Children and Adolescents,
Affoltern am Albis, Switzerland
2University Children's Hospital Zurich, Children's Research Center, Zurich, Switzerland
3ETH Zurich, Department of Health Sciences and Technology, Zurich, Switzerland
Aims
Upper extremity function is crucial for everyday life skills and independence. Accordingly, children
with neurological impairment affecting upper extremity function are at risk struggling with activities
of daily living. However, before we can effectively target these restrictions, they should be
objectified first. Therefore, the aim of this study was to investigate upper extremity activity profiles
of children with neurological deficits outside of therapies during their rehabilitation stay in our
center.
Method
Eighteen patients with neuromotor disorders (10 boys, 8 girls, aged 12.7±3.7y) were each
equipped with a miniature camera at the chest and 4 inertial measurement units (IMU, consisting
of 3D accelerometers and gyroscopes, 1 at each wrist, 1 at the sternum and 1 at the dominant
foot/at the wheel of the wheelchair). The protocol comprised the Melbourne Assessment 2 (MA2)
to assess the quality of upper extremity movements, and a subsequent 4-hour recording of
unrestricted leisure time. IMU-derived activity counts and MA2-scores were compared and a
regression analysis was performed. Furthermore, we compared algorithm-derived activity
classifications with those scored from the video.
Results
Figure 1 shows the average distribution of activity counts of the dominant and non-dominant arm
during the 4-hour measurement. IMU-data of the MA2 together with the MA2-score explained
around 60% of the activity during the 4-hour measurement. Algorithms performed well in
detecting walking (true positive classification of 79%) and bimanual activities (77%), but poor for
unimanual activities (5% for the right and 12% for the left arm).
Conclusion
Accelerometers can provide information about the intensity of arm movements in everyday life.
By assessing the MA2 in combination with IMUs, a prediction about upper extremity movements
in everyday life can be made. Algorithms were well able to detect walking and bimanual activities,
but need to be improved for unimanual activities.
WCNR-0329
BOARD NUMBER: 051
OTHER - PART 1
DEVELOPMENT OF AN ITEM LIST TO ASSESS BILATERAL UPPER EXTREMITY
FUNCTION OF STROKE PATIENTS WITH HEMIPLEGIA
J.H. Lee1, Y.J. Lee1, Y. Kim1, M.Y. Kim1, J.H. Park1, H.Y. Park1
1Yonsei University, Occupational Therapy, Wonju, Republic of Korea
Aims
The purpose of the study is to develop items for a bilateral upper extremity assessment for stroke
survivors.
Method
The current study to generate potential item content for the Assessment of Bilateral Upper
Extremity Function during activities of daily living consisted of five Phases. In Phase I, we
conducted a literature search on upper extremity function assessment tools. For Phase II, experts
in upper extremity function were asked to nominate bilateral items relevant to stroke survivors. In
Phase III we administered a questionnaire to 20 stroke survivors. For Phase IV, the item list was
refined, duplicate items were deleted, and similar items were combined. For Phase V, the refined
item list was sent to an expert panel and patients for a final evaluation.
Results
In Phase I, the 68 studies addressed 46 assessment tools, with a total of 854 items. Of the 854
items, items not related to upper extremity function were deleted yielding199 items. In Phase II,
experts generated 24 new items, and in Phase III, 60 bilateral upper extremity items were
generated by stroke survivors. In phase IV, the 259 items were reduced to a total of 70 items for
expert rater review. In phase V, 21 items with CVI</ = 0.5 were dropped and of the remaining 49
items, 12 items with average scores for expansion<3, deletion >2 were dropped. This resulted in
37 items remaining on the list. Of the 37 items, items that were difficult to perform on a table, did
not consist of permanent materials, or applied only to specific people were eliminated. Thus, the
content for the Assessment of Bilateral Upper Extremity Function consisted of 25 items.
Conclusion
The items generated for a bilateral upper extremity function assessment tool will greatly assist
clinicians who assess and treat stroke survivors.
WCNR-0180
BOARD NUMBER: 052
OTHER - PART 1
VIBROTACTILE FEEDBACK IMPROVES GAIT SPEED IN LOWER EXTREMITY AMPUTEES
J. Lynskey1, E. Molzen2, S. Chayrez1, K. Christakos1, D. Cohee1, D. Cortez1, W. Dowling1,
K. Lucas1, E. Samel1, M. Winters1, C. Bay3, B. Glaister4
1A.T. Still University, Physical Therapy, Mesa, USA
2A.T. Still University, Research Support, Mesa, USA
3A.T. Still University, Interdisciplinary Health Sciences, Mesa, USA
4Cadence Biomedical, Research and Development, Seattle, USA
Aims
Impaired locomotor function and falls are common following lower extremity amputation. A major
barrier to restoring locomotor function is the lack of sensory feedback from the prosthetic foot.
The objective of this pilot study was to investigate if the incorporation of a novel vibrotactile
feedback system (Cadence Biomedical, Seattle WA, USA) into a comprehensive physical therapy
program would improve locomotor function in lower extremity amputees.
Method
The current study is a randomized controlled single blind trial. All subjects received sixteen 90
minute physical therapy sessions over 8 weeks. Subjects in the experimental group received
vibrotactile feedback proximal to their amputation during therapy, while control subjects did not.
The vibrotactile feedback was delivered in response to pressure sensors located in the prosthetic
shoe corresponding to the great toe, heel, and metatarsal heads. Locomotor function was
assessed using the 10 meter walk test, 6 minute walk test, timed up and go test (TUG), TUGCognitive (TUG-Cog), and amputee mobility predictor (AMPPRO). Data was collected at Weeks
0, 4, 8, 12, and 16 to assess both treatment effects and carryover.
Results
A total of 7 participants have been enrolled in the study to date (3 experimental) Preliminary data
analysis indicates that participants in the experimental group demonstrated greater improvements
in fast walking speed as measured by the 10 meter walk test compared to control group (average
improvement, .25 m/s versus .10 m/s at 8 weeks). In addition, these differences were maintained
during the follow up period (average improvement, .28 m/s versus .11 m/s at 16 weeks).
Improvements were also observed in the 6 minute walk test, TUG, TUG-Cog and AMPPRO.
However, these improvements were similar between groups.
Conclusion
The addition of vibrotactile feedback to a comprehensive physical therapy program appears to
enhance fast walking speed improvements in individuals with lower extremity amputation.
WCNR-0028
BOARD NUMBER: 053
OTHER - PART 1
OPTIMIZING ELECTRODE MONTAGES TO IMPROVE ACCURACY OF TRANSCRANIAL
DIRECT CURRENT STIMULATION
S. Madhavan1
1University at Illinois at Chicago, Physical Therapy, Chicago, USA
Aims
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that is
being increasingly used to enhance neurorehabilitation.1,2 The conventional placement of the
electrodes for motor cortex stimulation is the stimulating electrode on the region of interest (i.e.)
the primary motor cortex (M1), and reference electrode on the contralateral fronto-orbital region.
There have been recent reports about the increased variability and low reliability of the effects of
tDCS.3 Modelling studies have suggested examining other electrode montages that may enhance
effectiveness of tDCS.4 Hence the purpose of this study is to compare two different electrode
montages to determine which montage would demonstrate the greatest effectiveness of tDCS.
Method
20 healthy participants attended two sessions of testing where 1 mA of anodal (facilitatory) direct
current was delivered for 15 minutes during each session. During one session, the conventional
electrode placement was implemented. During the second session, the stimulating electrode was
placed 5 centimeters posterior and the reference electrode 5 centimeters anterior to the hotspot
of the tibialis anterior (TA) muscle. For each session, pre and post corticomotor excitability
measures using transcranial magnetic stimulation measures was obtained.
Results
Preliminary analyses of data demonstrated considerable inter individual differences in the
effectiveness of tDCS between the traditional and new montages. Some individuals demonstrated
the expected upregulation with the conventional montage while others did not. Those who did not
respond to the conventional montage performed better with the new montage.
Conclusion
Our preliminary results suggest that the effectiveness of tDCS, as influenced by electrode
placement, is variable. It is possible that electrode personalization may help overcome interindividual differences.Future studies will confirm these findings in a larger sample.This study
makes a significant contribution towards adopting optimal testing parameters to achieve decrease
inter-individual variability of tDCS.
WCNR-0498
BOARD NUMBER: 054
OTHER - PART 1
A NOVEL GESTURE RECOGNITION SYSTEM FOR ENVIRONMENTAL CONTROLS FOR
INDIVIDUALS WITH SPINAL CORD INJURY
S. Mccombe Waller1, A. Nelson2, R. Robucci2, N. Banerjee2
1University of Maryland- School of Medicine, Physical Therapy and Rehabilitation Science,
Baltimore, USA
2University of Maryland Baltimore County,
Department of Computer Science and Electrical Engineering, Baltimore, USA
Aims
The objective of this pilot project was to develop a touchless capacitive sensor array activated by
simple arm gestures and to test the feasibility of its use to remotely control appliances in the
environment by individuals with spinal cord injury.
Method
The project’s two phases included 1) sensor development and 2) feasibility testing with endusers. Subjects included 5 males mean age 33 years with cervical spinal cord injury (ASIA C)
who utilized wheelchairs for mobility. After sensor development, feasibility testing included, 1)
Training Phase in which subjects practiced gestures, based on the alphabet, and sensor
activation with visual feedback, 2) Home Control phase in which subjects activated devices
connected to a SmartHome system, and 3) Recall phase in which subject retention of learned
gestures was assessed. During all phases both system and subject accuracy was evaluated.
Subjects completed a questionnaire to capture feedback on their sensor use experience.
Results
All subjects performed the gestures with an accuracy rate averaging 92% across 5 gestures in a
single session of training with 98% recall. System accuracy and patient accuracy during the
Home Control phase was over 95% for all subjects. Subjects reported use of the “alphabet
gestures” were easy to remember, perform and could be reasonably associated with the
environmental device (C for computer, L for light). The sensory array was easily adapted to
varied motor abilities of the 5 subjects without cost to system accuracy. All subject found the
flexible sensor array easy to use from their wheelchair.
Conclusion
This collaborative project led to the development of a low cost touchless sensor system, easily
used by individuals with cervical spinal cord injury to remotely control appliances in the
environment. Collaborative teams including input from the end users can lead to meaningful
device development for use in rehabilitation.
WCNR-0358
BOARD NUMBER: 055
OTHER - PART 1
DISKO - AN INTERACTIVE DISTANCE SOLUTION FOR STROKE REHABILITATION IN THE
HOME SETTING BASED ON MODERN INFORMATION AND COMMUNICATION
TECHNOLOGY
S. Palmcrantz1, J. Plantin1, A. Wall1, M. Sjölinder2, P. Hansson2, J. Borg1, D.K. Sommerfeld3,
I.L. Boman1
1Karolinska Institutet, Clinical Sciences- Danderyd Hospital, Stockholm, Sweden
2SICS, Swedish ICT, Stockholm, Sweden
3Karolinska Institutet, Neurobiology- Care Science and Society, Stockholm, Sweden
Aims
To enhance recovery after stroke, rehabilitation needs to start early and be followed by
continuous and recurrent long-term interventions to sustain regained functioning and
compensation strategies. Beneficial effects of using virtual reality have been reported. However,
there is a need for further development of virtual reality tools that meet evidence based
requirements for stroke rehabilitation.
Method
A prototype based on the motion sensing Kinect sensor was developed using a participatory
design. First, needs and requirements from end-users were identified in workshops. In a following
iterative development testing of technology, a prototype and the outline of corresponding
evidence based exercises were developed by technicians, in collaboration with end users
(participants with stroke and therapists). This tool (DISKO-tool) was then piloted in the home
setting at different stages after stroke (n=15 participants with stroke). The pilot was followed by
further development.
Results
The DISKO-tool was found to be safe and feasible by participants with stroke and therapists.
Needs for further technical development to improve design and functionality were identified and
related to the computer based training program, the component for video communication as well
as to the interface for planning and monitoring the training.
Conclusion
A virtual reality tool was developed that can be used by the patient in the home setting to
intensify training, prevent gaps in the provision of rehabilitation interventions and that enables
monitoring of training as well as video communication with a therapist. Further development of
the tool is ongoing and an effect study will start in 2016.
WCNR-0222
BOARD NUMBER: 056
OTHER - PART 1
AGE-RELATED DIFFERENCES IN A MULTI-DIMENSIONAL ASEESSMENT OF
PERFORMANCE OF A COMPLEX DAILY ACTIVITIY IN A REAL VERSUS SIMULATED
SHOPPING MALL
K. Rachel1,2, I. Baum-Cohen2,3, P. Weiss2, G. Zeilig4,5, M. Bondi4, I. Mintz6, M. Kafri7
1Sheba Medical Center Tel hashomer, Center of Advanced Technologies in Rehabilitation,
Ramat Gan, Israel
3Sheba Medical Center Tel hashomer, Occupational Therapy, Ramat Gan, Israel
4Sheba Medical Center Tel hashomer, Neurological Rehabilitation, Ramat Gan, Israel
5Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
6Sheba Medical Center Tel hashomer, Physical Therapy, Ramat Gan, Israel
Aims
To compare performance of a real and simulated complex daily activity (shopping) of older and
young adults, from physiological, motor and cognitive aspects and to examine correlations
between simulated and real performances.
Method
Fifteen adults with a mean±SD age of 25.80 ±4.25 years and 16 community dwelling adults aged
72.12±5.58 years were tested in a real and in a simulated small shopping malls. The simulation
was created and run in the CAREN™ (Motek Medical B.V.) Integrated Reality System and
projected onto a 52" wall-mounted monitor. Participants performed the Multiple Errands Test
(MET; lower scores indicate better performance) in the real mall and the Virtual MET (VMET) in
the simulation while walking on a self-paced treadmill and navigating with a joystick. Gait
parameters were recorded with the APDM system and Metabolic Equivalents were measured by
K4 system.
Results
The elderly group’s score of the MET (4.56±2.12) was significantly worse than the younger group
(2.33±1.75, U = 51.00, p <0.01). They also performed the VMET (5.00±2.94) significantly worse
than the younger group (2.64±2.34, U=45.50, p<0.03). No significant differences were found in
gait speed between the groups in both settings. For the elderly group, strong correlations were
found between the MET and VMET performance scores (rs = 0.88, P <0.01) and execution times
(rs = 0.65, P <0.02). The Metabolic Equivalents indicated low energy cost for the activity with no
differences between the groups or settings.
Conclusion
These results highlight the differences in pattern of performance of a daily task between young
and older adults. In addition, the similarities of performance of real and virtual complex tasks in
the elderly provide support for the use of realistic virtual environments that simulate the
challenges experienced by people when engaging in complex functional tasks, for assessment
and treatment of age-related functional decline.
WCNR-0559
BOARD NUMBER: 057
OTHER - PART 1
rTMS AS POSSIBLE ADD-ON APPROACH FOR DYSPHAGIA REHABILITATION
FOLLOWING BRAINSTEM INFARCTION
P. Rossi1, I. Antonini1, E. Donati1, M. Moranzoni1, G. Ruggieri1, G. Mazzucchelli1
1Clinica Hildebrand Centro Riabilitazione Brissago, Neurorehabilitation, Brissago, Switzerland
Aims
Here we describe clinical efficacy of rTMS combined with a multidisciplinary rehabilitative
approach in one patient with complete dysphagia following a brainstem infarction.
Method
A 61YO male patient arrived in our clinic 15 days after a left dorsolateral medullary ischemic
lesion following vertebral artery dissection. This lesion determined complete dysphagia and
severe central respiratory distress requiring tracheostomy and PEG. Basal evaluation showed
complete absence of pharyngeal activation and swallowing reflex both with voluntary activation
and after Daniel’s test. A fibroscopy (FEES) confirmed these clinical evidences with presence of
tracheal inhalation. We began a multidisciplinary rehabilitative approach leading to a clinical
improvement of respiratory function but without any positive functional effect on dysphagia. Two
months after hospitalization, a Rest Motor Threshold (RMT) evaluation demonstrated an
important bilateral inhibition of cortical excitability prevalent on left cerebral hemisphere. After
receiving patient’s consent, we began an add-on treatment with repetitive Transcranial Magnetic
Stimulation (rTMS) on cortical areas deputy to motor control of swallowing on for both emisphere.
He underwent to a course of 5 consecutive days of rTMS at 110% of RMT repeated after one
week.
Results
The post-treatment clinical evaluation showed presence of swallowing reflex both with voluntary
activation and after thickened water swallowing. FEES showed presence of thickened water in left
pyriform sinuses cleared with voluntary swallowing and without any sign of inhalation. Moreover
neurophysiological data showed an improvement in cortical exicitability of about 16% of RMT on
both cerebral emispheres. As side effect patient reported a subjective masseters stiffness.
Conclusion
This evidence is in accordance with already described results in literature even if these works
didn’t include multidisciplinary rehabilitative approach of swallowing failure. Our clinical report
suggest that combination of rTMS and rehabilitation should be further tested to determine if it
could be considered as an alternative gold-standard treatment in dysphagia following brainstem
infarction.
WCNR-0093
BOARD NUMBER: 058
OTHER - PART 1
COMBINATION OF rTMS AND NEUROCOGNITIVE PHYSIOTHERAPEUTICAL APPROACH
DETERMINES CHANGES IN CORTICAL PLASTICITY IN CHRONIC STROKES: EVIDENCE
FROM CLINICAL CASES
P. Rossi1, A. Califfi1, G. Ruggieri1, D. Dalla Libera1, B. Albertoni1, R. Arangio1, F.M. Conti1
1Clinica Hildebrand Centro Riabilitazione Brissago, Neurorehabilitation, Brissago, Switzerland
Aims
To describe neurophysiological changes associated with clinical and functional improvements in
two patients with motor deficits following chronic strokes. Both underwent an intensive course of
Neuro-Cognitive Reahabilitation (NCR) and repetitive Transcranial Magnetic Stimulation (rTMS).
Method
Patient 1: 41YO male subject with ischemic stroke in left capsulo-lenticular region. Complete
motor deficit of the right upper limb associated with severe spasticity (Ashworth 3) on elbow, wrist
and finger flexors. Cognitive impairment was characterized by a neglect of upper limb, attentional,
mnestic and executive deficits. Mapping of motor cortex revealed a great inter and intrahemispheric imbalance, enhanced neuronal excitability of right hand motor-cortex which
corresponded with an inhibited activity in the left side.
Patient 2: 52YO female patient with ischemic lesion in right bulbar pyramid, with consequential
motor impairment in left lower limb characterized by spastic functional irradiation during walking,
principally evident on the foot. Motor cortex mapping showed an important enhancement of
excitability in the right hemisphere with a correspondent inhibition on the left side. The patient
presented a sensory-motor neglect of the lower limb which was an unexpected feature.
Both patients underwent an intensive course of NCR combined with a rTMS course with
excitatory cortical stimulation on the inhibited motor cortex (15 rTMS sessions with 400 pulses at
10Hz each).
Results
Both patients improved in terms of voluntary motor activity and reduction of spastic irradiation.
Somato-sensory and spatial neglect was almost resolved after treatment. These clinical findings
correspond to significant changes in brain mapping with a better inter-hemispheric balance of
cortical excitability.
Conclusion
Our data indicates that NCR combined with rTMS induces changes in cortical activity resulting
into a better integration between sensorial afferences and voluntary motor activity which lead to a
clinical evidence of functional improvement.
WCNR-0319
BOARD NUMBER: 059
OTHER - PART 1
EFFECT ON ACTIVITY AND PARTICIPATION IN A CHILD WITH CEREBRAL PALSY USING
EEG NEUROFEEDBACK &THE SYNPHNE PROTOCOL IN SUCCESSION
D. Sadana1, J. Rajeswaran1, A. Bannerjee2, R. Kumar2, S. Banerji3
1National Institute of Mental Health and Neurosciences, Clinical Psychology, Bangalore, India
2Dharma Foundation, Rehabilitation, New Delhi, India
3Synphne PTE LTD, Biomedical Engineering, Singapore, Singapore
Aims
Cerebral Palsy (CP) affects body movement, muscle control, coordination, tone, reflex, posture
and balance and is a leading cause of physical disability. The overwhelming physical
manifestations of CP often conceal the associated cognitive impairments. In the absence of an
established intervention program, EEG Neurofeedback Training (NFT) with its emphasis on
regulation of brain wave activity was combined with the SynPhNe protocol to improve motor
control aimed at enhancing activity and participation.
Method
A single case study design was adopted. MasterI.J., 6 year old male, born of a full term cesarean
delivery with neonatal jaundice had normal development till 8 months of age but could not attain
sitting milestone. An MRI revealed bilateral focal abnormalities in the thalamus and internal
capsules while IQ assessment revealed a score of 86.The child was unable to write or grasp
objects with dominant right hand. 20 sessions of NFT (alpha -theta protocol) was followed by 18
sessions of SynPhNe training (mirror image video instruction combined with brain-muscle
biofeedback). Two codes from the activity and participation domain of the International
Classification of Functioning, Nine Hole Peg Test (NHPT) and muscle power were assessed
before and after intervention, along with psychological assessment tools.
Results
Improvements were noted in attention for a task, spontaneous expression of needs and emotions,
self-awareness and social skills.The child had improved performance in writing, hand use, muscle
power and NHPT.
Conclusion
NFT and the SynPhNe protocol is a promising combination to help CP children gain improved
activity and participation.
WCNR-0389
BOARD NUMBER: 060
OTHER - PART 1
USING THE THERA TRAINER BALO 524 IN THE REHABILITATION OF CHILDREN WITH
CEREBRAL PALSY
Y. SANCHEZ1
1hospital Julio Diaz Gonzalez. La Habana. Cuba, docencia, La Habana, Cuba
Aims
To evaluate the therapeutic efficacy of Balo Trainer Thera in the balance of cerebral palsy
patients treated at the "Julio Díaz" Hospital
Method
An experimental, longitudinal, prospective study was conducted explanatory applied during the
period December 2014 to September 2015. The universe was composed of all patients admitted
to the pediatric rehabilitation diagnosed with Cerebral Palsy. The sample consisted of 15 patients,
aged between 10 and 18 years old, classified in levels I, II, III classification system gross engine
function, which were distributed in a study group and a control group using the random method
simple. The rehabilitation program was used as the protocol of the service for the control group
and patients in the study group were added the training program thera Balo trainer. Gross Motor
function scales were applied, and Ashworth spasticity in addition to static balance the Cobs
platform assessed at the beginning and end.
Results
100% of the subjects showed changes in some of the measured parameters, variables most
affected were the load and symmetry index which improved by 15% and 20% respectively. He
predominated for females groups with 62% and the age group of 10-12 years with 38% overall,
coordination and balance of the study group by 15% compared to the control was improved.
Conclusion
The high sensitivity of Thera trainer balo 524 in the diagnosis and treatment of balance of children
with cerebral palsy in training them within a comprehensive rehabilitation program was
demonstrated.
WCNR-0506
BOARD NUMBER: 061
OTHER - PART 1
REHABILITATION BALANCE PATIENTS WITH HEMIPLEGIA USING BALO TRAINER 524
THERA
Y. SANCHEZ1
1, La Habana, Cuba
Aims
To evaluate the therapeutic efficacy of Balo Trainer Thera in the rehabilitation of patients with
hemiplegia balance seen at the "Julio Díaz" Hospital.
Method
An experimental, longitudinal, prospective study was conducted explanatory applied during the
period July 2014 to June 2015. The universe was composed of all patients admitted to the Brain
Injury hemiplegia diagnosed with vascular cause. The sample consisted of 25 patients, aged
between 40 and 70 years of age, who were divided into a study group and a control group using
simple random method. The rehabilitation program was used as the protocol of the service for the
control group and patients in the study group were added the training program thera Balo trainer.
Barthel scales and Ashworth spasticity in addition to static balance the Cobs platform assessed at
the beginning and end were applied.
Results
100% of the subjects showed changes in some of the measured parameters, variables most
affected were the load and symmetry index which improved by 12% and 18% respectively. He
predominated for females groups with 52% and the age group of 50-60 years with a 38% overall,
coordination and balance of the study group by 15% compared to the control was improved.
Conclusion
The high sensitivity of Thera trainer balo 524 in the diagnosis and treatment of patients with
hemiplegia balance and training them in a comprehensive rehabilitation program was
demonstrated.
WCNR-0565
BOARD NUMBER: 062
OTHER - PART 1
BRAIN FUNCTIONAL CHANGES AFTER A SOMATOSENSORY DISCRIMINATION TRAINING
IN HEALTHY YOUNG SUBJECTS
E. Sarasso1, F. Agosta2, F. Piccolo3, R. Gatti4, M. Filippi5
1Scientific Institute and Hospital San Raffaele,
Neuroimaging Research Unit and Rehabilitation Department, Milan, Italy
2San Raffaele Scientific Institute- Vita-Salute San Raffaele University,
Neuroimaging Research Unit- Institute of Experimental Neurology- Division of Neuroscience,
Milan, Italy
3San Raffaele Hospital, Rehabilitation Department, Milan, Italy
4San Raffaele Scientific Institute- Vita-Salute San Raffaele University, School of Physiotherapy,
Milan, Italy
5San Raffaele Scientific Institute- Vita-Salute San Raffaele University,
Neuroimaging Research Unit- and Department of Neurology- Institute of Experimental NeurologyDivision of Neuroscience, Milan, Italy
Aims
A somatosensory discrimination training may stimulate the use of cognitive processes, such as
movement planning and monitoring, which can be useful during active motor tasks. The aim of
this study was to assess the effect of a somatosensory discrimination training on brain functional
activity assessed by fMRI during tactile stimulation, object manipulation and complex hand-motor
tasks in healthy young subjects.
Method
Thirty-nine healthy young subjects were randomized into 2 groups to execute a 2-weeks training,
five times a week. The experimental group underwent a somatosensory discrimination training
consisting of shape, surface and two point distance discrimination; the control group performed a
simple object manipulation. At baseline and after 2 weeks of training, subjects underwent
sensorimotor functional evaluations and fMRI. fMRI tasks were performed with the right hand and
consisted of: 1. tactile stimulation; 2. manipulation of a simple object; and 3. a complex handmotor task.
Results
Right hand dexterity improved in both groups, but only the experimental group showed
improvements in all manual dexterity tests assessed. After training, the experimental group
showed a decreased activation of the ispilateral sensorimotor areas during the tactile stimulation;
during the manipulation task there was an increased activation of the contralateral postcentral
gyrus and bilateral thalamus, whereas during the complex hand-motor task the sensory training
was associated with a reduced recruitment of the ipsilateral pre/postcentral gyri and an increased
activation of the basal ganglia and cerebellum
contralaterally.
Conclusion
A sensory discrimination training determines an optimized lateralization of activity in sensorimotor
areas during sensory and motor tasks; specifically it facilitates the recruitment of basal ganglia
circuits and leads to a more task-specific cortical activation. This study suggests that such a
training could be useful in neurorehabilitation.
WCNR-0394
BOARD NUMBER: 063
OTHER - PART 1
TACTILE FEEDBACK RESTORATION USING SENSORY SUBSTITUTION IN CHRONIC
PARAPLEGIC PATIENTS
S. Shokur1, A.R.C. Donati1,2, R.C. Moioli3,4, M.A.L. Nicolelis3,5,6,7,8
1Associação Alberto Santos Dumont para Apoio à Pesquisa AASDAP,
Neurorehabilitation Laboratory, Sao Paulo, Brazil
2Associação de Assistência à Criança Deficiente AACD, Brain Injury, Sao Paulo, Brazil
3Edmond e Lily Safra International Institute of Neuroscience, Neuroengineering, Sao Paulo, Brazil
4Alberto Santos Dumont Education and Research Institute, Neuroengineering, Sao Paulo, Brazil
5Duke University, Center for Neuroengineering, Durham, USA
6Duke University, Psychology and Neuroscience, Durham, USA
7Duke University, Biomedical Engineering, Durham, USA
8Duke University, Department of Neurobiology, Durham, USA
Aims
Spinal Cord Injury (SCI) induces bidirectional loss of communication between the brain and the
body. In the last decade Brain Machine Interfaces (BMI) have been proposed as a potential
solution to restore motor functions in SCI patients. Here, we demonstrate a new paradigm for
reproducing somatosensory feedback from lower limbs in paraplegic patients by remapping
missing tactile sensations from the leg/foot onto the patients’ forearms.
Method
We developed a portable tactile display – called the tactile shirt – to reproduce the missing haptic
feedback from the legs on patients’ forearms through simple detachable vibrators. The feedback
represented the rolling of the feet on the floor and was generated by a 3D avatar in an immersive
virtual environment. EEG signals were recorded to track cortical changes throughout the
experiments. The setup was tested with eight chronic SCI patients.
Results
Relying on the tactile feedback only, patients could perceive the position of the leg in space. We
observed functional cortical plasticity following few minutes in our setup. Psychophysical and
neural data showed patients assimilated the 3D avatar as an extension of their own sensorial
body. Tactile feedback was found to be essential as the observation of the 3D avatar alone did
not elicit such an effect. This effect was paralleled with neurological improvement in the sensory
area under patients’ lesion area.
Conclusion
We propose use of rich sensory feedback in future development of neuroprosthetics with BMI for
SCI patients. Patients can rely on this feedback to improve their motor control, as sensory
feedback is known to be essential for locomotion control loop. Additionally we observed that
patients brain representation of their body changed which has potential rehabilitative effect on
patients’ sensory functions.
WCNR-0399
BOARD NUMBER: 064
OTHER - PART 1
RELIABILITY OF MOTOR EVOKED POTENTIAL RESTING THRESHOLD AND AMPLITUDE
OF ARM MUSCLES IN HEALTHY ADULTS
L. Tedesco Triccas1, D.A.M. Hughes2, P.J.H. Burridge2, M.A.E. Din2, D.M. Warner2, M.S. Brown2,
D.M. Desikan3, P.J. Rothwell4, D.G. Verheyden5
1University of East Anglia, School of Health Sciences, Norwich, United Kingdom
2University of Southampton, Faculty of Health Sciences, Southampton, United Kingdom
3National Hospital for Neurology and Neurosurgery, Neuromuscular Complex Care Centre,
London, United Kingdom
4University College London, Institute of Neurology, London, United Kingdom
5KU Leuven, Rehabilitation Sciences Department, Leuven, Belgium
Aims
To quantify the intra-rater and test-retest reliability of the motor evoked potential (MEP) resting
threshold (RT) and MEP amplitude of the anterior deltoid (AD) and extensor digitorum (ED) of
healthy adults using Transcranial Magnetic Stimulation (TMS).
Method
Stimulation was performed on healthy adults with a Magstim® 2002 device using Brainsight®
neuro-navigation. Surface EMG (Biometrics Ltd) was recorded from surface electrodes over AD
and ED muscles. RT was defined as the minimal TMS intensity to recruit an MEP > 50 μV in five
of ten consecutive measurements in both muscles. Measurements were made on three
occasions in each participant by the same assessor. Two measurements were carried out on day
one with 30 minutes rest in between (tests 1 and 2) and the third measurement was carried out
three days later (test 3). Mean peak to peak amplitude of five MEPs at RT were analysed using
MATLAB.
Results
Twenty participants (10 males and 10 females, mean age of 59.86 years ±11.70SD) completed
the study. There was good to excellent reliability of RT for ED and AD between tests 1 and 2
(ICC=0.89 and 0.94 respectively) and tests 1 and 3 (ICC=0.84 and 0.77 respectively). MEP
amplitude between tests 1 and 2 had a poor to moderate level of agreement (ICC=0.42 [ED] and
0.53 [AD]) and between tests 1 and 3, very poor to moderate agreement was found (ICC=0.62
[ED] and 0.14 [AD]).
Conclusion
RT and MEP amplitude are regularly used as neurophysiological outcome measures in
neurorehabilitation research. Measurement of the RT showed excellent intra-rater and test-retest
reliability in healthy adults. Measurement of MEP amplitude at RT of both muscles showed poor
to moderate agreement. RT provides less information about changes in cortical excitability,
however, our results suggest RT to be a more reliable neurophysiological measurement, which
could be included in future neurorehabilitation trials.
WCNR-0591
BOARD NUMBER: 065
OTHER - PART 1
VISCOSITY OF DAIRY FOOD IN THE CHILEAN MARKET; FIRST APPROACH TO THE
STANDARDIZATION IN THE FEEDING OF PEOPLE WITH DYSPHAGIA
R. Tobar Fredes1, S. Reyes Soto2, O. Correa Briones3, K. Basfi-fer Obregón2
1Universidad de Chile, Departamento de Fonoaudiología, Santiago, Chile
2Universidad de Chile, Departamento de Nutrición, Santiago, Chile
3Universidad de Chile, Departamento de Ciencias y Tecnología Farmacéutica, Santiago, Chile
Aims
In the treatment of people with dysphagia, it is recognized that dietary changes are efficient to
reduce associated complications (especially the viscosity change of liquids), which must be
selectively indicated for each case.
Moreover, it has been shown that: (1) the effectiveness of thickeners of food is scarce for long
time periods, (2) the selection of viscosity is highly dependent on the treating specialists, and (3)
there are few data to use safely foods that already offers the Chilean market.
In this context, the aim of this study is describe the rheological performance of various dairy foods
available in the domestic market; characterized by viscosity level, in order to make this
information available to those who give advice/treatment to people with dysphagia.
Method
60 different dairy foods were selected, all frequently used and with high availability in the chilean
market .
The tests were distributed by brand, flavor and presence of sugar and fat. The rheological tests
were determined on a digital rotational viscometer (Brookfield DV2-T).
The variables of temperature, torque and spindler were monitored. Subsequent analysis allows
obtaining the absolute viscosities.
Results
Of the total dairy food evaluated, 12% were thin liquid, 23% slightly thick liquid; 25% mildly thick
liquid, and 30% moderately thick liquid.
Conclusion
The objectification of the viscosity of the food available in the Chilean market, gives to the
specialists in swallowing disorders the information necessary for prescribing those foods more
appropriate to each condition.
The creation of this first table of rheological performance is a contribution to this purpose.
It is hoped that this study, in addition to others conducted in parallel, allow an improvement in the
quality of life in the people with dysphagia, by facilitating the use of products easily accessible.
WCNR-0327
BOARD NUMBER: 066
OTHER - PART 1
THE I.M. INJECTION OF TETANUS TOXIN IMPROVES THE STANDING OF PARAPLEGIC
AND THE LOCOMOTION OF PARAPARETIC DOGS: A FEASIBILITY STUDY
C. WERNER1, P.L. David2, D.D. Martin3, P.H. Stefan4
1Medical Park Berlin, Neurological Rehabilittaion, Berlin, Germany
2University Göttingen, Neurology, Göttingen, Germany
3Veterinarian Neurological Referral Service Berlin- Germany, Veterinarian neurology, Berlin,
Germany
4Medical Park Berlin, Neurological Rehabilitattion, Berlin, Germany
Aims
The i.m. injection of TTX was intended to facilitate centrally paretic muscles by inducing a local
tetanus to improve standing and locomotion in paraparetic and –plegic dogs. Preceding mice
experiments had resulted in a biologically valid tetanus toxin.
Method
Four dogs following acute disc herniation level L1/2 were i.m. injected with TTX. Prior to TTXinjection all dogs underwent a surgery.The dogs # 1, #2 were initially unable to stand or walk.
Dog #3 showed a monoparesis right (it rolled its paw), dog # 4 suffered from a right-dominated
paraparesis requiring 100% body weight support.
Intervention: Dogs #1,2 and 4 were bilaterally (#3 only unilaterally) injected into the MM.
gastrocnemius and quadriceps, # 2 and 4 additionally in the gluteal and paravertebral
muscles.The dilution of the TTX was 625 pg / 1 ml, the dosage ranged from 100-350pg/muscle.
Afterwards the patients received 10 times locomotor training on a treadmill and physiotherapy.
Gait ability was assessed with a 2D motion capture system.Additionally the modified Ashworth
score and ultrasound-based measurement of the muscle circumference was performedResults
The muscle tone and the circumference of the injected muscles increased markedly. The needle
EMG revealed a local tetanus in the injected but not in the non-injected muscles. Dog #1 started
to crawl, dog #2 stood for a few seconds, dog #3 relearned to place his paw correctly and dog #4
developed a locomotor pattern (body weight support < 20%).The effects lasted up 8 to 10 weeks
(dog #1,29 and sustained in dogs #3,4. TTX titer assessment did not become positive.
Conclusion
The i.m. injection of TTX into centrally paretic or paraplegic hindlimbs of dogs seems feasible to
increase muscle ton focally. Further studies are warranted.
WCNR-0422
BOARD NUMBER: 067
OTHER - PART 1
TARGETED MEMORY REACTIVATION DURING SLEEP IMPROVES SENSORIMOTOR SKILL
LEARNING IN HEALTHY YOUNG ADULTS
B. Johnson1, S.M. Scharf2, K.P. Westlake1
1University of Maryland- Baltimore, Physical Therapy and Rehabilitation Science, Baltimore, USA
2University of Maryland- Baltimore, Sleep Disorders CenterDivision of Pulmonary and Critical Care- Department of Medicine, Baltimore, USA
Aims
Memories are ‘replayed’ throughout sleep and possibly during quiet wake to strengthen involved
neural networks. We aimed to determine whether motor memory reactivation during quiet wake or
sleep, via auditory cues classically conditioned to an upper extremity (UE) task during wake, can
improve motor performance. We hypothesized that replaying auditory cues between two training
sessions that were experienced during training would improve throwing performance compared to
no cues.
Method
Eighteen right hand dominant individuals (26.6 +/-4.1yrs) were randomized into one of four
groups (differentiated by an 8-10 hour between-training session interval): (1) daytime wake with
auditory cues, (2) daytime wake without auditory cues, (3) sleep with auditory cues and (4) sleep
without auditory cues. The training protocol involved two 30-minute sessions of repetitive
throwing of a small ball using the left UE to five unique visuospatial targets with distinct auditory
cues paired with each target. Variability in spatial throwing error and elbow angle at point of
release were collected at 5 time points (baseline, post first training session, post 8-10 hour
between-training interval, post second training session, and approximately 1 week later).
Results
Change scores across the 8-10 hour interval demonstrated between-group differences in
variability of spatial throwing error specific only to targets having associated auditory cues
replayed between sessions (p=.049), with post hoc analysis revealing differences between ‘sleep
with auditory cues’ and ‘daytime wake without auditory cues’ (p=.017). Change scores from
baseline to 1-week retention demonstrated between-group differences in elbow angle variability
(p=.011), with post hoc analysis revealing differences between ‘sleep with auditory cues’ and
‘daytime wake without auditory cues’ (p=.017).
Conclusion
Sleep with auditory cues following motor training led to improved performance compared to wake
without cues. Further analysis will investigate sleep quality and quantity. This study marks a first
step towards a follow up study in individuals post-stroke.
WCNR-0709
BOARD NUMBER: 068
ROBOTICS
PERSONALIZED ROBOTIC TRAINING FOR STROKE REHABILITATION
V. ALURU1, S.Z. Ali2, X. Jin3, R. Dalsania4, S. Agrawal3, P. Raghavan1
1New York University School of Medicine, Rehabilitation Medicine, New York, USA
2New York College of Osteopathic Medicine, Rehabilitation Medicine, New York, USA
3Columbia University in the city of New York, Mechanical Engineering, New York, USA
4The Common Wealth Medical College, Rehabilitation Medicine, Scranton, USA
Aims
Stroke is the leading cause of long term disability and upper extremity hemiparesis is the most
common motor impairment after stroke. However, there is no clear evidence as to what
constitutes appropriate therapy for a patient at any given point during the course of recovery. The
objective of this study was to determine how stage of motor recovery affects motor learning under
different robotic training environments.
Method
Seven healthy subjects and 14 subjects with chronic post stroke right hemiparesis performed 3sets of 3-D circle drawing using a novel light weight 3-D cable driven upper limb exoskeleton
(CAREX) under 3 randomly assigned robotic environments during a single session. The training
environments were counterbalanced to reduce order effects. They were (a) gravity balance alone,
where the weight of the arm was balanced by an upward force applied by the robot (b) path
assistance alone, where a force-tunnel defined the movement trajectory, and (c) path assistance
and gravity balance together. Kinematic data were recorded by the potentiometers within the
CAREX, and upper limb motor impairment was measured using the Fugl-Meyer (FM) Scale.
Results
The path deviation on the circle-drawing task, calculated as the mean normalized distance from
target trajectory, was significantly greater in subjects with stroke across all conditions compared
to controls. The high FM subgroup (mean 58.7+2.20) showed near normal path deviation with
path assistance alone and path assistance and gravity balance together (p<0.05). In contrast
the low FM subgroup (15.75+3.56) showed the greatest path deviation with path assistance and
gravity balance together compared to controls (p<0.05). FM scores were inversely related to path
deviation with path assistance (r2=-0.53). Control subjects showed no difference in path deviation
across the three conditions.
Conclusion
Stratification of subjects based on their stage of recovery can determine optimum robotic
treatment strategies to enhance motor learning.
WCNR-0018
BOARD NUMBER: 069
ROBOTICS
INTERIM ANALYSIS OF RAPPER II - ROBOT ASSISTED PHYSIOTHERAPY EXERCISES
WITH REX POWERED WALKING AID IN PATIENTS WITH SPINAL CORD INJURY
N. Birch1, J. Graham2, T. Priestley3
1Chris Moody Rehabilitation Centre, Spinal Department, Northampton, United Kingdom
2Chris Moody Rehabilitation Centre, PhysioFunction, Northampton, United Kingdom
3Chris Moody Rehabilitation Centre, REX Bionics PLC, Thame- Oxfordshire, United Kingdom
Aims
Patients with spinal cord injury (SCI) benefit physically and psychologically from standing and
walking particularly if they can also exercise in the upright position. The REX powered walking aid
allows people with SCI to stand and walk without other aids. REX supports 60% of the user’s
weight and is inherently stable throughout any point of its movement so therapists can work with
the user on a variety of exercise programs. Combined with assisted ambulation in a REX, upright
function allows wheelchair users to regain some of the independence lost through their SCI.
Method
RAPPER II assesses the safety and effectiveness of an upper limb and trunk exercise regime for
SCI users in the REX device. It is a prospective, international, multi-centre, open label, single
arm, registry study supervised by an Independent Clinical Research Organisation
(Clinicaltrials.gov: NCT02417532) in 100 people with SCI.
Primary outcomes: Completion of transfer; completion of exercises; serious adverse events (AE).
Secondary outcomes: Time of transfer; ability to achieve autonomous control; Timed Up and Go
(TUG) Test; completion of satisfaction questionnaire.
Results
This is the report of the Interim analysis of the first 20 patients. 19 could transfer (mean 7 min 19
sec), 10 without help or with one assistant. Eight with two; one needed a hoist. 17 completed the
shoulder and trunk exercise program. There were no AEs.
18 completed a TUG Test (mean 5 min 12 sec); 17 with just one helper. All 18 achieved
autonomous control of the robot. User feedback showed positive responses for device
acceptability.
Conclusion
REX allows standing exercise in patients with SCI to be performed safely. This is unique among
powered assisted ambulation devices. Users were able to achieve control of the REX and learn to
move in it, quickly and easily and there was a very high overall level of acceptability of the device.
WCNR-0705
BOARD NUMBER: 070
ROBOTICS
CLOSED LOOP INTRACORTICAL BRAIN COMPUTER INTERFACE CONTROL USING
GAUSSIAN PROCESSES IN A NONLINEAR, DISCRIMINATIVE VERSION OF THE KALMAN
FILTER
D. Brandman1,2, M. Burkhart3, D.J. Milstein2,4, J. Saab2,4, T. Hosman2,4, A. Sarma2,4, B. Franco5,
J. Donoghue1,6, H. Matthew3, L. Hochberg4,5,6,7,8
1Brown University, Neuroscience, Providence, USA
2Brown University, Institute for Brain Sciences, Providence, USA
3Brown University, Applied Mathematics, Providence, USA
4Brown University, Engineering, Providence, USA
5Harvard Medical School, Neurology, Cambridge, USA
6Brown University, Brown Institute for Brain Sciences, Providence, USA
7Massachusetts General Hospital, Neurology, Boston, USA
8Department of Veterans Affairs Medical Center,
Center for Neurorestoration and Neurotechnology, Providence, USA
Aims
Brain Computer Interfaces (BCIs) are being designed to allow individuals with tetraplegia to
control assistive communication and environmental control devices. A core component of BCI
technology is a decoder: an algorithm that translates neural information into command signals for
external devices. Recent studies have used linear regression and Kalman filtering approaches,
modeling neuron firing rate as a linear function of underlying kinematic variables. Despite
evidence that the relationship between neural firing and motor commands have nonlinear
properties, there are few examples of closed-form nonlinear filters that compete with linear
approaches in closed-loop control. We developed a nonlinear decoding algorithm that we call the
Gaussian-process discriminative Kalman filter (GPDKF). The method yields an analytic solution
with interpretable parameters, and provides a principled approach to dealing with signal noise
and non-stationarities. We validated this decoding approach during closed-loop intracortical BCI
use by a person with tetraplegia.
Method
A research participant (T9) with amyotrophic lateral sclerosis was implanted with two 96-channel
multielectrode arrays in the dominant precentral gyrus as part of the BrainGate2 pilot clinical trial.
The participant performed standard BCI-enabled computer cursor tasks with the GPDKF decoder.
Results
T9 achieved unassisted closed-loop control at the first attempted session. On the third session,
T9 used the GPDKF to select letters on a QWERTY keyboard to communicate. Standard Fitts
regression parameters had slope 0.9 (+/- 0.1 SEM) and intercept 0.8 (+/- 0.1 SEM), comparable
to previously published results. Offline analyses suggested the GPDKF was more robust to nonstationary signal behavior than a Kalman filter.
Conclusion
The GPDKF decoder is a novel approach to neural decoding that removes linear assumptions of
neural behavior. It provides principled methods for addressing signal non-stationarities in BCIs,
and preliminary results suggest neural control quality is at least comparable to published controls.
WCNR-0443
BOARD NUMBER: 071
ROBOTICS
IMPROVEMENT OF TRUNK STABILITY IN CHRONIC PARAPLEGIC PATIENTS AFTER
LONG-TERM STUDY WITH ROBOTIC GAIT TRAINING
A.R. Cortelli Donati1,2, S. Shokur1, D.S.F. Campos1,2, D. Fischer1,2, M.A. Aratanha3, E. Morya3,4,
M.A.L. Nicolelis3,5,6,7,8
1Associação Alberto Santos Dumont para Apoio à Pesquisa AASDAP,
Neurorehabilitation Laboratory, Sao Paulo, Brazil
2Associação de Assistência à Criança Deficiente AACD, Brain Injury, Sao Paulo, Brazil
3Edmond e Lily Safra International Institute of Neuroscience, Neuroengineering, Sao Paulo, Brazil
4Alberto Santos Dumont Education and Research Institute, Neuroengineering, Sao Paulo, Brazil
5Duke University, Center for Neuroengineering, Sao Paulo, USA
6Duke University, Department of Psychology and Neuroscience, Durham, USA
7Duke University, Department of Biomedical Engineering, Durham, USA
8Duke University, Department of Neurobiology, Durham, USA
Aims
Trunk stability is essential for the execution of daily activities such as turning sideways from
supine lying, rolling, the supine to/from sitting transition, clothing, transfers, standing position or
walking. We analyzed the functional performance of the trunk in patients with chronic spinal cord
injury (SCI, 6 ASIA A and 1 ASIA B) throughout a long-term training (12 months) involving
orthostatic and gait training using the body weight support (BWS) system (Lokomat and ZeroG)
and custom-built exoskeleton.
Method
We used the clinical measurement known as Thoracic-Lumbar Control Scale and associated with
a high speed tracking system and a surface EMG (electromyography) recording to quantitatively
evaluate the motor performance of the thoracolumbar spine. The test was run three times over
the year with 7 chronic Spinal Cord Injury (SCI) paraplegic patients.
Results
We observed significant improvement in static and dynamic balance of the thoracic-lumbar spine
in sitting and lying positions in five out of seven patients. The patients with the lowest lesions
were the ones with the highest score at the end of the training (40 and 42 out of a maximum
score of 65 for the patients with lesion at T10). Interestingly the biggest improvement was
observed with the patient with the highest lesion (T4).
Conclusion
These findings reveal the importance of the physical rehabilitation training in orthostatic and
walking devices even with chronic complete SCI patients. Patients with lesions as high as T4
showed significant improvement with our training.
WCNR-0700
BOARD NUMBER: 072
ROBOTICS
ROBOT-ASSISTED PASSIVE MOTION POSITIVELY AFFECTS UPPER LIMB PERFUSION
AND SPASTICITY IN STROKE SURVIVORS
M. GOBBO1, P. Gaffurini2, C. Orizio1, S. Negrini1, L. Bissolotti3
1University of Brescia, Dept. of Clinical and Experimental Sciences, Brescia, Italy
3Teresa Camplani Foundation, Service of Functional Rehabilitation, Brescia, Italy
Aims
To evaluate the acute effects of robot-assisted passive hand mobilization on local perfusion and
hand function in individuals with post-stroke hemiparesis.
Method
Twenty-three patients (28.6% female; age: 60.5±6.3 years) with subacute (n = 11) and chronic (n
= 12) hemiparesis received hand passive mobilization (30 minutes) through robotic assistance
with Gloreha (Idrogenet, Italy). Gloreha is a wearable robotic device that consists of a soft
exoskeleton similar to a glove which envelops the wrist and fingers of the paretic hand. Passive
mobilization of the fingers is provided by the tension transmitted through semi-rigid cables
connected to a hydraulic system.
Near-infrared spectroscopy (NIRS), by quantifying total hemoglobin (THb) changes at the
microvascular level, was used for non invasive measurements of forearm regional blood supply
and detecting adaptations in tissue perfusion during the intervention.
Motricity Index (MI) and Modified Ashworth Scale (MAS) were selected to assess the functional
status of the paretic upper limb before (pre) and 5 minutes after (post) the mobilization session.
MAS was used to measure spasticity for shoulder, elbow, wrist, and fingers.
Results
Significant (p<0.05) improvements were found in THb and therefore in local tissue perfusion
during the session.
There were significant differences between pre- vs. post-treatment MAS scores, with more
evident decrease in spasticity at the finger level.
MI was unchanged after treatment.
Conclusion
The present work provides novel evidence that robot-assisted hand motion improves the upper
limb functional status in subjects with post-stroke hemiparesis.
This type of intervention is also able to induce substantial changes in local muscle blood flow with
possible beneficial effects in terms of catabolites washout. To note that improved local perfusion
changes represent a fundamental mechanical factor (shear stress) for angiogenesis at the
capillary level, suggesting remarkable implications for muscle tissue functions and circulatory
homeostasis in the hemiparetic limbs.
WCNR-0260
BOARD NUMBER: 073
ROBOTICS
EFFECTS OF VIRTUAL REALITY -BASED REHABILITATION ON DISTAL UPPER
EXTREMITY FUNCTION AND HEALTH-RELATED QUALITY OF LIFE: A RANDOMIZED,
SINGLE-BLINDED CLINICAL TRIAL
Y.J. Jeon1, J.H. Shin1, M.Y. Kim1, J.Y. Lee1, S. Kim2, S. Lee3, Y. Choi4
1National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
2Hanyang University, Law, Seoul, Republic of Korea
3Neofect, Researcher, Seoul, Republic of Korea
4Dankook University, Computer Engineering, Seoul, Republic of Korea
Aims
The purpose of the present study was to examine the effects of VR-based rehabilitation combined
with standard occupational therapy on distal upper extremity function and HRQoL, and compare
the findings to those of amount-matched conventional rehabilitation in stroke patients.
Method
The present study was a randomized, single-blinded controlled trial (NCT02029651). The study
included 46 stroke patients who were randomized to a Smart Glove (SG) group or a conventional
intervention (CON) group. In both groups, the interventions were targeted to the distal upper
extremity and standard occupational therapy was administered. The primary outcome was the
change in the Fugl–Meyer assessment (FM) scores, and the secondary outcomes were the
changes in the Jebsen– Taylor hand function test (JTT), Purdue pegboard test, and Stroke
Impact Scale (SIS) version 3.0 scores. The outcomes were assessed before the intervention, in
the middle of the intervention, immediately after the intervention, and 1 month after the
intervention.
Results
The improvements in the FM (FM-total, FM-prox, and FM-dist), JTT (JTT-total and JTT-gross),
and SIS (composite and overall SIS, SIS-social participation, and SIS-mobility) scores were
greater in the SG group than in the CON group.
Conclusion
VR-based rehabilitation combined with standard occupational therapy might be more effective
than amount-matched conventional rehabilitation for improving distal upper extremity function and
HRQoL.
WCNR-0255
BOARD NUMBER: 074
ROBOTICS
OUTCOME FROM BALANCE EXERCISE ASSIST ROBOT (BEAR) FOR OLDER ADULT WITH
FRAILTY SUGGESTED THE EXISTENCE OF SUBGROUP WITH EARLY OCCURRENCE OF
BALANCE DISORDER
I. Kondo1, O. Kenichi1, O. Aiko2, M. Hiroshi1, H. Satoshi3, S. Eiichi3, F. Youichi4
1National Center for Geriatrics and Gerontology, Rehabilitation medicine, Obu, Japan
2National Center for Geriatrics and Gerontology,
Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, Obu, Japan
3Fujita Health University, Department of Rehabilitation Medicine I, Toyoake, Japan
4Toyota Motor Cooperation, Department of Partner Robot, Toyota, Japan
Aims
Older adults with frailty often have impaired postural control and experience a high incidence of
falls. Robot exercise improves the balance ability of older adults efficiently. However, there is an
individual difference of responsiveness for robot training. The aim of this presentation is to define
the discrepancy between subjects of responsiveness to training with using balance exercise
assist robot (BEAR) for older adults with frailty.
Method
A randomized crossover trial was adopted in this study. Subjects were 26 volunteer from
community-dwelling elderly. All of them (7 men, 19 women; mean age, 74±6y) were judged to be
frail according to the 5 item criteria of our center. Each subject performed two exercise sessions.
In the robot exercise phase, participants used BEAR for training and in the conventional exercise
phase, they performed muscle-strengthening exercise, postural strategy training and movement
exercise needed fine motor control. Each exercise was performed twice a week for 6 weeks. The
initial exercise phase was randomly allocated to each subject. Evaluation tools were maximum
gait velocity, Functional Reach Test (FRT), Timed Up & Go test (TUG), center of pressure (COP)
and muscle strength of lower extremities. Participants were assessed before and after the each
exercise phase. In order to know the grade of frailty we use the number of item in the criteria of
frailty corresponded to each subject.
Results
In robot exercise phase, statistically significant improvements were observed for FRT (P=.003),
TUG (P=.005), muscle strength of hip abduction (P=.006) and plantar flexion (P=.001). However,
TUG correlated significantly to the grade of frailty ( rho=0.641, p<0.001), there were a number of
subjects whose balance ability stayed at low level even before the intervention.
Conclusion
From the results of this study, it was suggested the possibility of frailty subgroup with early
occurrence of balance disorder.
WCNR-0137
BOARD NUMBER: 075
ROBOTICS
THE CHALLENGE OF STUDYING INTERACTION IN CHILDREN WITH AUTISM SPECTRUM
DISORDERS DURING GAME ACTIVITIES WITH A ROBOTIC PLATFORM
M. Leonardi1, P. MEUCCI2, D. RIVA3, C. VAGO3, S. BULGHERONI3, F. CECCHI4, I. MANNARI4,
F.P. FALOTICO4, A. PRATESI4, G. PASSETTI4, C. LASCHI4, P. DARIO4, C. RIVA5,
E. ROSSONI5, M. CERNIAUSKAITE2, A.M. GIOVANNETTI2
1Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurology- Public Health- Disability, Milan,
Italy
2Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurology- Public Health- Disability unit,
Milan, Italy
3Fondazione IRCCS Istituto Neurologico Carlo Besta, Developmental Neurology Division, Milan,
Italy
4Scuola Superiore Sant'Anna, The BioRobotics Institute, Pisa, Italy
5ONLUS L'ABILITA CENTRE, ONLUS L'ABILITA CENTRE, Milan, Italy
Aims
The aim of this abstract is to introduce a project based on a game that uses a robotic platform as
a central element to engage a child with Autism Spectrum Disorders (ASD) in a playing activity:
"RODDI - New Robotic Platform for Rehabilitation of Children with Pervasive Developmental
Disorders and Cognitive Impairments". Based on the scientific literature we already know that
tailored robotic toys are attractive to children with ASD. We want to know if they can work as a
mediators between a child with autism and an adult (e.g. inducing child to ask help from the
educator in order to complete the game). This study is supported by a grant from the Italian
Ministry of Health
Method
RODDI study is composed of two phases: development of the robotic platform and
application.The platform evokes an interactive type of play with the children. RODDI elicits
behaviors and provides feedback or encouragements
Results
19 Children with ASD were enrolled and 9 of them completed the project. During the game
activities we observed that the robotic platform is a flexible tool that helps educator to engage
child. Moreover, the platform facilitates interaction between child and educator inducing child to
ask help from the educator in order to complete the game
Conclusion
Through RODDI project we make one step ahead in studying play with a robotic platform trying to
give back a more complex understanding on how interaction between a child with ASD and an
adult can be studied
WCNR-0352
BOARD NUMBER: 076
ROBOTICS
DEMAND SURVEY FOR FUNCTIONS OF BRAIN-MACHINE INTERFACE SYSTEM IN
SEVERELY DISABLED PERSONS
H.S. Nam1,2, H.G. Seo1, J.H. Leigh1, Y.J. Kim2, S. Kim2, M.S. Bang1
1Seoul National University Hospital, Department of Rehabilitation Medicine, Seoul,
Republic of Korea
2Seoul National University, Department of Biomedical Engineering, Seoul, Republic of Korea
Aims
It has long been described that the brain-machine interface(BMI) system would enable individuals
with severe motor disabilities, such as neuromuscular diseases or stroke, to control their
environment and perform activities of daily living(ADL). This study investigated the demand of
potential BMI users for the functions of robot arm controlled by the BMI system.
Method
A survey was conducted on severely disabled persons with severe neuromuscular diseases such
as Duchenne muscular dystrophy (NM,n=19), spinal cord injury (SCI,n=5) and chronic stroke
patients (CS,n=24). The subjects were asked the level of dependence(1: totally dependent, 2:
mostly dependent; 3: half dependent; 4: mostly independent, 5: totally independent),
importance(1: unimportant; 2: of little importance; 3: moderately important; 4: important; 5: very
important), and necessity of the 18 selected items of ADL using 5-point Likert scale.
Results
In overall analysis, ADL items requiring both hands such as food handling and clothing
demonstrated high dependency and were eventually rated highly important and necessary. NM
group were mostly dependent on others in toilet use(1.79), followed by hairdressing(1.84).
Chronic stroke patients were mostly dependent in food handling(2.58) and using
computers(2.88). SCI patients responded that hairdressing, using purse, cleaning and
handwriting(1.00) were most dependent activities. The NM considered eating(4.21),
clothing(4.11) and cleaning(3.89) as the most important functions in BMI, whereas the CS
considered food using computers(4.08), food handling(4.04) and handwriting(3.95) the most
important. Regarding the necessity, NM claimed that using hairdressing(3.74), clothing(3.68) and
moving close items(3.71) are important, and CS replied that food handling(3.83), clothing(3.71)
and moving close items(3.71) are most necessary functions in BMI. In SCI, using computers was
considered most important(3.4) and also necessary(3.2).
Conclusion
The level of dependence and demand of the potential BMI users differed according to the type of
motor weakness. These results would guide and accelerate the BMIs to meet end user needs in
development.
WCNR-0159
BOARD NUMBER: 077
ROBOTICS
CHARACTERIZATION OF WEIGHT SUPPORT PROVIDED BY SPRING-BASED UPPER
EXTREMITY EXOSKELETON
B.E. Perry1, E. Evans1, D. Stokic1
1Methodist Rehabilitation Center, Center for Neuorscience and Neurological Recovery, JacksonMS, USA
Aims
To quantify the available weight support provided by the Armeo®Spring exoskeleton in order to
guide clinicians and researchers with developing treatment goals and research protocols.
Method
Available weight support was quantified by measuring static force applied to a load cell attached
to the elbow joint of the exoskeleton (averaged over 10s, 1,000 samples/s). Each of the 9 upper
spring settings (A-I) was examined in 5° increments in the sagittal plane randomly selected
throughout the entire operating range of the Armeo®Spring upper arm module (-40° to +40°,
horizontal=0°). This was repeated for the minimum, maximum, and 2 intermediate upper arm (U)
and forearm (F) module lengths (U1F1, U10F12, U4F5, U7F8).
Results
The functional range of the exoskeleton was limited by slack in the spring attachment mechanism
for settings A through G, which occurred at higher operating angles with increasing spring tension
(A=-25°, G=+35°), regardless of the module length. Increasing the spring tension from A to I
increased the support, whereas extending either module length and increasing upper arm module
angle decreased the support (U1F1/-40°=13.9 lb, U10F12/+40°=6.2 lb for spring setting I). An
incremental increase in the spring tension also increased the angle at which the two modules
were balanced against gravity (U1F1=11.5°, U10F12=14.0°). From a practical standpoint, this
effectively divides the functional range into an “unloading zone” (entire weight supported below
the balance angle), a “partial loading zone” (progressively less weight supported between the
balance and slack angles), and a “full loading zone” (no weight supported above the slack angle).
Conclusion
Armeo®Spring provides variable to no weight support in the sagittal plane depending on selected
spring tensions and lengths of upper arm and forearm modules. Settings could be configured to
provide both assistive and resistive exercises (concentric or eccentric), which should be
considered when developing treatment goals and research protocols.
WCNR-0400
BOARD NUMBER: 078
ROBOTICS
CORTICALLY CONTROLLED WHEELCHAIR: A POTENTIAL REHABILITATION APPROACH
S. Rajangam1, P.H. Tseng1, A. Yin2, M. Lebedev1, M. Nicolelis1
1Duke university, Dept of Neurobiology, Durham, USA
2Duke university, Dept of Biomedical engineering, Durham, USA
Aims
Motorized wheelchairs are widely used as a major accessory to assist mobility in patients
suffering from paralysis. However, there are currently no practical wheelchairs that would be
controlled by the user's neural activity and would be useful for neurorehabilitation. Previous
designs of such wheelchairs were based on brain-machine interfaces (BMIs) that utilize
electroencephalographic (EEG) activity. These EEG-controlled wheelchairs worked for a limited
range of tasks, but generally suffered from the limited bandwidth of EEGs, which resulted in slow
responses and insufficient versatility. Here we tested a BMI-controlled wheelchair which uses
large-scale intracranial recordings as the source of control signal.
Method
Two monkeys were chronically implanted with multichannel microelectrode arrays in multiple
cortical areas, which yielded several hundreds of cortical neurons recorded simultaneously. The
neural activity was recorded using our recently developed wireless recording system which
sampled ensembles of premotor and sensorimotor cortical neurons. Multiple Wiener filters
decoded the monkeys’ cortical activity into the steering signals: forward or backward velocity and
turns, as the robotic wheelchair was passively navigated. The behavioral task consisted of driving
from an arbitrary room location to a location of a food reward.
Results
Both monkeys successfully steered the car towards a grape reward in an open area using their
cortical activity. The monkeys improved in this BMI control with practice, which indicated that
cortical plasticity occurred to incorporate the wheelchair in the brain internal representation of the
body. In addition to this modification of the body schema, we observed cortical remapping that
reflected wheelchair position in room coordinates, i.e. an occurrence of spatially tuned neuronal
responses.
Conclusion
This passive BMI training approach has clinical significance since severely paralyzed subjects
cannot produce overt body movements to train a BMI decoder. Our findings pave way to a new
generation of neurally controlled wheelchairs and open avenues for improved prototypes.
WCNR-0070
BOARD NUMBER: 079
ROBOTICS
NOVEL LOCOMOTOR TRAINING WITH ROBOTIC GAIT ORTHOSIS IN STROKE:
PRELIMINARY FINDINGS FROM AN ONGOING STUDY
T. Rodrigues1, D.G. Goroso2, L. Sawaki3
1Institute of Rehabilitation Lucy Montoro - IMREA - HCFMUSP, Department of Physiotherapy,
São Paulo, Brazil
2Institute of Science and Technology- Federal University of São Paulo,
Department of Biomedical Engineering, São Paulo, Brazil
3University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington KY, USA
Aims
To compare the effects of novel versus conventional locomotor training using a robotic gait
orthosis (LT-RGO) after stroke. The novel LT-RGO is structured to pose comparatively greater
mental and physical demand than the conventional LT-RGO. The novel LT-RGO therefore aligns
more closely and comprehensively with basic principles of experience-dependent neural plasticity
than conventional LT-RGO. A novel LT-RGO protocol that imposes progressive decrease of
speed and guidance force as recovery progresses will yield greater functional recovery compared
with a conventional protocol (i.e., progressive increase of Lokomat speed with progressive
decrease of guidance force).
Method
Here, we present the preliminary results from 16 of the projected 20 participants in this ongoing
study. This blinded, controlled, randomized study took place in an inpatient rehabilitation setting.
Participants were randomized to 1 of 2 groups (i.e., novel versus conventional LT-RGO).
Outcome measures included 10 meter walk test (10MWT), 6 minute walk test (6MWT), Time up
and go (TUG), Berg Balance Scale (BERG), Functional Ambulation Categories Scale (FAC),
Fugl-Meyer Assessment, and Functional Independence Measure (FIM). Each subject participated
in a 30-minute session of LT-RGO each day, 5 days a week, for 6 weeks.
Results
Preliminary results show marked improvements in locomotor function for both groups. However,
only the novel LT-RGO group yielded significant improvement on TUG, 6MWT, BERG, FAC, FIM
and Fugl-Meyer assessment after the intervention.
Conclusion
Novel LT-RGO appears to yield more benefit than conventional LT-RGO. Larger studies are
needed to establish conclusive evidence in this regard. Novel LT-RGO shows enormous potential
to expand the effectiveness of gait rehabilitation for stroke survivors. Long-range goals include
maximizing the restoration of lower extremity motor function for people with neurological
impairment.
WCNR-0558
BOARD NUMBER: 080
ROBOTICS
INTENSIVE ROBOT-ASSISTED THERAPY IMPROVES GAIT AND ARM FUNCTION IN
CHILDREN POST-CEREBRAL HEMISPHERECTOMY
S. Shaw1, J. Kasayama2, S. Kiseljak Dusenbury2, R. Chu3, E. Blydt-Hansen2, M. Aisen1
1Rancho Los Amigos National Rehabilitation Center, Neurology/Neurorehabilitation, Downey,
USA
2Rancho Los Amigos National Rehabilitation Center, Physical Therapy, Downey, USA
3Rancho Los Amigos National Rehabilitation Center, Occupational Therapy, Downey, USA
Aims
Evaluate the efficacy of intensive robot-assisted therapy for improving motor function in children
after cerebral hemispherectomy.
Method
Five post-hemispherectomy patients (10.6±0.9 years; age at time of first surgery 0.25-9 years; all
>1 year post-surgery) received two courses of intensive robot-assisted therapy, one year apart.
The first course of rehabilitation (R1), consisted of 8 days of therapy, three hours/day over 2
weeks (total 8 hours each of Hocoma Lokomat®, InMotion ANKLETM and InMotion ARMTM). In the
second course (R2), they received 9 days of therapy, three hours/day over 2 weeks (three
subjects had a total of 9 hours of Lokomat®, 9 hours of Hocoma ArmeoSpring®, 4.5 hours of
ANKLETM and 4.5 hours of ARMTM while the other two received the same overall hours of
rehabilitation, split evenly between traditional and robotic therapy). Outcome measures were
assessed on the hemiparetic side pre- and post-intervention during each rehabilitation course. As
no minimal clinically important difference (MCID) data exists for hemispherectomy, MCID
thresholds were used from stroke, which is similar in terms of impairments due to hemiparesis.
Results
MCID was achieved during R1 in 5 subjects on Wolf Motor Functional Ability Scale (WMFT-FAS),
in 4 subjects on Wolf Motor performance time (WMFT-Time), and in 3 subjects on Six-Minute
Walk Test (6MWT). During R2, 2 subjects attained MCID on WMFT-FAS and WMFT-Time. In
comparing the overall outcome of the two courses of rehabilitation, MCID was demonstrated
between pre-R1 and post-R2 in 4 subjects on WMFT-FAS, in 4 subjects on WMFT-Time, and in 3
subjects on 6WMT.
Conclusion
Clinically important differences in arm function and gait endurance were achieved with two
courses of short-duration, intensive robot-assisted therapy regimens, in children outside the acute
recovery period after hemispherectomy.
WCNR-0134
BOARD NUMBER: 081
SPASTICITY
HOW DO PEOPLE WITH SPASTICITY VIEW THEIR CARE? FINDINGS FROM AN
INTERNATIONAL PATIENT SURVEY
M. Barnes1, M.M. Fernandez2, K. Fheodoroff3, S. Kocer4, J. Balcaitiene5
1Christchurch Group, Christchurch Group, Newcastle, United Kingdom
2Neurological Comprehensive Care Center, Neurological Comprehensive Care Center,
Pamplona, Spain
4l’Hôpital du Jura, Centre de Rééducation, Porrentruy, Switzerland
5Ipsen Pharma, Medical Affairs, Boulogne Billancourt, France
Aims
To survey the views of people with spasticity regarding their condition and its management.
Method
Global Internet survey (April 2014-May 2015) of 29 multi-choice questions.
Results
281 patients (28 countries) with spasticity of various aetiologies responded. Respondents
indicated that spasticity has broad impact on their daily-life (Figure). Most respondents (64%)
were cared for by family members, of whom half had stopped/reduced working. Almost half (45%)
reported dissatisfaction with the information provided at diagnosis; main reasons were ‘not
enough information’ (67%) and ‘technical terminology’ (36%). Respondents had high treatment
expectations; 63% expected to be free of muscle spasm, 41% to take care of themselves and
36% to return to a normal routine. However, 33% had not discussed these expectations with their
physician. The most common treatments were physiotherapy (75%), botulinum neurotoxin (BoNT,
73%) and oral spasmolytic medications (57%). Of those treated with BoNT, 20% said they had
not discussed the benefits and side-effects of treatment with their physician and 47% waited >1
year from spasticity onset to treatment. Of those not treated with BoNT, several access issues
were identified: expensive for patient (13%) and provider (10%), travel inconvenience (4%) and
lack of experienced injectors (4%).
Conclusion
This survey emphasises the broad impact of spasticity on the lives of patients and their carers,
and highlights gaps in the treatment pathway and patient-physician communication.
WCNR-0568
BOARD NUMBER: 082
SPASTICITY
MULTIDISCIPLINARY REHABILITATIVE TREATMENT FOLLOWING BOTULINUM TOXIN
TYPE A IN POST STROKE SPASTICITY: REAL LIFE DATA FROM ITALIAN PATIENTS'
REGISTRY
A. Baricich1, E. Grana1, C. Stefano2, M. Invernizzi1, C. Cisari1
1Azienda Ospedaliera Universitaria Maggiore della Carità di Novara,
Physical and Rehabilitative Medicine, Novara, Italy
2CHUV, Neurorehabilitation and Neuropsychology Unit, Lausanne, Switzerland
Aims
Post stroke spasticity leads to activity limitations, caregiver burden, pain, reduced quality of life
with a significant increase in direct costs for stroke survivors.
Botulinum toxin type A (BoNT-A) is the treatment of choice in focal or multi-focal disabling
spasticity. Current guidelines recommend multidisciplinary rehabilitative programmes after BoNTA injections; however, no data are still available on current implementation of these suggestions.
Our aim was focused on providing real-life data on post-BoNT-A rehabilitation in order to improve
local implementation of guidelines and optimize the efficacy of the treatment.
Method
Patients affected by PSS and treated with BoNT-A in 20 Italian centres were prospectively
included in this study.
We registered demographical and clinical characteristics and the rehabilitative treatment after a
BoNT-A injection. Moreover, in order to evaluate the efficacy of the treatment, patients (or their
caregivers) were asked to rate the overall treatment efficacy (Global Assessment of Efficacy,
GAE) in a four-point scale after a post-injection period of 30 and 90 days.
Results
159 patients were included in the registry, and 142 completed the 3-month follow-up period.
90% of patients received post BoNT-A rehabilitative interventions: 64% in the same Centre where
the injection was performed, 36% in a different one. Among these patients, 44% received
stretching, 28% electrical stimulation, 13% taping, 9% splinting and 6% casting.
Half of the patients received a combination of 2 or more rehabilitative interventions. Interestingly,
we observed a significant increase in overall assessment of efficacy score in subjects who
received a multidisciplinary treatment, both at 1 and 3 months after BoNT-A injection (p<0.05).
Conclusion
Our real-life data confirmed the relevant role of a multidisciplinary rehabilitative treatment after
BoNT-A in order to improve clinical outcome in patients affected by PSS.
Further research is needed to better clarify the optimal doses, intensity and ideal settings of these
interventions.
WCNR-0619
BOARD NUMBER: 083
SPASTICITY
Clinical understanding of spasticity symptoms over time
R. Bhimani1, L. Carney Anderson2
1University of Minnesota School of Nursing, Nursing, Minneapolis, USA
2University of Minnesota, Integrative Biology and Physiology, Minneapolis, USA
Aims
Spasticity is a poorly understood symptom associated with upper motor neuron dysfunction.
Patient reports of spasticity are missing from the literature. The study aims were to: (a) identify
the effect of spasticity on daily life from a patient perspective, (b) understand the variability
pattern in spasticity, and (c) explore the relationship between Numeric Ratings Scale used by
patients compared to Modified Ashworth Scale used by clinicians.
Method
Longitudinal, concurrent mixed methodology design included spastic adults with diagnoses of
neurological disorders. Participants (a) rated their spasticity on a 0-10 scale on an hourly basis
when awake; (b) participated in daily spasticity evaluations using the Modified Ashworth Scale by
a clinician-researcher; and (c) described the nature of their spasticity during a daily semistructured interviews. Participants were followed for 7 consecutive days during in-patient
rehabilitation. Content analysis, models of individual trajectories of spasticity, and association
between Numeric Ratings and Modified Ashworth Scales with hierarchical generalized linear
modeling was utilized.
Results
A total of 23 participants were enrolled in this study. Patients identified missed opportunities for
care in activities of daily living, pain management, insomnia, and mobility. Uses of alternative
therapies in-conjunction with medications are needed to better manage spasticity. Self-ratings
using Numeric Rating Scale score showed that spasticity fluctuated and over time without any
discernable pattern. Numeric Rating Scale threshold was correlated with Modified Ashworth
Scale.
Conclusion
The experience of spasticity is a quality of life issue, as its effects are pervasive in all domains of
life. Individuals not only need medical intervention, but may also require psychological counseling
and strong spiritual connections to find an acceptable quality of life. Spasticity is best understood
by those who experience this symptom, as it is highly individualized. Better measurement tools
are needed to measure spasticity.
WCNR-0544
BOARD NUMBER: 084
SPASTICITY
EXTENSION RANGE OF MOVEMENT DEFICIENCY IN LONG FLEXOR HYPERTONIA OF
FINGERS
K. BO1
1Northern Lincolnshire and Goole NHS Foundation Trust, Rehab Medicine Service, Brigg,
United Kingdom
Aims
Long finger flexors cross multiple joints between their origins and insertions. If there is hypertonia
of the above muscles, the joints they cross will not be fully extendable. There will be Extensor
Range of Movement Deficiency (EROMD). In addition, change in ROM in one joint will affect
other joints.
The author is proposing the relationship of EROMD between the joints crossed by the hypertonic
long finger flexors (HLFF) and its application in the management of Hypertonic Hand. EROMD
can be calculated from the summation ROMs (∑ROMs) of fully extended hand.
Method
Proposed Relationship
In hand without significant HLFF, changes in ROM of any joint will not affect ROMs in other joints
and ∑ ROMs should be at least 585 degrees (Fig 1).
If there is HLFF, there will be deficiency in ∑ROMs on full extension but ∑ ROMs remains the
same regardless of the position of these joints (Fig.2 & Fig.3).
Results
1. If ∑ ROMs remains the same in different positions of an extended hypertonic hand,hypertonia
is due to HLFF.
2. If ∑ ROMs is found to be different in different extended positions, then Hypertonia has other
elements (short flexors hypertonia, small muscles hypertonia, arthritis of the joints, contractures
of palmar fascia etc. etc.)
3.Comparison can be made between two different hypertonic positions (Fig. 2 and Fig. 3)
They are equivalent hypertonia as they have the same ∑ROMs or EROMD.
Conclusion
∑ROMs in HLLF will be helpful in the documentation, comparing two different HLFF hands and
can be used in outcome measures in the management of hypertonic hand.
WCNR-0336
BOARD NUMBER: 085
SPASTICITY
LONGITUDINAL MEASUREMENTS OF SPASTICITY AND CONTRACTURES IN PATIENTS
WITH SEVERE ACQUIRED BRAIN INJURY USING A NOVEL HAND-HELD BIOMECHANICAL
DEVICE
S. Kirk Baagøe1, J. Damsager1, L. Weber1, T. Hvass Petersen1
1Rigshospitalet Neurocentret, TBI Unit, Hvidovre, Denmark
Aims
This study investigated the development of passive (contractures) and reflex mediated (spasticity)
muscle stiffness in the ankle joint plantar-flexor muscles in patients with severe acquired brain
injury using a biomechanical tool. We hypothesized, that increases in passive muscle stiffness
but not spasticity is the major cause of increased muscle tone over time in these patients.
Method
Patients admitted to sub-acute rehabilitation following severe acquired brain injury were
prospectively enrolled in the study. Inclusion criteria: 1) 18-65 years of age. 2) Paralysis or
paresis of one or both legs. Preliminary data from 11 patients is presented (age range 27-65, 7
males, 3 TBI).
During the period of hospitalization, at 2 month after discharge, and one year post injury, muscle
stiffness was assessed once a week in both ankle joints. Testing comprised of series of slow (<
20 deg/sec) and fast muscle stretches (>200 deg/sec) to assess passive and reflex mediated
muscle stiffness respectively. Surface electromyographic signals (EMG) were recorded from the
soleus and anterior tibialis muscle in all trial. The Modified Asworth Scale was used to clinically
assess spasticity in both ankle joints.
Results
Preliminary data analysis showed heterogeneous stiffness profiles for the patients included in the
study. In 4/11 patients muscle stiffness increased steadily during hospitalization and was further
increased at two month after discharge and at 1-year post injury. Increases were more
pronounced in the paretic leg. Spasticity was readily observed in one or both legs in 4/11 patients
at admission, however reflex evoked stiffness did not change further nor occurred during
hospitalization or at follow up. We found no association between the development of passive
muscle stiffness and spasticity.
Conclusion
Based on the present dataset we conclude that changes in passive muscle properties is the main
cause of the increased muscle tone over time in patients following severe acquired brain injury.
WCNR-0233
BOARD NUMBER: 086
SPASTICITY
RECOVERY OF HAND FUNCTION AFTER STROKE - DOES SPASTICITY MATTER?
J. Plantin1, G. Pennati2, J. Borg1, P. Lindberg3
1Karolinska Institutet- Department of Clinical Sciences, Department of Rehabilitation MedicineDanderyd University Hospital-, Stockholm, Sweden
2Danderyd University Hospital, Department of Rehabilitation Medicine, Stockholm, Sweden
3Karolinska Institutet- Department of Clinical Sciences, Department of Rehabilitation MedicineDanderyd University Hospital- Centre de Psychiatrie et Neurosciences- InsermUniversité Paris Descartes, Stockholm, Sweden
Aims
The relation between early signs of spasticity, voluntary control of the hand and its recovery after
stroke remains unclear. Our aim was to investigate the relation between longitudinal changes of
hand spasticity and hand function after stroke.
Method
41stroke patients with upper limb paresis, admitted to inpatient rehabilitation, were assessed at 26 weeks (T1), 3 months (T2) and 6 months (T3) after stroke. Measures included the Fugl-Meyer
Assessment for upper extremity (FMA-UE), a visuomotor force tracking task to quantify grip force
control, the NeuroFlexor method and normative (cut-off) values from a large sample of healthy
controls to determine neural (NC) elastic (EC), and viscous (VC) contributions to the force
resisting passive muscle stretch. Spasticity was defined as NC>3.4N.
Results
There was a wide range of initial voluntary hand function (FMA-UE 0-60) and a highly variable
degree of motor recovery (FMA-UE change over time [T3-T1] = 0-35, mean= 7.8SD=13.0).
At each time point, 27%, 30 % and 28% patients had NC above cut-off. NC increased significantly
over time (rmANOVA, p=0.02). EC was above cut-off in some patients 2-6 N) but EC or VC did
not significantly change over time. NC did not relate significantly to degree of recovery of FMAUE and grip force tracking measures. However, patients with high NC at T1 showed a reduction
of passive ROM over time. NC at T1 also correlated positively with increased pain (FMAsubscale) at 3 months (T2-T1). EC change over time correlated with passive ROM change (r=0.63).
Conclusion
This is the first longitudinal study of spasticity after stroke using a quantitative normative-based
measure of spasticity. Early spasticity did not impact on recovery of motor function measured
either at the functional or the activity level according to the ICF. However, high initial spasticity
was associated with decreasing range of movement and development of pain.
WCNR-0666
BOARD NUMBER: 087
SPASTICITY
Incobotulinum toxin for post-stroke upper-limb spasticity pain
D.A. RESTIVO1, M. Panebianco1, C. Zavanone2, M.C. Romano3, F. Molteni4
1Ospedale "Garibaldi" Centro, Neurological Unit, Catania, Italy
2Hopitè Salpetriere, Neurorehabilitation Unit, Paris, France
3Ospedale "Villa Sofia", Neurological Unit, Palermo, Italy
4Ospedale Valduce - Villa Beretta, Unit of Medical Rehabilitation, Lecco, Italy
Aims
Spasticity is often associated with pain. Pain may significantly worsen spasticity and thus
increasing the disability. Pain may be due to different causes, including local microvascular
compression associated to focal muscle hyperactivity with consequent ischemic pain. Botulinum
toxin A (BoNT/A) injected into the spastic muscles showed to be effective in reducing muscle
tone, but only few studies reported pain relief as additional benefit. Moreover, in most of them,
pain was one the secondary outcomes and consequently it was evaluated marginally. We
investigated the effects of local BoNT/A treatment in upper-limb spasticity pain.
Method
Twenty-four patients with post-stroke upper-limb spasticity pain in at least 2 joints were
randomized into two groups: 12 patients received BoNT/A injections plus a 4-week traditional
physiotherapy of upper-limb; 12 patients underwent upper limb traditional physiotherapy alone.
Based on the involved joint(s), a dose of incobotulinum toxin A (100U to 200U/joint; maximal total
dose 400U) was injected. Primary outcome: Brief Pain Inventory Modified Short Form (BPI-MSF)
24-hours average pain change. Secondary outcomes: BPI-MSF 24-hours changes at week 1(first
treatment period) comparing the 2 groups; variations in the mean intensity of pain measured by a
0-100 visual analogue scale (VAS) at rest and after passive joint movements, the five-point
modified Rating of Response to BoNT/A, the Patient Evaluation of Global Response to BoNT/A
treatment, the Clinical Global Impression of Improvement Score, the Patient Global Impression of
Improvement Score, the modified Ashworth Scale. Patients were evaluated at baseline, and at 1,
2, 4, 6, 8, 10, and 12 weeks after injections.
Results
As compared with controls, BoNT/A as adjunctive treatment to traditional physiotherapy of the
upper limb induced significant improvement between baseline values and week 1-12, for all the
outcomes.
Conclusion
BoNT/A injections into the upper limb in post-stroke patients are safe and effective in reducing
spasticity-associated pain.
WCNR-0143
BOARD NUMBER: 088
SPASTICITY
BEST PRACTICES IN INTRATHECAL BACLOFEN THERAPY: A QUALITATIVE SURVEY
M. Saulino1, A. Boster2
1Einstein Medical Center, MossRehab, Elkins Park, USA
2OhioHealth Neurological Physicians, Neuroimmunology, Columbus, USA
Aims
To summarize consensus/divergence for best practices in intrathecal baclofen (ITB) therapy for
severe spasticity with a qualitative survey.
Method
22 invited practitioners (20 physicians, 1 NP, 1 PT) who are currently managing more than 3,200
ITB patients participated in a day-long facilitated discussion.
Results
Patient Selection: Appropriate ITB candidates have severe generalized spasticity that negatively
impacts quality of life (e.g., function, movement, sleep, comfort). A patient must have tried at least
one oral therapy before ITB consideration. An unreliable patient with compliance issues should
not be considered. Patient/caregiver education is vital.
Screening Test: This determines efficacy and previews pump effects. During screening patients
are monitored for spasticity, vital signs, functionality, symptomatic hypotension, tachycardia, or
desaturation. Key measures include function (tone, strength, ROM, walking ability, stretching,
Modified Ashworth Scores). Patients are referred to an implanter after positive screening.
Dosing and Therapy Management: Dose titration usually starts in an inpatient setting, with
length of stay lasting 2-5 days. ITB doses for adults range from 25-100 mcg, with dosing changes
made according to response as oral medications are tapered. The optimal ITB dose allows the
patient to reach pre-defined, individual therapy goals.
Troubleshooting: Symptomatic patients usually go to the ED or use oral baclofen. First steps are
an x-ray to check for catheter problems and trying a bolus dose. Careful history may elicit nonpump problems. Acute underdose/withdrawal should be assessed in hospital where withdrawal
can be managed. Participants encouraged strong collaboration among clinicians.
Conclusion
Participants recommended follow-up quantitative research.
WCNR-0148
BOARD NUMBER: 089
SPASTICITY
BEST PRACTICES IN INTRATHECAL BACLOFEN THERAPY: A QUANTITATIVE SURVEY
M. Saulino1, A. Boster2
Aims
To survey current practices for intrathecal baclofen (ITB) therapy for spasticity.
Method
An online survey of 42 physicians (21 neurologists, 21 PM&R) who managed >25 ITB patients
each.
Results
Patients were pediatric (19%), adult (66%), or geriatric (15%). Physicians always/often used deep
tendon reflexes (95%), Manual Muscle Test (84%), and Ashworth/Modified Ashworth Score
(83%) to assess spasticity. Spasticity interfering with comfort, function and/or caregiving was the
main criterion (95%) for considering ITB therapy. Goals included improved quality of life (88%),
reduced spasticity (88%), increased comfort (81%), reduced pain (81%), and improved active
function (79%). 69% used a screening test. Before screening, oral antispasmodics were
maintained (49%), tapered (36%) or weaned (15%). Responses were measured at baseline (by
68% of physicians), 1 hr (by 60%), 2 hrs (by 68%), 3 hrs (by 35%) and 4 hrs (by 60%).
Timing of postop dose titration and oral medication weaning varied greatly. Average minimum
doses ranged from 100-170 mcg/day for adults and 50-125 mcg/day for children; maximum doses
varied by diagnosis. Continuous mode dosing was used in 59% of patients; flex dosing was most
common for predictable spasticity patterns.
Loss of ITB efficacy was the most common problem. Equipment problems most often involved
catheters or off-schedule dosing/refill issues. Troubleshooting started with a patient history (74%)
and pump interrogation (71%). ITB withdrawal was treated with oral baclofen (71%) or
benzodiazepines (43%).
Conclusion
Consensus was clear on key practices. Dosing and therapy management were individualized and
more variable.
WCNR-0154
BOARD NUMBER: 090
SPASTICITY
BEST PRACTICES IN INTRATHECAL BACLOFEN THERAPY: PATIENT SELECTION
M. Saulino1, C. Ivanhoe2, J. McGuire3, B. Ridley4, J. Shilt5, A. Boster6
2Baylor College of Medicine, Mentis Neurorehabilitation, Houston, USA
3Medical Caollege of Wisconsin, Physical Medicine and Rehabilitation, Milwaukee, USA
4Alta Bates Summit Medical Center, Disabled Community Health Clinic, Berkeley, USA
5St. Luke's Children's Hospital, Gait Lab, Boise, USA
Aims
To select appropriate candidates for intrathecal baclofen therapy (ITB) for spasticity.
Method
22 invited practitioners (20 physicians, 1 NP, 1 PT) currently managing more than 3,200 ITB
patients consulted on patient selection practices.
Results
Any patient who has spasticity that interferes with comfort, active or passive function, activities of
daily living, mobility, positioning, or caregiver assistance should be considered for ITB therapy.
ITB can be monotherapy or used in combination. It should not be exclusively reserved for
individuals who have failed other approaches. In ambulatory patients, ITB combined with
rehabilitation can be effective in certain patients. ITB is also highly effective in managing
spasticity in pediatric patients, who may suffer limb deformity, joint dislocation, and poor motor
function from spasticity and muscle tightness. Spasticity management often facilitates higher
function. When cognition is impaired, ITB controls spasticity without the cognitive side effects of
some oral medications.
ITB is contraindicated in patients with hypersensitivity to baclofen, which is rare, or active
infection. Some patients with an adverse reaction to oral baclofen may be mistakenly classified as
having an allergic reaction; they may benefit greatly from ITB. Relative contraindications include
unrealistic goals, unmanageable mental health issues, psychosocial factors affecting compliance,
and financial burden. Vascular shunting for hydrocephalus is not a contraindication, but
concurrent use may affect cerebrospinal fluid flow. Implanting surgeons, spasticity management
physicians, patients and caregivers should discuss seizures, or prior abdominal or pelvic surgery,
before proceeding to an ITB screening trial.
Conclusion
ITB should be considered when spasticity interferes with comfort or function.
WCNR-0155
BOARD NUMBER: 091
SPASTICITY
BEST PRACTICES IN INTRATHECAL BACLOFEN THERAPY: SCREENING TRIAL
M. Saulino1, S. Bennett2, G. Bilsky3, M. Gudesblatt4, S. Koelbel5, M. McManus6
2SUNY at Buffalo, Dept. of Rehabilitation Science, Buffalo, USA
3Shepherd Center, Acquired Brain Injury Services, Atlanta, USA
4Brookhaven Memorial Hospital Medical Center, South Shore Neurologic Assoc., Islip, USA
5Braintree Rehabilitation Hospital, Spasticity Management Program, Braintree, USA
6Alfred I DuPont Hospital for Children, Pediatric Rehabilitation, Wilmington, USA
Aims
To assess intrathecal baclofen (ITB) for severe spasticity before implantation of a drug delivery
device.
Method
22 invited practitioners who currently manage more than 3,200 ITB patients consulted on
screening trials.
Results
Individuals should not be trialed in the presence of active medical issues (e.g., MS exacerbations,
active urinary tract infection, nonhealing wounds). Decubitus ulcer in close proximity to the lumbar
puncture site is a contraindication, but asymptomatic bacterial bladder colonization is not an
absolute contraindication. Anticoagulant management must be considered before trial.
Appropriate venues accommodate safe delivery of medication, monitoring/evaluation, lumbar
puncture equipment, and gait evaluation. The standard baclofen test dose is a 50 mcg bolus, 25
mcg in very small children or patients who rely on spasticity for mobility. Patients unresponsive to
these doses may require 75 mcg or 100 mcg; 24 hours should elapse between bolus doses.
Cardiopulmonary parameters should be checked frequently for 2 hours postinjection, and
spasticity measures assessed at least twice within 4 hours. Protocols for adverse events should
be in place.
A successful trial achieves pre-determined goals (improved mobility speed, safety and quality,
decreased caregiver time/improved independence, and a decrease in home exercise stretching
time). Passive goals include improved positioning, wheelchair tolerance, decreased caregiver
time, improved sleep, and reduced pain. Long-term goals may not be fully realized during
screening. Rehabilitation postimplant is crucial to attaining improved function.
Trial results should be shared with the patient and team, and patients/caregivers should
understand the commitment necessary.
Conclusion
A trial helps identify appropriate candidates for ITB therapy.
WCNR-0157
BOARD NUMBER: 092
SPASTICITY
BEST PRACTICES IN INTRATHECAL BACLOFEN THERAPY: DOSING AND LONG-TERM
MANAGEMENT
M. Saulino1, A. Boster2, R. Adair3, J. Gooch4, M.E. Nelson5, A. Toomer6, J. Urquidez7
1Einstein Medical College, MossRehab, Elkins Park, USA
3Advocate Christ Medical Center, Physical Medicine and Rehabilitation, Oak Lawn, USA
4University of Utah, Neurorehabilitation, Salt Lake City, USA
5Medical College of Wisconsin, Spasticity Management Program, Milwaukee, USA
6Culicchia Neurological Clinic, Rehabilitation, New Orleans, USA
7Physical Medicine and Neurotoxin Instittue, Physical Medicine and Rehabilitation, Austin, USA
Aims
To provide best practices for dosing and management of intrathecal baclofen (ITB) therapy for
severe spasticity.
Method
22 invited practitioners who currently manage >3,200 ITB patients consulted on dosing.
Results
A pre-implant priming bolus should be given. After implant, priming of the catheter only quickly
advances drug. Monitor the patient for at least 8 hrs. Initiate with the 500 mcg/mL concentration.
The starting daily dose should be twice the effective bolus screening dose, or the screening dose
if response was prolonged (>8 hrs).
Oral baclofen doses can be decreased by 25%-50% at one time after implant. Daily adult dose
increases may be 5%-15% per 24 hrs for cerebral-origin spasticity and 10%-30% per 24 hrs for
spinal-origin spasticity. Daily child dose increases can be 5%-15% per 24 hrs.
Assess response at least every 24 hrs for inpatients. Outpatient adjustments can be scheduled
for patient convenience. Dosing options include simple continuous, variable 24-hr cycle, or
scheduled boluses. Step dosing can be used for patients who cannot return often.
Patients/caregivers should know possible side effects, low-reservoir alarm and refill dates, and
emergency contact information. A higher concentration at refill extends refill intervals. A bridge
bolus must be programmed, after which the pump will automatically adjust.
Pump replacement should be scheduled 3-6 mos in advance. In suspected catheter malfunctions,
ITB should be weaned preoperatively. In verified malfunctions, the dose should be reduced to the
starting dose before revision.
Conclusion
ITB dosing is multistep and individualized.
WCNR-0158
BOARD NUMBER: 093
SPASTICITY
BEST PRACTICES IN INTRATHECAL BACLOFEN THERAPY: TROUBLESHOOTING
M. Saulino1, D. Anderson2, J. Doble3, R. Farid4, F. Gul5, P. Konrad6, A. Boster7
2Mid County Orthopaedic Surgery & Sports Medicine, Neuro-orthopaedics, St. Louis, USA
3Associates in Physical Medicine and Rehabilitation, St. Joseph Mercy Hospital, Ypsilanti, USA
4University of Missouri Health Care, Physical Medicine & Rehabilitation, Columbia, USA
5University of Texas Southwestern Medical Center, Physical Medicine & Rehabilitation Clinic,
Dallas, USA
6Vanderbilt University Medical Center, Funtional Neurosurgery, Nashville, USA
Aims
To optimize and manage complications of intrathecal baclofen therapy (ITB).
Method
22 invited practitioners (20 physicians, 1 NP, 1 PT) currently managing >3,200 ITB patients
consulted on troubleshooting practices.
Results
Any patient with previously well-controlled hypertonia on a stable dosing regimen who has
increased spasticity should be examined. Comorbidities can "trigger" increased spasticity, and
some disorders mimic ITB underdosing/withdrawal (sepsis, autonomic dysreflexia, neuroleptic
malignant syndrome, and malignant hyperthermia).
Evaluation includes a targeted history, physical examination, radiologic/laboratory testing, and
pump telemetry. Rapidly progressing hypertonia with autonomic instability or hypotonia and
somnolence require emergent care and perhaps hospitalization. Mental status changes, hypo- or
hyperthermia, respiratory depression, dizziness, and drowsiness are important clues. Pruritus
without rash is considered diagnostic for ITB withdrawal.
Emergent ITB withdrawal requires immediate medical treatment in a monitored setting and
restoration of ITB delivery. The previous dosing schedule can be used in withdrawal cases of
short duration; lower doses of 10-20 mg every 6 hrs suffice in withdrawal of days to weeks. Oral
baclofen or benzodiazepines can also be used. Catheter disruption requires revision with 24-hr
postop monitoring. Supportive care includes maintenance of airway, respiration, and circulation.
Seizure prevention should be considered, along with pump reprogramming or interruption, CSF
drainage, and sequential lumbar punctures/drains.
Superficial infections are treated with oral antibiotics, and deep infections with broad-spectrum IV
antibiotics (e.g., ancef, clindamycin, vancomycin). Explantation is often required. A new pump can
be implanted under IV antibiotic coverage.
Conclusion
Orderly troubleshooting helps ensure patient safety.
WCNR-0231
BOARD NUMBER: 094
TUMORS
THE EFFECT OF BOBATH APPROACH AND COGNITIVE REHABILITATION THAT APPLIED
AT EARLY STAGE IN PATIENT WITH OLIGODENDROGLIOMA: A CASE REPORT
H. Çetin1, S. Atasavun Uysal1, C. Turkmen1, E. Dulger1, S. Bilgin1
Aims
Oligodendrogliomas are infiltrative tumors that consist of oligodendrocytes. These tumors are %14 of primary intracranial tumors and %4-8 of all glial tumors. Our purpose was to research the
effect of Bobath concept and cognitive rehabilitation that applied at early stage after operation in
patient who have oligodendroglioma in temporoinsular area.
Method
24 years old female patient refered to Hacettepe University Department of Neurosurgery because
of headache. The patient who had oligodendrogliom in left temporal and insular area result of
radiological examination, had subtotal tumor excision. It was started Bobath concept and
cognitive rehabilitation in addition to medical treatment at post-op first day. We applied 20
rehabilitation seance 5 times a week and recorded the pre and post treatment results.
Effectiveness of treatment was evaluated with Stroke Rehabilitation Assessment of Movement,
Berg Balance Scale, Karnofsky Performance Scale, Functional Independent Measurement, Mini
Mental State Examination (MMSE), Montreal Cognitive Assessment (MOCA).
Results
We found that the patient had right side hemiparesis, hemianesthesia, loss of balance by the
measurements we used before the treatment. Patient could do the activities with help rotation
inside bed, sitting and walking and was not independent in daily life activities. Also, she had
problems with cognitive skills like orientation, memory and thinking about abstract objects. She
gained independence in daily life acitivities except bathing after the treatment. MMSE test score
increased from 17 to 28 and MOCA test score increased from 13 to 15 after the treatment.
Increasing scores are gotten from the attention and naming subgroups.
Conclusion
As a result, at early stage after operation, positive effect of the physiotheraphy and cognitive
rehabilitation revealed in patients with oligodenroglioma in addition to medical treatments. The
importance of cognitive rehabilitation in addition to physiotheraphy should be considered in these
patients. Further more studies are required in this field with increasing numbers of patients.
May 13 – 12:45 –17:00
WCNR-0229
BOARD NUMBER: 001
UPPER LIMB MOVEMENT PATTERNS IN CHRONIC STROKE PATIENTS
L. Awai1, B. Day1, N. Ward1
1UCL Institute of Neurology, Sobell Department of Motor Neuroscience and Movement Disorders,
London, United Kingdom
Aims
The inability to use the arm and hand properly is a common consequence after stroke. In routine
clinical practice this is quantified by using ordinal scales such as the Fugl-Meyer assessment or
the Action Research Arm Test. However, in order to deduce underlying mechanisms of
impairment and recovery from movement behavior, more detailed analyses of the latter are
required.
Method
The movements of chronic stroke patients were studied by analyzing detailed kinematic data of
simple and complex multi-joint upper limb movements in order to establish a comprehensive view
of motor control alterations following stroke. Patients were classified into distinct groups based on
their movement patterns and compared to clinical outcome levels.
Results
Chronic post-stroke patients suffering from upper limb movement deficits could be classified into
distinct groups of impairment that do not coincide with the clinical levels of deficits as measured
by ordinal scales such as the Fugl-Meyer Assessment or the Action Research Arm Test. Rather,
kinematic movement patterns consist of specific combinations of altered and preserved features
that may reveal the distinct impairment of underlying structures involved in upper limb motor
control.
Conclusion
Patients can be stratified into groups of upper limb impairment based on detailed analysis of arm
and hand movements. Measures of impairment assessed by clinical scores do not sufficiently
segregate patients according to their specific movement phenotype. A refined assessment and
classification of motor behavior may ameliorate patient-tailored therapy and allow a more precise
reflection of underlying mechanisms of impairment and recovery.
WCNR-0177
BOARD NUMBER: 002
DEVELOPMENT AND PSYCHOMETRIC EVALUATION OF THE NEUROMUSCULAR
DISEASE IMPACT PROFILE (NMDIP)
I. Bos1, J.B.M. Kuks1, K. Wynia2
1University Medical Center Groningen- University of Groningen., Department of Neurology,
2University Medical Center Groningen- University of Groningen.,
Department of Neurology and Health Sciences- Community and Occupational Health.,
Aims
Aim of this study was to develop a measurement instrument with a broad scope on the
consequences of Neuromuscular diseases (NMDs), and to examine the psychometric properties.
Method
We first developed a preliminary questionnaire based on a valid sample of categories selected
from the International Classification of Functioning, Disabilities, and Health (ICF), reflecting the
most relevant NMD-related disabilities. Next, data were obtained from a cross-sectional postal
survey among 702 patients (70% response rate) with a broad spectrum of NMDs representing the
four Rowland classification groups, and registered at the Department of Neurology of the
University Medical Center Groningen, the Netherlands. We finally determined the psychometric
properties using data from the preliminary questionnaire, and from concurrent generic-quality of
life and domain specific measurement instruments.
Results
The NMDIP-scales showed moderate to good internal consistency. Convergent and discriminant
validity analysis indicated that the NMDIP-scales measure the impact of NMDs on physical,
mental, and social functioning. The NMDIP-scales discriminated between groups who differ in
extent of limitations, showed sufficient stability, and satisfactory to strong Relative Validity. The
final version ICF- based NMDIP consists of 36 items divided into four single items and eight
scales and representing the ICF-domains for Body Functions, Activities and Participation, and
Environmental Factors.
Conclusion
The NMDIP showed satisfactory psychometric properties. The NMDIP seems to be a valid and
reliable measurement instrument to support and improve clinical care and research.
WCNR-0415
BOARD NUMBER: 003
THE ASSOCIATION BETWEEN HEMISPATIAL NEGLECT AND DELIRIUM IN RIGHT BRAIN
STROKE
O. Boukrina1, M. Oh-Park1, D. Thiagaram2, A.M. Barrett1
1Kessler Foundation, Stroke Rehabilitation Research, West Orange, USA
2New Jersey Medical School, Medicine, Newark, USA
Aims
Delirium is an acute reduction in cognitive functioning, affecting awareness, thinking, attention,
and memory. Delirium increases length of hospitalization and mortality, and hinders functional
improvements. While the incidence of delirium is about 20% in the hospitalized geriatric
population, it is markedly increased after right-brain stroke, with incidence of up to 50%. High risk
of delirium has been linked to spatial and perceptual disorders after right-hemisphere stroke. For
quality care after stroke, it is critical to understand and address this high risk of medical morbidity.
In this study, we hypothesized that presence of hemispatial neglect may be associated with
higher delirium risk.
Method
We report behavioral results in 5 right-hemisphere stroke survivors (2 females), aged 69.4 years
(SD=7.4), comprised of 1 chronic stroke participant without spatial neglect and 4 acute stroke
participants with detectable contralesional hemispatial neglect based on > 6.5 mm rightward bias
in line bisection; > 2 picture cancellation errors on the left and a score of > 5 on the Kessler
Foundation Neglect Assessment Process (KF-NAP) scale. Delirium was assessed in these
participants using the long form of Confusion Assessment Method (CAM), a patient interviewbased approach, which measures constructs, such as disorganized thinking, perceptual
disturbances, altered level of consciousness, memory, and inattention. CAM allows a binary
delirium diagnosis, as well as an assignment of a severity score along a delirium scale. Neglect
severity was measured using Behavioral Inattention Test (BIT).
Results
Supporting our hypothesis, we found that more severe scores on the CAM delirium scale were
associated with greater deficits, i.e., greater rightward bias, on a number of the BIT subsets,
including figure and shape copying (r=.64), line bisection (r=.62), and star cancellation (r=.61).
Conclusion
While these results are still preliminary, together with previous work, they point to a potentially
common neural mechanism underlying these conditions.
WCNR-0353
BOARD NUMBER: 004
IMPAIRED ABILITY TO SUSTAIN BALANCE PERTURBATIONS IN PEOPLE WITH CHRONIC
STROKE AND ITS ASSOCIATION WITH LEG AND TRUNK MOTOR FUNCTION
D. De Kam1, A. Heeren1, J. Roelofs1, A. Geurts1, V. Weerdesteyn1
1Radboud University Nijmegen Medical Centre, Rehabilitation 901, Nijmegen, Netherlands
Aims
To investigate impairments in the ability to sustain balance perturbations in people with stroke
and the relation of these impairments with leg and trunk motor scores.
Method
Eighty-one people after stroke (>6 months) and 46 healthy controls were included. To identify
maximum balance capacity, participants were subjected to translational perturbations on a
moveable platform in four directions (forward, backward, towards paretic and towards non-paretic
leg). For each direction, we iteratively determined the highest perturbation intensity that could be
sustained 1) without stepping (‘stepping threshold’) and 2) with a maximum of one step (‘limit of
stability’). We assessed leg and trunk motor function with the Fugl-Meyer Assessment (FMA),
Motricity Index (MI) and Tr

May 11 – 07:00-12:30 - 9th World Congress for NeuroRehabilitation

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