- Email: [email protected]
Forward Shoulder Posture Measurement Techniques and Physical Therapy HEP Intervention
Research Posters Research Poster 197 The Effects of Cognitive Rehabilitation on Occupational Performance of Stroke Patients Gonca Bumin (Hacettepe University), Gonca Bumin, Sema Akyalcin Research Objectives: To investigate the effects of cognitive rehabilitation on functional independence, quality of life and participation of stroke patients. Design: Randomized controlled trial. Setting: Institutional practice. Participants: 20 patients who have been diagnosed with having had stroke, were randomly divided into two groups, each including 10. Interventions: Patients in each group were treated with neurophysiological exercises and the subjects in Group 1(CRG) recieved cognitive rehabilitation additionally. All patients recieved therapy 3 days a week for 8 weeks. Main Outcome Measure(s): Outcome measures included Motricity Index, Tinetti Balance Evaluation Scale, Fugl-Meyer motor evaluation scale, Loweinstein Occupational Therapy Cognitive Assessment (LOTCA), Montreal Cognitive Assessment (MoCA), Canadian Occupational Performance Measure and Craig Handicap Assessment and Reporting Technique- Short Form, Short Form - 36 (SF - 36), Functional Independence Measure (FIM). Results: CRG’ s scores received at MoCA, LOTCA, CRAIG-SF and SFaˆV“36 were found statistically significant (p<0.05) when compared to control group. Conclusions: Cognitive rehabilitation has positive impact on community participation and quality of life of stroke patients. Key Words: stroke, cognitive therapy, occupational therapy, social participation Disclosures: None disclosed. Research Poster 199 Activity Based Restorative Therapy in Functional Paralysis: A Case Series Paige Bourne (Kennedy Krieger Institute), Meredith Budai, Janet Dean, Rebecca Martin Research Objectives: To describe the results of two patients with functional paralysis participating in an Activity Based Restorative Therapy (ABRT) program. Design: Case Series. Setting: Patients participated in outpatient physical therapy (PT) in a spinal cord injury clinic. Participants: Two adolescent females presented to an outpatient clinic for treatment of paralysis. Both patients had a history of hypermobility, postural orthostatic tachycardia, and illnesses which precipitated the onset of paralysis. Organic origins for paralysis were ruled out. Patient A had gradual onset of paraplegia over three years, was non-ambulatory, and was not attending school. Patient B had flaccid triplegia onset five months prior to evaluation. She was unable to maintain unsupported sitting or ambulate and was not attending school. Both patients previously received therapy services without significant improvements. Interventions: Patients received PT, OT, aquatic therapy, and psychology services for 3-4 months. PT utilized principles of ABRT including functional electrical stimulation, weight bearing, and locomotor training. Main Outcome Measure(s): Manual muscle testing (MMT), Spinal Cord Independence Measure (SCIM), Six Minute Walk Test, 10 Meter Walk Test, Berg Balance Test, Walking Index for Spinal Cord Injury (WISCI). Results: Each patient made significant improvements in strength and functional outcome measures. Both patients were unable to complete the 6 minute walk test at evaluation but both ambulated >1400 feet at follow up. Both patients initially scored 0/20 on the WISCI and improved to 19/20 and 20/20 at follow up. The patients were initially classified as a high fall risk on the Berg and progressed to the low fall risk category by follow up. Gains translated to increased independence and participation in the home, school, and community.
www.archives-pmr.org
e29 Conclusions: Patients with functional paralysis may benefit from intensive ABRT to address impairments and functional limitations. Key Words: Conversion Disorder, Physical Therapy Specialty, Rehabilitation Disclosures: None disclosed. Research Poster 201 The Effects of Activity Participation on Quality of Life in Children with Cerebral Palsy Gonca Bumin (Hacettepe University), Sema Akyalcın Research Objectives: To investigate the effects of activity participation on quality of life in children with cerebral palsy. Design: Randomised controlled trial. Setting: Referral rehabilitation center. Participants: 30 children with cerebral palsy (CP) and 60 typically developing children (TDC) participated in the study. Interventions: Not applicable. Main Outcome Measure(s): CAPE (Children’s Assessment of Participation and Enjoyment), PAC (Preferences for Activity of Children) and KidKINDL were used to assess activity participation, activity preferences and quality of life respectively. Results: When the children with CP compared to the TDC, it was seen that they participated in less number of activities, less frequently and more home based (p0.05), but in terms of social activity children with CP have showed more interest in choosing social activities compared to TDC (p<0.05). It has been observed that children with CP chose mostly the social activities and the least physical activities, Children with CP had lower points on physical well-being, family and friendship domains in quality of life (p<0.05). It has been observed that with the increasing level of enjoyment the quality of life has also increased in children with CP (rZ0.370). When looked at the relationship between the activity preferences and quality of life the children with CP showed higher quality of life when the points of the total activity preferences and social activity preferences increased (rZ0.536). Conclusions: Enjoyment and social activities showed positive effects on the quality of life in children with CP. It is being thought that children who are encouraged by occupational therapists towards appropriate activities seem to have positive effects on their social participation and quality of life. Key Words: Cerebral palsy, participation, activity, quality of life, Disclosures: None disclosed. Research Poster 202 Forward Shoulder Posture Measurement Techniques and Physical Therapy HEP Intervention Patricia Hodson (East Carolina University Dept of Physical Therapy), Jennifer Keith, Christopher Fightmaster Research Objectives: Reliability and validity of 4 measures of forward shoulder posture (FSP) were determined and a 6 week home program to improve FSP was examined. Design: FSP measurements were performed by 2 DPT students. Subjects stood in natural relaxed posture, arms at sides. Markers were placed on the C7 spinous process and bilaterally on the shoulder acromion process. Double Square, Sahrmann Technique, Measure of Scapular Position, and ImageJ Software analysis of photographs were performed in random order on each subject to measure FSP. Setting: Testing was conducted in a student laboratory. Participants: Thirty adult volunteers, male and female, were recruited by email and flyers to university Division of Health Sciences students, staff and faculty. These individuals worked for extended periods at computer stations or in the seated position. Interventions: Initial measurements were taken in all subjects. Treated subjects were given exercise instructions and logs for an exercise program consisting of six exercises to strengthen scapular retractors, and to increase
e30 flexibility of anterior chest muscles. Treated subjects returned at three weeks to have repeated measures taken and to receive instructions to increase repetitions. At six weeks treated and control subjects were measured again and the control subjects received exercise instructions. Main Outcome Measure(s): Double Square, Sahrmann, and Measure of Scapular Position had strong inter-rater reliability. ImageJ measures had wide variance. Shoulder postures improved at 3 weeks though differences were small. Gains were not significant at 6 weeks. Results: There was high inter-rater reliability for all measurements and there were small shoulder posture improvements within subjects. Conclusions: The Double Square, Sahrmann Technique, and Measure of Scapular Position were precise measures of FSP. The treatment intervention benefited many subjects but warrants further investigation. Key Words: Shoulder, Posture, Scapular strengthening Disclosures: None disclosed. Research Poster 204 Development of a Rehabilitation Planning Consult for Survivors of Head and Neck Cancer Sara McEwen (Sunnybrook Research Institute), Colleen Dunphy, Jorge Rios, Daniel Bishev, Andrew Lam, Ian Poon, Jolie Ringash Research Objectives: To develop and pre-test an interprofessional rehabilitation planning consult (RPC) for survivors of head and neck cancer (HNC). Design: A 6-step intervention mapping process is being used. Theoretical methods selection and pretesting using iterative single case studies are presented here. Setting: 2 regional cancer centers. Participants: Survivors of HNC who had completed cancer treatment within 12 months. Exclusion criteria were lack of English fluency, cognitive impairment, or concurrent conditions likely to cause functional deterioration. Interventions: RPC methods were selected to foster key contributors of self management: access to resources, positive relationships with clinicians, selfefficacy, and having cognitive skills such as goal setting and action planning. The RPC consists of an initial consult, a follow-up consult, and an online resource compendium (www.hncrehab.ca). During the RPC, priority rehabilitation needs are determined, goals are set, the survivor is taught a problem solving strategy, is introduced to resources, develops an action plan and a coping plan, and then executes and evaluates the plan. Main Outcome Measure(s): Participant perceptions, feasibility of delivery, and change scores in the Self Efficacy Gauge, Reintegration to Normal Living Index, and quality of life as measured by the FACT H&N and SF-36. Results: Twelve (12) cases were recruited, 9 started and 6 completed. The RPC was refined after each case to develop a final version. Participants found the RPC feasible and acceptable, indicating that it helped them to formulate a plan and gave them confidence to move forward. All completing participants had clinically significant changes in at least one indicator, with quality of life being the most promising. Conclusions: The refined RPC is feasible to use with HNC survivors. There is early evidence of an effect on quality of life. A larger trial is planned. Key Words: Head and neck neoplasms, rehabilitation, health behaviour, goals Disclosures: None disclosed. Research Poster 205 Astym Therapy Improves Function and Range of Motion Following Mastectomy Claire Davies (Baptist Health Lexington), Dorothy Brockopp, Krista Moe Research Objectives: Investigate effects of Astym treatment on activities of daily living for women who have undergone a mastectomy.
Research Posters Design: Specific intervention before and after case series. Setting: Community hospital-based outpatient physical therapy clinic. Participants: Convenience sample of 42 women referred for rehabilitation following mastectomy due to decreased flexibility in the shoulder, chest pain, or scar tissue tightness. Subjects had undergone unilateral or bilateral mastectomy with or without axillary dissection. Forty subjects participated in this study age 33-75 years, mean 52.0. Interventions: The protocol used in this study involved manual lymph drainage followed by Astym therapy which utilizes hand held instrumentation applied topically in gentle gliding strokes to locate and treat the underlying dysfunctional soft tissue through a specific mastectomy protocol. This was followed by specific therapeutic exercises and stretches. Treatment was twice a week and repeated up to 8 sessions over 4- 6 weeks. Main Outcome Measure(s): The main outcomes measures were; Disability of Arm, Shoulder and Hand score (DASH), clothing questionnaire, Patient-Specific Functional Scale (PSFS), AROM shoulder flexion and abduction, before and after a course of Astym therapy. Results: Mean number of Astym treatments were 6.7 (SD 1.8). All five measurement scores: DASH (p<0.01), the clothing questionnaire on the ability to wear a bra (p<0.01), PSFS (p<0.01), AROM shoulder flexion (p<0.01) and abduction (p<0.01) demonstrated significant and clinically meaningful differences in functional outcomes following Astym treatment. Mean improvements in the DASH, clothing questionnaire, and PSFS scores were 10, 4 and 2 respectively. Mean clinical improvement in AROM was 17 degrees flexion and 19 degrees abduction. Conclusions: Astym therapy improved involved shoulder ROM and function following mastectomy. Astym therapy may be an effective treatment option for rehabilitation providers to utilize when addressing complications from scar tissue and soft tissue dysfunction that often result from breast cancer treatment. Key Words: Breast neoplasm, manual therapy, quality of life Disclosures: Dr. Davies is an occasional Clinical Consultant to Performance Dynamics on Astym therapy applications in post-mastectomy patients. The authors have no other conflicts of interest to disclose. Funding: A small grant was provided by Performance Dynamics to Baptist Health Lexington to offset some of the direct costs it incurred by allowing the study to take place at this institution. Research Poster 209 Effectiveness of Specific Types of Post-Inpatient Brain Injury Rehabilitation Programs James Malec (PM&R, Indiana University School of Medicine & Rehabilitation Hospital of Indiana), Debra Braunling-McMorrow, April Groff, Joshua Oros Research Objectives: To examine the effectiveness and participant characteristics of 3 intensive post-inpatient brain rehabilitation (IR) program types compared to supported living services (SL). Design: Retrospective before/after observational study. Setting: Network of residential and outpatient that includes 8 facilities in 6 states in the U.S. Participants: Data from 253 individuals with acquired brain injury in IR programs and 79 individuals in SL programs. Interventions: IR programs, with the goal of achieving significant functional gains for participants, included Neurorehabilitation (nZ159), Neurobehavioral Rehabilitation (nZ56), and Day Treatment (nZ38). SL programs aimed to assist participants to maintain current status in the long term. Main Outcome Measure(s): Mayo-Portland Adaptability Inventory (MPAI-4). Results: Analysis of covariance (ANCOVA) controlling for admission score, age, and chronicity revealed significant differences between IR and SL programs on discharge/second assessment MPAI-4 Total Tscore (FZ64.061, p<.001), Ability Index (FZ59.660, p<.001), Adjustment Index (FZ30.355, p<.001) and Participation Index (FZ53.097, p<.001). IR program participants improved about 1
www.archives-pmr.org
www.archives-pmr.org
e29 Conclusions: Patients with functional paralysis may benefit from intensive ABRT to address impairments and functional limitations. Key Words: Conversion Disorder, Physical Therapy Specialty, Rehabilitation Disclosures: None disclosed. Research Poster 201 The Effects of Activity Participation on Quality of Life in Children with Cerebral Palsy Gonca Bumin (Hacettepe University), Sema Akyalcın Research Objectives: To investigate the effects of activity participation on quality of life in children with cerebral palsy. Design: Randomised controlled trial. Setting: Referral rehabilitation center. Participants: 30 children with cerebral palsy (CP) and 60 typically developing children (TDC) participated in the study. Interventions: Not applicable. Main Outcome Measure(s): CAPE (Children’s Assessment of Participation and Enjoyment), PAC (Preferences for Activity of Children) and KidKINDL were used to assess activity participation, activity preferences and quality of life respectively. Results: When the children with CP compared to the TDC, it was seen that they participated in less number of activities, less frequently and more home based (p0.05), but in terms of social activity children with CP have showed more interest in choosing social activities compared to TDC (p<0.05). It has been observed that children with CP chose mostly the social activities and the least physical activities, Children with CP had lower points on physical well-being, family and friendship domains in quality of life (p<0.05). It has been observed that with the increasing level of enjoyment the quality of life has also increased in children with CP (rZ0.370). When looked at the relationship between the activity preferences and quality of life the children with CP showed higher quality of life when the points of the total activity preferences and social activity preferences increased (rZ0.536). Conclusions: Enjoyment and social activities showed positive effects on the quality of life in children with CP. It is being thought that children who are encouraged by occupational therapists towards appropriate activities seem to have positive effects on their social participation and quality of life. Key Words: Cerebral palsy, participation, activity, quality of life, Disclosures: None disclosed. Research Poster 202 Forward Shoulder Posture Measurement Techniques and Physical Therapy HEP Intervention Patricia Hodson (East Carolina University Dept of Physical Therapy), Jennifer Keith, Christopher Fightmaster Research Objectives: Reliability and validity of 4 measures of forward shoulder posture (FSP) were determined and a 6 week home program to improve FSP was examined. Design: FSP measurements were performed by 2 DPT students. Subjects stood in natural relaxed posture, arms at sides. Markers were placed on the C7 spinous process and bilaterally on the shoulder acromion process. Double Square, Sahrmann Technique, Measure of Scapular Position, and ImageJ Software analysis of photographs were performed in random order on each subject to measure FSP. Setting: Testing was conducted in a student laboratory. Participants: Thirty adult volunteers, male and female, were recruited by email and flyers to university Division of Health Sciences students, staff and faculty. These individuals worked for extended periods at computer stations or in the seated position. Interventions: Initial measurements were taken in all subjects. Treated subjects were given exercise instructions and logs for an exercise program consisting of six exercises to strengthen scapular retractors, and to increase
e30 flexibility of anterior chest muscles. Treated subjects returned at three weeks to have repeated measures taken and to receive instructions to increase repetitions. At six weeks treated and control subjects were measured again and the control subjects received exercise instructions. Main Outcome Measure(s): Double Square, Sahrmann, and Measure of Scapular Position had strong inter-rater reliability. ImageJ measures had wide variance. Shoulder postures improved at 3 weeks though differences were small. Gains were not significant at 6 weeks. Results: There was high inter-rater reliability for all measurements and there were small shoulder posture improvements within subjects. Conclusions: The Double Square, Sahrmann Technique, and Measure of Scapular Position were precise measures of FSP. The treatment intervention benefited many subjects but warrants further investigation. Key Words: Shoulder, Posture, Scapular strengthening Disclosures: None disclosed. Research Poster 204 Development of a Rehabilitation Planning Consult for Survivors of Head and Neck Cancer Sara McEwen (Sunnybrook Research Institute), Colleen Dunphy, Jorge Rios, Daniel Bishev, Andrew Lam, Ian Poon, Jolie Ringash Research Objectives: To develop and pre-test an interprofessional rehabilitation planning consult (RPC) for survivors of head and neck cancer (HNC). Design: A 6-step intervention mapping process is being used. Theoretical methods selection and pretesting using iterative single case studies are presented here. Setting: 2 regional cancer centers. Participants: Survivors of HNC who had completed cancer treatment within 12 months. Exclusion criteria were lack of English fluency, cognitive impairment, or concurrent conditions likely to cause functional deterioration. Interventions: RPC methods were selected to foster key contributors of self management: access to resources, positive relationships with clinicians, selfefficacy, and having cognitive skills such as goal setting and action planning. The RPC consists of an initial consult, a follow-up consult, and an online resource compendium (www.hncrehab.ca). During the RPC, priority rehabilitation needs are determined, goals are set, the survivor is taught a problem solving strategy, is introduced to resources, develops an action plan and a coping plan, and then executes and evaluates the plan. Main Outcome Measure(s): Participant perceptions, feasibility of delivery, and change scores in the Self Efficacy Gauge, Reintegration to Normal Living Index, and quality of life as measured by the FACT H&N and SF-36. Results: Twelve (12) cases were recruited, 9 started and 6 completed. The RPC was refined after each case to develop a final version. Participants found the RPC feasible and acceptable, indicating that it helped them to formulate a plan and gave them confidence to move forward. All completing participants had clinically significant changes in at least one indicator, with quality of life being the most promising. Conclusions: The refined RPC is feasible to use with HNC survivors. There is early evidence of an effect on quality of life. A larger trial is planned. Key Words: Head and neck neoplasms, rehabilitation, health behaviour, goals Disclosures: None disclosed. Research Poster 205 Astym Therapy Improves Function and Range of Motion Following Mastectomy Claire Davies (Baptist Health Lexington), Dorothy Brockopp, Krista Moe Research Objectives: Investigate effects of Astym treatment on activities of daily living for women who have undergone a mastectomy.
Research Posters Design: Specific intervention before and after case series. Setting: Community hospital-based outpatient physical therapy clinic. Participants: Convenience sample of 42 women referred for rehabilitation following mastectomy due to decreased flexibility in the shoulder, chest pain, or scar tissue tightness. Subjects had undergone unilateral or bilateral mastectomy with or without axillary dissection. Forty subjects participated in this study age 33-75 years, mean 52.0. Interventions: The protocol used in this study involved manual lymph drainage followed by Astym therapy which utilizes hand held instrumentation applied topically in gentle gliding strokes to locate and treat the underlying dysfunctional soft tissue through a specific mastectomy protocol. This was followed by specific therapeutic exercises and stretches. Treatment was twice a week and repeated up to 8 sessions over 4- 6 weeks. Main Outcome Measure(s): The main outcomes measures were; Disability of Arm, Shoulder and Hand score (DASH), clothing questionnaire, Patient-Specific Functional Scale (PSFS), AROM shoulder flexion and abduction, before and after a course of Astym therapy. Results: Mean number of Astym treatments were 6.7 (SD 1.8). All five measurement scores: DASH (p<0.01), the clothing questionnaire on the ability to wear a bra (p<0.01), PSFS (p<0.01), AROM shoulder flexion (p<0.01) and abduction (p<0.01) demonstrated significant and clinically meaningful differences in functional outcomes following Astym treatment. Mean improvements in the DASH, clothing questionnaire, and PSFS scores were 10, 4 and 2 respectively. Mean clinical improvement in AROM was 17 degrees flexion and 19 degrees abduction. Conclusions: Astym therapy improved involved shoulder ROM and function following mastectomy. Astym therapy may be an effective treatment option for rehabilitation providers to utilize when addressing complications from scar tissue and soft tissue dysfunction that often result from breast cancer treatment. Key Words: Breast neoplasm, manual therapy, quality of life Disclosures: Dr. Davies is an occasional Clinical Consultant to Performance Dynamics on Astym therapy applications in post-mastectomy patients. The authors have no other conflicts of interest to disclose. Funding: A small grant was provided by Performance Dynamics to Baptist Health Lexington to offset some of the direct costs it incurred by allowing the study to take place at this institution. Research Poster 209 Effectiveness of Specific Types of Post-Inpatient Brain Injury Rehabilitation Programs James Malec (PM&R, Indiana University School of Medicine & Rehabilitation Hospital of Indiana), Debra Braunling-McMorrow, April Groff, Joshua Oros Research Objectives: To examine the effectiveness and participant characteristics of 3 intensive post-inpatient brain rehabilitation (IR) program types compared to supported living services (SL). Design: Retrospective before/after observational study. Setting: Network of residential and outpatient that includes 8 facilities in 6 states in the U.S. Participants: Data from 253 individuals with acquired brain injury in IR programs and 79 individuals in SL programs. Interventions: IR programs, with the goal of achieving significant functional gains for participants, included Neurorehabilitation (nZ159), Neurobehavioral Rehabilitation (nZ56), and Day Treatment (nZ38). SL programs aimed to assist participants to maintain current status in the long term. Main Outcome Measure(s): Mayo-Portland Adaptability Inventory (MPAI-4). Results: Analysis of covariance (ANCOVA) controlling for admission score, age, and chronicity revealed significant differences between IR and SL programs on discharge/second assessment MPAI-4 Total Tscore (FZ64.061, p<.001), Ability Index (FZ59.660, p<.001), Adjustment Index (FZ30.355, p<.001) and Participation Index (FZ53.097, p<.001). IR program participants improved about 1
www.archives-pmr.org