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Leveraging the Electronic Medical Record to Identify Children with Cerebral Palsy Based on Function
Research Posters explore the component motor skills that can become a focus of rehabilitation. Key Words: Brain injury, Supervision, Transfers Disclosure(s): None Disclosed. Research Poster 3975 Effect of Bladder Dysfunction on Disability and Community Participation in Individuals with Traumatic Brain Injury (TBI) Giselle Vivaldi, Anthony Lequerica, Irene Ward, Neil Jasey, Denise Krch (Kessler Institute for Rehabilitation), Nancy D. Chiaravalloti Objective(s): To examine the relationship between bladder dysfunction and disability and community participation in persons with TBI. Design: Observational cohort study using prospectively collected data from a TBI Model Systems center (Northern New Jersey Traumatic Brain Injury System). Setting: Acute Inpatient Rehabilitation Hospital. Participants: Patients admitted with moderate or severe TBI (NZ258). Mean age was 55-years-old. Approximately 33.7 % of the sample was female. All participants provided informed consent in accordance with an Institutional Review Board. Interventions: N/A. Main Outcome Measure(s): FIMTM, Participation Assessment with Recombined Tools (PART), Disability Rating Scale (DRS), Traumatic Brain Injury Quality of Life (TBI-QOL), Patient Health Questionnaire9(PHQ-9) and General Anxiety Disorder (GAD-7). Results: Of the 258 cases identified, 255(98.8%) had bladder dysfunction on rehabilitation admission. By discharge, the number of patients with bladder dysfunction was 211(81.8%), and 78(30.2%) continued to have bladder dysfunction one year post-injury. Individuals with bladder dysfunction at discharge were significantly older in age (p<0.001), had higher DRS scores at discharge (p<0.001), and significantly lower PART scores at one year post injury. Logistic regression showed that those with bladder accidents at the time of discharge were more than 3 times more likely not to be in a private residence at one year post injury. Those who continued to have bladder dysfunction at one-year follow-up had significantly higher scores on measures of depression (pZ0.009) and anxiety (pZ0.019). Conclusions: Almost all inpatients in this sample had bladder dysfunction upon admission to acute rehabilitation. At discharge, bladder dysfunction was associated with higher levels of disability, and was predictive of community participation one year post-injury. Future studies should examine the various causes of bladder dysfunction so that effective interventions can be prescribed to mitigate these effects. For those who continue to have bladder dysfunction, additional research should investigate environmental barriers that preclude community participation. Key Words: Brain injury, Bladder dysfunction, Community participation Disclosure(s): None Disclosed. Research Poster 3976 Implementing Training Resources across Educational Contexts and Domains: A Pilot Study Jason H. Raad (Department of Veterans Affairs, Edward Hines, Jr. Hospital), Linda Ehrlich-Jones, Allen Heinemann Objective(s): Describe how training resources are utilized by allied health clinicians. Design: Survey Research. Setting: Educational organizations and contexts. Participants: 98 participants provided feedback. Interventions: A set of four training modules designed to promote the implementation and sustained use of clinical assessments were developed as part of a training effort funded by the Department of Education (NIDRR grant number H133B090024, PI: Allen Heinemann, PhD). The modules are available on the Rehabilitation Measures Database. This current analysis is based on user feedback collected between November 2014 and February 2015.
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e97 Main Outcome Measure(s): Self-reported demographic information and usage characteristics. Two scales, Instrumental Instruction (II) and Experiential Learning (EL) based on Gasha’s 1998 Teaching Styles Survey were assessed against perceptions regarding the effectiveness of the training modules. Results: The modules were predominately utilized by allied health professionals (PT’s Z 40, OT’s Z 27), in academic (n Z 50) or clinical settings (n Z 16). A majority of respondents used these modules in a classroom setting (n Z 25); however, a significant proportion of respondents reported using these modules as self-study aids (NZx). Participants were asked to rate the effectiveness of the modules on a 5-point scale that ranged from reported Excellent (5) to Poor (1). Most participants found the modules to be effective (M Z 4.51, SD Z 0.79). Ratings of effectiveness were then regressed on the II and EL scales. Only the EL scale approached significance (b Z .24, p Z .066), accounting for approximately 9% of the variance. Conclusions: Flexible and modifiable educational resources may be effective in graduate and in-service educational contexts. Further research is needed to determine which contexts benefit most from these resources and how teaching styles may moderate their effectiveness. Key Words: Clinical Education, Outcomes measurement, Training resources Disclosure(s): None Disclosed.
Research Poster 3978 Leveraging the Electronic Medical Record to Identify Children with Cerebral Palsy Based on Function John Charles Luce (Children’s Mercy Hospital), Matthew J. McLaughlin, Matthew Mayer Objective(s): To create and implement an electronic medical record (EMR) documentation system for classifying children with cerebral palsy (CP) based on key functional metrics. Design: Prospective cross-sectional study. Setting: Tertiary care pediatric hospital rehabilitation medicine clinic. Participants: Over 22 months, 518 unique patients with CP were categorized based on function. Interventions: An order set was created for the EMR to record information regarding function as well as other characteristics for children with CP. Once orders were placed, the EMR could be used to identify important de-identified information pertinent to clinical care and future CP research. Main Outcome Measure(s): Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS). Results: 518, 329 and 317 patients were categorized based on gross motor, fine motor and communication function, respectively. Children with the most severe functional impairment were the largest cohort seen in clinic and also incurred the longest inpatient hospitalizations. The most common GMFCS level was V with 164 (31.7%) children. Similarly, the most common MACS level was V with 97 (29.5%) children, and the most common CFCS level was V with 110 (34.7%) children. Additional metrics related to topography, type of movement disorder, frequency of clinic and emergency department visits, and length of hospital admissions were also collected. Conclusions: This EMR documentation system provides a successful way to establish a database for children with CP based on function. This database will serve as a strong foundation for future interventions. Key Words: Cerebral palsy, Pediatrics, Medical records Disclosure(s): None Disclosed. Research Poster 3979 Executive Functioning in Traumatic Brain Injury: A Detailed Investigation of the Hayling Test Matthew John Kmiecik (Center for BrainHealth), Daniel Krawczyk, Sandi Chapman
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e97 Main Outcome Measure(s): Self-reported demographic information and usage characteristics. Two scales, Instrumental Instruction (II) and Experiential Learning (EL) based on Gasha’s 1998 Teaching Styles Survey were assessed against perceptions regarding the effectiveness of the training modules. Results: The modules were predominately utilized by allied health professionals (PT’s Z 40, OT’s Z 27), in academic (n Z 50) or clinical settings (n Z 16). A majority of respondents used these modules in a classroom setting (n Z 25); however, a significant proportion of respondents reported using these modules as self-study aids (NZx). Participants were asked to rate the effectiveness of the modules on a 5-point scale that ranged from reported Excellent (5) to Poor (1). Most participants found the modules to be effective (M Z 4.51, SD Z 0.79). Ratings of effectiveness were then regressed on the II and EL scales. Only the EL scale approached significance (b Z .24, p Z .066), accounting for approximately 9% of the variance. Conclusions: Flexible and modifiable educational resources may be effective in graduate and in-service educational contexts. Further research is needed to determine which contexts benefit most from these resources and how teaching styles may moderate their effectiveness. Key Words: Clinical Education, Outcomes measurement, Training resources Disclosure(s): None Disclosed.
Research Poster 3978 Leveraging the Electronic Medical Record to Identify Children with Cerebral Palsy Based on Function John Charles Luce (Children’s Mercy Hospital), Matthew J. McLaughlin, Matthew Mayer Objective(s): To create and implement an electronic medical record (EMR) documentation system for classifying children with cerebral palsy (CP) based on key functional metrics. Design: Prospective cross-sectional study. Setting: Tertiary care pediatric hospital rehabilitation medicine clinic. Participants: Over 22 months, 518 unique patients with CP were categorized based on function. Interventions: An order set was created for the EMR to record information regarding function as well as other characteristics for children with CP. Once orders were placed, the EMR could be used to identify important de-identified information pertinent to clinical care and future CP research. Main Outcome Measure(s): Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS). Results: 518, 329 and 317 patients were categorized based on gross motor, fine motor and communication function, respectively. Children with the most severe functional impairment were the largest cohort seen in clinic and also incurred the longest inpatient hospitalizations. The most common GMFCS level was V with 164 (31.7%) children. Similarly, the most common MACS level was V with 97 (29.5%) children, and the most common CFCS level was V with 110 (34.7%) children. Additional metrics related to topography, type of movement disorder, frequency of clinic and emergency department visits, and length of hospital admissions were also collected. Conclusions: This EMR documentation system provides a successful way to establish a database for children with CP based on function. This database will serve as a strong foundation for future interventions. Key Words: Cerebral palsy, Pediatrics, Medical records Disclosure(s): None Disclosed. Research Poster 3979 Executive Functioning in Traumatic Brain Injury: A Detailed Investigation of the Hayling Test Matthew John Kmiecik (Center for BrainHealth), Daniel Krawczyk, Sandi Chapman