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Long-term Functional Outcomes Related to Age at Injury and Access to Treatment in Adults With Severe Brain Injuries
e68 Conclusions: In general, the longer the ICU stay and the more severe the injury, the longer to TTM. PT was not associated with a reduced TTM unless the patient received the order for PT after moving from the ICU to the floor. Key Words: Rehabilitation, acute care, motor vehicle accident, intensive care unit Disclosures: None disclosed. Research Poster 454 Long-term Functional Outcomes Related to Age at Injury and Access to Treatment in Adults With Severe Brain Injuries Josie Turbach (ResCare Premier), Dawn Good Research Objectives: This study examines the long-term trends in recovery for adults with catastrophic Acquired Brain Injury (ABI). Design: Long-term functional measures (over 16 years) are collected on a daily basis on adults living with the permanent effects of a severe ABI. Individualized goals permit examination of recovery trajectories. Setting: The participants live(d) in residences with others. They receive(d) ongoing neurorehabilitation support 24/7 by trained ABI staff. Participants: Participants include 36 adults who have sustained a catastrophic ABI (M GCSZ3.6; SDZ1.4) receiving rehabilitation for 1 to 16 years assessed in terms of age-at-injury, years-postinjury-to-treatment. Interventions: The neurobehavioural learning environment permits treatment as a continuous process and includes a variety of therapies that target multiple domains within a supported living, (a)vocational and social setting. Main Outcome Measure(s): Each participant’s contribution is derived from his/her Individual Development Plan in the domains of: Cognitive Abilities, Social Engagement, Emotional Behaviour, and Basic Activities of Daily Living. For each, a representative objective was selected to facilitate maximal coherence of measurement. Results: Continued, but conservative, gains are evident across time in 3 of the 4 domains (Emotional Behaviour, Social Engagement, and Cognition). Improvement trends of gains are evident for various age-at-injury groups, however 15-19 year olds were among the least successful across the four measures (R2Z 0.0 to 0.14), and the >50 were among the most effective for 3 measures (R2Z 0.21 to 0.70; not so for cognition, R2Z 0.01). Improvement trends were greatest for those with earlier access to rehabilitation (R2Z 0.50 to 0.18 for emotion; R2Z 0.30 to 0.06 for cognition) despite age-at-injury. Conclusions: Improvements in independence and reintegration are evident over time and are influenced by both the person’s age-at-injury, but also the age-of-injury at time of rehabilitation. Key Words: Traumatic Brain Injury, Recovery of Function, Age Factors Disclosures: Josie Turbach is a Program Director with ResCare Premier’s residential facility. Dr. Dawn Good is a tenured professor at Brock University. Research Poster 455 Cerebral FDG-PET Findings in Patients with Traumatic Disorders of Consciousness: Preliminary Results of a Pilot Study Maria Julieta Russo (FLENI), Lisandro Olmos, Silvia Va´zquez, Leandro Urrutia, Germa´n Falasco, Fernando Salierno, Lucas Bonamico, Melania Ron Research Objectives: The basic diagnostic evaluation for differentiating unresponsive wakefulness syndrome (UWS) from minimally conscious state (MCS) consists of a standardized clinical examination. However, the rate of misdiagnosis is high. 18F-fluorodeoxyglucosepositron emission tomography (FDG-PET) may help to establish the diagnosis. Objective: To describe patterns of cerebral metabolism on FDG-PET in patients with UWS or MCS. Design: Case series.
Research Posters Setting: Prospective study involving all patients with TBI admitted to a neurorehabilitation department of a tertiary hospital. Participants: A convenience sample of 10 patients, who were diagnosed with UWS (nZ8) or MCS (nZ2) with traumatic causes were included. Interventions: FDG-PET images in the resting state were obtained from all participants . All scans were analyzed by 2 nuclear medicine physicians, blinded to the clinical data of the patients. Main Outcome Measure(s): Based on the concentration of activity of FDG, the degree of cortical metabolism was determined. Results: At the present time 10 patients were registered into the study. Their age ranged from 18 to 71 years old. Seven were men. The mean interval between TBI and PET scan was 10.7 (SD) months. Overall, 100% of participants exhibited a consistent pattern of global hypometabolism in supratentorial structures, 50% showed a global hypometabolism in infratentorial structures, and 50% showed crossed cerebellar diaschisis. Only 2 patients showed thalamic unilateral hypometabolism. FDG-PET hypermetabolism was demonstrated in 4 cases. Two of those subjects exhibited relative hypermetabolism in the superior temporal cortex; in one subject, hypermetabolism was exclusively located in right supplementary motor cortex and in the other one, left hippocampal structure showed higher activity compared to the rest. Conclusions: Traumatic disorders of consciousness frequently manifests as FDG-PET hypometabolism, but focal hypermetabolism can also be observed. Cerebral FDG PET may to aid the clinical diagnosis. However, it should be tested in a large sample and in combination with other potential biomarkers. Key Words: Disorders of consciousness, traumatic brain injury, FDG-PET Disclosures: None disclosed. Research Poster 458 Voluntary Lateral Stepping in Community-Dwelling Stroke Survivors and Age-Matched Control Participants Lois Hedman (Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University Medical School), Kristin Horn, Meredith Krifka, Melissa Sayranian, Mengnan (Mary) Wu, Lara Martin Research Objectives: To characterize differences in voluntary lateral stepping in community-dwelling stroke survivors and age-matched control participants and determine differences in paretic and non-paretic stepping. Design: Descriptive. Setting: Academic. Participants: Four participants post-stroke were selected by convenience from a research registry. Subjects were at least 18 years old, 3 months poststroke, community-dwelling, able to understand instructions and walk 10 steps independently without an assistive device, and had no musculoskeletal or other neurological disorders. Two age-matched control subjects were selected by convenience from the academic community. All participants provided written consent per the institution’s Institutional Review Board. Interventions: Not Applicable. Main Outcome Measure(s): The vertical ground reaction forces for each foot and total center of pressure (COP) were measured while participants stood on 2 force platforms. They equalized weight distribution over both sides and received a visual signal to step laterally, 5 times per side. Mean stepping limb preload onset and peak times, unloading time, and subsequent loading time; stance limb peak loading time; and preload peak COP displacement were identified. Results: Stepping limb preload was present in all paretic stepping trials but not in any non-paretic stepping or healthy control stepping trials. COP was displaced significantly towards the stepping limb during paretic stepping but not during non-paretic stepping (p Z 0.007; t test) or age-matched control stepping. Paretic leg step time was significantly greater than nonparetic stepping time. (p Z 0.012; ANOVA). Conclusions: The COP shift towards the stepping limb and stepping limb preload prior to paretic leg stepping may represent a more cautious strategy (Sparto, 2014) for community-dwelling stroke survivors and contrasts with the strategy demonstrated during non-paretic and agematched control lateral stepping.
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Research Posters Setting: Prospective study involving all patients with TBI admitted to a neurorehabilitation department of a tertiary hospital. Participants: A convenience sample of 10 patients, who were diagnosed with UWS (nZ8) or MCS (nZ2) with traumatic causes were included. Interventions: FDG-PET images in the resting state were obtained from all participants . All scans were analyzed by 2 nuclear medicine physicians, blinded to the clinical data of the patients. Main Outcome Measure(s): Based on the concentration of activity of FDG, the degree of cortical metabolism was determined. Results: At the present time 10 patients were registered into the study. Their age ranged from 18 to 71 years old. Seven were men. The mean interval between TBI and PET scan was 10.7 (SD) months. Overall, 100% of participants exhibited a consistent pattern of global hypometabolism in supratentorial structures, 50% showed a global hypometabolism in infratentorial structures, and 50% showed crossed cerebellar diaschisis. Only 2 patients showed thalamic unilateral hypometabolism. FDG-PET hypermetabolism was demonstrated in 4 cases. Two of those subjects exhibited relative hypermetabolism in the superior temporal cortex; in one subject, hypermetabolism was exclusively located in right supplementary motor cortex and in the other one, left hippocampal structure showed higher activity compared to the rest. Conclusions: Traumatic disorders of consciousness frequently manifests as FDG-PET hypometabolism, but focal hypermetabolism can also be observed. Cerebral FDG PET may to aid the clinical diagnosis. However, it should be tested in a large sample and in combination with other potential biomarkers. Key Words: Disorders of consciousness, traumatic brain injury, FDG-PET Disclosures: None disclosed. Research Poster 458 Voluntary Lateral Stepping in Community-Dwelling Stroke Survivors and Age-Matched Control Participants Lois Hedman (Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University Medical School), Kristin Horn, Meredith Krifka, Melissa Sayranian, Mengnan (Mary) Wu, Lara Martin Research Objectives: To characterize differences in voluntary lateral stepping in community-dwelling stroke survivors and age-matched control participants and determine differences in paretic and non-paretic stepping. Design: Descriptive. Setting: Academic. Participants: Four participants post-stroke were selected by convenience from a research registry. Subjects were at least 18 years old, 3 months poststroke, community-dwelling, able to understand instructions and walk 10 steps independently without an assistive device, and had no musculoskeletal or other neurological disorders. Two age-matched control subjects were selected by convenience from the academic community. All participants provided written consent per the institution’s Institutional Review Board. Interventions: Not Applicable. Main Outcome Measure(s): The vertical ground reaction forces for each foot and total center of pressure (COP) were measured while participants stood on 2 force platforms. They equalized weight distribution over both sides and received a visual signal to step laterally, 5 times per side. Mean stepping limb preload onset and peak times, unloading time, and subsequent loading time; stance limb peak loading time; and preload peak COP displacement were identified. Results: Stepping limb preload was present in all paretic stepping trials but not in any non-paretic stepping or healthy control stepping trials. COP was displaced significantly towards the stepping limb during paretic stepping but not during non-paretic stepping (p Z 0.007; t test) or age-matched control stepping. Paretic leg step time was significantly greater than nonparetic stepping time. (p Z 0.012; ANOVA). Conclusions: The COP shift towards the stepping limb and stepping limb preload prior to paretic leg stepping may represent a more cautious strategy (Sparto, 2014) for community-dwelling stroke survivors and contrasts with the strategy demonstrated during non-paretic and agematched control lateral stepping.
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