Poster 13

A7 Poster 7 Shoulder Impingement Syndrome: Clinical Indicators and Short-Term Predictors of Disability. Luc J. He´ bert, PhD, PT (National Defence and Laval University, Quebec City, QC, Canada); He´ le`ne Moffet, PhD, PT; Clermont E. Dionne, PhD, OT; Bradford J. McFadyen, PhD; Marie Dufour, MD; Richard Lirette, MD. Disclosures: None declared. Objective: To identify the best indicators of the current disability of patients with shoulder impingement syndrome (SIS) and the strongest predictors of 3-month SIS-related disability. Design: Prospective cohort study. Setting: Movement analysis laboratory. Participants: 41 subjects with SIS. Interventions: Evaluations at baseline and at 3 months. Main Outcome Measures: Personal, occupational, and impairment variables and the Shoulder Pain and Disability Index (SPADI). Cross-sectional explicative and 3-month predictive regression models of the level of disability (SPADI score) were developed using multivariate analyses. Results: Strength deficits in shoulder abduction-lateral rotation, pain during muscle strength testing, painful arc in abduction, scapular anterior tilting asymmetry, gender, and age explained 91% of the variance of the SPADI at baseline. The SPADI score at baseline, perceived work capacity, acromiohumeral distance at 90° of abduction, acromiohumeral distance difference between shoulders at 110° of flexion, difference between active and passive range of motion in abduction, and the presence of SIS on the dominant side predicted 86% of the variance of the SPADI at 3 months. Conclusions: Variables that best explain the current disability level and predictors of short-term level of disability should be considered in SIS treatment planning as well as for establishing prognosis. Key Words: Disabled persons; Rehabilitation; Shoulder.

Poster 8 Emotion Processing in the Minimally Conscious State Studied by Functional Magnetic Resonance Imaging. Lisandro Olmos, MD (FLENI Escobar Rehabilitation Centre, Buenos Aires, Argentina); Tristan Bekinschtein, PhD; Silvia Vazquez, MD; Ramon Leiguarda, MD; Facundo Manes, MD. Disclosures: None declared. Setting: Rehabilitation center in Argentina. Patient: A 16-year-old man with severe traumatic brain injury who was in a minimally conscious state. Case Description: We measured the effect of his mother’s voice versus nonfamiliar voice recognition using functional magnetic resonance imaging (fMRI). We established an experimental control by removing the phrases read by the age-matched voice from silence. Assessment/Results: Removing the mother’s phrases from the age-matched voice phrases revealed strong activation of the amygdala and insula, spreading to the inferior frontal gyrus; there was also weaker activation of the transverse temporal gyrus, temporal operculum, and planum temporale. Discussion: These results provide the first anatomic evidence for a response by a patient in a minimally conscious state to a familiar voice. The amygdala and insula appear to play a major role in this response. Conclusions: Whether functional imaging represents a reliable method to evaluate neural processing in patients in a minimally conscious state remains to be seen. Key words: Magnetic resonance imaging; Minimally conscious state; Rehabilitation.

Poster 9 Motivating, Game-Based Stroke Rehabilitation: A Pilot Study. Susie R. Wood, MS, OTR (Cabrillo College Stroke Center, Apta, CA); Narda Murillo, RPT; Paul Bach-y-Rita, MD; Ron S. Leder, PhD; Jaclyn T. Marks, BS; Stephen J. Page, PhD. Disclosures: None declared. Objective: To determine the efficacy and reactions of stroke patient to a game-based rehabilitation modality for more affected upper limbs. Design: Case series. Setting: Outpatient rehabilitation clinic. Participants: 4 persons with stroke (3 men; mean age, 60.0⫾4.9y; age range, 56 – 66y; mean time since stroke, 84.3mo; range, 10 –264mo). Interventions: Each patient received thirteen 30-minute training sessions using the gaming device. Each session required participation in electronic table tennis using the more affected hand as the joystick, thus forcing use of the more affected limb. Instantaneous kinesthetic and force feedback was available via participation. Main Outcome Measures: Wolf Motor Function Test (WMFT) and patient interviews before and after intervention. Results: After the intervention, patients exhibited decreased median time to complete WMFT tasks (–5.3s), decreased mean time to perform WMFT tasks (–19.7s), and improved performance ratings as assessed by an objective rater. Interviews revealed high satisfaction and motivation; they also revealed that motor improvement had a high carryover to valued activities. Conclusions: This approach appears to be an efficacious, motivating, and enjoyable modality deserving of additional research. A larger, multicenter trial is planned. Key Words: Hemiplegia; Rehabilitation; Stroke.

Poster 10 Activity-Related Quality of Life: Activities and Personal Feelings About Them in the First Year After Traumatic Brain Injury. Mark V. Johnston, PhD (Kessler Medical Rehabilitation Research & Education Corp, West Orange, NJ); Yael Goverover, PhD, OT. Disclosures: None declared. Objective: To investigate relationships between community activities and feelings about specific activities, desires to change them, and global life satisfaction. Design: Observational study with follow-up 1 month after rehabilitation discharge and 12 months postinjury. Setting: Community. Participants: 144 adult survivors of serious traumatic brain injury. Interventions: Not applicable. Main Outcome Measures: Community Integration Questionnaire–2, augmented by individuals’ ratings of satisfaction and dissatisfaction, desire to change each activity, and the Diener Life Satisfaction Scale. Results: Although significant correlations were found for some items, most correlations between objective activities and subjective ratings of quality of life (QOL) were low and nonsignificant. Subjects generally reported that they were satisfied with their activities, but there were exceptions (eg, work situation). Correlations between activity-specific satisfaction and general life satisfaction were also weak and generally nonsignificant. Activity-specific satisfaction correlated robustly with subjects’ desires to change them, but general life satisfaction did not. Conclu-

sions: The lack of association between objective activities and subjective appraisals of them is a challenge to outcomes measurement and has implications for the targeting of rehabilitative interventions and evaluation of their worth. More research is needed to understand how individualizing functional objectives and gains might maximize likely effects on the QOL of persons served. Key Words: Brain Injuries; Rehabilitation.

Poster 11 Increasing Substance Use Disorder Treatment Compliance for Persons With Traumatic Brain Injury. Jennifer A. Bogner, PhD (Ohio State University); Allen W. Heinemann, PhD; John D. Corrigan, PhD; Dennis Moore, EdD. Disclosures: None declared. Objective: To compare the effectiveness of 3 interventions for increasing compliance during the initial phase of substance use disorder treatment. Design: Randomized controlled trial. Setting: 2 community-based programs for persons diagnosed with traumatic brain injury (TBI) and substance use disorder. Participants: 195 new clients (n⫽124, n⫽71) of 2 programs. Participants were randomly assigned to 1 of 4 treatment conditions, and stratified by race, gender, facility, and interviewer. Interventions: Reduction of logistical barriers to attending appointments; brief motivational interviewing to increase motivation for treatment; provision of financial incentives to participate in treatment; and attention control. Main Outcome Measures: Signed Individualized Service Plan (ISP) within 30 days of intake. Secondary outcomes included days to signing the ISP, premature termination, and missed appointments. Results: The sample was comprised of 70% men, and 31% of participants were of minority status. TBI onset occurred an average of 8 years before study entry. The barrier reduction and financial incentive interventions resulted in higher rates of signing the ISP within 30 days (P⬍.001). Significant differences between conditions were also found for days to signing ISP and premature termination. Conclusions: Initial participation in treatment can be improved by reducing barriers to participation or by providing financial incentives. Key Words: Brain injuries; Rehabilitation; Substance abuse.

Poster 12 Stay Well and Healthy! An In-home Preventive Health Care Program for Persons Aging With Developmental Disability. Harriet U. Aronow, PhD (Casa Colina Centers for Rehabilitation, Pomona, CA); Joan Earle Hahn, DNSc, RN, CDDN, CS. Disclosures: None declared. Objective: To pilot an intervention to prevent functional decline and health problems among persons with intellectual and developmental disability aging in the community. Design: Pilot for a large randomized trial. Setting: Private residences and group homes. Participants: 201 adults with intellectual and developmental disability, aged 32 years and older, were randomly assigned to an advance practice nurse (APN) intervention (n⫽101) or health-risk appraisal and feedback only (HRA) intervention (n⫽100). Interventions: The APN group received in-home multidimensional assessment, targeted recommendations, and quarterly follow-up visits for up to 1 year. The HRA group received an in-home interview with written feedback. Main Outcome Measures: Health, functional status, and risks; use of acute medical services; and feasibility assessment. Results: Assessment tools and interventions were demonstrated to be feasible in a population with mild to moderate intellectual and developmental disability. Recruitment and randomization were successful (avg age, 41y; 52% men). High levels of health risks were identified (mean, 7.6; range, 1–20y); 23.4% reported “fair” or “poor” general health; 16.4% reported probable depression; 34.5% reported recent falls; 36.8% reported fair or poor oral health; and 32.7% reported pain moderate or worse. Conclusion: Interventions are feasible for trials in this population and have broad applicability to other populations aging with disability. Key Words: Aging; Disabled persons; Rehabilitation.

Poster 13 Validation of the Assessment of Motor and Process Skills Among Older Adults in the Community. Steven M. Albert, PhD (Columbia University, New York, NY); Ann Burkhardt, MA, OTRL; Jane Bear-Lehman, PhD, OTRL. Disclosures: None declared. Objective: To assess the validity of the Assessment of Motor and Process Skills (AMPS), an occupational therapy tool, for epidemiologic research. Design: Population-based sample. Setting: Northern New York City. Participants: 217 elders aged ⱖ70 years were recruited from Medicare beneficiary files. Interventions: Not applicable. Main Outcome Measures: The AMPS composite motor and cognitive process scores. Results: In this sample of nondemented older people (32% men; mean age, 78.5⫾5.6y; two thirds minorities), motor scores correlated highly with gait speed (.53), grip strength (.34), and tandem stand time (.36) (P⬍.001). Process scores were significantly lower in people with mild cognitive impairment relative to those with normal cognition (P⬍.001). Correlations between process scores and physical indicators, and motor scores and cognitive performance, were much lower, indicating discriminant validity. 25% of participants scored in the impaired range in motor skills, 10% in process skills, and 7.5% in both. Self-reported deficits were related to both motor and process scores. Conclusions: The AMPS appears to be a valid tool for epidemiologic research. Key Words: Aging; Rehabilitation.

Poster 14 Cost Savings of Pulmonary Vest Therapy. Audrius V. Plioplys, MD, FRCPC, FAAP, CMD (Mercy Hospital, Chicago, IL); Jone Ebel, RN; Irene Kasnicka, RN. Disclosures: None declared. Objectives: To determine cost savings from using pulmonary vest therapy to prevent hospitalizations related to pneumonia. Design: Quantitative research using before-during treatment data. Setting: 2 pediatric skilled nursing facilities for children with severe cerebral palsy (CP). Interventions: Not applicable. Main Outcome Measures: The average hospitalization for pneumonia was 5 days, 4 of which were in the intensive care unit (ICU). The daily hospitalization rates were obtained from the business offices of 3 regional hospitals with pediatric ICU units that serve our patients. Results: During our 1-year study, the number of hospitalizations was decreased by 10. The

Arch Phys Med Rehabil Vol 84, October 2003