Poster 201 Characterization of Aphasia in Acute Stroke Patients and Correlation with Functional Outcomes

Abstracts / PM R 8 (2016) S151-S332 for possible paraneoplastic etiology of diffuse demyelinating polyneuropathy. Conclusions: Paraneoplastic diffuse demyelinating peripheral neuropathy is an uncommon cause of progressive weakness in the setting of malignancy and should be considered in the differential diagnosis of otherwise unexplained weakness in individuals with cancer. Acute inpatient rehabilitation can also help improve functional outcomes. Level of Evidence: Level V Poster 201 Characterization of Aphasia in Acute Stroke Patients and Correlation with Functional Outcomes Hongjie Yuan, MD (Kingsbrook Jewish Medical Center, Brooklyn, NY, Canada), Tasanyia Sebro, MS, Caroline J. Lee, MD, William A. Berrigan, MD, Steven J. Mann, MD, Seong Woo Hong, MS, Miksha Patel, MD, Todd R. Lefkowitz, DO Disclosures: Hongjie Yuan: I Have No Relevant Financial Relationships To Disclose Objective: To study the prevalence and correlation of aphasia and dysphagia with functional outcomes in acute stroke patients. Design: Retrospective study. Setting: Acute inpatient rehabilitation facility of a community hospital (IRF). Participants: 121 patients diagnosed with acute cerebrovascular accident (CVA) admitted to our inpatient rehabilitation facility of a community hospital (IRF) in 2014. Interventions: All patients received physical therapy (PT), occupational therapy (OT), speech language pathology (SLP), and neuropsychological evaluations and treatments during the acute rehabilitation stay. Patients were divided into 4 groups including control (patients with new CVA without aphasia or dysphagia), aphasia, dysphagia and both aphasia and dysphagia. Total functional independence measure (FIM) gains (difference in FIM scores between admission and discharge) and sub-item FIM score analyses were made. Main Outcome Measures: FIM evaluated at admission and discharge (18- item scale including self-care, sphincter control, mobility, communication, cognitive function, and psychosocial adjustment measured on a scale of 1-7, with 1 indicating total dependence and 7 as total independence). Results: Of 121 new acute CVA inpatients, 39 (32.23%) had aphasia (89.74% global aphasia of which 7.69% expressive and 2.56% receptive). Twenty-six (21.49%) patients had dysphagia (oral phase 26.92%, pharyngeal phase 11.54%, oralopharyngeal phase 57.69% and psychogenic 3.84%). Eleven (9.09%) patients had both aphasia and dysphagia. Total FIM gain in the aphasia group was significantly lower than in the control group (18.28
9.82 vs 26.25
11.30, P ¼ .0019). In the sub FIM scores: Motor subtotal functional gains in the aphasia group were significantly lower than in the control group (12.28
8.66 vs 18.51
8.37, P ¼ .0018) The sub-item sphincter control gain in the aphasia group was also significantly lower than in the control group (0.51
2.53 vs 1.93
2.63, P ¼ .028). The dysphagia group showed lower total FIM gains during their acute rehabilitation stay (21.50
9.83 vs 26.25
11.30, P ¼ .049). Cognitive subtotal gains did not differ between groups compared with the control group. Patients with both aphasia and dysphagia did not demonstrate any significant differences in overall FIM gain compared with control. Conclusions: Global aphasia was the most common type of aphasia observed in the cohort of patients admitted to our IRF. Previous research has shown a negative correlation between aphasia and functional outcomes in stroke patients. Our study adds to the body of scientific research negatively correlating the presence of aphasia (especially global aphasia) and dysphagia as poor prognostic indicators in patients with acute stroke. Level of Evidence: Level II

S227

Poster 202 A Translational Model of Traumatic Brain Injury: Motor Recovery from a Focal Controlled Cortical Impact to Primary Motor Cortex Scott Barbay, PhD (University of Kansas Medical Center, Kansas City, Kansas, United States), Hongyu Zhang, MD, PhD, Shawn B. Frost, PhD, Jeremy C. Peterson, MD, David J. Guggenmos, PhD, Heather M. Hudson, PhD, David T. Bundy, PhD, Stacey DeJong, Pt, PhD, PCS, Randolph J. Nudo, PhD Disclosures: Scott Barbay: I Have No Relevant Financial Relationships To Disclose Objective: To develop a focal model of traumatic brain injury (TBI) in nonhuman primates (NHPs) for the purpose of studying novel therapeutic interventions to improve motor function. Design: Longitudinal study. Setting: Laboratory. Participants: Subjects are 3 male NHPs (squirrel monkeys) approximately 6 years of age. Interventions: Not applicable. Main Outcome Measures: Post-injury recovery of hand function was assessed on two behavioral tasks to assess voluntary handgrip in one task, and manual dexterity in the other task. NHPs were trained to sustain grip forces between 100 and 300 grams (0.98 e 2.94 N) for 3 seconds to obtain a reward. A computer-controlled manipulandum equipped with a force transducer was used to record variability in handgrip before and after a unilateral, controlled cortical impact (CCI). Manual dexterity was measured by using a reach and retrieval task (Klu ¨ver board task) requiring skilled use of the digits. Recovery from the CCI injury was followed over three months. Results: Deficits related to the impact were limited to the forearm contralateral to the impact. All NHPs showed impairments in handgrip immediately following TBI, and recovered to their pre-injury baseline number of successful grips by 6-weeks post-injury. Impaired use of the digits on the Klu ¨ver board task persisted throughout the 3-month assessment period for two of the subjects. One subject was unable to successfully retrieve food pellets from the Klu ¨ver board during the first two weeks of recovery, but returned to near baseline levels by the third week of recovery. Conclusions: The results demonstrate that a focal CCI in M1 hand area can have differential effects upon voluntary handgrip and dexterity in NHPs as impairment in dexterity was more persistent in two of the three subjects. The results of this study will be used to guide development of novel therapies to aid rehabilitation. Level of Evidence: Level II Poster 203 Systematic Literature Review of AbobotulinumtoxinA in Randomized, Controlled Clinical Trials for Adult Lower Limb Spasticity Khashayar Dashtipour, MD, PhD (School of Medicine, Loma Linda University, Loma Linda, CA, United States), George C. Camba, BA, Jack J. Chen, PharmD, BCPS, CGP, Heather W. Walker, MD, Michael Y. Lee, MD, MHA Disclosures: Khashayar Dashtipour: Consulting fees or other remuneration (payment) - Allergan, Ipsen, Merz, US World Meds, Teva, Impax, Lundbeck Objective: To review the evidence base for the efficacy, safety and tolerability of abobotulinumtoxinA treatment in the treatment of adult patients with lower limb spasticity (ALLS). Design: A systematic literature review (English) was performed to identify randomized controlled trials of abobotulinumtoxinA in the treatment of ALLS. Keywords were: abobotulinumtoxinA, botulinum