- Email: [email protected]
Poster 322 Underutilization of Inpatient Rehabilitation Facilities for ThinkFirst Traumatic Injury Prevention Programs: A Case Study
PM&R
this disease, it is important that patients understand the natural course of this disorder, in order to plan appropriately for their future functioning. Conclusions: Inclusion body myositis must be considered in older patients with myopathic symptoms including weakness of the finger flexors. Poster 320 Development of a Modified Version of the Naturalistic Action Test for Korean Patients with Cognitive Impairment. Hyun Jung Kim, MD, PhD (Eulji Hospital, Eulji University School of Medicine, Seoul, Korea, Republic of); Miae Jung; Youn Joo Kang; Yonjoon Kim. Disclosures: H. Kim, No Disclosures. Objective: To develop and evaluate the reliability and validity of a modified version of the Naturalistic Action Test (m-NAT) for Korean patients with cognitive impairment. The NAT was originally designed to assess everyday action impairment associated with higher cortical dysfunctions. Design: We developed the m-NAT to adapt to the Korean cultural background. Inter-rater reliability was assessed between two raters. Validity was evaluated by comparing the m-NAT score with various measures of daily life, attention, and executive functions. Setting: University-affiliated hospital. Participants: 30 patients receiving neurorehabilitation (23 with stroke, 5 with traumatic brain injury, and 2 with dementia) and 20 healthy matched controls. Interventions: Not applicable. Main Outcome Measures: m-NAT; (2) Korean Instrumental activity of daily living (K-IADL); (3) significant other and self-report of daily life function, Executive Behavior Scale(EBS), Korean version of the Cognitive Failure Questionnaire(K-CFQ); (4) neuropsychological tests of attention and executive functions such as the Sustained Attention to Response Task(SART), Stroop test, and Trail making test A&B. Results: Performance on the m-NAT in terms of the total score was significantly different between patients and controls (P⬍.01). Patients made significantly more errors than controls (P⬍.01). Omission error was the most frequent type of error in patient group. Intraclass correlation coefficient (ICC) for total m-NAT score was 0.98 (95% confidence interval, 0.96-0.99; P⫽.00); total error was 0.91 (95% confidence interval, 0.89-0.92, P⫽.00). Total score of the m-NAT showed moderate to strong correlations with K-IADL (rs⫽⫺0.58; P⬍.05), EBS (rs⫽⫺.60; P⬍.01), K-CFQ (rs⫽⫺.51; P⬍.01), SART commission error (rs⫽⫺.44; P⬍.01), Stroop interference rate (rs⫽⫺.73; P⬍.01), and Trail making test A&B (rs⫽⫺.55/⫺0.65; P⬍.01). Conclusions: The m-NAT showed very good reliability and adequate validity. The m-NAT adjusted to Korean cultural background would be useful in performance-based assessment of naturalistic action for clinical and research purposes. Poster 321 Acute Rehab of Visual Dysfunction in Wall-Eyed Bilateral Internuclear Ophthalmoplegia After Dorsal Midbrain Stroke: A Case Report. Jackson Liu, MD (NYULMC Rusk Institute of Rehabilitation Medicine, Manhattan, NY, United States); Mohammad Fouladvand, MD; Jaime M. Levine, DO.
Vol. 4, Iss. 10S, 2012
S299
Disclosures: J. Liu, No Disclosures. Case Description: A 75-year-old man woke up 3 days after elective coronary artery bypass and mitral valve replacement procedures with complaints of double vision and dizziness. At onset, the patient had findings of wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome. His immediate post-operative course was complicated by atrial fibrillation which required rate controlling medications. A non-contrast computed tomography scan of the head showed diffuse scattered hypodensities including a lesion in the dorsal midbrain. After medical stabilization, he was started on empiric anticoagulation for presumed embolic stroke and transferred to an acute neurorehabilitation unit. Setting: Inpatient. Results or Clinical Course: On admission, the patient had bilateral findings of exotropia at rest, severe limitation of adduction, horizontal nystagmus upon abduction, and impaired saccades and visual pursuit. He exhibited poor standing balance with a wide base of support, poor foot placement upon ambulation, and poor endurance. Strength, sensation, acuity, vertical eye movements, and pupillary reflexes were all normal. He required moderate assistance for functional mobility and as much as maximum assistance for activities of daily living (ADL). The rehab program focused on visual therapy utilizing various oculomotor strengthening exercises, partial occlusion lenses, and monocular scanning. At discharge, he was at a contact guard level for functional mobility with markedly improved gait, balance, and ability to perform ADL. Discussion: Visual dysfunction is common after stroke and affects all functional ability. To our knowledge, stroke as a cause of WEBINO syndrome has rarely been reported after cardiac procedures and this is the first report in the context of acute rehab. It is produced by a lesion of the medial longitudinal fasciculi and the medial rectus subnuclei, which disrupts the coordinated movement of the opposing lateral and medial rectus muscles. In this patient, visual deficits were recognized early and treated with visual therapy as part of the acute rehab course. Conclusions: The visual system is one of the most important senses as it provides vital input during all aspects of function. Early recognition of visual deficits in acute rehab patients is crucial as it optimizes the treatment plan to include more focused therapy. Poster 322 Underutilization of Inpatient Rehabilitation Facilities for ThinkFirst Traumatic Injury Prevention Programs: A Case Study. James A. Whitaker, DO (University of Missouri, Columbia, MO, United States); Michelle M. Gibler, PhD; Fred Murdock, PhD. Disclosures: J. A. Whitaker, No Disclosures. Program Description: Since 1986, the ThinkFirst National Injury Prevention Foundation (TFNIPF) has been conducting evidence-based, theory-driven educational programs in schools and communities through an expansive network of national and international chapters. Chapters are based primarily in healthcare settings, including medical centers, children’s hospitals, and rehabilitation facilities. The primary method of education involves a survivor with a brain or spinal cord injury providing audiences with personal testimony about the experience of living with a preventable permanent disability.
S300
Setting: Free-standing inpatient rehabilitation facility with a physical medicine and rehabilitation academic training program. Results or Clinical Course: This study was completed using data provided by the TFNIPF and communication with chapters via phone and email. Based on 79 of 135 chapters completing the TFNIPF annual survey in 2011, 50 (63%) were located in a hospital trauma or neurosurgery department, 18 (23%) were located in a rehabilitation facility, 6 (8%) were located in ⬙other⬙ healthcare setting, and 5 (6%) were located at a children’s hospital. Combined, these chapters provided 5,973 presentations reaching 520,531 people. Discussion: Rehabilitation facilities are model settings for ThinkFirst chapters because they are staffed by experts in physical medicine and provide extended access to TF speakers. In a report to Congress, MEDPAC reported there were 1,196 inpatient rehabilitation facilities operating in the United States in 2009; however, only 18 (1.5%) reported primary injury prevention through ThinkFirst in the 2011 TFNIPF annual survey. Given the number and distribution of these facilities, there is great potential to expand the number of ThinkFirst chapters in rehabilitation settings and increase the number of people served. Conclusions: Rehabilitation facilities are ideal venues for conducting ThinkFirst injury prevention programs; however, participation in such programs is low. Progressive rehabilitation facilities should consider establishing a ThinkFirst chapter to provide injury prevention in the community. **Poster 323 Effectiveness of a Comprehensive Rehabilitation Services Program on Long-Term Physical Functioning in Injured Survivors of the 2008 Sichuan Earthquake. Jan Reinhardt, PhD (First Affiliated Hospital of Nanjing Medical University, Nanjing, China); Sijing Chen, MD; James Gosney, MD, MPH; Xiaorong Hu, MD; Jianan Li, MD; Shouguo Liu, MD; Xia Zhang, MD. Disclosures: J. Reinhardt, No Disclosures. Objective: To quantify the effectiveness of a comprehensive institutional and community-based rehabilitation (IBR/CBR) services program on long-term physical functioning of injured survivors of the Sichuan earthquake. Design: Longitudinal quasi-experimental. Setting: County hospitals and local community in the severely affected earthquake area. Participants: Five hundred ninety-three survivors from A, B, and C counties who sustained disabling injuries assigned to either the early (N⫽298) [NHV-E] or late (N⫽101) [NHV-L] intervention groups or control (N⫽111) group. Interventions: Subjects received IBR followed by CBR program interventions after hospital discharge. Main Outcome Measures: “Chinese version of the Barthel Index (BI).” Results: Physical functioning was significantly improved in the NHV-E and NHV-L groups at follow up by a clinically meaningful average score of 11 points (95% CI 8*98-13*31) compared with baseline after adjustment for gender, age, type of injury, and time to measurement. Controls did not show significant improvement. Further, the model differentiated a significant effect of both rehabilitation and recovery over time due to other factors (greater effect of
PRESENTATIONS
rehabilitation) on physical functioning. Sensitivity analysis indicated stability of findings. Conclusions: The comprehensive IBR/CBR program significantly improved the long-term physical functioning of injured survivors of the Sichuan earthquake. This finding has implications for civil society as well as for domestic and international rehabilitation disaster relief. Poster 324 Short-Term Effect of Whole Limb Vibration on the Magnetic Evoked Potential (MEP). Jared D. Olson, MD (University of Washington, Seattle, WA, United States); Arthur Rodriquez, MD. Disclosures: J. D. Olson, No Disclosures. Objective: To determine the short-term effect of whole limb vibration on cortico-spinal tract excitation as measured by the amplitude of the magnetic evoked potential (MEP) using transcranial magnetic stimulation (TMS). Design: Prospective, longitudinal cohort. Setting: Veterans Affairs Hospital. Participants: Five healthy subjects. Interventions: Baseline resting and post-vibration MEPs were measured at the extensor digitorum communis (EDC). The EDC primary motor area was defined as the cortical location with the largest average MEP found using a TMS neuronavigation suite on a 1 cm grid. The resting motor threshold (RMT) was defined as the lowest pulse intensity that produced a 50 uV MEP in 6 of 10 stimuli. The average of 10 MEPs was obtained at 130% of RMT. Subjects then underwent upper limb treatment on a vibration table at 2 mm amplitude, 35 Hz, for 15 seconds, with 15 seconds of rest, for 3 cycles. Subsequent averages of 10 MEPs were acquired every 10 minutes up to 60 minutes. Main Outcome Measures: MEP response at the EDC at 10 minute intervals up to 60 minutes after whole limb vibration, as compared to the pre-vibration control. Results: Analysis was performed using Repeated Measures Analysis of Variance (ANOVA) with Dunnett’s test to compare responses at each time interval versus the control. Statistically significant differences were seen between responses at 30 minutes compared with baseline with a 0.43 mV difference of means (one-sided 95% CI lower limit ⫽ 0.013 mV). Other time intervals had non-statistically significant differences of means. Conclusions: Whole limb vibration resulted in increased MEP amplitudes at 30 minutes after treatment, suggesting increased cortico-spinal tract excitation over a sustained period of time. This project was in part supported by the VA Multiple Sclerosis Center of Excellence West and the VA Puget Sound Health Care System. Poster 325 Rehabilitation Following Prolonged Hospitalization for Autoimmune Autonomic Ganglionopathy: A Case Report. Jessica Koch, DO (University Hospital/University of Cincinnati, Cincinnati, OH, United States); Mark J. Goddard, MD. Disclosures: J. Koch, No Disclosures. Case Description: The patient is a 39-year-old Caucasian man with past medical history significant for migraine headaches and a recent small bowel obstruction with subsequent bowel resection.
this disease, it is important that patients understand the natural course of this disorder, in order to plan appropriately for their future functioning. Conclusions: Inclusion body myositis must be considered in older patients with myopathic symptoms including weakness of the finger flexors. Poster 320 Development of a Modified Version of the Naturalistic Action Test for Korean Patients with Cognitive Impairment. Hyun Jung Kim, MD, PhD (Eulji Hospital, Eulji University School of Medicine, Seoul, Korea, Republic of); Miae Jung; Youn Joo Kang; Yonjoon Kim. Disclosures: H. Kim, No Disclosures. Objective: To develop and evaluate the reliability and validity of a modified version of the Naturalistic Action Test (m-NAT) for Korean patients with cognitive impairment. The NAT was originally designed to assess everyday action impairment associated with higher cortical dysfunctions. Design: We developed the m-NAT to adapt to the Korean cultural background. Inter-rater reliability was assessed between two raters. Validity was evaluated by comparing the m-NAT score with various measures of daily life, attention, and executive functions. Setting: University-affiliated hospital. Participants: 30 patients receiving neurorehabilitation (23 with stroke, 5 with traumatic brain injury, and 2 with dementia) and 20 healthy matched controls. Interventions: Not applicable. Main Outcome Measures: m-NAT; (2) Korean Instrumental activity of daily living (K-IADL); (3) significant other and self-report of daily life function, Executive Behavior Scale(EBS), Korean version of the Cognitive Failure Questionnaire(K-CFQ); (4) neuropsychological tests of attention and executive functions such as the Sustained Attention to Response Task(SART), Stroop test, and Trail making test A&B. Results: Performance on the m-NAT in terms of the total score was significantly different between patients and controls (P⬍.01). Patients made significantly more errors than controls (P⬍.01). Omission error was the most frequent type of error in patient group. Intraclass correlation coefficient (ICC) for total m-NAT score was 0.98 (95% confidence interval, 0.96-0.99; P⫽.00); total error was 0.91 (95% confidence interval, 0.89-0.92, P⫽.00). Total score of the m-NAT showed moderate to strong correlations with K-IADL (rs⫽⫺0.58; P⬍.05), EBS (rs⫽⫺.60; P⬍.01), K-CFQ (rs⫽⫺.51; P⬍.01), SART commission error (rs⫽⫺.44; P⬍.01), Stroop interference rate (rs⫽⫺.73; P⬍.01), and Trail making test A&B (rs⫽⫺.55/⫺0.65; P⬍.01). Conclusions: The m-NAT showed very good reliability and adequate validity. The m-NAT adjusted to Korean cultural background would be useful in performance-based assessment of naturalistic action for clinical and research purposes. Poster 321 Acute Rehab of Visual Dysfunction in Wall-Eyed Bilateral Internuclear Ophthalmoplegia After Dorsal Midbrain Stroke: A Case Report. Jackson Liu, MD (NYULMC Rusk Institute of Rehabilitation Medicine, Manhattan, NY, United States); Mohammad Fouladvand, MD; Jaime M. Levine, DO.
Vol. 4, Iss. 10S, 2012
S299
Disclosures: J. Liu, No Disclosures. Case Description: A 75-year-old man woke up 3 days after elective coronary artery bypass and mitral valve replacement procedures with complaints of double vision and dizziness. At onset, the patient had findings of wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome. His immediate post-operative course was complicated by atrial fibrillation which required rate controlling medications. A non-contrast computed tomography scan of the head showed diffuse scattered hypodensities including a lesion in the dorsal midbrain. After medical stabilization, he was started on empiric anticoagulation for presumed embolic stroke and transferred to an acute neurorehabilitation unit. Setting: Inpatient. Results or Clinical Course: On admission, the patient had bilateral findings of exotropia at rest, severe limitation of adduction, horizontal nystagmus upon abduction, and impaired saccades and visual pursuit. He exhibited poor standing balance with a wide base of support, poor foot placement upon ambulation, and poor endurance. Strength, sensation, acuity, vertical eye movements, and pupillary reflexes were all normal. He required moderate assistance for functional mobility and as much as maximum assistance for activities of daily living (ADL). The rehab program focused on visual therapy utilizing various oculomotor strengthening exercises, partial occlusion lenses, and monocular scanning. At discharge, he was at a contact guard level for functional mobility with markedly improved gait, balance, and ability to perform ADL. Discussion: Visual dysfunction is common after stroke and affects all functional ability. To our knowledge, stroke as a cause of WEBINO syndrome has rarely been reported after cardiac procedures and this is the first report in the context of acute rehab. It is produced by a lesion of the medial longitudinal fasciculi and the medial rectus subnuclei, which disrupts the coordinated movement of the opposing lateral and medial rectus muscles. In this patient, visual deficits were recognized early and treated with visual therapy as part of the acute rehab course. Conclusions: The visual system is one of the most important senses as it provides vital input during all aspects of function. Early recognition of visual deficits in acute rehab patients is crucial as it optimizes the treatment plan to include more focused therapy. Poster 322 Underutilization of Inpatient Rehabilitation Facilities for ThinkFirst Traumatic Injury Prevention Programs: A Case Study. James A. Whitaker, DO (University of Missouri, Columbia, MO, United States); Michelle M. Gibler, PhD; Fred Murdock, PhD. Disclosures: J. A. Whitaker, No Disclosures. Program Description: Since 1986, the ThinkFirst National Injury Prevention Foundation (TFNIPF) has been conducting evidence-based, theory-driven educational programs in schools and communities through an expansive network of national and international chapters. Chapters are based primarily in healthcare settings, including medical centers, children’s hospitals, and rehabilitation facilities. The primary method of education involves a survivor with a brain or spinal cord injury providing audiences with personal testimony about the experience of living with a preventable permanent disability.
S300
Setting: Free-standing inpatient rehabilitation facility with a physical medicine and rehabilitation academic training program. Results or Clinical Course: This study was completed using data provided by the TFNIPF and communication with chapters via phone and email. Based on 79 of 135 chapters completing the TFNIPF annual survey in 2011, 50 (63%) were located in a hospital trauma or neurosurgery department, 18 (23%) were located in a rehabilitation facility, 6 (8%) were located in ⬙other⬙ healthcare setting, and 5 (6%) were located at a children’s hospital. Combined, these chapters provided 5,973 presentations reaching 520,531 people. Discussion: Rehabilitation facilities are model settings for ThinkFirst chapters because they are staffed by experts in physical medicine and provide extended access to TF speakers. In a report to Congress, MEDPAC reported there were 1,196 inpatient rehabilitation facilities operating in the United States in 2009; however, only 18 (1.5%) reported primary injury prevention through ThinkFirst in the 2011 TFNIPF annual survey. Given the number and distribution of these facilities, there is great potential to expand the number of ThinkFirst chapters in rehabilitation settings and increase the number of people served. Conclusions: Rehabilitation facilities are ideal venues for conducting ThinkFirst injury prevention programs; however, participation in such programs is low. Progressive rehabilitation facilities should consider establishing a ThinkFirst chapter to provide injury prevention in the community. **Poster 323 Effectiveness of a Comprehensive Rehabilitation Services Program on Long-Term Physical Functioning in Injured Survivors of the 2008 Sichuan Earthquake. Jan Reinhardt, PhD (First Affiliated Hospital of Nanjing Medical University, Nanjing, China); Sijing Chen, MD; James Gosney, MD, MPH; Xiaorong Hu, MD; Jianan Li, MD; Shouguo Liu, MD; Xia Zhang, MD. Disclosures: J. Reinhardt, No Disclosures. Objective: To quantify the effectiveness of a comprehensive institutional and community-based rehabilitation (IBR/CBR) services program on long-term physical functioning of injured survivors of the Sichuan earthquake. Design: Longitudinal quasi-experimental. Setting: County hospitals and local community in the severely affected earthquake area. Participants: Five hundred ninety-three survivors from A, B, and C counties who sustained disabling injuries assigned to either the early (N⫽298) [NHV-E] or late (N⫽101) [NHV-L] intervention groups or control (N⫽111) group. Interventions: Subjects received IBR followed by CBR program interventions after hospital discharge. Main Outcome Measures: “Chinese version of the Barthel Index (BI).” Results: Physical functioning was significantly improved in the NHV-E and NHV-L groups at follow up by a clinically meaningful average score of 11 points (95% CI 8*98-13*31) compared with baseline after adjustment for gender, age, type of injury, and time to measurement. Controls did not show significant improvement. Further, the model differentiated a significant effect of both rehabilitation and recovery over time due to other factors (greater effect of
PRESENTATIONS
rehabilitation) on physical functioning. Sensitivity analysis indicated stability of findings. Conclusions: The comprehensive IBR/CBR program significantly improved the long-term physical functioning of injured survivors of the Sichuan earthquake. This finding has implications for civil society as well as for domestic and international rehabilitation disaster relief. Poster 324 Short-Term Effect of Whole Limb Vibration on the Magnetic Evoked Potential (MEP). Jared D. Olson, MD (University of Washington, Seattle, WA, United States); Arthur Rodriquez, MD. Disclosures: J. D. Olson, No Disclosures. Objective: To determine the short-term effect of whole limb vibration on cortico-spinal tract excitation as measured by the amplitude of the magnetic evoked potential (MEP) using transcranial magnetic stimulation (TMS). Design: Prospective, longitudinal cohort. Setting: Veterans Affairs Hospital. Participants: Five healthy subjects. Interventions: Baseline resting and post-vibration MEPs were measured at the extensor digitorum communis (EDC). The EDC primary motor area was defined as the cortical location with the largest average MEP found using a TMS neuronavigation suite on a 1 cm grid. The resting motor threshold (RMT) was defined as the lowest pulse intensity that produced a 50 uV MEP in 6 of 10 stimuli. The average of 10 MEPs was obtained at 130% of RMT. Subjects then underwent upper limb treatment on a vibration table at 2 mm amplitude, 35 Hz, for 15 seconds, with 15 seconds of rest, for 3 cycles. Subsequent averages of 10 MEPs were acquired every 10 minutes up to 60 minutes. Main Outcome Measures: MEP response at the EDC at 10 minute intervals up to 60 minutes after whole limb vibration, as compared to the pre-vibration control. Results: Analysis was performed using Repeated Measures Analysis of Variance (ANOVA) with Dunnett’s test to compare responses at each time interval versus the control. Statistically significant differences were seen between responses at 30 minutes compared with baseline with a 0.43 mV difference of means (one-sided 95% CI lower limit ⫽ 0.013 mV). Other time intervals had non-statistically significant differences of means. Conclusions: Whole limb vibration resulted in increased MEP amplitudes at 30 minutes after treatment, suggesting increased cortico-spinal tract excitation over a sustained period of time. This project was in part supported by the VA Multiple Sclerosis Center of Excellence West and the VA Puget Sound Health Care System. Poster 325 Rehabilitation Following Prolonged Hospitalization for Autoimmune Autonomic Ganglionopathy: A Case Report. Jessica Koch, DO (University Hospital/University of Cincinnati, Cincinnati, OH, United States); Mark J. Goddard, MD. Disclosures: J. Koch, No Disclosures. Case Description: The patient is a 39-year-old Caucasian man with past medical history significant for migraine headaches and a recent small bowel obstruction with subsequent bowel resection.