- Email: [email protected]
Poster 47
E17 accounted for more than 84% of variance in LOS. Conclusions: A relation exists between a combination of items of the admission BBS and outcome measures for individuals with acquired brain injury. Key Words: Balance; Rehabilitation; Treatment outcome.
Poster 44 The Pediatric Acquired Brain Injury Community Outreach Program: A Community-Based Rehabilitation Model for Children and Youth With Acquired Brain Injury. Jane Gillett (Hamilton Health Sciences), Janice Gray, Sara Somers. Disclosure: None declared. Objective: To show a community-based model of rehabilitation for children and youth with acquired brain injury. Design: A rehabilitation model (Pediatric Acquired Brain Injury Community Outreach Program [PABICOP]) was created after widespread consultation with families, schools, and community partners to identify needs. The community-based outreach program works with existing resources to support reintegration for children and youth with acquired brain injury. Setting: 5 counties in southwestern Ontario, Canada, an area of 30,000km2 with a population 1.5 million. Participants: Children and youth (age range, 1wk–19y) with acquired brain injury, their families, and communities. Interventions: Education on acquired brain injury, crisis counseling, advocacy, therapy consultation, medical management, school support, neuropsychology, and service coordination. Main Outcome Measures: Number of new referrals, education sessions to schools and community, number of clients seen in clinics and schools, and other service are provision per year. Results: The PABICOP receives 100 new referrals per year. 300 to 350 clients are actively followed at any time. Over 300 school contacts and 20 to 35 education sessions are provided per year. Conclusions: The PABICOP provides a family-centered and holistic method of service delivery for children and youth with acquired brain injury. Key Words: Brain injuries; Pediatrics; Rehabilitation.
Poster 45 Upper-Limb Coordination in Children With Congenital Brachial Plexus Palsy. Daniel Goble (University of Michigan, Ann Arbor, MI), Edward Hurvitz, Virginia Nelson, Susan Brown. Disclosure: None declared. Objective: To determine if affected arm reaching in children with congenital brachial plexus palsy (CBPP) improves when both arms perform the same task simultaneously. Design: Descriptive measurement study. Setting: Motor control laboratory. Participants: 7 control and 7 CBPP subjects with mild to moderate functional impairment. Interventions: Not applicable. Main Outcome Measures: Spatiotemporal characteristics of forward reaching. Movement speed and handpath trajectories were analyzed during unilateral, bilateral, and bilateral movements. Results: Across conditions, CBPP subjects moved more slowly than controls (P⬍.01). During unilateral reaching, the affected arm was significantly slower than the unaffected arm (P⫽.02). When in-phase, bilateral reaches were made, however, affected arm speed increased compared with the unilateral condition. This improvement was not evident during bilateral movements made in opposite directions (antiphase). Movement trajectories of both arms in CBPP subjects were consistently more variable than controls, regardless of condition. Conclusions: Multijoint coordination is compromised in CBPP, although bilateral tasks involving simultaneous activation of similar muscle groups (in-phase coupling) may improve the speed of motor performance in the affected arm. Impaired coordination may reflect central nervous system changes as a result of decreased arm usage, which may be reversible after task-based training.
Key Words: Brachial plexus neuropathies; Coordination impairment; Rehabilitation.
Poster 46 Pain After Traumatic Brain Injury: Predictors and Correlates. Jeanne Hoffman (University of Washington, Seattle, WA), Kati Pagulayan, Nadya Zawaideh, Kathleen Bell. Disclosure: None declared. Objectives: To examine the prevalence of pain 1 year after moderate to severe traumatic brain injury (TBI), to identify predictors from the time of injury, and to identify factors related to pain at 1 year postinjury. Design: Prospective cohort study. Setting: Inpatient rehabilitation for TBI and community follow-up at 1 year postinjury. Participants: Consecutive sample of 142 individuals (80.4% men) enrolled in the Traumatic Brain Injury Model System at the University of Washington. Main Outcome Measures: Bodily pain index from the Medical Outcomes Study 36-Item Short-Form Health Survey assessed 1 year after injury, categorized into none, mild, and moderate and severe. Results: At 1 year, 47.2% of individuals had mild pain and 25.3% had moderate to severe pain. Depression at baseline significantly predicted being in a higher pain category (OR⫽1.06, Pⱕ.003). Severity, cause of TBI, and associated injuries were unrelated to reports of pain at 1 year. Pain reports were associated with being female (r⫽⫺.20, P⫽.02), having lower function (r⫽⫺.27, P⫽.001), and being more depressed (r⫽.48, P⬍.001). Conclusions: Although pain was frequently reported 1 year later, injury-related factors were surprisingly unrelated. Depression and functional participation should be considered in treatment approaches for individuals with pain after TBI. Key Words: Pain; Brain injuries; Rehabilitation.
Poster 47 Naturalistic Assessment of Executive Function: The Multiple Errands Test. Deirdre Dawson (Kunin-Lunenfeld Applied Research Unit, Toronto, ON, Canada), Nicole Anderson, Paul Burgess, Brian Levine, Dmytro Rewilak, Erin Cooper, Stephanie Farrow, Katherine Krpan, Miki Peer, Donald Stuss. Disclosure: None declared. Objectives: (1) To propose the first standard scoring system for the Multiple Errands Test–Hospital Version (MET-HV) that enables reliable identification of error and strategy patterns, (2) to present data on the ecologic validity of the MET-HV, and (3) to report the interrater reliability of the MET-HV. Design: Case-control. Setting: Large health care center and participants’ homes. Participants: 30 people with acquired brain injury and 30 matched controls. Interventions: Not applicable. Main Outcome Measures: The MET-HV; performance-based measure of instrumental activities of daily living—the Assessment of Motor and Process Skills (AMPS); and a self-report measure of community participation—Mayo-Portland Adaptability Inventory (MPAI). Results: Videotape analyses showed error patterns of inefficiencies, interpretation failures, and task omissions and strategy patterns of checking task list and asking for help. Correlations between the MET-HV, the AMPS, and the MPAI were moderately strong to strong (r range, 0.5– 0.8), suggesting good ecologic validity. Interclass correlation coefficients (ICCs) on MET-HV summary scores were high (ICC, ⱖ.90, Pⱕ.01), showing excellent interrater reliability. Conclusions: These findings on the MET-HV provide further evidence of its clinical utility. It is a reliable and ecologically valid assessment that provides a standard way of categorizing executive performance errors and spontaneous use of strategies in a naturalistic environment. Key Words: Brain injuries; Rehabilitation. Arch Phys Med Rehabil Vol 86, October 2005
Poster 44 The Pediatric Acquired Brain Injury Community Outreach Program: A Community-Based Rehabilitation Model for Children and Youth With Acquired Brain Injury. Jane Gillett (Hamilton Health Sciences), Janice Gray, Sara Somers. Disclosure: None declared. Objective: To show a community-based model of rehabilitation for children and youth with acquired brain injury. Design: A rehabilitation model (Pediatric Acquired Brain Injury Community Outreach Program [PABICOP]) was created after widespread consultation with families, schools, and community partners to identify needs. The community-based outreach program works with existing resources to support reintegration for children and youth with acquired brain injury. Setting: 5 counties in southwestern Ontario, Canada, an area of 30,000km2 with a population 1.5 million. Participants: Children and youth (age range, 1wk–19y) with acquired brain injury, their families, and communities. Interventions: Education on acquired brain injury, crisis counseling, advocacy, therapy consultation, medical management, school support, neuropsychology, and service coordination. Main Outcome Measures: Number of new referrals, education sessions to schools and community, number of clients seen in clinics and schools, and other service are provision per year. Results: The PABICOP receives 100 new referrals per year. 300 to 350 clients are actively followed at any time. Over 300 school contacts and 20 to 35 education sessions are provided per year. Conclusions: The PABICOP provides a family-centered and holistic method of service delivery for children and youth with acquired brain injury. Key Words: Brain injuries; Pediatrics; Rehabilitation.
Poster 45 Upper-Limb Coordination in Children With Congenital Brachial Plexus Palsy. Daniel Goble (University of Michigan, Ann Arbor, MI), Edward Hurvitz, Virginia Nelson, Susan Brown. Disclosure: None declared. Objective: To determine if affected arm reaching in children with congenital brachial plexus palsy (CBPP) improves when both arms perform the same task simultaneously. Design: Descriptive measurement study. Setting: Motor control laboratory. Participants: 7 control and 7 CBPP subjects with mild to moderate functional impairment. Interventions: Not applicable. Main Outcome Measures: Spatiotemporal characteristics of forward reaching. Movement speed and handpath trajectories were analyzed during unilateral, bilateral, and bilateral movements. Results: Across conditions, CBPP subjects moved more slowly than controls (P⬍.01). During unilateral reaching, the affected arm was significantly slower than the unaffected arm (P⫽.02). When in-phase, bilateral reaches were made, however, affected arm speed increased compared with the unilateral condition. This improvement was not evident during bilateral movements made in opposite directions (antiphase). Movement trajectories of both arms in CBPP subjects were consistently more variable than controls, regardless of condition. Conclusions: Multijoint coordination is compromised in CBPP, although bilateral tasks involving simultaneous activation of similar muscle groups (in-phase coupling) may improve the speed of motor performance in the affected arm. Impaired coordination may reflect central nervous system changes as a result of decreased arm usage, which may be reversible after task-based training.
Key Words: Brachial plexus neuropathies; Coordination impairment; Rehabilitation.
Poster 46 Pain After Traumatic Brain Injury: Predictors and Correlates. Jeanne Hoffman (University of Washington, Seattle, WA), Kati Pagulayan, Nadya Zawaideh, Kathleen Bell. Disclosure: None declared. Objectives: To examine the prevalence of pain 1 year after moderate to severe traumatic brain injury (TBI), to identify predictors from the time of injury, and to identify factors related to pain at 1 year postinjury. Design: Prospective cohort study. Setting: Inpatient rehabilitation for TBI and community follow-up at 1 year postinjury. Participants: Consecutive sample of 142 individuals (80.4% men) enrolled in the Traumatic Brain Injury Model System at the University of Washington. Main Outcome Measures: Bodily pain index from the Medical Outcomes Study 36-Item Short-Form Health Survey assessed 1 year after injury, categorized into none, mild, and moderate and severe. Results: At 1 year, 47.2% of individuals had mild pain and 25.3% had moderate to severe pain. Depression at baseline significantly predicted being in a higher pain category (OR⫽1.06, Pⱕ.003). Severity, cause of TBI, and associated injuries were unrelated to reports of pain at 1 year. Pain reports were associated with being female (r⫽⫺.20, P⫽.02), having lower function (r⫽⫺.27, P⫽.001), and being more depressed (r⫽.48, P⬍.001). Conclusions: Although pain was frequently reported 1 year later, injury-related factors were surprisingly unrelated. Depression and functional participation should be considered in treatment approaches for individuals with pain after TBI. Key Words: Pain; Brain injuries; Rehabilitation.
Poster 47 Naturalistic Assessment of Executive Function: The Multiple Errands Test. Deirdre Dawson (Kunin-Lunenfeld Applied Research Unit, Toronto, ON, Canada), Nicole Anderson, Paul Burgess, Brian Levine, Dmytro Rewilak, Erin Cooper, Stephanie Farrow, Katherine Krpan, Miki Peer, Donald Stuss. Disclosure: None declared. Objectives: (1) To propose the first standard scoring system for the Multiple Errands Test–Hospital Version (MET-HV) that enables reliable identification of error and strategy patterns, (2) to present data on the ecologic validity of the MET-HV, and (3) to report the interrater reliability of the MET-HV. Design: Case-control. Setting: Large health care center and participants’ homes. Participants: 30 people with acquired brain injury and 30 matched controls. Interventions: Not applicable. Main Outcome Measures: The MET-HV; performance-based measure of instrumental activities of daily living—the Assessment of Motor and Process Skills (AMPS); and a self-report measure of community participation—Mayo-Portland Adaptability Inventory (MPAI). Results: Videotape analyses showed error patterns of inefficiencies, interpretation failures, and task omissions and strategy patterns of checking task list and asking for help. Correlations between the MET-HV, the AMPS, and the MPAI were moderately strong to strong (r range, 0.5– 0.8), suggesting good ecologic validity. Interclass correlation coefficients (ICCs) on MET-HV summary scores were high (ICC, ⱖ.90, Pⱕ.01), showing excellent interrater reliability. Conclusions: These findings on the MET-HV provide further evidence of its clinical utility. It is a reliable and ecologically valid assessment that provides a standard way of categorizing executive performance errors and spontaneous use of strategies in a naturalistic environment. Key Words: Brain injuries; Rehabilitation. Arch Phys Med Rehabil Vol 86, October 2005