- Email: [email protected]
**Poster 551 Mirror-Neuron System Recruitment by Action Observation in Stroke Rehabilitation
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circulation collateralization, there is increased risk of vascular accident with a propensity for ocular symptomatology. Discussion: Posterior circulation stroke with Balint’s syndrome causes ocular apraxia as evidenced by deficient visual scanning despite intact extraocular muscles, dysmetria secondary to visual perceptual deficits, and by inability to attend to multiple items contained within a visual field. Conclusions: Posterior circulation-involved Moyamoya presenting with Balint’s syndrome features is rare and case reports in the literature are limited. Depending on disease progression and comborbidities, these patients have the potential for modest functional recovery through adaptive strategies including patterned scanning, decreasing visual distracters, continued repetition, and provider cueing. Poster 549 Rehabilitation of a 46-Year-Old Woman with Subarachnoid Hemorrhage Complicated by Linezolid-Induced Posterior Reversible Encephalopathy Syndrome (PRES): A Case Report. Mary E. Russell, DO, MS (Baylor College of Medicine, Houston, TX, United States); Cindy B. Ivanhoe, MD; Monica Verduzco-Gutierrez, MD. Disclosures: M. E. Russell, No Disclosures. Case Description: The patient was admitted for rehabilitation after subarachnoid hemorrhage secondary to posterior communicating artery aneurysm. The patient was progressing well with therapy and started on linezolid for a vancomycin-resistant enterococcus (VRE) urinary tract infection. Six days after completing a 7-day course of linezolid, patient developed persistent tachycardia, hypertension, nystagmus and a generalized tonic-clonic seizure. Head CT showed abnormal attenuation of the left parietal lobe and adjacent white matter. The patient continued to deteriorate and was transferred to an acute-care hospital where she was restarted on linezolid and cefepime for a VRE urinary tract infection. On hospital day 3, patient became lethargic with new onset right-hemiplegia. Head CT showed severe left cerebral edema consistent with PRES. Blood pressure was controlled and other causes of PRES were excluded. Linezolid was stopped and the patient treated with cefepime and vancomycin. The patient’s neurologic status improved and she returned to the rehabilitation facility. Upon return, she was noted to have a significant functional decline from her previous admission. The patient continued to be lethargic and was found again to have a VRE urinary tract infection. Daptomycin was given with no untoward effects. Patient began to interact more and improve with therapy. Program Description: 46-year-old woman with severe stroke secondary to a ruptured posterior communicating artery aneurysm. Setting: Rehabilitation hospital. Results or Clinical Course: Four weeks after diagnosis, the patient has shown improvement. The patient is back to her level prior to transfer and continues to make significant progress. Further developments will be discussed. Discussion: Linezolid-induced PRES is a rare side effect with few reported cases. This resulted in a functional decline during rehabilitation course. Conclusions: PRES is a rare and serious adverse reaction that may occur when treating a vancomycin resistant infection with linezolid.
PRESENTATIONS
Poster 550 Effect of Strapping on the Hemiplegic Lower Extremity: Gait Speed, Balance and Proprioception. Min-ah Kim, (Dong-A University, Busan, Korea, Republic of); Sang-Beom Kim Jae-won Ri, MD. Disclosures: M. Kim, No Disclosures. Objective: To investigate the effect of strapping on the lower extremity in hemiplegic patients in gait speed, balance and proprioception. Design: Patients who had less than fair degree of knee extension power were not included. Twenty four hemiplegic patients were recruited. The balance and gait speed were assessed by Timed Up and Go test (TUG), 10 meter Walking Time (10 mWT), and Korean version of Berg Balance Scale (K-BBS). Proprioception was measured by passive joint position sense test five times. Before and after the strapping on the knee flexor and extensor muscles of hemiplegic lower extremity, TUG, 10 mWT, K-BBS and passive joint position sense test was checked. Also 10 controlled hemiplegic patients that did not have strapping were checked by same scales 2 times. Setting: Department of physical medicine and rehabilitation. Results: Control group did not have difference in all scales. Strapping on hemiplegic lower extremity group significantly improved joint position sense (P⬍.05) and K-BBS (P⬍.05). But there was no statistically significant difference in TUG and 10mWT. Conclusions: It seems that strapping on hemiplegic lower extremity may be helpful to improve proprioception and balance. **Poster 551 Mirror-Neuron System Recruitment by Action Observation in Stroke Rehabilitation. Nachum Soroker, MD (Loewenstein Rehabilitation Hospital, Raanana, Israel); Shlomo Bentin, MD; Silvi FrenkelToledo, MD; Dario Liebermann, MD. Disclosures: N. Soroker, No Disclosures. Objective: To identify a reliable electrophysiological marker of mirror-neuron system (MNS) recruitment, that can be used for physiological monitoring of rehabilitation treatment employing action observation (AO). Design: Prospective study contrasting the EEG patterns of stroke patients and matched healthy controls. Setting: Rehabilitation hospital; Department of Neurological Rehabilitation. Participants: 28 first-event stroke patients and 27 matched healthy controls. Interventions: Action observation in different conditions. Main Outcome Measures: Behavioral: Fugl Meyer and “Box and Blocks” tests of upper limb function; EEG: suppression shown at the alpha/mu range during observation and execution of reach and grasp activity. Results: Execution of arm movement elicited maximal suppression in central sites (over the sensory-motor cortex) at the higher mu range (10-12 Hz). Observation of similar movements elicited maximal suppression in the lower mu range (8-10 Hz), and despite being a visual task, the suppression recorded from central sites was greater than from occipital sites. The effect of viewpoint (in front or at the back of the performer) was more noticeable in central than in occipital sites. In the patient group, AO revealed less suppression in the affected hemisphere compared to the unaffected hemisphere. Suppression in the lower mu range was negatively correlated with
PM&R
lesion extent within the inferior parietal cortex, a region where damage often results in motor-control disorders (apraxia), and where large aggregates of mirror neurons were found in macaque monkeys. Conclusions: The findings corroborate the notion that mu (8-12 Hz) suppression is a valid marker of MNS activity in humans. However, they point also to a functional distinction between the higher and lower segments of the mu range, where only suppression of the latter seem to be associated with activation of a human MNS. Quantitative EEG combined with standard behavioral measurement of motor activity is an important tool in studies of AO role in stroke rehabilitation. Poster 552 Foreign Accent Syndrome in Stroke Patient: A Case Report. Priyan Perera, MD (Marianjoy Rehabilitation Hospital, Wheaton, IL, United States); Noel Rao, MD; Laura Veltman, SLP. Disclosures: P. Perera, No Disclosures. Case Description: A 53-year-old woman presented to the emergency room with acute right hemianesthesia and right foot drop. Magnetic resonance imaging revealed an acute ischemic infarct in the left corona radiata and left basal ganglia. The patient was also noted to have a speech production most consistent with a German accent. Despite previous studies in French and Spanish, the patient only spoke English and had never left the country. During the initial speech evaluation, some unusual findings in her speech pattern included vowel distortions, inconsistent consonant conversions and significant deviations in pitch pattern. These are changes more often associated with foreign accent syndrome rather than dysarthria. The patient was treated in speech therapy with the presumed diagnosis of foreign accent syndrome. She received 90 minutes of speech therapy daily with use of biofeedback to increase awareness of speech output. Therapy addressed consonant patterns, prosody, intonation and vowel modifications. Setting: Free-standing rehabilitation hospital. Results or Clinical Course: Patient was followed up 4 months after her stroke and was noted to have regained most of her native accent along with scoring a 100% intelligibility score as opposed to 80% on admission. Discussion: This case illustrates one of less than 100 known cases of foreign accent syndrome in the world, an overview of this rare syndrome and how to more effectively diagnose and treat it. Recognition of this speech disorder is imperative to providing appropriate speech therapy for a successful recovery. Conclusions: Early recognition of foreign accent syndrome and implementation of known techniques in the treatment of this disorder can result in a quicker recovery of their speech pattern along with a significant improvement in the quality of their life. Poster 553 Taping to Improve Movement Post-Stroke: A Case Report. Ri Sau (The Reading Hospital, Wyomissing, PA, United States); Kuen Chan, MA Mark Chai, MD; Kelley Crozier, MD. Disclosures: R. Chan, Ownership or partnership: East West Seminars; Consulting fees or other remuneration (payment), Kinesio
Vol. 4, Iss. 10S, 2012
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Tex Taping Association, Commission on the Accreditation of Rehabilitation Facilities, Harcum College, Zhongshan Hospital Fudan University (Shanghai), Penn State Unversity Occupational Therapy Assistant Program, Alvernia College Occupational Therapy Program, Mercy College Occupational Therapy Program, New York University Occupational Therapy Program, and Columbia University Occupational Therapy Program. Case Description: The patient is a 62-year-old right hand dominant woman with a left temporal parietal hemorrhage and right hemiparesis. The patient demonstrated limited active range of motion of the right shoulder to 110 degrees of flexion and 65 degrees of abduction. Functionally the patient was able to reach and touch her right ear. Taping was applied to facilitate the right serratus anterior, middle trapezius, infraspinatus, anterior and posterior deltoid muscles. Program Description: Photographs pre and post-taping will be available to supplement the case report. Setting: Post-acute rehabilitation hospital. Results or Clinical Course: Immediately following taping, the patient demonstrated increased active right shoulder flexion to 155 degrees and abduction to 130 degrees. Functionally the patient was able to reach and touch the top of her head. Four days later, with continued taping, the patient demonstrated increased active shoulder flexion to 170 degrees and abduction to 180 degrees. Discussion: This is the first reported case, to our knowledge, of taping that increased and maintained active movement affected by hemiparesis. Conclusions: The use of taping needs to be further explored as a treatment intervention with post-stroke patients. Poster 554 Dysphagia Outcomes for Patients With Feeding Tubes Undergoing Inpatient Rehabilitation. Richard Krieger, MD (Marianjoy Rehabilitation Hospital, Wheaton, IL, United States); Susan L. Brady, MS; Cari Manypenny, SLP; Karen Ng, MA CCC-SLP; Andrea Quill, SLP; R. Jordan Stewart, SLP. Disclosures: R. Krieger, No Disclosures. Objective: To investigate the outcomes associated with patients with a feeding tube (FT) placed secondary to neurogenic dysphagia following stroke or brain injury participating with inpatient rehabilitation (IPR). Design: Retrospective chart review. Setting: Freestanding rehabilitation hospital. Participants: Sixty-four patients who presented with a neurogenic dysphagia and a FT who were admitted over 18 months to IPR. Rehabilitation Impairment Code (RIC) for the study participants included the following groupings: Stroke (RIC 01), n⫽34; Brain Injury (RIC 02, 03, 18), n ⫽ 24; and Other Neurologic Impairment (RIC 04, 06, 20), n⫽6. Age range 19-91 years, mean age 64.91 years (SD⫽19.93 years) and gender distribution 40 males and 24 females. Interventions: Dysphagia treatment during IPR. Main Outcome Measures: Discharge diet level, length of stay, discharge destination, and FT status at time of discharge from IPR. Results: A Wilcoxon Signed Rank Test indicated there was a significant improvement in diet level from admission to discharge
circulation collateralization, there is increased risk of vascular accident with a propensity for ocular symptomatology. Discussion: Posterior circulation stroke with Balint’s syndrome causes ocular apraxia as evidenced by deficient visual scanning despite intact extraocular muscles, dysmetria secondary to visual perceptual deficits, and by inability to attend to multiple items contained within a visual field. Conclusions: Posterior circulation-involved Moyamoya presenting with Balint’s syndrome features is rare and case reports in the literature are limited. Depending on disease progression and comborbidities, these patients have the potential for modest functional recovery through adaptive strategies including patterned scanning, decreasing visual distracters, continued repetition, and provider cueing. Poster 549 Rehabilitation of a 46-Year-Old Woman with Subarachnoid Hemorrhage Complicated by Linezolid-Induced Posterior Reversible Encephalopathy Syndrome (PRES): A Case Report. Mary E. Russell, DO, MS (Baylor College of Medicine, Houston, TX, United States); Cindy B. Ivanhoe, MD; Monica Verduzco-Gutierrez, MD. Disclosures: M. E. Russell, No Disclosures. Case Description: The patient was admitted for rehabilitation after subarachnoid hemorrhage secondary to posterior communicating artery aneurysm. The patient was progressing well with therapy and started on linezolid for a vancomycin-resistant enterococcus (VRE) urinary tract infection. Six days after completing a 7-day course of linezolid, patient developed persistent tachycardia, hypertension, nystagmus and a generalized tonic-clonic seizure. Head CT showed abnormal attenuation of the left parietal lobe and adjacent white matter. The patient continued to deteriorate and was transferred to an acute-care hospital where she was restarted on linezolid and cefepime for a VRE urinary tract infection. On hospital day 3, patient became lethargic with new onset right-hemiplegia. Head CT showed severe left cerebral edema consistent with PRES. Blood pressure was controlled and other causes of PRES were excluded. Linezolid was stopped and the patient treated with cefepime and vancomycin. The patient’s neurologic status improved and she returned to the rehabilitation facility. Upon return, she was noted to have a significant functional decline from her previous admission. The patient continued to be lethargic and was found again to have a VRE urinary tract infection. Daptomycin was given with no untoward effects. Patient began to interact more and improve with therapy. Program Description: 46-year-old woman with severe stroke secondary to a ruptured posterior communicating artery aneurysm. Setting: Rehabilitation hospital. Results or Clinical Course: Four weeks after diagnosis, the patient has shown improvement. The patient is back to her level prior to transfer and continues to make significant progress. Further developments will be discussed. Discussion: Linezolid-induced PRES is a rare side effect with few reported cases. This resulted in a functional decline during rehabilitation course. Conclusions: PRES is a rare and serious adverse reaction that may occur when treating a vancomycin resistant infection with linezolid.
PRESENTATIONS
Poster 550 Effect of Strapping on the Hemiplegic Lower Extremity: Gait Speed, Balance and Proprioception. Min-ah Kim, (Dong-A University, Busan, Korea, Republic of); Sang-Beom Kim Jae-won Ri, MD. Disclosures: M. Kim, No Disclosures. Objective: To investigate the effect of strapping on the lower extremity in hemiplegic patients in gait speed, balance and proprioception. Design: Patients who had less than fair degree of knee extension power were not included. Twenty four hemiplegic patients were recruited. The balance and gait speed were assessed by Timed Up and Go test (TUG), 10 meter Walking Time (10 mWT), and Korean version of Berg Balance Scale (K-BBS). Proprioception was measured by passive joint position sense test five times. Before and after the strapping on the knee flexor and extensor muscles of hemiplegic lower extremity, TUG, 10 mWT, K-BBS and passive joint position sense test was checked. Also 10 controlled hemiplegic patients that did not have strapping were checked by same scales 2 times. Setting: Department of physical medicine and rehabilitation. Results: Control group did not have difference in all scales. Strapping on hemiplegic lower extremity group significantly improved joint position sense (P⬍.05) and K-BBS (P⬍.05). But there was no statistically significant difference in TUG and 10mWT. Conclusions: It seems that strapping on hemiplegic lower extremity may be helpful to improve proprioception and balance. **Poster 551 Mirror-Neuron System Recruitment by Action Observation in Stroke Rehabilitation. Nachum Soroker, MD (Loewenstein Rehabilitation Hospital, Raanana, Israel); Shlomo Bentin, MD; Silvi FrenkelToledo, MD; Dario Liebermann, MD. Disclosures: N. Soroker, No Disclosures. Objective: To identify a reliable electrophysiological marker of mirror-neuron system (MNS) recruitment, that can be used for physiological monitoring of rehabilitation treatment employing action observation (AO). Design: Prospective study contrasting the EEG patterns of stroke patients and matched healthy controls. Setting: Rehabilitation hospital; Department of Neurological Rehabilitation. Participants: 28 first-event stroke patients and 27 matched healthy controls. Interventions: Action observation in different conditions. Main Outcome Measures: Behavioral: Fugl Meyer and “Box and Blocks” tests of upper limb function; EEG: suppression shown at the alpha/mu range during observation and execution of reach and grasp activity. Results: Execution of arm movement elicited maximal suppression in central sites (over the sensory-motor cortex) at the higher mu range (10-12 Hz). Observation of similar movements elicited maximal suppression in the lower mu range (8-10 Hz), and despite being a visual task, the suppression recorded from central sites was greater than from occipital sites. The effect of viewpoint (in front or at the back of the performer) was more noticeable in central than in occipital sites. In the patient group, AO revealed less suppression in the affected hemisphere compared to the unaffected hemisphere. Suppression in the lower mu range was negatively correlated with
PM&R
lesion extent within the inferior parietal cortex, a region where damage often results in motor-control disorders (apraxia), and where large aggregates of mirror neurons were found in macaque monkeys. Conclusions: The findings corroborate the notion that mu (8-12 Hz) suppression is a valid marker of MNS activity in humans. However, they point also to a functional distinction between the higher and lower segments of the mu range, where only suppression of the latter seem to be associated with activation of a human MNS. Quantitative EEG combined with standard behavioral measurement of motor activity is an important tool in studies of AO role in stroke rehabilitation. Poster 552 Foreign Accent Syndrome in Stroke Patient: A Case Report. Priyan Perera, MD (Marianjoy Rehabilitation Hospital, Wheaton, IL, United States); Noel Rao, MD; Laura Veltman, SLP. Disclosures: P. Perera, No Disclosures. Case Description: A 53-year-old woman presented to the emergency room with acute right hemianesthesia and right foot drop. Magnetic resonance imaging revealed an acute ischemic infarct in the left corona radiata and left basal ganglia. The patient was also noted to have a speech production most consistent with a German accent. Despite previous studies in French and Spanish, the patient only spoke English and had never left the country. During the initial speech evaluation, some unusual findings in her speech pattern included vowel distortions, inconsistent consonant conversions and significant deviations in pitch pattern. These are changes more often associated with foreign accent syndrome rather than dysarthria. The patient was treated in speech therapy with the presumed diagnosis of foreign accent syndrome. She received 90 minutes of speech therapy daily with use of biofeedback to increase awareness of speech output. Therapy addressed consonant patterns, prosody, intonation and vowel modifications. Setting: Free-standing rehabilitation hospital. Results or Clinical Course: Patient was followed up 4 months after her stroke and was noted to have regained most of her native accent along with scoring a 100% intelligibility score as opposed to 80% on admission. Discussion: This case illustrates one of less than 100 known cases of foreign accent syndrome in the world, an overview of this rare syndrome and how to more effectively diagnose and treat it. Recognition of this speech disorder is imperative to providing appropriate speech therapy for a successful recovery. Conclusions: Early recognition of foreign accent syndrome and implementation of known techniques in the treatment of this disorder can result in a quicker recovery of their speech pattern along with a significant improvement in the quality of their life. Poster 553 Taping to Improve Movement Post-Stroke: A Case Report. Ri Sau (The Reading Hospital, Wyomissing, PA, United States); Kuen Chan, MA Mark Chai, MD; Kelley Crozier, MD. Disclosures: R. Chan, Ownership or partnership: East West Seminars; Consulting fees or other remuneration (payment), Kinesio
Vol. 4, Iss. 10S, 2012
S379
Tex Taping Association, Commission on the Accreditation of Rehabilitation Facilities, Harcum College, Zhongshan Hospital Fudan University (Shanghai), Penn State Unversity Occupational Therapy Assistant Program, Alvernia College Occupational Therapy Program, Mercy College Occupational Therapy Program, New York University Occupational Therapy Program, and Columbia University Occupational Therapy Program. Case Description: The patient is a 62-year-old right hand dominant woman with a left temporal parietal hemorrhage and right hemiparesis. The patient demonstrated limited active range of motion of the right shoulder to 110 degrees of flexion and 65 degrees of abduction. Functionally the patient was able to reach and touch her right ear. Taping was applied to facilitate the right serratus anterior, middle trapezius, infraspinatus, anterior and posterior deltoid muscles. Program Description: Photographs pre and post-taping will be available to supplement the case report. Setting: Post-acute rehabilitation hospital. Results or Clinical Course: Immediately following taping, the patient demonstrated increased active right shoulder flexion to 155 degrees and abduction to 130 degrees. Functionally the patient was able to reach and touch the top of her head. Four days later, with continued taping, the patient demonstrated increased active shoulder flexion to 170 degrees and abduction to 180 degrees. Discussion: This is the first reported case, to our knowledge, of taping that increased and maintained active movement affected by hemiparesis. Conclusions: The use of taping needs to be further explored as a treatment intervention with post-stroke patients. Poster 554 Dysphagia Outcomes for Patients With Feeding Tubes Undergoing Inpatient Rehabilitation. Richard Krieger, MD (Marianjoy Rehabilitation Hospital, Wheaton, IL, United States); Susan L. Brady, MS; Cari Manypenny, SLP; Karen Ng, MA CCC-SLP; Andrea Quill, SLP; R. Jordan Stewart, SLP. Disclosures: R. Krieger, No Disclosures. Objective: To investigate the outcomes associated with patients with a feeding tube (FT) placed secondary to neurogenic dysphagia following stroke or brain injury participating with inpatient rehabilitation (IPR). Design: Retrospective chart review. Setting: Freestanding rehabilitation hospital. Participants: Sixty-four patients who presented with a neurogenic dysphagia and a FT who were admitted over 18 months to IPR. Rehabilitation Impairment Code (RIC) for the study participants included the following groupings: Stroke (RIC 01), n⫽34; Brain Injury (RIC 02, 03, 18), n ⫽ 24; and Other Neurologic Impairment (RIC 04, 06, 20), n⫽6. Age range 19-91 years, mean age 64.91 years (SD⫽19.93 years) and gender distribution 40 males and 24 females. Interventions: Dysphagia treatment during IPR. Main Outcome Measures: Discharge diet level, length of stay, discharge destination, and FT status at time of discharge from IPR. Results: A Wilcoxon Signed Rank Test indicated there was a significant improvement in diet level from admission to discharge