ABILHOUSE: A Community-Based Clubhouse for Veterans and Civilians with TBI

Research Posters Setting: Inclusion criteria: (1) age 18 with TBI diagnosis; (2) all injury severities; any time post-injury; (3) treatment/intervention conducted during inpatient or outpatient/transitional rehabilitation. Exclusion criteria: (1) pediatric samples; (2) absence. Participants: A neuropsychologist reviewed all 84 articles. Three articles focused on GMT and four on APT. Quality of evidence was evaluated by a multi-disciplinary panel employing Grading of Recommendations, Assessment, Development, and Evaluation and Oxford Centre for Evidence Based Medicine levels. Delphi methodology was utilized to obtain consensus on the recommendation with 13 experts in Neuropsychology and TBI survivors/families. Interventions: N/A. Main Outcome Measure(s): N/A. Results: Based on the evidence, the Delphi Panel made the following recommendations: (1) GMT to improve goal-setting and problem-solving in TBI survivors is supported but is weak/conditional and (2) APT to treat attentional deficits in TBI survivors is supported but is weak/conditional. Sources of variation between studies included outcomes, chronicity and severity of TBI, study design, and sample sizes. Conclusions: Comparative effectiveness research is needed to enable rehabilitation providers, TBI survivors, and stakeholders to make informed decisions regarding appropriate treatments. Key Words: Brain Injuries, Evidence-Based Practice, Attention, Problem Solving, Rehabilitation Disclosures: The authors have no conflict of interest to declare. However, the contents of this manuscript were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DP0045-01-0). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government. The project was also supported by the Ginger Murchison Foundation. Research Poster 649 Posture Patterns Assumed During Technology use Among College Students Kimberly Szucs (Duquesne University), Marissa Rakow, Kara Cicuto Research Objectives: To determine postures assumed with use of different hand-held devices and determine if postural alignment of the upper quarter assumed during use of these devices deviate from normal. Design: Descriptive study. Setting: Research laboratory at academic institution. Participants: Convenience sample of 17 healthy college students (mean age: 21 years; 3 males, 14 females) have completed this study with a recruitment goal of 25 participants. Interventions: N/A. Main Outcome Measure(s): An iPad application, Posture Screen (PostureCo, Inc; Trinity, FL) was used to assess subjects’ postural alignment. Subjects stood in a neutral posture and pictures were taken from the anterior, lateral and posterior aspects. Pictures were then taken as subjects used different technology (cell phone, tablet, laptop) to complete various tasks. Subjects were encouraged to complete the task using their typical posture. The posture app was used to calculate anterior and lateral translations and angular displacements from neutral stance. The variables of interest include: head translation and angular displacement, shoulder translation (relative to ribs) and angular displacement, ribcage translation (relative to pelvis), pelvis translation (relative to ankles) and angular displacement. Results: Data analysis is ongoing. Baseline postures have been analyzed with descriptive statistics. On average, subjects stood with their head slightly translated and tilted to the right, with increased neck flexion. Subjects’ shoulders were translated and tilted to the right. The ribcage was translated to the left while the pelvis was translated to the right, with a left pelvic obliquity (left ASIS depressed relative to right).

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e101 Conclusions: Students who frequently use hand-held devices and electronic technology assume close to neutral standing postures, with the exception of large forward head flexion. An early analysis of postures during device use shows increased head and shoulder displacements from neutral. Key Words: Posture, Technology, Students Disclosures: None disclosed. Research Poster 650 Group Cohesion and Participation in Adaptive Sport: Spinal Cord Injury and Other Mobility Limiting Conditions Susan Lydick (Department of Rehabilitation Science, George Mason University), Amanda K. Rounds, Caitlin A. Bryson, Jeffrey E. Herrick, John P. Collins, Suzanne L. Groah, Jerome L. Short Research Objectives: To characterize the contribution of group cohesion to participation in adaptive sport among adults with spinal cord injury (SCI) or other health conditions that limit mobility. Design: Survey. Setting: Community-based adult adaptive sport team gatherings and adaptive fitness group practices. Participants: Volunteer sample of 107 adults, 57 reported spinal cord injury and 50 reported other primary mobility limiting conditions that quality them for participation in adaptive sport. Interventions: Not Applicable. Main Outcome Measure(s): Self-reported number of years with the team (TWT) and moderate and heavy leisure time physical activity (LTPA) in minutes per week were the primary outcome measures for participation. Attendance data was also obtained from the fitness group and two quad rugby teams. Results: Attraction to Group-Task (ATG-T), the individual team member’s feelings about his or her personal involvement with the group’s task and attendance correlated among fitness group participants (p<0.01). Group Integration Social (GI-S), the individual team member’s feelings about bonding within the team as a social unit, correlated with attendance for quad rugby participants (p<0.05). ATG-T and GI-S correlated with TWT (p<0.05) and (p<0.05) respectively. ATG-T and GI-S were predictors of LTPA in the regression model that was a significant fit to the data (p<0.05), R2Z0.100). Conclusions: Group cohesion is associated with participation in adaptive sports and leisure time physical activity among adults with severe mobility limitations and provides an important focus for future study of physical activity maintenance among groups at high risk for hypoactive lifestyle. Key Words: Exercise, Spinal Cord Injury, Adaptive sports, Group Processes Disclosures: None disclosed. Research Poster 651 ABILHOUSE: A Community-Based Clubhouse for Veterans and Civilians with TBI Christina Dillahunt-Aspillaga (University of South Florida), Deveney Ching, Dianne Duncan, Miranda Ray Research Objectives: To describe services provided by the ABILHouse community-based clubhouse (community integration, vocational preparation, and direct placement) and (2) to examine employment outcomes among clubhouse members with traumatic brain injury (TBI). Design: Descriptive case study. Setting: Community-based setting in Hillsborough and Pinellas Counties in Florida. Participants: Convenience sample consisted of 33 individuals with brain injuries (nZ15 Veterans, nZ 18 civilians) who were members of ABILHouse. Sample was primarily male (73%), Caucasian (70%) between the ages of 44- 69 years (64%). More than half to the sample was single (58%), with vocational training (30%) or some college preparation (26%). Participants were eligible for the study if they had a documented or

e102 self-reported TBI and were official members of the ABILHouse TBI Clubhouse. Participant consent was solicited prior to inclusion in the study. Interventions: Not Applicable. Main Outcome Measure(s): Employment. Results: ABILHouse member goals included 1) paid employment (60%), 2) volunteering (9%), 3) return to school (9%), and 4) not yet ready to set vocational goal (22%). Twelve participants (60%) have successfully returned to competitive employment while other members are in various stages of return to productive activity. Members reported positive experiences while participating in the program including improved self-esteem, increased community engagement, increased social support, and felt more empowered to seek employment. Conclusions: The ABILHouse community-based clubhouse program offers social and community supports for civilians and Veterans with TBI. Findings from this small descriptive study indicate that Veterans and may benefit from long-term community-based supports. ABILHouse may help meet the dynamic and chronic needs of this important population. Additional study with a larger and more representative sample is required before this information is used in clinical settings. Key Words: Brain Injuries, Employment, Veterans Disclosures: None disclosed. Research Poster 652 Cognitive Contributions to Gait Characteristics in Older Adults Wendy Huddleston (University of Wisconsin - Milwaukee), Evan W. Corbin, Nicole M. Recka, Brittany E. Smith Research Objectives: One of every 3 adults over 65 years falls each year. We investigated the effect of cognitive load on gait quality in this population. We hypothesized that high cognitive load conditions lead to visual attention deficits, impairing gait. Design: Cross-sectional, quasi-experimental, repeated measures design. Setting: General community research laboratory. Participants: Fourteen healthy and cognitively alert older adults (70-91 years) and 10 younger adults (18-28 years). Interventions: Participants performed three randomly assigned tasks including a modified Timed Up and Go (mTUG); a cognitive task (subtract 7s), and these two tasks combined. We compared gaze patterns (Mobile Eye-XG, ASL) across the two walking tasks as a proxy for overt visual attention, and recorded walking characteristics using a pressure-sensing mat (GAITRite). Main Outcome Measure(s): Cognitive performance, overt visuospatial attention (gaze time on targets), and gait parameters. Results: Total time to complete the walking task significantly increased with increased cognitive load across age groups. Associated gait changes included significantly decreased stride length, decreased walking speed, increased double stance time, and decreased cadence (stance width did not significantly change). Gaze time on target was significantly different for younger adults, but not significantly different for older adults; although older adults who had the most difficulty with the cognitive task also had the greatest differences in total walking time and gaze time on target between the two conditions. Conclusions: Deficits in visuospatial attention due to increased cognitive load do not completely explain observed gait changes in older adults. However, older adults with the greatest difficulty on the cognitive task demonstrated the greatest impairments in walk times and visuospatial attention. Thus, fall prevention programs should consider assessing and addressing cognitive status to optimize effectiveness. Key Words: Attention, cognition, aging, gait, accidental falls Disclosures: None disclosed. Research Poster 653 Impact of Conductive Education on Functional Skills for Adults with Chronic Stroke: A Pilot Study Roberta OShea (Governors State University), Renee Theiss, Maureen Michalski, Gabriella Molnar, Todd Parrish, Tim Rylander

Research Posters Research Objectives: To explore using Conductive Education(CE) for patients with chronic stroke symptoms. Design: This pilot study used a non-randomized pre/post intervention design. Subjects were evaluated before and after the conductive education program (“intervention”) using brain imaging and standard PT assessments. Setting: Outpatient Conductive Education Center. Participants: 4 volunteers who were at least 1 year post stroke, recruited from local therapists. IRB approval was obtained. Interventions: The subjects underwent pre- and post-test measures and imaging. The subjects participated in 10 weekly CE group sessions including fine motor tasks, ADL tasks, ambulation and stair climbing tasks. Main Outcome Measure(s): Outcome measures included changes in functional motor assessments (Barthel, TUG, 10mWT), changes in ADLs and participation (SIS), and changes in supraspinal neurological structure and connectivity (MRI, DTI/MT, resting fMRI). Results: Four adults with chronic motor impairments participated in the CE program. . Functional and structural gains after participating in the CE program were individualized.. Those with pontine lesions showed the greatest improvements in hand function, scoring greater than minimally clinically important difference (MCID) in the post-test SIS hand function scales. Imaging also showed increases in gray matter density in the sensorimotor cortices, bilateral thalamus, visual cortex, and cerebellum, as well as increases in connectivity between contralateral primary motor areas and motor and supplementary motor areas. Those with subcortical lesions showed the greatest improvements in mobility, scoring greater than MCID in the post-test SIS mobility scales. Gray matter density increased in bilateral motor areas, thalamus, visual cortex, and cerebellum with consolidation of connectivity in the subject with the largest and most severe lesion. Conclusions: CE could be effective for adults with chronic stroke, measurable through standard clinical outcome measures and emerging imaging techniques. Key Words: Stroke, Physical therapy Modalities, fMRI Disclosures: None disclosed. Research Poster 656 Role of Functional Status in Health Related Quality of Life in Individuals with Diabetic Peripheral Neuropathy Kavita Venkataraman (Saw Swee Hock School of Public Health, National University of Singapore), Hwee-Lin Wee, Eric YH. Khoo, Bee-Choo Tai, Wilson Wang, Gerald CH. Koh, E. Shyong Tai Research Objectives: To examine deficits in health related quality of life (HRQoL) between patients with and without diabetic peripheral neuropathy (DPN), and if these deficits can be explained by differences in functional status. Design: Cross-sectional study. Setting: Specialist outpatient clinics in a tertiary care hospital. Participants: Convenience sample of 75 (25 male) patients with Type 2 diabetes mellitus, mean age 61 years, 35 with DPN and 40 without. Study approved by the National Healthcare Group Domain Specific Review Board. Interventions: Not Applicable. Main Outcome Measure(s): HRQoL as measured by the health utility score derived from EQ-5D-5L. Results: Mean utility scores were 0.63 (SD 0.12) and 0.73 (SD 0.15) in patients with and without DPN respectively (P<0.01). Patients with DPN also had poorer functional status, with lower toe muscle strength (7.01.9 versus 8.63.5 pounds, pZ0.02), reduced range of motion at knee (9712 versus 11839 degrees, p<0.01), greater body sway velocity when standing with eyes closed (2.721.51 versus 2.110.78 mm/s, pZ0.03), poorer performance on the timed up-and-go test (124 versus 102 seconds, pZ0.03) and lower scores on the Activities-based Balance Confidence (ABC) scale (67.623 versus 76.218, pZ0.07), compared to those without DPN. On stepwise multiple regression considering DPN

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