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Article 4 (NIDRR) Substance Use in Young Adults with Pediatric-onset Spinal Cord Injury
2011 ACRM-ASNR ANNUAL CONFERENCE ABSTRACTS
or training with an applied pre-injury pattern. Interventions: Daily treatment for 4 weeks. Weekly overground assessment during training, and for an additional 2 weeks. Main Outcome Measures: Overground locomotor parameters such as, stride velocity, stride length, cycle time, and stance/swing phasing. Results: Left hindlimb overground stride length was restored with self-selected training patterns and not a rigid pre-injury pattern. This effect was still present two weeks after training. Right forelimb overground phasing was restored with pre-injury patterns and not self-selected patterns. Robotic training with selfselected patterns impedes the recovery of right hindlimb phasing. Step cycle time of all limbs is unchanged by robotic gait training. All measures were compared to pre-injury levels, with p⬍.05 considered significantly different. Conclusions: Pre-injury locomotion is not necessarily the best training pattern for neurologically impaired subjects. We have shown that other techniques exist that afford greater improvement for some overground gait measures. Key Words: Robotics; Gait dysfunction; neurologic; Spinal cord injuries; Animal research; Rehabilitation. Article 4 (NIDRR) Substance Use in Young Adults with Pediatric-onset Spinal Cord Injury. Miriam Hwang (Shriners Hospitals for Children, Chicago, IL, Medical College of Wisconsin, Milwaukee, WI), Kathy Zebracki, Kathleen Chlan, Lawrence Vogel. Disclosure: None disclosed. Objectives: To assess substance use in young adults with pediatriconset spinal cord injury (SCI) and assess its relationship with demographic factors and medical and psychosocial outcomes so as to increase awareness of such behavior before transition to adulthood. Design: Cross-sectional survey. Setting: Community. Participants: Individuals aged 21- 25 years who had sustained SCI before age 19 (N⫽215). Interventions: Not applicable. Main Outcome Measures: Use of cigarettes, alcohol, and marijuana; Functional Independence Measure® (FIM), Satisfaction with Life Scale (SWLS), Short-Form 12® (SF-12) Health Survey, Patient Health Questionnaire-9 (PHQ-9) Depression Scale, and Craig Handicap Assessment and Recording Technique (CHART). Results: Mean age at interview was 23.3 yrs; mean age at injury was 13.2 yrs. 24% had a college diploma, 36% were employed, and 12% were married. Regular substance use was reported by 28% for cigarettes, 55% for alcohol, and 11% for marijuana. Marijuana use was more prevalent in males (p⬍.05). There were no significant correlations between substance use and age at injury, duration of injury, FIM® scores, SWLS, or SF-12® mental. Cigarette use had a positive correlation with PHQ-9 (p⬍.05). Alcohol use was associated with higher CHART subscales for physical independence (p⬍.05), mobility (p⬍.01), social integration (p⬍.01), and economic self-sufficiency (p⬍.05); SF-12 physical (p⬍.05); having college education (p⬍.01), being employed (p⬍.01), not being married (p⬍.01), and independent drive (p⬍.01). Smoking was associated with being unemployed (p⬍.05). Marijuana use was associated with not having college education (p⬍.05). Conclusions: Substance use in young adults with pediatric-onset SCI was associated with demographic factors such as education, employment, and marital status. Cigarette smoking was associated with depressive symptoms, whereas alcohol use was associated with increased social and community participation. Clinicians caring for adolescents with SCI should counsel patients and caregivers regarding the use of substances and potential associations with negative outcome in their transition into adulthood. Key Words: Pediatric; Spinal cord injury; Substance use; Outcome; Rehabilitation. Article 5 Empowerment/Engagement: Front-line Clinicians Enhance the Research Process. Julie Gassaway (Institute for Clinical Outcomes Research, Salt Lake City, UT), Gale Whiteneck. Disclosure: None disclosed. Objective: Demonstrate how clinician-driven Practice-Based Evidence research methodology engages members of the multi-disciplinary
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treatment team in each phase of the research process. Design: Prospective observational study. Setting: Six inpatient rehabilitation facilities participating in the SCIRehab Project. Participants: 1042 clinicians treating 1,378 patients admitted for initial rehabilitation after traumatic SCI. Interventions: Not applicable. Main Outcome Measures: Extent of clinician involvement in each phase of the research process. Results: Multi-center discipline-specific teams (54 clinicians in total) developed ‘taxonomies’ for rehabilitation care during 2 in-person meetings and weekly teleconferences within each discipline over 9 months. These taxonomies were programmed into handheld computers and used by 1042 clinicians in seven disciplines to document treatment after each patient encounter for 2.5 years. Involvement in taxonomy development empowered clinicians to become clinical champions; they worked to achieve reliable documentation among all participants, managed technical difficulties, and encouraged peers through periods of frustration. Their efforts resulted in the documentation of details and time spent on almost one million interventions, during 300,000 sessions totaling 250,000 hours of treatment. Clinical champions are now involved in the analysis and dissemination phases. Taxonomies of care for each discipline have been published and form the foundation of further research/dissemination that includes a second paper by each discipline describing the intensity of interventions used during routine care and the association of patient/injury characteristics with time spent in discipline-specific activities, as well as presentations at the annual meetings for each discipline. Additional articles and presentations that involved front-line clinicians are planned as final outcomes are analyzed. Conclusions: Clinicians are eager to participate in the research process if provided sufficient guidance. The SCIRehab project’s discipline-specific taxonomies and technology, developed by clinicians, offer the first practical and replicable method to document details of the rehabilitation process and form the foundation for additional dissemination by front-line clinicians. Key Words: Rehabilitation.
Stroke Article 6 Neuromuscular Electrical Stimulation Efficacy in Acute Stroke Tube Dependent Dysphagia. David Kushner (University of Miami School of Medicine, Miami, FL), Kenneth Peters, Stacy Thomashaw-Eroglu, Perless Melissa, Douglas Johnson-Greene. Disclosure: None disclosed. Objective: Comparing efficacy of Neuromuscular Electrical Stimulation (NMES) with Progressive Resistance Therapy (PRT) to Traditional Dysphagia Therapy (TDT) for treatment of feeding tube dependent dysphagia in acute stroke patients during inpatient rehabilitation. Design: Non-concurrent cohort study. Setting: Inpatient rehabilitation unit. Participants: 38 subjects having acute stroke with initial Functional Oral Intake Scale (FOIS) scores of 3 or less indicating feeding tube dependant profound to severe dysphagia. Interventions: 26 subjects in the experimental group received NMES and PRT and 12 subjects in the control group received TDT. All participants were treated in hourly sessions daily for an average of 18⫹/⫺3 days. Chi-square analyses and t-tests revealed no significant statistical differences between the experimental and control groups for any demographic or clinical variables including age, gender, or stroke type/location. Main Outcome Measures: Comparison of FOIS scores after treatment. A t-test comparing the initial FOIS scores between the two groups showed no significant statistical difference in swallowing impairment severity prior to treatment. Results: Average FOIS score after NMES/PRT treatment was 5.5 ⫹/⫺ 1.4, a gain of 4.3 per experimental group subject, with 62% having minimal or no swallowing restrictions (FOIS score 6 or 7) following treatment. In contrast, only 2 subjects from the control group (TDT) improved to a FOIS score of 6 or 7 (17%). A t-test examining the effect of the treatment between the two groups showed significant improvement in swallowing performance in the experimental group (t⫽4.3; p⬍.001). Age, stroke location/type and gender appeared to have no significant impact Arch Phys Med Rehabil Vol 92, October 2011
or training with an applied pre-injury pattern. Interventions: Daily treatment for 4 weeks. Weekly overground assessment during training, and for an additional 2 weeks. Main Outcome Measures: Overground locomotor parameters such as, stride velocity, stride length, cycle time, and stance/swing phasing. Results: Left hindlimb overground stride length was restored with self-selected training patterns and not a rigid pre-injury pattern. This effect was still present two weeks after training. Right forelimb overground phasing was restored with pre-injury patterns and not self-selected patterns. Robotic training with selfselected patterns impedes the recovery of right hindlimb phasing. Step cycle time of all limbs is unchanged by robotic gait training. All measures were compared to pre-injury levels, with p⬍.05 considered significantly different. Conclusions: Pre-injury locomotion is not necessarily the best training pattern for neurologically impaired subjects. We have shown that other techniques exist that afford greater improvement for some overground gait measures. Key Words: Robotics; Gait dysfunction; neurologic; Spinal cord injuries; Animal research; Rehabilitation. Article 4 (NIDRR) Substance Use in Young Adults with Pediatric-onset Spinal Cord Injury. Miriam Hwang (Shriners Hospitals for Children, Chicago, IL, Medical College of Wisconsin, Milwaukee, WI), Kathy Zebracki, Kathleen Chlan, Lawrence Vogel. Disclosure: None disclosed. Objectives: To assess substance use in young adults with pediatriconset spinal cord injury (SCI) and assess its relationship with demographic factors and medical and psychosocial outcomes so as to increase awareness of such behavior before transition to adulthood. Design: Cross-sectional survey. Setting: Community. Participants: Individuals aged 21- 25 years who had sustained SCI before age 19 (N⫽215). Interventions: Not applicable. Main Outcome Measures: Use of cigarettes, alcohol, and marijuana; Functional Independence Measure® (FIM), Satisfaction with Life Scale (SWLS), Short-Form 12® (SF-12) Health Survey, Patient Health Questionnaire-9 (PHQ-9) Depression Scale, and Craig Handicap Assessment and Recording Technique (CHART). Results: Mean age at interview was 23.3 yrs; mean age at injury was 13.2 yrs. 24% had a college diploma, 36% were employed, and 12% were married. Regular substance use was reported by 28% for cigarettes, 55% for alcohol, and 11% for marijuana. Marijuana use was more prevalent in males (p⬍.05). There were no significant correlations between substance use and age at injury, duration of injury, FIM® scores, SWLS, or SF-12® mental. Cigarette use had a positive correlation with PHQ-9 (p⬍.05). Alcohol use was associated with higher CHART subscales for physical independence (p⬍.05), mobility (p⬍.01), social integration (p⬍.01), and economic self-sufficiency (p⬍.05); SF-12 physical (p⬍.05); having college education (p⬍.01), being employed (p⬍.01), not being married (p⬍.01), and independent drive (p⬍.01). Smoking was associated with being unemployed (p⬍.05). Marijuana use was associated with not having college education (p⬍.05). Conclusions: Substance use in young adults with pediatric-onset SCI was associated with demographic factors such as education, employment, and marital status. Cigarette smoking was associated with depressive symptoms, whereas alcohol use was associated with increased social and community participation. Clinicians caring for adolescents with SCI should counsel patients and caregivers regarding the use of substances and potential associations with negative outcome in their transition into adulthood. Key Words: Pediatric; Spinal cord injury; Substance use; Outcome; Rehabilitation. Article 5 Empowerment/Engagement: Front-line Clinicians Enhance the Research Process. Julie Gassaway (Institute for Clinical Outcomes Research, Salt Lake City, UT), Gale Whiteneck. Disclosure: None disclosed. Objective: Demonstrate how clinician-driven Practice-Based Evidence research methodology engages members of the multi-disciplinary
1691
treatment team in each phase of the research process. Design: Prospective observational study. Setting: Six inpatient rehabilitation facilities participating in the SCIRehab Project. Participants: 1042 clinicians treating 1,378 patients admitted for initial rehabilitation after traumatic SCI. Interventions: Not applicable. Main Outcome Measures: Extent of clinician involvement in each phase of the research process. Results: Multi-center discipline-specific teams (54 clinicians in total) developed ‘taxonomies’ for rehabilitation care during 2 in-person meetings and weekly teleconferences within each discipline over 9 months. These taxonomies were programmed into handheld computers and used by 1042 clinicians in seven disciplines to document treatment after each patient encounter for 2.5 years. Involvement in taxonomy development empowered clinicians to become clinical champions; they worked to achieve reliable documentation among all participants, managed technical difficulties, and encouraged peers through periods of frustration. Their efforts resulted in the documentation of details and time spent on almost one million interventions, during 300,000 sessions totaling 250,000 hours of treatment. Clinical champions are now involved in the analysis and dissemination phases. Taxonomies of care for each discipline have been published and form the foundation of further research/dissemination that includes a second paper by each discipline describing the intensity of interventions used during routine care and the association of patient/injury characteristics with time spent in discipline-specific activities, as well as presentations at the annual meetings for each discipline. Additional articles and presentations that involved front-line clinicians are planned as final outcomes are analyzed. Conclusions: Clinicians are eager to participate in the research process if provided sufficient guidance. The SCIRehab project’s discipline-specific taxonomies and technology, developed by clinicians, offer the first practical and replicable method to document details of the rehabilitation process and form the foundation for additional dissemination by front-line clinicians. Key Words: Rehabilitation.
Stroke Article 6 Neuromuscular Electrical Stimulation Efficacy in Acute Stroke Tube Dependent Dysphagia. David Kushner (University of Miami School of Medicine, Miami, FL), Kenneth Peters, Stacy Thomashaw-Eroglu, Perless Melissa, Douglas Johnson-Greene. Disclosure: None disclosed. Objective: Comparing efficacy of Neuromuscular Electrical Stimulation (NMES) with Progressive Resistance Therapy (PRT) to Traditional Dysphagia Therapy (TDT) for treatment of feeding tube dependent dysphagia in acute stroke patients during inpatient rehabilitation. Design: Non-concurrent cohort study. Setting: Inpatient rehabilitation unit. Participants: 38 subjects having acute stroke with initial Functional Oral Intake Scale (FOIS) scores of 3 or less indicating feeding tube dependant profound to severe dysphagia. Interventions: 26 subjects in the experimental group received NMES and PRT and 12 subjects in the control group received TDT. All participants were treated in hourly sessions daily for an average of 18⫹/⫺3 days. Chi-square analyses and t-tests revealed no significant statistical differences between the experimental and control groups for any demographic or clinical variables including age, gender, or stroke type/location. Main Outcome Measures: Comparison of FOIS scores after treatment. A t-test comparing the initial FOIS scores between the two groups showed no significant statistical difference in swallowing impairment severity prior to treatment. Results: Average FOIS score after NMES/PRT treatment was 5.5 ⫹/⫺ 1.4, a gain of 4.3 per experimental group subject, with 62% having minimal or no swallowing restrictions (FOIS score 6 or 7) following treatment. In contrast, only 2 subjects from the control group (TDT) improved to a FOIS score of 6 or 7 (17%). A t-test examining the effect of the treatment between the two groups showed significant improvement in swallowing performance in the experimental group (t⫽4.3; p⬍.001). Age, stroke location/type and gender appeared to have no significant impact Arch Phys Med Rehabil Vol 92, October 2011