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Assessment of Gait Variability: Towards an Optimal Testing Protocol
e90 Poster 282 Factors Associated with Nursing Home Placement of Patients Admitted for Inpatient Rehabilitation in Singapore Cynthia Chen (NUS SSHSPH) Objective: To (1) identify social and rehabilitation predictors of nursing home placement, (2) investigate the association between effectiveness and efficiency in rehabilitation and nursing home placement of patients admitted for inpatient rehabilitation from 1996 to 2005 by disease in Singapore. Design: case extraction. Data Sources: National data were retrospectively extracted from medical records of community hospital. Participants: There were 12,506 first admissions for rehabilitation in four community hospitals. Of which, 8,594 (90.3%) patients were discharged home and 924 (9.7%) patients were discharged to a nursing home. Interventions: Not applicable. Main Outcome Measure(s): Nursing home placement. Results: Those who were discharged to nursing home had 33% lower median rehabilitation effectiveness and 29% lower median rehabilitation efficiency compared to those who were discharged to nursing homes. Patients discharged to nursing homes were significantly older (mean age: 77 vs. 73 years), had lower mean Bathel Index scores (40 vs. 48), a longer median length of stay (40 vs. 33 days) and a longer time to rehabilitation (19 vs. 15 days), had a higher proportion without a caregiver (28 vs. 7%), being single (21 vs. 7%) and had dementia (23 vs. 10%). Patients admitted for lower limb amputation or falls had an increased odds of being discharged to a nursing home by 175% (p,0.001) and 65% (p Z 0.043) respectively compared to stroke patients. Conclusions: In our study, the odds of nursing home placement was found to be increased in Chinese, males, single or widowed or separated/ divorced, patients in high subsidy wards for hospital care, patients with dementia, without caregivers, lower functional scores at admission, lower rehabilitation effectiveness or efficiency at discharge and primary diagnosis groups such as fractures, lower limb amputation and falls in comparison to strokes. Key Words: Inpatient rehabilitation, Nursing home, Functional recovery Disclosure(s): None Disclosed.
Poster 283 Energy Expenditure During ADL in Korean Life Style Setting Hee Song Lee (Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University), MinYoung Kim Objective: To measure VO2, energy expenditure(EE) and metabolic equivalent of task(MET) values of activities of daily living and to compare each values between subjects and 11 activities. Design: Cross-sectional study. Setting: General teaching hospital. Participants: The subjects were normal adults with no specific medical history. Total 10 subjects were included. Interventions: We chose 11 daily activities that are relevant to Korean life style and tested it to subjects according to protocol respectively: typing (typing 2500 words or 10 min), sleeping, folding laundry (folding uniform made of wool), dish washing, cleaning the room (using a mop), studying (reading and writing), walking (4km/hr), running (8 km/hr), stair-climbing, walking uphill, and walking downhill. Duration of each activity was 10 minutes. Main Outcome Measure(s): Energy expenditure (EE) and metabolic equivalent of task (MET). Results: There were high internal consistency among the subjects for identical activities (Cronbach a Z 0.89). We obtained mean MET values
Diagnosis Independent of each activity: sleeping (0.77), typing (1.33), folding the laundry (0.85), washing the dish (2.76), cleaning the room (2.78), studying (2.30), walking (4.23), running (7.83), stair-climbing (6.89), walking uphill(5.70), and walking downhill(3.20). VO2 values were proportional to EE value (rZ0.997, pZ0.00). Conclusions: We identified intensity level of each activity according to the amount of EE and MET. We intend to provide a baseline for physical activity guideline development of normal adults. By integrating body weight, height, BMI in comparison to MET scores of different occupation groups in future studies. Key Words: Energy expenditure, Activity of daily living, Metabolic equivalents Disclosure(s): None Disclosed. Poster 284 Daily Activity Positively Impacts Motor Performance in Older Adults Jeanne Langan (University at Buffalo) Objective: Examine if meeting the steps/day recommendation for older adults, 7100 (Tudor-Locke et al., 2011), influenced performance on a computer-based cognitive/motor assessment. Design: Cross sectional. Setting: Computer assessments completed in a research lab, steps measured in home/community. Participants: 24 older adults 65-78 years (mean 70.3 +3.9 years, 11 male) with 3 years experience using a computer and who lived independently in the community. Interventions: Each participant underwent two computer-based cognitive/motor assessments, one as an orientation, the second representing the actual test. The assessment consisted of response time, verbal memory, spatial memory and motor performance (chase target using a mouse) tasks. Daily steps taken were measured using a Fitbit, an accelerometer device. Main Outcome Measure(s): Time and accuracy reported for computerbased assessment. The average number of steps was based on four weekdays and one weekend. Fitbit activity graphs were visually inspected and the number of days in which participants had 30 minutes of sustained activity was recorded. Using 7100 average steps/day as a cut point, participants were divided into two groups. Results: 10 participants, primarily women, fell below the recommended 7100 steps. They also had fewer days with 30 minutes of sustained activity. Despite the discrepancy in activity levels, the two groups performed similarly on the reaction time, verbal memory and spatial memory tasks. The more active group performed better on the motor task. Conclusions: Amount of daily activity impacted motor rather than cognitive performance. Intensity of daily activity should be further examined for influence on cognitive domains. Key Words: cognitive, older adults, motor performance, activity Disclosure(s): None disclosed.
Poster 285 Assessment of Gait Variability: Towards an Optimal Testing Protocol Lutz Schega (Otto-von-Guericke University Magdeburg), Daniel Hamacher, Dennis Hamacher Objective: Gait variability is frequently used to identify rehabilitation progresses in orthopedic and neurologic diseases by means of repeated testing. However, learning effects are a significant issue. This study examined if the inter-day reliability of gait variability parameters improves with an additional familiarization trial.
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Diagnosis Independent Design: Within a test-retest design, data were captured twice within the first day and also after 7 days. The inter-day reliability was assessed between the first trials and the second trials of each testing day. Setting: Motion laboratory equipped with 3-D motion analysis system based on inertial sensors (MTw, Xsens). Participants: 19 healthy elderly subjects (5 male, 14 female, age: 71 4 years) were included into the study. Interventions: None. Main Outcome Measure(s): The inner-subject standard deviations (SD) of stride velocity, minimum foot clearance, stride length, stance time and swing time were calculated. Reliability and absolute agreement were quantified using the intraclass correlation coefficient (ICC 2,1) and the smallest detectable difference (SDD). Results: The inter-day reliability of all parameters improved using each days’ second trials. The ICC improved at most for SD stride velocity (first trials: ICCZ0.212, SDDZ0.028m/s; second trials: ICCZ0.671, SDDZ0.015m/s) and at least for SD of stance time (first trials: ICCZ0.343, SDDZ0.006s; second trials: ICCZ0.549, SDDZ0.004m/s). Except for the SD of stance time, all variability parameters showed an ICC>0.6 indicating that the second trials measurements provide more reliable assessment of gait variability in clinical settings. Conclusions: To improve the assessment of gait variability in clinical settings, a familiarization trial is recommended. Key Words: Diagnosis, Gait, Reliability, 3-D motion analysis Disclosure(s): None disclosed.
Poster 286 Reliability of the Young Children’s Participation and Environment Measure (YC-PEM) for Pediatric Research and Practice Mary Alunkal Khetani (Colorado State University) Objective: Participation in meaningful everyday activities is a key functional outcome of interest within pediatric health and rehabilitation. We examine the psychometric properties of a newly developed proxy measure called the Young Children’s Participation and Environment Measure (YC-PEM) by estimating the internal consistency and test-retest reliability of the participation and environment summary scores. Design: Web-based survey validation involving caregivers of young children with and without developmental delays. Setting: Data were collected online and by telephone. Participants: Convenience and snowball sampling methods were used to recruit caregivers of 398 children (93 children with developmental delays, 304 without developmental delays) between 0-5 years (mean age Z 36.7 months, SD Z 20.29) and residing in the USA and Canada. Interventions: Ethics approval was obtained prior to participant recruitment and data collection. Data were collected online and by telephone and analyzed to estimate the internal consistency and test-retest reliability of the YC-PEM instrument. Cronbach’s alpha and ICC estimates were obtained for the total sample and 4 age subgroups (0-23, 24-47, 48-59, and 60-71 months). Main Outcome Measure(s): Demographic questionnaire and YC-PEM. Results: Internal consistency ranged from 0.674-0.860 for home, daycare/ preschool, and community participation subscales and 0.732-0.923 for environment subscales. Temporal stability ranged from 0.387-0.689 for frequency, 0.764-0.86 for involvement, and 0.733-0.915 for environmental supportiveness summary scores across the three sections and within a 2-4 week period. Conclusions: Results lend initial support for the use of the YC-PEM in outcomes studies involving young children with and without developmental delays to understand their home, daycare/preschool, and
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e91 community participation patterns, as well as examine perceived environmental supports and barriers to participation in each setting. Key Words: environmental impact, social participation, outcome assessment, pediatrics Disclosure(s): None Disclosed.
Poster 287 Inter-limb Postural Synchronization is Increased Prior to Bouts of Volitional Stepping Olinda Habib Perez (University of Toronto), George Mochizuki Objective: To examine the between limb synchronization associated with the preparation for postural instability. Design: Normative case series. Setting: Clinical research laboratory. Participants: Fifteen healthy young adult volunteers (12 for postural perturbations, 3 for volitional stepping). Interventions: Not applicable. Main Outcome Measure(s): Cross-correlation coefficient at zero phase lag, peak cross-correlation coefficient and phase lag (i.e. time of peak correlation) of the centre of pressure (COP) in the antero-posterior (AP) direction for two seconds prior to the onset of temporally predictable postural perturbations or volitional stepping. Trials were presented randomly or in blocks of one of two perturbation/step magnitudes. Root mean square (RMS) of the AP-COP was also calculated. Results: Volitional stepping produced greater synchrony than postural perturbations at zero phase lag, particularly when perturbation magnitudes were randomly presented. The proportion of trials with positive crosscorrelation functions was higher in volitional perturbations than externally triggered perturbations. Blocked conditions produced a higher proportion of trials with zero phase lag cross-correlation functions in postural perturbations; however, there was higher proportion of trials with zero phase lag cross-correlation functions in randomized conditions during volitional stepping. Increased AP-COP RMS was found in blocked conditions for large perturbations that required stepping reactions in response to postural perturbations. Conclusions: Volitional stepping enables tightly coupled inter-limb synchronization just prior to postural instability. The increased synchronization may be reflective of increased control requirements for volitional stepping to minimize fall risk in individuals whose ability to maintain balance during ambulation is compromised. Key Words: Psychomotor Performance, Postural Balance, Lower Extremity, Cross-correlation, Center of pressure Disclosure(s): None Disclosed.
Poster 288 WITHDRAWN Poster 289 Functional Magnetic Stimulation over Suprahyoid Muscle can Induce Plastic Change in Swallowing Motor Cortex Ryo Momosaki (The Jikei University School of Medicine), Masahiro Abo, Shu Watanabe, Wataru Kakuda, Naoki Yamada Objective: To evaluate the influence of functional magnetic stimulation with two different frequencies (20 and 30 Hz) on cortical excitability in motor area related to swallowing function in normal subjects.
Poster 283 Energy Expenditure During ADL in Korean Life Style Setting Hee Song Lee (Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University), MinYoung Kim Objective: To measure VO2, energy expenditure(EE) and metabolic equivalent of task(MET) values of activities of daily living and to compare each values between subjects and 11 activities. Design: Cross-sectional study. Setting: General teaching hospital. Participants: The subjects were normal adults with no specific medical history. Total 10 subjects were included. Interventions: We chose 11 daily activities that are relevant to Korean life style and tested it to subjects according to protocol respectively: typing (typing 2500 words or 10 min), sleeping, folding laundry (folding uniform made of wool), dish washing, cleaning the room (using a mop), studying (reading and writing), walking (4km/hr), running (8 km/hr), stair-climbing, walking uphill, and walking downhill. Duration of each activity was 10 minutes. Main Outcome Measure(s): Energy expenditure (EE) and metabolic equivalent of task (MET). Results: There were high internal consistency among the subjects for identical activities (Cronbach a Z 0.89). We obtained mean MET values
Diagnosis Independent of each activity: sleeping (0.77), typing (1.33), folding the laundry (0.85), washing the dish (2.76), cleaning the room (2.78), studying (2.30), walking (4.23), running (7.83), stair-climbing (6.89), walking uphill(5.70), and walking downhill(3.20). VO2 values were proportional to EE value (rZ0.997, pZ0.00). Conclusions: We identified intensity level of each activity according to the amount of EE and MET. We intend to provide a baseline for physical activity guideline development of normal adults. By integrating body weight, height, BMI in comparison to MET scores of different occupation groups in future studies. Key Words: Energy expenditure, Activity of daily living, Metabolic equivalents Disclosure(s): None Disclosed. Poster 284 Daily Activity Positively Impacts Motor Performance in Older Adults Jeanne Langan (University at Buffalo) Objective: Examine if meeting the steps/day recommendation for older adults, 7100 (Tudor-Locke et al., 2011), influenced performance on a computer-based cognitive/motor assessment. Design: Cross sectional. Setting: Computer assessments completed in a research lab, steps measured in home/community. Participants: 24 older adults 65-78 years (mean 70.3 +3.9 years, 11 male) with 3 years experience using a computer and who lived independently in the community. Interventions: Each participant underwent two computer-based cognitive/motor assessments, one as an orientation, the second representing the actual test. The assessment consisted of response time, verbal memory, spatial memory and motor performance (chase target using a mouse) tasks. Daily steps taken were measured using a Fitbit, an accelerometer device. Main Outcome Measure(s): Time and accuracy reported for computerbased assessment. The average number of steps was based on four weekdays and one weekend. Fitbit activity graphs were visually inspected and the number of days in which participants had 30 minutes of sustained activity was recorded. Using 7100 average steps/day as a cut point, participants were divided into two groups. Results: 10 participants, primarily women, fell below the recommended 7100 steps. They also had fewer days with 30 minutes of sustained activity. Despite the discrepancy in activity levels, the two groups performed similarly on the reaction time, verbal memory and spatial memory tasks. The more active group performed better on the motor task. Conclusions: Amount of daily activity impacted motor rather than cognitive performance. Intensity of daily activity should be further examined for influence on cognitive domains. Key Words: cognitive, older adults, motor performance, activity Disclosure(s): None disclosed.
Poster 285 Assessment of Gait Variability: Towards an Optimal Testing Protocol Lutz Schega (Otto-von-Guericke University Magdeburg), Daniel Hamacher, Dennis Hamacher Objective: Gait variability is frequently used to identify rehabilitation progresses in orthopedic and neurologic diseases by means of repeated testing. However, learning effects are a significant issue. This study examined if the inter-day reliability of gait variability parameters improves with an additional familiarization trial.
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Diagnosis Independent Design: Within a test-retest design, data were captured twice within the first day and also after 7 days. The inter-day reliability was assessed between the first trials and the second trials of each testing day. Setting: Motion laboratory equipped with 3-D motion analysis system based on inertial sensors (MTw, Xsens). Participants: 19 healthy elderly subjects (5 male, 14 female, age: 71 4 years) were included into the study. Interventions: None. Main Outcome Measure(s): The inner-subject standard deviations (SD) of stride velocity, minimum foot clearance, stride length, stance time and swing time were calculated. Reliability and absolute agreement were quantified using the intraclass correlation coefficient (ICC 2,1) and the smallest detectable difference (SDD). Results: The inter-day reliability of all parameters improved using each days’ second trials. The ICC improved at most for SD stride velocity (first trials: ICCZ0.212, SDDZ0.028m/s; second trials: ICCZ0.671, SDDZ0.015m/s) and at least for SD of stance time (first trials: ICCZ0.343, SDDZ0.006s; second trials: ICCZ0.549, SDDZ0.004m/s). Except for the SD of stance time, all variability parameters showed an ICC>0.6 indicating that the second trials measurements provide more reliable assessment of gait variability in clinical settings. Conclusions: To improve the assessment of gait variability in clinical settings, a familiarization trial is recommended. Key Words: Diagnosis, Gait, Reliability, 3-D motion analysis Disclosure(s): None disclosed.
Poster 286 Reliability of the Young Children’s Participation and Environment Measure (YC-PEM) for Pediatric Research and Practice Mary Alunkal Khetani (Colorado State University) Objective: Participation in meaningful everyday activities is a key functional outcome of interest within pediatric health and rehabilitation. We examine the psychometric properties of a newly developed proxy measure called the Young Children’s Participation and Environment Measure (YC-PEM) by estimating the internal consistency and test-retest reliability of the participation and environment summary scores. Design: Web-based survey validation involving caregivers of young children with and without developmental delays. Setting: Data were collected online and by telephone. Participants: Convenience and snowball sampling methods were used to recruit caregivers of 398 children (93 children with developmental delays, 304 without developmental delays) between 0-5 years (mean age Z 36.7 months, SD Z 20.29) and residing in the USA and Canada. Interventions: Ethics approval was obtained prior to participant recruitment and data collection. Data were collected online and by telephone and analyzed to estimate the internal consistency and test-retest reliability of the YC-PEM instrument. Cronbach’s alpha and ICC estimates were obtained for the total sample and 4 age subgroups (0-23, 24-47, 48-59, and 60-71 months). Main Outcome Measure(s): Demographic questionnaire and YC-PEM. Results: Internal consistency ranged from 0.674-0.860 for home, daycare/ preschool, and community participation subscales and 0.732-0.923 for environment subscales. Temporal stability ranged from 0.387-0.689 for frequency, 0.764-0.86 for involvement, and 0.733-0.915 for environmental supportiveness summary scores across the three sections and within a 2-4 week period. Conclusions: Results lend initial support for the use of the YC-PEM in outcomes studies involving young children with and without developmental delays to understand their home, daycare/preschool, and
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e91 community participation patterns, as well as examine perceived environmental supports and barriers to participation in each setting. Key Words: environmental impact, social participation, outcome assessment, pediatrics Disclosure(s): None Disclosed.
Poster 287 Inter-limb Postural Synchronization is Increased Prior to Bouts of Volitional Stepping Olinda Habib Perez (University of Toronto), George Mochizuki Objective: To examine the between limb synchronization associated with the preparation for postural instability. Design: Normative case series. Setting: Clinical research laboratory. Participants: Fifteen healthy young adult volunteers (12 for postural perturbations, 3 for volitional stepping). Interventions: Not applicable. Main Outcome Measure(s): Cross-correlation coefficient at zero phase lag, peak cross-correlation coefficient and phase lag (i.e. time of peak correlation) of the centre of pressure (COP) in the antero-posterior (AP) direction for two seconds prior to the onset of temporally predictable postural perturbations or volitional stepping. Trials were presented randomly or in blocks of one of two perturbation/step magnitudes. Root mean square (RMS) of the AP-COP was also calculated. Results: Volitional stepping produced greater synchrony than postural perturbations at zero phase lag, particularly when perturbation magnitudes were randomly presented. The proportion of trials with positive crosscorrelation functions was higher in volitional perturbations than externally triggered perturbations. Blocked conditions produced a higher proportion of trials with zero phase lag cross-correlation functions in postural perturbations; however, there was higher proportion of trials with zero phase lag cross-correlation functions in randomized conditions during volitional stepping. Increased AP-COP RMS was found in blocked conditions for large perturbations that required stepping reactions in response to postural perturbations. Conclusions: Volitional stepping enables tightly coupled inter-limb synchronization just prior to postural instability. The increased synchronization may be reflective of increased control requirements for volitional stepping to minimize fall risk in individuals whose ability to maintain balance during ambulation is compromised. Key Words: Psychomotor Performance, Postural Balance, Lower Extremity, Cross-correlation, Center of pressure Disclosure(s): None Disclosed.
Poster 288 WITHDRAWN Poster 289 Functional Magnetic Stimulation over Suprahyoid Muscle can Induce Plastic Change in Swallowing Motor Cortex Ryo Momosaki (The Jikei University School of Medicine), Masahiro Abo, Shu Watanabe, Wataru Kakuda, Naoki Yamada Objective: To evaluate the influence of functional magnetic stimulation with two different frequencies (20 and 30 Hz) on cortical excitability in motor area related to swallowing function in normal subjects.