Astym Therapy Improves Function and Range of Motion Following Mastectomy

e30 flexibility of anterior chest muscles. Treated subjects returned at three weeks to have repeated measures taken and to receive instructions to increase repetitions. At six weeks treated and control subjects were measured again and the control subjects received exercise instructions. Main Outcome Measure(s): Double Square, Sahrmann, and Measure of Scapular Position had strong inter-rater reliability. ImageJ measures had wide variance. Shoulder postures improved at 3 weeks though differences were small. Gains were not significant at 6 weeks. Results: There was high inter-rater reliability for all measurements and there were small shoulder posture improvements within subjects. Conclusions: The Double Square, Sahrmann Technique, and Measure of Scapular Position were precise measures of FSP. The treatment intervention benefited many subjects but warrants further investigation. Key Words: Shoulder, Posture, Scapular strengthening Disclosures: None disclosed. Research Poster 204 Development of a Rehabilitation Planning Consult for Survivors of Head and Neck Cancer Sara McEwen (Sunnybrook Research Institute), Colleen Dunphy, Jorge Rios, Daniel Bishev, Andrew Lam, Ian Poon, Jolie Ringash Research Objectives: To develop and pre-test an interprofessional rehabilitation planning consult (RPC) for survivors of head and neck cancer (HNC). Design: A 6-step intervention mapping process is being used. Theoretical methods selection and pretesting using iterative single case studies are presented here. Setting: 2 regional cancer centers. Participants: Survivors of HNC who had completed cancer treatment within 12 months. Exclusion criteria were lack of English fluency, cognitive impairment, or concurrent conditions likely to cause functional deterioration. Interventions: RPC methods were selected to foster key contributors of self management: access to resources, positive relationships with clinicians, selfefficacy, and having cognitive skills such as goal setting and action planning. The RPC consists of an initial consult, a follow-up consult, and an online resource compendium (www.hncrehab.ca). During the RPC, priority rehabilitation needs are determined, goals are set, the survivor is taught a problem solving strategy, is introduced to resources, develops an action plan and a coping plan, and then executes and evaluates the plan. Main Outcome Measure(s): Participant perceptions, feasibility of delivery, and change scores in the Self Efficacy Gauge, Reintegration to Normal Living Index, and quality of life as measured by the FACT H&N and SF-36. Results: Twelve (12) cases were recruited, 9 started and 6 completed. The RPC was refined after each case to develop a final version. Participants found the RPC feasible and acceptable, indicating that it helped them to formulate a plan and gave them confidence to move forward. All completing participants had clinically significant changes in at least one indicator, with quality of life being the most promising. Conclusions: The refined RPC is feasible to use with HNC survivors. There is early evidence of an effect on quality of life. A larger trial is planned. Key Words: Head and neck neoplasms, rehabilitation, health behaviour, goals Disclosures: None disclosed. Research Poster 205 Astym Therapy Improves Function and Range of Motion Following Mastectomy Claire Davies (Baptist Health Lexington), Dorothy Brockopp, Krista Moe Research Objectives: Investigate effects of Astym treatment on activities of daily living for women who have undergone a mastectomy.

Research Posters Design: Specific intervention before and after case series. Setting: Community hospital-based outpatient physical therapy clinic. Participants: Convenience sample of 42 women referred for rehabilitation following mastectomy due to decreased flexibility in the shoulder, chest pain, or scar tissue tightness. Subjects had undergone unilateral or bilateral mastectomy with or without axillary dissection. Forty subjects participated in this study age 33-75 years, mean 52.0. Interventions: The protocol used in this study involved manual lymph drainage followed by Astym therapy which utilizes hand held instrumentation applied topically in gentle gliding strokes to locate and treat the underlying dysfunctional soft tissue through a specific mastectomy protocol. This was followed by specific therapeutic exercises and stretches. Treatment was twice a week and repeated up to 8 sessions over 4- 6 weeks. Main Outcome Measure(s): The main outcomes measures were; Disability of Arm, Shoulder and Hand score (DASH), clothing questionnaire, Patient-Specific Functional Scale (PSFS), AROM shoulder flexion and abduction, before and after a course of Astym therapy. Results: Mean number of Astym treatments were 6.7 (SD 1.8). All five measurement scores: DASH (p<0.01), the clothing questionnaire on the ability to wear a bra (p<0.01), PSFS (p<0.01), AROM shoulder flexion (p<0.01) and abduction (p<0.01) demonstrated significant and clinically meaningful differences in functional outcomes following Astym treatment. Mean improvements in the DASH, clothing questionnaire, and PSFS scores were 10, 4 and 2 respectively. Mean clinical improvement in AROM was 17 degrees flexion and 19 degrees abduction. Conclusions: Astym therapy improved involved shoulder ROM and function following mastectomy. Astym therapy may be an effective treatment option for rehabilitation providers to utilize when addressing complications from scar tissue and soft tissue dysfunction that often result from breast cancer treatment. Key Words: Breast neoplasm, manual therapy, quality of life Disclosures: Dr. Davies is an occasional Clinical Consultant to Performance Dynamics on Astym therapy applications in post-mastectomy patients. The authors have no other conflicts of interest to disclose. Funding: A small grant was provided by Performance Dynamics to Baptist Health Lexington to offset some of the direct costs it incurred by allowing the study to take place at this institution. Research Poster 209 Effectiveness of Specific Types of Post-Inpatient Brain Injury Rehabilitation Programs James Malec (PM&R, Indiana University School of Medicine & Rehabilitation Hospital of Indiana), Debra Braunling-McMorrow, April Groff, Joshua Oros Research Objectives: To examine the effectiveness and participant characteristics of 3 intensive post-inpatient brain rehabilitation (IR) program types compared to supported living services (SL). Design: Retrospective before/after observational study. Setting: Network of residential and outpatient that includes 8 facilities in 6 states in the U.S. Participants: Data from 253 individuals with acquired brain injury in IR programs and 79 individuals in SL programs. Interventions: IR programs, with the goal of achieving significant functional gains for participants, included Neurorehabilitation (nZ159), Neurobehavioral Rehabilitation (nZ56), and Day Treatment (nZ38). SL programs aimed to assist participants to maintain current status in the long term. Main Outcome Measure(s): Mayo-Portland Adaptability Inventory (MPAI-4). Results: Analysis of covariance (ANCOVA) controlling for admission score, age, and chronicity revealed significant differences between IR and SL programs on discharge/second assessment MPAI-4 Total Tscore (FZ64.061, p<.001), Ability Index (FZ59.660, p<.001), Adjustment Index (FZ30.355, p<.001) and Participation Index (FZ53.097, p<.001). IR program participants improved about 1

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