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Can Galvanic Vestibular Stimulation Induce Lasting Relief from Hemi-Spatial Neglect?
e24 Conclusions: On the short term, PST has no significant psychosocial effects in patients after stroke compared to standard rehabilitation treatment. The upcoming long-term results may reveal potential late effects of PST on coping strategies or problem solving skills after stroke. Key Words: Rehabilitation, Stroke, Coping, Quality of Life Disclosure(s): None Disclosed.
Poster 45 Improvements in ICF Components in Individuals With Chronic Stroke Following a Yoga-Based Intervention Marieke Van Puymbroeck (Clemson University), Jared Allsop, Kristine K. Miller, Arlene A. Schmid Objective: To understand perceived outcomes following a yoga intervention for individuals with chronic stroke, framed within the context of the International Classification of Functioning, Disability, and Health. Design: Small, prospective mixed-method, randomized controlled trial of a yoga intervention for individuals at least 6 months post-stroke. Setting: Community-based rehabilitation laboratory. Participants: Forty-seven individuals were randomized to either the intervention or the wait-list control. Twenty-six individuals from the yoga arm agreed to participate in the focus groups. Individuals were eligible for the study if they were >6 months post-stroke and had completed all stroke related rehabilitation. Interventions: The yoga-based intervention was one-hour, twice per week, for a total of 16 yoga classes. Main Outcome Measure(s): Five focus groups occurred during the final week of the yoga intervention. A semi-structured focus group guideline was developed to include questions and probes. Data were analyzed using interpretative phenomenological analysis. Results: Two main themes emerged around domains of the ICF: improvements in body structures and functions; and improvements in activity and participation. In terms of body structure and functions, many study participants discussed substantial perceived changes in both mental and physical functioning, including improved emotional regulation, improvements in stability and range of motion, and unanticipated improvements, such as increases in vision, increased sensation perception, and reduction of diabetic complications. Many study participants commented on the benefits and increases in various activities and participation due to their involvement in the post-stroke yoga intervention. Conclusions: Qualitative data indicated that changes in body function allowed for improved activity and participation. Key Words: stroke, yoga, social participation Disclosure(s): None Disclosed. Poster 46 Implementation of a Clinical Practice Guideline for Walking Recovery: Standardized users improve knowledge translation Matt Wilks (Sheltering Arms Rehabilitation Hospitals), Amber Devers, Pete Pidcoe Objective: To determine the effectiveness of a novel clinical practice guideline (CPG) on motor recovery following a stroke. A specific knowledge translation (KT) strategy, called standardized user (SU) methodology, was used to limit unwarranted variability of CPG use. The hypothesis is SU following the CPG will demonstrate better outcomes in similar patients when compared to usual care. Design: Participants were matched and data collection performed near admission and discharge during inpatient rehabilitation facility (IRF) stay. A between-subject and between-cohort covariate comparison was performed. Setting: Sheltering Arms Hospital, 40-bed IRF facility in Richmond, Virginia. Participants: The experimental group (nZ12) was selected as a convenience sample. Participants had acute CVA and met inclusion criteria for
Stroke CPG application. Experimental group participants were matched to controls (nZ12) according to age, gender, diagnosis, motor function, severity of comorbities, cognition, admission date, and anticipated LOS. Interventions: Initial studies indicated greater clinician engagement was necessary. The SU methodology included clear expectation, curricula, and proficiency assessment for clinicians. The experimental group received treatment from SU according to the CPG, while the control group received standard care. Main Outcome Measure(s): Motor FIM and total FIM change, Timed-upand-Go, Berg Balance, gait speed, DynamicGait Index, Functional Ambulation Category, and gait capacity were compared between groups. Results: Statistically significant changes (p<.001-.033) were noted for all outcome variables in favor of the experimental group. Conclusions: SU methodology is effective to improve application of a CPG and achieve superior results when compared to usual care. Key Words: knowledge translation, practice guideline, stroke Disclosure(s): None Disclosed. Poster 47 Can Galvanic Vestibular Stimulation Induce Lasting Relief from Hemi-Spatial Neglect? Mohammed Sakel (Neuro-Rehabilitation Unit, East Kent University Foundation Hospitals Trust), David Wilkinson, Olga Zubko, Tracy Higgins, Patrick M. Pullicino, Simon Coulton, Emma Denby Objective: To test whether galvanic vestibular stimulation (GVS) induces lasting carry-over from neglect and, if so, whether this is more effectively induced via a single or repeated sessions. Design: Randomized Dose-Response trial. Setting: In-patient, out-patient clinics in the UK. Research funded by MRC & NIHR (UK) grant. Participants: Post-stroke (>6 weeks), evidence of left neglect on the conventional tests of the Behavioral Inattention test (BIT). NZ52. Interventions: Participants were allocated to one of 3 treatment arms that received either 1, 5, or 10 sessions, each lasting 25mins, of sub-sensory (1mA), left anodal-right cathodal GVS. Main Outcome Measure(s): Behavioral Inattention test (BIT), Barthel Index (BI) and Modified Ashworth Score (MAS) taken at baseline and 4 weeks post-stimulation. Results: 95% Confidence Intervals indicated that all 3 treatment arms showed statistically significant improvement in BIT scores between baseline and immediately after stimulation. These changes (mean change Z28%, SDZ18) persisted 1 month later (and were still present in a subgroup, nZ28, followed-up 12-30months later) and were coupled with a sustained 20% improvement in median BI score; mainly in the continence, bathing and transfer sub-scales. Time since stroke did not affect the changes in BIT or BI, and no statistically significant changes were found on the MAS. No increase in seizure noted. Conclusions: GVS, a simple and cheap technique suitable for home-based administration, may hold relevance to neglect rehabilitation. Further dose manipulation studies and comparisons with other forms of neuro-stimulation and treatment-as-usual are now needed. Key Words: hemi-inattention, neuro-stimulation, stroke, clinical trial, rehabilitation Disclosure(s): None Disclosed.
Poster 48 The Impact of Botulinum Toxin and Upper Limb Rehabilitation on Spasticity, Function and Pain: A Systematic Review Parvin Eftekhar (Toronto Rehab), Chetan P. Phadke, Kara Kathleen Patterson, Dina Brooks, George Mochizuki Objective: To examine the impact of the combination of botulinum toxin A (BoNTA) and upper limb (UL) rehabilitation on spasticity, UL function, and pain in individuals post stroke through a systematic review of the literature.
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Poster 45 Improvements in ICF Components in Individuals With Chronic Stroke Following a Yoga-Based Intervention Marieke Van Puymbroeck (Clemson University), Jared Allsop, Kristine K. Miller, Arlene A. Schmid Objective: To understand perceived outcomes following a yoga intervention for individuals with chronic stroke, framed within the context of the International Classification of Functioning, Disability, and Health. Design: Small, prospective mixed-method, randomized controlled trial of a yoga intervention for individuals at least 6 months post-stroke. Setting: Community-based rehabilitation laboratory. Participants: Forty-seven individuals were randomized to either the intervention or the wait-list control. Twenty-six individuals from the yoga arm agreed to participate in the focus groups. Individuals were eligible for the study if they were >6 months post-stroke and had completed all stroke related rehabilitation. Interventions: The yoga-based intervention was one-hour, twice per week, for a total of 16 yoga classes. Main Outcome Measure(s): Five focus groups occurred during the final week of the yoga intervention. A semi-structured focus group guideline was developed to include questions and probes. Data were analyzed using interpretative phenomenological analysis. Results: Two main themes emerged around domains of the ICF: improvements in body structures and functions; and improvements in activity and participation. In terms of body structure and functions, many study participants discussed substantial perceived changes in both mental and physical functioning, including improved emotional regulation, improvements in stability and range of motion, and unanticipated improvements, such as increases in vision, increased sensation perception, and reduction of diabetic complications. Many study participants commented on the benefits and increases in various activities and participation due to their involvement in the post-stroke yoga intervention. Conclusions: Qualitative data indicated that changes in body function allowed for improved activity and participation. Key Words: stroke, yoga, social participation Disclosure(s): None Disclosed. Poster 46 Implementation of a Clinical Practice Guideline for Walking Recovery: Standardized users improve knowledge translation Matt Wilks (Sheltering Arms Rehabilitation Hospitals), Amber Devers, Pete Pidcoe Objective: To determine the effectiveness of a novel clinical practice guideline (CPG) on motor recovery following a stroke. A specific knowledge translation (KT) strategy, called standardized user (SU) methodology, was used to limit unwarranted variability of CPG use. The hypothesis is SU following the CPG will demonstrate better outcomes in similar patients when compared to usual care. Design: Participants were matched and data collection performed near admission and discharge during inpatient rehabilitation facility (IRF) stay. A between-subject and between-cohort covariate comparison was performed. Setting: Sheltering Arms Hospital, 40-bed IRF facility in Richmond, Virginia. Participants: The experimental group (nZ12) was selected as a convenience sample. Participants had acute CVA and met inclusion criteria for
Stroke CPG application. Experimental group participants were matched to controls (nZ12) according to age, gender, diagnosis, motor function, severity of comorbities, cognition, admission date, and anticipated LOS. Interventions: Initial studies indicated greater clinician engagement was necessary. The SU methodology included clear expectation, curricula, and proficiency assessment for clinicians. The experimental group received treatment from SU according to the CPG, while the control group received standard care. Main Outcome Measure(s): Motor FIM and total FIM change, Timed-upand-Go, Berg Balance, gait speed, DynamicGait Index, Functional Ambulation Category, and gait capacity were compared between groups. Results: Statistically significant changes (p<.001-.033) were noted for all outcome variables in favor of the experimental group. Conclusions: SU methodology is effective to improve application of a CPG and achieve superior results when compared to usual care. Key Words: knowledge translation, practice guideline, stroke Disclosure(s): None Disclosed. Poster 47 Can Galvanic Vestibular Stimulation Induce Lasting Relief from Hemi-Spatial Neglect? Mohammed Sakel (Neuro-Rehabilitation Unit, East Kent University Foundation Hospitals Trust), David Wilkinson, Olga Zubko, Tracy Higgins, Patrick M. Pullicino, Simon Coulton, Emma Denby Objective: To test whether galvanic vestibular stimulation (GVS) induces lasting carry-over from neglect and, if so, whether this is more effectively induced via a single or repeated sessions. Design: Randomized Dose-Response trial. Setting: In-patient, out-patient clinics in the UK. Research funded by MRC & NIHR (UK) grant. Participants: Post-stroke (>6 weeks), evidence of left neglect on the conventional tests of the Behavioral Inattention test (BIT). NZ52. Interventions: Participants were allocated to one of 3 treatment arms that received either 1, 5, or 10 sessions, each lasting 25mins, of sub-sensory (1mA), left anodal-right cathodal GVS. Main Outcome Measure(s): Behavioral Inattention test (BIT), Barthel Index (BI) and Modified Ashworth Score (MAS) taken at baseline and 4 weeks post-stimulation. Results: 95% Confidence Intervals indicated that all 3 treatment arms showed statistically significant improvement in BIT scores between baseline and immediately after stimulation. These changes (mean change Z28%, SDZ18) persisted 1 month later (and were still present in a subgroup, nZ28, followed-up 12-30months later) and were coupled with a sustained 20% improvement in median BI score; mainly in the continence, bathing and transfer sub-scales. Time since stroke did not affect the changes in BIT or BI, and no statistically significant changes were found on the MAS. No increase in seizure noted. Conclusions: GVS, a simple and cheap technique suitable for home-based administration, may hold relevance to neglect rehabilitation. Further dose manipulation studies and comparisons with other forms of neuro-stimulation and treatment-as-usual are now needed. Key Words: hemi-inattention, neuro-stimulation, stroke, clinical trial, rehabilitation Disclosure(s): None Disclosed.
Poster 48 The Impact of Botulinum Toxin and Upper Limb Rehabilitation on Spasticity, Function and Pain: A Systematic Review Parvin Eftekhar (Toronto Rehab), Chetan P. Phadke, Kara Kathleen Patterson, Dina Brooks, George Mochizuki Objective: To examine the impact of the combination of botulinum toxin A (BoNTA) and upper limb (UL) rehabilitation on spasticity, UL function, and pain in individuals post stroke through a systematic review of the literature.
www.archives-pmr.org