Cognitive Contributions to Multiple Errands Test Performance

Research Posters Research Objectives: To explore the significance of large time differentials between the timed Up and Go (TUG) and 10m Walk Test (10MWT) in persons with stroke on an inpatient rehab unit (IRU). Based on clinical observations, we hypothesize a larger time difference is related to impaired cognition. Design: Descriptive, non-experimental. Setting: Academic Medical Center IRU. Participants: 152/242 (63%) IRU stroke discharges. Subjects were 52% male, 36.8% left hemisphere lesions with a mean age of 68.4 years and a mean of 10.3 days post-stroke. Interventions: Not Applicable. Main Outcome Measure(s): 10MWT time, TUG time, large difference group (LDG, NZ54, >50% increased 10MWT to TUG time), marginal difference group (MDG, NZ98, aˆ&¤50% increase), Trail-Making Tests A (TMT-A) and B (TMT-B), FIM motor (FIM-M) and cognitive (FIM-C) subscales at IRU discharge, Berg Balance Scale (BBS), turn 360 item on BBS (T360 ), Montreal Cognitive Assessment (MoCA), National Institutes of Health Stroke Scale (NIHSS), age, and lower extremity Motricity Index (LEMI). Results: The raw difference between 10MWT and TUG times correlated with BBS and FIM-M (rZ-.406 and rZ-.319, respectively, both pZ<.001), measures associated with increased falls risk. Significant differences between LDG and MDG were found for TMT-A (pZ.04), TMT-B (pZ.03), T360 (pZ.04), and age (pZ.04), all two-sample t-tests. No significant differences were observed for NIHSS, MoCA, FIM-C, or LEMI. Conclusions: Impaired processing speed and working memory as measured by TMT-A and B, and impaired balance while turning were significantly associated with the difference between TUG time and gait speed. Stroke severity and lower extremity strength, as well as more global cognitive measures were not. Future research should explore TUG and 10MWT time differential with respect to other functional measures, falls risk, and specific interventions. Key Words: Stroke, Rehabilitation, Balance, Outcome Assessments (health care) Disclosures: None disclosed.

Research Poster 472 Patient Engagement in Spinal Cord Injury Rehabilitation: Patient and Provider Perspectives Alex Wong (Washington University School of Medicine), Christina Papadimitriou, Gale Whiteneck, Anne Deutsch, Allen Heinemann, Arielle Goldsmith, Katrina Christopher, Christopher Focht, Eric Lenze Research Objectives: To identify patients’ and clinicians’ perceptions of barriers to and facilitators of patient engagement in inpatient spinal cord injury (SCI) rehabilitation. Design: We conducted a qualitative exploratory study. We analyzed transcripts for salient themes using a constant comparison approach. Our study was informed by the Multidimensional Framework for Patient and Family Engagement in Health and Health Care, and the Model for Therapeutic Engagement in Rehabilitation. Setting: One SCI unit in one large rehabilitation facility in Chicago. Participants: Nine patients with SCI participated in two focus groups. Ten clinicians working in the SCI rehabilitation unit participated in two focus groups during the Fall of 2015. Interventions: None. Main Outcome Measure(s): None. Results: Using a system’s approach, we categorize all focus group data into three general, but inter-related areas: post-acute care policy, hospital or unit related, and person specific. Patients and providers talked about perceived barriers to patient engagement at all these areas such as communication inadequacies among providers across settings of care and with insurance agencies as well as within the unit; lack of provider support in the hospital; patient expectations regarding recovery; and provider education gaps. We identified facilitators such as team collaboration to reach

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e71 patient goals, and tools or resources from professional organizations to assist with patient engagement. Conclusions: Our study provides information about factors that can influence patient engagement in SCI rehabilitation at the levels of person, hospital, and policymaking. Future work needs to investigate what factors, or combination of factors in all these levels will exert the greatest influence on patient engagement. Besides, we should identify what supports are needed and what effective methods should be implemented in each level to create opportunities for engagement. Key Words: Engagement, Spinal Cord Injury, Inpatient Rehabilitation Disclosures: None Disclosed. Research Poster 473 Mood and Quality of Life Self-Report Preliminary Outcomes for the Parkinson’s Disease-Cognitive Rehabilitation for Executive Functioning Program (PD-CoRE) Stella Kim (Baylor College of Medicine), Brenna Renn, Kathleen Crist, Joohi Jimenez-Shahed, Angelle Sander, Elizabeth DiNapoli, Michele York Research Objectives: To examine self-reported changes in mood, executive functioning, and quality of life (QoL) in patients with mild idiopathic Parkinson’s disease (PD) at the midpoint of the PD-Cognitive Rehabilitation for Executive functioning program (PD-CoRE), which uses a compensatory strategy model to target executive functions. Design: Pre- to mid-term outcome. Setting: Academic outpatient practice in Houston, Texas. Participants: Nine subjects (67% men, 33% women), age range 56-73, diagnosed with mild idiopathic PD, MoCA scores 22-30, and BDI-II scores 0-16. No subjects withdrew from the program. Interventions: The PD-CoRE program consists of 8 1.5-hour interactive group sessions targeting inhibition, working memory, and set-shifting abilities. Subjects completed self-report questionnaires that measure depression, anxiety, perceived executive functioning, and QoL before the program and again at the midpoint of the program. 78% of the subjects attended all sessions (2 participants missed one session each). Main Outcome Measure(s): Self-reported data: Beck Depression Inventory, 2nd Edition (BDI-II), Generalized Anxiety Disorder, Short Form (GAD-7), Dysexecutive Questionnaire (DEX), and Perceived Deficits Questionnaire (PDQ-39). Results: Repeated measures t-tests found no statistically significant differences on the BDI-II (NZ9, 95% confidence interval -10.14 to 1.69), GAD-7 (NZ9, 95% confidence interval -2.66 to 2.66), DEX (NZ9, 95% confidence interval -10.55 to 4.11), and PDQ-39 (NZ9, 95% confidence interval -15.41 to 6.30). Conclusions: There was no statistically significant difference in selfreported depression, anxiety, executive functioning, and QoL at the midpoint evaluation. Additional data will be collected to re-assess these areas, executive functioning on neuropsychological measures, and patient satisfaction following completion of the PDCoRE program. Key Words: Rehabilitation, Parkinson’s disease, executive function, mild cognitive impairment Disclosures: None disclosed. Research Poster 474 Cognitive Contributions to Multiple Errands Test Performance Nicole De Amicis (University of Toronto), Amanda J. Clark, Nicole D. Anderson, Malcolm A. Binns, Deirdre Dawson Research Objectives: To examine relationships between cognitive processes (attention, memory, executive function) and performance on the

e72 Multiple Errands Test (MET) to illuminate cognitive processes necessary to achieve optimal performance on the MET. Design: A non-experimental, correlational design was used. Setting: A secondary analysis was conducted of data collected for two previous studies establishing the psychometric properties of the Baycrest MET (BMET; Dawson et al., 2009; Clark et al., 2016). Participants: For these studies, 42 participants with stroke and acquired brain injury were recruited using convenience-sampling techniques. Interventions: Not applicable. Main Outcome Measure(s): Performance on standardized neuropsychological tests of attention, memory, and executive function, and BMET performance. Results: Canonical correlation analysis was conducted with the neuropsychological tests and performance measures of the BMET. Preliminary results suggest that participants with higher scores on tests of executive function make fewer errors and that those with poorer scores on tests of working memory omit more tasks. Conclusions: These results illustrate that optimal performance on the MET is compromised with executive dysfunction and working memory impairments. They also support the notion of the MET being an assessment that characterizes the impact of executive dysfunction in everyday life. Key Words: Brain Injuries, Stroke, Executive function Disclosures: Deirdre Dawson teaches workshops on the MET and receives payment for these workshops. None of the other authors have any relevant nonfinancial relationships to disclose. Research Poster 476 Supporting Factors for Follow-up Care in TBI Patients Post-inpatient Discharge Michelle Smith (NYU Langone Medical Center), Coralynn Long, Tamara Bushnik Research Objectives: Outpatient rehabilitation is a critical piece of the traumatic brain injury (TBI) care continuum to optimize physical or cognitive recovery gains after discharge from inpatient rehabilitation. The purpose of this study is to investigate post-inpatient discharge awareness of, attitude toward, and attendance in outpatient rehabilitation. Design: Utilized data collected through TBI Model Systems (TBIMS) Form I & II interviews and additional interview at first year post-injury follow up. Setting: A large, public, urban hospital. Participants: Respondents with TBI (Mage Z 48.8, SD Z 18.2) were primarily male (82%), White (44%) or Hispanic (22%), single (46%), and with a college education (53%). Interventions: Not Applicable Main Outcome Measure(s): Post-discharge care interview, psychosocial and functional variables from TBIMS Form I (pre-injury, medical record abstraction) and Form II (year one follow-up). Results: Analyses were carried out on the 34 patients who were discharged to a private residence. Out of these respondents, 36.4% did not return for their outpatient follow-up appointments. Figures and tables with descriptive statistics regarding patient attitudes toward and attendance in follow-up care at 1 year post-injury will be presented across demographic and psychosocial variables (age, race, social support), functional outcomes (Functional Independence Measure [FIM], length of stay (LOS), and patient attitudes toward participating in followup care. Conclusions: These results provide insight into the risk factors, circumstances, and beliefs that hinder patient attendance in recommended outpatient follow-up. Implications for clinical care include early identification of these patients (i.e., age, level of social support) to ensure adequate education about the importance of continued therapy in order to improve long-term outcomes.

Research Posters Key Words: Traumatic brain injury, Assessment, patient outcomes, Continuity of patient care Disclosures: None disclosed.

Research Poster 478 Predictors of Loss of Quadriceps Strength Over 60 Months in Older Adults with or at Risk for Knee Osteoarthritis Hiroo Matsuse (Kansas University of Medical center), Bo Hu, Michael C. Nevitt, Jingbo Niu, Carrie Brown, Cora E. Lewis, Neil A. Segal Research Objectives: To determine personal factors associated with risk for decline in quadriceps strength in adults with or at risk for knee osteoarthritis (KOA). Design: Community-acquired cohort with 60-month follow-up. Setting: Rural/suburban communities. Participants: 3026 persons, age 50 - 79, at elevated risk for KOA were enrolled. 2491 participants completed both baseline and 60-month followup strength assessments. Interventions: Not Applicable. Main Outcome Measure(s): Isokinetic knee extensor strength was measured at baseline and 60-months. Modifiable (BMI, physical activity (PASE) score, joint pain, and knee malalignment) and non-modifiable (age, sex, race, residential region, prior knee injury, and KOA severity (Kellgren-Lawrence grade)) factors at baseline were examined for contributions to prediction of clinically meaningful reduction in knee extensor isokinetic strength, based on the sex-specific difference between those who developed symptomatic KOA by 30 months and those who did not in prior studies. We used stepwise regression to determine which baseline factors predicted strength loss (p-to-enterZ 0.2; p-to-leave Z 0.1) and quantified the strength of the overall model prediction using the area under the ROC curve (AUROC). Results: 1532 knees (614 men, 918 women) met criteria for analysis. Overall prevalence of clinically meaningful loss of strength in men/women was 36/28%, respectively. In men, greater age, OA severity, hip pain when ascending/descending stairs, valgus knee malalignment and greater baseline muscle strength were predictive (AUROC Z 0.74). In women, greater age and greater baseline muscle strength were predictive (AUROC Z 0.75). Conclusions: Age,OA severity, hip pain on stairs and greater muscle strength longitudinally predict clinically-meaningful loss of knee extensor strength in men, while only age and greater muscle strength predict knee extensor strength loss in women with or at risk for KOA. Key Words: Longitudinal study, Osteoarthritis, Muscle strength, Risk factor Disclosures: None disclosed. Research Poster 480 The Impact of a Physical Activity Program in Persons with SCI Ryan McGrath (University of Michigan), Denise Tate, Martin Forchheimer, Claire Kalpakjian, Mark Peterson Research Objectives: To determine the effectiveness of a physical activity program on ASIA motor scores and HDL in persons with SCI. Design: Randomized clinical trial. Setting: Outpatient hospital setting. Participants: Inclusion criteria were 1 year post-injury, SCI diagnosis, and ages 18-80 years. Those with cognitive deficits preventing learning, medical problems posing health risks, or a primary disability other than SCI were excluded. Thirteen participants with complete paraplegia (TSI: 13.17.3 years), 9 participants with incomplete paraplegia (TSI: 8.29.6 years), 13 participants with complete tetraplegia (TSI: 20.714.5 years),

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