CoreAlign Training for a Person with Multiple Sclerosis: Effects on Strength, Walking, and Participation

Research Posters difficulties in the visuo-spatial domain, though overall performance patterns are similar to peers. Delay alone does not appear to differentially affect performance though increasing load has a negative effect on accuracy. Key Words: Cerebral palsy, Working memory, Neuropsychology Disclosure(s): None Disclosed. Research Poster 3910 Peer Mentoring After Traumatic Brain Injury (TBI) e a Valuable Experience for Mentees and Mentors Paula Kersten (AUT University), Nicola Maree Kayes, Christine Cummins, Richard John Siegert, Hinemoa Elder, Mark Weatherall, Richard Seemann, Allison Foster, Duncan Babbage, Kathryn McPherson Objective(s): To examine the feasibility of peer mentoring for people with a traumatic brain injury (TBI). Design: A prospective cohort study with ethics approval. Setting: Community. Participants: People with a moderate or severe TBI and who were about to be discharged from inpatient rehabilitation were matched with peer mentors who had sustained a TBI 1-5 years previous. Interventions: Peer mentors took part in a 2-day training workshop before beginning their mentoring role and attended regular debriefs. The peer mentoring intervention consisted of one session in the rehabilitation unit and five sessions in the community. Sessions focused on establishing what participatory activities are important to the mentee, developing goals, and supporting participation in these activities. Main Outcome Measure(s): Qualitative interviews on conclusion of the intervention with mentees and mentors. Results: Six mentees (18-46 years, 4 male) were matched with six mentors (21-59 years, 4 male). Two mentees did not remain in contact after the first session, due to personal circumstances. The sessions for the remaining four dyads took place over 5 months. Qualitative data suggest that the 2-day training workshop was effective in supporting mentors in their role. The workshop and experience of being a mentor provided them with skills and confidence in communication and relationship building that extended beyond the program. Mentees reported the intervention as a positive experience. Being able to talk with someone who understood their situation better than rehabilitation professionals, friends or family was especially beneficial. Conclusions: The peer mentoring program was feasible and valued by mentees and mentors. No safety issues were reported and funding for a definitive trial are being sought. Key Words: Brain injury, Mentoring, Participation Disclosure(s): None Disclosed. Research Poster 3913 Association of Obesity and Race/Ethnicity with Functional Status After Elective Primary Total Knee Arthroplasty Kshitija Kulkarni (University of Texas Medical Branch) Objective(s): Examine association between obesity and race/ethnicity on functional outcomes for patients with total knee arthroplasty undergoing post-acute inpatient rehabilitation. Design: Secondary analysis of Medicare data (2007-2009) using Medicare Provider Analysis and Review, and Inpatient Rehabilitation FacilityPatient Assessment Instrument, Files. Setting: Inpatient rehabilitation facilities in the US. Participants: Medicare beneficiaries aged 65 years and older with osteoarthritis who underwent elective primary total knee arthroplasty. Interventions: N/A. Main Outcome Measure(s): Primary outcome of interest was IRF discharge functional status. We defined obesity using ICD-9 codes associated with IRF stay (categories: normal weight, overweight and obesity, morbid obesity). Race/Ethnicity was classified into non-Hispanic white, non-Hispanic black, and Hispanic. Covariates included age, gender,

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e87 marital status, comorbidities, length of stay, and IRF admission functional status. We used multivariate regression model to adjust for covariates. Results: Among the cohort (nZ69003), proportions of individuals in overweight/obesity and morbid obesity categories were 16.9% and 8.1% respectively. Women were greater by 34.7%, 48%, and 56.6% than men in normal weight, overweight/obesity, and morbid obesity categories respectively. Non-Hispanic whites constituted 87.8%, 84.1% and 81.3% in normal weight, overweight/obesity, and morbid obesity categories respectively. Using normal weight as reference category, we found that morbid obesity negatively impacted functional status (bZ-0.5, SEZ0.168, pZ.003). NonHispanic blacks and Hispanics had lower discharge functional status (bZ1.93, SEZ0.18, p<.001; and bZ-0.73, SEZ0.20, pZ.0003 respectively). There was no interaction effect between obesity categories and race/ethnicity. Conclusions: Both morbid obesity and being Non-Hispanic black or Hispanic negatively affected functional status following TKA. Key Words: Inpatient rehabilitation, Total knee arthroplasty, Obesity, Race, Ethnicity Disclosure(s): None Disclosed. Research Poster 3914 CoreAlign Training for a Person with Multiple Sclerosis: Effects on Strength, Walking, and Participation Mark Manago (University of Colorado Hospital/ University of Colorado Denver), Carrie Lamb, Jeffrey R. Hebert Objective(s): Two of the most common symptoms that people with multiple sclerosis (MS) experience are muscle weakness and difficulty walking. To date, evidence to support strengthening aimed at improving gait in people with MS is limited. The objective of this report is to describe changes in strength, gait, and participation following a novel rehabilitation approach using a CoreAlign. Design: Case report with pre-post outcome measurements. Setting: Outpatient hospital-based rehabilitation clinic. Participants: A 40 year-old woman with a 22-year history of MS and gait disability (Patient Determined Disease Steps score of 3). Interventions: 6-week CoreAlign treatment program. CoreAlign is a novel exercise apparatus that targets movement patterns in functional postural positions. The program targeted lower extremity and postural stability, strength, and flexibility. Main Outcome Measure(s): Lower extremity and trunk strength measured by hand-held dynamometry (HHD); walk endurance (2-Minute Walk Test 2MWT) and speed (25-Foot Walk Test - T25FW); and self-determined participation (Patient-Specific Functional Scale - PSFS). Results: Clinically meaningful improvements were found for walking endurance (20% in 2MWT) and participation (> 2 point mean change on the PSFS). Notable improvements were found for strength: trunk flexion (18%); weaker limb ankle dorsiflexion (25%), knee flexion (11%), hip flexion (16%), and lateral trunk flexion (17%); and gait speed (17% on T25FW). Conclusions: The results demonstrate the potential of CoreAlign training to produce meaningful changes in important outcomes within each of the International Classification of Disability, Function, and Health (ICF) framework categories: impairment (strength), activity (gait), and participation (PSFS). Additional investigations are needed to study the effects of the CoreAlign in larger groups of people with MS. Key Words: Multiple sclerosis, Exercise, Walking Disclosure(s): Dr. Hebert and Dr. Manago have no disclosures. Dr. Lamb is a CoreAlign Master Instructor. Research Poster 3915 Employment Challenges Among Iraq and Afghanistan War Veterans with Traumatic Brain Injury Kathleen F. Carlson (VA Portland Health Care System), Pogoda K. Terri, Sandra G. Resnick, Maya E. O’Neil, Elizabeth Twamley, Nina A. Sayer Objective(s): To examine employment challenges among Iraq and Afghanistan War Veterans who sustained traumatic brain injury (TBI).