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Dysfluencies in Persons With Aphasia Showing Improvement: AphasiaBank Transcripts
e56 Research Poster 314485 Dysfluencies in Persons With Aphasia Showing Improvement: AphasiaBank Transcripts Lisa LaSalle (University of Redlands) Research Objectives: To investigate dysfluency types (false starts, interjections, incompletion, retraces), in persons with aphasia (PWA) who improve language skills between initial testing (Time 1) and Time 2. Design: This is a data mining descriptive longitudinal study using AphasiaBank. Nonparametric statistics will help compare repeated measures of dysfluencies in transcripts available at Time 1 & 2. Setting: Videos and transcripts are available on a NIH-funded American archive AphasiaBank (MacWhinney, Fromm, Forbes, & Holland, 2011), who share an online database of multimedia interactions for the study of communication in aphasia (http://aphasia.talkbank.org/browser/index. php?urlZEnglish/Aphasia/). Currently, the database includes almost 400 media files linked with transcripts for people with aphasia (PWA) and about 200 “control” samples, that is, adults without aphasia or any other neurological impairment. These transcripts include a variety of discourse samples gathered according to a standard discourse protocol. Because AphasiaBank researchers are interested in whether and how discourse changes over time, some PWA have provided multiple samples of their discourse over time at aphasia centers or community programs. Participants: Holland, Fromm, Forbes & MacWhinney (2016) used the Western Aphasia Battery-Revised (WAB-R) (Kertesz, 2006). All 26 PWA participated in speech therapy before being initially recorded for AphasiaBank. Holland et al. (2016) found that 16 of these 26 PWA demonstrated improved WAB-R Aphasia Quotient (AQ) scores at Time 2 (i.e., AQ change scores > WAB-SEM). Eleven of these 16 had the same protocol at Time 1 & 2, thus these 11 PWA are the present participants. Interventions: N/A. Main Outcome Measure(s): N/A. Results: Preliminary results show a variability in dysfluency frequency and types across tasks. Conclusion/Discussion: Present data will be compared to the linguistic data of Holland et al. (2016), suggesting that dysfluencies are linguistic markers of aphasia improvement. Key Words: False Starts, Retraces, Incomplete Utterances, People With Aphasia / Stroke / CVA, Aphasiabank Disclosures: None.
Research Poster 291999 Dystonia and Mixed Movement Disorder Management with Intrathecal Baclofen Therapy in the Pediatric Population Tamara Zagustin (Children’s Healthcare of Atlanta) Research Objectives: To identify common causes of secondary dystonia and mixed movement disorder in children with brain injuries. To identify ways to optimize intrathecal baclofen therapy in the management of secondary dystonia and mixed movement disorder in children. To report characteristics of the intrathecal baclofen therapy when managing secondary dystonia and mixed movement disorder in children. Design: This is a retrospective study at a large pediatric rehabilitation program in the state of Georgia from June 2011- March 2017. Setting: Inpatient rehabilitation unit and the outpatient rehabilitation clinic at the Children’s Healthcare of Atlanta, Georgia. Participants: 93 children total received ITB therapy. Close to 50% had secondary dystonia or a mixed movement disorder and assisted to the pediatric rehabilitation program of the Children’s Healthcare of Atlanta.
Research Posters Interventions: No interventions given that this is a retrospective study. Main Outcome Measure(s): Improved management of secondary dystonia and mixed movement disorder facilitating better quality of life for pediatric patient and care giver. Results: Intrathecal baclofen therapy is an effective intervention for managing secondary dystonia and mixed movement disorder in children when trying to assist patient with comfort and care yet it comes with certain risks and complications. Flex dosing and higher doses of intrathecal baclofen allow better response to this therapy when managing secondary dystonia and mixed movement disorder. Children usually need additional medications and interventions to help manage the secondary dystonia and mixed movement disorder despite having intrathecal baclofen therapy in place. Conclusion/Discussion: Intrathecal baclofen therapy in children is an additional intervention to consider for secondary dystonia and mixed movement disorder when all other conservative interventions have failed or have been suboptimal. Key Words: Intrathecal Baclofen Therapy, Secondary Dystonia, Children, Brain Injury, Mixed Movement Disorder Disclosures: Nothing to disclose.
Research Poster 321680 Early Postsurgical Intrathecal Baclofen System Integrity Confirmation with Programmed Bolus H/M Ratio Evaluation Stuart Yablon (Methodist Rehabilitation Center), Dobrivoje Stokic Research Objectives: Detect neurophysiologic evidence of early occult malfunction among patients with recently implanted programmable intrathecal baclofen (ITB) pump and catheter systems for treatment of spasticity. Design: Retrospective case series. Setting: Spasticity clinic in free-standing rehabilitation hospital. Participants: 32 patients with recent ITB pump and catheter system implantation ( < 21 days) for treatment of spasticity of brain or spinal cord origin. Interventions: Programmed ITB bolus (50mcg; 500mcg/mL) administered over 10 minutes via recently implanted pump and catheter, before clinical dose titration. Main Outcome Measure(s): Bilateral soleus H/M ratio measured up to 6 hours after programmed ITB bolus. The side with greater decrease in H/ M ratio was analyzed. A decrease of < 50% from baseline H/M ratio was considered abnormal, consistent with ITB dose administration failure. Results: 35 ITB boluses (50mcg, median “background” simple continuous dose of 50mcg/24h) were administered < 21 days (median 12d) post-surgery via implanted catheter among the 32 patients. Median H/M ratio decrease from baseline for the overall group was 100% (IQRZ14%). Five of 32 patients (13%) failed to demonstrate the expected H/M ratio decrease in subsequent hourly measurements. These subsequently underwent diagnostic imaging evaluation or revision of the malfunctioning catheter, with eventual successful ITB administration through the repaired systems. None of the patients manifested evidence of ITB withdrawal. Conclusion/Discussion: Unsuspected ITB pump and catheter system malfunction may occur early after surgical implantation, prior to initiation of clinical dose titration. Early concurrent neurophysiological evaluation can objectively detect evidence of occult system malfunction, and may thus help expedite surgical revision and subsequently successful ITB administration for treatment of spasticity. Key Words: Spasticity, Intrathecal Baclofen, Clinical Neurophysiology, H/M Ratio, Complications Disclosures: None.
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Research Poster 291999 Dystonia and Mixed Movement Disorder Management with Intrathecal Baclofen Therapy in the Pediatric Population Tamara Zagustin (Children’s Healthcare of Atlanta) Research Objectives: To identify common causes of secondary dystonia and mixed movement disorder in children with brain injuries. To identify ways to optimize intrathecal baclofen therapy in the management of secondary dystonia and mixed movement disorder in children. To report characteristics of the intrathecal baclofen therapy when managing secondary dystonia and mixed movement disorder in children. Design: This is a retrospective study at a large pediatric rehabilitation program in the state of Georgia from June 2011- March 2017. Setting: Inpatient rehabilitation unit and the outpatient rehabilitation clinic at the Children’s Healthcare of Atlanta, Georgia. Participants: 93 children total received ITB therapy. Close to 50% had secondary dystonia or a mixed movement disorder and assisted to the pediatric rehabilitation program of the Children’s Healthcare of Atlanta.
Research Posters Interventions: No interventions given that this is a retrospective study. Main Outcome Measure(s): Improved management of secondary dystonia and mixed movement disorder facilitating better quality of life for pediatric patient and care giver. Results: Intrathecal baclofen therapy is an effective intervention for managing secondary dystonia and mixed movement disorder in children when trying to assist patient with comfort and care yet it comes with certain risks and complications. Flex dosing and higher doses of intrathecal baclofen allow better response to this therapy when managing secondary dystonia and mixed movement disorder. Children usually need additional medications and interventions to help manage the secondary dystonia and mixed movement disorder despite having intrathecal baclofen therapy in place. Conclusion/Discussion: Intrathecal baclofen therapy in children is an additional intervention to consider for secondary dystonia and mixed movement disorder when all other conservative interventions have failed or have been suboptimal. Key Words: Intrathecal Baclofen Therapy, Secondary Dystonia, Children, Brain Injury, Mixed Movement Disorder Disclosures: Nothing to disclose.
Research Poster 321680 Early Postsurgical Intrathecal Baclofen System Integrity Confirmation with Programmed Bolus H/M Ratio Evaluation Stuart Yablon (Methodist Rehabilitation Center), Dobrivoje Stokic Research Objectives: Detect neurophysiologic evidence of early occult malfunction among patients with recently implanted programmable intrathecal baclofen (ITB) pump and catheter systems for treatment of spasticity. Design: Retrospective case series. Setting: Spasticity clinic in free-standing rehabilitation hospital. Participants: 32 patients with recent ITB pump and catheter system implantation ( < 21 days) for treatment of spasticity of brain or spinal cord origin. Interventions: Programmed ITB bolus (50mcg; 500mcg/mL) administered over 10 minutes via recently implanted pump and catheter, before clinical dose titration. Main Outcome Measure(s): Bilateral soleus H/M ratio measured up to 6 hours after programmed ITB bolus. The side with greater decrease in H/ M ratio was analyzed. A decrease of < 50% from baseline H/M ratio was considered abnormal, consistent with ITB dose administration failure. Results: 35 ITB boluses (50mcg, median “background” simple continuous dose of 50mcg/24h) were administered < 21 days (median 12d) post-surgery via implanted catheter among the 32 patients. Median H/M ratio decrease from baseline for the overall group was 100% (IQRZ14%). Five of 32 patients (13%) failed to demonstrate the expected H/M ratio decrease in subsequent hourly measurements. These subsequently underwent diagnostic imaging evaluation or revision of the malfunctioning catheter, with eventual successful ITB administration through the repaired systems. None of the patients manifested evidence of ITB withdrawal. Conclusion/Discussion: Unsuspected ITB pump and catheter system malfunction may occur early after surgical implantation, prior to initiation of clinical dose titration. Early concurrent neurophysiological evaluation can objectively detect evidence of occult system malfunction, and may thus help expedite surgical revision and subsequently successful ITB administration for treatment of spasticity. Key Words: Spasticity, Intrathecal Baclofen, Clinical Neurophysiology, H/M Ratio, Complications Disclosures: None.
www.archives-pmr.org