- Email: [email protected]
Gender Differences in Self-Reported Post-Concussion Symptoms
e20 Main Outcome Measure(s): GAITRite walking speed, Two-Minute Walk Test (2MWT), and Timed Up and Go (TUG) performed without AFOs. Results: By final training session, child trained longer (finalZ48 vs. initialZ23 minutes), intermittently over-rode motor (finalZ11 vs. initialZ0 minutes), and completed more Pedi-ICARE strides (finalZ2627 vs. initialZ878) at faster average speed (finalZ56 vs. initialZ35 RPM). Following intervention, child walked faster (GAITRite comfortable: postZ66 vs. preZ40.2 m/min; fast: postZ95.4 vs. preZ66 m/min) and farther (2MWT postZ137.5 vs. preZ98.8 m). TUG improved (postZ7.2 vs. preZ7.6 sec). Conclusions: Post-intervention walking and endurance improvements for single participant are encouraging, but more extensive study required. Key Words: Cerebral palsy, Rehabilitation, Exercise, Technology, Gait, Disclosures: Dr. Burnfield served as PI for grants to develop a motorassisted elliptical gait training device for adults (National Institute on Disability and Rehabilitation Research Grant #H133G070209) and children (National Institute on Disability, Independent Living, and Rehabilitation Research Grant #90IF0060, previously NIDRR #H133G130274). Dr. Burnfield is named as a co-inventor on three patents emerging from the adult technology. The technology has been licensed to SportsArt to manufacture and distribute. The adult ICARE technology served as the base technology for developing the pediatric technology. A portion of the royalties emerging from ICARE sales are paid to Madonna Rehabilitation Hospital and a portion of Madonna’s royalties are then distributed to Dr. Burnfield. Sonya Irons served as a research physical therapist on a grant to develop a motor-assisted elliptical gait training device for children (National Institute on Disability, Independent Living, and Rehabilitation Research Grant #90IF0060, previously NIDRR #H133G130274). Dr. Guilherme Cesar served as a co-investigator on a grant to develop a motor-assisted elliptical gait training device for children (National Institute on Disability, Independent Living, and Rehabilitation Research Grant #90IF0060, previously NIDRR #H133G130274). Thad W. Buster served as Chief Research Analyst for grants to develop a motor-assisted elliptical gait training device for adults (National Institute on Disability and Rehabilitation Research Grant #H133G070209) and children (National Institute on Disability, Independent Living, and Rehabilitation Research Grant #90IF0060, previously NIDRR #H133G130274). Mr. Buster is named as a co-inventor on three patents emerging from the adult technology. The technology has been licensed to SportsArt to manufacture and distribute. The adult ICARE technology served as the base technology for developing the pediatric technology. A portion of the royalties emerging from ICARE sales are paid to Madonna Rehabilitation Hospital and a portion of Madonna’s royalties are then distributed to Mr. Buster. Ruchika Khot does not have any conflicts of interest to disclose. Carl A. Nelson served as co-investigator for grants to develop a motor-assisted elliptical gait training device for adults (National Institute on Disability and Rehabilitation Research Grant #H133G070209) and children (National Institute on Disability, Independent Living, and Rehabilitation Research Grant #90IF0060, previously NIDRR #H133G130274). Dr. Nelson is named as a co-inventor on three patents emerging from the adult technology. The technology has been licensed to SportsArt to manufacture and distribute. The adult ICARE technology served as the base technology for developing the pediatric technology. A portion of the royalties emerging from ICARE sales are paid to the University of Nebraska - Lincoln and a portion of these royalties are then distributed to Dr. Nelson. Research Poster 937 Predictors of Arm Recovery for Chronic Stroke Survivors Amanda Vatinno (Rush University), Bethany Woodyatt, Megan Keller, Emily Lander, Mary Ellen Stoykov, Louis Fogg Research Objectives: To examine the predictors of motor recovery from upper extremity hemiparesis including movement repetitions per session, cortical inhibition, months post-stroke, and bilateral priming.
Research Posters Design: Data from two groups were gathered during a randomized, controlled trial (NCT 02277028). Participants were randomly assigned to either a healthcare education group or a bilateral priming group, also known as active-passive bilateral training (APBT). After receiving the education or priming, all participants completed the same task specific training (TST) protocol. This analysis examined predictors of motor recovery (as measured by FMUE) in all subjects. Setting: Clinical laboratory at a major medical center in the Midwest. Participants: The sample included 17 participants over the age of 55 who had sustained a unilateral stroke at least 6 months prior to enrollment. Participants were selected based on severity of arm impairment (indicated by scores on Fugl-Meyer Test of Upper Extremity Function [FMUE] of 23 to 38) and the ability to tolerate priming (Modified Ashworth Scale score of 3 or less for wrist). Interventions: There was a total of 30 hours of intervention with 15 sessions that included 1 hour of training, a 1-hour break, and a final hour of training. Main Outcome Measure(s): Behavioral and neurophysiological measures were taken at pre-and post-intervention and 6 weeks follow up. Behavioral measures: FMUE and the Chedoke Arm and Hand Activity Index. Occurrence of transcollosal inhibition from ipsilesional hemisphere was measured via transcranial magnetic stimulation. Results: Motor recovery (increases in FMUE scores) was found to be significantly related to median TST repetitions across sessions (rZ.82, p<.001) and marginally related to assignment to APBT (FZ4.12, dfZ(1,16), pZ.058). Conclusions: Median TST repetitions predicted 65% of the variance in FMUE. The effect was robust regardless of time post stroke. Key Words: Upper extremity hemiparesis, Bilateral priming, Motor recovery Disclosures: The research was supported by a grant from the American Occupational Therapy Foundation to Mary Ellen Stoykov. Research Poster 939 Gender Differences in Self-Reported Post-Concussion Symptoms Felicia Fraser (New York University Langone Medical Center, Rusk Rehabilitation), Yuen Shan Christine Lee, Yuka Matsuzawa, Amanda Childs, William Barr, William MacAllister, Joseph Ricker Research Objectives: Examine gender differences in self-reported postconcussion symptoms among individuals referred for neuropsychological services. Research has shown female gender is associated with increased susceptibility to emotional, physiological, sensory, and cognitive symptom clusters (King, 2014). Few studies have demonstrated which symptom cluster females are more likely to endorse. This study evaluates gender differences in symptomatology subsequent to various causes of concussion as research has shown this has implications for outcomes. Design: Retrospective study of adult concussion patients. Setting: Outpatient concussion center in an urban medical center. Participants: 100 patients (female Z 59; mean age Z 40.69 years) diagnosed with concussion or Post-Concussion Syndrome (PCS). Falls (33%), motor vehicle injuries (24%), and struck by an object (21%) were the top causes of injury. Interventions: Neuropsychological or psychological assessment. Main Outcome Measure(s): Sport Concussion Assessment Tool (SCAT 3). Results: Results indicated female concussion patients endorsed more physiological and sensory symptoms including nausea/vomiting (t(85.83) Z -2.02, p <.05), dizziness (t(91) Z -2.17, p <.05), balance problems (t(85.94) Z -2.33, p <.05), sensitivity to light (t(91) Z -3.18, p <.01 ), and sensitivity to noise (t(91) Z -2.30, p <.05) than males. Additionally, females reported experiencing higher total numbers of symptoms (t(54.45) Z -2.03, p <.05) and symptom severity (t(91) Z -2.29, p <.05 ) than males. No gender differences were found with regard to cognitive, emotional, and sleep symptoms. Conclusions: A gender effect was demonstrated on several physiological and sensory concussion symptoms suggesting females to be more
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Research Posters
e21
symptomatic than males. Results are consistent with previous findings indicating female athletes reported increased somatic symptoms postconcussion than male athletes. These findings can provide insight for rehabilitation specialists to develop more gender-specific approaches for treating female non-sport concussion patients. Key Words: Concussion, Post-concussion symptoms, gender differences Disclosures: Felicia Fraser is a Senior Psychologist at New York University Langone Medical Center and receives a salary. Yuka Matsuzawa is a Senior Psychologist at New York University Langone Medical Center and receives a salary. Yuen Shan Christine Lee is a Senior Psychologist at New York University Langone Medical Center and receives a salary.
and situation that reflects its capacity to facilitate sleep-onset in the majority of subjects”, is associated with the cultural/environmental component, certain behaviours, sleep-related variables, and somatization in general. Conclusions: Our study suggests that fatigue, alertness and daytime sleepiness in chronic concussion may not be solely explained by sociodemographic, brain-injury-, medical-, sleep-related variables, or medication/drug effects. Further attention to potential pathways in longitudinal studies is key to determining how to manage these states and also to the search for effective solutions. Key Words: Perceptual states, Concussion, Fatigue, Alertness, Sleepiness Disclosures: None disclosed.
Research Poster 940
Research Poster 941
Complex Perceived States in Work-Related Chronic Concussion
Polysomnographic Assessment of Sleep Function and Structure in Adults With Mild Traumatic Brain Injury/Concussion
Tatyana Mollayeva (Toronto Rehab-UHN), Shirin Mollayeva, Colin M. Shapiro, David J. Cassidy Research Objectives: Fatigue, alertness and daytime sleepiness are complex perceived states with significant implications for health and safety. These states are not diagnostically specific, and they may, or may not share interrelated features. Potential commonality or discordance is challenging in clinical situations, especially in controversial neurologic disorders, as in cases of concussion/mild traumatic brain injury (mTBI). Design: We performed a diagnostic multivariable modeling study to explore associations between patients’ characteristics, results of imaging tests and clinical investigations, and the states of fatigue, alertness and daytime sleepiness. Univariate and multivariate linear regression models were used to explicate covariates of fatigue, alertness, and daytime sleepiness. Setting: The Neurology Service of the largest rehabilitation teaching hospital in Canada has a contractual agreement with the insurer (i.e., Workers Safety and Insurance Board (WSIB)) to provide expert diagnostic opinions for persons who have or are suspected to have sustained neurological injuries at work. Injured workers were recruited at the admission to the insurer’s clinic. Participants: Initial contact was made with 178 subjects, of whom 110 provided written consent to participate in research and completed the required assessments. At the same time participants underwent comprehensive clinical investigations (i.e., psychiatry, neurology, occupational therapy, physiotherapy, neuropsychology, etc) and neuroimaging testing for establishing mTBI diagnoses. The researchers were blinded to the participant’s diagnosis until their medical charts became available for review, after clinical assessments were complete. All participants were also asked for consent to access their pre-morbid clinical and insurer’s files, and all gave written permission. To assess our sample’s representativeness indirectly, we compared it to a consecutive sample of workers (n Z 294) who were referred and assessed in the same clinic during 2003. No significant differences were observed in injury severity, sex, age, or clinical diagnosis. Interventions: N/A. Main Outcome Measure(s): The intensity of fatigue, alertness and daytime sleepiness was measured using the standardized Fatigue Severity Scale (FSS), the Toronto Hospital Alertness Test (THAT), and the Epworth Sleepiness Scale (ESS). Results: Our final model showed that fatigue can be explained by depressive illness and/or its treatments, insomnia disorder, the influence of the circadian and homeostatic drive at the time of reporting, and environmental state, potentially depicting protection from harm at work. Likewise, alertness shared the depressive illness aggregate, and its explanatory factors spanned across components related to brain health (i.e., restless leg’s, balance issues), together explaining 41% of the variance. Conversely, daytime sleepiness, conceptualized as “representing different levels of ‘somnificity’ that most people encounter as part of their daily lives” and defined as “the general characteristic of a posture, activity
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Tatyana Mollayeva (Toronto Rehab-UHN), Angela Colantonio, Lee Vernich, Shirin Mollayeva, David J. Cassidy, Colin M. Shapiro Research Objectives: Using established criteria for sleep architecture normality (e.g., sex- and age specific) we aimed to assess the magnitude of changes in sleep architecture in males and females with confirmed diagnosis of mild traumatic brain injury (mTBI)/concussion. Based on previous research, we hypothesized that: 1) sleep architecture in middle-aged persons with mTBI/concussion would deviate from age-and sex-determined normative data and 2) deviations from norms will be driven by changes in proportion of transitional stages of sleep (i.e., N1) and stage REM sleep. Design: Case series design. The raw measurements were converted to Zscores using sex-and age- specific normative population reference data. Box plots were employed to show change in relative sleep stage status for each stage of sleep. Setting: Research sleep facility within the teaching hospital, part of the university health network. Participants: Forty adults of working age (18-64 y.o.) with mTBI/ concussion, at least three months post-injury, were eligible. The clinical and polysomnographic investigations were performed at the facilities within the university health network, over a short period, during which no intervening treatments were commenced. Sleep function and structure was examined by polysomnography and compared with sex-and age- specific normative population reference data. We utilized the 2012 American Academy of Sleep Medicine (AASM) recommendations for recording, scoring, summarizing sleep stages, central nervous system arousals, breathing, movements in sleep, and electrocardiac activity. Interventions: N/A. Main Outcome Measure(s): The study objective centers around differences in sleep structure (i.e., percentage of N1, N2, N3 and stage REM sleep) between persons with mTBI/concussion in comparison to correspondent individually matched population-based norms, age- and sexspecific. We calculated z-scores for each sleep stage separately (i.e., N1, N2, N3, stage REM sleep), to determine overrepresented and underrepresented stages of sleep. Results: Sleep architecture Z-scores in males and females with mTBI/ concussion show deviations from the reference in the sleep architecture alternation pattern, stage REM sleep, and nocturnal wakefulness. The statistical significance of these deviations were sex-dependant. Conclusions: The observed deviations in the alternation pattern between NREM and REM sleep, increased nocturnal wakefulness, and diminished proportion of stage REM sleep from sex and age-specific normative data call for future investigation in determining the value of the disturbed sleep architecture and specific sleep stages in neurocognitive and behavioural functioning, mood, and other clinically relevant states through sex lens. Z-scores provide a way of comparing deviations in sleep structure from the reference (population norms). Key Words: Sleep structure, Concussion, Sex differences, Polysomnography Disclosures: None disclosed.
Research Posters Design: Data from two groups were gathered during a randomized, controlled trial (NCT 02277028). Participants were randomly assigned to either a healthcare education group or a bilateral priming group, also known as active-passive bilateral training (APBT). After receiving the education or priming, all participants completed the same task specific training (TST) protocol. This analysis examined predictors of motor recovery (as measured by FMUE) in all subjects. Setting: Clinical laboratory at a major medical center in the Midwest. Participants: The sample included 17 participants over the age of 55 who had sustained a unilateral stroke at least 6 months prior to enrollment. Participants were selected based on severity of arm impairment (indicated by scores on Fugl-Meyer Test of Upper Extremity Function [FMUE] of 23 to 38) and the ability to tolerate priming (Modified Ashworth Scale score of 3 or less for wrist). Interventions: There was a total of 30 hours of intervention with 15 sessions that included 1 hour of training, a 1-hour break, and a final hour of training. Main Outcome Measure(s): Behavioral and neurophysiological measures were taken at pre-and post-intervention and 6 weeks follow up. Behavioral measures: FMUE and the Chedoke Arm and Hand Activity Index. Occurrence of transcollosal inhibition from ipsilesional hemisphere was measured via transcranial magnetic stimulation. Results: Motor recovery (increases in FMUE scores) was found to be significantly related to median TST repetitions across sessions (rZ.82, p<.001) and marginally related to assignment to APBT (FZ4.12, dfZ(1,16), pZ.058). Conclusions: Median TST repetitions predicted 65% of the variance in FMUE. The effect was robust regardless of time post stroke. Key Words: Upper extremity hemiparesis, Bilateral priming, Motor recovery Disclosures: The research was supported by a grant from the American Occupational Therapy Foundation to Mary Ellen Stoykov. Research Poster 939 Gender Differences in Self-Reported Post-Concussion Symptoms Felicia Fraser (New York University Langone Medical Center, Rusk Rehabilitation), Yuen Shan Christine Lee, Yuka Matsuzawa, Amanda Childs, William Barr, William MacAllister, Joseph Ricker Research Objectives: Examine gender differences in self-reported postconcussion symptoms among individuals referred for neuropsychological services. Research has shown female gender is associated with increased susceptibility to emotional, physiological, sensory, and cognitive symptom clusters (King, 2014). Few studies have demonstrated which symptom cluster females are more likely to endorse. This study evaluates gender differences in symptomatology subsequent to various causes of concussion as research has shown this has implications for outcomes. Design: Retrospective study of adult concussion patients. Setting: Outpatient concussion center in an urban medical center. Participants: 100 patients (female Z 59; mean age Z 40.69 years) diagnosed with concussion or Post-Concussion Syndrome (PCS). Falls (33%), motor vehicle injuries (24%), and struck by an object (21%) were the top causes of injury. Interventions: Neuropsychological or psychological assessment. Main Outcome Measure(s): Sport Concussion Assessment Tool (SCAT 3). Results: Results indicated female concussion patients endorsed more physiological and sensory symptoms including nausea/vomiting (t(85.83) Z -2.02, p <.05), dizziness (t(91) Z -2.17, p <.05), balance problems (t(85.94) Z -2.33, p <.05), sensitivity to light (t(91) Z -3.18, p <.01 ), and sensitivity to noise (t(91) Z -2.30, p <.05) than males. Additionally, females reported experiencing higher total numbers of symptoms (t(54.45) Z -2.03, p <.05) and symptom severity (t(91) Z -2.29, p <.05 ) than males. No gender differences were found with regard to cognitive, emotional, and sleep symptoms. Conclusions: A gender effect was demonstrated on several physiological and sensory concussion symptoms suggesting females to be more
www.archives-pmr.org
Research Posters
e21
symptomatic than males. Results are consistent with previous findings indicating female athletes reported increased somatic symptoms postconcussion than male athletes. These findings can provide insight for rehabilitation specialists to develop more gender-specific approaches for treating female non-sport concussion patients. Key Words: Concussion, Post-concussion symptoms, gender differences Disclosures: Felicia Fraser is a Senior Psychologist at New York University Langone Medical Center and receives a salary. Yuka Matsuzawa is a Senior Psychologist at New York University Langone Medical Center and receives a salary. Yuen Shan Christine Lee is a Senior Psychologist at New York University Langone Medical Center and receives a salary.
and situation that reflects its capacity to facilitate sleep-onset in the majority of subjects”, is associated with the cultural/environmental component, certain behaviours, sleep-related variables, and somatization in general. Conclusions: Our study suggests that fatigue, alertness and daytime sleepiness in chronic concussion may not be solely explained by sociodemographic, brain-injury-, medical-, sleep-related variables, or medication/drug effects. Further attention to potential pathways in longitudinal studies is key to determining how to manage these states and also to the search for effective solutions. Key Words: Perceptual states, Concussion, Fatigue, Alertness, Sleepiness Disclosures: None disclosed.
Research Poster 940
Research Poster 941
Complex Perceived States in Work-Related Chronic Concussion
Polysomnographic Assessment of Sleep Function and Structure in Adults With Mild Traumatic Brain Injury/Concussion
Tatyana Mollayeva (Toronto Rehab-UHN), Shirin Mollayeva, Colin M. Shapiro, David J. Cassidy Research Objectives: Fatigue, alertness and daytime sleepiness are complex perceived states with significant implications for health and safety. These states are not diagnostically specific, and they may, or may not share interrelated features. Potential commonality or discordance is challenging in clinical situations, especially in controversial neurologic disorders, as in cases of concussion/mild traumatic brain injury (mTBI). Design: We performed a diagnostic multivariable modeling study to explore associations between patients’ characteristics, results of imaging tests and clinical investigations, and the states of fatigue, alertness and daytime sleepiness. Univariate and multivariate linear regression models were used to explicate covariates of fatigue, alertness, and daytime sleepiness. Setting: The Neurology Service of the largest rehabilitation teaching hospital in Canada has a contractual agreement with the insurer (i.e., Workers Safety and Insurance Board (WSIB)) to provide expert diagnostic opinions for persons who have or are suspected to have sustained neurological injuries at work. Injured workers were recruited at the admission to the insurer’s clinic. Participants: Initial contact was made with 178 subjects, of whom 110 provided written consent to participate in research and completed the required assessments. At the same time participants underwent comprehensive clinical investigations (i.e., psychiatry, neurology, occupational therapy, physiotherapy, neuropsychology, etc) and neuroimaging testing for establishing mTBI diagnoses. The researchers were blinded to the participant’s diagnosis until their medical charts became available for review, after clinical assessments were complete. All participants were also asked for consent to access their pre-morbid clinical and insurer’s files, and all gave written permission. To assess our sample’s representativeness indirectly, we compared it to a consecutive sample of workers (n Z 294) who were referred and assessed in the same clinic during 2003. No significant differences were observed in injury severity, sex, age, or clinical diagnosis. Interventions: N/A. Main Outcome Measure(s): The intensity of fatigue, alertness and daytime sleepiness was measured using the standardized Fatigue Severity Scale (FSS), the Toronto Hospital Alertness Test (THAT), and the Epworth Sleepiness Scale (ESS). Results: Our final model showed that fatigue can be explained by depressive illness and/or its treatments, insomnia disorder, the influence of the circadian and homeostatic drive at the time of reporting, and environmental state, potentially depicting protection from harm at work. Likewise, alertness shared the depressive illness aggregate, and its explanatory factors spanned across components related to brain health (i.e., restless leg’s, balance issues), together explaining 41% of the variance. Conversely, daytime sleepiness, conceptualized as “representing different levels of ‘somnificity’ that most people encounter as part of their daily lives” and defined as “the general characteristic of a posture, activity
www.archives-pmr.org
Tatyana Mollayeva (Toronto Rehab-UHN), Angela Colantonio, Lee Vernich, Shirin Mollayeva, David J. Cassidy, Colin M. Shapiro Research Objectives: Using established criteria for sleep architecture normality (e.g., sex- and age specific) we aimed to assess the magnitude of changes in sleep architecture in males and females with confirmed diagnosis of mild traumatic brain injury (mTBI)/concussion. Based on previous research, we hypothesized that: 1) sleep architecture in middle-aged persons with mTBI/concussion would deviate from age-and sex-determined normative data and 2) deviations from norms will be driven by changes in proportion of transitional stages of sleep (i.e., N1) and stage REM sleep. Design: Case series design. The raw measurements were converted to Zscores using sex-and age- specific normative population reference data. Box plots were employed to show change in relative sleep stage status for each stage of sleep. Setting: Research sleep facility within the teaching hospital, part of the university health network. Participants: Forty adults of working age (18-64 y.o.) with mTBI/ concussion, at least three months post-injury, were eligible. The clinical and polysomnographic investigations were performed at the facilities within the university health network, over a short period, during which no intervening treatments were commenced. Sleep function and structure was examined by polysomnography and compared with sex-and age- specific normative population reference data. We utilized the 2012 American Academy of Sleep Medicine (AASM) recommendations for recording, scoring, summarizing sleep stages, central nervous system arousals, breathing, movements in sleep, and electrocardiac activity. Interventions: N/A. Main Outcome Measure(s): The study objective centers around differences in sleep structure (i.e., percentage of N1, N2, N3 and stage REM sleep) between persons with mTBI/concussion in comparison to correspondent individually matched population-based norms, age- and sexspecific. We calculated z-scores for each sleep stage separately (i.e., N1, N2, N3, stage REM sleep), to determine overrepresented and underrepresented stages of sleep. Results: Sleep architecture Z-scores in males and females with mTBI/ concussion show deviations from the reference in the sleep architecture alternation pattern, stage REM sleep, and nocturnal wakefulness. The statistical significance of these deviations were sex-dependant. Conclusions: The observed deviations in the alternation pattern between NREM and REM sleep, increased nocturnal wakefulness, and diminished proportion of stage REM sleep from sex and age-specific normative data call for future investigation in determining the value of the disturbed sleep architecture and specific sleep stages in neurocognitive and behavioural functioning, mood, and other clinically relevant states through sex lens. Z-scores provide a way of comparing deviations in sleep structure from the reference (population norms). Key Words: Sleep structure, Concussion, Sex differences, Polysomnography Disclosures: None disclosed.