Impact of Biopsychosocial Factors on Quality of Participation in Persons with Spinal Cord Injury: Multisite Cross-Sectional Study

e136 Research Poster 815 Forearm Endurance Training in a Woman With Kearns-Sayre Syndrome: Case Report Kevin McCully (University of Georgia), Brad Willingham, Hannah Bossie, Fran Kendall Research Objectives: To measure clinical symptoms, muscle-specific endurance, and muscle mitochondrial capacity in a person with KSS before and after one month of endurance training. Design: Before-after case control. Setting: University setting. Participants: Participant was a 48-year-old female with a diagnosis of KSS, confirmed by an abnormal biopsy indicating a complex 1 defect, a genetically confirmed mitochondrial DNA deletion mutation, and elevated lactate levels. Interventions: The non-dominant forearm was trained for 18 sessions of 20-30 minutes using 3-5 pounds over 34 days. Main Outcome Measure(s): Muscle-specific endurance was measured with surface mechanomyography and electrical stimulation at 2, 4, and 6 Hz sequentially. Mitochondrial capacity was measured using the rate of recovery of oxygen consumption after a short bout of electrical stimulation. Results: Contractions per training session increased from 240 to 525. Symptoms of muscle fatigue and weakness following training sessions decreased markedly throughout the training program. Grip strength increased from 19.1 to 20.7 kg. Muscle endurance index at 6 Hz increased from 67% to 83%. Muscle mitochondrial capacity (recovery rate constant) increased from 1.4/min to 2.2/min. Conclusions: A patient with mitochondrial disease, specifically KSS, was able to significantly improve her muscle function with endurance training. The 57% increase in mitochondrial capacity is consistent with training adaptations reported for non-diseased controls using a similar training protocol. This suggests her muscles have the ability to upregulate mitochondrial biogenesis despite her genetic disease. This study also demonstrates the potential of accelerometry-based assessments of muscle endurance and muscle mitochondrial tests to noninvasively evaluate patients with mitochondrial diseases. Key Words: Exercise, mitochondrial, fatigue Disclosures: None disclosed. Research Poster 816 Retrospective Analysis of Clinical Practice Data of Robot-Assisted Gait Training in Patients with Spinal Cord Injury Gloria Vergara-Diaz (Department of Physical Medicine and Rehabilitation, Harvard Medical School Spaulding Rehabilitation Hospital), Jairo Alberto Dussan-Sarria, Massiel Dominguez-Iglesia, Anne O’Brien, Catherine Adans-Dester, Siew Kwaon Lui, Paolo Bonato Research Objectives: To study training settings and outcomes of robotassisted gait training in patients with spinal cord injury (SCI). Design: Retrospective cohort. Setting: Rehabilitation hospital (inpatient). Participants: Adults with stable SCI who received robot-assisted gait training between June 2009 and June 2014. Interventions: Robot-assisted gait training. Main Outcome Measure(s): Demographic and clinical data: type of injury, ASIA Impairment Scale (AIS) level; number of sessions and LokomatÒ therapy settings. Results: The data of 84 patients 47.1 [28 - 63.7] years of age (median and interquartile range) were included. 70.2% were male subjects. 84% had acute SCI; 52.4% with traumatic etiology. Only 14% were complete injuries. AIS grade was predominantly D (31%) with 57.7% of the injuries at the cervical level. A median of 14[10.75-17.25] patients per year underwent robot-assisted gait training. The median number of training sessions was 5 [3-8]. 39 patients performed more that 6 sessions. The settings (median and interquartile range) of the first session were: 50 % [36.5-50]

Research Posters Body-Weight Support, 85 % [70-100] guidance force, and treadmill speed 2.0 km/h [1.8-2.1]. We intend to compare our data with data extracted from the ARTIC database, a multi-site initiative aiming to evaluating correlations among the type of injury, therapy plan used, and functional outcomes in patients undergoing LokomatÒ therapy. Conclusions: The median number of robot-assisted gait training sessions was lower than we anticipated. However, considering our clinical setting, these results could be related to the short duration of inpatient stay when therapy time has to be allocated for other functional goals besides ambulation. We suggest that it would be advisable to establish standard protocols for robot-assisted gait training in order to assess the effectiveness of robot-assisted training in patients with SCI. Key Words: Spinal Cord Injuries, Robotic Exoskeleton, Biomedical Technology, Rehabilitation Disclosures: None disclosed. Research Poster 817 Impact of Biopsychosocial Factors on Quality of Participation in Persons with Spinal Cord Injury: Multisite Cross-Sectional Study Brent Walter (Washington University in St. Louis), Jess Dashner, Alex Wong, Allen Heinemann Research Objectives: To assess the role of biological, psychological, and socio-environmental factors in persons with spinal cord injury (SCI). Design: Multisite cross-sectional study. Participants completed patientreported measures of health, personal and environmental factors, and participation. We used the biopsychosocial model to guide the selection of study variables. We used exploratory factor analysis to obtain a factor score to represent the quality of participation. Variables reduction method (p<0.1) was used to select variables for the final regression model. Setting: Three medical institutions located in Chicago, Michigan and St. Louis. Participants: 150 community-dwelling adults with SCI. Interventions: Not applicable. Main Outcome Measure(s): PROMIS, NIH Toolbox, NeuroQoL, Community Participation Indicators, Economic Quality of Life, SCI Quality of Life Measurement System, Environmental Factors Item Banks and other legacy measures of environmental factors. Results: One single-factor solution was obtained to represent quality of participation (Only 1 factor with eigenvalue >1.0 and explained 69.5% of variances). Biological factors including pain (pZ0.045), upper extremity function (p<0.001), psychological factors including loneliness (pZ0.016 and meaning (pZ0.048), as well as socio-environmental factors including the use of assistive technology for mobility were associated with the quality of participation. The final model explained for 53.2% of variances in participation (F(11, 138)Z16.424, p<0.001). Conclusions: Pain, upper extremity function, loneliness, life meaning, and assistive technology use of adults with SCI were associated with the quality of participation. These results can provide targets for interventions to improve participation for SCI. Key Words: Outcome Assessment (Health Care), Participation, Spinal Cord Injury Disclosures: None disclosed. Research Poster 820 Community Reintegration in Veterans with Traumatic Brain Injury: Perspectives from Community Event Observations Christine Melillo (VA), Karen Besterman-Dahan, Gail Powell-Cope, Christina (Tina) Dillahunt-Aspillaga, Bridget Hahm, Jason Lind, Kiersten Downs, Nicole Antinori Research Objectives: The objective of this poster is to report preliminary data describing: (a) public events supporting community reintegration (CR), and (b) contextual factors that facilitate and impede CR.

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