Involving the Dimensions of Participation and Engagement to Improve Return-to-School Outcomes in Concussed Youth

Brain Injury AKI, SIADH, dysautonomia, pneumonia and respiratory failure with prolonged intubation and tracheostomy, and dysphagia with gastrostomy tube placement. At the onset of his rehabilitation, his Rancho Los Amigos (RANCHO) cognitive functioning level was II. Interventions: The patient was enrolled in the Veterans Health Administration emerging consciousness program (VHA-ECP) which involves a highly functional interdisciplinary rehabilitation team with treatment focus on detailed environmental regulation, direct stimulation interventions, mobility and positioning programs and management of medical comorbidities and traumatic brain injury-related sequalae. Main Outcome Measure(s): Overall improvement in alertness and cognition measured by the Rancho Los Amigos cognitive functioning scale, neuropsychiatric testing and gains achieved in activities of daily living (ADLs) measured by functional independence measure (FIM) scoring. Results: Upon completing the 90-day VHA-ECP, patient had improved his cognitive function and level of alertness to a RANCHO V and was able to be subsequently enrolled into a traditional acute inpatient rehabilitation program. Conclusions: This case report illustrates the efficacy of the VHA-ECP in an anoxic brain injury patient, which is different than the more typical traumatic brain injuries of blast or penetrating trauma. Key Words: anoxic brain injury, traumatic brain injury, emerging consciousness Disclosure(s): None Disclosed. Poster 163 Involving the Dimensions of Participation and Engagement to Improve Return-to-School Outcomes in Concussed Youth Dhruti Bhandari (University of Toronto), Courtney S. Ostrega, Catherine Wiseman-Hakes, Nick Reed Objective: To develop a client-centred model of return to school for children and youth with concussion based on an Occupational Therapy perspective. This perspective involves consideration of a holistic, clientcentred approach to Participation and Engagement in everyday activities. Data sources: Review of 25 articles from the current literature from three major health and medical research databases (Medline, CINAHL, and Scopus), in addition to grey literature. Study selection: Information on the return-to-school process for youth post-concussion was selected using the International Classification of Functioning Disability and Health model (ICF) as a framework for examination. Study selection: N/A Data extraction: The model was developed as a visual schematic that identifies relevant themes and gaps within the current literature on returnto-school, in order to inform policies and practices that will facilitate a successful reintegration of youth into school following a concussion. Data synthesis: From an occupational therapy perspective, the ideal return-to-school plan should address the concussed student’s Participation and Engagement at school in relation to the student’s a) personal factors b) environmental factors c) body functions and structures d) schoolrelated activity. Conclusions: This client-centered model is the first to add the dimensions of participation and engagement as key goals and determinants of successful return to school for youth following a concussion. This model can be used to guide clinical practice, education, policy, and future research with the goal of developing a comprehensive and accessible return-toschool guideline to improve overall outcomes for youth as they return to school following a concussion. Key Words: Return-to-school, Participation and Engagement, Concussion, Children and adolescents, Occupational Therapy Disclosure(s): None Disclosed. Poster 164 WITHDRAWN

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e57 Poster 165 Effectiveness of a Multimodal Cognitive Rehabilitation Program in Older Adults With Traumatic Brain Injury Eduardo N.M.N. Cisneros (Universite´ de Montre´al; CRLB), Sylvie Belleville, E´laine de Guise, Michelle McKerral Objective: To evaluate the effectiveness of the Cognitive Enrichment Program (CEP) in adults having sustained a traumatic brain injury (TBI) during late adulthood. Design: A controlled single-blind intervention study. Setting: Outpatient rehabilitation setting. Participants: 32 TBI patients aged 55 years +, assigned to two groups experimental (nZ20) receiving CEP training, and control (nZ12) not receiving CEP training. Interventions: The CEP consists of three modules, Introduction and selfawareness, Attention and Memory, Executive functions, which were presented to small groups of participants, in 90-minute sessions, twice weekly, during 12 weeks. Participants were presented with CEP conceptual framework, they performed practical exercises and homework was required. Main Outcome Measure(s): Specific neuropsychological tests, self-report questionnaires and real-life situations related to functions targeted by the CEP were used as measures of efficacy, whereas non-specific measures were also obtained. Impact on life habits and psychological well-being was also assessed through questionnaires. Results: ANOVAs indicated significant (p<.05) improvement on variables targeted by the program, and no effect on non-specific variables. Effects were found in the experimental group for the following variables: Attention - auditory sustained attention; Memory - memory for faces, word list memory; Executive functions - strategic organization, sorting and inhibition. Among the Psychological variables, significant effects were present for general well-being, and social participation. The effect-sizes of variables showing significant change were high except for auditory attention which was moderate. Conclusions: The CEP, an intensive and relatively brief cognitive rehabilitation program, provides significant benefits in cognitive, psychological and daily functioning in older persons with TBI. Key Words: Rehabilitation, Traumatic brain injury, Aging Disclosure(s): None Disclosed. Poster 166 Disability Rating Scale Criteria as a Screen for Consciousness Matthew James Doiron (Spaulding Rehabilitation Hospital), Anne Schnepf Citorik, Eileen Hunsaker, Marianne Beninato, Joseph Giacino Objective: Anecdotal evidence suggests that the Disability Rating Scale (DRS) descriptive categories “Vegetative State (VS) and Extreme Vegetative State” (DRS total score >21) misclassify some subjects who are actually in the minimally conscious state (MCS). We investigated the rate of misclassification and identified total DRS cut-off scores that can help differentiate MCS from VS. Design: Retrospective data analysis. Setting: Inpatient Rehabilitation Hospital. Participants: 183 adults aged 16-65 at 4-16 weeks post-injury with a diagnosis of traumatic VS or MCS, as defined by the Coma Recovery Scale-Revised (CRS-R). Interventions: Not Applicable. Main Outcome Measure(s): Diagnostic accuracy of DRS total scores (i.e. sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]). Results: Thirty-two percent of subjects in MCS were incorrectly classified as “Vegetative State” or “Extreme Vegetative State” using DRS descriptive categories. There was no DRS total score cut-off that was both highly sensitive and specific to MCS. However, a total score of 21 was highly predictive of MCS (PPVZ.95) and a total score of >24 was highly predictive of VS (NPVZ.88).