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Neurorehabilitation Outcomes: Does Age Really Matter?
e32 Research Poster 217 Texas Juvenile Justice Traumatic Brain Injury Screening Project Part I Amanda Hahn Ketter (Icahn School of Medicine at Mount Sinai), Wayne Gordon, Lisa Spielman, Karla Therese Sy, Bettie Beckworth Research Objectives: To determine the frequency of TBI in the Texas juvenile justice population and to identify whether injury occurred before or after criminality in young offenders. Design: A survey was performed using the Brain Injury Screening Questionnaire (BISQ), which provides a comprehensive exposure history and report of current symptoms. The survey was administered to juveniles on probation or incarcerated in Texas correctional facilities. Each juvenile offender completed the BISQ, and additional data obtained included demographic information, offense history, DSM diagnoses, and interventions received. Setting: Data was obtained from five county facilities and two state intake facilities in the state of Texas. Participants: 4,316 juvenile offenders were surveyed, with an average age of 15.69 (SDZ 1.25). The total sample was 89% male, with two facilities being male-only. Ethnicity was 52.4% Hispanic, 30.2% Black/African American, and 16.3% Caucasian. Interventions: Not applicable. Main Outcome Measure(s): Frequency of TBIs, severity of injury, and timeline of injury (before vs. after offense). Results: 1728 (40%) participants reported history of at least one blow to the head; of those, 44.3% met criteria for mild TBI and 23.0% sustained a moderate-severe TBI. In county facilities, 78.5% of TBIs preceded the participants’ first offense. This was also the case in state facilities, where 56.5% of TBIs preceded participants’ first offenses. Those with TBI prior to offense reported more symptoms (physical, emotional, cognitive, and behavioral) and more DSM diagnoses. Conclusions: In this study the majority of TBIs occurred prior to the first offense. It’s known that TBI can result in behavioral dysregulation and impulsivity. While current findings support that those with TBI prior to criminality had more symptoms, there was no indication they received services to address their special needs, which may further support criminality. Key Words: TBI (traumatic brain injury), Adolescent, Social justice Disclosures: None disclosed. Research Poster 219 Texas Juvenile Justice Traumatic Brain Injury Screening Project Part II Amanda Hahn Ketter (Icahn School of Medicine at Mount Sinai), Wayne Gordon, Lisa Spielman, Karla Therese Sy, Bettie Beckworth Research Objectives: To examine the relationship between TBI, DSM diagnoses, and types of offenses committed among incarcerated juvenile offenders in the state of Texas. Design: A survey was performed using the Brain Injury Screening Questionnaire (BISQ), which provides a comprehensive exposure history and report of current symptoms. The survey was administered to incarcerated juveniles in Texas correctional facilities. Each juvenile offender completed the BISQ, and additional data obtained included demographic information, offense history, DSM diagnoses, and interventions received. Setting: This study utilized a subset of participants from a multi-facility survey within the Texas juvenile justice system. It specifically included the only two juvenile intake facilities for incarcerated juvenile offenders in Texas. Participants: Felony-level incarcerated juvenile offenders were included for a total of 3,101 surveyed youths, of whom 473 (15%) sustained a TBI prior to their first felony offense. Interventions: Not applicable. Main Outcome Measure(s): DSM diagnoses; Offense type.
Research Posters Results: Participants with TBI prior to their first incarceration were more likely to have psychiatric (i.e. schizophrenia, bipolar disorder) and moodrelated (i.e. depression, anxiety disorders) diagnoses than those without TBI at first offense. Those with TBI committed more sexual-related crimes, but there was no difference in the overall reported number of violent crimes between groups. Conclusions: Incarcerated juvenile offenders with TBI prior to criminality have a distinct mental health profile, such that mood/psychiatric diagnoses are more common in young offenders with TBI history, yet there’s no indication that they receive specialized interventions to address mood symptomatology. It’s imperative that adolescents with TBI receive proper interventions, including mental health services, as early as possible post-injury. Key Words: TBI (traumatic brain injury), Adolescent, Social Justice Disclosures: None disclosed. Research Poster 220 Ankle Foot Orthoses for Children with Myelomeningocele: Functional Effects Under a Dual Task Paradigm Nikta Pirouz (Lurie Children’s), Tasos Karakostas, Bryan Malas Research Objectives: Ankle foot orthoses (AFOs) are used to improve the gait of children with myelomeningocele (MMC). They improve balance, stability and efficiency of gait. Recent evidence suggests that in everyday life, walking may involve a cognitive component. Therefore, we assessed the effect of AFOs in the ability of children with MMC to walk while attention is challenged. We hypothesized: gait parameters will improve with AFOs during quiet walking and walking while counting. Counting performance will improve while walking with AFOs. Design: Before-after trial, single group design, 2 week follow-up. Setting: Institutional. Participants: 16 ambulatory MMC (7y-12y; 4 males, 12 females); GMFCS I-III. Exclusion criteria: shunt revision before 2 years old, inability to follow 2-step commands, tethered cord. IRB approval and Informed consent obtained. Interventions: Subjects counted while seated to obtain baseline counting performance (BL) and walked at self-selected speed on an instrumented walkway with shoes but without AFOs, while walking and counting (WC) and while walking only (W). After two weeks, they performed BL, WC and W with their AFOs and shoes donned. The order of WC and W was randomized. ANOVA was performed (a<0.05). Main Outcome Measure(s): Velocity (V), Stride Length (SL), percent of correct responses, rate of correct responses. Results: V and SL significantly increased with the use of AFOs during W. V significantly increased during WC with the use of AFOs. Counting rate and the rate of correct responses significantly increased with the AFOs during WC. Conclusions: In addition to improving gait parameters during W, AFO use allowed for significant motor and cognitive improvements during WC. This provides a foundation to use the performance of cognitive tasks during walking as a measure of the efficacy of orthotic interventions. Key Words: Meningomyelocele, Orthotic Devices, Gait, Attention Disclosures: None Disclosed. Research Poster 227 Neurorehabilitation Outcomes: Does Age Really Matter? Frank Lewis (NeuroRestorative), Gordon Horn, Robert Russell Research Objectives: To investigate the impact of age on traumatic brain injury functional outcomes within post-hospital rehabilitation programs. Design: Prospective cohort pretest-posttest. Setting: Twenty-four residential post-hospital brain injury rehabilitation programs in 18 states. Participants: 957 traumatically brain injured adults divided into 6 groups based on age cohort: 18 to 29 (nZ276), 30-39 (nZ175), 40-49 (nZ207), 50-59 (nZ202), 60-69 (nZ82), and 70+ (nZ15).
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Research Posters Interventions: Multidisciplinary treatment by physicians, nursing, PTs, OTs, SLPs, Psychology. Main Outcome Measure(s): Mayo Portland Adaptability Inventory (MPAI- 4) Participation Index, and the Supervision Rating Scale. Results: Split-plot (mixed design) ANOVA revealed a significant main effect for time, F(1,951) Z296.29, p<001. Each group made significant improvement on the MPAI-4 Participation subscale from admission to discharge. The main effect for groups was not significant, showing that age did not affect admission or discharge Participation scores. A subset of 111 individuals from the larger sample was evaluated on the Supervision Rating Scale at discharge. These individuals comprised 5 age groups: 18 to 29 (nZ25), 30 to 39 (nZ28), 40 to 49 (nZ28), 50 to 59 (nZ19), and 60+ (nZ14). A one-way ANOVA found no significant differences between age groups on supervision requirements at discharge. Conclusions: Measures of both functional independence and supervision requirements revealed that age effects did not reduce post-hospital rehabilitation improvements following brain injury. Contrary to previous findings, the present study did not support the notion that recovery from TBI is lessened for older adults versus younger adults. Comprehensive rehabilitation reduced the impact of disability on outcomes. Key Words: Traumatic Brain Injury, Assessment, Age effects Disclosures: None disclosed. Research Poster 229 A Focus Group on Chinese Nurses’ Perceptions of Educational Needs in Rehabilitation Nursing and Lessons Learned from this Cultural Exchange Kristen Mauk (Colorado Christian University), Pei Ying Li, Huilu Jin Research Objectives: To investigate Chinese nurses’ perceptions of educational needs related to rehabilitation nursing and discuss lessons learned from this cultural exchange. Design: An exploratory, qualitative, descriptive design using an authordeveloped semi-structured questionnaire with a single focus group of Chinese nurse leaders. Setting: The focus group was conducted at a technical college in Hangzhou, China. Participants: A convenience sample of 13 female Chinese nurse leaders from Hangzhou, China. Mean age Z 37 years, mean experience Z 16 years; 92% (nZ12) had a Bachelor’s degree; the majority held leadership positions in rehabilitation or neurology units in large acute care hospitals in China. Interventions: Not applicable. Main Outcome Measure(s): This study did not emphasize main planned outcome measures. Results: Two major themes arose from analysis using qualitative methods: 1) current system issues present barriers to implementing rehabilitation nursing, and 2) Chinese nurses desire to be rehabilitation nurses, but they need support to assume this role. Nurses wanted more education on teamwork, collaboration, acute rehab nursing skills, acuity systems, rehabilitation nursing management models, quality assurance, and standards of practice. The participants felt that policy change at the highest governmental level in China would help to advance rehabilitation nursing in the country. Lessons learned included several barriers: Chinese nurse participants’ lack of familiarity and comfort with giving informed consent to participate, understanding their part in the focus group research process, and voicing their opinions without fear or intimidation. Conclusions: Since post-acute services are under-developed in China, little research has been done on the rehabilitation nursing knowledge of Chinese nurses. Cultural barriers need to be addressed to gain the emic perspective in qualitative rehabilitation nursing research in China. Key Words: rehabilitation, nursing, cultural characteristics, focus groups, qualitative research Disclosures: Kristen Mauk is President, consultant, and co-owner of Senior Care Central/International Rehabilitation Consultants. Pei Ying Li is President of RainbowFish Rehabilitation. Ms. Jin has nothing to disclose.
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e33 Research Poster 230 Improving the Stroke and Traumatic Brain Injury Rehabilitation Knowledge of Chinese Nurses through Education: A Pilot Kristen Mauk (Colorado Christian University), Pei Ying Li, Huilu Jin Research Objectives: To investigate the effect of an educational intervention on the knowledge of Chinese nurses about stroke and traumatic brain injury rehabilitation. Design: A single cohort, pre- and post-test design was used to measure learning outcomes. Setting: A vocational and technical college in Hangzhou, China. Participants: A volunteer sample of 12 experienced Chinese nurse leaders in Hangzhou, China. Interventions: A two-day, advanced practice nurse (APN)-facilitated educational program on stroke and TBI rehabilitation nursing was provided. A single cohort, pre- and post-test design was used to measure learning outcomes via two 20-question author-developed multiple choice tests. A master’s prepared Chinese rehabilitation nurse translated the variety of lectures and learning materials. Main Outcome Measure(s): An increase in rehabilitation nursing knowledge as measured by improved test scores on a 20-item author-developed multiple choice test. Results: A significant improvement (t(11)Z-5.731, p Z<.001) was found between the stroke pre-test (MeanZ12.42; SDZ1.240; SEMZ.358) and the post-test (Mean 15.83; SDZ2.125; SEMZ.613), although the mean percentage correct remained relatively low on the post-test (79%). For TBI preand post-tests, a significant improvement was also found as a result of the educational intervention (t(12)Z-5.864, pZ<.001). The pre-test mean was 74%, with a post-test mean of 87%, a statistically significant improvement (.000). Thus, the initial hypothesis was supported. Participants had a mean age of 37 years and an average of 16 years of nursing experience. No demographic variables showed a significant correlation with baseline knowledge. Conclusions: Findings and participant feedback suggested that Chinese nurses both want and need more education about stroke and brain injury. There is an identified need for additional rehabilitation nursing education to enhance quality care for these survivors in China. Key Words: stroke, rehabilitation, nursing, China Disclosures: Kristen Mauk is President, consultant, and co-owner of Senior Care Central/International Rehabilitation Consultants. Pei Ying Li is President of RainbowFish Rehabilitation. Ms. Jin has nothing to disclose. Research Poster 231 Double Blind Randomized Controlled Clinical Trial of Frontoparietal tDCS in Patients With Disorders of Consciousness Ge´raldine Martens (Coma Science Group) Research Objectives: To assess the effects of transcranial direct current stimulation (tDCS) over the fronto-parietal cortex in patients with disorders of consciousness. Design: Double-blind cross-over sham-controlled experimental study. Setting: Patients were seen at the hospital or in long term care facilities. Participants: We enrolled 15 patients in unresponsive wakefulness syndrome (UWS- nZ7), minimal conscious state (MCS- nZ7), and emergence of MCS (EMCS- nZ1). Average ageZ 44.6 14.4; 7 traumatic and 8 non-traumatic etiologies. Interventions: Two sessions of tDCS were delivered, using either anodal or sham stimulation in a randomized order. Fronto-parietal areas were stimulated using a current of 1 mA during 20 minutes. Main Outcome Measure(s): Consciousness was assessed with the Coma Recovery Scale-Revised (CRS-R) before and after each stimulation. We also defined responders as patients who showed a new sign of consciousness after the real tDCS that was not present neither before nor after the sham tDCS. Results: A tendency of improvement was observed after the real tDCS session (pZ0.075) while no significant change was found after the sham
Research Posters Results: Participants with TBI prior to their first incarceration were more likely to have psychiatric (i.e. schizophrenia, bipolar disorder) and moodrelated (i.e. depression, anxiety disorders) diagnoses than those without TBI at first offense. Those with TBI committed more sexual-related crimes, but there was no difference in the overall reported number of violent crimes between groups. Conclusions: Incarcerated juvenile offenders with TBI prior to criminality have a distinct mental health profile, such that mood/psychiatric diagnoses are more common in young offenders with TBI history, yet there’s no indication that they receive specialized interventions to address mood symptomatology. It’s imperative that adolescents with TBI receive proper interventions, including mental health services, as early as possible post-injury. Key Words: TBI (traumatic brain injury), Adolescent, Social Justice Disclosures: None disclosed. Research Poster 220 Ankle Foot Orthoses for Children with Myelomeningocele: Functional Effects Under a Dual Task Paradigm Nikta Pirouz (Lurie Children’s), Tasos Karakostas, Bryan Malas Research Objectives: Ankle foot orthoses (AFOs) are used to improve the gait of children with myelomeningocele (MMC). They improve balance, stability and efficiency of gait. Recent evidence suggests that in everyday life, walking may involve a cognitive component. Therefore, we assessed the effect of AFOs in the ability of children with MMC to walk while attention is challenged. We hypothesized: gait parameters will improve with AFOs during quiet walking and walking while counting. Counting performance will improve while walking with AFOs. Design: Before-after trial, single group design, 2 week follow-up. Setting: Institutional. Participants: 16 ambulatory MMC (7y-12y; 4 males, 12 females); GMFCS I-III. Exclusion criteria: shunt revision before 2 years old, inability to follow 2-step commands, tethered cord. IRB approval and Informed consent obtained. Interventions: Subjects counted while seated to obtain baseline counting performance (BL) and walked at self-selected speed on an instrumented walkway with shoes but without AFOs, while walking and counting (WC) and while walking only (W). After two weeks, they performed BL, WC and W with their AFOs and shoes donned. The order of WC and W was randomized. ANOVA was performed (a<0.05). Main Outcome Measure(s): Velocity (V), Stride Length (SL), percent of correct responses, rate of correct responses. Results: V and SL significantly increased with the use of AFOs during W. V significantly increased during WC with the use of AFOs. Counting rate and the rate of correct responses significantly increased with the AFOs during WC. Conclusions: In addition to improving gait parameters during W, AFO use allowed for significant motor and cognitive improvements during WC. This provides a foundation to use the performance of cognitive tasks during walking as a measure of the efficacy of orthotic interventions. Key Words: Meningomyelocele, Orthotic Devices, Gait, Attention Disclosures: None Disclosed. Research Poster 227 Neurorehabilitation Outcomes: Does Age Really Matter? Frank Lewis (NeuroRestorative), Gordon Horn, Robert Russell Research Objectives: To investigate the impact of age on traumatic brain injury functional outcomes within post-hospital rehabilitation programs. Design: Prospective cohort pretest-posttest. Setting: Twenty-four residential post-hospital brain injury rehabilitation programs in 18 states. Participants: 957 traumatically brain injured adults divided into 6 groups based on age cohort: 18 to 29 (nZ276), 30-39 (nZ175), 40-49 (nZ207), 50-59 (nZ202), 60-69 (nZ82), and 70+ (nZ15).
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Research Posters Interventions: Multidisciplinary treatment by physicians, nursing, PTs, OTs, SLPs, Psychology. Main Outcome Measure(s): Mayo Portland Adaptability Inventory (MPAI- 4) Participation Index, and the Supervision Rating Scale. Results: Split-plot (mixed design) ANOVA revealed a significant main effect for time, F(1,951) Z296.29, p<001. Each group made significant improvement on the MPAI-4 Participation subscale from admission to discharge. The main effect for groups was not significant, showing that age did not affect admission or discharge Participation scores. A subset of 111 individuals from the larger sample was evaluated on the Supervision Rating Scale at discharge. These individuals comprised 5 age groups: 18 to 29 (nZ25), 30 to 39 (nZ28), 40 to 49 (nZ28), 50 to 59 (nZ19), and 60+ (nZ14). A one-way ANOVA found no significant differences between age groups on supervision requirements at discharge. Conclusions: Measures of both functional independence and supervision requirements revealed that age effects did not reduce post-hospital rehabilitation improvements following brain injury. Contrary to previous findings, the present study did not support the notion that recovery from TBI is lessened for older adults versus younger adults. Comprehensive rehabilitation reduced the impact of disability on outcomes. Key Words: Traumatic Brain Injury, Assessment, Age effects Disclosures: None disclosed. Research Poster 229 A Focus Group on Chinese Nurses’ Perceptions of Educational Needs in Rehabilitation Nursing and Lessons Learned from this Cultural Exchange Kristen Mauk (Colorado Christian University), Pei Ying Li, Huilu Jin Research Objectives: To investigate Chinese nurses’ perceptions of educational needs related to rehabilitation nursing and discuss lessons learned from this cultural exchange. Design: An exploratory, qualitative, descriptive design using an authordeveloped semi-structured questionnaire with a single focus group of Chinese nurse leaders. Setting: The focus group was conducted at a technical college in Hangzhou, China. Participants: A convenience sample of 13 female Chinese nurse leaders from Hangzhou, China. Mean age Z 37 years, mean experience Z 16 years; 92% (nZ12) had a Bachelor’s degree; the majority held leadership positions in rehabilitation or neurology units in large acute care hospitals in China. Interventions: Not applicable. Main Outcome Measure(s): This study did not emphasize main planned outcome measures. Results: Two major themes arose from analysis using qualitative methods: 1) current system issues present barriers to implementing rehabilitation nursing, and 2) Chinese nurses desire to be rehabilitation nurses, but they need support to assume this role. Nurses wanted more education on teamwork, collaboration, acute rehab nursing skills, acuity systems, rehabilitation nursing management models, quality assurance, and standards of practice. The participants felt that policy change at the highest governmental level in China would help to advance rehabilitation nursing in the country. Lessons learned included several barriers: Chinese nurse participants’ lack of familiarity and comfort with giving informed consent to participate, understanding their part in the focus group research process, and voicing their opinions without fear or intimidation. Conclusions: Since post-acute services are under-developed in China, little research has been done on the rehabilitation nursing knowledge of Chinese nurses. Cultural barriers need to be addressed to gain the emic perspective in qualitative rehabilitation nursing research in China. Key Words: rehabilitation, nursing, cultural characteristics, focus groups, qualitative research Disclosures: Kristen Mauk is President, consultant, and co-owner of Senior Care Central/International Rehabilitation Consultants. Pei Ying Li is President of RainbowFish Rehabilitation. Ms. Jin has nothing to disclose.
www.archives-pmr.org
e33 Research Poster 230 Improving the Stroke and Traumatic Brain Injury Rehabilitation Knowledge of Chinese Nurses through Education: A Pilot Kristen Mauk (Colorado Christian University), Pei Ying Li, Huilu Jin Research Objectives: To investigate the effect of an educational intervention on the knowledge of Chinese nurses about stroke and traumatic brain injury rehabilitation. Design: A single cohort, pre- and post-test design was used to measure learning outcomes. Setting: A vocational and technical college in Hangzhou, China. Participants: A volunteer sample of 12 experienced Chinese nurse leaders in Hangzhou, China. Interventions: A two-day, advanced practice nurse (APN)-facilitated educational program on stroke and TBI rehabilitation nursing was provided. A single cohort, pre- and post-test design was used to measure learning outcomes via two 20-question author-developed multiple choice tests. A master’s prepared Chinese rehabilitation nurse translated the variety of lectures and learning materials. Main Outcome Measure(s): An increase in rehabilitation nursing knowledge as measured by improved test scores on a 20-item author-developed multiple choice test. Results: A significant improvement (t(11)Z-5.731, p Z<.001) was found between the stroke pre-test (MeanZ12.42; SDZ1.240; SEMZ.358) and the post-test (Mean 15.83; SDZ2.125; SEMZ.613), although the mean percentage correct remained relatively low on the post-test (79%). For TBI preand post-tests, a significant improvement was also found as a result of the educational intervention (t(12)Z-5.864, pZ<.001). The pre-test mean was 74%, with a post-test mean of 87%, a statistically significant improvement (.000). Thus, the initial hypothesis was supported. Participants had a mean age of 37 years and an average of 16 years of nursing experience. No demographic variables showed a significant correlation with baseline knowledge. Conclusions: Findings and participant feedback suggested that Chinese nurses both want and need more education about stroke and brain injury. There is an identified need for additional rehabilitation nursing education to enhance quality care for these survivors in China. Key Words: stroke, rehabilitation, nursing, China Disclosures: Kristen Mauk is President, consultant, and co-owner of Senior Care Central/International Rehabilitation Consultants. Pei Ying Li is President of RainbowFish Rehabilitation. Ms. Jin has nothing to disclose. Research Poster 231 Double Blind Randomized Controlled Clinical Trial of Frontoparietal tDCS in Patients With Disorders of Consciousness Ge´raldine Martens (Coma Science Group) Research Objectives: To assess the effects of transcranial direct current stimulation (tDCS) over the fronto-parietal cortex in patients with disorders of consciousness. Design: Double-blind cross-over sham-controlled experimental study. Setting: Patients were seen at the hospital or in long term care facilities. Participants: We enrolled 15 patients in unresponsive wakefulness syndrome (UWS- nZ7), minimal conscious state (MCS- nZ7), and emergence of MCS (EMCS- nZ1). Average ageZ 44.6 14.4; 7 traumatic and 8 non-traumatic etiologies. Interventions: Two sessions of tDCS were delivered, using either anodal or sham stimulation in a randomized order. Fronto-parietal areas were stimulated using a current of 1 mA during 20 minutes. Main Outcome Measure(s): Consciousness was assessed with the Coma Recovery Scale-Revised (CRS-R) before and after each stimulation. We also defined responders as patients who showed a new sign of consciousness after the real tDCS that was not present neither before nor after the sham tDCS. Results: A tendency of improvement was observed after the real tDCS session (pZ0.075) while no significant change was found after the sham