Outcome Measure Use in Community-Based Stroke Rehabilitation: Survey of Therapists' Current Practice in Scotland

e20 Results: Outcomes from healthy populations demonstrated the advantage of external focus (think about the task effect) over internal focus (thinking about the movement itself) during motor skill training leading to better motor performance and long-term learning (Wulf, 2007).The research for individuals with stroke is very limited with only two studies meeting our criteria (Fasoli et al., 2002; Durham et al., in press). Both studies recruited participants with mild arm impairments, and found that external focus improved arm reaching more than internal focus cues. No retention data was measured. Conclusions: There appears to be a temporary motor training benefit of utilizing external focus cues compared to internal focus cues for individuals with mild arm impairment after stroke. Additional studies are needed to address wide gaps in the literature including retention data to determine if there are long-term learning effects and the recruitment of individuals with moderate to severe arm impairments.A study is currently underway at our institution to address some of the key issues. Key Words: Motor Learning, Attentional Focus, Stoke Rehabilitation Disclosure(s): None Disclosed. Poster 32 WITHDRAWN

Poster 33 Outcome Measure Use in Community-Based Stroke Rehabilitation: Survey of Therapists’ Current Practice in Scotland Jacqui H. Morris (University of Dundee), Thilo Kroll Objective: To examine rationale for outcome measure selection by UK rehabilitation physiotherapists (PTs), occupational therapists (OTs), speech and language therapists (SLTs). Design: Web-based survey examining current outcome measure use, selection and satisfaction with measures. Telephone interviews with purposefully selected therapists to explore survey findings more fully. Setting: Community stroke rehabilitation settings in which rehabilitation therapists work across14 health boards in Scotland, UK. Participants: 113 therapists (51 physiotherapists, 39 occupational therapists, 23 speech and language therapists). Interventions: Not applicable. Main Outcome Measure(s): Web-based survey examining current outcome measure use, selection and satisfaction with measures. Telephone interviews with purposefully selected therapists to explore survey findings more fully. Results: Most commonly used instruments: PTs: Berg Balance Scale (80.4%), Tinetti Balance (74.5%), Tinetti Gait (68.6%); OTs: Rivermead Behavioural Memory Test (48.7%), Barthel Index (46.1%); SLTs: Therapy Outcome Measure (52.2%), Frenchay Aphasia Screening Test (30.4%); non-validated (21.7%); locally developed measures 9.9%. Measure selection: Relevance to patients’ goals (nZ68; 60.2%); easy to use (nZ59; 52.2%); Good evidence (nZ53; 46.9%); Sensitivity to change (nZ51; 45.1%); specificity to outcome (nZ49; 43.4%). Only 8.5% and 2.5% of respondents prioritised measure accessibility and aphasia friendliness respectively; only 13.6% considered eliciting patients’ views as a selection priority. 37.5% of respondents expressed dissatisfaction with available measures. Interviews highlighted tension between best measurement practice and financial constraints, lack of time and environmental barriers. Conclusions: Although therapists prioritised patient-centredness and outcome measures relevance as important for measurement selection many measures focused on impairment and few therapists prioritised eliciting patient views or measurement accessibility as a key selection

Stroke criteria.Findings highlight gaps between UK policies emphasising patientcentredness and community rehabilitation practice. Key Words: Rehabilitation, Stroke, Outcome assessment Disclosure(s): None Disclosed. Poster 34 Decreased Tidal Volume May Limit Cardiopulmonary Performance During Peak Exercise in Subacute Stroke Jason-Flor Villarosa Sisante (University of Kansas Medical Center), Anna Mattlage, Michael Rippee, Sandra Billinger Objective: Reduced pulmonary function may be an underlying cause of post-stroke fatigue during physical activities. The aim of this study is to determine whether pulmonary function is reduced at peak exercise in subacute stroke compared to sedentary adults. Design: A retrospective cohort design. Setting: Exercise Laboratories, Kansas City, Kansas. Participants: 10 individuals with subacute stroke and 10 sedentary, gender-matched and age-similar controls performed a cardiopulmonary exercise testing on a recumbent stepper. Interventions: Not applicable. Main Outcome Measure(s): We hypothesized the following cardiopulmonary measures during peak exercise would be lower in subacute stroke: peak oxygen consumption (peak VO2, in mlkg-1min-1), minute ventilation (VE, in Lmin-1), tidal volume (Vt, in L), respiratory rate (RR, in breaths per minute), and heart rate (HR, in bpm). Results: Independent t-test revealed subacute stroke had significantly lower values (p < 0.05) in peak VO2, VE and Vt compared to controls during peak exercise. However, RR and HR were not different between groups. No between-group differences were found for age, height, weight and body mass index. Both groups gave good effort as RER was > 1.1. Conclusions: These groups were similar with respect to age, body height and weight. We report that peak VO2 declines early after stroke. The largest deficit was found in Vt. Pulmonary function may have a greater influence on tolerance for physical activity and exercise. These results suggest that diminished cardiopulmonary fitness in subacute stroke is a result of impaired pulmonary function. Rehabilitation professionals should consider respiratory muscle training to improve pulmonary function. Key Words: Stroke, Exercise Test, Pulmonary Function Test Disclosure(s): None Disclosed.

Poster 35 Differences in Upper Extremity Versus Lower Extremity Motor Function in Person’s With Chronic Stroke Jill Seale (University of Texas Medical Branch), Katy Mitchell, Sharon Olson, Merry Lynne Hamilton, Alexis Ortiz Objective: To explore differences and relationships upper and lower extremity (UE/LE) motor function, mobility, gait and quality of life (QOL) in persons in the chronic phase of stroke. Design: Prospective, descriptive, methodological research. Setting: Participants were recruited from the community, and completed study at a university laboratory. Participants: Thirty participants, 29-80 years of age. Inclusion criteria: history of first stroke with unilateral motor deficits at least 1 year ago; ability to ambulate greater  10 meters, unassisted; medically stable; sufficient cognition. Exclusion criteria: other pathologies that affect gait. Interventions: Not applicable. Main Outcome Measure(s): QOL was assessed using the transformed Stroke Impact Scale-16 (SIS16), transformed participation (TP) and percent recovery (PR). Gait was measured using the GAITRiteÒ

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