- Email: [email protected]
Poster 177 (see Article 6): Multisite Randomized Controlled Trials for Neurorehabilitation: Lessons Learned from the International SIRROWS Trial
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2010 ACRM–ASNR JOINT EDUCATIONAL CONFERENCE ABSTRACTS
to symptom severity should improve the selection and evaluation of treatments for neurodegenerative diseases. Key Words: Muscle weakness; Rehabilitation. Poster 174 Old Age Reduces the Ability to Reorient Locomotor Trajectories Based on Visual Information. Anouk Lamontagne (School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada), Joyce Fung, Jessica Berard. Disclosure: None declared. Objective: To investigate the influence of changing optic flows (OF) on the control of locomotor steering in young and older adults. Design: Quasi-experimental, mixed model design. Setting: Virtual reality (VR) gait laboratory, rehabilitation hospital. Participants: 20 young (age, 18 –29y) and 20 older adults (age, 60 – 85y). Interventions: Participants were exposed to translational and rotational OFs viewed as a virtual room through a helmet-mounted display system during walking. The focus of expansion (FOE) was randomly translated or rotated to different locations: 40° right or left, or neutral (0°). Subjects were instructed to “walk straight in the virtual environment.” Main Outcome Measures: Horizontal plane movements of the body’s center of mass and angular displacements of head, thorax, pelvis, and feet in virtual and physical coordinates. Results: A shift in the FOE resulted in participants veering in the opposite direction in the physical world, in an attempt to maintain a straight trajectory in the virtual world. Translational OF induced contra-directional changes in physical walking trajectory with minimal body segment reorientations, while rotational OF induced similar changes in walking trajectory accompanied by large body segment reorientations. Older adults displayed altered walking trajectory corrections and body segment reorientations under both OF conditions. Conclusions: The nature of the OF has a profound influence on steering strategies. The dissociation between body segment and walking trajectory orientation suggests independent and distinct control mechanisms. The altered steering strategies in older adults indicate altered perception or utilization of visual motion information, which may contribute to their reduced ability to monitor and adapt locomotion to contextual demands. Present results also suggest that manipulation of OF through VR can be used to change or enhance specific features of locomotor steering for the purpose of gait rehabilitation. Key Words: Rehabilitation; Walking. Poster 175 Clinical Populations Can be Distinguished on Sit-to-Stand Movement Parameters. Heidi Sveistrup (University of Ottawa, Ottawa, ON, Canada), Megan Fitzpatrick, Jana MacLeod, Olinda Habib, Amaya Arcelus, Martin Bilodeau, Rafik Goubran, Frank Knoefel. Disclosure: None declared. Objective: To determine whether the Ottawa Sit-to-Stand (OSTS) Checklist distinguishes between Sit-to-Stand (STS) movements of older adults poststroke (Stroke), older adults post hip fracture (Hip), and healthy older (Healthy) participants. Design: Multiple group design; volunteer subjects. Setting: Inpatient rehabilitation center. Participants: 5 Healthy, 5 Stroke, and 5 Hip subjects. Interventions: Participants were videotaped performing a series of STS transfers. Main Outcome Measures: 2 independent raters coded the videos using the new OSTS. The OSTS consists of 4 subscales to characterize process, action, and symmetry of the upper limbs, lower limbs, head, and trunk. Data were analyzed using FLEISS and chi-square. Results: FLEISS’ kappa coefficients (k) were ⱖ0.41 for 96% of all items with only 2 items (4%) ⱕ0.4. The low kappa coefficients are likely due to test limitations (2- and 3-point scales for these items). Significant Arch Phys Med Rehabil Vol 91, October 2010
differences among the 3 groups included left and right hand position and action, arm symmetry, sit to stand process, feet position, and left and right foot action (P⬍.05 for all comparisons). Head position, pelvis position during sitting, forward trunk lean, left and right knee action, standing position and standing symmetry did not differentiate among groups. Conclusions: Compensatory and modified actions performed by Hip and Stroke participants can be identified visually using video. Inappropriate actions can be targeted in rehabilitation to increase safety and decrease energy expenditure. The use of the OSTS for documenting change in behavior following rehabilitation or as a function of normal recovery remains to be evaluated. Key Words: Outcome assessment (health care); Rehabilitation; Sit-to-stand. Poster 176 Neuropsychology and Functional Performance in Daily Activities Associated With Pontine and Subcortical Demyelination: A Case Study. Sabrina Arciero (Hoˆpital du Sacre´-Coeur, Montreal, QC, Canada), Christina Kempf, Franccis Bernard, Nadia Gosselin. Disclosure: None declared Objective: Central pontine and extra pontine myelinolysis (CPEM) is a rare neurological disease characterized by demyelination of the pons and other subcortical regions, secondary to rapid normalization of hyponatremia. A variety of movement disorders, psychiatric and behavioral manifestations can occur. However, very few studies on neuropsychological functioning and none on functional performance in daily activities have been reported. The objectives were to: (1) Document the neuropsychological and functional deficits associated with severe CPEM and their evolution. (2) Compare the results with those obtained prior to the first manifestations of CPEM. Design: Case study. Setting: Acute care hospital. Patient: A 55-year-old woman was admitted with severe hyponatremia (98mmol/L). CPEM occurred after correction of hyponatremia and was confirmed with resonance imaging (demyelination of the pons, caudate nuclei, putamen and globi pallidi). Interventions: We performed neuropsychological and functional evaluations prior to and after the first manifestations of CPEM. Testing was also done after medical intervention (Solumedrol 1g IV for 3 days and IVIG 0.4g/kg for 5 days) and occupational therapy in an acute setting. Main Outcome Measures: Neuropsychological and functional evaluations. Results: No impairments were found prior to CPEM. After CPEM diagnosis, many behavioral deficits were observed including apathy, paranoia, emotional lability, impulsivity, altered judgement, and disinhibition. The patient also presented motor impairments characterized by parkinsonism and decreased dexterity. The neuropsychological evaluation showed executive dysfunctions, with the performance varying between the 0.5 and 25th percentile. Executive function deficits were also observed in the functional evaluations, where impulsivity leads to reduced performance. Most deficits recovered progressively over 2 months. Conclusions: This case study showed neuropsychological and functional impairments that were specific to executive functions and these deficits were not observed prior to CPEM. Improvements in cognitive, behavioral and motor functions were observed after acute setting rehabilitation. Key Words: Executive function; Myelinolysis, central pontine; Rehabilitation. Poster 177 (see Article 6) Multisite Randomized Controlled Trials for Neurorehabilitation: Lessons Learned from the International SIRROWS Trial. Prudence Plummer-D’Amato (Northeastern University, Boston, MA), Bruce Dobkin, SIRROWS Group. Disclosure: None declared. Objectives: To determine the feasibility of creating a clinical trial structure uniting clinicians in an international network to conduct
2010 ACRM–ASNR JOINT EDUCATIONAL CONFERENCE ABSTRACTS
studies of neurorehabilitation interventions within the context of usual inpatient care, without any external funding. Design: Multisite singleblind randomized controlled trial. Setting: Inpatient rehabilitation facilities. Participants: Site principal investigators, intervention therapists, blinded evaluators, and site coordinators. Interventions: Each principal investigator and blinded evaluator received a manual of operations for the online database and a unique user identification and password. The blinded assessors also received protocols and data forms for all outcome measures. The intervention therapists received protocols concerning the study interventions. A quarterly newsletter from the coordinating center engaged participants, updated recruitment across sites, and answered questions via a question-and-answer column. Main Outcome Measures: Recruitment rate, number of sites who participated. Results: 18 sites in 8 countries enrolled 179 eligible participants in ⬍2 years. Recruitment rate averaged 9 –10 patients per month. Strategies facilitating study success were: use of simple and reliable outcome measures that could be easily implemented in clinical practice without need for training or funding, an uncomplicated intervention that was not difficult to standardize, use of electronic newsletters to motivate and communicate with sites, and an online data entry system. Obstacles included acquiring follow up data beyond discharge and tracking reasons for exclusion. Conclusions: There is widespread international interest by clinicians to participate in neurorehabilitation clinical trials. A clinical trials network may provide opportunity for clinicians to engage in clinical research as well as improve subject recruitment rates. Furthermore, we learned about each site’s population and limitations to aid preparation and design for the next trial with the group. Key Words: Gait; Rehabilitation; Stroke. Poster 178 Comparison of Outcomes and Costs of 2 Publicly-Funded Community-Based Models of Acquired Brain Injury Services. Kathryn Boschen (University of Toronto, Toronto, ON, Canada), Gary Gerber, Judith Gargaro. Disclosure: None declared. Objectives: This study compared outcomes of 2 rehabilitation services for persons with acquired brain injury (ABI) living in the regions of 2 small cities in Ontario, Canada who were receiving publiclyfunded community services. In 1 city, a coordinated interdisciplinary team provided services exclusively to ABI clients, and in the second city, a case manager assigned contracted service providers to ABI clients according to their needs. The case manager and providers worked with a broad spectrum of clients, and were not specialized in ABI. Design: Not applicable. Setting: Clients and designated family members home in Ontario, Canada. Participants: Persons with ABI. Interventions: Not applicable. Main Outcome Measures: Independent interviewers met with clients and designated family members in their homes every 12 months for 2 years using standardized rating scales and self-report measures. Results: 1-year follow-up data (N⫽64) showed that ABI team clients had better health status (P⬍.05) and community integration (P⬍.01) when compared to baseline, and were more satisfied with services provided compared to the generic service clients (P⬍.01). Generic service clients showed decreased functioning (P⬍.01) when compared to baseline. 2-year follow-up data (N⫽36) showed that ABI team clients had increased community integration (P⬍.01), maintained their improved health status, and reduced family burden (P⬍.01). Generic service clients showed greater disability (P⬍.05) when compared to baseline and 1-year follow-up data. Families of both client groups showed increased satisfaction with services from year 1 to year 2 (P⬍.05), and ABI team clients reported increased satisfaction with services from year 1 to year 2 (P⬍.05). A greater number of ABI Team clients received professional therapies and a greater number of generic services clients
E59
received nursing, dietary, and personal support services. Conclusions: 2-year follow-up data showed that a specialized community interdisciplinary team helped ABI clients improve their health status, and increase their community integration. Generic services maintained ABI clients in the community, but they became more disabled over time. Key Words: Brain injuries; Rehabilitation. Poster 179 Kinematic and Kinetic Comparison of Gait Profiles Between Poststroke and Spinal Cord Injured Individuals. Sylvie Nadeau (University of Montreal, Montreal, QC, Canada), Hugues Barbeau, Christiane Garneau, France Piotte. Disclosure: None declared. Objective: To compare the kinematic and kinetic gait parameters of persons with neurological muscle weakness of different origins (stroke and spinal cord injury [SCI]). Design: Cross-design study. Setting: Research laboratory at a university-affiliated inpatient rehabilitation hospital. Participants: 15 participants with poststroke hemiparesis and 14 participants with incomplete SCI. Interventions: Participants were asked to walk at natural and maximal gait speed. Kinematic data (angles) were derived from positions of markers recorded with an infrared movement analysis system (Optotrak). Ground reaction forces were collected using force plates; stride characteristics were computed from foot-switch recordings. Moments and powers at hip, knee, and ankle joints were obtained using an inversed dynamic approach. Main Outcome Measure: Profiles of the angles, moments and powers on the more affected side, peak angles and moments in flexion and extension, peak powers and time-distance parameters. Data were compared using statistical tests. Results: Mean ⫾ 1 SD values for natural and maximal speeds of 0.70⫾0.30m/s and 1.25⫾0.38m/s were found in stroke participants. In SCI individuals, the corresponding values were 0.79⫾0.34m/s and 1.09⫾0.49m/s. Stroke individuals have less hip extension amplitude on completion of the stance phase. For the peak moments, at natural speed, differences were observed at the hip (extensor moments SCI⬎stroke). At maximal speed, the extensor moment at the loading phase differed. Overall, the power at the knee and hip was greater in SCI at natural speed. This observation was not made at fast speed except for the energy generation by the hip extensors in the first part of the stance phase. Conclusions: SCI and stroke individuals walking at comparable speeds have a similar gait pattern at the ankle; the greatest differences are observed at the knee and hip. Moreover, they did not use the same muscle strategies to increase their gait speed. Key Words: Gait; Rehabilitation; Spinal cord injuries; Stroke. *Poster 180 Effect of Bilateral Isometric Forces in Different Directions on Motor Cortical Function. Juliette A. Yedimenko (University of Pittsburgh, Pittsburgh, PA), Monica A. Perez. Disclosure: None declared. Objective: The activity in the M1 reflects the direction of movements. The purpose of this study was to investigate physiological changes in the M1 during generation of bilateral isometric forces in different directions. Design: Randomized. Setting: Research laboratory. Participants: 12 right-handed healthy volunteers participated in this study. Interventions: None. Main Outcome Measures: We used transcranial magnetic stimulation to examine motor evoked potentials (MEPs), short-interval intracortical inhibition (SICI), and interhemispheric inhibition (IHI) in the left first dorsal interosseous (FDI) muscle during 10% of isometric index finger abduction while the contralateral side performed 30% of isometric index finger abduction (bilateral force, opposite direction) or adduction (bilateral force, same Arch Phys Med Rehabil Vol 91, October 2010
2010 ACRM–ASNR JOINT EDUCATIONAL CONFERENCE ABSTRACTS
to symptom severity should improve the selection and evaluation of treatments for neurodegenerative diseases. Key Words: Muscle weakness; Rehabilitation. Poster 174 Old Age Reduces the Ability to Reorient Locomotor Trajectories Based on Visual Information. Anouk Lamontagne (School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada), Joyce Fung, Jessica Berard. Disclosure: None declared. Objective: To investigate the influence of changing optic flows (OF) on the control of locomotor steering in young and older adults. Design: Quasi-experimental, mixed model design. Setting: Virtual reality (VR) gait laboratory, rehabilitation hospital. Participants: 20 young (age, 18 –29y) and 20 older adults (age, 60 – 85y). Interventions: Participants were exposed to translational and rotational OFs viewed as a virtual room through a helmet-mounted display system during walking. The focus of expansion (FOE) was randomly translated or rotated to different locations: 40° right or left, or neutral (0°). Subjects were instructed to “walk straight in the virtual environment.” Main Outcome Measures: Horizontal plane movements of the body’s center of mass and angular displacements of head, thorax, pelvis, and feet in virtual and physical coordinates. Results: A shift in the FOE resulted in participants veering in the opposite direction in the physical world, in an attempt to maintain a straight trajectory in the virtual world. Translational OF induced contra-directional changes in physical walking trajectory with minimal body segment reorientations, while rotational OF induced similar changes in walking trajectory accompanied by large body segment reorientations. Older adults displayed altered walking trajectory corrections and body segment reorientations under both OF conditions. Conclusions: The nature of the OF has a profound influence on steering strategies. The dissociation between body segment and walking trajectory orientation suggests independent and distinct control mechanisms. The altered steering strategies in older adults indicate altered perception or utilization of visual motion information, which may contribute to their reduced ability to monitor and adapt locomotion to contextual demands. Present results also suggest that manipulation of OF through VR can be used to change or enhance specific features of locomotor steering for the purpose of gait rehabilitation. Key Words: Rehabilitation; Walking. Poster 175 Clinical Populations Can be Distinguished on Sit-to-Stand Movement Parameters. Heidi Sveistrup (University of Ottawa, Ottawa, ON, Canada), Megan Fitzpatrick, Jana MacLeod, Olinda Habib, Amaya Arcelus, Martin Bilodeau, Rafik Goubran, Frank Knoefel. Disclosure: None declared. Objective: To determine whether the Ottawa Sit-to-Stand (OSTS) Checklist distinguishes between Sit-to-Stand (STS) movements of older adults poststroke (Stroke), older adults post hip fracture (Hip), and healthy older (Healthy) participants. Design: Multiple group design; volunteer subjects. Setting: Inpatient rehabilitation center. Participants: 5 Healthy, 5 Stroke, and 5 Hip subjects. Interventions: Participants were videotaped performing a series of STS transfers. Main Outcome Measures: 2 independent raters coded the videos using the new OSTS. The OSTS consists of 4 subscales to characterize process, action, and symmetry of the upper limbs, lower limbs, head, and trunk. Data were analyzed using FLEISS and chi-square. Results: FLEISS’ kappa coefficients (k) were ⱖ0.41 for 96% of all items with only 2 items (4%) ⱕ0.4. The low kappa coefficients are likely due to test limitations (2- and 3-point scales for these items). Significant Arch Phys Med Rehabil Vol 91, October 2010
differences among the 3 groups included left and right hand position and action, arm symmetry, sit to stand process, feet position, and left and right foot action (P⬍.05 for all comparisons). Head position, pelvis position during sitting, forward trunk lean, left and right knee action, standing position and standing symmetry did not differentiate among groups. Conclusions: Compensatory and modified actions performed by Hip and Stroke participants can be identified visually using video. Inappropriate actions can be targeted in rehabilitation to increase safety and decrease energy expenditure. The use of the OSTS for documenting change in behavior following rehabilitation or as a function of normal recovery remains to be evaluated. Key Words: Outcome assessment (health care); Rehabilitation; Sit-to-stand. Poster 176 Neuropsychology and Functional Performance in Daily Activities Associated With Pontine and Subcortical Demyelination: A Case Study. Sabrina Arciero (Hoˆpital du Sacre´-Coeur, Montreal, QC, Canada), Christina Kempf, Franccis Bernard, Nadia Gosselin. Disclosure: None declared Objective: Central pontine and extra pontine myelinolysis (CPEM) is a rare neurological disease characterized by demyelination of the pons and other subcortical regions, secondary to rapid normalization of hyponatremia. A variety of movement disorders, psychiatric and behavioral manifestations can occur. However, very few studies on neuropsychological functioning and none on functional performance in daily activities have been reported. The objectives were to: (1) Document the neuropsychological and functional deficits associated with severe CPEM and their evolution. (2) Compare the results with those obtained prior to the first manifestations of CPEM. Design: Case study. Setting: Acute care hospital. Patient: A 55-year-old woman was admitted with severe hyponatremia (98mmol/L). CPEM occurred after correction of hyponatremia and was confirmed with resonance imaging (demyelination of the pons, caudate nuclei, putamen and globi pallidi). Interventions: We performed neuropsychological and functional evaluations prior to and after the first manifestations of CPEM. Testing was also done after medical intervention (Solumedrol 1g IV for 3 days and IVIG 0.4g/kg for 5 days) and occupational therapy in an acute setting. Main Outcome Measures: Neuropsychological and functional evaluations. Results: No impairments were found prior to CPEM. After CPEM diagnosis, many behavioral deficits were observed including apathy, paranoia, emotional lability, impulsivity, altered judgement, and disinhibition. The patient also presented motor impairments characterized by parkinsonism and decreased dexterity. The neuropsychological evaluation showed executive dysfunctions, with the performance varying between the 0.5 and 25th percentile. Executive function deficits were also observed in the functional evaluations, where impulsivity leads to reduced performance. Most deficits recovered progressively over 2 months. Conclusions: This case study showed neuropsychological and functional impairments that were specific to executive functions and these deficits were not observed prior to CPEM. Improvements in cognitive, behavioral and motor functions were observed after acute setting rehabilitation. Key Words: Executive function; Myelinolysis, central pontine; Rehabilitation. Poster 177 (see Article 6) Multisite Randomized Controlled Trials for Neurorehabilitation: Lessons Learned from the International SIRROWS Trial. Prudence Plummer-D’Amato (Northeastern University, Boston, MA), Bruce Dobkin, SIRROWS Group. Disclosure: None declared. Objectives: To determine the feasibility of creating a clinical trial structure uniting clinicians in an international network to conduct
2010 ACRM–ASNR JOINT EDUCATIONAL CONFERENCE ABSTRACTS
studies of neurorehabilitation interventions within the context of usual inpatient care, without any external funding. Design: Multisite singleblind randomized controlled trial. Setting: Inpatient rehabilitation facilities. Participants: Site principal investigators, intervention therapists, blinded evaluators, and site coordinators. Interventions: Each principal investigator and blinded evaluator received a manual of operations for the online database and a unique user identification and password. The blinded assessors also received protocols and data forms for all outcome measures. The intervention therapists received protocols concerning the study interventions. A quarterly newsletter from the coordinating center engaged participants, updated recruitment across sites, and answered questions via a question-and-answer column. Main Outcome Measures: Recruitment rate, number of sites who participated. Results: 18 sites in 8 countries enrolled 179 eligible participants in ⬍2 years. Recruitment rate averaged 9 –10 patients per month. Strategies facilitating study success were: use of simple and reliable outcome measures that could be easily implemented in clinical practice without need for training or funding, an uncomplicated intervention that was not difficult to standardize, use of electronic newsletters to motivate and communicate with sites, and an online data entry system. Obstacles included acquiring follow up data beyond discharge and tracking reasons for exclusion. Conclusions: There is widespread international interest by clinicians to participate in neurorehabilitation clinical trials. A clinical trials network may provide opportunity for clinicians to engage in clinical research as well as improve subject recruitment rates. Furthermore, we learned about each site’s population and limitations to aid preparation and design for the next trial with the group. Key Words: Gait; Rehabilitation; Stroke. Poster 178 Comparison of Outcomes and Costs of 2 Publicly-Funded Community-Based Models of Acquired Brain Injury Services. Kathryn Boschen (University of Toronto, Toronto, ON, Canada), Gary Gerber, Judith Gargaro. Disclosure: None declared. Objectives: This study compared outcomes of 2 rehabilitation services for persons with acquired brain injury (ABI) living in the regions of 2 small cities in Ontario, Canada who were receiving publiclyfunded community services. In 1 city, a coordinated interdisciplinary team provided services exclusively to ABI clients, and in the second city, a case manager assigned contracted service providers to ABI clients according to their needs. The case manager and providers worked with a broad spectrum of clients, and were not specialized in ABI. Design: Not applicable. Setting: Clients and designated family members home in Ontario, Canada. Participants: Persons with ABI. Interventions: Not applicable. Main Outcome Measures: Independent interviewers met with clients and designated family members in their homes every 12 months for 2 years using standardized rating scales and self-report measures. Results: 1-year follow-up data (N⫽64) showed that ABI team clients had better health status (P⬍.05) and community integration (P⬍.01) when compared to baseline, and were more satisfied with services provided compared to the generic service clients (P⬍.01). Generic service clients showed decreased functioning (P⬍.01) when compared to baseline. 2-year follow-up data (N⫽36) showed that ABI team clients had increased community integration (P⬍.01), maintained their improved health status, and reduced family burden (P⬍.01). Generic service clients showed greater disability (P⬍.05) when compared to baseline and 1-year follow-up data. Families of both client groups showed increased satisfaction with services from year 1 to year 2 (P⬍.05), and ABI team clients reported increased satisfaction with services from year 1 to year 2 (P⬍.05). A greater number of ABI Team clients received professional therapies and a greater number of generic services clients
E59
received nursing, dietary, and personal support services. Conclusions: 2-year follow-up data showed that a specialized community interdisciplinary team helped ABI clients improve their health status, and increase their community integration. Generic services maintained ABI clients in the community, but they became more disabled over time. Key Words: Brain injuries; Rehabilitation. Poster 179 Kinematic and Kinetic Comparison of Gait Profiles Between Poststroke and Spinal Cord Injured Individuals. Sylvie Nadeau (University of Montreal, Montreal, QC, Canada), Hugues Barbeau, Christiane Garneau, France Piotte. Disclosure: None declared. Objective: To compare the kinematic and kinetic gait parameters of persons with neurological muscle weakness of different origins (stroke and spinal cord injury [SCI]). Design: Cross-design study. Setting: Research laboratory at a university-affiliated inpatient rehabilitation hospital. Participants: 15 participants with poststroke hemiparesis and 14 participants with incomplete SCI. Interventions: Participants were asked to walk at natural and maximal gait speed. Kinematic data (angles) were derived from positions of markers recorded with an infrared movement analysis system (Optotrak). Ground reaction forces were collected using force plates; stride characteristics were computed from foot-switch recordings. Moments and powers at hip, knee, and ankle joints were obtained using an inversed dynamic approach. Main Outcome Measure: Profiles of the angles, moments and powers on the more affected side, peak angles and moments in flexion and extension, peak powers and time-distance parameters. Data were compared using statistical tests. Results: Mean ⫾ 1 SD values for natural and maximal speeds of 0.70⫾0.30m/s and 1.25⫾0.38m/s were found in stroke participants. In SCI individuals, the corresponding values were 0.79⫾0.34m/s and 1.09⫾0.49m/s. Stroke individuals have less hip extension amplitude on completion of the stance phase. For the peak moments, at natural speed, differences were observed at the hip (extensor moments SCI⬎stroke). At maximal speed, the extensor moment at the loading phase differed. Overall, the power at the knee and hip was greater in SCI at natural speed. This observation was not made at fast speed except for the energy generation by the hip extensors in the first part of the stance phase. Conclusions: SCI and stroke individuals walking at comparable speeds have a similar gait pattern at the ankle; the greatest differences are observed at the knee and hip. Moreover, they did not use the same muscle strategies to increase their gait speed. Key Words: Gait; Rehabilitation; Spinal cord injuries; Stroke. *Poster 180 Effect of Bilateral Isometric Forces in Different Directions on Motor Cortical Function. Juliette A. Yedimenko (University of Pittsburgh, Pittsburgh, PA), Monica A. Perez. Disclosure: None declared. Objective: The activity in the M1 reflects the direction of movements. The purpose of this study was to investigate physiological changes in the M1 during generation of bilateral isometric forces in different directions. Design: Randomized. Setting: Research laboratory. Participants: 12 right-handed healthy volunteers participated in this study. Interventions: None. Main Outcome Measures: We used transcranial magnetic stimulation to examine motor evoked potentials (MEPs), short-interval intracortical inhibition (SICI), and interhemispheric inhibition (IHI) in the left first dorsal interosseous (FDI) muscle during 10% of isometric index finger abduction while the contralateral side performed 30% of isometric index finger abduction (bilateral force, opposite direction) or adduction (bilateral force, same Arch Phys Med Rehabil Vol 91, October 2010