- Email: [email protected]
Poster 18
ACADEMY ANNUAL ASSEMBLY ABSTRACTS Poster 17 Functional Outcome for Asian Americans at a Traumatic Brain Injury Model Systems Center. Trinh T. Tran, MD (Santa Clara Valley Medical Center, San Jose, CA); Thao Duong, MD; Jerry Wright, MD; Malcolm Lawton, MD; Wan Chi, MD, e-mail: [email protected]. santa-clara.ca.us. Disclosure: None. Objective: To compare the demographics and functional outcome for Asian Americans and whites treated at a Traumatic Brain Injury Model Systems (TBIMS) center. Design: Prospective, single-center trial. Participants: 30 Asian Americans and 133 whites admitted to a TBIMS center between February 1989 and July 2000. Subjects had to meet all the criteria to be entered into the Traumatic Brain Injury National Database. Interventions: Not applicable. Main Outcome Measures: All information was collected at the time of acute admission as well as at rehabilitation admission and discharge. Demographic data (gender, age), preinjury characteristics (prior employment, level of education, drug use), Glasgow Coma Scale (GCS), and outcome scales (Disability Rating Scale [DRS], FIM™ instrument) were obtained. Results: Most Asians (67%) and whites (74%) were men. More Asians were either students (20% vs 7%) or homemakers (10% vs 1%) preinjury. The average age at the time of injury was 30.7 years for Asians and 39.3 years for whites. Average admission GCS score was 9.1 for Asians and 10.5 for whites. Prior traumatic brain injury (TBI) requiring hospitalization was 7% for Asians and 21% for whites. The mean DRS change score ⫾ SD was 8.5⫾4.5 for Asians and 6.8⫾4.3 for whites. Conclusion: Preinjury employment status differed between Asians and whites, with more Asians being students or homemakers. The history of TBI was significantly lower for Asians than whites. Asians were generally younger at the time of injury. DRS change was slightly better for Asians. There were no other statistically significant differences between both groups in DRS or FIM scores. Key Words: Asian; Brain injuries; Ethnicity; Rehabilitation.
Cancer Poster 18 Resolution of Foot Drop as a Result of Radiation-Induced Fibrosis: A Case Report. Ainsworth B. Farrell, MD (New York Presbyterian Hospital, New York, NY); Michael Stubblefield, MD, e-mail: [email protected]. Disclosure: None. Setting: Tertiary care cancer hospital. Patient: A 43-year-old man with metastatic non-small cell lung cancer. Case Description: The patient had a solitary metastatic circumferential lesion of the right fibula. Chemotherapy and radiotherapy were initiated. 4 months later, he underwent resection of the lesion, which required removal of the fibula and associated muscles, soft tissue, peroneal vessels, as well as the peroneal nerve. As expected, the patient developed foot drop as well as an inability to evert his foot, and was prescribed a posterior leafspring orthosis (PLSO) and physical therapy for gait training. Over the next 8 months, he became extremely comfortable ambulating with his orthosis. However, he developed a progressive loss of dorsi- and plantarflexion despite compliant participation in a home exercise program. 14 months after surgery, the patient’s loss of plantarflexion range of motion progressed to where he no longer required use of the PLSO for ambulation. Assessment/Results: “Resolution” of the foot drop was secondary to the development of fibrotic tissue in the anterior compartment of the leg. Discussion: This is the first case report, to our knowledge, describing the discontinued use of an ankle-foot orthosis (AFO) because of the development of fibrosis after surgery and radiotherapy to the anterior compartment of the leg. Conclusion: Extensive surgery and radiotherapy may, over time, mitigate the need for an AFO for basic and safe ambulation. Key Words: Gait, Neoplasm metastasis; Orthotic devices; Rehabilitation.
Poster 19 Upper-Body Function and Other Health Outcomes in Breast Cancer Survivors. Mabel Caban, MD (University of Texas Medical Branch, Houston, TX); Jeff S. Chen, BA; Jean Freeman, PhD, e-mail: [email protected]. Disclosure: None. Objective: To research the relationship among upper-body function and patient characteristics, type of breast cancer treatment, and emotional health among breast cancer survivors participating in a trial of nurse case management. Design: Prospective, randomized controlled trial. Setting: Patients were recruited from 60 surgeons in 13 community and 2 public hospitals in southeast Texas from November 1, 1993, to October 31, 1996. Participants: Women (N⫽335) with newly diagnosed breast cancer, who were at least 65 years old in community hospitals or at least 60 years old in public hospitals. Intervention: Receipt of nurse case management services. Main Outcome Measures: Upper-extremity range of motion (ROM) and emotional health (depression, anxiety, life satisfaction, mood) at 2 and 12 months after breast cancer diagnosis. Results: 55% of patients who received nurse case management demonstrated full ROM at 2 months in contrast to 40% for the control group (P⫽.025). Controlling for nurse case management status, women treated with mastectomy were less likely to have full ROM at 2 months compared with women treated with breast-conserving surgery plus radiation (44% vs 74%, P⬍.003). At 12 months, African-American women were less likely to have full ROM than white women (66% vs 81%, P⫽.40). Full ROM was significantly associated (P⬍.05) with all measures of positive emotional health at both time periods. Conclusion: Women with nurse case management had significantly better upper-body function at 2 months after diagnosis compared with women without case management. The type of breast surgery and race were risk factors for decreased arm mobility at 2 months and 12 months. Full ROM was associated with better emotional health at both time periods. Key Words: Breast neoplasm; Breast surgery; Race; Rehabilitation.
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Cardiopulmonary Poster 20 Effects of a Cognitive Training Program on Outcomes in Extended Acute Inpatient Medical Rehabilitation for Patients With Cardiac Disease. Glenn M. Seliger, MD (Helen Hayes Hospital, West Haverstraw, NY); Steven W. Lichtman, EdD; Karen Roth, OTR/L; Michael Gallucci, MS, PT; Marjorie L. King, MD, e-mail: [email protected]. Disclosure: None. Objectives: To test the hypotheses that (1) a structured learning environment and computerbased cognitive training will improve cognition in elderly, extended acute (phase 1B) medical inpatients admitted for deconditioning secondary to cardiac disease, who demonstrate cognitive deficits on admission; and (2) a change in cognition will lead to improved functional outcomes. Design: Experimental, prospective, randomized, single-factor, pretest-posttest design. Setting: Phase 1B inpatient medical rehabilitation unit using a multidisciplinary approach. Participants: 50 patients (47 completed the study) admitted to a phase 1B inpatient medical rehabilitation unit who met study inclusion criteria (Mini-Mental State Examination score, ⬍25; ⬎1wk length of stay [LOS], cardiac diagnosis) were randomly assigned to a cognitive training group (experimental, n⫽25) or standard treatment (control, n⫽22) group. Interventions: Groups received 3 to 6 hours of daily standard therapy. The experimental group also received computer-based cognitive training sessions 3 times/wk, 20 min/session, and a morning and evening group session designed to improve memory and organization skills. Main Outcome Measures: For hypothesis 1, cognitive portion of the FIM™ instrument. For hypothesis 2, LOS, falls, number of home services on discharge, discharge placement, total and motor FIM scores, and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results: There were no significant differences in baseline characteristics. The experimental group showed a significantly greater percentage improvement for the cognitive portion of the FIM (23.6%⫾18.4% vs 11.8%⫾17.2%, P⫽.035). LOS, falls, home services, discharge placement, total FIM, motor FIM, and 7 of 8 of the SF-36 subscales did not differ between the groups. The control group showed a significantly greater percentage improvement on the physical functioning subscale of the SF-36 (130.0%⫾67.1% vs 83.3%⫾66.5%, P⫽.008). Conclusions: The structured learning environment and computer-based training program showed improvements in cognition, as measured by the cognitive portion of the FIM. However, there were no differences in functional outcomes. Key Words: Cardiac diseases; Cognition; Outcome assessment; Rehabilitation.
Poster 21 Does Severe Left Ventricular Dysfunction Impact the Result of Cardiac Rehabilitation? Listianingsih M. Hariman, MD (Hines VA Hospital and Loyola University Medical Center, Hines, IL); Xiangping Ren, MD; Susan Zajeski, RKT; Scott Kroculick, RKT; Jay V. Subbarao, MD, MS, e-mail: [email protected]. Disclosure: None. Objective: To evaluate the effect of severe left ventricular dysfunction on the improvement of functional capacity (FC) in cardiac patients undergoing phase 2 of a cardiac rehabilitation program (CRP). Design: Retrospective cohort study. Setting: Hospital-based CRP. Participants: 199 male cardiac patients. Group 1 (n⫽169) had a left ventricular ejection fraction (LVEF) ⬎30% (age, 66.2⫾9.8y); group 2 (n⫽30) had a LVEF ⱕ30% (age, 69.0⫾8.1y). Intervention: 10 weeks, thrice weekly, of phase 2 CRP, consisting of 60 minutes of supervised exercise to reach the target heart rate determined by the Karvonen method. Main Outcome Measures: We measured FC before and after completion of the CRP and the improvement expressed in percents of FC before the CRP. The FC results were compared using the Student t test. Results: FC in both patient groups improved after the CRP. In group 1 patients, FC increased from 5.6⫾2.3 metabolic equivalents (METS) before the CRP to 7.5⫾2.6 METS after the CRP (P⬍.01). In group 2 patients, FC increased from 4.7⫾2.1 METS before the CRP to 6.2⫾2.2 METS after the CRP (P⬍.01). Before the CRP, group 2 patients had significantly lower FC compared with group 1 patients (P⬍.05). Similarly, after the CRP, the FC of group 2 patients remained lower than FC of group 1 patients (P⬍.05). However, the percentage of improvement for group 1 patients (40.6%⫾34.3%) did not differ significantly from the percentage of improvement for group 2 patients (39.9%⫾34.5%). Conclusions: The CRP improved FC of all cardiac patients, including those with severe left ventricular dysfunction. Patients with severe left ventricular dysfunction have lower FC before and after the CRP. However, the FC of these patients improved to the same degree as the patients with better left ventricular function. These findings are important in designing strategies for the CRP in patients with severely impaired LVEF. Key Words: Functional capacity; Left ventricular dysfunction; Rehabilitation.
Poster 22 Comparison Between the Cardiovascular Responses of the 6-Minute Walk Test and That of Treadmill Testing in Patients Undergoing Cardiac Rehabilitation. Michael Joseph Magabo, MD (University of the Philippines, Manila, Philippines); Helen P. Pesigan, MD; Corazon C. Cipriaso; Jose Alvin Mojica, MD, e-mail: [email protected]. Disclosure: None. Objective: To compare the cardiovascular responses between the 6-minute walk test (6MWT) and treadmill exercise test (TET) in patients undergoing a phase 2 cardiac rehabilitation program. Design: Prospective cross-sectional study. Setting: Tertiary care general hospital. Participants: 25 patients with coronary artery disease, functional class 1 based on New York Heart Association classification, who will undergo phase 2 cardiac rehabilitation. Interventions: Patients underwent the 6MWT and the treadmill stress test. Cardiovascular parameters were tabulated, compared, and analyzed. Main Outcome Measures: Peak heart rate, systolic (SBP) and diastolic (DBP) blood pressures, and mean arterial blood pressure. Results: The cardiovascular responses to the 6MWT were significantly of lower magnitude compared with those of the treadmill stress test. Paired t test revealed significant differences between the means ⫾ SD of the heart rate (6MWT, 89⫾13; TET, 132⫾30; P⬍.00), SBP (6MWT, 134⫾13; TET, 161⫾21; P⬍.05) and DBP (6MWT, 82⫾9; TET, 94⫾8; P⬍.00), and mean arterial blood pressure (6MWT, 117⫾10; TET, 142⫾20; P⬍.01).
Arch Phys Med Rehabil Vol 84, September 2003
Cancer Poster 18 Resolution of Foot Drop as a Result of Radiation-Induced Fibrosis: A Case Report. Ainsworth B. Farrell, MD (New York Presbyterian Hospital, New York, NY); Michael Stubblefield, MD, e-mail: [email protected]. Disclosure: None. Setting: Tertiary care cancer hospital. Patient: A 43-year-old man with metastatic non-small cell lung cancer. Case Description: The patient had a solitary metastatic circumferential lesion of the right fibula. Chemotherapy and radiotherapy were initiated. 4 months later, he underwent resection of the lesion, which required removal of the fibula and associated muscles, soft tissue, peroneal vessels, as well as the peroneal nerve. As expected, the patient developed foot drop as well as an inability to evert his foot, and was prescribed a posterior leafspring orthosis (PLSO) and physical therapy for gait training. Over the next 8 months, he became extremely comfortable ambulating with his orthosis. However, he developed a progressive loss of dorsi- and plantarflexion despite compliant participation in a home exercise program. 14 months after surgery, the patient’s loss of plantarflexion range of motion progressed to where he no longer required use of the PLSO for ambulation. Assessment/Results: “Resolution” of the foot drop was secondary to the development of fibrotic tissue in the anterior compartment of the leg. Discussion: This is the first case report, to our knowledge, describing the discontinued use of an ankle-foot orthosis (AFO) because of the development of fibrosis after surgery and radiotherapy to the anterior compartment of the leg. Conclusion: Extensive surgery and radiotherapy may, over time, mitigate the need for an AFO for basic and safe ambulation. Key Words: Gait, Neoplasm metastasis; Orthotic devices; Rehabilitation.
Poster 19 Upper-Body Function and Other Health Outcomes in Breast Cancer Survivors. Mabel Caban, MD (University of Texas Medical Branch, Houston, TX); Jeff S. Chen, BA; Jean Freeman, PhD, e-mail: [email protected]. Disclosure: None. Objective: To research the relationship among upper-body function and patient characteristics, type of breast cancer treatment, and emotional health among breast cancer survivors participating in a trial of nurse case management. Design: Prospective, randomized controlled trial. Setting: Patients were recruited from 60 surgeons in 13 community and 2 public hospitals in southeast Texas from November 1, 1993, to October 31, 1996. Participants: Women (N⫽335) with newly diagnosed breast cancer, who were at least 65 years old in community hospitals or at least 60 years old in public hospitals. Intervention: Receipt of nurse case management services. Main Outcome Measures: Upper-extremity range of motion (ROM) and emotional health (depression, anxiety, life satisfaction, mood) at 2 and 12 months after breast cancer diagnosis. Results: 55% of patients who received nurse case management demonstrated full ROM at 2 months in contrast to 40% for the control group (P⫽.025). Controlling for nurse case management status, women treated with mastectomy were less likely to have full ROM at 2 months compared with women treated with breast-conserving surgery plus radiation (44% vs 74%, P⬍.003). At 12 months, African-American women were less likely to have full ROM than white women (66% vs 81%, P⫽.40). Full ROM was significantly associated (P⬍.05) with all measures of positive emotional health at both time periods. Conclusion: Women with nurse case management had significantly better upper-body function at 2 months after diagnosis compared with women without case management. The type of breast surgery and race were risk factors for decreased arm mobility at 2 months and 12 months. Full ROM was associated with better emotional health at both time periods. Key Words: Breast neoplasm; Breast surgery; Race; Rehabilitation.
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Cardiopulmonary Poster 20 Effects of a Cognitive Training Program on Outcomes in Extended Acute Inpatient Medical Rehabilitation for Patients With Cardiac Disease. Glenn M. Seliger, MD (Helen Hayes Hospital, West Haverstraw, NY); Steven W. Lichtman, EdD; Karen Roth, OTR/L; Michael Gallucci, MS, PT; Marjorie L. King, MD, e-mail: [email protected]. Disclosure: None. Objectives: To test the hypotheses that (1) a structured learning environment and computerbased cognitive training will improve cognition in elderly, extended acute (phase 1B) medical inpatients admitted for deconditioning secondary to cardiac disease, who demonstrate cognitive deficits on admission; and (2) a change in cognition will lead to improved functional outcomes. Design: Experimental, prospective, randomized, single-factor, pretest-posttest design. Setting: Phase 1B inpatient medical rehabilitation unit using a multidisciplinary approach. Participants: 50 patients (47 completed the study) admitted to a phase 1B inpatient medical rehabilitation unit who met study inclusion criteria (Mini-Mental State Examination score, ⬍25; ⬎1wk length of stay [LOS], cardiac diagnosis) were randomly assigned to a cognitive training group (experimental, n⫽25) or standard treatment (control, n⫽22) group. Interventions: Groups received 3 to 6 hours of daily standard therapy. The experimental group also received computer-based cognitive training sessions 3 times/wk, 20 min/session, and a morning and evening group session designed to improve memory and organization skills. Main Outcome Measures: For hypothesis 1, cognitive portion of the FIM™ instrument. For hypothesis 2, LOS, falls, number of home services on discharge, discharge placement, total and motor FIM scores, and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results: There were no significant differences in baseline characteristics. The experimental group showed a significantly greater percentage improvement for the cognitive portion of the FIM (23.6%⫾18.4% vs 11.8%⫾17.2%, P⫽.035). LOS, falls, home services, discharge placement, total FIM, motor FIM, and 7 of 8 of the SF-36 subscales did not differ between the groups. The control group showed a significantly greater percentage improvement on the physical functioning subscale of the SF-36 (130.0%⫾67.1% vs 83.3%⫾66.5%, P⫽.008). Conclusions: The structured learning environment and computer-based training program showed improvements in cognition, as measured by the cognitive portion of the FIM. However, there were no differences in functional outcomes. Key Words: Cardiac diseases; Cognition; Outcome assessment; Rehabilitation.
Poster 21 Does Severe Left Ventricular Dysfunction Impact the Result of Cardiac Rehabilitation? Listianingsih M. Hariman, MD (Hines VA Hospital and Loyola University Medical Center, Hines, IL); Xiangping Ren, MD; Susan Zajeski, RKT; Scott Kroculick, RKT; Jay V. Subbarao, MD, MS, e-mail: [email protected]. Disclosure: None. Objective: To evaluate the effect of severe left ventricular dysfunction on the improvement of functional capacity (FC) in cardiac patients undergoing phase 2 of a cardiac rehabilitation program (CRP). Design: Retrospective cohort study. Setting: Hospital-based CRP. Participants: 199 male cardiac patients. Group 1 (n⫽169) had a left ventricular ejection fraction (LVEF) ⬎30% (age, 66.2⫾9.8y); group 2 (n⫽30) had a LVEF ⱕ30% (age, 69.0⫾8.1y). Intervention: 10 weeks, thrice weekly, of phase 2 CRP, consisting of 60 minutes of supervised exercise to reach the target heart rate determined by the Karvonen method. Main Outcome Measures: We measured FC before and after completion of the CRP and the improvement expressed in percents of FC before the CRP. The FC results were compared using the Student t test. Results: FC in both patient groups improved after the CRP. In group 1 patients, FC increased from 5.6⫾2.3 metabolic equivalents (METS) before the CRP to 7.5⫾2.6 METS after the CRP (P⬍.01). In group 2 patients, FC increased from 4.7⫾2.1 METS before the CRP to 6.2⫾2.2 METS after the CRP (P⬍.01). Before the CRP, group 2 patients had significantly lower FC compared with group 1 patients (P⬍.05). Similarly, after the CRP, the FC of group 2 patients remained lower than FC of group 1 patients (P⬍.05). However, the percentage of improvement for group 1 patients (40.6%⫾34.3%) did not differ significantly from the percentage of improvement for group 2 patients (39.9%⫾34.5%). Conclusions: The CRP improved FC of all cardiac patients, including those with severe left ventricular dysfunction. Patients with severe left ventricular dysfunction have lower FC before and after the CRP. However, the FC of these patients improved to the same degree as the patients with better left ventricular function. These findings are important in designing strategies for the CRP in patients with severely impaired LVEF. Key Words: Functional capacity; Left ventricular dysfunction; Rehabilitation.
Poster 22 Comparison Between the Cardiovascular Responses of the 6-Minute Walk Test and That of Treadmill Testing in Patients Undergoing Cardiac Rehabilitation. Michael Joseph Magabo, MD (University of the Philippines, Manila, Philippines); Helen P. Pesigan, MD; Corazon C. Cipriaso; Jose Alvin Mojica, MD, e-mail: [email protected]. Disclosure: None. Objective: To compare the cardiovascular responses between the 6-minute walk test (6MWT) and treadmill exercise test (TET) in patients undergoing a phase 2 cardiac rehabilitation program. Design: Prospective cross-sectional study. Setting: Tertiary care general hospital. Participants: 25 patients with coronary artery disease, functional class 1 based on New York Heart Association classification, who will undergo phase 2 cardiac rehabilitation. Interventions: Patients underwent the 6MWT and the treadmill stress test. Cardiovascular parameters were tabulated, compared, and analyzed. Main Outcome Measures: Peak heart rate, systolic (SBP) and diastolic (DBP) blood pressures, and mean arterial blood pressure. Results: The cardiovascular responses to the 6MWT were significantly of lower magnitude compared with those of the treadmill stress test. Paired t test revealed significant differences between the means ⫾ SD of the heart rate (6MWT, 89⫾13; TET, 132⫾30; P⬍.00), SBP (6MWT, 134⫾13; TET, 161⫾21; P⬍.05) and DBP (6MWT, 82⫾9; TET, 94⫾8; P⬍.00), and mean arterial blood pressure (6MWT, 117⫾10; TET, 142⫾20; P⬍.01).
Arch Phys Med Rehabil Vol 84, September 2003