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Poster 23 The Effect of Repetitive Transcranial Magnetic Stimulation on Brain Injured Patients with Dysphagia
1700
2011 ACRM-ASNR ANNUAL CONFERENCE ABSTRACTS
individual’s neurobehavioral functioning early in the assessment process, treatment can be better individualized and outcome goals can be better achieved. Further implications for utilizing these findings within a comprehensive BI program will be discussed. Key Words: Brain injury; Social problem solving; Rehabilitation. Poster 22 Speed’s Impact on Muscle Demands during Partial Body Weight Supported Training on a Motorized Elliptical. Judith M. Burnfield (Madonna Rehabilitation Hospital’s Institute for Rehabilitation Science & Engineering, Lincoln, NE), Gretchen A. Hildner, Thad W. Buster, Adam P. Taylor, Yu Shu. Disclosure: None disclosed. Objectives: To examine how lower extremity muscle demands at different levels of body weight support (BWS) are influenced by training speed when using a motorized elliptical training system, the ICARE (an Intelligently Controlled Assistive Rehabilitation Elliptical). Design: Repeated measures. Setting: Rehabilitation gait laboratory. Participants: Ten individuals (5 men and 5 women; mean age 27 years) free from conditions that might affect their exercise/ walking ability. Interventions: Surface electromyography (EMG) of select lower extremity muscles was recorded as participants performed 12 ICARE training conditions (2 minutes each, order randomized). Specifically, at each of four levels of BWS (0, 20, 40, and 60% support), participants trained at three ICARE speeds (20, 40 and 60 RPM) with motor-assistance. Main Outcome Measures: Separate one-way analyses of variance with repeated measures (3 x 1 ANOVAs) identified significant differences in EMG variables (peak, mean, duration for eight muscles) across the three ICARE training speeds at each level of BWS. The Bonferonni adjusted alpha level for significance was Pⱕ0.006. Results: EMG activity in key stabilizer muscles (i.e., gluteus medius, gluteus maximus, vastus lateralis, gastrocnemius and soleus) increased with faster speeds, with significant differences most frequently identified at the 0% BWS (13 of 15 possible comparisons significant) and 20% BWS (11 of 15 significant) conditions, and to a lesser extent at the 40% (5 of 15 significant) and 60% (3 of 15 significant) levels of support. EMG activation of flexor muscles (i.e., lateral hamstrings, medial hamstrings and tibialis anterior) did not differ significantly across training speeds (0 of 9 comparisons significant) at any BWS level. Conclusions: Manipulating body weight support level and training speed can be used to customize lower extremity muscle demands of key stabilizers when using the ICARE trainer. Impact of ICARE training parameters on gait, transfer, and balance abilities is being studied. Key Words: Gait; Rehabilitation; Electromyography; Exercise therapy. Poster 23 The Effect of Repetitive Transcranial Magnetic Stimulation on Brain Injured Patients with Dysphagia. Gijeong Yun (Asan Medical Center, Seoul, Songpa-gu/ Pungnap-2dong, Republic of Korea), Sook Joung Lee, Min-Ho Chun. Disclosure: None disclosed. Objective: to invesigate the effect of rTMS on recovery of swallowing function in brain injured patients. Design: Case-control study. Setting: University research laboratory. Participants: Subjects (n⫽21) with brain injured patients who had dysphagia. Interventions: The patients were randomly assigned to sham, low and high frequency stimulation groups. We performed rTMS at 100% of motor evoked potential (MEP) threshold and 5Hz frequency for 10 seconds and then repeated every minute in high frequency stimulation group. In low frequency stimulation group, magnetic stimulation was carried out at 100% of MEP threshold and 1Hz frequency. Sham stimulation group was applied using the same parameters of the high frequency stimulation group, but the coil was rotated 90° to make the noise of the stimulation. The treatment period was two weeks (five days per week, 20 minutes per each session). Main Outcome Measures: Functional dysphagia scale (FDS), penetration aspiration scale (PAS) with vidArch Phys Med Rehabil Vol 92, October 2011
eofluoroscopic swallowing study. Results: After rTMS, FDS and PAS scores were significantly improved in all three groups. And in low frequency stimulation group, FDS and PAS scores were significantly improved than those of other groups. Conclusions: We demonstrated that low frequency rTMS facilitated the recovery of swallowing function in brain injured patients. We suggest that rTMS is a useful modality for recovery of swallowing function. Key Words: Stroke; rTMS; Dysphagia; Swallowing; Neurorehabilitation; Rehabilitation. Poster 24 The Effect of Wii-based Interventions on Physical, Cognitive and Social Functioning among Pre-frail Elderly Persons. Salvador Bondoc (Quinnipiac University, Hamden, CT), Pamela Hewitt, Nicole Frey, Brittany McQuide, Amy Johnson. Disclosure: None disclosed. Objective: The purpose of this study is to determine the effect of Wii-based functional interventions on participation and physical fitness of older persons with frailty in an institutional setting. Design: Randomized controlled trial, assessor-blind. Method: Forty residents of a nursing home and residential care facility were pre-screened based on a the following inclusion criteria: a) Mini-mental status score of ⬎ 23/30; b) ability to stand with contact guard assist for 15 seconds; c) Frailty Index of 1/5 or 2/5 (pre-frail level); d) ability to manipulate a TV remote control independently; e) of stable medical status. A total of 14 participants (female ⫽ 12, male ⫽ 2) met the inclusion criteria and were randomized between two groups: the Wii intervention group (n⫽7) and Bingo control group (n⫽7). The study further divided the intervention group into long term (4 participants) and residential care (3 participants) based on the physical location of the participants’ residence. The intervention consisted of twice weekly progressive activities using the Wii Sports and the Wii Fit programs. The program of intervention is designed to last for a total of 6 weeks for a total of 12 intervention sessions. The interventions are delivered by graduate occupational therapy students under supervision by a licensed occupational therapist. The assessments are conducted by a graduate occupational therapy student and another licensed occupational therapist who are blinded from the intervention groups. Inter-rater reliability between the assessors is high (r⫽.998). Results and Conclusions: Pretests have been completed; however, at the time of this submission, the intervention remains in progress. Posttests and a 1-month follow-up assessments are expected to be completed by May of 2011. Outcome measures were selected to be congruent with the ICF model and they include: UE goniometry, grip strength, timed standing tolerance, Berg Balance Test and Montreal Cognitive Assessment (Body structures and functions level); and the Activity Card Sort and the Executive Function Performance Test, and amount of Wii games played (activity and participation level). Anecdotal reports from the interventionists indicate positive progression in the participants’ social participation, amount of standing tolerance and games played. Key Words: Rehabilitation. Poster 25 New Access Technology for Individuals with Severe Physical Limitations Using AAC. Susan Fager (Madonna Rehabilitation Hospital, Lincoln, NE), David Beukelman. Disclosure: None disclosed. Objective: To investigate the impact of a new access strategy (Gesture-Enhanced Word Prediction-GWP) to support writing and Augmentative and Alternative Communication (AAC) for individuals with severe physical limitations. Design: Repeated measures. Setting: Inpatient Rehabilitation Hospital. Participants: Eight individuals with severe physical limitations (SCI, ALS, Guillain Barre, post polio) who required the use of alternative access to computers and AAC and eight controls participated in the project. Interventions: GWP was compared to the use of traditional word prediction (WP) only using an onscreen keyboard and head tracking technology. This technology required the user to precisely dwell on the first letter a word and then “gesture” through the next two letters. Main Outcome Measures:
2011 ACRM-ASNR ANNUAL CONFERENCE ABSTRACTS
individual’s neurobehavioral functioning early in the assessment process, treatment can be better individualized and outcome goals can be better achieved. Further implications for utilizing these findings within a comprehensive BI program will be discussed. Key Words: Brain injury; Social problem solving; Rehabilitation. Poster 22 Speed’s Impact on Muscle Demands during Partial Body Weight Supported Training on a Motorized Elliptical. Judith M. Burnfield (Madonna Rehabilitation Hospital’s Institute for Rehabilitation Science & Engineering, Lincoln, NE), Gretchen A. Hildner, Thad W. Buster, Adam P. Taylor, Yu Shu. Disclosure: None disclosed. Objectives: To examine how lower extremity muscle demands at different levels of body weight support (BWS) are influenced by training speed when using a motorized elliptical training system, the ICARE (an Intelligently Controlled Assistive Rehabilitation Elliptical). Design: Repeated measures. Setting: Rehabilitation gait laboratory. Participants: Ten individuals (5 men and 5 women; mean age 27 years) free from conditions that might affect their exercise/ walking ability. Interventions: Surface electromyography (EMG) of select lower extremity muscles was recorded as participants performed 12 ICARE training conditions (2 minutes each, order randomized). Specifically, at each of four levels of BWS (0, 20, 40, and 60% support), participants trained at three ICARE speeds (20, 40 and 60 RPM) with motor-assistance. Main Outcome Measures: Separate one-way analyses of variance with repeated measures (3 x 1 ANOVAs) identified significant differences in EMG variables (peak, mean, duration for eight muscles) across the three ICARE training speeds at each level of BWS. The Bonferonni adjusted alpha level for significance was Pⱕ0.006. Results: EMG activity in key stabilizer muscles (i.e., gluteus medius, gluteus maximus, vastus lateralis, gastrocnemius and soleus) increased with faster speeds, with significant differences most frequently identified at the 0% BWS (13 of 15 possible comparisons significant) and 20% BWS (11 of 15 significant) conditions, and to a lesser extent at the 40% (5 of 15 significant) and 60% (3 of 15 significant) levels of support. EMG activation of flexor muscles (i.e., lateral hamstrings, medial hamstrings and tibialis anterior) did not differ significantly across training speeds (0 of 9 comparisons significant) at any BWS level. Conclusions: Manipulating body weight support level and training speed can be used to customize lower extremity muscle demands of key stabilizers when using the ICARE trainer. Impact of ICARE training parameters on gait, transfer, and balance abilities is being studied. Key Words: Gait; Rehabilitation; Electromyography; Exercise therapy. Poster 23 The Effect of Repetitive Transcranial Magnetic Stimulation on Brain Injured Patients with Dysphagia. Gijeong Yun (Asan Medical Center, Seoul, Songpa-gu/ Pungnap-2dong, Republic of Korea), Sook Joung Lee, Min-Ho Chun. Disclosure: None disclosed. Objective: to invesigate the effect of rTMS on recovery of swallowing function in brain injured patients. Design: Case-control study. Setting: University research laboratory. Participants: Subjects (n⫽21) with brain injured patients who had dysphagia. Interventions: The patients were randomly assigned to sham, low and high frequency stimulation groups. We performed rTMS at 100% of motor evoked potential (MEP) threshold and 5Hz frequency for 10 seconds and then repeated every minute in high frequency stimulation group. In low frequency stimulation group, magnetic stimulation was carried out at 100% of MEP threshold and 1Hz frequency. Sham stimulation group was applied using the same parameters of the high frequency stimulation group, but the coil was rotated 90° to make the noise of the stimulation. The treatment period was two weeks (five days per week, 20 minutes per each session). Main Outcome Measures: Functional dysphagia scale (FDS), penetration aspiration scale (PAS) with vidArch Phys Med Rehabil Vol 92, October 2011
eofluoroscopic swallowing study. Results: After rTMS, FDS and PAS scores were significantly improved in all three groups. And in low frequency stimulation group, FDS and PAS scores were significantly improved than those of other groups. Conclusions: We demonstrated that low frequency rTMS facilitated the recovery of swallowing function in brain injured patients. We suggest that rTMS is a useful modality for recovery of swallowing function. Key Words: Stroke; rTMS; Dysphagia; Swallowing; Neurorehabilitation; Rehabilitation. Poster 24 The Effect of Wii-based Interventions on Physical, Cognitive and Social Functioning among Pre-frail Elderly Persons. Salvador Bondoc (Quinnipiac University, Hamden, CT), Pamela Hewitt, Nicole Frey, Brittany McQuide, Amy Johnson. Disclosure: None disclosed. Objective: The purpose of this study is to determine the effect of Wii-based functional interventions on participation and physical fitness of older persons with frailty in an institutional setting. Design: Randomized controlled trial, assessor-blind. Method: Forty residents of a nursing home and residential care facility were pre-screened based on a the following inclusion criteria: a) Mini-mental status score of ⬎ 23/30; b) ability to stand with contact guard assist for 15 seconds; c) Frailty Index of 1/5 or 2/5 (pre-frail level); d) ability to manipulate a TV remote control independently; e) of stable medical status. A total of 14 participants (female ⫽ 12, male ⫽ 2) met the inclusion criteria and were randomized between two groups: the Wii intervention group (n⫽7) and Bingo control group (n⫽7). The study further divided the intervention group into long term (4 participants) and residential care (3 participants) based on the physical location of the participants’ residence. The intervention consisted of twice weekly progressive activities using the Wii Sports and the Wii Fit programs. The program of intervention is designed to last for a total of 6 weeks for a total of 12 intervention sessions. The interventions are delivered by graduate occupational therapy students under supervision by a licensed occupational therapist. The assessments are conducted by a graduate occupational therapy student and another licensed occupational therapist who are blinded from the intervention groups. Inter-rater reliability between the assessors is high (r⫽.998). Results and Conclusions: Pretests have been completed; however, at the time of this submission, the intervention remains in progress. Posttests and a 1-month follow-up assessments are expected to be completed by May of 2011. Outcome measures were selected to be congruent with the ICF model and they include: UE goniometry, grip strength, timed standing tolerance, Berg Balance Test and Montreal Cognitive Assessment (Body structures and functions level); and the Activity Card Sort and the Executive Function Performance Test, and amount of Wii games played (activity and participation level). Anecdotal reports from the interventionists indicate positive progression in the participants’ social participation, amount of standing tolerance and games played. Key Words: Rehabilitation. Poster 25 New Access Technology for Individuals with Severe Physical Limitations Using AAC. Susan Fager (Madonna Rehabilitation Hospital, Lincoln, NE), David Beukelman. Disclosure: None disclosed. Objective: To investigate the impact of a new access strategy (Gesture-Enhanced Word Prediction-GWP) to support writing and Augmentative and Alternative Communication (AAC) for individuals with severe physical limitations. Design: Repeated measures. Setting: Inpatient Rehabilitation Hospital. Participants: Eight individuals with severe physical limitations (SCI, ALS, Guillain Barre, post polio) who required the use of alternative access to computers and AAC and eight controls participated in the project. Interventions: GWP was compared to the use of traditional word prediction (WP) only using an onscreen keyboard and head tracking technology. This technology required the user to precisely dwell on the first letter a word and then “gesture” through the next two letters. Main Outcome Measures: