- Email: [email protected]
Poster 36
A10 Objective: To examine barriers to community integration treatment (CIT) among a consecutive sample of referrals. Design: A retrospective chart review of a consecutive series of referrals to CIT. Setting: CIT program for persons with brain injury. Participants: 138 consecutive referrals (n⫽72 nonadmitted) to CIT from January 1 to December 31, 2002. Interventions: All persons referred were evaluated by an admissions counselor and/or treatment team to determine appropriateness. Main Outcome Measures: Data comparing persons entering treatment with those not entering treatment were retrieved from summary admissions reports. Results: Persons entering treatment did not differ in age, gender, race, distance to the program, or time postinjury from persons who did not enter treatment. Common barriers to persons not entering treatment included: reliable transportation (14%), funding for treatment (8%), poor family support (6%), and awareness for relevance of treatment (14%). Conclusions: Among a sample of consecutive referrals not admitted to CIT, approximately 42% of cases were due to barriers such as reliable transportation, funding for treatment, poor family support, and education about the relevance of CIT. These data suggest points of intervention for policymakers and clinicians to decrease disability and handicap in states serving large rural populations. Key Words: Rehabilitation. Poster 30 Relationship Between P300 and Neuropsychologic Test Performance During Early Recovery from Traumatic Brain Injury. Dobrivoje S. Stokic, MD (Methodist Rehabilitation Center, Jackson, MS); Antonio Hayes, REDT; Samuel T. Gontkovsky, PsyD; Risa Nakase-Thompson, PhD; Stuart A. Yablon, MD; Mark Sherer, PhD. Disclosure: Supported by Traumatic Brain Injury Model System of Mississippi. Objective: To examine the relationship between P300 latency and amplitude and neuropsychologic test scores in persons with traumatic brain injury (TBI) during acute inpatient rehabilitation. Design: Prospective, consecutive sample. Setting: Traumatic Brain Injury Model Systems (TBIMS) acute inpatient rehabilitation center. Participants: 52 patients with TBI were evaluated using a standardized neuropsychologic battery and P300 classical oddball paradigm after obtaining 2 consecutive Galveston Orientation and Amnesia Test scores within the target range. Data of 27 patients (age, 33⫾15y; admission Glasgow Coma Scale score, 8.0⫾3.9) satisfied electrophysiologic criteria (at least 20 correct rare responses) and were further analyzed. Interventions: Not applicable. Main Outcome Measures: Standard TBIMS neuropsychologic test battery and P300 latencies and amplitudes. Results: As expected, analyses revealed significant associations between Cz and Pz amplitudes and neuropsychologic measures of sustained attention (Symbol Digit Modalities Test, Trail-Making Test). However, relationships between Cz and Pz latencies and neuropsychologic test performance were less evident. Conclusions: During early recovery from TBI, P300 amplitudes more than latencies reflect cognitive processes associated with speed of information processing and attention. Key Words: Brain injuries; Event-related potentials, P300; Rehabilitation. Poster 31 Value of a Fitness Program After Completion of Rehabilitation Therapy Poststroke. Kathleen Edinger, MS, PT (Burke Rehabilitation Hospital, White Plains, NY); Janet Herbold, MA, PT; David Mohr; Sudhir Vaidya, MD. Disclosures: None declared. Objective: To assess the value of a fitness program after completion of formal stroke rehabilitation. Design: Randomized, controlled, prospective study. Setting: Community wellness center. Participants: 39 subjects with stroke randomly assigned to immediate (n⫽20) versus deferred treatment (n⫽19). Interventions: The immediate group (IG) was enrolled in a 12-week exercise program. The deferred group (DG) was deferred from the exercise program for 12 weeks. Main Outcome Measures: Fugl-Meyer motor and balance subscores, 2- and 6-minute timed walk tests, FIM™ instrument, number of falls, number of hospitalizations, Mini-Mental State Examination, Beck Depression Scale, Community Integration Questionnaire, and Burke Handicap Scores were obtained at baseline and at 12 weeks postenrollment. Results: Preliminary analysis showed that the change in Fugl-Meyer motor score from baseline to 12 weeks was the only significant outcome variable (IG score ⫾ SEM, 5.3⫾1.5 vs DG score, ⫺1.7⫾2.1; P⫽.01). Subject dropouts differed significantly between the 2 groups (1 in IG, 6 in DG; 2⫽4.0, P⫽.04). Conclusions: Structured exercise after completion of formal stroke rehabilitation has a significant effect on impairment. Subject dropouts in the DG indicated the strength of patient demand for a structured exercise program. Key Words: Physical fitness; Rehabilitation; Stroke.
Poster 32 Evaluating Program Effectiveness and Outcome in an Educationally Based Cognitive Retraining Program With Demographic Changes in Admission Versus Graduation Groups. Douglas E. Harrington, PhD (Coastline Community College Acquired Brain Injury Program, Costa Mesa, CA); Kim Dailey, MS; Mary Ann Giroux Bruce, PhD, OTR; Stacey Hunter Schwartz, PhD. Disclosures: None declared. Objective: To evaluate program effectiveness and outcome in an educationally based cognitive rehabilitation program comparing the demographic variables of students with acquired brain injury at admission with the demographic variables of students with acquired brain injury who have successfully completed the program on average 2 years later. Design: Retrospective cohort study. Setting: Community college special programs and services. Participants: 525 students at admission with medically verifiable acquired brain injuries compared with 72 students who successfully completed the program. Interventions: Not applicable. Main Outcome Measures: We analyzed various demographic factors of each group looking for changes in demographics in the population that successfully completed the educational intervention program. Results: There was a higher incidence of change in the following demographics of students who finished the structured 2-year educationally based cognitive retraining program: students whose injury occurred within 1 year before admission; students with left hemisphere strokes; students between the ages of 18 and 29 years; students with severe traumatic brain injury; and students with premorbid education of 16 to 17 years. Conclusions: Demographics do change when comparing students with acquired brain injury before starting and completing a 2-year educationally based cognitive retraining program.
Arch Phys Med Rehabil Vol 84, October 2003
Students who complete the program tend to be younger, have severe or left hemisphere–focused brain injuries, have had their injuries within 1 year of admission, and have a bachelor’s degree. Key Words: Brain injuries; Cognitive therapy; Rehabilitation. Poster 33 Evaluation of Balance Function on a Standing Platform in Subjects With Spina Bifida Occulta. Shin-Tsu Chang, MD, MS, PhD (Team of Neurorehabilitation, Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, National Defense University, Taipei, Taiwan). Disclosures: None declared. Objective: To evaluate the balance tests in subjects with spina bifida (SB) occulta. Design: Prospective study. Setting: Academic hospital. Participants: 52 patients, grouped as follows: normal (group I), SB occulta at L5-S1 (group II), and SB occulta of whole sacrum (group III). Interventions: All subjects performed 12 standing balance tests, 60 seconds in each, on a plate tilting at 0°, 10°, 20°, 30°, with dorsiflexion and plantarflexion, along with eyes open and closed. Main Outcome Measures: Balance profiles (including the swing velocity and sway area) were identified and measured using CATSYS plate system. Results: The sway area in group III was significantly larger than that of groups I and II, in both the eyes-open or eyes-closed tests, and at 0° to 30° tilting (P⬍.05). At 20°, the sway velocity in group III was significantly higher than that of groups I and II (P⬍.05), however, we found no significant difference at 0°, 10°, or even 30° between groups I and II. Conclusions: The value of balance profiles increased along with the variable challenges in standing balance and with severity of SB occulta, which manifested in patients with whole-sacral SB occulta. Key Words: Balance; Spina Bifida Occulta; Rehabilitation. Poster 34 Cognitive Impairment and Everyday Competence Among 3 Groups of Persons: An Empirical Study. Yael Goverover, PhD, OT (Kessler Medical Rehabilitation Research & Education Corp, West Orange, NJ); Naomi Josman, PhD, OT. Disclosures: None declared. Objective: To compare problem-solving skills and everyday competency across clinical groups. Design: Between-groups design. Setting: Acute neurosurgery unit, community for the elderly, assisted living facilities for elderly and people diagnosed with schizophrenia, and nursing homes for the elderly. Participants: 60 older adults (age, ⱖ65y), 40 adults diagnosed with schizophrenia, and 40 adults with brain injuries. Interventions: Not applicable. Main Outcome Measures: Everyday competency was assessed using the Revised Observed Tasks of Daily Living (OTDL-R). Results: OTDL-R performance was significantly worse for participants diagnosed with schizophrenia than for participants with brain injury or older adults. Performance of the latter 2 groups did not differ. Higher educated persons in each of the 3 groups performed at a significantly higher level than less educated persons. Furthermore, older persons in each group performed worse than younger persons. Conclusions: The OTDL-R is a sensitive performance-based tool of potential importance for occupational therapists in the assessment of instrumental activities of daily living and problemsolving skills. However, education level and age should be taken into consideration during assessment. Additional research is needed to characterize more fully the psychometric properties of the OTDL-R for appropriate use by clinicians and researchers. Key Words: Activities of daily living; Rehabilitation. Poster 35 High-Resolution Electroencephalography and Reorganization of Posterior Cortical Potentials. Joseph B. Green, MD (Veterans Medical Center, Memphis TN); Darren M. Strother, MA; Nancy Garrott, REEG/EPT. Disclosures: None declared. Objective: To test whether reorganization after spinal cord lesions is “unfavorable” because of a takeover of cortical areas representing weak or paralyzed muscles. Design: Randomized study of electroencephalograms. Setting: Spinal cord research laboratory. Participants: 16 patients with spinal cord lesions and 10 normal controls. Interventions: Subjects were instructed in moving their right middle or index fingers. The fingers were also moved in a similar manner by an operator. Voluntary movement was monitored by electromyography. Main Outcome Measures: Movementrelated cortical potentials and passive movements. Results: Posterior cortical reorganization represented reinforcement of residual motor pathways from somatosensory cortex (S1) to the spinal cord, and facilitated rehabilitation. Conclusion: Motor potentials can be generated by active and passive measurements of the fingers. Reorganization of somatosensory cortex is important in deriving potentials from proprioceptive input and creating the necessary templates to activate the motor networks and electroencephalographic activity. Key Words: Electroencephalography; Rehabilitation. Poster 36 Neuropsychiatric Symptoms in Patients With Traumatic Brain Injury: 2 Years Postdischarge. Livia Caldeira, PhD (Burke Rehabilitation Hospital, White Plains, NY); Fernanda Lucchese, BS; Karina Ortega-Verdejo, MA; Ellen Glass, RN; Barry D. Jordan, MD, MPH. Disclosures: None declared. Objective: To assess the prevalence of neuropsychiatric symptoms in traumatic brain injury (TBI) 2 years postdischarge from inpatient rehabilitation and its associated caregiver distress. Design: Follow-up study. Setting: Inpatient acute rehabilitation hospital and community. Participants: 39 consecutive patients with TBI. Interventions: Not applicable. Main Outcome Measure: The Neuropsychiatric Inventory. Results: Neuropsychiatric symptoms were present in 75% of our sample 2 years postdischarge from acute rehabilitation. Among these symptoms, the most frequently encountered were: irritability, 48.7%; depression, 43.6%; appetite and eating changes, 25.6%; night-time and sleep behavior, 23.1%; apathy, 20.5%; anxiety, 17.9%; agitation and aggression, 17.9%; and disinhibition, 10.3%. The least frequently observed behaviors included: hallucinations, 5.1%; euphoria and elation, 2.6%; and delusions, 0%. At 2-year follow-up, anxiety, agitation and aggression, apathy, and irritability caused the most emotional distress to the caregivers, while
A11 hallucination and euphoria caused the least. Conclusions: Neuropsychiatric symptoms are prevalent in patients with TBI after discharge from acute rehabilitation. These symptoms are associated with significant caregiver distress. These findings further support the continued need for adequate psychologic assessment and possible intervention postdischarge. Key Words: Brain injuries; Caregivers; Rehabilitation.
Poster 37 Prediction of Long-Term Vocational and Independent Living Status From Goal Attainment in Postacute Brain Injury Rehabilitation. Thomas F. Bergquist, PhD, ABPP (Mayo Clinic and Foundation, Rochester, MN); Lisa DeGiorgio, MA, CRC; Kathryn Kendall, RN, BSN, CRRN; James F. Malec, PhD, ABPP. Disclosures: None declared. Objective: To determine whether goal attainment is predictive of long-term outcome after postacute brain injury rehabilitation. Design: Prospective cohort study. Setting: Postacute rehabilitation program. Participants: 136 persons (106 men, 30 women; mean age, 34.0y) with the following diagnoses: traumatic brain injury, 92; vascular, 27; anoxic, 7; tumor, 5; and other, 5. 89% had a high school–level education or greater. Interventions: Not applicable. Main Outcome Measure: The Vocational Independence Scale (VIS) and Independent Living Scale (ILS). Results: At admission, 35% of persons were living independently and 10% were in community-based employment. Persons completing the program developed goals to improve vocational and independent living skills. Complete data were available for 121 of 136 persons completing the program. 42 met or exceeded goals (goal group), 66 met some goals, and 13 met no goals (no goal group). At 1-year follow-up, 74% of the goal group were living independently and 82% were in communitybased employment while 73% of the no goal group were living independently and 45% were in community-based employment. Conclusion: The goal method used in this program was not predictive of long-term living status, but it was predictive of vocational status. Key Words: Brain injuries; Rehabilitation.
Poster 38 Follow-Up Outcomes and Stroke Severity. Pamela Smith, DNS (State University of New York, Buffalo, NY); David M. Smith, BA; Kenneth Ottenbacher, PhD. Disclosures: None declared. Objective: To examine functional outcomes by case-mix group (CMG) for patients with stroke at 3 months after discharge from acute inpatient rehabilitation programs. Design: Retrospective, using information from US facilities subscribing to the National Followup Service. Setting: Data from follow-up telephone interviews and assessments administered by registered nurses at approximately 90 days postdischarge from 94 facilities for the reporting period of October 1, 2002 to March 15, 2003, were examined. Participants: A total of 17,975 follow-up records were examined. Of those, CMG data were available for 9917 patients; 2055 (20.4%) were patients in Rehabilitation Impairment Category 1 or Stroke (mean age ⫾ SD, 69.59⫾14.4y). The sample was comprised of 48.81% men and 48.66% women (2.53% missing data for gender) with an average length of stay (LOS) of 17.54⫾10.43 days. Patient characteristics were derived from associated inpatient records consisting of data from the Inpatient Rehabilitation Facility-Patient Assessment Instrument. Interventions: Not applicable. Main Outcome Measure: Patient/proxy report of follow-up functional status. Results: The mean admission, discharge, and follow-up scores for stroke patients were 61.71, 86.31, and 103.58, with a mean inpatient functional gain of 24.6 and a mean discharge to follow-up gain of 17.28 points. The overall gain from admission to follow-up was 41.87. Of 2055 stroke patients, the largest samples by CMG were: 0114 (19.6%), 0105 (14%), 0113 (13.7%), 0106 (12.2%), and 0105 (10.5%). The average LOS for 0101 was 6.67 days and the LOS for 0114 was 25.1 (r⫽.985). Average discharge to follow-up functional gain ranged from 3.17 for CMG 0101 to 21.54 for 0114 (r⫽.870). Conclusions: This study provides basic descriptive information regarding function across different stroke CMGs. In addition, we found that as the severity of stoke increased, follow-up functional gain increased. Further study regarding follow-up functional gain is indicated. Key Words: Follow-up studies; Rehabilitation.
Poster 39 Total Body Reciprocal Training Improves Hand Function in Chronic Stroke Survivors. Sandra A. Billinger, SPT (University of Kansas Medical Center, Kansas City, KS); James K. Cho, PT, PhD; Vicki Bouckhout, PT; Denise Gobert, PT, PhD. Disclosures: None declared. Objective: To examine changes in hand function of chronic stroke survivors participating in exercise using a total body recumbent stepper (TBRS). Design: Case series. Setting: University medical school. Participants: 11 participants (8 men; age, 61.3⫾11.0y) ⬎6 months poststroke with mild to moderate hemiparesis (6 with right side involvement). Intervention: An 8-week exercise program using TBRS 3 times a week for 30 minutes per session. Main Outcome Measures: Functional Rating Score (FRS) from the Wolf Motor Function Test and bilateral grip strength measured by dynamometry. Results: Statistical analyses were conducted using a repeated-measures 2⫻2⫻4 factorial analysis of variance for factors of gender and the more affected side along with time. Results indicated a significant interaction of the intervention with left grip strength. Left grip strength increased from 13.44⫾8.92lb to 16.72⫾7.23lb after intervention. Values were significant at P⬍.05. The average for right grip strength did not demonstrate significance after intervention. FRS improved, but not significantly. Conclusion: Improvements in function and strength are possible for chronic stroke survivors participating in exercise involving a TBRS. Key Words: Exercise; Rehabilitation; Stroke.
Poster 40 Comparison of Constraint-Induced Language Therapy and Traditional Therapy in the Rehabilitation of Chronic Aphasia: Preliminary Findings. Lynn M. Maher, PhD (Baylor College of Medicine/University of Texas Health Science Center Houston Physical Medicine and Rehabilitation Alliance and Houston Veterans Affairs Medical Center, Houston, TX); Diane Kendall, PhD; Jennifer A. Swearengin, MA; Amy Rodriguez, MA; Susan Leon, MA; Karyn Pingel, MA; Audrey Holland, PhD; Leslie J. Gonzalez Rothi, PhD. Disclosures: None declared. Objectives: To compare constraint-induced language therapy (CILT) to a more traditional multimodality intervention for rehabilitation of chronic aphasia. Design: Nonrandomized control trial, within-subject comparisons. Setting: Outpatient rehabilitation. Participants: 9 subjects with chronic nonfluent aphasia ⬎2 years poststroke. Intervention: 2 groups (n⫽4) were treated using key CILT principles: massed practice, constraint of other communication modalities, and forced use of language through the application of visual barriers in a supported environment; 2 groups (n⫽5) were treated using a traditional approach, which encouraged all modes of communication: verbal and nonverbal. Both groups received treatment 3h/d, 4d/wk for 2 consecutive weeks. Main Outcomes Measures: Western Aphasia Battery, Boston Naming Test, Action Naming Test, and linguistic analyses. Results: Although participants in both groups evinced positive outcomes posttreatment, CILT subjects showed increased performance on more measures than the traditional subjects. Conclusions: Findings support the notion that persons with chronic nonfluent aphasia may make substantial, measurable change in language after intensive CILT. Progress observed in both groups suggests intensity may be an important factor in the positive outcome for both conditions. Key Words: Aphasia; Language; Rehabilitation. Poster 41 Objectively Measured Personality Traits in the Prediction of Early Neurobehavioral Symptoms After Mild Traumatic Brain Injury. Beth A. Keys, PhD (Mayo Clinic, Rochester, MN); James F. Malec, PhD; Anne M. Moessner, RN, MSN; Allen W. Brown, MD. Disclosures: None declared. Objective: To determine if objectively measured preinjury personality predicts early neurobehavioral symptoms after mild traumatic brain injury (TBI) compared with orthopedic injury. Design: Cohort study with matched controls; participants and significant others completed questionnaires of preinjury personality and early postinjury symptoms. Setting: Inpatient hospital and outpatient follow-up. Participants: 87 people hospitalized with mild TBI and 82 with orthopedic injury. Interventions: Not applicable. Main Outcome Measures: The NEO Personality Inventory– Revised (NEOPI-R) and Neurobehavioral Functioning Inventory (NFI). Results: For both mild TBI and orthopedic injury groups, personality traits were generally normal; concordance rates between self and significant others personality and symptoms scales were moderate. Self and significant others’ ratings of conscientiousness on the NEOPI-R were higher in the orthopedic injury than in the mild TBI group. Significant others’ reports of NFI somatic symptoms were higher in the orthopedic injury than in the mild TBI group. Stepwise linear regression showed that, in both groups, NEOPI-R agreeableness and neuroticism accounted for a significant proportion of aggressive symptoms (orthopedic injury group, R2⫽.56; mild TBI group, R2⫽.46; P⬍.01). In the mild TBI group, NEOPI-R neuroticism accounted for a significant proportion of depressive symptoms (R2⫽.44, P⬍.01). Unfortunately, significant findings appear to be the result of substantial content overlap between the NEOPI-R and the NFI, rather than reflecting predictive relationships. Conclusion: Objectively measured personality holds limited predictive value in understanding early neurobehavioral symptoms after mild TBI. Key Words: Brain injuries; Neurobehavioral manifestations; Personality; Rehabilitation. Poster 42 Quality of Life and Satisfaction With Life in People With Spinal Cord Injury. Uma Rani Madhusudana, MD (University of Connecticut, Storrs, CT); Pouran D. Faghri, MD. Disclosures: None declared. Objectives: To determine whether quality of life (QOL) and satisfaction with life differ among persons with spinal cord injury (SCI) as they grow older and to compare the differences in QOL and satisfaction with life between men and women and different socioeconomic status (ie, level of education and income). Design: Descriptive, correlation. Setting: SCI association and an academic institution. Participants: Men and women with SCI. Intervention: One main questionnaire, which incorporated questions from Craig Handicap Assessment and Reporting Technique (CHART), the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12), and the Satisfaction with Life Scale (SWLS), was developed. Demographic questions, such as age, gender, race, time post injury, and level of education and income, were added. Main Outcome Measures: The CHART and SF-12 were used to assess the QOL and the SWLS was used to measure life satisfaction. Results: To date, 59 persons with SCI (39 men, 20 women; mean age, 76⫾14.1y; range, 20 –78y) have responded and were included in the analysis. Multiple regression analysis showed that age and level of income and education were significant predictors of QOL as measured by the CHART and SF-12. There were no differences between men and women. Overall mean QOL scores in persons with SCI were lower compared with the range of CHART and SWLS scores. Questions in these instruments are not gender specific. This may be why we found no differences between men and women. However, the survey questionnaire included open-ended questions about QOL and satisfaction with life specific to gender. Preliminary qualitative evaluations of the survey respondents showed that QOL and satisfaction with life in women were lower than men, which was attributable to social and physical barriers. Conclusion: Better QOL measures for gender are needed for people with SCI. Overall, there was a significant reduction in QOL and life satisfaction in people with SCI, and socioeconomic status was a good predictor for QOL postinjury. Key Words: Quality of life; Rehabilitation; Spinal cord injuries.
Arch Phys Med Rehabil Vol 84, October 2003
Poster 32 Evaluating Program Effectiveness and Outcome in an Educationally Based Cognitive Retraining Program With Demographic Changes in Admission Versus Graduation Groups. Douglas E. Harrington, PhD (Coastline Community College Acquired Brain Injury Program, Costa Mesa, CA); Kim Dailey, MS; Mary Ann Giroux Bruce, PhD, OTR; Stacey Hunter Schwartz, PhD. Disclosures: None declared. Objective: To evaluate program effectiveness and outcome in an educationally based cognitive rehabilitation program comparing the demographic variables of students with acquired brain injury at admission with the demographic variables of students with acquired brain injury who have successfully completed the program on average 2 years later. Design: Retrospective cohort study. Setting: Community college special programs and services. Participants: 525 students at admission with medically verifiable acquired brain injuries compared with 72 students who successfully completed the program. Interventions: Not applicable. Main Outcome Measures: We analyzed various demographic factors of each group looking for changes in demographics in the population that successfully completed the educational intervention program. Results: There was a higher incidence of change in the following demographics of students who finished the structured 2-year educationally based cognitive retraining program: students whose injury occurred within 1 year before admission; students with left hemisphere strokes; students between the ages of 18 and 29 years; students with severe traumatic brain injury; and students with premorbid education of 16 to 17 years. Conclusions: Demographics do change when comparing students with acquired brain injury before starting and completing a 2-year educationally based cognitive retraining program.
Arch Phys Med Rehabil Vol 84, October 2003
Students who complete the program tend to be younger, have severe or left hemisphere–focused brain injuries, have had their injuries within 1 year of admission, and have a bachelor’s degree. Key Words: Brain injuries; Cognitive therapy; Rehabilitation. Poster 33 Evaluation of Balance Function on a Standing Platform in Subjects With Spina Bifida Occulta. Shin-Tsu Chang, MD, MS, PhD (Team of Neurorehabilitation, Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, National Defense University, Taipei, Taiwan). Disclosures: None declared. Objective: To evaluate the balance tests in subjects with spina bifida (SB) occulta. Design: Prospective study. Setting: Academic hospital. Participants: 52 patients, grouped as follows: normal (group I), SB occulta at L5-S1 (group II), and SB occulta of whole sacrum (group III). Interventions: All subjects performed 12 standing balance tests, 60 seconds in each, on a plate tilting at 0°, 10°, 20°, 30°, with dorsiflexion and plantarflexion, along with eyes open and closed. Main Outcome Measures: Balance profiles (including the swing velocity and sway area) were identified and measured using CATSYS plate system. Results: The sway area in group III was significantly larger than that of groups I and II, in both the eyes-open or eyes-closed tests, and at 0° to 30° tilting (P⬍.05). At 20°, the sway velocity in group III was significantly higher than that of groups I and II (P⬍.05), however, we found no significant difference at 0°, 10°, or even 30° between groups I and II. Conclusions: The value of balance profiles increased along with the variable challenges in standing balance and with severity of SB occulta, which manifested in patients with whole-sacral SB occulta. Key Words: Balance; Spina Bifida Occulta; Rehabilitation. Poster 34 Cognitive Impairment and Everyday Competence Among 3 Groups of Persons: An Empirical Study. Yael Goverover, PhD, OT (Kessler Medical Rehabilitation Research & Education Corp, West Orange, NJ); Naomi Josman, PhD, OT. Disclosures: None declared. Objective: To compare problem-solving skills and everyday competency across clinical groups. Design: Between-groups design. Setting: Acute neurosurgery unit, community for the elderly, assisted living facilities for elderly and people diagnosed with schizophrenia, and nursing homes for the elderly. Participants: 60 older adults (age, ⱖ65y), 40 adults diagnosed with schizophrenia, and 40 adults with brain injuries. Interventions: Not applicable. Main Outcome Measures: Everyday competency was assessed using the Revised Observed Tasks of Daily Living (OTDL-R). Results: OTDL-R performance was significantly worse for participants diagnosed with schizophrenia than for participants with brain injury or older adults. Performance of the latter 2 groups did not differ. Higher educated persons in each of the 3 groups performed at a significantly higher level than less educated persons. Furthermore, older persons in each group performed worse than younger persons. Conclusions: The OTDL-R is a sensitive performance-based tool of potential importance for occupational therapists in the assessment of instrumental activities of daily living and problemsolving skills. However, education level and age should be taken into consideration during assessment. Additional research is needed to characterize more fully the psychometric properties of the OTDL-R for appropriate use by clinicians and researchers. Key Words: Activities of daily living; Rehabilitation. Poster 35 High-Resolution Electroencephalography and Reorganization of Posterior Cortical Potentials. Joseph B. Green, MD (Veterans Medical Center, Memphis TN); Darren M. Strother, MA; Nancy Garrott, REEG/EPT. Disclosures: None declared. Objective: To test whether reorganization after spinal cord lesions is “unfavorable” because of a takeover of cortical areas representing weak or paralyzed muscles. Design: Randomized study of electroencephalograms. Setting: Spinal cord research laboratory. Participants: 16 patients with spinal cord lesions and 10 normal controls. Interventions: Subjects were instructed in moving their right middle or index fingers. The fingers were also moved in a similar manner by an operator. Voluntary movement was monitored by electromyography. Main Outcome Measures: Movementrelated cortical potentials and passive movements. Results: Posterior cortical reorganization represented reinforcement of residual motor pathways from somatosensory cortex (S1) to the spinal cord, and facilitated rehabilitation. Conclusion: Motor potentials can be generated by active and passive measurements of the fingers. Reorganization of somatosensory cortex is important in deriving potentials from proprioceptive input and creating the necessary templates to activate the motor networks and electroencephalographic activity. Key Words: Electroencephalography; Rehabilitation. Poster 36 Neuropsychiatric Symptoms in Patients With Traumatic Brain Injury: 2 Years Postdischarge. Livia Caldeira, PhD (Burke Rehabilitation Hospital, White Plains, NY); Fernanda Lucchese, BS; Karina Ortega-Verdejo, MA; Ellen Glass, RN; Barry D. Jordan, MD, MPH. Disclosures: None declared. Objective: To assess the prevalence of neuropsychiatric symptoms in traumatic brain injury (TBI) 2 years postdischarge from inpatient rehabilitation and its associated caregiver distress. Design: Follow-up study. Setting: Inpatient acute rehabilitation hospital and community. Participants: 39 consecutive patients with TBI. Interventions: Not applicable. Main Outcome Measure: The Neuropsychiatric Inventory. Results: Neuropsychiatric symptoms were present in 75% of our sample 2 years postdischarge from acute rehabilitation. Among these symptoms, the most frequently encountered were: irritability, 48.7%; depression, 43.6%; appetite and eating changes, 25.6%; night-time and sleep behavior, 23.1%; apathy, 20.5%; anxiety, 17.9%; agitation and aggression, 17.9%; and disinhibition, 10.3%. The least frequently observed behaviors included: hallucinations, 5.1%; euphoria and elation, 2.6%; and delusions, 0%. At 2-year follow-up, anxiety, agitation and aggression, apathy, and irritability caused the most emotional distress to the caregivers, while
A11 hallucination and euphoria caused the least. Conclusions: Neuropsychiatric symptoms are prevalent in patients with TBI after discharge from acute rehabilitation. These symptoms are associated with significant caregiver distress. These findings further support the continued need for adequate psychologic assessment and possible intervention postdischarge. Key Words: Brain injuries; Caregivers; Rehabilitation.
Poster 37 Prediction of Long-Term Vocational and Independent Living Status From Goal Attainment in Postacute Brain Injury Rehabilitation. Thomas F. Bergquist, PhD, ABPP (Mayo Clinic and Foundation, Rochester, MN); Lisa DeGiorgio, MA, CRC; Kathryn Kendall, RN, BSN, CRRN; James F. Malec, PhD, ABPP. Disclosures: None declared. Objective: To determine whether goal attainment is predictive of long-term outcome after postacute brain injury rehabilitation. Design: Prospective cohort study. Setting: Postacute rehabilitation program. Participants: 136 persons (106 men, 30 women; mean age, 34.0y) with the following diagnoses: traumatic brain injury, 92; vascular, 27; anoxic, 7; tumor, 5; and other, 5. 89% had a high school–level education or greater. Interventions: Not applicable. Main Outcome Measure: The Vocational Independence Scale (VIS) and Independent Living Scale (ILS). Results: At admission, 35% of persons were living independently and 10% were in community-based employment. Persons completing the program developed goals to improve vocational and independent living skills. Complete data were available for 121 of 136 persons completing the program. 42 met or exceeded goals (goal group), 66 met some goals, and 13 met no goals (no goal group). At 1-year follow-up, 74% of the goal group were living independently and 82% were in communitybased employment while 73% of the no goal group were living independently and 45% were in community-based employment. Conclusion: The goal method used in this program was not predictive of long-term living status, but it was predictive of vocational status. Key Words: Brain injuries; Rehabilitation.
Poster 38 Follow-Up Outcomes and Stroke Severity. Pamela Smith, DNS (State University of New York, Buffalo, NY); David M. Smith, BA; Kenneth Ottenbacher, PhD. Disclosures: None declared. Objective: To examine functional outcomes by case-mix group (CMG) for patients with stroke at 3 months after discharge from acute inpatient rehabilitation programs. Design: Retrospective, using information from US facilities subscribing to the National Followup Service. Setting: Data from follow-up telephone interviews and assessments administered by registered nurses at approximately 90 days postdischarge from 94 facilities for the reporting period of October 1, 2002 to March 15, 2003, were examined. Participants: A total of 17,975 follow-up records were examined. Of those, CMG data were available for 9917 patients; 2055 (20.4%) were patients in Rehabilitation Impairment Category 1 or Stroke (mean age ⫾ SD, 69.59⫾14.4y). The sample was comprised of 48.81% men and 48.66% women (2.53% missing data for gender) with an average length of stay (LOS) of 17.54⫾10.43 days. Patient characteristics were derived from associated inpatient records consisting of data from the Inpatient Rehabilitation Facility-Patient Assessment Instrument. Interventions: Not applicable. Main Outcome Measure: Patient/proxy report of follow-up functional status. Results: The mean admission, discharge, and follow-up scores for stroke patients were 61.71, 86.31, and 103.58, with a mean inpatient functional gain of 24.6 and a mean discharge to follow-up gain of 17.28 points. The overall gain from admission to follow-up was 41.87. Of 2055 stroke patients, the largest samples by CMG were: 0114 (19.6%), 0105 (14%), 0113 (13.7%), 0106 (12.2%), and 0105 (10.5%). The average LOS for 0101 was 6.67 days and the LOS for 0114 was 25.1 (r⫽.985). Average discharge to follow-up functional gain ranged from 3.17 for CMG 0101 to 21.54 for 0114 (r⫽.870). Conclusions: This study provides basic descriptive information regarding function across different stroke CMGs. In addition, we found that as the severity of stoke increased, follow-up functional gain increased. Further study regarding follow-up functional gain is indicated. Key Words: Follow-up studies; Rehabilitation.
Poster 39 Total Body Reciprocal Training Improves Hand Function in Chronic Stroke Survivors. Sandra A. Billinger, SPT (University of Kansas Medical Center, Kansas City, KS); James K. Cho, PT, PhD; Vicki Bouckhout, PT; Denise Gobert, PT, PhD. Disclosures: None declared. Objective: To examine changes in hand function of chronic stroke survivors participating in exercise using a total body recumbent stepper (TBRS). Design: Case series. Setting: University medical school. Participants: 11 participants (8 men; age, 61.3⫾11.0y) ⬎6 months poststroke with mild to moderate hemiparesis (6 with right side involvement). Intervention: An 8-week exercise program using TBRS 3 times a week for 30 minutes per session. Main Outcome Measures: Functional Rating Score (FRS) from the Wolf Motor Function Test and bilateral grip strength measured by dynamometry. Results: Statistical analyses were conducted using a repeated-measures 2⫻2⫻4 factorial analysis of variance for factors of gender and the more affected side along with time. Results indicated a significant interaction of the intervention with left grip strength. Left grip strength increased from 13.44⫾8.92lb to 16.72⫾7.23lb after intervention. Values were significant at P⬍.05. The average for right grip strength did not demonstrate significance after intervention. FRS improved, but not significantly. Conclusion: Improvements in function and strength are possible for chronic stroke survivors participating in exercise involving a TBRS. Key Words: Exercise; Rehabilitation; Stroke.
Poster 40 Comparison of Constraint-Induced Language Therapy and Traditional Therapy in the Rehabilitation of Chronic Aphasia: Preliminary Findings. Lynn M. Maher, PhD (Baylor College of Medicine/University of Texas Health Science Center Houston Physical Medicine and Rehabilitation Alliance and Houston Veterans Affairs Medical Center, Houston, TX); Diane Kendall, PhD; Jennifer A. Swearengin, MA; Amy Rodriguez, MA; Susan Leon, MA; Karyn Pingel, MA; Audrey Holland, PhD; Leslie J. Gonzalez Rothi, PhD. Disclosures: None declared. Objectives: To compare constraint-induced language therapy (CILT) to a more traditional multimodality intervention for rehabilitation of chronic aphasia. Design: Nonrandomized control trial, within-subject comparisons. Setting: Outpatient rehabilitation. Participants: 9 subjects with chronic nonfluent aphasia ⬎2 years poststroke. Intervention: 2 groups (n⫽4) were treated using key CILT principles: massed practice, constraint of other communication modalities, and forced use of language through the application of visual barriers in a supported environment; 2 groups (n⫽5) were treated using a traditional approach, which encouraged all modes of communication: verbal and nonverbal. Both groups received treatment 3h/d, 4d/wk for 2 consecutive weeks. Main Outcomes Measures: Western Aphasia Battery, Boston Naming Test, Action Naming Test, and linguistic analyses. Results: Although participants in both groups evinced positive outcomes posttreatment, CILT subjects showed increased performance on more measures than the traditional subjects. Conclusions: Findings support the notion that persons with chronic nonfluent aphasia may make substantial, measurable change in language after intensive CILT. Progress observed in both groups suggests intensity may be an important factor in the positive outcome for both conditions. Key Words: Aphasia; Language; Rehabilitation. Poster 41 Objectively Measured Personality Traits in the Prediction of Early Neurobehavioral Symptoms After Mild Traumatic Brain Injury. Beth A. Keys, PhD (Mayo Clinic, Rochester, MN); James F. Malec, PhD; Anne M. Moessner, RN, MSN; Allen W. Brown, MD. Disclosures: None declared. Objective: To determine if objectively measured preinjury personality predicts early neurobehavioral symptoms after mild traumatic brain injury (TBI) compared with orthopedic injury. Design: Cohort study with matched controls; participants and significant others completed questionnaires of preinjury personality and early postinjury symptoms. Setting: Inpatient hospital and outpatient follow-up. Participants: 87 people hospitalized with mild TBI and 82 with orthopedic injury. Interventions: Not applicable. Main Outcome Measures: The NEO Personality Inventory– Revised (NEOPI-R) and Neurobehavioral Functioning Inventory (NFI). Results: For both mild TBI and orthopedic injury groups, personality traits were generally normal; concordance rates between self and significant others personality and symptoms scales were moderate. Self and significant others’ ratings of conscientiousness on the NEOPI-R were higher in the orthopedic injury than in the mild TBI group. Significant others’ reports of NFI somatic symptoms were higher in the orthopedic injury than in the mild TBI group. Stepwise linear regression showed that, in both groups, NEOPI-R agreeableness and neuroticism accounted for a significant proportion of aggressive symptoms (orthopedic injury group, R2⫽.56; mild TBI group, R2⫽.46; P⬍.01). In the mild TBI group, NEOPI-R neuroticism accounted for a significant proportion of depressive symptoms (R2⫽.44, P⬍.01). Unfortunately, significant findings appear to be the result of substantial content overlap between the NEOPI-R and the NFI, rather than reflecting predictive relationships. Conclusion: Objectively measured personality holds limited predictive value in understanding early neurobehavioral symptoms after mild TBI. Key Words: Brain injuries; Neurobehavioral manifestations; Personality; Rehabilitation. Poster 42 Quality of Life and Satisfaction With Life in People With Spinal Cord Injury. Uma Rani Madhusudana, MD (University of Connecticut, Storrs, CT); Pouran D. Faghri, MD. Disclosures: None declared. Objectives: To determine whether quality of life (QOL) and satisfaction with life differ among persons with spinal cord injury (SCI) as they grow older and to compare the differences in QOL and satisfaction with life between men and women and different socioeconomic status (ie, level of education and income). Design: Descriptive, correlation. Setting: SCI association and an academic institution. Participants: Men and women with SCI. Intervention: One main questionnaire, which incorporated questions from Craig Handicap Assessment and Reporting Technique (CHART), the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12), and the Satisfaction with Life Scale (SWLS), was developed. Demographic questions, such as age, gender, race, time post injury, and level of education and income, were added. Main Outcome Measures: The CHART and SF-12 were used to assess the QOL and the SWLS was used to measure life satisfaction. Results: To date, 59 persons with SCI (39 men, 20 women; mean age, 76⫾14.1y; range, 20 –78y) have responded and were included in the analysis. Multiple regression analysis showed that age and level of income and education were significant predictors of QOL as measured by the CHART and SF-12. There were no differences between men and women. Overall mean QOL scores in persons with SCI were lower compared with the range of CHART and SWLS scores. Questions in these instruments are not gender specific. This may be why we found no differences between men and women. However, the survey questionnaire included open-ended questions about QOL and satisfaction with life specific to gender. Preliminary qualitative evaluations of the survey respondents showed that QOL and satisfaction with life in women were lower than men, which was attributable to social and physical barriers. Conclusion: Better QOL measures for gender are needed for people with SCI. Overall, there was a significant reduction in QOL and life satisfaction in people with SCI, and socioeconomic status was a good predictor for QOL postinjury. Key Words: Quality of life; Rehabilitation; Spinal cord injuries.
Arch Phys Med Rehabil Vol 84, October 2003