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Poster 52: Case Study: Cognitive Remediation Techniques in the Case of Ischemic Encephalopathy and Comorbid Quadriplegia
2009 ACRM–ASNR JOINT EDUCATIONAL CONFERENCE ABSTRACTS
been identified to improve vigilance in self-care for wheelchair users. We developed a dynamic weekly automated telephone calling system (“Care Call”) to empower and motivate people with SCD to improve their skin care, seek treatment for depression, and appropriately utilize physical and mental health care. Such a system has proven useful for managing chronic conditions (eg, diabetes). Design: Care Call’s three modules focus on skin care, depression and wellness, and health care utilization. The automated calls generate action alerts to a Nurse Health Coordinator management system. Care Call also integrates audio taped vignettes from actual patients with SCD and clinicians. The system tailors content for each user based on previous calls. Setting: Not applicable. Participants: Not applicable. Main Outcome Measures: Not applicable. Results: Over 1.5 years, an interdisciplinary team met weekly. We describe the steps of this development initiative, including: special considerations; testing the system’s ability to process different voice characteristics of people with SCD; examples of patient audio clips; programming and web reporting; and developing supplementary materials such as a comprehensive Resource Book for referrals; and pilot and quality control tests. Conclusions: A randomized clinical trial of 240 people with SCD is currently underway. We are monitoring the cost of the intervention during the RCT, including costs related to: the phone system; the Nurse Health Coordinator; and other materials. A cost-effectiveness analysis is planned. Our ultimate goal is to offer Care Call to health care facilities for use with their own patient populations. Key Words: Pressure Ulcer; Rehabilitation; Telemedicine. Poster 52 Case Study: Cognitive Remediation Techniques in the Case of Ischemic Encephalopathy and Comorbid Quadriplegia. Amanda Sacks (Rusk Institute, New York, NY), Rose Lynn Sherr. Disclosure: None declared. Objective: To describe and measure the efficacy of cognitive remediation techniques in the case of a 25-year-old male with severe cognitive impairments secondary to ischemic encephalopathy. This type of brain injury resulted in severe impairment in all domains of cognitive functioning and functionality. However, through the utilization of repetitive attention, reading, memory, and self-monitoring exercises, an objective increase in cognitive functioning was possible. Design: Case study. Setting: Outpatient psychology department within a rehabilitation center. Participants: One individual with ischemic encephalopathy secondary to drug overdose. Interventions: Twice weekly individual cognitive remediation focusing on techniques within the domains of visual and auditory attention, retention and reading. Main Outcome Measures: Wechsler Assessment of Adult Intelligence (WAIS-III), Wechsler Memory Scales (WMS-III), Controlled Oral Word Association Test, sentence repetition, Head Injury and Stroke Family Questionnaire & Rusk IRM Cognitive ADL/IADL Questionnaire. Results: Assessment across three time points during treatment (Baseline, 1 year, 2 year). From baseline to time 1, significant increase in abstract reasoning (WAIS: Similarities: 25th to 75th percentile, 2 SD), verbal attention (WAIS: Arithmetic: 1st to 25th percentile, 2. SD), and delayed memory (WMS-III: Logical Memory II: 1st to 9th percentile, 1 SD). It is expected that gains will be maintained or continue at time 3. Conclusions: Individual cognitive remediation that capitalizes on attention, memory and self-monitoring has the potential to aid individuals in regaining premorbid skills in a variety of domains. Additionally, internalization of self-monitoring leads to the ability to generalize gains within treatment sessions. Despite poor prognosis for cognitive recovery in the context of ischemic encephalopathy, substantial gains are possible with consistent application of cognitive remediation. Key Words: Case study; Ischemic encephalopathy; Rehabilitation.
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Poster 53 Neurogenic Bladder In Cerebral Palsy. Gita Handa (All India Institute of Medical Sciences, New Delhi, India), Mallikarjuna Nallegowda, Upinderpal Singh. Disclosure: None declared. Objective: Cerebral palsy results in neurogenic bladder and bowel is well known but very few care givers assess the extent of bladder and bowel problems faced by a person with cerebral palsy. This study was done to evaluate bowel and bladder problems in patients with cerebral palsy. Design: Prospective study wherein the all the patients attending the clinic were screened for bladder and bowel problems and were included in study with the consent of the parents. Setting: Tertiay Care setting in a premier multispeciality hospital. Participants: All the children attending OPD were screened for duration of 1 year. Inclusion criteria being Patients who have symptoms of bowel and bladder disorder, informed consent and willingness to participate in the study. Exclusion criteria was Patients with congenital urinary tract anomaly excluded for CMG, Patients with uncontrollable urinary tract infection, fever and pain abdomen are excluded for CMG, Patients suffering from any other neurological disorder, spina bifida, IDDM, severe mental retardation, uncooperative for study were excluded for study. Total 184 patients were enrolled in the study. Interventions: Detailed history and physical examination. IQ assessment, urine examination and culture, bladder ultrasound and urodynamic studies were done as and when required. The results obtained were analyzed using chisquare test. Main Outcome Measures: Presence of urinary complaints ultrasound findings and abnormal urodynamic studies. Results: Demographic profile and the symptom evaluation of the study populaltion (n⫽184), revealed M greater than F (78/21%); Mean age, male, 6.74 years; female, 7.45 years; Spastic Diplegia most common (71.7%) stress incontinence and pain in beginning more in spastic diplegia group; IQ moderate to severe Mental Retardation was 20% in each group. Symptomatic bowel and bladder problems seen were Bedwetting during day in 33.7% more in moderate to severe MR (P⬍.005), Fever 15.7%, Vomiting 17.6 %, Frequency of urination in 15.8%, Urgency in 17.4%, Burning micturition in 5.4%, Disturbed stream (8.2%), Urinary retention (6%), Stress incontinence (6%), Day/night soiling (24.5%) more in moderate to severe MR (P⬍.005), Urge incontinence (9.2%), Pain abdomen (7.6%), Difficulty initiation (10.3%), Constipation (15.8), Seizures (20.1%), Speech hearing problems (20.1%), Congenital anomaly (0.5%), Dental problems were seen in 38.6% more in spastic and dyskinetic variety. Total patients screened with ultrasound were 82, Symptomatic were 42, Consent for urodynamic studies in was given in 30 patients, which revealed low capacity bladder in 27, with increased residual urine volume in 6, normal capacity bladder in 1 patient, increased bladder capacity in 2 patients. Follow-up was done after 1 year in 48 patients and none were symptomatic on follow-up. Conclusions: Bladder function screening should be done in every patient and symptomatic patients should be followed up with detailed urological investigations and appropriate timely treatment should be given so as to prevent long term sequelae and compromised kidney function and improve the quality of life of children with cerebral palsy. Key Words: Cerebral palsy; Neurogenic bladder; Rehabilitation. Poster 54 Effects of Dual Task Training on a Child with Cerebral Palsy: A Case Report Using ICF-Based Quantitative Analysis of Functional Progress. Raphael Sadiwa (San Antonio Independent School District, San Antonio, TX). Disclosure: None declared. Objective: Dual-task training combining cognitive and postural activities has been extensively studied as an intervention among elArch Phys Med Rehabil Vol 90, October 2009
been identified to improve vigilance in self-care for wheelchair users. We developed a dynamic weekly automated telephone calling system (“Care Call”) to empower and motivate people with SCD to improve their skin care, seek treatment for depression, and appropriately utilize physical and mental health care. Such a system has proven useful for managing chronic conditions (eg, diabetes). Design: Care Call’s three modules focus on skin care, depression and wellness, and health care utilization. The automated calls generate action alerts to a Nurse Health Coordinator management system. Care Call also integrates audio taped vignettes from actual patients with SCD and clinicians. The system tailors content for each user based on previous calls. Setting: Not applicable. Participants: Not applicable. Main Outcome Measures: Not applicable. Results: Over 1.5 years, an interdisciplinary team met weekly. We describe the steps of this development initiative, including: special considerations; testing the system’s ability to process different voice characteristics of people with SCD; examples of patient audio clips; programming and web reporting; and developing supplementary materials such as a comprehensive Resource Book for referrals; and pilot and quality control tests. Conclusions: A randomized clinical trial of 240 people with SCD is currently underway. We are monitoring the cost of the intervention during the RCT, including costs related to: the phone system; the Nurse Health Coordinator; and other materials. A cost-effectiveness analysis is planned. Our ultimate goal is to offer Care Call to health care facilities for use with their own patient populations. Key Words: Pressure Ulcer; Rehabilitation; Telemedicine. Poster 52 Case Study: Cognitive Remediation Techniques in the Case of Ischemic Encephalopathy and Comorbid Quadriplegia. Amanda Sacks (Rusk Institute, New York, NY), Rose Lynn Sherr. Disclosure: None declared. Objective: To describe and measure the efficacy of cognitive remediation techniques in the case of a 25-year-old male with severe cognitive impairments secondary to ischemic encephalopathy. This type of brain injury resulted in severe impairment in all domains of cognitive functioning and functionality. However, through the utilization of repetitive attention, reading, memory, and self-monitoring exercises, an objective increase in cognitive functioning was possible. Design: Case study. Setting: Outpatient psychology department within a rehabilitation center. Participants: One individual with ischemic encephalopathy secondary to drug overdose. Interventions: Twice weekly individual cognitive remediation focusing on techniques within the domains of visual and auditory attention, retention and reading. Main Outcome Measures: Wechsler Assessment of Adult Intelligence (WAIS-III), Wechsler Memory Scales (WMS-III), Controlled Oral Word Association Test, sentence repetition, Head Injury and Stroke Family Questionnaire & Rusk IRM Cognitive ADL/IADL Questionnaire. Results: Assessment across three time points during treatment (Baseline, 1 year, 2 year). From baseline to time 1, significant increase in abstract reasoning (WAIS: Similarities: 25th to 75th percentile, 2 SD), verbal attention (WAIS: Arithmetic: 1st to 25th percentile, 2. SD), and delayed memory (WMS-III: Logical Memory II: 1st to 9th percentile, 1 SD). It is expected that gains will be maintained or continue at time 3. Conclusions: Individual cognitive remediation that capitalizes on attention, memory and self-monitoring has the potential to aid individuals in regaining premorbid skills in a variety of domains. Additionally, internalization of self-monitoring leads to the ability to generalize gains within treatment sessions. Despite poor prognosis for cognitive recovery in the context of ischemic encephalopathy, substantial gains are possible with consistent application of cognitive remediation. Key Words: Case study; Ischemic encephalopathy; Rehabilitation.
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Poster 53 Neurogenic Bladder In Cerebral Palsy. Gita Handa (All India Institute of Medical Sciences, New Delhi, India), Mallikarjuna Nallegowda, Upinderpal Singh. Disclosure: None declared. Objective: Cerebral palsy results in neurogenic bladder and bowel is well known but very few care givers assess the extent of bladder and bowel problems faced by a person with cerebral palsy. This study was done to evaluate bowel and bladder problems in patients with cerebral palsy. Design: Prospective study wherein the all the patients attending the clinic were screened for bladder and bowel problems and were included in study with the consent of the parents. Setting: Tertiay Care setting in a premier multispeciality hospital. Participants: All the children attending OPD were screened for duration of 1 year. Inclusion criteria being Patients who have symptoms of bowel and bladder disorder, informed consent and willingness to participate in the study. Exclusion criteria was Patients with congenital urinary tract anomaly excluded for CMG, Patients with uncontrollable urinary tract infection, fever and pain abdomen are excluded for CMG, Patients suffering from any other neurological disorder, spina bifida, IDDM, severe mental retardation, uncooperative for study were excluded for study. Total 184 patients were enrolled in the study. Interventions: Detailed history and physical examination. IQ assessment, urine examination and culture, bladder ultrasound and urodynamic studies were done as and when required. The results obtained were analyzed using chisquare test. Main Outcome Measures: Presence of urinary complaints ultrasound findings and abnormal urodynamic studies. Results: Demographic profile and the symptom evaluation of the study populaltion (n⫽184), revealed M greater than F (78/21%); Mean age, male, 6.74 years; female, 7.45 years; Spastic Diplegia most common (71.7%) stress incontinence and pain in beginning more in spastic diplegia group; IQ moderate to severe Mental Retardation was 20% in each group. Symptomatic bowel and bladder problems seen were Bedwetting during day in 33.7% more in moderate to severe MR (P⬍.005), Fever 15.7%, Vomiting 17.6 %, Frequency of urination in 15.8%, Urgency in 17.4%, Burning micturition in 5.4%, Disturbed stream (8.2%), Urinary retention (6%), Stress incontinence (6%), Day/night soiling (24.5%) more in moderate to severe MR (P⬍.005), Urge incontinence (9.2%), Pain abdomen (7.6%), Difficulty initiation (10.3%), Constipation (15.8), Seizures (20.1%), Speech hearing problems (20.1%), Congenital anomaly (0.5%), Dental problems were seen in 38.6% more in spastic and dyskinetic variety. Total patients screened with ultrasound were 82, Symptomatic were 42, Consent for urodynamic studies in was given in 30 patients, which revealed low capacity bladder in 27, with increased residual urine volume in 6, normal capacity bladder in 1 patient, increased bladder capacity in 2 patients. Follow-up was done after 1 year in 48 patients and none were symptomatic on follow-up. Conclusions: Bladder function screening should be done in every patient and symptomatic patients should be followed up with detailed urological investigations and appropriate timely treatment should be given so as to prevent long term sequelae and compromised kidney function and improve the quality of life of children with cerebral palsy. Key Words: Cerebral palsy; Neurogenic bladder; Rehabilitation. Poster 54 Effects of Dual Task Training on a Child with Cerebral Palsy: A Case Report Using ICF-Based Quantitative Analysis of Functional Progress. Raphael Sadiwa (San Antonio Independent School District, San Antonio, TX). Disclosure: None declared. Objective: Dual-task training combining cognitive and postural activities has been extensively studied as an intervention among elArch Phys Med Rehabil Vol 90, October 2009