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Poster 56
E20 Poster 56 Comparison of 2 Methods of Standard Clinical Neuropsychologic Evaluation for Evaluation of Spatial Neglect. Sylvia John (Kessler Medical Rehabilitation Research and Education Corp, West Orange, NJ), Paul Eslinger, Kari Parkinson, Anna Barrett. Disclosure: None declared. Objective: To compare 2 methods of standard clinical neuropsychologic evaluation for evaluation of spatial neglect. Design: Retrospective analysis of clinical data. Setting: Acute inpatient rehabilitation unit. Participants: 36 consecutive admissions to an acute inpatient rehabilitation unit. Interventions: Evaluation of neglect using “blank-page bisection,” line bisection, and standard bedside screening tasks for spatial neglect. Main Outcome Measure: Observational report of performance on spatial bias tasks. Results: As part of clinical neuropsychologic screening, 36 consecutive patients were asked to “mark the center” of 5 blank pages and bisect 5 horizontal lines and perform other spatial neglect screening tasks. Patients were categorized as having left neglect, no neglect, right neglect, or other (mild right or left neglect or atypical). Retrospective comparison of page and line bisection performance revealed that there was a high correlation between the 2 tasks. Compared with no-neglect patients, left-neglect patients bisected lines rightward but only tended to bisect pages rightward. Conclusions: Blank-page bisection may be a valuable bedside test in screening for neglect along with the other standardized screening tests, especially if patients cannot perform line bisection. Further testing in a prospective manner needs to be done to validate this task in screening for spatial neglect. Key Words: Bisection; Hemispatial neglect; Rehabilitation.
Poster 57 Effectiveness of Retraining Using a Driving Simulator on the Driving Performance of Clients With a Neurologic Impairment. Barbara Mazer (Jewish Rehabilitation Hospital, Laval, QC, Canada), Isabelle Gelinas, Marie Vanier, Jose´e Duquette, Constant Rainville, James Hanley. Disclosure: None declared. Objective: To evaluate the effectiveness of retraining using a driving simulator in clients with neurologic impairment. Design: Randomized controlled trial. Setting: Rehabilitation center. Participants: 42 clients with nondegenerative acquired or traumatic brain injury who did not successfully pass a functional driving evaluation. Interventions: Participants were randomized to either the simulator retraining group or a control group. The experimental group received an intervention using a driving simulator 2 times a week for 8 weeks. The intervention approach was standardized, whereas the training sessions varied according to participants’ needs. Those in the control group did not receive any additional intervention. Main Outcome Measures: DriveAble Test: competence screen to evaluate driving-related perceptual and cognitive skills and the standardized on-road evaluation (participants rated as pass or fail). The evaluator was unaware of each participant’s group assignment. Results: Overall results indicated a small improvement in the rate of passing the on-road evaluation (57% vs 29%) after simulator training. Subgroups of participants according to diagnosis and severity were also examined. Conclusions: Driving simulator retraining is a promising approach to improving driving success in clients with neurologic impairments. This study provides clinicians with information on a potentially effective approach to driving retraining. Key Words: Rehabilitation; Automobile driving; Randomized controlled trials. Arch Phys Med Rehabil Vol 86, October 2005
Poster 58 Motor Learning in Chronic Stroke Patients Can Be Enhanced by Peripheral Nerve Stimulation. Pablo Celnik (Human Cortical Physiology Section, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD), Friedhelm Hummel, Michelle Harris-Love, Leonardo G. Cohen. Disclosure: None declared. Objective: To test the hypothesis that peripheral nerve stimulation associated with motor training of the paretic hand will enhance motor learning of a functional task (Jebsen-Taylor Hand Function Test [JTHFT]) relative to training with no-stimulation (no-stim) in chronic stroke patients. Design: Single-blind, counterbalanced, crossover. Setting: Laboratory. Participants: 9 chronic subcortical stroke patients (mean time since stroke ⫾ SD, 3.2⫾1.6y; age range, 35–73y; 55.2⫾14.3y). Interventions: JTHFT training while under the effects of a 2-hour period of peripheral nerve stimulation or no-stim on the paretic hand. Main Outcome Measures: Time to perform the JTHFT before (pre), 1 hour (1h post), and 24 hours (24h post) after completion of JTHT training. Results: There were no differences in attention and fatigue levels across sessions. Total JTHFT time was similar for preperipheral nerve stimulation and no-stim (t8⫽0.6, P⫽NS). Repeated-measures analysis of variance showed a significant effect for the interaction for time by intervention (F2-8⫽4.28, P⬍.03), and time (F2-8⫽4.11 P⬍.04) but not for intervention (F1,8⫽.35, P⫽NS). JTHFT at 1 hour post improved by 7.3% with peripheral nerve stimulation and 1.0% after no-stim and 8.9% versus 0.2% in 24h post, respectively. Conclusions: Peripheral nerve stimulation of the paretic hand of stroke patients before motor training results in prominent motor learning of a functionally relevant task, raising its possible use as adjuvant of rehabilitative treatments. Key Words: Rehabilitation; Nerve stimulation; Stroke. Poster 59 Effect of Intrathecal Baclofen Therapy on Gait Performance in Ambulatory Multiple Sclerosis Patients. Francois Bethoux (Cleveland Clinic Foundation, Cleveland, OH), Matt Sutliff, Darlene Stough. Disclosure: None declared. Objective: To evaluate changes in gait performance after implantation of a baclofen pump in patients with multiple sclerosis (MS). Design: Pre-post intervention study with prospective data collection up to 24⫾4 weeks. Setting: Spasticity clinic within a large outpatient MS center. Participants: Ambulatory patients with definite MS and severe spasticity refractory to oral medications. Interventions: Surgical implantation of a programmable intrathecal baclofen (ITB) infusion system. Main Outcome Measures: Rivermead Visual Gait Analysis Scale (RVGA), timed 25-foot walk (T25FW), and walking distance. Results: 9 patients were analyzed. There was significant improvement of Modified Ashworth Scale scores between baseline and 1 month and between baseline and 6 months after surgery. There was no statistically significant change in strength, RVGA, T25FW, or walking distance scores. Conclusions: A significant reduction in spasticity was achieved through ITB therapy, without significant loss of strength or decrease in performance on clinical gait tests. Our clinical impression of improved gait quality was not reflected in the evolution of RVGA scores; however, our sample size was small, and the RVGA may not be sensitive enough to measure these changes. We are conducting further assessments with 3-dimensional gait analysis. Key Words: Multiple sclerosis; Rehabilitation; Muscle spasticity; Baclofen; Gait.
Poster 57 Effectiveness of Retraining Using a Driving Simulator on the Driving Performance of Clients With a Neurologic Impairment. Barbara Mazer (Jewish Rehabilitation Hospital, Laval, QC, Canada), Isabelle Gelinas, Marie Vanier, Jose´e Duquette, Constant Rainville, James Hanley. Disclosure: None declared. Objective: To evaluate the effectiveness of retraining using a driving simulator in clients with neurologic impairment. Design: Randomized controlled trial. Setting: Rehabilitation center. Participants: 42 clients with nondegenerative acquired or traumatic brain injury who did not successfully pass a functional driving evaluation. Interventions: Participants were randomized to either the simulator retraining group or a control group. The experimental group received an intervention using a driving simulator 2 times a week for 8 weeks. The intervention approach was standardized, whereas the training sessions varied according to participants’ needs. Those in the control group did not receive any additional intervention. Main Outcome Measures: DriveAble Test: competence screen to evaluate driving-related perceptual and cognitive skills and the standardized on-road evaluation (participants rated as pass or fail). The evaluator was unaware of each participant’s group assignment. Results: Overall results indicated a small improvement in the rate of passing the on-road evaluation (57% vs 29%) after simulator training. Subgroups of participants according to diagnosis and severity were also examined. Conclusions: Driving simulator retraining is a promising approach to improving driving success in clients with neurologic impairments. This study provides clinicians with information on a potentially effective approach to driving retraining. Key Words: Rehabilitation; Automobile driving; Randomized controlled trials. Arch Phys Med Rehabil Vol 86, October 2005
Poster 58 Motor Learning in Chronic Stroke Patients Can Be Enhanced by Peripheral Nerve Stimulation. Pablo Celnik (Human Cortical Physiology Section, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD), Friedhelm Hummel, Michelle Harris-Love, Leonardo G. Cohen. Disclosure: None declared. Objective: To test the hypothesis that peripheral nerve stimulation associated with motor training of the paretic hand will enhance motor learning of a functional task (Jebsen-Taylor Hand Function Test [JTHFT]) relative to training with no-stimulation (no-stim) in chronic stroke patients. Design: Single-blind, counterbalanced, crossover. Setting: Laboratory. Participants: 9 chronic subcortical stroke patients (mean time since stroke ⫾ SD, 3.2⫾1.6y; age range, 35–73y; 55.2⫾14.3y). Interventions: JTHFT training while under the effects of a 2-hour period of peripheral nerve stimulation or no-stim on the paretic hand. Main Outcome Measures: Time to perform the JTHFT before (pre), 1 hour (1h post), and 24 hours (24h post) after completion of JTHT training. Results: There were no differences in attention and fatigue levels across sessions. Total JTHFT time was similar for preperipheral nerve stimulation and no-stim (t8⫽0.6, P⫽NS). Repeated-measures analysis of variance showed a significant effect for the interaction for time by intervention (F2-8⫽4.28, P⬍.03), and time (F2-8⫽4.11 P⬍.04) but not for intervention (F1,8⫽.35, P⫽NS). JTHFT at 1 hour post improved by 7.3% with peripheral nerve stimulation and 1.0% after no-stim and 8.9% versus 0.2% in 24h post, respectively. Conclusions: Peripheral nerve stimulation of the paretic hand of stroke patients before motor training results in prominent motor learning of a functionally relevant task, raising its possible use as adjuvant of rehabilitative treatments. Key Words: Rehabilitation; Nerve stimulation; Stroke. Poster 59 Effect of Intrathecal Baclofen Therapy on Gait Performance in Ambulatory Multiple Sclerosis Patients. Francois Bethoux (Cleveland Clinic Foundation, Cleveland, OH), Matt Sutliff, Darlene Stough. Disclosure: None declared. Objective: To evaluate changes in gait performance after implantation of a baclofen pump in patients with multiple sclerosis (MS). Design: Pre-post intervention study with prospective data collection up to 24⫾4 weeks. Setting: Spasticity clinic within a large outpatient MS center. Participants: Ambulatory patients with definite MS and severe spasticity refractory to oral medications. Interventions: Surgical implantation of a programmable intrathecal baclofen (ITB) infusion system. Main Outcome Measures: Rivermead Visual Gait Analysis Scale (RVGA), timed 25-foot walk (T25FW), and walking distance. Results: 9 patients were analyzed. There was significant improvement of Modified Ashworth Scale scores between baseline and 1 month and between baseline and 6 months after surgery. There was no statistically significant change in strength, RVGA, T25FW, or walking distance scores. Conclusions: A significant reduction in spasticity was achieved through ITB therapy, without significant loss of strength or decrease in performance on clinical gait tests. Our clinical impression of improved gait quality was not reflected in the evolution of RVGA scores; however, our sample size was small, and the RVGA may not be sensitive enough to measure these changes. We are conducting further assessments with 3-dimensional gait analysis. Key Words: Multiple sclerosis; Rehabilitation; Muscle spasticity; Baclofen; Gait.