- Email: [email protected]
Poster 61
E24
2006 CONGRESS ANNUAL MEETING ABSTRACTS
are met as predictors of QOL and mood after TBI. Setting: Community. Participants: 478 persons with TBI. Interventions: Not applicable. Main Outcome Measures: Living Life After TBI self-report questionnaire, Life–3, and Beck Depression Inventory–II. Results: Analyses of variance and correlations suggested a relationship between spirituality, mood, QOL, and injury severity in participants (P range, .000 –.04). Participants reported less depression and better QOL the more their spiritual needs were met. However, the importance of spirituality to the individual did not correlate significantly with QOL and mood. Surprisingly, participants who reported spirituality as important to their life satisfaction endorsed more depressive symptoms. Conclusions: Spirituality appears to be related to outcomes in persons with TBI. Having spiritual needs met is predictive of better mood and QOL. Key Words: Brain injuries; Rehabilitation; Spirituality. Poster 59 Training Needs in Traumatic Brain Injury for Nonspecialist Health Care Professionals: A Pilot Survey. M. Struchen (Baylor College of Medicine, Houston, TX), D. West, A. Clark. Disclosure: None declared. Objective: To assess perceived training needs and knowledge about traumatic brain injury (TBI) among social workers, clinical and counseling psychologists, and primary care physicians who do not specialize in neurologically impaired populations. Design: Survey. Setting: Online survey. Participants: 88 social workers and trainees, 72 psychologists and trainees, and 57 nonresident and resident physicians. Nontrainees comprised 47% of the sample. Results: Only 40% of nontrainees reported feeling comfortable evaluating psychologic and cognitive issues related to TBI, with no significant differences between professions. While 40% of nontrainee physicians and psychologists reported feeling comfortable with evaluating somatic symptoms associated with TBI, only 15% of nontrainee social workers reported such comfort (P⬍.02). Across trainees, 18.4% reported feeling comfortable evaluating psychologic and cognitive issues related to TBI and 16.7% with evaluating somatic symptoms. For nontrainees across professions, only 29% reported feeling prepared to address the needs of persons with TBI, while this was true for 8% of trainees. Only 38% of the entire sample was able to identify correctly TBI as having the highest incidence among other disorders and 54% could correctly select the most common symptom after TBI from a list. Conclusions: Significant training needs regarding TBI exist for nonspecialist health care professionals. Key Words: Brain injuries; Needs assessment; Rehabilitation. Poster 60 Challenges in the Diagnosis of Concussion in the Emergency Department. J. Powell (University of Washington, Seattle, WA), J. Ferraro, N. Vanneman, S. Dikmen, K. Bell. Disclosure: None declared. Objective: To determine the frequency of undiagnosed concussion in the emergency department (ED) in persons meeting the U.S. Centers for Disease Control and Prevention (CDC) operational definition of concussion. Design: Retrospective review of medical records of patients identified in the ED by study personnel as meeting CDC concussion criteria. Charts were reviewed for clinical diagnosis of concussion and key terms used in concussion epidemiologic studies. Setting: Urban academic level I trauma center ED. Participants: 200 consecutive participants enrolled in a concurrent, randomized controlled trial. Interventions: Not applicable. Main Outcome Measures: Identification of concussion based on clinical diagnosis and key descriptor terms from emergency records. Results: 56% of persons meeting CDC concussion criteria did not receive a clinical diagnosis of Arch Phys Med Rehabil Vol 87, October 2006
concussion in the ED. 20% of these also did not have clinical descriptors in their medical records consistent with the CDC definition of concussion. Conclusions: Concussion appears to be underdiagnosed in the ED. This has implications for clinical management and rehabilitation of postconcussive problems, for researchers using ED diagnoses in epidemiologic studies, and for legal liability issues. Key Words: Brain concussion; Emergency medical services; Rehabilitation. Poster 61 The Effects of a Pharmacologic Intervention (Botulinum Toxin Type A) and Occupational Therapy on Tone and Upper-Limb Function in Adults With Stroke: A Systematic Review. C. Giuffrida (Rush University Medical Center, Chicago, IL), M. Kavois, M. LaGrant, R. Gravehhorst. Disclosure: None declared. Objective: To synthesize findings on the effectiveness of botulinum toxin type A (BTX-A), with and without occupational therapy (OT), to reduce muscle tone and increase arm function in adult stroke patients. Data Sources: Databases searched were Medline, CINAHL, PsychInfo, and the reference lists of articles. Study Selection: Eligible studies included those with participants with stroke and residual arm spasticity; that measured upper-extremity tone and function; and were published in a peer-reviewed journal between 1996 and 2005. Of 27 studies retrieved, 12 met the inclusion criteria. Data Extraction: Data were extracted from the articles independently by 2 reviewers and cross-checked. Data Synthesis: 6 randomized controlled trials, 3 before-and-after studies, and 3 cohort design studies were analyzed for grade, level of evidence, and internal and external validity. Conclusions: BTX-A injections demonstrate promising short-term results by reducing tone in the arm. However, positive changes in function were limited. Limitations in the selected studies include significant variations in the dosage of BTX-A and use of functional outcome measures. Future research using functional measures and BTX-A injections is needed to determine the effectiveness of BTX-A and OT on adult stroke upper-limb function. Key Words: Botulinum toxin type A; Rehabilitation; Stroke; Upper limb. Poster 62 Impact of Evidenced-Based Behavioral Therapy and Botulinum Toxin Type A on Hand Function in Patients With Stroke. C. Giuffrida (Rush University Medical Center, Chicago, IL), C. Levy, L. Richards, S. Davis, C. Llanes, M. Woodbury, S. Arola, S. Nadeau. Disclosure: None declared. Objective: To examine the effects of an evidenced-based behavioral therapy protocol and botulinum toxin type A (BTX-A) on hand function in stroke patients ineligible for constraint-induced movement therapy (CIMT). Design: Single-subject AB multiple-probe research design. Setting: Rehabilitation research setting. Participants: Candidates with stroke and limited hand function, with an Ashworth Scale score of ⱖ3, received BTX-A and entered the evidenced-based behavioral therapy protocol. Candidates with stroke and limited hand function not due to spasticity entered the evidenced-based behavioral therapy protocol but did not receive BTX-A. Intervention: Therapy consisted of hand and wrist flexibility exercises, repetitive task practice with feedback, and a home program using mental practice. Main Outcome Measures: During baseline and 4 weeks of therapy, multiple probes of outcome measures were obtained. Pre- and postintervention, sensation, motor control, and hand function were assessed. Results: Graphic presentation of 2 cases with and without BTX-A and analysis of data from baseline to intervention indicated changes in
2006 CONGRESS ANNUAL MEETING ABSTRACTS
are met as predictors of QOL and mood after TBI. Setting: Community. Participants: 478 persons with TBI. Interventions: Not applicable. Main Outcome Measures: Living Life After TBI self-report questionnaire, Life–3, and Beck Depression Inventory–II. Results: Analyses of variance and correlations suggested a relationship between spirituality, mood, QOL, and injury severity in participants (P range, .000 –.04). Participants reported less depression and better QOL the more their spiritual needs were met. However, the importance of spirituality to the individual did not correlate significantly with QOL and mood. Surprisingly, participants who reported spirituality as important to their life satisfaction endorsed more depressive symptoms. Conclusions: Spirituality appears to be related to outcomes in persons with TBI. Having spiritual needs met is predictive of better mood and QOL. Key Words: Brain injuries; Rehabilitation; Spirituality. Poster 59 Training Needs in Traumatic Brain Injury for Nonspecialist Health Care Professionals: A Pilot Survey. M. Struchen (Baylor College of Medicine, Houston, TX), D. West, A. Clark. Disclosure: None declared. Objective: To assess perceived training needs and knowledge about traumatic brain injury (TBI) among social workers, clinical and counseling psychologists, and primary care physicians who do not specialize in neurologically impaired populations. Design: Survey. Setting: Online survey. Participants: 88 social workers and trainees, 72 psychologists and trainees, and 57 nonresident and resident physicians. Nontrainees comprised 47% of the sample. Results: Only 40% of nontrainees reported feeling comfortable evaluating psychologic and cognitive issues related to TBI, with no significant differences between professions. While 40% of nontrainee physicians and psychologists reported feeling comfortable with evaluating somatic symptoms associated with TBI, only 15% of nontrainee social workers reported such comfort (P⬍.02). Across trainees, 18.4% reported feeling comfortable evaluating psychologic and cognitive issues related to TBI and 16.7% with evaluating somatic symptoms. For nontrainees across professions, only 29% reported feeling prepared to address the needs of persons with TBI, while this was true for 8% of trainees. Only 38% of the entire sample was able to identify correctly TBI as having the highest incidence among other disorders and 54% could correctly select the most common symptom after TBI from a list. Conclusions: Significant training needs regarding TBI exist for nonspecialist health care professionals. Key Words: Brain injuries; Needs assessment; Rehabilitation. Poster 60 Challenges in the Diagnosis of Concussion in the Emergency Department. J. Powell (University of Washington, Seattle, WA), J. Ferraro, N. Vanneman, S. Dikmen, K. Bell. Disclosure: None declared. Objective: To determine the frequency of undiagnosed concussion in the emergency department (ED) in persons meeting the U.S. Centers for Disease Control and Prevention (CDC) operational definition of concussion. Design: Retrospective review of medical records of patients identified in the ED by study personnel as meeting CDC concussion criteria. Charts were reviewed for clinical diagnosis of concussion and key terms used in concussion epidemiologic studies. Setting: Urban academic level I trauma center ED. Participants: 200 consecutive participants enrolled in a concurrent, randomized controlled trial. Interventions: Not applicable. Main Outcome Measures: Identification of concussion based on clinical diagnosis and key descriptor terms from emergency records. Results: 56% of persons meeting CDC concussion criteria did not receive a clinical diagnosis of Arch Phys Med Rehabil Vol 87, October 2006
concussion in the ED. 20% of these also did not have clinical descriptors in their medical records consistent with the CDC definition of concussion. Conclusions: Concussion appears to be underdiagnosed in the ED. This has implications for clinical management and rehabilitation of postconcussive problems, for researchers using ED diagnoses in epidemiologic studies, and for legal liability issues. Key Words: Brain concussion; Emergency medical services; Rehabilitation. Poster 61 The Effects of a Pharmacologic Intervention (Botulinum Toxin Type A) and Occupational Therapy on Tone and Upper-Limb Function in Adults With Stroke: A Systematic Review. C. Giuffrida (Rush University Medical Center, Chicago, IL), M. Kavois, M. LaGrant, R. Gravehhorst. Disclosure: None declared. Objective: To synthesize findings on the effectiveness of botulinum toxin type A (BTX-A), with and without occupational therapy (OT), to reduce muscle tone and increase arm function in adult stroke patients. Data Sources: Databases searched were Medline, CINAHL, PsychInfo, and the reference lists of articles. Study Selection: Eligible studies included those with participants with stroke and residual arm spasticity; that measured upper-extremity tone and function; and were published in a peer-reviewed journal between 1996 and 2005. Of 27 studies retrieved, 12 met the inclusion criteria. Data Extraction: Data were extracted from the articles independently by 2 reviewers and cross-checked. Data Synthesis: 6 randomized controlled trials, 3 before-and-after studies, and 3 cohort design studies were analyzed for grade, level of evidence, and internal and external validity. Conclusions: BTX-A injections demonstrate promising short-term results by reducing tone in the arm. However, positive changes in function were limited. Limitations in the selected studies include significant variations in the dosage of BTX-A and use of functional outcome measures. Future research using functional measures and BTX-A injections is needed to determine the effectiveness of BTX-A and OT on adult stroke upper-limb function. Key Words: Botulinum toxin type A; Rehabilitation; Stroke; Upper limb. Poster 62 Impact of Evidenced-Based Behavioral Therapy and Botulinum Toxin Type A on Hand Function in Patients With Stroke. C. Giuffrida (Rush University Medical Center, Chicago, IL), C. Levy, L. Richards, S. Davis, C. Llanes, M. Woodbury, S. Arola, S. Nadeau. Disclosure: None declared. Objective: To examine the effects of an evidenced-based behavioral therapy protocol and botulinum toxin type A (BTX-A) on hand function in stroke patients ineligible for constraint-induced movement therapy (CIMT). Design: Single-subject AB multiple-probe research design. Setting: Rehabilitation research setting. Participants: Candidates with stroke and limited hand function, with an Ashworth Scale score of ⱖ3, received BTX-A and entered the evidenced-based behavioral therapy protocol. Candidates with stroke and limited hand function not due to spasticity entered the evidenced-based behavioral therapy protocol but did not receive BTX-A. Intervention: Therapy consisted of hand and wrist flexibility exercises, repetitive task practice with feedback, and a home program using mental practice. Main Outcome Measures: During baseline and 4 weeks of therapy, multiple probes of outcome measures were obtained. Pre- and postintervention, sensation, motor control, and hand function were assessed. Results: Graphic presentation of 2 cases with and without BTX-A and analysis of data from baseline to intervention indicated changes in