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Poster 66 Modified Ashworth Scale (MAS) at the Ankle. Risk of Error in Adults with Stroke
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2011 ACRM-ASNR ANNUAL CONFERENCE ABSTRACTS
Poster 66 Modified Ashworth Scale (MAS) at the Ankle. Risk of Error in Adults with Stroke. Andrea Merlo (Motion Analysis Laboratory, Dept. of Neurorehabilitation, AUSL di Reggio Emilia, Correggio (RE), Italy), Isabella Campanini, Francesco Lombardi. Disclosure: None disclosed. Objective: To determine the risk of error in inferring the presence of spasticity at the ankle on the basis of a positive MAS score in adult patients who have had a stroke. Design: A criterion standard study. Setting: A neurorehabilitation unit of a rehabilitation hospital. Participants: A consecutive sample of 80 inpatients with hemiplegia (53 males, 27 females; age 56⫾17 years ; 39 left, 41 right) recruited between 30 and 90 days after stroke. Interventions: Not applicable. Main Outcome Measures: The Modified Ashworth Scale (MAS) at the ankle and the presence of surface electromyographic (sEMG) activity at the calf muscles triggered by the MAS stretching manoeuvre, used as a criterion standard. Gastrocnemius and soleus were tested. The assessor who assigned the MAS score was blind with respect to EMG data. Similarly, the assessor who analysed EMG data was blind with respect to all MAS scores. The False Discovery Rate (FDR) was computed, that is the percentage of positive MAS scores assigned in absence of any reflex EMG activity. Results: FRD was 80% at the soleus and 77% at the gastrocnemius. Conclusions: The MAS score does not reflect the presence of muscular stretch-reflex activity, that is, of spasticity, at the ankle in adults who have had a stroke, with an error in four patients out of five. The assessment of spasticity at the ankle cannot rely on the MAS score. Key Words: Muscle spasticity; Ashworth; Assessment; Validation study; Diagnostic error; Rehabilitation. Poster 67 Stroke Caregiving Influences Cognitive Functioning among Older Adults. Amanda Botticello (Kessler Foundation Research Center, West Orange, NJ, University of Medicine and Dentistry of New Jersey, Newark, NJ), Peii Chen. Disclosure: None disclosed. Objective: To assess the health effects of stroke caregiving by comparing cognitive functioning between stroke survivors, caregivers, and healthy older adults. Design: Cross-sectional analysis of existing data from the Health and Retirement Study (HRS), a nationally representative population-based survey. Setting: United States. Participants: The initial 1992 HRS survey included a cohort of adults born between 1931 and 1941 and their spouses (Wave 1, N⫽13,483). The study sample was derived from couples followed in 1996 (Wave 3, N⫽10,964). Of this sample, 257 people reported suffering a stroke between Waves 1 and 3. A comparison group was randomly selected from the 759 couples who reported no health problems at Wave 3 yielding a final analytic sample of N⫽1,273. Interventions: Not applicable. Main Outcome Measures: Cognitive functioning was assessed using measures of working memory, declarative memory, time orientation, and verbal memory. Low scores indicate poor functioning. Results: The study sample was 50.7% female and had an average age of 58.7 years (SD⫽6.5). Approximately 22% rated their health as “poor or fair” and the average level of depressive symptoms was 1.2 (SD⫽1.8). Poisson regression models adjusted for gender, age, health status, and depressive symptoms showed that stroke caregivers had significant lower scores for working memory (b⫽-0.07, SE⫽0.03, p⫽0.021) and verbal memory (b⫽-0.08, SE⫽0.03, p⫽0.019) in comparison to healthy older adults. In contrast, the stroke survivors had poorer working memory (b⫽-0.12, SE⫽0.04, p⬍0.002) in comparison to healthy individuals. There were no significant differences between caregivers and healthy individuals in time orientation and declarative memory. Conclusions: Preliminary findings suggest that the effects of stroke extend to caregivers who may experience diminished cognitive functioning. Key Words: Care giver; Cognition; Stroke; Rehabilitation. Arch Phys Med Rehabil Vol 92, October 2011
Poster 68 Effect of Methylphenidate and/or Levodopa Combined with Physiotherapy on Mood and Cognition After Stroke. Ahmad Delbari (Karolinska Institute, Stockholm, Sweden), Reza SalmanRoghani, Johan Lokk, Leili Shahgholi, Reza Frouzan, Seyed Shahabodin Tabatabaei. Disclosure: None disclosed. Background and Aim: Stimulants can enhance mood and cognition in stroke rehabilitation, but human clinical trial results are inconclusive. We sought to prospectively study the effects of levodopa (LD) and /or methylphenidate (MPH), in combination with physiotherapy on mood and cognition following stroke in human subjects. Methods: Ischemic stroke patients were enrolled in our study 15 to 180 days after stroke onset. Patients were randomized into four medication groups (MPH, LD, MPH⫹LD, or placebo) and received a 15 day course of medication therapy (1 dose daily) and 45-minutes of standard physiotherapy treatment. Mood and cognitive function were assessed at the onset of study and 15, 90 and 180 days after study enrollment. Results: The strongest improvement of mood and cognitive were found between baseline and first follow-up immediately after the intervention. A significant improvement in mood compared to placebo was found with the combined treatment (MPH⫹LD) at 90 and 180 days. Conclusions: A 15 day course of MPH⫹LD combined with physiotherapy over a three week period was safe and significantly improved mood status in ischemic stroke patients. Future studies should determine the optimal therapeutic window for and dosage of psychostimulants, as well as to identify those stroke patients who might benefit the most from treatment. Key Words: Rehabilitation. Poster 69 Tongue-Based Biofeedback for Balance in Stroke: Results of an 8-Week Pilot Study. Stephen Page (The University of Cincinnati Academic Medical Center, Cincinnati, OH), Mary Beth Badke, Jack Sherman, Pierce Boyne, Kari Dunning. Disclosure: None disclosed. Objective: To assess balance recovery and quality of life after tongue-placed, electrotactile biofeedback training in patients with stroke. Design: Prospective, multicenter research design. Setting: Outpatient Rehabilitation Clinics. Participants: Twenty-nine patients with chronic stroke. Interventions: Patients were administered one week of therapy plus 7 weeks of home exercise using the BrainPort Balance Device. Main Outcome Measures: The Berg Balance Scale (BBS), Timed Up and Go (TUG), Activities Specific Balance Confidence Scale (ABC), Dynamic Gait Index (DGI), and the Stroke Impact Scale (SIS) were performed before and after the intervention on all subjects. Results: There were statistically and clinically significant improvements from baseline to post test in BBS, DGI, TUG, ABC and some SIS domains (Mobility, ADL/IADL, Social, Physical and Recovery domains). Average BBS increased from 35.9 to 41.6 (p⬍.001) and DGI from 11.1 to 13.7 (p⬍.001). Time to complete TUG decreased from 24.7 to 20.7 (p⫽0.002). Including the BBS, DGI, TUG, ABC, 27 subjects improved beyond the MDC-95 or MCID in at least one outcome and 3 subjects improved beyond the MDC-95 or MCID in all outcomes. Conclusions: Balance training with tongue electrotactile biofeedback is a promising method for improving balance, balance confidence, gait and quality of life in chronic stroke. Future randomized controlled research is needed. Key Words: Balance; Stroke; Medical devices; Rehabilitation. Poster 70 Training Memory Self-efficacy in the Chronic Stage after Stroke: A Randomized Controlled Trial. Laurien Aben (Erasmus MC, Rotterdam, The Netherlands, Rijndam Rehabilitationcentre, Rotterdam, The Netherlands), Majanka H. Heijenbrok-Kal, Ellen M.P. van Loon, Erny Groet, Rudolf W.H.M. Ponds, Jan J.V. Busschbach, Gerard M. Ribbers. Disclosure: None disclosed.
2011 ACRM-ASNR ANNUAL CONFERENCE ABSTRACTS
Poster 66 Modified Ashworth Scale (MAS) at the Ankle. Risk of Error in Adults with Stroke. Andrea Merlo (Motion Analysis Laboratory, Dept. of Neurorehabilitation, AUSL di Reggio Emilia, Correggio (RE), Italy), Isabella Campanini, Francesco Lombardi. Disclosure: None disclosed. Objective: To determine the risk of error in inferring the presence of spasticity at the ankle on the basis of a positive MAS score in adult patients who have had a stroke. Design: A criterion standard study. Setting: A neurorehabilitation unit of a rehabilitation hospital. Participants: A consecutive sample of 80 inpatients with hemiplegia (53 males, 27 females; age 56⫾17 years ; 39 left, 41 right) recruited between 30 and 90 days after stroke. Interventions: Not applicable. Main Outcome Measures: The Modified Ashworth Scale (MAS) at the ankle and the presence of surface electromyographic (sEMG) activity at the calf muscles triggered by the MAS stretching manoeuvre, used as a criterion standard. Gastrocnemius and soleus were tested. The assessor who assigned the MAS score was blind with respect to EMG data. Similarly, the assessor who analysed EMG data was blind with respect to all MAS scores. The False Discovery Rate (FDR) was computed, that is the percentage of positive MAS scores assigned in absence of any reflex EMG activity. Results: FRD was 80% at the soleus and 77% at the gastrocnemius. Conclusions: The MAS score does not reflect the presence of muscular stretch-reflex activity, that is, of spasticity, at the ankle in adults who have had a stroke, with an error in four patients out of five. The assessment of spasticity at the ankle cannot rely on the MAS score. Key Words: Muscle spasticity; Ashworth; Assessment; Validation study; Diagnostic error; Rehabilitation. Poster 67 Stroke Caregiving Influences Cognitive Functioning among Older Adults. Amanda Botticello (Kessler Foundation Research Center, West Orange, NJ, University of Medicine and Dentistry of New Jersey, Newark, NJ), Peii Chen. Disclosure: None disclosed. Objective: To assess the health effects of stroke caregiving by comparing cognitive functioning between stroke survivors, caregivers, and healthy older adults. Design: Cross-sectional analysis of existing data from the Health and Retirement Study (HRS), a nationally representative population-based survey. Setting: United States. Participants: The initial 1992 HRS survey included a cohort of adults born between 1931 and 1941 and their spouses (Wave 1, N⫽13,483). The study sample was derived from couples followed in 1996 (Wave 3, N⫽10,964). Of this sample, 257 people reported suffering a stroke between Waves 1 and 3. A comparison group was randomly selected from the 759 couples who reported no health problems at Wave 3 yielding a final analytic sample of N⫽1,273. Interventions: Not applicable. Main Outcome Measures: Cognitive functioning was assessed using measures of working memory, declarative memory, time orientation, and verbal memory. Low scores indicate poor functioning. Results: The study sample was 50.7% female and had an average age of 58.7 years (SD⫽6.5). Approximately 22% rated their health as “poor or fair” and the average level of depressive symptoms was 1.2 (SD⫽1.8). Poisson regression models adjusted for gender, age, health status, and depressive symptoms showed that stroke caregivers had significant lower scores for working memory (b⫽-0.07, SE⫽0.03, p⫽0.021) and verbal memory (b⫽-0.08, SE⫽0.03, p⫽0.019) in comparison to healthy older adults. In contrast, the stroke survivors had poorer working memory (b⫽-0.12, SE⫽0.04, p⬍0.002) in comparison to healthy individuals. There were no significant differences between caregivers and healthy individuals in time orientation and declarative memory. Conclusions: Preliminary findings suggest that the effects of stroke extend to caregivers who may experience diminished cognitive functioning. Key Words: Care giver; Cognition; Stroke; Rehabilitation. Arch Phys Med Rehabil Vol 92, October 2011
Poster 68 Effect of Methylphenidate and/or Levodopa Combined with Physiotherapy on Mood and Cognition After Stroke. Ahmad Delbari (Karolinska Institute, Stockholm, Sweden), Reza SalmanRoghani, Johan Lokk, Leili Shahgholi, Reza Frouzan, Seyed Shahabodin Tabatabaei. Disclosure: None disclosed. Background and Aim: Stimulants can enhance mood and cognition in stroke rehabilitation, but human clinical trial results are inconclusive. We sought to prospectively study the effects of levodopa (LD) and /or methylphenidate (MPH), in combination with physiotherapy on mood and cognition following stroke in human subjects. Methods: Ischemic stroke patients were enrolled in our study 15 to 180 days after stroke onset. Patients were randomized into four medication groups (MPH, LD, MPH⫹LD, or placebo) and received a 15 day course of medication therapy (1 dose daily) and 45-minutes of standard physiotherapy treatment. Mood and cognitive function were assessed at the onset of study and 15, 90 and 180 days after study enrollment. Results: The strongest improvement of mood and cognitive were found between baseline and first follow-up immediately after the intervention. A significant improvement in mood compared to placebo was found with the combined treatment (MPH⫹LD) at 90 and 180 days. Conclusions: A 15 day course of MPH⫹LD combined with physiotherapy over a three week period was safe and significantly improved mood status in ischemic stroke patients. Future studies should determine the optimal therapeutic window for and dosage of psychostimulants, as well as to identify those stroke patients who might benefit the most from treatment. Key Words: Rehabilitation. Poster 69 Tongue-Based Biofeedback for Balance in Stroke: Results of an 8-Week Pilot Study. Stephen Page (The University of Cincinnati Academic Medical Center, Cincinnati, OH), Mary Beth Badke, Jack Sherman, Pierce Boyne, Kari Dunning. Disclosure: None disclosed. Objective: To assess balance recovery and quality of life after tongue-placed, electrotactile biofeedback training in patients with stroke. Design: Prospective, multicenter research design. Setting: Outpatient Rehabilitation Clinics. Participants: Twenty-nine patients with chronic stroke. Interventions: Patients were administered one week of therapy plus 7 weeks of home exercise using the BrainPort Balance Device. Main Outcome Measures: The Berg Balance Scale (BBS), Timed Up and Go (TUG), Activities Specific Balance Confidence Scale (ABC), Dynamic Gait Index (DGI), and the Stroke Impact Scale (SIS) were performed before and after the intervention on all subjects. Results: There were statistically and clinically significant improvements from baseline to post test in BBS, DGI, TUG, ABC and some SIS domains (Mobility, ADL/IADL, Social, Physical and Recovery domains). Average BBS increased from 35.9 to 41.6 (p⬍.001) and DGI from 11.1 to 13.7 (p⬍.001). Time to complete TUG decreased from 24.7 to 20.7 (p⫽0.002). Including the BBS, DGI, TUG, ABC, 27 subjects improved beyond the MDC-95 or MCID in at least one outcome and 3 subjects improved beyond the MDC-95 or MCID in all outcomes. Conclusions: Balance training with tongue electrotactile biofeedback is a promising method for improving balance, balance confidence, gait and quality of life in chronic stroke. Future randomized controlled research is needed. Key Words: Balance; Stroke; Medical devices; Rehabilitation. Poster 70 Training Memory Self-efficacy in the Chronic Stage after Stroke: A Randomized Controlled Trial. Laurien Aben (Erasmus MC, Rotterdam, The Netherlands, Rijndam Rehabilitationcentre, Rotterdam, The Netherlands), Majanka H. Heijenbrok-Kal, Ellen M.P. van Loon, Erny Groet, Rudolf W.H.M. Ponds, Jan J.V. Busschbach, Gerard M. Ribbers. Disclosure: None disclosed.