- Email: [email protected]
Poster 67
E26
2006 CONGRESS ANNUAL MEETING ABSTRACTS
question whether the clinical scales are encompassing enough of the symptom range to adequately represent a patient’s motor performance state. Key Words: Parkinson disease; Rehabilitation. Poster 67 Impaired Visual Perception in a Patient With Idiopathic Parkinson’s Disease With Otherwise Intact Cognitive Function: A Case Report. S. Levy-Tzedek (MIT, Cambridge, MA), J. Arle, J.L Shils, C. Gould, H. Krebs, D. Penny. Disclosure: None declared. We present a 61-year-old man with a 15-year history of Parkinson’s disease (PD), who underwent bilateral deep-brain stimulation (DBS) surgery in the subthalamic nucleus 1 year before the experiment. Neuropsychologic testing showed mild difficulties with high-level executive functioning, but low visuospatial scanning and mild impairment in visuospatial organization within the context of otherwise intact visuospatial perception and constructional problem-solving abilities. New learning abilities were mildly variable secondary to difficulties in acquisition and retrieval functions within the context of intact encoding capacities. With the DBS turned on and off, the patient scored 2.5 on the Modified Hoehn and Yahr scale. The motor part score on the Unified Parkinson’s Disease Rating Scale part III (range, 0 –108) was 11 with DBS on and 22 with DBS off. The patient was asked to manipulate a robotic manipulandum using his wrist, to perform pointto-point reaching movements. He followed a visual target on a computer screen, moving to randomly presented targets around a periphery and back to a center target. After practicing the task, the patient was tested first in the DBS-on then -off state. Throughout the experiment, the patient’s normal medication regimen was followed. Consistently, the patient performed poorly both in the DBS-on and the DBS-off states, exhibiting an inability to perform the predictable back-to-thecenter task. It most likely correlated with his neuropsychologic testing, reflecting abnormal visuospatial testing. Those findings support deficits in visuospatial ability in PD and show the remarkable variability across the spectrum of patients with this disease. Key Words: Rehabilitation; Robotics. Poster 68 Efficacy of Cortical Stimulation Combined With Intensive Language Therapy for Patients With Chronic Broca’s Aphasia. Leora Cherney (Rehabilitation Institute of Chicago, Chicago, IL), Edna Babbitt, Rosalind Hurwitz, Steven Small. Disclosure: None declared. Objective: To test the efficacy of targeted epidural cortical stimulation delivered concurrent with speech-language therapy in stroke subjects with Broca’s aphasia. Design: Phase 1 randomized singleblinded clinical trial. Setting: Rehabilitation facility. Participants: 5 subjects with chronic Broca’s aphasia after ischemic stroke of the left cerebral hemisphere. Intervention: 2 subjects (investigational group) were implanted with an investigational cortical stimulation device; placement of electrodes was identified by functional magnetic resonance imaging. These subjects received cortical stimulation delivered concurrent with intensive speech-language therapy for 6 weeks. 3 subjects (control group) received identical intensive speech-language therapy. Language therapy included apraxia drills, cued naming tasks, choral reading of sentences, and conversation practice. Main Outcome Measures: Change in Aphasia Quotient (AQ) of the Western Aphasia Battery from pretreatment to post-treatment. Increases of 5 points are considered significant. Results: Investigational subjects had increases of 15.0 and 3.45 points; control subjects showed increases of 11.90, 3.95, and 2.65 points. Language changes were maintained or improved at 6-week and 12-week follow-ups, with 1 investigational Arch Phys Med Rehabil Vol 87, October 2006
subject showing an overall gain of 20.3 AQ points at week 12 followup. Conclusions: Cortical stimulation in combination with intensive speech-language therapy may enhance language rehabilitation for chronic Broca’s aphasia. Additional subjects are currently being studied. Key Words: Aphasia; Rehabilitation. Poster 69 Computer Treatment for Aphasia: Efficacy and Treatment Intensity. L. Cherney (Rehabilitation Institute of Chicago, Chicago, IL), E. Babbitt, R. Cole, S. Van Vuuren, R. Hurwitz, N. Ngampatipatpong. Disclosure: None declared. Objectives: To assess the efficacy of a novel computer treatment for aphasia and to evaluate the impact of treatment intensity. Design: Randomized single-blind clinical trial. Setting: Rehabilitation facility. Participants: 13 people with chronic nonfluent aphasia. Intervention: A computer treatment (Oral Reading for Language in Aphasia [ORLA]) that provides practice in reading aloud sentences in unison with an animated agent that produced visible speech much like a therapist. Subjects received either 4 hours or 10 hours of treatment a week for 6 weeks. Main Outcome Measure: Change in Aphasia Quotient (AQ) of the Western Aphasia Battery from pretreatment to post-treatment. Increases of 5 points are considered significant. Results: The mean change ⫾ SD in AQ for all subjects was 5.3⫾6.9. The mean change in AQ score was 6.4⫾5.8 for the 10-hour group and 5.3⫾6.9 for the 4-hour group. These changes compare favorably with changes of only ⫺.36⫾3.1 AQ points during a no-treatment control period for 25 subjects participating in a previous study. Conclusions: The computerized ORLA treatment may be efficacious for patients with chronic Broca’s aphasia. There was a trend for greater language improvements with increased intensity of therapy. Additional subjects are currently being studied. Key Words: Aphasia; Computers; Rehabilitation. Poster 70 Very Early Use of Intrathecal Baclofen in a Stroke Patient Is Safe and Efficacious: A Case Report. S. Azhar (Lutheran Medical Center, Brooklyn, NY). Disclosure: None declared. A 42-year-old man who suffered a partial left middle cerebral artery stroke with right hemiparesis developed spastic hypertonia 5 days later. The patient had a Modified Ashworth Scale (MAS) score of 3 in the upper extremity and 3 to 4 in the lower extremity with sustained clonus of the right foot. He underwent a trial with a 50g bolus injection of baclofen with a decrease in both upper- and lowerextremity MAS scores and improved gait velocity. A baclofen pump was implanted on day 15 poststroke, with no adverse effects. 15 months later the patient is ambulating with a quad cane in the community and still requires intrathecal baclofen (ITB) therapy for both static and dynamic spasticity. ITB therapy is well tolerated and improves spasticity in stroke patients in very early recovery. Key Words: Baclofen; Muscle spasticity; Rehabilitation; Stroke. Poster 71 Stroke Care and Outcomes in 2 Italian Health Authorities. M. Stuart (University of Maryland, Baltimore, MD), F. Benvenuti, M. Nerattini, D. Papini. Disclosure: None declared. Objectives: To establish baseline data in 2 defined populations in preparation for a translational research program for chronic stroke to be implemented in Empoli, Italy; and to compare structure, process, and outcomes between 2 independent health authorities in Italy for
2006 CONGRESS ANNUAL MEETING ABSTRACTS
question whether the clinical scales are encompassing enough of the symptom range to adequately represent a patient’s motor performance state. Key Words: Parkinson disease; Rehabilitation. Poster 67 Impaired Visual Perception in a Patient With Idiopathic Parkinson’s Disease With Otherwise Intact Cognitive Function: A Case Report. S. Levy-Tzedek (MIT, Cambridge, MA), J. Arle, J.L Shils, C. Gould, H. Krebs, D. Penny. Disclosure: None declared. We present a 61-year-old man with a 15-year history of Parkinson’s disease (PD), who underwent bilateral deep-brain stimulation (DBS) surgery in the subthalamic nucleus 1 year before the experiment. Neuropsychologic testing showed mild difficulties with high-level executive functioning, but low visuospatial scanning and mild impairment in visuospatial organization within the context of otherwise intact visuospatial perception and constructional problem-solving abilities. New learning abilities were mildly variable secondary to difficulties in acquisition and retrieval functions within the context of intact encoding capacities. With the DBS turned on and off, the patient scored 2.5 on the Modified Hoehn and Yahr scale. The motor part score on the Unified Parkinson’s Disease Rating Scale part III (range, 0 –108) was 11 with DBS on and 22 with DBS off. The patient was asked to manipulate a robotic manipulandum using his wrist, to perform pointto-point reaching movements. He followed a visual target on a computer screen, moving to randomly presented targets around a periphery and back to a center target. After practicing the task, the patient was tested first in the DBS-on then -off state. Throughout the experiment, the patient’s normal medication regimen was followed. Consistently, the patient performed poorly both in the DBS-on and the DBS-off states, exhibiting an inability to perform the predictable back-to-thecenter task. It most likely correlated with his neuropsychologic testing, reflecting abnormal visuospatial testing. Those findings support deficits in visuospatial ability in PD and show the remarkable variability across the spectrum of patients with this disease. Key Words: Rehabilitation; Robotics. Poster 68 Efficacy of Cortical Stimulation Combined With Intensive Language Therapy for Patients With Chronic Broca’s Aphasia. Leora Cherney (Rehabilitation Institute of Chicago, Chicago, IL), Edna Babbitt, Rosalind Hurwitz, Steven Small. Disclosure: None declared. Objective: To test the efficacy of targeted epidural cortical stimulation delivered concurrent with speech-language therapy in stroke subjects with Broca’s aphasia. Design: Phase 1 randomized singleblinded clinical trial. Setting: Rehabilitation facility. Participants: 5 subjects with chronic Broca’s aphasia after ischemic stroke of the left cerebral hemisphere. Intervention: 2 subjects (investigational group) were implanted with an investigational cortical stimulation device; placement of electrodes was identified by functional magnetic resonance imaging. These subjects received cortical stimulation delivered concurrent with intensive speech-language therapy for 6 weeks. 3 subjects (control group) received identical intensive speech-language therapy. Language therapy included apraxia drills, cued naming tasks, choral reading of sentences, and conversation practice. Main Outcome Measures: Change in Aphasia Quotient (AQ) of the Western Aphasia Battery from pretreatment to post-treatment. Increases of 5 points are considered significant. Results: Investigational subjects had increases of 15.0 and 3.45 points; control subjects showed increases of 11.90, 3.95, and 2.65 points. Language changes were maintained or improved at 6-week and 12-week follow-ups, with 1 investigational Arch Phys Med Rehabil Vol 87, October 2006
subject showing an overall gain of 20.3 AQ points at week 12 followup. Conclusions: Cortical stimulation in combination with intensive speech-language therapy may enhance language rehabilitation for chronic Broca’s aphasia. Additional subjects are currently being studied. Key Words: Aphasia; Rehabilitation. Poster 69 Computer Treatment for Aphasia: Efficacy and Treatment Intensity. L. Cherney (Rehabilitation Institute of Chicago, Chicago, IL), E. Babbitt, R. Cole, S. Van Vuuren, R. Hurwitz, N. Ngampatipatpong. Disclosure: None declared. Objectives: To assess the efficacy of a novel computer treatment for aphasia and to evaluate the impact of treatment intensity. Design: Randomized single-blind clinical trial. Setting: Rehabilitation facility. Participants: 13 people with chronic nonfluent aphasia. Intervention: A computer treatment (Oral Reading for Language in Aphasia [ORLA]) that provides practice in reading aloud sentences in unison with an animated agent that produced visible speech much like a therapist. Subjects received either 4 hours or 10 hours of treatment a week for 6 weeks. Main Outcome Measure: Change in Aphasia Quotient (AQ) of the Western Aphasia Battery from pretreatment to post-treatment. Increases of 5 points are considered significant. Results: The mean change ⫾ SD in AQ for all subjects was 5.3⫾6.9. The mean change in AQ score was 6.4⫾5.8 for the 10-hour group and 5.3⫾6.9 for the 4-hour group. These changes compare favorably with changes of only ⫺.36⫾3.1 AQ points during a no-treatment control period for 25 subjects participating in a previous study. Conclusions: The computerized ORLA treatment may be efficacious for patients with chronic Broca’s aphasia. There was a trend for greater language improvements with increased intensity of therapy. Additional subjects are currently being studied. Key Words: Aphasia; Computers; Rehabilitation. Poster 70 Very Early Use of Intrathecal Baclofen in a Stroke Patient Is Safe and Efficacious: A Case Report. S. Azhar (Lutheran Medical Center, Brooklyn, NY). Disclosure: None declared. A 42-year-old man who suffered a partial left middle cerebral artery stroke with right hemiparesis developed spastic hypertonia 5 days later. The patient had a Modified Ashworth Scale (MAS) score of 3 in the upper extremity and 3 to 4 in the lower extremity with sustained clonus of the right foot. He underwent a trial with a 50g bolus injection of baclofen with a decrease in both upper- and lowerextremity MAS scores and improved gait velocity. A baclofen pump was implanted on day 15 poststroke, with no adverse effects. 15 months later the patient is ambulating with a quad cane in the community and still requires intrathecal baclofen (ITB) therapy for both static and dynamic spasticity. ITB therapy is well tolerated and improves spasticity in stroke patients in very early recovery. Key Words: Baclofen; Muscle spasticity; Rehabilitation; Stroke. Poster 71 Stroke Care and Outcomes in 2 Italian Health Authorities. M. Stuart (University of Maryland, Baltimore, MD), F. Benvenuti, M. Nerattini, D. Papini. Disclosure: None declared. Objectives: To establish baseline data in 2 defined populations in preparation for a translational research program for chronic stroke to be implemented in Empoli, Italy; and to compare structure, process, and outcomes between 2 independent health authorities in Italy for