- Email: [email protected]
Poster 84: The Effects of Revised Exercise Programs for People with Disabilities Who Already Exercise
2009 ACRM–ASNR JOINT EDUCATIONAL CONFERENCE ABSTRACTS
Measurement, Health Policy, and Other Poster 82 Peer Mentoring Outcomes and Processes in In-Patient Rehabilitation: A Mixed-Methods Study Integrating Multiple Stakeholder Perspectives. Susan Magasi (Northwestern University, Brookfield, IL), Christina Papadimitriou, Lisa Rosen, Kristine Cichowski. Disclosure: None declared. Objective: To evaluate the outcomes and processes of a coordinated peer mentoring program in inpatient rehabilitation from the perspective of multiple rehabilitation stakeholders. Design: Iterative 3-phase mixed-methods design, including: (1) in-person patient surveys, (2) peer mentor focus groups, and (3) an internet-based survey of rehabilitation providers. Setting: Large free-standing rehabilitation hospital in the Midwestern United States. Participants: Rehabilitation inpatients (n⫽50), trained peer mentors with spinal cord injuries, strokes, traumatic brain injuries and amputations (n⫽19), rehabilitation professionals (n⫽366). Interventions: Not applicable. Main Outcome Measures: (1) 20-item in-person patient satisfaction survey that evaluates peer mentoring outcomes and processes, including: perceived benefits, quality of interactions, overall satisfaction, and resources sharing. (2) 27-item internet-based provider survey of knowledge and use of peer mentoring services including barriers to use. Results: Rehabilitation inpatients (94%) rated peer mentoring as an important component of the rehabilitation process. Inpatients reported receiving informational (90%), emotional (77%) and appraisal support (94%) from their interactions with disabled peer mentors. Informational support was most frequently related to independent living and community participation. Providers rated peer mentoring as an important component of the rehabilitation process (98%) and endorsed its coordination with clinical staff to support integration (60%) and communication (76%). Survey and focus group data point to the importance of systematic coordination of clinical and nonclinical staff for a successful peer mentoring program. They also suggest that important barriers to successful integration of peer mentors include concerns over patients’ readiness for peer interventions, clinician time constraints, and reduced patient stays. Conclusions: This study elucidates the process, outcomes, and integration of a coordinated peer mentoring program in inpatient rehabilitation. The study findings can help inform the development of best practice guidelines for peer mentoring services. Key Words: Program evaluation; Rehabilitation. Poster 83 Locked-In Syndrome in Children: Etiology, Diagnosis and Prognosis. Review of the Literature and Report of Cases. Marie-Aure´lie Bruno (University of Lie`ge, Lie`ge, Belgium), Caroline Schnakers, Franc¸ois Damas, Fre´de´ric Pellas, Steve Majerus, Gustave Moonen, Serge Goldman, Steven Laureys. Disclosure: None declared. Objectives: Some children may awake from their coma being nearly completely paralyzed and only able to communicate via eye movements. This condition is called the Locked-In Syndrome (LIS) (Plum and Posner, 1983) and is a rare neurologic disorder defined by the presence of sustained eye opening, preserved awareness, aphonia or hypophonia, quadriplegia or quadriparesis, and a primary mode of communication that uses vertical or lateral eye movement or blinking. The rarity of LIS in children causes the diagnosis to be oftentimes missed and/or delayed. Additionally, there is not much literature informing pediatric physicians and medical professionals about the management of LIS in children. Data Sources: Medline search September 2008 for papers in English, French, Spanish and German. Retrospective multicentric case-series. Study Selection: We here review previous literature on LIS in children and adolescents and report
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5 cases. Data Extraction: The most common etiology is ventral pontine stroke (20 out of 33 published cases including our 5 patients; ie, 61%), most frequently caused by a vertebrobasilar artery thrombosis or occlusion. Concerning the prognosis, 2 of our reported cases died (3 months and 2.5 years after onset; the former after treatment withholding) and 3 survived (one up to 11 years postinsult) remaining with a severely handicapped motricity. The most pediatric LIS patients show some motor recovery (11 out of 31; 35%); in 26% good recovery was reported, 16% remained quadriplegic and anarthric, and 23% died. Data Synthesis: Our review is the first to summarize LIS case-studies in children. Due to the rarity of the condition in children, the diagnosis of LIS may be missed and patients may wrongly be considered as being in a coma, vegetative state, or akinetic mutism. Conclusions: The discussed data stress the need for pediatric physicians to carefully interpret signs and symptoms of LIS. Key Words: Children; Locked-in syndrome; Rehabilitation. Poster 84 The Effects of Revised Exercise Programs for People with Disabilities Who Already Exercise. Nancy Flinn (Courage Center, Minneapolis, MN), Erin Simunds. Disclosure: None declared. Objective: To evaluate the effectiveness of re-evaluation and revision of exercise programs for people with disabilities who have been exercising regularly. Design: Cohort analysis. Setting: Fully accessible fitness program in a community-based rehabilitation center. Participants: Fifty-eight adults with disabilities who had been exercising for an average of 31 months⫾14.0. The participants had a variety of medical diagnoses, including brain injury (12), cerebral palsy (10), neurological diseases (9), stroke (8), spinal cord injury (5) and other (13). 28 women and 30 men enrolled in the project, with an average age 43.7 years ⫾11.8. Interventions: The primary intervention was an individualized exercise program. There were 3 points of evaluation: original intake into program, when the original exercise program was developed; the first reevaluation, during which a revised exercise program addressing strengthening, endurance, and flexibility was presented; the second reevaluation was completed after participants had exercised independently or with assistance for a 6-month period using the revised program. Main Outcome Measures: Endurance, strength, weight and secondary conditions. Results: Participants made significant gains in endurance, but changes in exercise program appeared to have no significant effect on strength or weight loss. Participants reported significant decreases in secondary conditions (P⫽.04), with an average decrease of .73 conditions between their original intake into the exercise program and the second reevaluation. Most commonly decreased conditions included bone and joint pain, leg pain with activity, and breathing problems. Conclusions: Program revision increased the intensity of the exercise program, and resulted in increased endurance, but not in increased strength or weight loss. The 37 months of exercise participation did decrease secondary conditions in the sample. This study demonstrates the value exercise in health promotion for a sample of individuals with a variety of disabilities. Key Words: Disability; Exercise; Rehabilitation. Poster 85 Payment-Efficiency Analysis of Joint Replacement Rehabilitation in Skilled Nursing and Inpatient Rehabilitation Facilities. Wenqiang Tian (National Rehabilitation Hospital, Washington, DC), Gerben DeJong, Koen Putman. Disclosure: None declared. Objective: To assess the payment-efficiency for joint replacement rehabilitation in skilled nursing facilities (SNFs) and inpatient Arch Phys Med Rehabil Vol 90, October 2009
Measurement, Health Policy, and Other Poster 82 Peer Mentoring Outcomes and Processes in In-Patient Rehabilitation: A Mixed-Methods Study Integrating Multiple Stakeholder Perspectives. Susan Magasi (Northwestern University, Brookfield, IL), Christina Papadimitriou, Lisa Rosen, Kristine Cichowski. Disclosure: None declared. Objective: To evaluate the outcomes and processes of a coordinated peer mentoring program in inpatient rehabilitation from the perspective of multiple rehabilitation stakeholders. Design: Iterative 3-phase mixed-methods design, including: (1) in-person patient surveys, (2) peer mentor focus groups, and (3) an internet-based survey of rehabilitation providers. Setting: Large free-standing rehabilitation hospital in the Midwestern United States. Participants: Rehabilitation inpatients (n⫽50), trained peer mentors with spinal cord injuries, strokes, traumatic brain injuries and amputations (n⫽19), rehabilitation professionals (n⫽366). Interventions: Not applicable. Main Outcome Measures: (1) 20-item in-person patient satisfaction survey that evaluates peer mentoring outcomes and processes, including: perceived benefits, quality of interactions, overall satisfaction, and resources sharing. (2) 27-item internet-based provider survey of knowledge and use of peer mentoring services including barriers to use. Results: Rehabilitation inpatients (94%) rated peer mentoring as an important component of the rehabilitation process. Inpatients reported receiving informational (90%), emotional (77%) and appraisal support (94%) from their interactions with disabled peer mentors. Informational support was most frequently related to independent living and community participation. Providers rated peer mentoring as an important component of the rehabilitation process (98%) and endorsed its coordination with clinical staff to support integration (60%) and communication (76%). Survey and focus group data point to the importance of systematic coordination of clinical and nonclinical staff for a successful peer mentoring program. They also suggest that important barriers to successful integration of peer mentors include concerns over patients’ readiness for peer interventions, clinician time constraints, and reduced patient stays. Conclusions: This study elucidates the process, outcomes, and integration of a coordinated peer mentoring program in inpatient rehabilitation. The study findings can help inform the development of best practice guidelines for peer mentoring services. Key Words: Program evaluation; Rehabilitation. Poster 83 Locked-In Syndrome in Children: Etiology, Diagnosis and Prognosis. Review of the Literature and Report of Cases. Marie-Aure´lie Bruno (University of Lie`ge, Lie`ge, Belgium), Caroline Schnakers, Franc¸ois Damas, Fre´de´ric Pellas, Steve Majerus, Gustave Moonen, Serge Goldman, Steven Laureys. Disclosure: None declared. Objectives: Some children may awake from their coma being nearly completely paralyzed and only able to communicate via eye movements. This condition is called the Locked-In Syndrome (LIS) (Plum and Posner, 1983) and is a rare neurologic disorder defined by the presence of sustained eye opening, preserved awareness, aphonia or hypophonia, quadriplegia or quadriparesis, and a primary mode of communication that uses vertical or lateral eye movement or blinking. The rarity of LIS in children causes the diagnosis to be oftentimes missed and/or delayed. Additionally, there is not much literature informing pediatric physicians and medical professionals about the management of LIS in children. Data Sources: Medline search September 2008 for papers in English, French, Spanish and German. Retrospective multicentric case-series. Study Selection: We here review previous literature on LIS in children and adolescents and report
E37
5 cases. Data Extraction: The most common etiology is ventral pontine stroke (20 out of 33 published cases including our 5 patients; ie, 61%), most frequently caused by a vertebrobasilar artery thrombosis or occlusion. Concerning the prognosis, 2 of our reported cases died (3 months and 2.5 years after onset; the former after treatment withholding) and 3 survived (one up to 11 years postinsult) remaining with a severely handicapped motricity. The most pediatric LIS patients show some motor recovery (11 out of 31; 35%); in 26% good recovery was reported, 16% remained quadriplegic and anarthric, and 23% died. Data Synthesis: Our review is the first to summarize LIS case-studies in children. Due to the rarity of the condition in children, the diagnosis of LIS may be missed and patients may wrongly be considered as being in a coma, vegetative state, or akinetic mutism. Conclusions: The discussed data stress the need for pediatric physicians to carefully interpret signs and symptoms of LIS. Key Words: Children; Locked-in syndrome; Rehabilitation. Poster 84 The Effects of Revised Exercise Programs for People with Disabilities Who Already Exercise. Nancy Flinn (Courage Center, Minneapolis, MN), Erin Simunds. Disclosure: None declared. Objective: To evaluate the effectiveness of re-evaluation and revision of exercise programs for people with disabilities who have been exercising regularly. Design: Cohort analysis. Setting: Fully accessible fitness program in a community-based rehabilitation center. Participants: Fifty-eight adults with disabilities who had been exercising for an average of 31 months⫾14.0. The participants had a variety of medical diagnoses, including brain injury (12), cerebral palsy (10), neurological diseases (9), stroke (8), spinal cord injury (5) and other (13). 28 women and 30 men enrolled in the project, with an average age 43.7 years ⫾11.8. Interventions: The primary intervention was an individualized exercise program. There were 3 points of evaluation: original intake into program, when the original exercise program was developed; the first reevaluation, during which a revised exercise program addressing strengthening, endurance, and flexibility was presented; the second reevaluation was completed after participants had exercised independently or with assistance for a 6-month period using the revised program. Main Outcome Measures: Endurance, strength, weight and secondary conditions. Results: Participants made significant gains in endurance, but changes in exercise program appeared to have no significant effect on strength or weight loss. Participants reported significant decreases in secondary conditions (P⫽.04), with an average decrease of .73 conditions between their original intake into the exercise program and the second reevaluation. Most commonly decreased conditions included bone and joint pain, leg pain with activity, and breathing problems. Conclusions: Program revision increased the intensity of the exercise program, and resulted in increased endurance, but not in increased strength or weight loss. The 37 months of exercise participation did decrease secondary conditions in the sample. This study demonstrates the value exercise in health promotion for a sample of individuals with a variety of disabilities. Key Words: Disability; Exercise; Rehabilitation. Poster 85 Payment-Efficiency Analysis of Joint Replacement Rehabilitation in Skilled Nursing and Inpatient Rehabilitation Facilities. Wenqiang Tian (National Rehabilitation Hospital, Washington, DC), Gerben DeJong, Koen Putman. Disclosure: None declared. Objective: To assess the payment-efficiency for joint replacement rehabilitation in skilled nursing facilities (SNFs) and inpatient Arch Phys Med Rehabil Vol 90, October 2009