- Email: [email protected]
Poster 93: Characterization of Upper Extremity Motion in Grasping and Reaching using Inertial Sensor Based Motion Capture System
Abstracts / PM R 9 (2017) S131-S290 Main Outcome Measures: Post-intervention caliper measurements of the dye spread were taken after each technique. A descriptive analysis of the dye diffusion before and after technique application was presented. A two-way ANOVA for repeated measurements was applied. In function of the ANOVA, a post LSD Fisher test was applied (p.05). Results: After the first mobilization, the mean experimental posttest, longitudinal dye spread measurement (7.516.63mm) was significantly greater (p¼.024) compared to the resting position. There was a significant diffusion effect with either tensioning (p¼.018) or sliding (p¼.016), with no statistically significant difference between both techniques (p¼.976, TT: 7.55.5mm SLT: 7.58.1mm). The order in which TT and SLT were administered did not influence diffusion in a significant way. Conclusions: Passive neurodynamic techniques in the form of 5-minute therapy of tensioning or sliding induced significant fluid dispersion in the median nerve at the level of the carpal tunnel of human cadavers. The close nerve relationship with the ligament could have had an increased effect as this has been previously suspected. These data provide an explanation regarding a potential mechanism of NDM in reducing intraneural edema. Level of Evidence: Level IV Poster 90: Safety and Efficacy of Repeated Abobotulinumtoxin A Injections for Dynamic Equinus Foot in Children Less Than 6 Years of Age: A Subgroup Analysis Ann Tilton (LSUHSC & Children’s Hospital New Orleans, New Orleans, LA, USA), Mark Gormley, MD, Edward Dabrowski, MD, Dennis J. Matthews, MD, Luisa Rodriguez Pose, MD, Anne-Sophie AS. Grandoulier, MD, Philippe Picaut, Pharm D, PhD, Mauricio R. Delgado, MD Disclosures: Ann Tilton: Research Grants - Ipsen, Consulting fees or other remuneration (payment) - Ipsen Objective: The safety and efficacy of single injections of abobotulinumtoxinA for pediatric dynamic equinus have recently been established in a Phase 3 trial. Treatment often begins in early childhood; we describe the effect of repeat injections from the open-label extension study, focusing on the subgroup of children aged <6 years. Design: Open-label extension study of repeat (up to 4 cycles) abobotulinumtoxinA injections into the gastrocnemius-soleus complex. Doses could be individually adjusted (minimum 5U/kg, maximum 30U/ kg) and other limb muscles were injected as required. Data were analyzed for the total safety population (TP; N¼216) and the younger patient subgroup aged <6 years (YP; N¼127). Setting: 23 sites across 6 countries. Participants: Ambulatory children (aged 2e17 y) with dynamic equinus due to cerebral palsy. Interventions: Repeated lower limb abobotulinumtoxinA injections. Main Outcome Measures: Mean change in Modified Ashworth Scale (MAS) and Physician’s Global Assessment (PGA) scores, and adverse events (AEs). Results: MeanSD age was 5.93.3y in the TP and 3.71.0y in the YP (both groups 60% male). Compared to the TP, more children were botulinum toxin treatment naı¨ve in the YP (53.2 vs. 63.8%). Treatmentemergent adverse events (TEAEs) were reported in 73.5% of the TP and 75.2% of the YP, the most common being upper respiratory infection in both groups. 1 patient (YP) withdrew from the study due to a TEAE in Cycle 1 (unrelated to treatment). Rates of serious AEs were also similar (TP:3.4%, YP: 5.0%). The magnitude of efficacy across open-label treatment cycles 1e3 was similar; mean change from baseline to Week-4 in MAS scores ranged from -1.0 to -1.1 in the TP and from -0.95 to -1.1 in the YP; mean Week-4 PGA scores were 1.4e1.5 in both groups. Conclusions: The efficacy and safety of abobotulinumtoxinA injections appear to be similar in the sub-population of younger children aged <6 years as compared to the total safety population. Level of Evidence: Level I
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Poster 92: Evaluation of Clinical Institute Withdrawal Assessment for Alcohol (CIWA) in Patients with Traumatic Brain Injury Jessica L. Hupe, MD (Virginia Commonwealth Univ Hlth Sys, Richmond, VA, United States), William E. Carter, MD, James Newman, MD, Adam Sima, PhD Disclosures: Jessica Hupe: I Have No Relevant Financial Relationships To Disclose Objective: Clinical Institute Withdrawal Assessment (CIWA) information regarding TBI severity outcomes and the role and impact of the Clinical Institute Withdrawal Assessment (CIWA) protocol on patient care is unclear. The purpose of this study is to evaluate the use and outcomes of those with TBI who received the CIWA protocol with primary hypothesis that severity of TBI will be positively correlated with elevated CIWA scores. Design: Retrospective cohort study. Setting: Single level one trauma center. Participants: 375 subjects identified from a single level 1 trauma center’s trauma registry positive for alcohol and/or who had suffered a brain injury from January 2009- July 2015. Inclusion criteria included CIWA protocol being implemented, age greater than 16, length of stay of at least 5 days. Interventions: Not Applicable. Main Outcome Measures: Frequency of elevated CIWA score, seizure incidence, medication administration incidence based on TBI severity. Results: When TBI specific outcomes are examined, no significant difference is found in the length of CIWA protocol utilization in days based on TBI severity. Patients with no TBI were on CIWA protocol for an average of 3.4 days, mild TBI 3.7 days, moderate TBI 4.2 days and severe TBI 4.0 days. Patients with no TBI were treated in the acute care hospital for an average of 7.0 days, mild TBI 9.0 days, moderate TBI 10.0 days and severe TBI 18.5 days. For subjects with no diagnosis of TBI the percentage of subjects receiving a CIWA score greater than eight was 4.5%, for mild TBI 12.5%, for moderate TBI 27.1% and for severe TBI the percentage of subjects receiving a CIWA score greater than eight was 50.0%. Conclusions: Subjects with TBI were assigned higher CIWA scores then their non-TBI counterparts. This highlights the importance of differentiating between acute ETOH withdrawal and TBI sequela when implementing CIWA protocol during acute care hospitalization. Level of Evidence: Level III Poster 93: Characterization of Upper Extremity Motion in Grasping and Reaching using Inertial Sensor Based Motion Capture System Hyung Seok Nam (Seoul National University College of Medicine), Han Gil Seo, MD, Sungwan Kim, PhD Disclosures: Hyung Seok Nam: I Have No Relevant Financial Relationships To Disclose Objective: To characterize upper extremity joint movements while performing grasping and reaching tasks in order to apply to the design of simplified rehabilitation robots. Design: Observational measurement study. Setting: University biomedical engineering and rehabilitation department. Participants: Five healthy volunteers without any upper limb impairments. Interventions: A whole body motion capture system based on 9-axis inertial measurement unit sensors were put on the volunteers and the upper extremity movements were recorded while performing the Action Research Arm Test (ARAT) tasks. Main Outcome Measures: Grasping (6 trials for each subject), pinching (6), and reaching (12) movements of the dominant arm during
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the ARAT tasks were taken into analysis. Angular positions and range of motion for shoulder internal rotation, elbow flexion, forearm supination, and wrist dorsiflexion/volarflexion were extracted. Neutral positions for shoulder rotation and wrist flexion, and full elbow extension and forearm pronation were set as zero degree. Results: Angular positions while grasping for shoulder internal rotation, elbow flexion, forearm supination, and wrist volarflexion were 90.672.69, 4.493.77, 29.012.43, and 22.062.66 degrees (meanstandard error mean), respectively, and 83.791.27, 1.501.28, 26.012.36, and 12.812.11 degrees for pinching, respectively (p¼.024, .455, .379, and .009 for grasping vs pinching, by independent t test). While reaching to a top of an eye-level shelf, the range of motion for each movement components in the direction of shoulder external rotation, elbow extension, forearm pronation, and wrist dorsiflexion were 68.8115.19, 19.7616.67, 38.6510.08, and 12.019.49 degrees (meanstandard deviation), respectively. Conclusions: This study provides essential angular positions and range of motion for major upper extremity joints for performing reaching, grasping, and pinching movements. This may serve as an important database for designing simplified and light weight upper extremity rehabilitation robots. Further investigation on angular characteristics during various activities of daily living is necessary. Level of Evidence: Level III
Poster 94: Posterior Cord Syndrome: Demographics and Rehabilitation Outcomes Adam S. Hills (Virginia Commonwealth University), William McKinley, MD Disclosures: Adam Hills: I Have No Relevant Financial Relationships To Disclose Objective: To describe demographics, clinical characteristics, and functional outcomes of patients with incomplete spinal cord injuries and a diagnosis of posterior cord syndrome (PCS). Design: A retrospective case series. Setting: A spinal cord injury (SCI) rehabilitation unit at a Level 1 tertiary university medical center. Participants: 9 patients with incomplete cord injuries and PCS admitted within the past 5 years. Interventions: Not applicable. Main Outcome Measures: Functional Independence Measure (FIM) motor scores, length of stay (LOS), discharge disposition. Results: Average age at onset of incomplete SCI with PCS was 61.5 years. Racial makeup was as follows: Caucasian (4), African American (3), African (1), Asian (1). 78% of patients developed paraparesis vs. 22% tetraparesis. All patients received an American Spinal Injury Association impairment scale (AIS) classification of AIS D. Most common etiology was spinal cord compression (78%) from localized tumors [thoracic (5), lumbar (1), cervical (1)]; other etiologies included thoracic epidural abscess and severe cervical spinal stenosis. SCI-related complications most commonly included: neuropathic pain (78%), spasticity (44%), neurogenic bladder (44%), neurogenic bowel (33%), and UTI (33%). Average LOS on the rehabilitation unit was 22 days. Average admission and discharge FIM motor scores were 28 and 56, respectively. Continence at admission and discharge was 22% vs 56% (for bladder) and 67% vs 78% (for bowel). 67% of patients were able to walk at least 150 feet with a rolling walker prior to discharge. 67% of patients were discharged home. Conclusions: We can conclude that PCS most often results in paraparesis due to tumor compression, and in typical SCI-related medical complications. These patients often experience significant functional improvements during SCI rehabilitation with the majority also having bladder and bowel continence allowing them to return home at discharge. Level of Evidence: Level IV
Poster 95: Functional Decline in Multiple Sclerosis: Effect of Etiology on the Outcome of Rehabilitation Kanakadurga R. Poduri, MD (Univ of Rochester, Rochester, NY, United States), Jean L. Nickels, MD, Catherine O. Flanagan, RN, MBA Disclosures: Kanakadurga Poduri: I Have No Relevant Financial Relationships To Disclose Objective: Multiple sclerosis (MS) is a disease with chronic disability resulting in progressive functional decline. The common causes for the decline are disease exacerbation/progression and unrelated illnesses. The purpose of this study is to compare the outcome of rehabilitation on functional decline from an exacerbation/progression versus an unrelated illness. Design: A retrospective study of patients who underwent acute inpatient rehabilitation with MS and an admitting diagnosis of exacerbation/progression versus an unrelated illness resulting in functional decline. Setting: Acute inpatient rehabilitation. Participants: 51 patients with average age of 58 years with a diagnosis of MS who underwent rehabilitation between 2011 and 2016. They were divided into two groups; group I with an exacerbation/progression resulting in functional decline and group II with an illness that was unrelated to MS. Interventions: The multidisciplinary team assessed the functional status of the patients through the Functional Independence Measure (FIM) at admission and discharge. Patients’ length of rehabilitation stay (LOS), FIM gain and Length of Stay Efficiency(LSE) (LSE ¼ LOS/FIM gain) were recorded. Main Outcome Measures: FIM Gain and LSE and the effect of etiology: exacerbation/progression vs. unrelated illness. Results: Group I was younger 54 vs. 61 group II. The difference of the mean age is significant at p<.05. The means of admission FIM (68 and 69), discharge FIM (90 and 96) and LOS (17 and 19 days) for the groups are not significant. The mean FIM gain 26 vs 22 is also not significantly different with the standard error of 3.15 for the difference (Z¼1.27). The Length of Stay Efficiencies (LSE) for the groups are significantly different (mean 2 vs. 1.42, standard error of the difference of the means is 0.28 with a Z¼ 2.1 and the p <.05). Conclusions: MS patients with functional decline from exacerbation/ progression make more efficient functional improvements with rehabilitation than patients whose functional decline is due to an illness. Level of Evidence: Level III Poster 96: Additive Effects of b-3 Agonist (Mirabegron) for Treatment of Neurogenic Detrusor Overactivity in Spinal Cord Injury Patients who had been Treated with Antimuscarinic Agent Jeong-Hwan Seo, MD, PhD (Chonbul Nat Univ Hosp) Disclosures: Jeong-Hwan Seo: I Have No Relevant Financial Relationships To Disclose Objective: Mirabegron is a beta-3 adrenoreceptor agonist used to treat neurogenic detrusor overactivity by relaxing detrusor muscle. Combination of conventional antimuscarinic drug and mirabegron can be more effective in spinal cord injury, however related study is hardly can be seen. The objective is to see the additive effect of mirabegron to the neurogenic bladder of spinal cord injury. Design: Single center, retrospective, clinical study. Setting: University hospital setting. Participants: Twenty-five spinal cord injured patients who were able to void without intermittent catheterization. Interventions: When anti-muscarinic drug usage was not effective enough, mirabegron was added to see some clinical differences.
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Poster 92: Evaluation of Clinical Institute Withdrawal Assessment for Alcohol (CIWA) in Patients with Traumatic Brain Injury Jessica L. Hupe, MD (Virginia Commonwealth Univ Hlth Sys, Richmond, VA, United States), William E. Carter, MD, James Newman, MD, Adam Sima, PhD Disclosures: Jessica Hupe: I Have No Relevant Financial Relationships To Disclose Objective: Clinical Institute Withdrawal Assessment (CIWA) information regarding TBI severity outcomes and the role and impact of the Clinical Institute Withdrawal Assessment (CIWA) protocol on patient care is unclear. The purpose of this study is to evaluate the use and outcomes of those with TBI who received the CIWA protocol with primary hypothesis that severity of TBI will be positively correlated with elevated CIWA scores. Design: Retrospective cohort study. Setting: Single level one trauma center. Participants: 375 subjects identified from a single level 1 trauma center’s trauma registry positive for alcohol and/or who had suffered a brain injury from January 2009- July 2015. Inclusion criteria included CIWA protocol being implemented, age greater than 16, length of stay of at least 5 days. Interventions: Not Applicable. Main Outcome Measures: Frequency of elevated CIWA score, seizure incidence, medication administration incidence based on TBI severity. Results: When TBI specific outcomes are examined, no significant difference is found in the length of CIWA protocol utilization in days based on TBI severity. Patients with no TBI were on CIWA protocol for an average of 3.4 days, mild TBI 3.7 days, moderate TBI 4.2 days and severe TBI 4.0 days. Patients with no TBI were treated in the acute care hospital for an average of 7.0 days, mild TBI 9.0 days, moderate TBI 10.0 days and severe TBI 18.5 days. For subjects with no diagnosis of TBI the percentage of subjects receiving a CIWA score greater than eight was 4.5%, for mild TBI 12.5%, for moderate TBI 27.1% and for severe TBI the percentage of subjects receiving a CIWA score greater than eight was 50.0%. Conclusions: Subjects with TBI were assigned higher CIWA scores then their non-TBI counterparts. This highlights the importance of differentiating between acute ETOH withdrawal and TBI sequela when implementing CIWA protocol during acute care hospitalization. Level of Evidence: Level III Poster 93: Characterization of Upper Extremity Motion in Grasping and Reaching using Inertial Sensor Based Motion Capture System Hyung Seok Nam (Seoul National University College of Medicine), Han Gil Seo, MD, Sungwan Kim, PhD Disclosures: Hyung Seok Nam: I Have No Relevant Financial Relationships To Disclose Objective: To characterize upper extremity joint movements while performing grasping and reaching tasks in order to apply to the design of simplified rehabilitation robots. Design: Observational measurement study. Setting: University biomedical engineering and rehabilitation department. Participants: Five healthy volunteers without any upper limb impairments. Interventions: A whole body motion capture system based on 9-axis inertial measurement unit sensors were put on the volunteers and the upper extremity movements were recorded while performing the Action Research Arm Test (ARAT) tasks. Main Outcome Measures: Grasping (6 trials for each subject), pinching (6), and reaching (12) movements of the dominant arm during
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the ARAT tasks were taken into analysis. Angular positions and range of motion for shoulder internal rotation, elbow flexion, forearm supination, and wrist dorsiflexion/volarflexion were extracted. Neutral positions for shoulder rotation and wrist flexion, and full elbow extension and forearm pronation were set as zero degree. Results: Angular positions while grasping for shoulder internal rotation, elbow flexion, forearm supination, and wrist volarflexion were 90.672.69, 4.493.77, 29.012.43, and 22.062.66 degrees (meanstandard error mean), respectively, and 83.791.27, 1.501.28, 26.012.36, and 12.812.11 degrees for pinching, respectively (p¼.024, .455, .379, and .009 for grasping vs pinching, by independent t test). While reaching to a top of an eye-level shelf, the range of motion for each movement components in the direction of shoulder external rotation, elbow extension, forearm pronation, and wrist dorsiflexion were 68.8115.19, 19.7616.67, 38.6510.08, and 12.019.49 degrees (meanstandard deviation), respectively. Conclusions: This study provides essential angular positions and range of motion for major upper extremity joints for performing reaching, grasping, and pinching movements. This may serve as an important database for designing simplified and light weight upper extremity rehabilitation robots. Further investigation on angular characteristics during various activities of daily living is necessary. Level of Evidence: Level III
Poster 94: Posterior Cord Syndrome: Demographics and Rehabilitation Outcomes Adam S. Hills (Virginia Commonwealth University), William McKinley, MD Disclosures: Adam Hills: I Have No Relevant Financial Relationships To Disclose Objective: To describe demographics, clinical characteristics, and functional outcomes of patients with incomplete spinal cord injuries and a diagnosis of posterior cord syndrome (PCS). Design: A retrospective case series. Setting: A spinal cord injury (SCI) rehabilitation unit at a Level 1 tertiary university medical center. Participants: 9 patients with incomplete cord injuries and PCS admitted within the past 5 years. Interventions: Not applicable. Main Outcome Measures: Functional Independence Measure (FIM) motor scores, length of stay (LOS), discharge disposition. Results: Average age at onset of incomplete SCI with PCS was 61.5 years. Racial makeup was as follows: Caucasian (4), African American (3), African (1), Asian (1). 78% of patients developed paraparesis vs. 22% tetraparesis. All patients received an American Spinal Injury Association impairment scale (AIS) classification of AIS D. Most common etiology was spinal cord compression (78%) from localized tumors [thoracic (5), lumbar (1), cervical (1)]; other etiologies included thoracic epidural abscess and severe cervical spinal stenosis. SCI-related complications most commonly included: neuropathic pain (78%), spasticity (44%), neurogenic bladder (44%), neurogenic bowel (33%), and UTI (33%). Average LOS on the rehabilitation unit was 22 days. Average admission and discharge FIM motor scores were 28 and 56, respectively. Continence at admission and discharge was 22% vs 56% (for bladder) and 67% vs 78% (for bowel). 67% of patients were able to walk at least 150 feet with a rolling walker prior to discharge. 67% of patients were discharged home. Conclusions: We can conclude that PCS most often results in paraparesis due to tumor compression, and in typical SCI-related medical complications. These patients often experience significant functional improvements during SCI rehabilitation with the majority also having bladder and bowel continence allowing them to return home at discharge. Level of Evidence: Level IV
Poster 95: Functional Decline in Multiple Sclerosis: Effect of Etiology on the Outcome of Rehabilitation Kanakadurga R. Poduri, MD (Univ of Rochester, Rochester, NY, United States), Jean L. Nickels, MD, Catherine O. Flanagan, RN, MBA Disclosures: Kanakadurga Poduri: I Have No Relevant Financial Relationships To Disclose Objective: Multiple sclerosis (MS) is a disease with chronic disability resulting in progressive functional decline. The common causes for the decline are disease exacerbation/progression and unrelated illnesses. The purpose of this study is to compare the outcome of rehabilitation on functional decline from an exacerbation/progression versus an unrelated illness. Design: A retrospective study of patients who underwent acute inpatient rehabilitation with MS and an admitting diagnosis of exacerbation/progression versus an unrelated illness resulting in functional decline. Setting: Acute inpatient rehabilitation. Participants: 51 patients with average age of 58 years with a diagnosis of MS who underwent rehabilitation between 2011 and 2016. They were divided into two groups; group I with an exacerbation/progression resulting in functional decline and group II with an illness that was unrelated to MS. Interventions: The multidisciplinary team assessed the functional status of the patients through the Functional Independence Measure (FIM) at admission and discharge. Patients’ length of rehabilitation stay (LOS), FIM gain and Length of Stay Efficiency(LSE) (LSE ¼ LOS/FIM gain) were recorded. Main Outcome Measures: FIM Gain and LSE and the effect of etiology: exacerbation/progression vs. unrelated illness. Results: Group I was younger 54 vs. 61 group II. The difference of the mean age is significant at p<.05. The means of admission FIM (68 and 69), discharge FIM (90 and 96) and LOS (17 and 19 days) for the groups are not significant. The mean FIM gain 26 vs 22 is also not significantly different with the standard error of 3.15 for the difference (Z¼1.27). The Length of Stay Efficiencies (LSE) for the groups are significantly different (mean 2 vs. 1.42, standard error of the difference of the means is 0.28 with a Z¼ 2.1 and the p <.05). Conclusions: MS patients with functional decline from exacerbation/ progression make more efficient functional improvements with rehabilitation than patients whose functional decline is due to an illness. Level of Evidence: Level III Poster 96: Additive Effects of b-3 Agonist (Mirabegron) for Treatment of Neurogenic Detrusor Overactivity in Spinal Cord Injury Patients who had been Treated with Antimuscarinic Agent Jeong-Hwan Seo, MD, PhD (Chonbul Nat Univ Hosp) Disclosures: Jeong-Hwan Seo: I Have No Relevant Financial Relationships To Disclose Objective: Mirabegron is a beta-3 adrenoreceptor agonist used to treat neurogenic detrusor overactivity by relaxing detrusor muscle. Combination of conventional antimuscarinic drug and mirabegron can be more effective in spinal cord injury, however related study is hardly can be seen. The objective is to see the additive effect of mirabegron to the neurogenic bladder of spinal cord injury. Design: Single center, retrospective, clinical study. Setting: University hospital setting. Participants: Twenty-five spinal cord injured patients who were able to void without intermittent catheterization. Interventions: When anti-muscarinic drug usage was not effective enough, mirabegron was added to see some clinical differences.