- Email: [email protected]
Presentation 9
2006 CONGRESS ANNUAL MEETING ABSTRACTS
will adequately identify at-risk drivers. The cost of a comprehensive driving evaluation is often related to the length of time required to administer the various clinical assessments and road test. By standardizing assessment methods for clinical and the behind-the-wheel portions of the comprehensive driving evaluation, practitioners should be able to more efficiently provide services to objectively and accurately identify at-risk drivers. Key Words: Activities of daily living; Aging; Cognition; Rehabilitation; Vision. Presentation 9 Stress in Women With Spinal Cord Injury. Anthony H. Lequerica (University of Michigan Health System, Ann Arbor, MI), Denise G. Tate, PhD. Disclosure: None declared. Objective: To examine how the perception of psychologic stressors reported by women with spinal cord injury (SCI) is associated with their experience of global stress and life satisfaction. Design: Survey. Setting: Collaboration between 2 large Midwestern medical centers. Participants: 50 women (age range, 22⫺85y) with SCI, including 24 African Americans and 26 whites. Interventions: Not applicable. Main Outcome Measures: Stressors mentioned during a semi-structured interview were coded and categorized according to context using NVivo software for qualitative data analysis. The degree to which participants spoke about stress as challenge versus loss was quantified and used to create a positive and negative stress appraisal group to examine the Pearson correlation between the experience of global stress (Perceived Stress Scale) and life satisfaction (Satisfaction With Life Scale) within each group. Results: The relative appraisal of stress as challenge versus loss was found to moderate the relationship between global stress and life satisfaction. The correlation between global stress and life satisfaction was significant in the negative stress appraisal group (r⫽⫺.61, P⫽.002) but not significant in the positive stress appraisal group (r⫽⫺.28, P⫽.178). Conclusions: These findings suggest a possible buffer effect of stress appraisal that supports the use of coping techniques such as cognitive reframing that may be effectively incorporated into stress management interventions for women with SCI. Key Words: Quality of life; Rehabilitation; Spinal cord injuries; Stress. Presentation 10 Evaluating Ankle-Foot Orthotics in Hemiplegic Stroke Patients Using Pedobarography. Karen J. Nolan (Kessler Medical Rehabilitation Research and Education Corp, University of Medicine and Dentistry, New Jersey-NJ Medical School, Newark, NJ), Howard J. Hillstrom, Sue Ann Sisto, Elie P. Elovic. Disclosure: None declared. Objective: To use dynamic pedobarography to evaluate the affect of an ankle-foot orthosis (AFO) on hemiplegic gait. Design: Subjects performed walking trials in 2 conditions: with an AFO and without an AFO while pedobarography data were collected using the Pedar-X, sampling at 100Hz. Setting: Clinical rehabilitation laboratory. Participants: 6 people with stroke-related hemiplegia were recruited for participation. Subjects were more than 6 months poststroke and used a prescribed AFO during ambulation. Interventions: Not applicable. Main Outcome Measures: Wireless pedobarography variables included regional analysis of peak pressure, maximum force, and pressure time integral (PTI) plantar to the foot. Results: Lateral (P⫽.006) and medial heel (P⫽.017) peak pressure and maximum force at the lateral heel (P⫽.033) were significantly reduced. Maximum force (P⫽.012) and PTI (P⫽.038) in the medial arch were significantly increased. Conclusions: The results of this pilot study suggest that pedobarography may become a valuable outcome measure in evaluating prescribed AFOs in hemiplegic gait. Data indicated that an
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AFO can significantly reduce plantar loading at the heel; more subjects are needed to clarify how and why plantar loading is altered with AFO use. Future research will focus on utilizing pedobarography to quantify changes in gait based on dynamic objective information acquired during walking with AFOs. Key Words: Gait; Hemiplegia; Rehabilitation. Presentation 11 Health-Related Quality of Life Outcomes of English- and SpanishSpeaking Persons Living With HIV and AIDS. Deepa Rao (Northwestern University, Chicago, IL), Elizabeth A. Hahn, David Cella, Lesbia Hernandez, Gail Shiomoto. Disclosure: None declared. Objective: To understand health-related quality of life (HRQOL) outcomes in a diverse sample of people living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) (PLWHA). Design: A survey design and regression analyses to explore the relationship between sociodemographic and clinical factors and HRQOL. Setting: Participants were recruited from multiple hospitals in the United States and Puerto Rico. Participants: Patients seeking treatment for HIV and AIDS (N⫽273) were referred for participation. Interventions: Not applicable. Main Outcome Measure: The study used the Functional Assessment of HIV Infection (FAHI), an illness-specific measure of HRQOL. Age, sex, ethnicity, education, insurance, language, living arrangement, literacy, antiretroviral status, CD4, and time since diagnosis were analyzed as independent variables. The physical, emotional, social, and functional and general well-being factors of the FAHI were analyzed as dependent variables. Results: Men and Spanish-speaking participants reported better physical well-being. Men also reported better functional and general well-being. Participants with a lower CD4 and Spanishspeaking Hispanics reported better emotional well-being. Participants who lived with others had a lower CD4, or who were white reported better social well-being. Conclusions: These results suggest that sociodemographic and clinical factors differentially influence HRQOL in PLWHA. This knowledge is essential for the development of targeted interventions aimed at improving the well-being of vulnerable PLWHA. Key Words: Acquired immune deficiency syndrome; HIV; Quality of life; Rehabilitation. Presentation 12 Preliminary Data From an Ongoing Study: Influence of Auditory Pacer on Gait Performance on Persons With Parkinson’s Disease. M. Suteerawattananon (Baylor College of Medicine, Houston, TX), D.H. Rintala, E.C. Lai, J.G. Hou, E.J. Protas. Disclosure: None declared. Objective: To evaluate the effectiveness of a simple auditory cuing device to improve gait in Parkinson’s disease (PD). Design: Intervention trial. Setting: Laboratory and home. Participants: To date, 8 persons with PD have been recruited (age, 74.3⫾8.3y; disease duration, 7.9⫾5.8y; Hoehn and Yahr stages, 2.9⫾0.4; Unified Parkinson Disease Rating Scale III score, 22.8⫾2.1). Intervention: Subjects were tested while “on” anti-parkinsonian medications. The auditory pacer was set at a rate 25% faster than each participant’s preferred pace. Participants wore the pacer for 1 week whenever they walked, then returned for follow-up gait measures. Main Outcome Measures: Gait speed, step length, and stride length. Results: The auditory pacer immediately improved gait velocity, cadence, and stride length in the preliminary testing. After 1 week, gait speed with auditory cuing was 22% faster than the initial preferred speed (P⫽.008) and right step length increased by 16% (P⫽.01). There were trends for improved cadence (9%) and stride length (12%). Conclusions: These preliminary results suggest that the pacer may improve gait performance in persons with PD. The study is ongoing and a total sample size of 25 is planned. Key Words: Parkinson’s disease; Rehabilitation.
Arch Phys Med Rehabil Vol 87, October 2006
will adequately identify at-risk drivers. The cost of a comprehensive driving evaluation is often related to the length of time required to administer the various clinical assessments and road test. By standardizing assessment methods for clinical and the behind-the-wheel portions of the comprehensive driving evaluation, practitioners should be able to more efficiently provide services to objectively and accurately identify at-risk drivers. Key Words: Activities of daily living; Aging; Cognition; Rehabilitation; Vision. Presentation 9 Stress in Women With Spinal Cord Injury. Anthony H. Lequerica (University of Michigan Health System, Ann Arbor, MI), Denise G. Tate, PhD. Disclosure: None declared. Objective: To examine how the perception of psychologic stressors reported by women with spinal cord injury (SCI) is associated with their experience of global stress and life satisfaction. Design: Survey. Setting: Collaboration between 2 large Midwestern medical centers. Participants: 50 women (age range, 22⫺85y) with SCI, including 24 African Americans and 26 whites. Interventions: Not applicable. Main Outcome Measures: Stressors mentioned during a semi-structured interview were coded and categorized according to context using NVivo software for qualitative data analysis. The degree to which participants spoke about stress as challenge versus loss was quantified and used to create a positive and negative stress appraisal group to examine the Pearson correlation between the experience of global stress (Perceived Stress Scale) and life satisfaction (Satisfaction With Life Scale) within each group. Results: The relative appraisal of stress as challenge versus loss was found to moderate the relationship between global stress and life satisfaction. The correlation between global stress and life satisfaction was significant in the negative stress appraisal group (r⫽⫺.61, P⫽.002) but not significant in the positive stress appraisal group (r⫽⫺.28, P⫽.178). Conclusions: These findings suggest a possible buffer effect of stress appraisal that supports the use of coping techniques such as cognitive reframing that may be effectively incorporated into stress management interventions for women with SCI. Key Words: Quality of life; Rehabilitation; Spinal cord injuries; Stress. Presentation 10 Evaluating Ankle-Foot Orthotics in Hemiplegic Stroke Patients Using Pedobarography. Karen J. Nolan (Kessler Medical Rehabilitation Research and Education Corp, University of Medicine and Dentistry, New Jersey-NJ Medical School, Newark, NJ), Howard J. Hillstrom, Sue Ann Sisto, Elie P. Elovic. Disclosure: None declared. Objective: To use dynamic pedobarography to evaluate the affect of an ankle-foot orthosis (AFO) on hemiplegic gait. Design: Subjects performed walking trials in 2 conditions: with an AFO and without an AFO while pedobarography data were collected using the Pedar-X, sampling at 100Hz. Setting: Clinical rehabilitation laboratory. Participants: 6 people with stroke-related hemiplegia were recruited for participation. Subjects were more than 6 months poststroke and used a prescribed AFO during ambulation. Interventions: Not applicable. Main Outcome Measures: Wireless pedobarography variables included regional analysis of peak pressure, maximum force, and pressure time integral (PTI) plantar to the foot. Results: Lateral (P⫽.006) and medial heel (P⫽.017) peak pressure and maximum force at the lateral heel (P⫽.033) were significantly reduced. Maximum force (P⫽.012) and PTI (P⫽.038) in the medial arch were significantly increased. Conclusions: The results of this pilot study suggest that pedobarography may become a valuable outcome measure in evaluating prescribed AFOs in hemiplegic gait. Data indicated that an
E9
AFO can significantly reduce plantar loading at the heel; more subjects are needed to clarify how and why plantar loading is altered with AFO use. Future research will focus on utilizing pedobarography to quantify changes in gait based on dynamic objective information acquired during walking with AFOs. Key Words: Gait; Hemiplegia; Rehabilitation. Presentation 11 Health-Related Quality of Life Outcomes of English- and SpanishSpeaking Persons Living With HIV and AIDS. Deepa Rao (Northwestern University, Chicago, IL), Elizabeth A. Hahn, David Cella, Lesbia Hernandez, Gail Shiomoto. Disclosure: None declared. Objective: To understand health-related quality of life (HRQOL) outcomes in a diverse sample of people living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) (PLWHA). Design: A survey design and regression analyses to explore the relationship between sociodemographic and clinical factors and HRQOL. Setting: Participants were recruited from multiple hospitals in the United States and Puerto Rico. Participants: Patients seeking treatment for HIV and AIDS (N⫽273) were referred for participation. Interventions: Not applicable. Main Outcome Measure: The study used the Functional Assessment of HIV Infection (FAHI), an illness-specific measure of HRQOL. Age, sex, ethnicity, education, insurance, language, living arrangement, literacy, antiretroviral status, CD4, and time since diagnosis were analyzed as independent variables. The physical, emotional, social, and functional and general well-being factors of the FAHI were analyzed as dependent variables. Results: Men and Spanish-speaking participants reported better physical well-being. Men also reported better functional and general well-being. Participants with a lower CD4 and Spanishspeaking Hispanics reported better emotional well-being. Participants who lived with others had a lower CD4, or who were white reported better social well-being. Conclusions: These results suggest that sociodemographic and clinical factors differentially influence HRQOL in PLWHA. This knowledge is essential for the development of targeted interventions aimed at improving the well-being of vulnerable PLWHA. Key Words: Acquired immune deficiency syndrome; HIV; Quality of life; Rehabilitation. Presentation 12 Preliminary Data From an Ongoing Study: Influence of Auditory Pacer on Gait Performance on Persons With Parkinson’s Disease. M. Suteerawattananon (Baylor College of Medicine, Houston, TX), D.H. Rintala, E.C. Lai, J.G. Hou, E.J. Protas. Disclosure: None declared. Objective: To evaluate the effectiveness of a simple auditory cuing device to improve gait in Parkinson’s disease (PD). Design: Intervention trial. Setting: Laboratory and home. Participants: To date, 8 persons with PD have been recruited (age, 74.3⫾8.3y; disease duration, 7.9⫾5.8y; Hoehn and Yahr stages, 2.9⫾0.4; Unified Parkinson Disease Rating Scale III score, 22.8⫾2.1). Intervention: Subjects were tested while “on” anti-parkinsonian medications. The auditory pacer was set at a rate 25% faster than each participant’s preferred pace. Participants wore the pacer for 1 week whenever they walked, then returned for follow-up gait measures. Main Outcome Measures: Gait speed, step length, and stride length. Results: The auditory pacer immediately improved gait velocity, cadence, and stride length in the preliminary testing. After 1 week, gait speed with auditory cuing was 22% faster than the initial preferred speed (P⫽.008) and right step length increased by 16% (P⫽.01). There were trends for improved cadence (9%) and stride length (12%). Conclusions: These preliminary results suggest that the pacer may improve gait performance in persons with PD. The study is ongoing and a total sample size of 25 is planned. Key Words: Parkinson’s disease; Rehabilitation.
Arch Phys Med Rehabil Vol 87, October 2006