Relationship Between Fall Risk and Driving Performance in Multiple Sclerosis

e118 Interventions: The participant received a commercially available FDS (WalkaideÒ, Innovative Neurotronics, Inc., Austin, TX, USA) at baseline, prescribed by the treating physician, for use during ambulation as part of the larger investigation and returned for 1 and 3 month follow-up visits. Main Outcome Measure(s): The pendulum knee drop (PKD) test (measurement of spasticity), modified Ashworth scale, and gait speed were collected while walking at a self-selected speed on a level surface at baseline, 1 month and 3 months post FDS implementation. Results: The PKD test demonstrated a slight increase in knee stiffness after 1 month of FDS use and larger decrease in knee stiffness at 3 months. Additionally, there was an increase in the overall gait speed at 1 month and 3 months post FDS implementation. Conclusions: The initial increase of knee’s stiffness after 1 month of utilization of the FDS device may be explained as a result of the adaptation period of the participant to the FDS device and the fact that electrical stimulation may lead to strengthening of muscles which had a secondary effect on the mechanical parameters of the knee joint. These preliminary results may indicate improvements to the mechanical characteristics of the knee joint as a secondary benefit to the FDS assistance for foot drop. Further studies with a larger number of participants are necessary to generalize the results found in this study. Key Words: Foot drop stimulator (FDS), spasticity, Rehabilitation, Cerebral palsy, Pendulum knee drop test (PKD) Disclosures: None disclosed. Research Poster 732 Shoulder Pain and Trunk Kinematics in Manual Wheelchair Propulsion Chandrasekaran Jayaraman (Rehabilitation Institute of Chicago), Carolyn Beck, Jacob Sosnoff Research Objectives: To investigate the relationship between shoulder pain and trunk kinematics during manual wheelchair propulsion in individuals with spinal cord injury. Design: Cross sectional. Setting: University research laboratory. Participants: Wheelchair propulsion data from 25 experienced adult manual wheelchair users (with shoulder pain pain/without shoulder pain: 13/12) was analyzed for this study. Inclusion criteria for this secondary analysis were: (1) between 18-65 years old and (2) use of a manual wheelchair as their primary means of mobility for 1+ year and (3) Spinal related disability. Interventions: Participants propelled their own wheelchairs fitted with SMARTWheels on a roller dynamometer at 1.1 m/s for 3 minutes. Motion capture data of the upper limbs were recorded during the 3 minute propulsion trial. Main Outcome Measure(s): The net drift in the trunk position (during steady state propulsion) from the initial reference position (rest) along the sagittal plane (X direction) during the 3 minute trial was computed. Twoway ANOVA with between group factor as shoulder pain was conducted to investigate if statistically significant differences in trunk drift existed as a function of shoulder pain (p<0.05). Results: Overall results show that the net trunk drift along the sagittal plane was greater for manual wheelchair users with shoulder pain those without pain (p<0.05; h2Z0.30). Conclusions: Incorporating trunk kinematics based outcome measures in assessments may provide additional knowledge to understand the adaptive strategies employed by manual wheelchair users with shoulder pain when propelling their wheelchair. Such knowledge could be useful in preventing the onset of secondary injuries arising due to adaptations to pain. To our knowledge this is the first work documenting trunk kinematic differences between in manual wheelchair users with and without shoulder pain. Future research in this direction with larger sample size is warranted. Key Words: Spinal cord, Shoulder pain, Repetitive strain injury, Wheechairs Disclosures: None disclosed.

Research Posters Research Poster 733 Relationship Between Fall Risk and Driving Performance in Multiple Sclerosis Abiodun Akinwuntan (University of Kansas Medical Center), Jacob Sosnoff, Hannes Devos Research Objectives: Walking and driving are important modes of mobility. Falls when walking and unsafe driving have both been associated with deficits in cognitive functions in individuals with Multiple Sclerosis (MS) (ref. 1-3). We investigated the domains of cognitive function involved in both falls risk and driving ability in MS. Design: Prospective cross-sectional study. Setting: Augusta University Driving Simulator Lab. Participants: Ten female participants with MS (mean age  SD, 46  12years) with moderate to relatively severe disability. Interventions: Not applicable. Main Outcome Measure(s): (i) Fall risk scores derived from the Physiological Profile Assessment (PPA), (ii) Test Ride for Investigating Practical (TRIP) fitness to drive test scores, and (iii) neuropsychological test battery scores measuring visual and cognitive functions. All correlation of at least 0.3 indicating medium relationship (ref. 4) was considered relevant in this pilot study. Results: A large inverse correlation was found between falls risk vs. TRIP scores (r Z -0.65, p Z 0.08). Both fall risk and driving performance (TRIP scores) showed medium to large correlations with tests that assess divided attention, visual scanning, visual perception, speed of information processing, and executive function. Conclusions: This study identified possible links between cognitive functions implicated in fall risk and impaired driving ability. If confirmed in a well-powered study, this finding offers promises for developing a future comprehensive rehabilitation to address both falls and driving performance in individuals with MS. Key Words: Driving, Falls, Cognition, Assessment Disclosures: None disclosed. Research Poster 735 Locomotor-Respiratory Coupling During Treadmill Walking Before and After Overground Locomotor Training in Incomplete Spinal Cord Injury Gino Panza (George Mason University), Peter Y. Jo, Kerry J. Bollen, Jared M. Gollie, Jeffrey E. Herrick, Andrew A. Guccione Research Objectives: The purpose of this study was to describe the LRC during treadmill walking before and after overground locomotor training (OLT) in an individual with a cervical iSCI. Patients with incomplete Spinal Cord Injuries (iSCI) present with a paradoxical movement between chest and abdomen, which is likely due to an inability to activate inspiratory and expiratory musculature. The locomotor-respiratory coupling (LRC) is a measure of breaths per stride which is often phaselocked at 2:1 and thought to be a result of the chest and abdominal coupling. Design: Case Study. Setting: Human Performance Research Laboratory. Participants: Male, 36 years with an iSCI at C4-C5-C6 diagnosed ASIA C. Interventions: OLT was based on dynamical systems theory and the principles of adaptation. The intervention included two 90-minute sessions per week for 12-weeks. Training sessions alternated between variations of forward and multi-planar stepping. Main Outcome Measure(s): The LRC ratio was calculated from data collected during a cardiopulmonary exercise test (CPET) at preferred walking speed (0.5 mph) for 6 minutes. Heel contact was measured using pressure mapping insoles. Breathing frequency was recorded from standard CPET procedures. Insole data was time aligned to the onset of exercise by visual inspection of the force data.

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