Seating Pressure Gradient Vectors in Response to the Changes of Wheelchair Tilt and Recline in People with Spinal Cord Injury

Research Posters Research Poster 615 Sleep Architecture Following Stroke is Distinct from TBI Sarah Finley (Centre for Neuro Skills), Jennifer Williams, David Harrington, Grace S. Griesbach Research Objectives: To investigate sleep disturbances after stroke and traumatic brain injury (TBI). Design: Sleep measures were compared between TBI and stroke groups and age-matched normative data. Setting: Private post-acute rehabilitation clinic and a controlled sleep lab for a night. Participants: Stroke (nZ25, M age Z 53.9) and TBI (nZ15, M age Z 43.8) patients. Interventions: NA. Main Outcome Measure(s): Polysomnography and apnea. Functional outcome: Disability Rating Scale (DRS) and Mayo-Portland (MPAI). Results: Wake after sleep onset (WASO) was over two times higher than normative data in both groups. WASO for stroke was higher compared to TBI (p Z 0.004), 95% CIs [50.4, 84.5] and [24.1, 46.6] respectively. Apnea events were negligible for those under 45 years, but higher for those above 45 regardless of injury (p Z 0.0002); 95% CIs [50.05, 8.05] and [35, 85.3]. Both groups spent more time on stage 1 compared to normative data. Stroke patients spent more time in stage 2 (p Z 0.06), 95% CIs [67.8, 78.5] and [59.3, 71.5] and significantly less time in stage 3 (p Z 0.03), 95% CIs [-0.2, 3.2] and [3.9, 19.8] compared to TBI. Stroke patients aged 50-60 also spent ten times less time in stage 3 compared to normative data. A higher WASO was correlated with more disability (DRS p Z 0.02) and with decreased initiation in social participation (MPAI, p Z 0.01). Conclusions: Both of these populations have sleep disturbances compared to normative data. Analysis of sleep architecture indicated distinct profiles for TBI and stroke. These findings have implications for cognitive functioning. Future research may want to identify therapy approaches most beneficial to these groups given their markedly distinct sleep profiles. Key Words: Sleep, stroke, traumatic brain injury Disclosures: Sarah Finley receives a salary from the Centre for Neuro Skills. All other authors have nothing to disclose. Research Poster 616 Seating Pressure Gradient Vectors in Response to the Changes of Wheelchair Tilt and Recline in People with Spinal Cord Injury Yih-Kuen Jan (University of Illinois at Urbana-Champaign), Chi-Wen Lung, Tim D. Yang, Waifong Cheung, Sanjiv Jain Research Objectives: To assess both peak pressure gradient (PPG) magnitudes and directions in response to six combinations of wheelchair tilt and recline angles. Pressure ulcer interventions are commonly assessed with measures of seating interface pressures, such as PPG. Decreases in PPG magnitudes may reduce pressure ulcer risk by decreasing tissue deformation and increasing tissue perfusion of at-risk weight-bearing tissues. Changes in PPG directions, which have previously been overlooked in the seating pressure literature, may provide a transient increase in blood flow to at-risk tissues, even if the PPG magnitude and location remain the same. Design: Treatment-outcomes, repeated-measures research design. Setting: University research lab. Participants: Power wheelchair users with spinal cord injury (n Z 13). Interventions: Six combinations of wheelchair tilt (15 , 25 , and 35 ) and recline (10 and 30 ) were tested in random order. Each combination was tested with 5-min upright sitting, 5-min tilt and recline, and 5-min maximal pressure relief recovery. Main Outcome Measure(s): PPG magnitudes and directions under the left ischial tuberosity. Results: The results suggested that when combining wheelchair tilt and recline, the recline function may be particularly useful in reducing PPG magnitudes, while the tilt function may be particularly useful in manipulating PPG directions.

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e93 Conclusions: The findings indicate that significant changes in PPG magnitude did not always correspond to significant changes in PPG direction, suggesting that PPG directional changes may provide additional information for the assessment of interface pressure in response to tilt and recline. Key Words: Pressure ulcer, Spinal cord injury, Wheelchair Disclosures: None disclosed. Research Poster 617 Priming the Ipsilesional Motor Cortex with Excitatory rTMS to Augment Functional Task Practice Post-Stroke Dorian Rose (University of Florida), Carolynn Patten, Alexandra Taylor, William Triggs Research Objectives: To test the hypothesis that ipsilesional hemisphere high-frequency repetitive Transcranial Magnetic Stimulation (rTMS) would augment Upper Extremity (UE) functional task practice (FTP) to improve motor ability compared to FTP alone in individuals with poststroke paresis. Design: Double-blind randomized controlled trial. Setting: Clinical research center. Participants: Twenty-two individuals (61.89.2 years; 26.220.5 months post-stroke) randomized to Real-experimental (EXP; nZ13) or sham-control (CON; nZ9) rTMS with stroke onset > 6 months prior and UE FuglMeyer-Motor (UEFMM) shoulder/elbow subcomponent score 15-25 signed a University of Florida IRB-approved Consent Form. Exclusion criteria were history of epilepsy, intracortical/subarachnoid hemorrhage, implanted pacemaker or metal in the skull or seizure threshold-lowering medications. Interventions: Ipsilesional hemisphere rTMS (10 Hz) paired with 16, 4-hour sessions of UE FTP. Main Outcome Measure(s): Evaluators blinded to group administered the Wolf Motor Function Test -Functional Assessment Scale (WMFT-FAS) and WMFT-time, Action Research Arm Test -FAS (ARAT-FAS) and ARAT-time, UEFMM, Motor Activity Log (MAL), and Stroke Impact Scale-Hand (SIS-H). Results: No differences between EXP and CON groups at post-intervention or 1-month retention. However, when data was pooled across groups significant Pre- to Post-intervention differences were observed for WMFTFAS (5.3 vs. 6.1), WMFT-time (6.3 s vs. 4.0 s), ARAT- FAS (4.0 vs. 4.6), ARAT- time (7.7 s vs. 5.5 s), UEFMM (48.1 vs. 54.0) MAL-How Well (2.0 vs. 3.1), MAL- Amount Of Use (1.7 vs. 3.0), SIS-H ( 44.0 vs. 56.9). Improvements were retained at 1-month. Conclusions: Reduction in UE impairment in both groups following 16 FTP sessions; ipsilesional excitatory rTMS did not serve as an adjuvant to improve UE motor ability. Key Words: Stroke, Rehabilitation, Transcranial Magnetic Stimulation, Upper Extremity Disclosures: None disclosed. Research Poster 618 Determination Cutoff Score for Independent Walking Ability in Community-Dwelling Post Stroke Jatuporn Suttiwong (Faculty of Physical Therapy, Mahidol University), Mantana Vongsirinavarat, Vimonwan Hiengkaew, Chutima Jalayondeja Research Objectives: To determine the cutoff scores of the Stroke Rehabilitation Assessment of Movement (STREAM) and Postural Assessment Scale for Stroke patients (PASS) for predicting independent walking in community-dwelling post stroke. Design: A Cross-Sectional Study. Setting: Community setting. Participants: One hundred and ten person with first stroke lived in community. The eligible participants were those aged over 18 years, able to understand the questionnaire, and no cognitive problems. Interventions: Not applicable.