OND Veterans

Research Posters Disclosure(s): None Disclosed. Research Poster 3782 Transcranial Direct Current Stimulation for a Patient with Chronic Right Hemiparesis: A Case Report April T. Hodge (Shepherd Center) Objective(s): To investigate the effectiveness of Transcranial Direct Current Stimulation (tDCS) on the improvement of right upper extremity (UE) motor control in an individual with chronic right hemiparesis. Design: Case report. Setting: Post-acute multidisciplinary outpatient day program for veterans with mild to moderate traumatic brain injury and post-traumatic stress disorder. Participants: A 24-year old male, marine corps veteran 3 years post left hemispheric stroke involving the left frontal, parietal, and temporal lobes resulting in right hemiparesis. Interventions: TDCS (2 ma), 20 minutes, 5 days/week, for 4 weeks immediately prior to physical and occupational therapy sessions. Main Outcome Measure(s): Modified Ashworth Scale (MAS) (tone) and UE Ful-Meyer Assessment (UE function) were used pre intervention at weekly intervals during the use of tDCS, and 1 and 4 weeks post intervention. Results: Right UE MAS scores decreased from between 1 and 4 to between 0 and 2 during the intervention and at 1 and 4 weeks post. UE Fugl-Meyer scores improved from 29 to 36 during the intervention period, decreased to 33 at 1 week post intervention, and returned to baseline (29) at 4 weeks post-intervention. Conclusions: TDCS was an effective intervention in the treatment of chronic hemiparesis in this individual. Motor control and tone can improve with the use of tDCS. However, there was no maintenance of the effect. Further research is needed to investigate the duration of application of this intervention for improved carry over and recovery of function. Key Words: Transcranial direct current stimulation, Stroke, Paresis, Recovery of function, Upper extremity Disclosure(s): None Disclosed. Research Poster 3783 Determining Whether a Dosage Specific Exercise Program with Consults Reduces Fall Risk in Elderly Patients Maria Stelmach (Rusk Rehabilitation at NYU Langone Medical Center), Estelle Gallo Objective(s): To compare Schubert’s fall prevention exercise program recommendations, with a shift in the delivery of care to consultative, with our current standard of practice for decreasing fall risk. The hypotheses were that the proposed program decreases the patient’s fall risk, is more effective in decreasing fall risk, and consultative visits after discharge improves exercise compliance. Design: Randomized controlled pilot study. Setting: Neurological outpatient physical therapy (PT) department. Participants: 36 independent community dwellers, 65 years-old, 1 neurological condition, and 1 fall risk factor (FTSTS >15sec, TUG >14sec, BERG <45, ABC<67%, and 1 fall in past year) were randomly assigned into control (CG) (23 subjects) or experimental group (EG) (13 subjects). Interventions: Both groups received PT 2x/week, 30 minutes, 10-32 visits. The CG received standard practice. The EG received a moderate-high intensity exercise program (designed using the mini-best). Exercise volume of 50 total hours in 6 months was emphasized with EG using a diary. The EG received 4 additional consults post discharge to update/reinforce exercises. Main Outcome Measure(s): TUG, FTSTS, BERG, ABC, and number of minutes of exercise/week were assessed at evaluation, 2, 4, and 6 months. Results: The baseline analysis at evaluation showed groups being similar and received similar number of visits. The EG exercised significantly more

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e67 exceeding the target of 115 minutes/week. When adjusting for baseline scores and risk factors, both groups made significant (p<.05) improvement in 6 months, but the EG’s change in improvements were significantly (p<.05) greater than CG on all outcomes measures. Conclusions: This study supported the hypotheses. The EG’s increased exercise compliance may be attributed to consults and dosage of exercise. Preliminary evidence supporting Shubert’s recommendation on exercise prescription for fall prevention and shift in delivery of care is demonstrated. Key Words: Physical therapy, Balance, Fall risk, Exercise prescription Disclosure(s): None Disclosed. Research Poster 3784 Cardiovascular Stress during Inpatient Spinal Cord Injury Physical and Occupational Therapy Janice Eng (University of British Columbia), Jeremy Noble, Molly C. Verrier Objective(s): 1) To measure the amount of cardiovascular stress experienced by individuals with spinal cord injury (SCI) during physical (PT) and occupational therapy (OT) and 2) To determine correlates of cardiovascular stress. Design: Observational study. Setting: Two inpatient SCI rehabilitation centers. Participants: Ninety-one consecutive admissions to inpatient SCI rehabilitation. Interventions: Heart rate (HR) was captured prior to discharge from rehabilitation via a Holter monitor over two days. Additionally, demographic information, questionnaires, and assessments were collected. Time spent at different HR intensities during PT and OT was calculated and compared against SCI specific physical activity guidelines. A Spearman correlation was performed to identify relationships between time spent at higher HR intensities and variables representing impairments and activities. Main Outcome Measure(s): Heart rate. Results: The average time spent at a heart rate of moderate/vigorous intensity was 6.210.4 minutes in PT and 4.19.2 minutes in OT sessions. Few patients met guidelines for obtaining a training effect. Decreased spasticity, orthostatic hypotension, and age and higher exercise selfefficacy and walking ability were correlated with a greater amount of time at moderate/vigorous HR. Conclusions: The cardiovascular stress incurred by individuals with SCI during PT and OT sessions is not enough to obtain a training effect; eighty-eight percent of our sample did not meet recommended physical activity guidelines. That individuals with less severe injury tended to accrue more time in the training zone suggests that solutions for more severely injured individuals to engage in physical activity of a sufficient duration and intensity are required. Near discharge from inpatient therapy, improving spasticity and orthostatic hypotension may allow individuals to increase time spent at higher heart rates during therapy if that is a therapeutic goal. Key Words: Heart rate, Physical therapy, Occupational therapy, Physical activity guidelines Disclosure(s): None Disclosed. Research Poster 3785 Sleep Misperceptions in Blast-Exposed OEF/OIF/OND Veterans Yelena Bogdanova (Boston University), Sarah Kark, Karina Stavitsky Gilbert, Vivian T. Ho, Megan K. Yee, Sicilia Montrond Objective(s): Sleep misperceptions in returning veterans may be common due to deployment-related trauma and blast exposure. Neuroimaging research suggests an association between frontal systems integrity and the capacity to experience sleep as restorative. We examined discrepancies between perceived and objective sleep quality, PTSD, and indices of mild

e68 traumatic brain injury (mTBI) in returning veterans with blast exposure, using subjective (Pittsburgh Sleep Quality Inventory, PSQI) and objective (actigraphy, ACT) measures. Design: Cross-sectional study. Setting: Outpatient research unit. Participants: Fifty-five veterans with blast exposure. Interventions: N/A. Main Outcome Measure(s): Participants completed the PSQI and PTSD Checklist (PCL-M), and underwent 7 days of continuous actigraphic monitoring. Clinical diagnoses of PTSD (CAPS) and duration of posttraumatic amnesia (PTA) were obtained. Absolute sleep discrepancy between PSQI- and ACT-measured Total Sleep Time (SD-TST) was calculated. Results: Almost a third (27%) of the participants under or overestimated TST by two or more hours. Results showed significant positive correlations between SD-TST and PCL-M and post-traumatic amnesia (PTA). Followup analyses revealed that the positive parametric relationship between PTA and SD-TST was only significant in the group with high levels of selfreported PTSD (PCL>50) (nZ31) or a PTSD diagnosis (nZ39). These results suggest that increased PTA severity is associated with increased sleep discrepancy in veterans with PTSD, but not in veterans without PTSD. Conclusions: These findings highlight the prevalence of sleep misperceptions in returning veteran populations with exposure to blast. Our results suggest that increased PTA severity might be associated with exaggerated sleep misperceptions in PTSD patients. Discrepancies between objective and subjective sleep measures might reflect clinically meaningful correlates of neuropsychiatric status and TBI severity. Key Words: Sleep discrepancy, Blast TBI, PTSD, Actigraphy, Veterans Disclosure(s): None Disclosed. Research Poster 3786 Test-retest Repeatability of Timed Up and Go Subcomponents in Patients with Parkinson’s Disease Mark A. Hirsch (Carolinas Medical Center), Mohammed Sanjak, Richard Peindl, Nahir Habet, Nigel Zheng, Danielle Englert, Brandy Dillard, Sanjay Iyer Objective(s): The Timed-Up-and-Go Test (TUG) is a widely used clinical test of axial movements including transfers, gait, turning and balance, however, its usefulness is limited by the fact that only the total time to complete all these different, complex movements is measured. We sought to evaluate the repeatability of sub-components (e.g., sit-to-stand, stand-tosit transfer movements) of a newly developed Electronically Augmented TUG Test (EATUG) in early-stage Parkinson’s disease (PD). Design: Cross-sectional. Setting: Large academic medical center. Participants: The study included 18 patients with PD (15 males/3 females; 64.610.1 years old; H & Y stage between 1 and 2, UPDRS motor score 18.611.5). Subjects performed two consecutive TUG tests wearing a single chest-mounted inertial measurement sensor package and custom software. Test-retest repeatability was calculated using Pearson correlations and intraclass correlation coefficients (ICC). Interventions: N/A. Main Outcome Measure(s): Maximum torso flexion/extension angle (MTFEA in deg), Peak Flexion/Peak Extension Angular Velocity (PFAV/ PEAV in deg/sec), Peak Vertical Acceleration (PVA in m/sec2), and Mean/ Peak Turning Angular Velocity (MTAV/PTAV in deg/sec), during TUG sub-components (i.e. sit-to-stand (STS) , walking turn segment (WT), turnbefore-sitting (TS), and stand-to-sit segments (STTS). Results: The software automatically detected all transitions and all turns. Reliability coefficients for STS were: PFAV, PEAV, MTFEA and PVA, 0.89, 0.64, 0.92 and 0.75, respectively p<0.01; WT: MTAV and PTAV, 0.92 and 0.94, respectively, p<0.001; TS: MTAV and PTAV, 0.58 and 0.61, respectively, p<0.01; STTS: MTFEA, PFAV and PEAV were 0.82, 0.53 and 0.64, respectively, p<0.01.

Research Posters Conclusions: Repeatability of the sit-to-stand was high for PFAV, MTFEA and PVA and also high for walking turn segments. The turn-before-sitting and stand-to-sit segments showed somewhat lower reliability for MTAV, PFAV and PEAV. Key Words: Parkinson’s disease, Mobility, Instrumentation Disclosure(s): None Disclosed. Research Poster 3791 The Progression and Rehabilitation of Anti-NMDA Receptor Encephalitis: A Case Series Eileen Shieh (AI DuPont Hospital for Children / Thomas Jefferson University Hospital), Nicole Marcantuono Objective(s): To describe the presentation of anti-NMDA encephalitis, define acute and long-term treatments, identify the role of rehabilitation, and report the wide spectrum of outcomes using cases with long-term follow up. Design: Case Series. Setting: Pediatric Tertiary Care Center. Participants: [1] 16-year-old female who presented to the hospital in 10/ 2011 for emotional lability, hypertension, and seizures requiring intubation. [2] 17-year-old female presenting in 02/2014 with uncontrolled eye movements and syncope after a week of headache, anxiety, and moodiness. 2 months after diagnosis, she was found to have an ovarian teratoma. [3] 5-year-old male admitted in 02/2012 for personality change, panic attacks, and seizures. All cases were diagnosed through CSF studies. Interventions: Each child received steroids and IVIG upon diagnosis. Cases 1 and 3 received plasmapheresis and Rituximab for refractory symptoms and mycophenolate for long-term immunosuppression. All patients received acute rehabilitation in a multidisciplinary brain injury model. Main Outcome Measure(s): This study does not emphasize one particular outcome measurement but collectively examines all functional deficits upon diagnosis, transfer to rehabilitation, discharge, and subsequent follow-ups. Results: These cases demonstrated widely variable improvement with immunosuppression and rehabilitation. Upon discharge from rehabilitation, the patient ranged from minimal to severe functional deficits. Case 1 demonstrates a protracted recovery course, while case 2 experienced the stereotypical rapid improvement following teratoma removal. All patients continue to show improvement throughout long-term follow-up. Conclusions: The hallmark of anti-NMDA receptor encephalitis is mood lability in the setting of altered mental status and seizure. Immunosuppression and rehabilitation remain the mainstays of treatment. As demonstrated, the recovery rate is widely variable. These cases also show that patients may continue to improve even months to years after diagnosis. Key Words: NMDA-receptor, Encephalitis, Rehabilitation, Long-term Disclosure(s): None Disclosed. Research Poster 3794 Accuracy of Injection Site for Obturator Nerve Block in Cadavers: Blind Injection vs. Ultrasound-guided Injection Bomi Sul (Catholic University of Korea), Young Jin Ko, Hyun Mi Oh Objective(s): To compare the accuracy rates of blind injection with ultrasound-guided injection during obturator nerve block in cadavers. Design: Criterion standard. Setting: A research laboratory with cadavers donated to our institution. Participants: Lower limbs (NZ8) of fresh cadavers which were donated to our institution were used. Interventions: Obturator nerve block was performed by an expert physiatrist on each lower limb (NZ8) in two ways: blind injection and ultrasound-guided injection. A 2ml of colored acryl solution was injected into the target area through an 18 gauge, 1.5 inch needle. Injection without guidance was performed first, and then ultrasound-guided injection was

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