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The effect of body mass index on functional outcome of patients on cardiac rehabilitation
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Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
Keywords Transcranial direct current stimulation; Mirror therapy; Stroke Disclosure of interest The author declares that he has no competing interest. https://doi.org/10.1016/j.rehab.2018.05.448 ISPR8-2544
Influence of body composition and muscle strength on functional outcomes in post-acute stroke
R. Boza ∗ , A. Bustos , A. Gonzales-Carhuancho , V. Dávalos-Yerovi , C. Barrera , E. Duarte , A. Guillén-Solà , E. Marco Parc de Salut Mar, Physical Medicine and Rehabilitation, Barcelona, Spain ∗ Corresponding author. E-mail address: [email protected] (R. Boza) Introduction/Background Despite skeletal muscle is the main effector organ of disability in stroke, there is a paucity of data on skeletal muscle disorders in stroke. In addition to loss of muscle mass as a result of normal ageing, reduced physical activity, poor nutrition, and hormonal changes can play a role in the development of sarcopenia in stroke. This preliminary study was aimed to determine the influence of body composition and muscle function on functional outcomes in patients with post-acute stroke. Material and method Within 2 weeks of stroke onset, 45 subjects (66.1 ± 8.8; 32 men) with a first ischemic stroke event were prospectively assessed during in-patient rehabilitation hospitalization. The main variables were fat-free mass and fat-mass (in kg and as a percentage of reference values) assessed with electrical impedance, body mass index (BMI), maximal isometric handgrip strength of non-paretic upper limb, and functional status assessed with the Barthel Index (BI) at hospital discharge. Results According to BMI, patients were classified in low weight (n = 2), normal weight (n = 10), overweight (n = 20) and obesity (n = 13). Fat-free mass was reduced in 3 patients and fat-mass in 8. Obese patients had lower BI (mean difference: 22.7, 95% CI: 8.6–36.8, P = 0.002, at admission; 14.9, 95% CI: 0.58–29.1, P = 0.042, at discharge). Twenty-eight patients had reduced strength of the non-paretic handgrip; these patients had lower BI (mean difference 15.2, 95% CI: 0.8–29.6, P = 0.039), but no differences in BI improvements at discharge were detected. Conclusion Strength in the non-paretic hand is reduced in 62% of the sample. Obesity and reduced handgrip strength are associated with worse functional status during stay in a neurorehabilitation ward. Further studies are required to assess the influence of body composition and muscle strength on functional outcomes. Keywords Stroke; Handgrip strength; Body composition Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.449 ISPR8-2622
The effect of body mass index on functional outcome of patients on cardiac rehabilitation D. Burke 1,∗ , R. Bratton Bell 1 , S. Al-Adawi 2 , D.P. Burke 3 Emory University School of Medicine, Rehabilitation Medicine, Atlanta, USA 2 Sultan Qaboos University, Department of Behavioral Medicine, Al-Khoud, Oman 3 Georgia State University, Georgia State University, Atlanta, USA ∗ Corresponding author. E-mail address: [email protected] (D. Burke)
1
Introduction/Background While data suggests that obesity increases the risk for cardiovascular disease, some have
demonstrated that after a cardiovascular event those with obesity tend to recover more quickly than do those whose weight is normal; a phenomenon termed the “obesity paradox”. This study was designed to determine whether this obesity paradox is also reflected in the recovery of patients with debility secondary to a cardiovascular event undergoing care in a rehabilitation hospital. Material and method Retrospective cohort study which included all patients admitted to a rehabilitation hospital, with a recent diagnosis of acute cardiac decline from January 2000–April 2006. Results Of the 678 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age, and sex, the FIM efficiency differed by BMI, though the difference was not statistically significant (P = 0.069). While not statistically significant, the normal weight group showed the best results, followed, in order by the obese group, the overweight group, and the underweight group. Conclusion This study of patients on a cardiac rehabilitation unit failed to demonstrate that obesity significantly impairs functional progress during the rehabilitation process. Keywords Stroke; Cardiovascular disease; FIM efficiency Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.450 ISPR8-0355
The cortical mechanism of “remind-to-move” in stroke patients: A near infrared spectroscopic topography case study X.J. Wei 1,∗ , N.K. Fong 2 , K.H. Ting 2 Southern Medical University, Department of Rehabilitation Sciences, Shenzhen, China 2 The Hong Kong Polytechic University, Department of Rehabilitation Sciences, Kowloon, Hong Kong ∗ Corresponding author. E-mail address: [email protected] (X.J. Wei)
1
Introduction/Background ‘Remind-to-move’ (RTM) has been shown to be useful on promoting hemiparetic upper extremity motor recovery in patients with stroke and children with unilateral cerebral palsy in our previous studies. This study was to explore the cortical mechanism of RTM on upper extremity related to the brain responses in the form of sensory cueing in both healthy and stroke participants. Material and method A block research design was used with Block 1 - baseline condition, Block 2 - sham condition, and Block 3 - experimental condition, on 2 stroke patients with hemiparetic upper extremity and their 2 healthy counterparts. They were required to wear cueing wristwatch device over both arms throughout the study but sensory cueing was emitted only in the experimental condition, i.e. Block 3. During sham condition, the participants were told to perform self-regulated hand movements every minute, whereas the participants just needed to perform hand movements after each sensory cue emitted from the device in the experimental condition. The cortical hemodynamics was recorded by functional near infrared spectroscopic topography (fNIRS). Results Activated regions of healthy and stroke participants showed different patterns of neuro correlates. Prefrontal cortex was found to be activated in healthy participants but the same area was less activated comparatively in stroke patients in the sham condition. Both prefrontal and primary motor cortices were less activated in healthy participants in the experimental condition but these areas in stroke patients were more activated instead. It was observed that the frontal cortex of both healthy participants and one stroke participant with higher paretic arm functioning was activated throughout different block conditions but not for another stroke participant with lower arm functioning.
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
Keywords Transcranial direct current stimulation; Mirror therapy; Stroke Disclosure of interest The author declares that he has no competing interest. https://doi.org/10.1016/j.rehab.2018.05.448 ISPR8-2544
Influence of body composition and muscle strength on functional outcomes in post-acute stroke
R. Boza ∗ , A. Bustos , A. Gonzales-Carhuancho , V. Dávalos-Yerovi , C. Barrera , E. Duarte , A. Guillén-Solà , E. Marco Parc de Salut Mar, Physical Medicine and Rehabilitation, Barcelona, Spain ∗ Corresponding author. E-mail address: [email protected] (R. Boza) Introduction/Background Despite skeletal muscle is the main effector organ of disability in stroke, there is a paucity of data on skeletal muscle disorders in stroke. In addition to loss of muscle mass as a result of normal ageing, reduced physical activity, poor nutrition, and hormonal changes can play a role in the development of sarcopenia in stroke. This preliminary study was aimed to determine the influence of body composition and muscle function on functional outcomes in patients with post-acute stroke. Material and method Within 2 weeks of stroke onset, 45 subjects (66.1 ± 8.8; 32 men) with a first ischemic stroke event were prospectively assessed during in-patient rehabilitation hospitalization. The main variables were fat-free mass and fat-mass (in kg and as a percentage of reference values) assessed with electrical impedance, body mass index (BMI), maximal isometric handgrip strength of non-paretic upper limb, and functional status assessed with the Barthel Index (BI) at hospital discharge. Results According to BMI, patients were classified in low weight (n = 2), normal weight (n = 10), overweight (n = 20) and obesity (n = 13). Fat-free mass was reduced in 3 patients and fat-mass in 8. Obese patients had lower BI (mean difference: 22.7, 95% CI: 8.6–36.8, P = 0.002, at admission; 14.9, 95% CI: 0.58–29.1, P = 0.042, at discharge). Twenty-eight patients had reduced strength of the non-paretic handgrip; these patients had lower BI (mean difference 15.2, 95% CI: 0.8–29.6, P = 0.039), but no differences in BI improvements at discharge were detected. Conclusion Strength in the non-paretic hand is reduced in 62% of the sample. Obesity and reduced handgrip strength are associated with worse functional status during stay in a neurorehabilitation ward. Further studies are required to assess the influence of body composition and muscle strength on functional outcomes. Keywords Stroke; Handgrip strength; Body composition Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.449 ISPR8-2622
The effect of body mass index on functional outcome of patients on cardiac rehabilitation D. Burke 1,∗ , R. Bratton Bell 1 , S. Al-Adawi 2 , D.P. Burke 3 Emory University School of Medicine, Rehabilitation Medicine, Atlanta, USA 2 Sultan Qaboos University, Department of Behavioral Medicine, Al-Khoud, Oman 3 Georgia State University, Georgia State University, Atlanta, USA ∗ Corresponding author. E-mail address: [email protected] (D. Burke)
1
Introduction/Background While data suggests that obesity increases the risk for cardiovascular disease, some have
demonstrated that after a cardiovascular event those with obesity tend to recover more quickly than do those whose weight is normal; a phenomenon termed the “obesity paradox”. This study was designed to determine whether this obesity paradox is also reflected in the recovery of patients with debility secondary to a cardiovascular event undergoing care in a rehabilitation hospital. Material and method Retrospective cohort study which included all patients admitted to a rehabilitation hospital, with a recent diagnosis of acute cardiac decline from January 2000–April 2006. Results Of the 678 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age, and sex, the FIM efficiency differed by BMI, though the difference was not statistically significant (P = 0.069). While not statistically significant, the normal weight group showed the best results, followed, in order by the obese group, the overweight group, and the underweight group. Conclusion This study of patients on a cardiac rehabilitation unit failed to demonstrate that obesity significantly impairs functional progress during the rehabilitation process. Keywords Stroke; Cardiovascular disease; FIM efficiency Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.450 ISPR8-0355
The cortical mechanism of “remind-to-move” in stroke patients: A near infrared spectroscopic topography case study X.J. Wei 1,∗ , N.K. Fong 2 , K.H. Ting 2 Southern Medical University, Department of Rehabilitation Sciences, Shenzhen, China 2 The Hong Kong Polytechic University, Department of Rehabilitation Sciences, Kowloon, Hong Kong ∗ Corresponding author. E-mail address: [email protected] (X.J. Wei)
1
Introduction/Background ‘Remind-to-move’ (RTM) has been shown to be useful on promoting hemiparetic upper extremity motor recovery in patients with stroke and children with unilateral cerebral palsy in our previous studies. This study was to explore the cortical mechanism of RTM on upper extremity related to the brain responses in the form of sensory cueing in both healthy and stroke participants. Material and method A block research design was used with Block 1 - baseline condition, Block 2 - sham condition, and Block 3 - experimental condition, on 2 stroke patients with hemiparetic upper extremity and their 2 healthy counterparts. They were required to wear cueing wristwatch device over both arms throughout the study but sensory cueing was emitted only in the experimental condition, i.e. Block 3. During sham condition, the participants were told to perform self-regulated hand movements every minute, whereas the participants just needed to perform hand movements after each sensory cue emitted from the device in the experimental condition. The cortical hemodynamics was recorded by functional near infrared spectroscopic topography (fNIRS). Results Activated regions of healthy and stroke participants showed different patterns of neuro correlates. Prefrontal cortex was found to be activated in healthy participants but the same area was less activated comparatively in stroke patients in the sham condition. Both prefrontal and primary motor cortices were less activated in healthy participants in the experimental condition but these areas in stroke patients were more activated instead. It was observed that the frontal cortex of both healthy participants and one stroke participant with higher paretic arm functioning was activated throughout different block conditions but not for another stroke participant with lower arm functioning.