The Effect of Continuous Theta Burst Stimulation (Ctbs) on Unilateral Neglect in Patients with Stroke: A Systematic Review

e144 Data Sources: Medline, CINAHL, EMBASE, and PsycINFO databases were searched for all relevant articles published in English from 1980 to January 2016. Study Selection: Studies were included for analysis if:  50% of participants had moderate to severe ABI,  3 of the participants had an ABI, and a pharmacological intervention for agitation was provided. Data Extraction: Data extracted included participant demographics, inclusion and exclusion criteria, study design, outcome measure(s) used, and results. Study quality was assessed using the Physiotherapy Evidence Database Scale (PEDro) assessment scale for randomized controlled trials (RCTs). A level of evidence was assigned to each intervention using a modified Sackett scale. Data Synthesis: The systematic review resulted in 165 studies, of which 15 studies met inclusion criteria. The included studies consisted of 3 RCTs and 12 observational studies. Two studies demonstrated Level 1b evidence, 1 Level 2 evidence, and the remaining were Level 4. Antipsychotics had the greatest number of studies (nZ7), followed by anticonvulsants (nZ4), antidepressants (nZ2), and beta-blockers (nZ2). Beta-blockers had the highest level of evidence (Level 1b). The anti-psychotic lithium carbonate was shown to be effective but was not recommended for use due to high risk of neurotoxicity. Conclusions: Studies consistently demonstrated that pharmacological treatment was effective in reducing agitation post ABI; however, there was insufficient information to develop a conclusion due to the strength of evidence and limited number of studies. Key Words: Brain injury, rehabilitation, agitation, systematic review Disclosures: None disclosed. Systematic & Meta-Analytic Review Poster 479 The Effect of Continuous Theta Burst Stimulation (Ctbs) on Unilateral Neglect in Patients with Stroke: A Systematic Review Andreea Cotoi (Lawson Health Research Institute), Jerome Iruthayarajah, McIntyre Amanda Objectives: To evaluate the effect of continuous theta burst stimulation (cTBS) on unilateral visual neglect in individuals post stroke. Data Sources: Studies were generated by conducting a comprehensive literature search up to December of 2015 using the following electronic databases: Scopus, PubMed, ProQuest, PsycINFO, AMED, Embase, and CINAHL. Study Selection: Studies were included for analysis if (1) they were published in English, (2) consisted of an adult stroke population, and (3) treated neglect severity using cTBS. Data Extraction: Participant characteristics, study design, treatment information, outcome measures and results were extracted from each study. Methodological quality of randomized controlled studies (RCTs) was assessed using the PEDro tool, and a level of evidence was assigned to all studies using a modified Sackett scale. Data Synthesis: Of the 519 studies initially identified, eight studies met the inclusion criteria. Four RCTs (level 1B), two prospective controlled trials (level 2), one pre-post study (level 4), and one case study (level 5) were analyzed. In seven studies, cTBS was found to significantly improve neglect severity (p<0.05) on at least one of the following outcome measures: the star cancellation test (NZ3), the behavioral inattention test (NZ2), the random shape cancellation test (NZ2), the line bisection test (NZ2), the Bird cancellation task (NZ1), the Vienna Test System (NZ2), and the Catherine Bergego Scale (NZ1). One case study indicated a clinical improvement. Conclusions: Relative to sham stimulation, cTBS was shown to reduce unilateral spatial neglect in individuals post stroke. Future RCTs and intervention studies with larger sample sizes are encouraged to establish a strong evidence-based foundation for the use of cTBS in rehabilitation practices. Key Words: Stroke, transcranial magnetic stimulation, perceptual disorders Disclosures: None disclosed.

Systematic/Meta-Analytic Review Posters Systematic & Meta-Analytic Review Poster 482 Using Theta Burst Stimulation (TBS) to Improve Upper Limb Motor Function Following a Stroke: A Systematic Review Andreea Cotoi (Lawson Health Research Institute), Jinah Ashna, Brar Josh Objectives: To evaluate the effectiveness of theta burst stimulation (TBS) in improving upper limb motor functioning among individuals post stroke. Data Sources: A literature search for articles published up to December 2015 was conducted using the following databases: PubMed, Scopus, Embase, PsycINFO, ProQuest, AMED, and CINAHL. Study Selection: Studies meeting the following inclusion criteria were selected: (1) published in English, (2) adult population (18 years of age), and (3) TBS targeting the upper extremity cortical region was used. Data Extraction: Patient characteristics, treatment information, study design, outcome measures, and results were extracted. Randomized controlled trials (RTCs) were scored using the PEDro tool. All studies were assigned a level of evidence according to a modified Sackett scale. Data Synthesis: Of the 3350 studies found, nine studies met inclusion. Analysis was conducted on three RCTs (level 2B), four prospective controlled trials (level 2), and two pre-post studies (level 4). Four studies evaluated intermittent TBS (iTBS), two evaluated continuous TBS (cTBS), and three examined both protocols. Regarding cTBS, significant findings (p<0.05) were found on the following outcome measures: Wolf Motor Function Test, Fugl-Meyer Assessment, and preload duration. ITBS was found to be significant (p<0.05) when measuring finger tapping, muscle strength, peak torque, peak angle, and preload duration. Conclusions: Overall, findings regarding the use of cTBS and iTBS for improving upper motor function among individuals post stroke are inconclusive. Due to the large variability in the outcomes used, the low study samples, and the moderate-to-low methodological quality of the studies, there is insufficient data available to provide a concluding statement regarding cTBS or iTBS as a rehabilitative therapy for upper motor function. Key Words: Transcranial magnetic stimulation, upper extremity, stroke Disclosures: None disclosed. Systematic & Meta-Analytic Review Poster 520 The Relationship between Cognition and Disability in Older Adults: A Systematic Review Jessica Jarvis (UTMB) Objectives: To investigate the relationship between cognition and disability in adults. Data Sources: A trained reference librarian assisted the development of this search strategy. All articles were selected from an electronic database. Databases searched were CINAHL, Medline Ovid, Cochrane CENTRAL, and PsycINFO. Keywords were descriptors of cognition and disability. Included articles were not limited to a specific time frame and were accepted for publications at time of inclusion. Study Selection: Studies were selected for inclusion if their independent variable was cognition or frailty and their dependent variable was cognition or disability. Studies were excluded if they were not an experimental design, not in English, not about humans, or included children. The search strategy resulted in 1,159 articles and after systematically screening nine articles remained. Data Extraction: Articles were screened in four steps. First, by removing duplicates. Next articles were systematically screen by title, abstract, and then full text. Two reviewers conducted the screening independently. Any disagreement was settled by discussion between the reviewers. Quality of the studies was assessed using the Cochrane review risk of bias screening tool. Data Synthesis: A total of 1,159 articles were located from the search strategy, 162 duplicates were removed, and 998 were excluded for not

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