Transcranial Direct Current Stimulation for a Patient with Chronic Right Hemiparesis: A Case Report

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