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Transdisciplinary Individualized Patient Protocols- A Pilot Study In Inpatient Neurorehabilitation
e8 allogeneic) and 45.5% of the allogeneic cohort had an acute myeloid leukemia (AML) diagnosis (1.9% autologous). Premorbid low back pain and peripheral neuropathy was present in 21.2% and 15.4% of autologous, and 7.7% and 9.1% of allogeneic participants. The average distress score (0-10) was 2.2 for autologous and 2.7 for allogeneic transplant recipients. Physical problems were most concerning for all patients, including sleep difficulty (38%), numbness/tingling (33%), constipation (33%), nausea (33%), fatigue (29%), pain (29%), and dry skin (24%). Non-physical distress was greatest in nervousness (28%), worrying (26%), and financial concerns (21%). Disparities existed between cohorts, but only distress regarding physical appearance reached statistical significance on chisquare analysis (pZ0.04, allogeneic recipients had greater distress). Conclusions: Distress exists in patients prior to BMT, primarily regarding physical function. There were no statistically significant differences between allogeneic and autologous recipients except in physical appearance, possibly due to hair loss secondary to chemotherapy for AML. Pre-BMT assessment gives providers a baseline by which to measure future distress, and should be considered. Key Words: Cancer Rehabilitation, Bone Marrow Transplant, Distress Thermometer, Pre-Screening Disclosure(s): None Disclosed. Research Poster 4835 Creative, Interactive Graphic Arts Movement Feedback Increases Movement Dose During Balance Therapy: A Pilot Study Lise Worthen-Chaudhari (The Ohio State University), Marisa Butler, Sara Schiffbauer, Karen Hock, Courtney Bland, W. Jerry Mysiw Objective(s): Evaluate the effect of creative real-time movement feedback (feedback) on movement dose within neurologic physical therapy. Achieving a sufficient dose of movement during activity-based medicine is challenging (Lang et al. 2007, 2009, 2010). Although feedback shows potential to increase movement dose by increasing patient engagement (Worthen-Chaudhari et al. 2011,2013), no study of the effect of feedback on movement dose during therapy has been performed. Design: Case-Active Control. Setting: Outpatient Neurorehabilitation. Participants: Individuals referred to neurologic physical therapy for balance deficits, stemming from any etiology, were recruited and matched pairwise by age, diagnosis, and starting balance function (Berg Balance Scale). The first participants to enroll received feedback; thereafter we recruited patients eligible to serve as active control. Pairwise-matched data were obtained within the following diagnoses: Parkinson Disease, Multiple Sclerosis, and Chemotherapy-Induced Peripheral Neuropathy for a total of 6 participants (3 case-active control pairs). Interventions: All participants received balance therapy directed to falls prevention. Half of participants used adjunctive feedback that took the form of graphic art. Main Outcome Measure(s): Percent activity was expressed as time engaged in therapeutic exercise vs. time dedicated to balance. Therapeutic activity/inactivity was defined per Lang et al. Five consecutive sessions were recorded per participant, yielding 15 sessions per group. Comparisons were made using the Mann Whitney U statistic. Results: Percent activity was higher among those who used feedback (pZ0.003; mean 57+/-9% control; mean 71+/-13% feedback). Functional gains were greater for feedback participants, the central tendency showing minimal detectable change (Berg Balance Scale per Donoghue et al, 2009) for the feedback but not control group. Conclusions: Use of real-time movement feedback that takes the form of graphic art seems to increase movement dose performed by clients during neurorehabilitation therapy. Key Words: Postural Balance, Neurodegenerative Diseases, Creativity, Accidental Falls, Interactive Media Disclosure(s): Worthen-Chaudhari advises Rekovo, a start-up company, about design and evidence-based practices in interactive neurorehabilitation. She performed this research under a conflict of interest management plan
Research Posters established by her employer, The Ohio State University. This research was supported by a grant from the Ohio State University Center for Personalized Health Care. Research Poster 4838 Concussion Symptoms in Adolescents Are Alleviated Through Use of a Gamified Health App Lise Worthen-Chaudhari (The Ohio State University), Kelsey Logan, Jane McGonigal, Keith Yeates, W. Jerry Mysiw Objective(s): Determine the effect of using a smart phone-based application called SuperBetter (app) that uses social game mechanics to address health, on persistent symptoms and depression after concussion. Design: Controlled intervention trial. Setting: Outpatient concussion clinic. Participants: Sixteen adolescents (11 female/5 male; ages 13-18 years) with persistent, unresolved symptoms 3+ weeks post-concussion. Those with neurologic involvement other than concussion were excluded (e.g. chiari malformation; ADHD). The first 10 participants underwent the experimental intervention; the last 6 served as active control. Interventions: All participants received standard of care for persistent concussion symptoms, including prescription medication when indicated. In addition, the experimental group interacted with the app once per weekday for at least 3 weeks and no longer than 6 weeks. Players interacted with content designed by the authors to deliver a gamified symptoms journal. Main Outcome Measure(s): Main Outcome Measure(s): Sports Concussion Assessment Tool-3 Symptoms score. Secondary Measure: Center for Epidemiology Studies Depression Scale for Children (CES-DC). Analysis: Repeated Measures One way MANOVA, with days elapsed between preand post-test as co-variate. Results: Groups were equivalent in baseline symptoms, duration of study participation, gender distribution, and incidence of medication use. All members of the experimental group showed a positive response in symptoms while only half of the active control group improved (symptoms improvement mean+SD Z 23.3+21.6 exp; -2.8+14.9 control). A group effect was evident for both symptoms and depression (pZ0.036 and pZ 0.012 respectively). Conclusions: Smart phone based applications that promote health management through social game mechanics are feasible for use in conjunction with medical treatment by youth with persistent symptoms post-concussion. Furthermore, some standard medical management material, such as concussion symptoms journals, can be delivered in gamified form through such apps. Key Words: Concussion, Mild, Post-concussion syndrome, Mobile Applications Disclosure(s): Funding was provided by NIH-NICHD SBIR grant 1R43HD075638-01A1. SuperBetter was developed under the auspices of SuperBetter, LLC and is now owned by Cherry Street Studios, both forprofit organizations. J.M. founded SuperBetter, LLC and is Chief Scientific Officer of Cherry Street Studios. L.W.C. has served as a Science Advisor to SuperBetter Labs, LLC, on a strictly pro bono basis. No other authors have any conflict to report. Thank you to Dr. Marcia Bockbrader for assistance with statistics. Research Poster 4844 Transdisciplinary Individualized Patient Protocols- A Pilot Study In Inpatient Neurorehabilitation Liat Rabinowitz (NYU-RUSK REHABILITATION), Melissa Chung, Amy LaPorte Objective(s): To develop a systematic transdisciplinary approach to assess and treat cognitive-perceptual-behavioral impairments for patients with severe acquired brain injury. To target specific goals in a unified way to improve patient’s overall functional status.
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Research Posters Design: Case series. Duration of follow up is length of stay for patient in inpatient setting. Setting: Inpatient Acute Neurorehabilitation unit in urban city. Participants: 42 participants selected with severe acquired brain injury admitted to inpatient neurorehabilitation between 2012 and 2014. Interventions: Therapists administer standardized outcome measures. The team meets weekly and analyzes the standardized tests to guide the development of specific individualized protocols based on evidence based practice. All therapists administer the protocol during each session for a total of three trials daily until protocol is terminated or modified. Data is compiled and discussed with the medical team each week, which guides addition of and changes to pharmacological treatments as well as adjustments in therapeutic interventions. Main Outcome Measure(s): Individualized protocols, orientation log/ GOAT, Coma Recovery Scale-Revised, Mississippi Aphasia Screening Test, and Agitation Behavioral Scale. Results: Overall changes in the areas of arousal, orientation and consistency of accuracy in yes/no response are well documented and tracked. This program has facilitated improved patient management via timelier transdisciplinary discussion. Data shown that patients receiving orientation protocol which is based on use of errorless learning and spaced retrieval improved on average 30% in responses and recall of orientation information and those patient receiving a protocol targeting functional communication via yes/no responses improved on average 25%. Conclusions: There are limited standardized objective measures developed to track progress in significantly cognitively impaired patients. These protocols have allowed us to capture progress and recovery patterns in this specific patient population. Key Words: Interdisciplinary Health Team, Individualized Medicine, Acute Brain Injuries Disclosure(s): None Disclosed.
Research Poster 4846 Cerebral Palsy: Association of Cranial Magnetic Resonance Imaging with Clinical Levels of Disease Jorge Rodrigo Va´squez Rı´os (Instituto Nacional de Rehabilitacio´n), Carlos Vin˜als Laban˜ino, Saul Renan Renan Leon Hernandez, Ana Marı´a, Corte´s Rubio, Claudia Flores Flores Objective(s): To identify cranial Magnetic Resonance Imaging (MRI) findings, cognitive and sensory impairment, in children with Cerebral Palsy (CP) and the possible association with automobility level according to the gross motor function classification system (GMFCS). Design: Cross-sectional, descriptive, observational study. Setting: Tertiary care center, Me´xico City. Participants: 284 children (174 male, 110 female, age range 2-11 years) with CP were included in whom it was performed simple cranial MRI. Interventions: Patients were divided in 5 groups regarding MRI findings according Korzeniewski’s classification, and 1 group without abnormalities. Clinical features were classified using the GMFCS in ambulatory and non-ambulatory patients, topographic condition, and the presence of cognitive and sensory impairment. Main Outcome Measure(s): Statistical descriptive, quantitative variables where analyzed by X2 test. OR were determined by univariate logistic regression and contrasted by Mantel-Haenszel statistical test. Variables where analyzed by a multivariate model, p<0.15. Results: Spastic CP had mayor representation with 78.9%. According to the GMFCS 38.7% were non-ambulatory. The total sample’s prevalence of cognitive impairment was 58.1% and epilepsy 22.9%. Patients with one pathological MRI finding had mayor prevalence (52.1%), followed by association of 2 abnormalities (28.9%), in third place the group without pathological changes (11.3%). White matter anomalies alone or combined with other pathologic findings accounted for 67.1%. Spastic and mixed forms of CP had higher proportion of combined abnormal findings (0.0001), non-ambulatory had OR 1.9 (95% CI 1.2-3.2) higher than ambulatory patients with 2-4 combined findings (pZ0.009).
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e9 The non-ambulatory group had a higher risk of cognitive/sensory impairment among which intellectual deficit had higher representation (76.4%) followed by epilepsy (29.1%). Conclusions: There is direct relationship between the extent of brain damage found by MRI and GMFCS in patients with CP. Cranial MRI in children with CP is commonly abnormal and may help determine the etiology and severity of brain injury and generate counseling and intervention strategies. Key Words: Cerebral Palsy, Neuroimaging, Magnetic Resonance Imaging, Children Disclosure(s): None Disclosed. Research Poster 4847 Functional Gain after Rehabilitation Program in Patients with Brain Tumor and Stroke Louise Cunha Ramos (Associac¸a˜o das Pioneiras Sociais), Leandro Marcelino de Lima, Maryfranci Silva Ferreira Objective(s): To investigate functional gains in brain tumors (BT) survivors after an interdisciplinary rehabilitation program (IRP) and compare with gains made by stroke survivors. Hypothesis: both populations could achieve similar functional gains. Design: Retrospective cohort study. Setting: SARAH Network of Rehabilitation Hospitals, Fortaleza CE, Brazil. Participants: Patients with BT (nZ39) and Stroke (nZ2091) who had diagnosis confirmed by imaging and had concluded IRP between September 2001 and August 2014. Mean age: 45 17.1 and 61 13.8 respectively. Patients with associated central nervous system pathologies or those totally dependent in activities of daily living were excluded. Interventions: Application of Functional Independence Measure (FIM) for functionality assessment (electronic records). Data analyzes: SPSS v21 software. Significance was set at pZ0.05. Main Outcome Measure(s): Both groups showed functional improvement, evidenced by the increase in discharge FIM scores (p<0.050). No difference was observed between the groups in total FIM (pZ0.104), neither in cognitive (pZ0.085) and motor (pZ0.167) sections. Results: Mean length of stay: 25 6.5 days (pZ0.346). There was no significant difference between the groups for total FIM efficiency (pZ0.346), motor efficiency (pZ0.343) or cognitive efficiency (pZ0.625). The BT group had a higher admission FIM score (p<0.050) in total FIM and motor section. Conclusions: Previous studies show that increased functionality may be related to a better quality of life. Participation in IRP can alleviate the disabilities faced by patients with BT, although there is no evidence established. Our study showed that participation in IRP can bring similar functional gains, both in stroke and brain tumors patients. Key Words: Brain Tumors, Rehabilitation, Stroke, Disability Evaluation, Cancer Disclosure(s): None Disclosed. Research Poster 4851 Impact of Coping Skills Intervention Group for Patients with Acquired Brain Injury and Their Caregivers Thomas F. Bergquist (Mayo Clinic), Danielle Klunk, Kamini Krishnan, Anita Milburn, Jeffrey Smigielski Objective(s): The study aim was to assess the impact of a 12-week intervention focused on coping and compensation skill development for patients with acquired brain injury (ABI) and their caregivers on perceived caregiver burden, caregiver patient relationship, and self-perceived patient coping skills. Design: Coping skills and caregiver satisfaction measures were administered before and after completion of a 12-week manualized Brain Injury Coping Skills intervention for patients and their caregivers.
Research Posters established by her employer, The Ohio State University. This research was supported by a grant from the Ohio State University Center for Personalized Health Care. Research Poster 4838 Concussion Symptoms in Adolescents Are Alleviated Through Use of a Gamified Health App Lise Worthen-Chaudhari (The Ohio State University), Kelsey Logan, Jane McGonigal, Keith Yeates, W. Jerry Mysiw Objective(s): Determine the effect of using a smart phone-based application called SuperBetter (app) that uses social game mechanics to address health, on persistent symptoms and depression after concussion. Design: Controlled intervention trial. Setting: Outpatient concussion clinic. Participants: Sixteen adolescents (11 female/5 male; ages 13-18 years) with persistent, unresolved symptoms 3+ weeks post-concussion. Those with neurologic involvement other than concussion were excluded (e.g. chiari malformation; ADHD). The first 10 participants underwent the experimental intervention; the last 6 served as active control. Interventions: All participants received standard of care for persistent concussion symptoms, including prescription medication when indicated. In addition, the experimental group interacted with the app once per weekday for at least 3 weeks and no longer than 6 weeks. Players interacted with content designed by the authors to deliver a gamified symptoms journal. Main Outcome Measure(s): Main Outcome Measure(s): Sports Concussion Assessment Tool-3 Symptoms score. Secondary Measure: Center for Epidemiology Studies Depression Scale for Children (CES-DC). Analysis: Repeated Measures One way MANOVA, with days elapsed between preand post-test as co-variate. Results: Groups were equivalent in baseline symptoms, duration of study participation, gender distribution, and incidence of medication use. All members of the experimental group showed a positive response in symptoms while only half of the active control group improved (symptoms improvement mean+SD Z 23.3+21.6 exp; -2.8+14.9 control). A group effect was evident for both symptoms and depression (pZ0.036 and pZ 0.012 respectively). Conclusions: Smart phone based applications that promote health management through social game mechanics are feasible for use in conjunction with medical treatment by youth with persistent symptoms post-concussion. Furthermore, some standard medical management material, such as concussion symptoms journals, can be delivered in gamified form through such apps. Key Words: Concussion, Mild, Post-concussion syndrome, Mobile Applications Disclosure(s): Funding was provided by NIH-NICHD SBIR grant 1R43HD075638-01A1. SuperBetter was developed under the auspices of SuperBetter, LLC and is now owned by Cherry Street Studios, both forprofit organizations. J.M. founded SuperBetter, LLC and is Chief Scientific Officer of Cherry Street Studios. L.W.C. has served as a Science Advisor to SuperBetter Labs, LLC, on a strictly pro bono basis. No other authors have any conflict to report. Thank you to Dr. Marcia Bockbrader for assistance with statistics. Research Poster 4844 Transdisciplinary Individualized Patient Protocols- A Pilot Study In Inpatient Neurorehabilitation Liat Rabinowitz (NYU-RUSK REHABILITATION), Melissa Chung, Amy LaPorte Objective(s): To develop a systematic transdisciplinary approach to assess and treat cognitive-perceptual-behavioral impairments for patients with severe acquired brain injury. To target specific goals in a unified way to improve patient’s overall functional status.
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Research Posters Design: Case series. Duration of follow up is length of stay for patient in inpatient setting. Setting: Inpatient Acute Neurorehabilitation unit in urban city. Participants: 42 participants selected with severe acquired brain injury admitted to inpatient neurorehabilitation between 2012 and 2014. Interventions: Therapists administer standardized outcome measures. The team meets weekly and analyzes the standardized tests to guide the development of specific individualized protocols based on evidence based practice. All therapists administer the protocol during each session for a total of three trials daily until protocol is terminated or modified. Data is compiled and discussed with the medical team each week, which guides addition of and changes to pharmacological treatments as well as adjustments in therapeutic interventions. Main Outcome Measure(s): Individualized protocols, orientation log/ GOAT, Coma Recovery Scale-Revised, Mississippi Aphasia Screening Test, and Agitation Behavioral Scale. Results: Overall changes in the areas of arousal, orientation and consistency of accuracy in yes/no response are well documented and tracked. This program has facilitated improved patient management via timelier transdisciplinary discussion. Data shown that patients receiving orientation protocol which is based on use of errorless learning and spaced retrieval improved on average 30% in responses and recall of orientation information and those patient receiving a protocol targeting functional communication via yes/no responses improved on average 25%. Conclusions: There are limited standardized objective measures developed to track progress in significantly cognitively impaired patients. These protocols have allowed us to capture progress and recovery patterns in this specific patient population. Key Words: Interdisciplinary Health Team, Individualized Medicine, Acute Brain Injuries Disclosure(s): None Disclosed.
Research Poster 4846 Cerebral Palsy: Association of Cranial Magnetic Resonance Imaging with Clinical Levels of Disease Jorge Rodrigo Va´squez Rı´os (Instituto Nacional de Rehabilitacio´n), Carlos Vin˜als Laban˜ino, Saul Renan Renan Leon Hernandez, Ana Marı´a, Corte´s Rubio, Claudia Flores Flores Objective(s): To identify cranial Magnetic Resonance Imaging (MRI) findings, cognitive and sensory impairment, in children with Cerebral Palsy (CP) and the possible association with automobility level according to the gross motor function classification system (GMFCS). Design: Cross-sectional, descriptive, observational study. Setting: Tertiary care center, Me´xico City. Participants: 284 children (174 male, 110 female, age range 2-11 years) with CP were included in whom it was performed simple cranial MRI. Interventions: Patients were divided in 5 groups regarding MRI findings according Korzeniewski’s classification, and 1 group without abnormalities. Clinical features were classified using the GMFCS in ambulatory and non-ambulatory patients, topographic condition, and the presence of cognitive and sensory impairment. Main Outcome Measure(s): Statistical descriptive, quantitative variables where analyzed by X2 test. OR were determined by univariate logistic regression and contrasted by Mantel-Haenszel statistical test. Variables where analyzed by a multivariate model, p<0.15. Results: Spastic CP had mayor representation with 78.9%. According to the GMFCS 38.7% were non-ambulatory. The total sample’s prevalence of cognitive impairment was 58.1% and epilepsy 22.9%. Patients with one pathological MRI finding had mayor prevalence (52.1%), followed by association of 2 abnormalities (28.9%), in third place the group without pathological changes (11.3%). White matter anomalies alone or combined with other pathologic findings accounted for 67.1%. Spastic and mixed forms of CP had higher proportion of combined abnormal findings (0.0001), non-ambulatory had OR 1.9 (95% CI 1.2-3.2) higher than ambulatory patients with 2-4 combined findings (pZ0.009).
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e9 The non-ambulatory group had a higher risk of cognitive/sensory impairment among which intellectual deficit had higher representation (76.4%) followed by epilepsy (29.1%). Conclusions: There is direct relationship between the extent of brain damage found by MRI and GMFCS in patients with CP. Cranial MRI in children with CP is commonly abnormal and may help determine the etiology and severity of brain injury and generate counseling and intervention strategies. Key Words: Cerebral Palsy, Neuroimaging, Magnetic Resonance Imaging, Children Disclosure(s): None Disclosed. Research Poster 4847 Functional Gain after Rehabilitation Program in Patients with Brain Tumor and Stroke Louise Cunha Ramos (Associac¸a˜o das Pioneiras Sociais), Leandro Marcelino de Lima, Maryfranci Silva Ferreira Objective(s): To investigate functional gains in brain tumors (BT) survivors after an interdisciplinary rehabilitation program (IRP) and compare with gains made by stroke survivors. Hypothesis: both populations could achieve similar functional gains. Design: Retrospective cohort study. Setting: SARAH Network of Rehabilitation Hospitals, Fortaleza CE, Brazil. Participants: Patients with BT (nZ39) and Stroke (nZ2091) who had diagnosis confirmed by imaging and had concluded IRP between September 2001 and August 2014. Mean age: 45 17.1 and 61 13.8 respectively. Patients with associated central nervous system pathologies or those totally dependent in activities of daily living were excluded. Interventions: Application of Functional Independence Measure (FIM) for functionality assessment (electronic records). Data analyzes: SPSS v21 software. Significance was set at pZ0.05. Main Outcome Measure(s): Both groups showed functional improvement, evidenced by the increase in discharge FIM scores (p<0.050). No difference was observed between the groups in total FIM (pZ0.104), neither in cognitive (pZ0.085) and motor (pZ0.167) sections. Results: Mean length of stay: 25 6.5 days (pZ0.346). There was no significant difference between the groups for total FIM efficiency (pZ0.346), motor efficiency (pZ0.343) or cognitive efficiency (pZ0.625). The BT group had a higher admission FIM score (p<0.050) in total FIM and motor section. Conclusions: Previous studies show that increased functionality may be related to a better quality of life. Participation in IRP can alleviate the disabilities faced by patients with BT, although there is no evidence established. Our study showed that participation in IRP can bring similar functional gains, both in stroke and brain tumors patients. Key Words: Brain Tumors, Rehabilitation, Stroke, Disability Evaluation, Cancer Disclosure(s): None Disclosed. Research Poster 4851 Impact of Coping Skills Intervention Group for Patients with Acquired Brain Injury and Their Caregivers Thomas F. Bergquist (Mayo Clinic), Danielle Klunk, Kamini Krishnan, Anita Milburn, Jeffrey Smigielski Objective(s): The study aim was to assess the impact of a 12-week intervention focused on coping and compensation skill development for patients with acquired brain injury (ABI) and their caregivers on perceived caregiver burden, caregiver patient relationship, and self-perceived patient coping skills. Design: Coping skills and caregiver satisfaction measures were administered before and after completion of a 12-week manualized Brain Injury Coping Skills intervention for patients and their caregivers.