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Unilateral Transtibial Amputees Use Symmetric Joint Moments and Response Latencies Following Perturbations
Research Posters SF-36), accounting for 60.53% of the variance the follow-up measures. Using hierarchical linear regression, family resources and age, but not family functioning, were significant predictors of self-reported post concussive symptoms at follow-up. Neither family resources nor functioning predicted current functional and participation status. Conclusions: Fewer family resources and greater age were associated with increased self-reported post concussive symptoms. Neither premorbid family functioning nor resources were associated with current functional and participation status. Premorbid resources and age at time of injury may be risk factors for greater reporting of post concussive symptoms in persons with mild TBI. Key Words: mTBI, post concussive symptoms, functional status, family functioning, family resources Disclosure(s): None Disclosed. Research Poster 3281 Sexual Functioning of Partners of Persons with Traumatic Brain Injury Angelle M. Sander (Baylor College of Medicine & TIRR Memorial Hermann), Kacey Maestas, Monique Renae Pappadis, Flora Hammond, Robin Hanks Objective(s): To investigate self-reported sexual functioning and its predictors in partners of persons with traumatic brain injury (TBI). Design: Inception cohort survey study. Setting: Community, following inpatient rehabilitation at one of 6 TBI Model Systems centers. Participants: 70 persons with complicated mild, moderate, or severe TBI and their partners, assessed at approximately 1 year post-injury. Interventions: N/A. Main Outcome Measure(s): Derogatis Interview for Sexual Functioning Self-Report (DISF-R) and Global Sexual Satisfaction Index (GSSI). Results: 20% percent of partners of persons with TBI reported impaired sexual functioning relative to the normative DISF-SR sample. This was similar to the 25% of persons with TBI who reported impaired sexual functioning. Partners of persons with TBI scored significantly below the normative mean on the DISF-SR Total score and on subscales of Sexual Cognition/Fantasy, Sexual Arousal, Sexual Behavior/Experience, Orgasm, and Sexual Drive/Relationship. 44% of partners reported GSSI scores consistent with dissatisfaction with sexual functioning, as compared to 20% of persons with TBI. Multivariable linear regression showed that worse sexual functioning in the partner was associated with older age and with worse sexual functioning in the person with TBI. There were trends for worse partner sexual functioning to be associated with poorer motor functioning and less participation in the person with TBI. Conclusions: A substantial number of partners of persons with TBI experience sexual impairment and dissatisfaction with sexual functioning. Poorer sexual functioning in partners is associated partly with older age and with sexual dysfunction in the person with injury. Rehabilitation professionals should provide education on possible changes in sexual functioning to persons with TBI and their partners and integrate assessment of sexual functioning into evaluations. Referrals for marital/couples therapy and for sexual therapy should be made as appropriate. Key Words: Brain Injuries, Sexuality, Rehabilitation Disclosure(s): None Disclosed. Research Poster 3283 Considering the Role of Moral Injury and Spiritual Health in OEF/OIF Veterans with Mild TBI Ryan O. Stephenson, Holly Gerber, Lisa Brenner (Department of Veterans Affairs) Objective(s): This study aims to explore psychological, moral, and spiritual health factors that may contribute to the maintenance of postconcussive symptoms (PCS) in Veterans with mild traumatic brain injury (mTBI).
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e27 Design: This is an observational study of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans with mTBI. Setting: All participants were recruited from the Veterans Health Administration Eastern Colorado Health Care System. Participants: OEF/OIF Veterans with mTBI (NZ57). The majority of participants were male (89.5%) with a mean age of 32.5 and two combat deployments. Interventions: N/A. Main Outcome Measure(s): Clinical interviews were used to assess lifetime history of mTBI and PTSD. Questionnaires included the Moral Injury Events Scale (MIES), Spiritual Health and Life-Orientation Measure (SHALOM), and Brief Multidimensional Measure of Religiousness/ Spirituality (BMMRS). Results: Participants reported high levels of perceived moral transgressions (MZ20.8, SDZ8.1) and perceived moral betrayals (MZ11.1, SDZ4.5), as well as high rates of PTSD diagnoses (86%). Discrepancies were found between ideal (MZ16.2) and current (MZ12.5) levels of spiritual health. Preliminary results suggest a preference for individuals to identify as spiritual rather than religious (MZ 2.5, 3.1, respectively, SDZ1). Further, 33.4% of the sample identified as atheist, agnostic, or as having no religion, while 50.8% identified as Christian. Conclusions: Preliminary data reveal rates of moral injury, spiritual health, and post-traumatic stress disorder. Veterans with mTBI reported greater moral injury than has been previously reported in other military samples. Discrepancies found between ideal and current states of spiritual health highlight unsatisfactory spiritual well-being. Religious preferences (or rejection thereof) were noteworthy. These findings call attention to potential factors associated with PCS maintenance, and reinforce the need for continued exploration of moral injury and spirituality. Key Words: TBI, Moral injury, Spirituality, PTSD Disclosure(s): None Disclosed. Research Poster 3293 Unilateral Transtibial Amputees Use Symmetric Joint Moments and Response Latencies Following Perturbations Jonathan Akins (Widener University), Deepan C. Kamaraj, Rory Cooper, David Michael Brienza Objective(s): To investigate reactive postural responses to multi-directional support surface perturbations in unilateral transtibial amputees. We hypothesized participants would use an asymmetric postural response at the ankle (reduced moment and increased response latency in prosthetic ankle) and symmetric postural response at the hip. Design: Cross-sectional study. Setting: Research laboratory. Participants: Twelve unilateral transtibial amputees (Age: 56.3 12.8 years, Height: 175.5 10.5 cm, Mass: 89.8 13.3 kg). Participants were at least two years post-amputation and ambulatory without other assistive technology aids. Interventions: N/A. Main Outcome Measure(s): Peak ankle and hip joint moments and response latencies following support surface perturbations applied in the horizontal plane - anterior, posterior, towards the prosthetic limb, towards the sound limb. Results: Paired t-tests were used to identify between-limb differences with Bonferroni correction (a Z .025). Our hypothesis of an asymmetric postural response at the ankle was not supported. No between-limb difference was identified in peak ankle moments (P .054) or response latencies (P .207). The hypothesis of no between-limb difference in peak hip moments (P .176) and response latencies (P .111) was supported. Conclusions: Reactive postural responses to external perturbations is a critical area of study in fall prevention research because falls regularly occur when balance is hindered by external forces. Unilateral transtibial amputees used a symmetric postural response at the ankle and hip following support surface perturbations. A symmetric response at the ankle is counterintuitive because unilateral transtibial amputees cannot actively control the prosthetic ankle. The observed results may be due to small sample size, the participants being experienced prosthesis users (8.7 5.7
e28 years post-amputation) and using energy-storage-and-return prosthetic feet. Key Words: Amputees, Postural balance, Reaction time, Kinetics Disclosure(s): None Disclosed. Research Poster 3295 Acute Inpatient Rehabilitation in Children with Recent Posterior Fossa Tumor Resection: A Case Series Nikola Dragojlovic (University of Texas Health Science Center, Houston), Zach Wirt, Christian Niedzwecki Objective(s): To describe the presentations, deficits, and functional outcomes of children who have undergone recent posterior fossa tumor resection and completed acute inpatient rehabilitation. Design: Case series. Setting: Academic, tertiary pediatric referral center, free standing pediatric hospital. Participants: Four children (age 5 years to 12 years), with posterior fossa tumors who underwent surgical resection and were admitted to acute inpatient rehabilitation. Interventions: Completion of acute inpatient rehabilitation with three hours of daily physical, occupational, and/or speech therapies and ongoing medical management. Main Outcome Measure(s): Total and subtotal WeeFIMTM scores at admission and discharge, week-to-week score differences, and efficiency scores. Results: All patients reviewed had gains in their functional outcome scores (22-46 points). Despite variations in their presenting and admission symptoms, all patients reviewed had functional outcome efficiency scores (1.38) that were comparable to aggregate scores of patients admitted to the same unit for similar periods of time with other diagnoses (1.34). Further discussion on their presenting symptoms, advanced imaging, treatment challenges, and outcomes will also be included in the final poster. Conclusions: Children with recent posterior fossa tumor resections demonstrate improved functional gains after admission to an acute inpatient rehabilitation unit. Specific criteria should be developed based on presentation, tumor type, and treatment pathway to determine which children would benefit most from inpatient rehabilitation. Key Words: Pediatrics, Brain tumor, Rehabilitation, Central nervous system tumor, Cancer rehabilitation Disclosure(s): None Disclosed. Research Poster 3299 Integration of a Hybrid Program: Impacting Individualized Therapy Outcomes Julie Wooster (Brooks Rehabilitation Hospital), Lou DeMark, Robert John McIver Objective(s): To introduce patients to an individualized rehabilitation program utilizing community resources early in the continuum of care to improve outcomes for individuals with acute neurological injury. Design: Five-month descriptive cohort study. Setting: Inpatient Rehabilitation Hospital. Participants: Fifty-one patients in an inpatient setting following a neurologic incident were referred for screening by a physical therapist for participation in the program. Informed consent and physician clearance were obtained prior to their inclusion. Interventions: Patients and caregivers were trained on advanced rehabilitation technology to have access to additional therapy, while in an independent setting. Patients were instructed on additional independent exercises, supervised by an exercise physiologist. Following discharge from inpatient services, their program continued while receiving skilled outpatient therapy. Main Outcome Measure(s): A 32-item anonymous QOL assessment survey given at onset of outpatient services and at 2-months. Patient healthcare cost savings were also utilized to determine efficiency. Results: After 6 months there was a 30% retainment rate in community programming of the patients who utilized the program. This resulted in a
Research Posters 16% increase in community program memberships in 6 months from 8% the previous 6 months. Cost savings for the sum of the patients’ healthcare costs were $19,000. QOL surveys were conducted at the same time in community programming (concurrently) that showed a 4% overall increase in patient QOL after inception. Conclusions: The hybrid program conserved outpatient visits and financial resources while indicating a trend towards improved QOL and sustained engagement. This innovative program allowed patients to receive additional services maximizing therapeutic gains while transitioning into a supportive culture and community. Key Words: Nervous system diseases, Physical and rehabilitation medicine, Quality of life, Patient participation Disclosure(s): None Disclosed. Research Poster 3313 Unexpected Improvement Following OSA Treatment during PostAcute Recovery from Brain Injury and Minimally Conscious State Marc A. Silva (James A. Haley Veterans’ Hospital), Adam Christopher Haskin, Daniel Schwartz, Risa Nakase-Richardson Objective(s): To describe cognitive and motor improvement in a minimally conscious patient with obstructive sleep apnea and initially a poor prognosis. Design: Case Study. Single-subject intervention and observation. Setting: Inpatient neurorehabilitation unit of a VA hospital. Participants: A veteran admitted 24 days post injury in a minimally conscious state following anoxic brain injury. Interventions: CPAP for severe obstructive sleep apnea plus routine inpatient neurorehabilitation. Main Outcome Measure(s): Functional Independence Measure (FIM). Galveston Orientation and Amnesia Test (GOAT). Results: Despite no improvement across outcome measures in the first 71 days post-insult, the participant demonstrated improvement in cognitive domains on the FIM within four weeks following initiation of CPAP treatment. At ten weeks post-injury, the participant continued to make functional gains on the FIM and regained orientation on the GOAT. His communication became functional but he remained largely functionally dependent for virtually all ADLs due to relative lack of motor recovery. Conclusions: Although sleep disturbances are prevalent in neurorehabilitation, phenotyping sleep disorders can help direct initiation of specific treatments. This case study highlights unexpected improvement in cognitive domains following initiation of a specific sleep apnea treatment (CPAP) that minimized hypoxemia and facilitated neurorestorative sleep in the post-acute stages despite lack of progress earlier in recovery. Phenotyping sleep disorders earlier in recovery may help facilitate ongoing neural recovery. Key Words: Brain injuries, Minimally conscious state, Sleep apnea syndromes Disclosure(s): Financial Disclosures: None; This research was sponsored by VHA Central Office Division of Rehabilitation Medicine and VA TBI Model System Program of Research, HSR&D Center for Innovation in Rehabilitation Outcome (Tampa & Gainesville, Florida); This material is based upon work supported in part by the Defense and Veterans Brain Injury Center (DVBIC) and US Army Medical Research and Material Command (USAMRMC); This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital. Research Poster 3319 Systematic Implementation of Cognitive Rehabilitation Techniques in an Outpatient Brain Injury Treatment Setting Larissa Swan (Rehabilitation Hospital of Indiana), Theresa Mull, Edmund Charles Haskins, James F. Malec Objective(s): To implement a process to assure consistent use of evidence-based cognitive rehabilitation procedures by therapists in an outpatient brain rehabilitation setting.
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e27 Design: This is an observational study of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans with mTBI. Setting: All participants were recruited from the Veterans Health Administration Eastern Colorado Health Care System. Participants: OEF/OIF Veterans with mTBI (NZ57). The majority of participants were male (89.5%) with a mean age of 32.5 and two combat deployments. Interventions: N/A. Main Outcome Measure(s): Clinical interviews were used to assess lifetime history of mTBI and PTSD. Questionnaires included the Moral Injury Events Scale (MIES), Spiritual Health and Life-Orientation Measure (SHALOM), and Brief Multidimensional Measure of Religiousness/ Spirituality (BMMRS). Results: Participants reported high levels of perceived moral transgressions (MZ20.8, SDZ8.1) and perceived moral betrayals (MZ11.1, SDZ4.5), as well as high rates of PTSD diagnoses (86%). Discrepancies were found between ideal (MZ16.2) and current (MZ12.5) levels of spiritual health. Preliminary results suggest a preference for individuals to identify as spiritual rather than religious (MZ 2.5, 3.1, respectively, SDZ1). Further, 33.4% of the sample identified as atheist, agnostic, or as having no religion, while 50.8% identified as Christian. Conclusions: Preliminary data reveal rates of moral injury, spiritual health, and post-traumatic stress disorder. Veterans with mTBI reported greater moral injury than has been previously reported in other military samples. Discrepancies found between ideal and current states of spiritual health highlight unsatisfactory spiritual well-being. Religious preferences (or rejection thereof) were noteworthy. These findings call attention to potential factors associated with PCS maintenance, and reinforce the need for continued exploration of moral injury and spirituality. Key Words: TBI, Moral injury, Spirituality, PTSD Disclosure(s): None Disclosed. Research Poster 3293 Unilateral Transtibial Amputees Use Symmetric Joint Moments and Response Latencies Following Perturbations Jonathan Akins (Widener University), Deepan C. Kamaraj, Rory Cooper, David Michael Brienza Objective(s): To investigate reactive postural responses to multi-directional support surface perturbations in unilateral transtibial amputees. We hypothesized participants would use an asymmetric postural response at the ankle (reduced moment and increased response latency in prosthetic ankle) and symmetric postural response at the hip. Design: Cross-sectional study. Setting: Research laboratory. Participants: Twelve unilateral transtibial amputees (Age: 56.3 12.8 years, Height: 175.5 10.5 cm, Mass: 89.8 13.3 kg). Participants were at least two years post-amputation and ambulatory without other assistive technology aids. Interventions: N/A. Main Outcome Measure(s): Peak ankle and hip joint moments and response latencies following support surface perturbations applied in the horizontal plane - anterior, posterior, towards the prosthetic limb, towards the sound limb. Results: Paired t-tests were used to identify between-limb differences with Bonferroni correction (a Z .025). Our hypothesis of an asymmetric postural response at the ankle was not supported. No between-limb difference was identified in peak ankle moments (P .054) or response latencies (P .207). The hypothesis of no between-limb difference in peak hip moments (P .176) and response latencies (P .111) was supported. Conclusions: Reactive postural responses to external perturbations is a critical area of study in fall prevention research because falls regularly occur when balance is hindered by external forces. Unilateral transtibial amputees used a symmetric postural response at the ankle and hip following support surface perturbations. A symmetric response at the ankle is counterintuitive because unilateral transtibial amputees cannot actively control the prosthetic ankle. The observed results may be due to small sample size, the participants being experienced prosthesis users (8.7 5.7
e28 years post-amputation) and using energy-storage-and-return prosthetic feet. Key Words: Amputees, Postural balance, Reaction time, Kinetics Disclosure(s): None Disclosed. Research Poster 3295 Acute Inpatient Rehabilitation in Children with Recent Posterior Fossa Tumor Resection: A Case Series Nikola Dragojlovic (University of Texas Health Science Center, Houston), Zach Wirt, Christian Niedzwecki Objective(s): To describe the presentations, deficits, and functional outcomes of children who have undergone recent posterior fossa tumor resection and completed acute inpatient rehabilitation. Design: Case series. Setting: Academic, tertiary pediatric referral center, free standing pediatric hospital. Participants: Four children (age 5 years to 12 years), with posterior fossa tumors who underwent surgical resection and were admitted to acute inpatient rehabilitation. Interventions: Completion of acute inpatient rehabilitation with three hours of daily physical, occupational, and/or speech therapies and ongoing medical management. Main Outcome Measure(s): Total and subtotal WeeFIMTM scores at admission and discharge, week-to-week score differences, and efficiency scores. Results: All patients reviewed had gains in their functional outcome scores (22-46 points). Despite variations in their presenting and admission symptoms, all patients reviewed had functional outcome efficiency scores (1.38) that were comparable to aggregate scores of patients admitted to the same unit for similar periods of time with other diagnoses (1.34). Further discussion on their presenting symptoms, advanced imaging, treatment challenges, and outcomes will also be included in the final poster. Conclusions: Children with recent posterior fossa tumor resections demonstrate improved functional gains after admission to an acute inpatient rehabilitation unit. Specific criteria should be developed based on presentation, tumor type, and treatment pathway to determine which children would benefit most from inpatient rehabilitation. Key Words: Pediatrics, Brain tumor, Rehabilitation, Central nervous system tumor, Cancer rehabilitation Disclosure(s): None Disclosed. Research Poster 3299 Integration of a Hybrid Program: Impacting Individualized Therapy Outcomes Julie Wooster (Brooks Rehabilitation Hospital), Lou DeMark, Robert John McIver Objective(s): To introduce patients to an individualized rehabilitation program utilizing community resources early in the continuum of care to improve outcomes for individuals with acute neurological injury. Design: Five-month descriptive cohort study. Setting: Inpatient Rehabilitation Hospital. Participants: Fifty-one patients in an inpatient setting following a neurologic incident were referred for screening by a physical therapist for participation in the program. Informed consent and physician clearance were obtained prior to their inclusion. Interventions: Patients and caregivers were trained on advanced rehabilitation technology to have access to additional therapy, while in an independent setting. Patients were instructed on additional independent exercises, supervised by an exercise physiologist. Following discharge from inpatient services, their program continued while receiving skilled outpatient therapy. Main Outcome Measure(s): A 32-item anonymous QOL assessment survey given at onset of outpatient services and at 2-months. Patient healthcare cost savings were also utilized to determine efficiency. Results: After 6 months there was a 30% retainment rate in community programming of the patients who utilized the program. This resulted in a
Research Posters 16% increase in community program memberships in 6 months from 8% the previous 6 months. Cost savings for the sum of the patients’ healthcare costs were $19,000. QOL surveys were conducted at the same time in community programming (concurrently) that showed a 4% overall increase in patient QOL after inception. Conclusions: The hybrid program conserved outpatient visits and financial resources while indicating a trend towards improved QOL and sustained engagement. This innovative program allowed patients to receive additional services maximizing therapeutic gains while transitioning into a supportive culture and community. Key Words: Nervous system diseases, Physical and rehabilitation medicine, Quality of life, Patient participation Disclosure(s): None Disclosed. Research Poster 3313 Unexpected Improvement Following OSA Treatment during PostAcute Recovery from Brain Injury and Minimally Conscious State Marc A. Silva (James A. Haley Veterans’ Hospital), Adam Christopher Haskin, Daniel Schwartz, Risa Nakase-Richardson Objective(s): To describe cognitive and motor improvement in a minimally conscious patient with obstructive sleep apnea and initially a poor prognosis. Design: Case Study. Single-subject intervention and observation. Setting: Inpatient neurorehabilitation unit of a VA hospital. Participants: A veteran admitted 24 days post injury in a minimally conscious state following anoxic brain injury. Interventions: CPAP for severe obstructive sleep apnea plus routine inpatient neurorehabilitation. Main Outcome Measure(s): Functional Independence Measure (FIM). Galveston Orientation and Amnesia Test (GOAT). Results: Despite no improvement across outcome measures in the first 71 days post-insult, the participant demonstrated improvement in cognitive domains on the FIM within four weeks following initiation of CPAP treatment. At ten weeks post-injury, the participant continued to make functional gains on the FIM and regained orientation on the GOAT. His communication became functional but he remained largely functionally dependent for virtually all ADLs due to relative lack of motor recovery. Conclusions: Although sleep disturbances are prevalent in neurorehabilitation, phenotyping sleep disorders can help direct initiation of specific treatments. This case study highlights unexpected improvement in cognitive domains following initiation of a specific sleep apnea treatment (CPAP) that minimized hypoxemia and facilitated neurorestorative sleep in the post-acute stages despite lack of progress earlier in recovery. Phenotyping sleep disorders earlier in recovery may help facilitate ongoing neural recovery. Key Words: Brain injuries, Minimally conscious state, Sleep apnea syndromes Disclosure(s): Financial Disclosures: None; This research was sponsored by VHA Central Office Division of Rehabilitation Medicine and VA TBI Model System Program of Research, HSR&D Center for Innovation in Rehabilitation Outcome (Tampa & Gainesville, Florida); This material is based upon work supported in part by the Defense and Veterans Brain Injury Center (DVBIC) and US Army Medical Research and Material Command (USAMRMC); This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital. Research Poster 3319 Systematic Implementation of Cognitive Rehabilitation Techniques in an Outpatient Brain Injury Treatment Setting Larissa Swan (Rehabilitation Hospital of Indiana), Theresa Mull, Edmund Charles Haskins, James F. Malec Objective(s): To implement a process to assure consistent use of evidence-based cognitive rehabilitation procedures by therapists in an outpatient brain rehabilitation setting.
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