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 Table of Contents  
POSTER ABSTRACTS
Year : 2018  |  Volume : 1  |  Issue : 1  |  Page : 103-557

Poster Abstracts


Date of Web Publication10-Jul-2018

Correspondence Address:
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-7904.236308

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How to cite this article:
. Poster Abstracts. J Int Soc Phys Rehabil Med 2018;1, Suppl S1:103-557

How to cite this URL:
. Poster Abstracts. J Int Soc Phys Rehabil Med [serial online] 2018 [cited 2018 Oct 19];1, Suppl S1:103-557. Available from: http://www.jisprm.org/text.asp?2018/1/1/103/239537




  A1.01 PAIN - Acute Pain Top



  ISPR8-0147 Top


A randomised clinical investigation into placing pain spot externally to crossing area of the two currents of interferential therapy on pain

A. Beatti, E. Al Zahrani1, T. Al Qahtani2, H. Al Saif2, A. Khamis3

Rehabilitation Centre, Alhada Armdforce Hospital, Taif, 1Prince Sultan Military College of Health Sciences, Dharan, 2Department of Physiotherapy, King Fahd Military Medical Complex, Dharan, Saudi Arabia, 3Department of Research, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates

E-mail: a.beatti@gmail.com

Introduction/Background: Interferential therapy (IFT) has been applied in a quadripolar way so that the two currents intersect in the painful area. Clinically, no clear reduction effect of pain has been confirmed with this application method of IFT. Experimentally, the highest voltage of IFT is being induced outside the intersection area of the two used currents. Thus, it is probably true that placing the painful area outside the intersection spot of the two currents would reveal a significant pain reduction. Materials and Methods: A Double-Blind Placebo-Controlled Clinical Investigation. Setting: A public hospital physiotherapy department. Participants: 168 subjects with subacute low back pain. Interventions: Participants were randomly assigned to: 1- external IFT (painful spot was at 2 cm outside of the outer borders of the electrodes) 2- placebo external IFT 3- traditional IFT (painful spot was at the crossing area of the two currents) 4- placebo traditional IFT. Groups 1 and 3 received 20 min of IFT at 100 Hz and comfortable stimulation intensity. Groups 2 and 4 received sham IFT for 20 min. Main outcome measures: Before and immediately after IFT session, pain severity, pressure threshold (PPT) and distribution were assessed using visual analogue scale (VAS), algometer, and distance from pain source, respectively. Distance from the tip of middle finger to the ground during forward trunk flexion determined range of motion (ROM). Results: Only VAS and ROM improved with all groups, P ? 0.03 with no statistical differences between them, P > 0.1. Active IFTs changed all outcomes to same extent. There was a trend of better VAS reduction with active IFTs compared to placebos. Conclusion: No therapeutic difference between external and traditional applications. The effect IFT in pain and ROM is not more than placebo. However, a trend of better pain reduction with active IFTs compared to placebos was noticed.

Keywords: Interferential therapy, pain management

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1799 Top


Feasibility study for the generalization of early management of low back pain in work stoppage after a work-related injury

F. Moretto

Department of Physical Medicine and Rehabilitation, CHRU Lille, Lille, France

E-mail: moretto_fabien@hotmail.fr

Introduction/Background: A considerable proportion of work absence is attributed to low back pain (LBP), with high lost productive time and health spending, specialy after a work-related injury. The French Health Insurance try to improve the return-to-work for these patient with a early care in rehabilitation center. The objectif of this study is to determinate if a early care three months after a work stoppage after a work-related injury improve the return to work three months after, and to determinate factors that influence the return-to-work. Materials and Methods: Five center in France taked part in this protocol, in an open prospective study. 147 LBP patients (handler) were included in 2016, three months after the work-related injury. The intervention was a multidisciplinary functional restoration program for 67 patients. The other were follow-up about the return-to-work. The outcome was the return-to-work rate three months after the intervention. Results: In the 52 remaining patients, 26 (50%) were at work at 3 months: 16 in full time at the same job. 9 patients were in occupational retraining. For the other 80 patients, 70 (87,5%) were at work at three months. Active physiotherapy, TAMPA, FABQ, DALLAS, Visual Analog Scale (VAS) after the program were found to have relationships with the outcome. LBP background and being sportif before ou after the program, were not found to have relationship with the outcome. Conclusion: Unfortunately, we fund an adverse effect of the multidisciplinary functional restoration program from patients with low back pain in work stoppage after a work-related injury in our study. Maybe the overmedication, or the drama caused by this program in hospitalization, must influence the situation of workers. Surprisingly, sports practice did not show any influence on the results. Active physiotherapy should be offered to any patient in this situation to promote the return to work.

Keywords: Early care, low back pain, return-to-work

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2584 Top


The effects of cervical kinesio taping on pain, range of motion, and disability in patients following thyroidectomy: A randomized clinical trial, preliminary results

A. Genç, V. Genç1, S. U. Celik1, D. Gokmen2, B. S. Tur

Departments of 1Physical Medicine and Rehabilitation, 2General Surgery and 3Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey

E-mail: draysung@yahoo.com

Introduction/Background: Thyroidectomy is a frequently performed surgical procedure and the head and neck extension during this operation facilitates surgery. Patients may experience postoperative neck pain and range of motion (ROM) limitation due to the surgical position following thyroidectomy. We aimed to investigate the short-term effects of Kinesio Taping (KT), applied to the cervical spine, on neck pain, cervical ROM, and disability in patients following thyroidectomy. Materials and Methods: This was a prospective, double blind randomized controlled trial. A total of 80 patients were randomly assigned to applied either KT (Group 1, n = 40) or sham taping (Group 2, n = 40) using sequence of random numbers. Six patients from each group dropped out. Patients were only allowed to use paracetamol after surgery and the daily dose was recorded. Neck pain, cervical ROM, and neck disability were evaluated with VAS, inclinometer, and Neck Disability Index (NDI) questionnaire, respectively. While VAS was recorded preoperatively and 30 min, 4 hr, 12 hr, 24 hr, and 7 days after surgery, ROM and NDI was recorded preoperatively and 24 hr after surgery. Results: The mean ages of the Group 1 and Group 2 were 51.6 and 49.2 years, respectively. There was no significant differences with respect to age, gender and educational background and body mass index. The demographic data of the two groups are presented in Table 1. The improvement in VAS values was more significant in favor of Group 1 (p = 0.032) [Figure 1]. There was no significant differences with respect to improvement of ROM values and NDI values between groups during study [Table 2]. Patients in Group 1 needed less paracetamol during study than patients in Group 2 (p = 0.011). Conclusion: Our results revealed that cervical KT reduced postoperative neck pain and pain medication consumption. KT can be use as an alternative treatment for neck pain relieving after thyroidectomy.
Figure 1: The change of VAS in groups during study

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Table 1: Demographic data of the two groups

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Table 2: Comparisonof VAS, ROM and NDI values before and aflet surgery.

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Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0692 Top


Retrospective study to determine the effectiveness of combining pre-procedure clinical evaluation with fluoroscopy before diagnostic facet joint injection for evaluating the source of neck pain

A. Bhargava

Advanced Interventional Pain and Sports Medicine Center, Spine and Sports Medicine, Owings Mills, USA

E-mail: indore2003@yahoo.com

Introduction/Background: Use of minimally invasive procedures has increased over the years. Use of fluoroscopy for diagnostic purpose before a procedure has not been well defined to increase the accuracy of the injections. Objective was to retrospectively evaluate the effectiveness of combining pre procedure clinical evaluation with fluoroscopic evaluation with diagnostic cervical facet joint injection. Materials and Methods: Retrospective observational study of 15 neck pain patients of cervical facet joint injection after pre procedure clinical evaluation and fluoroscopic evaluation. Assessment was: percentage pain relief. Successful pain relief was defined as ≥50% reduction in pain. Results: The mean age of the entire group was 50.3 (43-58) years. The mean BMI was 29.34 (24.69-37.66). There were total of 18 injections performed on 15 patients (two were bilateral and one was 2 level). 16 of the 18 tender areas were at the facet joint under fluoroscopy evaluation and 2 were posterior to the facet joint. The cervical facet joints which were injected were C2-3 (5-including one two levels and one bilateral), C3-4 (6-including two levels), C4-5 (6-including one bilateral) and C5-6 (1). The percentages of patients experiencing successful pain relief were 82.3 % (14/17 injections-one patient had two level injection) including 5 who had 100% relief after the diagnostic injection. Conclusion: This small trial demonstrates the overall clinical success of diagnostic cervical facet joint injection when combined with pre procedure clinical evaluation and fluoroscopy evaluation. Further research with a larger trial is needed to evaluate the efficacy of this procedure.

Keywords: Injection, neck, spine

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1048 Top


Factors associated with psycho-cognitive functions in patients with persistent pain after surgery for femoral neck fracture

A. Kiatayama, M. Hida1

Iwaki Meisei University, Faculty of Allied Health Sciences, 1Osaka Kawasaki Rehabilitation University, Department of Rehabilitation, Kaizuka-City, Japan

E-mail: kitapro1008@gmail.com

Introduction/Background: To solve problems arising from fracture of the femoral neck in elderly people, the proportion of which continues to increase in the population of Japan, we need to examine factors in patients with fractured femur necks to develop and ways to assist affected patients. Materials and Methods: In this study, we examined the relationships among sex, age, fracture site, operative procedure, physique, lifestyle, psycho-cognitive functions, and types of pain in 142 patients, performed multiple regression analysis using the Mini-Mental State Examination (MMSE) and the Montgomery–Asberg Depression Rating Scale (MADRS) scores as dependent variables, and created MMSE and MADRS models. Results: The results of analysis of the MMSE and MADRS models identified night pain and the number of family members as factors that affected mental function in a population with persistent pain for 1 week after surgery for fractured femoral neck. In addition, the number of family members was identified in multiple regression analysis models as a factor associated with psycho-cognitive functions. Pain, night pain in particular, affects psycho-cognitive functions. We speculated that emotional ups and downs were associated with the number of family members. The results showed that the patients living with family members maintained psycho-cognitive functions better than did those living alone, even when they experienced pain in their daily lives. Conclusion: We speculated that emotional changes were associated with number of family members. Patients living with family members maintained psycho-cognitive functions better than did those living alone, even when they experienced pain in their daily lives.

Keywords: Femoral neck fracture, persistent pain, psycho-cognitive functions

Disclosure of interest: The authors did not declare any conflict of interest.


  A1.02 PAIN - Chronic Generalised Pain Syndromes (Including Fibromyalgia) Top



  ISPR8-0360 Top


Treatment of neuropathic pain in patients with spinal cord lesions by intrathecal ziconotide

P. Mertens, B. André1, S. Helene2, L. Jacques3

Department of Neurosurgery, Université Claude Bernard Lyon 1, - Hopital Neurologique, 1Department of Neurosurgery, Hospices Civils de Lyon, Neurosurgery- Hopital Neurologique, Lyon, France, 3Université Claude Bernard Lyon 1, Medecine physique et rehabilitation- Hopital H. Gabrielle, Lyon, 2Assistance Publique - Hopitaux de Paris, Neurosurgery Hopital Beaujon, Paris, France

E-mail: patrick.mertens@chu-lyon.fr

Introduction/Background: The goal of this study was to evaluate the efficacy and safety of ITZ in patients with harmful refractory neuropathic pain following spinal cord lesions. Materials and Methods: This study was designed as a prospective cohort of twenty patients with pain following spinal cord injury (SCI) of various etiologies (post traumatic, postsurgical, ischemic syringomyelia). Primary endpoint is the number of patients responders to the ITZ tests. Secondary endpoints is the assessment of long term efficacy and study of impact on different features of pain and changes in antalgic medications. The efficacy of the drug was tested initially by lumbar bolus injection (1 to 2.5 mcg) and/or continuous lumbar infusion using external pump (increased progressively max 10 mcg/d). Patients were considered responders if >40% reduction from baseline visual analogic scale (VAS) was observed without side-effects. Pump placement with continuous intrathecal infusion was then proposed. Detailed analysis of test failures were performed in order to identify reasons for lack of efficacy. Results: Overall out of twenty patients tested, fourteen were considered responders to test (70%). Only eleven of them (55%) benefited from a permanent pump implantation without any side-effects. Pump were followed up on average for 3.59 years (±1.94). The absolute value of pain on VAS significantly decreased between baseline and last follow-up from 7.91 to 4.31 with an average decrease of more than 3 points (45.5% p = 0.02 Wilcoxon rank sum test). After pump implantation, minor increases in CPK levels have been noted in three patients. Conclusion: This pilot study shows significant decrease of pain after ITZ for well selected patients with SCI in whom other antalgic options are not available. This study include a short population but is encouraging as facing with one of the most difficult to treat neuropathic pain. Further study with randomized controlled design is ongoing.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0418 Top


Chronic pain in persons with multiple sclerosis

B. Amatya, J. Young, M. Galea, F. Khan

Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, Australia

E-mail: bhasker.amatya@mh.org.au, fary.khan@mh.org.au

Introduction/Background: Pain can be a significant long-term problem for a substantial proportion of persons with multiple sclerosis (pwMS). The aim of this study was to examine the course and impact of chronic pain over a span of 10-years. Materials and Methods: A longitudinal, cross-sectional study assessed pwMS residing in the community at seven and ten years using validated measures: Visual Analogue Scale; Numerical Rating Scale; Chronic Pain Grade (CPG); Assessment of Quality of Life and the Carer Strain Index (CSI). Results: Mean age of the participants (n = 70) was 59.8 ± 9 years (range: 39-74 years) and majority (70%) were female. The findings show that over 10-year period, majority report bilateral lower limb dysesthesia (40%), mixed pain (35.2%) and widespread pain (17.1%). There was a significant deterioration in quality of life (QoL) in those with more severe CPG. Almost half of the participants (44%) required care either from a private carer/family or institution. The carers (n = 13) reported higher carer strain (mean CSI = 5.2), with over half reporting sleep disturbance, inconvenience, physical strains, family and personal constraints. Although fear of taking medications and side effects were common barriers to treatment for pain, there was an increase in the use of pharmacological treatment and healthcare services, mainly neurologists and general practitioners over time. Conclusion: This study demonstrates that persistent chronic pain is a significant issue over time in pwMS, with clinical and health implications, poorer QoL, and increased healthcare utilisation. Greater awareness of chronic pain in pwMS and interdisciplinary approach is required to improve long-term patient outcomes and well-being.

Keywords: Chronic pain, longitudinal study, multiple sclerosis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0419 Top


Non-pharmacological interventions for chronic pain in multiple sclerosis: A cochrane systematic review

B. Amatya, J. Young, F. Khan

Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, Australia

E-mail: bhasker.amatya@mh.org.au, fary.khan@mh.org.au

Introduction/Background: Chronic pain is common and significantly impacts on the lives of persons with multiple sclerosis (MS). Various types of non-pharmacological interventions are used to improve pain control in persons with MS (pwMS), however the effectiveness and safety of many modalities is still unknown. This review evaluated the effectiveness of currently used non-pharmacological interventions for chronic pain in pwMS. Materials and Methods: A literature search was performed using the Cochrane MS Group Trials Register which contains Cochrane CENTRAL, Medline, EMBASE, CINAHL, LILACUS, Clinical trials.gov and World Health Organisation International Clinical Trials Registry Platform in April 2017. Manual searching in the relevant journals and screening of reference lists of studies was done. Randomised controlled trials (RCTs), cross-over studies and clinical controlled trials were included. All authors independently selected studies, extracted data and assessed the methodological quality. Pooling data for meta-analysis was not possible due to methodological/statistical heterogeneity of included studies. Results: Overall, 12 RCTs (610 participants) which investigated different non-pharmacological interventions for the management of chronic pain in MS fulfilled the review inclusion criteria. The non-pharmacological interventions evaluated included: transcutaneous Electrical Nerve Stimulation (TENS), psychotherapy (telephone self-management, hypnosis and electroencephalogram biofeedback), transcranial random noise stimulation (tRNS), transcranial direct stimulation (tDCS), hydrotherapy (Ai Chi) and reflexology. The findings suggest that there is ‘low level’ or limited evidence for the use of evaluated non-pharmacological management for chronic pain in MS. Though, there is improved changes in pain scores and secondary outcomes, these were not clinically or statistically significant for TENS for lower back pain and tRNS, hydrotherapy exercises, tDCS, reflexology and psychotherapy for overall pain. The evidence was limited for other interventions. Conclusion: Despite the use of wide range of non-pharmacological interventions for the treatment of chronic pain in pwMS, the evidence for these interventions is still limited and/or insufficient. More robust studies are needed to justify the beneficial effect of these interventions.

Keywords: Chronic pain, multiple slerosis, systematic review

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1667 Top


A pole of competence for ehlers-danlos syndromes

M. Enjalbert

Centre Bouffard-Vercelli, MPR, Cerbere, France

E-mail: michel.enjalbert@wanadoo.fr

Introduction/Background: The Ehlers-Danlos syndromes (EDS) are a heterogeneous group of heritable connective tissue disorders characterized by joints hypermobility, skin hyperextensibility and tissue fragility. The international EDS Consortium proposes a revised EDS classification (1) and a set of clinical criteria that are suggestive for the diagnosis. In France, poles of competences were created in 2017, one of which in Perpignan Hospital. We reports one year’s activity of this. Materials and Methods: We use the EDS Consortium classification and clinical criteria for diagnosis, possibly supplemented by a geneticist for questionable dagnosis. The confirmed diagnosis entered into treatment protocols including rehabilitation, pain treatment, pychological and socio-professional handlings. Results: The population includes 36 subjects (29 female, 7 male) with a medium age of 36.7 years (6-73) with EDS diagnosis. 19 of them (52.8 %) were confirmed, 6 (16.6 %) refuted and 11 (30.6 %) questionable, justifying a geneticist view. Among these, 6 were confirmed, 5 refuted. Finally, 25 subjects (69.4 %) were confirmed and enter into treatment protocols, including sphincters disorders for 9 (25.0 %), 11 (30.6 %) were refuted, arising from differential diagnosis. Conclusion: EDS have underestimated for a long time. Currently, the risk is the opposite, relating to the banality of some symptoms that can carry a diagnosis by excess, hence the importance of specific criteria.[1] As to the treatment protocols, they can make use of validated drugs and technics. A work in this area (evidence based medicine) is ongoing to define these with French Health Insurance and National Authority for Health.



Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J, et al. The 2017 International Classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet 2017;175:8-26.



Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1568 Top


Fnirs a new tool for assessment of central sensitization in fibromyalgia

S. Hazra, V. Srikumar, G. Handa, S. L. Yadav, S. Wadhwa, K. P. Kochhar1, K. K. Deepak1, K. Sarkar2, U. Singh

Departments of Physical Medicine and 1Rehabilitation, All India Institute of Medical Sciences, New Delhi, 2Narula Institute of Technology, Electronics and Communication Engineering, Kolkata, West Bengal, India

E-mail: sandipanrgkmc@gmail.com

Introduction/Background: Fibromyalgia (FM) is a multi-symptomatic disorder with a varying degree of widespread pain in the body. With emerging evidences pathophysiological concept shifted from peripheral damage or inflammation to central neural mechanism. Fibromyalgia is characterised by dysfunction in central pain processing, “central sensitivity”. In this cross sectional study central sensitization was recorded in patients with fibromyalgia by observing cortical oxygenation in prefrontal cortex using Functional Near Infrared Spectroscopy (fNIRS). Materials and Methods: fNIRS 300B (BIOPAC), a wearable continuous fNIRS system with 4 optode and 16 detectors was used to assess changes in oxy-haemoglobin concentration (μM) from Brodmann areas 9, 10, 45 and 46. Number of activation (max and 60% max signals) was compared in time series of Oxygenated Haemoglobin level with Rt foot immersed in ice cold water. For comparison of categorical variable, sex Chi-square test was used. For non-parametric data ie age and fNIRS data Mann-Whitney U test was used. Both of the test was done in SPSS Statistics 23 by IBM, Chicago, IL with a confidence interval of 95% and a significance level lower than 5%. Results: Fifty FM patients diagnosed according to ACR 2010 fibromyalgia criteria and equal number of age and sex matched controls were enrolled in the study. There was increased oxygenation in FM compared to control in prefrontal cortex. Conclusion: This increased oxygenation in prefrontal cortex in FM group objectively demonstrates alteration in central activity in FM group. Changes in central activity along with pain hypersensitivity in FM points towards central sensitisation. Lack of 3D digitiser restrict us to comment on localisation of activation. fNIRS can be used as tool to evaluate central sensitization.

Keywords: Central sensitization, fibromyalgia, functional near infrared spectroscopy

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1749 Top


Sex-related demographic and symptomatologic characteristics of patients with fibromyalgia

L. Jiang, W. Qu1, T. H. Oh2, A. Vincent3, A. Mohabbat3, W. D. Mauck1, L. Law1, S. Cha4

Department of Rehabilitation Medicine, The Third Affiliated Hospital- Sun Yat-sen University, Guangzhou, China, 1Division of Pain Medicine, Mayo Clinic, 2Department of Physical Medicine and Rehabilitation, Mayo Clinic, 3Division of General Internal Medicine, Mayo Clinic, 4Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA

E-mail: jiangli0909@163.com

Introduction/Background: To assess sex-related characteristics in patients with fibromyalgia, specifically in terms of patient demographics (age, body mass index, marital status, and educational level), tender point count, symptoms (cognition, sleep disorder, fatigue, anxiety, and depression), and quality-of-life measurements. Materials and Methods: We studied 668 consecutive patients (606 women) who participated in the Fibromyalgia Treatment Program at Mayo Clinic (Rochester, Minnesota) from May 2012 through November 2013. All patients completed a series of questionnaires at the initial consult, including the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), the Medical Outcomes Study Sleep Scale (MOS-Sleep Scale), the Revised Fibromyalgia Impact Questionnaire (FIQ-R), the Multidimensional Fatigue Inventory (MFI-20), the Multiple Ability Self-Report Questionnaire (MASQ), and the 36-item Short Form Health Survey (SF-36). Nonparametric Wilcoxon rank test and the χ2 test for continuous variables and categorical variables were used to detect differences between sexes. Results: We observed no significant sex-based differences in demographics, including age, marital status, and educational level. Likewise, no significant sex differences were seen in body mass index, mood, sleep, cognition, symptom impact, or fatigue. However, women had a significantly higher tender point count than men (P = .001). Conclusion: The only sex-related difference observed in our cohort was the tender point count; the assumption of other sex-based differences in the clinical presentation of fibromyalgia was not supported in our study.

Keywords: Cognition, fibromyalgia, sex

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2221 Top


Safety and effectiveness of percutaneous electrical nerve stimulation on pain reduction in patients suffering from neuropathic or mixed pain

A. de Sire, L. Cosenza1, C. Cisari1, A. Baricich2, M. Invernizzi1

Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, 1Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 2Physical Medicine and Rehabilitation Unit, University Hospital “Maggiore della Carità”, Novara, Italy

E-mail: marco.invernizzi@med.uniupo.it

Introduction/Background: Pain is a harmful symptom, strongly influencing HRQoL and rehabilitative treatment and often refractory to pharmacological and non-pharmacological therapeutic strategies. In recent years, Percutaneous Electrical Nerve Stimulation (PENS) has been proved to be an effective procedure in the management of refractory neuropathic pain and some conditions of refractory mixed pain like low back pain. However, up to date, evidences in literature about the effectiveness of PENS in terms of pain reduction and HRQoL improvement in the rehabilitation field are scarce. Therefore, aim of our study was to evaluate safety and effectiveness of PENS on short-term pain reduction in patients suffering from neuropathic or mixed pain, non-responders to conventional therapies in a rehabilitative setting. Materials and Methods: This retrospective study was performed on a cohort of 75 adults (25 men and 50 women), mean aged 70.05 ± 14.16 years, suffering from neuropathic or mixed pain non responsive for more than 3 months to both pharmacological and non-pharmacological therapies. From 2014 to 2017, patients were treated by subcutaneous needle-electrode insertion in the sore area and return-on-skin electrode placement, both connected to a generator (AS SUPER 4 digital by TÜV Rheinland) for a 40-minute session at alternate frequencies of 2 and 100 Hz. Pain was assessed by Numerical Rating Scale (NRS) before and immediately after the treatment. Results: Five patients experienced self- limiting and short-term pain mainly due to subcutaneous needle placement. No complication affected the continuation of the procedure. There was a significant reduction in NRS (defined as >50%) after treatment in 70% of patients. Conclusion: PENS has been proven to be a safe and effective procedure in the treatment of neuropathic and mixed pain in patients non-responders to both pharmacological and non-pharmacological treatments. Its use in Physical and Rehabilitative Medicine should be encouraged and supported by other studies.

Keywords: Mixed pain, neuropathic pain, percutaneous electrical nerve stimulation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1556 Top


Microcurrent electrical neuromuscular stimulation to improve myofascial neck pain and stiffness

J. W. Park, J. Kwak, S. Lee, S. Lee

Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital, Seoul, Republic of Korea

E-mail: spotdoc88@gmail.com

Introduction/Background: Myofascial pain syndrome can cause not only the pain, but also the muscle stiffness by the densification of excessive hyaluronic acid in muscle and fascia. The first aim of this study was to evaluate the therapeutic effects of microcurrent electrical neuromuscular stimulation on chronic myofascial pain syndrome of upper trapezius muscles and the second aim was to evaluate the viscoelastic change of myofascial trigger points and neighboring tissues with ultrasonoelastography using acoustic radiation force impulse (ARFI) imaging. Materials and Methods: This study was designed as a prospective, randomized, double-blinded, placebo-controlled trial. The patients with chronic neck pain who visited the outpatient clinic voluntarily were included in this study. Total 40 minutes’ microcurrent electrical therapy using a Granthe Advance (8Hz, 25 μA, Cosmic Co., Seoul, Korea) or sham stimulation was applied on both upper trapezius muscles daily for 2 weeks, total 14 times. All MENS and control groups took the standard care including postural education, and self-exercise. All participants visited total 3 times; baseline, 2 weeks and 4 weeks follow-up. At every visit, we evaluated the usage of analgesics, existence of trigger points of upper trapezius, visual analogue scale (VAS), pressure pain threshold, neck range of motion (ROM), and viscoelasticity by shear wave velocity using ultrasonoelastography. Results: There was no significant difference in baseline characteristics. MENS significantly improved pressure pain threshold on upper trapezius muscles (p = 0.001). Also, MENS significantly reduced shear wave velocity (p = 0.001) on upper trapezius muscles and patients rated pain intensity (p = 0.024). The detailed values were summarized in [Table 1]. Conclusion: Our findings demonstrate that the microcurrent electrical neuromuscular stimulation improved pressure pain threshold, pain intensity and shear wave velocity in chronic myofascial pain syndrome on upper trapezius muscles. Therefore, MENS can be a useful treatment tool for the myofascial pain syndrome.
Table 1: Summary of measurements

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Keywords: Elastography, microcurrent, myofascial pain syndrome

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0559 Top


Study of the low back paravertebral allodynia surface of chronic low back pain patients before and after pain neuroscience education

O. Raymaekers, R. Keunebroek

Department of PRM, CHU Lille, Lille, France

E-mail: olvonline@hotmail.com, heimekine@gmail.com

Introduction/Background: Thanks to advances in neuroscience, we know that pain neuroscience education (PNE) helps to reduce central sensitisation. We adapted PNE to chronic low back pain patients. Measuring the allodynia surface is indicative of central sensitisation. We applied this method on low back pain to assess the effect of PNE. Materials and Methods: Controlled and non-randomised single-blind study involving 31 adults having an average age of 43.74 years, recruited from the Regional University Hospital of Lille. A control group (CG) followed a multidisciplinary protocol during 4 weeks. An experimental group (EG) benefited, in addition to the protocol, of one hour of PNE. They must then fulfil a questionnaire in order to prepare an individual interview of twenty minutes during the 4th week. Allodynographies were performed during the 1st and 4th week and after 3 months. Results: The surfaces are very significantly decreased in the EG at 4 weeks while the CG shows no significant difference. After 3 months, the evolution of the surfaces is very significantly improved in both groups. On the other hand, between the allodynography performed at 4 weeks and at 3 months, the CG shows a very significant decrease of the surfaces, where the surface increases very slightly for the GE. Conclusion: We have successfully adapted to chronic low back pain patients an allodynography technique that had already been tested in other studies. Compared with the CG patients, the PNE provided to EG patients significantly decreased low back paravertebral allodynia surface after 4 weeks but no further improvement was observed after 3 months. Further studies are needed to understand the reasons.

Keywords: Central sensitisation, chronic low back pain, pain neuroscience education

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0643 Top


Ultrasound-guided genicular nerve block in chronic knee pain

N. Albuquerque, J. Pinto1, M. D. C. Loureiro1, T. Félix, I. Peixoto

Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, 1Department of Anesthesiology, Chronic Pain Unit, Centro Hospitalar Tondela Viseu, Viseu, Portugal

E-mail: nfal.albuquerque@gmail.com

Introduction/Background: Chronic knee pain is the most common site of osteoarthrosis. Pain associated with it is multifactorial and its management is multimodal, including minimally invasive procedures such as nerve block of geniculates. The objective of this study is to evaluate the immediate and short-term symptomatic improvement of patients with chronic knee pain after an ultrasound-guided block of genicular nerves. Materials and Methods: Twenty ultrasound-guided blocks of geniculate nerves (Ropicavaine + Methylprednisolone) were performed in patients with chronic knee pain. The efficacy of the block was evaluated through the Numerical Analgesic Scale, immediately after the procedure, after 48 hours and 1 month later. Safety was also evaluated through monitoring of side effects and the level of patient satisfaction. Statistical analysis was performed using IBM-SPSS Software version 24.0. Results: A total of 20 patients were included (85% female) with an average age of 75 years. The median pain before the procedure was 9, immediately after it was 2, two days later it was 3 and one month later 6 (37% pain relief at the end of one month). Regarding the overall Patient Global Improvement Change Scale (PGIC) 90% reported improvement 48 hours after the procedure. 100% of patients reported being willing to repeat the procedure. No adverse effects were reported after one month. There was a tendentially significant positive correlation (p < 0.10) between pain before the procedure and pain one month after the procedure and a statistically significant positive correlation (p < 0.05) between pain with the procedure and pain one month later. Conclusion: Corticoanesthetic ultrasound-guided blocks of geniculate nerves contributed to the symptomatic relief of these patients in the short term. The most ab initio complainants and those who complained of the greatest pain with the procedure, were the patients with lowest symptomatic relief at the end of one month.

Keywords: Genicular nerve block, gonarthrosis, knee pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0836 Top


The relation between personal resources and quality of life in patients with fibromyalgia

A. Winkelmann, B. Oettl, M. Weigl

Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital- LMU Munich, Munich, Germany

E-mail: mweigl@med.uni-muenchen.de, andreas.winkelmann@med.uni-muenchen.de

Introduction/Background: Patients with fibromyalgia (FM) suffer from chronic widespread pain, nonrestorative sleep and varying more complaints like depressive symptoms or anxiety. We hypothesized that analogously to patients in psychotherapy FM patients have low levels of personal resources. We aimed to evaluate the reliability of the Essen Resources-Inventory (ERI), to compare resources of FM patients to other groups and to assess the association of resources to health-related quality of life. Materials and Methods: In this cross-sectional study with 169 FM patients we applied the ERI scales for personal resources, the quality of life questionnaire Short-Form 36 (SF-36) and the Patient Health Questionnaire (PHQ-4). Reliability (internal consistency) of the ERI scales was assessed by Cronbach’s alpha. Scores of ERI scales were compared to historic control groups. Associations between ERI scales and the SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) were analyzed by Pearson correlation coefficients or Spearman correlation coefficients according to the scale distributions. Results: The mean age was 50.9 (SD 10.5), 94.1% were female. FM patients compared to healthy controls showed worth scores for PHQ depression (3.05 vs. 0.95), anxiety (2.98 vs. 0.90), PCS (31.9 vs. 49.9) and MCS (39.6 vs. 47.5). Internal consistency of the Eri scales was moderate to high (Cronbach’s alpha = 0.67 to 0.95). The comparison of resources of FM patients to controls is presented in Table 1. All Eri scales showed significant correlations to the MCS (p < 0.01), but not to the PCS (p > 0.05). Correlation coefficients above 0.3 were found for the total ERI personal scale (r = 0.38), openness (r = 0.39), meaningfulness (r = 0.35) and social competence (r = 0.32). Conclusion: This study supports the reliability of the ERI in patients with FM. FM patients have lower personal resources than average somatic patients. Low levels of resources are associated with low levels of the mental component of quality of life.

Keywords: Fibromyalgia, quality of life, resources

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1107 Top


Rehabilitation program improves quality of life in fibromyalgia patients up to one year: preliminary results

H. Jacobs, B. Grillet1, D. De Bacquer2

Department of Physical Medicine and Rehabilitation, Maria Middelares, Assenede, 2Department of Public Health, Ghent University, Ghent, Belgium, 1Department of Rheumatology, Reumazorg Zuid West Nederland, Terneuzen, The Netherlands

E-mail: herlinde.jacobs1@telenet.be

Introduction/Background: Cognitive Behaviour Therapy (CBT) and Graded Activity (GA) have a beneficial effect on the Quality of life (QoL) of patients with fibromyalgia. However the question remains how long this effect will last. Materials and Methods: Patients with fibromyalgia meeting the 1990 ACR classification criteria are well informed about the problem of fibromyalgia and checked on motivation before starting the program. They were evaluated by the SF36v2 questionnaire at the beginning (T0) of an 8 week multidisciplinary (psychologist, occupational therapist and physical therapist) rehabilitation program, at the end of the 8 week program (T1), at 6 months (T2) and 1 year (T3). Results: So far, of the 88 patients that were included, 71 were evaluated after 8 weeks, 55 after 6 months and 30 had a final evaluation after 1 year. Dropout at 1 year is 5/35 (14%). At 8 weeks, a substantial improvement compared to baseline was noticed in all subscales of the SF-36v2. At 6 months, the effect was slightly reduced, but both Physical Component Summary score and Mental Component Summary score were still significantly improved when compared to baseline (p < 0.001). At 1 year, a persistent improvement (p < 0.001) in Role Limitation (physical), General Health Perception, Energy and Vitality scores was observed. Conclusion: One year after starting the rehabilitation program with CBT and GA, QoL has consistently improved. The effect was most explicit in the domain of Role Limitations (physical), General Health, Energy and Vitality and weakest in the domain of Physical Functioning.
Table 1: Comparison of ERl-scales of patients with fibromyalgia to historic controls from the ERI validation study.

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Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2249 Top


State anxiety is independently associated with visual analog scale pain rating in women with fibromyalgia

H. Rogers, S. Cardosa1, S. Olivera Plaza2, A. Córdoba Patiño2, M. Peña Altamar3

BioCruces Health Research Institute, Psychology and Health, Barkaldo, Spain, 1Department of Psychology, University of Oporto, Oporto, Portugal, 2Department of Psychology, Surcolombian University, 3Department of Rheumatology, Saludcoop Clinic, Neiva, Colombia

E-mail: rogersheatherl@gmail.com

Introduction/Background: The relationship between psychosocial factors and pain may not be the same across social-cultural contexts. The aim of this study was to examine associations among psychosocial factors and pain perception in women with Fibromyalgia (FM) from Colombia. Materials and Methods: 96 women with FM were recruited from an ambulatory clinic in Neiva, Colombia. They had an average age of 54 and 87.5% were from the lowest socio-economic strata (SES) in the country. Visual Analog Scale (VAS) pain rating was adminsitered, with the State-Trait Anxiety Inventory (STAI) to measure transient anxiety; Symptom Checklist 90 Revised (SCL-90R) to measure psychopathology; and the Brief COPE to measure coping with stress. Results: Spearman correlations indicated that increased VAS pain scores were positively associated with years of diagnosis (rho = 0.21, p = 0.040), STAI-S (rho = 0.21, p = 0.043), SCL-90R global severity index (rho = 0.21, p = 0.037), SCL-90R positive symptom distress index (rho = 0.26, p = 0.012), SCL-90R somatization (rho = 0.28, p = 0.006), and SCL-90R depression (rho = 0.26, p = 0.009). Higher VAS scores were associated with more active coping (rho = 0.23, p = 0.024), positive reframing (rho = 0.21, p = 0.040), self-distraction (rho = 0.21, p = 0.040), acceptance (rho = 0.25, p = 0.014), and religiosity (rho = 0.27, p = 0.008). The multi-variable linear regression model showed that STAI-S was the only independent factor associated with VAS rating (Beta = 0.31, p = 0.012). Conclusion: Transient emotions are more highly associated with pain perception in women with FM than more stable psychosocial factors. It is possible that those women with more state anxiety experienced more pain, or that the experience of more pain caused more anxiety. Further research is warranted, especially with under-studied populations like those with low SES.

Keywords: Fibromyalgia, pain perception, state anxiety

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0594 Top


Spinal fluid taps provide temporary relief in patients with unexplained widespread pain and fibromyalgia

M. Hulens

Department of Rehabilitation Sciences, KU Leuven, Sint-Joris-Weert, Belgium

E-mail: miekehulens@skynet.be

Introduction/Background: Chronic unexplained widespread pain (WSP) and fibromyalgia (FM) are generally assumed centralized pain disorders. However, FM shows characteristics of neurological disorder. Moreover there are similarities between FM, WSP and cerebrospinal pressure dysregulation syndromes such as Idiopathic Intracranial Hypertension and Idiopathic Normal Pressure Hydrocephalus. When intracranial pressure increases, drainage of excess CSF through the cranial and the spinal nerves increases. Increased CSF pressure inside the nerves irritates the nerve fibers and consequently causes widespread radicular pain. We hypothesized that the neurological symptoms may be caused by CSP dysregulation and that withdrawal of spinal fluid might relieve the pain in patients suffering from FM and unexplained WSP. Materials and Methods: Retrospectively, CSP measurements followed by spinal fluid taps in an attempt to relieve the pain were reviewed in 30 patients (12 males and 18 females, mean age 42.0 y + 11.2 y) suffering from debilitating WSP and FM. Within the first week postpuncture, patients were asked to observe to list the most striking changes of their symptoms. Results: The opening pressure ranged from 12 to 32 cm H20 (mean 19.7 + 4.8 cm H20, median 20.0 cm H20). In 21 patients (70%) spinal fluid withdrawal had a favorable effect on the pain from a few hours to 8 weeks. Other improvements were: relief of low back pain, leg pain and/or coccygodynia; disappearance of headache; improved concentration; improved mood; improved sleep; more clear in the head; being able to sit longer without pain; being able to walk better; no more urinary frequency; more easy to empty the bowel and/or the bladder; less pain in the jaw. Conclusion: Exploring the issues on raised CSP may open perspectives for the diagnosis and treatment of unexplained WSP and fibromyalgia. In patients with chronic pain, when performing a lumbar puncture for diagnostic reasons, opening pressure should be measured.

Keywords: Fibromyalgia, lumbar puncture

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0599 Top


Strain counter-strain technique versus kinesio tape in treating patients with myofascial neck pain syndrome

A. Abdelfattah, O. kattabei1, S. Nasef1

Department of Basic Science, Faculty of Physical Therapy, Cairo University, Giza, 1Department of Basic Science, Faculty of Physical Therapy, Cairo University, Cairo, Egypt

E-mail: dr.ahmedsamer21@yahoo.com

Introduction/Background: Myofascial pain syndrome is one of the most common complaints in clinical practice. Strain Counter Strain technique is non-invasive therapeutic modality for treatment of soft tissue disorders. Kinesio tape is now widely used in management of musculoskeletal injuries. Materials and Methods: Forty five patients with myofascial neck pain syndrome assigned randomly into: strain counter-strain technique group (n = 15), kinesio tape group (n = 15) and control group (n = 15). The strain counter-strain technique was applied for two weeks (3 sessions/ week-20 minutes per session). Kinesio tape was applied for upper Trapezius muscle for two weeks (3 days on and one day off). Pressure algometry, Visual analogue scale (VAS) and Neck disability index (NDI) were used to evaluate participants before and after the corresponding interventions. Analysis of variance test (ANOVA) was used to determine differences between groups for all measured parameters. Paired t-test was used to compare between the pre- and post-treatment values within groups. Results: For the 45 study participants (33 women and 12 men; mean age = 44.1 ± 7 years) statistical analysis revealed that subjects in strain counter-strain technique and kinesio tape groups experienced significant increase in pressure pain threshold, decrease in neck disability scale and pain level than those in the control group in favour of strain counter-strain technique group (p > 0.05). Conclusion: The results suggest that treatment with strain counter-strain technique and kinesio tape were effective however strain counter strain technique was more effective for management of myofascial neck pain syndrome.

Keywords: Kinesio tape, myofascial pain syndrome, strain counter strain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2406 Top


Chronic neck pain and its relationship with stress symptoms: regular physical exercise could be a protective factor?

G. Camacho, T. Nakazato

Cedomuh, Lima, Peru

E-mail: galocamacho@hotmail.com

Introduction/Background: Mental stress is usually associated with neck pain. Physical exercise is typically recommended to deal with stress and therefore, to relieve neck pain. We studied the relationship of these common variables. Materials and Methods: A national cross-sectional interview survey was carried out to the adult Peruvian population with a probabilistic sample on November 2016, through the market research institute GfK. Chronic neck pain was considered for those who referred pain in the neck, the nape and/or the upper shoulders at least once a week on average for the last 6 months. Mental stress was determined asking for eight common symptoms (headache/migraine, stomachache/heartburn, feeling tired, difficulty to sleep, irritability, nervousness, dizziness, and hands tremor – all without any reason or disease), and considered positive for those with 5 or more. Regular physical exercise was determined for those who responded making any sports activity two or more days a week on average, and the lack of it for those making it once a week or none. Odds ratio was calculated using multivariate simple logistic regression with IBM SPSS 20. Results: A total of 1244 responded the survey. The OR between mental stress and chronic neck pain was 7.096, p > 0.000, adjusted for age, sex, socioeconomic status. The OR between the lack of regular physical exercise and neck pain was 0.978, p > 0.377 [Table 1]. Conclusion: The study confirms the usual belief about the strong association between chronic neck pain and mental stress but does not with the lack of regular physical exercise. We ought to consider the management of mental stress in the treatment of cervicalgia, but we should not recommend any sports activity to relieve it. Future studies may determine if specific exercises, such as aerobics or stretching, would be a protective factor.
Table 1: Risk of chronic neck pain associated with stress symptoms and lack of regular physical activity, adjusted for age, sex and socioeconomical status.

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Keywords: Exercise, neck, stress

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0274 Top


The rehabilitative role of motor imagery in the treatment of pain in fibromyalgia syndrome: preliminary results

T. Paolucci, D. Altavilla1, C. Turriziani1, S. Scienza2, M. Sorgi3, M. Luciani1, A. Torquati2, C. Lai1, V. Santilli

Unit of Physical Medicine and Rehabilitation, Policlinico Umberto I Hospital, Sapienza University of Rome, 1Department of Clinical Psychology, Sapienza University of Rome, 2Unit of Physical Medicine and Rehabilitation, Sapienza University of Rome, 3Unit of Rheumatology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy

E-mail: teresapaolucci@hotmail.com

Introduction/Background: FM is a prototypical form of central sensitization syndrome that affects the dysregulation of mechanisms that normally govern pain sensation and should have to be treated in a multidisciplinary approach, which entails physical exercise, multimodal cognitive behavioral therapy, and pharmacological therapy. The aim of this research is to investigate whether a neurocognitive rehabilitative approach based on the use of motor imagery ( MI) coul be efficacy in reducing chronic pain in FM. Furthermore, as a secondary outcome, we assess the efficacy of MI on the improvement in the recognition and awareness respect pain by EEG. Materials and Methods: Ten females (mean age 51 ± 6,1 years) with FM were recruited and performed ten rehabilitation sessions, twice a week lasting one hour, using the motor imagery. The following evaluation scales were used at the baseline (T0), after treatment (T1) and after two months of follow-up (T2): The Fibromyalgia Impact Questionnaire (FIQ), The Visual analogue scale (VAS), The Fibromyalgia Assessment Status (FAS) and the Health Assessment Questionnaire (HAQ), the SF-12 was administered to assess the quality of life. The EEG was used to record cortical activation with respect to recognize pictures divided into “algic” and “non-algic”, versus a control group of healthy women. Results: By Mann-Whitney U Test, at baseline, by EEG there is a statistically significant difference in the recognition of “algic” images compared to “non-algic” ones between the FM group and the healthy group (P < 0,05): this difference is not found after the rehabilitative treatment. In the FM group there is a statistically significant improvement for FIQ, FAS, VAS (P < 0,05) and SF-12. Follow-up date are still ongoing. Conclusion: A neurocognitive rehabilitation approach with motor imagery improves the recognition and perception of pain in the FM patient and is efficacy in reducing pain and improving related symptoms.

Keywords: Exercise, fibromyalgia, neurocognitive rehabilitation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0658 Top


Comparison of ozone and lidocaine injection vs dry needling in myofascial pain syndrome patients

S. A. Raeissadat, S. M. Rayegani1, F. Sadeghi2, E. Tabibian3, S. Rahimi Dehgolan4

Department of Physical Medicine and Rehabilitation, Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, 1Department of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, 2Department of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, 3Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, 4Department of Physical Medicine and Rehabilitation, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

E-mail: shahram.rahimi.dehgolan@gmail.com, ahmad_raeissadat@yahoo.com

Introduction/Background: Myofascial pain syndrome (MPS) is a common musculoskeletal disorder among young adults. There are many therapeutic options including oral medications, physical agent modalities and some alternative treatments like dry needling (DN) without any drugs, ozone (OI) or lidocaine injection (LI). Our aim is to compare these last three methods in a randomized clinical trial. Materials and Methods: In this single-blinded study among patients who presented at our musculoskeletal clinic, a total of 72 eligible participants were enrolled. Patients were randomly divided into three groups: first group (DN group) underwent dry needling, while the second and third groups received wet needling with ozone and lidocaine injection, respectively. All injections were repeated in three weekly sessions. Visual analog scale (VAS) for pain, neck range of motion (ROM), pain pressure threshold (PPT) and neck disability index (NDI) were the main outcome measures, applied two times: once before intervention and another at 4 weeks after the last injection. Results: One month after injections in comparison to baseline, significant improvement was seen in pain and function for all three groups. Cervical ROM, except for dry needling group, was significantly improved in ozone and lidocaine groups (p value = 0.025 and 0.009, respectively). In comparison to DN group, both ozone and lidocaine had significantly better efficacy in PPT and NDI improvement (p value= 0.05 and 0.01, respectively); however there was no significant difference regarding to VAS changes between three groups (p value=0.21). Conclusion: While it seems that in short term follow up all three methods of dry needling, ozone and lidocaine were effective in MPS patients, the two latter treatments were more successful, with no preference between them.


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Table 2: VAS: PPT: NDI and ROM scoresof the three groups 1 month after injection

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Keywords: Dry needling, myofascial pain syndrome, ozone injection

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1504 Top


The effects of transcranial direct current stimulation combined with aerobic exercise on pressure pain thresholds and electroencephalography in healthy control: pilot study

G. Sato1,2, M. Osumi1, S. Nobusako1, S. Morioka1

1Neuro Rehabilitation Research Center, Kio University, Kitakatsuragi-gun, 2Department of Rehabilitation, Nara Prefecture General Rehabilitation Center, Shiki-gun, Japan

E-mail: gpamjl@live.jp

Introduction/Background: Transcranial direct current stimulation (tDCS) has an analgesic effect and increases the peak alpha frequency (PAF) on electroencephalography. The analgesic effect of tDCS also appears to be greater when combined with another intervention (e.g. motor imagery), compared to tDCS alone. Aerobic exercise (AE) itself was reportedly effective for decreasing pain sensivity. Therefore, we hypothesize that tDCS/AE would exert a larger analgesic effect that tDSC alone, or sham tDCS/AE. Materials and Methods: Ten healthy adults participated in this study under three conditions: tDCS, tDCS/AE, or sham tDCS/AE. All conditions were performed over a single session. For tDCS, the anode was placed just above the left primary motor cortex and the stimulation intensity was 2 mA for 20 min. AE was carried out using an ergometer at an intensity of 50%~60% for 20 min. We used a measure of pressure pain threshold (PPT) on the right middle finger to investigate the effects of interventions. PPT was measured at pre-intervention and at every 5 min and post-15 min. We recorded resting-state electroencephalography for 3 min, both before and after the intervention. PAF was defined as the frequency with the highest mean power within the alpha band. Statistical analyses included the Friedman and Wilcoxon signed rank tests, Bonferroni correction, and the level of statistical significance was set at 5 %. This study was approved by our institution’s ethics committee. Results: Significant differences were found in PPT among the three conditions at all time points. On post-hoc testing, PPT increases during tDCS/AE were earlier and higher magnitude than other two conditions. No significant differences were found in PAF. Conclusion: The combined intervention of tDCS/AE exerted analgesic effects that manifested earlier, and at a higher magnitude, than those produced during the other two conditions. However, PAF did not significantly vary among the three conditions.

Keywords: Aerobic exercise, pain, transcranial direct current stimulation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2409 Top


Looking at the smartphone screen for a prolonged time is associated with chronic neck pain, specially in young adults

G. Camacho, T. Nakazato

Cedomuh, Lima, Peru

E-mail: galocamacho@hotmail.com

Introduction/Background: Never has a technology been so universally accepted as the smartphone. Of concern is the potential consequences of its prolonged use. Studies have conflictive results to find an association between them and musculoskeletal disorders. Looking at the small screen of these devices would be a crucial factor for bad neck posture, and therefore we studied if that would be related to chronic neck pain. Materials and Methods: A national cross-sectional interview survey was carried out to the adult Peruvian population with a probabilistic sample on February 2017, through the market research institute GfK. Chronic neck pain was considered for those who referred pain in the neck, the nape and/or the upper shoulders at least once a week on average for the last 6 months. Prolonged look at the smartphone´s screen was defined for those who responded reading e-mails and news, watching photos or videos, or interacting with social networks for two or more hours a day on average. Odds ratios were calculated using multivariate simple logistic regression with IBM SPSS 20. Results: A total of 1246 responded to the survey. The OR between chronic neck pain and prolonged look at the smartphone screen was 1.604, p > 0.01, and in the 18-24 yrs-old group was 3.078, p > 0.002. These results were adjusted for gender, socioeconomic status, mental stress and prolonged use of other computer devices (PC, laptop, tablet) [Table 1]. Conclusion: We found an association between prolonged looking at the smartphone screen and chronic neck pain in the general population, being three times higher in young adults. The use of smartphones is not harmful per se, but it seems that the bad posture using them would be the critical factor. We recommend preventive health campaigns about proper posture when using these devices.
Table 1: Risk of chronic neck pain associated with prolonged exposition to smartphone screen, adjusted for age, sex, socioeconomical status, mental stress and prolonged use of other computer devices.

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Keywords: Neck, pain, smartphone

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1588 Top


Neuropathic pain in spinal cord injury population in Cali, Colombia

W. A. Reyes Campo1, S. G. Pacichana Quinayáz2, F. J. Bonilla Escobar1,3, M. A. Tovar Sánchez1

1Universidad del Valle, Medicina Fisica y Rehabilitación, 2Universidad del Valle, Escuela de Salud Pública, Cali, Colombia, 3University of Pittsburgh, Clinical Research and Translational Science, Pittsburgh, USA

E-mail: andres.reyes.86@gmail.com

Introduction/Background: Neuropathic Pain (NP) following traumatic Spinal Cord Injury (SCI) is the complication that has the worst negative impact on the quality of life of people with SCI. The prevalence of NP in high-income countries is 53% and predictive factors related to its presentation have been described, such as mechanisms of SCI and others like clinical complications associated. The characteristics of NP in this population are unknown in Cali and Colombia. Aim: To determinate differences between patients with NP following traumatic SCI and patients without NP but with traumatic SCI, in Cali, Colombia. Materials and Methods: A Cross-sectional study based on clinical histories records of people suffering SCI, who attended a trauma center during 2016. Adjusted risk analyses of NP were performed using multiple logistic regressions. Risk was expressed with Odds Ratio (OR). Results: 190 patients of SCI were included, 91 (47.89%) of them had NP, age mean of 35,35 ± 13,31 years old, mostly men (95.60%). 81.32% of the injuries were traumatic in the context of violent aggressions; follow by 14.29% car accident. The most frequent injury level was thoracic (65.93%) and ASIA (American Spinal Injury Association) classification mainly A and B (64.84%; 12.09% respectively). Clinical complications like spasticity and neurogenic bladder/bowel were presented in 49.45% and 93.41% of patients with NP. Higher probabilities of developing NP (p < 0.05) were found when injury mechanism was car accident (OR = 8.96; IC95% = 1.51-53.40), and when there were clinical complications like neurogenic bladder/bowel (OR = 6.09; IC95% = 1.97-18.90). This probability decreased when injury chronicity was higher than 10 years ago (OR = 0.23; IC95% = 0.074-0.71). Conclusion: Prevention and treatment strategies aimed to reduce clinical complications should be prioritized. It is necessary to continue exploring factors associated to NP in this population and complications such as bladder or neurogenic bowel, besides the injury stabilization through the time.

Keywords: Neuropathic pain, spinal cord injury, traumatic

Disclosure of interest: The authors did not declare any conflict of interest.


  A1.03 PAIN - Complex Regional Pain Syndromes Top



  ISPR8-0326 Top


Could the complex regional pain syndrome (sudeck atrophy), emerged as a distal radius at the typical site fracture complication, be prevented by physical therapy?

D. Petrovic, M. Zlatkovic-Svenda1, B. Lazovic2

The Belgrade City Institute of Gerontology/Rehabilitation, 1School of Medicine, Institute of Rheumatology, University of Belgrade, 2University Clinical Hospital Center “Zemun”, School of Medicine, University of Belgrade, Belgrade, Serbia

E-mail: daypetrovic19@gmail.com

Introduction/Background: The complex regional pain syndrome (CRPS)-Sudeck disease is a frequent complication of a distal radius at the typical site fracture (DRF). Aim of the study was to evaluate the conventional physical agents application alone and combined with light therapy for treatment of distal radius at the typical site fracture and to follow-up patients for the CRPS occurrence in a six months period. Materials and Methods: Study comprised 52 female patients with DRF, involved after removing of the plaster and divided into two age-matched groups. Besides identical drug therapy, Group 1 was treated with cryotherapy, exercises and Group 2 with cryotherapy, exercises and the bioptron (polarized, polychromatic, non-coherent low energy radiation) light on the wrist and dorsal side of the hand. Patients were evaluated at 0, 7 and 15 days for pain (visual numerical rating scale-VAS), range of the wrist motion-supination and pronation, and the hand fist forming capacity and followed up for 6 months. Results were analysed by computer statistic programme SPSS 20.0. Results: Pain was significantly decreased in Group 2 at 15th day of therapy. Significant improvement in supination was shown for Group 2 on 7th (p = 0.019) and 15th day of treatment (p = 0.001) [Table 1]. Both groups have shown significant improvement in VAS, supination and pronation on 15th day of therapy, as compared to baseline (p = 0.000). The complete hand fist forming capacity was achieved in 16 (61.5%) patients in Group 1 and 19 (73.1%) in Group 2. In a 6 months period of follow-up, CRPS was developed in 4 patients (15.4%) from Group 1. Conclusion: Bioptron light therapy combined with conventional therapy has shown good pain control, significant degree of pain reduction and improvement of the wrist motion range, with no CRPS development within the 6 months period of follow-up. Further studies would be beneficial.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1951 Top


Complex regional pain syndrome: new insight and therapeutic approach

L. Christophe, E. Chabanat, P. Revol, Y. Rossetti, S. Jacquin-Courtois

INSERM, ImpAct U864, Lyon, France

E-mail: laur.christoph@gmail.com

Introduction/Background: CRPS implies sympathetic, inflammatory, neurogenic, vascular, peripheral and central mechanisms. The pathophysiology of type 1 CRPS is complex and yet poorly understood. The relative part of each mechanism in CRPS type 1 development and resistance is not established, as their respective contribution varies amongst patients during the course of clinical evolution. A growing consensus has developped for a central participation to this pathology, even if the very nature of spatial and body representation alterations is still discussed. It has been clinically observed and repeatedly argued that CRPS implies pathological motor neglect. Materials and Methods: We reviewed the available literature about central pathophysiology and new therapeutic approaches and will illustrate new perspectives with our own clinical and research practice. Results: Even if spatial cognition explorations has given rise to a variety of inconsistent results, it is now admitted that central participation, manifested as a spatial reference frame alteration plays a central role in CRPS. This new view blazed the trail to new therapeutic strategies targeting spatial reference frame alterations: mirror therapy, prism adaptation, rTMS. Conclusion: Central participation to CRPS’ pathophysiology is nowadays admitted. Amongst the new therapeutic strategies rising from this recent comprehension, the most promising seems to be prismatic adaptation.

Keywords: complex regional pain syndrome, prismatic adaptation, spatial and body representation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2007 Top


Cervical myofascial pain syndrome - is the ultrasound-guided needling approach a therapeutic option?

P. Araujo, S. Serrano, A. Canelas

Centro Hospitalar de Leiria, Medicina Física e de Reabilitação, Leiria, Portugal

E-mail: paulocaraujo89@gmail.com

Introduction/Background: Myofascial Pain Syndrome (MPS) is a frequent entity in clinical practice and is characterized by the presence of trigger points, limitation of joint mobility and neurological symptoms. The main purpose of this work was to evaluate the results obtained by perform an ultrasound-guided needling of the trapezius and levator scapulae muscles with simultaneous injection of steroids and local anesthetics, in the pain intensity and interference in daily life and the subjective benefits in patients with cervical MPS. Materials and Methods: Prospective longitudinal study, including patients with clinical diagnosis of unilateral or bilateral cervical MPS refractory to the conventional rehabilitation program, submitted to treatment during the year 2017. The technique included to pepper the trigger point with a fanlike manner under ultrasound guidance, using a 22G needle with simultaneous injection of 2% lidocaine and methylprednisolone acetate 40 mg/ml. A sociodemographic questionnaire, the pain numerical rating scale (NRS) and the brief pain inventory (BPI) were applied prior and 1 month after the procedure. In this last evaluation, a Likert scale was also applied to evaluate the subjective benefits. Results: Eighteen patients were included, 82% female, with a mean of 54 years (SD = 8.2). No adverse effects were recorded. There was a statistically significant and clinically relevant reduction in the score obtained in the NRS (2.9, P < 0.001) and in all components of the BPI, including intensity (2.6, p < 0.001), pain interference in general activity (1.9, p < 0.001) and in the affective subdimension (1.7, p < 0.001). 54% of the patients reported a very significant improvement with the procedure, but only 33% presented a ≤ 4 value in the NRS at 1 month reassessment. Conclusion: The results presented in this study show the importance of ultrasound-guided needling procedures in the treatment of myofascial pain and, at least, it short-term efficacy on reliefing pain, particularly in refractory cervical MPS.

Keywords: Myofascial pain, needling, ultrasound

Disclosure of interest: The authors did not declare any conflict of interest.

A1.04 PAIN - Miscellaneous


  ISPR8-2736 Top


Trackable pill digital technology in PRM and pain: hype or hope?

M. A. Young, L. Dimartino1

Division of Rehabilitation Services Faculty, The Workforce and Technology Vocational Rehabilitation Center, State of Maryland, The Johns Hopkins School of Medicine, Baltimore, MD, 1University of West Florida, Pensacola, FL USA

E-mail: markyoung123@gmail.com

Background: Technological advances in the domain of wearable rehabilitation medical technology holds promise to optimize delivery and efficiency of healthcare. In no area of PRM is this more evident than in acute pain management. The combination of wearable technology with a “Digital Ingestion Tracking Program” (DITP) embedded within a pain pill may allow patients, caregivers as well as healthcare providers to track ingestion of pills through the web or a smartphone app. Monitoring of pill consumption compliance and adherence may be optimized. Materials and Methods: This study will explore the DITP system and assess its clinical utility and applicability to rehabilitation medicine. A systematic review of the literature will be presented along with the illuminating case history of a PMR patient who’s functional outcome was significantly impacted by the technology. Photos of DITP technology will be shared for didactic purposes. Results: While there are many advantages of DITP including fostering enhanced compliance, improved adherence, empowerment of patients; several disadvantages exist such as cost and potential privacy concerns. Conclusions: DITP can aide physiatrists in the daily management of pain patients by electronic verification of whether the patient has taken their prescribed pill and at what time. For patients on opioid medication, this is immensely important a s compliance is a cornerstone of proper pain management. Enforcement and support of statutory safeguards can prevent improper diversion and abuse of pills. In an age of international concern over opioid abuse, DITP may offer an innovative strategy for enforcing proper use of pain medication in PRM.


  ISPR8-0074 Top


The impact of benzodiazepine on analgesic costs to treat spinal cord injury patients in taiwan: A population-based retrospective cohort study

W. C. Lien

Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, Tainan, Taiwan

E-mail: lwclwhab@ms8.hinet.net

Introduction/Background: The aim of this study was to evaluate the impact of benzodiazepine (BZD) on analgesic costs to treat spinal cord injury (SCI) patients in Taiwan. Materials and Methods: The retrospective cohort study used a subset of the Taiwan National Health Insurance Research Database (NHIRD) comprising information on two million beneficiaries randomly sampled from the entire population of Taiwan. A total of 3170 patients aged 16 and above with newly diagnosed SCI were identified during a period from 2001-2010. Results: The multivariate linear regression using average daily costs of prescription of nociceptive pain, including non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics for 1 year and 4 years after SCI showed increased costs in benzodiazepine (BZD) user, especially in high-dose BZD users (cumulative defined daily dose [cDDD] > 0.3) (parameter estimate = 3.79 and 1.37 respectively. P < 0.05). The multivariate linear regression using average daily costs of prescription of neuropathic pain, including antidepressants and anti-epileptic drugs for the treatment of neuropathic pain for 1 year and 4 years after SCI showed increased costs in BZD user, especially in high-dose BZD users (parameter estimate = 5.95 and 3.85 respectively. P < 0.05). Conclusion: This study showed that the baseline BZD exposure may significantly increase the analgesic costs in SCI patients.

Keywords: Analgesic costs, benzodiazepine, spinal cord injury

Disclosure statement: This study was supported by grants from the Ministry of Science and Technology (MOST 105-2314-B-006-081-).


  ISPR8-0072 Top


Transcutaneous electrical nerve stimulation and placebo analgesia: Are young and older adults the same?

I. Daguet1, 2, 3, K. Bergeron-Vézina1,2, M. P. Harvey1,2, M. Martel1,2, G. Léonard1,2

1Research Center on Aging, University Institute of Geriatrics of Sherbrooke, 2Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada, 3Département de Chronobiologie, Institut Celle Souche et Cerveau, Lyon, France

E-mail: ines.daguet@inserm.fr

Introduction/Background: Placebo analgesia refers to a perceived reduction in pain following the administration of a simulated or otherwise medically ineffective treatment. Previous studies have shown that many factors can influence placebo analgesia. However, few investigations have examined the effect of age on placebo analgesia, and none have done it in the context of rehabilitation interventions. The objective of this study was to compare the placebo response induced by sham transcutaneous electrical nerve stimulation (TENS) between young and older individuals, using an experimental heat-pain paradigm. Materials and Methods: Twenty-two young (21-39 years) and 22 older (58-76 years) healthy adults participated in this comparative study. Experimental heat pain was evoked with a thermode (2-min stimulation at a constant, individually adjusted temperature) applied on the lumbar region. Participants were asked to evaluate the intensity of their pain using a computerized visual analog scale. Experimental pain was induced before and after an unconditioned placebo intervention (sham TENS). Results: In young individuals, no significant pain reductions were noted, whereas in older individuals, a statistically significant pain reduction was observed after the placebo stimulation (P < 0.01). Between-group analysis revealed that placebo analgesia was greater in older individuals (40% pain reduction) compared to young individuals (15% reduction; P < 0.05). Conclusion: Our results indicate that placebo analgesia is influenced by age, with older individuals showing higher placebo analgesia than young adults. Although these results should be confirmed in clinical pain populations, the current observations bear important consequences for the design of future placebo-controlled trials in rehabilitation and for healthcare professionals.

Keywords: Ageing, pain, placebo

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0456 Top


Comparison course of pregnancy related carpal tunnel syndrome in breastfeeding and non-breastfeeding women during the first 6 months after delivery

P. Yazdanpanah, A. Mousavizadeh1, P. Mousavifard2, F. Vafaei3

Department of Physical Medicine and Rehabilitation, Yasuj University of Medical Sciences, 1Department of Statistics and Epidemiology, Social Determinants of Health Research Center, Yasuj University of Medical Sciences, 2Yasuj University of Medical Sciences, Student Research Committee, 3Department of Pediatric, Yasuj University of Medical Sciences, Imam Sajad Hospital, Yasuj, Iran

E-mail: yazdanpanahparviz29@gmail.com

Introduction/Background: Entrapment of median nerve in carpal tunnel is called carpal tunnel syndrome (CTS). The main purpose of this research is to compare the natural course of the syndrome during the first 6 months after delivery in the women feeding their children using formula and breastfeeding mothers. Materials and Methods: The present research was done in 50 pregnant women with symptoms and signs of CTS visited by obstetricians and then referred to physiatrist for electrodiagnostic studies. After delivery and confirming the CTS, women classified in two groups: breastfeeding (33) and non-breastfeeding (17) women. The 5 breastfeeding women missed from study. Follow- up of clinical and electrodiagnostic of women were done in first 6 months after delivery. Results: Complete recovery in breastfeeding, non-breastfeeding and all women were 10.7%, 52.9% and 26.7% respectively. Partial recovery in breastfeeding and non-breastfeeding women was 71.4% and 47% respectively. Complete recovery in mild stage in breastfeeding, non-breastfeeding and all women were 22.2%, 57.1% and 33.3% respectively. Complete recovery in moderate and severe stages in all women were 23.3%. Rate of complete recovery to partial recovery in non-breastfeeding women was 1.7 times than breastfeeding women. Conclusion: This study was showed the relief of symptoms and reduction of severity of CTS in the women who feed their children on formula is higher than those who breastfeed their children. Pregnancy related CTS would not usually resolve after delivery and must be follow-up by clinical symptoms and electrodiagnostic studies. Hormonal changes during lactation and repetitive motions and/or excessively flexed wrist positions during breastfeeding may be causing aggravated pregnancy related CTS after delivery.

Keywords: Breastfeeding, pregnancy related carpal tunnel syndrome, recovery

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1632 Top


Effect of power training on walking abilities in children with cp with poor gross motor function

S. Smati1,2, M. Chevalier2, M. Lemay1, 2, 3, L. Ballaz1, 2, 3

1Department of Physical Activity Sciences, UQAM, 2Research Center, Sainte-Justine UHC, 3Groupe de recherche en activité physique adaptée GRAPA, Physical Activity Sciences, Montreal, Canada

E-mail: sofia.smati@hotmail.fr

Introduction/Background: Power training (PT) has recently been raised as a promising training modality to improve functional abilities in children with cerebral palsy (CP). Nevertheless, its effect on walking ability in CP children with poor gross motor function has never been investigated. The present study aimed to evaluate the feasibility to implement PT in an adapted school and its effect on walking abilities. Materials and Methods: Eleven children with CP (6-11 years old, Gross Motor Function Classification System (GMFCS) level I-V, including 9 children with GMFCS level III-V) were included. They were trained three times a week during 12 weeks. The training session took place during the 50-minute physical activity courses and included 20 minutes of high intensity exercise (i.e. running, fast walking with appropriated technical aids, including weight bearing walker), as well as a warm up and cool down period. Heart rate was monitored during three training sessions for each participant. A kinesiologist, a physical therapist, and the sport teacher, supervised the training sessions. Self-selected comfortable and fast walking speed, gait efficiency, as evaluated with the energy expenditure index (EEI), as well as running speed were assessed before and after the training period. Results: Ten children completed the whole training period. Participants spent 19 ± 7 min and 6 ± 7 min at an intensity superior to 40% and 60% of the heart rate reserve, respectively. The EEI was reduced after training (p = 0.01), resulting in a more efficient gait. Comfortable and fast walking speed also increased after training (p < 0.05). Greater improvements were observed in children with higher GMFCS level. Conclusion: PT is feasible in adapted school environment with children with CP with GMFCS level III-V. These data suggested that PT increases walking capacities. More studies are needed to assess the impact of PT in children with poor walking abilities.

Keywords: Adapted school, cerebral palsy, power training

Disclosure of interest: The authors did not declare any conflict of interest.

A1.04 PAIN - Miscellaneous


  ISPR8-1021 Top


The inherent role of the multidisciplinary palliative care team on pain management: A critical review

I. Amorim, S. Rego1, G. Pires, S. Proeça, F. Correia

CMRA, Serviço de Reabilitação de Adultos, Lisboa, 1Centro Hospitalar Universitário do Algarve, Serviço de Medicina Física e de Reabilitação, Faro, Portugal

E-mail: isabeldeamorim@gmail.com

Introduction/Background: Cancer pain and palliative care (PC) are recognized as significant international health issues. Treatment of pain and rehabilitation programs in PC are challenging. Rehabilitation is the process that helps a person to reach physical, psychologic, social and educational potential with physiologic, anatomic impairment, desires and life ambitions. Rehabilitation improves patients physical function, independence and pain management to improve quality of life and patients’ dignity. Materials and Methods: Update on the role of rehabilitation in PC by detailed view of rehabilitation treatment methods and their evidence for application into PC conditions. Databases of Cochrane Library, Google Scholar and Pubmed were search from January 2005-December 2016. Results: There is few evidence that rehabilitation can impact function and pain management in PC. However, experience suggests that physical modalities should be applied early to minimize the generalized deconditioning and aid in the pain management, decreasing the need for pain medications. Physical modalities can be applied by health care providers. Passive, active, and active-assisted motion exercises and gentle strengthening exercises can aid in the maintenance of strength and joint range of motion. The prescription of assistive devices, and the teaching of compensatory techniques for mobility can aid in ambulation. There is also evidence that immune function may be improved by moderate exercise. Conclusion: A rehabilitation team has the ability to integrate physical aspects of treatment in a biopsychosocial model of pain into a comprehensive rehabilitation program for cancer patients. More research should focus on the role of rehabilitation and defining appropriate interventions.

Keywords: Pain, palliative care, rehabilitation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1655 Top


Importance of sleep quality in chronic pain

M. Parada Marcilla

FLENI, Neurology, Buenos Aires, Argentina

E-mail: m.paradamarcilla@gmail.com

Introduction/Background: Poor sleep is a risk factor of a range of several adverse outcomes including disabling pain conditions. The aim of this study is to analyze the Interdisciplinary Outpatient Pain Rehabilitation Program (IOPRP) treatment outcomes of chronic back and neck pain (spinal pain) with comorbidity sleep disorders. Materials and Methods: We included 513 patients, between 1/8/14 and 28/2/16, in our IOPRP. A battery of self-reported questionnaires was completed at the beginning and end of a 16-session program; follow up visits were scheduled three months and one year after discharge. The presence of chronic spinal pain and sleep disturbances were recorded. All subjects were separated into two groups, chronic spinal pain with sleep disturbances group 11.30% (n = 58), and chronic spinal pain without sleep disturbances group 88.7% (n = 455). Visual analogue Scale (VAS) was used to evaluate pain, Insomnia Severity Index (ISI) to evaluate sleep quality, those with ISI > 8 underwent polysomniography to confirm sleep disturbances, and Short Form Survey (SF-36) to evaluate the quality of life. Both groups were treated with the IOPRP, working under international standards (Carf accreditation). Treatment included pain medication, physical and occupational therapy, cognitive and behavioral techniques for pain, sleep and stress management. Results: Mean age was 55.76Â ± 0.44 years; 68.9% were females; IOPRP at baseline showed: Visual Analogue Scale (VAS) 5.66Â ± 0.07, poor quality of life (SF36) 41.9 (Â ± 0.54), subclinical insomnia Insomnia Severity Index (ISI) 11.31Â ± 0.26. At the end of the program, statistically significant improvement (p < 0.05) was observed on VAS, SF-36 (8 domains), and ISI. Conclusion: The IOPRP, working under international standards, shows improvement in sleep associated with better physical functioning and pain reduction. Interventions in the interaction between pain and sleep could potentially reduce pain and increase quality of life for patients suffering chronic pain. More studies are needed for a better understanding of this relation, pain-sleep disorders.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1792 Top


Multilevel evaluation of motion and posture patterns in lower extremity and spine using dynamic ultrasound

R. Bubnov, L. Kalika1

Clinical Hospital “Feofaniya”, Ultasound, Kyiv, Ukraine, 1New York Dynamic Neuromuscular Rehabilitation and Physical Therapy, https://nydnrehab.com/, New York, USA

E-mail: rostbubnov@gmail.com

Introduction/Background: Evaluation of intrinsic/extrinsic muscles posture is a crucial task for physical therapy and pain treatment. Integrative assessment of pain case in order restoring postural imbalance has not been developed. The aim was to evaluate feasibility of motion posture analysis using M-mode ultrasound in foot, ankle, gluteus region, pelvis and spine. Materials and Methods: We included 33 patients (both sexes, aged 17-52 y.o.) with clinically diagnosed leg, back pain with reduced motility in spine, pelvis and lower extremity levels. Another 20 patients (aged 18-53 y.o.) without pain and related complains on MSK disorders were controls. We conducted precise physical tests, extensive neuromuscular ultrasound using M-mode to evaluate muscle thickness, CSA and motion in intervetrebral spaces, pelvis, intrinsic/extrinsic muscles in pelvis, gluteus region, foot and ankle. Results: We obtained sufficient quality panoramic scans on leg using convex 5-8 MHz probe in 2 approaches to evaluate structure and motion of extrinsic/intrinsic muscles during one session. Thickness measurements of peroneal portion, plantar intrinsic foot muscles on the plantar surfase in two transverse positions and one longitudinal using linear probe; contractility using M-mode tested in walking were most representative data. We evaluated different patterns of decreasing motility, contractility (muscle contracted/rested thickness) on M-mode during functional tests and walking at all levels in group 1 (p < 0.05). We preliminary observed correlation of changes (muscle hypertrophy) in contralateral extrinsics/intrinsics muscles at same levels, due to biomechanical instability; trigger points detection corresponded to areas of hypomobility in 95% cases. Conclusion: Extensive evaluation of motion posture in foot, ankle, and gluteus region, pelvis and spine is feasible and informative protocol. Further research needed for development US patterns, conducting comparative RCT using US, CAREN, static & dynamic balance tests, pressure analysis, etc.; and to develop educational programs).

Keywords: Lower extremity, motion analysis, ultrasound

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2156 Top


Acupuncture as an adjuvant therapy in amputation pain

P. Sautreuil, B. Bignami, D. Mazevet, L. Borrini1, P. Thoumie2

Department of Physical Medicine and Rehabilitation, Pitié-Salpêtrière Hospital- AP-HP, 2Department of Physical Medicine and Rehabilitation, Rothschild Hospital- AP-HP, Paris, 1Department of Physical Medicine and Rehabilitation, Percy Military Hospital, Clamart, France

E-mail: patrick2sautreuil@gmail.com

Introduction/Background: Stump pain is usually hard to cure. This pain is often beyond the efficiency of painkillers, so hard that some patients threaten to commit suicide in order to end it. We analyzed our experience of the efficiency of acupuncture for painful amputees suffering from their stumps. Materials and Methods: Retrospective analysis of acupuncture sessions performed on painful amputees referred to our center for intractable pain. Pain was evaluated with Visual Analog Scale, before and after acupuncture sessions. We used a various number of needles per patient (1 to 10) and depth of puncture varies from 1 mm to few centimeters. The average duration of the acupuncture sessions was 30 minutes. Stumps were carefully analyzed in order to puncture the acupuncture needles in the damaged tissues (painful neuroma, muscular trigger point, painful scar) and in classical acupuncture points. The needles were carefully places to avoid the pain caused by a too fast and too deep puncture. Results: Fifty painful amputees (34 men and 16 women) were included in our study. The cause of amputation was traumatic (n = 45), arteritic (n = 2), septic shock (n = 2), tumoral (n = 2). The level of amputation was transtibial (n = 26), transfemoral (n = 14), hands (n = 3), forearms (n = 2), arms (n = 2), disarticulation of shoulder (n = 2), foot (n = 1). These intractable pains were relieved by successive acupuncture session in 80% of patients; among those, the mean VAS improved from 9 to 3/10. Conclusion: Acupuncture seems to be particularly efficient for pathologic neuromas pains as for causalgias, muscles trigger points and algo-hallucinosis. After some sessions, acupuncture may alleviate for months or years the neuroma pain. Acupuncture is a cheap, easy and efficient antalgic therapy for neuroma pains, causalgias, muscular triggers points and algo-hallucinosis of amputated stumps. Further studies are needed to determine the best modalities of this therapy.

Keywords: Acupuncture, amputation, pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0330 Top


Phantom pain in congenital amputees: Myth or reality?

D. Garcia, E. Flores, P. Nahuelhual1, F. Solis1

Departments of Physical Medicine and Rehabilitation and 1Investigation, Instituto Teleton Santiago, Chile

E-mail: mdgarcia@uc.cl

Introduction/Background: Until not long ago, pain was underdiagnose in children (1). Its similar in congenital amputees (CA) and the presence of phantom pain (PP). Even do PP is common in adult amputees, its existence in CA is denied by many clinicians. But articles have corroborate that pediatric CA can develop PP (2-4). The aim is to study the presence of PP in CA who assist to our center and study its characteristics. Materials and Methods: Descriptive study. Population: 10 years and older patients with diagnosis of CA or deficiency who attended our center. Instruments: Previously validated telephone survey to determinate the presence and characteristics of PP (5). Variables: PP and sensation, ISPO classification, prosthesis use. Analysis: Lapsic prevalence, data was analyzed using STATA 14. Results: 77 patients were contact, 57 of them consented to answer the telephone survey. Main age was 18.6 years (12-25), 43.9% male. 60% had longitudinal deficiency, 38% had a transversal and 2% had both. The most commonly affected extremity was the left arm. 33% reported to use prosthesis. Regarding our survey, 24.6% had phantom sensation and 7% had PP, with a lapsic prevalence of 5.3%. Analyzing the patients with pain, all of them had an upper extremity deficiency, none used a prosthesis and 1/2 had phantom sensation. Conclusion: This is a small study, but its an important contribution to consolidated that PP can be present in CA. Nowadays there is much more conscience on the importance to suspect, diagnose and treat pain in children, so phantom pain should not be an exception.

Keywords: Congenital amputee, deficiency, phantom pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0265 Top


Study of carpal tunnel syndrome in peripheral neuropathy with comparison of two methods: Inching method and second lumbrical-interossei test

M. Emad, L. Abolfathi Momtaz

Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran

E-mail: mrezaemad@gmail.com

Introduction/Background: Diabetes mellitus is the most common metabolic disease. The carpal tunnel syndrome (CTS) occurs frequently in this disease. In diabetes mellitus due to effects of generalized neuropathy on peripheral nerves, the diagnosis of CTS with conventional EDX criteria (onset latency of median SNAP or distal latency of median CMAP) is challenged, so another methods such as 2nd lumbrical-interossei test is used. On the other hand Inching method is a technique in which used for diagnosis and determining the site of compression in carpal tunnel. The purpose of the present study is to evaluate diagnostic value of the inching method and 2nd lumbrical-interossei test in patients with diabetic peripheral neuropathy and signs or symptoms of carpal tunnel syndrome. Materials and Methods: Thirty hands with history of diabetes mellitus and signs and symptoms of CTS that confirmed diagnosis of peripheral neuropathy with conventional electrodiagnosis were evaluated. Then for diagnosis of CTS, sensory and motor median distal latencies were measured by nerve conduction study. In the next step inching method and second lumbrical interossei test was performed for all hands and sensitivity and specificity of two tests was calculated. Results: Mean age of participants was 53.87 ± 11.53 years (range 26 to 70 years). 10 participants were female and 6 participants were male. The sensitivity and specificity of inching method in this study were 95.65 and 85.71 respectively and the results for second lumbrica-interossei test 73.91 and 71.42 were calculated. Conclusion: In this study, we showed the inching method is more sensitive and specific than second lumbrical-interossei test in diagnosis of CTS in diabetic peripheral neuropathy with sensitivity and specificity 95.65 and 85.71 respectively and also the sensitivity of inching method was greater than specificity.

Keywords: Carpal tunnel syndrome, diabetic peripheral neuropathy, electrodiagnostic inching method and second lumbrical interossei tests

Disclosure of interest: The authors did not declare any conflict of interest.


  A10 Miscellaneous Top



  ISPR8-1029 Top


Disaster preparedness in rehabilitation in an area at high risk of mega-earthquakes in Japan

S. Katoh, N. Sato, M. Kurihara1

Department of Rehabilitation Medicine, Tokushima University Hospital, Tokushima, 1Nagasaki Rehabilitation Hospital, Japan Disaster Rehabilitation Assistant Team, Nagasaki, Japan

E-mail: skatoh@tokushima-u.ac.jp

Introduction/Background: At the Great East Japan Earthquake, more than 15,000 people perished, and another 3000 people were died of the disaster-related conditions. Materials and Methods: Japan Disaster Rehabilitation Assistant Team (JRAT) was established after the earthquake by physiatrist and the allied professionals’ organizations, and JRAT has been playing a pivotal role of the preparedness to decrease preventable deaths. The main foci of the preparedness of JRAT are sustaining rehabilitation in hospitals and community, and prevention of inactivity or disuse of the suffered inhabitants. The principles of JRAT are officially authorized and not volunteer-basis. Results: At the Kumamoto earthquakes in 2016, the JRAT started working on the next day of the first attack. A total of 2039 rehabilitation professionals worked in the area and another 895 worked for logistics in the next 10 weeks, and he manual of the disaster rehabilitation is revised. Risk of the mega-earthquake of south-east Japan has been estimated as 70% in the next 30 years. Worst scenario in Tokushima with 777,000 inhabitants close to the epicenter, is expecting 46% of the inhabitants being in the shelters, and many disaster-related deaths. The local government appointed physiatrists and allied professionals as the coordinators, and they are reviewing condition of planned refugees’ shelters, and seeking collaboration with other health professionals. Conclusion: The society which does not have comprehensive information of the disabled and rehabilitation would need to prepare for the massive natural disasters. This is a part of ISPRM-ISCoS collaborative session: Supporting global disaster planning and response for sci in low resource settings.

Keywords: Disaster, preparedness, spinal cord injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0105 Top


Development and preliminary psychometrics of the exercise therapy burden questionnaire for patients with chronic conditions

W. Martin, S. Poireaudea, C. Palazzo

Department of Physical Medicine and Rehabilitation, Cochin Hospital, Paris, France

E-mail: wmartin.mpr@gmail.com

Introduction/Background: Chronic diseases are the leading cause of mortality and disability worldwide. Exercise therapy has been found effective for mortality, disability and well-being in many chronic conditions. Burden of treatment may reduce patient compliance and treatment efficacy. We aimed to develop and validate a self-reporting questionnaire assessing the burden of exercise therapy for patients with chronic conditions. Materials and Methods: We conducted semi-structured interviews with patients to develop items of the questionnaire. The dimensional structure of the questionnaire was assessed by principal component analysis. Construct validity of the instrument was assessed by exploring convergent validity with the Treatment Burden Questionnaire (TBQ) and divergent validity with pain, self-efficacy, treatment satisfaction and health state. Reliability was assessed with the Cronbach alpha coefficient, a test–retest method using the intraclass correlation coefficient (ICC) and Bland-Altman plotting. Results: A preliminary list of items was developed from semi-structured interviews with 28 patients and reviewed by two expert physicians. Items obtained were reduced. Then, a sample of 163 patients was used to measure the psychometrics of the Exercise Therapy Burden Questionnaire (ETBQ), consisting of 10 items. Principal component analysis extracted one dimension. The Cronbach alpha was 0.86 [0.82-0.89]. Test–retest reliability (n = 24 patients) was good, with ICC 0.93 [0.85-0.97], and Bland-Altman analysis did not reveal a systematic trend. The ETBQ showed expected convergent validity with the TBQ (rs = 0.52) and expected divergent validity with pain (rs = 0.37), self-efficacy (rs = -0.34), treatment satisfaction (rs = -0.49) and perceived health state (rs = -0.28). Conclusion: The ETBQ is the first questionnaire assessing exercise therapy burden in patients with chronic conditions. Its psychometric properties are promising.

Keywords: Burden of treatment, chronic diseases, exercise therapy

Disclosure of interest: The authors did not declare any conflict of interest


  ISPR8-0705 Top


Psychometric evaluation of patient responses to clinician-generated items assessing domains relevant to rehabilitation service needs among hospitalized populations

J. Basford, A. Cheville

Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA

E-mail: basford.jeffrey@mayo.edu

Introduction/Background: To access the utility of the responses of chronically ill patients to ad hoc legacy clinician-generated medical and social questionnaires used by many institutions in assessing mood, function, symptoms, and social support. Materials and Methods: The study population included 8,561 unique patients who generated a total of 12,659 hospital admissions over the period of the study. Items administered from 2004 to 2014 to outpatients in a large US Midwestern medical center who were hospitalized during the study period were identified. Exploratory factor analysis yielded item-to-factor loadings that were in turn used to identify meaningful clusters. Content-matter experts independently described the attributes of the clusters and rated the relevance, coverage, and clarity of the involved items. Factor scores were established with a confirmatory factor model. Validity based on inter-factor relationships and to assigned diagnostic codes was assessed. Results: Six factors addressing depression, pulmonary symptoms, musculoskeletal pain, living situation, mobility, and activities of daily living had reliabilities of >0.64 and were retained for further analysis. Content-matter experts rated the clarity each item and their relevance to their assigned domains. Factor inter-correlations provided evidence of convergent and discriminant validity, as did weak to moderate relationships (-.13 to .32) with the related diagnostic code assignments. Conclusion: A legacy PRO instrument similar to those of many healthcare systems can be utilized to aggregate and characterize the validity of items that can be used to assess the mood, function, symptoms, and social support of chronically ill patients. However, the relationships are likely to be only weak to moderate.

Keywords: Function, psychometrics, screening

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0101 Top


Minimum technical standards and recommendations for traumatic brain injury specialist rehabilitation teams in sudden-onset disasters (for disaster rehabilitation committee special session)

V. Vasudevan, B. Amatya, S. Chopra, N. Zhang, I. Astrakhantseva, F. Khan

Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, Australia

E-mail: vandana.vasudevan@mh.org.au

Introduction/Background: Sudden-onset disasters (SODs) result in increased number of survivors with complex and long-term disabling injuries, including traumatic brain injury (TBI) that warrants comprehensive specialist rehabilitation. This presentation highlights the minimum technical standards required for specialised TBI rehabilitation teams and their integration into WHO Emergency Medical Teams (EMTs) to facilitate comprehensive management of TBI survivors in disaster settings. Materials and Methods: A team of medical rehabilitation physicians from the Royal Melbourne Hospital conducted a comprehensive review of literature for TBI management, based on the WHO core-guidelines for ‘Minimum technical standards and recommendations for rehabilitation for EMTs’. These were endorsed by a specialist TBI expert panel in the Asia-Pacific region. Results: Comprehensive rehabilitation programs improve functional outcomes and quality of life of TBI survivors. It is recommended that specialised TBI care teams need to be embedded into EMTs for disaster response and management for early diagnosis, management and social reintegration. This guidance documents the minimum standards for deployment of TBI specialist rehabilitation teams in the context of SODs, including: skill requirements, team configuration and profile, professional competencies for management of TBI and complications, list of required equipment and consumables, information management/dissemination. Conclusion: TBI rehabilitation should commence from the early response phase in SODs by accredited rehabilitation professionals to minimise complications and disability. Integration of specialised TBI rehabilitation professionals into EMTs for disaster response will improve functional outcomes of survivors.

Keywords: Disaster rehabilitation, traumatic brain injury, WHO emergency medical teams

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2168 Top


Looking at hospitalized persons throughout the prism of the handicap

M. Giral, B. Boussat1, F. Lombard1, S. Stempfle1, P. Francois1, D. Perennou1

General Hospital Metropole-Savoie, Savoie, Chambery, 1CHU, Isere, Grenoble, France

E-mail: mael.giral@ch-metropole-savoie.fr

Introduction/Background: To describe the disability status of non-selected hospitalized persons. Materials and Methods: We conducted a cross-sectional survey to assess activity limitations of every persons older than 18 years old hospitalized in a regional university hospital covering all medical fields. Evaluators rated on a scale from 0 to 4), 22 selected items of the International Classification of Functioning, covering the 6 following domains: learning and applying knowledge, general tasks and demands, communication, mobility, self-care, interpersonal interactions and relationships. Univariate and multivariate analyses were performed to analyze the prevalence, severity and profile of the handicap in terms of socio-demographic characteristics and care pathways. Results: Among 1572 eligible persons, 1267 (81%) were surveyed (mean age 62.7 ± 20.4 years; 655 male [51.7%]). Overall, 82% showed at least one activity limitation. For 52%, disability was severe or total for at least one ICF item. Prevalence of disabilities was higher for mobility (75%) and self-care domains (63%). Disability was strongly related to age: age older than 80 years versus 18 to 44 years (OR=12.8; p<0.01). Disability was associated with hospitalization in rehabilitation units (96%; OR=4.3; p<0.01). Severe disability was associated with hospitalization in critical care units (OR=6.7; p<0.001) and psychiatry units (OR=5.3; p<0.001). Conclusion: Handicap was common in hospitalized persons, involving all 6 tested ICF activity domains, particularly mobility and self-care. This study alerts care givers, hospital administrators, and in general people influencing health policies about the need to plan actions to reduce activity limitations of hospitalized persons, whatever the cause of the hospitalization.

Keywords: Disability, handicap, ICF

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2605 Top


Bone mineral density in postmenopausal women

S. Modanloujouybari, B. Heidari1, R. Hosseini2, Y. Javadian3

Departments of Women Health, 1Internal Medicine, 2Social Health and 3Physiotherapy, Babol University of Medical Sciences, Babol, Iran

E-mail: shahrzadmodanlou@gmail.com

Introduction/Background: The impacts of various factors on bone mineral density (BMD) differ across diverse population. The aim of this study was to determine the relationship between BMD in the femoral neck (FN) and lumbar spine (LS) with some common clinical, demographic, and biochemical parameters in postmenopausal women. Materials and Methods: In this cross-sectional case-control study, all postmenopausal women of the Amirkola Health and Ageing Project (AHAP) who performed bone densitometry were included. BMD at FN and LS was measured by DXA method. Data regarding clinical, demographic, and biochemical characteristics were provided. OP was diagnosed by the International Society for Clinical Densitometry criteria. Pearson correlation and multivariate regression analyses with simultaneous adjustment were performed to determine relationship. Results: Five hundred thirty-seven women with mean age of 67.9±6.7 years and mean menopause duration (MD) of 15.8± 5.1 years were studied. MD correlated negatively with FNBMD and LS-BMD g/cm2 (r=−0.405, p=0.001 and r= −0.217, p=0.001). Body mass index (BMI) correlated positively with FN and LS-BMD g/cm2 (r=0.397, p=0.001 and r=0.311, p=0.001). The association of MD with risk of FNOP was stronger than LS-OP. Obesity and metabolic syndrome (MS) and higher serum ferritin reduced the risk of OP at both LS and FN similarly, whereas the impacts of parity, prior fracture, high level of education, and physical activity were significantly different across BMD measurement sites. Conclusion: The results of this study indicated a significant association between OP and MD, obesity, parity, MS, history of fracture, serum ferritin, level of education, and physical activity. However, the direction and the strength of association varied across BMD measurement sites.

Keywords: Bone mineral density, obesity, postmenopausal

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0886 Top


Interdisciplinary collaboration: 30 years of experience in a neuro-orthopedic consultation at raymond poincare hospital

M. Salga, L. Gatin1, A. Geffrier1, F. Calé1, A. Schnitzler2, F. Genêt2, P. Denormandie1

Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Departments of 1Orthopedic Surgery and 2Physical Medicine and Rehabilitation, Hôpital Raymond Poincaré- APHP- CIC-IT 1429, Garches, France

E-mail: marjoriesalga@hotmail.fr

Introduction/Background: Raymond Poincaré hospital is a national rehabilitation center for disabled patients with orthopedic issues. Physical Medicine and Rehabilitator physicians and orthopedic surgeons have developed interdisciplinary neuro-orthopedic approach for treatment of patients, with over 30 years of experience. The framework of diagnosis and therapeutic treatment outcome decision making considers patient concerns and expectation. An initial selection consultation is performed to identify complex cases requiring interdisciplinary expertise, as approximately 60% of new patient referrals (1000 patients annually) present with a surgical indication; otherwise patients are reoriented to different departments. Materials and Methods: Patients are stratified into one of four consultation services, dedicated to conditions associated with: upper limb and geriatric /lower limb /cerebral palsy /heterotopic ossification, Charcot-Marie-Tooth, and poliomyelitis. Results: Consultations are split into 4 phases. The primary phase is performed by a single physician and is dedicated to understand what the complaint is depending on the patients’ medical history. Phase 2 involves the entire interdisciplinary team, where there is time dedicated to clinical exam and an interactive discussion between doctors and patient and the best therapeutic options are debated. In the 3rd phase of consultation, the therapeutic options are presented to the patient with clear goals being established in a formal “agreement” with the patient. The 4th part of the consultation is done by one single doctor who stay with the patient to summarize, answer questions and precise the procedure. Discussion with patients is essential for identifying the unique pathological features of individual cases. The interdisciplinary team is comprised of experts in OS and PMR seniors and interns; who participate equally in the process. Conclusion: The interaction between medico-surgical experts in this framework of consultation has developed a cooperative network of experts in PMR that spans French territory. Thus, diagnosis and consultation using this novel framework delivers ideal treatment strategies for the rehabilitation of patients.

Keywords: Interdisciplinary consultation, neuro-orthopedic disorders

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2435 Top


Predictors of disability outcome after major trauma

P. Kersten, K. Czuba1, D. Anstiss1, R. Maheswaran2, G. Smith1, N. Kayes1, G. Terry1, R. Siegert3

School of Health Sciences, University of Brighton, Brighton, United Kingdom, 1Centre for Person Centered Research, School of Clinical Sciences, AUT University, Departments of 2Biostatistics and Epidemiology and 3Psychology, AUT University, Auckland, New Zealand

E-mail: p.kersten@brighton.ac.uk

Introduction/Background: Many people survive major trauma, often with complex consequences of their injuries. However, data on outcomes is lacking. This paper aims to evaluate disability and functional outcomes after major trauma at 12-months post-injury. Materials and Methods: A one-year prospective cohort study of major trauma survivors, recruited from two major trauma centres in New Zealand. In- and exclusion criteria are in [Table 1]. Baseline variables included demographics, Injury Severity Score, diagnosis, cause of injury, length of hospital stay (LOS). 12-months post-injury participants completed the Extended Glasgow Outcomes Scale (GOS-E), the Short Form 12 (SF12), the EQ5D, Pain Numeric Rating Scale (NRS), World Health Organization Disability Assessment Schedule 2.0 (WHODAS), questions regarding productivity status. Ordinal step-wise regression was performed to investigate the impact of baseline variables on GOS-E outcome. Ethical approval was received from the Health and Disability Ethics Committee of New Zealand. Results: 121 people took part (response rate 58%), the majority having received injuries through road traffic accidents (33%) or falls (24%); 58% sustained neurological injuries. 69% were in paid employment pre-injury, 41% at 12 months. 36% reported experiencing moderate to severe pain within the last 24 hours at 12-months post-injury. Ongoing disability was significant as measured with the GOSE (15% severe and 32% moderate disability) and WHODAS (23%). Many had ongoing problems with mobility (33%), usual activities (39%), pain (52%) and anxiety (34%) (EQ5D). Ethnicity (p=0.003), LOS (p=0.002), education (p=0.056) and comorbidity (p=0.051) were significant predictors of GOS-E outcome [Table 2]. Conclusion: A significant proportion of major trauma survivors experience ongoing disability a year later. Some of the significant predictors suggest health outcomes are poorer for disadvantaged groups, who should be better supported by rehabilitation services.
Table 1: Inclusion and exclusion criteria

Click here to view
Table 2: GOS-E predictor variables

Click here to view


Keywords: Disability, major trauma, pain

Disclosure statement: The study received funding from the Accident Compensation Corporation of New Zealand. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the funder.


  ISPR8-2500 Top


Comparison of participation and health-related quality of life between persons with neurological and rheumatic diseases

B. Sonel Tur, M. Kurt, D. Özmen1, A. A. Küçükdeveci

Departments of Physical Medicine and Rehabilitation and 1Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey

E-mail: ayse.kucukdeveci@gmail.com

Introduction/Background: Both neurological and rheumatic diseases constitute significant causes of disability. Participation (defined as involvement in a life situation) and health-related quality of life (HrQoL) are considered important outcomes in physical and rehabilitation medicine. Documentation of participation and HrQoL in various disabling conditions would guide rehabilitation professionals while planning their treatment interventions. The aim of this study is to determine and compare the participation and HrQoL of people with neurological versus rheumatic diseases. Materials and Methods: 90 patients with neurological disorders (44% stroke, 23% spinal cord injury, 20% Parkinson’s) and 89 patients with rheumatic diseases (49% osteoarthritis, 33% rheumatoid arthritis, 18% ankylosing spondylitis) who were in the follow-up at the Department of Physical Medicine & Rehabilitation of a university hospital were included. Participation was assessed by Impact on Participation and Autonomy Questionnaire (IPAQ), HrQoL by Nottingham Health Profile (NHP) and activities of daily living by Modified Barthel Index (MBI). Results: Mean age was 58.1 in neurological patients (61% male) and 61.5 in rheumatic patients (19% male). Mean disease duration was 40.3 months in neurological group while it was 170.6 in the rheumatic group. MBI score was significantly lower in neurological group (p=0.0001) showing more dependence in activities of daily living. Comparison of IPAQ revealed that neurologic patients experienced more participation restriction than rheumatic patients regarding autonomy indoors (p<0.0001), family role (p=0.023), autonomy outdoors (p=0.001), and work and education (p=0.05) while social life was similar. Rheumatic group reported more distress in pain (p<0.0001) and sleep (p=0.009) domains of NHP, whereas neurologic group was worse in physical mobility (p=0.012). Fatigue, social isolation and emotional reactions domains did not differ. Conclusion: Although neurological diseases had great impact on physical activities and participation of patients, their social and emotional aspects of health status were similar with patients having rheumatic diseases. Furthermore, rheumatic diseases led to more pain and sleep problems.

Keywords: Health-related quality of life, participation

Disclosure of interest: The authors did not declare any conflict of interest.


  A2.01 Musculoskeletal Conditions - Inflammatory Joint Diseases (E.G. Rheumatoid Arthritis, Ankylosing Spondylitis) Top



  ISPR8-0185 Top


Effectiveness of combined use of cryotherapy and neuromuscular electrostimulation in rheumatoid arthritis

M. Sukhareva, A. Karateev, A. Lila

Department of Physical Therapy and Rehabilitation, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia

E-mail: aekarat@yandex.ru;marina-su@mail.ru

Introduction/Background: Non-pharmacological methods have an important role in the complex treatment of rheumatoid arthritis. The combination of cryotherapy and neuromuscular electrostimulation (NMES) is one of the new non-pharmacological methodic that reduces pain and local inflammation. Materials and Methods: The study group comprised 69 RA patients, 52.4 ±17.6 years, 88.4% women with moderate activity (DAS28 3.48 ±1.17) who received standard therapy: methotrexate or leflunamide, glucocorticoids <10 mg prednisolone (43.5%), NSAIDs. The criterion for inclusion was the presence of pain and a decrease in muscle strength in the hand. Three groups were randomly assigned to 23 patients who received 10 daily procedures: group 1 NMES on the posterior surface of the forearm muscles, with cooling (t -10 ° C), group 2 NMES on the posterior surface of the forearm muscles, with false cooling t + 10 ° C), group 3 only cryotherapy with cooling (t -10 ° C), NMES was switched off. Evaluation of the results was conducted after 28 days. Results: In group 1, there was a greater improvement in comparison with groups 2 and 3. DAS28 decreased from 3.51 ±1.31 to 3.11 ±1.07, from 3.44 ± 1.24 to 3.34 ±1.12 and from 3.45 ± 1.24 to 3.31 ±1.24 (p <0.05). Severity of pain (100 mm VAS) decreased by 15.01 ±5.21, 6.4 ±5.45 and 8.12 ±5.01 mm (p <0.05). The increase of compression force of the most affected hand > 50% was noted in 53.0%, 18.2% and 25.6% of patients (p <0.05). In 5 patients from group 1 who had symptoms of the carpal canal, a significant decrease in numbness of the fingers was noted. Serious side effects were not noted. Conclusion: Cryotherapy and NMES can reduce pain and improve function in RA. The combined use of cryotherapy with NMES provides more pronounced effect and is well tolerated.

Keywords: Cryotherapy, neuromuscular electrostimulation, rheumatoid arthritis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0161 Top


Abstract need to be edited - effectiveness of lavendula stoechas essential oil in treatment of mild to moderate carpal tunnel syndrome: A randomized controlled clinical trial

B. Eftekharsadat, A. Babaei-Ghazani1

Department of Physical Medicine and Rehabilitation, Tabriz University of Medical Sciences, 1Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Tehran, Iran

E-mail: binasadat@yahoo.com

Introduction/Background: In this study, we investigated the effectiveness of topical Lavender (Lavendula stoechas) essential oil on pain intensity, isometric pinch strength, specific parameters of electro-diagnosis study (EDS), symptom severity and functional status of patients with mild to moderate carpal tunnel syndrome (CTS). Materials and Methods: Forty eight patients with mild to moderate CTS were enrolled in this randomized placebo-controlled trial. Group A was treated with night wrist splint and topical Lavender oil ointment. Group B was treated with night wrist splint and a placebo ointment. Patients were evaluated at baseline and after 40 days of intervention with Boston CTS questionnaire (BCTQ), visual analog scale (VAS) for pain, pinch grip strength (PGS), power grip (PG), median compound motor action potential latency (MCMAPL) and median sensory nerve action potential latency (MSNAPL). Results: At the end of the study period, both groups improved significantly in terms of BCTQ, VAS, isometric pinch powers, and EDS parameters. However, group A showed significantly greater improvements in BCTQ (mean difference: 0.39 ± 0.31 VS. 0.6 ± 0.35; p=0.03), VAS (3.37 ± 1.86 VS. 1.33±2.07; p=0.001), and PGS (0.73 ± 0.63 VS. 0.27 ± 0.54; p=0.01) than group B. No significant differences in PG, MCMAPL and MSNAPL were seen between the two groups. Conclusion: This study was the first trial of topical Lavender oil used in patients with CTS. The results of this study suggested that splinting therapy combined with topical Lavender oil is more effective than splinting and placebo in treatment of mild to moderate CTS.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1960 Top


Correlations among disease activity, functional status, quality of life and clinical and ultrasonographic enthesitis assessment in patients with spondyloarthritis

G. Er

Department of Physical Medicine and Rehabilitation, Abant Izzet Baysal University, Izzet Baysal Hospital, Bolu, Turkey

E-mail: gunay221188@hotmail.com

Introduction/Background: Enthesitis is regarded as the primary lesion in all spondyloarthritis (SpA) subtypes. The aim of the study is to determine the relationship between disease activity, functionality, quality of life and enthesitis assessment in patients with SpA. Materials and Methods: 90 patients with diagnosis of SpA according to 2009 ASAS criteria were recruited to the study. In the clinical evaluation, BASDAI, ASDAS, BASFI, ASQoL, SF-12 scales were applied. Enthesitis assessments were done clinically by MASES and SPARCC. Bilaterally distal triseps tendon was evaluated clinically. Ultrasonographic enthesis was evaluated by a 10 years-experienced, blinded sonographer according to MASEI. Results: The mean age was 37,5 and 57 of cases were male. The median scores of BASDAI, ASDAS-CRP, ASDAS-ESR, BASFI, ASQoL, MCS and PCS were 3, 9, 3, 5, 2, 6, 2, 5, 7, 44,1 and 41, 7, respectively. The median scores of both MASES and SPARCC were 2. The median score of MASEI was 16. Clinical enthesitis scores correlated with disease activity scores, functional status and quality of life measure. No correlation was found between the MASEI and clinical enthesitis score, BASDAI, quality of life measure. There was also correlation between MASEI and ASDAS-CRP, BASFI. Conclusion: Although clinical enthesitis scores correlated with clinical parameters, but not with biochemical markers and sonographic score. Sonographic score was not correlated with disease activity measure except ASDAS-CRP. The result attributed to clinical scales that were less sensitive. Due to the requirement of scales that depend on more objective methods in evaluation of disease activity, ASDAS-CRP could be preferred compared to other present scales.US confirms its validity and reliability in the assessment of entheseal involvement in patients with SpA. This study propose also that sonographic detection of enthesopathy should be incorporated into the clinical protocol for evaluating patients with SpA in routine clinical practice.

Keywords: Enthesitis, spondyloarthritis, ultrasonography

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2670 Top


Relation between fracture risk assessment tool index and anti–citrullinated protein antibody serum level in premenopausal rheumatoid arthritis patients

N. Aboeladl, M. Hassan1

Department of Physical Medicine, Rheumatology and Rehabilitation, Helwan University, Cairo, 1Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, Egypt

E-mail: dr_nesrin_ahmed@hotmail.com

Introduction/Background: Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis in adults and is characterized by synovial inflammation and hyperplasia, autoantibody production: rheumatoid factor (RF) and anti–citrullinated protein antibody (ACPA), cartilage and bone destruction, and systemic features, including cardiovascular, pulmonary, psychological, and skeletal disorders. FRAX (Fracture Risk Assessment Tool) is a computer-based algorithm developed by the World Health Organization (WHO) Collaborating Centre for metabolic bone diseases and first released in 2008. The outputs of FRAX are the 10-year probability of a major osteoporotic fracture (hip, spine, humerus or wrist fracture) and the 10-year probability of hip fracture. Materials and Methods: The study included 25 premenopausal RA patients and 20 healthy subjects. The serum ACPA level was assessed by ELISA technique, RF using Rose waaler test in IU/ml was measured as well. BMD in (g/cm2) has been measured for all subjects enrolled in the study by a Lunar Prodigy Advanced DEXA scanner system and were carried out by the same technician. FRAX index was calculated for all members in both groups by using online FRAX calculator. Femoral neck BMD was added to enhance fracture risk prediction. Results: The range of ACPA in the patients group ranged between 11.40 – 525.0 U/ml. 80% of our patients were ACPA positive. While RF range was from 8.30 to 648.0 IU/ml. Strong statistically significant difference between both groups was found where FRAX index was significantly higher in patients group compared to control group as regards major osteoporotic and hip fractures (p <0.001). Serum ACPA and RF level showed insignificant correlation with FRAX index in premenopausal RA patients. Conclusion: FRAX index was found to be high in RA patients but it was not correlated to ACPA nor RF serum level.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2694 Top


Correlation between serum interleukin-17 level, disease activity and functional disability in premenopausal rheumatoid arthritis patients

N. Aboeladl, M. Hassan1

Department of Physical Medicine, Rheumatology and Rehabilitation, Helwan University, Cairo, 1Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, Egypt

E-mail: dr_nesrin_ahmed@hotmail.com

Introduction/Background: Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis in adults and is characterized by chronic, progressive, systemic inflammation. Interleukin-17 (IL-17) is a cytokine that is expressed in inflammatory and autoimmune diseases and is expected to play an important role in the pathogenesis of RA. Since many years, the measurement of disease activity in RA has been done by Disease Activity Score-28 (DAS-28). Regarding the correlation between serum level of IL-17 and disease activity, some authors found a good significant correlation between these parameters, while others stated that DAS-28 values for expressing disease activity in RA patients may be flawed by coexisting fibromyalgia lead to higher total scores. Disability assessment in RA patients has usually been assessed by Health Assessment Questionnaire –Disability Index (HAQ-DI) and it is one of the most widely used comprehensive, validated, patient-oriented outcome assessment instruments. Materials and Methods: The study included 25 premenopausal RA patients and 20 healthy subjects. Serum IL-17 was assessed by ELISA, disease activity by DAS-28 CRP and functional disability by HAQ-DI. Results: Serum IL-17 level among RA patients was significantly higher than healthy control (p <0.001). Serum IL-17 levels showed insignificant correlation with DAS-28 CRP and HAQ-DI of RA patients. Conclusion: Serum IL-17 is increased among RA patients but it has no correlation with disease activity and functional disability in premenopausal RA patients.



Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1187 Top


Radial extracorporeal shock wave therapy for adhesive capsulitis of the shoulder: A prospective, randomized, placebo controlled, double blind study with subjective and objective endpoints

A. Hussein, C. Schmitz1, M. Ibrahim2

Faculty of Physical Therapy, Pharos University, Alexandria, Egypt, 1Department of Neuroanatomy, Ludwig-Maximilians-University of Munich, Institute of Anatomy, Munich, Germany, 2Department of Physical Medicine and Rehabilitation, Health Check Medical Center, Brooklyn, NY, USA

E-mail: c.schmitz@biomed-science.de

Introduction/Background: This study tested the hypothesis that radial extracorporeal shock wave therapy (rESWT) is effective and safe in the treatment of adhesive capsulitis of the shoulder (adC-S). Materials and Methods: One hundred and six patients (mean age, 55.8 years; range, 39-77) with pain and limitations in shoulder mobility due to adC-S lasting for averaged 11.6 months (range, 9-14) were randomly allocated to either rESWT (n= 53) (four sessions, one session per week, Swiss DolorClast [Electro Medical Systems S.A., Nyon, Switzerland], radial handpiece, 15-mm applicator, 2000 rESWT impulses per session, positive energy flux density 0.14 mJ/mm2, rESWT impulses applied at 8 Hz) or placebo Treatment (n=53). Patients completed the Visual Analog Scale (VAS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at baseline (BL) as well as at one month (M1), six months (M6) and twelve months (M12) after baseline. Moreover, passive and active abduction of the arm (pA and aA) as well as passive external rotation of the shoulder (pER) were measured at BL, M1, M6 and M12. Results: All patients completed the final review at M12 and were included in the study. Mean pretreatment VAS scores, DASH scores and pA, aA and pER measurements for the rESWT and control groups were 6.3 and 6.3 (VAS), 73.5 and 72.5 (DASH), 98.2 and 99.3 degrees (pA), 65.8 and 68.8 degrees (aA), and 20.3 and 22.0 degrees (pER), respectively. Compared to placebo treatment rESWT resulted in statistically significantly reduced VAS score (by averaged 3.5 points) and statistically significantly improved DASH score (53.8 points), pA (63.9 degrees), aA (79.1 degrees) and pER (43.3 degrees) at all follow-up examinations. Conclusion: rESWT as performed in the present study is an effective and safe treatment for adhesive capsulitis of the shoulder.

Keywords: Adhesive capsulitis, shock wave therapy, shoulder

Disclosure statement: AH and MI declare that no competing financial interests exist. CS served (until December 2017) as a paid consultant for and received benefits from Electro Medical Systems (Nyon, Switzerland), the distributor of the Swiss DolorClast extracorporeal shock wave device. However, Electro Medical Systems had no any role in study design, data collection and analysis, decision to publish, or preparation of this abstract. No other potential conflicts of interest relevant to this article were reported.


  ISPR8-1125 Top


Trends in musculoskeletal surgery and postoperative rehabilitation in patients with rheumatoid arthritis

S. Maniwa, N. Maeki, H. Ishihara, T. Tadenuma, Y. Sakai

Department of Rehabilitation Medicine, Shimane University, Izumo, Japan

E-mail: smaniwa@med.shimane-u.ac.jp

Introduction/Background: Trend in the use of methotrexate (MTX) and biological disease-modifying anti-rheumatic drugs (DMARDs) has led to decrease the number of musculoskeletal surgery in patients with rheumatoid arthritis (RA). We investigated the changes in incidence of surgery and prescription of postoperative rehabilitation. Materials and Methods: Retrospective study was performed using medical records in Shimane University Hospital from 2002 to 2016. The number of surgery, prescription of postoperative rehabilitation, duration of hospital stay, and status of pharmacological treatment were studied in 152 patients. Linear regression analysis and Bonferroni/Dunn test were used for statistical analysis for the time trends in the incidence of surgeries. Results: There was a decreasing trend in the incidence of surgery, especially in the surgery of lower extremities (p=0.08). On the other hand, there was an increasing trend in the incidence of spinal surgery and operations in upper extremities. Hospitalization days became shorter (p<0.01) and the incidence of postoperative rehabilitation decreased, especially for occupational therapy (OT). The proportion of patients receiving MTX and DMARDs significantly increased from 33.3% and 0% in 2002 to 63.2% and 52.6% in 2016, respectively. Conclusion: The incidence of surgery of lower extremities decreased, however, the number of surgery in upper extremities increased among the patients with improved ADL and QOL owing to the use of effective drugs. Decreasing prescription of OT might bring a negative influence to individualized joint protection education in patients with RA.

Keywords: Postoperative rehabilitation, rheumatoid arthritis, surgery

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2408 Top


Items comparison of questionnaires, scales and clinical outcomes used in ankylosing spondylitis based on the international classification of functioning, disability and health: A systematic review

P. Wang

Shanghai Jiaotong University School of Medicine, Ruijin Hospital, Shanghai, China

E-mail: wangpu0816@qq.com

Introduction/Background: To identify questionnaires and scales used measuring Ankylosing Spondylitis (AS) patients’ functions, disability and health as well as determining whether these instruments can be matched to the International Classification of Functioning, Disability and Health (ICF) framework. Therefore comparing the results with available ICF Core Set for AS. Materials and Methods: We searched PubMed in English from January 2001 to December 2016 using the search term: Ankylosing Spondylitis. Among all searched literatures, AS specific questionnaires and scales were identified and classified. Based on the ICF framework, each item of all included instruments was extracted and interpreted into ICF categories. Results: A total of 15 questionnaires, involving reviewed 295 articles, were identified. A total of 112 items were analyzed and a total of 148 concepts covered these rest 99 items, left 13 items not being linked to ICF concepts. 69 linked to body function, 21 to body structure, 50 to activities and participation and 8 to environment factors. In the body function component, most questionnaires covered sensation of pain, mobility of joint functions and muscle stiffness as well as movement. In the activities and participation component, most questionnaires covered body position changing and maintaining, lifting and carrying objects as well as carrying out daily routine. We recommend the Assessments in Ankylosing Spondylitis Working Group 5/6 improvement criteria (ASAS5/6) and Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) for well-balanced and comprehensive distribution of four ICF contribution. Conclusion: The research may help choose the proper questionnaire in clinical and research setting on the framework of ICF with comprehensive functioning assessment.

Keywords: Ankylosing spondylitis, disability and health, International Classification of Functioning

Disclosure of interest: The authors did not declare any conflict of interest.


  A2.02 Musculoskeletal Conditions - Degenerative Joint Diseases (E.G. Osteoarthritis) Top



  ISPR8-0025 Top


Cardiorespiratory response according to weight support and velocity using a lower-body positive pressure treadmill early after bilateral total knee arthroplasty

B. R. Kim

Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju, Republic of Korea

E-mail: brkim08@gmail.com

Introduction/Background: This study was undertaken to investigate cardiorespiratory response according to weight support and velocity using a Lower-body positive pressure (LBPP) treadmill and to find specific velocity and weight support combinations after bilateral TKA. Materials and Methods: Twenty five patients who underwent a primary TKA were enrolled. Subjects walked with 2.5 km/h and 3.5 km/h on a LBPP treadmill at 3 levels (50%, 75%, 100%) of body weight (BW). Each trial was performed for 2 minutes. Oxygen consumption (VO2), Heart rate, systolic (SBP) and diastolic blood pressure (DBP), respiratory exchange ratio (RER) and rate pulse product (RPP) were measured continuously with average values. Borg’s rating of perceived exertion scale (RPE) and visual analog scale (VAS) of knee pain were recorded immediately after each condition. Results: In the two-way repeated measures ANOVA, VO2 levels (p<0.01) were increased in proportion to BW. HR (p<0.01), RPP (p<0.01), RPE (p<0.01), RER (p<0.01) and VAS (p<0.01) were also higher at 100% of BW compared with 50% and 75% of BW. However, SBP (p=0.65) and DBP (p=0.39) were not influenced by difference of BW levels. While walking with a speed of 3.5 m/s at same BW level, only RPE (p<0.01) and RER (p=0.01) values were statistically greater than 2.5 m/s. Based on BW and gait velocity settings of the LBPP treadmill, the equations were VO2 = 1.46 v + 0.081 BW + 3.13 (r2 = 0.34). Conclusion: This study demonstrated that cardiorespiratory responses during LBPP treadmill were determined by combination of weight support and velocity, and it was more influenced by change of weight support than velocity. These findings suggest that factors such as body weight support and speed should be considered for gait training to improve aerobic capacity early after bilateral total knee arthroplasty.

Keywords: Knee osteoarthritis, rehabilitation, total knee arthroplasty

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0024 Top


Preoperative physical function influences on stair climbing ability 1 month after total knee arthroplasty

B. R. Kim

Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju, Republic of Korea

E-mail: brkim08@gmail.com

Introduction/Background: This study was undertaken to identify preoperative physical performance factors predictive of stair climbing ability 1 month following total knee arthroplasty (TKA). Materials and Methods: In this prospective cohort study, we assessed a total of 84 patients (8 males and 76 females) who underwent a primary unilateral TKA. Before and 1 month after TKA, patients completed physical performance tests including stair climbing test (SCT), 6-minute walk test (6MWT), timed up and go test (TUG), isometric knee flexor and extensor strength of the surgical and non-surgical knees. Results: In the bivariate analyses, the postoperative SCT-ascent had a significant positive correlation with the SCT-ascent (p=0.01), SCT-descent (p=0.01), TUG (p<0.01), preoperative age (p=0.02), and a significant negative correlation with the preoperative 6MWT (p<0.01), peak torque (PT) extensor of surgical knee (p=0.01), PT flexor of surgical knee (p=0.02), PT extensor of the non-surgical knee (p=0.02), PT flexor of the nonsurgical knee (p=0.02). The postoperative SCT-descent had a significant positive correlation with the SCT-ascent (p=0.01), SCT-descent (p<0.01), TUG (p<0.01), preoperative age (p=0.01), and a significant negative correlation with 6-MWT (p<0.01), PT extensor of surgical knee (p=0.04), PT flexor of surgical knee (p=0.03), PT extensor of the nonsurgical knee (p=0.03), PT flexor of the nonsurgical knee (p=0.03). In the linear regression analyses, the postoperative SCT-ascent had a significant positive correlation with the preoperative TUG (p<0.01), PT extensor of surgical knee (p=0.03) and the postoperative SCT-descent had a significant positive correlation with preoperative SCT-descent (p=0.01), and the age (p=0.04). Conclusion: This study demonstrated that preoperative physical function influenced on postoperative stair climbing ability 1 month after TKA. These results could be of importance in determining variable preoperative rehabilitation strategies to improve stair climbing ability, especially focusing on balance, endurance and strengthening exercises.

Keywords: knee osteoarthritis, rehabilitation, total knee arthroplasty

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2127 Top


Implication of unloader braces in guideline recommended knee osteoarthritis management- an expert consensus

A. Schulz

Praxis Für Orthopädie, Orthopdädie, Laedenscheid, Germany

E-mail: aschulz@ossur.com

Introduction/Background: The goal of the expert consensus recommendation was to provide a tool which helps medical professionals to select the right patient and to provide a guidance for when and how to use an unloader brace for different patient types. Materials and Methods: 27 physicians developed recommendations to achieve the best possible treatment outcome for the younger knee osteoarthritis (OA) patient, the active & demanding knee OA patient and the older knee OA patient. Questionnaires on were used to prepare F2F meeting where the experts agreed patient group specific treatment recommendations, which have been consented thereafter in two Delphi rounds. Results: In order to provide specific recommendations three different patients groups have been defined: The younger knee OA patient, the active and demanding knee OA patient and the older knee OA patient. Experts concluded on detailed recommendations for these groups Candidates who will most likely benefit from an Unloader brace can be identified by the Unloader brace test. Conclusion: The expert consensus approach was utilized to translate knee OA treatment recommendations and guidelines from international societies down to the patient´s needs in daily orthopedic and sports medicine practice. By dividing the patients in three different groups patient specific treatment recommendations have been established based on the existing clinical evidence and can be applied in daily practice. An expert consensus can be useful in order to support medical professionals in daily practice as they can offer a more practical patient centric treatment recommendation regarding the use of an Unloader Brace within knee OA management.

Keywords: Expert consensus, knee osteoarthritis, osteoarthritis management

Disclosure statement: Axel Schulz is working alongside his orthopedic & sportsmedicine office as Medical Director for Össur bv.


  ISPR8-0253 Top


Different types of exercise relieve pain symptoms of knee osteoarthritis by modulating the cognitive control network

J. Tao, J. Liu1, Y. Tu2, K. Hu, Y. Tu, M. Lin, X. Guanli, C. Shanjia, H. Jia, L. Weilin, W. Jinsong, X. Tianshen, L. Courtney2, P. Joel2, C. Lidian, K. Jian2

College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China, 2Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, USA

E-mail: jiangtaoflyinsky@163.com

Introduction/Background: Knee osteoarthritis (KOA) is a common degenerative joint disease with unsatisfactory treatment. Recently, non-pharmacological therapies, such as physical exercise and mind-body exercises, have received considerable attention for their implications in pain management in KOA. However, the mechanisms underlying the efficacy of different exercises on pain improvement remain unclear. In this study, we investigate the effect and underlying mechanisms of mind-body exercises (Tai Chi Chuan and Baduanjin) and physical exercise (stationary cycling) in patients with knee osteoarthritis (KOA). Materials and Methods: 140 patients were randomized into Tai Chi Chuan, Baduanjin, stationary cycling, and health education control groups for 12 weeks. The Knee injury and Osteoarthritis Outcome Score (KOOS), resting-state functional connectivity (rsFC) of the cognitive control network (CCN), and blood markers (serum Protectin D1 (PD1) and brain derived neurotrophic factor (BDNF) levels) were measured at the beginning and end of the experiment. We also applied support vector machines regression to predict the effectiveness of different exercises on KOA patients based on rsFC of CCN. Results: Results: We found 1) KOOS pain subscores and serum PD1 levels significantly increased in all three exercise groups compared to the control group, and there were no significant differences among the three exercise groups; 2) rsFC between the bilateral dorsal lateral prefrontal cortex (DLPFC) and bilateral supplementary motor area (SMA) and temporoparietal junction (TPJ) was significantly decreased in all exercise groups compared to control group, and the decreased DLPFC-SMA rsFC was significantly associated with improvements in knee pain and serum PD1 levels across all subjects at baseline; and 3) baseline DLPFC-SMA rsFC can significantly predict the effect of exercise on pain improvement in KOA patients. Conclusion: Our findings demonstrate different exercises may achieve clinical improvements through shared pathways and highlight the potential of neuroimaging biomarkers for predicting the therapeutic effect of exercises on KOA pain.

Keywords: Cognitive control network, exercise, knee osteoarthritis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0490 Top


Development and validation of a questionnaire assessing the perception of physical activity (epap) in knee osteoarthritis people

N. Coste, C. Gay, L. Gerbaud1, C. Aucair1, E. Coudeyre

Department of Physical Medicine and Rehabilitation, Clermont-Ferrand University Hospital, Auvergne University, 1Departement of Public Health, Ferrand University Hospital, Clermont, Ferrand, France

E-mail: nicolascoste4@gmail.com

Introduction/Background: Physical activity (PA) level of patients with knee osteoarthritis is lower than general population. International recommendations recommend a non-pharmacological intervention including self-management education program, weight loss and an adapted exercise program. Howerer, there is no scale assessing the perception of PA in this population. Our purpose is to develop and validate a self-questionnaire assessing barriers and facilitators to practice regular PA in patients with knee ostéoarthritis. Materials and Methods: Semi-structured interviews identified 22 barriers and facilitators. We developed a 24 items questionnaire (evaluated by a 5-point Likert scale) completed by 548 patients with knee osteoarthritis. In addition to EPAP, patients completed 3 other questionnaires: KOFBeQ (assessing the fears and beliefs of knee osteoarthritis patients), WOMAC (assessing the severity of osteoarthritis) and IPAQ (assessing the level of physical activity). Reproductibility and sensitivity to change were evaluated by a second group of 142 patients included in a three weeks spa therapy resort. Results: Seven items were removed after preliminary statistical analysis. Seventeen items were grouped into four dimensions (Barriers, Facilitators, Motivations, Beliefs). The internal consistency is good for Barriers, Facilitators and Motivations dimensions (Croncach’s α > 0.7); intermediate for Beliefs dimension (Croncach’s α = 0.64). EPAP was significantly correlated with KOFBEQ and WOMAC but not with IPAQ. Reproducibility was good for all dimensions with intraclass correlation coefficients higher than 0.60. Only « Beliefs » dimension showed a significant improvement between day 1 and month 3 after spa therapy resort. Conclusion: EPAP questionnaire has good psychometric properties and can help to guide the management of patients with knee ostoarthritis. It can be used in research for the evaluation of the perception of physical activity.

Keywords: Knee osteoarthritis, physical activity, questionnaire validation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1904 Top


The role of patient’s education in knee osteoarthritis management

W. Haj Hamad, M. Sghir, M. Maraoui, M. Guedria, S. Zrour1, W. Kessomtini

Department of Rehabilitation, University Hospital of Mahdia, Mahdia, 1Department of Rhumatology, Fattouma Bourguiba Hospital Center, Manastir, Tunisia

E-mail: wafa.haj88@gmail.com

Introduction/Background: Therapeutic education is an integral part of the management of knee osteoarthritis (OA) to acquire or to maintain skills allowing patients to manage their lives better. The aim of our study is to assess the contribution of therapeutic education in the management of knee osteoarthritis. Materials and Methods: This is a randomized prospective study on patients with knee OA referred to the department of Physical Medicine and Rehabilitation of Mahdia from January 2016 to Mars 2017. Patients were divided into 3 groups. The first group G1 (32 patients) underwent physical rehabilitation, the second group G2 (30 patients) underwent therapeutic education and the third group G3 (31 patients) underwent therapeutic education and physical rehabilitation. Assessments were performed before and after intervention (1, 3 and 12 months). Evaluation parameters were: pain with the Visual Analog Scale (VAS), overall physical function with WOMAC score, disability with the Lequesne index, mobility of the knee joint, and the psychological profile with the HAD scale. Health-related quality of life was also assessed using the 36-Item Short Form Health Survey (SF-36). Results: Ninety three patients diagnosed with knee OA were enrolled in this study. The mean age was 58 years old. At the beginning of the protocol, the 3 groups were homogeneous in terms of all the parameters studied. At the end of protocol, we noticed a decrease in pain and an improvement in joint mobility in the three groups with a better improvement in G3. The physical function, psychological profile and quality of life also improved after the end of the protocol in the three groups, especially G3. This improvement persisted at 3 months and at 1 year of follow up. Conclusion: Our study showed the short and long-term interests of therapeutic education associated with rehabilitation in the treatment of knee osteoarthritis.

Keywords: Knee osteoarthritis, patient’s education

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0457 Top


Effect of unloading traction in patients with knee osteoarthritis

M. T. I. Khan

Department of Physical Medicine, Rajshahi Medical College, Rajshahi, Bangladesh

E-mail: tareq_cmc@yahoo.com

Introduction/Background: Knee Osteoarthritis (OA) is the most common form of disability in comparatively elderly patient. Different modalities in physiotherapy have been shown to help improve clinical symptoms and functions of knee OA, Unloading knee traction is among those non-invasive therapies which can be applied as an adjunct to pharmacotherapy to treat osteoarthritis the patients with OA knee. To evaluate the effectiveness of unloading traction on patients with knee osteoarthritis. Materials and Methods: A randomized prospective study was carried out in the department of Physical Medicine & Rehabilitation, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2010 to June 2010. Patients with OA knee by American College of Rheumatology Criteria were selected. Two intervention groups were compared. Group-A (40 patients) in these group patients to be treated with NSAID + Short Wave Diathermy + Activities of Daily Living. Patients of Group-B were given (40 patients) Knee unloading traction along with above treatment. The change between six weeks post therapeutic and baseline WOMAC (Western Ontaro and Mc Master Universities) subscale and scores were calculated. Patients were followed up weekly for six weeks and in each visit, patients were assessed for pain, stiffness and physical function by WOMAC index. Results: A total 80 patients with OA knee were included in this study. The mean age 49.72 ± 3.5 years. Male to female ratio 1.35:1. Comparison of mean pretreatment and 6th week post treatment WOMAC physical function subscale score in Group A (6.85±0.92 vs 2.15±0.92) showed significant improvement and in Group B (6.45±1.13 vs 1.15±0.92) which also shows significant improvement more than group A. The result was compared and student t-test was done to see the level of significance. Method was found significant after treatment (p<0.0001). Conclusion: Unloading knee traction in patients with OA knee is beneficial.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0781 Top


Saphenous nerve block on medial compartment knee pain in patients with knee osteoarthritis

S. H. Yoon

Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Republic of Korea

E-mail: yoonsh@ajou.ac.kr

Introduction/Background: Knee osteoarthritis (KOA) is a common disease in middle-aged and elderly people. Pain is the chief complaint of symptomatic KOA and a leading cause of chronic disability, which is most often found in medial knees. The aim of this study is to evaluate the efficacy of pain relief and functional improvement in KOA patients treated with ultrasound-guided saphenous nerve block (SNB). Materials and Methods: This is a 3-month retrospective case-controlled comparative study. 200 patients with medial knee pain owing to KOA that was unresponsive to 3-month long conservative treatments. 92 patients received SNB with 9 mL of 1% of lidocaine and 1 mL of 10 mg triamcinolone acetonide (SNB group), and 108 continued conservative treatments (control group). The main outcome measure was visual analog scale (VAS) of the average knee pain level for the past one week. Secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the timed up and go test, numbers of analgesic ingestion per day, and opioid consumption per day. Results: During the 3-month follow-up, 86 patients in SNB group and 92 in control group were analyzed. There was no significant difference, with the exception of the duration of symptoms, between the 2 groups in age, sex, body mass index, and Kellgren- Lawrence grade. Repeated-measures analysis of variance and post hoc tests showed improvement of VAS (at month 1), WOMAC (at month 1), and opioid consumption per day (at month 1 and 2) in SNB group. No adverse events were reported. Conclusion: This study looked into the possibility of SNB as an alternative treatment for medial knee pain owing to KOA. Although a palliative treatment, SNB can be an option for patients with refractory KOA who cannot take or are not responsive to analgesics. However, to prove the efficacy of SNB, further studies on prospective randomized controlled trials would be needed.

Keywords: Knee joint, nerve block, osteoarthritis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1528 Top


Changes in physical function and isokinetic muscular strength of quadriceps and hamstrings three months after a rapid recovery total knee arthroplasty

M. Ruiz, M. Torra, L. Sola, N. Perez, M. Carrillo, M. Guma, D. Mateu, R. Garreta

Department of Rehabilitation, Hospital Universitari Mutua Terrassa, Terrassa, Spain

E-mail: martarjulve@gmail.com

Introduction/Background: The Osteoarthritis Research Society International recommends evaluating physical function in gonarthrosic patients after a total knee arthroplasty using tests such as timed up and go (TUG) and six-minute walking test (6MWT). In 1991, Berman et al. found that strength was not fully recovered until two years after surgery. Our aim was to demonstrate the results in physical function and isokinetic muscular strength of gonarthrosis patients prior to undergoing surgery and three months after a Total Knee Arthroplasty (TKA). Materials and Methods: Prospective study (September 2016–December 2017) of patients with gonarthrosis awaiting a total knee arthroplasty surgery. Variables recorded: Gender, age, dominant hand, operated side, body mass index (BMI), walking aids. Measured outcomes before surgery and three months afterwards: visual analogue scale (VAS) at rest and active, TUG, 6MWT and mean peak torque (PT) of isokinetic strength of quadriceps and hamstrings between the TKA side and the unaffected knee at 60º/sec. Data analysis of means and percentages. Means compared using t-student and non-parametric tests. Statistical significance was set at p<0.05. Results: 44 patients, 36.4% male. Mean age 67.8±6.5. Mean BMI 30.3±6.7. 63.6% of the individuals used walking aids before surgery and 84.1% did not use them after surgery. The results obtained on VAS and physical function prior to surgery and three months after the intervention were:



A decrease of strength in the affected quadriceps and a significant decrease of strength in the affected hamstrings were observed. However the strength of the unaffected quadriceps increased slightly and the unaffected hamstrings strength did not vary.



Conclusion: Three months after a TKA surgery, even though there was a descent in muscular strength in the affected limb, our patients experienced an improvement in physical function possibly due to pain decrease.

Keywords: Isokinetic, osteoarthritis, rapid recovery

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1713 Top


Relationship between metabolic syndrome and knee osteoarthritis

B. J. Lee, W. Kim1, K. H. Choi1

Department of Rehabilitation Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 1Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

E-mail: bjl84@naver.com

Introduction/Background: Recent studies suggest that metabolic disorders that provoke systemic inflammation are associated with knee OA. However, most studies have only examined associations between single metabolic diseases and knee OA. This study investigated the effect of metabolic syndrome (MS) on development of knee OA. Materials and Methods: Data were obtained from the 2010 to 2012 Korea National Health and Nutrition Examination Survey. Subjects with knee OA (≥Kellgren-Lawrence grade 2) and severe knee OA (≥Kellgren-Lawrence grade 3) were evaluated based on radiologic findings. Medical information, in accordance with MS, and demographic data were obtained from survey records. Multivariate regression analysis was performed to investigate the relationship between knee OA and MS, in addition to various demographic factors. Analyses were adjusted by age group (model 1), or by age group, education, smoking, alcohol consumption, and physical activity (model 2). Results: In women, MS increased the risk of knee OA (odds ratio [OR]=1.644, p-value<0.001 and OR=1.608, p-value<0.001, respectively, for model 1 and 2) and severe knee OA (OR=1.593, p-value<0.001 and OR=1.559, p-value<0.001, respectively, for model 1 and 2). However, in men, knee OA and severe knee OA were not associated with MS. As the number of MS components increased, knee OA and severe knee OA generally increased in women. However, this trend was not definite in men. Conclusion: MS affects the development of knee OA and severe knee OA in women. Additionally, dose- response relationships were observed between MS components and knee OA. However, these relationships were not definite in men.

Keywords: Metabolic syndrome, osteoarthritis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1152 Top


The effects of virtual reality on the rehabilitation of patients with knee OA: A randomized controlled clinical trial

F. Cyrillo, J. Greve

USP, IOT HC, Sao Paulo, Brazil

E-mail: fabiocyrillo@me.com

Introduction/Background: Knee OA is one of the most prevalent orthopedic diseases in the elderly population, with a degenerative and progressive character that affects the articular cartilage, limiting the articular range of motion (ROM) due to rigidity and causing important functional restrictions. Virtual Reality (VR) is one of the instruments that can help in the rehabilitation process of patients, motivating them and enabling more assertive movements and exercises. Materials and Methods: Ninety patients (65 women and 25 men) between 50 and 70 years old, with a medical diagnosis of OA in at least one knee participated in the study. After completing the WOMAC and Lequesne questionnaires, they were evaluated for pain and muscular strength. The volunteers signed the Consent Term and were then randomly divided, using opaque, sealed envelopes, into 3 groups: Control group - performed a conventional physiotherapy program with aerobic and muscle strengthening exercises; Experimental group 1 (Wii) - in addition to the conventional program used Nintendo’s Wii Fit games; Experimental group 2 (Kinect) - complemented the conventional treatment with the Xbox Kinect video game system. Results: It was observed that, in general, the three study groups demonstrated statistically significant improvement (p <0.05) in relation to pain and muscular strength. The groups with inclusion of the VR resources only presented better results than the control group in the function dimension of the WOMAC questionnaire. Conclusion: The methodological conditions used in the study suggest that Virtual Reality as an additional instrument in rehabilitation programs for patients with knee OA was better than the control group only in the function dimension of the WOMAC questionnaire.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0054 Top


Sports and physical activities of patients with medial compartment knee osteoarthritis after high tibial osteotomy

S. Kamada

Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan

E-mail: kmd@fukuoka-u.ac.jp

Introduction/Background: The purpose of this study was to compare the changes and resumption of sports and physical activities (SPA) between older and younger patients after opening wedge high tibial osteotomy (OWHTO). Materials and Methods: One hundred and one patients (120 knees) with medial compartment knee osteoarthritis were investigated. The 53 patients aged >65 years were defined as the O group and the 48 patients aged <64 years were defined as the Y group. The ratios of SPA cases, time points at which SPA was started after surgery, frequencies of SPA, and Lysholm scores were compared between the two groups. The level of significance was set at p<0.05. Results: The preoperative and postoperative ratios of SPA cases were 28.3% and 26.4% in the O group, respectively (p=0.82). The corresponding ratios were 20.8 % and 41.6% in the Y group, respectively (p=0.027). The mean time points for starting SPA after surgery were 12.3±7.5 months in the O group and 11.2±11.0 months in the Y group (p=0.18). The mean frequencies of SPA after surgery were 4.04±2.15 days/week in the O group and 2.7±1.99 days/week in the Y group (p=0.021). The mean postoperative Lysholm scores were 89.5±5.4 in the O group and 88.8±4.9 in the Y group (p=0.61). Conclusion: The postoperative ratio of SPA cases showed a significant increase compared with the preoperative ratio in the Y group only. However, older patients performed SPA more often than younger patients postoperatively. Both older and younger patients required a relatively long time to resume or start SPA.

Keywords: High tibial osteotomy, medial compartment knee osteoarthritis, sports and physical activities

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0449 Top


A functional restoration program in chronical low back pain is efficient both in labourers and in sedentary workers

S. Fardjad, L. Condamine, C. Valser, C. Colas, B. Hardy, S. Cosme, E. Hareau, E. peyron, E. Hutin, Y. Coulomb, C. Pauwels, F. Brunet, D. Zawistowicz, P. Parejo-Margallo, J. M. Gracies

Groupe Hospitalier Henri Mondor, 51- Avenue Delattre De Tassigny, Cretiel, France

E-mail: shahab.fardjad@aphp.fr

Introduction/Background: Work conditions increase the prevalence of chronically low back pain (CLBP) in labourers (LW) as well as in sedentary workers (SW). Previous studies showed that functional restoration program (FRP) improved the condition of patients with CLBP. Here we evaluated the differential value of FRP in LW and SW groups, with respect to spinal and abdominal muscle functions, functional capacity and autonomy, and professional reintegration. Materials and Methods: Between 2012 and 2015, 89 patients (aged 18 to 65) with CLBP, included in the FRP, completed the program. There were 45 LW and 44 SW. Judgment criteria were physical (Sorensen test, for spinal muscles, and Shirado-Ito test, for abdominal muscles), functional (Quebec score), and socio-professional (number of sick leave days in 6 months), before and after completing the FRP. Results: Both groups, LW and SW, improved their functional capacities (Quebec score: 29.194 after, vs 40.622 before the program, p=0.0022, in LW; 26. 33 % after the FRP, vs 37.6 % before the program, p=0.0008, in SW), and the number of sick leave days dramatically decreased after the FRP (19.23 days after, vs 58.08 days before, p=0.0121, in LW; mean 0.41 days after vs 26.53 days before, p=0.0018, in SW). Sorensen test improved in both groups (119.18 after vs 76.65 before, p=0.0192, in LW; 119.10 after FRP vs 65.08 before, p=0.0011, in SW). Shirado-Ito Test also improved: 340.13 vs 91.81, in LW and 128.73 vs 65.08, p=0.0338, in SW. Conclusion: FRP improved the condition of patients with CLBP in all analysed criteria, both in LW and in SW. However the repartition of improvement between LW and SW was different, particularly in physical criteria (LW improved more their abdominal muscles, and SW improved more their spinal muscles). These results suggest that isokinetic studies are needed to specifically adapt the FRP to the work conditions.

Keywords: Chronical low back pain, Functional Restoration Program, isokinetic studies

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1408 Top


Clinical prediction rule for pain relief in conservative treatment of patients with knee osteoarthritis

R. Tanaka, J. Ozawa

Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan

E-mail: rmt_sgl@yahoo.co.jp

Introduction/Background: Pharmacological and physical therapy are an essential conservative treatment option for knee osteoarthritis (OA). However, a group of patients with knee OA does not have adequate pain relief through the conservative treatment. Knee OA patients who have unique pain-related affective and/or cognitive characteristics may not be able to obtain adequate pain relief with conservative treatment. Early detection of patients with inadequate pain relief from conservative treatment allows for alternative treatment options to be considered, such as cognitive behavioral therapy. Therefore, in this study, we developed clinical prediction rules (CPRs) to identify knee OA patients who will likely obtain adequate pain relief with conservative treatment. Materials and Methods: Subject were patients with symptomatic knee OA (N = 88). The Numeric rating scale and the Knee Injury and Osteoarthritis Outcome Score scale were used to evaluate pain relief. Potential predictors for pain relief were depressive symptoms, self-efficacy, and pain catastrophizing. The classification and regression trees methodology was used to develop the CPR for predicting the presence or absence of pain relief at 1 and 3 months after the start of observation. The area under the receiver operating characteristic curve (AUC) was calculated to assess the accuracy of CPR developed. Results: The CPR at 1 month after the start of observation included the information about pain intensity at baseline, positive affect, and disease duration. The AUC of this CPR was 0.793 (95% confidential interval, 0.687-0.898). The CPR at 3 months after the start of observation included pain catastrophizing and self-efficacy. The AUC of this CPR was 0.808 (95% confidential interval, 0.682-0.934). Conclusion: Information on the disease duration of knee OA, the intensity of pain, pain-related affective and/or cognitive characteristics can be used for developing CPR to predict pain relief in patients with knee OA receiving conservative treatment.

Keywords: Clinical prediction rule, conservative treatment, knee osteoarthritis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2344 Top


Time wearing orthosis in the management of chronic low back pain: Preliminary study of the impact on the isokinetic parameters

A. Schmitt, L. Have

Hôpital d’Instruction des Armées Desgenettes, Service de Médecine Physique et Réadaptation, Lyon, France

E-mail: am.schmitt@yahoo.fr

Introduction/Background: There is no strong consensus on the modalities about the duration of time wearing thoraco-lombo-sacral-orthosis in chronic low back pain. To evaluate the influence of orthotic wear time on the isokinetic parameters of low back muscles. We choose a temperature monitoring device and present a preliminary study of 7 patients. Materials and Methods: Patients included in this study were treated in the Department of Physical Medicine and Rehabilitation of the Desgenettes Army Training Hospital. Observance was assessed using an ELITECH® RC-4 data logger. Each device is attached to the posterior part of the TLSO, protected by a box inaccessible to the patient and the external sensor is buried at the level of the waist and directly in contact with the patient. Each patient realized an isokinetic evaluation at start and at the end of wearing the orthosis. Results: For each patient, we calculate the average time wearing orthosis per day, and we study the correlation with the evolution of the isokinetic parameters of the spinal musculature. The first results show that there is no significantly decrease of the isokinetic parameters in concentric test, we confirm that the use of the rigid orthosis increases the eccentric peak torque of the spinal extensor which can explain the efficiency in addition to the analgesic effect. Conclusion: A precise and reliable measurement of the wearing time of TLSO is essential for the study of the impact on the isokinetic parameters in chronic low back pain. The device for recording the temperature at the orthosis is therefore simple, reliable and reproducible.

Keywords: Time wearing orthosis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0588 Top


Effectiveness of kinesio taping in severe pain treatment due to knee osteoarthritis: A randomized double blinded controlled trial

V. Donec, R. Kubilius

Department of Rehabilitation, Lithuanian University of Health Sciences, Kaunas, Lithuania

E-mail: venta.donec@lsmuni.lt

Introduction/Background: Severe pain in knee osteoarthritis (KO) leads to disability and decreased quality of life. Current pharmaceutical and non-pharmaceutical approaches have limited effectiveness, implying the need to look for more effective pain management means. Aim of the Study: to evaluate effectiveness of kinesio taping in severe pain treatment due to KO. Materials and Methods: A randomized double blinded controlled trial. 54 participants (mean age 69.7±8 years) with KO, indicating severe knee pain (≥7 points according the numeric pain rating scale (NPRS)), received either kinesio taping (KT) or nonspecific taping (NT) once a week for four weeks. Measured outcomes: changes in pain intensity according to NPRS, change in the usage of anti-inflammatory drugs, the subjective participant’s evaluation towards effectiveness of received tape applications for knee pain management and for improvement of ability to move at the end of intervention. Results: Both taping techniques were found to be beneficial for pain alleviation (p<0.05), however, more (72%) of the participants in the KT group experienced clinically significant reduction of knee pain in comparison to the NT taping group (44.4%) (p<0.05). KT was also found to be more effective in alleviating knee pain while changing body positions (p<0.05). Neither of techniques was superior in alleviating nocturnal pain, pain during prolonged movement or at rest. Subjectively, more KT group participants (85%) indicated tapes to be effective in alleviating ability to move than from the NT group 56% (p<0.005). The usage of anti-inflammatory drugs was reduced for 46% of KT and for 31% of NT group participants (p=0.067). Conclusion: Both taping techniques were found to be beneficial for severe pain management due to KO, however kinesio taping was found to be superior over non-specific taping in diminishing general knee pain and knee pain while changing body positions, also in subjectively perceived alleviation of ability to move among participants.

Keywords: Kinesio taping, knee osteoarthritis, knee pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0621 Top


Risk of knee osteoarthritis in patients using n-acetylcysteine: A nationwide population-based cohort study

Y. T. Yeh, C. C. Liang, J. H. Chiang1

Department of Physical Medicine and Rehabilitation Medicine, Buddhist Tzu Chi General Hospital, Hualien, 1China Medical University Hospital, Management Office for Health Data, Taichung, Taiwan

E-mail: jake10598@hotmail.com

Introduction/Background: Knee osteoarthritis (OA) is known as a progressive degenerative disorder, but recent evidence suggests that inflammatory mediators contribute to cartilage degradation. N-acetylcysteine (NAC) is an antioxidant that can directly scavenge reactive oxygen species. According to basic studies, NAC had an apparent effect on reducing the synthesis of proinflammatory and structural mediators by synovial cells. In contrast, chondrocyte in osteoarthritic cartilage was found significantly lower intracellular p53 expression. NAC was also reported to decrease p53 expression through reduction of oxidative DNA damage. Due to lacking clinical trials, we conducted this study to determine the relationship between NAC use and risk of knee OA. Materials and Methods: We designed a retrospective cohort study using the Taiwan’s Longitudinal Health Insurance Database from 2000 to 2013. Patients receiving oral form N-acetylcysteine over 28 days within one year after first prescription were defined as case group, whereas those without N-acetylcysteine use were considered as candidates of control group. We adopted a 1:10 propensity score matching by age, sex, index year and comorbidities to consist the control group. Patients with previous history of knee operation (total knee replacement and anterior cruciate ligament reconstruction), bed-ridden status, and less than 20 years old were excluded. The primary outcome was a new diagnosis of knee OA during follow-up period. Results: Our study samples consist of 7726 using NAC subject and 77260 non-used NAC subject. People with NAC use have significantly higher incidence of osteoarthritis (adjusted HR: 1.39, p <.0001) [Figure 1]. In addition, analyses stratified by age group and sex, all subgroups showed significantly higher incidence of osteoarthritis (p <.0001) in NAC users [Table 1]. Conclusion: Patients who take oral N-acetylcysteine more than 28 days per year have higher risk of developing knee osteoarthritis.
Figure 1: The estimated cumulative incidence of osteoarthritis of knees between the accepted and nonaccepted N-acetylcysteine drug used cohort by Kaplan-Meier analysis (log-rank test, P < 0.0001)

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Table 1: Cox model with hazard ratios and 95% confidence intervals of osteoarthritis of knees associated with N-acetylcysteinc used.

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Keywords: Acetylcysteine, knee, osteoarthritis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0678 Top


Intra-articular ozone injection efficacy in knee osteoarthritis: A systematic review with meta-analysis

S. A. Raeissadat, S. M. Rayegani1, E. Tabibian2, S. Rahimi Dehgolan3

Department of Physical Medicine and Rehabilitation, Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, 1Department of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, 2Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital Complex IKHC, Tehran University of Medical Sciences TUMS, 3Department of Physical Medicine and Rehabilitation, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

E-mail: shahram.rahimi.dehgolan@gmail.com, ahmad_raeissadat@yahoo.com

Introduction/Background: The main aim of this review was to discuss the literature on ozone intra-articular injection in knee osteoarthritis (OA) patients and to synthesize the available evidence as a meta-analysis. Materials and Methods: A systematic review of Pubmed, Google scholar and Cochrane Central Register of Controlled Trials was performed to identify all English-language RCTs that evaluated the efficacy of ozone intra-articular injection versus a control injection for knee OA patients. A Random effect model was used to compare efficacies among trials based on Visual Analogue Scale (VAS) for pain and Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. Results: From 231 records screened, only 26 one had relevant topics. Among them only five studies satisfied our inclusion criteria. A total of 428 patients were included which 53% of them (n=225) in the treatment group and 47% in the control [HA, hypertonicdextrose and air injection] group (n=203). The mean age of ozone groups was 64.5 years compared with 64.4 years for control group. Females were the majority in both treatment and control group (80% and 77% respectively). All studies had at least 2 months followup. In almost all of them 3-4 weekly rounds of ozone injection were performed, with concentration of 15-30 ug/cc. Conclusion: Intra-articular ozone in comparison to HA or hypertonic dextrose injections, may have quietly equal effects in the treatment of mild to moderate knee OA patients throughout short term period; However by 3-6 months after injection, this therapeutic effect would be disappeared, more earlier than other control injections.
Figure 1: Comparison of visual analogue scale between ozone and control groups [at 1 month (a) 2-3 months (b) and 4-6 months (c) follow up]

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Table 1: Baseline characteristics of included studies

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Keywords: Intra articular ozone injection, knee osteoarthritis, systematic review with meta-analysis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1582 Top


Associations between early postoperative pain outcome measures and late functional outcomes in patients after knee arthroplasty

E. Dubljanin Raspopovic, S. Tomanovic Vujadinovic, N. Ilić1, U. Nedeljkovic1, S. Silvana2

Clinical Center Serbia, Clinic for Physical Medicine and Rehabilitation, Faculty of Medicine, University of Belgrade, 1Clinic for Physical Medicine and Rehabilitation, Faculty of Medicine, University of Belgrade, 2Clinical Center Serbia, Clinic for Physical Medicine and Rehabilitation, Belgrade, Serbia

E-mail: edubljaninraspopovic@gmail.com

Introduction/Background: Early rehabilitation, return to daily life activities and function are the ultimate goals of perioperative care. It is unclear which pain-related patient-reported outcome measures (PROM) mirror treatment effects, or are related to early and late functional outcomes. Materials and Methods: We examined associations between two approaches of pain management (scheduled vs ‘on demand’) and PROMs on post-operative days one and five (POD1, 5) with function on POD5 and 3 months after surgery in patients undergoing Total Knee Arthroplasty (TKA) in a single center. Results: On POD1, patients in the scheduled treatment group reported reduced severity of worst pain, less interference of pain with activities in-bed and sleep, and a higher proportion got out of bed. Furthermore, tests of function, extension and flexion ranges, Barthel index and 6 minutes walking test on POD5, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) 3 months later were better in the scheduled treatment compared to the ‘on demand’ treatment group. PROMs of perceived pain relief at POD1 and worst pain, time in severe pain, interference with activities in bed and with sleep, and participation in treatment decisions on POD5 were significantly associated with KOOS 3 months later. Conclusion: Our study demonstrates that insufficient pain management immediately after TKA has substantial impact not only on PROMs in the early days after surgery but also on important physical function up to 3 months later. Pain related PROMs assessed at POD1 and especially at PO5 are associated with functional recovery up to 3 months.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1785 Top


Parameters affecting pain, physical function and radiology in patients with hip osteoarthritis: A preliminary report of a multicenter longitudinal study

D. Sindel, F. Ayhan1, T. Tuncer2, T. L. A. R. Osteoarthritis Study Group3, E. L. Sen

Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul University, 3Osteoarthritis Study Group- J. Öncü, Eİ. Şen, L. Altan, A. Bal, GT. Bozbaş, L. Cerrahoğlu, R. Çevik, T. Duruöz, D. Dülgeroğlu, G. Gürer, S. Gürsoy, S. Hizmetli, T. Kaya, B. Kuran, K. Nas, Ş. Özçakır, Ö. Şahin, F. Şendur, C. Tıkız, H. Uğurlu, Turkish League Against Rheumatism, İstanbul, 1Department of Physical Medicine and Rehabilitation, University of Health Sciences Ankara Training and Research Hospital, Ankara, 2Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey

E-mail: ekinozgorgu@gmail.com, dilsadsindel@gmail.com

Introduction/Background: The aim of this multicentric study is to investigate the characteristics of patients with hip osteoarthritis (HOA) and to assess the relationship of clinical and functional features with radiographic parameters in a Turkish population. Materials and Methods: A total of 220 subjects with HOA who participated in a multicenter national cohort study were enrolled in this study. Demographic characteristics, as well as duration of pain, pain severity, night pain, Timed Up and Go (TUG) test score were recorded. The self-reported pain and physical function were assessed using the Western Ontario McMaster Universities (WOMAC) Osteoarthritis Index. The X-rays of the hips were assessed by the Kellgren-Lawrence (KL) method. Relationships between parameters were analyzed with bivariate analysis. Analysis of covariance was used to create a model for pain, physical function, and other disease-related parameters. Variables showing a statistically significant correlation were included into ANOVA. Results: The mean age of the patients was 62.1±12.2 years. WOMAC-pain was significantly correlated with female sex, pain severity, night pain, symptom duration, KL score, and TUG test score (p<0.05). WOMAC-physical function showed a significant correlation with pain severity, night pain, KL score, and TUG test score (p<0.05). KL score was significantly correlated with the presence of scoliosis, leg length discrepancy, and TUG test score (p<0.05). Factors most strongly affecting WOMAC-pain and function were overall pain severity, night pain severity (p<0.05). Factors most strongly affecting KL radiographic grade were TUG test score, leg length discrepancy, and scoliosis (p<0.05). Conclusion: In case of disability; overall and night pain severity are significant predictors of pain and function. High TUG test score, scoliosis and leg length discrepancy are better predictors of a high radiographic grade. Since HOA is a multifactorial process, several factors might affect pain, function, and radiographic features. Therefore, clinicians should consider all these factors in patients with HOA.

Keywords: Hip osteoarthritis, pain, physical function

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2207 Top


Bone marrow lesion in advanced osteoarthritis of the knees: Correlation study between histopathological findings and structural damage

Y. Gazar

Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicin, Al-Azhar University, Cairo, Egypt

E-mail: dr.yasser_rh@yahoo.com

Introduction/Background: Loss of hyaline articular cartilage is a central pathologic event in osteoarthritis, but the pathogenesis of cartilage loss is poorly understood. Bone marrow lesion (BML) is indicated by focally increased signal in the marrow on fat-suppressed T2- weighted images. Purpose: To correlate histopathology of a bone marrow lesion (BML) pattern with severity and structural damage in osteoarthritic knees. Materials and Methods: Twenty consecutive patients (age range, 59–66 years; mean, 65 years) referred for total knee replacements were examined with sagittal short inversion time inversion-recovery (STIR) and T1- and T2-weighted MRI one week prior to surgery before surgery. Different structural abnormalities on MRI were compared with those on histologic maps. Results: The histopathology of BML in cases of OA revealed that (6) biopsies of cases showing bone marrow fibrosis (30%), (4) of them grade 1 (20%) and (2) of them grade 2 (10%). (18) biopsies showing cyst (90%), (9) biopsies showing abnormal trabeculae (45%), (2) of them with grade 1 (10%), (4) of them grade 2 (20%) and (3) of them grade 3 (15%). (5) Biopsies showing lymphocyte (25%), (40%) of them had++CD3, while (60%) of them had ++ CD20. (5) Biopsies showing fatty marrow (25%), (9) biopsies showing haemosidrotic marrow (45%), (6) biopsies showing blood vessels (30%), (5) of them with grade 2 (25%) and (1) with grade 3 (5%). The MRI findings of OA patients had been revealed that there was (6) patients with BML of grade 1 (30%) (10) patients of grade 2 (50%) and (4) patients of grade 3 (20%). Conclusion: (1) BML has a strong correlation with radiographic severity measurements of osteoarthritis of the knee and pain. (2) In patients with knee osteoarthritis, BML in bone underneath cartilage markedly increase risk for structural progression in the knee. (3) Hyperemia and hematopoietic marrow were possible reasons for appearance of BML as high signalintensity on STIR images. (4) BMLs are a cornerstone in progression of osteoarthritis.

Keywords: Bone marrow lesion

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0455 Top


Combined therapy in osteoarthritis of the knee, double blind randomized clinical trial

P. Yazdanpanah, H. Mohammadi1, A. Arjmand2, H. Sadeghi3, H. Ghaffarian Shirazi4

Departments of Physical Medicine and Rehabilitation, 1Orthopedics, 2General Physician and 3Pharmacology, Yasuj University of Medical Sciences, 4Social Determinations of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran

E-mail: yazdanpanahparviz29@gmail.com

Introduction/Background: Osteoarthritis is the most common joint disease during which knee joints are affected more than the other joints. Various drugs are used to treat osteoarthritis that each with advantages and disadvantages. The purpose of this study was to compare the efficacy of single and combination of acetaminophen, naproxen and omega-3 with a special focus on knee osteoarthritis. Materials and Methods: In a randomized clinical trial, 156 patients with moderate osteoarthritis, in 6 groups of 26 persons with acetaminophen, naproxen, acetaminophen + naproxen, acetaminophen + omega-3, naproxen + omega-3, acetaminophen + naproxen + omega-3 therapy. With acetaminophen 1000 mg was used every 8 hours, naproxen 500 mg every 12 hours and omega-3 1000 mg every 8 hours for 6 weeks. Twelve patients missed the study. Before the start of the treatment and at the end of treatment, we evaluated the results of the treatments using Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: Patients pain, physical function, joint stiffness and WOMAC ranking in all treatment groups significantly decreased after the treatment. WOMAC ranking after the treatment between groups was significantly different and triple -drug therapy yielded better results than one- drug therapy. Conclusion: The least cost of treatment is attributed to acetaminophen and the highest cost of treatment is attributed to acetaminophen+ napronex+omega-3.The best results of therapies of knee osteoarthritis was attributed to napronex+omega-3. The study showed that adding omega-3 will increase the efficacy, reduce joint stiffness and reduce severity of the side effects of these drugs. The efficacy of omega-3 may be due to anti-inflammatory effect through competitive inhibihition of the arachidonic pathway.

Keywords: Joint stiffness, knee osteoarthritis, Omega-3

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1348 Top


Improvement in joint instability reduces inflammatory pain of early knee osteoarthritis

A. Nakajima, K. Murata, Y. Morishita, T. Kokubun1, Y. Oka, N. Kanemura1

Department of Health and Social Services, Graduate School of Saitama Prefectural University, 1Department of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan

E-mail: 1881308n@spu.ac.jp

Introduction/Background: In osteoarthritis of the knee, recognition of pain pathophysiology and effective exercise therapy is an important issue for establishing effective treatment methods. Both animals and humans, the increase in mechanical stress due to joint instability induces joint deformity and pain. Improvement in joint instability may be effective in reducing joint deformity and pain. The purpose of this study is to understand a part of the pain mechanisms in the knee OA and to prove the pain relief effect by improving joint instability. Materials and Methods: 45 Wistar male rats, aged 11 weeks, were divided into three groups, ACL transection (ACLT) group, controlled abnormal movement (CAM) group and sham group (each group n=5). At 4 weeks and 8 weeks after surgery, immunofluorescence staining of substance P, calcitonin gene-related peptide in spinal dorsal root ganglia (DRG) and safranin O staining of knee joint were performed. Furthermore, pain behavior evaluation was performed every week after surgery. Results: By immunofluorescent staining, the number of positive cells per DRG area of calcitonin gene-related peptid was significantly larger at 8 weeks than 4 weeks. Both the ACLT group and the CAM group showed significantly higher scores of cartilage damage than the sham group at 4 and 8 weeks. Pain behavior evaluation was significantly lower in the CAM group than in the other two groups. Conclusion: From the results of immunofluorescent staining, it was suggested that inflammatory pain mainly appears until 8 weeks postoperatively. Therefore, it was inferred that this model may be early OA, which is the main symptom of intraarticular inflammation. We considered that inflammatory pain was not involved in lowering 50% paw withdrawal threshold of early knee OA. Intervention to improve joint instability from an early stage contributes to the reduction of inflammatory pain in early knee OA.

Keywords: Instability, osteoarthritis, pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0248 Top


Intra-articular steroids versus hyaluronic acid knee arthritis

M. D. E. Mammari, R. Doumi, A. M. L. Belfodil, M. Y. Medjahdi

Department of Physical Medicine and Rehabilitation, Military Hospital of Oran, Oran, Algeria

E-mail: mamjam2011@hotmail.fr

Introduction/Background: The main objective of the study is to assess the efficacy of intra-articular (IA) injections of hyaluronic acid (HA), compared to corticoids in patients with osteoarthritis of knee in both the long-term follow up, and wether there is a difference. Materials and Methods: Randomized study, from Mars 2015 until June 2016, compared two groups of patients with knee osteoarthritis; 1rst group: injected by corticoids (only 1 injection/knee/month, n,=14), controlled by group (3 injections / knee of HA, n=18). Evaluated by: pain intensity; Visual Analog Scale (VAS), Lequesne Algofunctional Index, and quality of life. The follow-up time was 12 months. Results: After 12 months of follow-up, both treatment groups showed improvement in knee function, the corticoids group showing a gratter improvement compared to HA group; in pain relief, in overall Lequesne Algofunctional Index, and quality of life. Conclusion: The IA injection of corticoids was better to improve the symptomatology in the long-term, corticods provided pain relief and quality of life in patients with knee OA, compared with IA of hyaluronic acid. However, IA hyaluronic acid is a good alternative the delay the surgery.

Keywords: Corticosteroids, hyaluronic acid, knee arthritis

Disclosure of interest: The authors did not declare any conflict of interest.


  A2.03 Musculoskeletal Conditions - Bone Diseases (E.G. Osteoporosis) Top



  ISPR8-2198 Top


Correlation of bone resistance with muscle strenght and power in posmenopausal patients with and without osteopenia

A. Olascoaga-Gómez de León, R. Coronado-Zarco, R. Zepeda-Mora, V. M. Domínguez-Hernández1, V. M. Araujo-Monsalvo1, E. Martínez-Coria

Department of Spine Rehabilitation, Osteoporosis Clinic, National Institute of Rehabilitation, 1National Institute of Rehabilitation, Biomechanic Laboratory, Mexico City, Mexico

E-mail: aolascoagag@gmail.com

Introduction/Background: Although bone mineral density (BMD) is used to diagnose osteoporosis, it does not determine bone strength. Moment of inertia (MI) predicts 70-80% of bone strength. In animal models and young patients, the positive relationship between bone strength and muscle strength has been demonstrated by the thickness of the muscle in computerized tomography (CT). However, isokinetic dynamometry has not been widely used to analyze this interaction. The aim of this research was to analyze the correlation between muscle strength and power measured by isokinetic dynamometry, with bone resistance measured by MI and BMD, in patients with (PWO) and without osteopenia (PWoO). Materials and Methods: 40 postmenopausal women were included (45-65 yo); 23 PWO and 17 PWoO. BMD was determined by x-ray dual densitometry; MI was determined by hip CT at femoral neck (MIFN), intertrochanteric region (MIIT) and femoral diaphysis (MIDiaf). Strength (in N/m) and muscle power (in W) was estimated in quadriceps, hamstrings, psoas, gluteus maximus, adductors and gluteus medius bilaterally. Correlation analysis was performed between strength and power with MI and BMD, and between groups. Coefficient of variation in isokinetics was verified. Results: Significant differences between groups in left gluteus medius strength was found (p=0.007) being higher in PWoO. Significant correlations [Table 1] were showed in PWoO with strength in quadriceps bilaterally, left hamstrings, psoas and adductors; strength in PWO correlated in psoas bilaterally and left gluteus medius. Power show significant correlation [Table 2] with PwoO in quadriceps and gluteus medius bilaterally, left hamstrings, psoas and adductors; for PWO in psoas bilaterally and left gluteus medius. Conclusion: MI correlated with muscle strength and power. Correlation of strength and power was predominant in PWoO (83 versus 33% of muscles evaluated) on the ipsilateral side. No differences in power between groups were found.
Table 1: P value and Pearson correlations (r) between strength and Ml, only muscles with significance are shown.

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Table 2: P value and Pearson correlations (r) between power and Ml, only muscles with significance are shown.

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Keywords: Bone resistance, osteopenia, osteoporosis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1723 Top


Multidimensional evaluation in siblings affected by late onset Pompe disease

S. Colonna, G. Iolascon, R. Gimigliano, L. Sodano, S. Liguori, A. de Sire, F. Gimigliano1

Departments of Medical and Surgical Specialties and Dentistry and 1Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy

E-mail: stefanocolonna.mail@gmail.com

Introduction/Background: Late Onset Pompe Disease (LOPD) is an autosomal recessive neuromuscular disorder. Among the other symptoms patients are characterized by a reduction of bone mineral density (BMD) and muscle strength. Moreover there seems to be a cognitive involvement which hasn’t been well described yet. Therefore, the aim of this study was to assess bone, muscle, and cognitive impairments in all the members of a family affected by LOPD. Materials and Methods: We included siblings with same genotype (p.R40X/p.N882fs) affected by LOPD. These patients underwent an experimental evaluation protocol in order to evaluate: BMD, using the Dual-energy X-ray Absorptiometry (DXA); muscle strength, by Hand Grip Strength Test (HGS); level of independence, using the Functional Independence Measure (FIM); cognitive functions, using Trial Making Test A (TMT-A) and B (TMT-B) and the Stroop Color Test. Results: Of 10 siblings with a diagnosis of LOPD, 7 (3 males and 4 females, mean aged 53.71 ± 6.05 years) had the same genotype (p.R40X/p.N882fs). Of these 7 patients, 4 (57.14%) had low BMD values (2 osteoporotic and 2 osteopenic) and hypovitaminosis D (<30 ng/ml); two reported previous vertebral fragility fractures. The mean HGS was: 21.17±0.76 kg in males and 14.50±4.58 kg females. The mean FIM was 119.33±2.31 in males and 121.00±2.45 for females. Furthermore, in the neuropsychological evaluation, we found a mild attentional and executive deficit with a global cognitive framework within the normal ranges. Conclusion: In this study we found low BMD values in more than half of the examined cases, a reduction of muscle strength and a mild attentional and executive deficit. These results testify the necessity of a multidimensional assessment to better investigate all the characteristics of these patients.

Keywords: Musculo-skeletal health, neuropsychological assessment, Pompe disease

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0885 Top


Blocking neuromuscular junctions to impair muscle overactivity enhances neurological heterotopic ossifications development in a mouse model of spinal cord injury

M. Salga1, 2, 3, H. W. Tseng2, K. Alexander2, B. Jose2, F. Genêt3,4, J. P. Levesque2

1Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, 4Department of Physical Medicine and Rehabilitation, Hôpital Raymond Poincaré- APHP- CIC-IT 1429, Garches, 3Université Versailles Saint Quentin en Yvelines, END:ICAP U1179 INSERM- UFR des Sciences de la Santé-Simone Veil, Montigny le Bretonneux, France, 2Mater Research Institute, University of Queensland, Blood and Bone Diseases Programme, Woolloongabba, Brisbane, Australia

E-mail: marjoriesalga@hotmail.fr

Introduction/Background: To ascertain a role for muscle spasticity in the development of NHO, by blocking neuromuscular signalling using botulinum toxin during spinal cord injury-induced NHO formation in a murine model. Materials and Methods: Spinal Cord Injury (SCI) was performed on 5-6-week-old C57BL/6 mice. To promote NHO development, cardiotoxin (CDTX) dose injections were administered at the time of the surgery to the right and left hamstring muscles. Botulinum toxin A (BTA) injections were administered at the site of NHO formation in the right hamstrings to block neuromuscular signalling, and mock equivalent volume of PBS was injected in the contralateral site 4 days prior to SCI, and weekly for 3 weeks. Twenty-one days post SCI, quantitative assessment of NHO volume and density within each hamstrings muscle were performed using Micro-computed tomography scan. Results: μCTscan analysis revealed the development of NHO in 100% of mice in both hamstrings. NHO volume average was 1.6 mm3 (± 1.0) in the left hamstrings injected with PBS in contrast to 3.3 mm3 (± 1.4) in the right hamstrings with BTA. This doubling of NHO volume in BTA-treated hamstrings was statistically significant (Wilcoxon matched-pairs signed rank test, p = 0.013). Furthermore, NHO were more compact in muscles injected with BTA with a density of 1244.6 mg/cc (± 10.4) and was significantly denser compared to NHO in the PBS-treated contralateral side density of 1231.2 mg/cc (± 20.1) (Wilcoxon matched-pairs signed rank test, p = 0.027). Conclusion: In our murine model of SCI-induced NHO, we demonstrated a doubling of the NHO volume, and increased density burden when treated locally with BTA. These results demonstrate that local administration of BTA exacerbates NHO development leading to an overall increase in bone formation. The outcome suggests that in contrast to risk spasticity, resulting from defective neuromuscular signalling, may be an inhibitor of local NHO development.

Keywords: Botulinum toxin type A, heterotopic ossification, spinal cord injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1397 Top


Degree of functional capacity, bone mineral density and phosphocalcic metabolism alterations in paediatric patients with reduced mobility

M. Entrenas Valle, E. Palomo Atance1, E. Medina Cano, M. L. León Sánchez2, C. Montoliu Peco, A. Rodríguez González, L. Cuevas Moreno, J. R. Muñoz Rodríguez3

Departments of Physical Medicine and Rehabilitation and 1Paediatric Endocrinology, Ciudad Real University Hospital, 3Ciudad Real University Hospital, Translational Research Unit, Ciudad Real, 2Department of Physical Medicine and Rehabilitation, Montilla Hospital, Córdoba, Spain

E-mail: martaentrenas@gmail.com

Introduction/Background: Mobility is essential for adequate bone mineralisation. Neuromuscular diseases can cause pathological fractures, bone pain, and a decrease in bone mineral density (BMD). Establish the association between BMD, phosphocalcic metabolism parameters, and degree of functional capacity. Materials and Methods: Observational, cross-sectional and prospective study in children under 18 with reduced mobility. The selection is performed by consecutive, non-randomised sampling. Variables analysed: age, gender, functional capacity according to the Functional Mobility Scale (FMS), which evaluates the ability to walk in 3 distances (5 metres, 50 metres and 500 metres) from 0 to 6, BMD (L2-L4) by DXA expressed in Z-scores according to bone age and gender, calcium, phosphorus, parathormone, 25-hydroxy-vitamin D3, alkaline phosphatase and osteocalcin in blood and calcium/ creatinine ratio, tubular reabsorption of phosphorus and cross-linked N-terminal telopeptides of type I collagen in urine (NTX-I). Alkaline phosphatase, osteocalcin and NTX-I values are expressed in standard deviations according to reference values for age/gender. The results are analysed with the SPSS programme. Results: 36 patients (53% children), average age of 8.6 +/- 4.7 years. Mean FMS value was was 5.3 out of 18 (36% obtained a value of 0). Mean BMD was -1.99 +/- 1.7, average alkaline phosphatase was -2.64 +/- 1.08 SD, mean osteocalcin was -2.15 +/- 1.39 SD, and mean NTX-I was +3 +/- 1.72 SD. A significant association was observed between BMD and the FMS for the 5-metre distance (p = 0.017) and for the total score (p = 0.029), and between parathormone and the FMS at 5 (p = 0.041), 50 (p = 0.033) and 500 metres (p = 0.046). Conclusion: There is a decrease in BMD and in bone neoformation markers such as alkaline phosphatase and osteocalcin in our population, and elevation of bone resorption markers such as NTX-I. Patients with a lower degree of mobility have a lower BMD.

Keywords: Osteoporosis, paediatrics, reduced mobility

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1616 Top


Are calcaneal quantitative ultrasound variables better than radial bone mineral density in identifying women with osteoporosis?

A. Oral, S. Esmaeilzadeh, S. Asghari, E. İ. Şen, D. Sindel, A. Yalıman

Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul University, İstanbul, Turkey

E-mail: ekinozgorgu@gmail.com, dilsadsindel@gmail.com

Introduction/Background: In certain circumstances when axial bone mineral density (BMD) cannot be measured using dual-energy X-ray absorptiometry (DXA), DXA BMD of the one-third radius (33% radius) can be used for the diagnosis of osteoporosis. Calcaneal quantitative ultrasound (cQUS) variables may also be used for assessing osteoporosis. The aim of this study was to test the hypothesis that cQUS variables may be better than one-third radius (33% radius) BMD for the identification of axial osteoporosis in women. Materials and Methods: 209 women aged between 21 and 85 years whose posteroanterior spine, hip, and 33%radius DXA BMD measurements as well as cQUS variables were measured were included in this study. WHO criteria were employed for defining osteoporosis in postmenopausal women and premenopausal women with Z-scores of ≤-2.0 were considered as having osteoporosis in axial regions. We used receiver operating characteristic (ROC) analysis to evaluate lumbar spine or hip osteoporosis discriminative performance of radius DXA BMD and cQUS parameters. Results: While 33% radius BMD and its T-score revealed greater areas under ROC curves (AUCs) (0.760 and 0.759) than those of the cQUS variables [0.707 for quantitative ultrasound index (QUI), 0.705 for QUI T-score, 0.682 for broadband ultrasound attenuation (BUA), 0.718 for speed of sound (SOS), and 0.706 for estimated heel BMD (eBMD)] for identifying lumbar spine osteoporosis, the AUC values for all cQUS variables (0.816 for QUI, 0.815 for QUI T-score, 0.829 for BUA, 0.791 for SOS, and 0. 813 for eBMD) in the discrimination of femoral neck osteoporosis were greater than those of 33% radius DXA BMD and its T-score (0.779 and 0.783). Conclusion: The results of this study confirmed our hypothesis for femoral neck osteoporosis, but not for lumbar spine osteoporosis. Our results have implications that cQUS can be used for the prediction of femoral neck osteoporosis in women whose hip DXA BMD cannot be measured.

Keywords: Bone mineral density, calcaneal quantitative ultrasound, osteoporosis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1801 Top


Troublesome heterotopic ossification. does the etiology have an impact on joint location and surgical complications?

A. Grelier, M. Salga, L. Gatin1, C. Debaud2, G. Genet, N. De L’Escalopier1, P. Denormandie1, F. Genet

Hôpital Raymond-Poincaré, Médecine Physique de Réadaptation, 1Hôpital Raymond-Poincaré, Chirurgie Orthopédique, 2HEGP, Chirurgie Orthopédique, Paris, France

E-mail: amandine.grelier@aphp.fr

Introduction/Background: Heterotopic ossification (HO) is a frequent complication after damage to the central nervous system (CNS), with an estimated prevalence of up to 76%. The primary site of HO is the hip joint (60,9%). The only effective treatment of troublesome HO is surgery. The main purpose of this study was to identify the relationship between the location of troublesome hip HO treated by surgery and the etiology of the cerebral damage. The secondary aim was to identify risk factor of sepsis and recurrences after the surgery. Materials and Methods: We retrospectively analyzed data from an anonymous prospective survey of patients undergoing surgery for troublesome HO from 1993 to 2016 (417 patients, 609 surgeries). Results: The sites of HO on the hip joint were associated with its etiology (p<0,01): for brain damaged patients, the hip HO was most frequently anterior and internal with a rate of 40,0% whereas it was anterior for patients with spinal cord injury (SCI), with a rate of 54,4%. The main side effect after surgery of troublesome HO was sepsis, with a rate of revision surgery of 8,2%. SCI patients were more affected (18,3%) than traumatically brain injured patients (TBI) (4,4%) or stroke patients (8,7%). Sepsis seemed to occur most frequently on hip surgeries, but no statistically significant relationship was found. The rate of recurrence was 2,8% for the whole population. It occurred most frequently after TBI (3,6%) rather than after stroke (1,9%) or SCI (1,5%). Conclusion: The sites of hip HO, their recurrences and sepsis were associated with its etiology. The patients with SCI will develop most frequently anterior hip HO, with a risk of sepsis that is more frequent than in the other etiologies.

Keywords: Heterotopic ossification, spinal cord injury, traumatic brain injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0653 Top


The comparison of quality of life, patient satisfaction and compliance in parenterally treated patients with postmenopausal osteoporosis

T. Ozsoy-Unubol, G. Akyuz1, S. Khudiyeva1, T. Guler2

Department of Physical Medicine and Rehabilitation, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospi, 1Department of Physical Medicine and Rehabilitation, Marmara University, Istanbul, 2Department of Physical Medicine and Rehabilitation, Numune Training and Research Hospital, Ankara, Turkey

E-mail: tugbaozsoyy@gmail.com

Introduction/Background: Osteoporosis and fractures due to osteoporosis cause significant morbidity and mortality. It has been shown that patients are more compliant with parenteral forms of medication. In this study we aimed to evaluate parenterally treated patients’ satisfaction, compliance and quality of life (QoL). Materials and Methods: A hundred thirteen patients with postmenopausal osteoporosis using denosumab-DEN (40), intravenous zoledronic acid-ZA (41) and ibandronic acid-IA (32) for at least 1 year were enrolled. Secondary osteoporosis, metabolic bone disease, bone metastasis, hypogonadism were defined as exclusion criteria. The demographic data, bone mineral density T scores and clinical risk factors were recorded. For QoL evaluation qualeffo-41 was applied. A 3-item questionnaire was used to evaluate the satisfaction with the medication, route and frequency of administration. Results: Demographic data and clinical characteristics were similar (p> 0,05). There were no significant difference in any subdomain of qualeffo-41 or total score. Most of the patients (90%) who have used DEN were satisfied with drug. However, big percent of the patients using ZA (48.8%) and IA (53.1%) were hesitant. When we evaluate the satisfaction with the route of administration 90% of DEN group was satisfied. For ZA and IA it was 46.3 and 53.1. For the frequency of administration it was 87.5, 68.3 and 43.7 for DEN, ZA, IA respectively. Conclusion: Regardless of the medication, QoL is affected. No medication has any superiority to the others in terms of QoL. Patients’ satisfaction is affected by both the route and frequency of administration. They are more satisfied with 6 months or 1 year intake period and with the subcutaneous form. Most of the patients in DEN group have emphasized that subcutaneous administration is fast and less invasive, like immunization. In these 3 treatment options, DEN is a step ahead in terms of patients’ satisfaction.

Keywords: Osteoporosis, patient satisfaction, quality of life

Disclosure of interest: The authors did not declare any conflict of interest.


  A2.04 Musculoskeletal Conditions - Regional Pain Syndromes of The Neck and Upper Extremity (Including Enthesopathy, Tendinitis and Others) Top



  ISPR8-0149 Top


Ultrasound-guided vs. landmark-guided local corticosteroid injection for carpal tunnel syndrome: A systematic review and meta-analysis

A. Babaei-Ghazani, P. Roomizadeh, A. Shirin1

Department of Physical Medicine and Rehabilitation, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, 1Dr. Shirin Alyan Clinic, Physical Medicine and Rehabilitation- Dentistry, Tehran, Iran

E-mail: arashbabaie@gmail.com

Introduction/Background: To review the randomized controlled trials (RCTs) and assess the comparative effectiveness of ultrasound-guided versus landmark-guided local corticosteroid injections in patients with carpal tunnel syndrome (CTS). Materials and Methods: RCTs from Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), EMBASE (Ovid), and Web of Science (from inception to 1 February 2017) were included. Two authors independently screened abstracts and full texts. The Outcomes of interest were symptom severity scale (SSS) and functional status scale (FSS) scores of Boston Carpal Tunnel Questionnaire as well as four electro-diagnostic parameters including compound muscle action potential, sensory nerve action potential, distal motor latency, and distal sensory latency. Results: Overall, 569 abstracts were retrieved and checked for eligibility and finally 3 RCTs were included (181 injected hands). Pooled analysis showed that ultrasound-guided injection was more effective in SSS improvement (mean difference [MD] = -0.46, 95% confidence interval (CI) = -0.59 to -0.32, P<0.00001); whereas, no significant difference was observed between the two methods in terms of FSS (MD= -0.25, 95%CI= -0.56 to 0.05, P=0.10). There were also no statistically significant differences in improvements of CMAP (MD=1.54, 95%CI=0.01 to 3.07, P=0.05), SNAP (MD= -0.02, 95%CI= -6.27 to 6.23, P=1.00), DML (MD=0.05, 95% CI= -0.30 to 0.39, P=0.80) or DSL (MD=0.00, 95%CI= -0.65 to 0.65, P=1.00). Conclusion: Ultrasound-guided injection was more effective than landmark-guided injection in symptom severity improvement in patients with CTS; however, no significant differences were observed in functional status or electro-diagnostic improvements between the two methods.

Keywords: Carpal Tunnel Syndrome, injection, ultrasonography

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0160 Top


The comparison between effectiveness of ultrasound guided corticosteroid injection above versus below the median nerve in mild to moderate carpal tunnel syndrome

B. Eftekharsadat, A. Babaei-Ghazani1

Department of Physical Medicine and Rehabilitation, Tabriz University of Medical Sciences, 1Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Tehran, Iran

E-mail: binasadat@yahoo.com

Introduction/Background: In this study the clinical effectiveness of ultrasound-guided corticosteroid injection “above” versus “below” the median nerve for treatment of patients with mild to moderate carpal tunnel syndrome (CTS) was compared. Materials and Methods: This prospective randomized double-blind clinical trial included 44 patients with mild to moderate CTS. The subjects were randomly assigned to two groups to receive ultrasound-guided injection of 40 mg triamcinolone either “above” or “below” the involved median nerve. Outcome measures were the Boston Carpal Tunnel Questionnaire, Visual Analogue Scale, electrophysiological tests, and ultrasonographic measurement of the median nerve cross-sectional area at baseline, 6 weeks and 12 weeks after the injection. Results: All outcome measures improved significantly in both groups at 6 weeks after intervention, and these improvements were persevered up to 12 weeks follow up (all P-value<0.05). However, there was no significant difference in measured outcomes between the two groups. No adverse side effects were observed. Conclusion: Both above and under median nerve ultrasound-guided steroid injection techniques were effective in reducing the symptoms, improving the function and electrodiagnostic and sonographic findings of CTS. However the amount of improvement in the outcomes did not differ between groups, implying that none of technique has the superiority over another.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0601 Top


Ultrasonographic measurements of axillary recess capsule thickness in unilateral frozen shoulder: Study of correlation with MR imaging measurements

D. H. Kim

Department of Rehabilitation Medicine, Dongsan Medical Center, Keimyung University, Daegu, Republic of Korea

E-mail: ri-pheonix@hanmail.net

Introduction/Background: The aims of this study were to compare the ultrasonographic (US) thickness of the affected axillary recess capsule (ARC) with that of the unaffected ARC in patients with frozen shoulder (FS), to analyze whether the US measurements of the ARC thickness are correlated with those using MR imaging (MRI), and to assess whether the US thickness of the ARC is correlated with the patterns of range of motion limitation. Materials and Methods: Forty-four patients with clinically diagnosed unilateral frozen shoulder and MRI evaluation performed US measurement of ARC. The US measurement of the ARC thickness was performed with the patients in a supine position with their shoulder abducted by 40 degrees. The ARC thickness was also measured by MRI on oblique coronal images by another physician blind to US measurements. With both US and MRI, ARC thickness was determined at the widest portion of the capsule [Figure 1]. Results: The US thickness of ARC was significantly higher in the affected shoulder (4.4 ±1.1 mm) than in the unaffected one (2.2 ± 0.5 mm) (p<.001) [Figure 2]. IMAGE/TABLE The US thickness of the ARC in the affected shoulder was correlated with that measured by MRI (8.9±1.9 mm) (p<.001, r=.83). The ARC thickness, whether measured by US or MRI, was not significantly related with the limitation of movement in specific directions. Conclusion: US can demonstrate the difference in ARC thickness between the affected and unaffected shoulders in patients with unilateral FS. The ARC thickness measured by US is correlated with that measured by MRI.





Keywords: Frozen shoulder

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0651 Top


Reliability and validity of the modified range-of-motion assessment for frozen shoulder with a smartphone

H. H. Hsu, Y. W. Tsai, Y. L. Chiu, Y. R. Hou, W. H. Sung

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan

E-mail: hsu.hsunhan@gmail.com

Introduction/Background: Frozen shoulder (FS) is a common disease which may cause restricted shoulder range of motion (ROM). Recently, studies have indicated that the smartphone goniometer apps could be reliable tools for shoulder ROM assessment. Nevertheless, patients with FS couldn’t use most of these apps in normal measurement position due to shoulder capsular pattern. Hence, if we can design a new method in modified position to measure ROM with smartphones, it will be a helpful assessment for them. The purpose of this study was to investigate the reliability and validity of the smartphone goniometer app to measure shoulder ROM in modified position for healthy subjects. Materials and Methods: Ten healthy subjects (5 male, 5 female; age=26.6±3.6 y/o) were recruited. Two physical therapists utilized the universal goniometer (UG) and ASUS Zenfone 4 smartphone with an accelerometer-based goniometer app to conduct various active shoulder ROM (flexion, abduction, external rotation (ER) and internal rotation (IR) at 0° abduction). The smartphone was stabilized at the hand with an armband to reduce measurement errors. All measurements were taken for 3 times (2 measurements on the first day and 1 on the next day). Intraclass correlation coefficients (ICC) and Pearson’s correlation coefficients (PCC) were used for statistical analysis. Significance level was set as α<0.05. Results: Both the UG and smartphone demonstrated high within-day and between-day reliability (ICC > 0.800, p<0.001) except the flexion for which the ICC values was 0.622 (p=0.023, first day) and 0.787 (p=0.002, second day). The validity between the UG and the smartphone showed significant correlation (PCC > 0.800, p < 0.001) among all shoulder motions. Conclusion: The smartphone goniometer app has good reliability and validity for shoulder ROM assessment in modified position which indicates that the method is feasible to evaluate the restricted ROM for patients with FS.

Keywords: Assessment, frozen shoulder, smartphone

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1226 Top


A pilot randomized controlled study of comparative effectiveness of kinesiology taping, sham taping or exercises only in treatment of lateral epicondylitis

E. Giray, D. Karali Bingül, G. Akyuz

Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey

E-mail: gulserena@gmail.com

Introduction/Background: Lateral Epicondylitis (LE) is a common musculoskeletal condition presenting with pain due to overuse of common extensor tendon. It is treated with many different methods. The aim of this study is to compare efficacy of kinesiology taping (KT) and sham taping in addition to exercise or exercises only in the treatment of LE. Materials and Methods: Thirty patients, aged 25-68 years, with clinically diagnosed LE less than 12 weeks were randomized into three groups; KT (n=10), sham taping (n=10) and control (exercises only) (n=10) groups. All groups received home exercise program including strengthening and stretching exercises. In KT and sham taping groups, tapings were performed and changed every 3-4 days for two weeks. Visual analog scale (VAS), grip strength, The Disabilities of the Arm, Shoulder and Hand (QuickDash) and The Patient-Rated Tennis Elbow Evaluation (PRTEE) scales were used for assessments before and after treatment. The immediate effect was assessed by VAS and grip strength immediately after both tapings. Results: Among the KT, sham and control groups, there were statistically significant differences regarding the changes in VAS at activities of daily living (ADL) (-2.5, 0, 0; p=0.02) and PRTEE (-26.25, 0.5, 1.25; p=0.006). Post-hoc analyses revealed that VAS at ADL and PRTEE (p<0.01) showed significantly greater improvement in the KT group than sham taping and control groups. VAS at ADL (p=0.007), painless and maximum grip strength (p=0.03; p=0.04), QuickDash (p=0.03) and total PRTEE (p=0.004) scores were significantly lower after treatment compared to baseline in the KT group. Grip strength immediately increased after taping in the KT group (p=0.02). Neither sham taping group nor control group showed improvement in any of the outcome measures after treatment. Conclusion: Kinesiology taping in addition to exercise is more effective than sham taping and exercises only for improving pain at ADL and arm disability due to LE.

Keywords: Kinesiology taping, lateral epicondylitis, treatment

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1385 Top


Are psychological factors associated with the 4 components of the Constant-Murley score?

G. A. Pires Rodrigues, P. Vuistiner1, M. Konzelmann, B. Léger1, C. Burrus, F. Luthi

Clinique Romande de Réadaptation Suva Care, Réadaptation de l’appareil locomoteur, 1Clinique Romande de Réadaptation Suva Care, Recherche, Sion, Switzerland

E-mail: gil.piresrodrigues@crr-suva.ch

Introduction/Background: The Constant-Murley score (CMS), one of the most popular clinician-rated measurement tool for shoulder patients, has 4 components: 2 subjective (pain and activity) and 2 observational (mobility / strength). Some studies suggest that patient-related psychological factors may also influence the scoring. The purpose of this study was to measure which components may be related with psychological factors. Materials and Methods: Inclusion criteria were patients with chronic shoulder pain (> 3 months) treated in rehabilitation from 01.05.2012 to 30.08.2017. Exclusion criteria were other upper limb injuries, upper limb neuropathies, and inability to complete the questionnaires. At entry, the CMS was performed by trained physiotherapists, and the following questionnaires were completed by patients: Brief Pain Inventory (BPI), Hospital Anxiety and Depression (HADs), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), and Disability of Arm-Shoulder-Hand (DASH). Correlations between the 4 components of CMS and the questionnaires were measured with the Pearson coefficient (weak correlation: 0.20-0.40, moderate: 0.41-0.60, strong: ≥0.61). Results: 735 patients were included (mean age (sd): 47 (11) years; men: 85%; rotator cuff lesions: 72%). Median duration of symptoms was 14 months (IQR 9-22). The pain component of the CMS was correlated with disability (DASH: -0.43) and pain (BPI: -0.56), but also with psychological factors: anxiety, depression (HADs: -0.28 and -0.32, respectively), catastrophizing (PCS: -0.45), and kinesiohobia (TSK: -0.25).The activity component was correlated with disability (-0.42) and pain (-0.29). Mobility and strength were only correlated with DASH (-0.40 and -0.33, respectively). Conclusion: A clinician-rated measurement tool should be independent of patient-related psychological factors, which may limit its validity. This study suggests that the pain component of the CMS should be measured separately to the others in order to reduce the risk of measurement bias.

Keywords: Constant Murley score, psychological factors, shoulder pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1213 Top


Musculoskeletal disorders in physiotherapists of a university hospital center

S. Salah, H. Abdelghaffar1, A. Kalai, I. Feki, Z. Ben Salah Frih

Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, 1School of Health Sciences and Technology, University of Monastir, Monastir, Tunisia

E-mail: feki_islem@yahoo.fr, sanasalah@live.fr

Introduction/Background: The objective of the current study was to determine the prevalence of musculoskeletal disorders (MSDs) in physiotherapists and to look for predictive factors of their early onset. Materials and Methods: A cross-sectional descriptive study was conducted on March 2017 including thirty physiotherapists of a university hospital center. A self-questionnaire was administered to the participants assessing their epidemiological profile, the MSDs they suffered from, and their level of information on MSDs as well as their level of exposure to these disorders. Results: The mean age of the participants was 39.4 years± 8.7 years. The sex ratio H/F was 0.57. The mean professional practice duration was 10.9 years±7.11 years. The prevalence of MSDs was 93.3%, these disorders were localized in the lumbar spine (73.3%), cervical spine (30%), shoulder (40%), elbow and wrist (23.3%), hand (13.3%) and lower limb (13.3%). Respondents rated their level of exposure to MSDs as high and their level of information on these disorders as medium. MSDs had an early onset (≤2 years) in younger physiotherapists with higher levels of stress (p <0.05). However, no predictive factor for early onset of MSDs was found in the studied sample. The presence of MSDs was correlated to age (r = 0.538, p = 0.002), to professional practice duration (r =0.889, p<0.001) and to the level of stress experienced by the physiotherapist. It seems that the higher this level was, the more likely the physiotherapist would experience MSDs earlier in his career (r = -0.397, p = 0.03). Conclusion: Although difficult, the prevention of MSDs is of considerable benefit. The initial training of physiotherapists must include information on occupational risks and adaptation strategies as well as ergonomics of workstations and stress management.

Keywords: Musculoskeletal disorders, physiotherapist, stress

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0280 Top


Musculoskeletal pain symptoms in bagpipers: A pilot study

F. C. Tan III, D. Bloodworth1, F. Chiou-Tan1

St. Thomas Episcopal School, Scottish Arts, 1Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, USA

E-mail: ch3_ch9@sbcglobal.net

Introduction/Background: Musicians have musculoskeletal pain and overuse syndromes related to their instrument. Great Highland bagpipers (GHB) also have pain related to use, but this has not been well documented because of their relatively rare instrument. Historically, bagpipers were used to direct troops on the battlefield. Bagpipers or their instruments were shot to prevent the ability to do this. Bagpipers are required to suspend part of the instrument on their shoulder, squeeze a bag under the same arm, and blow a wind instrument simultaneously. The literature shows only one previous study that documented the most common musculoskeletal complaint was of the left arm and low back, but did not study pain scales. Materials and Methods: An institutional review board approved, prospective, anonymous survey was sent to adult bagpipers that play in a GHB band. This pilot study was conducted to determine if they experience musculoskeletal pain or not. A larger scale international survey is planned since this pilot data is positive. Demographic data, pain location, severity (verbal numerical scale - VNS), duration, and McGill pain questionnaire were collected. Descriptive statistics computer program was applied. Results: Ten surveys were collected in this pilot study. Ninety percent of bagpipers reported pain related to playing the instrument (SE 0.1). The most severe pain was the ipsilateral (bagside) cheek (3.3/10), followed by ipsilateral shoulder, ipsilateral forearm, and contralateral cheek (2.4/10) on VNS. The average pain duration lasted 3.3 hours (+/- 2.3 SE) after playing the instrument. Pain was most commonly described as “aching” or “sore” on McGill questionnaire. Conclusion: This pilot data supports bagpipers experience musculoskeletal pain related to playlng their instrument. Future studies underway will conduct this survey internationally. This will be followed by detailed history, physical exam to determine exact sources of pain. It is hoped this research will help Physiatrists understand and treat musculoskeletal pain in bagpipers.

Keywords: Bagpipes, musculoskeletal, pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0804 Top


Shear wave sonolastography of supraspinatus muscle in patients with rotator cuff tear

G. Y. Park, D. R. Kwon, J. H. Rim

Department of Rehabilitation Medicine, Daegu Catholic University Hospital, Daegu, Republic of Korea

E-mail: parkgy@cu.ac.kr

Introduction/Background: To investigate the elastic properties of the supraspinatus (SSP) muscle in patients with rotator cuff tear (RCT) by using shear wave sonoelastography (SWS) and comparing the stiffness of SSP muscle according to severity of RCT. Materials and Methods: Seventy six patients (43 males, 33 females; mean age 64.4±9.2 year) with one hundred and fifty two shoulders (85 symptomatic, 67 asymptomatic) were recruited. Severity of RCT, fatty infiltration and echogenicity of SSP muscle, and SSP muscle atrophy were assessed on B-mode ultrasound (US). Shear wave velocity (SWV) was measured twice in proximal and distal upper trapezius and SSP muscles at suprascapular fossa on longitudinal SWS using acoustic radiation force impulse imaging. Results: In the 85 symptomatic/67 asymptomatic shoulders, US revealed 1/37 shoulders with normal supraspinatus tendon (group 1), 16/16 shoulders with tendinopathy (group 2), 41/2 shoulders with partial-thickness tear (group 3), and 27/12 shoulders with full thickness tear (4/4 small and 8/2 medium (group 4), 4/3 large and 11/3 massive (group 5)). The SWV of SSP muscle in groups 1, 2, 3, 4, and 5 were 2.88 ± 0.25 m/s, 2.79 ± 0.27 m/s, 2.64 ± 0.21 m/s, 2.34 ± 0.14 m/s, and 2.12 ± 0.17 m/s, respectively. SWV in SSP muscle was negatively correlated with the severity of RCT (r = -0.809), fatty infiltration grade of SSP muscle (r = -0.677), echogenicity grade of SSP muscle (r = -0.637), Warner grade (r = -0.671), and Goutallier stage (r = -0.672, p < .05). Conclusion: The SWS demonstrated a difference of elastic properties of SSP muscle according to the severity of RCT and was correlated with fatty infiltration, echogenicity, and atrophy of SSP muscle, and the severity of RCT. Therefore, SWS can be used as an imaging method to provide insight into the biomechanics and pathophysiology of supraspinatus muscles in patients with RCT.

Keywords: Rotator cuff tear, sonoelastography, supraspinatus muscle

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0816 Top


The effectiveness of kinesio taping on pain, range of motion and disability in patients with chronic neck pain: A randomized controlled study

H. Dogan, E. Aslan Telci1, M. Pekesen Kurtca2

Zübeyde Hanım Application and Research Center, Baskent University, Izmir, 1School of Physical Therapy and Rehabilitation, Pamukkale University, 2Pamukkale University, Denizli Vocational School of Health Services Therapy and Rehabilitation Department, Denizli, Turkey

E-mail: easlantelci@gmail.com

Introduction/Background: Chronic neck pain is a major public health problem in most communities. The aim of this study was to investigate the effectiveness of kinesio taping on pain, cervical range of motion and disability in patients with chronic neck pain. Materials and Methods: Forty four subjects (age range: 30-55; mean age: 40.7±7.3 yrs; 32 females, 12 males) were randomly divided into two groups (study group: 22, control group: 22). Conventional physiotherapy methods including active (exercise) and passive (hotpack, therapeutic ultrasound and TENS) treatment were applied to all subjects for 15 sessions (5 days a week). Additionally, in the study group kinesio taping was performed at the end of each session. Pain intensity (Visual Analogue Scale), pressure pain threshold (digital algometer), cervical range of motion (CROM device) and disability (Neck Disability Index) were evaluated before treatment, on the second day of treatment and after treatment. Results: There was no significant difference between the groups for demographic data (age, height, weight, BMI) and any outcome at baseline (p>0.05). When the intra-group comparison is examined, in the study group second day outcomes for pain intensity, range of motion and disability were higher than the pre-treatment assessment (p <0.05). There was no significant improvement in any of the parameters in the control group on the 2nd day outcomes when compared to the pre-treatment (p>0.05). In both groups, there were significantly improvements in all parameters after treatment than the pre- treatment (p<0.05). In study group, pressure pain threshold and disability level were found to be better than control group according to the post-treatment outcomes (p <0.05). Conclusion: The results of this study have shown that kinesio taping in addition to conventional physiotherapy provides additional benefits in chronic neck pain.

Keywords: Disability, kinesio taping, neck pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1607 Top


Changes in muscle tone and stiffness around shoulder associated with radiotherapy in breast cancer patients

S. M. Yeo, S. Y. An, I. Y. Cheong, W. Park1, J. H. Hwang

Department of Physical Medicine and Rehabilitation and 1Radiation Oncology, Samsung Medical Center, Seoul, Republic of Korea

E-mail: sm.yeo@samsung.com

Introduction/Background: Treatment related shoulder dysfunction and anterior chest wall stiffness is common in breast cancer patients. Radiotherapy is known to alter the properties of muscles such as fibrosis, but it is difficult to objectively assess. Objective measurements of muscle properties can be useful for evaluating these problems and the effect of intervention. Our study aimed to assess changes in serial muscle properties associated with radiotherapy in breast cancer patients using MyotonPRO, device measuring muscle properties. Materials and Methods: 35 breast cancer patients who underwent mastectomy and scheduled to undergo radiotherapy were enrolled. Frequency (tone, Hz) and Stiffness (N/m) were measured in both Pectoralis major (PM), Sternocleidomastoid (SMC) and Upper trapezius (UT) before radiotherapy and immediately after radiotherapy. Paired t-test was used to investigate the side to side difference and changes associated with radiotherapy of tone and stiffness of muscles around shoulder. Results: Before radiotherapy, the stiffness and tone of affected PM were significantly higher than unaffected PM. Immediately after radiotherapy, the stiffness and tone of affected PM were still significantly higher than unaffected PM and the difference became larger than before radiotherapy. Although there was no side to side difference of parameters before radiotherapy, the stiffness of affected UT was significantly higher than unaffected UT immediately after radiotherapy. Stiffness/ tone of affected PM and affected UT increased significantly immediately after radiotherapy compared to before radiotherapy. Conclusion: After operation, only the tone and stiffness of affected PM were increased. After radiotherapy, the stiffness and tone of affected PM were higher than before radiotherapy, and the tone and stiffness of affected UT were also increased. Our findings confirmed that surgical treatment and radiotherapy affect the stiffness and tone of affected PM. And stiffness and tone of affected UT increased before and after radiotherapy, which is thought to be due to posture of receiving radiotherapy.

Keywords: Breast cancer, MyotonPRO, reliability

Disclosure statement: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea goverment (MSIP) (NRF-2017R1A2B4010795).


  ISPR8-2243 Top


A new iPhone application for the measurement of active craniocervical range of motion in patients with non-specific neck pain: A reliability and validity study

M. R. Pourahmadi, R. Bagheri1, M. Taghipour2, I. Ebrahimi Takamjani

Department of Physiotherapy, Iran University of Medical Sciences, 2Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, 1Department of Physiotherapy, Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran

E-mail: pourahmadipt@gmail.com

Introduction/Background: Measurement of cervical spine range of motion (ROM) is often considered to be an essential component of cervical spine physiotherapy assessment. This study aimed to investigate the reliability and validity of an iPhone application (app) (Goniometer Pro) for measuring active craniocervical ROM (ACCROM) in patients with nonspecific neck pain. Materials and Methods: A cross-sectional study was conducted at the musculoskeletal biomechanics laboratory located at Iran University of Medical Sciences. Forty non-specific neck pain patients participated in this study. The outcome measure was the ACCROM, including flexion, extension, lateral flexion, and rotation. Following the recruitment process, ACCROM was measured using a universal goniometer (UG) and iPhone 7 app. Two blinded examiners each used the UG and iPhone to measure ACCROM in the following sequences: flexion, extension, lateral flexion, and rotation. The second (2 hours later) and third (48 hours later) sessions were carried out in the same manner as the first session. Intraclass correlation coefficient (ICC) models were used to determine the intra-rater and inter-rater reliability. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone app. Minimum detectable change at the 95% confidence level (MDC95) was also computed. Results: Good intra-rater and inter-rater reliability was demonstrated for the goniometer with ICC values of ≥0.66 and ≥0.70 and the iPhone app with ICC values of ≥0.62 and ≥0.65, respectively. The MDC95 ranged from 2.21° to 12.50° for the intra-rater analysis and from 3.40° to 12.61° for the inter-rater analysis. The concurrent validity between the two instruments was high, with r values of ≥0.63. The magnitude of the differences between the UG and iPhone app values (effect sizes) was small, with Cohen d values of ≤0.17. Conclusion: The iPhone app possesses good reliability and high validity. It seems that this app can be used for measuring ACCROM.

Keywords: Cervical vertebrae, range of motion, Smartphone

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0314 Top


Evaluation of suprascapular nerve block and intraarticular steroid injection as a treatment modality in patients with periarthritis shoulder

S. Jain, D. Borah, D. S. Meena1

Departments of Physical Medicine and Rehabilitation and 1Anaesthesia, Safdarjung Hospital, New Delhi, India

E-mail: jsakshi32@yahoo.com

Introduction/Background: Periarthritis shoulder (PA) characterized by gradual onset of pain with restriction of active and passive shoulder range of motion is one of the commonest musculoskeletal conditions of upper limb. Treatment options include rest, NSAID, active and passive mobilization, physical modalities, hydro-dilatation, manipulation under anaesthesia, arthroscopic capsular release, intraarticular injections and regional nerve blocks. Materials and Methods: 90 patients of periarthrits shoulder were enrolled in the study and randomly allocated into two groups. Group A received methyl prednisolone 80 mg intraarticular injection and Group B received suprascapular nerve block of 0.5% bupivacaine and methyl prednisolone. Each patient was assessed before intervention, at 1, 4 and 12 weeks after intervention. 0-10 Numeric Pain Intensity Scale, Active and passive range of motion, Quick Disability of Arm, Shoulder and Hand (DASH) score and Shoulder Pain and Disability Index (SPADI) were used for assessment. Results: Group A showed statistically significant improvement (p<0.05) in pain, ROM and functional index on follow up at 1, 4 and 12 weeks whereas, group B showed improvement (p<0.05) in all parameters except passive flexion and external rotation on first follow up. However, this difference disappeared at subsequent follow ups. Comparison between the groups revealed a better outcome in Group A, in terms of Numerical Pain Intensity Scale Scores, SPADI Score, passive extension, active and passive internal and external rotations at 1, 4 and 12 weeks. Both the groups were comparable in terms of qDASH, active and passive abduction, flexion and active extension at first week with Group A showing subsequent improvement. Conclusion: Both intrarticular steroid injection and suprascapular nerve block showed improvement in patients with periarthritis shoulder, but intrarticular steroid injection was found to be more efficacious as compared to suprascapular nerve block.

Keywords: Periarthritis shoulder, suprascapular nerve block

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0920 Top


Ultrasonographic guided subacromial sodium hyaluronate injection for rotator cuff disease

F. Dehghan, A. Moghtaderi, S. Sajadiyeh, V. Bateni1

Departments of Physical Medicine and Rehabilitation and 1Radiology, Isfahan University of Medical Sciences, Isfahan, Iran

E-mail: dr.farnaz.dehghan@gmail.com

Introduction/Background: Rotator cuff disease is a common cause of shoulder pain. There are studies about the effectiveness of sodium hyaluronate injection on shoulder and knee pain, but few studies demonstrating the efficacy of sodium hyaluronate ultrasonography guided injection for rotator cuff disease. This study evaluates effectiveness of ultrasonography guided subacromial sodium hyaluronate injection in patients with impingment syndrome without rotator cuff complete tear. Materials and Methods: This prospective, double-blind, placebo controlled clinical trial study was performed among 40 patients with subacromial impingement syndrome without complete tear of rotator cuff. Patients randomly injected ultrasonography guided in 2 groups: Case group by 20 mg of sodium hyaluronate and control group by 0.9% normal saline. Both groups received 3 weekly injections. The pain score (100 mm visual analogue score [VAS]) was evaluated before first injection and one week after each injection. The constant score was evaluated before first and 12 week after last injection. Data was analyzed statistically by Independent t-test. Results: In both groups mean VAS has decreased, but more significantly in case group (P < 0.001). Mean constant score was significantly higher in case group 12 weeks after last injection (P < 0.001). The constant score improved 12 weeks after the last injection in both groups with a significantly better result in case group (P < 0.001). Conclusion: Subacromial injections of sodium hyaluronate are effective in treating rotator cuff disease without complete tears.

Keywords: Injection, rotator cuff, ultrasonography

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1154 Top


Safety and efficacy of polydeoxyribonucleotide injections versus prolotherapy for patients with elbow epicondylitis in a randomized double-blind active-controlled trial

H. K. Do, C. H. Yi, J. Y. Lim

1Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Bundang-Gu, Seongnam, Gyeonggi, Republic of Korea

E-mail: drlim1@snu.ac.kr

Introduction/Background: Our aim was to evaluate the efficacy of polydeoxynucleotide (PDRN) injections compared to standardized prolotherapy for patients with lateral epicondylitis (LE). Materials and Methods: In this randomized, double-blind, active-controlled trial, eligible patients with LE received intra-tendinous injections (1 ml of PDRN or hypertonic dextrose [15%]) under ultrasound (US) guidance at weeks 0, 2 and 4. Primary outcome was Visual Analogue Scale (VAS) for elbow pain. Secondary outcomes were pain-free grip strength (PFGS), pressure pain threshold (PPT), isokinetic wrist extensor strength (IWES), patient-rated tennis elbow evaluation (PRTEE), EQ-5D-5L and US characteristics of the LE. All outcomes and adverse events were assessed at weeks 0, 6 and 12. Results: The final analysis included 38 patients (PDRN injection, n = 19; prolotherapy, n = 19) [Figure 1] and [Table 1]. Significant improvements from baseline to 12 weeks were observed in VAS for elbow pain in both groups (53.6 ± 19.1 mm, p<0.001 in PDRN; 50.6 ± 16.8 mm, p<0.001 in prolotherapy) [Figure 2]. While the between-group difference in VAS was not significant (p = 0.605). Significant pre-versus-post improvements were observed within each group for the secondary outcomes other than US characteristics (p<0.001, p = 0.001, and 0.003, respectively). Of these outcomes, PFGS, PPT, and IWES exhibited increase of up to 90 % (ratio = affected side/unaffected side × 100) in both groups. However, all secondary outcomes showed non-significant between-group differences. There were no serious adverse events that resulted in drop-outs. Conclusion: PDRN injections and prolotherapy used as standardized interventions can be safe and effective treatments improving for LE-related pain and function.
Table 2: Baseline characteristics

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Keywords: Lateral epicondylitis, polydeoxyribonucleotide, prolotherapy

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1965 Top


A personalized self-management and intensive spa therapy intervention for musculoskeletal disorders of the upper extremities contributes to reduce disability: A randomized controlled trial

C. Lanhers, B. Pereira1, C. Gay, C. Hérisson2, A. Dupeyron3, E. Coudeyre

CHU Clermont-Ferrand, Médecine Physique et de Réadaptation, 1CHU Clermont-Ferrand, Direction de la recherche Clinique, Clermont-Ferrand, 2CHU Montpellier, Médecine Physique et de Réadaptation, Montpellier, 3CHU Nîmes, Service de Médecine Physique et de Réadaptation, Nîmes, France

E-mail: clanhers@chu-clermontferrand.fr

Introduction/Background: Musculoskeletal disorders (MSDs) constitute a major occupational health problem in the working population. MSDs manifest as localized pain or functional difficulty in one or more anatomical areas, such as the cervical spine, shoulder, elbow, hand, and wrist. Although physical exercise is widely recommended, few studies with a good level of evidence have enabled us to base a complete, well-constructed intervention on exercise that can be offered as secondary prevention in these disorders. Materials and Methods: A prospective, multicenter, comparative, randomized study using Zelen’s design. This study falls under active prevention of MSDs of the upper extremities. Participants are workers aged between 18 and 65 years, with any type of job or workstation, with or without a history of sick leave. The primary aim is to show the superiority at 3 months of a combination of spa therapy, exercise, and self-management workshops for 6 days over self-management workshops in terms of employee functional capacity in personal and professional daily life (QUICK DASH scale). Results: We included 148 patients, 73 assigned to the intervention group and 75 to the control group. At 3 months, the total score of functional disability assessed by QUICK DASH decreased in both groups. This reduction was higher in the intervention group (-10.04±15.83) versus control group (-5.57±13.45). We noticed a non-significant decrease for QUICK DASH total score (p=0.10). However, the field specifically assessing disabilities in physical activities; QUICK DASH sport; had significantly decreased in the intervention group (-14.58±21.49) versus control group (-6.72±19.04) (p=0.02). Conclusion: The originality of this intervention lies, in its short, intensive format, which is compatible with remaining in work; and in its multidisciplinary approach. This trial demonstrates the benefits of a short course of spa therapy combined with a personalized self-management program on the functional capacity in their daily life.

Keywords: Exercise, musculoskeletal disorders, spa therapy

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2193 Top


Quantitative stiffness measurement of structures in carpal tunnel according to motion of wrist and fingers using acoustic radiation force impulse elastography

S. Lee, J. W. Park, J. Kwak, S. Lee

Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital, Seoul, Republic of Korea

E-mail: tjdwp4907@gmail.com, spotdoc88@gmail.com

Introduction/Background: Repetitive use of wrist and finger is well known cause of damage of the median nerve and the soft tissue around it and contributes to development of the carpal tunnel syndrome. The aim of this study is to unveil the stiffness variation of the structures in the carpal tunnel according to the hand and the wrist motions. Materials and Methods: This study was designed as a prospective, cross-sectional study and 26 healthy volunteers were enrolled [Table 1]. Target structures for stiffness measurement in the carpal tunnel were median nerve (MN), transverse carpal ligament (TCL), and tendon of flexor digitorum superficialis (FDS) and profundus (FDP). Stiffness measurement were done transversely at the carpal tunnel inlet (pisiform bone to scaphoid tubercle) of non-dominant hand in combination of the 2 wrist joint motions; wrist neutral and wrist 30 degrees extension, and the 3 finger motions; finger neutral, full finger grasp, and full finger extension.



Results: Stiffness (m/s) of mean and range of the target structures in wrist neutral-finger neutral position were 2.3 (1.6-3.4), 3.4 (2.7-3.9), 2.9 (2.7-3.4), and 3.2 (2.8-3.8) each. Those in wrist extension-finger full extension position were 3.0 (2.3-4.0), 4.0 (3.3-5.1), 3.5 (2.8-5.1), and 3.9 (2.9-5.0) [Table 2]. Stiffness were significantly higher compared to wrist neutral-finger neutral position in other all five wrist-finger motions [Figure 1]. Conclusion: Generalized estimating equation (GEE) analysis among the all six wrist-finger joint motions shows that wrist and finger joint movement increases stiffness of the structures in carpal tunnel compared to the wrist neutral-finger neutral position. Further study with large sample size and with carpal tunnel syndrome patients should be required to clarify these tendencies.

Keywords: Carpal tunnel syndrome, elastography, median nerve

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0200 Top


Abstract need to be edited – Evaluation of functional discomfort in the thoracic outlet syndrome: A self-questionnaire

H. Quentin1, V. Wieczorek2, M. Wypych2, A. Thevenon1,3

1CHRU LILLE- Hôpital Swynghedauw, Médecine Physique et de Réadaptation, 2CHRU - Lille, Médecine Physique et de Réadaptation, 3URePSS Université Lille 2, Médecine Physique et de Réadaptation, Lille, France

E-mail: quentin.hanot1@gmail.com

Background and Aims: The compression of vascular and nerve structures for the upper limbs is the origin of TOS. If the clinical forms are variable (arterial, venous, neurological form), the functional discomfort in the activities of the daily life can be serious. Global scales (EN, DASH, CBSQ) can be used to evaluate the functional impact, but this evaluation is nonspecific. A specific scale was built and used during the rehabilitative treatment carried out in Lille. The purpose of this study is to evaluate its validity. Materials and Methods : A self-questionnaire was constructed.16 items were evaluated in 4 categories: impossible, major discomfort, moderate discomfort, without difficulty. An overall score is calculated. An evaluation is carried out parallel by a numerical scale. The self-questionnaire is completed on day 1, day 2 and the last day (LD). Between May 2015 and July 2017, 37 subjects were evaluated. Results: There is excellent intra observer reproducibility (correlation coefficient = 0.92464). There is a significant improvement between D1 and LD (mean difference = -6.4594595, p < 0.0001). The correlation between the EN and the total score is good at D1 (correlation coefficient at 0.66796, p < 0.0001) and at LD (correlation coefficient at 0.67313, p < 0.0001) and mean at D2 (correlation coefficient at 0.53485; p = 0.0008). There is an improvement in all items studied between D1 and LD, although the difference is significant for only 9 items.
Table 1: Main results. PWMD = Patents Without Missina Data

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Table 2: item evaluation

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Conclusion: The questionnaire is a fast, simple way of assessing and focusing on activities of daily living. The excellent reproducibility intra observer, the good correlation with the EN and the evolution of most of the studied items attest that it is a suitable way to evaluate the functional discomfort in the TOS.

Keywords: Functional evaluation, self-questionnaire, thoracic outlet syndrome

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0261 Top


Effects of hypertonic dextrose injection on chronic supraspinatus tendinopathy: A pilot study of randomized controlled trial

S. Huang

Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

E-mail: 13001@s.tmu.edu.tw

Introduction/Background: Rotator cuff lesions are common causes of shoulder pain. Although patients with symptoms caused by chronic rotator cuff tendinopathy can be treated using conservative treatments, some of them may still experience refractory symptoms. Hypertonic dextrose prolotherapy (DPT) may be another treatment choice for these refractory symptoms. However, conventional prolotherapy injection is complicated with multiple injection sites. Thus, we considered it necessary to design a rigorous trial to specifically evaluate the effectiveness of DPT injection for the supraspinatus tendon, which is mostly involved in rotator cuff tendinopathy. Materials and Methods: This double blind, randomized, controlled study will recruit patients with chronic shoulder pain diagnosed as chronic supraspinatus tendinopathy. We recruit 20 participants, with a total of 10 participants in each treatment arm. The hypertonic DPT group will receive 5 mL of 20% glucose water prolotherapy injection, and the control group will receive normal saline by using the same injection protocol as that used for the study group. Demographic data will be recorded at baseline. Visual analog scale, Shoulder Pain and Disability Index, range of motion, ultrasound will be recorded at baseline, after intervention (week 2, and week 6). Descriptive statistics will be calculated for feasibility outcomes, and measures of clinical effectiveness will be explored using repeated measures analysis of variance. Results: Prolotherapy injection group presented improved of VAS, SPADI, and range of motion after 2 weeks of injection with comparing baseline. However, the effect was not maintained to 6 weeks after injection. There was no difference of histogram changes before and after prolotherapy injection. With comparing control group, improved VAS and SPADI was better among study group at 2 weeks after injection but no difference at 6 weeks after injection. Conclusion: Our pilot study demonstrated that hypertonic dextrose prolotherapy injection can improve pain and function of chronic rotator cuff tendinosis patients in short term period.

Keywords: Chronic supraspinatus tendinosis, prolotherapy, ultrasound

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1411 Top


Effectiveness of group shoulder therapy: Our experience

M. Entrenas Valle, A. Rodríguez González, M. L. León Sánchez, C. Montoliu Peco, L. Cuevas Moreno, E. Medina Cano, M. Muñoz Serrano

Department of Physical Medicine and Rehabilitation, Ciudad Real University Hospital, Ciudad Real, Spain

E-mail: martaentrenas@gmail.com

Introduction/Background: Painful shoulder is one of the most common diseases in the Rehabilitation doctor’s appointmets, being the third in frequency in musculoskeletal pathology. According to the bibliography its incidence is 0.9-2.5%. This means 1.2% and 12% of medical and Rehabilitation consultations, respectively. Approximately 50% of patients continue with pain at 18 months after starting symptomatology. There is scant evidence of the efficacy using conventional treatments. A program of therapeutic exercises is the only treatment with scientific evidence in short and long term, both for the improvement of pain and functional limitation. Materials and Methods: Descriptive observational study before-after. Rotator cuff diseases as well as subacromial syndrome were included. A program of 1 hour per week for 8 weeks of controlled exercises was carried out. To this, it was added 1 hour of occupational therapy with anatomical teaching, ergonomic measures and adaptations. Results: Our sample includes 140 patients. The primordial sex is feminine with a frequency of 71%. The most frequent profession is housewife (36%), followed by retirees (12%) and administrative staff (11%). There was a significant improvement in the value of the Constant scale (t = -8.658, p <0.001) between before (=50.02) and after (=60.61) means of the shoulder group therapy. This improvement was maintained 6 months after implementing exercises (t = -3.569, p <0.001). Regarding the EVA, there was also a significant betterment (Z = -5.663, p <0.001) comparing pre and post treatment values and this result was maintained at 6 months (Z = 3.256, p <0.001). Conclusion: Group shoulder therapy improves the painful symptomatology as well as the function in the tendinopathies of the rotator cuff and the subacromial syndrome. This improvement is maintained in long term. Population education improves the adherence to the treatment.

Keywords: Group therapy, pain, shoulder

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0532 Top


Ultrasound-guided, percutaneous, needle technique, a1-pulley release for trigger finger

N. Luanchumroen, D. Cifu1

Department of Medicine, Rehabilitation Division, Ministry of Health, Nopparat Rajathanee Hospital, Bangkok, Thailand, 1Virginia Commonwealth University School of Medicine, Rehabilitation, Florida, USA

E-mail: noraritton@gmail.com

Introduction/Background: Trigger finger is a common cause of hand pain and disability and an A1-pulley dividing, percutaneous release is a definitive treatment for advanced stage disease. High-resolution, musculoskeletal ultrasonography provides clear visualization of the A1-pulley and flexor tendon, however, the evidence to support ultrasonographic guidance of this procedure is scarce. This study aim to evaluate the results of ultrasound (US)-guided, percutaneous, needle technique, annular, A1-pulley release for trigger finger (TF); specifically identifying whether this minimally-invasive procedure had low complication rates and enables early functional recovery. Materials and Methods: Single center, prospective cohort study of consecutive patients who were > 20 years of age, had grade II TF or higher for at least 4 months, and were unresponsive to conservative treatment. Patients with chronic connective tissue disease, rheumatoid arthritis, previous TF surgery, pregnancy, or bleeding risks were excluded. The procedure was an US-guided percutaneous A1 pulley release using needle technique. Outcome measures at 1 week post-surgery included; recovery time, pain level and duration, use of analgesic medications, time to normal activity of affected TF, and subject satisfaction for cosmesis and overall results. Surgical complications were monitored for 6 months. Results: Thirty-nine fingers from 33 patients who received US-guided, percutaneous, A1-pulley release using needle technique were included in the analysis. Mean operative time was 6.17 (SD=1.70) minutes. Median post-operative pain duration, use of analgesic medications, and recovery time to normal activity were 1.0 (IQR=0-2), 0.5 day (IQR=0.5-1), and 2 days (IQR=1-2), respectively. Mean subject satisfaction scores for wound appearance and overall treatment were 9.87 and 9.61, respectively. Only one patient had an incomplete release and no severe complication were observed. Conclusion: US-guided, percutaneous, A1-pulley release with needle technique was an effective treatment for TF, with high levels of overall satisfaction and no significant complications.

Keywords: A1 pulley release, percutaneous, ultrasound-guided

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1082 Top


The effect of adding eccentric exercises to conventional physical therapy for patients with rotator cuff tendinopathy

Y. S. Horng1, V. Chiu1, Y. S. Horng1,2

1Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 2Tzu Chi University, School of Medicine, Hualien, Taiwan

E-mail: yushiow0413@yahoo.com.tw

Introduction/Background: To evaluate the effectiveness of adding an eccentric training of the rotator cuff to conventional physical therapy in patients with subacromial pain syndrome involving rotator cuff tendinopathy. Materials and Methods: Fifty-nine patients with rotator cuff tendinopathy, diagnosed by an physiatrist, were included and randomly allocated into an experimental group (EG) or a control group (CG). The experimental group (n=31, mean age=57.4+13.4 years) received an eccentric training plus a conventional physical therapy, including modalities, scapular stabilization exercises and stretching, while the control group (n=28. Mean age=63.1+10.0 years) received a conventional physical therapy only. Patients in both groups received treatments twice a week for 3 months. Primary outcomes were shoulder pain (a 0-100 mm visual analog scale; VAS) and function measured with the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcome measures were isometric strength of abduction at 900 of scapular abduction (hand-held dynamometer) and shoulder range of motion (forward elevation, external rotation, and internal rotation). All measurements were taken at baseline and after treatment. Results: After treatment, both groups showed a significant decrease in VAS scores (EG:-16.4 mm, P=0.003 and CG:-21.9 mm, P<0.001) and a significant decrease in DASH score (EG:-8.8 points, P=0.01 and CG:-7.5 points, P=0.002). Both groups also had a significant increase in isometric muscle strength (EG: 1.9 pounds, P<0.001 and CG: 1.8 pounds, P=0.002). No statistically significant differences were found between the groups for any of the evaluated outcome measures. Conclusion: It was shown that both groups had significantly increased isometric strength, decreased pain and better function after 3 months of treatment. Conventional physical therapy with or without eccentric training is effective in treating patients with rotator cuff tendinopathy.

Keywords: Eccentric training, physical therapy, rotator cuff tendinopathy

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2266 Top


Evaluating degree of symptom improvement, safety and the change of electrophysiological findings after ultrasound versus landmark guided steroid injection in treatment of carpal tunnel syndrome

S. Haghighat, B. Vahdatpoor, Z. Azimi

Department of Physical Medicine and Rehabilitation, Isfahan Medical School of Sciences, Isfahan, Iran

E-mail: haghighatshila@gmail.com

Introduction/Background: To evaluate the degree of symptom improvement, safety and the change of electrophysiological findings after Ultrasound (US)-guided versus Landmark (LM)- guided local steroid injection in treatment of carpal tunnel syndrome (CTS). Materials and Methods: Fifty two patients with moderate or moderate to severe CTS were recruited in this study. The subjects were randomly assigned into each US-guided or LM-guided steroid injection group and received 40 mg methylprednisolone. After 4 weeks and 12 weeks, the patients were evaluated using Boston questionnaire and electrophysiologic parameters. Results: All variables including symptom/functional scores and electrophysiological findings improved significantly in both groups after 4 weeks (all P < 0.05) except CMAP amplitude in LM-guided group. However, LM-guided group showed a regress with all variables after the 12 week period compared with the 4-week period, these improvements persisted at the week 12 after treatment in the US-guided group (P < 0.05) except Functional Status Scale (FSS) and Sensory Nerve Action Potential (SNAP). The improvement in the Compound Muscle Action Potential (CMAP) amplitude in the US-guided group at the week 12 was higher than in the LM- guided group (P < 0.05); however, SNAP amplitude and SNAP Nerve Conduction Velocity (NCV) had improved significantly in the LM-guided group. Significant differences were not observed between groups with respect to Symptom Severity Score (SSS), FSS, SNAP latency, and CMAP latency in 4 or 12 weeks after treatment (P < 0.05). Conclusion: Symptom severity, functional status and all electrophysiologic parameters improved significantly in both groups and generally no statistical significant difference was observed between two groups.

Keywords: Carpal tunnel syndrome, steroid injection, ultrasound

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1096 Top


Effects of cervical stabilization/strengthening exercises in violinists with chronic non-specific neck pain

Y. J. Tsai, T. H. Lee, Y. L. Kuo

Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan

E-mail: yiliangkuo@mail.ncku.edu.tw, yijutsai@mail.ncku.edu.tw

Introduction/Background: Violinists frequently assume an asymmetrical neck posture and activate their superficial neck flexor muscles to stabilize the violin for prolonged playing. It is unclear whether this augmented activation of superficial neck flexors may influence the effects of stabilization exercises for violinists with neck pain. The aim of this study was to investigate the effect of cervical stabilization/strengthening exercises on pain intensity, function, sensorimotor function, and upper body posture in violin players with chronic non-specific neck pain. Materials and Methods: The one-group pretest-posttest design with a double pretest was used. Violin players with chronic non-specific neck pain were recruited from students of a university symphony orchestra. Pain intensity (numeric rating scale), function (neck disability index), sensorimotor function (craniocervical flexion test, cervical muscle endurance tests, cervical range of motion tests, and cervical reposition error tests), and upper body posture were assessed at three time points (week 0, 4, and 10). After the completion of two pretests, participants followed instructional videos and performed cervical stabilization/strengthening exercises, 20 minutes a day, 3 days a week for 6 weeks. Results: Twenty-four participants were initially enrolled, and 20 completed all testing sessions. Participants reported moderate neck pain and no disability at week 0. The outcome measures of pain intensity, function, and sensorimotor function showed statistically significant improvement during the intervention period (week 4 vs. week 10). Meanwhile, these outcome measures remained relatively unchanged during the baseline period (week 0 vs. week 4). For the outcome measure of upper body posture, only the craniovertebral angle relative to the horizontal plane significantly increased during the intervention period. Conclusion: Six-week video based cervical stabilization/strengthening exercises resulted in clinically meaningful and beneficial effects. A randomized controlled study with a larger sample is suggested to further investigate the effects of cervical stabilization/strengthening exercises in violin players with more severe neck pain.

Keywords: Exercise, musician, neck pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1402 Top


Intra-articular distension without arthrography for adhesive capsulitis

W. Ouannes, S. Layouni, R. Moncer, I. Feki, S. Elmtaouaa, E. Toulgui, F. Khachnaoui, S. Jemni

Department of Physical Medicine and Rehabilitation, University Hospital Sahloul, Sousse, Tunisia

E-mail: saoussenlayouni@yahoo.fr, elmtawa.sahbi@yahoo.fr

Introduction/Background: Adhesive capsulitis is a clinical entity characterized by spontaneous onset of shoulder pain accompanied a loss of motion and a decrease of the joint volume capacity. The distension of the shoulder joint has proven to be an efficient percutaneous treatment, and various techniques have been proposed. The objective of the study is to determine the effectiveness and safety of the technique “repeated intra articular distension without arthrography” combined with an intensive program of rehabilitation in patients with adhesive capsulitis. Materials and Methods: A prospective controlled study. Fifteen patients with adhesive capsulitis were included. Intervention consisted of three intra articular distension with saline, xylocaine and corticosteroid, given at one week intervals. The same technique was combined with an intensive program of rehabilitation associated. the evaluation parameters used were Hospital Anxiety and Depression Scale (HADS), visual analog scale (VAS) pain score, a shoulder-specific disability measure by DASH score and range of active and passive motion (anterior elevation, lateral elevation and external rotation). Patients were evaluated before intra articular distension. The outcome measures were assessed at 1, 2, 3, and 4 weeks after last capsular distension. Results: Study population comprised fifteen patients with a mean age of 54,8±8,6 underwent capsular distension. All patients reported significant improvement during the study in terms of the pain score, anterior elevation and lateral elevation after the first distension. External rotation, the DASH score and HADS improved after three capsular distension. One month after last capsular distension, this gain persisted in all functional parameters and in psychological profile. Results did not differ by etiology of capsulitis. No severe complications occurred as a result of the capsular distension. Conclusion: Our results show that three capsular distension and intensive program of physiotherapy have a beneficial effect. This combination has a useful role in the early management of adhesive capsulitis.

Keywords: Adhesive capsulitis, intra articular distention, shoulder

Disclosure of interest: The authors did not declare any conflict of interest.


  A2.05 Musculoskeletal Conditions - Regional Pain Syndromes of The Pelvis and Lower Extremity (Including Enthesopathy, Tendinitis and Others) Top



  ISPR8-0434 Top


Anterior knee pain and its intrinsic risk factors among runners in poor resourced peri-urban communities

S. H. Kunene

Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa

E-mail: siyabonga.kunene@wits.ac.za

Introduction/Background: Anterior knee pain (AKP) is the most common overuse injury experienced by runners and is prevalent among females, adolescents and young adults. Several modifiable intrinsic risk factors have been suggested to contribute to AKP. The objective was to determine the prevalence and modifiable intrinsic risk factors for AKP among runners in poor resourced peri-urban communities in Ekurhuleni, South Africa. Materials and Methods: A cross–sectional study design was used. Population comprised of 347 runners from six developing running clubs. Convenient sampling method was used, and 183 participants were sampled using a Raosoft statistical tool. Participants were aged between 13 and 55-year-old with no history of degenerative and traumatic injuries. Standardized questionnaire was used to determine AKP prevalence and 12 physical tests were used to screen for modifiable intrinsic risk factors. Ethical clearance, permission from club managers and consent from participants were obtained. Data were collected over four months and SPSS was used to obtain descriptive (frequencies) and inferential (logistic regression) statistics. Results: Anterior knee pain accounted for 40%. Males (57.9%) and youth (57.9%) with 3-5 years of running experience (31.1%) dominated. The AKP was significantly associated with age (c2=6.484, p=0.039) and running experience (c2=8.389, p=0.036). The following modifiable intrinsic risk factors were found to have contributed significantly to AKP: tight hamstrings (p=0.051, OR=1.021); tight iliotibial band (p=0.046, OR=1.122); weak quadriceps (p=0.040, OR=0.154), weak hip control muscle (p=0.004, OR=1.131) and patellar tilt abnormalities (p=0.015, OR=1.332). Conclusion: Anterior knee pain is prevalent and modifiable intrinsic risk factors exist amongst runners. Routine approach to AKP should include consideration of modifiable risk factors. A transdisciplinary approach should be considered to compensate for the lack of resources in low socioeconomic communities.

Keywords: Anterior knee pain, intrinsic risk factors, runners

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0673 Top


The effect of paraffin bath therapy versus extracorporeal shockwave therapy in the management of plantar fasciitis: A randomized clinical trial

A. Karahan, B. Ordahan1, K. Ozkuk2

Department of Physical Medicine and Rehabilitation, Medical Faculty of University of Usak, 2Medical Faculty of University of Usak, Medical Ecology and Hydroclymatology, Usak, 1Department of Physical Medicine and Rehabilitation, Konya Training and Research Hospital, Konya, Turkey

E-mail: ali.karahan@usak.edu.tr

Introduction/Background: Plantar Fasciitis (PF) is the most common cause of painful heel. The etiology is multifactorial but usually involves inflammation and degeneration of the plantar fascia origin. Physical therapy interventions such as contrast bath, ultrasonography and iontophoresis help in resolution of symptoms. According to our current knowledge the efficacity paraffin bath therapy (PBT) is ambiguous. This prospective, randomized controlled study aims to compare the efficacy of PBT and extracorporeal shockwave therapy (ESWT in the treatment of plantar fasciitis. Materials and Methods: Seventy patients were randomized into either the PBT (12 men, 23 women; mean age 39.12±7.15 years) or ESWT (14 men, 21 women; mean age 38.37±8.87 years) groups. Four patients in PBT group and five patients in ESWT group were lost to follow-up. Groups were similar regarding age, sex, and body mass index (all p>0.05). PBT group had paraffin bath therapy (5 times per week, for 3-week duration) for affected foot while ESWT was applied twice a week for three weeks. As outcome measures patients’ pain and functional status were evaluated with Visual Analog Scale (VAS), Heel Tenderness Index (HTI), Foot and Ankle Outcome Score (FAOS) and ultrasonographic thickness of the plantar fascia recorded. The study parameters were administered at baseline, immediately after treatment and after 12 weeks. Results: Statistically significant improvement was observed in several studied parameters after the treatment and during the follow-up study in the both groups. The PBT significantly improved the VAS, HTI and FAOS but not in thickness of the plantar fascia. even in the long term. Conclusion: Both PBT and ESWT treatments improved pain levels and function and quality of life in individuals with plantar fasciitis. But ESWT method was superior according to PBT in treating plantar fasciitis.

Keywords: Heel, pain, paraffin

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2116 Top


Analyze the effects of botulinum toxin infiltration in the shortening of the aquiles-calcaneal-plantar system as a treatment for plantar fascitis

C. De Miguel Benadiba, A. Teixeira Taborda1, J. C. Estupiñan, S. Domínguez, M. J. Buzzetta, M. P. Sánchez Tarifa, M. J. Lillo Gonzalez

Department of Rehabilitation, Ramon y Cajal Hospital, 1Department of Rehabilitation, Fundación Jimenez Diaz Hospital, Madrid, Spain

E-mail: teixeirastrid@hotmail.com, cdemibe@gmail.com

Introduction/Background: The aquiles-calcaneal-plantar system shortening (ACPSS) is a frequent cause of ankle/foot pain. Pain can be located in the Achiles tendon or in the calcaneal insertion of the Plantar Fascia (PF), is the most frequent cause of chronic heel pain. Diagnosis is clinical given by heel pain that may vary in location, although calcaneus anteromedial region is the most common point. At physical examination it’s important to evaluate the ankle range of motion. Silverskiold test informs about the relantionship between the origin of the shortening if it´s the gastrocnemius muscle or the soleus. Materials and Methods: Prospective study, from December 2016-December 2017, were selected 41 patients but 56 infiltrated legs, with PF resistant to conservative treatment, who had performed 2 or more of this treatments, without improvement: analgesics, insoles, physiotherapy and corticosteroids infiltration. All had clinical criteria for ACPSS. Patients were infiltrated in the gastrocnemius intern muscle with 100-150 IU of botulinum toxin, associated with triceps sural eccentric stretching 3/day, from the 4th day postinfiltration. Visual analog scale for pain (VAS) and the Foot Function Index- Spanish version (FFI) were evaluated. Patients were reviewed after 1, 4 and 6 months. Results: The results were analyzed through the SPSS program; 66% (27 patients) were women between 40-60 years of age; 73% (30 patients) had received more than 3 treatments at the beginning of the study; 46% (19 patients) showed a treatment adherence of 2-3 times a day. Initial VAS was 7, one month later was 5 and 6 months after infiltration was 4. FFI scale one month after infiltration was 38% and sixth month was 28%; 78% (32 patients) recommended the treatment. Conclusion: Infiltration with botulinum toxin, allow to improve the length of the posterior compartment in patients with ACPSS as well as decrease in VAS, and the improvement in the functionality and limitation of the activities according to the FFI scale.

Keywords: Boyulinum toxin, infiltration, plantar fasciitis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1783 Top


Widespread myofascial dysfunction and spinal sensitization in women with endometriosis-associated chronic pelvic pain

P. Stratton, H. Tandon1, N. Sinaii2, J. Shah1, B. Karp

National Institutes of Health, National Institute of Neurological Disorders and Stroke, 1Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, 2Clinical Center, National Institutes of Health, Biostatistics and Clinical Epidemiology Service, Bethesda, USA

E-mail: hannah.tandon@nih.gov, strattop@mail.nih.gov

Introduction/Background: Despite optimal surgical/hormonal treatment, some women with endometriosis continue to have chronic pelvic pain (endo-CPP). Co-morbid non-pelvic pain, myofascial dysfunction, and sensitization have rarely been reported in this population. We systematically assessed the presence and distribution of pain, myofascial dysfunction, and spinal sensitization in women with endo-CPP. Materials and Methods: Women (18-50 years) with endo-CPP after optimized surgical/hormonal treatment were evaluated. Participants underwent gynecologic examination of pelvic floor muscles to identify tenderness/spasm. Neuromusculoskeletal examination included assessment of paraspinal tactile allodynia (Von Frey monofilament) and hyperalgesia (Wartenburg pinwheel). Myofascial trigger points (MTrPs) were identified in 13 regions bilaterally. Pressure-pain thresholds (PPTs) were measured over interspinous ligaments and MTrPs. Results: Twenty-eight women with endo-CPP for a median of 12 years (range 1-20) were evaluated. All had pelvic floor muscle spasm on gyn examination. All endorsed the pelvic floor as a major focus of pain, which was described as focal in 19/28. All women had widespread myofascial dysfunction with MTrPs in more than two-thirds of assessed regions. Low PPTs (<9 lb/in²) were found over interspinous ligaments in 24 (86%) women. Widespread spinal segmental sensitization (allodynia and hyperalgesia) was present in 15 (53%) subjects. Thoracic sensitization was present in 19 (68%) women and lumbosacral sensitization related to the pelvic region in 17 (61%). While cervical sensitization was detected in only 2 (7%), 22 (79%) reported recurrent, severe headaches and 14 (50%) experienced orofacial pain. Conclusion: Women with endo-CPP can have myofascial dysfunction beyond the pelvic focus of pain, demonstrated by widespread diffuse and regional allodynia, hyperalgesia, MTrPs, and lowered PPTs, likely reflecting central sensitization. Sensitization may be initiated and maintained by pelvic floor spasm and may account for pain persisting after resection of endometriosis lesions and despite continued use of hormonal treatment. These diffuse and focal myofascial and central nervous system manifestations warrant consideration in management of pain in this population.

Keywords: Central sensitization, chronic pelvic pain, endometriosis

Conflict of interest Disclosure statement: Toxin and funds for study monitoring are provided by Allergan through a clinical trials agreement with the National Institutes of Health.


  ISPR8-0403 Top


Comparisons of bracing and patella taping on knee three-dimensional kinematics of women with patellofemoral pain syndrome in stance phase of running

M. Taghipourdarzinaghibi, S. Hosseinzadeh, M. Eslami1

Mobility Impairment Research Center, Babol University of Medical Sciences, Babol, 1Department of Physical Education and Sport Sciences, University of Mazandaran, Babolsar, Iran

E-mail: taghipourm@yahoo.com

Introduction/Background: Patellofemoral pain syndrome is one of the most common knee injuries that accounted for between 25-40% of all knee problems presenting to sports medicine centers. Two treatment methods of bracing and taping are recommended in these patients that their effectiveness is unclear. The aim of this study was to evaluate the efficacy of the two treatment methods on knee three-dimensional kinematics in patients with PFPS during stance phase of running. Materials and Methods: Fourteen patients with PFPS in range of 20-40 ages were participated in this study. Three-dimensional angles at the knee during stance phase of running were recorded by motion analysis cameras [Figure 1] in three conditions, namely; without intervention, bracing [Figure 2] and taping [Figure 3] conditions. Results: Results of this study showed that knee valgus angle in PFPS patients was decreased significantly with brace when compared to without intervention during running. Patella taping did not show significant differences on knee joint kinematics as compared to other conditions (p>0.5). Conclusion: Using patellofemoral brace during running can cause change more than patella taping in knee kinematics. Our finding shows that reduction of knee abduction angle by using brace could decrease perceived pain in women with PFPS during stance phase of running.

Keywords: Bracing and taping, knee kinematics, PFPS

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0931 Top


The effectiveness of steroid injection in treatment of plantar fasciitis: A systematic review and meta-analysis of controlled-randomized trials

J. Lee, Y. H. Kim

Department of Rehabilitation Medicine, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of K, Uijeongbu-si, Republic of Korea

E-mail: drlee1971@gmail.com

Introduction/Background: Plantar fasciitis is very troublesome in clinical fields. Although steroid injection has been a widely used treatment option in musculoskeletal disorders, there have been arguments about the effectiveness in plantar fasciitis. This study is to determine the effectiveness of steroid injection in the treatment of plantar fasciitis. Materials and Methods: Meta-Analysis was conducted using searching engines such as Google Scholar, PubMed, CINAHL, Embase and manual searching which were searched to December 2017. The following key search terms were used; plantar fasciopathy fasciitis in google scholar, “fasciitis, plantar”[Mesh] with two filter options “Randomized Controlled Trial” and “human” in PubMed, plantar fasciopathy fasciitis in CINAHL, plantar AND fasciopathy AND (‘fasciitis’ OR ‘fasciitis’/exp OR fasciitis) in Embase. Two articles were also found using manual searching. Total 35 articles were found and duplicates were removed. Two reviewers reviewed and selected the articles which has randomized controlled design and eligible data. Four articles were determined to be relevant, meeting inclusion and exclusion criteria. Results: We found that the overall standardized mean differences of pain outcome between steroid injection and other treatments or sham was -0.57 (95% confidence interval, -0.83 to -.0.30), with low heterogeneity (P = 0.52, I2 = 0%) at 1 month, but -0.33 (95% confidence interval, -0.76 to 0.10, P = 0.13, I2 = 50%) at 3 month. It suggested evidence of the effectiveness of short-term steroid injection, compared with autologous blood injection or other conservative treatment, but limited evidence of long-term effectiveness and functional improvement. Conclusion: Although steroid injection in treating plantar fasciitis has been arguing, there is evidence of the effectiveness of steroid injection in relieving pain for 1 month. But further study is needed to determine long-term effectiveness of steroid injection.

Keywords: Plantar fasciitis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0435 Top


The impact of anterior knee pain on the quality of life among runners in poor resourced peri-urban communities

S. Kunene

Department of Physiotherapy University of the Witwatersrand, Johannesburg, South Africa

E-mail: siyabonga.kunene@wits.ac.za

Introduction/Background: Anterior knee pain (AKP) is the most common injury among runners and has a negative impact on the quality of life (QOL) of many athletes. The objective was to determine the impact of anterior knee pain on the QOL among runners in poor resourced peri-urban communities in Ekurhuleni, South Africa. Materials and Methods: A cross–sectional study design was used. A population of 73 runners with AKP were all included to participated in this study. Participants included runners aged 13 to 55 year-old with no history of degenerative and traumatic knee injuries. The standardised SF-36 questionnaire was used to collect data. Ethical clearance, permission from club managers and consent from participants were obtained. Data were collected over six weeks and analysed using SPSS. Descriptive statistics included the calculation of frequencies, means, standard deviations and ranges. Inferential statistics included Spearman’s rank correlation coefficient calculation. Results: The lowest QOL scores were found among the following SF-36 scales: role functioning/physical (62), role functioning/emotional (59), energy/fatigue (59), emotional well-being (68) and pain scales (63). Males, youth and runners with least experience in running presented with the lowest scores. Significant correlation was found between the following variables: role functioning/physical and experience (p =.030, r =-.221), role functioning/emotional and gender (p =.017, r =-.247) and race (p =.012, r =-.265), general health and experience (p =.021; r =-.239), energy/fatigue and race (p =.012; r =.264), emotional well-being and age (p =.020; r =.241), general health and gender (p =.013; r =.456), social functioning and age (p =.010; r =.271) and energy/fatigue and experience (p =.001; r =-.371). Conclusion: Multidimensional rehabilitation programme is recommended to improve the QOL among runners with AKP. This study will provide valuable knowledge that will assist clinicians in their development of rehabilitation programmes for AKP.

Keywords: Anterior knee pain, quality of life, runners

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0230 Top


Autologous blood-derived products compared to corticosteroids for treatment of plantar fasciopathy: A systematic review and meta-analysis

Y. Chen

Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan

E-mail: noah08300@gmail.com

Introduction/Background: This review article evaluated the efficacy of autologous blood-derived products (ABPs), including autologous blood (AB) and platelet-rich plasma (PRP), in reducing pain and improving function compared with corticosteroids (CS) for plantar fasciopathy (PF) patients. Materials and Methods: Literature comparing ABP and CS to treat PF up to August 2017 was systematically reviewed. The visual analogue scale score or American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was evaluated at 1.5, 3, and 6 months’ follow-up. A subgroup analysis concerning PRP preparation techniques and study designs was performed. Twelve randomized controlled trials (RCTs) and three quasi-experimental studies with 680 patients were included. Results: CS reduced pain more than AB within 1.5 months and 3 months, but the effect disappeared at 6 months. PRP reduced pain more effectively at 6 months post-injection than CS. However, there was no significant difference in AOFAS scores between PRP and CS injections at all time points. In the subgroup analysis, pain was significantly reduced due to self-prepared PRP, one-step separation, and RCT-designed studies at 6 months. Conclusion: The results of this meta-analysis will provide evidence-based information for making treatment decisions for patients with PF.

Keywords: Corticosteroids, plantar fasciopathy, platelet rich plasma

Disclosure of interest: The authors did not declare any conflict of interest.


  A2.06 Musculoskeletal Conditions - Back Pain and Spine Disorders Top



  ISPR8-0257 Top


Catastrophizing and chronic low back pain: A functional magnetic resonance study

L. Jorge, L. Rocha, A. C. Cruz Jr.1, P. P. M. Oliveira Jr.1, E. Amaro Jr.1

Instituto do Cérebro, Hospital Israelita Albert Einstein, 1Instituto de Radiologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

E-mail: lilianalj@gmail.com

Introduction/Background: Pain depends on the interaction of cognitive, and emotional factors. Individuals with negative coping strategies such as catastrophizing are prone to develop chronic pain syndromes, and poor functional outcomes. This maladapted behavior may be caused by abnormalities in attention systems and amplification of pain processing. Low back pain (LBP) is a disabling pain syndrome, but it is poorly known how catastrophizing affects brain activity. To explore catastrophizing neural correlates in LBP, we performed an fMRI study to verify the central pain system (pain matrix), and anticipation responses. Under unpredictable stimuli, we expected to see catastrophizing LBP showing lower ability to disengage attention to pain and lower pain threshold. Materials and Methods: We studied 43 LBP and 27 C subjects. LBP responded catastrophizing questionnaires (FABQ, CSQ). We used a pressure-pain device, to deliver stimuli in the thumbnail. Pain thresholds detected apriori, for moderate pain. Subjects performed 2 event-related fMRI experiments: 1-Supraliminal Pain for the pain matrix study; 2-Variable Pain for anticipation at unpredictable stimuli. T2* images acquired in a 3T Siemens scanner. FMRI data was preprocessed and carried out using FSL tool. Corrected cluster significance threshold: p=0.05. Results: Both groups were similar for demographics. LBP had lower threshold for pressure stimulus. Both groups activated pain matrix areas, and had the same pattern during anticipation. When covarying with FABQ during experiment 2, LBP showed greater posterior cingulate cortex activation, indicating that in LBP, FABQ reduces brain activity. Conclusion: LBP had lower pain threshold, suggesting central sensitization. Although both groups activated the pain matrix and had the same anticipation pattern, catastrophizing LBP had decreased activity in posterior cingulate cortex, suggesting negative coping skill influences pain appraisal in anticipation. The area belongs to the attention system and antinociception pathways in healthy subjects. Our results are in line with previous data showing greater posterior cingulate activity in low catastrophizers.

Keywords: Catastrophizing, functional neuroimaging, low back pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1715 Top


Brace wearing time is the strongest predictor of final reults: A regression model in 1457 high risk consecutive adolescents with idiopathic scoliosis

S. Donzelli, S. Negrini1, F. Zaina2, F. Di Felice2

Italian Scientific Spine Institute, ISICO, Milano, 1University of Brescia, Chair of Phyisical and Rehabilitation Medicine, Brescia, BS, 2 Italian Scientific Spine Institute, Isico, Milan, Italy

E-mail: sabrina.donzelli@isico.it, stefano.negrini@isico.it

Introduction/Background: Current Guidelines propose PCA, but there are no large studies to check final results, and predict which patients will respond better.A personalised conservative approach (PCA) to Adolescents with Idiopathic Scoliosis (AIS) is based on different treatment protocols according to risk groups (11-20, 21-30, 31-40, 41-45).The aim of the present research is to develop a model to predict end results of a PCA in Adolescents with Idiopathic Scoliosis (AIS). Materials and Methods: Design: retrospective observational study nested into a prospective database. Inclusion criteria: AIS, 11-45°, Risser 0-2, age 10-16, first consultation, no previous bracing, at end of observation (Risser 3, medical prescription). Treatments followed a personalised conservative approach (PCA) following the step-by-step theory (Negrini 2018): intensity increases with estimated risk factors. Outcomes: end Cobb angle <50° and <30° and no-progression. A backward selection regression modelling used to assess the effect of 7 covariates: age, BMI, ATR, TRACE (Trunk Aesthetic Clinical Evaluation) score, Risser and Cobb angle at baseline; referred brace wear (RBW) and risk groups according to which different PCA. Results: 1457 patients, 82.6% females, age 12.11+-1.05. End<50° was predicted by BMI and RBW (0.21 and 0.10 probability respectively) while age, Cobb and ATR were statistically significant but weighting <0.005. End<30° is predicted by RBW (0.37), and Cobb (0.03), while age counts <0.0005. No-progression was predicted by RBW (0.33); Cobb, TRACE and ATR counted <0.02, and age <0.0002. Considering the 4 risk groups, end<30° and end<50° probability decreases with the groups (R2=0.3 and 0.04 respectively). Conclusion: Time of brace wearing is the strongest predictor of final results whether a <50, <30 or stability outcomes are considered. Risk groups based on PCA are good predictors.

Keywords: Brace, scoliosis, treatment outcome

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2110 Top


Prevalence of sacroiliac joint disfunction and sacroiliac pain provocation tests in people with low back pain.

C. Ramírez, L. Sanchez, B. Oliveira1

Universidad Industrial de Santander, Physical Therapy School, Bucaramanga, 1Department of Physical Therapy, Universidad Federal de Sao Carlos, Sao Carlos, Brazil

E-mail: fisiocaro@gmail.com

Introduction/Background: Sacroiliac Joint Dysfunction (SIJD) can explain about 15% to 30% the presence of idiopathic low back pain (LBP). SIJD can be diagnosed through the sacroiliac pain provocation tests (PPT), considering SIJD when 3 or more tests are positive. The aim of the study was to establish the prevalence of SIJD and sacroiliac PPT in people with LBP. Materials and Methods: One hundred and thirty-six people with LBP of both genders, with 29±12 years old and BMI 23.35±2.9 Kg/m2 were evaluated. A trained physical therapist applied six sacroiliac PPT with the best psychometric properties described in the literature (Distraction, Thigh thrust, Gaenslen, Compression, Sacral thrust and FABER). Results: A prevalence of 40% of SIJD was found. Most prevalent tests were FABER and Sacral Thrust, while Distraction test was the least prevalent (Figure). Twenty-five percent of the population presented one positive test, 16% had at least 3 positive tests and only 5% of participants had 6 positive tests. Conclusion: To our knowledge, there are no reports in the literature of the individual prevalence of sacroiliac PPT. According to the results, during the examination of people with low back pain suspected of having SIJD, FABER and Sacral Thrust tests should be done first, followed by compression and Gaenslen tests. The above mentioned could avoid unnecessary sacroiliac stress and pain to the patients´ joint.

Keywords: Prevalence, provocation tests, sacroiliac pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2244 Top


Test-retest reliability of sit-to-stand and stand-to-sit analysis in people with and without chronic non-specific low back pain

M. R. Pourahmadi, I. Ebrahimi Takamjani, J. Sarrafzadeh, S. Jaberzadeh1

Department of Physiotherapy, Iran University of Medical Sciences, Tehran, Iran, 1Faculty of Medicine, School of Primary Health Care, Monash University Peninsula Campus, Nursing and Health Sciences, Melbourne, Australia

E-mail: pourahmadipt@gmail.com

Introduction/Background: Sit-to-stand (STD) and stand-to-sit (SIT) analysis can provide information on functional independence in daily activities in patients with low back pain (LBP). However, in order for measurements to be clinically useful, data on psychometric properties should be available. The main purpose of this study was to investigate intra-rater reliability of STD and SIT tasks in participants with and without chronic non-specific LBP (CNLBP). The second purpose was to detect any differences in lumbar spine and hips sagittal plane kinematics and coordination between asymptomatic individuals and CNLBP patients during STD and SIT. Materials and Methods: Twenty-three CNLBP patients and 23 demographically-matched controls were recruited. Ten markers were placed on specific anatomical landmarks. Participants were asked to perform STD and SIT at a preferred speed. Peak flexion angles, mean angular velocities, lumbar to hip movement ratios, and relative phase angles were measured. The procedure was repeated after 2 h and 6–8 days. Differences between two groups were analyzed using independent t-test. Intraclass correlation coefficient (ICC 3,k), standard error of measurement (SEM), and limits of agreement (LOAs) were also estimated. Results: The ICC values showed moderate to excellent intra-rater reliability, with relatively low SEM values (≤10.17°). The 95% LOAs demonstrated that there were no differences between the measured parameters. Furthermore, CNLBP patients had limited sagittal plane angles, smaller angular velocities, and lumbar-hip discoordination compared to asymptomatic participants. Conclusion: The results showed moderate to excellent test-retest reliability of STD and SIT analysis. Moreover, CNLBP patients had altered kinematics during STD and its reverse compared to asymptomatic participants.

Keywords: Biomechanical phenomena, functional activity, low back pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0411 Top


Comparison of the cross sectional area of longus colli muscle between patients with cervical radicular pain and healthy controls

P. Noormohammadpour, A. Dehghani, M. A. Mansournia1, N. Moghaddam, M. Miri2, R. Kordi

Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, 1Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, 2Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran

E-mail: normohamadpour@tums.ac.ir

Introduction/Background: Previous studies have shown atrophy of paravertebral lumbar muscles in patients with lumbar radicular pain, and proposed rehabilitative approaches based on these findings. However, changes of cervical paravertebral muscles in patients with cervical radicular pain are still unknown. The aim of this study was to compare the cross sectional area (CSA) of longus colli muscle (LCM) in patients with cervical radicular pain and healthy controls via ultrasound measurement. Materials and Methods: Twenty patients with more than 4 weeks of cervical radicular pain and 20 healthy matched (for body mass index, age, and gender) control subjects. The CSA of LCM at the level of C5-C6 was measured by ultrasound with the subject in a supine position. Also, Neck Disability Index (NDI), and visual analogue scale (VAS) were reported by patients. Independent sample t-test was used for investigation of differences in cross sectional area and other variables between both groups. Results: Twenty patients with cervical radicular pain with mean (SD) age of 42.4 (7) years and 20 healthy matched controls with mean (SD) age of 40.7 (7) years participated in the study. Patients with cervical radicular pain showed smaller CSA of LCM bilaterally compared with controls (mean (SD) difference: 0.37 (0.15)) (P value<.001). Within patients group, there were no significant differences between CSA of LCM in the involved and non-involved sides. Conclusion: This is the first study which showed that patients with cervical radicular pain had smaller bilateral CSA of LCM in comparison with healthy controls via ultrasound assessment. It is also not clear whether atrophy of longus colli muscle in patients with cervical radicular pain is a consequence or a cause of it. Reduction in the stability of neck due to atrophy of LCM could make the cervical spine region susceptible to more injuries which might be prevented by functional and strengthening exercises.

Keywords: Cervical radicular pain, longus colli muscle, ultrasound measurement

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0424 Top


The effect of positive changes during intraoperative monitoring on the functional improvement in patients with cervical compressive myelopathy

S. J. Lee, S. B. Kim1, K. W. Lee1, J. H. Lee1, M. K. Park1

Department of Rehabilitation Medicine, Dong-a University Hopsital, 1Department of Physical Medicine and Rehabilitation, Dong-A University Hospital, Busan, Republic of Korea

E-mail: lsj995414@hanmail.net

Introduction/Background: Cervical compressive myelopathy (CCM) is a progressive, degenerative spine disease and the most common cause of spinal cord dysfunction in older individuals. Current clinical guidelines for spinal surgery strongly recommend multimodal intraoperative monitoring (IOM) during spinal surgery as a reliable and valid diagnostic adjunct to assess spinal cord integrity. The aim of this study was to evaluate the effect of positive changes during IOM on the functional status in patients with CCM. Materials and Methods: Patients who underwent spinal surgery with IOM due to CCM were enrolled. During the surgery, patients underwent IOM using motor evoked potential (MEP) and somatosensory evoked potential (SEP). MEP and SEP were checked before and immediately after decompression. A shortened in latency greater than 10 % or an increase in amplitude greater than 50% was regarded as a ‘positive changes’. Subjects were divided according to the presence of positive changes. Motor scores of American Spinal Injury Association (ASIA) impairment scale and Korean version of modified Barthel index (K-MBI) were evaluated before and after operation. Results: Twenty-nine patients underwent spinal surgery due to CCM. Among these patients, 11 showed positive changes in MEP during IOM. When the two groups were compared, improvement rate in the AISA motor score and K-MBI were significantly higher in patients with positive changes than in patients without positive changes at 1 month after surgery. The duration of hospital stay was significantly shortened in the ‘positive change’ group. Regardless of positive change, nearly all patients suffered from neuropathic pain after operation. Conclusion: Positive changes in MEP during IOM may affect better functional improvement 1 month after operation and early discharge without significant complications in CCM patients. However they do not affect the neuropathic pain. Thus, tailored, proper management is needed to achieve maximal functional recovery in each patient after cervical spinal decompression surgery.

Keywords: Cervical myelopathy, functional improvement, intraoperative monitoring

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1702 Top


Back pain in adolescents with spinal deformities

S. Donzelli, S. Negrini1, F. Zaina, F. Di Felice

Italian Scientific Spine Institute, Isico, Milano, 1University of Brescia, Physical and Rehabilitation Chair, Brescia, BS, Italy

E-mail: sabrina.donzelli@isico.it, stefano.negrini@isico.it

Introduction/Background: Back pain prevalence ranges from 7 to 58% of subjects aged between 13 and 15, equally distributed in males and females. Back pain is thought to be associated with spinal deformities but no studies investigated the prevalence of back pain in different spinal deformities like, spondylolisthesis, scheuermann disease, hyperkyphosis, scoliosis. AIM:To document the prevalence of back pain, in all its forms in a large population of adolescents with spine deformities and to investigate the association of back pain and different spine pathologies. Materials and Methods: All the patients visited in 2010-2015 were asked for pain at first clinical evaluation by a single expert phyisician. PAINGroup and NOPAINGroup were formed. Pain description was then classified into 4 subtypes (localized or generalized, limiting or occasional). Inclusion criteria: age between 10 and 18, spine deformity diagnosis, Exclusion criteria: secondary deformities and other associated pathologies. Desriptive statistics. T-test to check the difference in the two groups considered for SRS-22 score, age and BMI. Chi-2 test to check the association between the presence of pain and diagnosis and pain subtypes; sports activities and previous treatment with brace. Results: 702 included patients (males n=468), mean age 13.3+-1.92. Subjects’ diagnosis: adolescent idiopathic scoliosis (n=387; 55.1%), sagittal unbalance (idiopathic) (n=134; 19.1%) Scheuermann deformities (n=67; 9.55%); all other diagnosis (n=114; 16.2%).). In AIS 32% referred pain, 55%in sagittal unbalanced patients and 52% in Scheuermann disease. Only Scheuermann disease predispose to pain (chi2= 10.2 Fisher exact test = 0.002), Sagittal unbalance is slightly associated to pain with chi2 = 3.65 Fisher exact test = 0.05.. BMI, Age, sports and brace were not associated with SRS-22. Conclusion: This is the first study investigating the epidemiology of different type of back pain in a large adolescents population with spinal deformities, Scheuermann deformity resulted associated to pain.

Keywords: Adolescent, back pain, scoliosis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0376 Top


Observation of the effect of scalp electrical stimulation on acute low back pain

X. Huang

Department of Special Education Rehabilitation, Zhejiang Special Education Career Academy, Hangzhou, China

E-mail: hxia0329@126.com

Introduction/Background: To explore the therapeutic effect of scalp electrical stimulation on pain. Materials and Methods: A total of 60 outpatients were randomly divided into scalp stimulation group and electrotherapy group. First, we used the taylor-hanghton method to locate the central sulcus accurately, and translate the 0.75 cm in front and back of the central groove. It was determined as the stimulation area of the motor area and the stimulation line of sensory area respectively, and it was used as the stimulation point of acupuncture at the intersection point with the nasal occipital line. A 6805I electroacupuncture instrument produced by Shantou Medical device Factory was used with dense wave frequency of 30 hz. The patient was tolerated for 20 minutes. During the treatment, the patient was instructed to perform lumbar activities in the sitting position. The control group using computer intermediate frequency treatment, electrodes placed on the pain, stimulate the strength to comfort patients as of the end of treatment, the treatment time of 20 min, 10 min with McGill Pain Questionnaire for pain evaluation survey. Results: There was no significant difference in the scores of PRI, PPI and vas before treatment in the 2 groups. (P > 0.05). After treatment, the scores of PRI, PPI and vas in 60 patients with pain improved significantly before and after scalp electrical stimulation and electrotherapy, and the difference in the group was statistically significant (P < 0.01); compared with scalp electrical stimulation group and electrotherapy group PRI, PPI and VAS score difference was statistically significant (P < 0. 01). Conclusion: Scalp electrical stimulation is a safe and effective method for pain treatment. It can relieve pain, improve function, quality of life and patient satisfaction, and reduce the use of non-steroidal anti-inflammatory drugs.

Keywords: Acupuncture, low back pain, scalp electrical stimulation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0512 Top


Responders to glucocorticoid or contrast intradiscal injections among chronic low back pain patients with an active disc disease: A secondary analysis of the predid trial

C. Pauwels, F. Rannou1, C. Nguyen1

AP-HP- Hôpital Cochin, Rééducation et Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, 1Université Paris Descartes - Faculté de Médecine, Rééducation et Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Paris, France

E-mail: christelle.nguyen2@aphp.fr, charlotte.pauwels@aphp.fr

Introduction/Background: Non-specific low back pain is first cause of years lived with disability. An active disc disease is present in up to 58% of patients with low back pain. We aimed to describe patients with chronic low back pain and an active disc disease who respond and those who do not respond to intradiscal glucocorticoid or to intradiscal contrast. Materials and Methods: We conducted a secondary analysis of the PREDID study, a randomized trial of 135 patients with chronic low back pain and an active disc disease. Overall, 61 participants received an intradiscal injection of glucocorticoid (25 mg prednisolone acetate) during discography and 60 received discography alone. Fourteen participants did not receive the allocated treatment and were not included in this secondary analysis. The primary outcome was the description of clinical, demographical, psychological and social characteristics of responders and non-responders to intradiscal glucocorticoid and to intradiscal contrast at 1 month, as defined in the primary trial. Independent variables associated to clinical response were assessed by logistic regression. Results: Participants who responded to intradiscal corticosteroid injection were more often highly educated (18/34 [52.9%] vs. 6/26 [23.1%], respectively), whereas participants who did not respond were more often on sick leave (14/27 [51.9%] vs. 5/34 [14.7%]). The independent variable most strongly associated with the absence of therapeutic response to intradiscal glucocorticoid was sick leave (OR = 33.8, 95% CI = 2.4 to 472.2). Similar results were observed with response to intradiscal contrast injection but the magnitude of differences was lower. Conclusion: Patients with chronic low back pain and an active disc disease who respond to an intradiscal injection of corticosteroids or contrast have a social profile different from those who do not respond.

Registration. ClinicalTrials.gov number NCT00804531 (First received: December 8, 2008. Last updated: June 23, 2016).

Funding. French Ministry of Health (Programme Hospitalier de Recherche Clinique, project no. P070157).

Keywords: Active disc disease, intradiscal therapy, low back pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0514 Top


Pelvic parameters in patients with chronic low back pain and an active disc disease: A case-control study

C. Blandin, M. Boisson, F. Segretin, A. Feydy1, F. Rannou2, C. Nguyen2

AP-HP, Rééducation et Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, 1Université Paris Descartes-Faculté de Médecine, Radiologie B, 2Université Paris Descartes-Faculté de Médecine, Rééducation et Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Paris, France

E-mail: christelle.nguyen2@aphp.fr, charlotte.pauwels@aphp.fr

Introduction/Background: Active disc disease is characterized by inflammatory-like low back pain (LBP) and the presence of Modic 1 changes on MRI. Its prevalence ranges from 19% to 50 % in patients with non-specific chronic LBP. Pelvic parameters are important determinants of shear and compressive forces applied to the lumbar intervertebral disc. The association between an active disc disease and abnormal pelvic parameters has not been addressed yet. We aimed to compare pelvic parameters between chronic LBP patients with an active disc disease (Modic 1) and those without (Modic 0). Materials and Methods: We used a convenient sample from patients prospectively and consecutively recruited in a previous single center case-control pilot study. Cases were defined as chronic LBP male patients with an active disc disease on MRI and controls as patients without. Pelvic parameters, namely sacral slope, pelvic tilt and pelvic incidence, were assessed in an independent and standardized manner by two trained investigators using EOS system imaging performed at inclusion. Results: Overall, 35 cLBP patients (13 cases and 22 controls) fulfilled inclusion criteria and had an EOS imaging available. Median age was 42 (35-51.5) years and median LBP duration 50 (33.5-104) months. Pelvic parameters did not differ between the 2 groups: absolute mean (95% IC) difference between Modic 0 and Modic 1 was -7.2° (-15.5;1.0) for pelvic incidence, -3.7° (-8.7;1.3) for pelvic tilt and -3.3 (-8.9;2.3) for sacral slope. Conclusion: Pelvic parameters in patients with chronic LBP and an active disc disease do not differ from those in patients without.

Keywords: Active disc disease, full spine EOS imaging, pelvic parameters

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0279 Top


Abdominal curl-up with elastic band prevents inadequate activation of superficial cervical flexors

K. Nam, P. Teajoon

Departments of Physical Medicine and Rehabilitation, College of Medicine, Dongguk University, Goyang-si, Republic of Korea

E-mail: rusl98@hanmail.net, bskwon@dumc.or.kr

Introduction/Background: The abdominal curl-up is often recommended as part of a rehabilitation program. The curl-up exercise may, however, activate the superficial cervical flexors, such as the sternocleidomastoid (SCM), which can induce neck pain. The purpose of this study was to assess the effectiveness of using an elastic band to decrease SCM activity while maintaining abdominal muscle activity during the curl-up. Materials and Methods: Twenty-two healthy male subjects participated. All subjects performed a traditional curl-up exercise, a curl-up with neck flexion restriction, and a curl-up with an elastic band. Surface electromyography signals were recorded from the sternocleidomastoid, rectus abdominis, and external oblique muscles during the exercises. Results: The curl-up technique with an elastic band showed a significantly lower root mean square (RMS) value of SCM activity compared with the traditional curl-up (p < 0.000) and the curl-up with neck flexion restriction (p < 0.021). There were no significant differences in the RMS values of RA or EO activity between the three techniques (RA; p = 0.294, EO; p = 19 0.097). Conclusion: The results of this study suggest that the curl-up technique with an elastic band can reduce SCM activation while maintaining activation of the abdominal muscles in healthy subjects compared with the traditional curl-up or the curl-up with neck flexion restriction.

Keywords: Abdominal muscles, electromyography, exercise therapy

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1229 Top


Juvenile idiopathic scoliosis, the cobb angle and surgery: An inevitable trio? – A case report

D. Portugal, E. Marques1

Hospital Prof. Doutor Fernando Fonseca, Serviço de Medicina Física e de Reabilitação, Amadora, 1Centro Hospitalar de Lisboa Central- E.P.E - Hospital de Curry Cabral, Serviço de Medicina Física e de Reabilitação, Lisboa, Portugal

E-mail: diogoportugal@campus.ul.pt

Introduction/Background: Juvenile idiopathic scoliosis (JIS) refers to scoliosis occurring between the ages of 4-10 and represents 10-15% of all idiopathic scoliosis. The growth potential rises the risk of curve progression and subsequent surgery. Curves that reach 30° tend to worsen without treatment. The general indication for surgery is a curve size > 50°. This case report aims to alert the clinicians to the value of looking beyond the Cobb angle when approaching JIS. Materials and Methods: We present a case of JIS with a Cobb angle > 50° treated with bracing, evaluated in Physical and Rehabilitation Medicine outpatient. Results: A 6-year-old girl with asymptomatic JIS and a structured 56° right thoracic curvature and Risser 0/5 was referenced to our department by the Spinal Surgeon to delay surgery. Clinically, she presented a 30 mm right thoracic hump in the Adams test and hypokyphosis. Brace treatment was started with a thoraco-lumbo-sacral-orthosis Boston, 23 hours per day. After 3 months and 1 year of treatment, the in-brace x-rays revealed a reduction of Cobb angle to 23° and to 20° respectively, and Risser 0/5. Currently, at 3-year follow-up, she has a 36º curve on out-of-brace x-ray and a 10 mm hump on physical examination. The Orthotist technician care was crucial (she needed 3 braces and several adjustments). She maintains treatment with noteworthy compliance and continues asymptomatic. Conclusion: Growth restriction and complications associated with spinal fusion make conservative treatment a frequent first option. Reports on the success of bracing in JIS range between 13-81%. Clinical experience, multidisciplinary approach (Physiatrist, Physiotherapist, Orthotist technician, Spinal surgeon) and compliance to bracing play a significant role. This case highlights the enduring importance of questioning ourselves if we are properly managing scoliosis in early ages. JIS natural history is not always the same; besides the growth potential and Cobb angle, we should consider other factors.

Keywords: Bracing, cobb angle, juvenile idiopathic scoliosis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1500 Top


Isotonic versus isometric exercises on core muscle in patients with low back pain

F. Unver, A. Alarab

Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey

E-mail: azzam@paluniv.edu.ps

Introduction/Background: To observe the effects of isotonic and isometric exercises with conservative therapy on core muscle in patients with low back pain. Materials and Methods: Twenty participants, 10 male and 10 female aged between 30 and 50 years suffering from low back pain were taken. Sample was divided into two groups, group A isometric exercises and group B isotonic exercises, both the group received conservative therapy of transcutaneous electrical neuromuscular stimulation and hot pack. Outcomes measure visual analog scale (VAS) and Modified Oswestry disability index (MODI) were used the pre-treatment and at the end of 4 weeks. Results: There was no significant differences for the demographic data between the groups. Both group were comparable in term of age, height, weight, and BMI. Intergroup analysis of VAS score was done using Mann- Whitney test. Pre interventional analysis showed no significant differences between group A and group B (p=0.6469) and also post- intervention analysis showed no significant difference between group A and group B (p=0.3525). Analysis of MODI score was done using Mann- Whitney test, there was significant difference between group A (Mean=9.90, SD= 5.87) and group B (Mean=19.39, SD=7.27) in their post-test measurements (p=0.002). Experiment of results showed isotonic and isometric exercises were effective in all measured variables (pain intensity and functional disability) in treatment of patients with low back pain. Conclusion: There was no difference between the use isotonic and isometric in decrease pain intensity, but there was significant differences in improvement functional disability where isometric exercises allow a greater improvement in functional disability than isotonic in low back pain.

Keywords: Isometric exercises, isotonic exercises, low back pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1746 Top


End-growth results of a personalised conservative approach in 1938 high risk adolescents with idiopathic scoliosis: Prospective observational multicentre study

S. Donzelli, S. Negrini1, F. Zaina, F. Di Felice

Italian Scientific Spine Institute, Isico, Milano, 1University of Brescia, Chair of Physical and Rehabilitation Medicine, Brescia, BS, Italy

E-mail: sabrina.donzelli@isico.it, stefano.negrini@isico.it

Introduction/Background: End of growth RCTs showed the efficacy of bracing and Physiotherapic Scoliosis Specific Exercises (PSSE). Current Guidelines propose PCA according to the step-by-step theory: invasivity increases with treatment intensity, from observation to PSSE to soft, rigid and very rigid bracing. This requires to set individualised outcomes and propose the less invasive treatment according to the outcome. Materials and Methods: Inclusion criteria: AIS, 11-45°, Risser 0-2, age 10-16, first consultation, no previous bracing. End of observation: Risser 3, medical prescription. Groups were defined according to the main end outcome (SRS-SOSORT Consensus): Low Degree (LD) (<31° at start) remain <30°; High Degree (HD) (>30° at start) remain <50°. Treatment: PCA including observation, PSSE (SEAS school), soft (SpineCor), hard (Sibilla) and very rigid (Sforzesco) braces. Classical statistics and propensity scores have been applied. Results: We excluded 207 (10.7%) drop-outs and 274 (14.1%) still in therapy. Treatment intensity increased with Cobb degrees, as well as rate of improvement (from 13.6% to 56.1% - P <0.05). Rate of progression was higher in the less intensively treated very low degree curves (11-20°) (P <0.05), while did not change significantly in those above 20° (between 12.9 and 15.9%). Rate of patients <30° were 69.3% at start and 78.3% at the end (P <0.05); patients >50° at the end were 1.6%. Conclusion: Defining different outcomes according to PCA allows to perform less aggressive treatments for LD, and concentrating the efforts in HD. Failure rates can be low in both groups. Progression is not the best outcome for all patients and type of treatments.

Keywords: Brace, scoliosis

Disclosure of interest: The authors did not declare any conflict of interest.


  A2.06 Musculoskeletal Conditions - Back Pain and Spine Disorders Top



  ISPR8-0015 Top


The effect of needle tip position on lumbar transforaminal epidural steroid injection using nerve stimulator

C. H. Lee, S. U. Lee1

Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, 1Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea

E-mail: ychkhk1407@gmail.com

Introduction/Background: To determine the effect of needle tip positions on short-term effect of transforaminal epidural steroid injection (TFESI) using nerve stimulator (NS) for lumbar radiculopathy. Materials and Methods: 45 patients who received TFESI using NS were retrospectively reviewed. The TFESI was conducted under fluoroscopic guide. The goal of positioning was to allow a needle tract toward injection site such as “safe triangle”. We used the NS to optimize the position of needle tip. The needle tip was repositioned to achieve minimal current output (0.2 mV) when the patients had paresthesias within dermatomal areas. The needle tip positions were assessed by dividing the intervertebral foramen into 4 quadrants in the anterior-posterior view [Figure 1]. The grade of nerve root compression on MRI in 45 patients was evaluated [Figure 2]. The outcome measurement (OM) was evaluated before pre-injection and after 2 weeks. Results: 91 TFESIs were conducted in the 45 patients. The position of needle tip was 68, 19 and 4 cases in the quadrant 1, 2 and 3 respectively. The mean score of OM reduced significantly in the quadrant 1 and 2, but not in the quadrant 3 after 2 weeks. There were no significant differences in the mean score of OM according to the grade of nerve root compression. Conclusion: As the neural structures lie medially in the foramen, it is believed that a medially placed needle such as quadrant 2 has a higher likelihood of causing neurological complication. Bogduk proposed the ideal needle tip position by defining a “safe triangle” like quadrant 1. Our study showed that there was a similar effect in the quadrant 2 just the same in the quadrant 1. We conclude that the NS to guide TFESI in addition to fluoroscopy can be a useful therapeutic tool in the patient with radicular symptoms.

Keywords: Needle tip position, nerve stimulator, transforaminal epidural steroid injection

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0597 Top


The effects of stabilization exercise on low back pain and pelvic girdle pain in pregnant women

J. Bogaert, M. Stack, S. Partington, J. Marceca, A. Tremback-Ball

Department of Physical Therapy, Misericordia University, Dallas, USA

E-mail: bogaertj@misericordia.edu

Introduction/Background: Pain in the lumbar or sacroiliac region during pregnancy is common. However, it should not be considered a normal part of pregnancy. There are non-invasive approaches to treatment to effectively manage symptoms not only during pregnancy but also postpartum. A systematic review was performed to examine the effects of stabilization exercises on low back and pelvic girdle pain in pregnant women. Materials and Methods: A database search of EBSCO (CINAHL, HealthSource, MEDLINE, and PsycINFO) was conducted from September 2017 to January 2018. Our search terms included “pregnancy”, “pregnan*”, “stab* exercis*”, “back pain”, “pelvic pain”, and “pelvic floor”. The studies were reviewed for content to determine if they met the inclusion and exclusion criteria. Articles were then examined for quality on a hierarchy of evidence scale and the PEDro Scale by four researchers. Results: Twenty three articles were included in the systematic review. Most concluded that stabilization exercises had a positive effect on low back and pelvic girdle pain in pregnant women. A few articles found no significant reduction in pain. The discrepancies may be due to differences in protocol such as administering a home exercise program, frequency of exercises, weeks of gestation, and direct supervision exercises. These factors may influence the effectiveness of stabilization exercise in this population. Conclusion: The effects of stabilization exercise vary based on type of pain, type of exercise, location of pain and timing of intervention. Overall, the use of stabilization exercises is beneficial in reducing low back and pelvic girdle pain in pregnant women. Further, rehabilitation during pregnancy may prevent future episodes of low back and pelvic girdle pain in subsequent pregnancies.

Keywords: Low back/pelvic girdle pain, pregnancy, stabilization exercise

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0626 Top


Differences of nature of disease, socioeconomic and psychological factors in chronic low back pain patients between Thailand and Germany

P. Boonyapaisancharoen, P. Yotnuengnit, K. Piravej, E. Kraft1, N. Arnstadt1, H. Schulte-Goecking1, N. Jamin1

Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 1Department of Orthopedics, Physical Medicine and Rehabilitation, University Clinic, Ludwig-Maximilian-University, Munich, Germany

E-mail: pongrinb@gmail.com

Introduction/Background: To study the differences of nature of disease, socioeconomic status and psychological factors in chronic low back pain (LBP) patients between Thailand and Germany. Materials and Methods: Cross Sectional Analytic study. Setting: Out Patient Clinic, Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Thailand and Department of Orthopedics & PM&R, Großhadern Hospital, Germany. Subjects: 100 Thai and 100 German patients with chronic LBP more than 6 months. Methods: The data from both hospitals were collected before chronic LBP patients received treatment. The data consisted of 4 domains; demographic data, socioeconomic status, nature of disease i.e. Numerical Rating Scale (NRS), Pain Disability Index (PDI), etc. and psychological factors (Center for Epidemiologic Studies Depression Scale: CES-D). The data was analyzed by using statistic program. Results: Mean age of both Thai and German was 47.7 ± 11.7 years old. Majority were female, married, white collar and has LBP duration for more than 3 years. Comparison between Thai and German, the average and maximal NRS were not significantly different. However, German patients had significantly higher than Thai patients in PDI (median 26 and 10,respectively, P = 0.00) and CES-D total scores (median 17 and 4, respectively, P = 0.00). Conclusion: Despite the non-significant difference in LBP severity, there were the differences among Thai and German patients. German patients had more depressive symptom and pain related impairment than Thai patients.

Keywords: Chronic low back pain, Germany, Thailand

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0891 Top


Comparison between the effect of lumbopelvic belt and home based pelvic stabilizing exercise on pregnant women with pelvic girdle pain; a randomized controlled trial

M. Azimi, M. Abolhasani1, R. Kordi

Department of Sports and Exercise Medicine, Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, 1Department of Sports and Exercise Medicine, MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

E-mail: dr.m.azimi@gmail.com

Introduction/Background: Pelvic girdle pain is a common complaint of pregnant women. There are limited data on comparison between the effectiveness of stabilizing exercises and lumbopelvic belt on the treatment of these patients. The objective of this study was to compare the effect of lumbopelvic belt plus information, home based pelvic girdle stabilizing exercises plus information and information alone on pain intensity, functional status and quality of life of pregnant women with pelvic girdle pain. Materials and Methods: In this randomized clinical trial pregnant women with pelvic girdle pain (n=105) were randomly allocated to three groups; Control group (n=35) that received general information, exercise group (n=31) that in addition to general information were asked to perform specific pelvic stabilizing exercises at home and belt group (n=31) that received non-rigid lumbopelvic belt and the information. The primary outcome variables were pain intensity and functional status of the participants which were measured using visual analogue scale and Oswestry Disability Index (ODI) respectively. Quality of life of participants was measured using WHOQOL-BREF questionnaire. All measurements were performed at baseline, 3 and 6 weeks after the study conduction. Results: The pain intensity of patients in belt group in comparison to other groups was decreased significantly at both 3 and 6 weeks follow-ups. The mean score of ODI of patients in belt group was also improved more than exercise and control groups significantly. Conclusion: On base of our results, it can be found that in short term lumbopelvic belt and information in treatment of pregnant women with pelvic girdle pain is superior to exercise plus information or information alone.

Keywords: Multiple sclerosis, muscle strength, resistance training

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1049 Top


Association between idiopathic scoliosis and bone quality

X. Zhou, Q. Du

Department of Rehabilitation, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

E-mail: zhouxuanxh@163.com

Introduction/Background: It is reported that adolescent idiopathic scoliosis patients have abnormal bone quality. However, the study of bone quality in idiopathic scoliosis (IS) patients is still sparse. The objective of this study was to determine whether an association exists between IS and bone quality in a school scoliosis screening program. Materials and Methods: 391 IS patients (263 girls/128 boys) and 282 healthy controls (185 girls/97 boys) from 6 to 19 years of age in a school scoliosis screening program were included. Quantitative ultrasound measurements were performed at the left distal 1/3 of the radius, and the standard method to estimate speed of sound was recorded. Z-score was then calculated. The z-score is defined as the difference between the raw score to be standardized and the mean difference divided by the standard deviation (a z-score less than or equal to -2.0 indicates low bone quality and a z-score greater than -2 indicates normal bone quality). Results: The mean age of IS patients and healthy controls were (12.1 ± 3.2) and (10.7 ± 3.0) years old respectively. The mean Cobb angle of IS patients was 14.7° ± 4.9°. Of 391 IS patients, 101 (25.8%) had low bone quality. Of 282 healthy controls, 51 (18.1%) had low bone quality. There was significant association between IS and low bone quality (OR, 1.58; 95% CI, 1.08-2.30). After adjustment for age, gender and body mass index, a positive association was seen between IS and low bone quality (OR, 1.60; 95% CI, 1.08-2.37). Conclusion: IS patients have a higher risk of low bone quality. It is recommended that bone quality should be monitored in IS patients.

Keywords: Bone quality, idiopathic scoliosis, quantitative ultrasound

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1232 Top


Evaluating the walking perimeter in patients with spinal stenosis. A comparison between clinical interview and standardized walk test at comfortable speed

A. Gouteron, J. M. Casillas, D. Laroche1, M. Grelat2

CHU de Dijon, Pôle de rééducation-réadaptation, 2CHU de Dijon, Service de neurochirugie, 1CHU de Dijon, CIC-P Inserm 803- plateforme d’investigation technologique, Dijon, France

E-mail: anais0709@hotmail.com

Introduction/Background: Gait dysfunctions are common in patients with spinal stenosis. In fact, these patients may present intermittent radicular claudication, which result in a decreased walking perimeter. Thus in these patients, the walking perimeter reveals the impact of the disease on quality of life and accounts for the therapeutic decision, notably surgical. Usually, in clinical practice, walking perimeter is assessed by a medical interview. Some authors highlight the error of subjective verbal quantification. Therefore, the main objective was to quantify the difference between the walking perimeter determined using either a medical interview or a walk test at comfortable speed. The secondary objective was to correlate functional tests with walking perimeter. Materials and Methods: In this monocentric study, each patient was asked to verbally estimate his walking perimeter during a preoperative consultation. Walking perimeter was then evaluated using a walking test at comfortable speed in which the patient walked a maximal distance. Functional muscular tests (Sorensen and Shirado) were also performed. Results: Twenty patients have been included (age: 68.9±8.6 years, BMI: 28.7±3.5 kg.m-2). During medical interview, patients reported a significantly lower average walking perimeter than during walk test (317 ± 178 m and 442 ± 99 m respectively; P < 0.05). Among functional tests (Shirado: 84.2±51.0 s; Sorensen: 75.4±39.1 s), only Shirado test was correlated with walking perimeter assessed by walk test (Shirado: r=0.48; p=0.03) whereas no correlation was found for walking perimeter assessed by medical interview. Conclusion: Our study confirms previous results showing that subjective walking perimeter estimation is not a valid outcome. Patients with spinal stenosis underestimated their actual walking perimeter during the preoperative consultation. Thus comfortable walk test should be used in clinical practice to quantify the walking perimeter in patients with spinal stenosis, and more broadly, because it seems correlated to functional capacities of patients. The underlying reasons explaining the difference observed need to be explored.

Keywords: Spinal stenosis, walk test, walking perimeter

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1489 Top


MRI-based morphological parameters to quantify lumbar disc degeneration

B. S. Kim, C. H. Park, J. H. Lee, S. G. Chung, S. J. Park1

Department of Rehabilitation Medicine, Seoul National University Hospital, 1Department of Rehabilitation Medicine, Dobong Hospital, Seoul, Republic of Korea

E-mail: mattkim9966@gmail.com

Introduction/Background: When an intervertebral disc degenerates, structural deterioration occurs in a wide range of anatomical components within and adjacent to the disc, being clearly represented in cross-sectional imaging. To suggest reliable and valid MRI-based morphologic parameters to quantify lumbar disc degeneration, the reliabilities of 6 parameters were analyzed to choose those with high reliability. The selected parameters were further tested to determine validity by correlating with disc height, which is regarded as a hallmark of structural integrity of the intervertebral disc. Materials and Methods: 85 patients over 60 years old who underwent MRI of the lumbar spine for mild low back pain were included. Two reviewers independently assessed the degree of degeneration and assigned one of the 4 ordinal scores from 0 to 3 in the following 6 parameters at 6 spinal segments: T2-signal intensity (T2-SI), disc extension beyond interspace (DEBIT), annular fissure, Modic changes, endplate integrity, and osteophytes. Inter-observer and intra-observer agreements were assessed using Cohen’s kappa statistic. For those parameters with high reliability, relationships with disc height were examined by calculating Pearson’s correlation coefficients. Results: While intra-observer agreements were excellent for all parameters (weighted kappa range 0.801-0.875), the inter-observer agreements were substantial to excellent for T2-SI, DEBIT, Modic changes, and endplate integrity (weighted kappa range 0.629-0.874), moderate for osteophytes (weighted kappa 0.573), and only fair for annular fissure (weighted kappa 0.29). Modic changes (r=-0.497, p<0.01), endplate integrity (r=-0.359, p=0.01), and osteophytes (r=-0.448, p<0.01) showed strong relationships with disc height whereas T2-SI (r=-0.149, p=0.175) and DEBIT (r=-0.208, p=0.057) did insignificant correlations. Conclusion: To quantify lumbar disc degeneration using MRI, Modic changes, endplate integrity, osteophytes, T2-SI, and DEBIT could be used as reliable parameters. However, different weights might be applied to each parameter because validities to represent degeneration varied.

Keywords: Lumbar disc degeneration, morphological parameters, MRI

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1759 Top


Lumbar spinal stenosis in adult achondroplasia: An analysis of intervertebral disk alterations

J. Beaudreuil, T. Huet1, M. Cohen-Solal1, P. Orcel1, A. Yelnik2

Departments of PRM and Rheumatology, 1Rheumatology and 2Physical and Rehabilitation Medicine, GH St. Louis-Lariboisière-F. Widal- Paris Diderot University, Paris, France

E-mail: johann.beaudreuil@aphp.fr

Introduction/Background: Lumbar spinal stenosis is a major contributor to disability in adults with achondroplasia. It arises from congenital dysplasia and acquired degenerative changes. The aim of the study was to characterize degenerative changes of the intervertebral disk in adult achondroplasia patients with lumbar spinal stenosis and to identify factors associated with the process. Materials and Methods: The study was a case series of adult achondroplasia patients. Clinical parameters were recorded. Radiographs were used to analyze spino-pelvic parameters. MRI of the lumbar spine was used to measure antero-posterior diameter of the canal and disk degeneration using the Pfirrmann grading system. Comparisons were done using the Kruskal-Wallis test and correlations using the Spearman coefficient. Results: Eighteen patients were included: Age 37±17, female 12, size 127±7 cm, weight 57±13 kg. All had symptoms due to lumbar spinal stenosis. Antero-posterior diameters of the spinal canal differed according to level (P<0.05). Lower values were observed at T12-L1, L1-L2 and L2-L3 levels. The lumbar spinal stenosis was maximal at L2-L3 (9.9±1.8 mm). Degrees of disk degeneration also differed according to level (P < 0.05). Higher degrees of degeneration were observed at L1-L2, L2-L3 and L3-L4 levels. Most advanced degenerative changes were observed at L2-L3 (2.9±1.4). Correlation analysis between disk degeneration and spino-pelvic parameters found a significant relationship with thoraco-lumbar kyphosis at L2-L3 level (0.55). Correlation analysis between antero-posterior diameter of the spinal canal and the spino-pelvic parameters found a significant relationship with lumbar lordosis at T12-L1 (0.66) and L2-L3 (0.89) levels, and with thoraco-lumbar kyphosis at L1-L2 level (-0.55). Conclusion: Spinal stenosis and disk degeneration mainly involve the upper part of the lumbar spine in adult achondroplasia patients. Thoraco-lumbar kyphosis and lumbar lordosis are related with these processes. The findings may be of importance in rehabilitation and in early prevention of spinal stenosis in the course of achondroplasia.

Keywords: Adult achondroplasia, disk degeneration, lumbar spinal stenosis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1793 Top


Physical fitness and chronic low back pain: A case-control study including 517 individuals

J. Beaudreuil, A. Grelier1, O. Bailliart2, A. Yelnik1, P. Orcel3

Departments of PRM and Rheumatology, 1Physical and Rehabilitation Medicine, 2Physiology and 3Rheumatology, GH St. Louis-Lariboisière-F. Widal- Paris Diderot University, Paris, France

E-mail: johann.beaudreuil@aphp.fr

Introduction/Background: Deconditioning syndrome in chronic low back pain is admitted. However, profil of physical fitness, on the basis of energy expenditure, is controversial. The goal of the study was to assess physical fitness in chronic low back pain patients using markers of energy expenditure. Materials and Methods: This was a case-control study. Patients with chronic low back pain and healthy age- and sex-matched controls underwent bicycle exercise test, up to muscle exhaustion. Recorded energy variables were: duration of exercise in seconds, maximal power (P max) in watts, percentage of age-predicted maximum heart rate (HR max) and metabolic equivalents (MET). Pain intensity using the 0-100-VAS, pain duration and functional limitation using the Quebec scale were also assessed in chronic low back pain patients. Relationship between energy variables and clinical parameters was investigated using the Spearman correlation coefficient. Results of both groups were compared using the Student t test. Results: 192 chronic low back pain patients (age 44±8, ratio M/F 106/86, pain intensity 47±19, pain duration 51±57 months, Quebec 39±16) and 325 healthy controls (44±8, ratio M/F 199/126) were included. Duration of exercise (-0.23), P max (-0.21), and MET (-0.29) were related with the Quebec score in chronic low back pain patients (P < 0.05). There was no other relationship between energy variables and clinical parameters. Energy variables were not different in both groups as they were globally considered. However, chronic low back pain patients with highest functional limitation (the fourth quartile of the Quebec scores) had lower duration of exercise (349±134 vs. 431±189), lower P max (129±39 vs. 147±49), and lower MET (7±2 vs. 8±2) than healthy controls (P < 0.05). Conclusion: Physical fitness was not altered in the entire chronic low back pain population. However, physical fitness appeared to be decreased in chronic low back pain patients with highest functional limitation.

Keywords: Chronic low back pain, physical fitness

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2107 Top


Investigating the effect of the orthotic treatment on sagittal plane pelvic parameters in adolescents with idiopathic scoliosis: Literature review

M. Saeedi, T. Babaee

Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran

E-mail: saeedi.mrjn@gmail.com

Introduction/Background: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine. Morphologic changes in AIS alter the orientation of the body in all three anatomic planes. These changes may alter the angular position of the spinopelvic and pelvic parameters. Cobb angle is the only key index used to predict the curve improvement of the patient with AIS wearing the corrective brace. The importance of the pelvic parameters is almost neglected, hence the study of these parameters as indexes in the other two planes can provide information about other aspects of brace treatments. Materials and Methods: An Internet search for terms related to AIS, orthosis and brace treatments and sagittal pelvic parameters was performed in bibliographic databases. By summarizing the obtained publications, sagittal pelvic parameters and bracing treatments of AIS were described, and their information about their relation in sagittal plane with cobb angle in the coronal plane were reported. Results: Pelvic Incidence (PI), Pelvic Tilt (PT) and Sacral Slope (SS) are the three main sagittal pelvic parameters. PI is specialized for each person but it is changed according to the age and spinopelvic deformities. Lumbar lordosis is related with sagittal pelvic parameters specially PI and SS. So, they can be used as sagittal plane indexes to predict the improvement procedure and treatments’ outcome. Conclusion: Apparently there is a relationship between spino-pelvic parameters in the skeletal chain of body. Nevertheless, this relation is clear, there is not any index in the sagittal plane to refer to, and therapists are satisfied to the only index, cobb angle, in the coronal plane. So, introducing another index in another plane besides cobb angle in sagittal plane, considering the three dimensional aspect of AIS, can be very helpful to all the society which handling with.

Keywords: Adolescents with idiopathic scoliosis, orthotic treatment, sagittal plane pelvic parameters

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1670 Top


Assessment of neck pain in chronic obstructive pulmonary disease

A. Yilmaz, A. Ünal, O. Telli Atalay, F. Altug

Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey

E-mail: aunal@pau.edu.tr

Introduction/Background: Supplementary respiratory muscles such as upper part of the trapezium and scalenes are used extensively in order to facilitate ventilation in Chronic Obstructive Pulmonary Disease (COPD). These situations cause pain restricting by the upper body mobility and neck movements. This study was planned to investigate the presence of neck pain in individuals with COPD. Materials and Methods: In this study, 30 patients (W: 5 / M: 25) were evaluated with COPD. The severity of pain was determined according to Visual analog scale (VAS). Spirometric measurements were used to determine the respiratory parameters. Neck Disability Index were used to for severity of neck disability level. Results: Mean age of patients was 69.93 ± 9.46 years. Mean of pain intensity was 2,35± 2,77 and pain duration 46,47± 123,64 weeks. The mean FEV1% of all patients was 58.96 ± 19.15, FVC% was 72.73 ± 25.78 and FEV1 / FVC ratio was 64.43 ± 21.18. There was a positive correlation between pain intensity and FEV1 and FVC (r = 0.368, p = 0.046), (r = 0.382, p = 0.037). There was a positive mean moderate correlation between duration of pain and smoking and alcohol use (r = 0, 652, p = 0,005 / r = 0, 655, p = 0,004). The mean of Neck Disability Index was 26.65 ± 19.70. All patients have a mild disability level. We did not find a significant correlation between Neck Disability Index and spirometric parameters. Conclusion: Individuals with COPD have neck pain. When these patients rehabilitate, musculoskeletal problems, such as neck pain should be considered.

Keywords: Chronic obtructive pulmonary disease, neck disability level, neck pain

Disclosure of interest: The authors did not declare any conflict of interest.


  A2.06 Musculoskeletal Conditions - Back Pain and Spine Disorders Top



  ISPR8-2640 Top


Characteristics of the rigid spine syndrome due to sepn1-myopathy: A long-term follow-up series of 21 patients

R. Sauvagnac-Quera, A. Pages, D. Verollet, K. Kpadey, B. Mbieleu1, A. Benezit2, I. Dabaj2, P. Guicheney3, M. Cohen-Solal4, L. Miladi5, D. Mompoint6, V. Azzi-Salameh2, C. Glorion5, S. Quijano-Roy2

Departments of Pediatric PRM, 1Pediatric Resuscitation and 6Radiology, Hôpital Raymond-Poincaré, 2Centre de Référence de Maladies Neuromusculaires, Garches-Necker-Mondor-Hendaye, Hôpital Raymond-Poincaré, Garches, 3INSERM, Unité de recherche sur les maladies cardiovasculaires- du métabolisme et de la nutrition, 4Department of Rheumatology, INSERM, USPC Paris-Diderot, 5Department of Pediatric Orthopedic, Hôpital Necker-Enfants-Malades, Paris, France

E-mail: rebecca.sauvagnac@gmail.com

Introduction/Background: SEPN-1 related myopathy is a recessive autosomal disorder caused by SEPN1 gene mutations. Patients present homogeneous clinical features, in particular a striking cervico-axial hypotonia and a weakness associated with poor head control. A progressive spinal stiffness and severe restrictive respiratory insufficiency with diaphragmatic failure is observed in the course of the first or second decade. They are described as a “rigid spine syndrome” (RSMD1). The aim of this study was to describe the course of the spinal deformity and the clinical and respiratory complications. Materials and Methods: We reviewed retrospectively the medical charts of 21 patients with mutations in the SEPN1 gene. Genetic, clinical, radiological (X-rays) and respiratory studies (spirometry) were reviewed and analyzed. Results: Mean age at last follow-up was 23 years (4 – 55). All patients except one, showed poor weight and height for their age, with a mean body mass index of 13,3 kg/m2 (8 – 25). Mechanical ventilation was required in 19 patients (age range 4-15), usually only nocturnally, but in three cases a tracheostomy was performed. Four patients lost walking at a mean age of 28 (12-44). Clinical and radiological examinations were available for 15. Cervical spine stiffness was present in 65% of patients (mean chin-sternum distance in maximal cervical flexion of 7 cm). Scoliosis was observed in 12 (7 spinal translation; 6 pelvic obliquity). Clinically, a thoracic lordosis was observed in 87% of patients, and X-ray showed a flat thoracic spine. Management of the spinal deformity was focused mainly in axial stretching and antilordotic bracing. Two cases developed a severe progressive scoliosis before puberty. Spinal surgery was performed in 15 patients. Conclusion: SEPN1-related myopathy should be suspected in children developing a characteristic stiff and lordotic thoracic spinal deformity associated with a cervical rigidity. Due to constant respiratory complications, these patients require specialized multidisciplinary management.

Keywords: Ridig spine syndrom, SEPN1-related myopathy, thoracic lordosis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1439 Top


Efficacy of ultrasound-guided injections of incobotulinumtoxina in the management of piriformis muscle syndrome

C. Cordero-García, M. M. García-Delgado1

Department of Physical Medicine and Rehabilitation, Hospital Juan Ramón Jiménez, Huelva, 1Emergency Department, Hospital Juan Ramón Jiménez, Huelva, Spain

E-mail: ccordero.rhb@gmail.com

Introduction/Background: Piriformis muscle syndrome is a painful disorder characterized by buttock and hip pain usually due to sciatic nerve compression. Some previous works have studied the efficacy and safety of botulinum toxin in the management of piriformis muscle syndrome. Our objectives are analyze the efficacy of ultrasound-guided injections of incobotulinumtoxinA (Xeomin®) in the reduction of pain in piriformis muscle syndrome, and study if there are differences in the efficacy related with the dilution volume. Materials and Methods: A retrospective cohort including patients admitted to Rehabilitation Department from January 1st 2015 to June 30th 2016 was analyzed. 58 patients who fulfilled the required criteria were registered. In all the included patients, Visual Analogical Scale (VAS) was measured before performing a ultrasound-guided injection of 100 Units of incobotulinumtoxinA in piriformis muscle, and 6 weeks after the injection. All the injections were performed by the same investigator. All the injections were performed using volume dilutions of 50 U/mL (n=18), 20 U/mL (n=19) or 10 U/mL (n=21). Results: After performing Kolmogorov-Smirnov test, we checked that the data did not follow a normal distribution so a non-parametric test (Wilcoxon signed-rank test) was used. There was a statistically significant reduction of pain 6 weeks after incobotulinumtoxinA injection (ZW = -6.649, p < 0.01). All dilutions showed statistically significant reduction of pain: (10 U/mL: ZW = -4.027, p < 0.01; 20 U/mL: ZW = -3.837, p < 0.01; 50 U/mL: ZW = -3.753, P < 0.01). Conclusion: IncobotulinumtoxinA seems to be an useful therapy in the management of piriformis muscle syndrome. There is no differences in the efficacy related with the volume of dilution.

Keywords: IncobotulinumtoxinA, pain, piriformis muscle

Conflict of interest Disclosure statement: C. Cordero-García received research grant support and served as a consultant for Merz. M. M. García-Delgado has no potential conflict of interest to disclose. No funds were received for conducting this trial.


  ISPR8-1542 Top


Muscles endurance in children with low back pain

W. Ouannes, R. Moncer, E. Toulgui, S. Mtaouaa, I. Haddada, M. Gaddour, F. Khachnaoui, S. Jemni

Physical and Rehabilitation Unit, Sahloul Hospital, Sousse, Tunisia

E-mail: rihabmoncer@hotmail.com, nedra.feni@gmail.com

Introduction/Background: Low back pain (LBP) in children has been related to a serious problem for longtime. Recent studies have shown that no specific LBP in such age is as important as in adulthood and prevalence could reach 50%. Despite this high prevalence, it seems to be neglected by the child, family and doctors. Such a high rate, leads us to insist on meticulous clinical evaluation. Evaluation needs to include the measurement of trunk muscle strength and endurance. Our goals were to determine the prevalence of low back pain in children and adolescents, describe the characteristics of spine muscles endurance in children with LBP and showing the interest of muscles evaluation. Materials and Methods: We conducted an analytical cross-sectional study about 444 students, 201 boys and 243 girls, with average age of 14.95 years. We conducted an analytical cross-sectional study about 444 students, 201 boys and 243 girls, with average age of 14.95 years. Evaluation includes anthropometric assessment, extensibility of sub pelvic muscles and the endurance of back muscles and quadriceps with spine examination. Results: The prevalence was 22.3%, 95% CI [18.2 to 26.2]. This prevalence increases with age with a marked female predominance. Muscles endurance was lower in the LBP group (P < 0,001 Sorensen test). More weakness was identified in extensors muscles with high signification (shirado/ Sorensen P < 0,001). Conclusion: Low back pain in children and adolescents is a common symptom, multifactorial, which is responsible of limitations of school and leisure activities. Trunk Muscles weakness may be a consequence or a cause of pain. Surely, it leads to chronic pain. The study of muscles endurance is necessary for diagnosis, rehabilitation and survey.

Keywords: Children, low back pain, muscles endurance

Disclosure of interest: The authors did not declare any conflict of interest.


  A2.07 Musculoskeletal Conditions - Musculoskeletal Trauma (E.G. Fractures) and Sports Injury Top



  ISPR8-0264 Top


Acute and chronic musculoskeletal injury in para sport: A systematic review

T. Ottesen, E. Mashkovskiy1, M. Gentry2, D. Jensen3, N. Webborn4, Y. Tuakli-wosornu

Department of Orthopedics, Yale School of Medicine, 2Yale School of Medicine, Cushing/Whitney Medical Library, New Haven, 3Black Hills State University, Exercise Science, Spearfish, USA, 1I.M. Sechenov First Moscow State Medical University, Sports Medicine and Medical Rehabilitation, Moscow, Russia, 4School of Sport and Service Management, University of Brighton, Eastbourne, United Kingdom

E-mail: taylor.ottesen@yale.edu

Introduction/Background: The health benefits of sport are myriad, but sport also carries an inherent risk of injury. This systematic review summarizes musculoskeletal injury epidemiology in elite and recreational Para athletes, and highlights research gaps. Materials and Methods: Five electronic databases were searched for relevant articles: Ovid Medline, Ovid Medline In Process & Other Non-Indexed Citations, Ovid Embase, Cumulative Index to Nursing and Allied Health (CINAHL), and Web of Science. Evaluation and data extraction were performed by two independent examiners. Inclusion criteria were: (a) written in English; (b) published in a peer-reviewed journal between January 1975 and June 2017; (c) describe Para athletes participating in recreational or elite sport; and (d) describe sports-related, acute traumatic or chronic overuse musculoskeletal injury [1]. Results: Fifty full-text manuscripts were reviewed. Seated Para athletes sustain upper extremity injuries more commonly, while ambulant Para athletes frequently sustain lower extremity injuries. The upper extremity, including shoulder, elbow, wrist/hand, is the most commonly injured anatomical area in all Para athletes, unlike able-bodied athletes for whom lower extremity injuries predominate. Increased age and spinal cord injury may increase risk of upper extremity injury. Sprains, strains, blisters and lacerations are the most common injuries among Paralympians, but winter Paralympic sports carry higher risk of head injury, fracture and contusion, possibly due to the high-velocity elements. Male and female summer Paralympic athletes have similar overall injury rates, and Football 5-a-Side, Para powerlifting, Goalball, Wheelchair fencing, and Wheelchair rugby are consistently highest-risk sports. Para ice hockey, alpine skiing, and snowboarding are highest-risk winter sports. Upper and lower extremity injury rates match in winter sport, unlike summer sport trends. Injury data for recreational and youth Para athletes are sparse. Conclusion: MSK injury epidemiology data continues to mature. Recreational and youth athletes remain under studied. Updating such data may accelerate the development of injury prevention strategies and lifetime injury models for Para athletes.

Keywords: Injury epidemiology, para athlete, systematic review

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2664 Top


Isokinetic and neuromuscular testing of the knee, return to sport following reconstruction of the anterior cruciate ligament: Prospective study in a cohort of 234 athletes

B. Guerrier, S. Klouche1, Y. Bohu1, B. El Hariri, T. Raoul1

L’éKipe - Kinés du Sport, 1Clinique du Sport, Paris, Paris, France

E-mail: guerrierbaptiste@gmail.com

Introduction/Background: After an anterior cruciate ligament (ACL) reconstruction, a complete functional recovery of the knee is required before returning to sport. According to the latest recommendations, a deficit < 10% on isokinetic and functional tests of the operated side versus the healthy side means a satisfactory functional recovery. The main objective was to assess the objective postoperative functional recovery of the knee in a large cohort. Materials and Methods: A prospective study has included a series of athletes operated in 2013-2016 for a primary total isolated ACL tear, with healthy contralateral knee and having complete postoperative evaluation. Isokinetic tests measured the strength of the quadriceps and hamstrings. Functional tests consisted of hop tests. The primary judgement criterion was postoperative functional recovery (yes/no) defined by a differential < 10% on the strength measurement of quadriceps in concentric at 60°/s (Q60°/s) and on single-leg hop test for distance (SLH), at a minimum of 4-months postoperative follow-up. Results: 173 men and 61 women were included, mean age 28,4±8,6 years. At 6,5±1,7 (4-12) months mean follow-up, 44 (18,5%) had satisfactory functional recovery of the knee whose 52 (21,8%) at Q60°/s and 125 (54,3%) at SS. There was no significant difference in the return-to-sport depending on the level of functional recovery. During follow-up, 2 patients showed transplant rupture and 2 controlateral ACL rupture, all classified with insufficient functional recovery. Conclusion: At 6-months mean follow-up after ACL reconstruction, the objective functional recovery of the knee is mostly unsatisfactory and appears to be a risk factor for further rupture.

Keywords: Anterior cruciate ligament reconstruction, hop test, isokinetic test

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0401 Top


Stability of extracapsular hip fracture: Does it affect rehabilitation outcome of post-acute patients?

A. Hershkovitz, S. Heler1, T. Luria1, N. S. Lior2, S. Brill3

Beit Rivka’ Geriatric Rehabilitation Center, “D”, 1Department of Orthopedic Surgery, Rabin Medical Center, 2’Beit Rivka’ Geriatric Rehabilitation Center, Rehabilitation Ward “D”, 3‘Beit Rivka’ Geriatric Rehabilitation Center, Hospital Manager, Petach Tikva, Israel

E-mail: avitalhe@clalit.org.il

Introduction/Background: Various factors have been shown to affect rehabilitation outcome of hip fractured patients. The degree of extracapsular fracture stability may also affect functional recovery. The aim of our study was to assess the relationship between extracapsular hip fracture stability and rehabilitation outcome in a post-acute setting. Materials and Methods: A retrospective cohort study of 144 hip fractured patients was carried out in a post-acute geriatric rehabilitation center from 1/2014 to 6/2015. The main outcome measures were the Functional Independence Measure (FIM) instrument, motor FIM (mFIM), Montebello Rehabilitation Factor Score (MRFS) on the mFIM and length of stay (LOS). The associations between patients with stable vs. unstable and clinical, demographic and comorbidity variables, were assessed by the Mann-Whitney U and chi-square tests. A multiple linear regression model was used to estimate the association between fracture stability and LOS score after controlling for sociodemographic characteristics and chronic diseases (p=.009). Results: Rehabilitation outcomes (FIM and mFIM score changes, mFIM MRFS) were found independent of extracapsular hip fracture stability. Patients with an unstable fracture presented with a significantly longer LOS compared with a stable fracture (p=.008). Multiple linear regression analysis showed that fracture stability was significantly associated with LOS after adjustment for confounding demographic, clinical and functional variables (p=.009). Conclusion: Patients with unstable extracapsular hip fractures may require a prolonged rehabilitation period in order to achieve the same functional gain as patients with stable fractures.

Keywords: Hip fracture, rehabilitation, stability

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2044 Top


Stress fracture of distal femur identified with musculoskeletal ultrasound after normal X-ray and magnetic resonance imaging

E. Morrison

Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, USA

E-mail: ericjmorrison@gmail.com

Introduction/Background: Magnetic resonance imaging (MRI) and x-ray have traditionally been used to identify musculoskeletal pathology. Diagnostic musculoskeletal ultrasound, however, is becoming increasingly popular among physiatrists. Materials and Methods: A 35-year-old male runner with no significant past medical history presented with a complaint of right medial knee pain for the past 6 to 8 weeks. He reports that he had recently increased his running mileage significantly while running in shoes that were due to be replaced. He had stopped running but noted that the pain persisted. He described the pain as located in one specific spot on the medial aspect of the right knee, rated 4/10 most of the time, but was exacerbated by putting more force through his leg with activities including jogging, going up and down stairs, or carrying heavy objects. Results: X-rays of the right knee were obtained and were normal, which prompted further imaging with an MRI one week later, which was also normal. Laboratory testing was remarkable for Vitamin D deficiency of 13 ng/mL. Musculoskeletal ultrasound revealed a small fracture of the medial epicondyle of the femur measuring 3 mm x 3 mm that was tender to sonopalpation. The patient was instructed to avoid running until pain free for at least 2 weeks before starting on a graduated return to running protocol. Conclusion: Musculoskeletal ultrasound may be a useful imaging modality for identifying stress fractures even in some cases where traditional imaging with x-ray and MRI are negative. This may have important implications for use in resource-limited settings where ultrasound is portable and relatively inexpensive in comparison to MRI.

Keywords: Musculoskeletal, stress fracture, ultrasound

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0540 Top


How does ballet alter ankle tendinous morphology and hemodynamics in asymptomatic dancers? An ultrasonographic study

W. S. Shih, C. H. Wu, T. G. Wang

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan

E-mail: nojred@gmail.com

Introduction/Background: Among symptomatic dancers, sonographic abnormalities are common. Whether asymptomatic dancers have any abnormalities remains unknown. Some dancers became cyanosis over distal feet after ballet training. The hemodynamic changes at the feet in ballet are not clearly understood. We aimed to investigate tendon morphology and hemodynamic changes in ankles of asymptomatic pre-professional ballet dancers with ultrasonography (US). Materials and Methods: In 25 dancers and 14 non-dancers, B-mode US was used to measure cross-sectional areas (CSA) of flexor tendons in the ankle. Doppler US was used to measure peak velocity of posterior tibial artery in three ankle postures: the neutral position, passively and forced actively plantar flexion (en pointe). The big toe oxygen saturation was recorded in neutral position and during 1-minute en pointe. Nonparametric Mann-Whitney test was used for between-group comparison and Wilcoxon signed-rank test for within-group comparison. Results: Ankle plantar flexion range of motion was significantly larger in dancers (p < 0.01). The flexor hallucis longus (FHL) tendon CSA was larger in dancers (0.26 cm2 [0.2, 0.3] vs. 0.21 cm2 [0.17, 0.24], p < 0.01), while other flexor tendons were not different between two groups (all p > 0.05). The peak velocity was significantly higher in passively plantar flexion than in neutral position (p < 0.01, in both groups). The blood flow was undetectable during en pointe, more frequently in dancers (54.9% vs. 14.3%, p < 0.01). Oxygen saturation decreased during en pointe more prominently in dancers (85% [80, 90] vs. 94% [84, 97], p < 0.01). Ankle hypermobility and the FHL muscle contraction may decrease the blood flow of posterior tibial artery, more frequently in ballet dancers. Conclusion: US showed the FHL tendon thickening and en pointe-related vascular compromise in pre-professional dancers, even when they were asymptomatic.

Keywords: Ankle, dancer, ultrasound

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1371 Top


How to assess the return to physical activities following anterior cruciate ligament injury?

O. Ucay1,2, A. Renault1, B. Chaminade3, E. Cavaignac3, D. Gasq1,4

1Department of Functional Physiological Explorations, Centre Hospitalier Universitaire- Hôpital de Rangueil, 3Centre Hospitalier Universitaire- Hôpital de Purpan, Department of Orthopaedics Surgery, 4Toulouse NeuroImaging Center, University of Toulouse- Inserm UMR 1214- UPS, Toulouse, 2Centre Européen de Rééducation du Sportif, Cers, Capbreton, France

E-mail: olivier.ucay@gmail.com

Introduction/Background: Several outcomes could be used to assess return to physical activities (RTPA) after anterior cruciate ligament (ACL) injury: qualitative outcomes like return to main sport or pre-injury level; quantitative outcomes like weekly hours of practice or Tegner score. Performing a relevant clinical assessment is challenging, especially for patients who practice at a moderate sport level. Our objective was to compare the use of different outcomes to assess RTPA after functional and surgical treatment of ACL injury. Materials and Methods: 40 patients were included after surgery (group ST; 31.7±10.6 years-old, 15.0±5.0 months after ACL reconstruction);18 after functional treatment (group FT; 38.1±14.8 years-old, 23.0±6.0 months after ACL tear). Qualitative criteria were subjectively assessed answering yes/no when questioned concerning their RTPA. Objective criteria were defined as variations between pre-injury and post-treatment of Tegner score, weekly hours of practice, “Tegner.h” (global volume of activity equal to Tegner score multiplied by weekly hours of practice) for main physical activity (MPA) and global activity (3 MPA included). Results: Return to subjective global pre-injury level was 22% for FT group vs. 25% for ST group (p=0.999). Return to pre-injury (i) level of MPA was 17 vs. 23% (p=0.736); (ii) Tegner score for the MPA was 56 vs. 30% (p=0.083); and (iii) global Tegner.h was 61 vs. 18% (p=0.002) for FT versus ST group, respectively. Evolution of Global Tegner.h score, MPA Tegner.h score and Global weekly hours of practice were congruent for FT group, but not for ST group. Conclusion: We found low RTPA rates with some discrepancies between different outcomes of RTPA. Global Tegner.h could be an interesting alternative to Tegner score of the MPA for assessment of RTPA in non-operated patients who have a moderate physical activity level.

Keywords: Anterior cruciate ligament, patient reported outcome measures, return to sport

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0637 Top


Benefits of a self-rehabilitation booklet in muscle recovery measured 4 months after anterior cruciate ligament reconstruction

L. Ghozlane, M. Bovard, V. Salvator Witvoet

CRRF La Châtaigneraie Convention, Paris, Paris, France

E-mail: l.ghozlane@lachataigneraie.fr

Introduction/Background: We created and validated a self-rehabilitation booklet to allow patients to perform by themselves muscle reinforcement after they completed rehabilitation in a rehab center (between 2 and 4 months after surgery). The aim of the study is to evaluate the impact of a self-rehabilitation booklet on quadriceps and hamstrings recovery 4 months after Bone Patellar Tendon Bone (BPTB) or Hamstrings (HST) autograft. Materials and Methods: Open mono-centric prospective clinical trial on 2 periods.

1st period: 124 patients received non-standardized information, according to center usual practice. When leaving the rehab center, patients were provided either a prescription for physiotherapy sessions or strengthening sessions in a gym. 67 patients in this group returned to the center for a clinical assessment, isokinetic and a functional test. 2nd period: 165 patients received a self-rehabilitation booklet with instruction to perform three times a week muscle strengthening session in a gym or at home. 76 patients in this group returned for similar assessment as the first group (2nd arm). We compared subjective and objective IKDC scores, quadriceps and hamstring peak torque deficiency and the functional score. Results: All measured variables show no significant difference between the 2 groups.Quadriceps and hamstrings deficit are equal to literature. Patients with BPTB graft showed a greater deficit in quadriceps (p =0,00001) and lower deficit in hamstring strength (p = 0,0001) at 60°/s. The number of sessions at the gym significantly improves the subjective IKDC score and hamstrings recovery in both groups. Conclusion: The self-rehabilitation booklet allows patients to perform by themselves muscle strengthening. The number of sessions at the gym improves IKDC score and hamstrings recovery.

Keywords: Anterior cruciate ligament, knee, rehabilitation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2099 Top


Comparison of functional results after early controlled motion for surgical repair of acute and chronic ulnar collateral ligament injury of the thumb

B. Başar, N. Güneşaslan, B. Erhan, H. Başar1

Departments of Physical Medicine and Rehabilitation and 1Orthopedics and Traumatology, Istanbul Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey

E-mail: hbasar80@hotmail.com, betulakarvardar@hotmail.com

Introduction/Background: Injuries to the UCL can lead to functional impairment. Rehabilitation is very important for functional results. Early motion after surgery is avoided. Usually the controlled motion starts after the 6th week.The aim of this study was to evaluate functional results of early controlled motion before 6th week. Materials and Methods: 19 patients (18♂/1♀) had an acute UCL rupture, 25 patients (23♂/2♀) had a chronic UCL rupture. Two soft anchor (Mini 1.0 mm) were used to repair ruptured UCL to bone insertion at the acute UCL injury group. For chronic UCL injury group, 3,0 mm bone tunnels were prepared to proximal and distal insertion of UCL and than tendon graft was passed through the tunnels. The tendon graft was stabilized by placing 3,0-mm bioabsorbable suture anchors within the tunnels. The motion was restricted in the 2 week with thumb spica. Dynamic splint and passive ROM exercises were started after 2 week. Active ROM exercises were started after 4 week. Results: There were no significant differences between the two groups in the men/women ratio, mean age, mean follow-up period. All patients regained full stability at MCP joint in acute UCL injury group;21 patients regained full stability and 4 patients presented with mild laxity (<10° laxity) in chronic UCL injury group. The ROM of injured MCP joint of thumb was regained at 8-10 week as good as healthy extremity MCP joint of thumb. There were no significant differences between operated and healthy thumb MCP joint in both groups in the grip and pinch strength, flexion, extension, radial deviation, ulnar deviation motions at final control. Glickel grading scale was excellent for 19 patients for acute UCL injury group; it was excellent for 21 patients and good for 3 patients in chronic UCL injury group. Conclusion: Early controlled motions affect functional results positively. Repair with 1-mm soft anchors in acute UCL injury and reconstruction with tendon graft which stabilized by 3-mm bioabsorbable suture anchors within the tunnels in chronic UCL injury provides adequate stability for early controlled motion.

Keywords: Acute ulnar collateral ligament injury of thumb, chronic ulnar collateral ligament injury of thumb, early controlled motion

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2313 Top


Interest of the botulinum toxin in adductor related groin pain

T. Fok Cheong Kah Wai, A. Creuzé1, P. Bordes2, M. De seze2

île de la Réunion, 97460, Saint Paul, 1Clinique des Grands chênes, Gironde, 2CHU Bordeaux, Gironde, Bordeaux, France

E-mail: thomas.fok-cheong-k-ah-wai@u-bordeaux.fr

Introduction/Background: Groin pain in athletes is a common problem. The use of botulinum toxin (BTX) has shown good results in neuromuscular diseases and more recently in pathologies such as epicondylitis. The aim was to assess the effectiveness and side effects of the BTX injections in adductor related groin pain which resists to rehabilitation and/or surgery. A pilot study with one year follow-up. Materials and Methods: Between March 2014 and April 2016 we systematically registered patients who received BTX injections in adductor muscles under both control by ultrasound and electrostimulation. We carried out a follow up at 1, 3, 6 and 12 months on pain intensity, HAGOS scores, professional disability, and side effect recording. Results: 30 patients, 83% males and 17% females have been included. Adductor tenotomy was recorded in 14 patients before the injection. Pain intensity decreased significantly (D0: 65±16 mm; D30 31±23; D90 28±23; D180 33±28; D36531±30; p<0.05). HAGOS score showed significant improvements on all sub-scales (symptoms, pain, physical function in daily living, in spot and recreation, participation on physical activities and hip or groin related quality of life (p<0.05)). The intensity Professional disabilities decreased significantly at D30, 90, 180 and D365 (p<0.05). Three patients failed to be relieved and all of them had a previous adductor tenotomy. Five patients had a recurrence during the follow up and 3 of them had a previous adductor tenotomy too. Conclusion: This present study suggests that BTX is an effective treatment for the adductor related groin pain with no side effect and a low rate of recurrence.

Keywords: Botulinum toxin, groin pain, sports injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2455 Top


Remote after-effects of resistive static contractions of lower trunk depressors and upper extremity on maximal active range of motion of ankle extension in ankle fractures

T. Shiratani, R. Hobara, I. Natsuki1, M. Arai2

Department of Rehabilitation, Sonoda Second Hospital, 2Division of Physical Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Tokyo, 1Department of Physical Therapy, Tsukuba International University, Manabe- 6-20-1- Tsuchiura-shi- Ibaraki-ken, Japan

E-mail: pnfsw@tmu.ac.jp

Introduction/Background: Direct approaches to improve maximal active range of motion (MAROM) of restricted joints may be difficult because of pain or weakness of agonist and/or antagonist muscles. Resistive static contraction (SC) of posterior depressors (RSCPD) using a PNF pattern in the mid-range of pelvic motion increases the flexibility of remote joints, such as the upper shoulder and knee, as remote after-effects in the clinic. The purpose of this study was to investigate the remote after-effects of RSCPD on the MAROM of ankle plantar flexion in patients with isolated ankle fractures. Materials and Methods: Thirteen patients with ankle fractures (7 men and 6 women, mean age 50.9 years, SD 11.9 years) were randomly assigned to resistive SC of shoulder flexion on the affected side (SCUE), RSCPD on the affected side, and SC of the affected ankle extensors. Each SC was induced by resistance (20% MVC) generated by a manual force using a handheld dynamometer. The duration of each resistive exercise and stretch was 20 s. The % MAROM change for ankle extension after each technique was calculated by subtracting the MAROM before each technique. Results: The mean (SD) MAROM was 3.32 (11.35%) for RSCPD, 0.64 (6.25%) for SCUE, and -5.65 (8.05%) for SC. A two-way ANOVA for the %MAROM change showed significant main effects for technique (F (2,24)=3.84, p=0.04, partial eta squared=0.24) and individual (P=0.32). A post hoc Scheffe test indicated that the % MAROM change for RSCPD was significantly larger than that for SS (p=0.04). Conclusion: RSCPD showed a significant improvement over SC, which suggests that RSCPD may have immediate remote after-effects that improve flexibility of the plantar flexor muscle in patients with ankle fracture.

Keywords: PNF, remote after-effect, static contraction

Disclosure of interest: The authors did not declare any conflict of interest.


  A2.08 Musculoskeletal Conditions - Miscellaneous Top



  ISPR8-2616 Top


Is muscle strength related to spatio-temporal gait parameters in adults with myotonic dystrophy type 1?

M. Harvey, M. Gosselin, M. Vocos1, A. S. Comtois, L. N. Veilleux2, L. Ballaz3

Département des Sciences de l’Activité Physique, Université du Québec à Montréal, 1Centre de Réadaptation Lucie-Bruneau, Physiothérapie, 2Centre d’analyse du mouvement, Hôpital Shriners Pour Enfant-Canada, 3Centre de Réadaptation Marie Enfant, CHU Sainte-Justine, Laboratoire de la Marche – LAM CRME, Montréal, Canada

E-mail: myriamharvey@hotmail.com

Introduction/Background: The Myotonic Dystrophy type 1 (DM1) is the most common adult muscular dystrophy. DM1 is clinically characterized by a decrease of muscle strength during adolescence and adulthood, resulting in a decrease of functional capacity. In this population, gait is characterized by a lack of hip and knee range of motion, as well as lower ankle power generation during the push-off phase. Distal muscle weakness can be suspected as a key parameter resulting in such gait adaptation in people with DM1. The aim of this study was to explore the relationship between lower limb muscle strength and spatio-temporal gait parameters in adults with DM1. Materials and Methods: An instrumented gait analysis, including kinematic and kinetic measurements was performed in 17 adults with DM1. All participants were asked to walk at their comfortable speed along a 13-meter walkway. Maximal isometric muscle strength was measured at the hip and knee joints by an experimented assessor using hand held dynamometer. Ankle power generation during walking was used as plantar strength indicator. Results: Ankle peak power generation was correlated with stride length (r=0.64) and walking speed (r=0.76, p<0.01). Stride length was also correlated with maximal contralateral (r=0.64) and ipsilateral (r=0.68) knee extensors strength (p<0.01) and maximal contralateral (r=0.59) and ipsilateral (r=0.53) hip abductors strength (p<0.05). Linear regression models were fitted using a forward stepwise model selection procedure to explain the variance of spatio-temporal gait parameters. Maximal isometric lower limb muscle strength and ankle peak power generation were considered as independent variables. Ankle peak power generation accounted for 57% of the walking speed variance (p<0.001). Ankle power, knee extension and hip flexion account for 72% of the step length variance (p<0.05). Conclusion: The present study highlighted the key role of ankle power generation and knee extensor strength on gait pattern adaptation in people with DM1.

Keywords: Gait, muscle strength, steinert disease

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0464 Top


Relationships between hand strength and motor abilities in non-ambulant patients with duchenne muscular dystrophy or spinal muscular atrophy

V. Decostre, M. Anoussamy1, M. De Antonio2,3, A. Canal, L. Servais1,4, J.Y. Hogrel

Institut de Myologie, Pôle Evaluations Neuromusculaires, 1Institut de Myologie, I-Motion, 2APHP - GH Pitié-Salpêtrière, Centre de référence Pathologie Neuromusculaire Paris-Est, 3Centre de recherche des Cordeliers UMRS 1138, Universités Descartes et Pierre et Marie Curie, Paris, France, 4Centre Hospitalier Régional de La Citadelle, Reference Center for Neuromuscular Disease, Liège, Belgium

E-mail: v.decostre@institut-myologie.org

Introduction/Background: Upper limb function is fundamental for non-ambulant patients. In neuromuscular diseases, the impact of handgrip and key pinch progressive weakness on hand function is not described. This study aims to establish the relationships between hand strength and function in non-ambulant patients with Duchenne Muscular Dystrophy (DMD) or Spinal Muscular Atrophy (SMA). Materials and Methods: The handgrip and key pinch maximal strength were measured with the MyoGrip and MyoPinch highly sensitive dynamometers, respectively. Hand function was assessed by the 6 items regarding distal upper limb function in the Motor Function Measure (MFM, a 4-points based scale rater-controlled with a total of 32 items) and by the Cochin scale (a 6-points based self-administrated-questionnaire on hand abilities in everyday life with 18 items).



Results: 53 DMD and 23 SMA patients (age 8–31 years) were included. The scales and single items functional scores were highly correlated to strength (P<0.001). However, depending on the items, the Spearman coefficients reflected correlation varying from high to negligible, suggesting that some functional items require strength more than others. For all the functional items but one, strength corresponding to the “greatest disability” score was significantly lower than strength corresponding to the “no disability” score (Kruskall-Wallis, P<10-5). Hand function was rather preserved until a handgrip and key pinch strength cut-off. For strength lower than the cut-off, hand function scores decreased with decreasing strength although a large variability was observed. Conclusion: Hand functional ability is correlated to strength. However, contractures, motor compensations and psychological state may contribute to the large variability observed in the strength – function relationships. Therefore, functional hand ability of a single individual cannot be predicted solely from handgrip or key pinch strength.

Keywords: Hand function, muscle strength, neuromuscular diseases

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2172 Top


Neuromuscular reprogramming in femoro patellar pain syndrome using combined muscle contractions

S. Mesure, F. Grazziani1, J. B. Grisoli2, J. M. Coudreuse3

Institut of Mouvment Science, UMR- FSS 7287, 1Centre de kinésithérapie du sport 33, Médecine du sport, 2Pôle de médecine physique et de réadaptation, Service de médecione du sport, 3Pôle de médecine physique et de réadaptation, Service de médecine du Sport, Marseille, France

E-mail: serge.mesure@univ-amu.fr

Introduction/Background: The main objective of this study is to measure the effect induced by combined muscle contraction of the Quadriceps and rectus femoris (by neuro-muscular reprogramming) on pain phenomena and on the short-term recovery of muscle power. The goal to be achieved for these patients is to reduce the pain phenomena and to modify voluntarily and actively the orientation of their functional mechanical axes. Materials and Methods: Evaluation of isokinetic quadriceps strength before and after stretching the injured knee and the healthy knee for 27 patients with FPPS and 12 healthy control subjects (matched). No pathology on the contralateral knee. The evaluation is carried out at 60°/s concentric 120°/s concentric and 30°/s eccentric contraction by an isokinetic dynamometer. After performing the isokinetic tests and evaluating the pain (by EVA), specific contraction work of the quadriceps of the injured knee according to an identical protocol for each patient was performed (3 times). Results: Our results show a significant effect of these contraction exercises on the pain phenomena of patients in the short term. We obtained after quadriceps contraction a significant decrease in pain -38% and an increase in the strength of +17% for the pathological group. No significant change in the control group. There is a statistical correlation between the decrease of pain and recovery of strength after stretching. This significant decrease in pain associated with an increase in force parameters in only eccentric contraction. Conclusion: We confirm the effectiveness of quadriceps stretching with slow eccentric contraction in the care of FPPS. These beneficial effects are in favor of a systematic use with muscle building. These results are in favor of a new therapeutic care by using this kind of stretching. The management of stiffness and neurophysiological components that are directly associated with these phenomena of stiffness during the onset of this syndrome, encourages therapists to continue.

Keywords: Isokinetic, neuromotor reprogramming, pain

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0670 Top


Comparison of the effects of ozone versus steroid injection, in treatment of patients with tennis elbow

S. A. Raeissadat, M. H. Abdollahzadeh1

Department of Physical Medicine and Rehabilitation, Research Development Center of Shahid Modarres Hospital, 1Department of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitarion Research Center, Tehran, Iran

E-mail: hesam.abdollahzadeh@gmail.com

Introduction/Background: Tennis elbow is a prevalent musculoskeletal disorder. In recent years ozone injection has been proposed as a treatment for many musculoskeletal disorders. The aim of this study was to compare the effect of ozone with the standard treatment of steroid injection in patients with tennis elbow, resistant to conservative treatments. This comparison is made according to VAS score, Pressure pain threshold (PPT) and modified Mayo clinic performance index for elbow. Materials and Methods: In this study 64 patients with tennis elbow, which have had the symptoms for more than 3 months and were resistant to conservative treatments, were randomized to two groups. In steroid injection group 40 mg of methylprednisolone acetate and in zone injection group 4 ml of ozone with concentration of 15 mcg/ml was injected. 32 patients in steroid and 29 patients in ozone injection group finished this study. Data were gathered before injection and 2 and 6 months after that by VAS score, modified Mayo clinic performance index for elbow and PPT (measured by the means of an algometer). Variables were compared between the two groups and also the changes in each group have been measured in reference to baseline data. Results: In both groups VAS score, Mayo clinic performance index and PPT improved significantly in 2 and 6 month follow up. Steroid injection was significantly better than ozone injection in improving 2 and 6 months pressure pain threshold and 6 months Mayo clinic performance index. Other data didn’t show significant difference between the two groups. Conclusion: Both steroid and ozone injection improved pain and function in patients with recalcitrant tennis elbow for at least 6 months. Steroid injection was superior to ozone injection in improving PPT in 2 and 6 month and Mayo clinic performance index score at 6 month follow up.

Keywords: Ozone, steroid, tennis elbow

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1427 Top


Benefits of botulinum toxin type a in shoulder dysfunction and regional pain in assistance to reconstructive mammary surgery: A pilot study

S. Corio Lombardi, L. Adrover Kirienko, P. Launois Obregon, A. Gomez-Garrido, V. Pujol Blaya

Department of Physical Medicine and Rehabilitation, Hospital Vall d’Hebron, Barcelona, Spain

E-mail: saro42@gmail.com

Introduction/Background: Shoulder dysfunction and regional pain in patients undergoing breast reconstruction with prostheses due to breast cancer is a long-term disabling condition. To evaluate the effect of botulinum toxin type A 60 U im regarding the volume differences of the affected arm before and after treatment. Materials and Methods: Descriptive longitudinal study of a rehabilitation program during the reconstructive process addressed to women undergoing mastectomy and lymphadenectomy. All patients performed a structured program of group exercise before infiltration. Subsequently, if pain persisted and functional joint range decreased, a 60 U injection of botulinum toxin type A (Xeomin®) was performed in pectoralis major with ultrasound elastography. The difference in volume, distal force measured by claw dynamometry and VAS symptoms (pain, heaviness, tightness and hardness) was evaluated before (T0), at one (T1) and at six months (T2) of treatment, as well as changes in ultrasound images. SPSS 16.0 statistic program was used to compare paired data means (IC 95% alfa 0.005). Results: Ten patients were selected. Baseline characteristics were: mean average age 51.1 years. Nine right -handed, nine with right arm affected (8 right, 1 bilateral). They all presented significant improvements regarding pain, heaviness, tightness and hardness (T0-T1) that remained at 6 months for tightness and hardness (T0-T2).They did not present significant differences in regard to volume difference or distal claw force after infiltration. Conclusion: The use of botulinum toxin at doses of 60 U im in pectoralis major has been shown to be a safe technique for lymphedema, improving symptoms during the first month post infiltration without decreasing distal claw force.

Keywords: Botulinum toxin, breast cancer, reconstructive mammary surgery

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0331 Top


Effects of short foot exercise with visual feedback on balance and knee joint function in subjects with flexible flatfeet

J. Kim, M. Lee, J. Seo

Department of Physical Therapy, Daegu Haany University, Gyeongsan, Republic of Korea

E-mail: wntkd-c@hanmail.net

Introduction/Background: This study examined the effects of a 5-week short foot exercise (SFE) program with visual feedback on the balance and knee joint function in flexible flatfeet and compared the measures between a flexible flatfoot and normal foot. Materials and Methods: A total of 30 subjects participated in this study (15 subjects with a flexible flatfoot, 15 subjects with a normal foot). The subjects were divided through the Navicular Drop Test (NDT). The flexible flatfoot group included subjects with an NDT greater than 10 mm. The normal foot group included subjects with an NDT of 5-9 mm. The subject group performed SFE with visual feedback. SFE programs were completed 20 minutes a day, five times a week for 5 weeks. Results: A significant difference in the static balance area was observed between the flatfoot group and normal foot group on the pre-test (p<0.05), and there was a significant difference in the Ant. direction and PM direction between the flatfoot group and the normal foot group on the pre-test (p<0.05). The knee joint motions accuracy on the closed chain was significantly different between group on the pre-test (p<0.05). A comparison of the pre and post intervention revealed a significant difference in the static balance area and all directions of dynamic balance in the flatfoot group, but only the dynamic balance was significantly different in the normal group (p<0.05). The closed chain motions accuracy of the knee joint after the intervention was similar in the flat foot group and normal foot group. Conclusion: The balance and knee joint motions accuracy was different in the flat foot group and normal foot group. The SFT program with visual feedback was effective in improving the balance and knee joint motions accuracy.

Keywords: Flat foot, short foot exercise

Disclosure of interest: The authors did not declare any conflict of interest.


  A2.08 Musculoskeletal Conditions - Miscellaneous Top



  ISPR8-0956 Top


Resection of neurogenic heterotopic ossification of the hip, lessons learned after 377 procedures

N. de l’Escalopier, P. Denormandie, L. Gatin, A. Grelier1, F. Genet1

Departments of Orthopaedic Surgery and 1Physical Medicine and Rehabilitation, Hopital Raymond Poincare, Garches, France

E-mail: ndelescalopier@gmail.com

Introduction/Background: Neurogenic heterotopic ossification (NHO) of the hip is secondary to neurologic lesions such as cranial trauma, stroke, medullary injury or cerebral anoxia. Our practice of heterotopic ossification surgery has progressed during our experience, becoming better adapted to the pathology and to the patients, who are often fragile and show neurologic sequelae. We want to give a feedback of the lessons we learned in the Raymond Poincare Hospital about NHO resection. Materials and Methods: 377 first-line procedures were performed for heterotopic ossification of the hip between 1993 and November 2016. Surgery requires rigorous organization and planning, preferably in a rehabilitation department, by a multidisciplinary team experienced in this pathology. Preoperative work-up should include contrast-enhanced CT; scintigraphy is non-contributive. Indications for surgery are decided in a multidisciplinary team meeting, with a contract laying out expected functional gain. It is this contract that determines the extent of resection, without seeking complete resection, which would incur an increased risk of complications. Results: The surgical approach and resection strategy depend on lesion location and any resulting neurovascular compression. In our own series, 3,5% of patients required revision for recurrence. The most common complications is infection: 10.3% in our experience, with wide variation according to location. No adjuvant treatments have demonstrated efficacy against recurrence. Conclusion: Surgical treatment of heterotopic ossification of the hip is reliable when performed in an adapted center by an experienced multidisciplinary team. Clinical results are satisfactory. There remains, however, a risk of sepsis, especially with medullary injuries.

Keywords: Hip, neurogenic hetrotopic ossification, surgery

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1205 Top


New technique of ultrasound guided injection in the carpal tunnel syndrome

K. Joon-Sung, S. Bomi, H. Bo Young, L. Seong Hoon

Department of Rehabilitation Medicine, St. Vincent’s Hospital, Suwon, Republic of Korea

E-mail: joonsungg.kim@gmail.com

Introduction/Background: In conventional ultrasound-guided corticosteroid injection in carpal tunnel syndrome (CTS), the entry point is usually at the distal crease of the wrist. However, actual pathology of CTS is caused by thickening of the transverse carpal ligament (TCL). Injection of corticosteroid can reduce inflammation and ameliorate the symptoms, but it cannot reduce the thickness of TCL. If we change the entry point to just 10 mm below the distal crease rather than at the distal crease, we can inject corticosteroid around the median nerve and into the TCL. Materials and Methods: Five patients with CTS treated with ultrasound-guided corticosteroid injection around median nerve and into the TCL. The diagnosis of CTS was made by history, physical examination, sonographic evaluation, and electrophysiologic confirmation. Sonographic examinations were performed by one physiatrist using Samsung scanner with a 5-12 MHz linear transducer. Standard 23-gauge needles were used for administration of local anesthetics and triamcinolone mixture (total 1cc). After transverse view and longitudinal view, the entry point was determined. The entry point was below the distal crease, where the needle could easily introduce the injection material into the thickened TCL. The direction of the needle entry point was from lateral to ulnar side. Results: Total of five female patients with CTS were included. The mean age was 55. 4 ± 3.6 years. The mean duration of disease was 4.6 (range 3-8 mo) months. The results were good to excellent in all patients. There were no complications during the procedure. Conclusion: Ultrasound-guided corticosteroid injection in CTS, combined with injection at the thickened TCL may be a good method and further research is needed to confirm the usability.

Keywords: Carpal tunnel syndrome, injection, sonography

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1802 Top


Reliability study of sub-acromial impingement tests including a new clinical manoeuver

J. Beaudreuil, A. Ferenczi1, A. Yelnik2, P. Orcel1

Departments of PRM and Rheumatology, 1Rheumatology and 2Physical and Rehabilitation Medicine, GH St. Louis-Lariboisière-F. Widal- Paris Diderot University, Paris, France

E-mail: johann.beaudreuil@aphp.fr

Introduction/Background: Neer, Hawkins, and Yocum tests are used in clinical practice to detect sub-acromial impingement. Their reliability has been few investigated. The goal of the study was to investigate reliability of Neer, Hawkins and Yocum tests. We also assessed an original manoeuver. Materials and Methods: Patients with shoulder pain due to degenerative rotator cuff disease were prospectively included. They were twice assessed at one week interval by two independent observers. Results of Neer, Hawkins and Yocum tests were recorded as positive or not. Results of an original manoeuver (OM) including elevation in medial rotation followed by lateral one were also. Intra- and inter-observer reliability was assessed. Criteria of reliability were the percentage of agreement and the kappa coefficient of concordance with 95% confidence interval (CI). Kappa coefficient indicated moderate concordance if > 0.4, good > 0.61. Results: 34 Patients were included: age 60±11, ratio F/M 26/8, pain duration 27±67 months. For intra-observer reliability, agreement was 80-88% with Neer, Hawkins and Yocum tests. It was 80% with OM. Using kappa coefficient, intra-observer reliability was poor with Neer test (0.34 [-0.1;1]) and moderate with Hawkins (0.56 [0;.9]), Yocum (0.48 [0;0.8]) and OM (0.6 [0.2;0.9]). For inter-observer reliability, agreement was 73-88% with Neer, Hawkins and Yocum tests. It was 79% with OM. Using kappa coefficient, inter-observer reliability was poor with Yocum test (0.35 [0;0.7], moderate with Hawkins (0.54 [0.2;0.8]) and OM (0.58 [0.2;0.8]), and good with Neer (0.64 [0.2;0.9]). Conclusion: Neer test was impaired by poor intra-observer reliability and Yocum test was impaired by poor inter-observer reliability. Hawkins test and OM had a balanced profile of moderate reliability. There was a trend to higher values with OM. We underlined there an interesting profile of reliability of an original clinical manoeuver to detect sub-acromial impingement.

Keywords: Rotator cuff, subacromial impingement

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0508 Top


The relationship between core endurance and upper extremity performance in sedentary collegiate males

R. Savkin, K. Y. A. Alsayani, N. Büker

Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey

E-mail: nasuk@pau.edu.tr

Introduction/Background: Core muscles contribute to general spine stabilization when the trunk is exposed to flexion and extension moments. It is thought that movements begin from the center of the body (called the “powerhouse” or “core”) and flow outward to the extremities, and a strong core strengthens the whole body. Few studies have examined the relationship between core endurance and upper extremity performance and most of the studies has been done in athletes. Thus, the purpose of this study was to investigate relationships between core endurance, and upper extremity performance in sedentary collegiate males. Materials and Methods: Sedentary collegiate males who had not suffered any orthopedic injury in the past year were enrolled the study. Core endurance (CE) was evaluated using trunk extensor test, bilateral side bridge tests, and The Core Muscle Strength and Stability test. The results of the core endurance tests were compared with several upper extremity performance measurements: The Upper Quarter Y Balance Test (bilaterally in medial, inferolateral, and superolateral directions-UQYBT), Close Kinetic Chain Upper Extremity Stability Test (CKCUES test), medicine ball throws test (forward, reverse, right, and left in static and dynamic positions), hand grip strength, and Nelson hand reaction test. Results: Eighty-three males were assessed during the study. Their mean age was 22.07±1.89 year (range:18-25) and mean body mass index was 23.77±3.26 kg/m2 (range:17.67-36.11). We observed low correlations between the CE tests and UQYBT (r range=0.220−0.393, p<0.05) but no correlations between the CE and hand grip strength and Nelson hand reaction test. CKCUES and medicine ball throws test (non-dominant side in dynamic position) correlated with side bridge test, r=0.279 and r=0.240, respectively (p<0.05). Conclusion: The results of this study imply that the core endurance is related to the upper extremity performance in closed kinetic chain but not with open kinetic chain functions, where only distal extremity performance is present.

Keywords: Trunk endurance, upper extremity, upper quarter Y balance test

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1877 Top


The relationship between transversus abdominis muscle thickness with static and dynamic balance in healthy adults

K. Y. A. Alsayani, R. Savkin, N. Akkaya1, N. Büker

Pamukkale University, School of Physical Therapy and Rehabilitation, 1Department of Physical Medicine and Rehabilitation, Pamukkale University Medical School, Denizli, Turkey

E-mail: nasuk@pau.edu.tr

Introduction/Background: Current evidence suggests that enhanced core stability increase lower extremity function and promote postural stability. Thus, the purpose of this study was to investigate relationships between ulrasonographic thickness of transversus abdominis muscle (TrA), which is one of the core muscle, and static and dynamic balance and core endurance in healthy collegiate males. Materials and Methods: Healthy collegiate males who had not suffered any orthopedic injury in the past year were enrolled the study. The thickness of TrA was measured at rest and during contraction on both dominant and nondominant side using ultrasound. Also percentage of change in TrA thickness was calculated as [(thickness(contraction)-thickness(rest))/thickness(rest)]×100. The static and dynamic balance parameters were evaluated with a balance system (Korebalance Mobile System). Core endurance (CE) was also assessed using trunk extensor test, bilateral side bridge tests and the core muscle strength and stability test. Results: Sixty males were assessed during the study. Their mean age was 22.20 ± 1.77 years and mean body mass index was 23.53 ± 2.93 kg/m2. Dominant side TrA muscle thickness at rest was correlated with dynamic balance (r = -0.319, p = 0.013) wheras no correlation for dominant side TrA muscle thickness at contraction. Nondominant side TrA muscle thickness at rest was correlated with core endurance (r = 0.350 p = 0.006) wheras no correlation for nondominant side TrA muscle thickness at contraction. Percentage of change in dominant side TrA thickness was correlated with dynamic balance (r = 0.464, p = 0.000). Percentage of change in nondominant side TrA thickness was correlated with core endurance (r = 0.-361, p = 0.005). Conclusion: According to our results, muscle thickness of TrA is associated with postural balance and core endurance. Training to increase the muscle mass of the TrA would be useful to improve balance parameters. Further prospective studies are warranted to investigate the effects of the training of TrA and core endurance on postural balance and athletic performance.

Keywords: Balance, transversus abdominis, ultrasonography

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2339 Top


Extracorporeal shockwave therapy for pain reduction of musculoskeletal diseases: predictors and responders

A. T. Sugawara, M. D. C. Lima, C. B. Dias1, M. S. C. Oliveira

Hospital do Servidor Público Estadual de São Paulo, Physical and Rehabilitation Medicine Service, 1Hospital do Servidor Público Estadual de São Paulo, Clínica Médica, São Paulo, Brazil

E-mail: andre.sugawara@gmail.com

Introduction/Background: Musculoskeletal disorders are a continuous challenge for the search for practical and viable treatment solutions that generate analgesia and well-being. Objectives: To discover the predictors of the outcome of radial extracorporeal shockwave therapy (rESWT) on pain reduction of patients with musculoskeletal diseases and to identify the best responders of this therapy. Design: Short-term retrospective before-after trial. Materials and Methods: Setting: Outpatient facilityof a Physical Medicine and Rehabilitation Service. Participants: 900 medical records of patients with musculoskeletal disorders (rotator cuff syndrome, De Quervain syndrome, trigger finger, lateral epicondylitis, pseudarthrosis, trochanteric bursitis, anserine syndrome, knee osteochondritisdissecans, patellofemoral syndrome, plantar fasciitis, Achilles tendinitis) who undertook rESWT for pain reduction. Patients younger than 18 years of age, with ongoing treatment at the time of the medical record selection, with other associated diseases, and whose information was unclear or incomplete in the medical records were not included. Intervention: Radial extracorporeal shockwave therapy, applied once a week for two weeks. Main Outcome Measure: Pain, assessed before and one week after the end of the intervention is the main outcome and was measured by Visual Analogue Scale (VAS). The participants’ pathology, demographic data and pain at baseline were approached via multiple regression for the predictors and odds ratio for the responders. Results: Pain was reduced in 63.4% (VAS = 2.90, CI 95% 2.72-3.08). Higher levels of pain at baseline, higher frequencies of rESWT application, and knee diseases were the predictors of the treatment outcome (β = -0.21, p ≤ 0.001, β = -0.88, p ≤ 0.001, and β = 1.10, p = 0.001, respectively). Patients with shoulder diseases were the best responders to the rESWT (OR = 1.91, CI 95% 1.21–3.02). Conclusion: There is strong evidence that rESWT is effective for reducing pain of patients with severe pain treated with higher application frequencies. Patients with knee diseases tend benefit less from rESWT, whereas those with shoulder diseases are the best responders this treatment.

Keywords: High-energy shock waves, musculoskeletal diseases, therapeutics

Disclosure of interest: The authors did not declare any conflict of interest.


  A3.01 Neurological and Mental Health Conditions - Stroke Top



  ISPR8-1748 Top


Examining the impact of prism power on prism adaptation effects using a home-friendly procedure

A. S. Champod, L. Mckenzie, K. Hagen, B. Fougere, L. Smith, G. Eskes1

Department of Psychology, Acadia University, Wolfville, 1Department of Psychiatry, Dalhousie University, Halifax, Canada

E-mail: anne.champod@acadiau.ca

Introduction/Background: Studies investigating the use of prism adaptation to treat symptoms of spatial neglect have used goggles inducing a rightward shift of 6 to 15o. However, the impact of prism power (i.e., the magnitude of visual shift) on after-effects (i.e., leftward shift in pointing movements after prism exposure), and effects on more functional tasks (e.g., a throwing task) are unknown. The purpose of this study was to clarify the relationship between these variables in a sample of healthy young adults as a first step towards the validation of a new home-friendly prism adaptation procedure (Peg-the-Mole/PTM). Materials and Methods: Sixty participants were randomly assigned to one of four conditions and used PTM with 5o (condition 1), 10o (condition 2), 5o/10o/15o deviating goggles (gradual shift – condition 3) or with sham/non-deviating goggles (condition 4). Pointing tasks and a throwing task were administered before and after PTM to assess a prism-induced leftward shift in pointing or throwing movements. Results: The main effect of prism power on after-effects and throwing effects was significant (p < 0.05). After-effects were larger in the gradual and 10o group when compared to the 5o and sham groups (gradual = 10o > 5o > sham). For the throwing task, only the effects in the gradual condition differed from the sham condition (only participants in the gradual condition threw significantly more to the left after PTM). Direct effects (pointing errors during PTM) predicted after-effects (p < 0.05) but not throwing effects. Furthermore, after-effects did not correlate with throwing (functional) effects. Conclusion: These findings suggest that larger prism power induces larger after-effects and a gradual transition from increasingly larger prism power may facilitate the generalization of after-effects to functional tasks. The lack of relationship between after-effects and throwing effects should be investigated further as it may explain the mixed findings regarding the generalization of prism effects to functional activities.

Keywords: After-effects, prism adaptation, spatial neglect

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2595 Top


Early prediction of falls after stroke: One-year follow up of the fall study of Gothenburg

C. M. Samuelsson, P. O. Hansson1, C. U. Persson2

Department of Occupational and Physiotherapy, Sahlgrenska University Hospital, 1Department of Molecular and Clinical Medicine, Institute of Medicine-Sahlgrenska Academy, University of Gothenburg, 2Department of Clinical Neuroscience, Institute of Neuroscience and Physiology-Sahlgrenska Academy, University of Gothenburg, Rehabilitation Medicine, Gothenburg, Sweden

E-mail: carina.m.samuelsson@vgregion.se

Introduction/Background: Only a few studies have investigated the occurrence and the determinants of falls after stroke based on variables assessed during the acute phase. In the effort to prevent falls after stroke, however, it is valuable to already during hospitalisation be able to predict the risk of falling after discharge. This study aimed to investigate the incidence and the determinants of self-reported falls the first year after discharge from a stroke unit after acute stroke. Materials and Methods: In this prospective, longitudinal and observational sub study, a one-year follow up of the recently published FallsGOT, the primary endpoint was any fall during the first year after discharge from a stroke unit. Within four days after admission to a stroke unit, assessments of baseline variables were performed. At twelve months after discharge, data collection of self-reported falls was conducted using a standardized questionnaire. Of the consecutive sample of 504 patients with acute stroke, 435 individuals were eligible for follow-up at twelve months, of which 348 (80%) answered the questionnaire. Results: Of the respondents, 140 (40%) experienced at least one fall during the first year after discharge from the stroke unit. In the multivariable analysis, impaired postural control as assessed with the Swedish modified version of Postural Assessment Scale for Stroke Patients (SwePASS) OR 3.90 (95% CI 2.06-7.41, p < 0.0001) and use of a walking aid OR 2.91 (95% CI 1.75-4.83, p < 0.0001) were statistically significantly associated with falling. Conclusion: Postural control and use of a walking aid acute after stroke in a stroke unit predicted falls during the first year after discharge from a stroke unit.

Keywords: Accidental fall, postural balance, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2319 Top


The effect of transcranial magnetic stimulation combined with melodic intonation therapy treatment in stroke patients with non-fluent aphasia

Q. Zhang

Shanghai Second Rehabilitation, Rehabilitation Medicine, Shanghai, China

E-mail: 1144232439@qq.com

Introduction/Background: To explore the effect of repetitive transcranial magnetic stimulation combined with melodic intonation therapy in patients with non-fluent aphasia after stroke. Materials and Methods: An A-B design was used in the study of 8 patients with non-fluent aphasia after stroke (>3 months post stroke). Classic melodic intonation therapy coupled with sham rTMS was implemented for 2 weeks (ten working days) in phase A. Classic MIT coupled with rTMS for 2 weeks in phase B. RTMS was administered on the affected side of the frontal lobe, 1 Hz, 1200 pulses, 20 minutes per day, 5 days per week, the stimulation intensity was 90% of the threshold value of the healthy lateral limb movement. MIT was performed after the completion of rTMS therapy. The therapist guides the aphasia patients to sing the target words, while helping the patient to beat the affected hand rhythmically to induce the patient’s language expression, 30 minutes per day, 5 days per week. The total treatment time is 50 minutes. The cookie-theft picture description task in BDAE was used to assess all patients before and after therapy sessions, evaluating the index of the length and complexity of content for each phrase. Results: There was no significant change in spontaneous speech before and after phase A in the aphasic patients,suggesting their language ability reached to “plateau”. After intervention, spontaneous speech results in the cookie-theft picture description task improved more significantly in patients treated with phase B, as compared to patients treated with phase A (P < 0.05). Conclusion: RTMS combined with MIT can promote spontaneous speech in non-fluent aphasia patients after stroke, with a better performance on speech fluency and information content. The underlying mechanism may be related to stronger cortical activation in language area, which reflects the functional reorganization and remodeling of the brain circuits associated with verbal expression.

Keywords: Cerebral apoplexy, melodic intonation therapy, transcranial magnetic stimulation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1047 Top


Leukoaraiosis induce discrepancies between neurological severity and activities of daily life in patients with ischemic stroke at convalescent rehabilitation

J. Senda1,2, K. Ito2, T. Kotake2, M. Kanamori2, H. Kishimoto2, M. Katsuno3, G. Sobue3

1Department of Neurology and Rehabilitation, Komaki City Hospital, Komaki, 2Department of Rehabilitation, Kami-Iida Rehabilitation Hospital, 3Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan

E-mail: joesenda@gmail.com



Introduction/Background: There are discrepancies between neurological severity and activities of daily life (ADL) after stroke. We investigated associations between neurological severity and ADL in patients with ischemic stroke at the convalescent rehabilitation stage. We particularly focused on the severity of leukoaraiosis on magnetic resonance imaging (MRI) and various clinical factors. Materials and Methods: The participants included 723 patients with ischemic stroke (484 men and 239 women; mean age, 73.2 ± 8.5 years; subtypes, lacunar infarction [n = 54], atherothrombosis [n = 305], artery-to-artery embolism [n = 105], cardiogenic embolism [n = 129], undetermined embolism [n = 93], and uncategorized ischemic stroke [n = 37]) that were transferred from acute care hospitals for inpatient convalescent rehabilitation. Leukoaraiosis was graded according to periventricular hyperintensity (PVH) and deep white matter hyperintensity on MRI. The National Institutes of Health Stroke Scale (NIHSS) was used to measure neurological severity and the Functional Independence Measure (FIM) was used to assess ADL on admission and at discharge. Results: Multiple regression analysis revealed that total FIM scores were significantly associated with leukoaraiosis as estimated by PVH grade (P = 0.001) and NIHSS score (P < 0.001) both on admission and at discharge for all patients, in addition to clinical factors, such as age, history of heart disease, and bilateral infarction lesions. In contrast, multiple regression analysis of NIHSS scores revealed no association with PVH. Conclusion: Our study revealed that ADL were associated with the degree of leukoaraiosis as indicated by PVH at the convalescent rehabilitation stage in patients with ischemic stroke. However, neurological severity was not associated with leukoaraiosis, likely because the progression patterns and anatomic backgrounds of PVH affect ADL in patients who have had ischemic stroke.

Keywords: Convalescent rehabilitation, ischemic stroke, leukoaraiosis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2501 Top


Conception and content validity of a new scale assessing lateropulsion after stroke: The scale for lateropulsion

A. Odin, B. Moineau1, E. Clarac, A. Kistner, M. Barbado2, E. Chipon2, A. Moreau-Gaudry2, M. Medici3, S. Dai, C. Vuillerot4, J. L. Bosson3, D. Pérennou

Departments of Physical Medicine and Rehabilitation and 3Biostatistics, CHU Grenoble-Alpes, Echirolles, 2Centre D’investigation Clinique - Innovation Technologique, CHU Grenoble-Alpes, Grenoble, 4Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, Lyon, France, 1Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, Toronto, Canada

E-mail: anais.odin@gmail.com

Introduction/Background: As a primary cause of postural and gait disorders, lateropulsion must be systematicallyassessed after stroke. The current gold standard presenting unsatisfactory metrological properties,we propose a new scale optimized through 4 methodological steps:- 1) Conception based onscientific rationale, a critical review of the literature, and local testing of feasibility an relevance ofitems retained (V0). -2) Improvement and validation of the content through a Delphi process with apanel of international experts (V1). -3) Monocentric study to adjust the SCALA construction (V2). -4)Final multicentric validation (V3). Here we present the V1 of the SCAle for LAteropulsion (SCALA),obtained after 3 years of work. Materials and Methods: The V0 locally conceived was submitted to a panel of 21 international experts having clinicaland scientific background of lateropulsion. At each round, their degree of agreement/disagreementwas analyzed on Likert scales from 1 to 9 for general procedure and each item (separately forinstructions, procedure, scoring). In addition an in-depth analysis of comments served to guideimprovements between rounds. Results: Two rounds were needed to reach consensus, the 3 rd one serving to finalize smalladjustments in the instructions, and to get final approval. The final degree of agreement was high:median 8 [Q1 = 8 and Q3 = 9]/9. The SCALA V1 is a matrix comprising 4 components (spontaneouslateral tilt, self-initiated lateral pushing, resistance to passive lateral tilting, and unawareness of thelateropulsion) and 10 different postural tasks (sitting, transfers, standing, walking, in differentpostural and visual conditions). Items are scored with a four-grade scoring, except for onecomponent where the score is binary. The total score ranges from 0 to 50 points. Conclusion: Strong consensus and enthusiastic comments prejudges the success of this promisingtool, designed to detect and evaluate contraversive and ipsiversive post-stroke lateropulsion, regardless its mechanisms.

Keywords: Lateropulsion, scale for lateropulsion, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1599 Top


Assessment of the relationship between observational Wisconsin gait scale and gait indexes such as gait deviation index and gait variability index in individuals after stroke

A. Guzik, M. Drużbicki, A. Wolan-Nieroda, P. Kiper1, G. Przysada, K. Bazarnik-Mucha, M. Szczepanik, A. Kwolek

Institute of Physiotherapy, University of Rzeszow, Rzeszów, Poland, 1Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, Venice, Italy

E-mail: agnieszkadepa2@wp.pl

Introduction/Background: There are no studies evaluating compatibility of visual gait assessment scales and Gait Deviation Index (GDI), Gait Variability Index (GVI) in individuals after stroke. The study was designed to compare results of the observational Wisconsin Gait Scale (WGS) and the global gait indexes such as GDI and GVI, constituting an objective method of assessing gait. The objective was to answer the question whether simple, inexpensive, easy to use, observational WGS may be an effective alternative for costly equipment-based analyses in assessing gait after stroke. Materials and Methods: The study group comprised 50 participants who had experienced a stroke and were in a chronic phase of recovery, as well as 50 healthy individuals, without gait disorders. The subjects’ gait was evaluated using the WGS, and the GDI and GVI values were acquired using a 3-dimensional gait analysis system. GDI was calculated based on kinematic parameters, while GVI was computed from spatiotemporal parameters. Results: The study has shown statistically significant correlations between the parameters of GDI affected leg and WGS total score (R = -0.87), GVI affected leg and WGS total score (R = -0.93), GVI unaffected leg and WGS total score (R = -0.88), GVI affected/unaffected leg and the total score in the assessment of spatiotemporal parameters on the WGS (R = -0.81) as well as GDI affected leg and the total score in the assessment of kinematics parameters on the WGS (R = -0.85). All correlations were strong (0.7≤|R|<0.9) or very strong (0.9≤|R|<1). Conclusion: There is a strong or very strong correlation of the GDI and GVI to the WGS scores. WGS is an excellent tool enabling qualitative assessment of gait abnormalities in individuals after a stroke, and providing results which correspond with the objective assessment of spatiotemporal and kinematic gait parameters, i.e. by means of global gait indexes. WGS should be applied in daily clinical practice.

Keywords: Gait indexes, stroke, Wisconsin Gait Scale

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0059 Top


The relationships between diffusion-tensor fractional anisotropy within cerebral peduncles and outcomes among patients with hemiparesis due to cerebral infarction

T. Koyama, U. Yuki, K. Domen

Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Nishinomiya, Japan

E-mail: koyama.t@nk-hospital.or.jp

Introduction/Background: This study aimed to evaluate the relationships between diffusion-tensor fractional anisotropy (FA) within cerebral peduncles and outcomes among patients with hemiparesis due to cerebral infarction. Materials and Methods: Diffusion-tensor FA brain images were acquired 14-21 days after cerebral infarction. The ratio of FA values within the cerebral peduncles of the affected and unaffected hemispheres (rFA) was calculated for each patient (n = 40) and assessed for correlation with Brunnstrom stage (BRS: 1-6), motor component of the functional independence measure (FIM-motor: 13-91), and the total length of stay (LOS) until discharge from rehabilitation (P < 0.05). Results: The rFA values were 0.582-1.037 (median, 0.881) and BRS scores were 1-6 (median, 5) for shoulder/elbow/forearm, 2-6 (median, 4.5) for hand, and 3-6 (median, 5) for lower extremities. FIM-motor scores were 51-91 (median, 79.5) and LOS ranged from 45 to 195 days (median, 130 days). Correlation coefficients were statistically significant between rFA and shoulder/elbow/forearm BRS (0.646), hand BRS (0.621), lower extremity BRS (0.637), FIM-motor (0.337), and LOS (-0.446). Conclusion: Diffusion-tensor FA values correlated with outcome measurements. This observation suggests that FA values within cerebral peduncles may subserve as an index for outcome prediction of patients after cerebral infarction.

Keywords: Hemiparesis, prognosis, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2594 Top


Inter-hemispheric rivalry versus completion: lessons from line bisection performance with the right and left hands following callosal section

C. Serfaty, N. Soroker

Department of Neurological Rehabilitation, Loewenstein Hospital Rehabilitation Center, Raanana, Israel

E-mail: sara_h@012.net.il

Background and Aim: Unilateral hemispheric stroke disrupts the inter-hemispheric balance which is normally maintained by reciprocal inhibitory influences exerted by each hemisphere on the other. This leads to a state where the damaged hemisphere loses its capacity to support function, beyond the direct outcome of focal tissue loss, due to widespread physiological suppression by the overactive healthy hemisphere. This line of theorizing dominates the practice of tDCS and rTMS application in stroke rehabilitation, where reversal of the pathological balance is aimed using excitatory stimulation of the damaged hemisphere and/or inhibitory stimulation of the healthy hemisphere. We present here an examination of the ‘reciprocal inhibition’ concept in a patient with callosal section. Materials and Methods: GH (M/35) suffered from idiopathic epilepsy with major convulsions almost every day, despite intensive efforts to control disease activity pharmacologically. He was admitted for rehabilitation after a complete surgical section of the forebrain commissures, leaving him with marked apraxia and tactile anomia in the left hand, and with manifestations resembling left neglect dyslexia. Given the disconnection of each hemisphere from the other, performance of diagnostic tests for spatial neglect, by each hand, is assumed to reflect the net effect of the contralateral hemisphere, in the absence of inhibitory influences exerted by the ipsilateral hemisphere. Results: In representational-drawing and figure-copying tasks executed by the dominant right hand, GH manifested classical left-side neglect. Each of the two disconnected hemispheres demonstrated ipsilateral inattention in manual cancellation and line bisection tasks. Displacement of the subjective midpoint in line-bisection performance was greater in right-hand (left-hemisphere) performance. Conclusion: As the post-operative MRI disclosed no extra-callosal damage, the left neglect pattern shown by the isolated left-hemisphere (right-hand) points to an important role of “completion” rather than “rivalry” in inter-hemispheric relationships, raising questions with regard to current practices of non-invasive brain stimulation in stroke rehabilitation.

Keywords: Callosotomy, neglect, recovery

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0098 Top


Assessing upper limb function: transcultural adaptation and validation of the Portuguese version of the stroke upper limb capacity scale

J. Branco, J. Pinheiro1

1Centro de Medicina e de Reabilitação Região Centro - Rovisco Pais, Reabilitaçao Geral de Adultos, 2Centro Hospitalar Universitário de Coimbra, Serviço de Medicina Fisica e de Reabilitaçao, Coimbra, Portugal

E-mail: joaobrancofmuc@hotmail.com

Introduction/Background: Brachial hemiparesis is one of the most frequent sequelae of stroke, leading to important functional disability given the role of the upper limb in executing activities of daily living (ADL). The Stroke Upper Limb Capacity Scale (SULCS) is a stroke-specific assessment instrument that evaluates functional capacity of the upper limb based on the execution of 10 tasks. The objective of this study is the transcultural adaptation and psychometric validation of the Portuguese version of the SULCS. Materials and Methods: A Portuguese version of the SULCS was developed, using the process of forward-backward translation, after authorisation from the author of the original scale. Then, a multicentre study was conducted in Portuguese stroke patients (n = 122) to validate the psychometric properties of the instrument. The relationship between sociodemographic and clinical characteristics was used to test construct validity. The relationship between SULCS scores and other instruments was used to test criterion validity. Results: Semantic and linguistic adaptation of the SULCS was executed without substantial issues and allowed the development of a Portuguese version. The application of this instrument suggested the existence of celling effect (19.7% of participants with maximum score). Reliability was demonstrated through the intraclass correlation coefficient of 0.98. As for construct validity, SULCS was sensible to muscle tonus and aphasia. SULCS classification impacted the scores of the Motor Evaluation Scale for Upper Extremity in Stroke (MESUPES) and the Stroke Impact Scale (SIS). Conclusions: The present version of SULCS shows valid and reliable cultural adaptation, with good reliability and stability.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0259 Top


The impact of post-acute care rehabilitation on functional status in stroke patients from different hospital accreditation level

C. Y. Wang

Pingtung, Rehabilitation, Pingtung, Taiwan

E-mail: m86arthur@gmail.com

Introduction/Background: In order to construct a medical transfer system for the stroke, Taiwan Ministry of Health and Welfare implemented a national program of Post-acute Care for Cerebrovascular Diseases (PAC-CVD) in March 2014. Under the intensive in-patient rehabilitation programs and per diem payment, the healthcare utilization was expected to be improved. The purpose of this study was to investigate the impact of intensive post-acute stroke rehabilitation on functional status in different hospital accreditation level. Materials and Methods: The stroke patients who were admitted to post-acute ward in two hospitals during 2014/03/01 to 2017/8/31 were indicated to the study. The patients was separated to group 1 (a rural regional hospital) and group 2 (a metropolitan district hospital). The modified Rankin Scale (mRS) score, Barthal Index (BI), Instrumental Activities of Daily Living Scale (IADL) and Berg Balance Scale (BBS) were used to evaluate functional status. Results: 740 stroke patients (311 patients in group 1, and 429 patients in group 2) were included. The length of days (LOS) between stroke onset and post-acute care (PAC) ward admission were 11.60 days in group 1, and 21.41 days in group 2. The length of days in PAC ward were 27.02 days in group 1, and 36.85 days in group 2. The percentage of patients referred from other acute hospitals were 23.47% in group 1, and 89.51% in group 2. The severity (MRS grading on PAC admission day) was 3.53 in group 1, and 3.88 in group 2. The functional improvement after rehabilitation training was noted in both groups. Conclusion: Under the intensive post-acute in-patient rehabilitation programs, the stroke patients got functional improvement. No matter the accreditation level of the hospital, the same payment may make more chance for the district hospitals to develop. The healthcare utilization may work efficiently under the medical transfer system.

Keywords: Post-acute rehabilitation, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0342 Top


Predicting accuracy of return to work of male stroke patients at working age by WHO Disability Assessment Schedule 2.0

S. Huang

Department of Physical Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

E-mail: 13001@s.tmu.edu.tw

Introduction/Background: Stroke is one of the main causes of morbidity and mortality in younger male adults and is particularly relevant to working individuals. When stroke at working-age, these patients must to face the challenges of employment and maintain the quality of life. How to comprehensively and objectively evaluation the opportunity of return to work is an important issue. The WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) was developed based on International Classification of Functioning, Disability and Health (ICF) framework for evaluating functioning, including social participation and cognition-related daily activities. WHODAS 2.0 can be a reliable comprehensive functional assessment tool, and the aim of this study was to investigate the predicting accuracy of return to work of male stroke patients at working-age. Materials and Methods: A total of 7687 male stroke patients at working-age (aged from 25 to 55 years old) were obtained from Taiwan Data Bank of Persons with Disability from the July 2012 to October 2017. According to their working status, we separated them as return-to-work group and nonreturn to work group. Demographic data and WHODAS 2.0 standardized scores of patients with stroke of both groups were analyzed and compared using the chi-squared and independent Student’s t-tests. Receiver operating characteristic curve analysis was performed to investigate the prediction opportunity for the return-to-work status, and the optimal cutoff point was determined using the Youden index. Results: All domains of return-to-work group (n = 481) had lower WHODAS 2.0 scores than nonreturn-to-work group (n=7206). The receiver operating characteristic curve showed moderate accuracy for all domain-specific and summary scores of WHODAS 2.0 [area under the curve, 0.6–0.8]. The cuff-off point of summary score was 39.67 with 70.0% sensitivity and 65.3% specificity. Conclusion: Our study presented that WHODAS 2.0 can be taken as an assessment tool to predicting the opportunity of return to work of male stroke patients at working-age.

Keywords: Return to work, stroke, WHO Disability Assessment Schedule 2.0

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0460 Top


The effect of core stabilization training combined with virtual reality for treatment of the upper limb function in stroke

Z. Ming

Department of Rehabilitation Medicine, Xuzhou Central Hospital, Jiangsu, China

E-mail: zm1455@163.com

Introduction/Background: To study the therapeutic effect of core stabilization training combined with virtual reality for treatment of the upper limb function in stroke. Materials and Methods: Forty-six patients for hospitalization and outpatient treatment after stroke were randomly divided into a control and an experimental group. The two groups are all treated with physical therapy,Occupational therapy,physical agents therapy and virtual reality, and core stabilization training are adopted in the experimental group. After four weeks of treatment, range of motion (ROM), Fugl-Meyer Assessment Upper Extremity (FMA-UE), Fugl-Meyer Assessment balance subscale (FMA-B) and Modified Barthel Index (MBI) used for evaluation and comparison before and after treatment. Results: Before treatment, the ROM, FMA-UE, FMA-B and MBI scores in the two groups had no statistical significance (P > 0.05). But after four weeks of treatment, the two groups had a significant improvement in the four scores (P < 0.05). What is more, patients in the experimental group improved significantly more than those in the control group. The difference between the two groups is statistically significant (P < 0.05). Conclusion: The core stabilization training combined with virtual reality can improve the upper limb activity range and balance function after stroke.At the same time it can obviously improve patients’ upper extremity motor function and quality of life.

Keywords: Core stabilization training, stroke, virtual reality

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0629 Top


Early mobilization in intensive care for severe acquired brain injury patients: current practices and implementation barriers in France

F. Feuvrier, C. Jourdan, K. Griffiths1, M. Ascher2, F. Pavillard3, K. Chalard3, P. Bory3, F. Pellas4, P. F. Perrigault3, I. Laffont

CHRU Lapeyronie, Physical and Rehabilitation Medicine, 2CHRU Gui de Chauliac, Physical and Rehabilitation Medicine, 3CHRU Gui de Chauliac, Neurological Intensive Care Unit, Montpellier, 1CHRU La Timone, Public Health, Marseille, 4CHRU Carémeau, Physical and Rehabilitation Medicine, Nîmes, France

E-mail: feuvrier.f@gmail.com

Introduction/Background: Early mobilization (EM) in intensive care units is safe, feasible and beneficial for patients; however, little is known about the current practices of early mobilization for patients with brain injury in intensive care units (ICU) in France. Aim: To evaluate the current mobilization practices and its barriers in ICUs for patients with acquired brain injury. Materials and Methods: A cross sectional survey online was conducted with two questionnaires on early mobilization practices distributed to physicians and physiotherapists working in 130 ICUs across France. Results: The survey was completed by 31 physiotherapists and 25 physicians in 24 different wards. Rehabilitation specialists were involved with care according to 88% of doctors. EM was most frequently started within 24-48 hours, according to 8 doctors and 15 physiotherapists. The majority of physiotherapists (84%) stated that 75%-100% of patients received positioning and passive range of motion therapy, alongside head of bed elevation (84% PTs). A lower proportion of patients received standing exercises (32% PTs reported 25-30% of patients), walking therapy (48% reported <25% of patients), whilst 77% of PTs reported that no patients received muscular electrostimulation. The most common medical barriers were high intracranial pressure and hemodynamic instability. Two thirds of doctors and over 80% of physiotherapists stated they did not use any pre-established protocol criteria for initiation of EM. Fourteen doctors (56%) did not have a wakening protocol to reduce sedation. Conclusion: Early mobilization in various forms is being practiced in the ICUs of France. Main results demonstrate a good willingness and enthusiasm amongst physicians and physiotherapists, but a lack of medical support and not enough personnel to attain early mobilization objectives. We suggest a need to have a standardize protocol to encourage early safe mobilization of neurological patients in intensive care. Further prospective research on safety and outcomes specific to neurological patients is needed.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0746 Top


Simultaneous recording of brain activations and movement kinematics sub-acute post-stroke: Understanding neuromotor control to optimize recovery

L. van Dokkum1,2, E. Le Bars2,3, D. Mottet4, J. Froger5, A. Bonafe3, N. Menjot de Champfleur2,3, I. Laffont1,4

1CHU Montpellier, Physical Medicine and Rehabilitation, 2CHU Montpellier, I2FH Research Platform, 3CHU Montpellier, Neuroradiology, 4Montpellier University, Euromov, Montpellier, 5CHU Nimes, Physical Medicine and Rehabilitation, Grau de Roi, France

E-mail: l-vandokkum@chu-montpellier.fr

Introduction/Background: Rehabiliation, aiming to stimulate underlying neural plasticity, takes an important place in patients’ treatment post-stroke. Here we confront fine-grained movement kinematics with corresponding brain activations to reveal recovery markers usable to individualize therapeutic approaches favoring plasticity and maximizing recovery. Materials and Methods: 21 participants early post-stroke with initial severe motor deficits were compared with 13 controls. Participants were evaluated twice, <8 weeks post-stroke and after 6 weeks of rehabilitation. Kinematic data were collected during movement execution within the fMRI. The movement consisted of a continuous elbow flexion/extension. Calculated kinematics captured the movements’ shaping (amplitude, frequency) and the structure (fluency, directness, and the variability’s entropy). Results: People post-stroke generally moved with decreased amplitude, smoothness, directness and entropy compared to controls. The frequency was lower for the paretic upper-limb and during bilateral movements, but comparable to controls during ipsilesional upper-limb movement. The variability’s entropy was in both controls and patients related to increased activations in the middle frontal lobe, presumably indicating more feedforward based control. In patients, the amplitude and smoothness were correlated with strong implication of the occipital lobe, and additional recruitment of the rolandic opercularis (visualization) was observed during both paretic and ipsilesional movement, related to motor learning. Patients’ kinematic characteristics were unrelated to clinical scores and lesion characteristics, supporting the idea that they reflect motor control strategies. Conclusion: The co-registration of fine-grained kinematics and fMRI measures revealed how different kinematic profiles are related to different motor control organizations. Analyzing kinematics in a standardized manner might contribute to the implementation of a personalized rehabilitation strategy, and more targeted brain stimulation protocols to stimulate plasticity and optimize recovery.

Keywords: Brain imaging, movement kinematics, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0876 Top


Efficacy of repetitive transcranial magnetic stimulation on motor outcomes in patients with stroke: A preliminary study

C. L. Chen1,2, Y. Z. Huang3, C. Y. Chen4, H. C. Chen5

Departments of 1Physical Medicine and Rehabilitation and 3Neurology, Chang Gung Memorial Hospital, Linkou, 2Chang Gung University, Graduate Institute of Early Intervention, 4Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taiwan, Keelung, 5Department of Industrial and Management, National Taipei University of Technology, Taoyuan, Taiwan

E-mail: clingchen@gmail.com

Introduction/Background: Intermittent and continuous theta burst stimulation (iTBS/cTBS), a form of repetitive transcranial stimulation (rTMS), is often used to facilitate the affected hemisphere and inhibit the unaffected hemisphere, respectively. This study aims to examine the efficacy of combined iTBS and cTBS on motor outcomes of upper extremity (UE) in patients with stroke. Materials and Methods: This was a double-blind randomized controlled trial enrolled patients from a rehabilitation department. Fourteen patients with first-ever chronic and unilateral cerebral stroke, aged 30-70 years, were randomly assigned to the combined TBS or sham group. All patients received 15 daily sessions of either TBS (combined iTBS over affected hemisphere and cTBS over the affected hemisphere) or sham stimulation in addition to conventional neurorehabilitation. Outcome measures, including Modified Ashworth Scale (MAS), Fugle-Meyer Assessment Upper Extremity (FMA-UE), Box and Block test (BBT), and Functional Independence Measure (FIM), were implemented before and immediately after the intervention. The change score is calculated as (post-treatment score – pre-treatment score). An independent t-test was used to compare the pre-treatment and change scores. A p < 0.05 is considered as significant differences. Results: The TBS group showed greater improvement in the FMA than the sham group (p < 0.05). However, the change scores in the MAS, BBT, and FIM did not achieve the significant differences between two groups. Conclusion: The combined iTBS and cTBS may induce greater gains in functional improvement of upper limb. The combined iTBS and cTBS may emerge as an adjuvant intervention in neurorehabilitation. However, we could not draw the definite the conclusion due to limited case numbers. Future studies may increase the sample size and longitudinal follow-up.

Keywords: Motor outcome, repetitive transcranial stimulation, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1207 Top


Using functional near-infrared spectroscopy in the assessment of cognitive-motor interference in post-stroke patients

B. Tapie1,2, A. Perrochon2, M. Compagnat1,2, F. Dalmay3, O. Dupuy4, J.Y. Salle1,2, J. C. Daviet1,2

1CHU de Limoges, Physical and Rehabilitation Medecine, 2HAVAE, Limoges University, 3UMR-S, Limoges University, Limoges, 4MOVE, Poitiers University, Poitiers, France

E-mail: tapie.bertrand@yahoo.fr

Introduction/Background: Pre-Frontal Cortex (PFC) activity during dual-task (DT) condition in stroke patients remains unclear. Functional near-infrared spectroscopy (fNIRS) is a functional neuroimaging technique for studying cortical activity. The purpose of this study was to evaluate the hemodynamic activity of the PFC in two DT conditions in post-stroke patients. Materials and Methods: Stroke patients were instructed to perform a cognitive task (n-back test) while continuously walking. They were evaluated in DT low (n-1 back) and high (n-2 back) cognitive load. fNIRS recorded bilateral PFC activity and GAITRite measured gait parameters in these two DT conditions. Cognitive performance was evaluated by the number of answers, the number of correct answers and the error percentage. The main endpoint was the DT cost, and we compared the change in oxygenated hemoglobin (an indicator of the changes in PFC activation) between the DT high and DT low. Results: Eleven stroke patients (8 men and 3 women; mean age, 64,2 ± 19,5 years; range, 28-87 years) were included in the study. The DT cost was higher in DT n-2 (82,1% ± 15,6) compared with DT n-1 (61,2% ± 38,6), p = 0,007. There was no decline of spatiotemporal gait parameters with the increasing of cognitive load (p > 0,05) and no difference for the number of answers in DT high versus low cognitive load (p > 0,05). The number of correct answers was lower during DT high (3±2,4) versus DT low (7,8 ± 3,6), p = 0,0015 ; and the error percentage was higher during DT high (62,3 ± 23,2) versus low condition (24,4 ± 12,9), p = 0,0001. Conclusion: There was a greater increase bilateral PFC activity during DT high versus DT low. The increasing DT cost allowed to maintain spatiotemporal gait parameters in DT high and led to a degradation of the cognitive performance. During DT, PFC activation might prioritize gait performances in stroke patients when the cognitive load is high.

Keywords: Cognitive motor interference, dual task, functional near-infrared spectroscopy

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1474 Top


Relationship between motor imagery ability and motor function of hemiplegic upper limbs and their use in stroke patients

S. Morioka, M. Osumi, S. Sakauchi1, R. Ishibashi2

Department of Neurorehabilitation, Kio University, Koryo, 2Department of Rehabilitation, Hanna Central Hospital, Ikoma, 3Department of Rehabilitation, Murata Hospital, Rehabilitation, Osaka, Japan

E-mail: s.morioka@kio.ac.jp

Introduction/Background: We quantitatively examined the motor imagery ability using bimanual circle-line coordination task (BCT) in stroke patients and clarified the relationship between motor imagery ability and motor function of hemiplegic upper limbs and amount of the use of paralyzed limbs. Materials and Methods: Thirty-one stroke patients participated. Tasks included unimanual-line (UL) which involved drawing a straight line on the non-paralyzed side, and imagery circle-line (ICL) which involved drawing a straight line on the non-paralyzed side, during imagery drawing on the paralyzed side using a tablet PC. Each task was carried out in 3 sets of 12 seconds. Drawn linear trajectory was decomposed at every cycle and ovalization was calculated using the formula: Ovalization Index (OI) = Standard deviation of X axis / Standard deviation of Y axis × 100 (%). The value obtained by subtracting OI of UL from OI of ICL was defined as the ability of motor imagery (ImageOI). Fugl-Meyer motor assessment (FMA), amount of use (AOU), and quality of motion (QOM) of motor activity log (MAL) were the 3 variables used for cluster analysis. The explanation variable was Image OI, parametric variables were AOU and QOM, and the objective variable was FMA, and mediation analysis was performed. Results: Cluster 1 (FMA <26 points) and Cluster 2 (FMA >=26 points) were formed. In Cluster 2, significant single correlations were found between ImageOI and FMA, AOU, and QOM. When AOU and QOM were mediated between ImageOI and FMA, there was no significant direct correlation between ImageOI and FMA, and a significant indirect effect of AOU and QOM was observed (p < 0.01, bootstrap method). Conclusion: In stroke patients with moderate to mild movement disorder, the motor imagery ability directly affects the amount of use of hemiplegic upper limbs and their quality of motion in daily life. Moreover, it indirectly influences the motor functions via those parameters.

Keywords: Motor function, motor imagery, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1535 Top


Recovery of language function and prognostic factors during the first year after ischemic stroke

K. Kim

1Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

E-mail: kyungk721@naver.com

Introduction/Background: In this study, we investigated the language function recovery and influencing factors at 1 year after their first-ever ischemic stroke in patients with language disorders. Materials and Methods: We analyzed the data of 235 patients with first-ever acute ischemic stroke in the left hemisphere who completed Korean version of Frenchay Aphasia Screening Test (K-FAST) at 7 days, 3 months, 6 months, and 1 year after stroke onset. Repeated measures ANOVA was used to investigate changes of language function among each time points. Subgroup analysis was performed according to the K-FAST score category at 7 days after onset. The Broca’s area, Heschl’s gyrus, and Wernicke’s area were selected as the regions of interests (ROIs). Using the MRIcro® software, each patient’s lesion volume and involvement of ROIs were examined in their diffusion-weighted images. Improvement of language function was assessed by a shifting of the K-FAST score category and the K-FAST score changes (delta K-FAST) from 7days to 1 year after stroke onset. Multiple logistic regression analysis and multiple regression analysis were performed to investigate influencing factors for category shift and delta K-FAST, respectively. Results: Significant differences were noticed in mean K-FAST scores between each assessment time points, however, secondary analysis revealed that these differences were contributed by initially severe K-FAST subgroup (p < 0.05). Positive factors for the K-FAST category shift over time were female, alcohol consumption, and involvement of Heschl’s gyrus, whereas negative factors were involvement of Wernicke’s area and old age. Obesity and stroke lesion volume were positively related to higher delta K-FAST from 7 days to 1 year. Conclusion: These results demonstrated that recovery of language function differently occurred according to the initial severity of language dysfunction. Patients who initially suffered from larger stroke lesion or patients who had involvement of Heschl’s gyrus demonstrated better catch-up of language function over 1 year after their stroke onset.

Keywords: Aphasia, prognosis, recovery

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1690 Top


Responsiveness of the activity measure for post-acute care from discharge from inpatient stroke rehabilitation to 6 months follow-up

M. O’Dell, A. Jaywant1, E. Kwong, R. Patel2, M. Frantz3, M. Taub, J. Toglia4

Department of Rehabilitation Medicine, Weill Cornell Medicine, 1Department of Psychiatry, Weill Cornell Medicine, 2Department of Rehabilitation Medicine, NewYork-Presbyterian Hosptial, 3Kaiser Permanente Northern California, Rehabilitation Medicine, San Francisco, 4School of Health and Natural Sciences, Mercy College, Dobbs Ferry, USA

E-mail: mio2005@med.cornell.edu

Introduction/Background: Functional stroke scales must detect significant change over time, but defining “significant” is difficult. The Activity Measure for Post-Acute Care (AM-PAC) measures activity limitations in 3 domains: basic mobility (BM), daily activity (DA), and applied cognitive (AC). This study assesses the ability of the AM-PAC to detect change from inpatient rehabilitation facility (IRF) discharge (DC) to an outpatient setting 6 months (6M) later. Materials and Methods: We analyzed data from a observational database for stroke patients treated at our academic IRF. We assessed AM-PAC domains at IRF DC and again by phone 6M later. Change between DC and 6M was calculated by: 1) standardized response mean (SRM, 0-0.4-0.6 = moderate effect) and 2) proportion achieving the minimal clinically important difference (MCID, estimated as 0.5SD of baseline scores after Norman et al., 2003) with our data and 3) the published, mixed population minimal detectable change (MDC). Results: Of 273 patients at DC, 139 (51%) had both AM-PAC scores and were included. Those included were not demographically different but were better on physical and cognitive measures at IRF admission. The mean age = 67.1 ± 14.8 y, NIHSS = 7.9 ± 7.5, discharge FIM = 84.1 ± 19.1, FIM Gain = 20.2 ± 10.6, and rehabilitation length of stay = 14.8 ± 7.6 d. The mean DC/6M scores for BM were 51.7 ± 11.2/56.0 + 12.1, DA = 44.4 ± 9.9/49.2 + 14.5 and AC = 40.0 ± 9.8/44.7 + 9.2. Change metrics for the 3 AM-PAC domains are below:



Conclusion: Between 40%-50% of stroke patients were classified as “significantly” improved, depending on measure, suggesting the AM-PAC is able to capture “real life” change. The sample experienced change at the lower end of “moderate improvement” by SRM. Estimated MCID and the MDC were similar for DA and AC, not BM. Further research should explore factors which predict functional success or failure.

Keywords: Activity measure post actue care, responsiveness, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1691 Top


Extracorporeal shock waves versus botulinum toxin type a in the treatment of poststroke upper limb spasticity: A randomized, noninferiority trial

G.C. Hu

Department of Rehabilitation Medicine, Mackay Memorial Hospital, Taipei, Taiwan

E-mail: kung527@gmail.com

Background and Aims: Botulinum toxin type A (BoNT-A) is the recommended first-line treatment for regional spasticity affecting the upper limb in patients with stroke. Despite optimal treatment, BoNT-A injection might induce muscle weakness and might be associated with high cost and invasiveness. Recent studies have suggested that extracorporeal shock wave therapy (ESWT) is an effect method for the treatment of spasticity in stroke patients. The objective of this study was to investigate whether extracorporeal shock wave therapy is noninferior to botulinum toxin type A (BoNT-A) for treatment of post-stroke upper limb spasticity. Materials and Methods: 42 patients with chronic stroke (28 men; mean age, 61.0 ±10.6 years) were randomly assigned to receive either ESWT or BoNT-A. During the study period, all patients continued their regular rehabilitation. Assessments were performed at baseline and at one, four, and eight weeks after the intervention. The outcome was the change from baseline of the Modified Ashworth Scale (MAS) at the wrist flexors at week 4. Results: The outcome in ESWT group (-0.80 ± 0.41) was similar to that in BoNT-A group (-0.90 ± 0.44), with the higher confidence limit (0.33) for the difference between groups within the pre-specified margin of 0.5, indicating noninferiority of ESWT to BoNT-A. Conclusion: Our results suggest that ESWT is a noninferior treatment alternative to BoNT-A for post-stroke upper limb spasticity. Our results provide physicians with more options for the treatment of spasticity in patients with stroke.

Keywords: Botulinum toxin, extracorporeal shock waves, spaticity

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1737 Top


The value of frontal assessment battery in stroke patients

M. Kim, J. H. Leigh, M. H. Han

Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea

E-mail: minukkim@nate.com

Introduction/Background: The aim of this study is to evaluate the value of Frontal Assessment Battery (FAB) compared with Mini-Mental State Examination (MMSE) for detecting frontal lobe dysfunction and evaluate the correlations between FAB and neurocognitive function test. Materials and Methods: Medical records of stroke patients underwent cognitive assessment including the FAB and MMSE were retrospectively reviewed and the patients divided into three groups; lesions involving frontal lobe cortex, lesions related with frontal subcortical circuit and other lesion groups. We compared the FAB and MMSE scores, especially frontal lobe function domain among these groups. Results: A total of 186 Patients with frontal lobe lesion had significantly lower total FAB score compared to other lesions with frontal subcortical circuit. In correlation with neurocognitive function test, FAB scores were more correlated with measures of high cognitive function and memory tests, such as trail making test A, card sorting test, digital span and visual span, than MMSE. Even after controlling MMSE scores, FAB scores were correlated with trail making test A, digital span and visual span tests. In scatterplots, there was a positive correlation between MMSE and FAB scores. When divided group by median MMSE score, high MMSE score group showed lower correlation with FAB compared to low MMSE score group [Figure 1]. Conclusion: FAB showed better correlation with other frontal lobe function tests than MMSE, especially executive and memory functions domains. The FAB scores were proportional to MMSE scores and this correlation was more prominent in low MMSE score group. In patients with high MMSE scores, there may also be frontal dysfunction that cannot be detected with the MMSE score, therefore additional FAB testing should be performed. The FAB has screening value for frontal lobe function added to MMSE and can be used in clinical to detect cognitive impairment more specifically.
Figure 1: Scatterplotes for frontal assessment battery and Mini-Mental State Examination scores of brain lesion patients

Click here to view


Keywords: Frontal assessment battery, mini-mental state examination

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2264 Top


Effects of virtual reality with robot training on the gait of subacute stroke patients

Y. Mao, X. Wei1, P. Chen2, L. Li, L. Chen, Z. Xu, D. Huang

Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, 1Department of Rehabilitation Therapy, Sun Yat-sen University, Guangzhou, China, 2Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong (SAR)

E-mail: maoyr@mail.sysu.edu.cn

Introduction/Background: Ambulation is always one of the most significant issues for post-stroke patients as well as a formidable challenge. There was few study, to our best knowledge, focusing on the kinetic and kinematic changes resulting from training using robotic devices with virtual reality (VR) for subacute stroke patients. Thus, we analyzed the gait parameters of these patients at 1week and 3 weeks after they suffered the disease. Materials and Methods: 20 patients were included in this single blind randomized control study. Patients were randomized to either a VR with robot group (n = 10) or non-VR group (n = 10). The training was performed on a robotic gait-training system with situational interaction. Subjects in VR group were trained 5 times a week for two weeks for approximately 30 minutes every time. Others were trained by traditional therapies. Results: After the two-week training, the step time of patients in VR group significantly decreased (from 0.88 ± 0.29 to 0.77 ± 0.16), while the stride length average (from 0.72 ± 0.26 to 0.81 ± 0.25), step length average (from 0.36 ± 0.12 to 0.42 ± 0.10) and walking speed average (from 0.49 ± 0.25 to 0.59 ± 0.23) significantly increased (p < 0.05). Subjects in VR group demonstrated an obviously larger improvement in the maximum hip moment and minimum ankle moment (p = 0.028 and p = 0.040 respectively) compared with those in non-VR group. Conclusion: VR training with robot system could also be applied, as traditional therapy, in rehabilitation process of subacute stroke patients, especially in the improvement of step length and walking speed.

Keywords: Gait, stroke, virtual reality

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2491 Top


Physiatrist and registered therapist operating acute rehabilitation in stroke

T. Yoshikawa, T. Kinoshita, K. Kouda, Y. Nishimura1, T. Nakamura2, H. Arakawa3, F. Tajima

Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, 1Department of Rehabilitation Medicine, Iwate Medical University, Morioka, 2Department of Rehabilitation Medicine, School of Medicine, Yokohama City University, 3Department of Rehabilitation Medicine, Yokohama City University, Yokohama, Japan

E-mail: pliftyns@gmail.com

Introduction/Background: Clinical evidence suggests that early mobilization of patients with acute stroke improvesactivity of daily living (ADL). The purpose of this study was to compare the utility of the physiatristand registered therapist operating acute rehabilitation (PROr) applied early or lateafter acute stroke. Materials and Methods: This study was prospective cohort study, assessment design. Patients with acute stroke (n = 227) admitted between June 2014 and April 2015 were divided into three groups based onthe time of start of PROr: within 24 hours (VEM, n = 47), 24 ± 48 hours (EM, n = 77), andmore than 48 hours (OM, n = 103) from stroke onset. All groups were assessed for the numberof deaths during hospitalization, and changes in the Glasgow Coma Scale (GCS), National Institute of Health Stroke Scale (NIHSS), and Functional Independence Measure (FIM) at hospital discharge. All patients were assessed by physiatrists, who evaluated the specific needs for rehabilitation, and then referred them to registered physical therapists and occupational therapists to provide early mobilization (longer than one hour per day per patient). Results: The number of deaths encountered during the PROr period was 13 (out of 227, 5.7%),including 2 (4.3%) in the VEM group. GCS improved significantly during the hospital stay inall three groups, but the improvement on discharge was significantly better in the VEM group compared with the EM and OM groups. FIM improved significantly in the threegroups, and the gains in total FIM and motor subscale were significantly greater in the VEM than the other groups. Conclusion: PROr seems safe and beneficial rehabilitation to improve ADL in patients with acute stroke.

Keywords: Acute stroke, functional independence measure, very early mobilization

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0730 Top


Impact of somatosensory deficits on functional independence after first inpatient rehabilitation program post stroke

C. Barbeiro, J. Fortunato, D. Martins1, J. Jacinto1

Department of Adult Neuro-rehabilitation, Centro de Medicina de Reabilitação de Alcoitão, 1Hospital São Jose, Physical Medicine and Rehabilitation, Cascais, Portugal

E-mail: carolinabarbeiro@gmail.com

Introduction/Background: It is estimated that somatosensory deficits (SSD) are present in more than half of ischemic strokes. SSD can influence motor outcomes and thereby impair participation in activities of daily living (ADL). Rather few studies have investigated SSD after stroke. Previous studies showed a negative correlation between SSD following stroke, the functional prognosis of rehabilitation. The aim of this study is to illustrate the influence of SSD in functional outcomes as measured by the functional independence measure (FIM). Materials and Methods: Prospective observational study, with retrospective analysis of admission and discharge data, after a 1st inpatient rehabilitation program. Four groups were created: A - no SSD, B - only superficial SSD, C - only deep SSD, and D - both types of SSD. Functionality was measured by the FIM, subdivided in ADL, motor outcomes, cognitive outcomes and total outcome. The results were analyzed with ANOVA. Results: From a total of 119 patients who were discharged in 2014, complete data on SSD were available for 79, of which 57% were women. Mean age was 60.84 years. In 68% of cases the stroke was ischaemic. On average, patient stay was 65.82 days (SD 13.66). At admission, 22 patients had no SSD, 9 patients had changes only in superficial sensitivity, 3 had only deep sensitivity and 45 had both types of SSD. There are significant differences between having no SSD and having both types of SSD, regarding ADL, motor scores and total FIM scores, at admission. At discharge, the differences were statistically significant for: ADL, motor scores, cognitive and total FIM scores, as well as for the change of ADL scores and total FIM scores. Conclusion: SSD had an impact in the functional outcomes, especially when both SSD were impaired. In agreement with previously published data, SSD after stroke have a negative effect on motor and functional performance.

Keywords: Somatosensory deficits, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2676 Top


Effectiveness of shock wave therapy on triceps surae spasticity in chronic stroke patients

G. Stoquart, O. Roland1, S. Boulet2

Cliniques Universitaires Saint-Luc, Physical and Rehabilitation Medicine, Woluwé-Saint-Lambert, 1Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-la-Neuve, 2Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium

E-mail: gaetan.stoquart@uclouvain.be

Introduction/Background: Shock wave therapy (SWT) has shown some effectiveness in the spasticity treatment. However, few randomized controlled trials remained available, particularly in long-term spasticity, and the effect of a single session of treatment has poorly been assessed. Materials and Methods: Sixteen adults with a long-term stroke (4,3 ± 6 years post-stroke) and presenting a spasticity of the triceps surae were included. Patients were submitted to two sessions of shock wave therapy: one session (real-SWT) of 6000 real shocks (8Hz; 1.6 bar) applied on the triceps surae, and one session (sham-SWT) of 6000 sham shocks. Both sessions were separated by a one week interval, and allocated in a random order. Patients were assessed immediately before and after each session of SWT. Assessment was carried out by a blind assessor, and included the Modified Ashworth Scale (MAS) and the Tardieu scale (TS) of the triceps surae (assessed with knee flexed and knee extended), as well as a ten-meter walking test (10MWT). Results: The MAS score (knee flexed) and the TS score (knee extended) improved significantly after real-SWT, but not after sham-SWT (p = 0.007 and 0.01, respectively). The median improvement was 0.5 [0;1] on the MAS and 1 [0;2] on TS. However, the 10MWT remained unchanged. Conclusion: A single session of shock wave therapy can be effective to improve spasticity, but not walking ability, in long-term spasticity. Larger studies are needed to confirm this hypothesis.

Keywords: Shock wave therapy, spasticity, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0201 Top


Treatment efficacy of a hybrid home-based rehabilitation intervention for patients with stroke: A randomized crossover trial

Y. W. Hsieh, C. Y. Wu, K. C. Chang1

Department of Occupational Therapy, Chang Gung University, Taoyuan, 1Department of Neurology, Division of Cerebrovascular Diseases, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

E-mail: ywhsieh@gap.cgu.edu.tw

Introduction/Background: This study aimed to investigate the treatment effects of a hybrid home-based rehabilitation program combining mirror therapy and task-specific training compared with clinic-based rehabilitation in stroke patients. Materials and Methods: This was a single-blinded, 2-sequence, 2-period, crossover-designed study. The participants were randomly allocated to 1 of 2 order conditions: home-based rehabilitation first or clinic-based rehabilitation first. During each period, each participant received 12 treatment sessions, with a 4-week washout phase between the 2 periods. Both the home-based and clinic-based rehabilitation groups received 30 to 45 minutes of mirror therapy, followed by 45 to 60 minutes of functional task training, at each 90-min session. Before the interventions began, the client-centered Canadian Occupational Performance Measure was administered to help identify individual tasks and goals of patients. Outcome measures were selected based on the ICF. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire. Results: A total of 24 and 18 patients with stroke completed the study during the intervention period 1 and 2, respectively. Pretest analyses showed that there was no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the amount of use subscale of Motor Activity Log (P = 0.01) than clinic-based rehabilitation. Clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P = 0.02) than home-based rehabilitation. There were no statistically significant differences between the 2 groups on the other outcomes. Conclusion: This study is unique in developing a hybrid home-based stroke rehabilitation intervention with patient-oriented goals. The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

Keywords: Home-based rehabilitation, mirror therapy, stroke

Disclosure statement: This study is supported by the Chang Gung Memorial Hospital (CMRPD1E0391), and partly supported by the Chang Gung Memorial Hospital (BMRP553 and BMRPD25) and the Ministry of Science and Technology (MOST 106-2314-B-182-015-MY3) in Taiwan.


  ISPR8-0465 Top


Effects of botulinum toxin a therapy and multidisciplinary rehabilitation on lower limb spasticity classified by spastic muscle echo intensity in poststroke patients

T. Hara, A. Masahiro1, H. Hiroyoshi2, K. Kazushige1

Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Rehabilitation Medicine, Minato-Ku, 1Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Tokyo, 2Department of Rehabilitaion Medicine, Kikyougahara Hospital, Nagano, Japan

E-mail: t_hara1019@jikei.ac.jp

Objectives: The purpose of the present study was to investigate retrospectively the relationship between botulinum toxin type A plus multidisciplinary rehabilitation and muscle echo intensity in post-stroke patients with spasticity. The primary aim was to investigate whether the effects of the intervention on the improvement of spasticity depend on muscle echo intensity, and the secondary aim was to investigate whether the motor function of the lower limbs depends on muscle echo intensity. Materials and Methods: A 12-day inpatient protocol was designed for 102 post-stroke patients with spasticity due to lower limb paralysis. Muscle echo intensity of the triceps surae muscle was measured by ultrasonography, and the patients were categorized into 4 groups based on Heckmatt scale grades (Grades I–IV). Results: All 4 groups classified by the Heckmatt scale showed significant pre-to-post-intervention differences in the knee and ankle modified Ashworth scale scores (p < 0.05). Grade I–III patient groups showed a significant improvement in lower limb motor function following intervention. Grade IV patients did not show a significant improvement in lower limb motor function. Conclusion: We observed significant improvements in the modified Ashworth scale scores after botulinum toxin type A and multidisciplinary rehabilitation therapy on post-stroke patients with spasticity. Although patients with lower muscle echo intensity demonstrated improvements in motor function, the improvement was poor in those with higher muscle echo intensity.

Keywords: Botulinum toxin A, muscle echo intensity, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1703 Top


Association between the intensity of outpatient rehabilitation therapy and the risk of dementia in patients of ischemic stroke

H. K. Yu

Department of Nursing, Mackay Junior College of Medicine Nursing- and Management, Taipei, Taiwan

E-mail: kung527@yahoo.com.tw

Introduction/Background: Patients with stroke have an increased risk of dementia. Some studies have found that outpatient rehabilitation programs may improve cognitive function in chronic stroke patients. However, little is known about the use of rehabilitation in the outpatient setting and its impact on the risk of dementia. The objective of this study was to examine the association between the intensity of outpatient rehabilitation services received and the risk of dementia. Materials and Methods: We used the National Health Insurance Research Database in Taiwan to identify 16264 patients diagnosed with stroke from 1997 to 2005. Rehabilitation intensity was categorized as none, low, medium or high based on the sum of physical therapy, occupational therapy, and speech therapy within the first 6 months after discharge from inpatient rehabilitation. Cox proportional hazard regression models were used to evaluate the association between the intensity of rehabilitation and the risk of dementia. Results: During the follow-up period (median, 7.5 years), 1429 patients were diagnosed with incident dementia. Compared to patients in the no rehabilitation group, those who received high intensity therapy had a decreased risk of dementia during the follow-up period (hazard ratio, 0.68; 95% confidence interval, 0.56–0.84). The results remained consistent in analyses stratified by gender. Conclusion: The intensity of outpatient rehabilitation therapy and the risk of dementia was significantly inversely related in the ischemic stroke patients. Thus, further programs aimed at promoting greater use of outpatient rehabilitation services in patients with stroke are warranted.

Keywords: Dementia, rehabilitation, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1099 Top


Repetitive transcranial magnetic stimulation related choreic movement as an adverse effect in stroke: A case report

S. H. Ko, M. Myunghoon, M. Ji-Hong, K. Soo-Yeon, S. Yong-Il

Department of Rehabilitation Medicine, Yangsan Hospital, Pusan National University, Yangsan-Si, Republic of Korea

E-mail: ijsh6679@gmail.com

Introduction/Background: Repeated transcranial magnetic stimulation (rTMS) has been suggested to be a therapeutic approach for rehabilitation after stroke. Generally, it is considered a safe and well-tolerated procedure, however, it can cause some adverse. In this article, we report a case of choreic movement as an adverse effect of rTMS in the patient with thalamic pain after stroke. Materials and Methods - Case Report: A 65-year-old female was admitted to our rehabilitation department for management of thalamic pain after stroke. We tried many pharmacologic treatments to relieve her thalamic pain, however it was not successful. We applied rTMS to her pain. RTMS was applied over the left M1 area using a navigation system. She received 10 rTMS sessions for 2 weeks. Each session was consisted of a total of 1000 pulses at 10 Hz with intensity of 90% of resting motor threshold (RMT) for 20 minutes. Results: After 5 therapeutic rTMS sessions, her pain and hand function were improved. The pain was reduced and the right thumb opposition became possible that she could not perform before rTMS. After 8 sessions, she reported an abnormal involuntary movement of the right hand, lasts less than 10 seconds, once a day. After 10 sessions, her pain and hand function were more improved. However, frequency and intensity of the abnormal involuntary hand movement were increased while the improvements in thalamic pain and hand function were maintained. We consulted the neurologist about the symptom with a video. The neurologist diagnosed it as an episodic choreic movement of the hand and recommended haloperidol if the symptom worsens. The episodic choreic movement gradually decreased without medication, and it disappeared after one month. Conclusion: This is the first report of rTMS related choreic movement as an adverse effect of rTMS after stroke
Figure 1: Repeated transcranial magnetic stimulation navigation systems

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Figure 2: Flowchart of this case

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Keywords:Chorea, repetitive transcranial magnetic stimulation, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1149 Top


Factors affecting aspiration in chew-swallow and discrete swallow in stroke patients

E. Mizokoshi, H. Kagaya, Y. Aoyagi, S. Shibata, K. Onogi1, Y. Inamoto1, K. Pongpipatpaiboon2, E. Saitoh

Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan, 2Department of Rehabilitation Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

E-mail: eriko-mi@fujita-hu.ac.jp

Introduction/Background: Dysphagia after stroke is common. Many authors postulated factors affecting aspiration in discrete swallow, but eating solids and liquids, like soups, is usual in daily meals. Chew-swallow is unique because the chewed solid food is transported to the pharynx (stage II transport) before swallow onset even in healthy subjects. The aim of this study was to compare the factors affecting aspiration both chew-swallow and discrete swallow in stroke patients. Materials and Methods: One-hundred eighty-one stroke patients (average age 68) who swallowed both a two-phase mixture of 4 g of corned beef hash with 5 mL of thin liquid, and 10 mL of thin liquid during videofluoroscopic examination of swallowing (VF) were retrospectively evaluated. Oral, vallecular, and piriform sinus residue, hyoid elevation, laryngeal elevation, laryngeal closure, movement of epiglottis, mastication, bolus transition time, pharyngeal response time, and leading edge of bolus at swallow onset were evaluated by 2 physiatrists until consensus was reached from careful observation frame by frame. This study was approved by the institutional review board. Results: The vallecular residue, reduced hyoid elevation, and inadequate mastication caused aspiration in chew-swallow. On the other hand, movement of epiglottis, leading edge of bolus at swallow onset, bolus transition time, pharyngeal response time, and initiation of laryngeal closure are associated in aspiration during discrete swallow. In addition, vallecular residue and reduced hyoid elevation were significant factors affecting aspiration in chew-swallow, while the movement of epiglottis and leading edge of bolus at swallow onset were selected in discrete swallow by multiple logistic regression analysis. Conclusion: Factors affecting aspiration are different between chew-swallow and discrete swallow in stroke patients. We should check not only discrete swallow but chew-swallow during VF.

Keywords: Chew-swallow, dysphagia, videofluoroscopic examination of swallowing

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1688 Top


Plasma D-dimer level for prediction of functional outcome in ischemic stroke

I. S. Choi, H. G. Prof1

Department of Physical and Rehabilitation Medicine, Chonnam National University Hospital, 1Department of Physical and Rehabilitation Medicine, Chonnam National University Bitgoeul Hospital, Gwangju, Republic of Korea

E-mail: drchoiis@hanmail.net

Introduction/Background: Elevated D-dimer level has positive correlations with infarction volume and stroke severity on admission. Previous studies have demonstrated that D-dimer levels predict a progressing stroke, which is associated with poor short-term outcome in acute ischemic stroke. Conflicting data about the relationship between D-dimer level and functional outcomes were reported. We aimed to investigate the relations between serum D-dimer levels on admission and functional outcome of subacute stage in ischemic stroke patients. Materials and Methods: We retrospectively reviewed the medical records of 68 first-ever acute cerebral infarction patients (35 men, 33 women; age 67.2 ± 13.8 years). Plasma D-dimer level was measured on admission within 24 hours after stroke onset. The patients were classified into elevated group (plasma D-dimer >0.55 mg/L FEU, 31 patients) and control group (≤0.55 mg/L FEU, 37 patients) based on the level of plasma D-dimer. National Institutes of Health Stroke Scale (NIHSS) was checked within a week after stroke onset. Modified Barthel Index (MBI) and PULSES profile were assessed on admission and at 3 months after stroke onset. Results: 1) Plasma D-dimer level on admission was 0.32 ± 0.11 mg/L in control group and 2.59 ± 3.61 mg/L in elevated group. 2) NIHSS was 6.32 ± 3.80 in control group and 9.30 ± 6.63 in elevated group. There was no significant difference in NIHSS between both groups (p = 0.073). 3) ΔMBI was 23.39 ± 16.28 in control group, 12.00 ± 13.05 in experimental group. There was significant difference in ΔMBI between both groups (p = 0.004). There was a significant correlation between the level of plasma D-dimer on admission and ΔMBI (r = -0.304, p = 0.012). 4) ΔPULSES was 2.00 ± 2.42 in control group and 1.03 ± 1.83 in elevated group. There was no significant difference in ΔPULSES between both groups (p = 0.059). Conclusion: Plasma D-dimer level measured on admission would be helpful for predicting the functional outcome at subacute stage in ischemic stroke patients.

Keywords:D-dimer, functional outcome, subacute stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0340 Top


A pilot study on the immediate and long-term effects of hybrid therapy of computer-based cognitive training and aerobic exercise in stroke patients with cognitive decline

C. Y. Wu, T. T. Yeh, K. C. Chang1

Department of Occupational Therapy, Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, 1Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan

E-mail: cywu@mail.cgu.edu.tw

Introduction/Background: While the salient physical disability after stroke has long been emphasized, post-stroke cognitive decline hindering motor and functional recovery is often ignored. This study evaluated the immediate and long-term effects of hybrid therapies of computer-based cognitive training and aerobic exercise in stroke patients with cognitive decline. Materials and Methods: Stroke survivors with cognitive decline were separated into sequential (SEQ) and control groups (CON). Participants in the SEQ group (N = 15) received 30-minute aerobic exercise followed by 30-minute computerized cognitive training; participants in the CON group (N = 12) received 30-minute non-aerobic exercise (e.g., stretching and muscle strengthening) and 30-minute unstructured cognitive training (e.g., reading newspapers and playing board games). All participants received trainings for three days per week for 12 weeks. The cognitive function outcomes included Montreal Cognitive Assessment (MoCA) and Verbal Paired Associates and Word Lists subtests from the Wechsler Memory Scale-III (WMS-III). Health-related quality of life was measured by EQ5D. Outcome measures were administered at baseline, immediately after training (3rd month), and at 6-month follow-up (9th month). Results: Preliminary results showed that the SEQ group showed greater improvement in MoCA, WMS-Verbal Pair and Word Lists at post-training than the CON group, but not the EQ5D. These effects remained or had less decrements 6 months post-training compared to the CON group. Conclusion: Hybrid therapy of computer-based cognitive training and aerobic exercise training is favored to facilitate cognitive function in stroke survivors with cognitive decline. Our study demonstrates the potential benefit of this hybrid approach for long-term enhancement of cognition following stroke.

Keywords: Cognitive decline, computer-based cognitive and aerobic exercise training, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2497 Top


Interpreting spatial dysgraphia after stroke: Straight ahead or straight above?

C. Jolly1, C. Piscicelli1,2, L. Mathevon1, C. Berenger1, A. Chrispin1, D. Pérennou1,2

1CHU Grenoble Alpes, Medecine Physique et Readaptation Neurologique, 2Laboratoire de Psychologie et Neurocognition, Université Grenoble-Alpes, Grenoble, France

E-mail: cpiscicelli@chu-grenoble.fr

Introduction/Background: Spatial dysgraphia after a right hemisphere lesion, associates signs of spatial compression in relation to spatial neglect, and a tilted writing which remains to be explained. Here we present a case study suggesting that tilted writing is due to a tilted representation of the vertical. Materials and Methods: JW, a 75 year-old patient who underwent a right parietal hemorrhage showed a pusher syndrome and a writing tilted 11.1° upwardly without other signs of spatial dysgraphia. We comprehensively assessed and followed most aspects of spatial cognition (spatial neglect, verticality perception) and handwriting, until nine months post-stroke. Examination of JW’s handwriting was performed by means of a graphic tablet quantifying writing orientation and speed, in the presence or not of spatial indexes, and after a transient modulation of verticality perception. Results: In acute stage, spatial neglect was severe with predominant signs of body neglect. At three months, visual (VV) and postural (PV) perceptions of the vertical were tilted of 11°, counterclockwise. This transmodal tilt was similar both in direction and magnitude to the tilt found congruent on both features of writing: left-hand margin and lines. JW’s writing speed was found slower than a control subject in the blank paper condition (1.67 vs 0.82 sec/letter; p < .001), and faster when writing on lines inclined 24° upwardly (1.11 sec/letter; p < 0.05). The transient modulation of verticality perception (PV = 0.5°) was performed by tilting the patient for 10 min at 30° to the right side, in the dark. This PV modulation reduced the writing tilt, measured 20 min later (6.2°; p =.001) and increased the writing speed (0.89 sec/letter; p = .002). Nine months post-stroke, while spatial neglect had completely recovered, a congruent tilt both in verticality perception and writing persisted (5° and 8.8°, respectively). Conclusion: After right hemisphere stroke, a tilted writing is likely a sign of a tilted verticality representation.

Keywords: Spatial dysgraphia, stroke, verticality representation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1668 Top


Effects of physiological ischemic training on post-stroke neuroprotection and angiogenesis in adult rats

J. Ni, C. Mei, S. Yu1, G. Shen, X. Lu2, J. Li3

Department of Rehabilitation Medicine, The Affiliated Hospital of Nantong University, 1Department of Rehabilitation Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, 2Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, 3Department of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China

E-mail: nijun1000@126.com

Objective: To examine potentially beneficial effects of physiological ischemic training (PIT) following stroke. Materials and Methods: Threehundred-seventyfive adult male rats were subjected to 90-min transient middle cerebral artery occlusion (MCAO) and randomized into a PIT group and a non-PIT control group. A sham-operated group was used as negative control. After 1- and 2-weeks of PIT, brain infarct volume was measured by Triphenyl tetrazolium chloride (TTC) staining, and behavioral outcomes, presence of intact neurons, apoptosis, and cerebral edema were assessed with modified neurological severity score (mNSS), Nissl staining, TdT-mediated dUTP Nick-End Labeling (TUNEL) staining and cerebral water volume. The mRNA expression of vascular endothelial growth factor (VEGF) was assayed with RT-PCR and protein expression of VEGF was quantified with Western blot. Results: Cerebral infarction, neurological deficits and neuronal apoptosis were reduced significantly in the PIT groups, while the presence of neurons was increased in comparison with MCAO controls. Moreover, mRNA and protein expression of VEGF were enhanced after 1 and 2 weeks of PIT. Conclusion: PIT may promote angiogenesis and neuroprotection during post-stroke rehabilitation and provide a novel strategy for rehabilitation of stroke patients.

Keywords: Middle cerebral artery occlusion, neuroprotection against stroke, physiological ischemic training

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2576 Top


Within-session effects of selected physical rehabilitation interventions for a dysfunctional arm post-stroke on arm movement and muscle firing patterns

R. Lazaro

Department of Physical Therapy, California State University Sacramento, Sacramento, USA

E-mail: rolando.lazaro@csus.edu

Introduction/Background: Upper extremity (UE) impairments and activity limitations are a common problem in individuals following a cerebrovascular accident (CVA). Eighty-five percent of individuals with CVA report UE functional limitations that are associated with decreased health-related quality of life. Occupational therapy (OT) and physical therapy (PT) approaches are typically aimed to treat impairments, activity limitations, and participation restrictions following a CVA. This study examines the effects of five therapeutic approaches on upper extremity (UE) movement and muscle activation patterns in persons with CVAs: (1) Proprioceptive Neuromuscular Facilitation (PNF); (2) Neurodevelopmental Treatment (NDT); (3) Functional Electrical Stimulation (FES); (4) Weight-bearing and (5) modified Constraint-Induced Movement Therapy (mCIMT). Materials and Methods: This is a case report involving a 61-year-old male who underwent 30-minute intervention sessions for each approach stated above. Electromyography (EMG) and 3D motion capture data were collected pre and post intervention and at 30 minute follow-up. Data were analyzed for reaching a cup at waist level, maximum shoulder flexion, and moving cup to mouth as in drinking. Results: No significant differences were seen for UE movements across all interventions for kinematic or EMG data. There appears to be a trend towards normal elbow movement following NMES, mCIMT and PNF and increased variability in shoulder flexion in mCIMT and NDT interventions. Weight bearing provided the least amount of evidence for improved kinematic motion. Improvement in elbow kinematics may indicate proximal stability following PNF, FES, and mCIMT allows for increased distal mobility at the elbow. Conclusion: Some interventions produced trends that indicate better UE movement. Increased proximal stability may have caused better distal mobility as shown by improved elbow movement. Increased variability of shoulder flexion may indicate the participant learned different options to perform the same movement. Further research is needed o provide a more transparent understanding of the efficacy of interventions for individuals with hemiparesis following a CVA.

Keywords:Paresis, rehabilitation, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0094 Top


Reliability and validity of arm function assessment for the fugl-meyer assessment with a japanese guideline

S. Amano, A. Umeji1, A. Uchita1, Y. Hashimoto1, T. Takebayashi, Y. Kanata, Y. Uchiyama, K. Domen

Department of Rehabilitation, Hyogo College of Medicine, 1Department of Rehabilitation, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan

E-mail: satoru@hyo-med.ac.jp

Introduction/Background: The Fugl-Meyer Assessment (FMA) is widely used in stroke research as a gold standard. However, the FMA has not been used in general clinical practice in Japan, which may be related to that the FMA was not translated in the standardized way (including forward translation and back translation). Against the background of linguistic and cultural differences, we translated the standardized FMA into Japanese and adapted it for use in Japan. The aim of the present study is to assess its reliability and validity for the FMA with a Japanese guideline. Materials and Methods: A prospective single-center study involving 30 patients with mild-to-severe hemiparesis was conducted. This study was registered in 2016 as a pre-initiation condition. A standardized guidebook for the FMA test administration and scoring was used. The FMA and the Action Research Arm Test, the Box-and-Block Test, and the Motor Activity Log were employed. The simultaneous/non-simultaneous inter-rater reliability and the criterion-referenced validity were assessed in the following ways: the intraclass correlation coefficient (ICC) and the Spearman’s rank-order correlation coefficient (Spearman’s rho). Results: The ICC for the simultaneous and the non-simultaneous reliability in the motor section were 0.999 (0.997–0.999, P < 0.001) and 0.983 (0.928–0.994, P < 0.001). The Spearman’s rho for the validity in the motor section ranged from 0.93 to 0.95 (P < 0.05). Conclusion: The FMA with a Japanese guideline reliably assesses the affected upper extremities in patients with hemiparesis after stroke.

Keywords: Fugl-Meyer assessment, reproducibility of results, translation/adaptation

Disclosure statement: This research was supported by Teijin Pharma Limited (Tokyo, Japan). Mr. Takebayashi serves as a consultant to Teijin Pharma Limited.


  ISPR8-0379 Top


Reaction time and visual field are the most relevant factors of driving ability of motorized mobility scooters after stroke

F. L. Ku1, W. C. Chen2, T. W. Chen1

Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, 1Department of Traditional Chinese Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

E-mail: kufangling@gmail.com

Introduction/Background: Maintaining active community mobility and community participation are important instrumental activities of daily living, and are issues that occupational therapists concern about. The use of motorized mobility scooters (MMS) has grown in older people and disabled people to improve active community mobility. However, traffic accidents related to MMS driving increase. How to judge whether patients can drive MMS safely or not becomes an important issue. The objective of this study was to investigate the related factors of MMS driving ability. Materials and Methods: This study was a cross-sectional study to investigate the association between cognitive, visual, motor function and MMS driving performance. Inclusion criteria of subjects were diagnosis of stroke and Mini-Mental State Examination score ≥24. Cognition related measurements included Color Trails Test (CTT) and reaction time test. Visual function related measurements included visual acuity and visual field. Motor function related measurements included Jamar dynamometer and Box and Block Test. MMS driving performance was measured with Power Mobility Clinical Driving Assessment Tool (PMCDA). Results: Thirty participants with stroke were recruited (age 63.8 ± 13.4 years old). There were significant associations between CTT (rho = -.40, p = .03), reaction time (rho = -.66, p<.01), visual acuity (rho = .42, p = .02), visual field (rho = .63, p < .01), Jamar dynamometer (rho = .48, p = .01) and PMCDA. The stepwise multiple regression analyses found that reaction time (Beta = -.44, p = .01) and visual field (Beta = .37, p = .03) were the significant related factors of PMCDA (adjusted R2 = .30). Conclusion: There were various levels of association between cognitive, visual, motor function and MMS driving performance. Reaction time and visual field were the most relevant factors especially. The finding of this study could provide professionals an efficient method to determine MMS driving ability from cognitive and visual function of stroke patients.

Keywords: Community mobility, motorized mobility scooters, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0951 Top


The relationship between dysphagia in patients with supratentorial acute small subcortical infarcts and cerebral white matter lesions

N. Koga, T. Ishihara1, T. Towata1, M. Kodama, Y. Masakado

Department of Rehabilitation Medicine, Tokai University School of Medicine, 1Department of Rehabilitation, Tokai University Hospital, Isehara, Japan

E-mail: nobnob@tokai-u.jp

Introduction/Background: Dysphagia is commonly expected to occur in patients with severe stroke and large infarct size. However, to what extent dysphagia in acute penetrating branch infarction is still largely unknown. The aim of this study is to determine whether cerebral white matter (WM) lesions exert negative effects on swallowing function with acute small subcortical infarction. Materials and Methods: We identified all inpatients with magnetic resonance imaging between October 2015 and September 2017. This study included 20 supratentorial acute small subcortical infarction patients (mean age, 76.6±11.9 years; 55% male) referred for dysphagia rehabilitation. They could communicate and had no sign of dysphagia before admission. Patients were excluded if their scans showed multiple acute subcortical infarcts, additional acute infarcts in other locations, or previous history of stroke. The patients were divided into the following two group by their final food form: the swallowing recover group and the unchanged group. The severity of WM lesions was using fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging and rated based on the Fazekas scale, which categorizes WM lesions into four grades. The scale divides the WM lesions into periventricular and deep white matter lesions. We statistically examined the relationship between presence of dysphagia and severity of WM lesions. Results: Dysphagia is present in a quarter of patients with supratentorial acute small subcortical infarcts and has to be expected especially in those with severe WM lesions.



Conclusion: Many anatomic structures/pathways associated with swallowing function are located in subcortical regions and may not only be disrupted by small infarction but also by coexisting morphological damage such as cerebral WM lesions.

Keywords: Cerebral white matter lesions, dysphagia, supratentorial acute small subcortical infarcts

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1027 Top


Differences in alteration of motor network between supra- and infra-tentorial ischemic stroke patients

J. Lee, A. Lee, S. Y. Lee, H. Kim, W. H. Chang, Y.H. Kim

Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Seoul, Republic of Korea

E-mail: yunkim@skku.edu; jungsoo0319@gmail.com

Introduction/Background: In recent stroke studies, connectivity-based approaches have been used to investigate recovery-related indicators. However, most of previous studies were performed in heterogenous patients with different lesion locations or different types of stroke. In addition, there is not enough investigation on recovery-related network analysis in the infratentorial stroke (ITS) which may show different network dynamics from the supratentorial stroke (STS). In this study, we investigated the differences in alteration of motor network between STS and ITS in ischemic stroke patients. Materials and Methods: Forty first-onset ischemic stroke patients were recruited within 2 weeks after stroke onset. Patients were divided into STS and ITS groups according to their lesion location. All patients underwent resting-state fMRI scans twice (2 weeks and 3 months after onset). Twenty-four healthy subjects participated as an age-matched control group. To investigate the altered connectivity during recovery and to compare between groups, various analysis methods such as interhemispheric connectivity, network symmetry, and graph theoretical analysis which were already established in the previous studies were used. Results: In STS group, interhemispheric connectivity was significantly decreased and network symmetry was disrupted compared to control group at 2 weeks post stroke, while the ITS group did not show differences compared to control group at this time point. During recovery, global efficiency and global reorganization including increasing network efficiency and randomization showed only in the STS group. In contrast, the ITS group demonstrated significantly increased interhemispheric connectivity during recovery. There was an interactive relationship between cortico-cerebellar connectivity and interhemispheric connectivity in the ITS group. Conclusion: Alterations of recovery-related motor network connectivity in ITS patients were very different from that of STS patients. These results may be caused by differences of damage of diverse motor-related pathways by stroke lesion. (This work was supported by the National Research Foundation of Korea grant funded by the Korea government (MSIP) (NRF-2017R1A2A1A05000730, NRF-2017R1D1A1B03034109))

Keywords: Ischemic stroke, lesion location, motor network

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1170 Top


Upper limb activity in chronic post stroke survivors: A comparison of accelerometry data with the action research arm test

J. Parker, L. Powell, B. Heller1, E. Schweiss2, S. Mawson

School of Health and Related Research, University of Sheffield, 1The Centre for Sports Engineering Research, Sheffield Hallam University, Sheffield, UK, 3RunScribe, Research and Data Analytics, Greater St. Louis, USA

E-mail: jack.parker@sheffield.ac.uk

Introduction/Background: Only 5-20% of stroke survivors will regain full function of the upper limb (UL) with up to 60% still being impaired in the chronic phase. A plethora of outcome measures are used to assess UL function. However, they are often only a snap shot in time of the stroke survivor’s capability and do not always reflect the stroke survivor’s UL use in everyday real-world settings and contexts. The use of technologies has become a viable option for quantifying movements and activities during post-stroke rehabilitation in real-world contexts. This research compares the use of accelerometry with the ARAT over 96 hours with chronic stroke survivors and age matched controls. Materials and Methods: 30 chronic stroke survivors and 30 age matched controls wore an accelerometer on each wrist for 96 hours. Stroke survivors were also assessed using the ARAT and reported their functional ability. Data were analysed to compare affected UL v non-affected UL, stroke survivor movement v control, and hand dominance v non-dominance. Accelerometry data were compared with the stroke survivors’ functional capability. Results: Findings suggest there is an association between the ARAT and accelerometry; the greater the capability score the higher the usage of the affected UL. Controls carryout more bi-lateral activities compared to the stroke survivors who tend to use each arm independently. However, despite full functional capability scores, stroke survivors still do not use their impaired UL compared to their non-affected UL. This is due to sensory loss or mistrust of their affected UL. Conclusion: Compared to controls, chronic stroke survivors do not use their affected UL, nor do they carry out as much bi-lateral activity despite full capability. Accelerometry has the potential to measure UL movement and movement characteristics over long periods which can provide essential feedback for both clinicians and stroke survivors.

Keywords: Stroke, technology, upper-Limb

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1451 Top


Motor imagery-assisted brain-computer interface for gait retraining in neurorehabilitation in chronic stroke

N. Tang, C. Guan1, K.K. Ang2, K.S. Phua2, E. Chew

Division of Neurology, National University Hospital, 1School of Computer Science and Engineering, Nanyang Technological University, 2ASTAR, Institute for Infocomm Research, Singapore, Singapore

E-mail: ning_tang@nuhs.edu.sg

Introduction/Background: Stroke is the most common cause for physical disability and impairments to lower limb function remain one of its most debilitating symptom. Motor imagery (MI), as a safe, self-paced technique, has been shown to effectively facilitating the effects of motor practice. When combined with brain-computer interface (MI-BCI), it also demonstrates an improvement in stroke motor recovery. A feasibility trial was carried out to investigate the effect of MI-BCI neurofeedback in chronic hemiplegic lower limb rehabilitation. The neurophysiological correlates to clinical outcomes was also studied by using, transcranial magnetic stimulation (TMS). Materials and Methods: Subjects (n = 13) with more than 9 months post-stroke and Functional Ambulation Category 3-4 underwent 12 sessions of MI-BCI gait training, at a frequency of thrice a week. Subjects were instructed to perform a MI task whereby they imagined themselves walking properly with both legs. If the MI task is performed correctly as detected via electroencephalography acquisition, a pair of cartoon foot prints in the monitor will be activated to walk forward. Each MI-BCI session includes 160 MI trials with resting interval every 40 trials. Timed up-to-go test and 10 meter walk test, as well as the resting motor threshold measured by TMS were performed before, after and 6 weeks after MI-BCI gait training. Results: It was shown that MI-BCI was safe and well tolerated by stroke subjects. Both walking speed and balance improved after MI-BCI gait training [Figure 1]. This was in line with an increase in the corticospinal activity in the contralesional M1 motor cortex [Figure 2]. Conclusion: MI-BCI could improve mobility in chronic stroke patients with residual mobility impairment. The study also suggested that the contralesional motor cortex is involved in the recovery of mobility.



Keywords: Brain computer interface, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2060 Top


Effects of noninvasive brain stimulation for upper limb rehabilitation in acute stroke patients: A controlled clinical trial

K. H. Wong

Department of Physiotherapy, Tuen Mun Hospital, Hong Kong, Hong Kong (SAR)

E-mail: wkh179@ha.org.hk

Introduction/Background: This study was conducted in Tuen Mun Hospital (TMH) to evaluate the effects of rTMS and tDCS on upper limb functional recovery in acute stroke patients. Materials and Methods: Patients with acute stroke were randomly assigned to rTMS, tDCS or control group. For rTMS group, patient received 1 Hz rTMS at 90% of resting motor threshold to M1 of the unaffected hemisphere for 1200 pulses. For tDCS group, patient received 1 mA anodal stimulation to hand area of the affected hemisphere for 20 minutes. Five consecutive sessions of rTMS or tDCS together with intensive physiotherapy upper limb training were given. For control group, only intensive physiotherapy upper limb training were given. The upper-extremity section of Fugl-Meyer Scale (UE-FM) was used as outcome measure. Results: Twenty-nine patients (17 female and 12 male) were assigned to the rTMS (n = 9), tDCS (n = 11) and control (n = 9) group. The mean age was 62.7 ± 12.0 years old and the mean time between stroke onset and the first UE-FM assessment was 9.14 ± 3.30 days. There was no statistically significant difference in mean age, baseline UE-FM mean score, mean time between stroke onset and the first UE-FM assessment among three groups. (X²(2) = 4.81, p=0.09) (X²(2) = 1.56, p=0.457) (X²(2) = 0.04, p=0.98). No adverse effects of rTMS or tDCS were reported. For between-group comparison, the changes in mean score of UE-FM in rTMS (20.8 ± 6.59) and tDCS group (16.1 ± 4.97) were statistically significantly larger than that in control group. (10.6 ± 4.13) (U = -2.97, p = 0.002) (U = -2.29, p = 0.02), however there was no significant difference between rTMS and tDCS group (U = -1.49, p = 0.152). Conclusion: Findings of the present study showed that both rTMS and tDCS could augment physiotherapy treatment in enhancing upper limb motor functional recovery in acute stroke patients. These positive findings warrant further investigation of the application of non-invasive brain stimulation techniques to neuro-rehabilitation.

Keywords: Noninvasive brain stimulation, physiotherapy, stroke rehabilitation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2570 Top


Effects of physical therapy on postural imbalance depending on time since stroke: A meta-analysis

A. Hugues, J. Di-Marco1, P. Janiaud2, Y. Xue3, J. Zhu4, J. Pires5, H. Khademi6, L. Rubio7, P. Hernandez Bernal8, Y. Bahar9, H. Charvat10, P. Szulc11, C. Ciumas12, H. Won13, M. Cucherat2, I. Bonan14, F. Gueyffier15, G. Rode

Hospices Civils de Lyon- Centre de Recherche de Neurosciences de Lyon et Université de Lyon, Service de Médecine Physique et de Réadaptation de l’Hôpital Henry Gabrielle- Unité Impact et Plate-forme “Mouvement et Handicap,” Lyon et Saint Genis Laval, 1Assistance Publique des Hôpitaux de Paris et Université Paris Descartes, Service de Medecine Physique et de Réadaptation, Paris, 3Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, HESPER EA 7425- F-69008 Lyon- F-42023 Saint-Etienne, Lyon et Saint-Etienne, 2CNRS Lyon et Université de Lyon 1, Umr 5558, 11INSERM et University of Lyon, Umr 1033, 15Hospices Civils de Lyon, CNRS Lyon et Université de Lyon 1, Service Hospitalo-Universitaire de Pharmaco-Toxicologie et UMR 5558, 6World Heath Organisation, International Agency of Research on Cancer, Lyon, 12Department of Clinical Neurosciences, INSERM U1028, CNRS UMR5292, Centre de Recherche en Neuroscience de Lyon, Université de Lyon, Institute of Epilepsies, Centre Hospitalier Universitaire Vaudois, Translational and Integrative Group in Epilepsy Research, Lyon et Lausanne, 13Université Grenoble Alpes, KyungHee University, UMR 5316 Litt and Arts, Grenoble et Séoul, 14Centre Hospitalier Universitaire de Rennes, Service de médecine physique et de réadaptation, Rennes, France, 4Université Jiaotong de Shanghai, Pharmacologie, Shanghai, China, 5Rovisco Pais Rehabilitation Centre, Medicine Faculty of Oporto University, Tocha and Oporto, Portugal, 7Centro Lescer, Rehabilitation, Madrid, Spain, 8Rehaklinik Zihlschlach, Neurologisches Rehabilitationszentrum, Zihlschlacht, Switzerland, 9Department of Physical Medicine and Rehabilitation, Hitit University, Erol Olcok Training and Research Hospital, Corum, Turkey, 10Center for Public Health Sciences, National Cancer, Division of Prevention, Tokyo, Japan

E-mail: huguesaurelien@gmail.com

Introduction/Background: Several studies highlight that the physical therapy (PT) timing is important in rehabilitation process from physical disability after stroke. The purpose of this meta-analysis was to investigate the effect of all PT on balance after stroke and to evaluate whether changes are related to stroke stage of recovering (acute and sub-acute (ASS) or chronic stage (CS)). Materials and Methods: Randomised controlled trials (RCT), without language restriction, until October 2015, assessing the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke, the posturographic parameters in static condition and measures of independence in activities of daily living were included. Two independent authors (AH and JDM) led this selection following the Cochrane recommendations (Hugues et al., 2017). Results: 193 parallel and crossover RCT from 9337 records were included, involving 8018 subjects (study sample: mean 41,5 (SD 49.7) subjects, age: pooled mean 61,7 (pooled SD 12.78) years). A significant difference in favor of PT compared to no treatment was immediately found after the intervention for the BBS at ASS and CS (ASS: 11 studies, mean difference (MD) 3.14; 95% confidence interval (CI) [2.21; 4.06]. CS: 12 studies, MD 1.31; 95% CI [0.79; 1.82]. Mixed: 2 studies, MD 0.89; 95% CI [-0.63; 2.40]). Only at CS, PT is more effective than sham treatment or usual care immediately after the intervention for the BBS (ASS: 12 studies, MD 2.21; 95% CI [-0.37; 4.78]. CS: 13 studies, MD 2.50; 95% CI [1.00; 3.99]. Mixed: 2 studies, MD -1.17; 95% CI [-2.94; 0.60]). Conclusion: These results show immediately after the intervention: i) that balance can be improved by PT compared to no treatment whatever the stage of stroke, and ii) an improvement of balance by PT compared to sham treatment or usual care at chronic stage.

Keywords: Meta-analysis, physical therapy, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2577 Top


Epiglottic kinematics alterations and risk of laryngeal penetration-aspiration

A. Duarte, J. Lopes de Almeida1, Ú. Martins2, C. Magro3, C. Lima1, S. Araújo1, N. Pereira1, M. Coutinho1, H. Marques1

Department of Physical Medicine and Rehabilitation, Centro Hospitalar de São João, Porto, 1Department of Physical Medicine and Rehabilitation, Centro de Reabilitação do Norte, Vila Nova de Gaia, 2Department of Physical Medicine and Rehabilitation, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, 3Department of Physical Medicine and Rehabilitation, Hospital Universitário de Santa Maria, Physical Medicine and Rehabilitation, Lisboa, Portugal

E-mail: andre05marques@gmail.com

Introduction/Background: Epiglottic retroflexion seems to be an important mechanism of airway protection during swallowing. Although epiglottic dysfunction has been correlated with aspiration, the kinematics alterations underlying this condition remain unclear. Two distinct movements of epiglottic inversion were described in videofluoroscopic swallowing studies (VFSS). The first epiglottic movement brings the epiglottis to a horizontal position and the second consists of its full inversion. Materials and Methods: Retrospective cohort study of 28 patients with post-stroke dysphagia admitted to our institution in 2017. Based on VFSS images, and in regard with the epiglottic mobility, two groups were assigned for comparison: one group with complete epiglottic inversion and other with partial inversion. Other parameters of VFSS were also compared. Results: Of the 28 patients in the study, 68% were male (19) and 32% female (9). 28.6% of the patients had hemorrhagic stroke, 67.9% ischemic, and 3.5% ischemic stroke with hemorrhagic transformation. We found significant statistical correlation between epiglottic mechanics alterations and risk of laryngeal penetration (Fisher´s exact-test; p = 0,036). Regarding other evaluated parameters, only the absence of the cough reflex was shown to statistically correlate with the risk of laryngeal penetration (Pearson´s chi-square; p = 0,007). Conclusion: The results suggest that epiglottis movement is an important mechanism to avoid penetration-aspiration. The absence of cough reflex in patients with laryngeal penetration (silent aspiration) emphasizes the importance of the VFSS. We are also of the opinion that this result may be related to the pre selection of patients with suspected silent aspiration. Further studies are needed to better understand the influence of these epiglottic movement alterations in the swallowing process.

Keywords: Dysphagia, epiglottic movement alterations, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0251 Top


A systematic review: Efficacy of botulinum toxin in walking and quality of life in post-stroke lower limb spasticity

A. Datta Gupta

The Queen Elizabeth Hospital, Rehabilitation Medicine, Adelaide, Australia

E-mail: anupam.dattagupta@adelaide.edu.au

Introduction/Background: We performed a systematic review of the randomized control trials (RCT) to evaluate effectiveness of Botulinum toxin A (BoNTA) injection on walking and Quality of Life (QOL) in post-stroke lower limb spasticity (PSLLS). Materials and Methods: We searched PubMed, Web of Science, Embase, CINAHL, ProQuest Thesis and Dissertation checks and Google Scholar, WHO International Clinical Trial Registry Platform, ClinicalTrials.gov, Cochrane, ANZ and EU Clinical Trials Register for RCTs looking at improvement in walking and QOL following injection of BoNTA in PSLLS. The original search was carried out prior to 16 September 2015. We conducted an additional verifying search on CINHAL, EMBASE, and MEDLINE (via PubMed) from 16 September 2015 to 6 June 2017 using the same clauses. Results: Of 2026 records, we found 107 full text records and 5 RCTs qualifying our criteria. Two independent reviewers assessed methodological validity prior to inclusion in the review. Two studies reported significant improvement in gait velocity (p=0.020) and <0.05 respectively). One study showed significant improvement in 2-min-walking distance (p <0.05). QOL was recorded in one study without any significant improvement. Meta-analysis of reviewed studies could not be performed because of different methods of assessing walking ability, and small sample size with large confidence interval. This review identifies the need for a well-designed RCT to adequately investigate the issues highlighted. Conclusion: This review could not conclude there was sufficient evidence to support or refute improvement on walking or QOL following BoNTA injection. Reasons for this are discussed and methods for future RCTs are developed.

Keywords: Botulinum toxin, spasticity, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1631 Top


A comparison of prism adaptation, optokinetic stimulation and visuo-spatial training in the rehabilitation of spatial neglect

A. Facchin, G. Figliano, A. Dante, N. Beschin1, R. Daini

Department of Psychology, University of Milano-Bicocca, Milano, 1Department of Rehabilitation, Neuropsychological Service, A.S.S.T. Valle Olona, Somma Lombardo, Italy

E-mail: alessiopietro.facchin@gmail.com

Introduction/Background: Prism adaptation (PA) is one of the most investigated and effective therapy among those for the rehabilitation of unilateral spatial neglect. Two other techniques have received the higher degree of efficacy from the literature analysis: Visuo-Spatial Training (VST) and Optokinetic Stimulation (OKS). The aim of this study was to compare the effectiveness of these rehabilitation methods between and within two groups of neglect patients. Materials and Methods: Two groups of post-acute spatial neglect patients (of 12 and 8 participants), who have never been received rehabilitation, were subjected to different rehabilitation procedures: PA and OKS for the first group and PA and VST for the second group. Within each group a crossover design was applied for the sequence of the two therapies. Each theraphy was applied for 10 sessions, twice a day. Neuropsychological assessments were performed before the first type of training, between the first and the second training, after the second training and two weeks after the end of treatment. Results: All three methods induced an improvement. The first group showed a significant effect of the first training, independently from which type. Similar trend of results was show in the second group. Overall the sequential application PA- VST seems to be more effective than VST- PA. Conclusion: The results suggest that bottom-up techniques (PA and OKS) induce higher amelioration of neglect patients than VST, at least for a short therapy. OKS and PA showed a comparable degree of efficacy in the first session of rehabilitation. Finally, a first treatment with a bottom-up technique and a subsequent top-down method seems to show the high efficacy in rehabilitation of neglect.

Keywords: Neglect, prism adaptation, rehabilitation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2473 Top


The impact of the pharmacotherapy on stroke recovery: A retrospective cohort study

S. Straudi, G. Busà1, S. Volpato2, E. Maietti2, N. Basaglia

Department of Neuroscience and Rehabilitation, Ferrara University Hospital, 1School of Medicine, Ferrara University, 2Clinical Epidemiology Center, Ferrara University, Ferrara, Italy

E-mail: s.straudi@ospfe.it

Introduction/Background: Stroke represents a leading cause of worldwide disability with a reduced quality of life and participation to work, family and social life activities. During the recovery stage, several approaches have been studied to enhance the processes underlying spontaneous recovery, among which drugs, such as the dopaminergic or serotoninergic agents. Conversely, several classes of drugs have been proposed to have a detrimental effect on recovery, such as the anti-cholinergic agents, anticonvulsants, neuroleptics and GABAergic agents. The aim of this study is to evaluate the possible association between drug assumption during an inpatient rehabilitation and functional recovery after stroke. Specifically, we hypothesized that there is a different use of antidepressants (positive effect) or GABAergic, anticholinergic agents and neuroleptics (negative effect) in patients with different level of functional recovery. Materials and Methods: We included in the study subjects (aged >18 y) who underwent a stroke multidisciplinary rehabilitation program at Ferrara University Hospital. We categorized them into Good Responders (GR) or Poor Responders (PR) according with their functional improvement, measured by the Functional Independence Measure (FIM) score. From digital medical records, we extrapolated clinical, demographic data, the total FIM score and the drugs assumed. Results: We enrolled 181 subjects (76 female), age 65.30 ± 13.27 y, with a diagnosis of ischemic (n = 118) or hemorrhagic stroke (n = 63). Antidepressants were assumed by 40.98% of the PR group and the 20.83% of the GR group (p = 0.004); Benzodiazepine were taken by 31.15% of the PR group compared with the 15% of the GR group (p=0.01). Anticholinergic agents were assumed by 31.15% of the PR group compared with the 12.50% of the GR group (p = 0.002). Conclusion: Benzodiazepines and anticholinergic agents may play a negative role on functional recovery after stroke. Acknowledgment: this study was partially supported by ER Grant 1786/2012.

Keywords: Drugs, recovery, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1862 Top


Music-supported therapy in the rehabilitation of subacute stroke patients: A randomized controlled trial

J. Grau-Sánchez, E. Duarte1, N. Ramos-Escobar, J. Sierpowska, N. Rueda1, S. Redon1, M. Veciana de las Heras2, J. Pedro2, T. Särkämö3, A. Rodriguez-Fornells4

Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, 2Department of Neurology, Bellvitge University Hospital, 4Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, Catalan Institution for Research and Advanced Studies, L’Hospitalet de Llobregat, 1Department of Physical Medicine and Rehabilitation, Parc de Salut Mar- Hospitals del Mar i l’Esperança, Barcelona, Spain, 3Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland

E-mail: jenny_grau@hotmail.com

Introduction/Background: Music-supported Therapy (MST) has been developed as a tool in neurorehabilitation to restore hemiparesis of the upper extremity after a stroke based on the ability of music training to promote brain plasticity. However, the effects of MST have not been appropriately contrasted with conventional therapy. The aim of this trial was to test the effectiveness of adding MST to a standard rehabilitation program in subacute stroke patients. Materials and Methods: A two-arm, parallel-group controlled trial was conducted where 40 patients in the first 6 months from the stroke onset were randomly allocated to conventional treatment (CT-group, n = 20) or MST treatment (MST-group, n = 20) in addition to the rehabilitation program. Before and after 4 weeks of treatment, patients were evaluated on four domains: motor functions, cognitive functions, mood and quality of life, and brain plasticity assessed with functional Magnetic Resonance Imaging (fMRI). A follow-up at 3 months was conducted to examine the evolution of the motor gains. Results: Both groups significantly improved their motor function, and no differences between groups were found. The only difference between groups was observed in the language domain for quality of life. Importantly, an association was encountered between the capacity to experience pleasure from music activities and the motor improvement in the MST-group. A pattern of intrahemispheric reorganization in motor-related areas was observed in both groups, being more prominent in the MST-group. Conclusion: MST as an add-on treatment showed no superiority to conventional therapies for motor recovery with a similar pattern of plastic changes. Importantly, patient’s intrinsic motivation to engage in musical activities was associated to better motor improvement.

Trial Registration: NCT02208219

Keywords: Music therapy, randomized controlled trial, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2684 Top


Correlation between coefficients of impairment at various muscles and active function in the paretic upper limb

M. Pradines, M. Ghédira, V. Mardale1, C. Loche1, J.M. Gracies, E. Hutin

EA7377 BIOTN- Hôpitaux Universitaires Henri Mondor, Université Paris-Est Créteil, Laboratoire d’Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, 1Hôpitaux Universitaires Henri Mondor, Service de Rééducation Neurolocomotrice, Créteil, France

E-mail: maud.pradines@aphp.fr

Introduction/Background: In hemiparesis, motor function may be hindered to various degrees by soft tissue contracture, spasticity, spastic co-contraction and agonist paresis. This retrospective study explores correlations between neuromuscular impairments at shoulder, elbow, wrist and fingers and overall function in the paretic upper limb. Materials and Methods: Fifty one patients with chronic hemiparesis (25 W, 48(±15) years (mean (±SD)), time since lesion, 7.7(±5.5) years) were assessed using the Five Step Assessment, at least three months after any botulinum toxin injection. The first step assessed motor function of the upper limb by the Modified Frenchay scale (MFS; score between 0 and 10). The 2nd, 3rd and 4th steps assessed coefficients of impairment in four key muscles: shoulder extensors, elbow flexors, wrist flexors and fingers flexors. These coefficients were calculated as: coefficient of shortening (CSH=(XN-XV1)/XN; XN, normally expected amplitude; XV1, angle of arrest upon slow stretch), coefficient of spasticity (CSP=(XV1-XV3)/XV1; XV3, angle of catch upon fast stretch), coefficient of weakness (CW=(XV1-XA)/XV1; XA, maximal active range of motion). For each impairment factor, a mean coefficient across the four muscles was calculated (CSHmean, CSPmean, CWmean). For each muscle group and for the mean, multivariable correlations were explored between CSH, CSP, CW and MFS. Results: The MFS correlated with CSH-shoulder (r=-0.28, p=0.03) and CW-shoulder (r=-0.46, p=0.001); CW-elbow (r=-0.45, p=0.002); CW-wrist (r=-0.33, p=0.003); CW-Fingers (r=-0.63, p<0.0001); CWmean (r=-0.78, p<0.0001). Conclusion: The main factors impeding motor function in chronic spastic paresis are the combination of paresis in agonist and spastic cocontraction in antagonist (limiting active motion) for shoulder extensors and for elbow, wrist and finger flexors. Soft tissue contracture for shoulder extensors also contributed to hinder motor function. Spasticity was not correlated with the mean score of MFS, whichever the muscle considered.

Keywords: Modified Frenchay Scale, muscle shortening, spastic overactivity

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0838 Top


Prediction of the oxygen cost of walking in hemiparetic stroke patients

M. Compagnat, J.C. Daviet, S. Mandigout1, D. Chaparro1, J.Y. Salle

CHU LIMOGES, HAVAE University of Limoges, MPR, 1CHU LIMOGES, HAVAE University of Limoges, Staps, Limoges, France

E-mail: maxence.compagnat@icloud.com

Introduction/Background: The energy cost of walking is a marker of metabolic solicitation and allows energy quantification of walking. It is strongly correlated to the patient’s walking speed with post-stroke sequelae. We wanted to develop a model for predicting the energy cost of walking to create of walking distance recommendations aimed at achieving recommended energy expenditure levels to ensure health benefits (>1000 kcal/week during physical activities). Objective: To verify the close relationship between spontaneous walking speed (Sfree) and energy cost of walking at Sfree (Cwfree) in subjects with post-stroke hemiparetic patients sequelea and to test the validity of a prediction model to estimate Cwfree based on Sfree. Materials and Methods: Twenty-six mild to moderately disabled chronic participants with stroke aged 65 yrs (+/- 15.7 yrs) walked at Sfree using mobility aids if necessary, for 6 minutes. The Cwfree was measured at a stabilized metabolic rate by indirect calorimetry using the Metamax3B device. The relationship between Sfree and Cwfree was analyzed using the correlation coefficient, coefficient of determination. The Cwfree prediction model was developed from a regression equation and then tested on a new population with the same inclusion/exclusion criteria (n=29). Results: Sfree and Cwfree had a correlation coefficient of -0.94 and a R2 of 0.97 enabling to formulate a regression equation and develop the Cwfree prediction model based on Sfree. The prediction model tests yielded accurate results with a mean bias of -0.02 mL.kg-1.m-1 – MD%=4%. The limits of agreement were -0.31; 0.26 mL.kg-1.m-1 MD%=30.9% of the mean measured Cwfree. Conclusion: Cwfree can be estimated precisely by a simple measurement of the walking speed. In this way, we can easily define the distance the subject must travel according to his Cw to reach the recommended energy expenditure targets. It is a great help for the practitioner for recommendations in the field of physical activity after stroke.

Keywords: Oxygen cost of walking, prediction model, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1698 Top


Diffusion tensor imaging as a prognostic biomarker for motor recovery in patients with pontine infarction

M. Kim, J.H. Leigh

Department of Rehabilitation Medicine, Incheon St.Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea

E-mail: minukkim@nate.com

Introduction/Background: To investigate the dynamic evolution of diffusion indexes in the corticospinal tract (CST) distal to a pontine infarct by using diffusion-tensor imaging, to determine the relationship of these indexes with clinical prognosis, and to explore the structural changes in the motor pathway during recovery. Materials and Methods: Twenty-four patients (17 men; average age, 58.6 years; range, 42–83 years) were recruited for this study. All patients were diagnosed with pontine infarct and underwent diffusion-tensor imaging examinations after stroke (mean duration: 50±115 days). Reconstructions of the CST were performed. All Fiber numbers were measured in the medulla, cerebral peduncle, internal capsule, and centrum semiovale. Fiber numbers across the pons of the CST in the ipsilateral side of the infarct were calculated. Their relationships with clinical scores such as Fugl-Meyer score (FMS), Berg balance test (BBS) and Modified Barthel index (MBI) were analyzed by using Pearson correlation analysis. A P value of .05 (two tailed) was considered to indicate a significant difference for all statistical procedures. Results: All patients had some degree of motor deficit. The FMS ranged from 0 to 66 at the first examination. The number of fiber across pons were correlated positively with BBS at discharge (r=0.549, P=0.005) and MBI at discharge (r=0.682, P=0.000). Fractional ratio of fiber across pons (The number of fiber across pons/total number of CST fiber) were correlated positively with BBS at discharge (r=0.423, P=0.039) and MBI at discharge (r=0.511, P=0.013). Difference between admission and discharge of MBI score was well correlated with the number of fiber across pons (r=0.436, P=0.038) diffusion-tensor tractographic images showed regeneration and reorganization of the motor pathways. Conclusion: Secondary degeneration of the CST can be detected at diffusion-tensor imaging in the subacute stages after pontine infarction, which could help predict the motor outcomes. Diffusion-tensor tractography can allow detection of regeneration and reorganization of the motor pathways during recovery.

Keywords: Diffusion tensor imaging, Pontine, prognosis

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1729 Top


Recovery of upper limb use after stroke and its relationship with upper limb function

M. Fanchamps, R. Regterschot, L. Boers, R. Selles, G. Ribbers1, H. Stam, J. Bussmann

1Department of Rehabilitation Medicine, Erasmus MC, 2Department of Neurorehabilitation, Rijndam Rehabilitation, Rotterdam, The Netherlands

E-mail: m.fanchamps@erasmusmc.nl

Introduction/Background: A stroke often results in functional impairments of the affected upper limb and in distorted upper limb use of the affected arm in daily life (ULUaff). It is currently unclear how ULUaff recovers after stroke and how it relates to upper limb function (ULF). Therefore, the aims of this study were to explore the recovery of ULUaff post-stroke and its relationship with the recovery of ULF during rehabilitation. Materials and Methods: In fifteen people after stroke receiving ‘usual care’ in a rehabilitation center, ULUaff and ULF was assessed at 3, 12, and 26 weeks post-stroke. ULUaff was estimated for one week using an activity monitor consisting of three accelerometers: one on the unaffected leg and one on each wrist and was defined as the ratio of the amount of movement of the affected arm divided by the unaffected arm, with 1 expressing equal levels of use. ULF was measured with the Fugl-Meyer Assessment (FMA). Results: Data of 10 participants could be used for analysis. At 3 weeks, ULUaff was on average 0.26 with a large inter-individual variability (ranging from 0.14 to 0.62). The average ULUaff increased to 0.37 at 12 weeks and 0.43 at 26 weeks. The recovery patterns also showed a large inter-individual variability [Figure 1]. Changes in ULUaff had no significant correlation with changes in ULF [r=0.48, p=0.18**, [Figure 2]]. Conclusion: At group level the amount of use of the affected arm is strongly affected in the 6-month period after a stroke, but increases over time. However, considerable inter-individual differences were found, in the amount at three time moments post-stroke as well as in the recovery patterns. Recovery of use of the affected arm was not related to recovery of upper limb function.
Figure 1: Change in ULUaff per participant after stroke.

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Figure 2: The change in ULUaff and ULF per participant. Horizontal line is improvement threshold ULF; vertical line is improvement threshold ULUaff.

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Keywords: Accelerometry, longitudinal data, upper limb use

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2006 Top


Combining transcranial direct current stimulation and computerized mirror therapy in upper limb rehabilitation in stroke patients: A feasibility study

J. Touly1, L. Fanfano2, D. Rimaud1,2, P. Giraux1,2

1Department of Physical Medicine and Rehabilitation, University Hospital of Saint-Etienne, 2Univ Lyon- UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité- EA 7424, Saint-Etienne, France

E-mail: pascal.giraux@univ-st-etienne.fr; julia3103@wanadoo.fr

Introduction/Background: Mirror therapy (MT) relies on a mirror and movements of the healthy limb to generate visual illusions of movement of the paralyzed limb. MT has proven to be effective for the motor rehabilitation of the upper limb of stroke patients, but suffers several limitations for patients. To overcome these difficulties, a computerized mirror therapy device was developed (IVS3TM, Dessintey). MT effects could also be enhanced by applying simultaneous neuromodulation with tDCS. This small sample trial was conducted to evaluate the feasibility and tolerance of an IVS3 motor training combined with simultaneous bi-hemispheric tDCS. Materials and Methods: Four patients with right or left hemiparesis following stroke were included in this trial. They received 20 sessions of computerized MT (IVS3 TM, Dessintey; 5 sessions / week; 1 hour and 200 movements / session) combined with bi-hemispheric tDCS over the hand motor cortex (2 mA, 20 minutes). The primary endpoint was adherence to the therapeutic program. The secondary judgment criteria were the safety assessment and the evolution of the tolerance of repeated tDCS stimulation coupled with IVS3. Results: The synergy of these two therapies is well tolerated by patients with a compliance rate of 99% ± 0.025. There have been no serious adverse reactions or unknown side effects. The upper-limb motor function of the 4 patients improved, but this small sample non-controlled trial do not allow to conclude on a significant effect. Conclusion: In this feasibility small sample study, the 4 patients well tolerated and perfectly complied with the computerized mirror therapy associated with bi-hemispheric tDCS. This finding calls for clinical controlled study to evaluate the efficacy of this combined IVS3-tDCS program in stroke patients.

Keywords: Mirror therapy, stroke, transcranial direct current stimulation

Disclosure statement: P. Giraux is co-founder of the Dessintey company.


  ISPR8-2047 Top


The association of neurostimulant and antidepressant use with functional recovery during stroke rehabilitation

V. Q. C. Nguyen, Q. Yang1, J. G. Thomas, T. Guerrier2, M. Hirsch2, T. Pugh, G. Harris1, J. Prvu Bettger3

Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, 2Carolinas Rehabilitation, Research, Charlotte, 1School of Nursing, Duke University, 3Duke Clinical Research Institute, School of Medicine, Duke University, Durham, USA

E-mail: janet.bettger@duke.edu

Introduction/Background: Different therapies may be required to support recovery after stroke. Although the primary method is intensive rehabilitation therapy, medications may augment therapist-led rehabilitation. The purpose of this study was to describe the differences in admission motor and cognitive function for stroke patients who received neurostimulants or anti-depressants during acute rehabilitation compared with patients without each of these medications, and determine the association between medication use and functional recovery. Materials and Methods: We examined data for a patient cohort who received acute rehabilitation at three facilities in the United States from 2009-2014. From the electronic medical record we obtained sociodemographics, clinical characteristics, and whether neurostimulants or anti-depressants were prescribed and administered within one week of rehabilitation admission. Functional status as the outcome was measured by the Functional Independence Measure (FIM – higher score is better function). After excluding patients using both medications, we modeled use of each medication for its association with FIM motor, cognitive and total scores at discharge from inpatient rehabilitation. Results: Patients in this cohort were 66 years of age (median), 49% were female, and the acute rehabilitation length of stay was 16 days (median). Neurostimulants or antidepressants were not prescribed for 2,159 patients whereas 526 (19.6%) received a neurostimulant and 700 (24.5%) an antidepressant. Motor and cognitive function were significantly more impaired on admission for patients who received the neurostimulant or the antidepressant [Table 1]. After adjusting for sociodemographics and clinical characteristics, receipt of neurostimulants or antidepressants was not associated with discharge FIM motor and was associated with a lower discharge FIM cognitive score (p<0.01).
Table 1: Medication Use and Functional Status

Click here to view


Conclusion: In this stroke rehabilitation patient cohort, medication therapy with neurostimulants and antidepressants was associated with more impaired cognitive function at discharge but no longer a difference in motor function. Further research is needed to determine how medications interact to assist in functional recovery.

Keywords: Medication, recovery, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2129 Top


Pilot testing a positive psychology intervention to promote well-being in couples coping with stroke

A. Terrill, J. Einerson, M. Reblin1, J. MacKenzie2, C. Berg3, J. Majersik4, L. Richards

Departments of Occupational and Recreational Therapies, 2Physical and Rehabilitation Medicine, 3Psychology and 4Neurology, University of Utah, Salt Lake City, 1Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, USA

E-mail: alex.terrill@hsc.utah.edu

Introduction/Background: Depressive symptoms post-stroke occur in 30-50% of survivors and partner caregivers, and can have negative consequences for recovery, function, and quality of life. Further, emotional well-being is interdependent in couples; depression in one partner increases risk of depression in the other. Sustaining well-being in both partners is important for rehabilitation engagement and community re-integration. However, support for couples post-stroke is lacking or inaccessible. We aimed to pilot test a self-administered positive psychology-based intervention (PPI) for these couples. Materials and Methods: Eighteen couples consisting of one partner who had a stroke >6 months ago and a cohabiting caregiver were enrolled. One or both partner (s) reported depressive symptoms. The sample was primarily White, well-educated, consisted of 50% female survivors and male caregivers, and had a mean age of 55 years (range: 27-84). A variety of stroke types and locations were represented. After a brief training, participants engaged in the PPI at home, completing two activities alone and two together each week. Activity booklets, tracking calendars, and weekly check-in calls were provided. Pre-, post-intervention, and 3-month-follow-up measures included the PROMIS-Depression, PROMIS-Fatigue, PROMIS-Positive Affect and Well-being, and Stroke Impact Scale 3.0 (SIS). Due to the exploratory nature of the study, significance was set at p=.10. Results: Fourteen of 18 couples completed the program. Analyses show a trend for decreased depressive symptoms across time points. Fatigue and well-being significantly improved. Caregivers demonstrated greater improvement in fatigue and depressive symptoms. Participants with stroke reported significant improvement in the SIS cognition, communication, and participation in meaningful activities domains. Conclusion: Preliminary results suggest the PPI may be effective for improving mood, fatigue, and well-being in couples post-stroke as well as stroke-specific quality of life. Though more research is needed, this represents a promising first step in a novel dyadic intervention for this population with exciting potential clinical implications.

Keywords: Caregiver, poststroke depression, stroke

Disclosure statement: Research reported in this abstract was supported by the University of Utah Consortium for Families & Health Research (PI: Terrill), Utah StrokeNet Research Training and Career Development Program (NIH NINDS #5U10NS086606-03 PI: Majersik), and the National Center for Medical Rehabilitation Research of the National Institutes of Health under Award Number 1R03HD091432-01 (PI Terrill).


  ISPR8-2384 Top


The combined effect of non-invasive cortical stimulation and motor training on hand motor deficit in chronic stroke

N. Ilic, E. Dubljanin Raspopovic, U. Nedeljkovic, S. Tomanovic Vujadinovic

Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Belgrade, Belgarde, Serbia

E-mail: nelavilic@gmail.com

Introduction/Background: A growing body of evidence supports the effectiveness of transcranial direct current stimulation (tDCS) in rehabilitation of patients with hand motor impairment in the chronic phase of stroke. Furthermore, it is assumed that the combination of stimulation- and practice-induced plasticity may be especially beneficial. Aim is to compare the combined effects of anodal tDCS and specific motor training (MT) to sham tDCS and MT (control) on hand motor deficit in patients with chronic stroke. Materials and Methods: A total of 30 patients were randomly assigned to an active treatment group (real tDCS+MT) or a control group (sham tDCS+MT) in this parallel, two-arm, double-blind, sham-controlled study. MT was administered for 45 min/day (10 sessions) and preceded by 20 minutes of either 2 mA anodal tDCS or sham tDCS over the ipsilesional primary motor cortex. A modified Jebsen- Taylor Hand Function Test (mJTt) was the primary outcome measure, with handgrip dynamometer and upper limb Fugl-Meyer (ULFM) assessments as secondary outcomes. A subset of 21 patients was additionally evaluated by transcranial magnetic stimulation measures of the primary motor cortex excitability. Results: The ANCOVA, controlling for baseline status (T0), showed a stastistically significant Time x Group interaction for mJTt due to a statistically significant change over time in the active tDCS group compared to the sham tDCS group. In the active tDCS group, the mJTt time was significantly shorter both at the end of treatment (T2 vs. T0, decrease of 35.36 ± 22.90 s or 28.42 ± 14.56%) and at the follow-up (T3 vs. T0, decrease of 24.21 ± 24.66 s or 19.98 ± 17.49%). The active motor threshold decreased and the MEP amplitude increased. Conclusion: Our findings suggest that hand motor deficits in chronic stroke survivors can be reduced when intensive MT is primed with anodal tDCS over the ipsilesional primary motor cortex.

Keywords: Noninvasive brain stimulation, stroke rehabilitation, transcranial direct current stimulation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0907 Top



  Factors to Estimate Swallowing Function in Patients with Acute Stroke Top


K. Okamoto, N. Yamazaki, A. Kobe, K. Kagechika1

Department of Medical Engineering, Kanazawa Medical University Hospital, 1Department of Physical Medicine and Rehabilitation, Kanazawa Medical University, Uchinada, Japan

E-mail: st-okam@kanazawa-med.ac.jp

Introduction/Background: Evaluation of the swallowing ability by video nasal endoscopic examination of the swallow (VEES) and videofluorographic swallow study (VFSS) is recommended to safely resume oral intake after fasting patients with stroke. However, expert staff and special equipment are needed to perform these examinations. Furthermore, these are difficult to perform in patients who are not cooperative during examinations due to delirium or cognitive impairment. We sought to investigate the predictive factors of oral intake and create a model to estimate the swallowing function of patients with acute stroke. Materials and Methods: We included 93 patients with first ever stroke, who underwent VEES or VFSS at our hospital between October 1, 2015 and October 31, 2017. Patients’ functional oral intake scale (FOIS) was recorded at the time of the procedures. A multiple linear regression analysis was performed using FOIS as a dependent variable. Independent variables were age, FIM motor, FIM cognition, Onodera’s prognostic nutritional index (O-PNI), speech intelligibility (SI), and Brunnstrom recovery stage for the arm (BRS-A), leg (BRS-L) and hand (BRS-H). The ethical committee of our hospital approved the study. Results: An estimation model of FOIS using three factors (FIM motor, O-PNI, speech intelligibility) was derived by multiple linear regression analysis. The formula used for estimating FOIS (YFOIS) was YFOIS = exp (.098 + .308 × FIM motor + .304 × O-PNI - .575 × SI) - 1. The multiple correlation coefficient was .76, and the adjusted R-square was .56. Conclusion: The ability to perform activities of daily living, overall severity of speech function, and nutritional status before disease onset are effective ways to estimate swallowing function in patients with acute stroke.

Keywords: Acute stroke, dysphagia, estimation model

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1537 Top


Effects of combining transcranial direct current stimulation with mirror therapy on motor control, motor performance and daily function in stroke patients: A pilot study

C. Y. Wu

Department of Occupational Therapy, Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan

E-mail: cywu@mail.cgu.edu.tw

Introduction/Background: This study investigated whether the sequential and concurrent combination of transcranial direct current stimulation (tDCS) and mirror therapy (MT) engenders greater benefits than MT alone in stroke patients. Materials and Methods: Thirty patients with stroke were randomized into one of the three groups: sequentially applying tDCS and MT group (SEQ), concurrently applying tDCS with MT group (CON), and MT with sham tDCS group (SHAM). The interventions were carried out 90 minutes per day, 5 days per week, for 4 weeks. Motor control was evaluated using kinematic variables of a reaching movement. Motor performance was measured by the Fugl-Meyer Assessment (FMA), and the daily function was assessed by the Functional Independence Measure (FIM). Results: A significant group difference was found in motor control. The post-hoc analysis demonstrated that the CON group had smoother reaching trajectories in the reaching task than the SHAM group. No significant differences were noted in motor performance and daily function among groups. However, within-group comparisons of the SEQ and the CON group revealed significant improvements in the motor function of the proximal and distal upper-extremity after the interventions, but not in the SHAM group. Similarly, the CON group increased the functional independence in the domain of social cognition after the interventions, but no significant improvement was noted in the SHAM group. Conclusion: Applying tDCS with MT exerted significant effects on the motor control strategy in stroke patients. Future studies using large sample size is warranted to identify possible effects of the combination of tDCS and MT on motor performance and daily function.

Keywords: Mirror therapy, stroke, transcranial direct current stimulation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2544 Top


Influence of body composition and muscle strength on functional outcomes in postacute 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

E-mail: rboza@parcdesalutmar.cat

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 postacute stroke. Materials and Methods: 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% 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: Body composition, handgrip strength, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2622 Top


The effect of body mass index on functional outcome of patients on cardiac rehabilitation

D. Burke1, R. Bratton Bell1, S. Al-Adawi2, D.P. Burke3

Department of Rehabilitation Medicine, Emory University School of Medicine, 2Georgia State University, Atlanta, USA, 1Department of Behavioral Medicine, Sultan Qaboos University, Al-Khoud, Oman

E-mail: daverir@aol.com

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. Materials and Methods: 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: Cardiovascular disease, functional independence measure efficiency, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0355 Top


The cortical mechanism of “remind-to-move” in stroke patients: A near infrared spectroscopic topography case study

X. J. Wei, N. K. Fong1, K. H. Ting1

Department of Rehabilitation Sciences, Southern Medical University, Shenzhen, China, 1Department of Rehabilitation Sciences, The Hong Kong Polytechic University, Kowloon, Hong Kong S.A.R.

E-mail: wayne.wei@connect.polyu.hk

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. Materials and Methods: 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. Conclusion: The cortical mechanism leading to the positive effect of sensory cueing might be contributed by the enhanced attention and activation of the prefrontal cortex for preparedness of movements.

Keywords: Hemodynamics, stroke, upper extremity

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0922 Top


Factors necessary for independent walking in patients with putaminal hemorrhage

S. Maeshima, S. Okamoto, H. Okazaki, H. Maeda, I. Fuse, H. Hori, K. Yagihashi, Y. Senju, A. Kiso, S. Sonoda

School of Medicine, Fujita Health University, Tsu, Japan

E-mail: shinichiromaeshima@gmail.com

Introduction/Background: Putaminal haemorrhage accounts for 30%–40% of all cerebral haemorrhages and is responsible for various neurological symptoms, including motor paralysis. Its prognosis varies according to factors such as age, neurological severity, site and size of hematoma, complications, and choice of treatment. We examined the factors related to independent walking in patients with putaminal hemorrhage who were admitted to a rehabilitation hospital. Materials and Methods: We evaluated 264 patients with thalamic hemorrhage (172 men and 92 women; age range, 29–88 years) who were admitted to our rehabilitation hospital. The mean duration from symptom onset to rehabilitation hospital admission was 29.9 ± 14.8 days, and the mean rehabilitation hospital stay was 74.6 ± 35.3 days. Patients’ neurological and cognitive functions were examined with the National Institutes of Health Stroke Scale (NIHSS) and Mini-Mental State Examination (MMSE), respectively. The relationship between patients’ scores on these scales and their walking ability at discharge from the rehabilitation hospital was analyzed. Additionally, a decision-tree analysis was used to create a model for predicting independent walking upon referral to the rehabilitation hospital. Results: Among the patients, 143 could walk independently and 121 could not. The two patient groups were significantly different in terms of age, duration from symptom onset to rehabilitation hospital admission, hematoma type, hematoma volume, neurological symptoms, and cognitive function. The decision-tree analysis revealed that the patient’s age, motor leg of the NIHSS, MMSE score, and hematoma volume were factors that could predict independent walking. Conclusion: In patients with putaminal hemorrhage, the neurological symptoms, and neuroimaging factors at onset are useful for predicting independent walking.

Keywords: Ambulation, cerebral hemorrhage, functional outcome

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0506 Top


Effect of comorbidity on functional recovery in stroke patients

M. Kao, K. C. Chiu1, P.H. Lin1, S.Y. Lin1

Department of Rehabilitation, Taipei City Hospital, Zhong Xiao Branch, 1Department of Rehabilitation, Taipei City Hospital, Yang Ming Branch, Rehabilitation, Taipei, Taiwan

E-mail: woodkao35@yahoo.com.tw

Introduction/Background: The impact of comorbidities on stroke functional recovery has yet to be studied in Taiwan. This study evaluated the comorbidities and their impact on functional recovery in stroke patients. Materials and Methods: The participants were 105 acute stroke patients with moderate to severe functional disability who were admitted for comprehensive rehabilitation. Participants were 76 people who underwent Post-acute Care program and other 29 participants accepted a regular rehabilitation program within six months after stroke. The effect of each comorbidity on the patients’ post-hospitalization daily living activities was analyzed based on the Charlson Comorbidity Index (CCI). Results: The average Barthel Index (BI) scores increased from 41.8 at admission to 75.5 at discharge; the average progress was 33.7 points. The stroke patients in control group had an average BI score of 37.2 at admission and 47.2 at discharge; the average progress was only 10 points. The functional recovery rate of daily living activities in the post-acute care group was equal to [(BI scoring improvement/BI at admission)x100%] and was significantly higher than that of the control group (post-acute care: control=1.4±1.7/0.4±0.6; p=0.015). For each 1 point increase to a patient’s CCI score, there was a 0.97 point decrease to the patient’s score on the BI after discharge from the hospital (p=0.013). An analysis of 19 comorbidities showed that the order of highest prevalence was diabetes (21%), prior cerebrovascular accident with mild or no residual or transient ischemic attack (17.1%), and diabetes with end-organ damage (14.3%). Analysis of the impact of the various comorbidities on stroke patients’ daily living activities indicated that the most harmful disease was chronic pulmonary disease, followed by prior history of hemiplegia. Conclusion: Comorbidities, especially chronic pulmonary disease and hemiplegia, can affect the functional recovery and daily living activities of stroke patients.
Table 1: Characteristics of the participants in the 2 groups

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Table 2: Effect of comorbidities on stroke patients' performance of daily Irving activities

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Keywords: Comorbidity, outcome, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1136 Top


Short term effect of low intensity forced aerob exercise added to conventional physiotherapy on cognitive functions and fitness after stroke: A randomized controlled pilot study

Z. Jenei, A. Nagy, N. Kovacs, J. Horvath

Department of Physical Medicine and Rehabilitation, University of Debrecen Faculty of Medicine, Debrecen, Hungary

E-mail: jenei.zoltan@med.unideb.hu

Introduction/Background: Emerging experimental and clinical findings suggest that aerob forced exercise may potentially have positive benefits on cognitive functions. The purpose of our pilot study was to assess the effect of low intensity aerobic exercise on cognitive functions in individuals with chronic stroke. Materials and Methods: Thirty-five chronic, ambulatory stroke patients aged between 33 and 76 years old completed the 4-week program, 90 min session/day in every workday. They were randomized into two groups: study group (SG, n=19, median age 59 /40-76/ years and control group (CG, n=16 median age 62 /33-69/) years. Both groups participated in conventional physiotherapy but only SG performed aerob exercise training with bicycles (30 min/day). Exercise intensity progressed from 30 to 40% of heart rate reserve defined by ergospiromety. Functional Independence Measure (FIM-cognitive) and Wechsler Adult Intelligence Scale processing speed (symbol search, coding) and working memory (digit span forward, backward and sequencing) subtests were recorded at baseline and 4 weeks later. Maximum oxygen intake (VO2max) was measured at baseline and 4 weeks later. Results: Inside group analysis showed a significant improvement in both groups in cognitive-FIM (p=0,008). A significant change was not found in working memory (digit span) subtest (p=0,16) in either of the groups. In processing speed subtest (coding) a significant improvement was only measured in SG (p=0,003) while in a symbol search test an improvement was found in both groups (SG: p=0,041, CG: p=0,006). There were not inter-group differences in any subtest (all p=0,201) and in VO2max (p=0,8). Any significant improvement in VO2max was not found in either of the groups (p=0,7). Conclusion: The results suggested that low intensity aerobic exercise training integrated into conventional stroke rehabilitation program had effects on the selected measures of cognitive functions, nevertheless the VO2max remained unchanged. Further studies are needed to get evidence with sufficient power.

Keywords: Cognition, exercise, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0803 Top


Evaluation of kinematic onset for sit-to-stand task in stroke patients

H. Hanawa, M. Sonoo, K. Hirata, K. Kubota, T. Miyazawa1, Y. Matsumoto, T. Kokubun2, N. Kanemura2

Saitama Prefectural University, Graduate Course of Health and Social Services, 2Department of Health and Social Services, Saitama Prefectural University, Koshigaya, 1Department of Rehabilitation, Ageo Futatsumiya Clinic, Ageo, Japan

E-mail: 1991005n@spu.ac.jp

Introduction/Background: Sit-to-stand task is an important and kinetically challenging task for stroke patients. From the muscular strength perspective, it is well known that a large knee extension moment is required to lift the thigh. Energy flow from trunk and shank to lift the thigh has already been shown. Therefore, kinematic coordination is also necessary for the sit-to-stand task. Materials and Methods: In this study, sagittal movement onset of each segment of the body (thorax, pelvis, thigh, shank), hip joint center (HJC), and knee joint center (KJC) were compared between young (YOUNG, three people) and elderly (ELDERLY, four), and stroke patients (STROKE, three) for sit-to-stand task. We used VICON Nexus 2.5 (VICON corp.) to measure the body kinematics.

Results:



A figure presents temporal order of movement onset of the body parts. The time difference within 0.005 [sec] is regarded as simultaneous, and a single quotation is added on number. The group difference existed between YOUNG and ELDERLY (e.g. mean thigh-shank was 0.13, -0.07 [sec], respectively; p = 0.01). ELDERLY and STROKE (two-thirds people, paretic side) had similar timing. Conclusion: In YOUNG, there is a possibility that trunk flexion lead to the translation of HJC and KJC, so that tilted the shank forward. Also, these results were consistent with a previous study that movement (work) of the trunk and shank contributes to lift the thigh. ELDERLY and some STROKE were different from this order. They may have used the movement strategy inferior in terms of energy cost, because the movement trajectory of healthy adults is controlled so that the torque of each joint is minimized. Although movement coordination is difficult to evaluate, we could provide basic knowledge from the standpoint of kinematics.

Keywords: Coordination, kinematics, sit-to-stand

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0830 Top


Take care of the stroke patients hospitalized out of the neurovascular pathway: The multi-disciplinary follow-up post stroke consultation on the university hospital of Rennes

F. Leblanche, S. Butet, E. Le Beguec, G. Silvestre-Beccarel, C. Bethuel, I. Bonan

CHU Pontchaillou, Physical and Rehabilitation Medicine, Rennes, France

E-mail: frederique.leblanche@gmail.com

Introduction/Background: “The lack of formalised monitoring following in the year after the stroke establishes a reduction of likelihood in the course of patient care.” (DGOS instruction 2015) A third of the patients return home at best with only a single follow-up neurological consultation. Within the context of this reality establishing the deficits is therefore held up, favouring a negative socio-professional impact. To overcome this, a Multidisciplinary Consultation Post-stroke program (CM post-stroke) was developed at the University Hospital of Rennes in 2016 (French National Stroke Program 2010-2014). The particular characteristic of our consultation was to single out those patients who neither went through the neuro-vascular pathway. Materials and Methods: Patients hospitalized in the CHU for stroke were extracted from the Program For Medicalization of Information Systems. Patients who neither went through the neuro-vascular pathway were selected. Neurologist and PMR physician cheeked together the medical history of these patients. During a telephone interview, our occupational therapist coordinator filled out a questionnaire orienting the choice of professionals met at the consultation. The consultation was personalized and centred on the patient specific needs. A feedback was made for the treating physician permitting for continuous follow up of the patient. Results: On the basis of a sample of patients selected over 6 months, we study 80 patient files, they were interviewed and 40 consultations were organized (including 25 with 2 professionals and 15 with more 2 professionals), 9 were directed towards the physical medicine and rehabilitation department, 30 to a liberal professional and only 1 did not have any change in his Physical Medecine and Rehabilitation care. This tends to show interest in the follow-up of these patients. Conclusion: The CM post stroke appears as a link filling a deep in the follow-up of the care of post-stroke patients and a transversal work between neurologic and PMR departments.

Keywords: Multi-disciplinary follow-up poststroke consultation, neurovascular pathway, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0960 Top


Predictability of walking ability and of bed-chair transfers at the end of inpatient rehabilitation period of elderly patients after stroke

Y. Levin-Yosef, M. Katz-Leurer1

Beit Rivka, Physical Therapy, Petach Tikva, 1Department of Physical Therapy, Sackler Faculty of Medicine, School of Health Professions, Tel Aviv University, Tel-Aviv, Israel

E-mail: michalkz@post.tau.ac.il

Introduction/Background: Walking independently is one of the most important goals for patients post-stroke and their families. Standing up is an essential function for walking independently. The aim was to explore initial physical evaluation component that predict patients ability to stand up and walk independently at discharge from rehabilitation, in older adults’ post-stroke. Materials and Methods: 131 elderly patients post-stroke addmited to rehabilitation. Excluded were patients with debilitating orthopedic conditions, or previous progressive neurological diseases . Initial evaluation, within 3-7 days of admission, included motor function, lower extremities muscle strength, sitting balance and cognitive assessment. Patients had a follow up one week before discharge, the follow up included two parts of the Functional Independence Measure (FIM) test: walking and chair-bed transition. Results: Initial pelvic lift, bed rolling performance were significantly correlate (r>0.7, p<0.01) to patients’ outcome measures at discharge and had highly significant prediction value. A combination of the inadequate static balance upon admission, dependence of rolling to the affected side and lack of independence at pre-stroke daily function predicted 85% chance that a patient will be dependent in walking at discharge. Inadequate static balance upon admission, major/full dependence of rolling to the less affected side and major/full dependence in pelvic lift at bed predicted 89% chance that patient will be dependent in chair-bed transfer at discharge. Conclusion: Initial physiotherapists evaluation to evaluate patient current functional status have a significant predictive value for patients’ outcome at discharge in terms of standing and walking. These clinical predictors can help in setting treatment goals, educating families, and coordinating expectations.

Keywords: Predict, stroke, transfer

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1040 Top


Assessment tools for functional independence and residual disability after stroke: Are they comparable?

Y. H. Kim, S. Y. Lee, M. K. Sohn1, J. Lee2, D. Y. Kim3, S. G. Lee4, Y. I. Shin5, S. Y. Kim5, G. J. Oh6, Y. S. Lee7, M. C. Joo8, E. Y. Han9, J. Han10, J. Ahn11, W. H. Chang, Y. Kim12

Department of Physical and Rehabilitation Medicine, Samsung Medical Center, 2Department of Rehabilitation Medicine, School of Medicine, Konkuk University, 3Department and Research Institute of Rehabilitation Medicine, College of Medicine, Yonsei University, 11Ewha Womans University, Health Convergence, Seoul, 1Department of Rehabilitation Medicine, Chungnam National University, Daejeon, 4Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, 5Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Departments of 6Preventive Medicine and 8Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, 7Department of Rehabilitation Medicine, Kyungpook National University Hospital, 9Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju, 10Hallym University, Statistics, Chuncheon, 12Korea Center for Disease Control, Division of Chronic Disease Control, Osong-Eup, Republic of Korea

E-mail: yunkim@skku.edu;jungsoo0319@gmail.com

Introduction/Background: The aim of this study was to investigate the correlations between the modified Rankin Scale (mRS) grades and Korean versions of the MBI (K-MBI) scores in assessing the residual functional status of stroke survivors. Materials and Methods: The Korean versions of the MBI and mRS scales were administered to 5,759 ischemic stroke patients at 3 months after onset of stroke. The sensitivity and specificity were calculated at all possible K-MBI score cutoffs for each mRS grade in order to obtain the optimally corresponding K-MBI scores and mRS grades. Receiver operator characteristic (ROC) curves and the area under the curve (AUC) was calculated. Results: The K-MBI cutoff points with the highest sum of sensitivity and specificity were 100 (sensitivity 0.940; specificity 0.612), 98 (sensitivity 0.904; specificity 0.838), 94 (sensitivity 0.885; specificity 0.937), 78 (sensitivity 0.946; specificity, 0.973), and 55 (sensitivity 937; specificity 0.986) for mRS grades 0, 1, 2, 3, and 4, respectively. The AUC for the ROC curve was 0.791 for mRS grade 0, 0.919 for mRS grade 1, 0.970 for mRS grade 2, 0.0 for mRS grade 3, and 0.991 for mRS grade 4. Conclusion: The K-MBI cutoff score ranges for representing mRS grades were variable. mRS grades 0, 1, and 2 had narrow K-MBI score ranges, while mRS grades 3, 4, and 5 showed broad K-MBI score ranges. mRS grade seemed to sensitively differentiate mild residual disability of stroke survivors, whereas K-MBI can provide more specific information of the functional status of stroke survivors with moderate to severe residual impairment. (This work was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (2016E3300302)).

Keywords: Disability scale, functional evaluation, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1178 Top


Gait disorders in sub-acute stroke: Meta-analysis and case series

T. Sader, O. Godefroy1, M. Hyra, M. Diouf2, P.L. Doutrellot, C. Duchossoy, S. Tasseel-Ponche3

Department of Physical Medicine and Rehabilitation, CHU Amiens-Picardie, Departments of 1Neurology and 3Physical Medicine and Rehabilitation, Laboratory of Functional Neurosciences, CHU Amiens-Picardie, EA 4559- SFR CAP-Santé, 2Department of Biostatistics, CHU Amiens-Picardie, Amiens, France

Introduction/Background: Gait disorders are one of the first complaints after a stroke. No specific classification of these gait disorders has been proposed in the literature. Furthermore, few epidemiological data are available, including speed and walking abilities in acute and sub-acute stages. Objectives: To determine the walking speed and prevalence of acute and subacute gait disorders after stroke. To propose a classification of gait disorders, and analyze the link between motor and cognitive impairments, walking abilities and patient outcomes. Materials and Methods: A meta-analysis was performed, selecting hospital based-studies reporting walking speed after a first stroke. Then, we evaluated the walking abilities of patients in a Neurovascular unit. The severity of the stroke was evaluated using the National Institute of Health Stroke Scale (NIHSS), cognitive functions with the MMSE (Mini-Mental State Examination), autonomy using Rkm (Modified Rankin Scale), and gait autonomy with the FAC (Functional Ambulation Categories). In addition, a classification of gait disorders was established for the study. Results: Prevalence of gait disorders in acute and sub-acute stroke was 63.6%, with an average walking speed of 0.34 m/s. Walking abilities depends on initial stroke severity, location of ischemic stroke, and patient’s outcome (p=0001). Walking speed was associated with cognitive functions (p=0.01), as well as walking abilities (p=0.001). Conclusion: Gait disorders are frequent in acute and subacute post-stroke stages, with a decrease in walking speed >70%. Walking abilities depends on the initial severity of the stroke, and are predictive of patients’ outcome. In addition, walking and cognitive functions seem to be linked after stroke, demonstrating cognitive-motor interference. Eventually, the classification proposed in this study will allow a better management of post-stroke gait disorders and rehabilitation.

Keywords: Neurologic gait disorders, stroke, walking speed

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1237 Top


Electroencephalography predicts upper limb motor improvement after robotic rehabilitation in chronic stroke patients

F. Bertolucci, G. Lamola, C. Fanciullacci1, F. Artoni1,2, A. Panarese1, S. Micera1,2, C. chisari

Neurorehabilitation Unit, University Hospital of Pisa, 1Biorobotic Institute, Scuola Superiore Sant’Anna Pisa, Pisa, Italy, 2Translational Neural Engineering Laboratory, Echole Polytechnique fédérale de Lausanne, Lausanne, Switzerland

E-mail: federicabertoluccimed@gmail.com

Introduction/Background: Robotic rehabilitation is known to be at least as effective as conventional training for upper limb motor recovery after stroke; nevertheless, which patients could benefit from this treatment is unknown and finding markers that could predict rehabilitation outcome is a challenge. We aimed at understanding the neural mechanisms of motor function recovery after upper limb robotic rehabilitation in chronic stroke patients using neurophysiological markers obtained by electroencephalography recording (EEG). Materials and Methods: Fourteen chronic stroke patients (M/F: 11/3; 59,5 ± 13 yrs) with mild to moderate upper limb paresis were subjected to 10 sessions of upper limb rehabilitation with a planar mobile robotic device (MOTORE, Humanware).Fugl-Meyer Assessment Scale (FMAS) and Wolf Motor Function Test (WMFT) were administered before (t0), at the end (t1) and at 1 month follow-up (t2); at the same timing 64-channals EEG was recorded. We analyzed power spectrum density in different frequency bands of the affected and unaffected hemispheres with 64-ch EEG and their correlation with motor impairment as measured by clinical scales. Correlation analysis were performed to identify the indicators of good rehabilitative outcome. Results: Clinical assessment indicated a significant functional improvement in upper limb motor function at the end of rehabilitation as assessed with FMAS and WMFT score that is maintained at follow-up. We found a positive correlation between global Alpha activity at t0 and WMFT score variation (t0-t1) and between global Beta activity at t0 and WMFT time variation (t0-t1) and a positive correlation between Beta activity at t0 in the unaffected hemisphere and FMAS variation (t0-t1 and t0-t2). Conclusion: Robotic rehabilitation improves upper limb motor performance in stroke patients even in the chronic phase. The amount of Alpha and Beta band power at t0 is suggestive of rehabilitation-related motor outcome. Our results suggest that EEG recording preliminarily to robotic rehabilitation could help identifying good responders to treatment thus optimizing results.

Keywords: Electroencephalography, robotic rehabilitation, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1708 Top


Sensorimotor strategies for the improvement of naming abilities in aphasia: neural and behavioural correlates of poem - personalized observation, execution, and mental imagery therapy

E. Durand, P. Berroir, A.I. Ansaldo

Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Laboratoire Ana Inés Ansaldo, Montreal, Canada

E-mail: edith.durand@umontreal.ca

Introduction/Background: Anomia is the most frequent and pervasive symptom for people with aphasia (PWA) and can affect all grammatical categories. Research has long focused on name retrieval, while therapies targeting verb anomia remain scarce. Single word retrieval therapy for verbs is effective across different approaches. Nevertheless, the impact of sensorimotor strategies on aphasia recovery has been rarely explored. This study reports on the efficacy of Personalized Observation, Execution, and Mental Imagery therapy (POEM), a new therapy approach designed to integrate sensorimotor and language based strategies to treat verb anomia. Materials and Methods: Two participants with chronic aphasia and verb anomia were followed-up in a pre-post therapy fMRI study. Tests of language and cognitive functions were completed. A personalized set of stimuli was built based on the naming performance on baseline controlled for linguistic variables.POEM therapy was administered in a massed stimulation schedule: three 60-minutes sessions per week for 5 weeks. Results: The results show a significant improvement in both participants, with trained and untrained items. Changes in fMRI patterns following POEM reflect a reduction in the number of recruited areas supporting recovered naming, and the recruitment of brain areas, part of language and mirror neuron systems. Conclusion: This study originally contributes to the research on verb anomia treatment with an innovative structured combination of sensorimotor strategies allowing PWAs to retrieve more precisely and quickly treated and untreated verbs. Changes in fMRI patterns following POEM reflect a reduction in the number of recruited areas supporting recovered naming, and the recruitment of brain areas, part of language and mirror neuron systems. Future studies with a larger sample of participants are required to further explore this avenue.

Keywords: Aphasia, neuroimaging, therapy

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1974 Top


Oxford case complexity assessment measure, a new scale to measure complexity in patients affected by stroke and its concordance with other scales of disability

E. Martin Castillo, P. Marquez Rodriguez, A. Báez Suárez, J.C. Lopez Fernandez, A. Deniz Caceres, P. Saavedra Santana, D. Rodriguez Molina

University of Las Palmas de Gran Canaria, Medical and Surgical Sciences, Las Palmas de Gran Canaria, Spain

E-mail: anibal.baez@ulpgc.es; varena83@hotmail.com

Introduction/Background: Stroke is considered the most common cause of complex disability in our society.There are only few scales evaluating complexity. The aim of our study is to evalutate the correlation of the Spanish version of OCCAM score, which includes biopsychosocial aspects, with other scales which measure disability and quality of life, in patients affected by stroke: National Institutes Health Stroke Scale (NIHSS), Barthel Index (BI), Modified Rankin Scale (MRS) and the Short Form 12 Questionnaire (SF-12). Materials and Methods: A prospective study was conducted, 74 patients admitted to hospital diagnosed with stroke and subsidary to rehabilitation programs. The concordance between the OCCAm scale with the other scales were evaluated by means of the Spearman correlation coefficient.Statistical significance was set at p <,05. Results: A total of 74 patients were analysed, 62% men against 38% women, mean age 74 years. Previous history of : high blood pressure (60%), Diabetes Mellitus (36%), Dyslipidemia (39%), previous stroke (12%), arrythmia (33%).The correlation coefficients with OCCAM were: NIHSS (ρ= 0,697), BI (ρ= 0,905), MRS (ρ= 0,829), SF-12 (ρ=0,331). Conclusion: The OCCAM scale has a strong correlation with other measures of disability, less with the quality of life measures; and is a quick and easy way to evaluate complexity in patients affected by stroke. It is based in a biopsychosocial model taking into considerations all factors that influence patients, so resources can be used more efficiently and predict prognosis/outcomes.

Keywords: Oxford case complexity assessment measure, quality of life, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  A3.01 Neurological and Mental Health Conditions - Stroke Top



  ISPR8-2040 Top


Brazilian functioning index application in stroke individuals: Functional profile assessment

J. Nogueira Coelho

Faculdade de Medicina De Ribeirão Preto-USP, Ciências da saúde aplicada ao parelho locomotor, Ribierão Preto, Brazil

E-mail: juncoelho@yahoo.com.br

Introduction/Background: The Brazilian Functioning Index (BR-FI) was developed and published by an interministerial task force at the request of the Presidency of the Republic, aiming to standardize and quantify the functioning assessment of the population for social benefit purposes. Aims: Analyze psychometric properties and the functional profile of stroke individuals using the BR-FI. Materials and Methods: An observational, longitudinal, prospective, and descriptive study. In order to ascertain intra and inter-examiner concordance two evaluations were conducted, with a six-month interval between them, in which the BR-FI was applied and compared with another evaluation instrument, the Functional Independence Measure (FIM), in 30 individuals (women 56.7%, mean age: 64.6±14.6) that had a history of stroke from December 2016 to January 2018. Results: The Spearman correlation between the BR-FI and the FIM was performed (0.85; p < 0.001), after which a strong, positive relationship was observed, indicating that the functional assessment instruments are directly proportional. When comparing the inter-examiner data, all of the correlations were identified as positive among the stroke individuals. In turn, when analyzing the intra-examiner data during the six-month interval, both evaluation instruments displayed positive associations, and all of the stroke individuals were observed to be more functional. Among the seven domains that compose the BR-FI, the sensorial, domestic life and education, work, and economic life domains did not exhibit any correlation with FIM. Conclusion: The BR-FI is considered a complete evaluation instrument to assess functional profiles since it analyzes aspects that are not contemplated in other tools, such as Environmental Factors.

Keywords: Brazilian Functioning Index, functional evaluation scales, functioning

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2443 Top


The study of event-related potentials in unilateral spatial neglect

G. Shan

Department of Rehabilitation, XuanWu Hospital, Capital Medical University, Beijing, China

E-mail: sgx0606@126.com

Introduction/Background: To compare the amplitude and latency of P1, N1, P2, N2, P300 between the Unilateral Spatial Neglect patients after right hemisphere stroke and normal people, in order to study the spatial attention processing characteristic of Unilateral Spatial Neglect patients, further to explore the mechanism of USN. Materials and Methods: 20 cases (10 USN patients and 10 Normal people) were enrolled in the study. We recorded the ERP, and then compared the reaction time and correct rate, the amplitude and latency of P1, N1, P2, N2, P300 when the target appeared in the left and right, to study the mechanism of USN. Results: The correct rate of the USN group was lower than the Normal group. There were no significant differences between the two groups in P1 amplitude and N2 amplitude. The N1 and P2 amplitude of right hemisphere of the USN group was lower than the Normal group. When the target appeared in the left, the P300 amplitude of the USN group was lower than the Normal group. The latency of P1, N1, P2, N2, P300 in the USN group was prolonged than the Normal group.



Conclusion: During the spatial attention processing, regardless of the stimulus from the left or right, the information processing speed of the USN group slowed down compared with the normal group. In the early stage, there was no significant reduction of activitied neurons. In the mid-stage, the number of activitied neurons was reduced significantly in the right hemisphere. But in the late stage, the number of activitied neurons was reduced significantly when the stimulus from the left side.

Keywords: Event-related potentials, mechanism, unilateral spatial neglect

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1259 Top


Validity and reliability of clinical tests to assess seated balance and transfer tasks for adults with stroke: Literature review

A. V. Bruyneel

Department of Physiotherapy, University of Applied Sciences, Western Switzerland, Carouge, Switzerland

E-mail: anne-violette.bruyneel@hesge.ch

Introduction/Background: The seated balance and transfer tasks have been used in clinical practice and research to assess trunk control in adults with hemiparesia post-stroke. But, it is unclear if the evidence is sufficient to warrant its use in stroke patients. The aim of this study was to realize a literature review about validity and reliability (intra and inter-raters) of seated balance and transfer tasks tests in patients with hemiparesis post-stroke. Materials and Methods: The research was conducted using keywords related to seated balance and transfer tasks on electronic databases: PubMed, ScienceDirect, Pedro, Cochrane and Kinedoc. Observational studies involving adults with stroke that explored any measurement property of transfer tasks or seated balance were included. The Qarel scale was used to assess the methodological quality of included studies. Results: 1241 articles were identified. Following the selection criteria, 12 articles were included, with 5 on seated balance (Qarel: 7 / 12, min: 6 / max: 8) and 7 on transfer tasks (Qarel: 8.14 / 12 min: 6 / max: 10). The findings about the seated balance revealed that these tests had efficient inter-raters (0.92<ICC<0.97) and intra-rater (0.93<ICC<0.99) reliability, while the validity was more variable (0.20<r<0.94). For transfer tasks, the studies highlighted good inter-raters (0.93<ICC<1.00) and intra-rater (0.64<ICC<0.99) reliability, but poor to moderate validity (0.03<r<0.75). Conclusion: Despite a large number of tests used in clinical practice, very few studies exist on the measurement properties of the tests used to assess sitting balance and transfer tasks in stroke patients. This review indicates that appropriate tests with good validity and reliability exist. The tests are varied (stable sitting position, unstable, sit-to-stand, standing floor, etc.) and with a good feasibility in clinical practice.

Keywords: Seated balance, stroke, transfer tasks

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1288 Top


Impact of post-stroke check list in chronic stroke patients management

A. Mena, A. García Martin1

Hospital Dr. Negrin, Rehabilitation Service, 1Complejo Hospitalario Materno Insular, Servicio de Rehabilitación, Las Palmas de Gran Canaria, Spain

E-mail: amenrodm@gmail.com

Introduction/Background: Post-Stroke Checklist (PSCL) is an easy-to-use questionnaire to standardize follow up care of Chronicpost-stroke patients and facilitate referral to Rehabilitation Services by general practioners (GPs) in an evidence-based-way. Although it was developed some time ago, there is no published Our main objective was to further understand if training GPs if the use of the PSC makes an impact on referral of these patients in our area. Materials and Methods: We reviewed 55,000 inter-consultations (IC) from chronic stroke patients 6 months before and after training and presentation of the PSC to GP in our area. We determined endpoints such as number and percentage of patients undergoing treatment and concordance in goal setting between GP and Physical Rehabilitators (PR). Results: We identified 16 chronic stroke patients from 756 inter-consultations from GPs in our area, 6 months before PSC training session. Only seven in these 16 patientunderwent any intervention (5 were treated with botulinum toxin (BT) and in 3 patient postural orthosis was recommended). Goals between GPs and PhisicalRehabilitator matched in less than 50% of patients. After PSC training session, we identified 23 patients that suffer from a cardiovascular event in 682 inter-consultations reviewed. 20 underwent any interventions, 18 were treated with BT (10/18 cases after a diagnostic nerve block), 21 were referred to physiotherapist and we prescribed functional orthosis to 8 patients. Diagnosis between GPs and our team matched in 20/23 patients. Conclusion: Bearing in mind limitations of the study such as the small numbers of patients included, we may conclude that training in PSC to GPs may improve referral of chronic stroke patients, as it improves diagnosis concordance and the ratio of patient that underwent any intervention.

Keywords: Spasticity, stroke list

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0029 Top


Spasticity measurements using pendulum test for predicting gait performance in patients with hemiplegic stroke

W. Li

Department of Rehabilitation, Taipei Medical University Hospital, Taoyuan City, Taiwan

E-mail: a4910131@gmail.com

Introduction/Background: The association between spasticity and gait performance in patients with stroke is yet to be sufficiently explored. The present study assessed whether spasticity measurement using the pendulum test can predict gait performance in patients with hemiplegic stroke. Materials and Methods: This study included 40 patients with post-stroke hemiplegia who could walk independently. Spasticity measurements were obtained using the pendulum test and the Modified Ashworth Scale (MAS) for knee and ankle. The timed up and go test, Brunnstrom stage assessment, Tinetti balance assessment, and 10-meter walking test (10 MWT) were conducted. The correlations among the aforementioned clinical variables were evaluated through multiple stepwise regression analyses. Results: The relaxation index (RI) calculated using the pendulum test had a significant positive correlation with 10 MWT performance (c = 0.274, p = 0.021). However, the MAS scores for knee flexion and ankle dorsiflexion, Brunnstrom stage, and Tinetti balance assessment were not significantly correlated with gait speed performance. Conclusion: The pendulum test is a simple and objective method for evaluating spasticity. We suggest that the RI obtained from the pendulum test can be used as a predictive parameter of gait performance in patients with stroke. However, the MAS may not be a favorable predictor of gait outcomes.

Keywords: Gait, pendulum test, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0734 Top


The effect of paralytic arm pain in the shoulder joint on the effectiveness of rehabilitation after stroke

L. Varzaityte, T. Bubnelis, J. Krisciokaityte

Hospital of Lithuanian University of Health Science, Rehabilitation, Kaunas, Lithuania

E-mail: lina.varzaityte@gmail.com

Introduction/Background: Post-stroke shoulder pain (PSSP) is a common impairment and occurs in approximately one-third of an unselected stroke population. Although PSSP can improve during rehabilitation, studies have shown that it can be a long-lasting or persistent problem. Patients with more severe paralysis of the arm are increasingly likely to develop shoulder pain. The aim of study was to investigate effectiveness of rehabilitation after stroke in individuals with and without PSSP. Materials and Methods: The study consisted of 58 after stroke patients treated in the neurology department of rehabilitation clinic from 2016 October to 2017 September. The patients were divided into two groups PSSP and non-PSSP. The data were collected using questionnaire, interviews, medical records before and after patient rehabilitation. Functional independence was measured by Functional Independence Measure (FIM) scale. Patients emotional health was evaluated by SF-36 questionnaire which was adapted for this study. Pain in the shoulder of paralytic arm was evaluated by pain scale from 0 to 10 when 0 – no pain and 10 – unbearable pain. Statistical analysis was performed with SPSS, p<0.05 was significant. Results: The analysis of pain influence for rehabilitation after stroke shown, that rehabilitation has statistically significant effect for both groups of patients (p<0.001). FIM has been statistically significant higher in non-PSSP group than in PSSP group (58,86±13,68→93,64±17,41 vs 52,90±13,49→ 79,80±10,72). Non-PSSP group has shown statistically significant improvement for physical health than PSSP group (34,32±7,24 →54,67±17,95 vs 28,70±7,74→29,85±14,29). Study has shown that there was no statistically significant difference in improvement of emotional health between groups (p<0.001). Conclusion: Rehabilitation has statistically significant effect for patients after stroke with and without PSSP. The analysis has shown statistically significant effect for functional independence and physical health for non-PSSP patients group.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2679 Top


Improve of dysphagia with electroestimulation after a stroke

R. Andolz Linares, M. M. María Mercedes, B. A. Maria, R. A. Àngels1, D.M. María José

Health Sciences Research Institute of the “Germans Trias i Pujol,” Physical Medicine and Rehabilitatio n, Badalona, Spain

E-mail: rubdn@hotmail.com

Introduction/Background: Patients who have suffered a stroke may have dysphagia in more than 30% of cases. when the alteration is located in the bulbar area, since the neural control of swallowing is located at the bulbar level, where the centers responsible for processing the afferent sensory signals and programming the motor deglutory sequence are located this percentage increases. The goal of treatment is to obtain secure and sufficient oral intake for adequate hydration and nutrition. Treatment techniques are designed to change the physiology of swallowing. Neuromuscular electrical stimulation can also be performed as studies have shown that this treatment appears to help people with moderate dysphagia. Materials and Methods: Clinical Observation: We present the case of a 44-year-old woman who suffered laterobulbar ischemic Ictus. The physical exam, showed dysarthria, facial paresis and limb dysmetry without motor deficit and severe alteration of swallowing. Fibroendoscopic studies were performed and oral diet was contraindicated thus enteral nutrition was required from the time of admission. Speech therapy plus the application of electrostimulation was initiated. Results: After 4 months of treatment, enteral nutrition was removed and the patient was able to change to a complete oral diet. Conclusion: Patients who are diagnosed of a bulbar stroke have a high percentage of swallowing dysfunction. Swallowing therapy with electrical stimulation may help clinical improvement of dysphagia.

Keywords: Neuroestimulation, neurologycal dysphagia, posterior stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1669 Top


Time related changes of post stroke spasticity

H. Y. Jung, E. Y. Han1, S. B. Pyun2, S. D. Yoo3

Department of Rehabilitation Medicine, Inha University Hospital, Incheon, 1Department of Rehabilitation, Jeju National University Hospital, Jeju, 2Department of Rehabilitation, Korea University Hospital, 3Department of Rehabilitation, Kyung Hee University Hospital, Seoul, Republic of Korea

E-mail: rmjung@inha.ac.kr

Introduction/Background: Poststroke spasticity (PSS) is one of functional barrier for stroke survivors. There is a need for early identification and understanding of change of PSS over time. Therefore, we want to establish the change of post stroke spasticity until 12 months from the onset of stroke. Materials and Methods: Seven hundred and eighteen stroke patients with emerging spasticity (430 cerebral infarct and 278 cerebral hemorrhagic patients) were enrolled. These patients were followed up 12 months after the onset of stroke to monitor the development of spasticity via a retrospective review of medical record. Main outcome measures were change of post stroke spasticity (PPS) measured at the elbow, and wrist in hemiplegic upper limb using the Modified Ashworth Scale at 1, 3, 6, and 12 months after stroke. Results: PPS was aggrevated from at 1 month after the onset of stroke to at 3, 6 and 12 months measured in hemiplegic elbow (1.16, 1.29, 1.54 and 1.82) and wrist (1.23, 1.30, 1.47 and 1.84) using the Modified Ashworth Scale, respectively. PPS in hemiplegic elbow measured 1 month after stroke was more severe in cerebral hemorrhage than in cerebral infarction (p<0.01), but not significantly at 3, 6 and 12 months in all stroke patients. When the changes of PPS in patients with supra- or infra-tentorial lesion were followed up for one year, there was significant increment in only supratentorial lesion at 3, 6, and 12 months after onset (p<0.05). Conclusion: PPS has a tendency to deteriorate over time, especially in hemiplegic upper limb of patients with cerebral hemorrhage and supra-tentorial lesions.

Keywords: Spasticity, stroke

Disclosure statement: This work was supported by a research grant from Eisai Korea Inc.


  ISPR8-1431 Top


Patient and professional views of motivation for rehabilitation of subacute stroke

Y. Otaka1,2, T. Yoshida2,3, M. Kumagai2, S. Kitamura2, Y. Tomita2, J. Yaeda3

1Department of Rehabilitation Medicine I, Fujita Health University, Aichi, 2Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, 3University of Tsukuba, Graduate School of Comprehensive Human Sciences, Tokyo, Japan

E-mail: otaka119@mac.com

Introduction/Background: Despite its importance, both patients and rehabilitation staff lack knowledge about the motivation for rehabilitation. This qualitative study aimed to identify factors related to motivation for rehabilitation in patients with subacute stroke. Materials and Methods: Semi-structured interviews were performed with 20 patients with subacute stroke (mean age, 65.8 years) as well as with rehabilitation staff (10 physical therapists, 10 occupational therapists, and 10 nurses). Individual interviews were recorded in a quiet room. Text data were subjected to content analysis. The local ethics committee approved the research protocol and all participants provided prior written informed consent. Results: The average patient interview time was 19 minutes, with total interview time of 370 minutes. The average staff interview time was 20 minutes, with total interview time of 590 minutes. For both patients and staff, the same 7 core categories were considered as factors influencing motivation: rehabilitation goals, relationships with staffs, relationships with other patients, support of patients, success and failure experiences, physical and cognitive status, and resilience of patients. Additional factors of “patient behavior related to motivation” and “labeling patient motivation” were identified as categories for patients and rehabilitation staff, respectively. Conclusion: This study found that the motivation for rehabilitation in patients with subacute stroke is influenced by multiple internal and external factors. In addition, motivation may change patient behavior, and rehabilitation staffs tend to label patient motivation.

Keywords: Cerebrovascular disease, motivation, qualitative study

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1803 Top


Motor overflow in spastic hemiplegia after stroke

S. Li, Y. T. Chen1, E. Magat1, S. Li1, P. Zhou1

The University of Texas McGovern Medical School, PM and R, 1Department of Physical Medicine Rehabilitation, University of Texas McGovern Medical School, Houston, USA

E-mail: sheng.li@uth.tmc.edu

Introduction/Background: The phenomenon of exaggerated motor overflow (involuntary movements accompanying a motor task) is well documented, particularly in stroke survivors with spasticity. In this study, we aimed to investigate the possible underlying mechanisms its possible relations with post-stroke spasticity. Materials and Methods: Methods: 11 stroke patients (63.6 yrs ± 6.4 yrs; 4 women) and 11 healthy subjects (Age: 31.18 yrs ± 6.18 yrs; 2 women) were recruited and performed unilateral isometric elbow flexion at submaximal levels (10%, 30%, and 60% of maximum voluntary contraction, MVC). Electromyograms (EMG) was measured from the contracting biceps muscle and resting contralateral biceps, ipsilateral flexor digitorum superficialis, and contralateral FDS muscles. Motor overflow was quantified as the normalized EMG of the resting muscles. EMG-EMG coherence was calculated between the contracting muscle and each of the resting muscle. Elbow flexor spasticity was quantified through reflex torque. Results: Overall, our results demonstrated that unilateral elbow flexion caused diffuse motor overflow from proximal to distal muscles on the impaired side (ipsilateral motor overflow) and from the non-impaired side to the impaired side (contralateral motor overflow). Moreover, there were significantly high EMG-EMG coherence between 6-12Hz between the contracting muscle and all other resting muscles during elbow flexion on the non-impaired side. Our results of diffuse ipsilateral and contralateral motor overflow with EMG-EMG coherence in the alpha band suggest subcortical origins of motor overflow. Post-stroke spasticity is attributed to reticulospinal hyperexcitability secondary to the unmasking of ponto-medullary reticular formation. A high correlation between spasticity and motor overflow supports a potential role of reticulospinal activation in motor overflow. Conclusion: Collectively, these results suggest that diffuse motor overflow to the impaired side is likely related to activation of hyperexcitable reticulospinal pathways after stroke.

Keywords: Motor overflow, spasticity, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0641 Top


Disturbances of spatial reference frame and postural asymmetry after a chronic stroke

K. Jamal, S. Leplaideur, C. Rousseau1, L. Chochina2, A. Moulinet Raillon3, I. Bonan

Department of Physical and Rehabilitation Medicine, University Hospital of Rennes,

1Department of Clinical Pharmacology, University Hospital of Rennes, Clinical Investigation, Center INSERM 1414, Rennes, 2Department of Neurology Physical and Rehabilitation Medicine, CMRRF Kerpape, Kerpape, 3Department of Physical and Rehabilitation Medicine, Hospital of Saint Vallier, Saint Vallier, France

E-mail: krmjamal@me.com

Introduction/Background: Asymmetrical postural behaviours are frequently observed after a stroke. They are due in part to the sensorimotor deficit, but could also be related to a disorder of the representation of the body in space. The objective was to determine whether the asymmetrical postural behaviours of chronic stroke patients are related to a disruption of the perception of spatial frame. Materials and Methods: 30 chronic stroke patients (mean age 60,3 y± 10, mean delay post-stroke 4,78 y±3) 15 patients with right brain damage (RDB) and 15 patients with left brain damage (LBD) and 20 healthy subjects participated in the study. Postural asymmetry was detected by the evaluation of body weight repartition on a force platform (Weight Body Asymmetry) and was related to the Longitudinal Body Axis (LBA) and the Subjective Straight Ahead (SSA) (egocentric space representation) and also to the Subjective Visual Vertical (SVV) (allocentric space representation) by means of a multivariate analysis of variance (MANOVA) which was adjusted with motor function and sensitivity as covariables. Results: Both patients with RBD (35%+/-8) and LBD (39%+/-4) had a body weight asymmetry and there was still space misperception at this stage of recovery, especially in the RBD group. WBA was related to LBA when considering both patients with RDB and LDB (p=0,03). However, this relation was dependent on the side of the lesion (p=0.0006) with a stronger relation in the RBD group (58,26%). No relation with WBA was found neither with SSA (p=0,58) nor with SVV (p=0,47). Conclusion: This study pointed out a strong relationship between disturbance in the perception of the longitudinal body axis and postural asymmetry in chronic strokes, and predominantly within the RBD group. Whereas other spatial perturbations did not seem to be involved in this particular postural behaviour.

Keywords: Postural asymmetry, spatial frame of reference, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0739 Top


The association between serum bdnf levels with post-stroke depression and anxiety: A cohort study

Z. Han, Y. Wang1, L. Qi2, Y. Zhou, Q. Ye, J. Wang, X. Luo3, J. Wong4, Y. Wang5, Q. Wang6

Shanghai Seventh Hospital, Neurology and Rehabilitation, 2Department of Rehabilitation, Shanghai Yueyang Hospital, Shanghai University of TCM, Shanghai, 1Department of Rehabilitation Medicine, Nan’ao People’s Hospital of Shenzhen, The First Affiliated Hospital, Shenzhen University, 3Kerry Rehabilitation Medicine Research Institute, Shenzhen Sanming Group, 5ShenZhen Second People’s Hospital, Rehabilitation, Shenzhen, China, 4School of Nursing, MGH Institute of Health Professions, 6Spaulding Rehabilitation Hospital, The Teaching Affialiate of Harvard Medical School, Stroke Biological Recovery Laboraotry, Boston, USA

E-mail: hanxiang798007@gmail.com

Introduction/Background: Brain-derived neurotrophic factor (BDNF) has been shown to play an important role in psychological function. The aim of this study was to investigate the association of serum BDNF and development of poststroke depression and anxiety. Materials and Methods: Serum concentration of BDNF was measured in stroke patients on admission to inpatient rehabilitation hospital. Depression and anxiety mood was diagnosed using (Diagnostic and Statistical Manual of Mental Disorders 4th edition[DSM-IV] criteria). The functional outcome was measured using Functional Independent measures (FIM). Results: Poststroke depression was diagnosed in 61 (37.7%) patients and anxiety was diagnosed in 40 (24.7%) patients. Except for marital status (P=0.030) and BDNF levels (P=0.033), none of the predictor variables showed statistically significant differences among the three groups. Low level of BDNF was significantly associated with poststroke depression (P=0.009, OR: 0.93, 95% CI: 0.88-0.98), but not with PSA (P=0.469, OR: 0.98, 95% CI: 0.93-1.04). In addition, BDNF level was associated FIM motor scores at discharge in this cohort patients (P=0.027, OR: 0.036-0.602, B: 0.319). Conclusion: Low BDNF levels were found to be important risk factors for PSD but not for PSA.

Keywords: Brain-derived neurotrophic factor, outcome measure, poststroke depression and anxiety

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1117 Top


Gastroesophageal reflux during nasogastric tube feeding versus oroesophageal tube feeding in stroke patients: A 24 h esophageal PH-monitoring

K. D. Park, J. W. Lee1

Department of Rehabilitation Medicine, Gachon University Gil Medical Center, Incheon, 1Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

E-mail: bduck@gachon.ac.kr

Introduction/Background: Patients who are diagnosed to dysphagia after stroke may receive tube feeding such as percutaneous endoscopic gastrostomy (PEG), nasogastric tube or oroesophageal (OE) tube. Although the most common complication for stroke patients is known to be aspiration pneumonia, the physiology of gastroesophageal reflux (GER) associated with tube feeding has not been fully assessed. OE tube feeding and nasogastric tube feeding are non-invasive tube feeding methods both, but the tube can be inserted intermittently using OE tube to avoid continuous esophageal reflux. Materials and Methods: The goal of this study was to examine, by 24-hour esophageal pH monitoring, whether GER is related to feeding method, nasogastric tube versus OE tube. 7 stroke patients were examined 24-hour esophageal pH monitoring during nasogastric tube feeding and OE tube feeding, sequentially. The parameters were collected of total acid exposure time, the mean esophageal pH, total reflux episode and deMeester composite score. Results: Total reflux episode improved only in OE tube feeding, statistically. (P < 0.05) There were no significant differences between the two groups for total acid exposure time, the mean esophageal pH and deMeester composite score. Conclusion: OE tube can be a possible substitute for nasogastric tube in patients with dysphagia suffering from gastroesophageal reflux disease. And OE tube feeding may be used to facilitate recovery of swallowing function without aggravated reflux disease associated with tube feeding.

Keywords: Dysphagia, troke, tube feeding

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1325 Top


Improvement in gait parameters in adults with spastic hemiparesis due to stroke or traumatic brain using wheeleo crutch

T. Deltombe, L. Mie, J. Jacques1, F. Anne2, D. Geoffroy2

Department of Physical Medicine and Rehabilitation, CHU UCL Namur Site Godinne, 1Department of Biostatistics, CHU UCL Namur Site Godinne, Yvoir, 2Department of Neuro Rehabilitation, Centre Hospitalier Neurologique William Lennox, Ottignies, Belgium

E-mail: thierry.deltombe@uclouvain.be

Introduction/Background: Patients with chronic hemiparesis following stroke or traumatic brain injury (TBI) often necessitate a quadripod crutch to improve the balance during gait. The quadripod crutch, by inducing a 3-step gait participates to an asymmetric and slow walking speed. This study aims to assess changes in gait parameters and balance in patients using a quadripod crutch with small wheels (Wheeleo) compared with a classical quadripod crutch. Materials and Methods: Prospective, multicentre, randomised study comparing Wheeleo and quadripod crutch (NCT02279069). Thirty-two ambulatory adults with spastic hemiparesis following stroke or TBI necessitating a quadripod crutch for walking participated to the study. The walking speed (WS), the frequency of the 2-step gait, the physiological cost index (PCI) and the number of therapist interventions to control the balance during a 10-meter walking test (10 mWT)and a 6-minutes walking test (6 MWT) were assessed with a Wheeleo and a quadripod crutch at comfortable and maximal WS. The cadence (during a 10 mWT) and the distance (during a 6 MWT) were also monitored. The patient satisfaction was assessed by a VAS scale. Results: When using a Wheeleo, improvements in WS, cadence, frequency of a 2-step gait, PCI and distance were observed at comfortable and maximal WS. The number of therapist interventions to control the balance remained unchanged. Conclusion: Improvements in WS, cadence, distance, 2-step gait, energy cost and patient satisfaction were achieved in hemiparetic adults using a Wheeleo crutch without additional fall risk.
Table 1: Changes at comfortable walking speed

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Keywords: Crutch, gait, technical aid

Disclosure of interest: The authors did not declare any conflict of interest.

Disclosure statement: Geoffroy Dellicour is the funder of Innorehab which will commercialized the Wheeleo crutch.


  ISPR8-1456 Top


Trunk exercise using the Swiss ball improves the functional balance and walking of stroke patients in the early stages of recovery

M. Wu, C. M. Ni, J. Cui, Z. L. Tao

Department of Rehabilitation, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China

E-mail: ahslyywm@163.com

Introduction/Background: At present, we pay more attention to limb function assessment and improvement in stroke, and rarely give intensive training on their trunk control functions, resulting in unsatisfactory rehabilitation outcomes. Based on the above background, we used Swiss ball to enhance the trunk function of stroke patients in the early stage and observed the impact on patient balance and walking ability. Materials and Methods: Sixty hemiplegic stroke patients were randomly assigned to a control group or an experimental group, each of 30. Both groups were treated with routine physical training. Those in the control group did conventional trunk exercises, while the patients in the experimental group were given trunk exercises performed using a Swiss ball. The trunk control test (TCT) and the Berg Balance Scale (BBS) were used to assess the patient,s trunk and balance function. Gait and balance function training and assessment apparatus (model AL-080) was used to measure and compare the scope of movement of the patient’s center of pressure in static sitting over 30 seconds (LOM), the limits of stability (LOS), velocities and a gait asymmetry index (GAI). Results: Significant improvements in TCT, BBS, LOM and LOS were observed in both groups after the training, but all of the measures improved significantly more in the experimental group than in the control group. Conclusion: Swiss ball trunk exercise can obviously improve the trunk control, functional balance and walking of stroke patients in the early stages of recovery.

Keywords: Stroke, Swiss ball, trunk exercise

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2273 Top


The influence of activity-dependent stimulation on gait re-training in chronic stroke survivors: a pilot study

J. Watson1, K. Welman1, B. Sehm2

1Stellenbosch University, Sport Science, Stellenbosch, South Africa

2Max Planck Institute for Human Cognitive and Brain Sciences, Neurology, Leipzig, Germany

E-mail: jeaninewtsn@gmail.com

Introduction/Background: While walking is a major goal in stroke rehabilitation, many chronic stroke survivors have not achieved independent ambulation. Task-specific gait re-training shows promise in post-stroke therapy. Research on transcranial direct current stimulation (tDCS) has shown potential benefits for fine motor skill learning but lacks evidence for gross motor skill learning; specifically gait re-training. It is hypothesized that a combination of these therapies may yield benefits for stroke rehabilitation. Consequently, this study endeavoured to compare the efficacy of gait re-training during real and sham stimulation on gait kinematics in chronic stroke survivors. Materials and Methods: A randomized double-blinded case study was implemented, whereby 10 chronic stroke survivors (≥6 months) were divided into either an attention-matched control group (CON; n=4), or an 8-week task-specific gait re-training program with concurrent tDCS (1 mA; 20 minutes; n=2) or with sham stimulation (20 minutes; n=3). Gait kinematics were measured pre- and post-intervention by using the two-minute walk test and the APDM mobility lab™. Results: Double support (DS) time improved in real (Median=0.46, IQR=0.59), compared to sham stimulation (Median=0.73, IQR=1.93) and the CON attention-matched group (Median=-1.12, IQR=1.36). Additionally, DS variability decreased in real (Median=-0.08, IQR=0.18) and sham (Median=0.05, IQ =0.04) stimulation groups; compared to the CON group (Median=0.25, IQR=0.46). Conclusion: This study presents preliminary evidence for the benefits of tDCS combined with task-specific gait re-training on gait quality, specifically synchronization, in chronic stroke survivors. Additionally, task-specific gait re-training alone may also benefit gait steadiness.

Keywords: Stroke, transcranial direct current stimulation, gait

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1871 Top


Characteristics of postural reactions to unexpected loss of balance during standing in stroke survivors with emphasis on arm reactions

F. Steinberg Henn, S. Handelzalts, N. Soroker1, I. Melzer2

Loewenstein Rehabilitation Hospital, Physiotherapy, 1Department of Neurological, Loewenstein Rehabilitation Hospital, Kfar Saba, 2Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev- Beer-Sheva, Physiotherapy, Beer Sheva, Israel

E-mail: flaviachen@hotmail.com

Introduction/Background: Falls after stroke are a major health concern, as they are one of the most frequent complications. An important and effective strategy to avoid falling is the “change of support” strategy, which is characterized by rapid compensatory stepping and/or grasping that increase the base of support, and by so, stability is regained. Using the arms may also be an effective way to avoid falling when balance is lost due to balance perturbations. Here we aimed to characterize the arm responses to perturbations in stroke patients. Materials and Methods: 15 post-stroke subjects and 15 age and gender matched healthy controls were exposed to unexpected surface translations while standing on a movable platform (Balance Tutor, MediTouch, Israel). Perturbation intensity increased in six levels of difficulty. Kinematic parameters were collected using the Ariel Performance 3D motion Analysis System (APAS) and the data was analyzed by MatLab algorithms written especially for the study. Results: Post- stroke subjects and healthy controls had a symmetric response with two arms. Stroke group had a few reactions with one arm mostly with the paretic arm. We found a significant difference in the overall arm displacement and overall arm velocity between the right arm of control group and the paretic arm of stroke group. When we compared between the paretic and non-paretic arms of stroke survivors we found that the non-paretic arm had a faster reaction time, larger displacement and the paretic arm has a higher velocity. Arm reaction time was faster than leg reaction time. Conclusion: Our results show that hemiparetic stroke patients have the ability to respond with both arms, similar to healthy control subjects, but stroke survivors’ responses seems to have reflexive and spastic movement patterns, not as effective as the movement patterns observed in healthy controls.

Keywords: Arm responses, falls, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0241 Top


Relationship between cortical or subcortical lesions and long-term functional capacity in stroke patients

E. Neto, T. Caires1, R. Bazan2, G. Luvizutto1

Department of Physical Therapy, Faculty of Human Talents, 1Universidade Federal do Triângulo Mineiro, Uberaba, 2Department of Neurology, Botucatu Medical School, Botucatu, Brazil

E-mail: gluvizutto@gmail.com

Introduction/Background: Strokes occur in the cortical or subcortical regions of the brain, compromise cortical functions and sensory-motor performance, and have a negative impact on long-term functional capacity. The aim of this study was to evaluate the relationship between strokes in the cortical or subcortical regions and autonomy, functional independence, and use of locomotor aids. Materials and Methods: We evaluated 62 patients with ischemic strokes confirmed by CT-scan. The cortical and subcortical regions were defined by an experienced neuroradiologist. Patients were divided into two groups: those with cortical strokes (Group 1: n = 47) and those with subcortical strokes (Group 2: n = 15). Patients were then assessed for autonomy and independence 90 days after stroke using the Barthel Index and modified Rankin scale. Locomotor aid included the use of wheelchairs, crutches, and walking sticks for community outings. The associations of cortical or subcortical strokes with autonomy, independence, and use of locomotor aids were analyzed by simple logistic regression corrected for confounding variables (age, severity of stroke and treatment received) and were considered significant when p < 0.05. Results: Lower autonomy was observed in Group 1 than in Group 2. Specifically, 6.4% of patients in Group 1 scored higher than 95 on the Barthel Index, compared to 46.7% in Group 2 (p = 0.04). A significant difference in the use of locomotor aids was observed between the groups [wheelchair: 29.8% of Group 1 vs 6.7% of Group 2, p = 0.03; walking sticks or crutches: 44, 7% of Group 1 vs 33.3% of Group 2, p = 0.03; [Table 1]]. Conclusion: Patients with ischemic strokes in cortical regions demonstrate less autonomy and have a greater chance of using locomotor aids than patients with strokes in subcortical regions do.
Table 1: Locomation aid and funcional capacity in cortical and subcortical strokes.

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Keywords: Disability, stroke, topography

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0571 Top


Six month follow-up comparison of low and moderate intensity walking activity in community-dwelling people with stroke

W. Nakano, Y. Ohashi1, Y. Saito2, T. Maezawa3, Y. Kohno4

Department of Physical Therapy, Tsukuba International University, Tsuchiura,

1Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 3Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Ami, 2Ibaraki Health Service Association, Ibaraki Health Plaza, Mito, Japan

E-mail: w-nakano@tius.ac.jp

Introduction/Background: Although regular physical activity is vital for cardiovascular health, little is known about how the intensity of physical activity changes over time in community-dwelling people with stroke. The purpose of this study was to examine the changes in low and moderate intensity walking activity in community-dwelling people with stroke between discharge from a rehabilitation setting and in a 6 month follow-up. Materials and Methods: Twenty-three stroke patients participated in this study. Step counts were measured using Step activity monitor for three days at baseline and at 6 months after baseline measurement. Step data were collected every 5 seconds. The start of a walking bout was defined as 3 strides within a 15 second interval and the end of a walking bout was defined as a 10 second interval in which no strides occurred. Based on the cadence in the walking bout, each bout was categorized as low intensity (<80 steps per min) or moderate intensity (≥80 steps per min). The number of steps per day, number of bouts per day, walking time per day, and percentage of time spent walking per day were calculated at each intensity. The differences in each variable were compared by paired t-test. Results: Participants’ characteristics are shown in Table 1. The baseline assessment was conducted 133.6 ± 5.6 days post stroke (11.7 ± 5.6 days post discharge). The follow-up measurements were conducted 182.5 ± 9.1 days from baseline assessment. Table 2 shows a comparison of the walking activity by intensity at baseline and follow-up. There were no significant differences between baseline and follow-up in all variables. Conclusion: Not only low intensity walking activity but also moderate intensity walking activity did not change over 6 months. Establishing exercise habits at discharge might promote long-term physical activity in community-dwelling people with stroke.
Table l. Participant Demographics

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Table 2: Comparison of walking activity by intensity at baseline aud 6 months follow-up.

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Keywords: Community-dwelling, physical activity, secondary prevention

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1626 Top


Sleep disorders in patients with chronic stroke: A cross-sectional study

C. Curci, F. Gimigliano1, A. de Sire, M. T. Giamattei, G. Iolascon, R. Gimigliano

Departments of Medical and Surgical Specialties and Dentistry and 1Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy

E-mail: claudio_curci@hotmail.it

Introduction/Background: Sleep disruption is a common disorder (about 50%) in patients after stroke, resulting in reduction in sleep time due to the increased number of awakens. It has already been described that sleep architecture is modified in stroke patients: time spent in non-rapid eye movement-1 (NREM1) phase is increased, while rapid eye movement (REM) and non-rapid eye movement-3 (NREM3) phases are reduced. The aim of this cross-sectional study was to investigate the mechanisms of sleep alterations and the correlation with the impact of the cerebrovascular accident on health and quality of life in patients with chronic stroke. Materials and Methods: We included patients aged ≥18 years with a diagnosis of chronic stroke (≥ 12 months from acute event). Patients with Sleep Breathing Disorders (SBD) or presenting other major comorbidities were excluded. We assessed: stroke severity, using the Stroke Impact Scale (SIS); depression, by Hamilton Depression Rating Scale (HAM-D); pain using the Brief Pain Inventory (BPI); sleep perception by Pittsburgh Sleep Quality Index (PSQI). Sleep architecture was assessed by X4 Sleep Profiler™ In-Home EEG Sleep Monitor–Advanced®, an in-home multi-night sleep monitoring device. Results: We enrolled 9 patients, mean aged 71.11±12.64 years, with a mean HAM-D = 15.11 ± 6.90, a mean BPI intensity index = 3.75±1.51 and mean BPI interference index = 6.21±2.82. Sleep was perceived as poor, with a global PSQI of 10.00±4.66. We found a reduction of time spent in NREM3 phase and an increased time spent in NREM1 and NREM2 with an increased number of awakens and cortical arousals in accordance with the literature. Moreover, time spent in NREM3 phase was significantly correlated to SIS mobility (r=0.861; p=0.003) and SIS hand function (r=0.707; p=0.030). Conclusion: This cross-sectional study suggests a correlation between sleep alteration and the functioning of stroke patients, although prospective trials are necessary to better clarify this finding.

Keywords: Polysomnography, sleep disorders, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1672 Top


Developing a clinical prediction rule for discharge home in patients with severe stroke

Y. Inoue1,2, J. Matsuba3, S. Hiragami4, K. Harada1,5, F. Hiragami1,5

1Kibi International University, Research Institute of Health and Welfare, 5School of Health Science and Social Welfare, Kibi International University, Takahashi, 2Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, 3Faculty of Medical Sciences, Teikyo University of Science, Tokyo, 4School of Rehabilitation, Hyogo University of Health Science, Kobe, Japan

E-mail: y.inoue@kiui.ac.jp

Introduction/Background: Even in patients with severe stroke, it is necessary to predict in an early stage whether they can be discharged home from hospital in order to offer the later services at home. The purpose of this study was to develop a clinical prediction rule (CPR) for discharge home after rehabilitation in patients with severe stroke. Materials and Methods: The subjects were 206 patients with stroke during post-acute phase, registered in the Japan Rehabilitation Database, whose Functional Independence Measure (FIM) scores was 36 points or less. The following potential independent variables at the time of admission to the rehabilitation ward were collected; age, gender, side of lesion, duration since stroke onset, National Institutes of Health Stroke Scale score, cognitive status, speech disorder status, motor/sensory impairment status and scores of each item of FIM. The collected data were evaluated using Classification and Regression Trees (CART) analysis method to develop a CPR for discharge home. Results: Forty-six percent of the patients were discharged home after rehabilitation. The CART analysis found the CPR included age, motor FIM score, motor impairment status of upper limb, functional status of eating, grooming, and memory (sensitivity=76.6%, specificity=76.8%, positive predictive value=73.5%, negative predictive value=79.6%, accuracy=76.7%). The best predictor for discharge home was the level of functional status of eating, the next predictors were age and motor FIM score. Conclusion: The CPR with moderate accuracy was developed to predict discharge home after rehabilitation in patients with severe stroke. Further investigation including environmental factors is necessary to improve accuracy of the CPR.

Keywords: Clinical prediction rule, discharge home, severe stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1804 Top


Resilience through adaptive recreation in stroke survivors: a biopsychosocial approach

K. Hreha, A. Kirby1, I. Molton, N. Nagata1, A. Terrill1

Department of Rehabilitation Medicine, University of Washington, Seattle, 1Department of Occupational and Recreational Therapies, University of Utah, Salt Lake, USA

E-mail: khreha318@gmail.com

Introduction/Background: Due to medical advances, survivability after stroke is increasing. Intensive rehabilitation focusing on regaining physical, cognitive, and language function, is often necessary after stroke However, stroke survivors are at risk of chronic disability, depression, and social isolation. Community-based providers, such as adaptive recreation programs, are often challenged to continue the long-term job of rehabilitation and community reintegration after stroke. The objective of this study was to explore the effects of adaptive cycling participation (using modified equipment or assistive devices) on aspects of physical, psychological and social resilience in stroke survivors. We hypothesized that participants, who engaged in a 16-week cycling program, would demonstrate improvement on measures of all three aspects of resilience. Materials and Methods: The current study utilized a longitudinal design (baseline, 8, and 16 weeks). Outcome measures include: resting heart rate, 10 Meter Walk Test (10 MWT), 2 Minute Walk Test (2 MWT), Timed Up and Go, UW-Self-efficacy Scale, NeuroQOL Positive Affect and Well-being, Connor-Davidson Resilience Scale, NeuroQOL Satisfaction with Social Roles and Activities (SSRA), Interpersonal Support Evaluation List. Due to sample size and exploratory design, we calculated effect sizes. Results: We enrolled 18 stroke survivors (ages 25-72) in the study. Outcomes were available at all time points for 10-18 participants depending on the measure. Pairwise comparisons were calculated between baseline to 8-weeks and baseline to 16-weeks. We observed change score effect sizes >0.5 for one social and two physical measures. For baseline to 8-weeks, the NeuroQOL-SSRA had a medium effect (Cohen’s d= .564). For baseline to 16-weeks, the 2 MWT and 10 MWT had large and medium effects respectively (d= 1.068 & 0.612). Conclusion: The results highlight the importance of exploring: (1) the influence of adaptive recreation on not only physical but social outcomes. Due to the exploratory design of this pilot, future research is warranted.

Keywords: Adaptive sports, resilience, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2493 Top


Effect of sensory-motor training on gait quality and executive functioning of chronic stroke survivors

R. La Grange, K. Welman

Department of Sport Science, Stellenbosch University, Stellenbosch, South Africa

E-mail: lagrangereghard@yahoo.com

Introduction/Background: Traditionally gait was believed to be an automated task; however current research shows that walking involves higher cognitive functions i.e. executive function (EF). Optimal EF allows allocation of appropriate attentional resources to performing motor tasks correctly and effectively and is severely affected in stroke survivors. Limited research has been done on the effectiveness of sensory-motor training (SMT) on cognitive functioning in stroke. It is hypothesized that SMT may improve this motor-cognitive interaction during gait, as well as EF. This study endeavoured to determine if an eight-week SMT programme would influence executive functioning and dual-task gait quality in chronic stroke survivors. Materials and Methods: This pre-post study design consisted of ten chronic stroke survivors (67±14 years; ≥6 months since stroke) with no severe cognitive impairment (24±2 score on Montreal Cognitive Assessment) who participated in the eight-week SMT programme, three times a week (45-60 minutes per session) under therapist-supervision. A two-minute walk test assessed single (ST) and dual-task (DT) spatial-temporal gait variables; while EF was assessed with an adapted Stroop, Trail Making (Part A and B) and Verbal Digit Span Forward and Backward tests. Stroke related self-efficacy was determined by completing the Stroke Self-efficacy Questionnaire. Results: No significant changes were found in EF or ST gait variables. DT stride velocity (p=0.05, d=0.39, 95%CI: -11.07 to -0.73), paretic stride velocity (p=0.04, d=0.40, 95%CI: -11.34 to -1.18), cadence (p=0.03, d=0.78, 95%CI: -19.04 to -2.50), stride time (p=0.02, d=0.82, 95%CI: 0.00 to 0.40) and peak medio-lateral trunk acceleration (p=0.02, d=0.45, 95%CI: -5.93 to -1.16) showed improvement. Stroke-related self-efficacy (p<0.001; d=2.66, 95%CI: 1.26 to 4.57) also improved. Conclusion: Preliminary findings suggest that SMT have some benefits for improving cognitive-motor interaction during walking, while also improving factors that specifically influence performance in stroke survivors. Furthermore, studies should investigate the use of DT as an ecological assessment tool for stroke survivor’s EF.

Keywords: Chronic stroke, cognitive-motor interaction, executive function

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2582 Top


Kinematic analysis of real and virtual dart games played by stroke patients: a decision tree for neurorehabilitation

H. J. Batista Costa, A. Braga Galvão Silveira Fernandes, D. Carvalho de Oliveira, T. Barbosa Ferreira Pacheco, J. Simões Brasileiro, E. Ramos Vieria1, T. Fernandes Campos

Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil, 1Department of Physical Therapy, Florida International University, Miami, USA

E-mail: thaianab@ufrn.edu.br

Introduction/Background: Stroke is a pathology that causes several motor and functional impairments. The aim of the study was to realize a kinematic analysis of the elbow joint during real and virtual dart games and to construct decision trees for neurorehabilitation. Materials and Methods: The sample consisted of 11 hemiparetic patients (8 men), mean age of 51±7 years. Participants made 15 attempts in two dart games (real and virtual). Elbow kinematics was video recorded during the dart throwing phase. Analysis was conducted using Kinovea software, paired Student’s t-test and Classification Regression Trees. Results: Patients exhibited a higher elbow extension angle (P = 0.008) and greater velocity in the real game (P = 0.005). In the virtual game patients had longer throwing time (P = 0.021) and better performance (fewer absolute errors) (P < 0.0001). The decision tree showed that there was a balance between the frequency of patients who played the virtual and real game and displayed elbow extension angles above 157˚. Similar frequencies between velocity ≤ 29 cm/s and >87 cm/s for the virtual and real games were found. In regard to dart throwing time, there was greater frequency of patients with time ≤1.37 s for the real game and >1.37 s for the virtual game. Conclusion: The construction of decision trees showed evidence that the patients can evolve satisfactorily in terms of angulation, velocity and time during virtual game training. Thus, we propose that the virtual dart game may be a useful tool in the neurorehabilitation of patients with chronic stroke, in line with therapeutic objectives and the patient’s clinical condition.

Keywords: Kinematic analysis, stroke, virtual reality

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2662 Top


First-ever ischemic stroke in young adult patients in a rehabilitation unit

H. Tavares, D. Amaral, H. Amorim, P. Lopes, M. J. Festas, S. Magalhães, A. R. Almeida, N. Pinto, F. Parada

Centro Hospitalar de São João- Porto, Physical and Rehabilitation Medicine Service, Porto, Portugal

E-mail: tavares2510@hotmail.com

Introduction/Background: Stroke in young adults is reported as being uncommon, with recent publications reporting an increased incidence. Causes of ischemic stroke in young adults are diverse, but undetermined etiology predominates in the majority of studies. Stroke in young adults may have a dramatic impact on quality of life and economy by leaving victims disabled during their most productive years, when compared with stroke in older adults. This study aims to evaluate incidence and clinical characteristics of first-ever ischemic stroke in young patients. Materials and Methods: Retrospective analysis of patients with a first-ever ischemic stroke admitted between September 1, 2014 and June 30, 2017 in a Rehabilitation Unit. A young patient was defined as the patient with 45 or less years of age. Results: One hundred and two patients with a first-ever ischemic stroke were identified, with 58.8% of male gender and with a mean age of 59.2 years old. Twelve were considered young patients (11.8%), with 8 patients of male gender (66.7%). In these patients, dyslipidemia, smoking, and hypertension were the most prevalent risk factors (33.3%, 33.3%, 16.7%, respectively). According to TOAST classification, stroke was caused by large-artery atherosclerosis in 25.0%, cardioembolism in 16.7%, small-vessel occlusion in 8.3%, another determined etiology in 16.7%, and undetermined etiology in 33.3%. According to Oxfordshire classification, half of the patients have total anterior circulation stroke, 25% partial anterior circulation stroke, 16.7% posterior circulation stroke and 8.3% lacunar stroke. NIHSS was higher in younger patients (18.5 points vs 9 points). Conclusion: Stroke in subjects under 45 years of age is not such a rare disease and is associated with high NIHSS. Given the increase incidence of stroke in young adults, there is an objective need for more research in order to reduce this social and economical burden.

Keywords: Ischemic stroke, rehabilitation, young patient

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0382 Top


The effect of high blood pressure on total barthel index and 10 items of bi after stroke rehabilitation

N. Saito, T. Nshikawa1

Departments of Rehabilitation and 1Internal Medicine, Yokohama Rosai Hospital, Yokohama, Japan

E-mail: 10q711246@gmail.com

Introduction/Background: We previously analyzed inpatients of conventional ward (ICW, n=9951) and subacute ward (ISW, n=6322) of Japan Association of Rehabilitation Database (JARD) and reported the effect of HBP on 10 items of BI after stroke rehabilitation. We analyzed total BI both with using method of dichotomized ordinal scale and continuous scale, because the method how to analyze total BI remains controversy. Materials and Methods: In the analysis of ordinary scale, we dichotomized total BI into 80−100 (BI80+) versus 0−75 (BI80−), 60−100 (BI60+) versus 0−55 (BI60−), 40−100 (BI40+) versus 0−35 (BI40−), or 20−100 (BI20+) versus 0−15 (BI20−), compared between each category and control with using chi-squared test and 2×2 contingency table, and calculated odds ratios (ORs) and 95% confidence intervals (CIs). In the analysis of continuous scale, Shapiro-Wilk test and Wilcoxon test were conducted. Results: In the ordinary analysis, HBP ameliorated total BI among ICW of atherothrombotic infarction (BI40+ versus BI40− OR 1.881 CI 1.088−3.253, and BI20+ versus BI20− OR 3.135 CI 1.660−5.918), and ISW of other infarction (BI80+ versus BI80− OR 1.823 CI 1.080−3.076), and deteriorated total BI of ICW of subarachnoid hemorrhage (SAH) (BI80+ versus BI80− OR 0.395 CI 0.166−0.939). In the continuous analysis, total BI of hypertensive ICW (median 60) of SAH was deteriorated (p=0.013) compared with non-hypertensive ICW (median 95). Conclusion: HBP had both a favorable and unfavorable effect on total BI after stroke rehabilitation. The results of total BI of dichotomous ordinal analysis were consistent with those of BI items, while those of continuous analysis were not. Dichotomous ordinal analysis might be appropriate to analyze total BI, and results of BI items should be considered as well as total BI.

Keywords: Barthel index, database, high blood pressure

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0494 Top


Effect of turning direction on timed up and go test results in stroke patients

H. Son, C. Park1

Department of Physical Therapy, Catholic University of Pusan, 1Rehabilitation Center, Keunsol Medical Hospital, Busan, Republic of Korea

E-mail: sonhh@cup.ac.kr

Introduction/Background: The Timed Up and Go (TUG) test is an assessment tool for measuring mobility for stroke patients. In the stroke patients, turning direction of the affected and un unaffected side may influence turning time. Aim: To investigate the effects of the turning direction according to the affected and non-affected sides of stroke patients during their Timed Up and Go (TUG) test and to define clinically salient outcomes during TUG tests performed in the clinic. Materials and Methods: Observational design. SETTING: Department of physical therapy in rehabilitation center. POPULATION: One-hundred thirteen hemiparetic stroke patients. METHODS: Stroke patients were asked to perform the TUG tests by turning toward their affected and unaffected sides. Patients were divided according to gait speed, and their gait speed from the 10 mWT was used. Those with a gait speed <48 m/min were assigned to the severe ambulatory dysfunction (SAD) group, whereas those with a gait speed ≥48 m/min were assigned to the moderate ambulatory dysfunction (MAD) group. Results: The TUG test results showed a longer turning time when turning with the non-affected side as the turning axis (17.10±5.69 sec) than with the affected side was the turning axis (17.52±5.90 sec). When the patients were divided into the MAD and SAD groups based on the 10 mWT results, patients in the SAD group exhibited slightly longer times (0.55±1.11 sec) than did those patients in the MAD group (0.29±1.03 sec); however, this difference was not significant. Conclusion: The present study found that stroke patients showed differences in the TUG test results based on their turning direction, and less time was required when turning in the direction of the affected side compared to the non-affected side. Clinical Rehabilitation Impact: Turning direction can affect the results of TUG test, it should be controlled in the execution of the TUG test in clinical settings.

Keywords: Stroke, timed up and go test, turning direction

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1092 Top


Stepwise intervention for proximal and distal upper extremity motor function in patients with chronic stroke: a report of 2 cases

K. Okuyama, M. Kawakami, M. Ogura, K. Takasaki1, F. Liu, T. Noda2, S. Tanabe3, T. Yamaguchi4, J. Ushiba1, M. Liu

Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-Ku, Tokyo, 1Department of Biosciences and Informatics, Faculty of Science and Technology, Keio University, Yokohama Kanagawa, 3Department of Brain Robot Interface, Advanced Telecommunications Research Institute International, Soraku Kyoto, 4Fujita Health University, Faculty of Rehabilitation- School of Health Sciences, Toyoake- Aichi, 5Yamagata Prefectural University of Health Sciences, Yamagata- Yamagata, Japan

E-mail: okuyama@keio.jp

Introduction/Background: Upper extremity (UE) dysfunction is a common problem in patients with stroke. Recently, several neurorehabilitation approaches have been developed to improve the UE motor function (Langphorene P, Lancet Neurol, 2009). However, most approaches target either proximal or distal UE motor function, although interventions targeting both portions are necessary to restore functional UE in actual daily life. Therefore, we conducted stepwise intervention for both shoulder and finger function to improve UE motor function. Materials and Methods: Two stroke patients with severe hemiparetic stroke participated in the study. Firstly, we attempted to improve shoulder function using brain machine interface (BMI) technology for 7 days [Figure 1]. After the shoulder BMI training, a combination of motor imagery and electrical stimulation (MI+ES) was conducted to improve finger function for 10 days [Figure 2]. Motor function of the affected UE was assessed with motor items of the Fugl-Meyer assessment UE motor score (FMA-UE). FMA-UE consists of 4 categories (A: Shoulder/Elbow/Forearm; B: Wrist; C: Hand; D: Coordination) and has a maximum score of 66. Results: The FMA-UE score increased remarkably after the stepwise intervention (Patient A: 17→33; Patient B: 11→25). The effect of shoulder BMI training is shown in Fig 3. It became possible for patients to raise their arms above the shoulder position after the shoulder BMI training. Patients’ UE motor function was also further improved by the subsequent MI+ES intervention. Conclusion: The improvement in UE motor function with our stepwise intervention for proximal and distal motor functions greatly exceeded the minimal clinically important difference in the subjects of this study.
Figure 1: The system of brain machine interface training for proximal upper extremity motor function.

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Figure 2: The system of motor imagery training combined with electrical stimulation for distal upper extremity motor function.

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Figure 3: The effect of shoulder BMI training

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Keywords: Brain machine interface, motor imagery, rehabilitation

Disclosure statement: This study was supported by “Development of medical devices and systems for advanced medical services” by the Japan Agency for Medical Research and Development (AMED).


  ISPR8-1922 Top


Unpredictable gait perturbation training improves balance and gait abilities more than gait training without perturbations in individuals post-stroke

V. EsmaeiliMahani, L. Bouyer1, D. Kairy, A. Lamontagne2, J. O. Dyer3, C. Duclos

Rehabilitation School-Montréal University- Center for Interdisciplinary Research in Rehabilitation – Gingras-Lindsay Rehabilitation Institute of Montreal CRIR-IRGLM of CIUSSS of Centre-Sud-de-l’Ile-de-Montréal, Faculty of Medicine, 2Interdisciplinary Rehabilitation Research Center CRIR- Jewish Rehabilitation Hospital JRH of Laval, School of Physical and Occupational Therapy, McGill University, Canada, School of Physical and Occupational Therapy, Montreal, 1Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada

E-mail: vahid.esmaeilimahani@umontreal.ca

Introduction/Background: Balance perturbation training is a promising rehabilitation approach, but limited research is available on its effectiveness for balance post-stroke. The aim of this study was to compare the effects of training with and without unpredictable gait perturbations, on dynamic balance and gait abilities in individuals post-stroke. Materials and Methods: Nineteen stroke individuals were assigned to two groups: perturbation training (PT) and no-perturbation training (nPT), and attended 9 training sessions over 3 weeks using a split-belt treadmill. For PT, perturbations were produced by changing the speed of one of the belts during stance phase every 8 to 16 steps. The intensity of the perturbations increased progressively between sessions according to participants’ tolerance. The duration of the training sessions in nPT, i.e. without perturbation, was matched with a PT subject with similar speed. The effects of the training programs on dynamic balance (Mini-BESTest), balance confidence (ABC Scale), gait speed (10-meter walk test (10 MWT)), knee extensors strength (dynamometry), and reintegration into social activities (Reintegration to Normal Living Index (RNLI)) were evaluated and compared using ANOVAs and t-tests. Results: MiniBESTest (+4.0 (±5.2) /28 points, p=0.005), ABC scale (+4.4% (±6.0), p=0.026), 10 MWT at faster speed (+0.17 (±0.15) m/s, p=0.009), non-paretic knee extensors (+37.2 (±41.7) Nm, p=0.056), and RNLI (- 3.4 (±2.9) /11, p=0.04) increased significantly with PT, with no significant changes on 10MWT at self-selected speed (0.13 (±0.19) m/s, p=0.065) and maximum strength generation on the paretic side (+32.7 (±41.3) Nm, p=0.081). MiniBESTest, gait speed (self-selected and faster) and maximum knee extensors strength of paretic side in PT changed significantly in comparison to nPT which did not show any improvement. Conclusion: Results support the clinical effectiveness of unpredictable gait perturbation training over walking on the treadmill in improving gait and dynamic balance after stroke. Impact on fall risk should be evaluated in a future clinical study.

Keywords: Gait and balance, perturbation training, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2196 Top


A research on efficacy of rehabilitation for post-stroke patients in krasnoyarsk region performed upon the programme of the ministry of health of Russia in 2016

M. Abroskina, I. Gordyukova, N. Isaeva, S. Prokopenko

The Department of Nervous Diseases with a Course of Medical Rehabilitation in Postgraduate Education, Prof. V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia

E-mail: mabroskina@yandex.ru

Introduction/Background: Krasnoyarsk Region is among the largest regions of Russia. Its population amounted 2 875 790 by January 1, 2017. A three-stage rehabilitation system for patients after stroke has been created in the region. Over 6000 patients received successive rehabilitation in 2016. The purpose of the research was to assess efficacy of complex successive post-stroke rehabilitation in Krasnoyarsk Region in 2016. Materials and Methods: A total of 163 patients after stroke (12 months), were enrolled into the unblinded study among which were 103 male and 60 female patients. The age varied from 32 to 91 years (57 ± 12.4). Ischaemic stroke was revealed in 144 patients while haemorrhagic stroke was revealed in 18. The study was conducted in the regional vascular centre at Stage I, in the Centre of neurorehabilitation of the FSSRCC of FMBA of Russia at Stage II and in the clinic of Krasnoyarsk Medical University at Stage III. Glasgow Coma Scale (Stage I only), modified ranking scale, NISSH, Ashworth spasticity, pain, dysarthria assessment scales, Wasserman test, MASA, HADS, MOCA, Rivermead Mobility Index, BBS, Hauser Ambulation Index, Frenchay Arm Test, FIM, EQ-5D were used. Statistical analysis was performed using nonparametric Wilcoxon and Mann-Whitney criteria. Results: The patients were divided into 3 groups after examination: Group I (n=39) included patients after only rehabilitation Stage I. Group II (n=61) included patients after Stages I and II, and Group III (n=63) included patients after all stages. It has been found that best statistically significant results according to clinical scales were found in Group III patients as manifested by disablement and neurological deficit decrease and motion activity value enhancement. Conclusion: In Krasnoyarsk Region, the best efficacy has been shown by the complex successive rehabilitation for patients after stroke performed in stages.

Keywords: Efficacy, Krasnoyarsk, rehabilitation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2276 Top


Analysis of the subjective postural vertical on diagonal plane in elderly subjects and left hemiparetic patients after stroke

D. Sekine, K. Fukata, K. Amimoto1, Y. Fujino, M. Inoue, M. Inoue, Y. Takahashi, H. Takahashi, S. Makita

Department of Rehabilitation Center, International Medical Center, Saitama Medical University, Hidaka, 1Department of Physical Therapy, Tokyo Metropolitan University, Arakawa-Ku, Japan

E-mail: s.daisuke1012@gmail.com

Introduction/Background: The subjective postural vertical (SPV) in healthy subjects is robustly maintained by integrating somatosensory and vestibular information, and extremely correct on frontal and sagittal plane. It is well-known that brain injury patients indicate disturbance of SPV on frontal or sagittal plane. On the other hand, stroke patients frequently fall paretic side and backward, but SPV on diagonal plane in normal subjects and stroke patients is unclear. The purpose of present study was to clarify the difference of SPV on diagonal plane between elderly subjects and stroke patients. Materials and Methods: The subjects comprised 14 elderly subjects (control group) and 10 left hemiparetic patients (LHP group). All subjects provided their written informed consent to take part in the study. SPV was measured using an electrical vertical board (EVB). The subjects sat on the EVB and was moved in the opposite direction from the left-backward or right-forward. The tilt of the seat when the subject feels and judges vertical position was recorded with a digital inclinometer. The mean (tilt direction) and standard deviation (variability) of eight trials were calculated. A true vertical position was considered 0°, diagonally backward and diagonally forward was treated as negative and positive, respectively. The values of SPV were compared between groups using the unpaired t-test (P<0.05). Results: There was no difference between control group (66.8±9.2 years [mean ± SD]) and LHP groups (67.5±10.8 years) in age. In tilt direction, LHP group (-2.5±0.7°) demonstrated significant tilt backward to the left than control group (-1.3±1.4°). Variability was significantly higher in LHP (5.4±2.0°) than control (2.5±0.9°). Conclusion: In stroke patients, tilt direction deviated to the diagonally backward and the judgement of verticality was unstable. These results suggest a possibility to explain the tilt of sitting posture and the difficulty of transfer movement in stroke patients.

Keywords: Diagonal plane, stroke, subjective postural vertical

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1848 Top


Upper limb position sense quantification using robotics in patients with stroke: Preliminary results

A. K. Blanchette, A. Deblock-Belamy, C. S. Batcho, M. H. Milot1, C. Mercier

CIRRIS - Université Laval, Département de réadaptation, Faculté de Médecine, Quebec City, 1Centre de recherche sur le vieillissement, Université de Sherbrooke, Faculté de médecine et des sciences de la santé, Sherbrooke, Canada

E-mail: andreanne.blanchette@fmed.ulaval.ca

Introduction/Background: Proprioceptive deficits affect around 50% of stroke survivors. Most commonly used proprioception assessments have poor psychometric properties and are not adapted for people with multiple impairments. To address these limitations, we developed an assessment protocol that enables the quantification of elbow position sense without using the opposite arm, involving active movement of the evaluated limb or relying on working memory. The objectives of this study were to quantify elbow position sense of stroke survivors and to compare it with a control group. Materials and Methods: Elbow position sense of the affected arm was quantified in subacute stroke patients and compared to age-matched healthy persons. Elbow position sense was evaluated using a KINARM exoskeleton and a virtual reality display. The exoskeleton passively moved the participant’s arm from an initial to a target position (no visual cues of arm position). A virtual arm representation was then projected on a screen placed over the participant’s arm. The participant had to indicate verbally its relative position (more flexed or more extended) compared to the virtual representation. A 75% detection threshold was extracted from a sigmoid curve fit representing the relationship between the angular difference and the percentage of successful trials. Independent T-tests were used to compare the results of both groups. Results: Eleven people with a stroke (67±9 yrs old; 6 males; 72±30 days post-lesion) and 19 age-matched controls (63±6 yrs old; 8 males) were recruited. A significant difference in the mean elbow position sense detection thresholds between the stroke group (12.8±5.2 degrees) and the control group (7.2±3.5 degrees) was noted (p=0.001). Conclusion: This robotic assessment enables the quantification of elbow position sense in patients with stroke. Difference in detection thresholds observed between both groups demonstrated that stroke survivors might have impaired proprioception. More participants are required to confirm these results.

Keywords: Proprioception, robotics, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0399 Top


Study of bone mineral density in stroke survivors

S. Gorle1

Department of PM and R, Safdarjung Hospital, Vijayawada, India

E-mail: sujathagorle@gmail.com

Introduction/Background: Osteoporosis after stroke differs from age-related and other causes of osteoporosis. Stroke is frequently followed by extensive bone loss, precipitating the increased fracture risk in survivors. It is more evident on the paretic side and that too in the upper extremities. The present study is to assess the Bone Mineral Density (BMD) in hip, spine and wrist and to assess BMD difference between paretic and non-paretic side in ambulatory stroke survivors. Materials and Methods: The study design is Cross-sectional observational study . Forty individuals attending the OPD of Department of Physical Medicine and Rehabilitation, VMMC & Safdarjung hospital, New Delhi with the diagnosis of stroke, fulfilling inclusion criteria were enrolled . Tools of measurement used were 1) BMD using Dual Energy X-ray Absorptiometry (DEXA) by OSTEOSCORE-3 (Digital 2D Densitometer) at spine, forearm and hip, 2) Biochemical markers (S.Ca, Phosphorous, ALP) 3) X –ray of spine, bilateral hip and wrist. Results: Our study involved total 40 subjects having 33 (82.5%) males and 7 (17.5%) females. Mean age of study group was found to be 53.9 ± 10.9 years. The T score for forearm was found to be significantly higher in non-paretic side (Mean = -4.11 ± 2.46) compared to paretic side (Mean = -4.85 ± 2.01) (P=0.04). The T score for hip on non-paretic side was found to be higher (Mean = -1.96 ± 1.74) compared to that of paretic side (Mean = -2.14 ± 1.57) (p=0.4). 15 (37.5%)subjects were found to be osteoporotic on DEXA scanning of spine. Conclusion: Most of the patients who presented after one year of stroke had low T-score at hip and forearm on paretic side in comparison to non-paretic side.

Keywords: Osteoporosis, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  A3.01 Neurological and Mental Health Conditions - Stroke Top



  ISPR8-0323 Top


A brain-computer interface based stroke rehabilitation system, controlling an avatar and functional electrical stimulation, to improve motor functions

A. Lechner, W. Cho1, R. Ortner1, G. Christoph1

Guger Technologies OG, Research, Graz, 1g.tec Medical Engineering GmbH, Validation, Schiedlberg, Austria

E-mail: lechner@gtec.at

Introduction/Background: Brain-Computer Interfaces (BCI) can detect the neuronal activity of patients’ motor intention to control external devices. With the feedback from the device, the neuronal network in the brain to reorganizes due to neuroplasticity. Materials and Methods: The BCI controls an avatar and functional electrical stimulation (FES) to provide the feedback. The expected task for the patient is to imagine either left or right wrist dorsiflexion according to the instructions. The training was designed to have 25 sessions (240 trials of either left or right motor imagery) of BCI feedback sessions over 13 weeks. Two days before and two days after we did clinical measures to observe motor improvement. The primary measure was upper extremity Fugl Meyer assessment (UE-FMA) which evaluates the motor impairment. Four secondary measures were also performed to exam the spasm (modified Ashworth scale, MAS), tremor (Fahn tremor rating scale, FTRS), level of daily activity (Barthel index, BI), and finger dexterity (9-hole peg test, 9HPT). Results: One male stroke patient (53 years old, 11 months since stroke, and right upper limb paralyzed) participated in the training. He quickly learned to use the BCI and the maximal classification accuracy was over 90% after the 5th session. The UE-FMA increased from 25 to 46 points. The BI increased from 90 to 95 points. MAS and FTRS decreased from 2 to 1 and from 4 to 3 points respectively. Although he could not conduct the 9HPT until 18th training session, he was able to complete the test from 19th session in 10 mins 22 secs and the time was reduced to 2 mins 53 secs after 25th session. Conclusion: The patient could be more independent in his daily activity, he had less spasticity and tremor. Also, the 9HPT was possible to do, which wasn’t before. The system is currently validated with a study of 50 patients.

Keywords: Brain-computer interface, EEG, stroke rehabilitation,

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0504 Top


The effects of non-elastic taping combined with exercises training on motor function in cane-assisted individuals after stroke

C. Y. Lin, R. Y. Wang, C. S. Lee1, Y. R. Yang

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 1Department of Rehabilitation Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan

E-mail: chiehyu516@gmail.com

Introduction/Background: Cane is one of the common assistive devices prescribed for individuals with stroke to improve walking ability and safety. It was revealed that long term cane-assisted individuals with chronic stroke perform abnormal gait pattern during walking. To improve these impairments, strengthening, balance training, task-specific training and intensive mobility training have been suggested. However, the training effects on motor function were limited in cane-assisted individuals with chronic stroke. It is supposed that musculoskeletal alignment of these individuals isn’t on the efficient position which may restrict the training effects. The immediate effects of joint alignment adjusted with Luekotape® P on muscle strength, balance and gait performance has been proved in individuals with stroke. However, the effects of taping combined with exercise training is unknown. This study aimed to investigate the effects of non-elastic tape combined with exercise training on motor function in cane-assisted individuals with chronic stroke. Materials and Methods: Subjects were randomized into either the experiment group with Luekotape®P or control group with sham tape. Subjects in both groups received the same exercise training for six weeks. The primary outcomes were gait performance and Berg balance scale. The secondary outcomes were muscle strength of hip extensors and abductors, endurance and fear of falling. Outcomes measurements were performed before and after the intervention and then one-month follow-up. Results: The intervention significantly improved cadence, stance time of affected side, spatial asymmetry ratio, Berg balance scores, and fall efficacy scale scores as well as 6-minutes walk test in the experimental group. In the control group, only the Berg balance scores and 6-minutes walk test had been significantly improved. Conclusion: Although all outcomes didn’t show significant differences between groups. Our results suggested that exercise combined with Luekotape®P may have more improvement than exercise alone in stance time, cadence, spatial asymmetry ratio, endurance, and fall efficacy scale.
Table 1: Basline demographic characteristics of the experimental and control groups

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Table 2: The mean (standard deviation) motor function of subjects in the experimendal and control groubs at pre, post and follow up

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Table 3: Change scores of motor function in experimental and control groups

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Keywords: Chronic stroke, gait, Leukotape® P

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2035 Top


Depression in a situation of persistent motor handicap: case of vascular hemiplegia in an african context

K. B. Manou, A. Dibi, A. D. Akadje, N. A. Ngandeu, K. N. Azanlin, D. J. Bombo, K. J. Kouakou, A. D. Alloh, M. B. Nandjui

University Félix Houphouët-Boigny, UFR Sciences Médicales, Abidjan, Ivory Coast

E-mail: benmanou@yahoo.fr

Introduction/Background: Post-stroke depression is a very common nosological entity and its perception in Africa is sometimes experienced as a stigmatizing situation, often poorly accepted. Objectives: To specify the incidence of depression after vascular hemiplegia, and also its functional repercussion in rehabilitation in the PMR department at Yopougon’s University Hospital. Materials and Methods: It was an eight-month prospective cross-sectional study from January to August 2016. It involved all cases of patients with hemiplegia following a stroke managed in the PMR service. Patients presenting in addition severe cognitive impairment were excluded. Results: On 49 hemiplegic patients, 19 patients with a mean age of 57.21 years with extremes of 37 and 70 years had post-stroke depression (38.8%), mostly men with a sex ratio of 1, 71. Ischemic stroke represented 89.5% of the PSD; 11 patients (57.9%) had minor depression and 8 patients (42.1%) had severe depression. There was a suicidal risk in 6 patients, 31.6%. Motor handicap was present in all depressed patients with an average Demeurisse’s score at 55.16 / 100 and extremes ranging from 9 up to 80. Discussion: Post-stroke depression is common in our context despite its debilitating and poorly accepted nature by a segment of the general population. It compromises the functional prognosis, which is a source of demotivation for patients, especially for the execution of the rehabilitation program. Conclusion: Post stroke depression should be searched systematically in all hemiplegic vascular in our African context, during the decline in performance and achievements during rehabilitation sessions, and during regular meetings with the family.

Keywords: Depression, rehablitation, sroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2285 Top


Peripheral plus central repetitive transcranial magnetic stimulation for upper limb motor rehabilitation in chronic stroke: A case report

Q. Yang, S. Chen, P. Deng1, J. Jia

Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, 1Department of Rehabilitation Medicine, Central Hospital of Jing’an District, Fudan University, Shanghai, China

E-mail: 07301010208@fudan.edu.cn

Introduction/Background: Motor dysfunction of the hand and upper limb is a major cause of physical disability for patients with chronic stroke. Our aim was to investigate the effectiveness of a peripheral plus central repetitive transcranial magnetic stimulation (rTMS) treatment for upper limb motor rehabilitation in chronic stroke patients. Materials and Methods: We reported the case of a patient WLX, who had one ischemic stroke more than 3 years ago, and had underwent intermittent rehabilitation since then. He still had profound right upper limb paralysis and moderate spasm, accompanied with non-fluent aphasia when came to our department; and complained that his recovery had been rather slow for about two years. In addition to the custom rehabilitation, we applied a peripheral plus central rTMS paradigm to him, which included 3 sessions of peripheral magnetic stimulation to his paralyzed right forearm, followed by a session of high frequency rTMS to the bilateral sensorimotor cortex region. The total magnetic stimulation therapy lasted about 30 min a day, and was applied 5 days / week for 4 weeks. Results: After 4 weeks’ treatment, the patient’s Fulg-Meyer upper limb assessment (FMA) score was obviously improved (from 27 to 37 points), and the spasm was largely relieved in his right hand and arm. Conclusion: Peripheral plus central rTMS might be an effective treatment for motor dysfunction of chronic stroke patients.

Keywords: Magnetic stimulation, motor dysfunction, upper limb rehabilitation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0014 Top


Long-term functional outcomes of stroke patients

R. Suksathien, T. Sukpongthai

Department of Rehabilitation Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand

E-mail: rachawan.su@cpird.in.th

Introduction/Background: Predictors of functional outcomes of stroke patients are important for providing efficient post-stroke care according to the degree of impairment. The authors attempted to use the data that are routinely recorded in acute stroke care to determine long-term functional outcomes of stroke patients. Materials and Methods: This analytic study examined the long-term functional outcomes of stroke patients admitted to Maharat Nakhon Ratchasima Hospital with acute stroke between January 1 and December 31, 2015. We recorded patients’ characteristic data and functional level on admission using Barthel index (BI) score. Long-term functional outcomes were evaluated with BI score at least 6 months after stroke onset by telephone interview and medical records. The predictors of long-term functional outcomes were determined with stepwise multiple logistic regression analysis. Results: Of the 907 patients, 191 (21%) died during acute stroke admission, 117 (13%) died after and 210 (23%) were lost to follow-up and could not be contacted. There were 5 variables significantly correlated with good functional outcomes after multiple logistic regression analysis. Subjects aged 55 or under, male, admission BI score 30-100, muscle power grade 0-1 and with consciousness problems had adjusted odds ratios of 12.56, 3.78, 3.33, 0.28 and 0.24 respectively. Four variables correlated with poor functional outcomes were impaired consciousness, age over 65, more than 3 comorbidities, and admission BI score of 0-30 had adjusted odds ratios of 4.83, 4.08, 2.39, and 1.89 respectively. Conclusion: Long-term functional outcomes of stroke patients were associated with age, consciousness, gender, muscle power, admission BI score and number of comorbidities.

Keywords: Long-term functional outcomes, predictors, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2571 Top


Effects of physical therapies aiming directly or indirectly at the recovery of balance after stroke: A meta-analysis

A. Hugues, J. Di-Marco1, P. Janiaud2, Y. Xue3, J. Zhu4, J. Pires5, H. Khademi6, L. Rubio7, P. Hernandez Bernal8, Y. Bahar9, H. Charvat10, P. Szulc11, C. Ciumas12, H. Won13, M. Cucherat2, I. Bonan14, F. Gueyffier15, G. Rode

Hospices Civils de Lyon- Centre de Recherche de Neurosciences de Lyon et Université de Lyon, Service de Médecine Physique et de Réadaptation de l’Hôpital Henry Gabrielle- Unité Impact et Plate-forme “ Mouvement et Handicap “, Lyon et Saint-Genis Laval, 1Assistance Publique des Hôpitaux de Paris et Université Paris Descartes, Service de Medecine Physique et de Réadaptation, Paris, 2CNRS Lyon et Université de Lyon 1, Umr 5558, 6World Heath Organisation, International Agency of Research on Cancer, 11INSERM et University of Lyon, Umr 1033, 15Hospices Civils de Lyon- CNRS Lyon et Université de Lyon 1, Service Hospitalo-Universitaire de Pharmaco-Toxicologie et UMR 5558, Lyon, 3Université de Lyon- Université Claude Bernard Lyon 1- Université Saint-Étienne, HESPER EA 7425- F-69008 Lyon- F-42023 Saint-Etienne, Lyon et Saint-Etienne, 12INSERM U1028- CNRS UMR5292- Centre de Recherche en Neuroscience de Lyon- Université de Lyon- Institute of Epilepsies- Centre Hospitalier Universitaire Vaudois, Translational and Integrative Group in Epilepsy Research TIGER- Department of Clinical Neurosciences, Lyon et Lausanne, 13Université Grenoble Alpes- KyungHee University, UMR 5316 Litt&Arts, Grenoble et Séoul, 14Centre Hospitalier Universitaire de Rennes, Service de médecine physique et de réadaptation, Rennes, France, 4Université Jiaotong de Shanghai, Pharmacologie, Shanghai, China, 5Medicine Faculty of Oporto University, Rovisco Pais Rehabilitation Centre, Tocha and Oporto, Portugal, 7Centro Lescer, Rehabilitation, Madrid, Spain, 8Rehaklinik Zihlschlach, Neurologisches Rehabilitationszentrum, Zihlschlacht, Switzerland, 9Hitit University Erol Olcok Training and Research Hospital, Physical Medicine and Rehabilitation, Corum, Turkey, 10Center for Public Health Sciences- National Cancer, Division of Prevention, Tokyo, Japan

E-mail: huguesaurelien@gmail.com

Introduction/Background: After stroke, standing balance is usually described as a predictor of functional recovery. Regarding literature, various type of physical therapy (PT) is used to improve balance. The aim of this meta-analysis is to evaluate the effects of PT directly focused on balance training (DFBT) and theses of PT indirectly focused on balance training (IFBT) on balance after stroke. Materials and Methods: Randomised controlled trials (RCT), without language restriction, until October 2015, assessing the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke, the posturographic parameters in static condition and measures of independence in activities of daily living were included. Two independent authors (AH and JDM) led this selection following the Cochrane recommendations (Hugues et al., 2017). Results: 193 parallel and crossover RCT from 9337 records were included, involving 8018 subjects (study sample: mean 41.5 (SD 49.7) subjects, age: pooled mean 61.7 (pooled SD 12.78) years). A significant difference in favor of PT compared to no treatment was immediately found after the intervention for the BBS (DFBT: 7 studies, mean difference (MD) 1.38; 95% confidence interval (CI) [0.71; 2.05]. IFBT: 18 studies, MD 1.88; 95% CI [1.31; 2.45]). Only IFBT PT is more effective than sham treatment or usual care immediately after the intervention for the BBS (DFBT: 1 study, MD 5.33; 95% CI [-4.68; 15.34]. IFBT: 26 studies, MD 1.85; 95% CI [0.67; 3.03]). Conclusion: These results show immediately after the intervention: i) that balance can be improved by PT aiming directly or indirectly at the recovery of balance compared to no treatment, and ii) an improvement of balance by PT indirectly focused on the recovery of balance compared to sham treatment or usual care.

Keywords: Meta-analysis, physical therapy, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0649 Top


Development of a smartphone-based balance assessment system for subjects with chronic stroke

Y. R. Hou, Y. L. Chiu, S. L. Chiang1, W. H. Sung

Department of Physical Therapy, National Yang-Ming University, 1Department of Rehabilitation, Tri-Service Hospital, Taipei, Taiwan

E-mail: yrhou.pt@gmail.com

Introduction/Background: Balance is one of the most important issues that chronic stroke sufferers have to deal with. Balance assessment is needed to be taken to know the balance performance. However, assessing balance performance with existed objective methods (such as forceplate or biodex balance sysytem) are not convenient and with subjective methods (such as functional tests or questionnaires) are not accurate enough. Smartphones had been proved effective in assessing balance, but new specific application is needed to be developed for subjects with chronic stroke. Therefore, the purpose of this study is to develop a smartphone-based balance assessment system for subjects with chronic stroke. Materials and Methods: Android Studio was used to develop the balance assessment application. Six postures were designed to evaluate the balance performance: shoulder-width stance with eyes opened (E/O) and closed (E/C), feet-together stance with E/O and E/C, and semi-tandem stance with E/O and E/C. Each posture was tested for 30 seconds, with a ASUS Zenfone 3 smartphone fixed at back on the level of second sacrum spine. The smartphone collected built-in accelerometer and gyroscope data to represent balance performance: the more data changed, indicated the more instability. The reliability test was executed after development of the application, and it included within-day (1-hour rest) and between-day (24-hour rest) assessments. Ten healthy adults were recruited. Intraclass correlation coefficient (ICC) was used to analyze the reliability, calculated by SPSS 20. Confidence interval was set as 95%. Results: The within-day ICC of the accelerometer data is 0.904 (p=0.000), between-day ICC is 0.764 (p=0.000); the within-day ICC of the gyroscope data is 0.897 (p=0.000), between-day ICC is 0.857 (p=0.000). The results demonstrate that the application is reliable. Conclusion: The developed application is reliable to assess balance ability, and have the potential to be a convenient and valid alternative in assessing balance.

Keywords: Balance, smartphone, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0778 Top


Early rehabilitation by electrical muscle stimulation in intensive care unit for patients with intracranial hypertension

K. Saigusa, M. Kuroha, N. Tamada, K. Sawada, T. Kino, A. Mizuno1

Departments of Neurosurgery and 1Rehabilitation, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan

E-mail: kuniyasus@jadecom.jp

Introduction/Background: Japanese guidelines for the management of stroke recommend early rehabilitation for the prevention of disuse syndrome. However, there are few reports concerning the safety and risk of the rehabilitation for the patients with intracranial hypertension. The patients with intracranial hypertension can’t attempt to move their extremities, and ROM exercise without contraction of muscle tends to the main early rehabilitation in intensive care unit. It leads to disuse muscle atrophy. Therefore we introduced Belt electrode-Skeletal muscle Electrical Stimulation (B-SES) as electrical muscle stimulation, which causes a muscle contraction, for patients with intracranial hypertension, and we assessed the safety of B-SES for the patients with intracranial hypertension. Materials and Methods: We use AUTO Tens PRO Rehabili Unit made by HOMER ION LABORATORY CO.,LTD, and selected LEG DISUSE MODE, and the duration of the stimulation is 20 minutes. Physical therapist determined the output level by palpation of triceps surae muscle of each patient, and the effective intensity was usually between 20 V and 50 V. Results: Case1: A 43-year-old woman underwent coil embolization of the ruptured right VA-PICA aneurysm. We monitored her intracranial pressure (ICP) by external drainage, and her ICP kept 14.5-18.0 cmH2O during B-SES. Case 2: A 66-year-old man underwent external drainage for the acute hydrocephalus due to left thalamic hemorrhage and intra ventricular hemorrhage. His ICP kept under 17.5-19.0 cmH2O during B-SES. Case 3: A 49-year-old man with right acute subdural hematoma underwent hematoma removal with decompressive craniotomy. His ICP kept 8-11 mmHg during B-SES. Case 4: A 41-year-old woman presented with subarachnoid hemorrhage underwent neckclipping of the left middle cerebral artery aneurysm. Her ICP kept 8-11 mmHg during B-SES. Conclusion: Electrical muscle stimulation with B-SES, as can be seen from these four cases, never worsened intracranial hypertension. Therefore, early rehabilitation with B-SES is safety and worth introducing for the patient with intracranial hypertension in intensive care unit.

Keywords: Early rehabilitation, electrical muscle stimulation, intracranial hypertension

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0895 Top


Impact of unilateral spatial neglect on the quality of life of individuals after stroke

K. R. F. Sobrinho, C. L. S. Marques1, E. D. M. Neto2, R. Bazan3, G. Luvizutto4

Department of Physical Therapy, Marechal Rondon Faculty, São Manuel, 1Department of Rehabilitation, Botucatu Medical School, 3Departmetn of Neurology, Botucatu Medical School, Botucatu, 2Department of Physical Therapy, Faculty of Human Talents, 4Department of Physical Therapy, Universidade Federal do Triângulo Mineiro, Uberaba, Brazil

E-mail: gluvizutto@gmail.com

Introduction/Background: Unilateral spatial neglect (USN) is characterized by the inability to respond to people or objects that are presented contralaterally to the lesioned side of the brain and can decrease a patient’s ability to return to work, and thus, has socioeconomic impacts on a community’s public health status. The aim of this study was to evaluate the relationship between the degree of USN with quality of life in stroke patients. Materials and Methods: This is a cross-sectional study including stroke patients of both genders, aged 18 to 85 years, in the acute, subacute, or chronic phase of the USN clinical diagnosis setting. Patients with prior stroke, pre-existing dementia, global aphasia, previous visual disturbances and other associated neurological diseases were excluded. The USN was evaluated by Behavioral Inattention Test (BIT), and quality of life through the European Quality of Life (EuroQoL), and analyzed: mobility, health care, usual activities, pain or discomfort, and anxiety or depression. An association among USN and EuroQoL items was analyzed using the Spearman correlation and was considered statistically significant if p <0.05. Results: Fifteen individuals were evaluated, 75% of whom men, with a mean age of 64 years, a BIT variation from 53 to 124 (mean = 96.63) and a EuroQoL score from 5 to 11 (mean = 7.75). The correlations are shown in [Table 1]. The association between a higher BIT value indicated a higher score in the personal care items (r = 0.95, p <0.001), usual activity (r = 0.81, p <0.001); pain or discomfort (r = 0.75, p <0.001); anxiety and depression (r = 0.95, p <0.001), and total EuroQoL score (r = 0.74, p <0.001). There was no association with mobility (r = 0.51, p> 0.05). Conclusion: The data demonstrated that a lower degree of neglect indicated a higher quality of life in individuals after stroke.
Table 1: Correlation of the items of the quality of life scale with the degree of unilateral spatial neglect measured by the BIT

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Keywords: Quality of life, stroke, unilateral spatial neglect

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1129 Top


Gait speed is a strong predictor of the ability to walk independently without wheelchair assistance in a facility setting for post-stroke patients

R. Yamada, Y. Ichinosawa, S. Shimizu1, N. Takemura2, K. Taira2, M. Goya2, Y. Nakachi2, A. Onodera3, T. Nakanishi2, A. Matsunaga

Graduate School of Medical Sciences, Kitasato University, 1School of Allied Health Sciences, Kitasato University, 3Department of Rehabilitation, Kitasato University East Hospital, Sagamihara, 2Department of Rehabilitation, Okinawa Rehabilitation Center Hospital, Okinawa, Japan

E-mail: ap13337@st.kitasato-u.ac.jp

Introduction/Background: The ability to walk independently without wheelchair assistance around a hospital ward or facility, i.e., practical ambulation, is not taken into account when assessing ambulation status of patients. To our knowledge, no study has adequately examined indicators of practical ambulation in stroke patients living in facilities. This study aimed to identify factors associated with practical ambulation in a facility setting based on prospective observational data from recovering stroke patients. Materials and Methods: Ninety-four stroke patients (mean age, 67.9 years) who received inpatient rehabilitation services at the Okinawa Rehabilitation Hospital from January 2011 to November 2016 were enrolled in this observational study. Exclusion criteria were dementia, orthopedic disease, or requiring assistance to walk 10 m. In addition to clinical characteristics, lower limb motor function on affected and unaffected sides (Stroke Impairment Assessment Set and leg strength, respectively) and comfortable gait speed (CGS) in a 10 m-walk test were examined at the time when 10 m-walking was acquired without assistance. Ambulation status was continuously assessed for up to 6 months after stroke onset. Cox proportional hazards regression was used to assess the contribution of clinical characteristics, lower limb motor function and CGS to practical ambulation ability, and receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic accuracy of these indicators. Results: A total of 72 stroke patients acquired practical ambulation during the study period. Only CGS was associated with practical ambulation, and the hazard ratio of acquiring practical ambulation per 1 m/min increase in CGS was 1.03 (95% confidence interval (CI), 1.02-1.08; P<0.001). ROC curve analysis revealed the optimal cut-off point and diagnostic accuracy to be 19.9 m/min and 0.903, respectively (area under curve, 0.923; 95% CI, 0.814-0.970). Conclusion: These findings suggest that gait speed is a strong predictor of practical ambulation ability in a facility setting for recovering stroke patients.

Keywords: Gait speed, stroke, walking ability

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1352 Top


Virtual reality interest in chronic vascular hemiplegia

P. Y. Libois, A. De Beer, M. Ghislain, M. Grimée, A. Libois, F. Assaban1

Centre Neurologique de Réadaptation Adultes-Enfants, Neuro-réadaptation, Montigny-le-Tilleul, Belgium, 1Physical Therapist PT and Founder of Virtualis, Virtualis, Montpellier, France

E-mail: py.libois@gmail.com

Introduction/Background: In chronic hemiplegia, physiotherapy often only aims at upkeeping of the few recovered mobility in the upper limbs. In partnership with Virtualis®, we adapted, to virtual reality, a rehabilitation protocol based on mirror therapies combined with a sensorimotor approach. Our goal was to modulate by this method the brain plasticity for improving this chronic disability. Materials and Methods: 14 stable hemiplegic patients, still benefiting from “maintenance by physiotherapy” (average of 66.8 ± 36.6 months post-stroke) were rehabilitated for 2 months, 3 times per week by virtual therapy. Each patient was assessed at T0 (before treatment), T1 (after 1 month of treatment), T2 (after 2 months of treatment), T3 (1 month after the treatment end and 3 months after its beginning). The evaluation was based on a video analysis, a dynamometric analysis, an evaluation of spasticity, a “Jebsen Test” and a FIM. Results: 4 patients gave up the study. For the other 10 (9 males, 1 female, average 55.4 ± 13.96 years-old), our results converge towards a positive change but with a very variable progression gradient. We observed a change in spasticity, an analytic and functional improvement with a tendency to reintegrate the paretic limb into daily life. Conclusion: Our results, even if they are still preliminary, highlight the interest of this immersive therapy. Having modified the plasticity in cerebral palsy patients, who was stable since several years, we are now encouraged to extent this technique to patients in the acute phase.

Keywords: Hemiplegia, plasticity, virtual reality

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1458 Top


Accurate assessment of cardiopulmonary fitness and analysis of its related factors in stroke patients

W. Chen, Q. Zhen1

Department of Rehabilitation , Xuzhou Central Hospital, Xuzhou, 1Department of Rehabilitation , Chang Zhou De an Hospital, Chang Zhou, China

E-mail: chenwei2339@163.com

Introduction/Background: To accurately assess cardiopulmonary fitness of stroke patients and to analyze its related factors. Materials and Methods: The basic data of 38 stroke patients, such as age, sex, height, etc, were collected. Fugl-Meyer, MMSE, ADL, and Berg scales were used to evaluate their exercise function, cognitive function, daily activity and balance function. All the patient used the power bicycle to carry out the maximum progressive cardiopulmonary exercise test with a restrictive symptom,and data on cardiopulmonary index, subjective fatigue, heart rate, blood pressure and other data were collected. Single factor analysis and multiple factors logistics regression analysis of cardiopulmonary fitness in stroke patients were carried out by SPSS 17.0 statistical software to explore the factors affecting the cardiopulmonary fitness. Results: 38 stroke patients enrolled in the study were able to complete the cardiopulmonary exercise test without adverse events. Cardiopulmonary fitness significantly decreased (VO2 peak was 12.89 + 3.42 ml/kg/min). Single factor analysis showed that age, sex, Fugl-Meyer, MMSE, ADL, bad habits and daily exercise habits were the influencing factors of cardiopulmonary fitness in stroke patients (P < 0.05). Multiple factor logistic regression analysis showed that high Fugl-Meyer score, high MMSE score and regular exercise habit were independent protective factors of cardiopulmonary fitness (OR < 1), while advanced age, women and bad living habits were their independent risk factors (OR > 1). Conclusion: Cardiopulmonary fitness significantly decreases in stroke patients. High Fugl-Meyer score, high MMSE score and regular exercise habit are independent protective factors of cardiopulmonary fitness, while advanced age, women and bad living habits are its independent risk factors.

Keywords: Cardiopulmonary exercise test, cardiopulmonary fitness, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1693 Top


Prediction of functional ambulation with sitting posturography in patients with subacute hemiplegic stroke

J. W. Lee1, B. R. Kim1, J. Lee1,2

1Department of Rehabilitation Medicine, Konkuk University Hospital, 2Department of Rehabilitation Medicine, The Graduate School of Konkuk University, Seoul, Republic of Korea

E-mail: 20140078@kuh.ac.kr

Introduction/Background: The purpose of this study is to investigate the usefulness of sitting posturography in stroke patients. Materials and Methods: A retrospective review of medical records was performed for subacute hemiplegic stroke patients admitted to the university hospital from December 1, 2016 to May 31, 2017. Twenty-nine patients (17 males and 12 females; average age, 63.41±15.44 years) were evaluated for balance ability using sitting posturography and clinical assessment of balance, such as Scale for the Assessment and Rating of Ataxia (SARA, using balance categories) and Berg Balance Scale (BBS). Posturography parameters are consisted of percentages of weight bearing distribution (WBD), static stability and dynamic stability. Static stability index was obtained by measuring sway of surface area and length from the center of pressure. The limit of stability (LOS), representing the dynamic stability. In addition, gait status were also assessed by Functional Ambulatory Categories (FAC) after 4 weeks of conventional treatment. Collected data were statistically processed using Pearson correlation coefficients to investigate the relationships between posturography parameters and the clinical assessment of balance (BBS, SARA). Multiple regression analysis was used to find independent variables related to FAC after 4 weeks of conventional rehabilitation. Results: The average ratio of percentages of WBD and ratio of LOS were 0.852±0.09, 0.766±0.23, respectively. A strong relationships were found in posturography parameters (ratio of percentages of WBD, ratio of LOS) in regards to BBS (r=0.761, r=0.781, p<0.01) and SARA (r=−0.852, r=-0.804, p<0.01) scores. The ratio of LOS statistically significantly predicted FAC after 4 weeks. (b = 1.89, SE = 0.72, 95% CI =3.38, 0.40, p <0.01). Conclusion: In patients with subacute hemiplegic stroke, sitting balance parameters of posturography correspond well with SARA and BBS. Furthermore, our data suggest that the ratio of LOS, which evaluated in sitting position, can significantly predict FAC after 4 weeks of rehabilitation.

Keywords: Balance, posturography, subacute hemiplegic stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1106 Top


Awareness of stroke and assessment of knowledge of risk factors among stroke survivors in a tertiary care level hospital

D. Tripathi, S. Chaudhary, S. Singh

Department of Physical Medicine and Rehabilitation , PGIMER and Dr. RML Hospital, New Delhi, India

E-mail: tripathideorishi@gmail.com

Introduction/Background: Stroke is one of the leading causes of the death worldwide. Those who survive suffer with disability affecting their quality of life. Knowledge of stroke risk factors and awareness of stroke symptoms would reduce the incidence of stroke for the first time or recurrent. Also timely management would remains instrumental in reducing morbidity and mortality from stroke. The aim of the study was to examine knowledge of stroke, risk factors and its determinants among stroke survivors. Materials and Methods: An ongoing cross sectional study in PMR department. Consenting stroke survivors attending the OPD and satisfying the inclusion criteria were enrolled for the study. Subjects were interviewed through a structured proforma which included questions to assess their knowledge regarding stroke and risk factors. Results: A total of 100 subjects enrolled for the study. Mean age of subjects was 55.6 ± 6.8 years, M:F ratio was 7:1 & mean duration of stroke was 18.10 ± 12.2 months. Only 12 percent reported to specialized care within the window period. Almost 80 % were unable to name a warning sign of stroke. Hypertension (80%), diabetes mellitus (42%), and smoking (23%) were identified as major risk factors. The knowledge of the risk factors was also very low and varies among the subjects depending on age and level of education. Forty three percent could not name a single risk factor. It was also observed that management of risk factors were not appropriate in 55 % of stroke survivors despite treatment either due to non adherence to the medication, improper follow up, diet, lifestyle changes and education. Conclusion: Knowledge about stroke and risk factors were relatively poor. Large gaps in knowledge thereby place patients at high risk for stroke. Our finding highlights the need to develop stroke-education programs for stroke survivors as well for those high risk for stroke.

Keywords: Awareness of stroke, stroke risk factor

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1788 Top


The neural network change of acute stroke patients along the robot therapy

A. Matsushita, K. Saotome1, A. Marushima2, T. Ueno3, T. Masumoto4, H. Kawamoto1, K. Nakai, H. Tsurushima2, Y. Hada3, Y. Kohno, M. Yamazaki5, Y. Sankai1, A. Matsumura2

Department of Neuro-Rehabilitation, Ibaraki Prefectural University of Health Sciences, Ami- Inashiki, 1Center for Cybernics Research, University of Tsukuba, Departments of 2Neurosurgery, 3Rehabilitation, 4Radiology and 5Orthopedic Surgery , University of Tsukuba, Tsukuba, Japan

E-mail: matsushita-nsu@umin.ac.jp

Introduction/Background: Robot therapy becomes more and more important in clinical practice. In our facility, a robot suit HAL® (hybrid assistive limbs) has been applied to stroke patients for several years. In addition, we evaluated their motor function and brain function using functional MRI along the robot therapy. In this study, we investigated the relationships between motor and brain functions during recovery from acute stroke. Materials and Methods: Acute stroke patients participated to this study. The robot therapy with HAL® applied a participant two or three times a week in two or three weeks during hospitalization in addition to conventional rehabilitations. We also acquired 10 m walk speed and functional MRI along the therapy almost two times a week. Functional connectivity (FC) among the 20 regions, assumed as motor related area, were calculated from functional MRI. The relationships between the walk speed and FC were evaluated statistically. Results: Five subjects, 3 men and 2 women, participated, and gave their informed, written consent. The subjects (mean age; 49.8 years from 12 to 79) with acute stroke (3 intracranial hemorrhages and 2 cerebral infarctions) suffered left hemiparesis, and were applied the robot therapy. All patients gradually improved in walk speed. Statistically significant FC were shown in many regions, and the most significant FC in each side was between primary motor area and primary somatosensory area. The statistically significant negative correlation between walk speed and FC was found at between primary motor area in unaffected side and premotor area in affected side. That might suggest the relationships among functional connectivity and interhemispheric inhabitation. Conclusion: The robot therapy with HAL® was performed for acute stroke patients. They improved gradually in motor function, and the walk speed and functional connectivity between primary motor area in unaffected side and premotor area in affected side were correlated negatively.

Keywords: Functional MRI, robot therapy, stroke

Disclosure of interest: The authors did not declare any conflict of interest.


  A3.02 Neurological and Mental Health Conditions - Traumatic Brain Injury Top



  ISPR8-2214 Top


Effect of a speaking valve on biomechanical properties of swallowing and the upper airway flow characteristics for tracheotomized patients after acquired brain damage

X. Han, Z. Dou, X. Wei

Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

E-mail: zsdxhanxiaoxiao@163.com

Introduction/Background: Alterations in swallowing and the upper airway flow characteristics can occur after tracheotomy and can result in varying degrees of aspiration. We investigated the effect of a Passy-Muir speaking valve (PMV) on biomechanical properties of swallowing and the upper airway flow characteristics, explored swallowing-breathing interactions preliminarily for tracheotomized patients after acquired brain damage. Materials and Methods: Six tracheotomized patients who were able to tolerate the PMV and eight healthy volunteers were recruited. High resolution manometry (HRM) and videofluoroscopic swallowing study (VFSS) were performed to evaluate the swallowing function of the healthy and patients without and with PMV. Iohexol injection was used. Three-dimensional models of the upper airway were constructed based on the CT scan data. Pressure in pharynx which was measured by HRM was used as boundary conditions. Computational fluid simulations were performed to acquire upper airway flow characteristics. Results: The patient group showed significantly lower upper esophageal sphincter (UES) resting pressure, shorter UES opening times and less hyoid anterior movement (HAM), but significantly higher UES residual pressure, as well as higher airflow velocity and pressure during inspiratory, expiratory, especially swallowing phase. With the PMV, higher UES resting pressure, larger hyoid superior movement (HSM) and UES opening diameter, lower airflow velocity and pressure were observed, the airflow velocity dropped to almost normal level during swallowing phase. However, there was no significant difference of the maximum pharyngeal pressure, UES residual pressure, laryngeal closure times, UES opening times, HAM, or Penetration-Aspiration Scale score before and instantly after wearing the PMV. Conclusion: The PMV demonstrated significant effects on UES resting pressure, HSM, UES opening diameter, upper airway airflow velocity and pressure in tracheotomized patients after acquired brain damage.
Figure 1: Velocity contour and pressure contour in sagittal cross-section during inspiratory, expiratory and swallowing phase.

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Table 1: Comparation of biomechanical properties of swallowing between patients and healthy subjects

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Table 2: Comparation of biomechanical properties of swallowing without and with the PMV

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Keywords: Airflow, speaking valve, tracheotomy

Disclosure of interest: The authors did not declare any conflict of interest


  ISPR8-1706 Top


Relationship between long-term impairments and compensation capital in traumatic brain injury: Results from the paris-tbi study

E. Bayen, A. Ruet1, G. Idir2, N. Gaelle2, A. Philippe2, V. A. Claire3, C. James4, P. D. Pascale5, J. Claire6, P. Azouvi3

Sorbonne Université - GRC Handicap and Pitié-Salpêtrière Hospital, Neuro-Rehabilitation, 3Ambroise Paré hospital EA4047- University of Versailles Saint Quentin, Biostatistics, 5Centre Ressource Francilien du Traumatisme Crânien, crftc, 6Sorbonne Université - GRC Handicap- and Pitié-Salpêtrière Hospital, Neuro-Rehabilitation, Paris, 2CHU Caen Inserm U1077, Neuro-Rehabilitation, Caen, 4Raymond-Poincare Hospital- EA4047 University of Versailles Saint Quentin, Neuro-Rehabilitation, Garcehs, 7CHRU Lapeyronie Hospital and Biostatistic, Neuro-Rehabilitation, Montpellier, France

E-mail: eleonore.bayen@aphp.fr

Introduction/Background: Persons with a Traumatic Brain Injury (TBI) are frequently involved in a litigation with claim compensation because another person was at fault for causing the accident. However, settling a lump sum is a complex and multi-determined process that is related to patients’ past, present and future losses and needs, but also to external factors (such as the attorney’s skills, the jurisdiction specificities, the TBI expert involved during court proceedings). We report preliminary results about the final lump sum and long-term TBI outcomes. Materials and Methods: Prospective study of severe TBI patients injured in the Parisian area in 2005-2007. Questions regarding involvement in a litigation and lump sum were asked 4 and 8-years after the TBI concurrently with 4 and 8-years outcomes. Results: Among 147 out of 160 patients that answered to the question about litigation, 80 were not involved and 67 were litigants. The litigation was over after 4 and 8 years for 25 and 32 people respectively, and still in progress for 10 of them. The final capital awarded was reported in 38 people and amounted €0 for 1 person and a mean €292 653 (SD=436 334; minimum=1500-maximum=2000000) for the others. No difference in capital amount was found according to gender and working status. In separate correlation, capital was found to correlate with 4/8 yrs Glasgow Outcome Scale–extended (GOS-E) score, Dysexecutive Questionnaire (DEX) score, functional status and caregiving time, but not with age, years of study, mood, caregiver burden. Conclusion: Among a wide range of factors that play a role in the financial settlement, a higher capital seems to be related to long-term severe impairment in patients, with the notable exception of working status.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1231 Top


Documenting the gusto group cooking intervention for knowledge transfer

F. Poncet1, 2, 3, S. Bonnie3,4, H. Migeot5, S. Crop5, C. Picq2,5, E. Caron5, P. Pradat-Diehl2,5

1Université Concordia, Psychologie, 3Centre for interdisciplinary Research in Rehabilitation of Greater Montreal, Research, 4Université de Montréal, Réadaptation, Montréal, Canada, 2GRC_UPMC- Groupe Recherche Clinique Handicap cognitif et réadaptation après lésion cérébrale, Recherche, 5Hopitaux Universitaires Pitié-Salpêtrière - Charles Foix, Réadaptation, Paris, France

E-mail: frederiqueponcet@gmail.com

Introduction/Background: The effect of the holistic, intensive acquired brain injury (ABI) rehabilitation program developed at the Pitié-Salpêtrière hospital, France (5 days/week for 7 weeks) was demonstrated (Poncet et al. 2017). This program includes the Gusto intervention (i.e. group cooking activity once a week). Based on these results, and to ensure the sustainability of the intervention and to enable it being used in other rehabilitation centers and other settings, the authors wished to document the Gusto intervention. Objective: To document the Gusto intervention for the purpose of knowledge transfer. Materials and Methods: Using a participatory and iterative approach, two occupational therapists (OT) created a theoretical logic model (Champagne et al. 2011) of the intervention and documented its components using a common language (i.e. the International classification of functioning disability and health (ICF); OMS, 2001). Four experts (OTs and neuropsychologists) validated the documentation. Results: The Gusto intervention targets 7/8 domains from the Activities and Participation sections of the ICF, the 8th domain (engagement in education, work) not being covered by Gusto. More than 50 body functions appear to be targeted (e.g. Calculation functions - consider the number of guests and modify the food portions accordingly) and more than 80 activities/participation are involved (e.g. listening). Conclusion: Because cooking is complex, persons with ABI require many body functions/capacities to be able to cook meals. Documenting Gusto with the ICF should allow an understanding of the intervention by different professions (clinician, manager …) and thus its applicability in other rehabilitation centers and for other populations (e.g. the elderly).

Keywords: Cooking intervention, ICF, logical model,

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2073 Top


Therapeutic options for behavioral disorders following traumatic brain injury: a regional cross-sectional overview

A. Pauline, T. Bourseau1, V. Saout2, U. Pouliquen-Loriferne3, P. Allain4, M. Dinomais5

Department of Physical Medicine and Rehabilitation, Angers University, CHU Angers, 1Department of Physical Medicine and Rehabilitation, Les Capucins, 2Department of Physical Medicine and Rehabilitation, Arceau Anjou- Mutualité Française Anjou Mayenne, , 4CHU Angers, Laboratoire de psychologie des pays de la Loire EA 4638, 5Department of Physical Medicine and Rehabilitation, Les Capucins -Angers University-CHU Angers, Angers, 3Department of Physical Medicine and Rehabilitation, Le Confluent-Croix Rouge Française, Nantes, France

E-mail: pauline.ali@hotmail.fr

Introduction/Background: To give an overview of the management of behavioral disorders following traumatic brain injury (TBI) in a cohort of 129 patients, in post-acute period. Materials and Methods: This cross-sectional regional cohort study included 129 adults suffering from moderate-to-severe TBI, in post acute period, and referred to medical or community based facilities in our region. A structured interview of patients and proxies collected information regarding socio-demographic data and the ongoing interventions, including psychotherapy and medication. Psychiatric outcomes were assessed by the Hospital Anxiety and Depression scale (HADS), and behavioral disorders by the Behavioral Dysexecutive Syndrome Inventory (BDSI). Each type of intervention was expressed as the prevalence in percentage of the study sample. Chi-square test, Fisher’s exact test or Student’s-t test were used to search an association between the type of intervention and behavioral disorders, living area, psychiatric outcomes, psychiatric history, or delay after TBI. Results: Patients were predominantly young men (mean age 26 years and 76% males) having sustained traffic accidents (78%). Forty-four percent received no interventions; 33% received psychotherapy and 43% were on pharmacological medication. 23% received medication alone with no other intervention. The prescribed medications were antidepressants (21%), neuroleptics (18%), anxiolytics (16%), mood stabilizers (14%) but no beta-blockers. Polypharmacy concerned 20% of patients. BDSI was completed for 120 patients and 85 (71%) presented current BDS. The main factor that was found to be associated with the different types of prescription was BDS. Patients with current BDS received more frequently interventions (p=0.004), psychotherapy (p=0.048), medications, all types combined (p=0.007), and antiepileptics mood stabilizers (p=0.037). Conclusion: Our study highlights that compliance with the current recommendations remains insufficient. Non pharmacological interventions, like psychotherapy, are inadequately implemented, although they are recommended as a first line treatment. Medications are overused, especially neuroleptics. Recommended medications, such as mood stabilizers and beta-blockers, are poorly used.

Keywords: Behavior, disease management, traumatic brain injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0860 Top


Correlation between the quality of life after brain injury in japanese version; qolibri-j and community integration questionnaire; CIQ

K. Ota, M. Suzuki1, I. Kondo2, M. Naito3

Department of Rehabilitation Medicine , International University of Health and Welfare Hospital, Nasushiobara, 1Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, 2Department of Rehabilitation Medicine , National Center for Geriatrics and Gerontology, Obu, 3Department of Preventive Medicine , Nagoya University Graduate School of Medicine, Nagoya, Japan

E-mail: rkota@iuhw.ac.jp

Introduction/Background: The Quality of Life after Brain Injury (QOLIBRI; 37 items) is a disease specific subjective questionnaire of health-related quality of life (HRQoL) in persons after traumatic brain injury. We developed Japanese version of QOLIBRI; QOLIBRI-J and reported that it’s test-retest reliabilit y (ICC; 0.92, Cronbach α= 0.86) and validity (Correlations of SF-36) were excellent. The Questionnaires of QOLIBRI-J are based on subjective satisfaction, although those of another popular QOL instrument, Community Integration Questionnaire; CIQ is based on objective situations. We investigated between the relationship of QOLIBRI-J and CIQ of the persons with higher brain dysfunctions after TBI to show the differences of subjective and objective QOL. Materials and Methods: Subjects: 73 recruited community-dwelling Japanese with higher brain dysfunction after traumatic brain injury (61 male, 12 female: age41.6±14.3, Glasgow Outcome Scale-Extended; GOSE (3 to 8: median 5). Design: The Correlations between QOLIBRI-J and CIQ were investigated in 73 subjects at the same time. They were also asked to fill the GOSE. The questionnaires were administered in one of three modes: by self-report (mail), self-report (participant presents at the clinic), and face-to-face interview. Results: Distribution of GOS-E score were as follows, 3: lower severe disability (12.3%), 4: upper severe disability (27.4%), 5: lower moderate disability (27.4%), 6: upper moderate disability (16.4%), 7: lower good recovery (11.0%), 8: upper good recovery (5.5%). There was a low correlation between QOLIBRI-J total score and the CIQ total score (ρ=0.326 Spearman correlation coefficient). By the subscale analysis, the strongest correlation was found between QOLIBRI-J (Daily life/autonomy)and CIQ (social life). In contrast there was the weakest correlation between QOLIBRI (emotions) and CIQ (productive life). There was no correlation between the QOLIBRI and GOSE (ρ=0.21). Conclusion: QOLIBRI-J had a mild correlation with CIQ. There were some differences between QOLIBI and CIQ. One of the reasons of this difference was thought to be the subjective emotional factor about taking a productive work.

Keywords: QOL, satisfaction, TBI,

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2141 Top


Case series of MTBI patients receiving the modified story memory technique intervention

N. E. Kucukboyaci, J. DeLuca, N. Chiaravalloti

Kessler Foundation, Research, East Hanover, USA

E-mail: ekucukboyaci@kesslerfoundation.org

Introduction/Background: Concussion / mild TBI (hereafter mTBI) prognosis is still a divisive topic in clinical practice. While some continue to subscribe to a “full recovery model,” others note slower recovery with longer term residual symptoms that may respond well to psychotherapy (CBT) and multimodal rehabilitative care. While evidence for functional gains resulting from mTBI interventions like psychoeducation is accumulating, there is little research and support for cognitive interventions that target learning and memory, despite patient complaints in these domains. We present early evidence of possibly therapeutic gains made by chronic mTBI survivors. Materials and Methods: •Design: Participants with mTBI completed a double-blind, placebo-controlled randomized clinical trial, with baseline, post-treatment and 6-month follow-up assessments. Outcomes were compared using non-parametric statistics (Wilcoxon Signed Ranks Test) for related samples given the small sample size in this pilot study. (1) Setting: Not-for-profit research organization in a diverse, suburban setting. (2) Participants: 5 out of 9 mTBI patients in intervention group (N=9). (3) Interventions: Modified Story Memory Technique (mSMT) aims to improve learning by teaching context and imagery strategies in 10 sessions. (4) Main Outcome Measure(s): California Verbal Learning Test II (CVLT-II) and Memory Assessment Scale (MAS) – Prose Memory. Results: Treated participants showed improvement in CVLT short delayed free recall (+5/0/0/, Z = -2.04, p = 0.041) and long delayed free recall (+5/0/0/, Z = -2.02, p = 0.043) following the mSMT. No differences were observed for the MAS Prose Memory.



Conclusion: Our pilot data provides preliminary evidence for cognitive gains resulting from cognitive rehabilitation targeting acquisition of context and imagery strategies for memory. A full-scale study can better address the mechanisms of change (e.g., depression, anxiety, socialization) since one-on-one interactions introduce confounders.

Keywords: Cognitive rehabilitation, concussion/mild TBI, memory strategies

Disclosure of interest: The authors did not declare any conflict of interest.


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Hypogonadism is associated with lower functional performance during inpatient rehabilitation following hypoxic ischemic encephalopathy

D. Ripley, B. Ingraham1, M. Kocherginsky2, M. Maneyapanda3, K. Franzese1

Department of PM and R, Shirley Ryan Ability Lab, 1Department of Physical Medicine and Rehabilitation, Northwestern McGaw Medical Center, Shirley Ryan Ability Lab, 2Department of Preventive Medicine Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, 4Bryn Mawr Rehabilitation Hospital, Brain Injury Program, Malvern, PA, USA

E-mail: dripley@sralab.org;bingraham@sralab.org

Introduction/Background: Neuroendocrine dysfunction, including hypogonadism, is a frequent complication after traumatic brain injury (TBI). Hypogonadism has been associated with worse functional performance after TBI. The prevalence of hypogonadism and its relationship to functional status after hypoxic ischemic encephalopathy (HIE) has not been previously reported. This study aimed to determine if hypogonadism is also negatively associated with functional performance during inpatient rehabilitation following HIE. Materials and Methods: Records were reviewed from male patients sequentially admitted for inpatient rehabilitation following HIE over a three-year period at an academic inpatient rehabilitation facility in the United States. Demographic, diagnostic, Functional Independence Measure (FIM) data, and serum endocrine results were collected. Linear regression analysis was performed to investigate the association between hormone values and functional status with a focus on Testosterone (T) function. Results: Twenty-nine male subjects were admitted with HIE during the target time frame. Subjects had a mean age of 37.6 years. Twenty subjects had T levels drawn on admission to rehabilitation; of these, five (25%) had levels below the normal range (2.0 – 8.0 ng/mL). Lower T levels were associated with worse admission total FIM (p=0.001), motor FIM (p=0.004) and cognitive FIM scores (p=0.003). Low T levels were also associated with worse discharge total FIM (p=0.04) and cognitive FIM scores (p=0.05) and a trend towards lower discharge motor FIM scores (p=0.06). Conclusion: The prevalence of hypogonadism in this population of HIE subjects was 25%, similar to that seen in studies of subjects with TBI. Hypogonadism was negatively associated with a lower functional status across domains. This relationship is similar to that seen in the traumatic brain injury population. Impaired hormone function should be considered clinically following HIE and warrants further investigation.

Keywords: Brain injury, endocrine, hypogonadism

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0346 Top


Dual task gait after moderate to severe traumatic brain injury: Characterization of troubles and consequences

L. Abadie, O. Kozlowski, K. Youssef1, C. Rogeau2, W. Daveluy, A. Benoit, E. Allart

Lille University Medical Centre, Neurorehabilitation Unit, Lille, 1Sainte Barbe Rehabilitation Centre, Neurorehabilitation Unit, Fouquières les Lens, 2Brain Injuries Department, MAS de Loos, Loos, France

E-mail: etienne.allart@chru-lille.fr;abadielaurine@hotmail.fr

Introduction/Background: Patients suffering from traumatic brain injury (TBI) often present with cognitive but also posture and gait impairments. In this study, we aimed at evaluating the cost of the addition of 3 types of cognitive concurrent tasks on gait parameters, and studying the relationship between dual task cost and patient-reported perception of their confidence in balance and gait in daily living. Materials and Methods: Spatiotemporal gait parameters were assessed using a GAITRITE mat in 22 moderate to severe TBI patients and 26 age-matched healthy controls. The addition of 3 cognitive tasks (letter back-task, substractions by 3, talking when walking) was studied during unobstructed walking and stepping over an obstacle. We also evaluated the relationship between dual task cost during gait and (1) cost in another motor task (Baddeley) and (2) patient perceived confidence in dynamic balance and gait in daily living (ABCscale). Results: Dual task cost during gait was higher in TBI patients compared to healthy controls when walking unobstructed and in the subtraction and talking concurrent tasks. Alteration of gait speed was primarily due to a decrease of step length more than of gait cadence. TBI patients tended to prioritize the cognitive task. Dual task cost during gait was correlated with the Baddeley dual task performance (r=-0.420; p=0.003) but not with the ABCscale score. Conclusion: TBI patients exhibit difficulties in dual task gait conditions, which can be easily assessed and should be addressed in rehabilitation. The dual task cost could be not specific to locomotor activities. Finally, other factors seem to explain the alteration in confidence in gait and balance in daily living.

Keywords: Dual task gait, gait, traumatic brain injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0846 Top


A change of cerebral perfusion of patients with chronic neuropsychological impairments before and after a day treatment group rehabilitation

G. Uruma, K. Hashimoto1, N. Takashi2

Division of Rehabilitation Medicine, Kajiwara Hospital, 1National Center for Child Health and Development, Division of Rehabilitation Medicine, Tokyo, 2Division of Psychiatry, Kashiwa Ekimae Nakayama Mental Clinic, , Kashiwa, Japan

E-mail: uruma-jk@jikei.ac.jp

Introduction/Background: The objective of this study is to evaluate a change of cerebral perfusion of patients with chronic neuropsychological impairments (NPIs) before and after a daytreatment group rehabilitation, using 99mTc-ethylcysteinate dimer single photon emission computed tomography (Tc-ECD SPECT) and its novel analytic software. Materials and Methods: 8 patients were examined in the chronic period of acquired brain injury with NPIs. All patients received a daytreatment group rehabilitation (3 hours once per week for half a year). The group rehabilitation included patient and family education, mindfulness exercise and group discussion exercise. The examinations of patients were performed before and after the group rehabilitation, and it included the assessment of neurological deficit, cognitive functions, and Tc-ECD SPECT. Statistical parametric mapping (SPM) was applied to each Tc-ECD SPECT image, for spatial pre-processing and analysis and to determine the quantitative perfusion change before and after the group intervention (paired t-test, uncorrected, p<0.001). Results: SPM analysis of Tc-ECD SPECT showed the significant improvement of cerebral perfusion in right frontal lobe (Brodmann area 10) before and after the group rehabilitation. There was no significant improvement in cognitive functions as assessed with structured batteries for NPIs, while there was a trend towards the improvement behaviorally (for example, 6 patients had been able to rework after the intervention). Conclusion: Using Tc-ECD SPECT and its novel analytic software, we identified specific lesions with improvement of cerebral perfusion before and after the daytreatment group rehabilitation for NPIs. It might relate with social reintegration of patient with NPIs.

Keywords: Cognitive rehabilitation, group rehabilitation

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0218 Top


Pharmacological management of post-traumatic seizures in adults: Current practice patterns in the United Kingdom and the republic of Ireland

H. Mee, A. Kolias1, P. Hutchinson1

Department of Rehabilitation Medicine , Cambridge Hospital NHS Trust, 1Department of Neurosciences , Cambridge Hospital NHS Trust, Cambridge, United Kingdom

E-mail: harrymee@nhs.net

Introduction/Background: Patients who have suffered a traumatic brain injury (TBI) uncertainty remains around post-traumatic seizure prophylaxis and for duration of treatment with anti-epileptic drugs (AEDs) for those who developed post-traumatic seizures (PTS). In early 2017, a collaborative group of neurosurgeons, neurologists, neuro-intensive care physicians and rehabilitation medicine physicians was formed in the UK with the aim of examining current practice patterns, gauging the degree of uncertainty, and thus designing relevant future studies. In order to address the first two objectives, we undertook a questionnaire survey of clinicians managing patients with TBI. Materials and Methods: An online questionnaire survey was developed and piloted. Following approval by the Academic Committee of the Society of British Neurological Surgeons, it was distributed via relevant electronic mailing lists. Results: The online questionnaire was answered by 117 respondents, predominantly neurosurgeons (76%) from 30/32 trauma-receiving hospitals in the United Kingdom and Ireland. 53% of respondents do not use seizure prophylaxis and 38% prescribe prophylaxis for 1 week. 70% feel there is uncertainty regarding seizure prophylaxis and 69% would participate in further research to address this question. 62% of respondents used levetiracetam for treatment of seizures and 42% continued for a total of 3 months’ post seizure but 90% were unclear concerning duration of treatment of seizures. Conclusion: The survey results demonstrate the uncertainty in both described aspects of management of patients who have suffered a TBI. The majority of respondents would want to participate in future research to help try and answer these questions and this shows the importance and relevance of these two clinical questions.

Keywords: Posttraumatic seizures, traumatic brain injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0125 Top


Applicability of clinical practice guidelines for rehabilitation in traumatic brain injury in disaster settings: A critical appraisal

S. Y. Lee, B. Amatya, F. Khan

Royal Melbourne Hospital, Rehabilitation Medicine, Parkville, Australia

E-mail: leesuyi121@gmail.com

Introduction/Background: To provide an overview of recommendations and quality of existing clinical practice guidelines (CPGs) for management of traumatic brain injury (TBI) focusing on rehabilitation medicine; and synthesise recommendations from these for applicability in disaster settings. Materials and Methods: Comprehensive literature search including health databases, CPG clearinghouse/developer websites, and grey literature using internet search engines to September 2017. All TBI CPGs published in the last decade were selected if their scope included: management of TBI, systematic methods for evidence search, clear defined recommendations and supporting evidence for rehabilitation interventions. Three authors independently critically appraised the quality of included CPGs using the Appraisal of Guidelines, Research and Evaluation (AGREE) Instrument. All recommendations were extracted, compared and categorized for applicability in disaster settings. Results: Only 4 of the 14 potential identified CPGs met the inclusion criteria. Despite variation in scope, target population, size, and guideline development processes, all four CPGs were assessed as of good quality (AGREE Global score of 5-7 out of 7). The recommendations included: patient/carer education, general physical therapy, practice in daily living activities and safe equipment use, direct cognitive/behavioural feedback, basic compensatory memory/visual strategies, basic swallowing/communication and psychological input for TBI survivors in disaster settings. More advanced interventions are generally not applicable following disasters due to limited access to services, trained staff/resources, equipment, funding and operational issues. Conclusion: Although CPGs in this study were of high quality, many recommendations for TBI care are challenging to implement in disaster settings and need further research to identify and address barriers for implementation.

Keywords: Clinical practice guidelines, natural disasters, traumatic brain injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0223 Top


Post-traumatic cognitive deficits: whether speech training improve cognitive functions?

E. Zubrickaya, E. Mozhejko, S. Prokopenko

Department of Nervous Diseases, Krasnoyarsk State Medical University, Krasnoyarsk, Russia

E-mail: ekat.bikova@yandex.ru

Introduction/Background: TBI is the leading cause of disability in the world due to the development of motor and cognitive disorders that occur in 70-100% depending on the extent of the injury. Object: to evaluate the results of rehabilitation capacities of the author computer program based on the application of functional training verbal domains of the brain to recovery cognitive deficits. Materials and Methods: with the aim to study the problem of the cognitive impairment of post-traumatic genesis, 49 patients after TBI of moderate severity (20,4%) and after severe TBI (79,6%) were examined. Before and after the treatment all patients were examined with the help of neurological examination, neuropsychological examination using rating scales: Schultes table (TSh), the literal and categorical associations test; Mini-Mental-State-Examination (MMSE); Frontal-Assessment-Battery (FAB); Clock-Drawing-Test; Test “10 words”; Hospital-scale-of-anxiety-and-depression (HADS). Patients were randomized into two groups: I-control group (22 people) - the patients took the medication according to generally accepted standards of treatment; II-experimental group (27 people) - patients who in addition to treating of TBI, have the rehabilitation of cognitive impairments, using the author correction programs. The complex of programs was represented by 8 blocks of items, each of which is designed in accordance with exposure to a specific speech domain: motor, amnestic, acoustic-gnostic and semantic domains. Analysis of the results was performed using the method of non-parametric statistics for two independent groups (Mann-Whitney test) of package Statistica 10.0. Results: in experimental group (II) there was statistical advantage in recovery of cognitive functions scale (I-II-p*): MMSE (24[22;26]-26[24;28]-0,011*), FAB (14[13;16]-16[15;17]-0,003*), TSh (82[52;100]-56[40;70]-0,009*), “10 words” (6[5;8]-8 [6;9]-0,050*), “Categorical Association” (11[9;16]-15[12;18]-0,018*). Conclusion: the obtained result indicates the presence of a regenerative effect on the gnostic, speech functions, mediated by the second functional unit of the brain and general activating effects on regulatory and neurodynamic processes of the brain, and can be recommended in complex rehabilitation treatment of TBI.

Keywords: Cognitive rehabilitation, posttraumatic cognitive impairments, the computer stimulating programm

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2618 Top


The effect of body mass index on indices of functional prognosis: evidence for ‘obesity paradox’ among traumatic brain injury population

D. Burke, R. Bratton Bell, S. Al-Adawi1, D. P. Burke2

Department of Rehabilitation Medicine , Emory University School of Medicine, 2Georgia State University, Atlanta, USA, 1Department of Behavioral Medicine, Sultan Qaboos University, Al-Khoud, Oman

E-mail: daverir@aol.com

Introduction/Background: While many studies have demonstrated that obesity is correlated with an increased risk of chronic disease, some have reported a paradox by which those in the higher weight categories actually recover better during hospitalization. This study was designed to determine whether this obesity paradox is also reflected in the recovery of patients with a traumatic brain injury who were undergoing care in a rehabilitation hospital. Materials and Methods: Retrospective cohort study which included all patients admitted to the brain injury unit of a rehabilitation hospital from January 2000 – April 2006. The data used for this study included patient height and weight (measured on admission) and functional independence measurements (scored on admission and discharge). Results: For the 444 patients admitted, the overall FIM efficiency did not differ significantly by BMI (p= 0.93). After adjusting for age and sex, the overweight and obese patients had the lowest FIM efficiency (1.04 for both groups), followed by the underweight and normal weight groups (1.11 and 1.26). Conclusion: This study demonstrated that higher BMI patients did not adversely influence the rate of functional recovery among patients admitted to a rehabilitation hospital for TBI.

Keywords: FIM efficiency, stroke, traumatic brain injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0386 Top


Transcranial direct current stimulation on the clinical curative effect of patients with disturbance of consciousness

L. Hongling

Department of Rehabilitation, The Second Hospital of Hebei Medical University, Shijiazhuang, China

E-mail: honglingli2007@126.com

Introduction/Background: Transcranial direct current stimulation (Transcranial direct current stimulation, tDCS) is a non-invasive brain stimulation techniques. tDCS plays a role by regulating the activity of spontaneous neuronal networks. Such as stimulation in patients with primary cerebral cortex motor area (M1), which can effectively improve the patient’s motor dysfunction, and stimulate the prefrontal cortex, which can effectively improve patient swallowing dysfunction, etc. but the tDCS with conventional rehabilitation therapy in patients with disturbance of consciousness of clinical research is rarely reported. Objective To explore the clinical efficacy of transcranial direct current stimulation on the clinical curative effect of patients with disturbance of consciousness (DOC). Materials and Methods: Thirty-eight DOC patients were randomly divided into a observation group and a control group, each of 19. Both groups were given routine rehabilitation intervention, and the observation group were treated with transcranial direct current stimulation on this basis for 20 sessions. The Brainstem auditory evoked potential (BAEP), the Upper sense evoked potential (USEP), the nerve electrophysiology evaluate electroencephalogram (EEG) and the Glasgow coma scale (GCS) or PVS rating scale were used to test both groups before and after the treatment. Results: Before treatment, the two groups of patients were compared with BAEP, USEP, EEG, GCS or PVS scores, and the difference was not statistically significant (P > 0.05). After treatment, BAEP, USEP, EEG, GCS or PVS scores were compared with those in the group before treatment, and the difference was statistically significant (P<0.05). And the observation group’s BAEP, USEP, EEG, GCS or PVS scores were better than the control group (P<0.05). Conclusion: On the basis of conventional rehabilitation therapy, tDCS treatment can further improve the patients’ consciousness disorder, and this combination therapy is worthy of clinical promotion and application.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0726 Top


Voluntary postural or dual-task training improves motor and mental functions in patients with traumatic brain injury

L. Zhavoronkova, T. Shevtsova1, A. Pozdneev2, S. Kuptsova3, O. Maksakova4, S. Moraresku5

Institute of Higher Nervous Activity and Neurophysiology of RAS IHNA and NPh RAS, General and Clinical Neurophysiology Lab, 1Moscow State University, Fundamental Medicine, 2Faculty of Medicine, Sechenov Medical Institute, 3Center of Speech Rehabilitation, Neurorehabilitation, 4Burdenko Neurosurgery Institute, Neurorehabilition , 5Biological Faculty, Moscow State University, Moscow, Russia

E-mail: lzhavoronkova@hotmail.com

Introduction/Background: Traumatic brain injury (TBI) is the most common cause of social disadaptation among young people and accompanied by disorders in motor and cognitive spheres. The aim of our study was to estimate a rehabilitation effect of voluntary postural and dual-task training at different periods after TBI. Materials and Methods: Seventeen TBI patients (28±5.3) and 32 healthy persons (27,6±0,07) participated at the investigation. Electroencephalographic (EEG), stabilographic studies and clinical scales (MMPI, FIM, MMSE, Berg’s scale) were utilized for estimation of different spheres of human functioning. Results: Clinical scales demonstrated deficits in all domains including motor and cognitive activity at the early terms after TBI. These deficits accompanied by global decrease of EEG connectivity between brain areas especially for distant brain areas while the increase of connectivity for local networks was observed as a reflection of compensator brain mechanisms. Postural training focused at vertical pose recovery while demonstrated improvement of motor as well as mental functions and accompanied by an increase of EEG connectivity. Dual-tasking was used as next step of rehabilitation course. EEG data demonstrated additional increase of EEG connectivity between different brain areas. Clinical scales showed improvement of all functions and improvement the quality of patient’s life and their social adaptation. Conclusion: Thus, voluntary postural and dual-task training may be used as effective rehabilitation approach that can serve as trigger for brain functional integration resulting in recovery of disordered functions. This approach may be recommended for patients with functional deficits to enhance their social adaptation and quality of life.

Keywords: Cognitions, dual-tasking, postural control

Disclosure of interest: The authors did not declare any conflict of interest.

Disclosure of statement: Supported by RBRF grant № 17-06-001012 and № 18-013-00355.


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Excessive complaints » more than one year after a mild traumatic brain injury: Hysterical psychic functioning or not?

P. Bruguière1,2, M. C. Pheulpin3, C. Picq1,2, P. Pradat-Diehl1,2

1Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Médecine Physique et Réadaptation, 2Sorbonne Universités- UPMC Univ Paris 06- AP-HP- GRC n°18, Handicap cognitif et réadaptation HanCRe, 3Université Paris 13- Sorbonne-Paris-Cité- UTRPP EA4403, Psychologie clinique et psychopathologie, Paris, France

E-mail: pascale.bruguiere@aphp.fr

Introduction/Background: A wide range of cognitive, emotional and somatic symptoms are frequently reported after mild Traumatic Brain Injury (mTBI) and usually disappear in a few months. However a « miserable minority » keeps looking for medical attention more than one year post mTBI. Their complaints are often considered excessive, histrionic and unfounded. Here we present a prospective study to assess neuropsychological disorders and intrapsychic functioning in such patients. Materials and Methods: Twenty-three adults (6 men, 17 women), mean age 48, sought care at our consultation about 41 months after mTBI. They all had a neurological, neuropsychological, psychological (projective tests: Rorschach and TAT) and psychiatric assessments (Minnesota Multiphasic Personality Inventory: MMPI). Projective tests are known to bring to light intrapsychic functioning in terms of narcissistic and objectal relationships while MMPI assesses personality traits and psychiatric symptomatology. Results: While 21 patients were socially well integrated pre mTBI, only 6 were back to effective work at the time of assessments. The neuropsychological assessment showed cognitive impairments, from moderate to severe, notably in attention (87%), working memory (74%), long term memory (65%) and psycholinguistic abilities (74%). Some patients (38%) also presented discrete visuo-spatial impairments. Patients talkatively told their mTBI story in a tragic, histrionic style, with impressive suffering feelings. The MMPI pointed out a non-significant value of malingering (5%) and a significant high value of hysteria (73%) and somatisation (45%) scales. Surprisingly projective tests never highlighted an hysterical psychic functioning but exhibited signs of narcissistic fragility. Conclusion: Despite of the histrionic style of excessive expression of emotion, dramatization, attention seeking and physical symptoms, the projective tests were not in favour of an hysterical psychic functioning. The specific role of the traumatizing context of mTBI in conjunction with psychic specificities, notably self-image and aggressivity drive are discussed.

Keywords: Cognitive disorders, mild traumatic brain injury, psychic functioning

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1005 Top


Prevalence and severity of all head impacts among semi-professional soccer players over one full season, according to their game position

M. Bildet, H. Cassoudesalle, H. Petit, P. Dehail

Hopital Pellegrin, Medecine Physique et de Readaptation, Bordeaux, France

E-mail: helene.cassoudesalle@chu-bordeaux.fr;maximebildet@gmail.com

Introduction/Background: Soccer players are frequently subject to head injuries, from impacts with another player’s head or body part and impacts with the ground. Moreover, game-play in soccer involving intentional and repeated head impacts through heading the ball. These impacts can sometimes cause concussion and soccer players might have a risk of developing neurodegenerative disorders on the long term by cumulative effect. However, the prevalence of head impacts when playing soccer is relatively unknown, because until now this was evaluated most of the time by only self-assessment questionnaires. The objective of this study was to quantify players’ exposure to all various head impacts during one soccer season. Materials and Methods: We have followed a group of 51 semi-professional soccer players, aged from 16 to 35 years old, during one full season. With video analysis of the games, the number of head impacts per player, including heading and concussion, has been counted. Results: The average of heading per hour during a game was from 0 to 9 depending on the player position, with a median of 4.61 for the forwards, 5.84 for the centre backs, 2.85 for the fullbacks, and 2.48 for the midfielders (p=0.0001.) We recorded three concussions due to a direct head to head trauma, including two on the same player. The number of head trauma recorded during practices was lower than during games. Conclusion: We have evaluated the exact prevalence of heading and all other head impacts during a full soccer season, and their direct consequences during the games (stoppage time, medical stoppage, exit game). Forwards and centre backs are mostly exposed. Next step should focus on improving the evaluation of the consequences of these repeated head impacts on brain structure and function, in order to consider possible prevention and protection tools for soccer players.

Keywords: Concussion, heading, soccer

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1731 Top


The family as a resource for improved patient and family functioning after traumatic brain injury: a descriptive non-randomized feasibility study of a family-centred intervention

M. S. Rasmussen1,2, N. Andelic1,2, T. H. Nordenmark1, J. C. Arango-Lasprilla3,4, H. L. Soberg1,5

1Department of Physical Medicine and Rehabilitation , Oslo University Hospital,

2University of Oslo, Research Centre for Habilitation and Rehabilitation Models and Services CHARM- Faculty of Medicine, 5Oslo Metropolitan University, Physiotherapy- Faculty of Health Sciences, Oslo, Norway, 3Cruces University Hospital, BioCruces Health Research Institute, Barakaldo, 4Ikerbasque, Basque Foundation for Science, Bilbao, Spain

E-mail: m.s.rasmussen@studmed.uio.no

Introduction/Background: Disability following traumatic brain injury (TBI) is multidimensional, affecting those injured and their family members. The family as a whole is seldom recognized as an arena for rehabilitation efforts. The aim of this study was to evaluate the feasibility of an eight-session, manualized multidisciplinary family-centred rehabilitation intervention for families facing TBI, aimed at improving individual and family functioning. We evaluated the families’ willingness to participate; the appropriateness of inclusion criteria; the need for cultural adjustment of the intervention; the collaboration with municipal health care service and the leadership structure of the sessions; and the appropriateness of the selected self-reported questionnaires for data collection. Materials and Methods: Two families, six people, participated in this non-randomized feasibility study of the intervention arm of a full-scale RCT, conducted at the University Hospital in Oslo, Norway (ClinicalTrial.gov #NCT03000400). The study was performed in close collaboration with a municipal health care service. Pre-defined success criteria were determined prior to conducting the feasibility study. The evaluation of these criteria was based on the families’ feedback regarding acceptability of the intervention, the self-report measures and the experiences of the group facilitators conducting the intervention. Results: The pre-defined succes criteria were fulfilled. Both families completed all eight sessions of the intervention. Minor cultural differences were detected, however, the topics and strategies covered in the intervention were perceived as relevant and recognizable. Some challenges emerged and were discussed before commencing the full-scale RCT. The challenges were related to the logistics regarding the delivery of the intervention. This pertained to keeping an acceptable level of burden of participation for the families and the collaborating municipal health professionals, and making the necessary adjustments of the intervention to suit the families’ unique needs. Conclusion: The family-centred intervention and trial procedures were feasible. A pragmatic approach is considered necessary when commencing the full-scale RCT.

Keywords: Family-centred intervention, feasibility study, traumatic brain injury

Disclosure of interest: The authors did not declare any conflict of interest.


  A3.02 Neurological and Mental Health Conditions - Traumatic Brain Injury Top



  ISPR8-1738 Top


School future of teenagers with a severe brain injury after a hospitalization at the Centre Medical et Pedagogique Pour adolescents in neufmoutiers en brie France

O. Jaziri, M. Desdomaines, S. Sarkis, G. Erbenova

Service MPR, Centre Médical et Pédagogique Pour Adolescents, Neufmoutiers En Brie, France

E-mail: omarjaziri@gmail.com

Introduction/Background: To study the school progress of teenagers with a severe brain injury at the end of their inpatient stay at rehabilitation center of the Centre Médical et Pédagogique pour Adolescents. All of them have benefited from both schooling and rehabilitation at the same time. Materials and Methods: Only patients aged between 12 and 17 years and hospitalized between 2012 and 2017 were included in the study. Demographic data (age, sex), initial Glasgow coma scale (GCS), duration of coma, duration of intubation, time between accident and hospitalization in rehabilitation, duration of stay in rehabilitation, neuropsychological assessment results, school level prior to the brain injury and at the end of the hospitalization were noted. Results: Eighty-six brain injury cases were examined. Only 25 patients were included in the study among them 17 males and 8 females. The average age at admission was 15.8+/-1.7 years. The average time between accident and hospitalization in rehabilitation was 145+/- 269 days. The average duration of stay in rehabilitation was 260+/- 197 days. The average GCS was 5.6+/-1.8. The average duration of coma was 9.9+/-4.1 days. The average duration of intubation was 14 +/- 6 days. Twenty teenagers have resumed their school education. Ten students have returned to pre-traumatic brain injury level, four patients have increased to a level higher than before the accident. Two patients were redirected to apprentiship studies, two referred to Training and Orientation Assessment Unit and two have resumed their education with additional support. Conclusion: Teenagers with severe brain injury require multidisciplinary rehabilitation and appropriate school education. The follow up of this population should be extended beyond hospitalization in a rehabilitation center.

Keywords: Schooling, severe brain injury, teenagers

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2087 Top


Evaluation of medical decision making capacity in acute traumatic brain injury rehabilitation

J. MacKenzie, C. Derbidge, C. Daniel1, S. Trapp, J. Speed

Department of Physical Medicine and Rehabilitation , University of Utah, 1George E. Wahlen Department of Veterans Affairs, Home-Based Primary Care, Salt Lake City, USA

E-mail: justin.mackenzie@hsc.utah.edu

Introduction/Background: Concerns regarding medical decision-making capacity (MDC) occur during acute traumatic brain injury (TBI) rehabilitation. Although a majority of providers report MDC as a common concern, the level of training is inconsistent. This presentation provides an overview of MDC assessment and recommendations during acute TBI rehabilitation. Materials and Methods: MDC assessment involves a clinical interview, cognitive examination, and record review, although clinical practice varies. Clinical determination of MDC includes “has capacity,” “diminished capacity,” and “lacks capacity.” Four commonly adopted standards for determining MDC are: expressing a choice, understanding relevant information, appreciation of the situation and its consequences, and reasoning through the benefits and consequences of treatment options. While clinical judgment remains the “gold standard” for MDC assessment, instruments have been designed to enhance and support these evaluations [Table 1]. In acute TBI rehabilitation, evaluators should consider how TBI-related changes influence MDC [Figure 1]. Appreciation of temporal changes in awareness and cognitive function might require assessment of MDC at multiple time points. Efforts to improve capacity, such as addressing communication barriers or treatment of delirium, might be necessary. Within the acute environment, providers have unique opportunities to assess and observe functional abilities on an inpatient service (e.g., psychology, speech therapy). Given the complexities of MDC assessment, potential “pitfalls” exist in determining MDC [Table 2]. Results: Although MDC concerns are common among individuals during acute TBI rehabilitation, there is a dearth of MDC assessment training. While determination of MDC is based upon clinical judgment, instruments enhance MDC assessment. Given the complex dynamic nature of acute TBI rehabilitation, providers should be mindful that chronic and acute factors may influence evaluation of MDC. Conclusion: Awareness of MDC standards and TBI factors allow for more accurate assessment of MDC during acute rehabilitation.

Keywords: Medical decision making capacity, traumatic brain injury

Disclosure of interest: The authors did not declare any conflict of interest


  ISPR8-0527 Top



  Post-Traumatic Brain Injury Olfactory Dysfunction: Factors Influencing Quality of Life Top


F. Ahmedy1,2, M. Z. Abu Bakar3, M. Mazlan4

1Department of Surgery, Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu, 2Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, 3Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, 4Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

E-mail: drmazlina@gmail.com

Introduction/Background: Previous studies have explored the quality of life (QoL) in people with olfactory dysfunction from various aetiologies. However, knowledge on QoL in people with post-traumatic brain injury (TBI) olfactory dysfunction is still limited. This study evaluates the impact of post-TBI olfactory dysfunction on QoL and determine factors influencing resultant QoL. Materials and Methods: A case-control study conducted in a single centre on 30 TBI adults with olfactory dysfunction; matched by age and gender with 32 TBI controls having intact olfactory function. All 64 adults self-rated their olfactory function using a Visual Analogue Scale (VAS). Sniffin’ Sticks test was used as an objective olfactory function assessment and results measured as TDI (Threshold, Discrimination and Identification) score. QoL was determined by a self-rated questionnaire; Questionnaire for Olfactory Disorders (QOD). Influential factors evaluated include age, gender, employment, level of education, marital status, smoking habit, TBI-related clinical information and Disability Rating Scale (DRS) score. A correlation test between the VAS and natural log TDI was also conducted. Results: Mean QOD score of case group was significantly higher than control group (26.31±14.37 vs 9.44±8.30 respectively; p<0.001). After removing the effect of employment, smoking habit, co-morbidities, TBI duration and DRS score; there was a significant difference of mean QOD score between the two groups (F=16.426, p<0.001, η2=0.224). Calculated effect size was large with d=1.07 and odds ratio of 7.02. The most affected QoL domain was “perception of smell changes”. DRS score and olfactory function severity were factors influencing QoL (p<0.05). VAS score was positively correlated with natural log TDI score (r=0.433, p<0.05). Conclusion: Individuals with post-TBI olfactory dysfunction are at higher risk of developing a lower QoL. One of the factors influencing this is the severity of olfactory dysfunction itself.

Keywords: Anosmia, brain injury, quality of life

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0776 Top


Rehabilitation nursing for traumatic intracranial hemorrhage: Case report

Y. C. Chen, B. J. Chen1

Department of Nursing, Taipei Tzu Chi Hospital, 1Department of Rehabilitation, Taipei Tzu Chi Hospital, New Taipei City, Taiwan

E-mail: butterlion100714@gmail.com

Introduction/Background: Traumatic brain injury affects the physical and cognitive aspects. Intensive rehabilitation has been shown to benefit this population. However, emotional distress could hinder patients’ will to engage in rehabilitation. We described the supporting role of nurses to drive a patient’s motivation in the rehabilitation regime. Materials and Methods: A 60-year-old male underwent ventriculoperitoneal shunt evacuation for intracerebral hemorrhage after a car accident. The person soon revealed negative mood regarding his recovery from physical and occupational therapy. The staff nurses administered Gordon 11 Functional Health Patterns to identify patient’s need and provide according therapeutic care. Barthel Index was applied to evaluate improvement in performing activities of daily life. Results: Powerlessness, incapacity of self-care, and locomotor disabilities were determined as the primary issues. With accompanying and encouragement, the patient became motivated to engage in and practice therapeutic exercises. The ability to complete daily activities improved from 35 to 80 in the Barthel Index. The patient could independently ambulate with a quadricane >100 m and fulfill dressing and hygiene. By 47 days of hospitalization, he was discharged home and then continued outpatient therapies. Conclusion: In patients experienced catastrophic disability, psychosocial involvement often aggravates dysfunction alongside with physical impairment. A systematic approach to each individual may help to cope stress and improve the quality of intervention. The case raises our awareness of including nursing care in the holistic practice.

Keywords: Case report, Gordon 11 Functional Health Patterns, rehabilitation nursing

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1552 Top


Neuropsychological assessment of a long-term (lt) outcome after severe traumatic brain injury

E. Caron1,2, B. Lesimple3,4, C. Debarle5, M. Lefort6, D. Galanaud7, V. Perlbarg8, L. Puybasset3, P. Pradat-Diehl1,5

1APHP- HxU Pitié-Salpêtrière, Physical and Rehabilitation Medicine, 3APHP- HxU Pitié-Salpêtrière, Intensive Care Unit, 4Fondation Partage et Vie, Samsah La Note Bleue, 5APHP- GRC-UMPC n°18 HanCRe, Physical and Rehabilitation Medecine, 6Laboratoire d’imagerie Biomédicale LIB, Sorbonne Universités- UPMC Paris 06- Inserm- CNRS-, 7APHP - HxU Pitié-Salpétrière, Neuroradiology, 8Brain and Spine Institute- ICM, Bioinformatic and Biostatistics Core facility- iCONICS, Paris, France, 2Association Guyanaise contre les Maladies Neuromusculaires, Samsah - Savs, Cayenne, French Guiana

E-mail: elsacaron1@gmail.com

Introduction/Background: Neuropsychological assessment of a LT outcome after severe TBI, in correlation with daily life disability. Materials and Methods: Severe TBI patients admitted in the Intensive Care Unit in Pitié-Salpêtrière hospital (France) from 2005 to 2012 were included. MRI, clinical PRM and neuropsychological assessments were performed. Neuropsychological performances were measured by 10 composite scores (CS) representing the main cognitive functions. The Glasgow Outcome Scale Extended (GOSE) assessed the global functional outcome. Use of self and relatives’ assessment questionnaires allowed evaluation of cognitive complaints in everyday life (Dysexecutive questionnaire – DEX; Working Memory Questionnaire -WMQ; Brain Injury Complaint Questionnaire - BICoQ). Results: 101 patients (84.16% men; mean age 38.55 ± 16.03 [19 - 73]) were included. They presented with initial severity of TBI: GSC median 8 ±3.6 [3-15]; coma duration 19.01 days ±18.22 [0-120]; PTA duration 97,8% > 1 day. Assessments were performed at a mean delay of 5 years and 2 months after BI. This cohort had a mean moderate disability according to GOSE (Median 6 ±1.32 [3-8]). Neuropsychological evaluation emphasized high prevalence of different cognitive deficits: attention (sustained attention deficit in 63,04% of subjects, tonic alertness 24.75%, divided attention 43.56%), executive functions (EF) (planning 55.56%, mental flexibility 24.75%, generation of new information 20.79%), working memory (WM) (46%) and update (46.88%), anterograde episodic memory (AEM) (46%). Surprisingly inhibition was not noticeable in this cohort (1%). GOSE was significantly related to EF, WM (0.0047*), AEM (<0.0001*), Tonic alertness (<0.0001*), divided attention (0.0012*) and to relatives’ complaints questionnaire (DEX & BICoQ <0.0001*). Moreover, several CS (AEM, fluency…) were significantly associated with the relatives’ complaints in the BICoQ. Conclusion: 5 years after TBI, patients and their relatives are still affected by cognitive disorders. Relatives complaints are clearly informative of participation restrictions. This study emphasizes the importance of LT assessment and follow up in TBI patients and their relatives.

Keywords: Neuropsychology, outcome, traumatic brain injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1695 Top


Role of CXCL1 and CCL2 in patients with severe traumatic brain injury

L. Su, G. Shen, L. Sun1

Department of Rehabilitation Medicine , Affiliated Hospital of Nantong University, Nantong, 1Department of Rehabilitation Medicine, Changzhou Maternal and Child Health Care Hospital, Changzhou, China

E-mail: 327202278@qq.com

Introduction/Background: Neuroinflammation is considered to be an essential entry point for clinical treatment after traumatic brain injury (TBI). We have found that Chemokine C-C motif ligand 2 (CCL2)-Chemokine C-C motif receptor 2 (CCR2) signaling has deleterious effects on neuronal survival and learning in TBI rats. However, the molecular mechanism of neuroinflammation in TBI patients is still remained to be fully characterized. Materials and Methods: Immunofluorescent staining for Chemokine (C-X-C motif) ligand 1 (CXCL1), CCL2 and their receptors Chemokine (C-X-C motif) receptor 2 (CXCR2), CCR2 expression was performed to analyze the expression and cell location in human neurocytes. Post-traumatic chemokine expressions were analyzed by using ELISA method. Preoperative GCS, GOS and GCS 30 days after operation were assessed to measure the degree of damage, clinical curative effect and prognosis. The relationships between chemokine expression and clinical prognosis were analyzed by univariate analysis. Results: The expression of CXCL1 was elevated in neurons and astrocytes after TBI, while in neuron without injury. CXCL1 in blood was peaking preopetation (GCS:6-8) and 1 day after opertation (GCS:3-5) then gradually decreasing. The CCL2 was mainly was elevated in astroglial and peaking preopertation (GCS:6-8) and 1 day post-trauma (GCS:3-5). Serum CXCL1, CCL2 concentrations in sTBI (GCS:3-5) group were negatively correlated with GCS and GOS. Conclusion: CXCL1 mainly expressed in neurons and astrocytes after TBI, and in astrocytes of normal brain. CCL2 was mainly co-localized in astrocytes post-trauma. In sTBI (GCS:3-5) group, the higher CXCL1 and CCL2 protein expression mains the more severe damage and worse prognosis.

Keywords: CXCL1, neuroinflammation, traumatic brain injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2661 Top


Urinary dysfunction in traumatic brain injury survivors: A retrospective study

C. Magro, M. Costa Pereira1, M. Torres1, G. Beça1, R. Nunes1

Centro Hospitalar Lisboa Norte - Hospital de Santa Maria, Physical Medicine and Rehabilitation, Lisboa, 1Centro de Reabilitação do Norte, Physical Medicine and Rehabilitation, Vila Nova de Gaia, Portugal

E-mail: cesarmagro@gmail.com

Introduction/Background: Survivors of a traumatic brain injury (TBI) frequently suffer from urinary dysfunction. Possible causes are midbrain dysfunction and primary lesions, but cognitive and behavior factors may also play a role. Overactive bladder (OAB) is a frequent urinary disturbance as opposed to urinary retention. In this study, we aim to investigate altered findings in urodynamic tests and possible relations to other TBI outcomes. Materials and Methods: A retrospective study was conducted with 24 post-TBI patients (21 male, 3 female) admitted to our unit during a 3 year period. Exclusion criteria included stroke, spinal cord injury, previous history of urological pathology or surgery and absence of urodynamic evaluation. Information was gathered relative to results of urodynamics, TBI imaging, initial GCS scale, urinary symptoms, vesical regime, neuropsychological and ultrasound results. Results: Of the 24 patients studied, all had severe TBI with a mean age of 40.1 years and a predominance of motor vehicle related accidents (66,7%) and axonal diffuse injury (62,5%). Median time from TBI was 7,5 months and only 2 patients had a normal urodynamic study. Urinary symptoms were present in 17 (70,8%) patients and the majority (58,3%) had filling symptoms. There was previous history of urinary tract infection in 32% patients. Neuropsychological evaluation was altered in all but one of the assessed patients. The majority had OAB (62,4%) and altered bladder sensation (70,8%). Mean total vesical capacity was 343,6mL. Elevated postvoid residual volume (37,5%) and detrusor sphincter dyssynergia (37,5%) was observed. Conclusion: Most patients had urinary symptoms and an overactive bladder. A subset of patients showed detrusor sphincter dyssynergia, a finding not frequently described. Cognitive impairment can play a role in urologic dysfunction and pseudodyssynergia might be present during the urodynamic test. Further studies are needed to assess urologic dysfunction in severe TBI survivors.

Keywords: Neurogenic bladder, traumatic brain injury, urodynamics

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0454 Top


Rasch analysis for the recovery process for patients of persistent vegetative state using the national agency for automotive safety and victims’ aid score

E. Takano, I. Kondo, J. Shinoda1, Y. Nagamine2, C. Honda3, K. Sato4, T. Teranishi5

National Center for Geriatrics and Gerontology, Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, 4National Center for Geriatrics and Gerontology, Rehabilitation, Obu, 1Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, 2Tohoku Medical Center for Prolonged Traumatic Brain Dysfunction, Kohnan Hospital, Sendai, 3Okayama Medical Center for Prolonged Traumatic Brain Dysfunction, Kibi Hospital, Okayama, 5School of Health Sciences, Fujita Health University, Toyoake, Japan

E-mail: eikoath@ncgg.go.jp

Introduction/Background: The purpose of this study was to analyze NASVA scores using Rasch analysis, and to create a difficulty map of NASVA score to predict the recovery process for persistent vegetative state, and to improve the fitness of the sub-items of NASVA score. Materials and Methods: Participants were 114 inpatients (mean age, 37.4 ± 20.4 years) who had been diagnosed with persistent vegetative state after a traffic accident. Rasch analysis was performed by an application named “winsteps”. This application produces a score table, an item measure of the sub-items containing an information-weighted mean square fit statistics (infit) and an outlier-sensitive mean square fit statistics (outfit) of the sub-items. First, I replaced NASVA score with the binary score. Rasch analysis provided a scaled score corresponding to the binary score. The raw score was the sum of the binary score of the sub-item. Then, I made the difficulty map using the scaled score that was calculated in winsteps as the item measure. Furthermore, I analyzed the fitness of the sub-items for the recovery process for persistent vegetative state using their infit and outfit. Here, I set 1.5 or more as misfits for infit or outfit of sub-items. Results: In the results of the fitness analysis, nine sub-items were identified as misfits: one motor function, three feeding functions, one excretory function, one cognitive function, and three articulatory and utterance functions. Conclusion: Nine misfit sub-items had room for interpretation depending on the insufficient of the items description. Therefore, it was suggested that we improve the scale by removing sub-items from the NASVA score, or creating an interpretation manual. On the other hands, by making use of the difficulty map of NASVA score, the medical staff might be able to decide on the proper goals of rehabilitation and care according to the recovery process of the patient.

Keywords: Rasch analysis, recovery process, vegetative state

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1732 Top


Exploring verbal assistance used by occupational therapists to improve financial management skills after brain injury: A case study

F. Poncet1,2, I. Habi2,3, G. Le Dorze2,4, C. Bottari2,3

1Université Concordia, Psychologie, 2Centre for interdisciplinary Research in Rehabilitation of Greater Montreal, Recherche, 3Université de Montréal, Réadaptation, 4Université de Montréal, Orthophonie et Audiologie, Montréal, Canada

E-mail: frederiqueponcet@gmail.com

Introduction/Background: Cognitive difficulties following a brain injury can impact an individual’s capacity to complete activities of daily living (ADLs). Combining metacognitive strategies, such as those part of the Cognitive Orientation to Daily Occupational Performance (CO-OP) approach and assistive technology for cognition (ATC) can facilitate financial management (Poncet, 2017). The objective of this study was to examine how the COOP approach was implemented by paying attention to the type of verbal assistance (VA) provided by the therapist throughout the intervention and how it affected the participant’s process of taking ownership of the CO-OP approach and therefore improving his ability to manage his finances. Materials and Methods: Case study of a 41-year old man, XC, who suffered a moderate traumatic brain injury (TBI). He participated in 10 individual therapy sessions where he learned to use CO-OP in combination with ATC. Throughout the sessions, an emphasis was placed on his personal goal of managing his grocery expenses. A qualitative analysis of the verbatim of the therapist-client interactions was completed. Two (representative) extracts from sessions 6 (first independent use of CO-OP) and 9 were selected to illustrate how XC established a goal to improve the management of grocery expenses. Results: The quantity and type of VA changed between sessions 6 and 9 (i.e. n=8 VA to 2). In session 6, the therapist provided several restarting and scaffolding assistances in order for XC to formulate a goal (Le Dorze, 2014). However, in session 9, the therapist only used restarting and explicit advice to support XC in formulating a goal, indicating improvement. Conclusion: This study begins to fill a gap with regards to the use of CO-OP by examining how a therapist assisted an individual with TBI in taking ownership of cognitive strategies for managing expenses. A more in-depth understanding of the use of VA could benefit therapists in their clinical practice.

Keywords: Financial management, traumatic brain injury, verbal assistance

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2636 Top


Effect of body mass index on functional outcome in patients with traumatic brain injury

A. J. Costa, A. Borges, I. Carneiro, M. Pereira, G. Beça, R. Nunes

Centro de Reabilitação do Norte, Unidade de Reabilitação do Traumatismo Cranioencefálico, Vila Nova de Gaia, Portugal

E-mail: anajocosta@gmail.com

Introduction/Background: Currently, there is a considerable body of literature that has reviewed the effect of body mass index (BMI) on the individual´s health. However, there are few data on how BMI influences the outcome of people with traumatic brain injury (TBI). The purpose of this study was to investigate the association between body mass index (BMI) and functional outcome of patients admitted to a Rehabilitation Center, after TBI. Materials and Methods: This retrospective study included patients admitted with TBI between January 2016 and December 2017. Data collected included patient demographic features (age, sex, weight and height by admission), severity of TBI (Glasgow Coma Scale score), and functional outcome measured by the Functional Independence Measure (FIM) score, on admission and on discharge. Inclusion criteria consisted of age of 18 years or older and complete information on FIM score, height or weight. Results: A total of 58 subjects met the criteria for inclusion in the study. The mean age was 43,31 ± 17,82 years (range, 19-86), 84,5% were male and 15,5% were female. Of these, 10 (17,2%) were underweight, 37 (63,8%) were normal weight, 11 (18,9%) were overweight and moderately obese. All groups showed similar improvement in FIM score: 31,00±21,04 for the underweight group, 26,75±19,26 for the normal weight group and 27,82±15,80 for the overweight and moderately obese group (p=0,873). All groups showed similar FIM score by admission (p=0,633) and discharge (p=0,628). The weight showed a negative correlation with improvement of FIM score (r=-0, 326, p=0,013). Conclusion: Among patients undergoing inpatient rehabilitation after TBI, BMI by admission had no impact on functional outcomes. This was found to be consistent with other study demonstrating no impact of obesity on motor functional outcomes of the TBI patients. However, this is contrary to previous studies in non-TBI patients that suggested that obesity hampered recovery of motor functions during rehabilitation.

Keywords: Body mass index, functional outcome, traumatic brain injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0756 Top


Effective rehabilitation services in the post-acute phase of moderate and severe traumatic brain injury

C. Roe1, 2, 3, C. B. Tverdal1, E. I. Howe1, N. Andelic1,2

1Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 2Research Center for Habilitation and Rehablitation Models and Services, Faculty of Medicine, University of Oslo, 3Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Oslo, Oslo, Norway

E-mail: eller@medisin.uio.no

Background and aims: Rehabilitation services to traumatic brain injury (TBI) have been focused in the acute phase, underpinning the importance of early initiated and well-organized delivery. Less is known about effective rehabilitation service delivery in the post-acute and later phases after TBI. Lack of a framework for depicting differences in service delivery may also contribute to the knowledge gap. Recently, Gutenbrunner et al (J Rehabil Med 2015) proposed a classification for health-related rehabilitation services (International Classification System for Service Organization in Health-related Rehabilitation, ICSO-R) describing provision (i.e., context of delivered services), funding (i.e., sources of income and refunding) and delivery (i.e. mode, structure and intensity) aspects which may be useful for contrasting and comparing rehabilitation services. Aims of this review are (1) Provide an overview of randomized controlled trials (RCTs) with rehabilitation service relevance provided to moderate and severe TBI in the post-acute phase. (2) Evaluate to which extent providing, funding and delivery dimensions of rehabilitation services are addressed. Materials and Methods: A systematic literature search was carried out in OVID MEDLINE; EMBASE, CINHAL, PsychINFO and Social SCI, identifying 50 relevant RCTs. Results: The studies emerged from nine different counties across all continents except Africa. Two-third of the studies was conducted in a hospital-based rehabilitation setting. In general, funding of the services was not described. In the delivery dimension, therapeutic strategies targeting body functions (78%) was dominating. Only one study was clearly designed to evaluate service delivery mode aspects, finding no difference between the effects of in-hospital or home-based rehabilitation regarding return to gainful employment. Conclusion: There is a lack of RCTs for evaluation of rehabilitation services in the post-acute phase for moderate and severe TBI. Service aspects may be implicit and possible to evaluate given standardized and better descriptions of the provider, funding and delivery dimensions according to ICSO-R.

Keywords: Postacute, rehabilitation services, traumatic brain injury

Disclosure of interest: The authors did not declare any conflict of interest.


  A3.03 Neurological and Mental Health Conditions - Spinal Cord Injury Top



  ISPR8-0011 Top


Pre- and post-intervention factor structure of functional independence measure (fim®) in patients with spinal cord injury

M. Saltychev, J. Lähdesmäki1, P. Jokinen, K. Laimi

Departments of PR and M and 1Neurology , Turku University Hospital, Turku, Finland

E-mail: mikhail.saltychev@gmail.com

Introduction/Background: The usefulness of Functional Independence Measure (FIM®) scores was questioned by several previous research due to its multidimensional factor structure. The FIM® has been widely used amongst people with spinal cord injury (SCI). Previous evidence on FIM® validity amongst people with SCI is scarce. A few studies have reported that FIM® has substantial ceiling effect in a cognitive area, a possible item redundancy in a motor area, and poor psychometrics assessed by the Rasch analysis. Based on the Rasch analysis, the FIM® motor score was not recommended for use, at least as a raw sum of items’ scores. The cognitive scale was found to work well except for considerable ceiling effect. The aim was to evaluate the factor structure of FIM® scale amongst people with SCI. Materials and Methods: The 155 people with SCI participated in multidisciplinary inpatient rehabilitation. FIM® was assessed at the beginning and at the end of intervention. Retrospective register-based study. Cronbach’s alpha and exploratory factor analysis. Results: The internal consistency demonstrated a high Cronbach’s alpha of 0.95 to 0.96. For both pre- and post-intervention assessments, the exploratory factor analysis resulted in 3-factor structures. Except for two items (‘walking or using a wheelchair’ and ‘expression’), the structures of the identified three factors remained the same at the beginning and at the end of rehabilitation. The loadings of all the items were sufficient exceeding 0.3. Both pre- and post-intervention chi-square tests showed significant p-values <0.0001. Conclusion: Within the sample of people with SCI, FIM® failed to demonstrate unidimensionality. Instead, it showed a 3-factor structure that was unstable depending on the timing of measurement. Using a total or subscale FIM® scores seem to be unjustified in the studied population.

Keywords: Functional independence measure, spinal cord injury, validity

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0794 Top


Furosemide unmasks inhibitory dysfunction following spinal cord injury in humans: implication for spasticity

A. Lackmy-Vallee, W. Klomjai1, N. Roche2, J. C. Lamy, B. Bussel3, D. Bensmail3, P. Pradat-Diehl4, R. Katz

Sorbonne Universite, Laboratoire d’imagerie Médicale, 4APHP Hopitaux Universitaires Pitié Salpétrière -Charles Foix, Service de médecine Physique et Réadaptation, Paris, 2Université Versailles -Saint -Quentin, Equipe Associée 4497, 3APHP Hopital Raymond Poincaré, Service de médecine physique et réadaptation, Garches, France, 1Mahidol University, Faculty of Physical Therapy, Nakonpathom, Thailand

E-mail: rose.katz@upmc.fr;alexandra.lackmy@upmc.fr

Introduction/Background: Potassium chloride co-transporter KCC2 plays a key role in chloride homeostasis and inhibitory functions in mature neurons. Animal studies have demonstrated a down-regulation of KCC2 function following spinal cord transection. This reverses the inhibitory effect of gamma aminobutyric acid and glycine to an excitatory effect, resulting in reduced inhibition. We have previously demonstrated in healthy subjects that furosemide, a potent KCC2 antagonist, can be readily used to assess inhibitory synapse efficiency in humans. We have shown that furosemide reduces both presynaptic and postsynaptic inhibitions without altering monosynaptic excitatory transmission[1] thus suggesting that furosemide can be used as a probe to study the function of inhibitory synapses in humans. The aim of this presentation is to explore if in paraplegic patients a down regulation of KCC2 may contribute to the reflex hyperexcitability following spinal cord injury. Materials and Methods: In the present study, we used a similar experimental design to that developed in healthy subjects: the study of the effects of 40 mg of furosemide intake per os onto soleus H reflexes conditioned by inhibitory percutaneous stimulations were explored during 60 minutes following furosemide intake. Results: Furosemide fails to modulate both pre- and postsynaptic inhibitions relayed to soleus spinal motoneurons in spinal cord injured patients. The reduced inhibitory effect of furosemide in spinal cord injury patients suggests a KCC2 dysfunction in human spinal neurons, resulting in a regression to immature inhibitory synapses, similarly to animal models. Conclusion: The reversal from inhibitory to excitatory synapses may be an important contributor to hyperreflexia in spinal cord injury and may lead to novel therapeutic strategies centred on chloride homeostasis



Darji JA, Panchal DN, Kalele SD, Parmar DJ, Bhagora RV. Euthanasia: Most controversial and debatable topic. National Journal of Integrated Research in Medicine 2011;2:94-7.



Keywords: Neurophysiology, spasticity, spinal cord injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0889 Top


Spinal cord injury trends in the United States, 1972–2017

Y. Chen, H. Wen, M. DeVivo

Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, USA

E-mail: yuyingchen@uabmc.edu

Introduction/Background: This cross-sectional analysis of longitudinal data was conducted to document demographic and clinical characteristics of newly injured and prevalent population with spinal cord injury (SCI) in the United States. Materials and Methods: 32,727 people with traumatic SCI who received initial hospital care from one of the 30 SCI Model Systems Centers since the early 1970s were included in the analyses with data on demographic, injury and medical characteristics, and psychosocial wellbeing obtained during the initial hospitalization and at year 1, 5, and every 5 years after injury through 2017. Results: Age at injury has increased from 29 years in the 1970s to 42 years currently. This aging phenomenon was noted for all sexes, races, and etiologies except acts of violence. Although vehicular crashes continue to be the leading cause of SCI overall, injuries due to falls have increased over time particularly among those aged 46 years and older. Injuries resulting in tetraplegia are increasing while neurologically complete injuries are decreasing. Lengths of stay in the acute hospital and rehabilitation unit have declined. About 30% of persons with SCI are re-hospitalized during any given year following injury. Diseases of the genitourinary system are the leading cause of re-hospitalization. Mortality rates are significantly higher during the first year after injury. The life expectancy has improved but remain significantly below life expectancies of persons without SCI. The causes of death that have the greatest impact on reduced life expectancy over the last 5 decades are pneumonia and septicemia. Conclusion: Study findings call for geriatrics expertise in the care for SCI and also highlights the need for a multi-dimensional risk assessment and intervention to reduce falls and SCI in older adults. Within the prevalent population, those who survive many years typically will have less severe injuries, high levels of independence and overall good health.

Keywords: Epidemiology, spinal cord injury, trends

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1700 Top


Clinical efficacy of upper limb robotic therapy in cervical spinal cord injured patients: A randomized control trial

Z. A. Han, J. Kim1, H. J. Lee, H. R. Kim, D. Y. Cho2, B. S. Lee, J. Kim, J. E. Lim2, H. Y. Kim2

National Rehabilitation Center, Spinal Cord Injury Rehabilitation, 1National Rehabilitation Center, Rehabilitation, 2National Rehabilitation Center, Assistive Technology, Seoul, Republic of Korea

E-mail: zeeahan@naver.com

Introduction/Background: The efficacy of upper limb robotic therapy (UERs) in cervical SCI patients is relatively limited. With a better understanding of the effect of UER in cervical SCI patients, development of therapy programs with more adequate dosing, method, and safe protocols along with valid assessment tools will be possible in the future. This study evaluates the potential effects of (exoskeleton type) UER in cervical SCI patients using a randomized controlled design. Materials and Methods: Study patients were randomly allocated to the robotic therapy (RT) or occupational therapy (OT) groups. Both groups received 5 sessions of therapy per week for 4 weeks (both received OT with additional 30 minutes respectively of RT [using the Armeo Power] and OT). Outcome measures were modified Medical Research Council (mMRC) scale motor strength score and Korean Spinal Cord Independence Measurement version III (KSCIM-III) score changes. Measurements were performed twice (baseline and therapy termination). Results: A total of 30 individuals with cervical SCI were included, with 15 patients in each group. At therapy termination, C6, C7, T1 key muscle score, and the sum of C5–T1 key muscle score increased in the RT group. Increase in C7 and T1 was higher in the RT than OT group. Among (KSCIM-III) sub-categories, use of toilet, mobility, and the total score increased in the RT group. Improvement in mobility in bed and action to prevent pressure sores, mobility indoor, and total score were higher in the RT group. Conclusion: This is a randomized control trial that investigated the effects of upper-limb exo-skeletal RT in SCI patients. With upper limb RT, cervical SCI patients showed some improvements in muscle power and KSCIM-III scores. For better C7, T1 key muscle power and related functional recovery, upper limb RT seems to be a feasible option. Superiority over one therapy could not be determined in this study.

Keywords: Exoskeletal robotics, rehabilitation with robotics, spinal cord injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0262 Top


Effect of early treatment with zoledronic acid on prevention of bone loss in spinal cord injury patients a randomized prospective interventional study

A. Ranga, S. Goenka, S. Sethi1, N. Pandey

Department of Physical and Rehabilitation Medicine , S. M. S. Medical College and Attached Group of Hospitals, Jaipur, 1Department of Physical and Rehabilitation Medicine , Safdarjang Hospital and Vardhman Mahavir Medical College, New Delhi, India

E-mail: dr.anuragranga07@gmail.com

Introduction/Background: This hospital based randomized, prospective, longitudinal study was conducted at Rehabilitation Research and State Spinal Injury Centre, by department of Physical and Rehabilitation Medicine (PRM) Jaipur, India to assess the magnitude of bone loss and to study the effect of early administration of zoledronic acid in the prevention of bone loss following spinal cord injury. Materials and Methods: Subjects were randomized to either control group to receive standard nursing and medical treatment along with physical therapy for traumatic spinal cord injury or intervention group to receive standard treatment along with intravenous zoledronic acid (5 mg/100 ml) infusion. A total of 212 acute spinal cord injury (SCI) patients were screened for eligibility criteria and 118 eligible patients were assigned to either control or intervention group. 28 patients in control group and 29 patients in the intervention group completed the study. Bone mineral density (BMD) was measured at hip and forearm at baseline, 3 months, 6 months and 12 months by Hologic QDR-Delphi dual X-ray absorptiometry (DXA) machine. Results: After comparison of the BMD by DXA scan at baseline, 3, 6 & 12 months a significant difference (p<0.03) was observed between control and interventional group at both 6 and 12 months in both quadriplegics and paraplegics at all sites of hip and at 12 months in quadriplegics at all sites of forearm. Conclusion: This was a pioneer study of this nature in India which showed a single dose of 5 mg intravenous zoledronic acid to be an effective treatment in preventing bone loss at the hip and forearm for 12 months following SCI. However, in the bones which continue to be non-weight-bearing, it is logical that there will be ongoing bone resorption. So, larger, controlled studies with longer durations of follow up are still required to determine whether further treatment with bisphosphonates would be required.

Keywords: Bone loss, spinal cord injury, zoledronic acid

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0053 Top


Respiratory complications in pediatric patients with acute traumatic spinal cord injury in Spain

D. Gonzalez-Paesani, A. Falco, K. Rojas, L. Montesinos, P. Launois, M. A. González-Viejo, A. Gómez-Garrido, B. Planas

Department of Physical Medicine and Rehabilitation , Hospital Universitario Vall D´Hebron, Barcelona, Spain

E-mail: albagomez40528@gmail.com

Introduction/Background: Spinal cord injury (SCI) in the pediatric age continues to be an unusual pathology. In Spain the incidence of SCI in children is low, being approximately 1 per million inhabitants per year, corresponding to the 4%. However, there is not enough statistical data to determine how many of these correspond to traumatic injuries. In the acute phase, especially in cervical and upper thoracic SCI, respiratory complications remain the leading cause of death. Materials and Methods: Retrospective study of all patients aged 0-18 years, who suffered traumatic acute spinal cord injury above D6, admitted to the University Hospital Vall D’Hebron, Barcelona from March 2010 to August 2017 using a database specific of the unit. The objective of the study was to determine the incidence of respiratory complications in these patients with respect to the adult population of our center and to correlate the appearance of these complications with the early onset of respiratory physiotherapy. Results: The total number of children with spinal cord injury was 46, of which 27 were excluded due to spinal cord injury below D6 or traumatic brain injury, thus obtaining a study sample of 19 patients. The 52.6% presented respiratory complications; this result is higher when compared with the adult population of our center (incidence of 36.5%). When correlating the early onset of respiratory physiotherapy and the development of these complications, we found that none of the patients who started the treatment within 72 hours after the injury presented respiratory complications. Conclusion: In our center, there is a higher incidence of respiratory complications in pediatric patients affected by acute traumatic SCI when compared to adults. There is a significant relationship regarding the impact and importance of the initiation of early physiotherapy, between 72 hours after the SCI, in the prevention of the development of respiratory complications.

Keywords: Pediatrics, repiratory complications, spinal cord injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1208 Top


Walking speed is associated with walking behavior in ambulatory people with a recent spinal cord injury

S. van den Oever1, K. Postma1,2, H. Horemans1, R. van den Berg-Emons1

1Erasmus MC- University Medical Center, Rehabilitation Medicine, Rotterdam, 2Spinal Cord Unit, Rijndam Rehabilitation Institute, Rotterdam, The Netherlands

E-mail: 380120so@student.eur.nl

Introduction/Background: Regaining and optimizing walking function for mobility and daily physical activity purposes is one of the most important goals during inpatient rehabilitation for many people with incomplete spinal cord injury (iSCI). In clinical practice, walking function is almost exclusively objectified with measures of capacity, such as distance, speed, or ability to perform a task. However, it is unclear to what extent walking capacity relates to actual walking behavior in people with a recent iSCI. Therefore, the aim of this study was to assess the association between walking speed and walking behavior in ambulatory people with a recent iSCI. Materials and Methods: People with iSCI who were expected to become at least household walkers were tested before discharge from inpatient rehabilitation. Walking capacity was determined by walking speed measured with a standardized 10 meter walking test. Walking behavior was measured objectively, during one week, with a validated accelerometry based activity monitor attached to the front of the thigh. Results: Forty-six people with iSCI participated in this study. Their mean (SD) walking speed was 0.79 (0.41) m/s. The walking time averaged per day varied between 2.1 and 142.6 minutes; the group median (IQR) was 52.7 (15.2-87.8) minutes. A two-tailed spearman’s ranked correlation analyses revealed a positive association between walking speed and daily walking time (rs = .734, p <.000). Conclusion: We found a significant association between walking speed and walking behavior, suggesting that people who walk faster are likely to walk more during daily life.

Keywords: Accelerometry, walking behavior, walking speed

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0652 Top


Thoraco-abdominal asynchrony analysis using optoelectronic plethysmography in patients with cervical spinal cord injury

K. Hanayama, S. Takefumi, T. Akio, H. Takashi, M. Hiromichi, S. Sousuke, H. Masaki1

Department of Rehabilitation Medicine, Kawasaki Medical School, Kurashiki, 1Department of Rehabilitation Medicine, Isehara Kyodo Hospital, Isehara, Japan

E-mail: hanayama@med.kawasaki-m.ac.jp

Introduction/Background: Patients with acute cervical spinal cord injury (CSCI) sometimes present paradoxical respiratory pattern, that is, the chest cage is displaced inward during inspiration. It is known as an example of thoraco-abdominal asynchrony which increases work of breathing. On the other hand, it is known that respiratory movement of such paralytic patients are influenced by position change. The aim of this study was to investigate thoraco-abdominal asynchrony and influence of posture on it in patients with chronic cervical spinal cord injury using optoelectronic plethysmography. Materials and Methods: Five patients with chronic CSCI (aged 42±14, ASIA impairment scale classified into A in all patients, neurological level C4: 2, C5: 2, C8: 1) were recruited from outpatient clinic of regional rehabilitation center. As control group, 5 age-gender matched healthy subjects were recruited. Volume change of the rib cage and the abdomen were measured with 3 dimention optoelectronic motion analysis system (VICON MX, Motion Capture Systems, Oxford, UK), using 45 reflective markers on the chest wall monitored by 6 infrared cameras. The breath which showed maximum volume change among 3 deep breaths was sampled for analysis in each patient. Measurement was done in the supine position and 30 and 60 degrees head elevation position. With obtained volume change of rib cage and abdomen, Konno Mead Diagram was drawn for each sample. Then we calculated the phase shift angle. Results: The phase shift angle was 47±2 degrees for the patients and 9±6 degrees for healthy controls in supine position, that is, the CSCI patients group showed larger abdominal contribution. The angle tended to increase as head elevation in both groups. Conclusion: Patients with chronic CSCI showed larger asynchrony than healthy controls. Asynchrony tended to increase with head raising in both CSCI patients and controls.

Keywords: Respiration, tetraplegia

Disclosure of interest: The authors did not declare any conflict of interest


  ISPR8-0762 Top


We describe the development and validation of an online wheelchair maintenance training program for clinicians that is freely available for use

J. Pearlman, S. Munera1

Department of Rehabilitation Science and Technology , University of Pittsburgh, Pittsburgh, USA, 1Department of Rehabilitation , University CES, Medilin, Colombia

E-mail: jpearlman@pitt.edu

Introduction/Background: It is well known that wheelchairs which are well maintained suffer breakdowns less frequently, and their users are less likely to be injured. But until recently, there was no widely known wheelchair maintenance training program. Our team recently developed the wheelchair maintenance training program (WMTP) that we used to train clinicians on how to train wheelchair users in an in-person format, but was difficult to scale due to the in-person nature of the training. Materials and Methods: This manuscript presents the development of the online version of the WMTP program and compares learning results from the in-person and online program using the wheelchair maintenance training questionnaire (WMT-Q). Results: The training program was well received and valued by participants all 22 participants. A significant increase in all scores after online training program was found: manual wheelchair open-ended questions, t(25) = -3.367, p<.05; power wheelchair open-ended questions, t(25) = -5.360, p<.05; multiple choice questions related to knowledge, t(25) = -6.368, p<.05; confidence, t(25) = -13.521, p<.05; and capacity, t(25) = -10.735, p<.05. There were no statistical difference in WMT-Q scores between individuals who participated in the in-person and online participants: knowledge: t(34)=.371 p=.185, capacity: t(34)=.540, p=.793. Conclusion: Our results suggest that there was a similar trend of increased knowledge for participants in both training programs indicating that web-based training is a viable avenue for delivering maintenance training.

Keywords: Maintenance, online training, wheelchair

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0935 Top


Botulinum toxin a external urethral sphincter quadrant injection guided by transrectal ultrasound for treatment of detrusor sphincter dyssynergia

W. Yang, N. Bian1, H. Zhu, Y. Hou1, C. Shen1

Department of Rehabilitation, The First Affiliated Hospital of Soochow University, 1Department of Rehabilitation, The Affiliated Suzhou Hospital of Nanjing medical University, Suzhou, China

E-mail: weixinsuda@163.com

Introduction/Background: Detrusor sphincter dyssynergia (DSD) causes impaired micturition and high intra-vesical pressure that leads to potentially life-threatening urological complications. Botulinum toxin A (BTX-A) is an inhibitor of acetylcholine release at the neuromuscular junction, which can decrease muscle contractility. It has been used successfully in the treatment of focal dystonia and spasticity of skeletal muscles. This study investigates the effectiveness of BTX-A injection to the external urethral sphincter guided by transrectal ultrasound in the treatment of spinal cord injury (SCI) patients with DSD. Materials and Methods: A total of 18 patients with DSD (15 men and 3 women)were caused by SCI. BTX-A (100 u) was injected into external urethral sphincter (EUS) respectively in four sites at 12, 3, 6, 9 o’clock guided by transrectal ultrasound. Clinical effects and urodynamic paramete rs were compared at baseline and after treatment one month. Results: The EUS was clearly identified as a neatly hypoechoic area extending from the prostatic apex to the levator ani muscle in men patients, but not in women patients. After treatment, the urinary function and urodynamic parameters is improved significantly compared with the baseline (P<0.05), and at 4 week up to a maximum efficacy. 6 (33.3%) patients had an excellent result and had 5 (27.7%) significant improvement. Relatively poor bladder contractility tended to be more frequent in the unimproved patients. However, the catheter insertion becomes easier In patients with failed treatment,. Stress urinary incontinence was reported in 4 patient. There was no other obvious side effects occurred in patients. Conclusion: Transrectal ultrasound is an effective method to visualize the lower urinary tract and allows for the accurate targeting of the EUS. It is a simple and repeatability method for the treatment of DSD. BTX-A injection to the EUS guided by transrectal ultrasound is an effective method in the treatment of SCI patients with DSD.

Keywords: Botulinum toxin A, detrusor sphincter dyssynergia, spinal cord injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1250 Top


Repetitive tests and association midodrine-penile vibratory stimulation help to preserve fertility in spinal cord injury patients: Results from a cohort of 86 patients

E. Castel-Lacanal, M. Salib, X. De Boissezon, J. M. Soler1, R. Mieusset2, P. Marque

CHU Toulouse Rangueil, Medecine Physique et Réadaptation, 2CHU Purpan, Médecine de la reproduction, Toulouse, 1Centre de rééducation Cerbere, Medecine Physique et réadaptation, Cerbere, France

E-mail: c_evelyne@yahoo.com;mathilde.prudhomme@neuf.fr

Introduction/Background: Ejaculation disorders are common in Spinal Cord Injury (SCI) patients and require often samples to preserve their fertility potential. The means to obtain ejaculation depend on the neurological level and the experience of the team. We reviewed the results of our cohort, the means used, particularly the benefits of adding Midodrine or penile vibratory stimulation (PVS) to obtain the sample. Materials and Methods: We collected retrospectively in our cohort of patients the epidemiological data, the type of ejaculation (anterograde or retrograde) and the means used to obtain a frozen sample of sperm. We compared the data of two groups : those who obtained an anterograde ejaculation (AE) and those only a retrograde (ER). Results: Between January 2013 and July 2017, 86 patients were seen in consultation, with a mean age of 30 years, mainly after traumatic injury (90%), cervico-thoracic level (89%) and complete lesion (59%). Ejaculation was not obtained in 13 patients (15%): 7 (8%) were considered to be failing, 4 had dropped out of care, and 2 were starting treatment. AE and RE were obtained in 73 patients (85%), which could be frozen in 63 patients (73%) mainly from an EA for 47 patients. Only 9 patients were able to obtain their sperm by self-stimulation, the other 54 needed to use single or double PVS associated or not with Midodrine. In the only ER group, predominantly patients with complete deficiency below T10, the dose of Midodrine, the number of trials and the frequency of use of double PVS were more important than in the EA group (respectively 23.5 mg vs 9 mg, 3 vs 1.8, 64% vs 29%). Conclusion: In SCI patients for whom it is difficult to obtain an ejaculation, it’s fundamental to look for ER, repeat the tests, aided by increasing dose Midodrine and PVS.

Keywords: Ejaculation, fertility, spinal cord injury

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1300 Top


Prevention and treatment of osteoporosis after spinal cord injury: A systematic review

M. Lauwers, M. De Jaeger1, N. Draulans, F. Luyten2, K. Peers, C. Kiekens

Departments of Physical and Rehabilitation Medicine and 2Rheumatology, KU Leuven, Leuven, 1Department of Neurosurgery, University Hospitals Brussels, Brussels, Belgium

E-mail: maarten.lauwers92@student.kuleuven.be

Introduction/Background: Spinal cord induced osteoporosis is a significant health condition associated with fragility fractures beneath the level of injury. In the scientific literature several treatment options have been proposed. The aim of this paper is to review the current literature about treatments’ efficacy for osteoporosis in spinal cord injury. Materials and Methods: A systematic literature search is conducted in four electronic databases: PubMed, Embase, The Cochrane Library and PEDro. All identified records are analysed by title, abstract and if relevant by full text to determine if they meet all inclusion criteria. Additionally, the included RCTs are judged to a quality control according to the Cochrane Handbook for Systematic Reviews of Interventions, Risk of bias assessment. Due to the heterogeneity of the included trials no meta-analysis is performed. Results: Thirty-two randomized controlled trials are included. Bisphosphonate therapy, if applied correctly, is effective to optimize bone quality, in both the early and chronic phase of the disease, although the evidence is debatable. Moderate-quality evidence suggests that intravenous administration of zoledronic acid is potentially the best approach to tackle this condition. Rehabilitation techniques, although widely used, show no proven efficacy on this matter. In addition, numerous experimental therapies have been proposed, but require further research to prove their applicability. Conclusion: This systematic review suggests that bisphosphonate administration could attenuate sublesional bone loss, while we did not find conclusive evidence about various rehabilitation techniques. Although this paper does not provide final evidence, it could be a useful tool for future research purposes.

Keywords: Osteoporosis, spinal cord injuries, therapy

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-2482 Top


Hot water immersion elevates interleukin-6 in persons with cervical spinal cord injury

K. Kouda, Y.I. Kamijo, T. Kinoshita, M. Banno, T. Yoshikawa, Y. Umemoto, F. Tajima

Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan

E-mail: ken.ac.kouda.0923@gmail.com

Introduction/Background: Core temperature elevations can impact positively on immunity, potentially due to increases of catecholamines acting on immune cells’ adrenergic receptors. The dysfunctional sympathetic nervous system in individuals with cervical spinal cord injury (CSCI) impairs adrenergic responses and may contribute to depressed immunity and the occurrence of low grade systemic inflammation related disorders. However, some immune markers improve following exercise in CSCI, even though the positive effects are often blunted. Non-exercise induced body temperature manipulations have yet to be investigated in CSCI. Materials and Methods: Seven male participants with a motor complete CSCI and 8 male able-bodied controls were immersed for 60 min in water set at a temperature 2 C above the individuals’ resting oesophageal temperature. Blood was collected before, during, and every hour up to 4 h after immersion and analyzed for interleukin-6 (IL-6). Results: Hot water immersion increased IL-6 in both groups (P < 0.001). IL-6 plasma concentrations were higher in CSCI, but it was not significant. Possibly, the reduced active muscle mass in CSCI does not allow for sufficient core temperature elevations during exercise to increase these cytokines. Together with the lower catecholamine levels usually found in CSCI, this may explain the blunted exercise response on some aspects of immunity. This seems especially concerning as higher average levels of IL-6 support the indication of chronic low grade systemic inflammation in CSCI. Conclusion: This is the first study to show an acute cytokine response induced by hot water immersion in CSCI. Passive elevation of core temperature may help to improve the cytokine profile in CSCI.

Keywords: Cervical spinal cord injury, cytokine, hot water immersion

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-0012 Top


Do spinal cord-injured individuals with stronger sense of coherence use different psychological defense styles?

M. Yazdanshenas Ghazwin

Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Universal Scientific Education and Research Network USERN, Tehran, Iran

E-mail: yazdanshenasm57@yahoo.com

Introduction/Background: Although the importance of sense of coherence (SOC) and psychological defense mechanisms (PDMs) in the process of coping has been demonstrated, it has not yet been clarified whether individuals with stronger SOC use specific PDMs. Materials and Methods: Demographic and injury-related variables including injury level, time since injury, American Spinal Cord Association (ASIA) Scale and Spinal cord independence measure-III were collected among individuals with spinal cord injury (SCI). SOC was assessed by the Short-form Sense of Coherence Scale. PDMs were identified using 40-version of the Defense Style Questionnaire. Results: Neurotic defense style was the most commonly used style especially. The overall most commonly used PDM was ‘rationalization’, which was used by 95%. Individuals with stronger SOC used more mature style (P=0.001, r=0.52), particularly ‘humor’ and ‘suppression’ mechanisms (Po0.0001 and 0.024, respectively). There was a negative correlation between stronger SOC and the use of immature defenses including passive aggression (P=0.001, r=− 0.51), acting out (P=0.001, r=− 0.48), isolation (P=0.009, r=− 0.50), autistic fantasy (P=0.010, r=− 0.30) and somatization (Po0.0001, r=− 0.62). Married individuals had significantly stronger SOC (P=0.01). Age, gender, age at the time of injury incidence, time since injury, ASIA score and cause of injury were not determinants of SOC. Conclusion: In this study, PDMs, which are more probable to be used by individuals with stronger SOC, have been identified. Mature defenses including ‘humor’ and ‘suppression’ are used by stronger SOC more often, whereas immature mechanisms are less likely to be used.

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1350 Top


Usability of the participation and quality of lifeoutcomes tool-kit website for spinal cord injury

M. Beaudoin1,2, K. L. Best1,2, F. Routhier1,2, L. Atack3, S. L. Hitzig4, 5, 6, 7, D. Kairy8,9

1Université Laval, Département de réadaptation, 2Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec , 3Applied Research and Innovation Centre, Centennial College, 4Sunnybrook Health Sciences Centre, St. John’s Rehab Research Program, 5Rehabilitation Sciences Institute, University of Toronto, 6University Health Network, Neural Engineering and Therapeutics Team, Toronto Rehabilitation Institute, 7Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, 8Université de Montréal, École de réadaptation, 9Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, n/a, Montréal, Canada

E-mail: maude.beaudoin.1@ulaval.ca

Introduction/Background: Spinal cord injury (SCI) is a life-changing event as it incurs primary impairment (e.g., paralysis, bladder dysfunction), as well as secondary health conditions (e.g., spasticity, pressure sores), and impacts on life domains (e.g., housing, transportation). As a result, assessing quality of life (QoL) post-SCI is challenging since QoL can be impacted in various ways depending on specific (or a combination of) health conditions and life domains. To address these challenges, the Participation and Quality of Life (PAR-QoL) website, an online knowledge mobilization tool, was developed to aid clinicians and researchers in the selection of QoL outcome tools specific to SCI. The aim of this study was to evaluate the usability and use of the website. Materials and Methods: Using a technology acceptance framework, an online usability survey was developed and employed to gain information about how the website was used, perceived ease of use, and improvement recommendations. The actual use was assessed through a 26-item survey and through Google analytics. Recruitment targeted researchers and clinicians who worked with individuals with SCI. Survey and web data were analyzed using descriptive statistics. Results: Forty-six individuals responded. More than 60% used the website to find tools for work. The website was perceived as easy to use by 80% of respondents. To improve the website, respondent suggested rearranging classification, developing a French version, and adding more up-to-date evidence. There were a total of 181,179 users who made 303,810 visits to the website between April 2012 and November 2017. Returning visitors comprised 13% of the total visits. Conclusion: The PAR-QoL website was perceived to be an important and useful knowledge mobilization tool with QoL outcome tools for SCI that are easy to find. Usability may be improved through modification of navigation processes and improved organization of content, which may facilitate greater uptake.

Keywords: Outcome tool, quality of life, usability

Disclosure of interest: The authors did not declare any conflict of interest.


  ISPR8-1864