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 Table of Contents  
ORAL ABSTRACTS
Year : 2018  |  Volume : 1  |  Issue : 1  |  Page : 3-102

Oral Abstracts


Date of Web Publication10-Jul-2018

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


DOI: 10.4103/2349-7904.236307

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How to cite this article:
. Oral Abstracts. J Int Soc Phys Rehabil Med 2018;1, Suppl S1:3-102

How to cite this URL:
. Oral Abstracts. J Int Soc Phys Rehabil Med [serial online] 2018 [cited 2018 Dec 9];1, Suppl S1:3-102. Available from: http://www.jisprm.org/text.asp?2018/1/1/3/239536




  A1.01 PAIN - Acute Pain Top



  ISPR8-0221 Top


Comparative study of treatment outcome of plantar fasciitis with local steroid injection by ultrasound versus palpation technique

D. Sharma

Department of Physical Medicine and Rehabilitation, VMMC and Safdarjung Hospital, New Delhi, India

E-mail: dpksharma268@gmail.com

Introduction/Background: Plantar fasciitis is a degenerative tissue condition occurs at the site of origin of plantar fascia at the medial calcaneum tuberosity. Most common symptom is described as first step pain. The treatment include heat modalities, patient education, stretching and strengthening exercises, NSAIDS, injections (steroids, local anesthetics, PRP), and surgical interventions (fasciotomy). Materials and Methods: It is a prospective and interventional randomised comparative study. 80 cases (40 in each group) in otherwise healthy individuals with the diagnosis of unilateral or bilateral plantar fasciitis attending Outpatient department of PMR of VMMC and Safdarjung hospital were enrolled in this study. The diagnosis of plantar fasciitis was made based on history and clinical examination.Patients who satisfied inclusion and exclusion criteria was randomly assigned by computerised block method into two groups-both were treated with injection of 40 mg (1ml) methyl prednisolone, one group with palpation guided and other with ultrasound guided. All patients underwent pain intensity assessment by VAS, ultrasound examination and X-ray at preinjection (0 week), 2 weeks and 8 weeks after steroid injection. Results: Statistically significant improvement in pain (VAS) at the end of 2 weeks (3.25 ± 0.95 vs. 2.65 ± 0.83, P = 0.003) and 8 weeks (2.28 ± 1.24 vs. 1.12 ± 1.07, P = 0.0005) of intervention in both groups but more in the USG guided group. There was decrease in plantar fascia thickness at the end of 2 weeks (0.33 ± 0.02 vs. 0.31 ± 0.02, P = 0.0005) and 8 weeks (0.30 ± 0.02 vs. 0.28 ± 0.02, P = 0.0005) of intervention in both groups but more in the USG guided group, which was statistically significant. No statistically significant difference in heel pad thickness at the end of 2 weeks (18.08 ± 0.76 vs. 18.23 ± 0.80, P = 0.356) and 8 weeks (18.00 ± 0.75 vs. 18.12 ± 0.79, P = 0.444) of intervention in both groups. Conclusion: Ultrasound guided injection is better than palpation method as it enhances the accuracy of injection by precisely localising the lesion and needle placement giving more relief in symptoms and normalisation of plantar fascia thickness.

Keywords: Heel pad thickness, plantar fascia thickness, ultrasound

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


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



  ISPR8-0397 Top


Whole body cryotherapy in fibromyalgia patients: effects on pain and functional mobility

M. Vitenet, F. Legrand1, B. Bouchet2, F. Bogard3, R. Taiar3, G. Polidori3, A. Rapin, F. C. Boyer4

Department of Physical and Rehabilitation Medicine Hospital, Reims Champagne Ardenne University Hospital, 1Reims Champagne Ardenne University, C2S-Cognition Health and Socialization, 2Reims, Cryotherapy Pole, 3Reims Champagne Ardenne University, (GRESPI) Groupe de Recherche en Sciences Pour l’Ingénieur, 4Department of Physical and Rehabilitation Medicine,Reims Champagne Ardenne University Hospital, Reims, France

E-mail: fboyer@chu-reims.fr

Introduction/Background: Fibromyalgia is a chronic disease that causes muscle pain and fatigue. Our objective was to determine whether Whole Body Cryotherapy (WBC) can result in improved functional status and pain in fibromyalgia patients. It was hypothesized that positive effects will be realized due to the cold-induced modulation of the inflammation-immune axis. Materials and Methods: This present study is a randomized controlled trial with one between-subject factor (WBC group vs. Control group) and one within-subject factor (measurement point with 4 levels: pre-study, J8, 2 weeks later, 1 month later). Several parameters assessing pain intensity and functional status were measured repeatedly. In the WBC group, 10 cryostimulation sessions were performed (in addition to usual care) in a two-stage cryogenic chamber over a duration of 8 days. Duration of each cold exposure session was set to 3 minutes at a temperature of -110°C. Subjects in the control group did not receive this intervention, and changed nothing in their everyday activities. Our primary study outcome measurement was recalled pain intensity over the last 7 days. Results: A convenience sample of 28 patients (Mage= 52.4 ± 10.3 years-old; 75% females) with fibromyalgia diagnosis were randomized (WBC, control). In pretest, the usual pain scores were respectively 7.50 ± 1.81 for the experimental group (WBC) and 5.92 ± 1.75 for the control group. It was a usual pain reduction at J8, 2 weeks and 1 month with respectively 4,88 ± 2,98 (P < 0,001), 3.13 ± 2.40 (P < 0.001), 3.25 ± 2.92 (P < 0.001) for WBC compared between 6.00 ± 1.47 and 5.62 ± 1.66 for control group. It was no change in the control group, WBC patients reported significant improvements on all secondary outcome measures (decreased disability/improved functional mobility). Conclusion: Patients with fibromyalgia were improved for pain and functional mobility after 10 whole-body cryostimulation (WBC) sessions compared the outcomes in the control group.

Keywords: Fibromyalgia, mobility, whole body cryotherapy

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


  ISPR8-1899 Top


Outcome of treatment of myofascial pain syndrome using a sequenced multidisciplinary rehabilitation protocol

D. Sharan

Department of Orthopaedics and Rehabilitation, RECOUP, Bengaluru, Karanataka, India

E-mail: drdeepaksharan@yahoo.com and joshua.samuel@recoup.in

Introduction/Background: Myofascial pain syndrome (MPS) is a common cause of non-articular musculoskeletal pain. The aim of this study was to estimate the prevalence and to describe the clinical features and outcome of treatment of MPS among persons with Work Related Musculoskeletal Disorders (WRMSD). Materials and Methods: A retrospective study was conducted among 20500 clients diagnosed with WRMSD, with a mean age of 33 ± 3 years. The relevant clinical data were extracted from the treatment chart of WRMSD patients who received treatment at a tertiary level Rehabilitation Centre or on-site Occupational Health Clinics. All the clients received a sequenced, multidisciplinary treatment protocol incorporating manual therapy techniques including trigger point therapy, muscle energy technique, myofascial release, psychological approaches, yoga, exercises and ergonomic modifications. Results: 87% of participants were diagnosed to have MPS. The commonest region affected was the upper back (54%), followed by the low back (44%). 76% were male and 56% worked for 8-12 hours. The commonest job categories of the participants were Managerial (33%), Software Engineers (32%) and Application Engineers (14%). Prolonged sitting, lack of rest breaks, lack of tray for keyboard and mouse, and poor posture was found to be the commonest risk factor. Associated co-morbidities were Hypovitaminosis D (26%), Hypermobile joints (24%), Osteopaenia/Osteoporosis (14%), Hypothyroidism (6%) and Hyperuricemia (6%). The commonest symptoms were Regional pain (78%), Stiffness (58%), Generalised pain (40%), Weakness (38%), Disturbed Sleep (38%), Fatigue (32%), Tingling (20%) and Numbness (18%). There was a significant reduction (P < 0.05) in pain following the rehabilitation. Ninety-five percent of the subjects made a complete recovery and returned to their regular work. Conclusion: In view of the high prevalence of MPS in this study, healthcare professionals dealing with musculoskeletal pain need to be trained in the current approaches to diagnose and manage MPS. A comprehensive, protocol-based multidisciplinary approach is recommended for the successful management of MPS.

Keywords: Muscle pain, outcome, rehabilitation

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


  ISPR8-2315 Top


Extracorporeal shock wave therapy versus 1% xylocaine injection for myofascial trigger point release with novel analysis by sonoelastography

A. Suputtitada, C. Schmitz1, N. Ngamrungsiri

Department of Rehabilitation Medicine, Chulalongkorn University, bangkok, Thailand, 1Department of Anatomy II, Ludwig Maximilians University, Munich, Germany

E-mail: sareerat1111@gmail.com

Introduction/Background: Introduction and Backgroun: Extracorporeal shock wave therapy (ESWT) has become an alternative in the treatment of myofascial trigger points (MTPs). Sonoelastography has evidences in quantitative assessment of MTPs. Purpose: This study tested the hypothesis that both radial ESWT (rEWST) and injection of 1% xylocaine are effective and safe treatments for active MTPs with novel analysis by sonoelastography. Design: Prospective, randomized single blinded clinical trial. Materials and Methods: Patients (n = 20) with active MTPs of UTM were randomized to receive either rESWT (n = 10); three rESWT sessions; one session per week; 2000 rESWT impulses per session; positive energy flux density = 0.10 mJ/mm2) or 1% xylocaine (4 ml) injection (n = 10) (three injections; one injection per week). The outcome measure were the elasticity score of MTPs assessed with sonoelastography, pain (VAS score), active range of motion of the neck, and McGill scores three weeks after baseline. Results: Both rESWT and injection of 1% xylocaine resulted in statistically significantly (P < 0.05) reduced elasticity scores, VAS scores of UTM and McGill scores, as well as statistically significantly (P < 0.05) increased range of motion of the neck at three weeks after baseline. Except of a lower mean McGill sensory score after injection of 1% xylocaine compared to rESWT (-29%; P < 0.05) repeated measures two-way analysis of variance followed by Bonferroni post-tests for pairwise comparisons showed no statistically significant differences between rESWT and injection of 1%xylocaine. Conclusion: Both rESWT and 1% xylocaine injection are effective and safe treatments of active MTPs of UTM. Ultrasound elastography appears useful for objectively monitoring treatment success.

Keywords: Myofascial trigger points, radial extracorporeal shock wave therapy, sonoelastography

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


  A1.04 PAIN - Miscellaneous Top



  ISPR8-2720 Top


Patient pain satisfaction scores unaffected by opioid reduction protocol utilizing morphine equivalent dose calculations

P. Kunj, R. McCarty, M. Rozak, E. Chandrasekhar, A. McCrate, B. Abramoff, M. Reed, B. Milton, D. Strasser

Department of Rehabilitation Medicine, Emory Rehabilitation Hospital, Atlanta, Georgia, USA

E-mail: michael.rozak@emory.edu

Introduction/Background: Opioids are important for pain management during inpatient rehabilitation facility (IRF) stays, but are potentially overprescribed. Previously, we performed a prospective study utilizing an opioid reduction protocol to significantly reduce the opioid burden in patients admitted to an IRF. This study retrospectively analyzed patient pain satisfaction survey scores to determine the effect of the opioid reduction protocol on patient pain satisfaction. Materials and Methods: We included all patients admitted to an IRF at an academic institution during a two-month period in 2016 and calculated the Morphine Equivalent Dose (MED) for admission and discharge. We delivered informative lectures to prescribers regarding CDC recommendations, posted MED charts, calculated weekly MED scores and repeated MED calculations for all admissions and discharges over the following two months. Satisfaction surveys were sent to all patients upon discharge, with pain scored 0 to 5 (0-not controlled, 5-extremely well controlled). Results: Surveys were obtained from 34 of 75 patients in the pre-intervention group and 41 of 87 in the post-intervention group. There was no statistical difference in pain satisfaction between the two groups (P = 0.38) with an average satisfaction of 3.68 and 3.32 for the pre and post-interventional groups, respectively. MED was decreased from admission to discharge in the pre-intervention group by an average of 17.79, a 44% decrease, while the post-interventional group MED decreased on average by 24.08, a 49% decrease. These findings are an important, since the primary study showed dramatic reductions in MED between pre and post intervention groups, reducing the percent of patients whose MED was greater than 50 by nearly half (23% to 12%). Conclusion: This study demonstrates a method of tracking patient pain satisfaction whilst reducing opioid utilization in an IRF setting, and provides evidence that opioid weaning by tracking MED calculations does not negatively influence patient pain control satisfaction.

Keywords: Opioid, pain, satisfaction

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


  ISPR8-1313 Top


Five days of rtms associated with motor imagery can decrease durably central neuropathic pain: results from a cohort of 47 patients

E. Castel-Lacanal, M. Prudhomme, X. De Boissezon, M. Belle, P. Marque

CHU Toulouse Rangueil Medecine Physique et Réadaptation, Toulouse, France

E-mail: c_evelyne@yahoo.com and athilde.prudhomme@neuf.fr

Introduction/Background: Neuropathic pain are frequent and often drug resistant, with an important impact on quality of life and function recovery. The aim of this study was to assess the efficacy of high frequency rTMS on motor cortex associated with motor imagery in patients with neuropathic pain. Materials and Methods: Between december 2014 and april 2017, 47 patients with central neuropathic pain were included. We studied clinical parameters (age, gender, pathology, pain duration and pain location) as well as cortical excitability. Before the treatment, a DN4 score and a BPI score were realized.Those two scores were repeated 48hours after the treatment, at the beginning and at the end of 5 days of treatment, and during the follow up (at M1, M3 and M6.). The treatment consisted in daily rTMS session, during five days, associated with motor imagery and mirror therapy.The primary outcome was a decreasing of the most intense pain of two points, defining responders. Results: Thirty-four men and 13 women, 56,5 years old mean, with neuropathic pain from 6,6 years on average, principally secondary to stroke (n = 24). Were included. Thirty percent of patients were responders at 48 hours, M1 and M3, and this diminution of pain was significant (all P < 0, 05). There was a significant association between responders at 48hours and responders at M1 and M3, as well as between pain duration and non responders at M3 (P < 0, 03). Conclusion: This study shows that high frequency TMS on the motor cortex associated with motor imagery can decrease neuropathic pain, as it is describes in literature, but durably with an effect until 3 months in our study. Furthermore, it may exist a link between responders at 48hours and responders in the long term.

Keywords: Motor imagery, neuorpathic pain, repetitiv transcranial magnetic stimulation

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



  ISPR8-0516 Top


Patient acceptable symptom state and minimally clinically important difference for patient-reported outcomes in systemic sclerosis: a secondary analysis of the sclereduc trial

C. Daste, F. Rannou1, L. Mouthon2, K. Sanchez, A. Roren, V. Tiffreau3, E. Hachulla4, P. Thoumie5, J. Cabane6, E. Chatelus7, J. Sibilia7, S. Poiraudeau1, C. Nguyen1

AP-HP-Hôpital Cochin, Rééducation et Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, 1Faculté de Médecine, Université Paris Descartes, Rééducation et Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, 2Faculté de Médecine, Université Paris Descartes, Médecine Interne, 5Department of Physical and rehabilitation Medicine, Université Paris Pierre et Marie Curie-Faculté de Médecine, 6Université Paris Pierre et Marie Curie-Faculté de Médecine, Internal Medicine, Paris, 7Department of Rheumatology,Université de Strasbourg, Strasbourg, 3Department of Physical and Rehabilitation Medicine, Université de Lille 2, 4Université de Lille 2, Internal Medicine, Lille, France

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

Introduction/Background: We aimed to determine patient acceptable symptom state (PASS) and minimally clinically important improvement (MCII) estimates for patient-reported outcomes (PROs) in systemic sclerosis (SSc). Materials and Methods: 220 patients participated in the SCLEREDUC trial, a 12-month, randomised controlled study comparing the efficacy on disability assessed by the HAQ-DI at 12-months of physical therapy compared to usual care in patients with SSc. Self-rated state and change in patient health at 12 months post-randomization were assessed by using 2 external anchoring questions from the Medical Outcomes Study 36-Item Short Form. Patients who self-rated their health as “excellent”, “very good” or “good” were considered as having an acceptable symptom state and those who self-rated their health change at 12 months as “somewhat better” were considered as minimally improved. PASS estimates were obtained using the 75th percentile method and the MCII estimates by using the mean change in scores method. Results: Answers to both anchoring questions at 12 months were available for 151/220 (68.6%) participants. PASS (95% CI) and mean (SD) MCII estimates at 12 months were respectively : 53.75 (34.00 to 68.00) and -6.74 (32.02) for the joint-pain visual analog scale (range 0-100), 1.41 (1.13 to 1.63) and -0.21 (0.48) for the Health Assessment Questionnaire Disability Index (HAQ-DI, range 0-3), 1.27 (1.07 to 1.62) and -0.13 (0.45) for the scleroderma HAQ (sHAQ, range 0-3), 26.00 (17.00 to 37.00) and -3.38 (9.87) for the Cochin Hand Function Scale (range 0-90), and 19.40 (17.20 to 21.90) and - 5.69 (6.79) for the McMaster-Toronto Arthritis Patient Preference Disability Questionnaire (range 0-30). For all PROs, higher scores indicate higher symptoms levels. Conclusion: The present study provides PASS and MCII estimates for commonly used PROs in SSc. These estimates are useful in interpreting the clinical relevance of outcomes used in patients’ care and in clinical trials.

ClinicalTrials.gov identifier: NCT00318188.

Keywords: Patient-reported outcomes, systemic sclerosis

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


  ISPR8-2043 Top


The discriminative ability of fraxto identify prevalent post-sci lower extremity osteoporotic fractures

R. Battaglino, G. Cobb1, N. Nguyen1, L. Morse1

Department of Physical Medicine and Rehabilitation, UC Denver, Aurora, 1Craig Hospital, Research, Englewood, Colorado, USA

E-mail: ricardo.battaglino@ucdenver.edu

Introduction/Background: SCI causes rapid, severe osteoporosis. More than half of those with motor complete SCI will experience an osteoporotic fracture at some point following their injury. Despite the high prevalence, there is no SCI-specific fracture risk prediction tool. Therefore, we sought to compare the discriminative value of risk fracture scores used in the general population, (FRAX score, T-score, and Z-score) in adults with spinal cord injury. We also assessed the sensitivity and specificity of osteoporosis definitions based on FRAX and T-score. Materials and Methods: We assessed 318 adult men with chronic SCI (at least 1 year post-injury). Bone density at the hip (total hip, femoral neck), knee (distal femur, proximal tibia), and radius was determined by DXA scan. Ten-year major osteoporotic fracture and hip fracture FRAX scores were calculated based on bone density at the femoral neck.Prevalent post-SCI fractures were categorized as osteoporotic or traumatic and only lower extremity osteoporotic fractures were considered in the analysis. The overall discriminative value of each score was assessed by calculating areas under the ROC curve. Results: The prevalence of post-SCI lower extremity osteoporotic fracture was 22%. When comparing bone density at the hip (AUC 0.7681-0.7858), bone density at the knee (AUC 0.7821-0.7733), bone density at the radius (AUC 0.6263), T-score (AUC 0.7890), Z-score (AUC 0.7040), and FRAX scores, 10-year major osteoporotic FRAX score (AUC 0.8381) had the greatest discriminative ability to identify prevalent post-SCI lower extremity osteoporotic fractures.Major osteoporotic FRAX score cut-point of >10% had greater sensitivity and specificity than the cut-point recommended in the general population (>20% probability of fracture) recommended in the general population. Conclusion: Ten-year major osteoporotic FRAX score may have clinical utility in fracture risk prediction after spinal cord injury. However, cut-points may need to be SCI-specific (>10%) to improve predictive value.

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


  ISPR8-0358 Top


The effect of intraarticular injection of botulinum toxin type a, triamcinolone or saline plus rehabilitation exercise shoulder pain on patients with post-stroke

X. Bao, Y. J. Shao1, H. Y. Liu

Department of Rehabilitation Medicine, Yue Bei People’s Hospital, ShaoGuan, 1Department of Rehabilitation Medicine, Ganzhou People’s Hospital, Ganzhou, China

Presenter Email: baoxiao1981@sina.com

Introduction/Background: Shoulder pain is the most common complication of post-stroke, which occur up to 60% patients with poststroke. The aim of our research is to study the effect botulinum toxin type A and triamcinolone for shoulder pain on patients with post-stroke. Materials and Methods: Eventy-five patients with shoulder pain on post-stroke patients were randomly divided into three groups based on difference of injection (A:BoNT-A, B: triamcinolone, C: saline). Each group was injected once with ultrasound guidance. All groups received therapeutic exercise up to 4 weeks. The Evaluation of Fugl-Meyer assessment (FMA), Visual Analogue Scale (VAS) and pain-free range of motion (ROM) were recorded for pain and quality of life at baseline and end of 4th week after injection. Results: The FMA of upper-limb were significantly improved in group A and group B patients between baseline and end of 4th week (P < 0.05). The VAS score in group A and group B significantly decreased from 6.9 ± 1.1 (baseline) to 2.7 ± 1.4, and from 6.3 ± 1.2 (baseline) to 4.4 ± 1.2 at 4 weeks (P < 0.05) respectively. The passive ROM and active ROM were significantly improved in group A and group B patients between baseline and 4 weeks (P < 0.05). The between-group comparison revealed significant differences in group A and group B, group B and group C with regard to the FMA of upper-limb, VAS score and ROM at 4 weeks (P < 0.05). No changes were observed for the group C after intervention. No adverse events was occurred in all group patients. Conclusion: The all treatments can significantly reduce shoulder pain and recovery function in patients with stroke, but BoNT-A combined with physical therapy seems to affect better for such patients.

Keywords: Botulinum toxin type a, shoulder pain, triamcinolone

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


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



  ISPR8-1787 Top


Sagging peribursal fat sign as a highly specific sonographic finding to diagnose full-thickness supraspinatus tendon tear

S. G. Chung, Y. S. Jung, J. G. Kim, C. L. Lim, S. J. Park

Department of Rehabilitation Medicine, SNUH, Seoul, South Korea

E-mail: suncg@snu.ac.kr

Introduction/Background: Diagnosing a chronic full-thickness supraspinatus tendon tear using ultrasound is challenging because tendon defects are usually obliterated with fibrous tissues, mimicking continuity of tendon. Among many direct and indirect ultrasonographic signs for full-thickness supraspinatus tendon tears, diagnostic values of indirect signs, especially sagging peribursal fat sign (SPFS), have been undervalued. To investigate whether the presence of SPFS would be suggestive of a full-thickness tear, the sensitivity, specificity and predictive value of SPFS were analyzed by regarding arthrosonography as a standard reference. Materials and Methods: 104 patients with shoulder pain for more than 3 months, who underwent arthrosonography under the suspicion of full-thickness supraspinatus tendon tear were included. Suspicion of full-thickness tear was determined by substantial loss (>50% of thickness) of fibrillary patterns in either the bursal or articular side with more than one of four indirect signs such as long biceps tendon sheath swelling, cortical irregularity, double cortex sign and SPFS. Patients with obvious tendon defect were excluded because diagnosis is too obvious to consider indirect sings. Arthrosonography was done by injecting 20ml of fluid into the glenohumeral joint capsule followed by careful sonographic evaluation on the subacromial subdeltoid bursal space to find any fluid leaking, which would confirm the existence of true full-thickness tear, serving as a communication channel between the joint capsule and superficial space overlying the rotator cuff tendons.



Results: The SPFS was the most sensitive (88.4%) and specific (98%) to diagnose full-thickness tear among the indirect signs. When SPFS was combined with other indirect signs such as biceps tendon sheath swelling, cortical irregularity of humeral head, double cortex sign, the specificity and positive predictive value reached up to 100%. Conclusion: These results highlight that SPFS can be served as a strong evidence of full-thickness supraspinatus tendon tear.

Keywords: Rotator cuff tendon tear, shoulder pain, ultrasonography

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


  ISPR8-0026 Top


Comparison between platelet-rich plasma and hyaluronic acid treatments for talar osteochondral lesions: a systematic review with a network meta-analysis of randomized controlled trials

W. Li

Department of Rehabilitation, Taipei Medical University Hospital, Taipei City, Taiwan

E-mail: a4910131@gmail.com

Introduction/Background: Both platelet-rich plasma (PRP) and hyaluronic acid (HA) with or without surgical intervention can enhance healing and improve function in talar OCLs. However, recent studies on OCLs have not thoroughly investigated the effects among PRP, HA, and conventional treatment.Our purpose is to synthesize evidence by comparing the effects (pain score and foot and ankle condition scores) among PRP, HA, and conventional treatment strategies for talar OCLs. Materials and Methods: All relevant research articles were included using related terms in the PubMed, EMBASE, Web of Science, ScienceDirect, and Cochrane library databases from their inception to June 2017. The screening criteria for this systematic review were as follows: randomized controlled trials (RCTs) that compared PRP with HA, PRP with control, or HA with control in patients with talar OCLs. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias Tool. Data were extracted and recorded as weighted mean difference (WMD) and their standard deviations (SDs) with 95% confidence intervals (CI), consistency H, and I 2 for continuous data in the network meta-analysis. Results: A total of 1199 references were identified, of which five RCTs were included in the final synthesis. These studies randomized 197 patients into the PRP, HA, and control groups. PRP caused higher reductions in the visual analog scale score than HA and conventional treatment, and the WMDs were −1.109 (95%CI: −1.716, −0.502) and −2.301 (95%CI: −2.825, −1.777). Moreover, PRP improved the American Orthopedic Foot and Ankle Society score more than the other treatment methods, and the WMDs were 12.448 (95%CI: 7.224, 17.672) and 18.617 (95%CI: 13.536, 13.698). Conclusion: PRP reduced pain and improved ankle conditions to a greater extent than HA and conventional treatment. Therefore, PRP might be recommended for the treatment of talar OCLs. Further investigation is required to guarantee the safety and efficacy of different surgical treatments.

Keywords: Hyaluronic acid, osteochondral lesions of talus, platelet rich plasma

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


  ISPR8-0096 Top


Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: a randomized clinical trial

S. Mohsenolhosseini

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

E-mail: saramah22@gmail.com

Introduction/Background: Knee osteoarthritis is a major cause of disability among the middle to senior age groups. Despite beingeffective, office-based physical therapy (OBPT) needs professional human resources and is both costly and time-consuming.We aimed to compare the efficacy of tele-rehabilitation (tele-rehab) compared with OBPT in patients with kneeosteoarthritis. Materials and Methods: In this randomized clinical trial, patients with symptomatic osteoarthritis of the knee were assigned to participate ineither a 6-week home-based tele-rehab or an OBPT program between 2015 and 2016. Our primary outcome was the meanchange from the baseline until 1 and 6 month’s post-intervention in scores of the Knee injury and Osteoarthritis OutcomeScore (KOOS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used analysis ofvariance for the repeated measure statistical test. Results: A total of 54 patients entered the final analysis, with 27 in each group. The mean age of the patients was 58.2–7.41years and 60.2% were female. In the tele-rehab and OBPT group, KOOS scores increased from baseline to 6 months post-intervention (50.6 to 83.1 and 49.8 to 81.8) respectively. There was no significant difference between tele-rehab and OBPTgroups in any of the studied scales. Conclusion: The tele-rehab program is as effective as OBPT in improving the function of patients with knee osteoarthritis.Considering the much lower time and cost consumed by tele-rehab, it is the recommended program for the older populationliving in remote sites.



Keywords: Knee osteoarthritis, telerehabilitation

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


  ISPR8-2286 Top


Rasch analysis of the “forgotten joint” questionnaire

D. D. Niama Natta, E. Thienpont1, A. Bredin2, G. Salaun2, C. Detrembleur2

Department of Physical Medecine and Rehabilitation, National University Hospital of Cotonou, Cotonou, Benin, 1Department of Orthopaedic Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, 2Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium

E-mail: digitalesfr@yahoo.fr

Introduction/Background: Total knee arthroplasty has revolutionized the management of knee osteoarthritis in the world. The “Forgetten Joint Score” was developed to evaluate the patient after total knee arthroplasty. The aim of this study is to validate the FJS-12 questionnaire according to Rasch model. Materials and Methods: Data from 263 subjects regarding the response to the FJS-12, KOOS and KUJALA scales as well as their ages, genders, body mass index, type of knee arthroplasty were collected. Rasch analysis was performed to verify item response categories, overall fit to the Rasch model, differential item functioning, unidimensionality of the scale, and internal consistency. The validity of the construct was also studied according to the Classical Test Theory. Results: The item-trait interaction shows a good fit with the Rasch model: Chi-squared = 24.34 and P = 0.23. The item difficulty ranges from -0.57 logits to 1.41 logits with residual average of -0.47 ± 2.26. Comparison of the subgroup estimates in each factor did not reveal a significant difference between the different subgroups. There was a good correlation between the estimates of the different subgroups: for ICC age = 0.97 and P < 0.001; for sex, ICC = 0.88 and P < 0.001. The reliability index of the scale is 0.87. Conclusion: The “Forgetten Joint Score” validated include 10 items with four response categories. It has good internal consistency. It has neither a ceiling effect nor a floor effect. It is one-dimensional and linear. It has excellent correlation with the KOOS and KUJALA scales.

Keywords: Forgetten joint score, rasch analysis, total knee arthroplasty

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


  ISPR8-0526 Top


Knee osteoarthitis and platelet-rich plasma treatment : how to improve the efficency?

C. Milants1, O. Bruyère1, J. F. Kaux2

1Department of Epidemiology, University of Liège, 2Department of Physical and Rehabiitation Medicine and Sports Traumatology, University of Liege, Liege, Belgium

E-mail: jfkaux@chuliege.be

Introduction/Background: The management of chondral disease is challenging. New studies have focused on modern therapeutic methods that stimulate cartilage healing process and improve the damage, including the use of platelet-rich plasma (PRP). PRP is prepared from autologous blood by centrifugation to obtain a highly concentrated sample of platelets. Due to the mixed results from controlled studies, the clinical efficacy of PRP in the treatment of knee OA is unclear with shortcomings in the current literature. Materials and Methods: A comparison of the outcomes of randomized controlled trials (RCTs) included in the 3 most recent and high-quality meta-analyses to classify the different studies in 2 groups (bad responders group (BRG) and very good responders group (VGRG)). The minimal clinically important improvement (MCII) was defined to help determining whether an observed difference is clinically important. We used MCII values to classify the different studies in 2 groups depending on the outcomes: BRG < MCII and VGRG >2xMCII. Results: From the 19 RCTs analyzed, 7 trials were included in the VGRG and 4 in the BRG. In VGRG, 1 or 2 injections were performed in 4/7 trials, time between injections was 2 to 3 weeks in 4/5 studies with many injections, volume injected varied from 2.5 to 8mL, and single spinning technique was used in 5/7 studies. PRP classification was Mishra 4B and PAWP2Bβ in 5/7 studies. The use of PRP with leukocytes is only found in the BRG. Conclusion: Our study helped identify features of PRP recommended for knee OA treatment, such as the use of a single spinning technique, a platelet concentration lower than 5 times the baseline (from 3 to 4), and avoiding leukocytes and erythrocytes. We recommend leveraging this information about PRP for future studies.

Keywords: Osteoarthritis, platelet-rich plasma

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


  ISPR8-0120 Top


Study of effectiveness of lateral wedge insole in medial compartment of osteoarthritis of knee treated with viscosupplementation

V. Kanaujia

Department of Physical Medicine and Rehabilitation, AIIMS, Rishikesh, Uttarakhand, India

E-mail: vinay.kanaujia87@gmail.com

Introduction/Background: Osteoarthritis (OA) of knee is one of most common musculoskeletal disorder affecting theelderly population in Asia-Pacific region. The goals of OA treatment include alleviation of pain andimprovement of functional status. Viscosupplementation (VS) is being a more widely accepted andpracticed mode of treatment for symptomatic osteoarthritis of knee. In addition to this heat and coldtherapy, exercise, electro therapy, ADL modification, orthotic devices like Lateral Wedge Insole (LWI), shock absorbing insoles and knee brace are also available and widely prescribed in day to day practice. Materials and Methods: This study is a single center randomized interventional study in which total 60patients were selected from tertiary care center and divided in two equal groups using computerizedblock randomization. Group A got only VS while Group B got VS and LWI. Assessment was done atbaseline and then after 2, 4 and 12 weeks after the intervention by using VAS, WOMAC and HAQ. Results: In this study all the patients in both group showed statistically significant improvement in VAS,WOMAC and HAQ on all three follow ups over the previous assessment(P value and lt; 0.0005). On inter-groupcomparison, statistically significant better results were noticed in the WOMAC scores of group B at 2 and4 week (P value and lt; 0.0005) follow up over group A. Similar benefit or difference was not evident in terms ofVAS or HAQ (P value and gt; 0.0005.) at any follow up in any of the two groups. The statistically better result in group B on WOMAC was not seen at the 12 week follow up. Conclusion: Bimodal approach of VS and LWI with different mechanism of action has a definite benefit in the management of OA knee. Lateral wedge on combination with VS results in faster onset of benefit within 2 weeks in function as tested by WOMAC scale. OA knee equalized by 12 week of follow up.

Keywords: Knee osteoarthritis, lateral wedge insole, viscosupplimentation

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


  ISPR8-1603 Top


Minimally invasive surgery leads to earlier recovery of quality of gait after total hip arthroplasty secondary analysis of a randomized controlled trial

D. Lussato, D. Biau1, M. M. Lefevre-Colau2, F. Rannou3, P. Anract1, A. Roren2

Hôpital Cochin AP-HP, Rééducation et Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, 1Hôpital Cochin AP-HP, Equipe ECaMO, CRESS-UMR1153, Chirurgie Orthopédique, Université Paris Descartes, 2Hôpital Cochin AP-HP, Equipe ECaMO, CRESS-UMR1153, Institut Fédératif de Recherche sur le Handicap, Rééducation et Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Université Paris Descartes, 3Hôpital Cochin AP-HP, INSERM U1124, Rééducation et réadaptation de l’appareil locomoteur et Des pathologies du Rachis, Université Paris Descartes, Paris, France

Presenter Email: alexandraroren@yahoo.fr

Introduction/Background: Recently, minimally invasive hip surgery (MHS) has been developed as a mean of accelerating patient’s time to full recovery. Previous analysis of early postoperative data showed that the time to reach complete functional independence (including walking 30 meters) wasn’t shortened with MHS compared to standard hip surgery (SHS). However there is only little evidence on the benefits of MHS on the quality of gait. Symmetrical distribution of load is a useful clinical tool related to it. The aim of this secondary analysis was then to compare the quality of gait in patients with MHS or SHS. Materials and Methods: One-hundres seventy patients were randomized into 2 groups, SHS and MHS. The major criterion was bilateral distribution of load assessed on a stabilometric platform 3 months after surgery. Other criteria were pain, lameness, need of a walking aid and difficulty in using stairs assessed by self-administered questionnaire at 3 and 12 months after surgery. Continuous and categorical variables of interest were compared using Student’s t and Chi-square tests. Results: Patients of the MHS group showed significantly more symmetrical distribution of load (48 VS 52% in the MHS group and 45.2 versus 54.8% in the SHS group, for operated and contralateral limb, respectively, P = 0.020) and less functional impairment: decreased lameness (6.4 vs. 21% in MHS and SHS groups, respectively, P = 0.021), need of walking aid (75.8 vs. 88.6% in MHS and SHS groups, respectively, P = 0.027), difficulty in using stairs (14.5 vs. 34%, in MHS and SHS groups, respectively P = 0.015) at 3 months after surgery. There were no more differences between groups 12 months after surgery and no difference in pain score. Conclusion: MHS allows earlier recovery of symmetric load and physiological gait. Difference in pain can’t explain the differences in functional abilities that could be the result of the decreased muscle trauma and of the deterioration of proprioceptive sensors.

Keywords: Gait, minimally invasive surgery, total hip arthroplasty

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


  ISPR8-1644 Top


Clinical and laboratory data are both essential to assess the locomotor patterns at 4 months post total-knee arthroplasty

S. Nadeau, H. Moffet1, H. Corriveau2

Centre de Recherché Interdisciplinaire en Réadaptation (CRIR), CIUSSS, Centre-Sud-de-l’Île-de-Montréal, Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, École de Réadaptation Université de Montréal, Montreal, 1Département de Réadaptation, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), CIUSSS de la Capitale-Nationale, Institut de Réadaptation en Déficience Physique de Québec, Université Laval, Québec, 2Centre de Recherché sur le Vieillissement du Centre de Santé et de Services Sociaux, Institut Universitaire de Gériatrie de Sherbrooke, Université de Sherbrooke-Réadaptation, Sherbrooke, Canada

E-mail: sylvie.nadeau@umontreal.ca and johanne.higgins@umontreal.ca

Introduction/Background: A recent randomized clinical trial, comparing the clinical effectiveness of a rehabilitation program delivered at home using videoconference technology or face-to-face visits, has revealed equivalent outcomes at 4 months after total-knee arthroplasty (TKA). Here we present the results of the laboratory analysis and the relationships with clinical outcomes for a subgroup of participants. The aim of this subgroup analysis (43% of the whole cohort) was to determine whether the clinical outcomes obtained from a physical assessment are sufficient to predict asymmetry during locomotor patterns at 4 months post-TKA. Materials and Methods: Eighty-four individuals (mean age and standard deviation: 66 (7.5) years) who had received 8 weeks of physiotherapy were assessed 4 months after TKA. In addition to clinical assessment (pain, ROM and strength, 6MWT and comorbidity, global function of the lower limb with WOMAC), the locomotor patterns during two tasks, sit-to-stand (three foot conditions) and walking at two speeds, were evaluated in the laboratory. Statistical analyses assessed the relationships between clinical outcomes and biomechanical data, more specifically locomotor asymmetry of performance. Results: Participants had moderate pain, and ROM and strength at the knee were inferior on the operated side. Mean values in the WOMAC, 6MWT and stair capacity were 84.7 (14.4), 411.4m (93.9) and 19.2 (23.5), respectively. They performed the STS with an asymmetrical use of the operated knee although they could perform more symmetrically when imposed. They were more asymmetrical at fast than normal speed during walking. The knee angles, moments, powers and force asymmetries correlated weakly with clinical outcomes except for the knee extensor strength asymmetry with STS. The clinical outcomes explained only a small part of the variance in the locomotor asymmetry. Conclusion: These results bring more evidence that laboratory assessment is essential to characterize the locomotor patterns post-TKA and that it provides useful information to the clinicians.

Keywords: Gait, knee arthroplasty, sit-to-stand

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


  ISPR8-0664 Top


Intra-articular oxygen-ozone therapy in knee osteoarthritis: results of a 31-week randomized, single-blind study versus intra-articular hyaluronic acid

A. De Sire, D. Stagno1, M. A. Minetto2, C. Cisari3, A. Baricich1, M. Invernizzi3

Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, 1Physical Medicine and Rehabilitation Unit, University Hospital”Maggiore Della Carità”, 3Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, Novara, 2Department of Surgical Sciences, Division of Physical Medicine and Rehabilitation, Turin, Italy

E-mail: alessandro.desire@gmail.com and m.pinto@istitutotumori.na.it

Introduction/Background: Intra-articular (IA) oxygen-ozone (O2O3) has recently grown as a novel therapeutic option in knee osteoarthritis (KOA) and few studies in literature explored its safety and impact on pain and functional status in these patients. The aim of this study was to assess the effectiveness and safety of IA O2O3 compared to ialuronic acid (HA) in terms of pain, knee function, and health-related quality of life in patients affected by KOA over 31 weeks. Materials and Methods: In this randomized, single-blind, controlled study patients aged ≥60 years affected by KOA have been enrolled and randomly allocated to receive 4 IA knee injections once per week for 4 consecutive weeks of O2O3 or HA (T0-T3) and a follow-up visit 4 weeks after the fourth injection (T4). Patients having a Visual Analogue Scale (VAS) ≥4 at 6 months follow-up visit (T5) underwent a second treatment cycle (T5-T8) and a 1-month follow-up visit (T9). All adverse events occurred, VAS, Oxford Knee Questionnaire, 12-Item Short Form Health Survey, and European Quality of Life-5 dimensions scores have been assessed. Results: Forty-six patients (mean aged 70.8±2.4 years) were enrolled and randomly allocated to O2O3 (n = 23) or HA treatment group (n = 23). Nineteen patients reported a VAS ≥4 at T5, undergoing a second treatment cycle: 10 in O2O3 group and 9 in HA group. There were no significant differences in adverse events occurrence between the two groups. VAS scores showed a statistically significant reduction (P < 0.013) compared to baseline during both treatment cycles in both groups. At both follow-up visits (T4 and T9) the VAS score was significantly lower in the HA group compared to O2O3 group (P < 0.013). Conclusion: IA O2O3 therapy could be comparable to IA HA in terms of safety profile and effectiveness in reducing pain in patients with KOA, even on a multiple injection cycles and long term follow-up.

Keywords: Hyaluronic acid, knee osteoarthritis, oxygen-ozone

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


  ISPR8-1457 Top


The efficacy of land versus water exercise program on body composition in obese patients with knee osteoarthritis

T. Tamin, N. Loekito

Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

E-mail: tirzaediva.tamin@gmail.com

Introduction/Background: Obesity and Osteoarthritis (OA) can affect each other and make a reciprocal causal chain with negative feedback that caused by physical inactivity. Water-based (WB) and land-based (LB) exercises are effective to improve body composition and physical activities. The aim of this study was to compare the effects of both exercise programs on body composition in obese patients with knee OA. Materials and Methods: A single-blind randomized controlled trial was done involving 33 men and women aged 40–80 years old with BMI ≥25 kg/m2 and knee OA grade 2 and 3 based on Kellgren-Lawrence grading scale. Subjects were randomly divided into LB (n = 18) and WB group (n = 15) with aerobic and knee-strengthening exercises for 8 weeks. Body weight (BW), body mass index (BMI), and waist circumference (WC) were measured before and after the program. Data will be analyzed using SPSS 20.0 with independet t test, Wilcoxon and Mann–Whitney test if necessary. Results: Participants who performed the LB exercise program showed significant improvement in BW (mean, 0.22 ± 0.92; P = 0.025), BMI (median, 0.36 (0.68–2.88); P = 0.040), and WC (mean, 2.13 ± 3.66; P = 0.024). While there was no significant improvement of body composition in WB group. However, when both groups were compared, BMI was the only variable that was significantly different (P = 0.048), with subjects of LB group showing better result than the WB group. Conclusion: Land-based exercise program was more effective to improve body composition in obese patients with knee OA due to the effect of gravity that improved muscle strengthening without buoyancy such as in the water. Warm water temperature gives relaxation effect that increases appetite. We suggest longer period of research and greater number of participants to better show a significant improvement for WC and BW variables.

Keywords: Body composition, land-based exercise, obesity

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


  ISPR8-1547 Top


Volumetric findings of mri after platelet rich plasma injection in knee osteoarthritis. (a randomized clinical trial)

S. A. Raeissadat, E. Ghorbani, S. M. Rayegani, M. Sanei Taheri1, M. Babaee, R. Soleimani1

Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, 1Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran

E-mail: rambabaee@yahoo.com

Introduction/Background: Most of studies have focused on subjective and clinical symptoms effect of PRP and fewer papers have studied its objective effect on cartilage. In this study, we investigated the effect of PRP on cartilage characteristics by special MRI sequencings. Materials and Methods: In the double blind randomized clinical trial, patients with grade 1, 2 and 3 of osteoarthritis were included in this study. All of the knees divided to groups randomly and exercise was prescribed for all of knees. Beside, PRP was injected 2 courses with 4 weeks interval in PRP group. For all of patients before and 6 months after treatment VAS (visual analogue scale) and WOMAC (Western Ontario and McMaster Universities Arthritis Index) were fulfilled and MRI was performed. Sequencings of MRI were PD fat saturated (coronal and sagittal) and transverse TRUFISP 3D. Imaging was scored according to 4 cartilage’s characteristics including, Patellofemoral cartilage volume, Subarticular bone marrow abnormality, Medial and lateral meniscal disintegrity and Synovitis. Results: Twenty-three knees in case group and 23 knees in control group were studied. All of patients were female with mean age 57.57±5.9 years old and mean BMI 28.49 ± 3.24 (Kg/m2).Mean total WOMAC and VAS changes before and after treatment in control group were 11.61 ± 1.3 and 8.5± 1.1 respectively. In PRP group, mean total of WOMAC and VAS changes showed better improvement with 20±3.2 and 12.3 ± 1.6 respectively (P < 0.05). In PRP group all of the radiologic variables except subarticular bone marrow abnormality had significantly improvement (P < 0.05).In comparison between 2 groups, Patellofemoral cartilage volume and synovitis had significantly changes in PRP group (P < 0.05). Conclusion: In this study, in addition to the effect of PRP on VAS and WOMAC, there is effect on radiologic characteristics (Patellofemoral cartilage volume and synovitis) significantly. For more evaluation, Study with more sample size is recommended.

Keywords: Magnetic resonance imaging, osteoarthritis, platelet rich plasma

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


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



  ISPR8-1008 Top


Role of hypertension for fracture risk in osteoporotic women

M. T. Islam, A. Mahjabin1, T. Uddin

Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, 1Department of Pathology, Delta Medical College and Hospital, Dhaka, Bangladesh

E-mail: tariqul845@gmail.com

Introduction/Background: Osteoporosis is a risk factor for hip and other fractures. Hypertension is a progressive silent disease affecting bone mass and structure, leading to increased susceptibility to fractures. The aim of this study was to determine the role of hypertension for fracture risk in osteoporotic women. Materials and Methods: This comparative cross sectional study was conducted among 54 hypertensive and 34 non-hypertensive osteoporotic female patients at two tertiary centers in Dhaka city during the period of 1st January to 31st December, 2017. Data were collected by face to face interview using semi-structured questionnaire and checklist. Online assessment of fracture risk probability was done among the two groups by FRAX tool and statistical analysis was performed by Statistical Packages for Social Sciences (SPSS-23). Results: The study revealed that the mean ages were 61.94 ± 9.362 years in hypertensive and 59.18 ± 11.269 years in non-hypertensive patients. Majority were housewives in hypertensive (96.3%) and non-hypertensive (82.4%) patients. It was found that the mean duration of hypertension was 6.41 ± 4.049 years in osteoporotic women where as the mean duration of osteoporosis were 8.80 ± 5.022 years in hypertensive and 7.53 ± 5.920 years in non-hypertensive patients. The difference of major osteoporotic fracture (MOF) risk by age was significantly (X2, P < 0.05) higher among the patients belonged to age group 60–79 years as well as comparatively higher in hypertensive patients. MOF risk by hypertension was comparatively higher among the hypertensive patients but it was not statistically significant (X2, Th P > 0.05). On the other hand, hip fracture (HF) risk by hypertension was comparatively higher among the hypertensive patients and it was statistically significant (X2, P < 0.05). Conclusion: The study reflected that the fracture risk was significantly higher in hypertensive patients.
Table 1: Distribution of Patients by Age and Duration of Osteoporosis (n=88)

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Table 2: Distribution of patients by hepertension and related attributes

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Table 3: Major Osteoporotic Fracture (MOF) Risk & Hip Fracture (HF) Risk by Hypertension

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Keywords: Fracture risk, hypertension, osteoporotic women

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


  ISPR8-1181 Top


The deep core stability back muscles training in rehabilitation of patients with osteoporotic vertebral fractures

L. Marchenkova, E. Makarova, M. Eryomushkin

Department of Rehabilitation for Patients with Somatic Diseases, National Medical Center of Rehabilitation and Balneology, Moscow, Russia

Presenter Email: MarchenkovaLA@rncmrik.com

Introduction/Background: The aim of the study is to estimate the effectiveness of kinesiotherapy based on deep core stability muscles training in the program of rehabilitation in patients with osteoporotic vertebral fractures (VF). Materials and Methods: Sixty patients (M-12, F-48) aged 43–81 years (average age 62.75 ± 12.5) with primary osteoporosis and at least one non-traumatic VF were included in the study. The rehabilitation program focused on training of deep core stability back muscles and consisted of 4 kinesiotherapy methods (Dr. Wolff and CBS simulators, kinesiohydrotherapy in the pool and complex physical exercises by Gorinevskaya-Dreving) was prescribed for 21 days to all patients. Isometric core strength test (Back-Check) was performed at baseline, at the end of the rehabilitation treatment and at 21 day follow-up visit. Results: At baseline relative flexion strength (REL FS), relative extension strength (REL ES), left lateral flexion strength (LLAT FS), right lateral flexion strength (RLAT FS) were lower than recommended indexes: 113.01 ± 34.03% of 150% (P = 0.001), 75 ± 12.78% of 100% (P = 0.006), 85 ± 12.78% (P = 0.04) and 79.73 ± 9.2% of 100% (P = 0.003) accordingly. Ratio relative flexion/extension strength (FLE: EXT S) also was in imbalance in 38 of 45 patients. Lateral flexion ratio (LLAT: RLAT FS) showed imbalance only in 6 patients. The all isometric core strength test indexes improved significantly: REL FS up to 132.57 ± 47.08% (P = 0.0001), REL ES up to 86.45 ± 9.4% (P = 0.03), LLAT FS up to 90.7 ± 9.55% (P = 0.07), RLAT FS up to 89.4 ± 2.5% (P = 0.03) after the rehabilitation course. The muscle strengths stay better than the baseline indexes at the follow-up measurement: REL FS = 121.5 ± 39.9% (P = 0.002), REL ES = 79.78 ± 10.5% (P = 0.02), LLAT FS = 87.1 ± 11.07% (P = 0.06), RLAT FS = 80.14 ± 8.62% (P = 0.09). Conclusion: The basic dysfunction of deep core muscles and imbalance flexion/extension strength in osteoporotic patients with VF were estimated. Complex rehabilitation with kinesiotherapy showed the high prolong effect on improving back muscle strength in patients with VF.

Keywords: Kinesiotherapy, osteoporosis, vertebral fractures

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


  ISPR8-2442 Top


Correlation between sarcopenia and osteoporosis in patients with post poliomyelitis syndrome

M. Lissens

Faculty of Biomedical Behavioural and Social Sciences, Thomas More University College, Geel, Belgium

E-mail: info@marklissens.be

Introduction/Background: Muscle mass,-strength and-density, sarcopenia, exercise and physical activity are correlated with bone mass, bone density and osteoporotic fractures. Bone and muscle decay and dysfunction are seen in ageing, but in neurological disorders with muscular atrophy, bone loss can be seen also at younger ages. Materials and Methods: Femoral neck and lumbar spine bone mineral density (BMD) is measured using dual X-ray absorptiometry in 30 patients with post poliomyelitis syndrome, 18 women and 12 men, with a mean age of 56,3 years (ranging from 37 till 70). Eight women were postmenopausal. Results: Mean femoral neck BMD was −22,76 % or −1.86 SD and mean lumbar BMD was −13,21% or −1.25 SD. Low femoral bone mass was found in 80% of the patients (12 men and 12 women, of whom 5 were postmenopausal) and low lumbar bone mass was seen in 63% (9 men and 10 women, of whom 8 were post-menopausal). Six patients (all women) had normal femoral BMD and 11 normal lumbar BMD, whereas 6 (3 male and 3 female) had osteoporotic femoral BMD-scores (<−2.5 SD) and 3 (1 man and 2 women) had osteoporotic lumbar BMD. The remaining patients had osteopenia: 18 showed femoral osteopenia (<−1 SD) and 16 lumbar osteopenia. A significant difference in femoral (cortical) BMD between men and women was found: −27, 72% or −2,24 SD in men and −19,46% or −1,62 SD in women. Only small sex differences were seen in lumbar (trabecular) BMD: −13, 85% or −1.37 SD in men and −12,78% or −1,17 SD in women. The lowest BMD scores were present in patients with visible and clear lower limb muscle atrophy. Conclusion: A correlation is shown between low muscle mass and low cortical BMD can be explained by neurogenic bone loss, both due to muscle atrophy and disturbed regulation of bone by the central nervous system.

Keywords: Osteoporosis, poliomyelitis, sarcopenia

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



  ISPR8-0353 Top


Evaluation of clinical efficacy on interscalene injections by ultrasound-guided for neurogenic thoracic outlet syndrome and ultrasonic observation

J. Wang

Department of Rehabilitation Medicine, Shenzhen Nanshan Hospital, Shenzhen, China

E-mail: wangjun0743@163.com

Introduction/Background: Neurogenic Thoracic Outlet Syndrome (nTOS) is a clinical diagnosis that describes the symptomatic manifestation of the compression of brachial plexus.The objective of this sduty is to evaluate the therapeutic effects of interscalene injections by ultrasound-guided for nTOS and observe the ultrasonic characteristics of brachial plexus and theirsurroundings. Materials and Methods: Thirty suspect patients with nTOS were received tow stages treatments. First stage , all patients were received one week conventional therapies , that included analgesics treatment and psychological treatment; After that ,the patients were given drug discontinuance 3 days .Then patients were got into the second stage, that were treated with interscalene injections by ultrasound-guided [Figure 1]. The changes of Vsiual Analogue Scale (VAS) scores before and after 2 stages treatment were recorded. At the interscalne level, the sonography and anatomic variations of the brachial plexus, superior and middle scalene muscles were observed [Figure 2].
Figure l: Abridged general view of the injections by ultrasound-guided
CC=cricoid cartilage,SCM=sternocleidomastoid, the rectangle= the position of the ultrasonic probe, black dots= needle points (in plane or out of plane)


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Figure 2: interscalene injections by ultrasound-guided for neurogenic Thoracic Outlet Syndrome

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Results: Before treatment the VAS sores were (8.25 ± 1.53), after 2 weeks of treatment, the VAS sores were (2.57 ± 1.06), comparisons of these tow VAS scores, there were significant differences (P < 0.05). At the interscalene level, the brachial plexus were identified in the transverse view as round to oval hypoechoic structures, anterior and middle scalene muscles showed hyperechoic structures [Figure 3]. There were 16 patients whose three trunks of the brachial plexus passed through between the anterior and middle scalene muscles ,accounted for 53.33% of the total;10 patients’ superior trunks of the brachial plexus pierced the anterior scalene muscle, their middle trunks and lower trunks passed through between the anterior and middle scalene muscles,accounted for 33.33% of the total;4 patients’ superior and middle trunks pierced the anterior scalene muscle, their lower trunks passed through between the anterior and middle scalene muscles,accounted for 13.33% of the total. Conclusion: Accurate positioning of interscalene injections by ultrasound-guided for the treatment of nTOS could have certain efficacy. There are variations in the brachial plexus crossing the scalene triangle.
Figure 3: Ultrasonoscopy that three trunks of the brachial plexus passed between the anterior and middle scalene muscles, AS- anterior scalene, MS -middle scalene, white triangle represent brachial plexus, the white dotted lines demarcate the muscles,

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Keywords: Neurogenic thoracic outlet syndrome, therapy, ultrasound-guided

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


  ISPR8-0167 Top


Is steroid phonophoresis effective in the treatment of subacromial impingement syndrome? randomized controlled study

S. Kutlay, E. Kars, D. Oztuna1, S. Ergin

Departments of PMR and 1Biostatistics, Ankara University Medical School, Ankara, Turkey

E-mail: skutlay@medicine.ankara.edu.tr

Introduction/Background: Subacromial impingement syndrome (SIS) is the most common cause of shoulder pain. Although, there are conservative and surgical treatment options for SIS, there isn’t a gold standart therapy.The aim of this study was to evaluate the effectiveness of steroid phonophoresis in patients with SIS. Materials and Methods: Sixty patients with SIS were participated in this prospective, single-blind randomized controlled study and randomly divided into 2 groups: intervention group (steroid phonophoresis) and control group (sham ultrasound). Hot pack and shoulder exercises including pendulum, range of motion (ROM) and strengthening exercises were given all patients. Steroid phonophoresis was applied with 1% hydrocortisone cream (2gr/session hydrocortisone with 1.5 watt/cm2 ultrasound for 7 minutes). All participants completed 15 treatment session and were assessed with visual analog scale for pain intensity, shoulder ROM, muscle strength, University of California Los Angeles (UCLA) Shoulder Rating Scale, Shoulder Disability Scale (SDS) and Nottingham Health Profile(NHP) for quality of life at pretreatment, post-treatment and 3rd month of treatment. Results: Baseline demographic characteristics of two groups were found similar except of their ages (the mean age ± SD 49.57 ± 6.73 for intervention group, 53.97 ± 5.81 for control group). Statistically significant improvements were observed in all parameters in both groups at the end of the therapy and 3 months afterterwards. There was a statistically significant difference in pain severity, shoulder ROM, UCLA Shoulder Rating Scale, SDS and NHP (pain, energy, sleep, social isolation, mobility) between two groups (P < 0.05). Conclusion: Steroid phonophoresis can be used as a well tolerated noninvasive therapy option for SIS.

Keywords: Steroid phonophoresis, subacromial impingement syndrome, treatment

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


  ISPR8-0284 Top


Diagnostic value of the clinical examination for diagnosing carpal tunnel syndrome assested with nerve conduction studies

O. Küçükakkaş, O. V. Yurdakul

Faculty of Medicine, Bezmialem University, Istanbul, Turkey

E-mail: okan4494@yahoo.com

Introduction/Background: Nerve conduction studies (NCS) are the most reliable methods in diagnosis of carpal tunnel syndrome (CTS). Although there are many clinical finding associated with CTS, there are a limited number of studies in the literature indicating the objective value of these finding for diagnosing. To evaluate the reliability of clinical examination in diagnosing CTS, with the help of NCS and detection of comorbid diseases likely to be risk factors in the CTS. Materials and Methods: We accepted 463 patients, who visited our outpatient clinic and presented with paresthesia or pain at the median nerve distribution. Demographic datas, clinical findings and comorbidities were recorded. According to the NCS results, patients were divided two groups (positive or negative) and analyzed. Results: 51.1% of the patients were negative and 48.9% were positive according to NCS. The highest sensitivity was at Durkan’s test (95.6%) and lowest was at thenar atrophy (22.1%). The highest specificity and positive predictive value were at thenar atrophy (100%) and the lowest were at Tinel’s test (40.9% and 59.1). The highest negative predictive value was at Durkan’s test (94%) and the thenar atrophy was the lowest (57.4%). There was a significant difference between the clinical findings in NCS groups (P < 0.001). %46.9 of the patients were had comorbidities. Hypertension, diabetes and obesity were the most common comorbidities. There was a significant difference between the groups for diabetes, obesity, rheumatoid arthritis, hypothyroidism and gout (P < 0.05). Conclusion: Thenar atrophy and sensory loss were highly specific in CTS but had limited value in early detection, due to their low sensitivities and observations in more advanced stage patients. For their low specifity, provocative tests seems to be insufficient to establish a definite CTS diagnosis. Maybe only Durkan’s test could be considered primarily with more balanced values. Diabetes, obesity, rheumatoid arthritis, hypothyroidism and gout were significantly increase the CTS risk.

Keywords: Carpal tunnel syndrome, diagnosis, nerve conduction studies

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


  ISPR8-2734 Top


Characterization of local muscle fiber anisotropy using shear wave elastography in patients with chronic myofascial pain

M. Bird, J. Shah1, L. Gerber, H. Tandon1, S. DeStefano, J. Srbely2, D. Kumbhare3, S. Sikdar

Department of Bioengineering, George Mason University, Fairfax, Virginia, 1Department of Physical Medicine and Rehabilitation, National Institute of Health, Bethesda, USA, 2Department of Human Health and Nutritional Sciences,University of Guelph, Ontario, 3Toronto Rehabilitation Institute, University Health Network, Toronto, Canada

E-mail: mbird2@masonlive.gmu.edu

Introduction/Background: Myofascial trigger points (MTrPs) are common in soft tissue musculoskeletal pain conditions. It is believed that MTrPs are local contractures within the extrafusal fibers of skeletal muscles. Further characterizing muscle pathophysiology is desirable to design effective treatments. This study was designed to measure muscle fiber architecture in the neighborhood of MTrPs using ultrasound Shear Wave Elastography (SWE), a novel approach for quantitatively assessing muscle fiber. We hypothesized that muscle containing active (symptomatic) MTrPs has disorganized fiber architecture. Materials and Methods: Twenty-four participants (14 women, ages 20–60 years) met criteria for chronic myofascial pain affecting the neck region. All underwent a clinical history and physical examination of the neck and upper trapezius to identify MTrPs and pain self-report. A Supersonic Aixplorer ultrasound imaging system with an L10-4 ultrasound transducer was used to image the upper trapezius muscle. A custom transducer holder [Figure 1] enabled imaging through a 20mm diameter window placed over the palpable MTrP or normal tissue, and rotation of the imaging plane to precise angles from 0° (along fibers) to 90° (perpendicular to fibers). Peak shear wave velocity (SWV) is observed longitudinally along muscle fibers (0°), and is minimum across fibers (90°). Muscle fiber anisotropy (a measure of fiber alignment and organization) was quantified as the asymmetry (degrees) in the shear-wave velocity profile around the peak SWV. Results: Muscles with active (symptomatic) MTrPs (n = 24) exhibited greater anisotropy (14.25 ± 11.01°), compared to normal, asymptomatic muscle tissue (n = 12), which is more isotropic (7.16 ± 6.70°) (P < 0.05) [Figure 2]. A positive correlation was found between the maximum anisotropy and average pain (Pearson’s r = 0.54). Conclusion: Muscle containing active MTrPs is anisotropic compared to normal muscle tissue, suggesting muscle contractures are in regions of anisotropy. The degree of anisotropy correlates with pain levels.





Keywords: Anisotropy, myofascial trigger points, shear wave

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



  ISPR8-0157 Top


The effect of additional strengthening and stretching of hip rotator muscles in patients with patellofemoral pain syndrome: a randomized controlled crossover study

A. Kalai, A. Jellad, M. Jeguirim1, H. Migaou, I. Ketari, S. El Mhamdi2, Z. Ben Salah Frih

1Departments of Physical Medicine and Rehabilitation, 1Rheumatology and 2Epidemiology, Faculty of Medicine, University Hospital, Monastir, Tunisia

E-mail: anisjellad@gmail.com

Introduction/Background: To evaluate the effect of hip external rotators and abductors strengthening in association with hip internal rotators stretching on pain and function in patients with Patellofemoral Pain Syndrome (PFPS). Materials and Methods: We conducted a cross-over randomized study including 109 patients with PFPS (75 females and 34 males aged of 31.6 ± 10.8 years). Patients were randomly assigned into first protocol A (G1, n = 67) of A-B arm with standard rehabilitation or protocol B (G2, n = 42) of B-A arm with standard rehabilitation associated to strengthening of hip external rotator and abductor musculature with stretching of hip internal rotators. Each protocol consisted of 3 sessions a week for 4 weeks. After a washout period corresponding to the recurrence of the same painful symptoms experienced by the patient rehabilitation programs were crossed-over. A visual analog scale (VAS) evaluating perceived pain, Functional Index Questionnaire (FIQ) and Kujala patellofemoral score were administered at baseline, at the end of each rehabilitation protocol and at 12 weeks after the completion of the second protocol for each group. Results: Pain and function were significantly improved in both arms for the total population (P < 0.001) until the last follow up. Protocol B provided a more significant improvement in terms of pain and function in G2 (VAS: P = 0.03; Kujala: P = 0.04) and G1 (VAS: P = 0.02; Kujala: P = 0.02). Conclusion: Associating strengthening of hip abductors and external rotators and stretching of hip internal rotators provided better outcome in terms of pain and function in patients with PFPS which was maintained until the end of the study.

Keywords: Patellofemoral pain syndrome, rehabilitation

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


  ISPR8-0862 Top


Knee painful arc, imaging by dynamic sonography: a novel technique 1muhammad dughbaj, 2diaa shehab, 3salem alkandari, 4levent ozcakar

M. Dughbaj

Department of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Hospital, Kuwait, Kuwait

E-mail: muhammaddughbaj@hotmail.com

Introduction/Background: Patellofemoral movement biomechanics is poorly understood and patellofemoral impingement is scarcely described in literature and only by MRI .We describe in this study a novel technique to visualize soft tissue impingement at and above patellofemoral joint using simultaneous goniometry and real time dynamic sonography and to coin the term Knee Painful Arc. Materials and Methods: Fifteen patients referred to PMR MSK US Unit with anterior knee pain and tenderness over quadriceps tendon underwent simultaneous goniometric measurements of the painful ROM during Keen flexion Extension and real time dynamic US to visualize which soft tissues are impinged at and above the patellofemoral joint [Figure 1]. Results: Dynamic US examination of two patients showed quadriceps fat pads and bursa impingement underneath prominent superior patellar osteophytes ( Pincer Type) [Figure 2a] reproducing pain at the last 30 degrees of extension Seven patients showed quadriceps tendon (QT) impingement over prominent anterior osteophyte arising from femoral condyle (Cam Type) [Figure 2b] reproducing pain during the range of 60 degree to full flexion and six patients showed mixed impingement of QT, fat pads and bursa between femoral and patellar osteophytes (Mixed Type) [Figure 2c] with pain free arc between 30 and 80 degree flexion. Conclusion: To our knowledge this is the first study to use dynamic US and goniometry to diagnose and coin the term knee painful arc,though painful arc of the shoulder is well described in literature, this technique can help understand mechanism and type of soft tissue impingement, modify exercise prescription using pain free arc exercise and improve rehabilitation outcome.



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


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



  ISPR8-0517 Top


Patient acceptable symptom state for patient-reported outcomes in 2 populations of patients with non-specific chronic low back pain: a secondary analysis of 2 randomized trials

C. Daste, F. Foissac1, H. Abdoul1, F. Rannou2, S. Poiraudeau2, C. Nguyen2

AP-HP-Hôpital Cochin, Rééducation et Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, 1URC Paris Centre, AP-HP-Hôpital Tarnier, 2Faculté de Médecine, Univerité Paris Descartes, Rééducation et Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Paris, France

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

Introduction/Background: We aimed to estimate and compare patient acceptable symptom state (PASS) at 1 month for 4 patient-reported outcomes (PROs) between 2 populations of patients with non-specific chronic low back pain (cLBP) and to determine which baseline variables contribute to having an acceptable symptom state at 1 month. Materials and Methods: Tw0-hundres fifty six patients were included: 135 patients with cLBP and an active disc disease participated in a randomized controlled trial assessing the efficacy on pain at 1 month of a single glucocorticoid intradiscal injection, and 121 patients with cLBP and without an active disc disease participated in a randomized controlled trial assessing the efficacy on pain at 4 months of 12 sessions of immersive virtual reality. Self-rated health status at 1 month was assessed by using an external anchoring question from the Medical Outcomes Study 36-Item Short Form. Patients who self-rated their health as “excellent”, “very good” or “good” were considered as having an acceptable symptom state. PASS for PROs was estimated using the 75th percentile method. Estimates were compared between the 2 populations using bootstrap resampling. Logistic regression was used to determine baseline variables contributing to PASS achievement. Results: At 1 month, 137/256 (53.52%) participants self-rated their health as acceptable. In the whole population, PASS (95% IC) were 47.50 (40.00 to 50.00) for the lumbar-pain VAS, 30.50 (30.00 to 40.00) for the radicular-pain VAS, 39.27 (33.60 to 45.26) for the QUEBEC score, 9.95 (9.16 to 10.00) for the HAD Anxiety subscale, and 6.70 (6.00 to 8.00) for the HAD Depression subscale. PASS estimates did not differ between the 2 populations. Symptom intensity was the only baseline variable contributing to having an acceptable symptom state at 1 month. Conclusion: Our study provides PASS thresholds for commonly used PROs in cLBP. Our findings can be useful in interpreting the clinical relevance of PROs values. ClinicalTrials.gov. NCT01407653 and NCT00804531.

Keywords: Low back pain, patient acceptable symptom state, patient-reported outcomes

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


  ISPR8-0316 Top


The effectiveness of manual therapy and proprioceptive neuromuscular facilitation (pnf) compared with traditional kinesiotherapy in the treatment of non–specific low back pain

K. Zaworski, R. Latosiewicz1

Department of Physiotherapy, Pope John Paul II State School of Higher Education in Biala Podlaska, Parczew, 1Department of Rehabilitation and Physiotherapy, Medical University of Lublin, Lublin, Poland

E-mail: kamil_zaworski@wp.pl

Introduction/Background: The aim of the study was to determine whether the use of combination therapy consisting of manual therapy and proprioceptive neuromuscular facilitation (PNF) is more effective than the use of the techniques of manual therapy, PNF method or traditional physiotherapy as singlemethods in the treatment of symptomatic non–specific low back pain. Materials and Methods: The study was designed as single-blinded RCT and conducted on a group of 200 patients of the Rehabilitation Ward of Hospital in Parczew. The patients were randomly divided into four 50–person groups: group A used manual therapy, B – PNF, C – manual therapy and PNF, and D – traditional kinesiotherapy. Pain intensity was measured using visual analogue pain scale (VAS) and modified Laitinen’s pain questionnaire. The evaluation was carried out four times: before, in the middle of, immediately after and two weeks after completion of therapy. Functional disability was assessed using Oswestry Disability Index (ODI) and Back Pain Functional Scale (BPFS). Assessmentswere done twice – before and after the treatment. Results: Reduction of pain intensity was statistically significant (p<0.05) in all groups at each stage of the study.However, the differences among the groups were not statistically significant (p>0.05). In all groups the change in the degree of disability measured by the ODI was statistically significant (p<0.05). The improvement in functional ability in patients as measured on the BPFS was statistically significant in all groups (p<0.05). Statistically significant differences were noticed between group C and group D (p<0.05). Conclusion: (1) All the methods used caused reduction in pain which lasted for at least 4 weeks. (2) The best improvement in the functional capability of patients was caused by the combined therapy consisted of manual therapy and PNF. (3) The degree of disability as measured in Oswestry Disability Index lowered evenly in all groups.

Keywords: Back pain, kinesiotherapy, manual therapy

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


  ISPR8-2090 Top


Effectiveness of an outpatient rehabilitation program with multidisciplinary approach on return to work for patients with non-specific chronic lombal pain

R. Champagne, Y. Ronzi, G. Roche-Leboucher, C. Begue1, V. Dubus, L. Bontoux, Y. Roquelaure2, I. Richard, A. Petit2

Rééducation, 1Département de Médecine Générale, Faculté de Médecine, 2CHU Angers, Centre de consultation de Pathologies Professionnelles, Angers, France

E-mail: champagne.rom@gmail.com

Introduction/Background: To compare the effectiveness of three treatment strategies for chronic low back pain with varying biomechanical intensity and multidisciplinary approach.? Materials and Methods: A monocentric controlled trial with a 12-months follow-up, conducted in the French Valley Loire region from May 2009 to April 2013. Participants were working-aged patients with chronic low back pain referred to a French chronic low back pain care-network to support medical and occupational issues. Three treatment strategies, each for five weeks were compared: (i) Intensive and multidisciplinary program conducted in a rehabilitation center; (ii) Less intensive outpatient program conducted by a trained private physiotherapist; (iii) Mixed strategy combining the same outpatient program associated with a weekly multidisciplinary intervention. The effects of treatment conditions were compared using an “intention to treat” approach: Number of days’ sick leave during the 12-months following treatment, and quality of life and social ability assessed by auto-questionnaires. Results: A total of 349 patients (52.2% men, 42.5 ± 8.7 years old, median duration of sick leave = 206.0 days (92.0–301.0)) were included. Sick leave duration significantly decreased during the 12-months following treatment in the three groups. Physical capacity improved in intensive program and mixed strategy groups. There was no significant difference for the evolution of participants’ quality of life, social ability, and personal beliefs between the three groups. Conclusion: This study confirms that disparate treatments might show similar effectiveness because they could all work through concomitant changes in beliefs, attitudes, and coping mechanisms. The original mixed strategy can treat a larger number of chronic low back pain patients, at a lower cost and provide local community-based care.?

Keywords: Chronic lombal pain, clinical trial, rehabilitation

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


  ISPR8-0226 Top


Effect of fluoroscopically guided caudal epidural steroid injection in degenerative lumbar spinal stenosis – a randomized controlled trial

M. Srivastava, A. K. Gupta, B. K. Ojha1, D. Kumar, S. Mishra, G. Yadav

Departments of Physical Medicine and Rehabilitation and 1Neurosurgery, King George’s Medical University, Lucknow, Uttar Pradesh, India

E-mail: rohitsriv14elec@gmail.com

Introduction/Background: Degenerative lumbar spinal stenosis (DLSS) is a common source of pain and disability in the elderly population. Epidural steroid injections are often used to treat lumbosacral radiculopathy in DLSS. There is paucity of clinical trials comparing caudal epidural steroid injections plus local anaesthetics with conservative treatment. Moderate and high-quality evidence for nonoperative treatment is lacking and thus prohibits recommendations for guiding clinical practice. So, the aim of this study was to compare the effects of conservative treatment (physical therapy) and caudal epidural steroid injection with physical therapy in patients of DLSS (grade A and B). Materials and Methods: An Open Label, Parallel randomized controlled trial was conducted from January 2016-August 2017 and patients fulfilling the inclusion criteria were enrolled after written informed consent. The Trial was registered under the Clinical Trial Registry of India (CTRI). Patients were randomized in two groups – 32 in Intervention Group A (caudal epidural steroid injection with physical therapy) and 32 in Control Group B (physical therapy only) with concealed allocation method. The outcome was assessed by Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), standing tolerance test and walking tolerance test at 3, 6, 12 and 24 weeks. Results: Significant improvement in NPRS, ODI and standing tolerance test was observed at 3, 6 and 12 weeks (Group A >> Group B). Equivocal effect in NPRS and ODI was seen at 24 weeks (Group A ~ Group B). Improvement in mean claudication distance was seen at each follow up from baseline (Group A>> Group B). The probability of improvement in intervention group (A) was more than in control group (B). Conclusion: Epidural steroid administration improved pain, physical ability and claudication distance (>200 metres) at 12 weeks aiding an early return to routine activities. Physical therapy also shows clinical improvement in patients of DLSS and can be an appropriate treatment modality.

Keywords: Caudal, epidural steroid, lumbar spinal stenosis

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


  ISPR8-2434 Top


Effects of high intensity training on pain, disability, exercise capacity and muscle strength in persons with nonspecific chronic low back pain: preliminary rct results

J. Verbrugghe, A. Agten, S. Stevens, B. O. Eijnde, F. Vandenabeele, A. Timmermans

REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium

Presenter Email: jonas.verbrugghe@uhasselt.be

Introduction/Background: Nonspecific chronic low back pain (NSCLBP) is a musculoskeletal disorder affecting many people worldwide. Exercise therapy (ET) is an important component of NSCLBP management. However, effect sizes remain low. High Intensity Training (HIT) is an effective training method for improving physical fitness and health related parameters in healthy persons as well as for decreasing pain and disability in persons with chronic disorders. The value of HIT in NSCLBP rehabilitation is unclear. The aim of this study is 1) to compare HIT to conventional ET, and 2) to compare the effects of different modes of HIT, with regard to pain, disability, exercise capacity, and muscle strength, in persons with NSCLBP.

Materials and Methods: A five-arm parallel RCT (n = 150) is carried out consisting of an ET program (24 sessions/12 weeks) organized at REVAL (Hasselt University, Belgium) in persons with NSCLBP. Participants are randomly assigned into one of four intervention groups performing various modes of HIT or a control group performing moderate intensity training resembling conventional care [Figure 1]. Participants are measured at baseline and after completing the program. Primary outcome measures are pain intensity (Visual Analogue Scale), functional disability (Oswestry Disability Index), exercise capacity (VO2max during exercise testing), and abdominal and back strength (Newton/kg during isometric strength testing).
Figure 1: Therapy protocols.

Click here to view


Results: Forty-three persons with NSCLBP have completed the program (group average: n = 9). All outcomes showed time-related improvements in all groups (P > 0.001). No between group differences were noted in any outcomes. Conclusion: Preliminary data of this RCT suggest that HIT has positive effects on pain intensity, functional disability, exercise capacity, and isometric abdominal/back muscle strength, in persons with NSCLBP. Patient recruitment is still ongoing to increase the power of this study and further analyse the differences between HIT groups with specific modalities and conventional therapy.

Keywords: Exercise therapy, high intensity training, low back pain

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


  ISPR8-0307 Top


Intradiscal glucocorticoid injection in chronic low back pain with modic 1 changes

I. Tavares, A. Dupeyron2, C. Cyteval, I. Laffont3, C. Herisson, E. Thomas1

CHU Montpellier, Médecine Physique, 1CHU Montpellier, Rhumatologie, 3CHU, Radiologie, Montpellier, 2CHU Nîmes, Médecine Physique, Nîmes, France

Presenter Email: i-tavaresfigueiredo@chu-montpellier.fr

Introduction/Background: The profit of an intradiscal injection of corticoids in low back pain with Modic 1 changes is not totally resolved. The objectives of this work is to estimate the clinical profit at 1, 3 and 6 months after an intradiscal injection of prednisolone acetate versus a lidocain one in low back pain with Modic. Materials and Methods: Fifty patients with low back pain in failure of the medical treatment for more than 6 weeks where included in this prospective, double blind, randomized study. Results: Pain intensity was significantly improved à 1 month in the prednisolone acetate group compared to the lidocain group. A significant diffrence is also observed at 1 and 3 months in the activities of the everiday life of DALLAS questionnaire in favour of the glucocorticoid group. There was no significant difference, throughout the follow up on Oswestry evolution, comsuption of analgesic or in professional condition. Conclusion: Intradiscal injection of prednisolone acetate in low back pain with modic 1 changes reduces pain intensity at 1 month but not at 3 and 6 month versus lidocain.

Keywords: Low back pain, modic

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


  ISPR8-0249 Top


Transcutaneous electrical nerve stimulation (tens ) versus physiotherapy for chronic low back pain

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

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

Presenter Email: mamjam2011@hotmail.fr

Introduction/Background: The objective of this study is: To analyse the effect in the long-term of (TENS) in chronic low back pain (CLBP) compared to physiotherapy, to improve the symptomatology, to delay the surgery or to ovoid it and to reduce the number of sick-leave days. Materials and Methods: Prospective and randomized study, from september 2010 until December 2016, compared two groups: 95 patients with CLBP treated by TENS versus 66 patients treated by physiotherapy (Infrared and Ultrasound). The duration of treatment was 12 weeks, 3 sessions a week/patient, evluated by: pain intensity, visual analog scale (VAS), neurological signs, MRI , length of sick-leave and the recourse to surgery. Follow up time was 12 months. Results: In the short and long-terms, pain relief was significantly better in group “TENS” compared with group “physiotherapy” (P < 0.001). The average of sick-leave was shorter in group TENS. However; in the two groups, the main radiological symptom was disc degeneration diseases. Conclusion: In the long-term TENS was better than physiotherapy, significantly improves the symptomatology and quality of life in patients with chronic low back pain.

Keywords: Low back pain, physiotherapy, TENS

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


  ISPR8-1878 Top


Biopsychosocial multidisciplinary rehabilitation in low back pain: a comparison of effects after 12 months in patients older and younger than 65 years

M. Weigl, P. Stephan

Department of Orthopaedics, Physical Medicine and Rehabilitation, Ludwigs Maximilians Universität, München, Germany

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

Introduction/Background: In patients with chronic low back pain (cLBP) guidelines recommend multidisciplinary biopsychosocial rehabilitation (MBR) if other treatments were unsuccessful. However, little is known about the long-term effects of MBR in patients older than 65 years. The objective of this study was to compare the 12 months course of effects of MBR in patients older than 65 years to younger patients. Materials and Methods: In this naturalistic prospective observational cohort study 118 participants of a 3-week MBR were included. The MBR comprised exercise therapy, hydrotherapy, occupational therapy, psychological interventions, patient education and instructions to home exercise programs. Outcome was assessed by the condition specific North American Spine Society (NASS) questionnaire pain/function scale and the generic Short-Form 36 Health Survey (SF-36). From the eight SF-36 scales only Physical Functioning (PF), Bodily Pain (BP) and Mental Health (MH) were included in the analyses. Data were collected at the beginning of treatment, after 3 months and after 12 months. Participants were grouped into “Old” or “Young” with the cut-off 65 years. Statistical differences between follow-up and baseline scores were tested by paired t-tests. Standardized Effect Size (ES) was calculated by dividing the difference between entry and follow-up by the standard deviation (SD) of the baseline score. Results: In this study 59 patients were older than 65 years and 59 were younger. The mean ages of the groups old/young were 70 years and 57years respectively. In the group old 64% of patients were female and in the young group 73% were female. The course of the outcomes and the statistical significance of changes are presented in [Table 1] and [Table 1].
Table 1: Course of outcomes until 12 months' follow-up in patients < 65 years (N=59)

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Table 2: Course of outcomes until 12 months' follow-up in patients >= 65 years (N=59)

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Conclusion: This study shows that a MBR program in cLBP patients has similar beneficial long-term effects on pain and condition specific function in patients older than 65 years compared to younger patients.

Keywords: Geriatrics, low back pain, rehabilitation

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


  ISPR8-0511 Top


Muscular capacity of the scoliotic spine evaluated by isokinetic device after orthopaedic treatment on a population of 50 patients. comparison with an asymptomatic population

J. C. Bernard, L. Sakoun, E. Chaléat-Valayer, K. Abelin-Genevois, G. Le Blay

Centre Médico-Chirurgical de Réadaptation des Massues Croix Rouge Française, Service MPR Enfants Adolescents, LYON Cedex 05, France

E-mail: bernard-mpr@cmcr-massues.com

Introduction/Background: The scoliosis is a deformation of the spine which muscular component is both little known in the determinism of the pathology as in its evolution during the growth. After a conservative treatment, it is important to estimate the residual scoliosis but also the muscular capacity of the spine. The objective of this study is to estimate the strength and the power of the trunk muscles by isokinetic dynamometer for teenagers treated orthopedically for idiopathic scoliosis. Materials and Methods: Monocentric and retrospective study made from 2015 to 2017 within the framework of a global assessment of the spine in 1 year of the definitive ablation of the brace. The evaluation was realized on the Cybex isokinetic dynamometer on a population of 50 scoliotic female patients. The flexor and extensor spinal muscles were explored in a concentric way in 60, 90 and 120 °/s speed. The isokinetic results were analyzed according to the type of scoliosis and according to the angulation. Results: The 14–16-year-old group is the most represented with 40 patients. For this group, we have a majority of thoracic and lumbar scoliosis (17 of every). In global analysis, the scoliotic patients present lower MFM than the control group, for three speeds, and the F/E ratio is increased. The power is the parameter which is the most impacted by the scoliosis. The MFM has decreased, the ratios of MFM have increased, the power is strongly lower than the asymptomatic group; the ratio of power has increased. Conclusion: The presence of the scoliosis is systematically associated with a decrease of strength of the flexor and extensors muscles of the spine. Afterward, one must study the implication of the orthopaedic treatment on the spinal muscular weakening by comparing the population studied for this work with a similar population, but untreated orthopedically.

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


  A2.08 Musculoskeletal Conditions - Miscellaneous Top



  ISPR8-1773 Top


Iterative percutaneous needle aponeurotomy for dupuytren’s disease: functional results at 5-year follow-up

J. Beaudreuil, M. Ferrari1, H. Lellouche1, E. Roulot1, A. Yelnik2, T. Bardin1, P. Orcel1, P. Richette1

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

Presenter Email: johann.beaudreuil@aphp.fr

Introduction/Background: Treatments of Dupuytren’s disease are currently not aetiological but symptomatic. They aim at reducing the flexion contracture of fingers and improving hand function, without excluding the possibility of recurrence. Percutaneous needle aponeurotomy (PNA) can be used as an iterative treatment for repeated recurrences. However, it has only been assessed as a unique therapeutic sequence and its long-term functional results have not been described. The aim of the study was to assess functional results of iterative PNA for Dupuytren’s disease at 5-year follow-up. Materials and Methods: Patients with digital flexion contracture due to Dupuytren’s disease were prospectively included and treated using PNA. Iterative treatment was performed as necessary during the follow-up. Assessment criteria were Tubiana score at 1 month, URAM functional score at 1-month and 5 years, satisfaction and need of second line open surgery at 5 years. Primary outcome was URAM functional score at 5 years in patients who did not undergo second line open surgery at follow-up. Results: Thirty patients were included: age 72 ± 10, ratio Female/Male 0, 2, diabetes 3, Tubiana score 7 ± 3, URAM score 13 ± 10. Three sessions of PNA were performed per patient in mean at 5-year follow-up. Two adverse events were observed: skin fissure recovering in one week (1 case), digital paresthesia recovering in 2 years (1 case). PNA reduced flexion contracture (Tubiana 2 ± 3, range 0–13, n = 30, p < 0.05). The URAM score was improved at 1 month (7 ± 9, range 0–35) and at 5 years (10 ± 12, range 0–41, n = 27, p < 0.05). Three patients underwent second line open surgery. 72% of patients were satisfied by PNA at 5 years and 83% recommended the treatment. Conclusion: Iterative PNA is safe, reduces flexion contracture and improves hand function in patients with Dupuyren’s disease. Functional improvement persists at 5 years in 90% of cases. Only 10% require second line open surgery.

Keywords: Dupuytren’s disease, percutaneous needle aponeurotomy

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


  ISPR8-1660 Top


Pain interference with physical functioning is associated with physical activity level in patients with chronic musculoskeletal pain

P. Terrier, C. Praz, J. Le Carré, P. Vuistiner, B. Léger, F. Luthi

Department of Research, Clinique Romande de Réadaptation SUVACare, Sion, Switzerland

E-mail: Philippe.Terrier@crr-suva.ch

Introduction/Background: In case of musculoskeletal pain, a decreased physical activity (PA) could favor deconditioning and chronicity. However, several studies have failed to highlight low PA in people suffering chronic pain. To explore this issue further, we analyzed PA level of patients with chronic musculoskeletal pain (CMP) with an inertial sensor. The objective was to assess whether pain interference (PI) with physical functioning correlated with PA level. Materials and Methods: We studied 267 CMP patients [age: 44 years (SD: 12)]. Pain sites were upper limbs (43%), spine (23%), and lower limbs (34%). The participants wore an accelerometer during two consecutive days. We assessed the daily duration of moderate-to-vigorous PA (MVPA), that is, all movements with an intensity above slow walking. We used the average score of the three interference items related to physical functioning in the brief pain inventory (BPI) questionnaire (0-10). We fitted a generalized linear mixed model (GLMM) with MVPA as the dependent variable. We defined PI as a continuous predictor, and pain site as a 3-level categorical covariate. Main effects and interaction (PI x Pain site) were included in the model. Results: The average duration of MVPA was 76 min (SD: 51), that is, 10% as high as the accelerometer wear time (13h, SD: 2.6). Average PI score was 5.3 (SD: 2.2). GLMM shows that PI was significantly and negatively associated with MVPA. The interaction result shows that the percent change for each PI point was upper limbs: -2%; spine: -10%; and lower limbs -3%. Conclusion: The results show that PA level correlates to how CMP patients perceived the interference between pain and physical functioning. The association is particularly strong in patients with back pain. This finding supports the hypothesis that chronic pain impairs PA through the interference with daily physical activities.

Keywords: Chronic musculoskeletal pain, physical activity, physical functioning

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


  A3.01 Neurological and Mental Health Conditions - Stroke Top



  ISPR8-2289 Top


The plasticity of resting-state brain networks associated with motor imagery training in chronic stroke patients

H. Wang, L. Sun, J. Jia

Department of Rehabilitation, Huashan Hospital Fudan University, Shanghai, China

Presenter Email: wanghew@126.com

Introduction/Background: Motor imagery training (MIT) is a widely used noninvasive treatment technique in stroke patients. Despite its clinical efficacy, little is known regarding the neural substrates underlying MIT. The aim of this study was to investigate the plasticity of resting-state brain networks associated with MIT in chronic stroke patients. Materials and Methods: A total of 34 chronic stroke patients with subcortical lesions were randomly assigned to the conventional rehabilitation therapy (CRT) group and the MIT group. Before and after the 4-week treatment, motor function of each patient was blindly assessed with Fugl–Meyer assessment Scale (FM-UL) and resting-state fMRI was administered. Functional connectivity (FC) analyses of the ipsilesional primary motor cortex (M1), measurements of the lateralization index (LI) and graph-theory based analysis were also performed in both group to investigate the altered whole-brain networks after treatment. Results: Both groups showed significant improvement in FM-UL scores and the change in MIT group was significantly greater than that of the CRT group. Similar changes patterns of FC were seen between the MIT and CRT group: increased FC of the ipsilesional M1 with the contralesional precentral gyrus and decreased FC within ipsilesional hemisphere were found in both group. Additional increased FC of contralesional SMA and postcentral gyrus and restored LI were observed in MIT group. Moreover, a significant positive correlation between increase of clustering coefficient and improvement of FM-UL score were identified in MIT group as well (P<0.05). Conclusion: Our results indicate that the impact of MIT on the plasticity of brain networks was measurable on resting-state fMRI, and widely recruitment of the brain areas, restoring symmetry of the FC reflected by LI and increased clustering coefficients after treatment on a broader level of brain network analysis might be related to the neural mechanisms of motor recovery in stroke patients after MIT.

Keywords: Motor imagery training, neural mechanisms, resting-state brain networks

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


  ISPR8-1750 Top


Active mobility early after stroke (amobes), 1 year follow up. a randomised controled trial

A. Schnitzler, A. Yelnik1, M. Wanepain1, P. Reiner2, J. P. Devailly3, E. Vicaut4

Department of PRM, Versailles University, Garches, Departments of 1PRM and 2Neurology, GH Lariboisière F. Widal, 4Department of PRM, Paris Nord Val de Seine Hospital, 5Research Unit, GH Lariboisière F. Widal, Paris, France

E-mail: alain.yelnik@aphp.fr

Physical therapy (PT) has to be provided early after stroke with early mobilization. But it seems that during the first days after stroke, intensive training cannot be recommended. The AMOBES study had been designed to assess the effect of early intensive PT provided within the first two weeks, during the 3 first months. The results were not in favour of intensive training (Yelnik et al. Stroke 2017). We report here the results in patients who could have being followed for one year. Patients have been recruited in this multicentre randomized controlled trial to compare “soft” (20mn/day apart from respiratory needs) versus “intensive” PT (idem + 45 minutes of intensive exercises/ day), initiated within the 72 first hours after a first hemispheric stroke. Blind assessment has been made. The primary criterion was the motor control assessed by the Fugl Meyer score at D90. At one year the following secondary criteria were assessed: Fugl Meyer, postural balance (PASS), autonomy (Rankin and FIM), unexpected medical events, length of hospital stay, quality of life (SIS). The study has been registered on clinical trial.gov NCT01520636. Sixty-one survivors of the 103 included patients could be examined, 40 males, 45 right hemispheric lesions, 47 ischemic lesions, age 63.1 ± 12.1. Number of patients with moderate stroke (NIHSS<8) was higher (25%) than in the initial group (10%). No significant difference between groups was observed (change in Fugl Meyer 36.7 vs 36.1) but an interesting trend in favour of the experimental group: FIM 78.5 vs 73.4, length of stay 92.8 vs 127.6, time to walk 10 meters alone 35.4 vs 43.2 days. The result of the initial study seems to be confirmed, but deserves to be qualified according to the initial stroke severity: mild severe stroke might beneficiate from early intensive physical therapy.

Keywords: Physical therapy, stroke

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


  ISPR8-0489 Top


Rehabilitation robotics of the upper limb after stroke. the rem_avc trial

O. Rémy-Néris, B. Médée1, D. Bensmail2, W. Daveluy3, C. Benaim4, J. Froger5, I. Bonan7, P. Marque8, J. Luaute9, A. L. Ferrapie10, A. Yelnik2, A. Stefan12, J. C. Daviet13, E. Coudeyre14, J. M. Beis15, J. Kerdraon16, J. L. Isambert17, P. Dehail18

1Department of Physical and Rehabilitation Medicine, Univerisity Hospital of Brest, Brest, 2Department of Physical and Rehabilitation Medicine, Assistance Publique Hôpitaux de Paris, Paris, 3Department of Physical and Rehabilitation Medicine, University Hospital of Lille, Lille, 4Department of Physical and Rehabilitation Medicine, University Hospital of Dijon, Dijon, 5Department of Physical and Rehabilitation Medicine, University Hospital of Nimes, Nimes, 7University Hospital of Rennes, Physical and Rehabilitation Medicine, Rennes, France, 8University Hospital of Toulouse, Physical and Rehabilitation Medicine, Toulouse, France, 9Hospices Civil de Lyon, Physical and Rehabilitation Medicine, Lyon, France, 10C3RF, Physical and Rehabilitation Medicine, Angers, France, 12University Hospital of Nantes, Physical and Rehabilitation Medicine, Nantes, France, 13University Hospital of Limoges, Physical and Rehabilitation Medicine, Limoges, France, 14University Hospital of Clermont Ferrand, Physical and Rehabilitation Medicine, Clermont Ferrand, France, 15University Institute of Rehabilitation of Nancy, Physical and Rehabilitation Medicine, Nancy, France, 16CMRF Kerpape, Physical and Rehabilitation Medicine, Ploemeur, France, 17Le Normandy, Physical and Rehabilitation Medicine, Granville, France, 18University Hospital of Bordeaux, Physical and Rehabilitation Medicine, Bordeaux, France

E-mail: olivier.remy-neris@univ-brest.fr

Introduction/Background: Rehabilitation robotics has been proposed as an efficient strategy to improve upper extremity (UE) motor function after stroke aspecially at the subacute phase. Many trials with several robots have been performed but very few large multicenter RCTs at the subacute phase. Materials and Methods: A multicenter parallel group, two arm, single blind, phase III, superiority, randomized, controlled trial has been conducted in France in 22 rehabilitation centers equipped with an Armeo Spring robot. 220 subjects must be included. The main inclusion criteria were an UE Fugl Meyer (UEFM) score between 10 and 40 and an occurence of the stroke between 3 and 12 weeks before inclusion. The main outcome measure was the UE FM 30 days. Each patient performed usual treatment (2hours a day of motor rehabilitation) with 20 additional rehabilitation sessions (1h each, 5 days a week, 4 weeks). Patients were randomized either to rehabilitation robotic sessions with the Armeo Spring device or to self rehabilitation (stretching and self paced movements) in equal timed sessions. Secondary outcome measures were, pain, hypertonia, functional improvement (FIM and Action research arm test ARAT) and quality of life (EQ5D and stroke impact scale). Evaluation were performed at day 30, 3, 6 and 12 months after inclusion. Results: Two-hundred eighteen subjects have been included and an attrition rate of 10% at 6 months and 20% at 12 months was observed. The gain in the main outcome criteria was not significantly different at day 30 nor any other secondary criteria except ARAT. Conclusion: An additional time 1h a day during 4 weeks of rehabilitation robotics to usual intensive rehabilitation seems not significantly influence the motor deficiency prognosis of the upper limb after stroke. It might influence functional outcome but this has to be explored in another design randomized control study.

Keywords: Robot, stroke, subacute

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


  ISPR8-0366 Top


The effect of the association between prism adaptation and auditory cues on virtual spatial navigation in patients with unilateral neglect

M. Cogné, E. Guillaud1, L. Guillot2, E. Klinger3, S. Jacquin-Courtois4, J. R. Cazalets5, P. A. Joseph

Department of Physical and Rehabilitation Medicine and ea 4136, University Hospital of Bordeaux, 1INCIA, UMR CNRS Bordeaux University, 2Department of ea 4136, Bordeaux University, 5University of Bordeaux, INCIA-UMR CNRS Bordeaux University, Bordeaux, 3Digital Interactions Health and Disability Lab, ESIEA, Laval, 4Department of Physical and Rehabilitation Medicine, Inserm UMR-S 864-Espace et Action, University Hospital of Lyon, Lyon, France

E-mail: melaniecogne@hotmail.fr

Introduction/Background: Spatial neglect is frequent among right-hemispheric stroke patients, and can concern the auditory modality. Some authors showed that a prism adaptation improved the auditory extinction during a dichotic listening task. However, this effect has not been studied yet during an ecological task. The aims of the study were to investigate whether right-hemispheric stroke patients with a contralesional visual and auditory neglect benefited from an auditory lateralized cueing during a navigation task in virtual condition and to determine if a prism adaptation could potentiate this improvement. Materials and Methods: We included 32 right-hemispheric stroke patients, 22 with a visual and auditory neglect and10 without neglect; and 12 healthy controls. They all performed three paths including six intersections, at first passively and then actively with a joystick in two randomized conditions: 1) with lateralized beeping sounds indicating the directions 2) without any sounds. After a prism adaptation, a third condition with lateralized beeping sounds was followed. Results: There was a significant difference between the 3 groups concerning the number of trajectory mistakes in the 3 conditions (p<0.05). Nevertheless, patients with unilateral neglect improved significantly their navigation performance in the condition with auditory stimuli compared to the condition without auditory stimuli, and even more so after a prism adaptation (p<0.05). Conclusion: This study demonstrates the positive effect of auditory cues for spatial navigation in virtual condition on patients with visual and auditory neglect, and the potentiation of the help of auditory cues after a prism adaptation in this population.

Keywords: Auditory cues, neglect, prism adaptation

Disclosure of interest: The authors thank the SOFMER (Société Française de Médecine Physique et de Réadaptation) for funding the project named “AudiPrism”.


  ISPR8-2209 Top


Association of bdnf val66met with post-stroke functional recovery

Z. Han, L. Qi1, J. Wong2, X. Luo4, Y. Zhou, J. Wang, Q. Wang3

Department of Neurology and Rehabilitation, Shanghai Seventh Hospital, Shanghai University of TCM, 1Department of Neurology and Rehabilitation, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of TCM, Shanghai, 4Spaulding Rehabilitation Hospital, Kerry Rehabilitation Medicine Research Institute, Shenzhen, China, 2School of Nursing, MGH Institute of Health Professions, 3Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, Boston, USA

E-mail: hanxiang798007@gmail.com

Introduction/Background: The Val66Met single nucleotide polymorphism (SNP rs6265) of the Brain-Derived Neurotrophic Factor (BDNF) gene decreases BDNF secretion. Previous studies in patients with stroke have shown that the Val66Met polymorphism is associated with poorer outcome. The aim of this study was to determine whether or not the BDNF Val66Met genotype is associated with functional outcome after stroke in our inpatient rehabilitation sample. Materials and Methods: One hundred and five individuals admitted for inpatient rehabilitation following a stroke and who were also enrolled in the Partners HealthCare Biobank.The genotypes for BDNF SNP rs6265 for individuals with stroke were obtained from the Partners HealthCare Biobank Portal. Main outcome measures were the Functional Independence Measure (FIM) on admission and discharge. Stroke outcome was defined as the change in FIM scores between discharge and admission. The prediction of motor and cognitive outcome at discharge was modeled using BDNF Val66Met genotype. Regression analyses were performed to identify the significant associations of the genetic factor with functional outcome. Results: Individuals with stroke who were homozygous for the GG genotype had significantly lower FIM cognition subscale (P=0.023) and memory subscores (P=0.011) as compared to those with either the heterozygous AG or homozygouse AA genotypes. In addition, the GG genotype was a significant predictor for poor memory outcome (P=0.021, OR=-0.036 [B=-0.067 to -0.005]) when controlling for age and gender. This association may be due to the association with memory since the memory score is contained within the cognition subscale. Conclusion: The preliminary data suggests that BDNF Val66Met polymorphsim may impede stroke recovery, especially cognitive function. Further studies with larger samples are warranted to elucidate the role and mechanism of BDNF genetic variants in stroke recovery.

Keywords: Alleles, brain-derived neurotrophic factor, stroke

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


  ISPR8-0659 Top


Home-based tele-rehabilitation presents comparable and positive impact on self-reported functional outcomes as center-based rehabilitation: singapore tele-technology aided rehabilitation in stroke (stars) trial

M. Asano, B. C. Tai, C. Chen, S. C. Yen1, A. Tay1, A. Cheong, Y. S. Ng2, D. A. De Silva3, K. Caves4, Y. Kumar1, S. W. Phan1, V. Cai, N. Wong, E. Chew5, Z. Chen6, H. Hoenig7, G. Koh

Saw Swee Hock School of Public Health, National University of Singapore, 1Department of Electrical and Computer Engineering, National University of Singapore, 2Department of Rehabilitation Medicine, Singapore General Hospital, 3National Neuroscience Institute, Neurology, 5Department of Rehabilitation Medicine, National University Hospital, 6National University Health System, Investigational Medicine Unit, Singapore, Singapore,4Department of Surgery, Duke University Medical Center, 7Durham Veterans Affairs Medical Centre, Physical Medicine and Rehabilitation Service, Durham, USA

E-mail: epham@nus.edu.sg

Introduction/Background: Stroke is a leading cause of disability worldwide. Functional, financial and social barriers commonly prevent individuals with acute stroke and disabilities from receiving rehabilitation following their hospital discharge. Home-based rehabilitation is an alternative to center-based rehabilitation but it is often costlier. Tele-rehabilitation is a promising solution for optimizing rehabilitation utilization, as it can enable clinicians to supervise patients and conversely, patients to receive the recommended care remotely. Our team therefore developed a novel tele-rehabilitation, with the primary aim to estimate the extent to which the proposed tele-rehabilitation resulted in an improvement in function during the first three-months after stroke in comparison to usual rehabilitation. Materials and Methods: This was a randomized controlled trial. We used the Late-Life Function and Disability Instrument (FDI) to assess our primary outcome (with adjustment made for baseline covariate). Results: We recruited 124 participants and randomized them to receive either 12-week home-based tele-rehabilitation or usual rehabilitation. Rehabilitation: Over the 12-week rehabilitation period, the intervention group spent 2246-minutes on their rehabilitation whereas the control group spent 2565-minutes. The median difference between the two groups was not statistically significant (p = 0.649). Primary Outcome (FDI): The mean FDI frequency score post-rehabilitation for the intervention and control groups were 39.7 (SD 11.7) and 43.0 (SD 10.6) respectively. The mean FDI limitation score post-rehabilitation for the intervention group was 78.5 (SD 20.6) and that for the control group was 85.4 (SD 19.6). The unadjusted and adjusted differences in both FDI scores between the two groups were not statistically significant. Conclusion: Both groups reported comparable amount of time spent on rehabilitation and similarly positive impact on the primary outcome. Home-based tele-rehabilitation can be an effective strategy for minimizing or eliminating rehabilitation utilization barriers while achieving the same functional outcome as center-based rehabilitation.

Keywords: Randomized controlled trial, stroke, telerehabilitation

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


  ISPR8-0925 Top


Sensory retraining of the lower extremity post stroke

H. Ofek, M. Alperin1, T. Knoll1, D. Livne1, L. Yocheved

Department of Physical Therapy, University of Haifa, 1Clalit Health Services, Haifa and Western Galilee Region, Haifa, Israel

E-mail: hadasbarkolofek@gmail.com

Introduction/Background: Sensory deficits are demonstrated in 50%-85% of individuals post-stroke and lead to slower motor recovery and to poorer prognosis. Yet, sensory rehabilitation is often not set as a therapeutic target within the therapeutic setting. Sensory Retraining (SR) has been found effective for the upper extremity post stroke. Aims: To study the effectiveness of Sensory Retraining (SR), an explicit perceptual learning approach focusing on sensation to the lower extremity post stroke, and to compare it with Repeated Exposure (RE) to sensory stimuli, an implicit perceptual learning approach. Materials and Methods: An RCT was conducted comparing the two sensory rehabilitation approaches in subjects with chronic hemiparesis (>6 months post stroke) and lower extremity sensory loss. Sixty-four recruited volunteers (SR-34, RE-30) were assessed by a physical therapist blind to treatment allocation for sensory capabilities, activity performance and participation. Two pre-intervention assessments were conducted a week apart, followed by 10 treatment sessions of 45 minutes each, and two post-intervention assessments (immediately after treatment and following 3 months). ANOVA and post hoc tests were used to determine treatment effects over time. Significance was set at p≤0.05. Results: The study demonstrated significant clinically meaningful differences for most sensory variables of the involved foot, and for all activity and participation variables. For example: A significant time effect (p<0.0001) for barefoot Timed Up and Go test demonstrated clinically significant decrease in time for both SR and RE groups (from 43.7 to 30.1 seconds and from 45.3 to 31.1 seconds respectively). A trend interaction effect (p=0.08) for tactile threshold was found, with post hoc analysis demonstrating improvement only for the SR group. Conclusion: Sensory rehabilitation treatment by either SR or RE can make clinically significant changes in performance and participation in subjects with sensory loss post stroke.

Keywords: RCT, sensory rehabilitation, stroke

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


  ISPR8-1846 Top


Cortical excitability of motor anticipatory in subacute stroke patients after virtual reality training: a preliminary movement-related potential study

L. Chen, H. Dong Feng

Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

E-mail: chenlingred@126.com

Introduction/Background: Virtual reality (VR) training has a prominent role in promoting functional recovery post stroke. Stroke survivors with upper limb hemiplegia lack the cognitive ability to anticipate the required control. The Cortical Excitability of the anticipatory phase for upper limb movement after VR training remains unknown. This study aims to investigate the changes of cortical excitability of VR training on the motion anticipation of upper limb hemiplegic in subacute stroke survivors. Materials and Methods: In this randomized, controlled, single blind trial, 40 stroke survivors with upper limb hemiparesis resulting from the first occurrence of unilateral brain lesion within 1 to 6months were recruited. Participants was randomized to either a group receiving VR training or dose matched conventional occupational training in addition to standard rehabilitation, 30 min per day and 5 days a week for 3 weeks. The primary outcome measure was the movement-related potentials (MRPS), the electroencephalogram recordings during the acquisition phase, subjects were asked to performed a self-paced voluntary palmar grasp; secondary outcome measures were the the Action Research Arm Test (ARAT) and the Upper Limb Fugl-Meyer Assessment (UL-FMA). Participants were assessed at baseline and after intervention. Results: There were a long latency and large peak amplitude MRPS of hand motor impairment at baseline and hand motor recovery over time. After treatment, the VR group exhibited a significant difference in the decrease of the latency and the peak amplitude (P<0.05), not significant difference in the control group (P>0.05). A significant improvement in the ARAT and UL-FMA within both groups before and after treatment. Conclusion: VR training is a promising tools for rehabilitation could pomote motor anticipatory and upper limb motor function after stroke. Their introduction in combination with traditional physical and occupational therapy may enhance cortical reorganization after stroke. Clinicians may consider adding VR training as an adjucnt to routine rehabilitation training.

Keywords: Cortical excitability, stroke, virtual reality

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


  ISPR8-0352 Top


Intervention time and course of the treatment of isokinetic strength training have a different impact on walking function in elder stroke patients with hemiplegia

H. Duan, Z. Li, F. Liu

Department of Physical Medicine and Rehabilitation, First Hospital of Jilin University, Changchun, China

E-mail: duanhy101129@163.com

Introduction/Background: Intervention time and course of the treatment of isokinetic strength training have a different impact on walking function in elder stroke patients with hemiplegia. Materials and Methods: Picking up 63 elder stroke patients from department of rehabilitation in the first hospital of Jilin university with hemiplegia and randomly divided into A group, B group and C intervention group. On the basis of routine rehabilitation therapy, the patients in A group were given isokinetic strength training in the first 4 weeks. After 4 weeks, the patients were given general anti-muscular strength training. In B group, the patients were given normal resistance training at first 4 weeks, after 4 weeks to give isokinetic strength training. The C group of patients were given 8 weeks isokinetic strength training. Using PT, BBS, FMA, FAC, and MBI to evaluate the function before treatment, at 4and8 weeks. Results: After 4 weeks of treatment, the PT, BBS, FMA, FAC and MBI scores of A group were (31.47±9.65/45.68±11.86) ,(38.42±8.03), (15.23±3.65), (2.31±0.51), (52.19±11.43), and the scores of C group were (32.82±8.52/46.37±12.02) ,(37.86±7.73), (14.91±3.58), (2.26±0.53), (51.88±10.93), which were significantly better than those of B group (P <0.05), but there was no significant difference between the A and C group (P> 0.05). After 8 weeks, the scores of the three groups were significantly improved compared with after four weeks treatment (P <0.05). The PT, BBS, FMA, FAC and MBI scores of A group were (35.61±9.72/53.48±14.63) ,( 42.29±8.61), (19.37±4.05), (3.57±0.63), (63.76±12.15), and the scores of C group were (44.71±12.34/58.86±15.20) ,(46.37±9.02), (22.19±4.24), (4.02±0.68), (70.23±13.19), which were significantly better than those of B group (P <0.05), and the C group were significantly better than A group, the difference was statistically significant (P <0.05). Conclusion: Early, whole course intervention of isokinetic strength training can be more effective in improving muscle strength, walking function and ADL of the elder stroke patients with hemiplegia.

Keywords: Course of the treatment, isokinetic strength training, ntervention time

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


  ISPR8-2645 Top


Descriptive study of post-minor stroke cognitive defects (modified ranking scale≤2), impact on quality of life and return to work

C. Trotry, G. Rode, S. Nash

Hospices Civils de Lyon, Hôpital Henry Gabrielle, Saint-Genis-Laval, Lyon, France

E-mail: c.trotry@gmail.com

Introduction/Background: Descriptive study of cognitive impairments in patients having presented a right-sided, left-sided or bilateral minor stroke (modified ranking scale ≤2), and evaluation of their impact on life quality and return to work. Materials and Methods: This study includes 47 patients having presented a minor stroke. Cognitive functions were evaluated in day hospital by neuropsychologists, ergotherapists and speech-therapists. These assessments were conducted between 6 and 24 months after the stroke, with evaluations of the patients’ executive functions, short- and long-term memory and information processing speed. The defects’ impact on everyday life was calculated with the MacNair and Kahn scale, the Reintegration to Normal Living Index (RNLI) and the Sickness Impact Profile-65 (SIP-65). Correlations between cognitive performances and everyday impacts were made. Results: On the professional level, 73% of patients working before the stroke had not resumed their professional activity at the time of their evaluation. No patient having presented a left-sided stroke returned to full-time work. Regarding life quality, scores showed no significant difference comparable between the three groups. In the cohort, the RNLI averaged at 78.5%, the SIP-65 at 0.32, and the MacNair at 58.4/156. Concerning neuropsychological tests, the Montreal cognitive assessment (MOCA) score was <26 for 54.6% of the patients, with a significant difference between the groups of bilateral and right-sided strokes, in favour of the latter. There was no significant difference between groups regarding the Virtual action planning supermarket (VAP-S). The Symbol Digit Modalities Test evaluated the information processing speed, with an oral score revealed pathological in 72.3% of the cohort, which is near ¾ of the patients. Conclusion: This study demonstrates the importance of cognitive impairments in minor stroke patients, as well as their impact on everyday life in terms of life quality and return to work. This shows the interest in implementing systematic post-stroke consultations in minor stroke patients.

Keywords: Cognitive impairment, minor stroke, quality of life

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


  ISPR8-2185 Top


Postural and gait disorders in subacute stroke patients: lateropulsion is the key

S. Dai, E. Clarac, A. Odin, B. Moineau, N. Leroux, A. Kistner, A. Chrispin, P. Davoine, C. Piscicelli, M. Jaeger, D. Pérennou

Department of Neurorehabilitation, CHU Grenoble Alpes, Echirolles Cedex, France

E-mail: sdai1@chu-grenoble.fr

Introduction/Background: Postural disorders after stroke may be partly caused by a wrong referential of verticality, leading to a deficit in the upright orientation (lateropulsion). The part played by lateropulsion in the postural and gait disorders after stroke remained to be investigated. Materials and Methods: Cohort study of consecutive patients admitted in a neurorehabilitation ward after a first hemispheric stroke, from 2012 to 2017. Retrospective analysis of data collected at one month post stroke (M1). Many deficits were assessed: spatial neglect, aphasia, apraxia, depression, visual field defect, motor weakness, spasticity, sensory loss, and lateropulsion with the SCP. Balance disorders were assessed with the PASS and gait disorders with the Lindmark Scale. Statistical analyses comprised uni and multivariate analyses. Descriptive data are given in the form median (first-third quartile). Results: One-hundred seventy eight persons met inclusion criteria: age 63.2(12.2) years, 57 females, 150 with infarction, 71 with a right hemispheric stroke. At M1, 21 presented a pushing behavior (12%), among them 86% had a right hemisphere stroke. We run a Generalized Linear Model to explain postural and gait disorders by deficits. Lateropulsion was the primary deficit (body orientation) contributing to postural and gait disorders. The second one was weakness. In patients with a right hemisphere stroke, lateropulsion explained 90% of the variance of postural disorders (p<0.001), and 65 % of the variance of gait disorders (p<0.001). Conclusion: Lateropulsion, which is a sign of biased representation of the vertical, is the primary cause of postural and gait disorders at the subacute phase. A greater attention should be focused on it assessment and rehabilitation.

Keywords: Balance, gait, lateropulsion

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


  ISPR8-0980 Top


Effectiveness of upper limb robotic-assisted therapy in the early phase of stroke rehabilitation: a single-blind, randomised, controlled trial

S. Dehem1,2, M. Gilliaux1, 2, 3, G. Stoquart1, 2, 4, C. Detrembleur1,2, T. Lejeune1, 2, 4

1Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab NMSK, 4 Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Brussels, 2Université Catholique de Louvain, Louvain-La-Neuve, Belgium, 3Institut de Formation en Masso-Kinésithérapie La Musse, Institut de Formation en Masso-Kinésithérapie La Musse, Saint-Sébastien-de-Morsent, France

E-mail: stephanie.dehem@uclouvain.be

Introduction/Background: Upper limb (UL) robotic assisted therapy (RAT) is a powerful promising tool for stroke rehabilitation, particularly in the early stage. Associated to conventional therapy (CT), studies agreed that RAT decrease UL impairment. When it is provided as substitution, RAT is at least as effective as CT, but it remains uncertain if it is more effective than CT. In addition, studies often confine themselves to a single domains of the International Classification of Functioning framework (ICF). This study aims to perform a single-blind randomized controlled trial to evaluate effectiveness of UL RAT in the acute phase of stroke rehabilitation following ICF, with RAT as partial substitution to CT. Materials and Methods: Forty-five acute stroke patients were randomized into two groups (CT group, n=22 and RAT group, n=23). Both interventions were dose-matched about the duration of treatment and lasted nine weeks. The CT followed a standard rehabilitation. In the RAT group, four sessions of CT (25%) were substituted by RAT each week. RAT consisted of moving the paretic UL along a reference trajectory while the robot provided an assistance-as-needed. A blinded assessor evaluated the patients before and after the intervention and at 6-month post-stroke according to all domains of ICF. Results: Seventeen patients dropped out during the study. The UL motor control (Fugl Meyer +16%; p=0.05) and gross manual dexterity (Box and Block test +10 blocks/min; p=0.02) improved significantly more in the RAT group than in the CT group at 6-months post-stroke. The ability to perform activities of daily living and their social participation tend also to improve more in the RAT group than in CT group. Conclusion: RAT is effective for the UL motor rehabilitation in the acute phase of stroke rehabilitation. Thus, a RAT protocol can be included in practice increasing patient intensity of rehabilitation and decreasing patient’s impairments.

Keywords: Acute stroke, robotic assisted rehabilitation, upper limb

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


  ISPR8-2569 Top


Polymodal areas in the right brain support the human sense of upright

C. Piscicelli1,2, J. Barra3, O. Detante4,5, A. Krainik5,6, C. Lopez7, D. Pérennou1,2

1CHU Grenoble-Alpes, Médecine Physique et Réadaptation Neurologique, 2Laboratoire de Psychologie et Neurocognition (LPNC), Université Grenoble-Alpes, 3Laboratoire de Psychologie et Neurocognition (LPNC), Université Savoie Mont Blanc, Grenoble, France, 4CHU Grenoble-Alpes, Neurologie Unité NeuroVasculaire, 5Institut de Neurosciences de Grenoble, Université Grenoble-Alpes, 6CHU Grenoble-Alpes, NeuroImagerie, Grenoble, 7CNRS Laboratoire de Neurosciences Intégratives et Adaptatives FR3C, Université Aix-Marseille, Marseille, France

E-mail: CPiscicelli@chu-grenoble.fr

Introduction/Background: In Humans, the sense of upright is fundamental reference for bipedal behavior and spatial cognition. Our knowledge of these neural bases is limited to the perception of the vertical in the extrapersonal space (visual vertical, VV). Anatomical correlates of the sense of body upright (postural vertical, PV) are unknown.We identified the polymodal neural bases of sense of upright (VV and PV) in stroke patients, in relation to a mapping of the vestibular cortex. Materials and Methods: VV and PV were assessed in 66 first hemisphere stroke patients (58±15 years, 25F-41M, 41 right-25left). Cerebral lesions were reconstructed with MRIcro from patients MRI axial slices (axial AC-PC, T2 flair, 4mm thickness), analyzed by a Voxel Lesion Behavior Mapping statistical approach (VLBM), and compared with a recent meta-analytic mapping of the vestibular cortex. Results: The VV tilts were contralesional in 45% and ipsilesional in 9% of patients. PV tilts (42%) were always contralesional. Transmodal tilts (PV+VV) were significantly more frequent after right (16/41 patients, 39%) than left lesions (2/25, 8%, Khi2=7.54, p=0.005). Tilts in vertical estimates were more pronounced after right than left lesions for VV (-4.2° vs -1.7°; t(64)=-2.11;p=0.03) and PV (-5°vs -0.7°;t(64)=-4.67;p<0.01). In right lesions, polymodal areas of sense of verticality were the inferior parietal cortex, parietal operculum, posterior insula, pre- and postcentral gyri, and the posterolateral thalamus. Only 14 % of this core for the sense of verticality overlapped the vestibular areas. In left lesions, the rarity of PV tilts (3 patients) made irrelevant any VLBM analysis. Conclusion: The operculo-insular cortex and posterolateral thalamus are the core polymodal regions for the human sense of upright, with clear right hemisphere predominance. Surprisingly, the overlap with the vestibular cortex was weak.

Keywords: Sense of upright, vestibular cortex, voxel lesion behavior mapping statistical approach

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


  ISPR8-0229 Top


Intermittent theta burst stimulation enhances upper limb motor function in patients with chronic stroke: a randomized controlled trial

Y. Chen

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

E-mail: noah08300@gmail.com

Introduction/Background: Intermittent theta burst stimulation (iTBS) is a form of repetitive transcranial stimulation to enhance upper limb (UL) motor recovery. However, only limited studies have examined its efficacy in patients with chronic stroke and therefore it remains controversial. Materials and Methods: This was a double-blind randomized controlled trial that enrolled patients from a rehabilitation department. Twenty-two patients with first-ever chronic and unilateral cerebral stroke, aged 30-70 years, were randomly assigned to the iTBS or sham group. All patients received 10 daily sessions of either iTBS or sham stimulation over the ipsilesional primary motor cortex in addition to conventional neurorehabilitation. Outcome measures were implemented before and immediately after the intervention period: Modified Ashworth Scale (MAS), Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Box and Block test (BBT), and Motor Activity Log (MAL). Analysis of covariance was used to compare treatment effects between groups. Results: The iTBS group showed greater improvement in the MAS and FMA than the sham group (η2=0.151–0.233; p<0.05), as well as in the ARAT and BBT (η2=0.161–0.460; p<0.05) with large effect size. Both groups showed an improvement in the BBT, and there were no significant between-group differences in the changes in the MAL. Conclusion: The iTBS induced greater gains in spasticity decrease and UL function improvement, especially in fine motor function, than sham TBS. This is a promising finding because patients with chronic stroke generally have a low potential for fine motor recovery. Overall, iTBS may be a beneficial adjunct therapy to neurorehabilitation for enhancing UL function.

Keywords: Stroke, theta burst stimulation, transcranial magnetic stimulation

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


  ISPR8-0988 Top


Resting motor threshold is a biomarker for motor stroke recovery

C. Kemlin1, E. Moulton1, J.C. Lamy1, C. Rosso1,2

1Institut du Cerveau et de la Moelle Épinière ICM, 2Stroke Unit, Pitié Salpêtrière Hospital, Paris, France

E-mail: claire.kemlin@gmail.com

Introduction/Background: Accumulated evidence supports motor evoked potential (MEP) status and neuroimaging measures of corticospinal tract (CST) integrity as useful biomarkers for predicting upper-limb motor recovery. Our aim was to determine which biomarkers among electrophysiological and MRI variables can accurately explain the motor impairment in subacute/chronic stroke patients. Materials and Methods: Forty patients (> 1 month) were assessed by the Fugl-Meyer score, grip force and the Jebsen Taylor test. A motor composite score was computed with principal component analysis for each patient. In both hemispheres were collected resting motor threshold (rMT), MEP amplitude and latency and fractional anisotropy of the CST (FA_CST). During a motor fMRI paradigm, laterality index was computed within the primary motor cortex and cortico-cerebellar functional connectivity. Lesion volume, age and time since stroke were also collected. Analysis was done with ratio values in patients with MEP in the affected hemisphere (MEP+). First, each variable was tested in simple regression with linear or nonlinear effects. Only significant variables (p<0.1) were included in the multiple regression analysis. Results: In the 34 MEP+ patients (median age: 63 years, median time: 2.3 months), the multiple regression model only retained the rMT and the time since stroke as predictors. Time had non-linear effects. This model explained 38 % of the motor composite score’s variance. Conclusion: In MEP+ patients, the resting motor threshold is the explanatory factor of the upper limb impairment. In contrast to MEP amplitude and latency, the rMT, which is a complex measure of both corticospinal excitability and influenced by the corticocortical interactions, was retained. No brain imaging measure was retained by the model. Other studies are required to determine the unexplained variance of the motor impairment.
Table 1: Regression coefficients, Cohen size effects and likelihood ratio test results

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Keywords: Biomarker, corticospinal excitability, motor recovery

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


  ISPR8-0347 Top


Influence of motor deficiency and spatial neglect on the contralesional posterior parietal cortex functional and structural connectivity in stroke patients

E. Allart, R. Viard1, R. Lopes1, H. Devanne2, A. Delval2

Lille University Medical Centre, Neurorehabilitation Unit, 1Lille University Medical Centre, Clinical Imaging Core Facility, 2Department of Clinical Neurophysiology, Lille University Medical Centre, Lille, France

E-mail: etienne.allart@chru-lille.fr and abadielaurine@hotmail.fr

Introduction/Background: The posterior parietal cortex (PPC) is a key structure for visual attention and upper limb function, two features that could be impaired after stroke, and could be implied in their recovery. If it is well established that stroke is responsible for intra- and interhemispheric connectivity troubles, little is known about those existing for the contralesional PPC. Materials and Methods: In this study, we aimed at mapping the functional (using resting state fMRI) and structural (using diffusion tensor imagery) networks associated with 3 subparts of the PPC of the contralesional hemisphere (the anterior intraparietal sulcus (aIPS), the posterior intraparietal sulcus (pIPS) and the superior parieto-occipital cortex (SPOC)) in 12 chronic stroke patients compared to 13 healthy controls. We also aimed at assessing the relationship between connectivity and the severity of visuospatial and motor deficiencies.Results: We showed that intrahemispheric functional connectivity between the contralesional PPC and posterior frontal regions (especially premotor areas) was altered, as were interhemispheric functional and structural connexions between each part of the contralesional PPC and their homologous area in the ipsilesional hemisphere. Neglect severity was associated with several alterations in intra- and interhemispheric connectivity, the behavioral/connectivity correlations were far less evident for motor deficiency. Conclusion: The results of this exploratory study shed a new light on the influence of the contralesional PPC in post-stroke patients, they have to be confirmed and refined in further larger studies.

Keywords: Connectivity, posterior parietal cortex, stroke

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


  ISPR8-1219 Top


Functional connectivity pattern during motor imagery and execution of paretic hand movements of stroke patients

N. Brihmat, M. Tarri, X. De Boissezon1, D. Gasq1, P. Marque1, E. Castel-Lacanal1, I. Loubinoux

Department of Neurosciences, UMR 1214-INSERM/UPS-ToNIC, 2Department of Neurosciences, Service de MPR- CHU Rangueil, Toulouse, France

E-mail: nabila.brihmat@inserm.fr

Introduction/Background: Motor imagery (MI) has emerged as a promising technique for promoting neuroplasticity and recovery of motor function after a stroke. It is used as an alternative to movement execution (ME). The brain structures involved in MI are largely documented but the existent functional connectivity (FC) during MI and the differences with ME in stroke patients remain underinvestigated. Functional magnetic resonance imaging (fMRI) techniques have the potential to reveal these changes. We aimed to investigate the FC during MI and ME and correlate FC measures between sensorimotor (SMN) regions with motor function of stroke patients. Materials and Methods: Twenty-four stroke patients with hemiparesis (time post-stroke = 10 ± 21 months; Upper-limb Fugl-Meyer Score (FMS) = 27.2 ± 13.5/66) were included. The patients underwent fMRI examination while they either imagined or executed wrist extension with their affected hand (AH). We studied FC using seed-to-voxels analysis. We compared the FC of SMN regions between MI and ME of AH movement. Additionally, correlations among brain FC measures and behavioral scores of motor function (FMS) were computed. Results: During MI of the AH in comparison with ME, FC of the ipsilesional SMN (BA 40) was decreased with the ipsilesional somatosensory cortex (BA 2, 40, 5) and the cerebellum. In parallel, it was increased with the bilateral frontal cortex (BA 8, 10) (figure). Besides this, correlation analyses with the FMS revealed that during MI, more impaired patients relied more on functional connections between contralasional BA4 and cerebellum (crus 1 and 2) than less impaired patients did. Conclusion: The connectivity changes observed may reveal compensatory networks for MI implicating more the frontal lobe and the contralesional hemisphere in most impaired patients. These results characterized the connectivity patterns of ME and MI and may provide new insights into the neural mechanism underlying them.



Keywords: Functional connectivity, motor Imagery, stroke

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


  ISPR8-1753 Top


Validation of a kinect-based system to quantify proximal arm non-use after a stroke

K. K. A. Bakhti1, I. Laffont1, M. Muthalib2, J. Froger3, D. Mottet2

1Department of Médecine Physique et de Réadaptation, CHU Montpellier, 2EuroMov, Université de Montpellier, Montpellier, 3Department of Médecine Physique et de de Réadaptation, CHU de Nimes, Grau du Roi, France

E-mail: k-bakhti@chu-montpellier.fr

Introduction/Background: Proximal arm non-use is when an individual with a weaker arm can use it, however spontaneously persists in under-using shoulder and elbow joints. The score of proximal arm non-use (PANU) is computed as the difference between the spontaneous use and the maximal use of shoulder and elbow joints. We previously quantified PANU using an ultrasound and marker-based movement analysis system (Zebris, CMS20s®). The aim of this study is to validate a low-cost markerless system (Microsoft Kinect®-based) against the reference system (CMS20s®) to determine PANU during seated reaching. Materials and Methods: In 19 hemiparetic stroke individuals the PANU score, reach length, trunk length, proximal arm use were measured during seated reaching simultaneously by the Kinect® (v2) and CMS20s® over two testing sessions separated by 2h. Results: Intraclass correlation coefficients (ICC) and linear regression analysis showed that the PANU score (ICC=0.95, r2=0,90), reach length (ICC=0.82, r2=0,70), trunk length (ICC=0.97, r2=0,94) and PAU (ICC=0.97, r2=0,93) measured using the Kinect were strongly related to those using the CMS20s. The PANU scores showed good test-retest reliability for both the Kinect (ICC = 0.76) and CMS20s (ICC=0,72) with Bland & Altman plots showing slightly reduced PANU scores (i.e., improved performance) in the re-test session for both systems (Kinect: -4,25 ± 6.76; CMS20s: -4,71 ± 7.88), which suggests a practice effect. Conclusion: We conclude that the Kinect® can offer a low-cost and widely available solution to clinically assess PANU to monitor the progress of paretic arm recovery and to better individualise rehabilitation.

Keywords: Arm non-use, movement analysis, stroke rehabilitation

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


  ISPR8-1495 Top


Effects of digital smart glove system on motor recovery of upper extremity in subacute stroke patients

H. Kim1, A. Lee1, Y. I. Shin2, W. H. Chang3, K. H. Koo3, H. Seong2, Y. H. Kim1,3

1Department of Health Sciences and Technology, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, 2Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan Hospital, Pusan, Republic of Korea, 3Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Center for Prevention and Rehabilitation, School of Medicine, Heart Vascular and Stroke Institute, Sungkyunkwan University, Seoul, South Korea

E-mail: yunkim@skku.edu and jungsoo0319@gmail.com

Introduction/Background: This study aimed to investigate the effect of novel rehabilitation system, Rapael Smart Glove® (NEOFECT, Yongin, Korea), on recovery of upper extremity in subacute stroke patients. Materials and Methods: Fourty-one subacute stroke patients (24 females; mean age 60.4±13.3 years) with hemiparesis were enrolled from two medical centers in this prospective, single-blind, randomized controlled study. All patients were treated with 40 therapeutic sessions during 4 weeks, five times a week, an hour per day. In experimental group, each session consisted of training using the Smart Glove for 30 mins and conventional OT (Occupational Therapy) for 30 mins. Control group received conventional OT for 60 mins per day. Functional assessments and fNIRS measurement was conducted before (T0), immediately after (T1), and 1 month after (T2) the intervention. Repeated-measures ANOVA was used for statistical analysis. Results: Thirty-two participants (15 experimental and 17 control groups) completed all intervention process. No serious complication was reported in both groups. Repeated-measures ANOVA demonstrated that scores for FMA upper-limb parameters and all subtest scores of Jebsen-Taylor Hand Function Test except writing were significantly improved in experimental group compared to control group (p < 0.05). In fNIRS measurement, oxyhemoglobin concentration of ipsilesional motor cortex was more increased during affected hand movement in experimental group compared to control group. Conclusion: The results of this study revealed that combination of Rapael Smart Glove® training with conventional OT was more effective to improve upper limb motor function than conventional OT alone in subacute stroke patients.(This research was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI15C0570) and a grant from the NRF (NRF-2017R1A2A1A05000730) funded by the Korean government.)

Keywords: Functional recovery, stroke, upper extremity rehabilitation

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


  ISPR8-1242 Top


Effect of the association of motor imagery exercises and paired associative stimulation in stroke patients (mipas)

N. Brihmat, M. Tarri, X. De Boissezon1, D. Gasq1, I. Loubinoux, P. Marque1, E. Castel-Lacanal1

Department of Neurosciences, UMR 1214, INSERM/UPS, ToNIC, 2Department of Neurosciences, CHU Rangueil, Service de MPR, Toulouse, France

E-mail: nabila.brihmat@inserm.fr

Introduction/Background: Paired associative stimulation (PAS) is a non-invasive brain stimulation method that modulate cortical plasticity. Motor imagery (MI) can be used as an alternative to movement execution (ME) after stroke. In this study, we want to compare the motor and electrophysiological effects of a session combining PAS and MI exercises to sessions where only one of the intervention was delivered. Materials and Methods: MIPAS is a prospective, randomized, cross-over study. Twenty-three stroke patients with hemiparesis (mean age = 52 ± 13 years; time post-stroke = 10 ± 22 months; Upper-limb Fugl-Meyer Score (FMS) = 28± 13 / 66; Kinesthetic and Visual Imagery score (KVIQ_S) = 119 ± 23 / 140) were included and randomely assigned to one of the three 15 minutes session: PAS+MI; PAS; placeboPAS+MI. The PAS intervention consists of a combination of electrical stimulation of the hemiplegic Extensor Carpi Radialis (ECR) with cortical magnetic stimulation of the ECR cortical representation. In MI condition, the patient is instructed to imagine extension of his hemiplegic wrist and in PlaceboPAS intervention, we used a sham probe. We compared the surface variation of the Motor Evoked Potential (MEP) of the ECR and the amplitude of Active Extension (AE) of the hemiplegic side after each session. Results: In comparison with the other two sessions, significant facilitation associated with motor improvement was observed 15’ after the end of session placeboPAS+MI (ΔPEM(C)=+ 62%±96.7%; ΔEA(C)=+2.9°±6.7°). Significant motor improvement were observed after the sessions PAS+MI and PAS (ΔEA(A)=4.1°±8.1° ; ΔEA(B)=5.4°± 6.1°) but not association with cortical excitability changes. The motor improvement after the session PAS was significantly higher in comparison with that observed after session placeboPAS+MI. Conclusion: Only the session PlaceboPAS+MI seems to induce increased cortical excitability associated with motor improvement, the other sessions inducing only motor effect.

Keywords: Motor imagery, paired associative stimulation, stroke

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


  ISPR8-0242 Top


Effects of virtual reality therapy on upper limb function after stroke and the role of neuroimaging as a predictor of better response

M. G. Gonçalves, G. J. Luvizutto1, E. D. M. Neto2, C. L. S. Marques, R. Bazan, E. G. G. Betting

Department of Neurology, Botucatu Medical School, Botucatu, 2Department of Physical Therapy, University Federal do Triângulo Mineiro, 3Department of Physical Therapy, Faculty of Human Talent, Uberaba, Brazil

E-mail: gluvizutto@gmail.com

Introduction/Background: Virtual reality therapy (VRT) is an interactive intervention that induces cortical activation. However, when this tool may aid in motor function recovery after stroke is not yet established. The aim of this study was to evaluate the effects of VRT on upper limb function after stroke. Neuroimaging features were also assessed to investigate a predictor of better response to this therapy. Materials and Methods: Patients with stroke were consecutively selected and underwent VRT. Clinical neurological characteristics, function of the upper limb, and quality of life were evaluated before and after VRT. Statistical analysis was performed using a general linear model (GLM) comparing pre- and post-intervention outcomes. Age, sex, and thrombolytic therapy were used as confounding factors. High-resolution computed tomography (CT) scans were obtained in the post-stroke phase. CT images were registered into standard space using a lesion mask protocol and flipped based on the side of the stroke. Voxel-based lesion symptom mapping (VLSM) was performed using GLM and searching for correlations between the clinical data and CT lesion. Results: Eighteen patients were studied (8 women; mean age, 55.5±13.9 years). Quality of life, functional independence, functional characteristics, and dexterity of the upper limb showed improvement after the intervention (p<0.001). The mean volume of lesions was 24,172±17,302 mm3. VLSM analysis showed negative correlations mainly between the posterior portion of the internal capsule and functional recovery [Figure 1].
Figure 1: Brain areas affected in patients with stroke and upper limb impairment underwent virtual reality therapy (A). Findings are overlaid in a template of axial magnetic resonance image slices and in a tridimensional model of the brain (B). The color code bar indicates the number of patients with the area injured

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Conclusion: VRT showed benefits for patients with stroke. Subcortical strokes with involvement of the internal capsule presented the worst response to therapy.

Keywords: Neuroimage, stroke, upper limb function

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


  ISPR8-0097 Top


S100β protein as a predictor of post-stroke functional outcome: a prospective study

J. Branco, J. Pinheiro1

Centro de Medicina e de Reabilitaçao, Rovisco Pais, Reabilitação Geral de Adultos, 1Centro Hospitalar e Universitário de Coimbra, Serviço de Medicina e de Reabilitaçao, Coimbra, Portugal

E-mail: joaobrancofmuc@hotmail.com

Introduction/Background: Background: Stroke is one of the leading causes of disability worldwide. Early prediction of post-stroke disability using clinical models is of great interest, especially in the rehabilitation field. Although some biomarkers and neuroimaging techniques have shown potential predictive value, there are still insufficient data to support their clinical utility in predicting post-stroke functional recovery. Aim: To assess the value of serum biomarkers (CRP, D-Dimer, fibrinogen, and S100β protein), in predicting medium to long-term (12 weeks) functional outcome, in patients with acute ischemic stroke. Materials and Methods: Methods: This is an observational, prospective study in a sample of patients hospitalised for ischemic stroke (n=131). Peripheral blood levels of biomarkers of interest were determined at admission (C-reactive protein, D-dimer, and fibrinogen) or at 48 hours post-stroke (S100β protein). Functional status was accessed at 48 hours and 12 weeks post-stroke, using the modified Rankin Scale (mRS). Results: S100β protein levels measured at 48 hours were significantly associated with mRS at 12 weeks (OR=1.005, 95%CI [1.005–1.007]; P<0.001). This association that was not seen for the remaining biomarkers of interest. The S100β cut-off for poor functionality at 12 weeks was ≥140.5 ng/L (sensibility 83.8%; specificity 71.4%; AUC=0.80, 95%CI [0.722, 0.879]). Conclusion: S100β levels in peripheral blood at 48 hours post-stroke reflect acute stroke severity and predict functional outcome at 12 weeks with a cut-off value of 140.5 ng/dL. The value of S100β as predictor of functional recovery after-stroke should be emphasised in further clinical research and clinical practice

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


  ISPR8-0144 Top


Development and validation of a questionnaire to assess barriers to physical activity after stroke: the barriers to physical activity after stroke scale (bapas)

J. Drigny, C. Joussain1, V. Grémeaux2, R. Morello3, P. Ho Van Truc4, E. Touzé5, A. Ruet

Department of Physical Medicine and Rehabilitation, Caen University Hospital, 4Unité de Biostatistique et Recherche Clinique, Caen University Hospital, 5Department of Neurology, Caen University Hospital, Caen, 2Université de Versailles St-Quentin en Yvelines, Inserm UMR 1179, Montigny-le-Bretonneux, 5Department of Physical Medicine and Rehabilitation, Institut de Médecine Physique et de Réadaptation, Herouville-Saint-Clair, France, 3Sport Medicine Unit, Institute of Sport Sciences of University of Lausanne (ISSUL), Lausanne, Switzerland

E-mail: j.drigny@gmail.com

Introduction/Background: Stroke survivors are encouraged to participate in regular physical activity (PA). However, the vast majority of patients do not practice PA as recommended and numerous “barriers” prevent the patient from getting back to a physically active lifestyle. Objective: To develop and validate a self-reported questionnaire assessing the barriers to 6 physical activity (PA) among stroke survivors. Materials and Methods: Population was stroke survivors with no to moderate disability (Rankin score 0-3, stroke >3 months). In part 1, semi-structured interviews were performed to identify potential barriers to PA, which were then selected by a group of experts and grouped in a BAPAS scale. In part 2, stroke survivors filled out a personal information questionnaire and the BAPAS scale. An item selection process and principal component analysis (PCA) were carried out, and internal consistency was evaluated by Cronbach’s α. Concurrent validity was established through correlation between the BAPAS sce and the modified Rankin Scale. Test-retest reliability was evaluated with the intraclass coefficient (ICC). Results: In part 1, 37 subjects reported 43 “barriers” of which 27 were selected in an initial BAPAS scale. In part 2, 109 subjects (63% men, 72% ischemic stroke, mean age 60.6 years) were included. Item selection process created a 14-item BAPAS scale suitable for factor analysis (KMO=.82) with two sub-scales (behavioral and physical). The maximum score was 70 (highest barriers). Internal consistency was high (α= .85) and a strong correlation with the modified Rankin Scale was found (r=.65, p<.001). Test-retest reliability was excellent with an intraclass coefficient at .91 (95 % CI .79-.97). BAPAS scores were higher in patients with greater disabilities and longer time since stroke (p <.01). Conclusion: We developed and validated the BAPAS scale to assess barriers to PA in stroke survivors. This scale could help to personalize strategies promoting physically active lifestyles after stroke.

Keywords: Physical activity, scale, stroke

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


  ISPR8-2548 Top


Dose-response relationship during motor learning with bimanual-to-unimanual training

P. Raghavan, A. Tang, S. Bilaloglu, C. Bayona, J. Stone, M. Wilfred, C. Hung, A. Yousefi, M. Caughey

School of Medicine, Rusk Rehabilitation, New York University, New York, USA

E-mail: preeti.raghavan@nyumc.org

Introduction/Background: Few options exist for training arm movements in patients with little active movement in their affected arm after a stroke. The purpose of this study was to test the efficacy of bimanual-to-unimanual training in reducing upper limb motor impairment and active movement in the affected arm, and to examine the effect of training dose on motor learning. Materials and Methods: Twenty subjects with chronic post-stroke hemiparesis underwent 6 weeks of usual care. They then received 12 one-hour sessions of bimanual-to-unimanual training using the Bimanual Arm Trainer (BAT, Mirrored Motion Works, Inc.). The training consisted of bimanual training of both arms followed by unimanual training of the affected arm alone. Some patients received the 12 sessions over 4 weeks, whereas others received it within 6 weeks. Extent of motor impairment on the Fugl-Meyer scale and active movement at upper limb joints was examined at baseline and pre- and post-training. The degree of improvement in the affected arm was computed both within and between training sessions as well as pre- and post-training. Repeated measures ANOVA was performed on the variables of interest. Results: Bimanual-to-unimanual training led to a significant improvement in upper limb Fugl-Meyer scores and active movement compared with usual care (p<0.05). The difference was significantly greater in patients who underwent 12 sessions of training within 4 weeks compared with those who underwent training over 6 weeks. Changes in within and between session learning curves enable characterization of patterns of motor learning across individuals that can facilitate the development of algorithms for precision rehabilitation for post-stroke motor learning and recovery. Conclusion: Bimanual-to-unimanual arm training can reduce motor impairment in patients with chronic post-stroke hemiparesis. Higher frequency of training leads to greater improvements despite the same total dose. The study provides a means for understanding dosing of treatment for motor learning post stroke.

Keywords: Hemiparesis, motor learning, motor recovery

Disclosure of interest: PR is co-founder and scientific advisor for Mirrored Motion Works, Inc.


  ISPR8-0818 Top


Wristband accelerometers to motivate arm exercise after stroke (waves): activity data from a pilot randomised controlled trial

R. Da Silva, H. Rodgers, L. Shaw, F. Van Wijck1, S. A. Moore2, D. Jackson3, R. Francis, L. Sutcliffe, M. Balaam3, T. Ploetz3, L. Brkic, C. I. Price2

Newcastle University, Institute of Neuroscience, 2NIHR Newcastle Biomedical Research Centre, 3School of Computing Science, Newcastle University, Newcastle upon Tyne, 1School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom

E-mail: ruth.da-silva@ncl.ac.uk

Introduction/Background: Encouraging impaired limb use during routine and rehabilitation activities after stroke is challenging. We evaluated changes in stroke arm activity related to vibration prompts delivered by a wrist-worn accelerometer (“CueS wristband”). Materials and Methods: A pilot randomised controlled trial was conducted with adults <3 months after stroke causing any arm impairment. All received instruction for a self-directed four-week programme encouraging bimanual tasks, and wore a wristband on the impaired side 8am – 8pm. Intervention wristbands were programmed to deliver vibration prompts if hourly activity targets were unmet. To allow for incremental recovery, patient preference and diurnal variability, the target was selected as 5%, 10% or 20% above median levels recorded hourly over the previous 3 days. Data were downloaded at twice weekly reviews. Activity counts per minute (CPM) were calculated from CueS mean signal vector magnitude (1s epoch) at the first (baseline) and the last (endpoint) review. Standard accelerometers recorded natural arm activity over 72hrs starting at 4 and 8 weeks post-baseline. Mann Whitney U test compared CPM between groups, and for 1 hour before/after prompts amongst intervention participants. Results: Thirty-thrree participants (14 intervention; 19 control) enrolled over 16 months: mean age 71 years (SD11); 13 male; mean days post-stroke 30 (SD19); median baseline Action Research Arm Test 20/57 [IQR 3.5,41]. Median number of prompts delivered were 7 per participant/day [IQR: 6,8]. Median CPM during 1 hour before/after prompts was 651 versus 759 (+16.6%; p=0.002). CPM increased immediately after prompting, suggesting a direct behavioural impact. Compared to control, the intervention group continued to increase CPM beyond wristband removal. Whilst these results are encouraging, this was a small study and data may not reflect only arm activity. Conclusion: Personalised prompts delivered by a wrist-worn accelerometer may enhance self-directed arm activity after stroke.
Table 1: CPM median [IQR] at each outcome interval.

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Keywords: Accelerometer, stroke, upper limb

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


  ISPR8-1709 Top


Effects of home-based physical activity incitation and education program in subacute phase of stroke recovery after 6 months of monitoring

D. A. Chaparro Obando, B. Borel, J. Y. Salle1, M. Compagnat1, J. C. Daviet1, M. Stéphane

Laboratory HAVAE EA 6310, Limoges University, 1Limoges Hospital Center, Physical Medicine and Readaptation Service, Limoges, France

E-mail: dvidch7@gmail.com

Introduction/Background: The aim of the study was to evaluate the effect of physical activity incitation and education program at home on functional capacity, fatigue and depression levels in subacute phase of stroke recovery. Materials and Methods: Eighty-four volunteers post-stroke patients participated in this randomized clinical trial (Mean ± SD; Age: 62 ± 13 years; Barthel Index: 95.4 ± 9.1; Weight: 76.8 ± 15 Kg; Stroke delay: 77.6 ± 45.7 days). Participants were divided into a Home-based Physical Activity Incitation group (HBPAI, n=42) and Control group (CG, n=42). HBPAI follow the physical activity incitation program during six months. The 6 minutes walking test (6MWT), Functional Ambulation Classification (FAC), Hospital Anxiety Depression Scale (HADS) and Multidimensional Fatigue Inventory questionnaire (MFI-20) were measured at baseline (T0), after 6 months (T1) and 12 months (T2). Results: 6MWT (m) performed by HBPAI and CG group at T0, T1 and T2 was (374 ± 141.1; 454 ± 134.8; 437.8 ± 146.4) and (372.5 ± 149.4; 385 ± 157.8; 400.1 ± 153) respectively. Distance walked during 6MWT significantly increased in HBPAI than CG (p<0.05) at T1, but not at T2. Score of general fatigue significantly decreased between T0 and T1 (11.9 ± 3.1 and 10.5 ± 2.9; p<0.004) and T2 (9.6 ± 4.1; p<0.001) in HBPAI. Depression score significantly decreased between T0 and T2 (8.6 ± 3.2 and 6.5 ± 3.7; p<0.01) in HBPAI. Conclusion: Increasing physical activity after stroke could improve post-stroke common functional problems. However, the efficacy of physical activity programs at home is still unknown (Jones et al 2015). Furthermore, there is limited information about the effects of PA on fatigue levels after stroke (Duncan F. et al 2012). HBPAI program could be a good strategy to improve the walking distance and decrease fatigue and depression scores in subacute phase of stroke recovery.

Keywords: 6 MWT, physical activity, stroke

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


  ISPR8-2602 Top


The neural substrate of residual motor function after stroke: comparison of left and right hemisphere damage

N. Soroker, G. Friedberg1, S. Frenkel-Toledo2

Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital and Sackler Faculty of Medicine Tel Aviv University, Raanana, 1School of Medicine, Sackler Faculty of Medicine Tel Aviv University, TelAviv, 3Department of Physiotherapy, School of Health Sciences Ariel University, Ariel, Israel

E-mail: soroker@netvision.net.il

Introduction/Background: Lesion characteristics exert a dominant effect on the severity of motor impairment following stroke and on the likelihood of obtaining natural and treatment-induced recovery. Here we aimed to assess the relationship between location of brain damage and residual motor function using voxel-based lesion-symptom mapping (VLSM). Materials and Methods: Residual motor function of the hemiparetic upper limb (HUL) was examined in 3 groups of patients - Subacute (n=72), Chronic (n=31), and Delta (n=20; patients examined both in the subacute and chronic stages) – using the proximal and distal sub-divisions of the Upper Extremity module of the Fugl-Meyer test and the Box and Blocks test. Normalized lesion data were used for VLSM analyses of lesion impact on motor function, separately for left and right hemisphere damage (LHD, RHD). Results: HUL function following LHD was affected in the subacute phase mainly by damage to the sensory-motor and premotor cortices, with an additional impact of damage to white matter tracts. In the chronic phase, the impact of damage to cortical structures was restricted to a smaller part of the sensory-motor cortex, whereas damage to white matter tracts maintained a dominant impact on HUL function. The RHD group revealed a less salient effect of assessment time and in both phases the major impact on HUL function was attributed to damage to the insular cortex, the basal ganglia and the adjacent white matter tracts. Proximal and distal HUL functions were affected mainly by lesions to dorsal and ventral cortical regions, respectively. Conclusion: The functional neuroanatomy underlying motor recovery is different in LHD and RHD patients. Proximal and distal HUL motor control is affected by different lesion patterns. Time after stroke onset (subacute, chronic) affects significantly the results of VLSM analyses.

Keywords: Motor function, stroke, voxel based lesion-symptom mapping

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


  ISPR8-2321 Top


Disturbed small-world networks in leukoaraiosis patients with cognitive impairment

Y. Zhang, J. Wang

Department of Neurology, Beijing Tiantan Hospital, Beijing, China

E-mail: zhangyumei95@aliyun.com

Introduction/Background: The small-world networks have been proposed to be the optimal brain network with maximal efficiency in information processing at a minimal cost, and facilitating rapid information interactions. Some research suggested that patients with cognitive impairment have disrupted small-world networks. Leukoaraiosis (LA) is characterized by white matter hyperintensities (WMH) on magnetic resonance imaging (MRI), which is known to be associated with vascular cognitive impairment (VCI). In this study, we aimed to investigate the small-world properties of the brain functional network and their relationship with cognition impairment in LA patients. Materials and Methods: Subjects were selected from communities using MRI, and given cognitive tests including Montreal Cognitive Assessment (MoCA) and Clinical Dementia Rating (CDR), and then divided into LA with normal cognition (LA-NC), LA with vascular mild cognitive impairment (LA-VaMCI) and the healthy control (HC) groups. Resting-state functional MRI data were collected and graph theoretical analysis was applied to evaluate the difference of the small-world networks among the three groups. Results: Both LA-NC and LA-VaMCI cases presented with modified small-world topological properties. Compared with HC group, LA-NC group had increased small-world properties, whereas LA-VaMCI group showed decreased small-world properties. Moreover, we also found the small-world network properties was negatively correlated with the score of MoCA in LA-VaMCI patients. Conclusion: Our study indicated that disrupted small-world networks may be one mechanism of cognitive impairment in LA patients, and the degree of small-world network changes might be associated with the level of cognitive impairment. The small-world networks could be used as a potential marker to detect vascular cognitive impairment in LA patients.

Keywords: Cognitive impairment, functional magnetic resonance imaging, small-world network

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


  ISPR8-0731 Top


Berg balance scores at admission strongly correlates with functional outcomes and with walking speed after inpatient rehabilitation post stroke

C. Barbeiro, J. Fortunato, D. Martins1, J. Jacinto

Centro de Medicina de Reabilitação de Alcoitão, Adult Neurorehabilitation, Cascais, 1Department of Physical Medicine and Rehabilitation, Centro Hospitalar Lisboa Central, lisbon, Portugal

E-mail: carolinabarbeiro@gmail.com

Introduction/Background: The Berg Balance Scale (BBS) is a test of functional balance. It is commonly applied during inpatient rehabilitation, and has been shown to predict length of stay and discharge destination as well as predict walking suitable for community ambulation at discharge from inpatient stroke rehabilitation. The aim of this study is to correlates BBS with Functional Independence Measure (FIM) scores and with walking speed at discharge in our cohort. Materials and Methods: Prospective observational study, with retrospective analysis of records after a 1st inpatient program in a rehabilitation service in 2014. The BBS was evaluated at admission and discharge. Functionality was measured by FIM, subdivided in activities of daily living (ADL), transfers, walking ability, cognitive outcome and total FIM score. Walking speed was measured by 10m walking test. The results were analyzed with t-student paired samples and Pearson correlation. Results: From a total of 119 patients discharged in 2014, in 105 it was possible to obtain BBS, and their respective FIM and walking speed at admission and discharge. From 105 patients, 47 (44.8%) were men and 58 (55.2%) were women. The mean age of the patients was 60.55 years. 31 (29.5%) patients had haemorrhagic strokes and 74 (70.5%) had ischaemic ones. 53 (50.5%) patients had left hemiparesis, 44 (41.9%) right hemiparesis and 8 (7.6%) double hemiparesis. On average, the patients were hospitalized for 69.11 days (SD 13.44). BBS presented a significant improvement from admission to discharge (p<0.05). There was a positive and strong correlation (r>0.7) with ADL, transfers, walking ability, total FIM scores, at admission and discharge. BBS also presented a positive strong correlation with walking speed at admission and at discharge. Conclusion: In our cohort, BBS had a strong correlation with functional and motor outcomes, which is in line with previously published studies.

Keywords: Berg balance score, stroke

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


  ISPR8-2485 Top


Effectiveness of short-term training with a synergy-based fes paradigm on motor function recovery post stroke

C. Niu, Y. Bao1, C. Zhuang2, S. Li2, T. Wang2, X. Zhang1, Y. Ma1, Z. Xuan1, L. Gu1, N. , Q. Xie

Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University, 1Department of Rehabilitation Medicine, Ruijin Rehabilitation Hospital, 3School Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China

E-mail: minos.niu@gmail.com

Introduction/Background: The objective of this study is to test the clinical effectiveness of a synergy-based multi-muscle functional electrical stimulation (FES) strategy to accelerate post-stroke motor function recovery via a new task-oriented training protocol. Materials and Methods: A randomized, single-blind, placebo controlled protocol was designed and tested in this study. Daily FES interventions were applied to patients, approximately one hour each day for 5 consecutive days. Stimulation parameters were determined for each patient using an algorithm based on muscle-synergies obtained from healthy subjects. The task-oriented training protocol required patients to repeat forward and lateral reaching movements, with concurrent assistance from FES. Sham interventions were tested with all FES electrodes attached but without actual stimulations.20 patients with ischemic post-stroke hemiparesis participated in this study. FES interventions were applied to 10 patients, and 10 patients received sham interventions. We measured kinematics, electromyography, and upper-extremity Fugl-Meyer scores of patients before and after intervention. Results: After 5 days of FES intervention, all patients showed increased Fugl-Meyer scores and peak movement velocity. Interestingly, the post-intervention muscle synergy in patients became more similar to that of healthy controls. No comparable improvements were observed after sham interventions. Particularly, a self-comparison in the patient received both sham and FES interventions highlighted the effectiveness of FES with task-oriented training. Conclusion: Our results provided early evidence that there is clear clinical benefit to concurrently stimulate multiple muscles to assist residual movements using FES, and synergy-based FES induces restoration of more normal kinematics and muscle activation pattern. The FES and task-oriented training protocol showed initial indications of effectiveness with a short-term intervention.

Keywords: Functional electrical stimulation, neuromuscular, stroke

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


  ISPR8-0335 Top


Spatial neglect, rather than asymmetrical physical impairment, impedes rehabilitation outcome

P. Chen, I. Ward1

Kessler Foundation Research, 1Brain Injury, Kessler Institute for Rehabilitation, West Orange, New Jersey, USA

E-mail: pchen@kesslerfoundation.org

Introduction/Background: Spatial neglect (SN) is 1) the failure to report stimuli in the contra-lesional space, or 2) the lack of initiation or ineffective movement toward or within the contra-lesional space. Because patients with SN often have hemiplegia or hemiparesis, some hypothesize that asymmetrical physical impairment, rather than SN, is the leading predictor of poor rehabilitation outcome. Materials and Methods: We developed the Movement and Mobility Scale (MMS) to assess upper and lower extremities in left versus right voluntary movement and mobility. Inter-rater reliability was examined by having two physical therapists (PT) independently assessed 13 patients. With a good inter-rater reliability, kappa = .75, seven PTs were trained to use the MMS. They then assessed patients admitted with a first stroke or traumatic brain injury (TBI) within 100 days post-injury to the inpatient rehabilitation facility. All patients also received the FIM (admission and discharge) and the Catherine Bergego Scale via the Kessler Foundation Neglect Assessment Process (admission). Results: Seventy-six patients were tested (61 with stroke; 15 with TBI). Median age was 69 years old (IQR = 55 – 79). 43 patients (56.6%) had SN. Patients with SN had lower FIM scores at discharge than those without SN (M = 71.2 vs. 89.2). Controlling for admission FIM and age, there was a significant main effect of SN, F(1,72)=19.71, p< .001. To examine the a priori hypothesis, we additionally controlled for MMS, which provided indices for asymmetrical movement in upper and lower extremities and asymmetrical mobility in left versus right space. The main effect of SN remained robust, F(1,69)=17.71, p< .001. Conclusion: As reported in previous studies, SN impedes rehabilitation outcome in individuals with acquired brain injury. Additionally, we confirmed that such finding cannot be attributed to asymmetrical physical abilities. SN must be addressed effectively in rehabilitation care in order to improve outcome.

Keywords: Spatial neglect, stroke, traumatic brain injury

Disclosure of interest: Dr. Peii Chen receives grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Administration for Community Living, U.S. Department of Human and Health Services. The content of this work was not developed under the NIDILRR grants. Dr. Peii Chen is the listed inventor of two pending patent applications (No.14/278,776 & No. 15/819,731), which are not related to the work reported in the Abstract either.


  ISPR8-0639 Top


Effects of repetitive neck muscle vibrations on postural disturbances in standing position in chronic patients

K. Jamal, S. Leplaideur, C. Rousseau1, L. Chochina2, A. Moulinet Raillon3, I. Bonan

Department of Physical and Rehabilitation Medicine, University Hospital of Rennes, 2Department of Clinical Pharmacology-Clinical Investigation, Center INSERM 1414, University Hospital of Rennes, Rennes, 3Department of Neurology Physical and Rehabilitation Medicine,CMMRF Kerpape, Kerpape, 4Department of Physical and Rehabilitation Medicine, Hospital of Saint Vallier, Saint Vallier, France

E-mail: krmjamal@me.com

Introduction/Background: Asymmetrical postural behaviors are frequent and related to poor equilibrium after a stroke. Proprioceptive neck vibration corrects in the short term the postural asymmetry probably through a sensory recalibration, but the effects of repetitive has yet to be tested. The objective was to test the effects of repetitive neck muscle vibration (rNMV) on postural disturbances and on spatial frame reference in right (RBD) and left (LBD) brain damage patients. Materials and Methods: Thirty-two chronic stroke patients (mean age 60,9y±10 and mean delay after stroke 4,9y±4 years), 16 RBD and 16 LBD, underwent a program of 10 sessions of vibrations (10 min) during a period of two weeks. Postural asymmetry on force platform (Weight Body Asymmetry WBA), spatial frames (Subjective Straight Ahead SSA, Longitudinal Body Axis LBA, Subjective Visual Vertical SVV) and clinical assessment (Motricity Index, Sensibility, Spasticity, Berg Balance Scale, Time Up and Go) were ascertained at the end of the vibrations (D+15) and at D+22, D+45. Results: In the post test, the results were depending of the side of the lesion with a significant reduction in WBA in the RBD (p= 0,0001), whereas no effect was observed in the LBD. No significant modification was found on the spatial frame in both groups. A significant improvement was found for the Motricity, TUG and BBS in the both groups at the end and at distance. Conclusion: rNMV causes a reduction of postural asymmetry only in the RBD patients. These results suggest that rNMV could be effective on sustainable disorders of balance of spatial cognition disorders. Further, this result was not maintained at distance.

Keywords: Neck muscle vibration, postural asymmetry, stroke

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


  ISPR8-1014 Top


Surgical treatment of disabling shoulder hypertonia in patients with brain injury

N. Sturbois-Nachef, E. Allart1, M. Y. Grauwin , A. Thévenon2, V. Tiffreau2, C. Fontaine

Hôpital R. Salengro CHRU Lille, Orthopédie B, 1Hôpital Swynghedauw CHRU Lille, Service de Rééducation Neurologique Cérébrolésion, 2Hôpital Swynghedauw, Service de Médecine Physique et Réadaptation, Lille, France

E-mail: nadinenachef@hotmail.fr

Introduction/Background: Little is known about shoulder hypertonia in patients with brain injury. The principal aim of our study was to assess the results of spastic shoulder surgery in our team experience. Materials and Methods: Sixteen patients (18 shoulders) were retrospectively reviewed. The following were studied: etiology of hypertonia, shoulder deformation schemes, initial aims of surgery, shoulder pre- and postoperative mobility, impact of surgery on limb function when possible. None limb was functional preoperatively. Spontaneously, shoulders were all in a medial rotation, in adduction in 15 cases, in abduction in 3 cases. One had spontaneous retroposition. Therapeutic aim was hygienic in all and pain-relief in 6. Ten neurotomies of the lateral pectoral nerve (LPN), 8 intramuscular lengthening of the latissimus dorsi (LD), 9 percutaneous tenotomies of the pectoralis major (PM), one neurotomy of the motor nerve for the long head of triceps brachii (LHTB) and one intramuscular lengthening of the teres major (TM) were performed. Results: Mean age at surgery was 52.1 (24-73). Etiology was vascular in 11, anoxic in 2, one had traumatic brain injury, one multiple sclerosis, one cervicarthrosic myelopathy. Preoperatively, the mean results for passive abduction of the shoulder was 50.6° (10-90) and for the passive lateral rotation was -5° (-70 – 20). Postoperatively, there were respectively improved at 87.7° (60-160) and 6.7° (-20 – 20). Only 3 muscles presented with residual tightness (two PM and 1TM) in patients where an isolated neurotomy of the lateral pectoral nerve (LPN) had been achieved. All of the initial objectives of the surgery were satisfied. One patient recovered a partial functionnal limb thanks to a recovered active shoulder flexion. Conclusion: In classical medial rotation-adduction deformation schemes, surgery performed on the 3 main involved muscles (PM, LD, TM) offers good results in term of passive mobility of the shoulder and pain-relief.

Keywords: Brain injury, shoulder hypertonia, surgery

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


  ISPR8-2703 Top


Comparing effects of constraint-induced movement therapy and robotic therapy: randomized clinical trial

T. Terranova, M. Simis, A. Santos, M. Imamura, F. Alfieri, F. Fregni1, L. Battistella

Department of Physical Medicine and Rehabilitation, University of Sao Paulo, Sao Paulo, Brazil, 2Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, USA

Presenter Email: marcelsimis@gmail.com

Introduction/Background: Stroke is the one of the main causes of adult disability and up to 80% of the stroke survivors will develop upper extremity motor dysfunction. Currently, Constraint-Induced Movement Therapy (CIMT) and Robotic Therapy (RT) have high level of evidence for upper limb dysfunction treatment. However, to the best of our knowledge, there have been no studies comparing CIMT and RT on functionality and motor recovery of upper limb in stroke patients. Therefore, this study aims to compare RT and CIMT and understand their effects of on upper limb motor recovery and functionality of chronic stroke patients. Materials and Methods: This is a parallel, single blinded, randomized (1:1) clinical trial. From May 2012 to May 2015, 51 patients, who fulfilled the eligibility criteria, were enrolled into one of treatment groups – CIMT or RT. The outcomes of upper limb function were measured by Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment – Upper Limb (FMA-UL), Arm motor Ability Test (AMAT), Modified Ashworth Scale (MAS), Functional Independence Measure (FIM) and Stroke Impact Scale (SIS). Results: Our results showed that both treatments are equally beneficial to chronic stroke patients, with no statistical difference between the groups for primary or secondary outcomes. From baseline, the mean improvement, standard deviation and p value are described in [Table 1]. Additionally, patients kept the gains along the follow up visits, 3 and 12 months after treatment. Conclusion: CIMT and RT could be equally effective in improve upper limb function, motor recovery, functionality and quality of life in chronic stroke patients, even when compared 12 months after the end of treatment.
Figure 1: The main outcome change in the experimental group during treatment (0-2-4wk)

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Table 1: Comparison of CIMT and RT Outcomes

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Keywords: Constraint-induced movement therapy, robotic therapy, stroke

Funding: This study was supported by USP NAP (Núcleos de Apoio a Pesquisa) University of São Paulo-Center for Advanced Studies in Rehabilitation-CEAR. ClinicalTrials.gov ID: NCT02700061.


  ISPR8-0578 Top


Effects of electromechanical assisted gait training with exowalk® on walking ability of chronic stroke patients: a randomized controlled trial

B. S. Kwon, Y. G. Nam, H. J. Lee, E. H. Jo, J. W. Lee2

Department of Rehabilitation Medicine, Dongguk University, Ilsan Hospital, Goyang-Si, 2Department of Rehabilitation, HMH, Incheon, South Korea

E-mail: bumsunkwon@gmail.com

Introduction/Background: Exowalk is an exoskeletal walk-robotic device designed for over-ground walking exercise. It is developed for any patients with gait difficulty to do gait training by providing a proper walking pattern. Electromechanical-assisted gait training is known to be effective for acute and sub acute stroke patients by many meta-analysis. This study was conducted to assess the effects of electromechanical-assisted gait training with Exowalk on gait ability of chronic patients who had suffered from stroke at least for 3 months. We measure the leg muscle power, balance and gait velocity and capacity its effectiveness. Materials and Methods: Design: Randomized controlled trial. Setting: University rehabilitation hospital. Participants: Individuals with stroke who could stand alone with onset > 3month.Interventions: Participants were randomly assigned into two groups: the experimental group (n=20) by robot assisted gait training and the control group (n=21) by physical therapist assisted gait training and receive gait training sessions(30 minutes a day, 5 days a week) with Exowalk (experimental group) or with physical therapist (control group) for 4 weeks. Main Outcome Measures: Functional ambulatory category (FAC) before and after gait training. Change of FAC was the primary outcome to evaluate the efficacy of robot assisted gait training. Changes of mobility, walking speed, walking capacity, daily activity and balance were secondary outcomes. Conclusion: No significant difference in baseline.(p>.05) Between pre and post-training of 0-2weeks, the changes of outcome measures such as FAC, 6MWT, 10MWT, BBS, MBI in the experimental group were statistically significant. (P <.05) Linear improvement showed in FAC, 10MWT, 6MWT,MI and BBS (0-2-4weeks) We try to analyzed the difference of two group 0-2-4week. But the small number of patients to achieve 4weeks(n=14) and it did not reach statistical significance. To verify comparison the improvement of two group 0-2-4week, more number of patients is needed.
Table 1: The changes of outcome measures between pre and post-training (0-2wk)

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Table 2: The changes of outcome measures between pre and post-training(0-2-4wk) in experimental group

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Keywords: Exoskeleton device, gait, stroke

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


  ISPR8-0721 Top


The severity of unilateral spatial neglect was positively correlated with that of pusher syndrome

M. Takase, M. Shirai, H. Matsushita, H. Umehara , S. Wakabayashi , A. Doi1, I. Inoue

Department of Rehabilitation, Fukuoka Seisyukai Hospital, Kasuya-Gun, 1Department of Rehabilitation, Graduate School of Kumamoto Health Science University, Kumamoto, Japan

E-mail: takasema11111111@gmail.com

Introduction/Background: While previous studies have reported that unilateral spatial neglect (USN) and pusher syndrome are related but independent symptoms, their relationship has not been investigated using a quantitative scale and causative lesions using brain imaging. This study aimed to clarify the relationship between evaluation scores and the extent of the damaged area revealed by brain imaging. Materials and Methods: We evaluated twenty patients with first-ever stroke and pusher syndrome (14 right and 6 left hemispheric patients). First, we analyzed the relationship between the Catherine Bergego Scale (CBS) and Scale for Contraversive Pushing (SCP). We also introduced a new way of quantifying the affected brain lesions at two levels of horizontal brain imaging slice. At each level, a brain hemisphere was divided into 3 areas, and the total number of damaged areas from these two levels was used as an indication of the extent of the damaged lesion, ranging 0 to 6 [Figure 1]. By using this score, the relationship between the CBS and SCP scores was further examined. Results: All patients with pusher syndrome had USN based on CBS. In each subject, the CBS score was positively correlated with the SCP score (Spearman=0.805, p<0.001) [Figure 2]. Brain imagining showed that six patients had damage in both slice 1 and slice 2, while the fourteen patients had damage only in slice 2. The imaging score at slice 1 was correlated with the CBS score in the first group. Conclusion: The severity of USN was positively correlated with that of pusher syndrome with clinical scales. The location and extent of the damaged area in relation to SCP and CBS needs to be examined with a larger sample size in future.





Keywords: Pusher syndrome, unilateral spatial neglect

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


  ISPR8-1596 Top


Therapeutic potential of the home-based exercise program with the augmented reality system on balance in stroke patients: a preliminary report

H. S. Lee, W. H. Chang, J. Y. Lee, J. H. Hwang

Department of Physical and Rehabilitation Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Souht Korea

E-mail: doctorhyosun.lee@samsung.com

Introduction/Background: Recent advances in the augmented reality (AR) technology have significantly extended to the clinical rehabilitation in patients with stroke. The aim of this study is to investigate the therapeutic potentials of the home-based exercise program with the AR system to improve balance in stroke patients. Materials and Methods: The home-based exercise program with AR system was designed as prospective, randomized controlled study with blind observer. We analyzed interim data of total 30 stroke patients who completed functional assessment immediately after the intervention for 4 weeks. In the experimental group (n=15), we provided the home-based exercise program with the AR system (Uincare®) which was composed with the task-specific game-based system. In the control group (n=15), the written home-based exercise pogrom was provided. All participants were recommended the home-based exercise with 30 minutes a day for 4 weeks. Functional assessments with Timed Up and Go test, Tinetti Performance Oriented Mobility Assessment, and Berg Balance scale were performed before and after the intervention for 4 weeks. Results: There was no significant difference in general and functional characteristics before the intervention. There was no serious adverse effect in both groups. In each group, there was a significant improvement on balance after the home-based exercise for 4 weeks (p<0.05). However, there was no significant difference in balance after the intervention between the two groups. Conclusion: This study was the first clinical trials to use the home-based exercise program with AR system in stroke patients. In addition, the results of present study revealed that a therapeutic potential of the home-based exercise program with the AR system to improve balance in stroke patients. Further study with larger number of patients will be needed to clarify the effects of the home-based exercise program with the AR system.

Keywords: Augmented reality technology, home-based exercise program, stroke

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


  ISPR8-2079 Top


Contralaterally controlled functional electrical stimulation improves wrist dorsiflexion and upper limb function in patients with early-phase stroke: a randomized controlled trial

L. Xiao, Z. Yu1, M. Mao

Department of Rehabilitation Medicine, The Fisrst Affiliated Hospital of Nanjing Medical University, Nanjing, 2Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China

E-mail: luxiao1972@163.com

Introduction/Background: To investigate the effectiveness of contralaterally controlled functional electrical stimulation (CCFES) on wrist dorsiflexion (WD) and upper limb function in patients with early-phase stroke. Materials and Methods: Eligible patients were randomly assigned into two study groups. Patients in the CCFES group were treated with routine rehabilitation combined with CCFES while those in the neuromuscular electrical stimulation (NMES) group were treated with routine rehabilitation combined with NMES. The time intervals from the onset of stroke to the appearance of WD and from the onset of treatment to the appearance of WD were recorded. The functional assessments, including active range of motion for WD, strength of extensor carpi, Fugl-Meyer assessment (FMA) for upper extremity, Jebsen Hand Function Test (JHFT), modified Barthel Index (mBI) and ICF Generic Set, were performed at baseline and endpoint. Results: Nineteen patients (90.48%) in CCFES group and 12 patients (60%) in NMES group were observed to obtain the active WD during the treatment period. The time interval from the onset of stroke to the appearance of active WD was significantly earlier in CCFES group (18.33±7.01 days) as compared to that in NMES group (40.95±20.02 days). For inter-group comparison, statistical differences were observed for all the items except JHFT at the endpoint. Changes between baseline and endpoint for each parameter were significantly different between groups. For intra-group comparison, the scores obtained at the endpoint were significantly higher than that of baseline. Conclusion: CCFES was superior to NMES in either shortening the course of WD appearance and the recovery of upper extremity function in patients with early-phase stroke.

Keywords: Contralaterally controlled functional electrical stimulation, stroke, wrist dorsiflexion

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


  ISPR8-2234 Top


Effect of tdcs on reaching kinematics in subacute stroke patients

J. Lowenthal Raz, N. Soroker, J. Friedman1, D. G. Liebermann1

Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra’anana, 1Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

E-mail: justine.raz@gmail.com

Introduction/Background: Upper limb (UL) paresis after stroke often leads to poor functional outcome. Application of transcranial direct current stimulation (tDCS) can modulate intra- and inter-hemispheric dynamics and promote treatment-related adaptive neural plasticity. However, the optimal stimulation mode for a patient with a given lesion pattern and a given level of motor impairment is unknown. Here we aimed to assess the likelihood of obtaining improvements in endpoint kinematics of the paretic UL, using different tDCS modes in stroke patients with variant residual motor functioning.

Materials and MethodS: Twenty-eight subacute stroke patients performed planar point-to-point reaching movements with the paretic upper limb, before and after anodal-tDCS (excitatory), cathodal-tDCS (inhibitory) and sham-tDCS, in a randomized order. tDCS was applied over the left and right M1 hand area (C3, C4). Spatio-temporal kinematic variables derived from the minimum-jerk model were analyzed before and after training, comparing the 3 stimulation modes one with each other. Results: a-tDCS had a larger effect when applied on the lesioned hemisphere. Number of peaks, straight-line deviation and movement time improved (only the former two reached statistical significance). The Fugl Meyer (FM) score at baseline correlated negatively with the magnitude of improvement post-anodal stimulation of the contralesional hemisphere. This was reflected in number of peaks and in movement time. Conclusion: a-tDCS applied on the lesioned hemisphere combined with motor training shows immediate positive effects on path smoothness (less fragmented paths) and path straightness (shorter paths). Higher FM scores at baseline likely imply smaller corticospinal damage in the affected hemisphere, and thus, greater likelihood that perilesional re-mapping will be the dominant mechanism underlying recovery. In the presence of higher corticospinal reserve, one would expect anodal (excitatory) stimulation of the contralesional hemisphere to exert a detrimental effect on function. It remains to be shown whether such stimulation is beneficial in the absence of corticospinal reserve.

Keywords: Stroke, tDCS, upper limb

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


  ISPR8-2332 Top


A new treatment of pusher syndrome based on central integration concept

L. Zhang, Q. Zhang1, Y. Su1, X. Zheng1, L. Zhang1, S. Chen

Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 2Department of Rehabilitation, The People’s Hospital of Bayingolin Mongol Autonomous Prefecture, Korla, China

E-mail: lxzhang16@sina.com

Introduction/Background: To observe the effect of central integration concept based treatment on Pusher Syndrome after stroke and illustrate the relationship between cognition integration and motor control after stroke, providing a new potential way to treat stroke. Materials and Methods: Thirty stroke patients with Pusher Syndrome who were unable to maintain sitting and standing balance were included in this study. The experimental group (15 cases)received the treatment based on central integration concept mainly including:1. Dynamic assessment showed the major dysfunction of patients was lack of directional and spatial ability. 2. Auditory and visual information was inputted and the appropriate environment were set accordingly, making the brain regain sequential cognitive function and the subjects actively establish the directional and spatial ability in static and dynamic sitting and standing process. 3. A 24 hour rehabilitation management was used to strengthen the spatial direction ability and the formation of implicit memory. The control group (15 cases) adopted routine rehabilitation training methods (sitting and standing balance training, muscle strength training, core control training, etc.). Fugl-Meyer balance scale and ADL scale (Modified Barthel Index) were used for functional assessment before and after 1 week of treatment. Time to reconstruct sitting and standing balance were recorded also. Results: Compared with the control group, the time to regain sitting and standing balance was significantly shorter. No significant difference showed between two groups before treatment. Experimental group demonstrated significantly higher scores both in Fugl-Meyer balance scale (P<0.001) and ADL (modified Barthel index) scale (P<0.001) after 1 week of treatment. Conclusion: Compared with the conventional rehabilitation training, central integration based treatment can effectively improve balance function and ADL ability of patients with Pusher syndrome after stroke so as to shorten the hospitalization period and return to family and society as soon as possible.

Keywords: Central Integration, pusher syndrome, stroke

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


  A3.02 Neurological and Mental Health Conditions - Traumatic Brain Injury Top



  ISPR8-2254 Top


Brain changes depending on head impacts over one season of semi-professional soccer: a resting state functional magnetic resonance imaging study

H. Cassoudesalle, M. Bildet, H. Petit, I. Sibon1, J. Badaut2, P. Dehail

Department of Medecine Physique et de Readaptation, Hopital Pellegrin, Bordeaux, 2Department of Neurologie, Hopital Pellegrin, Bordeaux Cedex, France, 3CNRS UMR 5287, Brain Molecular Imaging Group, Bordeaux, France

E-mail: helene.cassoudesalle@chu-bordeaux.fr and maximebildet@gmail.com

Introduction/Background: Soccer is the most popular sport in the world, but soccer players are exposed to repetitive head impacts (RHI) when heading the ball. While heading is repeated thousands of times over a player’s career, a possible brain cumulative effect might lead to neurodegenerative diseases. However, the lack of evidence explains the absence of prevention or protection for players. Our objective was to determine if playing soccer is associated with functional brain connectivity changes, depending on the exposure to RHI. Materials and Methods: In this longitudinal study, a cohort of 16 semi-professional male soccer players, aged between 18 and 26 years old, were recruited from 2 clubs in Bordeaux city which participating in a french regional championship. Twenty age-matched male controls without a concussion history and which don’t practice any contact sport were also recruited for comparison. Functional Magnetic Resonance Imaging (fMRI) data were acquired for both groups before and after the 2016-2017 soccer season. A follow-up of the exposure to RHI in soccer group was realized thanks to the video of the games. Results: Soccer players demonstrated an increase of functional connectivity particularly between bilateral precentral region and fronto-temporal regions, in comparison with controls. Over the soccer play season, these increasing of functional connectivity was higher. The median of head impacts per player was 56 over the season, with no concussion. Exposure to RHI was associated with changes in functional connectivity between frontal and cerebellum regions. Conclusion: Our data demonstrate changes of multiple brain networks at the resting state in trained soccer players, with greater changes over one play season. RHI effect or training effect could be implicated. Other imaging modalities are required to study possible microstructural and microvascular anomalies post RHI in soccer.

Keywords: Heading, neuroimaging, soccer

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


  ISPR8-1369 Top


8-year outcome after severe traumatic brain injury: results from the paris-tbi study

A. Ruet, E. Bayen1, C. Jourdan2, P. Pradat Diehl1, P. Azouvi3

Department of Physical and Rehabilitation Medicine, CHU de Caen, Caen, 2Department of Médecine Physique et de Réadaptation, AP-HP-Groupe Hospitalier Pitiée-Salpêtrière, Paris, 3CHU Montpellier, Service de MPR, Montpellier, 4AP-HP-Hôpital Raymond Poincaré, Service de Médecine Physique et de Readaptation, Garches, France

E-mail: alexis.ruet@gmail.com

Introduction/Background: Traumatic Brain Injury (TBI) is a leading cause of acquired persistent disabilities. Sequalae increase with TBI severity. As young adults are particularly exposed, TBI represent an important health and economic burden. However, long term outcome is poorly described in scientific literature. Materials and Methods: Prospective observational study of an inception cohort of adult patients with severe traumatic brain injury in the Parisian area (Paris- TBI). Outcome description assessed with face-to-face interview 8 years after TBI. Results: Five-hundred four patients were included between 2005 and 2007, 257 were discharged alive from acute care. At 8-year follow-up, 261 of initial 504 were deceased, 128 patients were lost to follow-up, 22 refused to participate, 86 were finally evaluated. Mean age was 41.9 (SD 13.6), 79% were male, median initial Glasgow Coma Scale Score (GOS) was 6. Age, sex, initial severity did not differ between evaluated patients and lost to follow-up who were more frequently students or unemployed. Detailed information on impairments, functional status, activities were obtained. 5% were institutionalized. 11% suffered seizure since TBI. According to GOS-Extended scale score, 30% remained severely disabled, 41% moderately disabled, 29% had a good recovery. The most frequent somatic disorders concern balance (47.5%), motricity (31%), headaches (36%) and were less frequent than cognitive complaints (Memory 71%, Slowness 68%, Concentration 67%). On Hospital Anxiety and Depression scale, 16 % had a score >10 for anxiety and 18% for depression. At 8 years, 12% worked temporarily after TBI 4, 45% had a job. Of those 37%, declared a salary loss since TBI. Among those who did not returned to work, 89% declared that was because of TBI consequences. Conclusion: These results from an inception cohort highlight that adult patients frequently suffer cognitive and somatic disorders after severe TBI. Long after the TBI, these impairments still interfere with social integration and participation

Keywords: Inception cohort, outcome, traumatic brain injury

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


  ISPR8-1987 Top


Needs of health services and barriers to care access post-tbi in the parisian area: results of the 8-year follow-up of the paris-tbi cohort

C. Jourdan, E. Bayen1, A. Ruet2, I. Gout3, S. Azerad3, G. Nelson4, L. Meaude4, K. Mesbahi4, P. Pradat-Diehl5, P. Azouvi6

Department of Physical Medicine and Rehabilitation, CHRU Gui de Chauliac Montpellier, montpellier, 2Deparetment of Rehabilitation, AP-HP, 5Unité Rech Clin, AP-HP, Boulogne, 6Department of Rehabilitation, AP-HP Pitié, Paris, 3Department of Rehabilitation, Caen CHU, Caen, 4Recherche Clinique, AP-HP, 7Departmernt of Rehabiliataion, AP-HP Garches, Garches, France

E-mail: cl-jourdan@chu-montpellier.fr

Introduction/Background: The variety of consequences of traumatic brain injuries (TBI) constitutes a challenge in defining priorities of care planning. Our aim was to assess care utilization and unmet care needs in a homogeneous well-described sample of patients with long-term TBI. Materials and Methods: The PariS-TBI inception cohort recruited adults with severe TBI (initial GCS<8) in 2005-2007 in the Parisian area. The 8-year evaluation included a section on care utilization, needs and barriers to care access, which was completed by 82 patients. A 27-item unmet care needs questionnaire and a 6-item questionnaire on barriers to care access were derived from literature and experts’ opinion. Results: Mean age was 43 years, mean Glasgow Outcome Score-Extended (GOSE) was 6 (moderate disability). Care utilization was important, with 20% having physiotherapy, 10% speech therapy, 2% occupational therapy, 6% psychotherapy. In the past year, 7% had been hospitalized; mean number of visits to general practitioners was 4.2. For everyday activities, 6% had professional help, 67% had help from a proxy. Most care needs were cited as unmet by 10 to 30% of the sample. Unmet needs for information on TBI to patients, to proxies, and for coordination of services were each cited by more than 50%. Unmet need for psychological help was cited by 46%. Mainly expressed barriers to care access were lack of information (52%), and waiting times (27%). Mean number of unmet needs per patient was 8 (min-max 3-12). Number of unmet needs was not significantly related with age and gender. It was significantly associated with GOSE (rho=-0.5, p<0.0001), and with the Hospital Anxiety and Depression scores (rho=0.24, p=0.03 for anxiety; rho=0.28, p=0.01 for depression). Conclusion: Such results can help address the needs of the brain injury population. A priority seems to be to improve the information offered to patients and proxies.

Keywords: Care needs, cohort, traumatic brain injury

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


  ISPR8-2205 Top


The effects of tdcs stimulation on motor learning in healthy and severe sub-acute traumatic brain injury adults

Y. Yona Rabinovich, S. Shaklai, Y. Sacher1, K. Cismariu Potash1, A. Ressel Zviely2

Rehabilitation Center, Loewenstein Hospital,Pediatrics, 1Rehabilitation Center, Loewenstein Hospital, Trumatic Brain Injury, Raanana, 3Reut Medical Center, Rehabilitation of Young Adults, Tel Aviv, Israel

E-mail: yaelr70@gmail.com

Introduction/Background: Procedural learning is a basic mechanism for acquisition of basic motor and cognitive skills. Optimizing this process using both training strategies and innovative technology is of great importance in rehabilitation of patients with traumatic brain injury (TBI), an important cause of severe disability. Recently an expanding body of evidence indicated that trans-Cranial Direct Current Stimulation (tDCS) may positively affect procedural learning. Aim: (1) Characterize the effect of tDCS on motor skill learning in healthy adults using the finger-to-thumb opposition sequence paradigm (FOS). (2) Compare the findings to those of sub-acute TBI patients. Materials and Methods: Thirty healthy and ten sub-acute TBI participants were included in a randomized double-blind, controlled trial. Participants were trained to perform a finger opposition task. The study group (20 participants) received anodal stimulation over the motor cortex contralateral to the performing hand, and the control group (20 patients) received “sham” stimulation. Performance (speed and accuracy) were tested before, immediately after and 24 hrs post-training. Retention was tested one week later. Results: tDCS stimulation resulted in increased speed with no accuracy trade-off in healthy participants compared to controls, in the consolidation (37.4% Vs 30.6% improvement compared with initial speed) and retention stages (41.9% Vs 37.8%). The relative effect of tDCS was larger in the TBI group in both consolidation and retention stages (1.32 and 1.27, respectively). However, neither effects reached significance. Conclusion: Our results are in line with previous findings that showed a positive effect of tDCS on learning but largre cohort studies are needed to substantiate this claim.

Keywords: tDCS

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


  ISPR8-0695 Top


Multicenter case-control study of driving behaviors 2-3 years after traumatic brain injury rehabilitation

M. McKerral, I. Gélinas1, P. Delhomme2

Department of Psychology, Centre for Interdisciplinary Research in Rehabilitation, CRIR, IURDPM, CCSMTL, Université de Montréal, 2CRIR, CISSS Laval, School of Physical and Occupational Therapy, McGill University, Montréal-Québec, Canada,3IFSTTAR-Institut français des Sciences et Technologies des Transports de l’aménagement et des Réseaux, Versailles, France

E-mail: michelle.mckerral@umontreal.ca

Introduction/Background: Of major importance for the social participation of adults with traumatic brain injury (TBI) is the possibility to drive. Return to safe driving is usually addressed during rehabilitation, but we know little about driving abilities and behaviours in the years following TBI. The aim of this study was to evaluate if individuals with a TBI having passed a driving evaluation differed, in terms of self-reported driving behaviors and documented driving offenses, from those who did not undergo a driving evaluation, and from normal controls. Materials and Methods: A total of 162 adults aged 18-60 years-old participated in this study: 48 with mild/moderate/severe TBI whose license was suspended after injury and reinstated following a driving evaluation during outpatient rehabilitation (TBI-DE) and 24 with TBI who maintained their driving privileges without undergoing a driving evaluation (TBI-NE), recruited from 6 rehabilitation centers, 2-3 years after rehabilitation; 90 normal control participants paired for age, sex and geographical region, recruited from the general population. Self-reported driving abilities and habits, driving anger expression, driving sensation seeking, breach of rules of driving, and driving accidents and offenses were measured during a telephone interview. Objective driving offenses were obtained from the Québec Automobile Insurance Board with participants’ consent. Results: The TBI-DE group included significantly more individuals with moderate and severe TBI than the TBI-NE group, and reported significantly lower scores for verbal expression of anger and use of vehicle to express anger compared to controls. However, the TBI-DE group presented significantly more objective driving offenses before their TBI and more demerit points after their TBI than the control group. Also, a significantly higher frequency of serious accidents was documented in the TBI-DE group compared to other groups. Conclusion: Self-perceived risky driving behaviors may be underestimated by some individuals with TBI and should be specifically addressed during and after rehabilitation.

Study funded by the FRQS.

Keywords: Driving behaviors, rehabilitation, traumatic brain injury

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


  ISPR8-2371 Top


Behavioral disorders after tbi: evaluation of pharmacological intervention 2 years after french guidelines of july 2013

M. Pouyfaucon, A. Chenet, B. Perrouin-Verbe

Department of Physical Medecine and Rehabilitation, CHU Nantes, Hôpital St Jacques, NANTES, France

E-mail: margaux.pouyfaucon@gmail.com

Introduction/Background: Behavioral disorders (BD) after Traumatic Brain Injury (TBI) are common and have a major impact on the patient, his family and caregivers, leading to longer length of stay in hospitalization, and difficulties of social rehabilitation. The usual psychoactive drugs are not efficient, leading to side effects harmful for neurological recovery. French guidelines about management of these BD have been elaborated by the French Society of Physical and Rehabilitation Medicine and the French High Authority for Health in July 2013. We focused on pharmacological interventions of disruptive behavior by excess (aggressiveness, agitation, irritability). Propranolol is recommended in first-line treatment, mood regulating antiepileptics in second. The purpose of this work was to evaluate the impact of the guidelines on the practitioner’s prescriptions for BD in intensive care, neurosurgery and physical and rehabilitation medicine (PRM) units. We compared the period 2011-2012 versus 2014-2015. Materials and Methods: This was a retrospective, descriptive, multicentric study. All adult patients with TBI hospitalized at primary stage in PRM, in the PRM center of Nantes and Angers University Hospitals were included. Results: Among 208 patients analyzed, 84 (40,4%) had BD by excess. Propranolol was more prescribed after the guidelines: 34% vs 13,5%(p=0,03). It was prescribed at the average dose of 45 mg, guidelines recommend 40 to 80 mg. Over 21 prescriptions of Propranolol, 10 were stopped, 3 for cardiovascular side effects. Patients with BD had more psychoactive drugs prescribed (2,7 vs 0,93, p<0,05) and there was no difference between before and after the guidelines (2,95 vs 2,51 p=0,33). PRM specialists prescribed more psychoactive drugs than the others. Intensive care specialists never prescribed mood regulating antiepileptics. Conclusion: There is a need to inform all the doctors who take care of these patients about the guidelines. Propranolol is more prescribed but at the limit of the efficient dose, and psychoactive drugs are still long-term prescribed.

Keywords: Behavioral disorders, pharmacological intervention, traumatic brain injury

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


  ISPR8-2157 Top


Lessons learned from the citicoline brain treatment trial (cobrit)

R. Zafonte

Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation/Mass General, Boston, USA

E-mail: RZAFONTE@mgh.harvard.edu

Introduction/Background: TBI is a serious public health problem and no treatment is yet able to improve functional outcome. Citicoline is an endogenous substance which enhances phospholipid membrane function and impacts a wide variety of pathways after injury. The medication had been approved in 59 countries and was employed to provide neuroprotection and neurofacilitation. The plieotropic mechanisms of action of citicoline and its prior positive results in clinical trials of stroke made this medication an attractive target. Materials and Methods: An eight site phase 3 randomized clinical trial was performed to evaluate the efficacy of 90 days of citicoline (200mg) or placebo. Functional and clinical outcome was assessed at 30, 90 and 180 days with a 9 scale combined clinical trials outcome metric. Those greater than age 18( > 19 in the state of Alabama) were enrolled, and the inclusion criteria included those with complicated mild ( neuroimaging verified), moderate and severe TBI. All patients where treated according to established clinical protocols. Results: Thousand tw0 hundred thirteen subjects where randomized to the study with excellent balance between groups.Rates of favorable outcome based on the glasgow outcome scale extended as well as the clinical trials global metric where similar between treatment groups. At 90 days the groups did not significantly, while at 180 days some sub group differences are potentially observed. Conclusion: The findings of the COBRIT study are surprising and suggest that this therapy is not effective. Of note issues related to subpopulation effects, lessons learned regarding method, outcome metric and recovery patters in subpopulations will be reviewed. Implications for future TBI clinical trials ( especially those in the rehabilitation setting) will be discussed.

Disclosure of interest: I am on the Scientific Advisory Board of Myomo, ElMInda and Oxeia Biopharma- none of which is related to this presentation. I receive funding from the NIH and NIDILRR as well as the USARMC.


  ISPR8-2393 Top


Long-term visuospatial performance abnormalities among elite athletes reporting history of concussion

G. Wilkerson, D. Nabhan1, W. Moreau1

Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, 1Department of Sports Medicine, US Olympic Committee, US Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs-CO, USA

E-mail: Gary-Wilkerson@utc.edu

Introduction/Background: Elevated risk for musculoskeletal injury after concussion may relate to impaired responsiveness to changing environmental conditions, which might be identified by appropriately designed clinical screening tests. Materials and Methods: A retrospective cohort study involved 48 elite athletes at an Olympic training center (34 males: 23.8 ±4.4 years; 14 females: 25.4 ±4.5 years). A 60-second test of dual-task visuomotor reaction time (VMRT) involved rapid manual contact with illuminated target buttons while simultaneously providing verbal responses to identify the right or left direction indicated by the center arrow of 20 successive trials of the Eriksen flanker test. A whole-body reactive agility (WBRA) test measured side-shuffling movements in response to 20 virtual reality targets that randomly appeared in right or left positions on a large computer monitor. A meaningful association was defined as having a 90% confidence interval lower limit >1.0. Results: Concussion occurrence prior to testing (2.0 ±2.3 years) was reported by 44% of the athletes (21/48). Strong univariable associations with concussion history were found for dual-task VMRT asymmetry (left minus right visual field difference ≥15 ms; OR=7.14) and time required to complete the WBRA test (≥ 73 seconds; OR=6.40). A VMRT asymmetry X WBRA time interaction effect demonstrated 81% sensitivity and 75% specificity (OR=13.00). A substantial bivariate correlation was also evident between the two continuous variables (r=.454; p=.001). The occurrence of a lower extremity sprain or strain within the previous 12 months was reported by 67% of the athletes (32/48), which demonstrated an association with concussion history (53% sensitivity, 75% specificity; OR=3.40). Conclusion: A cause-effect relationship cannot be inferred from retrospective analysis, but the results of both clinical tests suggest that impaired visuospatial performance capabilities may explain the previously reported elevation of musculoskeletal injury risk following concussion.

Keywords: Dual-task clinical assessment, neuromechanical responsiveness, sport-related concussion

Disclosure of interest: The reported data were acquired from computerized testing equipment loaned to the US Olympic Committee by Dynavision International (West Chester, OH) and Traq Global, Ltd. (Westlake, OH).


  ISPR8-0374 Top


The effect of early cognitive therapy in improving cognitive functions using neuropsychology and diffusion tensor imaging measurements following mild traumatic brain injury: a pilot study

N. Hamzah, J. H. Tan, V. Veeramuthu1, L. K. Tan2, N. A. Mustapha3, M. Danaee4, M. Mazlan, N. Ramli2, V. Narayanan5

Department of Rehabilitation Medicine, 2Biomedical Imaging and 5University of Malaya, 3Depatment of Rehabilitation Medicine, University Malaya Medical Centre, 4Department of Surgery, Academic Enhancement and Leadership Development Centre, University of Malaya, Kuala Lumpur, 1Neuropsychology Unit, Gleneagles Medini Hospital, Johor Bahru, Malaysia

E-mail: norhamizan@ummc.edu.my

Introduction/Background: Aims: To quantify clinical and structural white matter tract changes over six months, in patients with mild traumatic brain injury (mTBI) following early structured cognitive therapy. Materials and Methods: This was a non-randomized quasi-experimental study design. All patients with mTBI received written information and education on symptom(s) management before being assigned to structured cognitive therapy or conventional cognitive therapy at two weeks post injury. Structured therapy was one hour per week session by using computer-based and metacognitive training for the first three months followed by one hour per month session for the remaining three months. Conventional therapy was patient focused symptom(s) management and coping strategies. Neuropsychological assessment and Diffusion Tensor Imaging (DTI) were performed at baseline and six months post injury. Results: Each group consisted of four male participants (N=8). Mean cognitive therapy duration was 7 hours (SD ±1.8). There was no demographic, Glasgow Coma Scale, Post Traumatic Amnesia and loss of consciousness duration statistical difference between groups. Although all cognitive domains tested were not statistically significant, the scores for Attention, Memory, Language, and Executive Function domains were higher than conventional group at six months. We analysed nine white matter tracts. Almost all Fractional Anisotropy mean values were lower (Corpus Callosum genu: p=0.03; splenium: p=0.05) whereas Mean Diffusivity and Radial Diffusivity mean values were higher at six months. Conclusion: We quantified deficits in various cognitive domains as early as two weeks following mTBI, with higher normal scores in the structured therapy group as compared to conventional group at six months. Abnormal values of DTI parameters may suggest chronic axonal damage of various white matter locations and bundles. We did not yield statistical significance in our analysis due to small sample size caused by high drop-out rate. However, we concluded that early structured cognitive therapy may improve cognitive deficits beyond spontaneous recovery, despite persistent microstructural brain damage.

Keywords: Attention deficits, cognitive therapy, mild traumatic brain injury

Disclosure of interest: This research was funded by two grants: (1) Post Graduate Research Grant (IPPP) PPPC/C1-2016/DGJ/01. (2) High Impact Research Grant UM.C/625/1/HIR/MOHE/CHAN/12.


  ISPR8-0422 Top


A preliminary report on the effect of cognitive rehabilitation therapy in improving cognitive function of attention following mild traumatic brain injury: a randomised controlled trial

N. Hamzah, V. Narayanan1, N. Ramli2, V. Veeramuthu3, L. K. Tan2, N. A. Mustapha4, N. A. Mohammd Tahir4, A. Drummond5, R. Das Nair5, M. Mazlan

Department of Rehabilitation Medicine, 1Surgery, 2Biomedical Imaging, University of Malaya, 4Department of Rehabilitation Medicine, University Malaya Medical Centre, Kuala Lumpur, 3Brain and Cognition Recovery Centre, Gleneagles Medini Hospital, Johor Bahru, Malaysia, 5Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom

E-mail: norhamizan@ummc.edu.my

Introduction/Background: This is a randomised controlled study of cognitive rehabilitation for attention deficits following mild traumatic brain injury (mTBI). The study aims at improving patient’s cognitive and functional outcomes, measured by Neuropsychological Assessment Battery® (NAB®), Diffusion Tensor Imaging (DTI) and functional parameters. Materials and Methods: Participant recruitment is from University Malaya Medical Centre (UMMC), Malaysia. This study was ethically approved by Medical Research Ethics Committee UMMC (MREC ID NO: 2016928-4293) and registered at ClinicalTrial.gov (NCT03237676). Following randomisation, control group receives pre-existing patient-centred cognitive treatment whereas intervention group receives individualised structured cognitive rehabilitation therapy (computer-based and metacognitive approach for 1 hour/week/3months). The intervention begins at three months post injury and ends at six months post injury. Study outcome measurements are applied at pre and post treatment. Results: A total of 125 mTBI patients were screened from March 2017 till now. 43 patients fulfilled the study criteria. The male:female gender distribution ratio was 2:1. Within 72 hours post trauma, participants with Montreal Cognitive Assessment© (MoCA©) score of <26/30 (n= 34, mean score 23; p=0.03) had persistent cognitive deficits at 2 weeks post injury. Functionally, 68% of participants (n=23) had returned to work within 2 weeks injury time. Deficits of attention was most pronounced (T score 70; p<0.00; Cohen’s d 4.31) followed by executive function domain (T score 78; p=0.02; Cohen’s d 1.54). At 3 months post injury, 9 participants continued to have attention (T score 70, p<0.05, Cohen’s d 3.33) and language deficits (T score 74; p<0.05; Cohen’s d 1.32) but clinically recovered for other cognitive domains assessed. All 9 participants are undergoing cognitive treatment (structured cognitive rehabilitation n=4; patient-centred therapy is n=5). Conclusion: MoCA© total score <26/30 performed within 72 hours following injury may predict cognitive deficits at two weeks post injury. Cognitive deficits persist beyond 3 months post injury with variable affected domains and severity.

Keywords: Attention deficits, cognitive therapy, mild traumatic brain injury

Disclosure of interest: This study is supported by grant: (1) High Impact Research Grant UM.C/625/1/HIR/MOHE/CHAN/12.


  ISPR8-0548 Top


Functional outcome at 1 year following moderate to severe traumatic brain injury

M. Mazlan, Z. Abd Rahman1, N. Hamzah2

Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 1Department of Rehabilitation Medicine, Sultan IsmailHospital, Johor Bharu, Malaysia

E-mail: drmazlina@gmail.com

Introduction/Background: Traumatic brain injury (TBI) is a leading cause of disability among young adults population in Malaysia. The multi-cultural background and limited post-injury rehabilitation services in Malaysia may play a role in the long term outcome. This research aimed to describe the functional outcome of moderate to severe TBI patients at one year post-injury. Materials and Methods: A prospective cohort study was conducted at University Malaya Medical Centre (UMMC), a tertiary referral center iwth availability of an early inpatient rehabilitation after TBI. Patients with moderate to severe TBI were selected via a universal sampling method. The functional outcome was assessed at 1 year post injury using Glasgow Outcome Scale-Extended (GOSE). Factors associated with good outcome (GOSE score of 7&8) were analysed via regression analysis. Results: A total of 100 patients were included in this study. The mean age of the study population was 39.4 (± 17.6 ) years old. Majority of participants were male (87%), less than 40 years old (57%) and involved in a motor vehicle accident (77%). 25% of patients have good outcome at 1 year. Factors significantly affecting the functional outcome were age, premorbid marital status, education level, presence of concomitant extremity fractures and early inpatient rehabilitation. After adjusting for the confounders, absence of concomitant extremity fractures was found to be a significant predictor for good functional outcome at one year (OR 9.26, 95% CI 1.86 - 46.12, p = 0.007). Conclusion: Good functional outcome at one year following moderate to severe TBI is slightly lower than other Western studies. However, factors influencing good outcome is comparable to literature worldwide. Early inpatient rehabilitation should be provided as it can improve the functional outcome. Since concomitant extremity fractures significantly influenced outcome post TBI, it is very important to treat the fractures early and aggressively so that patients can start intensive rehabilitation earlier.

Keywords: Malaysia, outcome, rehabilitation

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


  A3.03 Neurological and Mental Health Conditions - Spinal Cord Injury Top



  ISPR8-0271 Top


Intensive exercise program after spinal cord injury (scipa full-on): a randomized controlled trial

M. Galea, S. Dunlop1, T. Geraghty2, G. Davis3, A. Nunn4, L. Olenko5

The University of Melbourne, Medicine Royal Melbourne Hospital, Parkville, 1School of Biological Sciences, University of Western Australia, Perth, 2Princess Alexandra Hospital, Queensland Spinal Cord Injuries Service, Brisbane, 3Department of Discipline of Exercise and Sport Sciences, University of Sydney, Sydney, 4Austin Health, Victorian Spinal Cord Service, Melbourne, 5Florey Institutes of Neuroscience and Mental Health, Statistics Platform, Melbourne, Australia

E-mail: m.galea@unimelb.edu.au

Introduction/Background: While upper body training is effective for improving aerobic fitness and muscle strength after spinal cord injury (SCI), activity-based therapies (ABT) intended to activate the paralysed extremities have been reported to promote neurological improvement. We investigated the effectiveness of intensive ABT compared with upper body training for people with SCI. Materials and Methods: One hundred and sixteen participants (C2-T12, AIS A-D) were recruited from six SCI units in Australia and New Zealand, and randomised to experimental or control groups. Experimental participants received a 12-week ABT program including locomotor training, functional electrical stimulation-assisted leg cycling, and trunk and lower extremity exercises, while control group participants undertook upper body strength and aerobic fitness training. The primary outcome measure was the ASIA motor scores for upper and lower extremities. Results: One hundred and three participants completed the interventions and were included in the primary analysis. Mean (SD) upper extremity motor scores for experimental (n-=49) and control (n=54) groups were 41.45 (12.11) and 39.39 (11.94), respectively, with an adjusted mean between-group difference of -0.039 (95% CI: -1.12 to 1.04). Mean (SD) lower extremity motor scores were 12.51 (17) and 10.24 (17.19) for experimental and control groups, with an adjusted mean between-group difference of 0.895 (95% CI: -0.48 to 2.27). There were 15 serious adverse events within each group, but only one of these was related to the experimental intervention (bilateral femoral condyle and tibial plateau subchondral fractures). Conclusion: Activity-based therapy did not lead to greater improvements in ASIA motor scores compared to upper body training.

Keywords: Randomised controlled trial, spinal cord injury

Disclosure of interest: This study was supported by a grant from the Transport Accident Commission (Victorian Neurotrauma Initiative).


  ISPR8-2106 Top


Does the use of an armrest modify upper extremity muscle demands during lateral sitting transfers in manual wheelchair users living with spinal cord injury?

C. Molenaar1,2, M. Blandeau1, F. Gabrielli3, D. H. Gagnon2, P. Pudlo1

Université de Valenciennes, UMR 8201-LAMIH, Valenciennes, 2NEURODOL University Clermont Auvergne, UMR 1107 Inserm/UCA, Clermont-Ferrand, France, 1Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Pathokinesiology Laboratory IRGLM, Montreal, Canada

E-mail: ciska.molenaar@univ-valenciennes.fr

Introduction/Background: Performing sitting transfers figures among the most demanding activities in manual wheelchair users living with spinal cord injury (MWUSCI). Surprisingly, little is known about how the built environment may change movement strategies and upper extremity (UE) muscle demands during transfers. This study aims to determine to what extent the use of an armrest changes UE muscle demands during lateral sitting transfers in MWUSCI. Materials and Methods: Twenty MWUSCI performed lateral transfers toward the left under three experimental conditions: 1. without armrest, 2. with a left armrest at 9cm, 3. with a left armrest at 18cm above seat surface. Bilateral recorded EMG signals of the anterior deltoid, pectoralis major, biceps, and triceps were selected for analysis. Muscular utilization ratio (MUR) was obtained through amplitude-normalization using maximum voluntary contractions. Peak MUR and area under the MUR curve (AUC) of each muscle were compared across conditions using a non-parametric ANOVA. Results: When transferring using the 9cm armrest, the peak MUR increased in both triceps and decreased in left anterior deltoid, while the AUC decreased in right biceps compared to transfers without armrest. When transferring using the 18cm armrest, the peak MUR increased in both triceps and decreased in left anterior deltoid and biceps, while AUC decreased in both biceps compared to transfers without armrest. Furthermore, the peak MUR increased in left pectoralis major compared to transfers using the 9cm armrest. Conclusion: The use of an armrest during sitting transfers shifts part of the UE muscle demands from the shoulder flexors to the elbow extensors in MWUSCI. This adaptation may be linked to a reduced forward trunk flexion during transfer, although a confirmatory kinematic analysis is needed. Nonetheless, the availability of an armrest during transfers provides additional opportunities to vary UE muscle demands and to minimize UE musculoskeletal risk exposure.
Figure 1: Group median, +/- 1st and 3rd quantile of peak MUR in eight UE muscles

Click here to view


Keywords: Muscle demands, sitting transfers, upper extremity

Disclosure of interest: This research was supported financially by Zodiac Seats France and Direction Générale de l’Aviation Civile (project n°2016 93 0805).


  ISPR8-1775 Top


Cross cultural comparisons in patients self reports of physical and psychological health and quality of life

D. Tate, M. Forchheimer, S. Charlifue1, J. Coker1, S. Bennett1, S. Huey1, J. Greve2, A. Christofi2, C. Witter2, P. New3, D. Ramirezhernandez4, M. Post5

Department of Physical Medicine and Rehabilitaion, University of Michigan, Ann Arbor, 1Division Research, Craig Hospital, Denver, USA, 2Faculdade deMedicina, Universidade de Sao Paulo, SaoPaulo, Brazil, 3Department of Rehabilitation Medicine, Caulifield Hospital, Melbourne, Australia, 4Division of Research, Caulifield Hospital, Melbourne, Australia, 5University Medical Center Utrecht, Center of Excellence in Rehabilitation Medicine, Utrecht, The Netherlands

E-mail: dgtate@umich.edu

Introduction/Background: Measures of Health Related Quality of Life (HRQOL) are increasingly used in multi-site clinical trials to determine the impact of medical interventions on health. Because patients’ perceptions of QOL, of their physical and psychological health can vary cross-culturally, there is a need for measures that can be used reliably across populations. The aim of this study is to examine differences in patients’ perceptions of their health and QOL across 4 countries: Australia, Brazil, Netherlands and USA (two sites: Colorado and Michigan). Materials and Methods: Outpatients with spinal cord injury and disease were administered the Spinal Cord Injury Quality of Life Basic Dataset which includes 3 items related to health and QOL. Cognitive interviews were conducted to test for differences in patients’ responses to these items and their overall perception of QOL. Interviews were transcribed and coded by two independent reviewers. Themes were compared to ensure data uniformity. Results: Participants were 60% males with mean age of 52; average time since onset was 16.5 years; 56% with paraplegia; 37%, tetraplegia. While English speaking patients described QOL as their ability to enjoy life in general, non-English speakers related QOL to specific situations and barriers to health and environment. Differences were observed in ratings of physical health. Patients in Melbourne, Australia and Colorado, USA rated theirs significantly lower than others (p<.005). Regional differences were found between the two USA sites. Colorado participants rated their physical health significantly lower than their Michigan counterparts. Conclusion: Regional and country variations were noted in patients’ ratings of physical health and QOL definitions. These suggest the need for guidelines to adapt HRQOL measures to specific contexts in which they will be used. Cognitive interviews are useful in examining the equivalence of such measures. This is a critical step towards the development of a common measure of HRQOL for the use in international studies.

Keywords: Cross cultural differences, physical health, patient self report

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


  ISPR8-1032 Top


Risk of pressure ulcers in persons with tetraplegia and regional experience: analysis of a long-term french survey

M. Le Fort, M. Espagnacq1, T. Albert2, C. Lefèvre1, B. Perrouin-Verbe, J.FRavaud3

Department of Neurological PMR, CHU Nantes, Nantes, 1IRDES-Institute for Research Documentation in Health Economics, Paris,2CMPR de Bobigny, Bobigny, France, 3CERMES3, INSERM, CNRS, EHESS, Université Paris Descartes, EHESP, High of Public Health, MSSH, House of Social Sciences and Disability, Villejuif, France

E-mail: marc.lefort@chu-nantes.fr

Introduction/Background: Pressure ulcer risk assessment provides an indicator of quality of care in French health establishments. The predictive value of clinical assessment tools is lower for people with spinal cord injury (SCI). We hypothesized that skin complications would be less frequent in traumatic SCI patients with tetraplegia (TSCIt) who were initially managed in French regions with a high level of specialized SCI rehabilitation experience. Materials and Methods: First, we used the most recent French epidemiological survey of patients with SCI to determine a “Level of Regional Experience in Specialized Physical Medicine and Rehabilitation” (LRE). We then studied the medical and social variables reported in the Tetrafigap survey (which compiled a cohort of TSCIt, to assess their trajectory and life conditions following the return to community life) using univariate analysis according to these LREs (chi² test using a significance threshold of p<0.05). We finally performed a series of logistic regressions to determine the link between LREs and pressure ulcers. Results: Management in high-LRE regions was associated with a lower occurrence of pressure ulcers during early treatment and in the long-term (on average, 8 years post-trauma). Conclusion: Using pressure ulcers as a marker, our study demonstrated the protective link of regional experience of the early management of TSCIt. In our opinion, efforts should first prevent a dilution effect through holistic health care for SCI, within the scope of a regional organization that would link referral centers and local health care networks.

Keywords: Cohort studies, prevention, surveys

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


  A3.04 Neurological and Mental Health Conditions - Autoimmune And Inflammatory Neurological Conditions (E.G. Multiple Sclerosis) Top



  ISPR8-1955 Top


Benefits of a program associating exercise therapy and therapeutic education on fatigue in multiple sclerosis

C. Chevalier, C. Jourdan, C. Cortez, M. Delorme, C. Palayer, V. Isoard, C. Guiraudie, M. Richou, I. Tavares, I. Laffont

CHU Montpellier, MPR, Montpellier, France

E-mail: constance-chevalier@chu-montpellier.fr

Introduction/Background: Literature findings have proven the efficacy of exercise training on fatigue symptoms in multiple sclerosis (MS). Other studies showed a benefit of educational programs on fatigue management in MS. A 2-week hospital-based rehabilitation program associating both of these aspects was created in 2016. The aim of this study was to analyze the efficacy of this program. Materials and Methods: Pre-post prospective observational study of patients with MS of EDSS below 7 presenting with disabling fatigue. Patients were evaluated before and 3 months after the program. Assessments included the 6-min walking test, the maximal oxygen uptake (VO2max) in a cycling exercise test, the numerical scale (NS) of fatigue, the Multiple Sclerosis Fatigue Self-Efficacy Scale (MSFSE, max=100), which assesses patients’ subjective feeling of self-efficacy to manage their fatigue, and level of weekly sport or physical activity. Results: Twenty-seven patients completed the program and 17 received the 3-month assessment (10 evaluation pending). Mean age was 43, mean EDSS was 3.4. Among the 17 patients, 5 suffered a relapse of MS before the 3-months follow-up. Mean 6-minutes walking distance was 398±73 m pre-program and 407±87m at 3 months. Mean VO2max before was 71±24 % and 76 ±24 % after. VO2max increased for 78% of patients (n=9). Mean fatigue NS remained stable at 5/10. Mean MSFSE score increased from 56±20 to 75±25. Among patients who had no physical activity before the program, 75% had started a regular activity which was maintained at 3 months. Among patients who had a previous physical activity, 44% increased their activity level. Conclusion: This 2-week program including education and exercise training did not seem to modify walking ability and fatigue, but patients improved their physical activity and their feeling of self-efficacy. It thus appeared that the educational aspects of the program were the most beneficial on the long term.

Keywords: Exercise retraining, fatigue management, multiple sclerosis

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


  ISPR8-2199 Top


Are simplified indices of exercise tolerance well correlated to vo2peak among patients with multiple sclerosis: a case-control study

C. Broglie, M. Valet1, G. Stoquart1, S. El Sankari2, V. Van Pesch3, M. Francaux4, T. Lejeune1

Institut de Experimentale et Clinique (IREC), Neuro-Musculo-Skeletal LabNMSK, Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, 1Institut de Recherche Experimentale et Clinique (IREC), Neuro-Musculo-Skeletal Lab NMSK- Service Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 2Institut Recherche Experimentale Clinique (IREC), Service de Neurologie, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, 3Institut de Recherche Experimentale et Clinique (IREC), Service de Neurologie, Université Catholique Louvain, Cliniques Universitaires Saint-Luc, Brussel, 4Catholique de Louvain, Institute of NeuroScience (IONS), Institut des Sciences de vie ISV, Pôle Cellulaire et moléculaire CEMO, Louvain-la-Neuve, Belgium

E-mail: clemence.debroglie@gmail.com

Introduction/Background: Measured maximal oxygen uptake (VO2peak) is the gold-standard to assess exercise tolerance functions. However, this measure can be very challenging in patients suffering from multiple sclerosis (MS) because of several limiting factors (e.g., fatigue, pain, unfamiliarity with exercise, lack of mobility…). Various submaximal indices have been studied to assess exercise tolerance functions in healthy subjects and in persons with neurological conditions. However, whether they relate to the gold-standard have been barely studied. Our aim was to explore the relations between simplified exercise indices and VO2peak among patients with MS and healthy controls. Materials and Methods: This case-control study included 39 patients with MS (mean age: 45±10 years; median EDSS 2.5 (range 0-4)) and 30 healthy subjects (HS) (mean age: 44±8 years). Participants performed a stepwise maximal exercise testing on a cycle ergometer. VO2peak, oxygen uptake efficiency slope (OUES) derived from different reference periods of the exercise test. Descriptive statistics, Student’s T-tests, Pearson’s correlation coefficients between VO2peak and simplified indices and Fisher Z-tests were computed. Measured VO2peak was also compared to PeakWR-based estimation of VO2max by the Bland-Altman method. Results: VO2peak and all the simplified indices were significantly lower in the MS group compared to the HC group (p<0.001). OUES appeared highly correlated (>0.70, p<0.001) with VO2peak, in both groups, without difference between groups. The relation slightly, but not significantly, increased with the duration period of the test taken into account of the exercise, in both groups. PeakWR-based prediction of VO2peak presented a standard error of the estimate of 315ml/min(10.7%) in HS, and 176 ml/min(12.5%) in MS. HR-based index appeared lowly-to-moderately correlated to VO2peak in both groups. Conclusion: OUES seem to be valid when comparing with gold standard, in both group, even for short-lasting submaximal efforts. PWR-based equation predicts VO2peak with an accuracy of 10%, at a group level.

Keywords: Exercice tolerance functions assessment, multiple sclerosis, oxygen uptake efficiency slope

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


  A3.05 Neurological and Mental Health Conditions - Neurodegenerative Diseases (E.G. Dementia) Top



  ISPR8-2611 Top


Exploring impact of frequency and intensity of fatigue in parkinson’s via self-report questionnaires

V. Agarwal, E. Stack1, A. Ashburn1

Faculty of Health Sciences, Southampton General Hospital, University of Southampton, University Hospital Southampton NHS Foundation Trust, 1Faculty of Health Sciences, Southampton General Hospital, University of Southampton, Southampton, United Kingdom

E-mail: vaa1v15@soton.ac.uk

Introduction/Background: Fatigue is one of the most disabling symptoms reported by a third of people with Parkinson’s (PwP), but is difficult to diagnose and manage. The aim of our study was to explore differences between PwP experiencing fatigue at varying frequencies. Materials and Methods: Following Ethics approval, we invited Parkinson’s UK members across southern England via email, website promotion and local branch meetings to complete a self-report survey on frequency, intensity and impact of fatigue defined as ‘intense/severe tiredness, or exhaustion’. Results: 100/130 (77%) people returned the questionnaires, 59 males. 67% respondents felt fatigued ‘frequently’ (2-5 times per week / few hours daily / all-day everyday), 23% ‘sometimes’ (2-5 times/month) and 10% ‘rarely’ (0-1 times/month). ‘Frequently-fatigued’, ‘sometimes-fatigued’ and ‘rarely-fatigued’ did not significantly differ in duration since diagnosis (6.8 v 6.4 v 7.25 years) or age (68.1 v 66.2 v 69.4 years). Higher proportion of ‘frequently-fatigued’ participants compared to ‘sometimes-fatigued’ and ‘rarely-fatigued’ were women (45% v 35% v 30%), working (22% v 17% v 10%), and reported greater intensity of fatigue on Parkinson’s Fatigue Scale (58 v 42 v 31/80). Sixty-one percent Frequently-fatigued participants satisfied the key diagnostic-criterion of ‘feeling fatigued most of the day nearly every-day/every-day’ for establishing Parkinson’s-related fatigue proposed by the Movement Disorder Society. They reported fatigue predominantly in early-afternoon (55%) and evening (49%). 84% frequently-fatigued participants could identify factors that triggered fatigue; 81% felt stress made fatigue worse. 84% frequently-fatigued participants felt tired despite resting. More frequently-fatigued PwP than sometimes-fatigued reported falls (51% v 26%);gave up routine activities (48% v 4%) and hobbies (49% v 30%); and planned further restrictions to activities (36% v 17%) and hobbies (37% v 13%) due to fatigue. Conclusion: Activity and leisure abandonment is higher among frequently-fatigued PwP who experience fatigue symptoms at greater intensity than other PwP. We plan to explore impact of fatigue in Parkinson’s using wearable sensors.

Keywords: Fatigue, parkinson’s, survey

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


  ISPR8-1155 Top


Association between physical fitness and cerebral grey matter integrity in patients suffering from parkinson’s disease, a structural mri study

M. Demonceau, K. A. Baquero1, F. Depierreux-Hardy1, MRouillard1, J. L. Croisier, T. Bury, B. Jidovtseff, D. Maquet, G. Gaëtan1

Department of Rehabilitation and Sport Sciences, University of Liege, 1Cyclotron Research Centre, Universityof Liege, Movere Group, Liège, Belgium

E-mail: mariedemonceau@gmail.com

Introduction/Background: Being physically active protects the elders against cerebral grey matter (GM) loss in regions particularly exposed to aging.1 This cross-sectional study extended this hypothesis by searching correlations between volume or microstructure of GM and physical fitness in the nigrostriatal system of patients suffering from Parkinson’s disease (PPD). Colcombe et al., Aerobic fitness reduces brain tissue loss in aging humans. J Gerontol, 2003. Materials and Methods: Cerebral grey matter volume (GMV), magnetization transfer (MT) and R2* (an index of local iron) parameters were extracted from whole brain 3T MRI and were analysed voxel-by-voxel using SPM12 in 42 PPD and 32 matched healthy controls (HC). All subjects were also tested for Peak work load (PWL) and knee flexor strength (KFS). First, we performed a two-sample t-test to look at areas affected in the nigrostriatal system of the PPD in comparison to HC. Next, we used a regression analysis to test which of these regions, if any, showed a relationship between (1) GMV, MT or R2* and (2) individual PWL or KFS. Results: The comparative study showed increased R2* in bilateral SN, reduced GMV and increased R2* in left and right striata (puncorrected<0.001). In PPD, GMV in the head of the right caudate nucleus and anterior putamen showed a positive correlation with PWL and GMV (pcorrected<0.023, Fig. 1). Besides, GMV in this cluster also correlated with global cognitive performance assessed by the Mattis Dementia Rating Scale (pcorrected<0.024). None of the disturbed regions correlated with KFS. No significant correlations were observed in these regions for HC. Conclusion: Aerobic fitness may have a specific neuroprotective effect on the right anterior striatum of PPD, and this could be associated with better cognition.

Keywords: Neuroprotection, Parkinson’s disease, physical fitness

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


  ISPR8-1735 Top


Relations between rhythmic impairment in speech and non-verbal domains in parkinson’s disease

F. Puyjarinet, V. Bégel1, C. Gény2, S. Pinto3, S. Dalla Bella4

EuroMov Laboratory, University of Montpellier, Montpellier, 1Department of Sciences Humaines, Charles-de-Gaulle University Lille 3, Lille, 2Department of Neurology, CHRU of Montpellier, Montpellier, 3Parole et Langage Laboratory (LPL), University of Aix-Marseille, CNRS 7309, Aix-en-Provence, France, 4Department of Psychology, International Laboratory Brain Music Research BRAMS, University of Montreal, Montreal, Canada

E-mail: f.puyjarinet@hotmail.fr

Introduction/Background: Rhythmic disorders are common in patients with Parkinson’s disease (PD), both in speech (i.e., dysarthria) and in non-verbal rhythmic tasks (e.g., tapping to a beat). However, it is still unknown whether rhythmic disorders in the speech and non-speech domains come from the same source (e.g., an impaired general system for beat perception and production). The goal of this study was to examine the relation between impaired speech rhythm in PD patients and non-speech rhythmic skills. Materials and Methods: Twenty-two PD patients (mean age: 69.3, SD : 5.5) performed i) an oral diadochokinesis task, ii) motor and perceptual non-verbal rhythmic tasks from the BAASTA battery. The patients were divided into two subgroups depending on their performance in the non-verbal rhythmic tasks: good beat-trackers (n = 12) and poor beat-trackers (n = 10). The two subgroup of patients were compared in terms of their speech performance. In addition, correlations were run to test the link between speech and non-verbal rhythmic skills. Results: Good beat-trackers showed greater speech-related rhythmic abilities as compared to poor beat-trackers, such as lower variability in producing oral diadochokinesis [Figure 1], and greater articulatory skills. In addition, the ability to synchronize to a beat was generally correlated with the ability to perform diadochokinesis [Figure 2]. Notably, this link was not confined to tasks involving rhythmic production, but was also apparent between speech production and rhythm perception with non-verbal material [Figure 3]. Conclusion: Our results point to close relations between speech-related rhythmic skills and non-verbal rhythmic motor and perceptual abilities in PD. These findings are consistent with an impaired general system for beat perception and production in PD. This system can be the target of dedicated techniques for rhythmic training (e.g., using non-verbal material) for alleviating some dysarthric symptoms in PD.

Keywords: Dysarthria, Parkinson’s disease, rhythm

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


  A3.06 Neurological and Mental Health Conditions - Language and Speech Disorders Top



  ISPR8-2619 Top


Lesion locations associated with outcomes for post-stroke aphasia

A. Hauwelle, I. Sibon1, M. Hatier2, M. Laganaro3, P. Dehail4, M. Villain5, T. Tourdias6, B. Glize7

CHU de Clermont-Ferrand, Service MPR, Clermont-Ferrand, 1CHU de Bordeaux, Stroke Unit, 2CHU de Bordeaux, Serice MPR, 4CHU de Bordeaux, Service MPR, 6CHU de Boredaux, Neuroradiologie, 7University of Bordeaux, Bordeaux, 5AP-HP la Pitié Salpétrière, Service MPR, Paris, France, 3Université de genève, neuropsycholinguistique, geneve, Switzerland,

E-mail: audrey.hauwelle@gmail.com

Introduction/Background: Several studies identified age, gender, handedness, lesion size, stroke subtype, aphasia/stroke initial severity as prognostic factors for recovery from aphasia. However, prediction of recovery still remains difficult to establish initially for patients with initial severe aphasia. The aim of this study was to identify the lesion location associated with poor recovery. Materials and Methods: One hunderd aphasic patients were included within fourteen days after a first ischemic or haemorrhagic stroke of the left hemisphere and had analysable MRI sequences. The severity of aphasia was determined using the Aphasia Severity Rating Scale in the acute phase and six months post-stroke. The ASRS is a 6-point Likert scale from the lowest score 0 to 5. A severe aphasia initially was defined as an ASRS score < 3. Good recovery at M6 was defined as an ASRS=4-5. In a first step, axial diffusion-weighted images, or T2*-weighted images for intra-cerebral haemorrhage, were imported. Lesions were drawn manually as regions of interest blinded to clinical data. Images were normalized to a standard brain template. The resulting normalized lesion maps were analysed in a VLSM approach, which applies the graded information at the behavioural level to voxel-wise binary lesion information. The resulting maps were corrected for multiple comparisons. Results: Regarding all patients, a better outcome was significantly associated (p<0.01) with lesion excluding the following areas of the left hemisphere: Putamen, transverse temporal gyrus (Heschl gyrus), Insula, Rolandic Operculum. Regarding patients with severe aphasia initially, a poor recovery (i.e. ASRS at M6<4) was significantly associated (p<0.05) with lesion in the Putamen and transverse temporal gyrus (Heschl gyrus). Conclusion: The present study identified critical areas associated with poor outcomes for aphasia, particularly lesions of the superior temporal gyrus for patients with severe aphasia initially. These findings are in line with previous results in the literature.







Keywords: Aphasia, MRI, stroke

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


  ISPR8-0872 Top


Inhibitory rtms in poststroke nonfluent aphasia facilitates functional brain changes and language recovery: an fmri study

W. S. Lin, P. Y. Tsai

Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan

E-mail: a8889bms47@gmail.com

Introduction/Background: Although the effect of inhibitory repetitive transcranial magnetic stimulation (rTMS) for the treatment of nonfluent aphasia has been successfully explored, the exact mechanism associated with the neuroplasticity of this regimen remains unclear. Materials and Methods: Twenty-two patients with sustained chronic nonfluent aphasia for more than 6 months after left hemispheric stroke were recruited for this randomized, sham-controlled, double-blind parallel study. Patients in the experimental group (n=11) received real 1 Hz rTMS intervention over right (R) pars triangularis for 10 consecutive weekdays and were compared with the sham stimulation (n=11). All patients underwent resting-state functional magnetic resonance imaging (fMRI) and Concise Chinese Aphasia Test (CCAT) pre- and post-rTMS intervention. Results: After intervention, the experimental group exhibited significantly superior results in total CCAT score, expression, conversation and description subtests (P<0.05). After rTMS, fractional amplitude of low frequency fluctuations (fALFF) significantly more active in several cortical and subcortical areas including R superior temporal pole (BA 38), R superior temporal gyrus (BA 22), R middle frontal gyrus (BA 46), R insular cortex and R caudate nucleus. Moreover, the R caudate nucleus and R middle frontal gyrus were associated with the clinical language performance. Conclusion: Inhibitory rTMS protocol may facilitate language recovery without compromising beneficial contralesional reorganization. Conversely, this regimen enhances the expression of newly organized areas for the improvement language performance in poststroke nonfluent aphasic patients, particularly the caudate nucleus and middle frontal gyrus, likely through intercortical modulating mechanisms.
Table 2: Mean Group Data (±SD) of CCAT Scores and Naming Tests for Each Group After Repetitive Transcranial Magnetic Stimulation Interventions

Click here to view










Keywords: Functional magnetic resonance imaging, poststroke nonfluent aphasia, repetitive transcranial magnetic stimulation

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


  ISPR8-2665 Top


Leukoaraiosis is not predictive of aphasia recovery

M. Hatier1,2, I. Sibon3,4, A. Hauwelle2,5, T. Tourdias6,7, H. Cassoudesalle1,2, P. Dehail1,2, M. Villain8, C. Gil-Jardiné9, B. Glize1,2

Department of Physical Medicine and Rehabilitation, CHU Bordeaux, 1University of Bordeaux, 2CHU Bordeaux, Sroke Unit, 3Incia-CNRS UMR5287, University of Bordeaux, 5CHU Bordeaux, Neuroimagerie Diagnostique et Thérapeutique, 6InsermU1215, Neurocentre Magendie, 8Department of Emergency, CHU Bordeaux, Bordeaux, 7Department of Medicine Rehabilitation, AP-HP Salpetriere, Paris, France, 4Department of Physical Medicine and Rehabilitation, CHU Clermont Ferrand, Clermont Ferrand,

E-mail: marie-hatier@live.fr

Introduction/Background: Stroke-related aphasia affects 20%to40% stroke patients and early prediction of aphasia recovery remains extremely difficult to predict. Leukoaraiosis LA is recognised as one of the neuroimaging features of cerebral small vessel disease and is associated with brain disturbances. LA is known to be associated with long term cognitive decline, mood disorders, gait disability and has a negative impact of post-stroke functional outcome. The aim of this study was to determine whether the extent of LA could contribute to the prediction of recovery from post-stroke aphasia. Materials and Methods: One-hundred two right handed aphasic patients with analyzable MRI sequences were included and assessed as soon as possible within fourteen days after a first left hemispheric stroke. The severity of aphasia was assessed using the Aphasia Severity Rating Scale (ASRS) at baseline and 6month (M6) after the stroke. The ASRS is a 6-point Likert scale from the lowest score 0 to 5. A severe aphasia initially was defined as an ASRS score < 3. Good recovery at M6 was defined as an ASRS=4-5. In a first step, axial diffusion-weighted images, or T2*-weighted images for intra-cerebral haemorrhage, and Flair images were imported. Lesions were drawn manually in order to measure the lesion size, as well as the volume of LA in Flair sequences. Results: Good recovery from aphasia was significantly associated with lower severity of aphasia initially (p<0.001) and smaller lesions (p<0.001). No significant association was found between the volume of LA and recovery from aphasia, even adjusted to the lesion size or age in a multi variable model. Conclusion: The extent of leukoaraiosis is not a predictor of aphasia recovery, even adjusted to the lesion size or age. Hence, aphasia recovery seems to be poorly influenced by diffuse lesions of sub-cortical white matter, strengthening the idea of crucial and localised brain areas and networks involved in recovery.

Keywords: Aphasia, leukoaraiosis, stroke

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


  ISPR8-2667 Top


Motor evoked potentials of upper-limbs predict aphasia recovery

B. Glize, M. Villain1, M. Laganaro2, D. guehl3, P. Dehail4, P. A. Joseph5, I. Sibon6

University of Bordeaux, Bordeaux, 1AP-HP Pitié Salpétrière, service MPR, Paris, 3CHU de Bordeaux, Exploration du Systeme Nerveux, 4CHU de Bordeaux, Service MPR, 5CHU de Bordeaux, Serice MPR, 6CHU de Bordeaux, Stroke Unit, Bordeaux, France, 2Université de Genève, neuropsycholinguistique, Genève, Switzerland

E-mail: bertrand.glize@chu-bordeaux.fr

Introduction/Background: Recovery from aphasia remains difficult to predict. Among the language features predicting recovery from aphasia, production scores such as repetition or phonology seem to be more relevant predictors than only severity. As motor cortex is strongly involved in language processes, both production and perception, the present study aimed to determine whether the integration of an electrophysiological measure of the motor networks using motor-evoked potentials MEP in the acute phase of stroke can improve the prediction of recovery from post-stroke aphasia. Materials and Methods: One hundred tweleve patients with aphasia within 14days after a first ischemic or haemorrhagic stroke completed the study. The severity of aphasia was assessed using the Aphasia Severity Rating Scale (ASRS) at baseline and 6month (M6) after the stroke. The ASRS is a 6-point Likert scale from the lowest score 0to5. A severe aphasia initially was defined as an ASRS score<3. MEPs were recorded from the abductor pollicis brevis muscle and orbicularis oris. The resting motor threshold (rMT) was defined for each muscle and a ratio between left and right rMT(rMTr) was calculated for upper-limbs and for lips. Results: A first-level model, including only clinical variables (i.e. initial severity) predicted severity at six months for severe patients. When the rMTr of upper limbs was added in a second-level model, the predictive power significantly increased from 41% to 51%, as well as adding in a third-level model rMTr of upper-limbs and initial fibres number ratio of the corticospinal tracts (41% to 55%). With the changes of severity as the dependent variable, the same factors made a significant contribution and the predictive power of a second-level model increased from 4%to20% to the same extent as in a third-level model (4% to 27%).



Conclusion: Added with usual clinical factors, MEPs of upper-limbs and lips contribute to the prediction of aphasia recovery, particularly for patients with severe aphasia initially.

Keywords: Aphasia, motor evoked potential, recovery prediction

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


  ISPR8-2165 Top


“Is grass really greener on the other side?” – a study of analogy perception across age groups

M. Thomas1,2, G Bajaj1,2

1Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Karnataka, India, 2Manipal Academy for Higher Education (MAHE), Manipal, Karnataka, India

E-mail: manita.thomas@manipal.edu

Introduction/Background: Analogy perception serves as the basis for numerous other kinds of human thinking,reasoning and successful communication.Since it is a complex cognitive communicative task it would be worth exploring how the age effects the accuracy and speed of processing.Hence the present study is to evaluate the effect of age on analogy perception.The objectives of the study were to explore age related changes in the accuracy and speed of analogy perception. Materials and Methods: A cross-sectional study design. Participated are divided it into three groups based on their age. Group 1 consisted of 12 participants between the age group 20-30 years. Group 2 consisted of 10 participants between the age group 30-50 years. Group 3 consisted of 7 participants between the age group 60-75 years. 18 stimuli were on 18 different slides using the software called the paradigm experiment version 2.1.0.95(86).The subjects were expected to read the entire conversational context and judge the interpretation of the used analogy from the four choices.Responses were recorded along with the time elapsed between the emergence of the slide and pressing the button to give the response. Reaction time were also noted.The data was collected from the participants was tabulated and analyzed on MSexcel. Results: The descriptive statistics was applied to analyse the accuracy and reaction time of the subjects of all the groups. Conclusion: Analogy perception is an integral part of the successful communication. Studies have shown that analogies are a series of leaps involving high level perception, activation of concepts in long term memory, transfer to short term memory, partial and context-dependent unpacking of chunks, and then further high-level perception (Hofstader,1996).We recommend usage of analogy mapping as a significant process which should be included in routine cognitive communicative assessments.This would surely enable us to understand various cognitive linguistic processes in a healthy as well as a pathologically ageing brain.

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


  A3.07 Neurological and Mental Health Conditions - Nerve Injury Top



  ISPR8-2081 Top


Evaluation of balance performance in vestibular loss patients using virtual reality system and single leg stance test

Q. Shen, C. de Waele, M. Gras1, P. Bendahan1, G. Lamas2

CNRS UMR8257, University Paris Descartes, Cognition and Action Group, 3Department of ENT, Pitie Salpetriere Hospital, Paris, 1ESPHI, La Ciotat, France,

E-mail: shenshenqiwen@gmail.com

Introduction/Background: This study is to evaluate the balance performance in unilateral vestibular loss (UVL) and bilateral vestibular loss (BVL) patients by using a new visual perturbation system including virtual reality (VR), Wii Balance Board (WBB), rubber foam, and a wearable accelerometer for body sway parameter quantification. Balance ability during 25s single leg stance was also assessed. Materials and Methods: Forty-six normal subjects and 27 vestibular loss patients were recruited. Subjects were instructed to stand on WBB plus foam, and to wear a goggle delivering VR image. Two visual conditions were assessed: stable visual world (VR0.0) and perturbed visual world (VR0.1). Each condition lasted for 25s. Subjects wore one 3D accelerometer attached on the site of L5 vertebra. The balance performance was quantified by calculating the average “jerk” at X, Y, and Z axis during the test. Patients who fell during the test were removed from “jerk” analysis. The body sway was also measured during single leg stance at eye open and eye closed condition. Results: All normal subjects and patients completed VR0.0 without falling. No normal subjects fell at VR0.0; whereas 33% UVL patients and all BVL patients fell. At VR0.0, the average “jerk” in healthy subjects is 2.10±0.98 (min-max: 0.68-5.59), and in patients is 4.97±2.84 (min-max: 0.80-14.82). At VR0.1, the average “jerk” in normal subjects is 3.54±1.73 (min-max: 0.68-8.68), while in UVL patients is 10.62±4.70 (min-max: 1.10-16.33). In one leg stance test, the “jerk” was also significantly increased in UVL patients compared to normal subjects. Conclusion: The new visual perturbation system and single leg stance test allows clinicians to efficiently evaluate balance performance and visual dependency at clinical settings. The body sway parameter “jerk” successfully distinguished vestibular deficit patients from healthy subjects. This system may be used in rehabilitation program to follow the improvement of balance performance in vestibular loss patients.

Keywords: Balance, vestibular loss, virtual reality

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


  A3.11 Neurological and Mental Health Conditions - Miscellaneous Top



  ISPR8-2564 Top


Ageing with cerebral palsy comes with deterioration of health and functioning

J. Benner, S. Hilberink, T. Veenis1, H. Stam, W. van der Slot2, M. Roebroeck

Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, 3Rijdam Rehabilitation, Neurorehabilitation, Rotterdam, 2Sophia Rehabilitation, The Hague, The Netherlands

E-mail: m.roebroeck@erasmusmc.nl;j.benner@erasmusmc.nl

Introduction/Background: Nowadays the majority of persons with cerebral palsy (CP) is of adult age. During the lifespan, adults with CP may face deterioration of health and functioning, which sets a new research area in Physical and Rehabilitation Medicine. Materials and Methods: A representative Dutch cohort of adults with CP formerly known in pediatric rehabilitation care (n=88) completed assessments at baseline (21-31 yrs), 4-y and 14-y follow-up (35-45 yrs). At 14-y follow-up (n=49) 55% was male, 75% had spastic CP, 22% intellectual disability. Repeated measurements over time addressed the primary outcomes: A) functional level (Barthel index; walking performance), B) perceived health and health issues (SF-36 general health (adapted); pain, severe fatigue) and C) employment status and work hrs/wk. Longitudinal change was explored using generalized estimating equations (GEE) and proportions of change analyses. Results: Over a 14-year period, an increasing proportion of adults with CP worried about their health (29-54%, p=0.008) or indicated that health problems limit their activities (19-45%, p=0.002), despite the majority continued to report to feel usually healthy (94 -86%; p=0.15). Presence of some health issues, such as pain, increased with ageing. Also, independence in mobility and self-care decreased (Barthel Index 17.1 (4.8) - 16.3 (5.6), p=0.007), specifically for walking indoors. Adults with CP were less often employed than the general population (38-45% versus 69-86%, p < 0. 001), although employment rate was stable over time. In the same period, work hours/week declined (35.0 (7.9) - 31.2 (10.3), p=0.03). Conclusion: On the long-term, adults perceived an increasing impact of CP, with early deterioration of health problems, functional level and work intensity. Their employment rate was consistently low up to age 45. Systematic monitoring of individuals aging with CP is required to better understand the growing impact of this condition with ageing, and to provide timely interventions.

Keywords: Ageing, cerebral palsy, new area in PRM

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


  ISPR8-1800 Top


Health and functional disability in adult survivors of childhood central nervous system (cns) tumours: illness/treatment-related dysfunction, and long-term rehabilitation and aftercare needs

K. K. Boman, L. Hörnquist1, B. Lannering2, G. Gustafsson1

Department of Women’s and Children’s Health, Uppsala University, Uppsala, 1Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, 2Department of Clinical Sciences-Pediatric Oncology, University of Gothenburg, Gothenburg, Sweden

E-mail: krister.boman@kbh.uu.se

Introduction/Background: As part of the longitudinal Swedish childhood CNS tumour LIFE study, this study aimed at identifying self-experienced late effects (SELEs) among very long-term survivors (VLTSs), and the extent to which sequelae were experienced as disabling. SELEs were analysed in relation to self-experienced needs of -, and current involvement in clinical follow-up and rehabilitation. Materials and Methods: The study targeted an entire national cohort of 706 Swedish 24-46 years old (mean=32) VLTSs diagnosed 1982-2001. SELEs data were collected using a study-specific questionnaire in the second wave of data collection, while single predictor factor data emanate from previous wave 6 years earlier. SELEs assessment included open-end question form. For survivors’ ratings of SELEs difficulty, a 5-point Likert-scale measurement was used. Data were quantitatively and qualitatively analysed. Results: Three hundred thirty, 65.7%, of 507 data-providers, reported one to several SELEs. Sixteen identified categories of problems, covered a range of SELEs of medical, neurological, neurosensory, or neuropsychological origin. Most prevalent sequelae involved one or several of vision, balance, endocrinopathy, fatigue, hearing, pain, memory, and seizures/epilepsy. SELEs were experienced as harmless by 7.4%; somewhat, clearly, very difficult by 33.4%, 28.5%, and 24.8% respectively; and completely disabling by 5.9%. Occurrence and severity varied with diagnosis age, gender, sub-diagnosis, and whether past cancer treatment included radiation therapy or not. Out of 132 survivors who suffered from considerable to entirely disabling SELEs, and who experienced need of surveillance/follow-up, 21% lacked access to such. Health status 6 years earlier predicted occurrence of SELEs later in life. Conclusion: A majority of CNS tumour VLTSs experience late effects that intrude upon health, function and quality of survival. Unmet needs of aftercare and rehabilitation can be identified, most prominently among females. Today, as many as one out of five studied CNS tumour VLTSs lack required specialized surveillance or access to needed rehabilitation in a long-term follow-up plan.

Keywords: Acquired disability, childhood central nervous systemtumours, rehabilitation needs

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


  A4.01 Internal Medicine and Other Conditions -Heart, Cardiovascular and Lymph Diseases Top



  ISPR8-0620 Top


Extended cardiac rehabilitation improves aerobic capacity and fatigue: a randomized controlled trial

N. Ter Hoeve1, M. Sunamura1, H. Stam2, R. Van Domburg3, R. Van Den Berg-Emons4

Department of Rehabilitation Medicine, Erasmus MC Rotterdam and Capri Cardiac Rehabilitation, 1Capri Cardiac Rehabilitation, 2Department of Rehabilitation Medicine, Erasmus MC Rotterdam, 4Department ofCardiology, Erasmus MC Rotterdam, Rotterdam-Zuid-holland, The Netherlands

E-mail: n.terhoeve@erasmusmc.nl

Introduction/Background: To investigate the effects of two behavioral lifestyle interventions integrated into cardiac rehabilitation on aerobic capacity, fatigue, and participation in society and to explore mediating effects of physical activity. Materials and Methods: In the OPTICARE trial, 914 patients with acute coronary syndrome were randomized to 1) 3 months of standard cardiac rehabilitation (CR-only); 2) CR-only with additional face-to-face physical activity group counseling sessions plus 9 months of after-care with general lifestyle group counseling (CR+F); or 3) CR-only plus 9 months of after-care with individual, general lifestyle telephone counseling sessions (CR+T). Aerobic capacity (6-minute walk test), fatigue (FSS), and participation in society (USER-P) were measured at randomization, 3 months, 12 months, and 18 months. Results: Generalized estimating equation analysis revealed favorable intervention effects for CR+F (compared to CR-only) in aerobic capacity up to 12 months (B= 12.49 m; 95% CI 0.53-24.46; P= .041) and in prevalence of fatigue until at least 18 months (OR= 0.47; 95% CI = 0.26-0.84; P= .010). No additional improvements were seen for participation in society. No intervention effects were found for CR+T. Additional analysis showed that improvements in aerobic capacity in CR+F were mediated by improvements in physical activity. No mediating effects were found for improvements in fatigue. Conclusion: Extending cardiac rehabilitation with a face-to-face behavioral group intervention was successful in sustaining aerobic capacity gains for up to 12 months and for reaching long-term goals for improvements in fatigue. The benefits in aerobic capacity seem to be mediated by improvements in daily physical activity. A telephonic behavioral intervention provided no additional benefits.

Keywords: Behavioral, cardiac rehabilitation, physical activity

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


  A4.04 Internal Medicine and other Conditions - Cancer Top



  ISPR8-0297 Top


Predicting return-to-work status in male head and neck cancer survivors with World Health Organization Disability Assessment Schedule 2.0 Score: A nationwide cross-sectional study



Y. H. Lee, S. W. Huang, T. H. Liou

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

E-mail: 15411@s.tmu.edu.tw

Introduction/Background: Even though return-to-work (RTW) status is crucial to the rehabilitation of head and neck cancer (HNC) survivors, few large-scale studies have objectively quantified predictions of the RTW status of HNC survivors. The objective of this nationwide study in Taiwan was to predict work participation by using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) score as an objective assessment tool, to provide implications for clinicians to formulate an effective rehabilitation and facilitating RTW care plan. Materials and Methods: Data from between July 2012 and July 2017 regarding 1171 male HNC survivors with disability aged <50 years were obtained from the Taiwan Data Bank of Persons with Disability (TDPD). Demographic data and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) scores were analyzed to compare employment statuses among HNC survivors. The receiver operating characteristic (ROC) curve was used to investigate the accuracy of the WHODAS 2.0 scores in predicting the RTW status, and the optimal cutoff point was determined using the Youden index. Binary logistic regression was used to identify predictors for the RTW status of HNC survivors. Results: The WHODAS 2.0 scores in all the domains were lower in unemployed than in employed HNC survivors (p < 0.001). The ROC curve revealed that the summary WHODAS 2.0 score (area under curve > 0.8) was an extremely accurate predictive tool. Binary logistic regression revealed that the severity levels of impairment and standardized WHODAS 2.0 summary scores less than the cutoff value (27.81) were predictors for the RTW status of HNC survivors with disability in the working age group. Conclusion: The WHODAS 2.0 score not only provides a reliable and applicable summary of the functionality and disability of HNC survivors but also is an objective quantitative assessment tool for evaluating the RTW possibility in this patient group.

Keywords: Head and neck cancer, return-to-work, World Health Organization Disability Assessment Schedule 2.0

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


  ISPR8-1567 Top


Effectiveness and implementation of work-related medical rehabilitation in cancer patients: Results from a cluster randomized multicenter trial

D. Fauser, M. Bethge, J. Wienert1, T. Beinert2, I. Biester3, H. U. Krüger4, J. Schmielau5

Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, 1Techniker Health Insurance, Scientific Institute of TK for Benefit and Efficiency in Health Care, Hamburg, 2Department of Oncology, Paracelsus-Klinik am See Bad Gandersheim, Bad Gandersheim, 3Department of Oncology, MediClin Rose Klinik, Horn-Bad Meinberg, 4Department of Oncology, Bavaria Klinik Freyung, Freyung, 5Department of Oncology, AMEOS Reha Klinikum Ratzeburg, Ratzeburg, Germany

E-mail: davidpeter.fauser@uksh.de

Introduction/Background: Work is a central resource for cancer survivors impacting health and quality of life. Effective rehabilitation programs supporting return to work become increasingly relevant for cancer survivors. In Germany, such programs were established as work-related medical rehabilitation, comprising work-related diagnostics, functional capacity training, psychosocial groups and intensified social counseling. The study investigated the effectiveness of work-related medical rehabilitation compared to conventional medical rehabilitation. Materials and Methods: We conducted a cluster randomized multicenter trial. 484 cancer patients aged 18 to 60 years were recruited in four inpatient rehabilitation centers. Patients of a center starting their rehabilitation in the same week represented a cluster. These clusters were randomly assigned with computer-generated randomization schedules to intervention (IG) or control group (CG). The primary outcome was the role functioning scale of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire as assessed at the 12-month follow-up. Secondary outcomes were other quality of life domains, disease coping and return to work. Effects were estimated using random effects models. The study was registered in the German Clinical Trials Register (DRKS00007770). Results: Analysis of delivered dose of treatments indicated a successful implementation of work-related medical rehabilitation. 379 patients, 197 in IG, were included in the analysis of the 12-month follow-up. There was no significant difference between IG and CG in role functioning (b = 3.69; 95% CI: -2.01–9.39; p = 0.204) and any secondary outcome. Results indicate effects in favor of those patients with a high risk for early retirement in IG regarding role functioning (b = 10.54; 95% CI: 1.68–19.40; p = 0.020) and physical functioning (b = 7.84; 95% CI: 2.60–13.08; p = 0.003). Conclusion: Work-related medical rehabilitation had no significant effects on primary and secondary outcomes compared to conventional medical rehabilitation. However, participants with an increased risk for health-related early retirement may benefit from a work-related medical rehabilitation program.

Keywords: Cluster randomized multicenter trial, oncology, work-related medical rehabilitation

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


  ISPR8-0486 Top


Oncological rehabilitation and the aim: Return to work. Development and evaluation of an MBOR module for rehabilitation named “job perspective”

B. Leibbrand, H. Kähnert1, A. K. Exner2

Salzetalklinik, Onkologische Rehabilitation, Bad Salzuflen, 1Insitut für Rehabilitations for Schung Norderney, Abbot Bad Salzuflen, Bad Salzuflen, 2Universität Bielefeld, Fakultät für Gesundheitswissenschaften, AG Epidemiologie and International Ublic Health, Bielefeld, Germany

E-mail: dr-leibbrand@t-online.de

Introduction/Background: Oncological rehabilitation also follows the aim return to work. But work-orientated therapies are only a rudimentary integrated part of rehabilitation (MBOR). The aim of our study was to design work-orientated therapies (MBOR module “job perspective”) for oncological rehabilitation and to implement them in the routine care. Materials and Methods: The development of “job perspective” was carried out after group interviews with rehabilitants in the rehabilitation team in expert meetings. After completion of the development and testing phase, the module was implemented in the routine care. For evaluation of the process operation and the content of the module, group interviews with rehabilitants and expert interviews were conducted. The interviews were evaluated by “category-led” text analysis (Mayring, 2010). Evaluation of MBOR module was in addition made by questionnaires for rehabilitants before and after introduction of “job perspective”. The participants were employed rehabilitants with cancer and work problems. Results: The development of “job perspective” needs seven months. The module offers work-related therapies for different professions. The evaluation of the expert interviews showed that the development of “job perspective” in the rehabilitation team was positive. The evaluation of the group interviews with the rehabilitants and questionnaires showed that the module “job perspective” was considered practical. The assessment of work-orientated therapies was valuated positively after introduction of “job perspective” of the IG (60%) but not of the CG (11%) without the module (Chi2 = 55.3, p < 0.001). All in all 86% of the IG but only 39% of CG evaluated their rehabilitation positively for integration into employment (Chi2 = 56.9, p < 0.001). Conclusion: The aim “return to work” of cancer patients is a major challenge in oncological rehabilitation. Therefore “job perspective” was created with an interdisciplinary rehabilitation team. Rehabilitants appreciate the consideration of work-related issues in their rehabilitation process. The results also show the importance of interdisciplinary teamwork.

Keywords: MBOR module, oncological rehabilitation, return to work

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


  ISPR8-1967 Top


Objective evaluation of physical activity level after breast cancer treatment

B. Joelle, S. Lavau-Denes1, L. Pervieux1, A. Labrunie2, B. Marin2, N. Tubiana1

HAVAE Laboratory, FST-Université de Limoges, 1Department of Oncology, Limoges Dupuytren University Hospital, 2Department of Medical Information and Evaluation, Clinical Research and Biostatistic Unit, Dupuytren University Hospital, Limoges, France

E-mail: joelle.bonis@unilim.fr

Introduction/Background: Engaging in sufficient physical activity post diagnosis has been consistently associated with reduced treatment-related side effects, recurrence, all cause and cancer specific mortality, and enhanced HRQOL in breast cancer survivors. Research indicates that adults spend the vast proportion of their sitting and light-intensity physical activity. Objective evaluation such as accelerometer provide detailed data of physical activities performed across the day and the week and can give a clearer understanding of the behavior of cancer survivors (Lynch 2011). The aim of this study was to evaluate and compare accelerometer-based and self-reported measures of physical activity level (PA) in patients having a breast cancer just after the end of adjuvant treatment without incitation or education program. Materials and Methods: For this prospective study 31 Women (mean age = 66.1 years) with no metastatic breast cancer were included after the treatment. Measures were released with an Actigraph GT3X accelerometer for seven consecutive days then complete the IPAQ-SF every 3 months after the last session of radiotherapy. Results: The evolution of level MET is not significantly different between P1-P2, P2-P3 and P1-P3 (p > 0.05), the score IPAQ-SF between P1-P2 is statistically different (p = 0.0461) and is not significantly different between P2-P3 and P1-P3. The analyses of the concordance both methods (Kappa coefficient) reveal poor to fair agreement between data for P1 (k = 0.0142), P2 (k = 0,0119) and P3 (k = 0,0057) period. Conclusion: The objective measure demonstrates the low physical activity level and no evolution during 3 months after treatment. This study shows poor agreement between accelerometer and self-reported physical activity data, these results are consistent with previous studies in cancer survivors (Pinto 2013, Johnson-Kozlow 2006). The finding of this study highlight the need to estimate physical activity level with objective method before intervention or incitation in breast cancer population.

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


  ISPR8-0350 Top


Impact of surgery type on physical fitness following a 16-week exercise intervention in breast cancer survivors

C. Dieli-Conwright, C. Chow, N. Sami, K. Lee

University of Southern California, Biokinesiology and Physical Therapy, Los Angeles, USA

E-mail: cdieli@usc.edu

Introduction/Background: Breast cancer survivors (BCS) undergo different types of surgery (e.g. lumpectomy, partial mastectomy, bilateral mastectomy) that may impair physical fitness. Regular participation in exercise is an effective strategy to improve physical fitness after surgery in BCS. The purpose of this study is to examine whether surgery type influences the effects of a 16-week exercise intervention on physical fitness in BCS. Materials and Methods: Sedentary, overweight/obese (BMI >25 kg/m2) BCS (Stage I-III) were enrolled as part of a larger ongoing RCT. BCS underwent supervised, progressive moderate-to-vigorous aerobic and resistance exercise sessions 3 times/week for 16 weeks. Cardiorespiratory fitness (CRF) and muscular strength (MS) were assessed at baseline and post-intervention. CRF was measured by calculating estimated VO2max using the 4-minute walk test. MS was assessed from 10-RM (repetition maximum) tests of the leg extension (LE), leg flexion (LF), chest press (CP), and lat pulldown (LP) to estimate 1-RM values. Surgery type was abstracted from medical records. Paired t-test and one-way ANOVA were used to examine the effects of exercise training and surgery variables on physical fitness. Results: Forty-six (52.7 ± 10.4 yr), primarily postmenopausal (56.1%), Hispanic (63.1%) BCS completed the intervention. CRF (mean % change 20.1 ± 7.2%) and MS (LE: 42.6 ± 28.1%; LF: 43.9 ± 21.4%; CP: 58.5 ± 55.0%; LP: 35.4 ± 14.1%) significantly increased following the intervention (p < 0.01). Post-intervention, MS was significantly higher in BCS who had mastectomy surgery when compared to those who had lumpectomy surgery (p < 0.001). Conclusion: Surgery type may impact improvements in physical fitness following a structured exercise intervention in BCS. Further research is required to understand whether surgical history impacts the effect of exercise on physical fitness in BCS.





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


  A4.05 Internal Medicine and other Conditions - Metabolic Disorders (E.G. Obesity, Diabetes Mellitus) Top



  ISPR8-1076 Top


Poliomyelitis: Is the calculated basal metabolic rate a reliable measure?

T. Laurent, A. Jouvion, G. De-brier, T. Trappier, G. Genet1, F. Genet1

Department of PRM, HIA Laveran, Marseille, 1Department of PRM, Hopital Raymond-Poincaré, Garches, France

E-mail: laurentthefenne@orange.fr

Introduction/Background: Poliomyelitis is still a problem because the eradication is not obtain and the population is more important than spinal cord injury population. The reduction of activity, the lean mass transformed into fat mass and the decreased in BMR are the significant risk factors that predisposes them to become overweight. Can we use the BMR’ equations to give specific nutritional prescriptions? Materials and Methods: It’s an observationnal study of a cohort of the polio who consulted in Garche during 3 years. We studied the demographic items, history of poliomyelitis and complications. We analysed the muscle strengh (especially hip flexors, knee extensions, dorsiflexion of the ankle). To limit the fluctuations in muscle testing and fatigability-related changes, we also considered trunk involvement (scoliosis), wearing an orthosis and using a wheelchair as the most serious impairment of the sequelae. The BMR was determined by indirect calorimetry and was estimated by equations of differents authors. Results: We analysed 298 polio consultations. 41 had a calorimetry. There’s a strong correlation between BMR and the weight. The correlation is low for the height and BMI. BMI underestimated the risk of obesity is this population. Therefore, a specific BMI should be used. Basal metabolism seems to be linked with the gravity of the sequelae. The best relation is with the trunk involvement. But the correlation and the sensibility is low. Our factors are not enough specific. There are correlations with each equations. The best results closed to those of indirect calorimetry is obtain with OMS equation. But the equations significatively overestimated the basal metabolism (p < 0,01). Conclusion: We can’t use these equations to treat and prescribe a suitable diet. We probably have to use corrections.

Keywords: Basal metabolic rate, obesity, poliomyelitis

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


  A5.01 Paediatrics - Developmental Disorders Top



  ISPR8-1058 Top


The clinical aspect of delayed development in the children with copy number variations

K. B. Park, J. H. Park, A. R. Cho

Department of Physical Medicine and Rehabilitation, College of Medicine, The Catholic University of Korea, Seoul, Korea

E-mail: keeboem86@gmail.com

Introduction/Background: Microarray-based comparative genomic hybridization (array CGH) has been widely adopted as a valuable clinical diagnostic test for children with delayed development. Bradley P Coe et al. suggested copy number variants (CNVs) are associated with many neurocognitive disorders. Hence, overall development was measured between two groups divided by array CGH results. Materials and Methods: A retrospective chart review was done in 42 children who underwent array CGH after visiting PM&R Department outpatient clinic with delayed development as chief complaints. Children were evaluated for Denver Developmental Screening Test (DDST), Sequenced Language Scale for Infants (SELSI)/Preschool Receptive-Expressive Language Scale (PRES) A Mann-Whitney U test was conducted to determine statistical differences of Developmental Quotient (DQ), Receptive Language Quotient (RLQ) and Expressive Language Quotient (ELQ) between two groups: 14 children with CNVs and 28 children without CNVs. Results: DDST showed that personal social and language DQ were higher and fine motor and gross motor were lower in CNV (+) group than in CNV (-) group, but the difference was not statistically significant. All 22 children who underwent SELSI or PRES showed delayed language in all domains and RLQ and ELQ were higher in CNV (+) group than in CNV (-) group and the difference was statistically significant for ELQ (p < 0.05). In the CNV (+) group, ELQ was assessed higher than RLQ; In the CNV (-) group, ELQ was assessed lower than RLQ, but statistical significance was not observed in both inter-group. Conclusion: DQ in all domains was not significantly lower in children with CNV compared to children without CNV. However, tendency of milder delay of ELQ was observed in children with CNV. Active detection of genomic imbalance could play some vital role in assessing development aspect in children with delayed development.

Keywords: Copy number variations, delayed development, development aspect

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


  A5.02 Paediatrics - Cerebral Palsy and Spina BIFDA Top



  ISPR8-0668 Top


Development curves of motor and daily activity performance of individuals with cerebral palsy from childhood into adulthood

M. van Gorp, M. Roebroeck1, L. van Wely2, V. de Groot2, J. W. Gorter3, D. W. Smits4, A. K. Schmidt1, A. J. Dallmeijer

Department of Rehabilitation Medicine, VU University Medical Center and Erasmus MC University Medical Center, 2Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, 1Department of Rehabilitation Medicine, Erasmus MC University Medical Center and Rijndam Rehabilitation Institute, Rotterdam, 4University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, Utrecht, The Netherlands, 3Department of Pediatrics, CanChild Centre-McMaster University, Hamilton, Canada,

E-mail: m.vangorp@vumc.nl

Introduction/Background: Knowledge on long-term development can guide expectations of young individuals with cerebral palsy (CP) and their parents and inform treatment decisions. In children with CP, development of motor capacity has been described using development curves. The present study adds to this knowledge by describing development curves of motor and daily activity performance from childhood into adulthood of individuals with CP by functional severity level. Materials and Methods: Individuals with CP (n = 421) aged 1-20 years, with GMFCS I-V, 27% with intellectual disability (ID) were included. Participants were assessed up to four times at 1- or 2-year intervals and at a 13-year follow-up (n = 122). Gross and fine motor performance and personal, domestic and community daily activity performance were assessed using the Vineland Adaptive Behavior Scales. Non-linear mixed effects analyses were used to describe development curves, characterized by a limit (average maximum score) and age90 (age reaching 90% of the limit). Results: Limits of gross and fine motor performance decreased significantly (p < 0.05) with each lower functional level. Children with GMFCS or MACS I-III reached age90s of gross and fine motor performance around 6-8 years. Individuals with lower functional levels reached age90s earlier (around 1-3 years). Individuals with GMFCS I-III without ID reach similar limits of daily activity performance. Their age90s for daily activity performance were around 11-14 years (personal), 26-32 years (domestic) and 22-26 years (community). Individuals with ID reached lower daily activity performance limits and approached their limits earlier. Conclusion: Children with CP approach motor performance limits between 6-8 years. Individuals with GMFCS I-III without ID develop performance of daily activities into adolescence and adulthood. Severely functionally affected individuals have the least favourable development of motor performance and those with ID of daily activity performance. Because of ongoing development of daily activities, we recommend routine monitoring of individuals with CP for activity limitations into adulthood.

Keywords: Cerebral palsy, daily activities, development curves

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


  ISPR8-1606 Top


Predicting respiratory hospital admissions in young people with cerebral palsy: A 3-year longitudinal study using linked data

K. Langdon1,2, A. Blackmore3, N. Bear1,4, E. Blair5, L. Moshovis3, K. Steer6, A. Wilson1,6

Departments of Paediatric Rehabilitation, 2Physiotherapy and 5Respiratory Medicine, Princess Margaret Hospital, Subiaco, Perth, Western Australia, 1Ability Centre, Therapy and Health Services, Mount Lawley, 3Telethon Kids Institute, Clinical Research, Subiaco, 4Ramsay Health Care, Organisational Effectiveness Unit, Joondalup, AustraliaE-mail: katherine.langdon@health.wa.gov.au

Introduction/Background: Respiratory disease is the leading cause of death in children and young people with cerebral palsy however the onset of the disease onset is insidious and clinical care pathways for prevention and treatment are unclear. The aim of this study is to determine the early predictors of respiratory hospital admissions in young people with cerebral palsy (CP). Materials and Methods: 3-year prospective cohort study using linked respiratory hospital admissions data for young people with CP, aged 1-26 years, who had previously provided self-reported and carer reported respiratory symptoms. The respiratory hospital admissions were defined by the International Statistical Classification of Diseases and Related Health Problems [ICD-10] codes. Incidence rate ratios (IRRs) were calculated for univariate and multivariate models. Results: 482 participants (including 289 males) were recruited. They were aged 1 to 26 years (M 10 years, 10 months; SD 5 years, 11 months) at the commencement of the study, and represented all Gross Motor Function Classification Scale (GMFCS) levels. During the 3-year period, 55 (11.4%) participants had a total of 186 respiratory hospital admissions, and spent a total of 1,475 days in hospital. Statistically significant risk factors for subsequent respiratory hospital admissions over 3 years in univariate analyses were GMFCS Level V, at least one respiratory hospital admission in the year preceding the survey, oropharyngeal dysphagia, seizures, frequent respiratory symptoms, gastroesophageal reflux disease (GERD), at least 2 courses of antibiotics in the year preceding the survey, mealtime respiratory symptoms, and nightly snoring. Conclusion: Most risk factors for respiratory hospital admissions are potentially modifiable. Early identification of oropharyngeal dysphagia and the management of seizures may help prevent serious respiratory illness. One respiratory hospital admission should trigger further evaluation and management to prevent subsequent respiratory illness.

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


  ISPR8-0463 Top


Intradetrusor injections of botulinum toxin type A in children with spina bifida: A multicenter study

J. Hascoet, B. Peyronnet, V. Forin1, M. Baron2, G. Capon3, T. Prudhomme4, C. Allenet3, S. Tournier1, C. Maurin5, J. N. Cornu2, O. Bouali6, M. Peycelon7, A. Arnaud8, M. Renaux-Petel9, A. Liard9, C. Olivari-Philiponnet10, G. Karsenty5, A. Manunta, X. Gamé6

Departments of Urology and 8Pediatric Surgery, CHU Rennes, 10CHU Rennes, Spina Bifida Dysraphisms Referral Center, Rennes, Departments of 1Pediatric Physical Therapy and Rehabilitation and 7Pediatric Surgery, Trousseau Hospital, Paris, Departments of 3Urology and 9Pediatric Surgery, CHU Rouen, Rouen, 3Department of Urology, CHU Bordeaux, Bordeaux, Departments of 4Urology and 6Pediatric Surgery, CHU Toulouse, Toulouse, 7Department of Urology, APHM, Marseille, France

E-mail: camilleolivari@hotmail.com

Introduction/Background: Intradetrusor injections of botulinum toxin type A (IDBTX-A) have become the gold standard in adults for treatment of neurogenic detrusor overactivity refractory to anticholinergics. Data regarding IDBTX-A in pediatric patients with spinal dysraphism are scarce. The purpose of this study was to assess the effectiveness of IDBTX-A in children with spina bifida. Materials and Methods: All patients aged under 16 year-old who underwent IDBTX-A between 2002 and 2016 at six institutions were included in a retrospective study. Our primary endpoint was the injection’s success defined subjectively as both clinical improvement (no incontinence episodes between clean intermittent catheterization (CIC), absence of urgency, less than 8 CIC per day) and urodynamic improvement (resolution of detrusor overactivity, normal bladder compliance for age), lasting ≥ 12 weeks. Predictive factors of success were assessed through univariate analysis. Results: 53 patients with a mean age of 8.5 years were included. 33 (62.3%) had repeated injections (from 2 to 8 injections) resulting in a total number of 141 IBTX-A performed. The global success rate of the first injection (clinical and urodynamic) was 30%. Patients with closed spinal dysraphism had a significantly better success rate than patients with myelomeningocele (p = 0.002). The clinical success rate was 66% and was significantly associated with maximum urethral closure pressure (34 vs. 54.4 cm H2O; p = 0.02). The urodynamic success rate was 34%. Patients with closed spinal dysraphism had higher success rate vs. patients with myelomeningocele (48.2% vs. 17.4%; p = 0.02). Patients in whom the first IDBTX-A succeeded urodynamically had higher baseline bladder compliance (15.5 vs. 7 ml/cmH2O; p = 0.02). Maximum cystometric capacity (p < 0.0001) and compliance (p = 0.01) significantly improved after the first IDBTX-A. After a mean follow up of 3.7 years, 23 patients (43.4%) required augmentation cystoplasty. Conclusion: Despite IBTX-A enabled clinical improvement in most patients (66%), urodynamic outcomes were poor, resulting in a low global success rate (30%).

Keywords: Botulinum toxin A, dysraphisms, neurogenic bladder

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


  ISPR8-0047 Top


Oxygen equimolar mixture of nitrous oxide during post-operative physiotherapy in patients with cerebral palsy: A randomised double-blind placebo-controlled study

A. Delafontaine, A. Presedo1, D. Mohamed2, D. Lopes1, C. Wood3, C. Alberti2

STAPS Orsay, Laboratoire CIAMS, Université Paris, Sud, Université Paris, Saclay - 91405 Orsay Cedex, CIAMS, Université d’Orléans - 45067, Orléans, CIAMS Laboratory, Rungis, 1AP-HP, Hôpital Robert Debré, Service de Chirurgie Orthopédique, F - 75019, Service de Chirurgie Orthopédique, 2AP-HP- Hôpital Robert-Debré- URC- UEC- F-75019 Unité de recherche clinique, Paris, 3Centre de la douleur chronique- service de rhumatologie- CHU Dupuytren- Limoges, Service de Rhumatologie, Limoges, France

E-mail: arnaud_94150@hotmail.fr

Introduction/Background: The administration of an equimolar mixture of nitrous oxide-oxygen (N2O) is recommended during painful procedures. However, the evaluation of its use during physiotherapy after surgery has not been reported, although pain may hamper physiotherapy efficiency. This study investigated whether the use of N2O improves the efficacy of post-operative physiotherapy after multilevel surgery in patients with cerebral palsy. Materials and Methods: It was a randomised 1:1, double-blind, placebo-controlled study. Sixty-four patients were enrolled. All patients had post-operative physiotherapy starting the day after surgery. Patients received either N2O or placebo gas during the rehabilitation sessions. All patients had post-operative pain management protocol, including pain medication as needed for acute pain. The primary objective was to reach angles of knee flexion of 110° combined with hip extension of 10°, with the patient lying prone, within 6 or less physiotherapy sessions. Secondary evaluation criteria were the number of sessions required to reach the targeted angles, the session-related pain intensity, and the analgesics consumption for managing post-operative pain. Results: Targeted angles were achieved more often in the N2O group (23/32, 72%, vs. Placebo: 13/32, 41%; p = 0.01). Patients treated with N2O tended to require less often level III analgesic agents for managing post-operative pain, compared to those receiving placebo: 18/32 (58%) vs. 24/32 (75%). Conclusion: The administration of N2O during post-operative physiotherapy can help to achieve more quickly an improved range of motion, and, although not significant in our study, to alleviate the need for pain medication. Further studies evaluating the administration of N2O in various settings are warranted.

Keywords: Cerebral palsy, oxygen-nitrous oxide, post-operative physiotherapy

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


  ISPR8-0247 Top


Participation in everyday activities of Thai children with cerebral palsy and factors associated with the frequency of participation

T. Ploypetch, C. Buasuk, K. Pajareya

Department of Rehabilitation Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

E-mail: teerada_rehab@hotmail.com

Introduction/Background: Different culture and socioeconomic possibly influence the level of participation, while limited information was available in developing countries. The study aims to explore participation of children with cerebral palsy (CP) in Thailand and factors associated with the frequency of participation. Materials and Methods: A survey descriptive research was done in 80 children with CP, aged 6-18 years, who visited outpatient clinics of a university hospital in Thailand. Family caregivers reported Thai-version questionnaires: the frequency of participation (FPQ), Gross Motor Function Classification System (GMFCS-ER), attitude of caregivers and socioeconomic information. Disease severity and comorbidities were reviewed. Factors were analyzed for the association with the frequency of participation. Results: Children with CP, a mean age 9.7 (SD 3.3) years and 46 (57.5%) males were participated. Most subjects were spastic (88.8%) and quadriplegic (41.2%) types. Various levels of motor function were included: GMFCS level I-8 (10%), II-27 (33.8%), III-6 (7.5%), IV-13 (16.2%), V-26 (32.5%). Within 14 activities, the most-frequently-participated activity was “helping with housework” that 59 (73.8%) children with CP participated in a few times/week, followed by going to shops (41.3%) and riding bike (36.3%). The least-participated activity was “taking part in community activities”, 32 (40%) children had never participated in, even though the attitude of almost caregivers (96.3%) was good. The multivariate analysis found that better GMFCS level (p = 0.014) and communication ability (p = 0.015) significantly correlated with higher frequency of participation. The children with positive family income more frequently participated in leisure activities (p = 0.031) and art/cultural events (p = 0.018). Conclusion: Thai children with CP tended to participate more frequently in family activities such as housework, shopping and riding bike, whereas rarely participated in community activities. Participation in leisure activity and art/cultural events which seemed to need free-time and money associated with family income. The children with higher level of motor function and communication ability had higher frequency of participation in everyday activities.

Keywords: Cerebral palsy, factors associated participation, frequency of participation

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


  ISPR8-0176 Top


Psychiatric symptomatology, behaviors related to executive functions and social responsiveness in children and youth with spina bifida

A. Bıkmazer, E. Karadag-Saygi1, E. Giray1, I. Gokce2, A. R. Arman

Departments of Child and Adolescent Psychiatry, 1Physical Medicine and Rehabilitation and 2Pediatric Nephrology, Marmara University School of Medicine, Istanbul, Turkey

E-mail: girayesra@hotmail.com

Introduction/Background: The present study aimed: 1. To determine if children with SB demonstrate psychiatric disorders more than typically developing children 2. To assess if children with SB have more problems in executive functions and social responsiveness than TD children. 3. To investigate their relationship with neurologic level, ambulation status and presence of hydrocephalus. Materials and Methods: Thirty-one patients (age 6-15 years) with spina bifida and age-and gender-matched 36 controls without any chronic health condition, were assessed by a detailed form for sociodemographic characteristics. Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version for clinical psychiatric diagnoses were also evaluated. Also, four subtests of Wechsler Intelligence Scale for Children-Revised (WISC-R) and Childhood Autism Rating Scale were administered by the clinician. Parents of the participants completed Behavioral Rating Inventory of Executive Functions (BRIEF), Social Responsiveness Scale (SRS) and Aberrant Behavior Checklist. Results: Compared to healthy controls; psychiatric disorder rates, SRS total scores, BRIEF planning and organization subscores were higher in children and adolescents with spina bifida. Furthermore, WISC-R subtest scores were lower in this group. Psychiatric diagnosis rate did not differ among spinal lesion levels (upper vs. lower). Initiate and organization of materials subscores of BRIEF were significantly higher in lower lesion level group than upper lesion level cases. And also metacognition index, initiate and organization of materials were significantly higher in community ambulators than non-community ambulators. SRS total score was significantly higher in children with spina bifida (p = 0.021). Conclusion: Children with spina bifida have more psychiatric problems, demonstrated impairments in planning and organization and may have problems in social functioning when compared to their same age peers without chronic disease. Lesion level and mobility status have an impact on metacognition index, initiate and organization of materials subscales of BRIEF.

Keywords: Cognitive functions, psychiatric symptomatology, spina bifida

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


  ISPR8-1970 Top


Qualitative and quantitative comparative study of accelerometer cut-points to evaluate physical activity in children with cerebral palsy

A. L. Guinet, E. Desailly

Fondation Ellen Poidatz, Pôle Recherche et Innovation, Saint Fargeau Ponthierry, France

E-mail: anne-laure.guinet@fondationpoidatz.com

Introduction/Background: Physical activity (PA) in daily life could be evaluated by accelerometer. Multiple algorithms have been validated to classify activity counts along several time intervals (epoch length), and with several set of cut-points. For children, three algorithms are the most frequently used by researchers in order to define the time spent in sedentary (SED) and in moderate to vigorous physical activity (MVPA). The aim of this study was to determine the more appropriate accelerometer based classification algorithms for children with CP. Materials and Methods: Participants were children and adolescents with CP (n = 20, age 10 - 18 y), with Gross Motor Function Classification System (GMFCS) levels I-III. Daily PA was measured with an Actigraph GT3X accelerometer over 7 consecutive days in free-living environment. Data collection protocols were the same for all children. The results of three different algorithms, Puyau (2002), Freedson (2005), Evenson (2008), were compared by ANOVA followed by multiple t-test after Bonferroni’s corrections: The results were also compared to qualitative data from the written diaries of daily PA completed by children and parents. Results: There is a significant difference between the results of physical activity, depending on the algorithm used (F = 16.88, p = 1.53.10-15). The average time spent in MVPA is 2.6 times higher with Freedson’s algorithm than with Puyau’s algorithm, whereas the Puyau and Evenson algorithms are comparable. The qualitative informations collected with the daily diary indicated that Freedson’s algorithm over-estimated PA among children with CP. Conclusion: The harmonisation of the methods regarding accelerometer’s data collection and processing is necessary. Especially to compare the level of PA of a specific patient to the World Health Organization recommendations. For children with CP, the more appropriate algorithm is based on Evenson’s cut-points.
Figure 1: Boxplot showing the difference in MVPA (hours:minutes converted in decimal) by algorithm, with median, 1st and 3rd quartile, min, max and outliers

Click here to view


Keywords: Accelerometer, algorithm, physical activity

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


  ISPR8-1075 Top


Efficacy of radial extracorporeal shock wave therapy compared to botulinum toxin type a in the treatment of lower extremity spasticity in patients with cerebral palsy

X. Vidal, J. Martí1, O. Canet1, M. Roqué2, A. Morral, M. Tur, C. Schmitz3, M. Sitjà

Blanquerna School of Health Science, Ramon Llull University, 1Department of Neurology, Hospital de la Santa Creu i Sant Pau, 2Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau-IIB Sant Pau, Barcelona, Spain, 3Institute of Anatomy, Ludwig-Maximilian University of Munich, Munich, Germany

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

Introduction/Background: Radial extracorporeal shock wave therapy (rESWT) and infiltration with botulinum toxin type A (BoNT-A) are established therapies for spasticity in cerebral palsy. Using a randomized, controlled, cross-over clinical trial design (level of evidence, 1) this study tested the null hypothesis that infiltration with BoNT-A is more efficient in reducing plantar flexor muscle spasticity in patients with cerebral palsy than rESWT. Materials and Methods: Seventy patients were randomly allocated to rESWT (Group A; n = 35) (three rESWT sessions; one session per week; 2000 radial extracorporeal shock waves [rESWs] per session; positive energy flux density of the rESWs between 0.10 and 0.12 mJ/mm2) or a single infiltration with BoNT-A (Group B; n = 35) at time point T0. Six months after T0 (i.e., at time point T1) patients in Group A received a single infiltration with BoNT-A, and patients in Group B three rESWT sessions as described for patients in Group A. Treatment success was evaluated using V1 and V3 of the Tardieu scale at three weeks (W3), two months (M2) and three months (M3) after both T0 and T1. Results: In six out of 32 direct comparisons (two muscles [soleus and gastrocnemius], two tests [V1 and V3 of the Tardieu scale], two rounds of treatment [starting at T0 and T1] and four times of evaluation per round of treatment [at T0 and T1 baseline as well as at W3, M2 and M3 after both T0 and T1]) rESWT resulted in statistically significantly better outcome than infiltration with BoNT-A. The null hypothesis was rejected. There were no significant complications. Conclusion: This study demonstrates that rESWT may be superior to infiltration with BoNT-A in the treatment of plantar flexor muscle spasticity in patients with cerebral palsy. Further studies need to evaluate long-term effectiveness and safety of rESWT in the treatment of plantar flexor muscle spasticity in patients with cerebral palsy.

Keywords: Botox, shock wave therapy, spasticity

Disclosure of interest: XV, JM, OC, MR, AM, MT and MS declare that no competing 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 radial 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.


  ISPR8-2372 Top


Determinants of satisfaction with motor rehabilitation in persons with cerebral palsy: A national survey in France (ESPACE)

G. Cornec, J. De La Cruz1, I. Desguerre2, P. Toullet3, J. Boivin4, G. Drewnowski4, M. Bodoria5, S. Brochard6

Department of Pediatric Physical Medicine and Rehabilitation, Brest University Hospital, 6Department of Pediatric Physical Medicine and Rehabilitation, Brest University Hospital, Fondation ILDYS, Brest, 2Department of Pediatrics, Radiology, and Genetics, Hôpital Necker-Enfants Malades, 3Institut Motricité Cérébrale, Cercle de Documentation et d’Information pour la reeducation des Infirmes Moteurs Cérébraux, n/a, 4Expert patient, n/a, Lyon, France, 5La Fondation Motice/Fondation Paralysie Cérébrale, n/a, Paris, France, 1Health Research Institute i+12, Madrid University Hospital “12 Octubre”-SAMID, Madrid, Spain

Email: gw.cornec@gmail.com

Introduction/Background: User satisfaction is a key indicator of health-care quality. The aim of this study was to identify factors that influence satisfaction with motor rehabilitation (MR) in children and adults with cerebral palsy (CP). Materials and Methods: This study was part of a national survey coordinated by Fondation Paralysie Cérébrale/La Fondation Motrice aimed at documenting the views of persons with CP and their families on the provision of MR in France. A steering committee, that included persons with CP, representatives of patient and family organisations, professional and scientific societies, developed a questionnaire that included the 8-item Client Satisfaction Questionnaire (CSQ-8) which was the study primary outcome. The questionnaire was disseminated nationally and locally through advocacy groups, health care professional and social networks. It was answered by the person with CP or by the main carer, online or on paper then mailed. Results: From June 2016 to June 2017, 1010 participants with validated entry criteria filled in a questionnaire (354 children, 145 youth and 511 adults) and 750 (75%) completed the CSQ-8. As for gross motor function, 12% reported GMFCS level I, 21% GMFCS II, 19% GMFCS III, 23% GMFCS IV, 25% GMFCS V. Univariate analysis showed that CSQ-8 was significantly related to 1) person with CP characteristics (age, GMFCS, MACS, associated deficiencies, occurrence of pain); 2) health care provision (organisation of physiotherapy sessions, continuity and coordination of health care); and 3) other environmental factors (regional, difficult access to available physiotherapists or to clinicians with specific training in CP). Multivariate analysis confirmed a large impact of age and GMFCS on CSQ-8. Conclusion: Key determinants of satisfaction with MR in CP were identified. Exploring changes in MR organisation and coordination, pain management and health care providers CP training may lead to improved motor rehabilitation care quality for persons with cerebral palsy.

Keywords: Cerebral palsy, motor rehabilitation, patient satisfaction

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


  ISPR8-0174 Top


The effect of dynamic elastomeric fabric orthosis on sitting balance and gross manual dexterity in children with cerebral palsy: A single-blinded randomized controlled study

E. Giray, E. Karadag-Saygi, S. Gungor, T. Ozsoy, O. Kayhan

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

E-mail: girayesra@hotmail.com

Background and Aims: The aim of this study was to investigate if the use of a vest type dynamic elastomeric fabric orthosis (DEFO) will lead to improvement in sitting balance, hip lateralization and gross manual dexterity. Methods: Twenty-four children with CP between the ages of 3-7 with impaired trunk control were allocated to either of three groups: Control group who received only conventional exercise therapy, DEFO 2 hours group who wore DEFO 2 hours during therapy and DEFO 6 hours group who wore DEFO 4 hours in addition to 2 hours of wear during therapy. Children were evaluated with sitting domain of Gross Motor Function Measure (GMFM), Sitting Assessment Scale (SAS), Box and Block Test (BBT) and Parent Satisfaction Questionnaire before treatment (BT), at posttreatment, at 1 month posttreatment (MPT) and at 3 MPT. SAS and BBT were also assessed when immediately after wearing the orthosis. To measure trunk asymmetry and effect of orthosis in hip lateralization, changes in Cobb (CA) and kyphotic angles (KA) and Migration index (MI) between BT and 6 MPT were determined. Results: All groups showed similar improvements except the control group showing less improvement in SAS scores than DEFO groups. SAS and BBT scores also improved immediately after wearing the orthosis. While CA and KA decreased significantly at 6 MPT, MI did not show statistically significant difference. Changes in radiographic assessments were similar between groups except kyphotic angle values. KA values showed less change in control group. When DEFO groups compared with each other, there were no significant differences in any of the assessments. Conclusions: DEFO vest has an immediate effect on sitting balance and gross manual dexterity. DEFO provides improvements in posture and balance during sitting. Using DEFO vest for 2 hours and 6 hours yielded similar outcomes. Wearing DEFO vest improves kyphotic posture but not scoliosis and hip lateralization.

Keywords: Cerebral palsy, dynamic elastomeric fabric orthosis, sitting balance

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


  ISPR8-1858 Top


A comparative study on the effectiveness of mirror therapy and constrained induced movement therapy in cerebral palsy

D. Sharan, J. S. Rajkumar1

Departments of Orthopaedics and Rehabilitation and 1Physiotherapy, RECOUP, Bengaluru, Karnataka, India

E-mail: drdeepaksharan@yahoo.com

Introduction/Background: Mirror therapy (MT) (affected limb is masked inside the mirror box) and modified constraint induced movement therapy (mCIMT) (unaffected limb is constrained during therapy hours) are well established and effective therapies in the upper extremity functioning of children with Cerebral Palsy (CP). But comparing the effectiveness of MT and mCIMT is an understudied area, especially in CP. The aim of this study was to compare the effectiveness MT with mCIMT in the rehabilitation of persons with hemiplegic CP post orthopaedic selective spasticity surgery (OSSCS). Materials and Methods: A prospective clinical trial was conducted among 80 persons with CP, who were selected and randomly assigned into two groups. All the persons underwent OSSCS of forearm flexors and pronators of affected upper limb and were undergoing rehabilitation with a sequenced protocol based physical and occupational therapy. Group A (n = 40) received MT (6 weeks-1 hour/day), Group B (n = 40) received mCIMT (6 weeks-1 hour/day) and both the groups received regular intensive physical and occupational therapy apart from the above interventions. The primary outcome measures included were the Besta scale and Melbourne assessment of upper extremity function (MAUULF). Outcomes were measured at baseline, 6 weeks after the treatment and follow ups at 1 month and 3 months later. Results: After six weeks of treatment, the mCIMT group showed significant improvements compared to the MT group in both Besta (p < 0.01) and MAUULF (p < 0.01) scores for hemiplegic upper extremity who underwent OSSCS. The obtained outcomes were maintained at 1 month and 3 months follow up also. Conclusion: Modified CIMT showed greater improvement than MT in the upper extremity function of persons with hemiplegic CP. However, both the groups improved in their outcomes compared to baseline.

Keywords: Comparative study, spastic hemiplegia, upper limb rehabilitation

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


  ISPR8-1881 Top


Two models of virtual reality devices for therapeutics in persons with cerebral palsy

D. Sharan, J. S. Rajkumar1

Departments of Orthopaedics and Rehabilitation and 1Physiotherapy, RECOUP, Bengaluru, Karnataka, India

E-mail: drdeepaksharan@yahoo.com and joshua.samuel@recoup.in

Introduction/Background: Virtual reality based therapy (VRBT) refers to the use of interactive simulations to present users with opportunities to perform neurorehabilitation in virtual environments that appear, sound, and less frequently, feel similar to real-world objects and events. This study compared the effects of 2 off-the-shelf gaming system devices on standing balance and weight shifting for persons with Cerebral Palsy (PWCP) following single event multilevel lever arm restoration and anti spasticity surgery (SEMLARASS). Materials and Methods: A prospective experimental study was conducted among 80 PWCP post SEMLARASS aged 5-20 years and randomly assigned into Group A (n = 40): received the VRBT with Xbox 360 with Kinect (XwK) and Group B (n = 40): received the VRBT with Nintendo Wii with Balance Board (WwB). The study duration was 5 weeks with 30 minutes of intervention per day for 6 days per week in each group. A total of 3 games (5 choices) were played per session supervised by a physiotherapist. Paediatric Balance Scale (PBS) and Dynamic Gait Index (DGI) were the primary outcome measures, performed at baseline, 5 weeks after the treatment and follow ups after 1 month and 3 months. The additional outcomes measured were walking test, steadiness test, COG and single-leg standing test using the stabilometer of the Wii balance board. Results: Both the groups improved significantly after the intervention. However, Group A showed significant difference in PBS (P < 0.01) and DGI (P < 0.05) when compared to group B. The obtained outcomes were maintained at 1 month and 3 months follow up. The X box 360 had a better connect to the virtual in comparison to the Nintendo Wii as reported by the users. Conclusion: While both devices were found effective, VRBT with XwKwas superior toWwB for improving standing balance and weight shifting in CWCP after SEMLARASS.

Keywords: Balance, rehabilitation, virtual reality

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


  ISPR8-0124 Top


Abstract need to be edited - Graphical skill in children with cerebral palsy in Cotonou

T. Kpadonou, E. Alagnide, D. Niama Natta1, P. Dessou1, G. Houngbedji

Department of Physical and Rehabilitation Medicine, FSS, 1Department of Physical and Rehabilitation Medicine, National Teaching Hospital HKM, Cotonou, Benin

E-mail: kpadonou_toussaint@yahoo.fr and ealagnide@yahoo.fr

Background and Objective: Children with disabilities, particularly with cerebral palsy (CP), generally have academic difficulties in reading, numeracy, speech and writing. As manual writing is a necessity in academic success, it seemed wise to evaluate graphic skills in children with CP in Cotonou. Methods: This was a descriptive and analytic case-control study that ran from July to October 2015, involving 174 children in school, 58 of whom were CP matched with healthy children. The evaluation of the writing was made with P. Bedard’s scale derived from that of AJURIAGUERRA. The drawing required was that of the man, so all the drawings having a human form are classified B and the others classified A. Results: There was a female predominance in CP with a sex ratio = 0.81. Average school age of children with CP was 6.4 years and that of healthy children 3.4 years. Spastic diplegia was the most common form of CP in children (48.3%). In terms of writing, children with CP had more problems with all items of writing compared to healthy children (P < 0.036). Writing was affected by the level of schooling of children with CP (p = 0.006) and the posture (0.004). In Drawing, Average of points obtained by healthy children surpassed that obtained by children with CP. Drawing was influenced by muscle tone (p = 0.0 04) and father’s grade level (p = 0.04). Conclusion: It appears from this study that children with CP had difficulties with writing and drawing influenced by several factors whose correction would improve their graphics. Community-based rehabilitation (CBR) could be a welcome way of solving these problems in developing countries with fewer resources.

Keywords: Cerebral palsy, community-based rehabilitation, Cotonou, graphic skill, schoolchildren, writting

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


  A5.03 Paediatrics - Traumatic Brain Injury in Children Top



  ISPR8-2556 Top


Memory functioning following severe traumatic brain injury in children: Results of the traumatisme crânien grave de L’enfant cohort

S. Viot, M. Chevignard, H. Camarâ-Costa1, G. Dellatolas1, H. Toure, D. Brugel, A. Laurent-Vannier, L. Watier2, P. Meyer3

Department of Rehabilitation for Children with Acquired Brain Injury, Hôpitaux de saint Maurice, Saint Maurice, 1INSERM Cesp, INSERM Cesp, Villejuif, 2Department of Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, Inserm, Inserm UMR 1181, 3Department of Paediatric Anesthesiology, Hôpital Necker Enfants Malades, Paris, France

E-mail: solene.viot@gmail.com

Introduction/Background: Severe Traumatic Brain Injury (=TBI) is the main cause of children mortality and disability in developed countries. Among cognitive sequelae, memory impairment is frequent and impacts everyday functioning and academic achievement. The aims of this study were: (1) to measure memory functioning in children who sustained a severe TBI, and performance’s evolution over time; (2) to assess factors associated to memory function and recovery. Materials and Methods: In the TGE (=Traumatisme crânien Grave de l’Enfant) cohort, a prospective longitudinal study, 65children aged 0 to 15years-old who sustained a severeTBI were included. Memory function was assessed using the Children’s Memory Scale (=CMS) at 3, 12 and 24months post-injury. Results: Memory was assessed in 46 children aged 5-15 years. Significant memory impairment was found at 3months post-injury (mean general memory (genm) score = 89.1, SD = 20.5). Significant improvement was found at 24months, but less so for verbal, learning and attention/concentration abilities. At 3 and 24months post-injury, genm score was significantly correlated to TBI severity indices (length of coma, Pediatric Traumatic Scale and Injury Severity Score). It was strongly correlated to full-scale intellectual quotient at each time point. Female gender was associated with worse memory impairment, whereas age at injury and socio-economic status were not. Furthermore, presence of motor impairment (=MI) was correlated with worse memory recovery, probably as a marker of injury severity. Finally, the genm score was significantly correlated with less favorable educational outcome. Conclusion: Memory functioning is significantly impaired following severeTBI; it is mostly influenced by initial TBI severity and strongly impacts educational outcome. Those patients should benefit from long term follow-up post injury.

Keywords: Children, memory functioning, severe traumatic brain injury

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






  ISPR8-0439 Top


Diagnostic criteria of shaking 2017: A crucial advance into knowledge on the shaken baby syndrome

L. V. Anne, C. Adamsbaum1, C. Rambaud2, C. Rey Salmon3, J. S. Raul4

Saint-Maurice’ hospitals, Val deMarne, Saint-Maurice, 1Hôpital Bicêtre, Val de Marne, Kremlin-Bicêtre, 2Hôpital Raymond Poincaré, Hauts de Seine, Garches, 3IML Hôtel Dieu, Paris, 4IML Strasbourg, Rhin, Strasbourg, France

E-mail: a.laurentvannier@gmail.com

Introduction/Background: Shaken baby syndrome constitutes a major public health risk. In 2011, guidelines have been established by the High Authority of Health and the SOFMER to help health professionals cope with the diagnosis of SBS. The method used was to compare the most frequent lesions observed in SBS, which are multifocal subdural hematoma and retinal haemorrhages with the lesions induced by mechanism often pointed out by the adults when the child is brought to hospital or during the judicial process. If the lesions induced were the same as those of SBS or therefore the mechanism was acceptable. If not the mechanism was rejected.From these results, diagnostic criteria of shaking were established based exclusively on the lesions observed and on the history related by the caretaker to explain the child’s state and not on the risk factors. Materials and Methods: Moreover, from 2011 it has been possible to go further (study of the literature and experts’ opinion). Other mechanisms have been brought forward: vaccines, apparent life-threatening events (ALTEs) … And the knowledge on the type of lesions in case of SBS has also improved: type and location of the SDH/lesions newly described as the rupture thrombosis of the bridging veins, intra thecal SDH … The diagnostic criteria were updated from these results. Results: For an infant, at the end of the clinical and radiological assessments, whatever the initial symptoms, after having ruled out differential diagnosis (infection/ metabolic disease) and if the clinical history is absent, incoherent, changes over time or is incompatible with the observed lesions or the child’s age, these new criteria let us make the diagnosis or consider it as probable. Conclusion: These guidelines to professionals make it easier to diagnose shaken baby syndrome. But these diagnostic criteria have to be known by professionals. Consequently better training is the key: the initial and continuing training must be reinforced. http://www.has-sante.fr/portail/jcms/c_1095929/recommandation-syndrome-du-bebe-secoue

Keywords: Diagnosis, inflicted head injury, prevention

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


  A5.05 Paediatrics - Miscellaneous Top



  ISPR8-0168 Top


Effects of kinesiology-taping and the application techniques in the treatment of congenital muscular torticollis: A randomized, single-blinded pilot study

E. Giray, E. Karadag-Saygi, B. Mansız-Kaplan, D. Tokgöz, Ö. Bayındır, Ö. Kayhan

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

E-mail: girayesra@hotmail.com

Introduction/Background: The aim of this study is to investigate the effects of kinesiology taping and different application techniques in the treatment of CMT in addition to therapeutic exercises. Materials and Methods: Thirty-three infants with congenital muscular torticollis were randomly assigned to three groups. Each was received stretching, strengthening and positioning exercises twice a week for three weeks. Group 1 included 11 infants who only received exercises, Group 2 included 12 infants who received kinesiology taping applied on the affected side by using inhibition technique in addition to exercises. Group 3 included 10 infants who additionally received kinesiology taping applied on the unaffected side by using facilitation technique and on the affected side by using inhibition technique. Range of motion in lateral flexion and rotation of the neck, muscle function and degree of craniofacial changes were assessed at pretreatment, posttreatment and, 1 month and 3 months’ posttreatment. Results: Friedman analysis of within-group changes over time revealed significant differences for all of the outcome variables in all groups except cervical rotation in Group 3 (P < 0.05). No significant differences were found between groups at any of the follow-up time points for any of the outcome variables (P > 0.05). Conclusion: There is no any additive effect of kinesiology taping to exercises for the treatment of congenital muscular torticollis. Also different techniques of applying kinesiology taping resulted in similar clinical outcomes.

Keywords: Congenital muscular torticollis, kinesiology taping, treatment

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


  A6.02 Geriatrics - Frailty Top



  ISPR8-2096 Top


A rehabilitation intervention in prefrail older people: Randomised trial

I. Cameron, S. Kurrle

John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, St Leonards, Australia

E-mail: ian.cameron@sydney.edu.au and kurrle@bigpond.com

Introduction/Background: The study aim was to determine whether an intervention could reduce pre frailty (defined phenotypically) and improve mobility disability. Materials and Methods: We conducted a single centre, randomised, controlled trial among older people who were pre frail in Sydney, Australia. One group received an intervention targeting the identified characteristics of frailty, while the comparison group received the usual healthcare and support services. Outcomes were assessed by a rater masked to treatment allocation at 4 and 12 months after study entry. The primary outcomes were frailty criteria with reference to the Cardiovascular Health Study criteria, and mobility as assessed by the lower extremity continuous summary performance score (CSPS) calculated from the Short Physical Performance Battery. Secondary outcomes were also assessed. Results: A total of 194 participants (84%) completed the study. Overall, 38% of participants were men and the mean (SD) age was 81.5 years (5.3). In the intention-to-treat analysis, the mean between group difference in frailty criteria was .062 at 12 months (95% CI -0.24 to 0.36, p = 0.7). The change score on the CSPS favoured the intervention group at 4 months (0.11, 95% CI 0.004 to 0.215, p = 0.042) but there was no between group difference at 12 months. There were no major differences between the groups with respect to secondary outcomes. Conclusion: This intervention trial for pre frail older people did not show a benefit on frailty of a multifactorial interdisciplinary intervention. The same intervention had positive effects in frail older people and the reasons for the difference are currently unclear.

Keywords: Frailty, randomized trial, rehabilitation

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


  ISPR8-1937 Top


Effects of brisk walking on autonomic nervous system reactivation in nursing home residents

J. Raffin, J. C. Barthélémy1, T. Busso2, P. Calmels3, L. Féasson4, P. Terrat, M. C. Diana, C. Montuy-Coquard, R. Bouvier, R. Poillerat4, F. Roche1, D. Hupin1

Mutualité Française, Mutualité Française SSAM Loire Haute-Loire, Department of 1Clinical and Exercise Physiology and 2Physical Medicine and Rehabilitation , University Hospital of Saint-Etienne, 2Inter-University Laboratory of Human Movement Biology, University of Lyon, EA 7424, Saint-Etienne, 4Matmut Health Support Community Organisation, Pault Bennetot Foundation, Paris, France

E-mail: jeremy.raffin@live.fr

Introduction/Background: The decrease of the autonomic nervous system (ANS) activity that occurs with age is associated with an increase of cardiovascular events and morbidities. It has been shown that physical activity helps reducing the ANS activity age-related decline but remains poorly practiced among nursing home residents. Therefore, we aim to compare the effects of a 9 month brisk walking training (1 time a week or 3 times a week) on the ANS activity in frail nursing home residents. Materials and Methods: One hundred 60-year-old subjects and older will be recruited within the ten nursing homes of La Mutualité Française Loire Haute-Loire, France (ClinicalTrials.gov identifier: NCT03302923) and will be randomized into 3 groups: G1: one brisk walking session a week; G2: three brisk walking session a week; G3: Control group (no training). Testing procedure will occur at the inclusion and after 3 months, 6 months and 9 months of training. The primary outcome is the heart rate variability measured by 24 hours Holter ECG, especially global and parasympathetic indices such as SDNN and RMSSD respectively. The maximal distance performed during the 6 minute walk test is also used as a secondary outcome measure. Results: Twenty-three subjects aged 80.1±10.7 years currently accomplished the whole training protocol. Compared with control group, subjects trained 3 times a week experienced an increase of parasympathetic activity (RMSSD value) by 58.3% (p < 0.01) while global (SDNN) activity did not differ significantly. Subjects from the latter group also improved their 6 min walking distance by 12.0% (p < 0.01). Conclusion: A nine month brisk walking training enhances parasympathetic activity and improves walking distance in frail institutionalized old people. In that view physical activity may prevent cardiovascular risks and might help to reduce the loss of autonomy even after 80.

Keywords: Heart rate variability, older adults, physical activity

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


  ISPR8-1086 Top


Long-term home-based physiotherapy for persons with signs of frailty – Randomized controlled trial (RCT) (NCT02305433)

K. Kukkonen-Harjula, S. Suikkanen, P. Soukkio, H. Kautiainen1, S. Kääriä2, K. Pitkälä3, S. Sipilä3, M. Hupli

South Karelia Social and Health Care District Eksote, Rehabilitation, Lappeenranta, 1Deparment of General Practice, University of Helsinki, Helsinki, 2Hyvis-ICT, Health, Kotka, 3Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland

E-mail: katriina.kukkonen-harjula@eksote.fi

Introduction/Background: Frailty is a multidimensional condition, which can lead to disability. To postpone long-term care, one alternative is home-based physiotherapy. We study the effects of a 12-month home-based physiotherapy program on functional capacity, and applying successive 12-month register follow-up, on the use and costs of social and health care services, and on the duration of living at home during 24 months (the primary outcome). Here we report about feasibility of the intervention and baseline characteristics. Materials and Methods: 300 home-dwelling persons (>65 y) with signs of frailty were recruited by September, 2016. Frailty was screened by Morley’s FRAIL questionnaire and verified by Fried’s frailty criteria. Participants were randomized to a physiotherapy (n = 150) or a usual care (n = 150) group. Home-based physiotherapy was progressive, including strength, endurance, balance, flexibility and functional exercises. Physiotherapy took place twice a week (max. 104 sessions), each session for 60 minutes. Assessments (among others Short Physical Performance Battery (SPPB), Functional Independence Measure (FIM), Mini Mental State Examination (MMSE), Geriatric Depression Scale, 15-dimensional health related quality of life, Mini Nutritional Assessment) were performed at baseline, and at 3, 6, and 12 months by the assessor physiotherapist at the person’s home. Results: At baseline the participants’ mean age was 82.5 (SD 6.3) y. 25 % were men and 61 % prefrail. Mean SPPB was 6.2 (2.6) points, FIM 109 (11) points and MMSE 24.4 (3.1) points. 134 persons in the physiotherapy group and 129 in the usual care completed the intervention year, while 5 and 10 persons had died, and 2 and 2 persons were transferred to long-term care, respectively. On average 95 (91 %) sessions were participated by the 134 completers. 128 persons participated in >75 % of the sessions. Conclusion: During 12 months, adherence to the trial was good, as well as compliance with home physiotherapy.

Keywords: Gerasthenia, home-dwelling elderly, RCT

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


  A6.03 Geriatrics - Sarcopenia Top



  ISPR8-0283 Top


Systemic inflammation and sarcopenia in recovery stage of stroke: The negative impact on functional rehabilitation outcomes

Y. Yoshimura, M. Yamaga, H. Koga

Department of Rehabilitation Medicine, Kumamoto Rehabilitation Hospital, Kikuyo, Japan

E-mail: hanley.belfus@gmail.com

Introduction/Background: To determine how systemic inflammation relates to sarcopenia and its impact on functional outcomes in the recovery stages of stroke. Materials and Methods: A retrospective cohort study was performed in consecutive patients admitted to convalescent rehabilitation wards. Patients with acute or chronic high-grade inflammatory diseases were excluded. Systemic inflammation was evaluated using the modified Glasgow Prognostic Score (mGPS). Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength with the cut-off values set by Asian Working Group for Sarcopenia. The primary outcome was the motor domain of the Functional Independence Measure (FIM-motor). Univariate and multivariate analyses were used to determine whether mGPS was associated with sarcopenia and FIM-motor at discharge. Results: The present study included 204 patients (mean age of 74.1 years, 109 men, and 95 women) for analysis. An mGPS score of 0, 1 and 2 was assigned to 149 (73.0%), 40 (19.6%) and 13 (6.4%) patients, respectively. Sarcopenia was diagnosed in 81 (39.7%) patients and independently associated with stroke history (odds ratio [OR] 1.890, p = 0.027), premorbid modified Rankin scale (OR 1.520, p = 0.040), body mass index (OR 0.858, p = 0.022), and mGPS score (OR 1.380, p = 0.021). Furthermore, the mGPS score was independently associated with FIM-motor at discharge (Beta = -0.134, p = 0.038). Conclusion: Systemic inflammation is closely associated with sarcopenia and poor functional outcomes in the recovery stage of stroke. Early detection of systemic inflammation and sarcopenia can help promote both adequate exercise and nutritional support to restore muscle mass and improve functional recovery in the post-stroke patients.

Keywords: Sarcopenia, stroke rehabilitation, systemic inflammation

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


  A6.04 Geriatrics - Risk of Falls in The Elderly Top



  ISPR8-2523 Top


Test-retest reliability, minimal detectable change and convergent validity of the performance-based balance scale in community-living older adults

H. Chen1,2, R. Palisano3, S. Silfies1, J. Melvin4, J. Li5, S. Smith1

1Department of Physical Therapy and Rehabilitation Sciences, Drexel University, 3College of Nursing and Health Professions, Drexel University, 4Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, USA, 2Department of Rehabilitation Medicine, Southwest Hospital, Army Medical University, Chongqing, 5Department of Rehabilitation Medicine, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medicine University, Nanjing, China

E-mail: chenhan204@yahoo.com

Introduction/Background: Balance assessment is critical to identify balance impairments in older adults and initiate balance improvement strategies to reduce fall risk. Current clinical balance tests have limitations including lengthy administration time, ceiling effects and lack of comprehensiveness. The Performance-based Balance Scale (PBS) is a recently developed comprehensive clinical balance test appropriate for use with Community-Living Older Adults (CLOAs). The PBS is uniquely designed in a non-fixed text format that eliminates the need to complete the entire test to determine the score. The purposes of this study were to examine the time to administer, test-retest reliability, minimal detectable change (MDC), and convergent validity of the PBS with CLOAs. Materials and Methods: Thirty-one CLOAs (3 men; 28 women; mean age = 69 yrs; 60-96 yrs) volunteered to participant in this study. Each participant was tested twice, 7 to 14 days apart, using the PBS. Test-retest reliability was determined using the intraclass correlation coefficient (ICC [2,1]). Minimal detectable change (MDC) and convergent validity were calculated. Results: Time to administer of the PBS was 15 to 20 minutes. The PBS total score showed excellent test-retest reliability with ICC(2,1) = .97. The SEM for the PBS was 0.95, MDC90%, was 2.2 and MDC95% was 2.6. The convergent validity with the Short Physical Performance Battery was r = 0.71. Conclusion: The PBS is a feasible, valid, and reliable balance test to assess balance ability among CLOAs. Minimal detectable change scores at the 90% and 95% confidence interval can be used to assess over time change in balance ability.

Keywords: Balance, measures, older adults

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


  A6.05 Geriatrics - Other Geriatric Conditions Top



  ISPR8-2692 Top


Aging and burn: A five-year retrospective study in a major burn centre in Portugal

P. Caetano, C. Brandão1, A. Pascoal, I. Campos, L. Cabral1, M. Tão2, J. Laíns

Centro de Reabilitação da Região Centro, Rovisco Pais, Reabilitação Geral, Tocha, 1Centro Hospitalar e Universitário de Coimbra, Serviço de Cirurgia Plástica e Queimados, 2Centro Hospitalar e Universitário de Coimbra, Serviço de Medicina Física e de Reabilitação, Coimbra, Portugal

E-mail: pedrofscaetano@gmail.com

Introduction/Background: Aging is an important factor that contributes to the clinical outcome of burn patients. The aim of this study was to examine the characteristics of patients admitted to a Burn Unit with the diagnosis of burn injury and to determine the impact of age on mortality. Materials and Methods: We made a retrospective analysis of successive patients admitted in a major burn centre in Portugal since 1/1/2012 until 31/12/2016. They were divided into 2 groups: “elderly” (≥65 years) and “non-elderly” (<65 years). The variables analysed were: demographic data, clinical presentation, complications and mortality. Results: 736 patients were included, 324 classified as elderly with a mean age of 78.12±7.14 years. Most of the patients in the elderly group were females (59.6%), in contrast to the non-elderly group (35%) (p < 0.001 OR = 2.74). The elderly patients had a higher mean LOS (20.14±18.46 days vs 16.89±16.61 days on the “non-elderly” group) (p = 0.01). Most of the burns were caused by fire (58.3%) and boiling liquid (36.1%) and mainly after domestic accidents (96.1%). Elderly patients showed a higher mean of burn severity index (7.26 vs 5.57) (p < 0.001) and 7.5% needed an amputation during hospitalization (vs 4.1%) (p = 0.076). The mortality rate was significantly higher in the elderly group (11.7% vs 3.4%) (p = 0.001 OR = 3.52). We found that elderly patients with inhalator injury (p < 0.001 OR = 6.87), 3rd burns (p < 0.001 OR = 11.76), burn by fire (p < 0.001 OR = 10.00) and who required mechanical ventilation (p < 0.001 OR = 12.23) have a higher mortality risk and reached statistical significance after a multivariate analysis. Conclusion: Burns in elderly had different clinical characteristics being an important epidemiological problem. The functional and vital prognosis of patients admitted to a burn centre are affected by multiple factors. Our study showed that age, 3rd burns, inhalator injury, burn by fire and need for mechanical ventilation seem to increase the risk of mortality.

Keywords: Aging, burn

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


  A7.01 Rehabilitation Addressing to Specific Issues - Sensory and Motor Control (Including Postural Control) Top



  ISPR8-2331 Top


Lateropulsion syndrome or pusher syndrome?

S. Dai, E. Clarac, A. Odin, A. Kistner, A. Chrispin, P. Davoine, M. Jaeger, C. Piscicelli, D. Pérennou

Department of Neurorehabilitation, CHU Grenoble Alpes, Echirolles Cedex, France

E-mail: sdai1@chu-grenoble.fr

Introduction/Background: After a hemisphere stroke, Lateropulsion has been empirically described as part of the pusher syndrome (Davies 1985), comprising a severe lateropulsion with active pushing to the contralesional side (pusher), resistance to passive corrections, and spatial neglect. Here we investigated whether the pushing behavior is the central sign of the pusher syndrome. Materials and Methods: Cohort study of consecutive patients admitted in a neurorehabilitation after a first hemispheric stroke. Retrospective analysis of data collected at M1 post-stroke. Lateropulsion was assessed with the SCP. We also assessed: spatial neglect, aphasia, apraxia, depression, visual field defect, motor weakness, spasticity, sensory loss. Results: 178 persons met inclusion criteria: age 63.2(12.2) years, 57 females, 150 with infarction, 71 with a right hemispheric stroke. Lateropulsion prevalence was 26%; 14% without and 12% with additional pushing. The multivariate analysis (ordinal logistic regression) retained only two variables significantly associated with Lateropulsion: overall spatial neglect then weakness. Severe and moderate spatial neglect increased the risk to show lateropulsion (with or without pushing): OR 5.7 (p < 0.001) and 3 (p = 0.004), respectively. Severe weakness increased the risk to show lateropulsion, with or without pushing, (OR 2.8; p = 0.001), but not moderate weakness (OR 0.8; p = 0.3). The association between spatial neglect and lateropulsion was confirmed by a frequency analysis (F = 135.6, p < 0.001). None patient without neglect showed lateropulsion whereas 97% patients with severe neglect showed lateropulsion (with or without pushing). Conversely all patients showing lateropulsion had a spatial neglect (moderate or severe), and this was true both for lateropulsion without pushing and lateropulsion with pushing. Conclusion: Spatial neglect is strongly associated with lateropulsion, regardless the existence of an additional pushing behavior. Spatial neglect has nothing to do specifically with the pusher syndrome but more generally with lateropulsion. This strengthens the idea that additional pushing behavior is a dramatic form of lateropulsion, not an idiosyncratic disease.

Keywords: Lateropulsion, pushing behavior, spatial neglect

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


  ISPR8-2504 Top


Biased spatial referentials are not the cause of the Pisa syndrome in Parkinson’s disease

C. Piscicelli1,2, A. Castrioto3,4, B. Debu4,5, M. Jaeger1, V. Fraix3,4, E. Moro3,4, P. Krack6, D. Pérennou1,2

1CHU Grenoble-Alpes, Medecine Physique et Reeducation Neurologique, 2Université Grenoble-Alpes, Laboratoire de Psychologie et Neurocognition, 3CHU Grenoble-Alpes, Département de psychiatrie et neurologie, Unité des Troubles du Mouvement, 4Institut de Neuroscience de Grenoble, Inserm UJF CEA, 5Université Grenoble-Alpes, Université Joseph-Fourier, Grenoble, France, 6Hôpitaux Universitaires de Genève, Département des Neurosciences Cliniques, Genève, Switzerland

E-mail: CPiscicelli@chu-grenoble.fr

Introduction/Background: The pathophysiology of Pisa Syndrome (PS), lateral trunk tilt occurring in the advanced stages of Parkinson’s disease (PD), remains to be solved. It might be the consequence of biased spatial referentials. We comprehensively investigated the representation of the vertical (visual-VV and postural-PV), together with that of the long body axis (LBA) in PD patients with PS. Materials and Methods: Double-blind controlled trial in 18 PD patients showing PS and treated with bilateral deep brain stimulation (DBS) of the subthalamic nuclei (STN): 63.5 [5.5] years, 11 females, disease duration 17.5 [5.2] years. Spatial estimates were tested off medication under four conditions of stimulation (bilateral on, bilateral off, unilateral on/off, unilateral off/on). Motor state (UPDRS), scoliosis and lateral trunk tilt were also assessed. Twenty healthy age- and gender-matched participants were also included. Results: The median lateral trunk tilt was 7.5° (IQD = 5) under the instruction to stand upright. Scoliosis was frequent (67%) reaching 82% in participants with severe PS, of moderate magnitude (16° [12.5]), and side congruent with that of the PS (67%). The correlation between PS and scoliosis (Cobb) magnitude was strong (r = 0.71, p = 0.008). In contrast no concordance was found between the side of the PS and disease sides (10/18 tilted to the side of the most denervated striatum; 11/18 tilted toward the most affected hemibody). Spatial perceptions were more frequently biased in patients than in controls (p < 0.05): VV 7/18; PV 6/18; LBA 6/18; but not more severe (p > 0.05). No statistical rule was found between any of biased referential (side or magnitude) and the trunk tilt (side or magnitude). No spatial referential was modulated by DBS. Conclusion: Spatial biases are frequently in PS but are not the cause of the lateral trunk tilt. In contrast scoliosis was not only strongly associated to severe PS. We found a troubling concordance in sides and magnitude.

Keywords: Parkinson’s disease, Pisa syndrome, spatial cognition

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


  ISPR8-1751 Top


Mobilization of navicular and its effects on balance and stability limits in young healthy subjects

A. Couto, M. Cardoso, S. Lopes, R. Carvalho

Department of Physiotherapy, CESPU - Instituto Politécnico de Saúde do Norte, Paredes, Portugal

E-mail: nita.couto@gmail.com and marlenesofia.14@hotmail.com

Introduction/Background: Background: The foot is an important component of the musculoskeletal system, responsible for the interaction between the base of support and the lower limb segments, allowing an adequate distribution of weight bearing in the foot. Motor tasks, such as, standing and/or gait, depends on the postural control system, which is related to the projection of the center of mass on the ground and the limits of stability. Aims: Verify the effect of navicular mobilization on the balance and the stability limits. Materials and Methods: Experimental study was performed. Forty university students, were randomly assigned to two groups: control group (mean age 22±2.4 years) and experimental group (mean age 22±2.7 years). The Pachymeter was used to assess navicular height. Balance and stability limits were assessed by Single Leg Stance, Functional Reach Test, and Y-Balance Test, at two sequential time periods. Subjects from experimental group underwent an intervention focused in navicular mobility for 10min. The t-Student and Mann-Whitney test was performed to compared differences between groups, while the Wilcoxon and t-Student test was used to compare moments. The level of significance was α = 0.05. Results: After intervention, the experimental group had differences in navicular height, Functional Reach Test (p < 0,001), Single Leg Stance (p = 0,004) and in Y-Balance Test (p < 0,001). Moreover, the experimental group showed an increase in Functional Reach Test (p = 0,003) and Y-Balance Test (p < 0,001) compared to control group, after intervention. Conclusions: This study showed that the navicular mobilization increases the balance and the stability limits in healthy young subjects.

Keywords: Navicular mobility, physiotherapy, stability limits

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


  ISPR8-2115 Top


Evaluation of the impact of a virtual self-avatar on gait parameters

P. Charbonneau, M. A. Chitour, T. Robert1, S. Saint-Pierre Cote, R. Aissaoui, D. R. Labbe2

École de technologie supérieure, Génie des technologies de la santé - Laboratoire de recherche en imagerie et orthopédie, 2École de technologie supérieure, Génie logiciel et des technologies de l’information - Laboratoire de recherche en imagerie et orthopédie, Montreal, Canada, 1Université de Lyon, LBMC - IFSTTAR, Lyon, France

E-mail: philippe.charbonneau.2@etsmtl.net

Introduction/Background: Studies in the field of gait rehabilitation frequently use treadmills rather than over-ground walking, in part because treadmills require less space and allow for the capture of multiple gait cycles within a limited motion capture volume. Walking on a treadmill alters some kinematic and spatiotemporal parameters, which may be in part a result of the absence of optical flow. To overcome this limitation, some studies have used immersive virtual environments (VEs) to create an optical flow during treadmill gait. Using a head-mounted device, this has the effect of also hiding a user’s body from himself. A real-time representation of the user can be displayed in the VEs, in the form of an animated self-avatar. Little is known on the effect of viewing one’s self-avatar on gait patterns. This study aims to quantify the differences between walking in a VE with and without a real-time self-avatar. Materials and Methods: Eleven healthy participants walked in 3 different conditions. In the 1st condition, participants walked over-ground in a hallway. In the 2nd and 3rd conditions (randomized), participants walked in a virtual replica of the hallway, respectively with and without a real-time self-avatar. Through all conditions, participants wore inertial sensors on their pelvis and lower limbs. Participants’ mean cadence and gait cycle duration were computed for each condition. Conditions were compared using paired t-tests. Results: The 2nd and 3rd conditions were compared. The addition of the self-avatar significantly reduced cadence (-1.9 step/min) and lead to a longer gait cycle duration (+0.04 sec), even though they walked at the same speed on the treadmill. Conclusion: These results show that the addition of a self-avatar alters spatiotemporal gait patterns. Different potential explanations for these changes will be discussed. Future work will include analysis of the kinematic data for all conditions.

Keywords: Gait rehabilitation, self-avatar, virtual reality

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


  A7.02 Rehabilitation Addressing to Specific Issues - Spasticity Management Top



  ISPR8-1721 Top


Incobotulinum toxin A treatment improves quality of life of patients with upper- and lower-limb spasticity

K. Fheodoroff, T. Rekand1, L. Medeiros2, P. Koßmehl3, J. Wissel4, D. Bensmail5, A. Scheschonka6, B. Flatau-Baqué6, O. Simon6, D. Dressler7, D. Simpson8

Gailtal-Klinik, Neurologische Rehabilitation, Hermagor, Austria, 1Department of Neurology, Haukeland University Hospital, Bergen, Norway, 2Department of Neurology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal, 3Kliniken Beelitz GmbH, Neurologische Rehabilitation, Beelitz-Heilstätten, 4Department of Neurorehabilitation and Physical Therapy and Neurology, Vivantes Hospital Spandau, Berlin, 6Merz Pharmaceuticals GmbH, Medical Affairs, Frankfurt am Main, Germany, 7Department of Neurology, Hannover Medical School, Hannover, Germany, 5Hôpital Raymond-Poincaré, AP-HP, University of Versailles Saint Quentin, Garches, France, 8Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA

E-mail: klemens.fheodoroff@me.com

Introduction/Background: The safety and efficacy of botulinum neurotoxin treatment for limb spasticity are well established. However, reports on the effect of treatment on quality of life (QoL) are inconclusive. Here we report QoL outcomes following incobotulinum toxinA treatment of upper- and lower-limb spasticity in the TOWER study (NCT01603459). Materials and Methods: This open-label study assessed the safety and efficacy of escalating incobotulinum toxin A doses (400U, 600U and 600–800U) in patients (18–80 years) with upper- and lower-limb spasticity on the same body side due to stroke or other cerebral causes. QoL was assessed using the EuroQoL-5 dimensions (EQ-5D) questionnaire, which includes five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), and a visual analogue scale (VAS) on which patients rate their current state of health from 0 (worst) to 100 (best). Results: In total, 155 patients were enrolled and received incobotulinum toxinA. For all EQ-5D dimensions, the proportion of patients with improvements from the study baseline to the end of injection cycle (IC) 3 was higher than the proportion with worsening: Mobility, 11.4% vs 2.9%; Self-care, 21.4% vs 7.1%; Usual activities, 24.3% vs 5.0%; Pain/discomfort, 30.7% vs 9.3%; Anxiety/depression, 25.0% vs 9.3%. The mean (SD) change in EQ-5D VAS score from the study baseline to 4 weeks post-treatment was 6.7 (14.1) points, 9.6 (16.3) points and 8.6 (17.0) points in IC1, IC2 and IC3, respectively (p < 0.0001 for all, t-test). The mean (SD) EQ-5D VAS score improved from 59.9 (18.9) at baseline to 70.5 (16.7) at the end of IC3, corresponding to a mean (SD) change of 10.5 (17.5) points (p < 0.0001, t-test). Conclusion: Treatment of upper- and lower-limb spasticity with increasing incobotulinum toxinA doses (up to 800U) improved QoL over the study duration (three treatments). Data encourage the further evaluation of the impact of botulinum neurotoxin A treatment on QoL in patients with spasticity.

Keywords: Incobotulinum toxinA, spasticity, quality of life

Disclosure of interest: This study was supported by Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany. Editorial support was provided, under the guidance of the authors, by Claire Cairney, PhD, of CMC CONNECT, a division of Complete Medical Communications and was funded by Merz Pharmaceuticals GmbH. D Dressler and DM Simpson contributed equally to this work. K Fheodoroff received research grants from Ipsen and Merz, and has received sponsorship from Ipsen, Merz and Allergan to attend conferences and advisory board meetings in the EU. T Rekand served as a consultant for Allergan, Ipsen, Merz, Medtronic and Almirall. L Medeiros received research grants from Merz P Koβmehl received research grants from Ipsen, Merz and Medtronic, and has received sponsorship from Ipsen, Merz and Medtronic to attend conferences and/or advisory board meetings in the EU J Wissel received research grant support from, and served as a consultant for, Merz, Allergan, Medtronic and Ipsen D Bensmail served as a consultant for Allergan, Ipsen, Merz, Medtronic and Almirall A Scheschonka is an employee of Merz Pharmaceuticals B Flatau-Baqué is an employee of Merz Pharmaceuticals O Simon is a former employee of Merz Pharmaceuticals D Dressler received payments from Allergan, Ipsen, Merz, Syntaxin, Bayer, UCB, Abbvie, IAB-Interdisciplinary Working Group for Movement Disorders, Sintetica and Medtronic. He holds patents in botulinum toxin and botulinum toxin therapy and is a shareholder of Allergan DM Simpson received research grant support from, and served as a consultant for, Merz, Allergan and Ipsen.


  ISPR8-1805 Top


Efficacy of incobotulinum toxin A in treatment of lower-limb spasticity, including pes equinovarus, in adults

D. Bensmail, J. Wissel1, I. Laffont2,3, O. Simon4, A. Scheschonka4, B. Flatau-Baqué4, D. Dressler5, D. Simpson6

Hôpital Raymond-Poincaré, AP-HP, University of Versailles Saint Quentin, Garches, 2Department of Physical Medicine and Rehabilitation, Hôpital Lapeyronie, 4Euromov, Montpellier University- IFRH, Montpellier, France, 1Department of Neurorehabilitation and Physical Therapy and Neurology, Vivantes Hospital Spandau, Berlin, 4Merz Pharmaceuticals GmbH, Medical Affairs, Frankfurt am Main, 5Department of Neurology, Hannover Medical School, Movement Disorders Section, Hannover, Germany, 6Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA

E-mail: djamel.bensmail@aphp.fr

Introduction/Background: The TOWER study (NCT01603459) previously demonstrated that escalating doses of incobotulinum toxinA (400U–≤800U) in patients with upper- (UL) and lower-limb (LL) spasticity due to stroke or other cerebral causes increased treatment efficacy without compromising safety or tolerability (Wissel, Neurology 2017). This post-hoc analysis assessed the efficacy of incobotulinum toxinA for LL spasticity, including pes equinovarus. Materials and Methods: Patients received treatment with escalating total incobotulinum toxinA doses on the same body side during three injection cycles (ICs) (400U, 600U and 600–800U, respectively; maximum 600U per limb; optional pes equinovarus, planned dose range 100–400U). Outcomes included change from IC baseline to 4 weeks post-injection in Ashworth Scale (AS) for the ankle joint (in patients treated for pes equinovarus or not) and LL resistance to passive movement scale (REPAS) scores (in patients treated in the LL [with/without UL treatment], or UL only). Results: In total, 155 patients were enrolled. In IC1, IC2 and IC3, respectively, 109, 137 and 137 patients received LL treatment with mean (standard deviation [SD]) total limb doses of incobotulinum toxinA: 191.7 (97.6), 254.0 (111.6) and 320.9 (127.6) U. Pes equinovarus was treated in 88, 117 and 122 of these patients. The mean (SD) improvement in ankle joint AS score at 4 weeks post-injection was –0.66 (0.77), –0.70 (0.82) and –0.82 (0.77) in patients treated for pes equinovarus, and –0.21 (0.64), –0.38 (0.85) and –0.61 (0.70) in patients who were not, with a significant difference between the groups in IC1 (p = 0.0006). For all ICs, the mean improvement in REPAS LL scores 4 weeks post-injection was greater in patients who were treated in the LL than in patients treated in the UL only, with significant differences between groups in IC1 (p < 0.0001) and IC2 (p = 0.0043). Conclusion: Results suggest that incobotulinumtoxinA is effective for treating LL spasticity, including pes equinovarus.

Keywords: Incobotulinum toxin A, lower limb, spasticity

Disclosure of interest: This study was supported by Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany. Editorial support was provided, under the guidance of the authors, by Claire Cairney, PhD, of CMC CONNECT, a division of Complete Medical Communications and was funded by Merz Pharmaceuticals GmbH. D Bensmail and J Wissel contributed equally to this work as co-first authors. D Dressler and DM Simpson contributed equally to this work as co-last authors. D Bensmail served as a consultant for Allergan, Almirall, Ipsen, Medtronic and Merz J Wissel received research grant support from and served as a consultant for Allergan, Ipsen, Medtronic and Merz I Laffont served as a consultant for Ipsen and received grant support from Merz O Simon is a former employee of Merz Pharmaceuticals A Scheschonka is an employee of Merz Pharmaceuticals B Flatau-Baqué is an employee of Merz Pharmaceuticals D Dressler received payments from Abbvie, Allergan, Bayer, IAB-Interdisciplinary Working Group for Movement Disorders, Ipsen, Medtronic, Merz, Sintetica, Syntaxin and UCB. He holds patents on botulinum toxin and botulinum toxin therapy and is a shareholder of Allergan DM Simpson received research grant support from and served as a consultant for Allergan, Ipsen and Merz.


  ISPR8-2530 Top


Relief of spasticity-related pain with botulinum neurotoxin-A in real life practice. Post hoc analysis from a large international cohort series

L. Turner-Stokes, J. Jacinto1, K. Fheodoroff2, P. Maisonobe3, O. Senturk3, S. Ashford

Department of Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, King’s College London School of Medicine, Northwick Park Hospital, Regional Hyperacute Rehabilitation Unit, London, United Kingdom, 1Centro de Medicina de Reabilitaçãode- Alcoitão, Serviço de Reabilitação de adultos, Estoril, Portugal, 2Department of Neurorehabilitation, Gailtal-Klinik, Hermagor, Austria, 3Ipsen Pharma, Medical Affairs, Boulogne-Billancourt, France

E-mail: lynne.turner-stokes@doctors.org.uk

Introduction/Background: Pain is a common treatment goal for upper limb spasticity (ULS). Whilst clinical trials of botulinum toxin A (BoNT-A) show variable results for spasticity-related pain, here we describe treatment in real-life clinical practice. This post-hoc analysis compares patients whose primary treatment goal is pain relief, with primary goals in other areas. Materials and Methods: The Upper Limb International Spasticity (ULIS) programme is a series of observational cohort studies across >30 countries, examining local clinical practice and patient-centred outcomes in ULS treatment with BoNT-A/concomitant therapies. ULIS-II (NCT01020500) examined a single treatment cycle in stroke patients. ULIS-III (NCT02454803) examines repeated cycles in all neurological conditions. Baseline data are recently available. Outcome Measures: Goal achievement, goal attainment scaling (GAS), Neurological Impairment Scale, Modified Ashworth Scale. Results: In ULIS-II (N = 456), pain was the fourth most common primary goal area, expressed by 13% of patients (pain group), whilst 87% had other primary goal areas, (e.g. function, mobility, involuntary movements). At baseline, the pain group showed significant differences in age (61 vs. 56 years; p = 0.014) and contracture severity (5.9 vs. 4.5; p = 0.008), compared with others [Table 1]. Time since stroke, sex, motor impairment and spasticity were comparable between groups. The pain group showed somewhat better primary goal achievement (84 vs. 79%) and mean [standard deviation] GAS-T score (54.3[9.4] vs. 52.5[9.5]). Pain group goal attainment was significantly associated with improved pain visual analogue scale (Spearman rho = 0.65; p < 0.001), proximal spasticity (rho = 0.40, p = 0.002) and patient-reported global benefit (rho = 0.41; p = 0.001), but unrelated spasticity duration (rho = 0.15; p = 0.298). ULIS-III baseline data showed pain was the second most common primary goal area, identified by 25% of patients. Conclusion: Pain reduction is an important goal in patient-centred spasticity management, irrespective of chronicity or presence of contractures. It is increasingly identified by clinicians and patients as a primary treatment goal.
Table 1: Baseline demographics and patient characteristics

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Keywords: Botulinum toxin A, real life practice, spasticity-related pain

Disclosure of interest: Lynne Turner-Stokes and Jorge Jacinto have received consulting fees from Ipsen. Stephen Ashford has received consulting fees from Ipsen, Allergan and Merz. Klemens Fheodoroff has received consulting fees from Ipsen and Merz. Pascal Maisonobe and Jovita Balcaitiene are employees of Ipsen.


  ISPR8-1287 Top


An examination of real-world onabotulinum toxin A utilization for the treatment of lower limb spasticity: The adult spasticity international registry study

A. Esquenazi, W. Jost1, G. Bavikatte2, D. Bandari3, M. Munin4, A. Zuzek5, A. Patel6, J. Largent7, G. Francisco8

Department of Physical Medicine and Rehabilitation, MossRehab Gait and Motion Analysis Laboratory, Elkins Park, 3Hoag Neurosciences Institute, Multiple Sclerosis Center of California, Newport Beach, 4School of Medicine, University of Pittsburgh, Pittsburgh, 5Allerga PLC, Medical Affairs, Irvine, 7IQVIA, Epidemiology, Cambridge, 8Department of Physical Medicine and Rehabilitation, University of Texas McGovern Medical School and TIRR Memorial Hermann, Houston, USA, 1Department of Neurology, University of Freiburg, Freiburg im Breisgau, Germany, 2Department of Neurology, The Walton Centre, Liverpool, 6Allergan PLC, Medical Affairs, Marlow, United Kingdom

E-mail: kuang_amy@allergan.com and gerard.e.francisco@uth.tmc.edu

Introduction/Background: Onabotulinum toxin A treatment for spasticity is variable as treatment is individualized and dependent on numerous factors. Here, we explore real-world patterns of onabotulinum toxin A utilization in patients with lower limb spasticity over 2 years. Materials and Methods: Multicenter, international, prospective, observational study (NCT01930786), examining adult patients with focal spasticity across multiple etiologies treated with onabotulinum toxin A at their physician’s discretion. Assessments include utilization (each treatment visit) and patient/physician satisfaction (5±1 weeks post-treatment). Results: Patients (N = 731) were on average 53.6 years of age (18.5-93.2 years), 52% female, and predominantly Caucasian (77%). Stroke was the most frequently reported etiology (56%). The most commonly treated lower limb spasticity presentation was equinovarus foot (59%). Across all equinovarus foot treatment sessions (N = 1609), percentage injected and dose (mode) injected into each muscle are as follows: gastrocnemius (79%, 100U), soleus (70%, 100U), tibialis posterior (48%, 50U), flexor digitorum longus (21%, 50U), flexor hallucis longus (8%, 50U) and other muscle (13%, 50U). EMG was frequently used to localize the muscles to treat equinovarus foot (>40%). Across all treatment sessions, 95% of physicians and 85% of patients reported being satisfied/extremely satisfied that treatment helped manage spasticity, 89% of physicians and 76% of patients reported treatment benefit was sustained, and 98% of physicians and 92% of patients would definitely/probably continue treatment with onabotulinum toxin A. 261 patients (36%) reported 831 adverse events (AEs); 23 AEs in 20 patients (3%) were considered treatment-related. 94 patients (13%) reported 195 serious AEs; 3 serious AEs in 2 patients (0.3%) were considered treatment-related. No new safety signals were identified. Conclusion: ASPIRE provides valuable, real-world data on dosing, injection guidance, and muscle targeting over 2 years, that may help guide clinical strategies. The study captured the individualized nature of onabotulinum toxin A utilization for spasticity, while demonstrating consistently high satisfaction. These results add to the body of evidence on the safety and effectiveness of onabotulinum toxin A for spasticity.

Keywords: Observational, onabotulinum toxin A, spasticity

Disclosure of interest: G. Francisco - Consulted for, and received research grants from, Allergan. D. Bandari - Consultant, speaker, and/or conducted research for Accorda, Allergan, Biogen, Genentech, Genzyme, EMD-Serono, Questcore, and Teva. Received research support from Biogen, Teva, Genentech, Allergan, and Genzyme. G. Bavikatte - Served on a steering committee as a consultant for Allergan. W. Jost - Speaker and consultant for Allergan, Ipsen, and Merz. A. Zuzek - Full-time employee of Allergan. A. Patel - Full-time employee of Allergan. J. Largent - Full-time employee of IQVIA (formerly QuintilesIMS), the contract research organization responsible for the management of this study and was formerly a full-time employee of Allergan. A. Esquenazi - Participated in advisory boards and consulted for Allergan. Received research grants from Allergan and Ipsen. M. Munin - Participated in an advisory board for Allergan and an advisory board meeting for Merz.


  ISPR8-1289 Top


Comparison of onabotulinum toxin A utilization across various etiologies of spasticity from the Adult Spasticity International Registry Study: ASPIRE

G. E. Francisco, D. S. Bandari1, G. Bavikatte2, W. H. Jost3, A. Zuzek4, E. McCusker5, A. Patel6, J. Largent7, A. Esquenazi8

Department of Physical Medicine and Rehabilitation, McGovern Medical School and TIRR Memorial Hermann, University of Texas, Houston, 1Hoag Neurosciences Institute, Multiple Sclerosis Center of California, Newport Beach, 4Allergan PLC, Medical Affairs, Irvine, 5Allergan PLC, Clinical Development, Irvine, 7IQVIA Real-World Evidence Solutions, Epidemiology, Cambridge, 8Department of Physical Medicine and Rehabilitation, MossRehab Gait and Motion Analysis Laboratory, Elkins Park, USA, 2Department of Neurology, The Walton Centre, Liverpool, 6Allergan PLC, Medical Affairs, Marlow, United Kingdom, 3Department of Neurology, University of Freiburg, Freiburg im Breisgau, Germany

E-mail: monica.elmore@allergan.com

Introduction/Background: Etiology-specific differences in onabotulinum toxin A utilization to treat spasticity are largely unknown. Real-world clinical practice data from the ASPIRE study may help optimize onabotulinum toxin A treatment for spasticity. Our objective is to evaluate real-world utilization of onabotulinum toxin A for spasticity caused by various etiologies. Materials and Methods: 1-year interim analysis; international, multicenter, prospective, observational study (NCT01930786) examining adult patients with spasticity across etiologies. Patients were treated with onabotulinum toxin A at the physician’s discretion; utilization patterns were recorded at each visit. Results: A total of 731 patients received ≥1 onabotulinum toxin A treatment; 37% of patients were naïve to botulinum toxins for spasticity. The most common etiology was stroke (n = 411/731, 56%), followed by multiple sclerosis (MS; n = 119/731, 16%), cerebral palsy (CP; n = 77/731, 11%), traumatic brain injury (TBI; n = 45/731, 6%), spinal cord injury (SCI; n = 42/731, 6%), and other (n = 72/731). Across etiologies (N = 731), total onabotulinum toxin A doses per treatment session ranged from 45–1038U. The most frequently treated lower limb presentations, with mean doses injected per presentation, varied by etiology. Stroke: equinovarus foot (223U [SD = 131]), flexed toe (64U [SD = 51]), and flexed knee (143U [SD = 86]); MS: equinovarus foot (206U [SD = 124]), stiff extended knee (155U [SD = 134]), and adducted thigh (173U [SD = 112]); CP: equinovarus foot (162U [SD = 116]), flexed knee (150U [SD = 89]), and adducted thigh (163U [SD = 94]); TBI: equinovarus foot (223U [SD = 109]), flexed toe (89U [SD = 61]), and flexed knee (154U [SD = 60]); and SCI: equinovarus foot (277U [SD = 168]), adducted thigh (140U [SD = 66]), and flexed knee (165U [SD = 84]). In the overall population (N = 731), adverse events (AEs) were reported by 28.9% of patients, with 2.3% of events considered treatment-related. Serious AEs were reported by 10.3% of patients, with 0.3% of events considered treatment-related. No new safety signals were identified. Conclusion: Real-world 1-year interim data from ASPIRE captured etiology-specific utilization of onabotulinum toxin A for spasticity in clinical practice, while further demonstrating safety across etiologies.

Keywords: Etiologies, onabotulinum toxin A, spasticity

Disclosure of interest: G. Francisco - Consulted for, and received research grants from, Allergan. D. Bandari - Consultant, speaker, and/or conducted research for Accorda, Allergan, Biogen, Genentech, Genzyme, EMD-Serono, Questcore, and Teva. Received research support from Biogen, Teva, Genentech, Allergan, and Genzyme. G. Bavikatte - Served on a steering committee as a consultant for Allergan. W. Jost - Speaker and consultant for Allergan, Ipsen, and Merz. A. Zuzek - Full-time employee of Allergan plc. E. McCusker - Full-time employee of Allergan plc. A. Patel - Full-time employee of Allergan plc. J. Largent - Full-time employee of IQVIA (formerly QuintilesIMS), the contract research organization responsible for the management of this study and was formerly a full-time employee of Allergan. A. Esquenazi - Participated in advisory boards and consulted for Allergan. Received research grants from Allergan and Ipsen.


  ISPR8-2524 Top


Botulinum toxin A in upper limb spasticity management: Baseline data from the upper limb international spasticity-III study

L. Turner-Stokes, S. Ashford, J. Jacinto1, K. Fheodoroff2, P. Maisonobe3, O. Senturk3, A. Brashear4

Department of Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, Northwick Park Hospital, King’s College London School of Medicine, Regional Hyperacute Rehabilitation Unit, London, United Kingdom, 1Centro de Medicina de Reabilitaçãode Alcoitão, Estoril, Portugal, 2Department of Neurorehabilitation, Gailtal-Klinik, Hermagor, Austria, 3Ipsen Pharma, Medical Affairs, Boulogne-Billancourt, France, 4Department of Neurology, Wake Forest School of Medicine, Winston-Salem, USA

Email: lynne.turner-stokes@doctors.org.uk

Introduction/Background: ULIS-III describes real-life clinical practice in upper limb spasticity (ULS) management using licensed botulinum toxin A (BoNT-A) products and concomitant therapies. ULIS-III assesses long-term impact on patient-centred outcomes and identifies best practice strategies according to patient needs. Baseline data are presented for patients enrolled by June 2017. Materials and Methods: This longitudinal, prospective, observational, cohort study of integrated ULS management in adults (NCT02454803) examines impact of repeated BoNT-A injections over 2 years. Person-centred outcomes are assessed using the Upper Limb Spasticity Index, combining individual goal setting with targeted standardised measures, using patient-selected goal areas. Injection practices and physical treatments are recorded, alongside economic and quality-of-life data. Results: Baseline data were analysed for 975 patients across 57 sites (14 countries; 5 continents). [Table 1] presents baseline characteristics; 82% of patients had spasticity post stroke; two-thirds had received previous BoNT-A for ULS (<5 injections, 46%; >10 injections, 28%). Median time from diagnosis to first injection and enrolment was 1.0 and 3.4 years, respectively. Baseline muscle tone and disability measures are shown in [Table 1]. Upper arm and forearm muscles were most commonly injected; 34% received concomitant BoNT-A for lower limb spasticity [Table 2]. Shoulder injection frequency increased since ULIS-II (e.g. pectoralis major: 34 vs. 19%). Instrumental injection guidance techniques were used in 73% of patients. Most common primary goal areas were passive function (31%) and pain (25%), showing notable changes in goal selection since ULIS-II [Figure 1]. Conclusion: ULIS III contributes to greater understanding of achievable treatment goals and developing practice with improved clinical reasoning, as reflected in ULIS-III baseline data. ULIS-III will improve understanding of treatment and outcomes for long-term ULS management. Final data are expected in 2019.
Figure 1: Primary goal selection at baseline of upper limb international spasticity-III compared with upper limb international spasticity-II

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Table 1: Baseline demographics and patient characteristics for UUS-III

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Table 2: BoNT-A injection practices at baseline

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Keywords: Baseline data, botulinum toxin A, upper limb spasticity

Disclosure of interest: Lynne Turner-Stokes and Jorge Jacinto have received consulting fees from Ipsen. Stephen Ashford has received consulting fees from Ipsen, Allergan and Merz. Klemens Fheodoroff has received consulting fees from Ipsen and Merz. Allison Brashear has consulted with Ipsen, Allergan, Concert, Revance and WorldMeds. Research is supported by NINDS, Allergan, Ipsen, Merz and Revance. Dr Brashear’s Disclosure of interest: is managed by Wake Forest School of Medicine. Pascal Maisonobe and Jovita Balcaitiene are employees of Ipsen.


  ISPR8-1719 Top


The effect of neuro-orthopedic surgery on spasticity in patients with stiff knee gait

M. Galletti, A. Merlo, E. Giannotti, P. Zerbinati, P. Prati, F. Mascioli, D. Mazzoli

O. P. A. Sol et Salus, Gait and Motion Analysis Laboratory, Torre Pedrera di Rimini RN, Italy

E-mail: m.galletti@soletsalus.com

Introduction/Background: Quadriceps femoris (QF) spasticity is frequent in patients with upper motor neuron lesion (UMNL) and SKG. Aim of this work is to study the effect of QF lengthening by functional surgery (FS) on spasticity in adults with UMNL following stroke or traumatic brain injury (TBI). Materials and Methods: A sample of 25 chronic patients with UMNL, 53(13) years, 16/19 L/R, 6(5) years after lesion, who underwent surgical QF lengthening was included in the study. The same surgeon always performed the surgeries. QF spasticity was assessed through the Modified Tardieu Scale (MTS) before and 1 month after surgery. MTS was used in this study as is not affected by passive muscle characteristics. Paired MTS values were compared using the non-parametric Wilcoxon test. Percentages of patients with worsened, unchanged and improved MTS scores were also computed and reported. Results: MTS distribution is presented in [Figure 1]. Spasticity significantly decreased at 1 month after surgery (p < 0.001). MTS score, was stable in 9 subjects (36%), improved in 16 subjects (64%) and never worsened. Noteworthy, 12 subjects (48%) were completely relieved from QF spasticity at the 1-month mark, with MTS decreasing from 3 to 0 and from 2 to 0.Conclusion: Along with restoring passive muscle length, FS can also be effective in reducing QF spasticity in adult stroke and TBI survivors. This is reasonably due to the reduction in spindle activation during the stretching maneuver consequent to the decrease in muscle shortening, passive tension and stiffness. Data collection is ongoing to obtain long term results on a wider sample.
Figure 1: Quadriceps femoris spasticity

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Keywords: Functional surgery, spasticity, stiff knee gait

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


  ISPR8-1160 Top


Comparative hybrid effects of combining botulinum toxin A injection with bilateral robot-assisted, mirror or task-oriented therapy for upper extremity spasticity in patients with chronic stroke

J. W. Hung, C. Y. Wu1, K. C. Chang2, Y. P. Pong

Departments of Rehabilitation and 2Neurology, Kaohsiung Medical Center, Chang Gung Memorial Hospital, Kaohsiung, 1Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan

E-mail: hung0702@adm.cgmh.org.tw

Introduction/Background: Spasticity, a common impairment after stroke, has profound negative impact on outcomes in patients with stroke. Botulinum toxin type A (BoNT-A) injection combined with rehabilitation training is suggested for spasticity treatment. However, there is no recommendation about what kind of rehabilitation training is more appropriate than others following BoNT-A injection. The purpose of this study was to compare the effects of combining BoNT-A injection with bilateral robot-assisted (RT) or mirror (MT) or task-oriented (TT) therapy for upper extremity (UE) spasticity in patients with chronic stroke. Materials and Methods: Participants were randomly assigned to RT, or MT, or TT group after BoNT-A injection. The participants received 45 minutes of intervention per day, 3 days/week, for 8 weeks according the allocated results. In addition, all participants received 30 minutes of functional practice training. At pre-intervention, post-intervention and 3-month follow-up a blinded research assistant did outcome measures, including body function and structures by Fugl-Meyer Assessment (FMA), and Modified Ashworth Scale (MAS); activity and participation measures by Motor Activity Log (MAL), and Nottingham Extended Activities of Daily Living Scale (EADLS). Results: Thirty-seven subjects met the inclusion criteria and underwent randomization, 13 were assigned to the RT; 12 to MT; and 12 to TT group. The 3 groups were well matched with regard to baseline characteristics and functional status. All groups had significant improvement in FMA, MAS and MAL post-intervention. There were no group differences in FMA, MAS, EADLs either post-intervention or at follow-up. There was a trend that TT group had higher quality of movement (QOM) in MAL post intervention than the other 2 groups (p = 0.07), at follow-up TT group had significantly higher QOM in MAL than the other 2 groups (p = 0.03). Conclusion: Combining BoNT-A injection with TT resulted in better quality of UE movement in patients with spastic stroke than with RT or MT.

Keywords: Mirror therapy, robot-assisted therapy, task-oriented

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


  A7.06 Rehabilitation Addressing to Specific Issues - Management Of Fatigue and Sleep Disorders Top



  ISPR8-0487 Top


Cancer-related fatigue, a problem in and after oncological rehabilitation

B. Leibbrand, H. Kähnert1, J. Maschke1

Salzetalklinik, Onkologische Rehabilitation, 1Institut für Rehabilitationsforschung Norderney, Abbot Bad Salzuflen, Bad Salzuflen, Germany

Email: dr-leibbrand@t-online.de

Introduction/Background: Cancer-related fatigue is the most distressing symptom of oncological patients with cancer-therapy, also in and after rehabilitation. The aim of our study was to adapt oncological rehabilitation to this symptom, so we developed and evaluated a fatigue-related management module called FaM-Modul for rehabilitation. Materials and Methods: The rehabilitation team developed and discussed the FaM-Modul. For study we used a sequential control group design with a control group (CG: n = 189) and an intervention group (IG: n = 194). Only participants with substantial fatigue-related problems in oncological rehabilitation were recruited. The effects of the FaM-Modul in the intervention group were evaluated by questionnaires asking for the fatigue-related therapies and fatigue-related outcomes (MFI: general- (GF), physical- (PF), mental fatigue (MF); health-related quality of life (QoL-EORTC)) at the beginning (t1), the end (t2) and 3 months after oncological rehabilitation (t3). Non-parametric-tests and analysis of covariance with repeated measures were applied to investigate differences between CG and IG. Results: The FaM-Modul consists additional to standard oncological rehabilitation of psychosocial, nutritional and exercise therapies. The IG evaluated both contents (p < 0.001) and organization (p < 0.001) better than the CG with standard oncological rehabilitation and they were more pleased with the fatigue-therapies (p < 0.001). There were improvements of the outcomes from t1 to t2 in both groups. However, from t1 to t3 the IG showed reductions in GF (p < 0.05), PF (p < 0.01) and MF (p < 0.01) and an increase in QoL (p < 0.01) compare to the CG. Conclusion: Also standard oncological rehabilitation is successful to reduce fatigue-related symptoms of oncological patients in rehabilitation, but not after discharge. With a symptom-oriented module, developed by the rehabilitation team we can reduce fatigue-related symptoms until 3 months after discharge. The FaM-Modul completes standard rehabilitation therapies and supports rehabilitation. A controlled and multi-center study should be carried out to verify these results.

Keywords: Cancer-related fatigue, oncological rehabilitation

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


  ISPR8-1123 Top


Sleep disordered breathing in adult with polio sequelae: A case control study of predictive factors

A. Leotard, A. Pages1, M. Salga1, G. Genet1, J. Levy1, M. A. Quera-Salva, F. Genet1

Sleep Unit, Hopital R Poincaré, 1Department of Physical Medicine and Rehabilitation, Hopital R Poincaré, Garches, France

Email: tonio.leotard@gmail.com

Introduction/Background: Estimates of sleep disorder breathing (SDB) prevalence are higher in patients with polio sequelae than in general population, ranging from 50% to 65%. No specific predictive factors have been described in our knowledge. The aim of this study was to identify SDB predictive factors among polio survivors. Materials and Methods: A case control study including patients with polio sequelae with confirmed SDB (apnea hypopnea index (AHI) ≥ 5; n = 38) compared to polio patients with AHI ≤ 5 or negative Berlin questionnaire (n = 114). Matching criteria were: sex, age at evaluation, and body mass index (BMI). For each patient, age at acute polio, bulbar, trunk, and lower limbs involvement, scoliosis, current walking abilities and history of arthrodesis, brace or iron lung were assessed using preexisting database and medical charts. SDB symptoms, Berlin questionnaire and AHI using polysomnographic reports were also assessed retrospectively. Results: Among the 362 polio patients from our systematic database 152 (38 cases and 114 controls) were matched for comparison. SDB ratio was significantly higher in patients with bulbar involvement at acute polio (100% vs 22.5%), trunk involvement at acute polio (41.9% vs 18.4%), bulbar involvement at evaluation (100% vs 23%), scoliosis (38.6% vs 13.8%) and non-walking patients (50% vs 22.5%) compared with polio controls. Multivariate analysis only shown scoliosis to be associated with SDB in those patients (OR = 2.72 (95% CI: 1.10–6.95); p = 0.03). Conclusion: Despite there was an increased ratio of SDB in patients with bulbar and trunk involvement, only scoliosis seems to specifically increase the risk of SDB occurrence among polio survivors. In those patients, symptoms suggestive of SDB should be searched for systematically, especially in case of trunk deformities.

Keywords: Poliomyelitis, predictive factors, sleep disorder breathing

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

A8 Sports in Rehabilitation And Sports Rehabilitation


  ISPR8-2113 Top


Return to play after cervical surgery: A Belgian Delphi analysis

E. Robben, K. Kempeneers1, B. Depreitere2, K. Peers

Departments of Physical and Rehabilitation Medicine and 2Neurosurgery, University Hospitals Leuven, Leuven, 1Department of Physical and Rehabilitation Medicine, Jessa Ziekenhuis, Hasselt, Belgium

E-mail: elise.robben@uzleuven.be

Introduction/Background: Decisions concerning the rehabilitation process and return to play (RTP) after cervical spine surgery in a general sporting population can be difficult and may be influenced by several factors. Moreover, no guidelines are present for this. The aim of this study was to create a consensus on this topic. Materials and Methods: A 5-step Delphi analysis with panels of neurosurgeons, orthopaedic surgeons, physiotherapists and physical and rehabilitation medicine practitioners in Belgium was conducted. The first round (R1) was a brainstorm phase. A comprehensive list of answers from R1 was validated in round 2 (R2). In round 3 (R3) experts ranked these items in a chronological order. Next, contraindications and criteria to start each rehabilitation step were linked by experts in round 4 (R4). In round 5 (R5) panellists ranked theses about contraindications and criteria on a 5-point Likert scale. Results: The response rate was 100% (n = 15) for R1, 93% (n = 14) for R2, 73% (n = 11) for R3, 53% (n = 8) for R4 and 67% (n = 10) for R5. In R5, 25 theses on absolute and relative contraindications and criteria were endorsed. Conclusion: This Delphi analysis resulted in contraindications and criteria for the rehabilitation process and return to play after cervical surgery. Tentative guidelines and timetable are proposed [Figure 1].
Figure 1: Tentative guidelines: timeline with different rehabilitation steps. Red lines indicate absolute contraindications/criteria. Green lines indicate relative contraindications/criteria.

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Keywords: Cervical spine, return to play, surgery

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


  ISPR8-1398 Top


Variations of central and skin temperatures during 24 h in elite wheelchair rugby players

F. Rusakiewicz, E. Cugy1, C. Delpouve2, J. Druvert3, V. Ferring4, D. Hornu5

Fédération Française Handisport/Centre Jacques Arnaud, Commission Médicale/Médecine Physique et de réadaptation, Paris, 1Fédération Française Handisport/CHU Bordeaux, Commission Médicale/Médecine Physique et de réadaptation, Bordeaux, 2Fédération Française Handisport/CRMPR Les Herbiers/IRMS2, Commission Natation/HDJ orthopédie-traumatologie/Médecine du sport, Bois Guillaume, 3Fédération Française Handisport, Commission Médicale, Redon, 4Fédération Française Handisport/IFMK Nancy, Commission Médicale, Kinésithérapeute fédéral/Classificateur international athlétisme, Nancy, 5Fédération Française Handisport/Clinique Médipôle Garonne, Commission Médicale/Médecine du sport, Toulouse, France

E-mail: claire.delpouve@gmail.com and emmanuelle.cugy@chu-bordeaux.fr

Introduction/Background: Spinal cord-injured athletes are of an inability to vasodilate and sweat below the injury, increasing the risk for marked core body temperature rises. Tetraplegics athletes have an important thermoregulatory impairment and are great risk of heat illness at a high intensity exercise or in hot environment. The magnitude of this impairment is proportional to the level of the lesion and requires adaptations adapted to each individual response. Thus, the objective of this study was to assess body temperature induced by wheelchair rugby sessions and to compare the skin (Ts°) and the central (Tc°) temperature measured during a one training day. Materials and Methods: Seven elite wheelchair rugby players with high-level lesions and all members in French team (1.3±0.8 points on international classification) participated of this study. Central (Tc°) and skin (Tsk°) temperatures were continuous recorded during 24h with an electronic pill and Thermocron® ibutton® devices placed on the shoulder. At the morning (Mo), before (Bef) and after (Aft) the training session and during the night (Ni), Tc° and Tsk° were noted. Results: Tsk° was significant lower than Tc° (P < 0.01). Training session increase significantly Tc° and Tsk° (+3.5% for Tc° and 4.8% for Tsk°, respectively between Aft and Bef, P < 0.01). Ni Tc° (35.8±0.2°C) was significant lower than all measures (P < 0.001) and the variation between extreme diurnal and night values were 2.4±0.6°C. Conclusion: The Tsk° values are lower than those obtained with the pills, Tc°. Tc° increase of 1.3±0.5°C after wheelchair rugby is lower than that obtained by Price and Campbell (2.1±0.5°C) during 60 min at 60% VO2pic on wheelchair ergometer in hot environment chamber (31.5°). However, skin measures are sensitive to exercise-induced imbalance and could be used by the staff to manage the thermoregulation troubles. It could be interesting to provide individual solutions to limit the effects of the large variation in Tc° measured during 24h.

Keywords: Spinal cord injury, thermoregulation, wheelchair rugby

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


  ISPR8-2508 Top


Estimation of the energy expenditure by the actigraph accelerometer in elderly on different physical activities

J. Lacroix1, M. Compagnat1,2, B. Ferry1, J.C. Daviet1,2, S. Mandigout1

1Laboratoire HAVAE EA 6310, Faculté des sciences et techniques, 2Service de médecine physique et de réadaptation, Hôpital Jean Rebeyrol- Pôle neuro-sciences tête et cou, Limoges, France

E-mail: yustong@hotmail.fr

Introduction/Background: For a same accelerometer, the manufacturer mentions that it can be worn at different positions on the body. However, we assume that the data are different according the accelerometer positions and the recorded activity. The aim of the study was to compare the energy expenditure values estimated by the Actigraph accelerometer according to accelerometer position on the body. Materials and Methods: 27 elderly (71 ± 4 years) volunteered to realize successively: 3 minutes computer-based word processing, 5 minutes biking (70 watts), 5 minutes walking (4.6km/h) and 5 minutes running (5.8km/h) on treadmill. The oxygen consumption was evaluated continuously by a gas analyzer (Metamax 3B). The energy expenditure was estimated by 3 accelerometers (Actigraph GT3X) worn on the hip, on the wrist and ankle on the dominant side (26 were right-handed and one was left-handed). Results: [Table 1] and [Table 2]. Conclusion: This study showed that for a same accelerometer positioned differently on the body, there are important differences in the energy expenditure estimation. This observation applies to both static and locomotor activities. Further works are necessary to find the best accelerometer position to estimate the energy expenditure in the elderly according to the activity.
Table 1: Mean of the estimated energy expenditure (Kcal) for each physical activity

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Table 2: Differences in the energy expenditure estimation according to the accelerometer position

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Keywords: Accelerometer, elderly, energy expenditure

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


  ISPR8-1418 Top


Around the concept of classification in para sport: Involvement of physical and rehabilitation medicine (close-up on athletics)

V. Ferring, E. Cugy1, C. Delpouve2, J. Druvert3, D. Hornu4, F. Rusakiewicz5

Fédération Française Handisport/IFMK Nancy, Commission Médicale – Kinésithérapeute fédéral/Classificateur international athlétisme, Nancy, 1Fédération Française Handisport/CHU Bordeaux, Commission Médicale/Médecine Physique et de réadaptation, Bordeaux, 2Fédération Française Handisport/CRMPR Les Herbiers/IRMS2, Commission Médicale/HDJ orthopédie - traumatologie/Médecine du sport, Rouen, 3Fédération Française Handisport, Commission Médicale, Redon, 4Fédération Française Handisport/Clinique Médipôle Garonne, Commission Médicale/Médecine du sport, Toulouse, 5Fédération Française Handisport/Centre Jacques Arnaud, Commission Médicale/Médecine Physique et de réadaptation, Paris, France

E-mail: claire.delpouve@gmail.com and emmanuelle.cugy@chu-bordeaux.fr

Introduction/Background: The Para-sport Movement aims to offset the restriction of sport participation by offering fair competition and rules. As such, the classification process is fundamental and unavoidable. It determines who can compete. Materials and Methods: Following the International Classification of Functioning Disability and Health, classification groups athletes with similar activity limitations in classes depending on how their impairments impact their ability to produce the core activities in each sport. Results: Ten physical, sensory, or intellectual impairments, are recognised and minimum impairment criteria are defined. Certain diseases or health conditions are excluded. (Ehlers Danlos, conversion disorders, fibromyalgia, pain…). ?Physical impairments taken into consideration are reduced muscle power, reduced passive range of movement, loss of limb or limb deficiency, leg-length difference, short stature, hypertonia, ataxia or athetosis. Physicians and Physiotherapists form panels with technical experts evaluating athletes and assigning classes following a specific procedure. The medical diagnosis has to be sent prior to the competition. Then, classifiers assess the impairment and its impact on the activity in three steps, physical and technical assessments, and if needed observation during the competition. Conclusion: Different issues are developed in the presentation: (1) Evidence-based classification: most valid, reliable and reproducible tests are needed to make the decisions. (2) Ethical aspects and controversies with potential cheating called Intentional Misrepresentation. (I.M.)?(3) Specific cases of dysautonomia for high level of Spinal Cord Injuries and Maximum Allowed Standard Height for bilateral lower limbs amputees. (4) Training to improve expertise and develop classifiers’ skills. (5) Problems of data protection. (6) Status (New, Confirmed, Review, Classification Not Completed…) (7) Non-eligible and borderline cases.

Keywords: Classification, competition, para-sport

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


  ISPR8-1404 Top


Epidemiology of para-athletic injuries: A cohort study

L. Caudel, E. Cugy1, C. Delpouve2, J. Druvert3, V. Ferring4, H. Dominique5, F. Rusakiewicz6

CHU Bordeaux, Médecine Physique et de réadaptation, 1Fédération Française Handisport/CHU Bordeaux, Commission Médicale/Médecine Physique et de réadaptation, Bordeaux, 2Fédération Française Handisport/CRMPR Les Herbiers/IRMS2, Commission Médicale/HDJ orthopédie - traumatologie/Médecine du sport, Rouen, 3Fédération Française Handisport, Commission Médicale, Redon, 4Fédération Française Handisport/IFMK Nancy, Commission Médicale - Kinésithérapeute fédéral/Classificateur international athlétisme, Nancy, 5Fédération Française Handisport/Clinique Médipôle Garonne, Commission Médicale/Médecine du sport, Toulouse, 6Fédération Française Handisport/Centre Jacques Arnaud, Commission Médicale/Médecine Physique et de réadaptation, Paris, France

Email: claire.delpouve@gmail.com and emmanuelle.cugy@chu-bordeaux.fr

Introduction/Background: Athletics practiced at high intensity is a source of injuries because of constraints on musculo-skeletal structures. Social and health interests of physical activities amongst disabled patients are demonstrated. In the last few years, popularization of paralympic sports implies an increased number of participants and injuries. These injuries can have functional consequences and alter the quality of life. The aim of this study was to measure the prevalence of para-athletics’ injuries during an entire sports season and to characterize them by types, location and modes of onset. Moreover, this study identifies risk factors and proposes a prevention program. Materials and Methods: A cohort study was undertaken of 210 athletes, who took part in one of four french national competitions in the 2016-2017 para-athletics season. Data were collected with help of medical staff during the competitions and identified athletes’ impairments, location, type and mode of onset. Results: Prevalence of injuries during the 2016-2017 season was 19% (9,4 for 100 athlete-days). Athletes with visual impairments experienced the highest number of injuries (42,5%, 16,8 for 100 athlete-days) followed by amputee athletes (23,8%, 10,8 for 100 athletes-days). The large majority of the injuries affected the thigh (39%) and were muscle strains (56%). Conclusion: This cohort study brings new data about para-athletics traumatology. Athletes with visual impairment experienced the highest rate of injuries and prevention programs must focus on hamstring strains.

Keywords: Musculoskeletal trauma, sports injury

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


  ISPR8-1559 Top


A physiological and biomechanical comparison of over-ground and treadmill during asynchronous wheelchair propulsion

M. Astier, E. Watelain1, J. M. Vallier, A. Faupin

University of Toulon, Lahmess - EA 6312, La Garde, 1University of Valencienne, Lamih-umr cnrs 8201, Valenciennes, France

E-mail: marjolaine.astier@univ-tln.fr

Introduction/Background: Two main modes of propulsion in manual wheelchair (MWC) are described in the literature: synchronous mode (Syn) in which arms are working together, and asynchronous mode (Asy) in which arms are working alternating. It has not yet been demonstrated that the propulsion technique used was identical on a treadmill and in the field, especially because of the movement of “steering” on the field during Asy propulsion. The aim of this study is to compare biomechanical and physiological responses of Asy during tests on the field vs. treadmill. Materials and Methods: 10 wheelchair basketball players performed 1 session of 4 minutes at 8 km.h-1 on the treadmill and 1 session on the field (‘figure 8’ tests). The MWC is equipped with an instrumented wheel allowing measuring temporal parameters: push time (PT), recovery time (RT) and cycle time (CT = PT + RT). Push frequency (PF), Rate of Rise (RoR), Fraction of Effective Force (FEF) and Rolling Resistance (RR) are also measured. Each subject is equipped with a K4, allowing to obtain the consumption of oxygen (Vo2.kg-1). Results: The parameters collected are presented in Table 1. Conclusion: Although the RR is higher for treadmill, Vo2.kg-1 and PT are superior on the over-ground. This can be explained by the steering on the field, which induces an increased use of the trunk muscles for stability. This could also explain lower PF and RoR. Therefore, field test is recommended to evaluate Asy propulsion.

Keywords: Asynchronous wheelchair propulsion, steering

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


  ISPR8-0337 Top


Is there a correlation between the psychological anterior cruciate ligament-return-to-sport-after-injury score and isokinetic and neuromuscular functional performance tests of the knee following primary anterior cruciate ligament reconstruction?

T. Raoul

Clinique du sport, 75, Paris, France

E-mail: tiana.raoul@gmail.com

Introduction/Background: The decision to allow an athlete to return to sport following anterior cruciate ligament (ACL) reconstruction should not only be based on the time since surgery. Physical and psychological readiness to return to sport are essential, and a premature return is a risk factor for recurrent tears. The ACL-Return-to-Sport-after-Injury (ACL-RSI) questionnaire quantifies the influence of psychological factors on the patient’s ability to return to play. The main goal of this study was to determine the relationship between the ACL-RSI score and postoperative isokinetic and neuromuscular tests. Materials and Methods: An analysis of a prospective cohort was performed including athletes who underwent surgery between 2013-2016 for an isolated full-thickness ACL tear, with a healthy contralateral knee and a complete evaluation of their knee’s functional performance by isokinetic and neuromuscular tests. The isokinetic tests were performed during flexion and extension at 3 angular velocities on a dynamometer to measure strength: quadriceps 60°/s and 240°/s for concentric movements, hamstrings 30°/s for eccentric movements. The neuromuscular assessment was based on single-limb hop tests. The main judgment criterion was the correlation between the ACL-RSI score at 6-month follow-up and the difference between the 2 knees for isokinetic and neuromuscular tests. The correlations were assessed using Pearson correlation coefficient (r). Results: 182 patients fulfilled the inclusion criteria, 132 men/ 50 women, mean age 28.7±8.6 years including 4 (2.2%) professional and 89 (48.9%) competitive athletes. The mean follow-up was 6.5±1.7 (4-12) months. The ACL-RSI score was positively and significantly but weakly correlated with the tests (r = 0.15 to 0.18, p = 0.01 to 0.03). The ACL-RSI score was significantly higher in patients who returned to sport (p = 0.0001). Conclusion: The ACL-RSI score at 6-month follow-up was significantly and positively, but weakly correlated to isokinetic and neuromuscular tests. This tool provides a good evaluation of the psychological factors involved in the return-to-sport.
Table 1: Mean and standard deviation of parameters

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Keywords: Anterior cruciate ligament-return-to-sport-after-injury scale, isokinetic tests, return-to-sport

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


  ISPR8-1185 Top


The role of tecar therapy in the delayed onset muscle soreness and functional recovery

B. Guimaraes, J. Barreto, A. Ú. Martins, J. Silva, J. Matos, R. Cardoso1, F. Melo, C. A. Branco

Department of Physical and Rehabilitation Medicine, Centro Hospitalar de Entre o Douro e o Vouga, Santa Maria Da Feira, 1Department of Physical Medicine and Rehabilitation, School-Hospital of Fernando Pessoa University, Porto, Portugal

E-mail: btsguimaraes@gmail.com

Introduction/Background: The practice of physical exercise can trigger the Delayed Onset Muscle Soreness (DOMS). This experimental study aims to evaluate the effects of Tecar Therapy on DOMS and Functional Recovery. Materials and Methods: A sample of 60 young volleyball female athletes (mean age 16.42 ± 1.78) was randomized into two groups (Tecar Therapy Group (TG) (n = 30) and Control Group (CG) (n = 30). All participants performed the fatigue protocol, and were evaluated in different moments (Before [M0] and after [M1] the fatigue protocol and Tecar therapy in TG; 24 hours after the protocol before [M2] and after [M3] Tecar therapy in TG; and 72 hours after the fatigue protocol [M4]). The participants were evaluated in regard to: 1) pressure pain threshold, 2) muscle soreness (visual analogue scale), 3) functionality (Single Hop Test) and 4) muscle strength (isokinetic evaluation - Peak Torque (PT), Peak Torque Body Weight (PTBW), Total Work (TW), Average Power (AP)). Results: The TG presented higher pain pressure threshold when compared to the CG, from M2 onwards of the evaluation (M2 p = 0,034, M3 p = 0,041 and M4 p = 0,002). Likewise, the TG presented less muscle soreness when compared to the CG, from M2 onwards of the evaluation (M2 p = 0,008, M3 p = 0,016 and M4 p = 0,034). On the other hand, it was verified that, when compared to the initial evaluation moment (M0), the GT recovers in functional performance by the end of 72 hours (M0 vs M4), in the Single Leg Hop and in three isokinetic parameters (PT, PTBW and AP), however this wasn’t observed among the CG. Conclusion: Tecar Therapy was shown to be effective in the relief of muscle soreness, from 24 hours after its application. Likewise, individuals treated with Tecar therapy had better recovery of muscle strength and function at the end of the 72 hours protocol.

Keywords: Delayed onset muscle soreness, isokinetic evaluation, tecar therapy

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


  ISPR8-0534 Top


Botulinum toxin: A new treatment for functional popliteal artery entrapment syndrome? Five patients relieved more than 1 year

M. Schultz, M. E. Isner-Horobeti, J. Lecocq

Department of Physical Rehabilitation Medicine, Strasbourg University Hospitals, Strasbourg, France

E-mail: magali.schultz@chru-strasbourg.fr

Introduction/Background: Functional popliteal artery entrapment syndrome (FPAES) is an uncommon cause of exercise-induced leg pain. Artery compression is mostly due to hypertrophic gastrocnemius muscles (GCM) without any anatomic abnormality. Surgical arteriolysis of popliteal artery is often proposed, sometimes with myotomy. But long-term efficacy of surgery is unknown. As botulinum toxin A (BoNT-A) injections can induce localised and partial muscular atrophy and hypotonia, we supposed that BoNT-A injections in GCM could relieve pain associated with FPAES. Materials and Methods: We describe five patients with a FPAES treated with BoNT-A and followed more than one year. Diagnostic was confirmed by provocative tests in plantar or dorsal flexion of the ankle on vascular imagery (doppler ultrasonography, computed tomography or magnetic resonance angiography). Other causes of leg pain were excluded, such as chronic exertional compartment syndrome with compartment pressure after exercise. BoNT-A was injected under electromyograph guidance in the proximal third of both heads of GCM (two sites / head), with 25 to 37,5 U of Incobotulinum toxinA or 100 to 160 US of Abobotulinum toxin A. Results: Exercise-induced leg pain completely disappeared after treatement for all patients and they resumed their normal level of sports or physical professional activities. 1 patient was treated twice, eight months after the first injections, since he relapsed. There were no muscular weakness but the patient treated with the highest dose had transient asthenia and mictional disorders. 4 patients are currently still asymptomatic, with a follow up between 14 and 28 months. 1 patient relapsed late after 50 months. Conclusion: BoNT-A injections could be used as a new conservative therapeutic strategy in FPAES and could reduce functional compression by improving artery-GCM impingement. This study is the first to demonstrate that BoNT-A could induce long-lasting resolution of symptoms, more than one year as previoulsy described (Hislop 2017). It is well tolerated if the dose is well choosed.

Keywords: Botulinum toxin, exercise-induced leg pain, functional popliteal artery entrapment syndrome

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


  ISPR8-1381 Top


Rehabilitation through adapted sports: The French military way

S. Truffaut, M. Thomas-Pohl, L. Borrini, D. Rogez, J. Facione, E. Lapeyre

Department of Physical Medicine and Rehabilitation, Percy Military Hospital, Clamart, France

E-mail: stephanie.truffaut@gmail.com

Introduction/Background: Since ancient civilizations, health through sports is a fundamental military rule. Bonaparte first integrates by law sports education in military schools. After word war I and II, a collective awareness has emerged, often under the impulse of mutilated warriors. Then, military sport then became a strong tool of peace among nations, and the awareness of this lever led to the creation of the CISM (International Military Sports Council) in 1948. Materials and Methods: France has developed a strong link between each steps of military sports management. The aim of this presentation is to sum up the military PMR French departments organisation and missions. Its strong links with the military forces, including Navy and Air forces, has strenghtened since the recent conflicts in Afghanistan, Middle East and terrorists attacks. Since the use of Improvised Explosive Devices, major limb injuries and traumatic amputations has emerged. The multidisciplinary approach of Percy Military hospital, is now highlighting a category of high-level expectations young wounded soldiers, whose aim is to go back to duty, and to get back to their former sporty way of life. Results: Since 2001, a french multidisciplinary process is improving, including military PMR, psychiatry practitioners, social workers, and headquarters, leading to the creation of wounded aid cells, and reconstruction courses by adapted sports. The global reflection around the recovery of a sport with a residual disability is a fundamental mission of PMR military departments. Thanks to the implementation of financial means, (including possibility of purchasing electronical high technologies prostheses), there is now a highlightening of these wounded soldiers, through local and international events like Invictus games or Ad victoriam. Conclusion: Thanks to the multidisciplinary approach of the wouded soldier, and the inclusion of adapted sport has a way of life, the glimpse at these soldiers is changing, in French armed forces but also in French population.

Keywords: Military rehabilitation, reconstruction through sports, wounded warriors

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


  ISPR8-1986 Top


Medical experience in the Paralympic Games in Rio 2016

F. Rusakiewicz, E. Cugy1, C. Delpouve2, J. Druvert3, V. Ferring4, D. Hornu5

Fédération Française Handisport/Centre Jacques Arnaud, Commission Médicale/Médecine Physique et de réadaptation, Paris, 1Fédération Française Handisport/CHU Bordeaux, Commission Médicale/Médecine Physique et de réadaptation, Bordeaux, 2Fédération Française Handisport/CRMPR Les Herbiers/IRMS2, Commission Médicale/HDJ orthopédie - traumatologie/Médecine du sport, Rouen, 3Fédération Française Handisport, Commission Médicale, Redon, 4Fédération Française Handisport/IFMK Nancy, Commission Médicale - Kinésithérapeute fédéral/Classificateur international athlétisme, Nancy, 5Fédération Française Handisport/Clinique Médipôle Garonne, Commission Médicale/Médecine du sport, Toulouse, France

E-mail: claire.delpouve@gmail.com and emmanuelle.cugy@chu-bordeaux.fr

Introduction/Background: When paralympic means «beside» the Olympic games and the International Paralympic Committee’s catchword is: «Spirit In Motion»; we wanted to report how the paralympic movement has increased during the last game. The medical team wanted therefore to present how the paralympic games in Rio were completed on their part. Materials and Methods: There were 5 sport federations united in the French team composed of 126 athletes (42 women and 84 men). They competed in 17 sports. The medical team was made up of 3 PRM doctor whose one was able to do ultrasounds and two others were sports physicians. There was also one adapted sport physician and 3 nurses. 14 Physiotherapists were split between the sports team. The medical team needed to answer all transport issues between France and Brasil depending on the impairment. They also had to bring many specific material and organise an health space adpated to all athletes’ needs. They collected all possibly data during the games concerning each athlete. Results: There were 35 orthopedic impairments, 48 neurologic impairments, 6 visual impairments and 5 cognitive impairments among the athletes. All athletes had a personnal medical record reviewed by the physicians and all therapeutic use exemptions had been required. There was a daily medical and paramedical meeting. There was a medical room with a drugstore and a moblie ultrasonography apparatus, a physical therapy room with many specific equipment and a cryotherapy bath. There were mainly ENT and digestive illnesses, followed by skins disorders and urinary infections. Sports injuries were tendinopathy and musculoskeletal disorders (50 ultrasounds and one punction). They had to order 3 medical rapatriations due to acute psychiatric disorders. Conclusion: All data collected bring up in-depth discussions about injury prevention and athlete’s follow-up.

Keywords: Injury, paralympic games, sport medicine

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


  A9.01 Social Integration Programmes and Rehabilitation for Specific - Community Based Rehabilitation Top



  ISPR8-1083 Top


A randomized controlled trial assessing the efficacy of an upper limb self-rehabilitation programme among chronic Beninese stroke patients

D. D. Niama Natta, T. Lejeune1, C. Detrembleur2, B. Yarou, E. Sogbossi, E. Alagnidé, T. Kpadonou, G. Staquart1

Department of Physical Medicine and Rehabilitation, National University Hospital of Cotonou, Cotonou, Benin, 1Department of Physical Medicine and Rehabilitation, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, 2Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium

E-mail: digitalesfr@yahoo.fr

Introduction/Background: After stroke, approximately 80% of patients have upper limb impairment. Upper limb is then a key issue in neurorehabilitation. The objective of this study was to evaluate the efficacy of self-rehabilitation program of upper limb after stroke, in Benin. Materials and Methods: It was a randomised controlled trial concerning 59 patients presenting hemiplegia more than 6 months after stroke. The 28 patients of experimental group have executed a self-rehabilitation program during 8 week at home. The control group had 31 patients who received no treatment related to the study. Patients have been evaluated before the treatment (T0), at the end of the treatment (T1) and 8 weeks after later5T2). Le primary outcome was the manual ability assessed by ABILHAND Stroke for Benin. The secondary outcomes were: neurological impairments (Fugl-Meyer), manual dexterity (Box and Block Test, Wolf Motor Function Test) and quality of life (Whoquol-Brief). Two way repeated measure ANOVA in intention to treat was did for analysis. Results: The experimental group improved significantly their manual ability in comparison to the control group (p < 0.001). Within the experimental group, means difference were 10% between T1 and T0 (IC95%: 1.61 to 18.56), maintained at T2 (IC95%: 1.48 to 18.44). Quality of life also improved in the intervention group. Conclusion: The self-rehabilitation program for upper limb after stroke is feasible and efficient in Benin to enhances the manual ability for chronic stroke patients. The self-rehabilitation program is an intensive program including unimanual and bimanual functional exercises, repeating movements of the daily life of patients.

Keywords: Hemiplegia, self-rehabilitation, upper limb

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


  A9.03 Social Integration Programmes and Rehabilitation for Specific - Support, Assistance and Independent Living Top



  ISPR8-0165 Top


Abstract need to be edited - Contribution of chronic diseases to educational disparity in disability in France: Results from the cross-sectional “disability-health” survey

C. Palazzo, Y. Renata1, T. Jean1, R. Jean-François2, C. Emmanuelle3, P. Serge4, V. O. Herman1, N. Wilma5

Spine Unit, Hopital R Poincaré, Garches, 2CNRS, Cermes 3, Villejuif, 3INED, 4Department of Rehabilitation, Cochin Hospital, APHP, Paris, 1Scientific Institute of Public Health, Public Health and Surveillance, Brussels, France, 5Erasmus MC, Public Health, Rotterdam, The Netherlands

E-mail: clemence.palazzo@aphp.fr

Introduction/Background: This study aimed to assess whether the contribution of chronic conditions to disability prevalence varies according to educational attainment and to disentangle the contributions of the prevalence and disabling impact of chronic conditions to educational disparities in the French household population 25 years and older. Materials and Methods: Data of the 2009-09 Disability Health Survey were examined (N = 23,348). The disability indicator was the Global Activity Limitation Indicator (GALI). The attribution method based on an additive hazard model was used to estimate educational differences in disabling impacts and in the contributions of diseases to disability. Counterfactual analyses were used to disentangle the contribution of differences in disease prevalence vs. disabling impact. Results: In men, the main contributors to the absolute difference in disability prevalence were arthritis (contribution to disability prevalence: 5.7% (95% CI 5.4-6.0) for low-educated vs. 3.3% (3.0-3.9) for high-educated men), spine disorders (back/neck pain, deformity) (3.8% (3.6-4.0) vs. 1.9% (1.8-2.1)), chronic obstructive pulmonary diseases (2.4% (2.3-2.6) vs. 0.6% (0.5-0.7)) and ischemic heart /peripheral artery diseases (4.1% (3.9-4.3) vs. 2.4% (2.2-3.0)). In women, arthritis (9.5% (9.1-9.9) vs. 4.5%, (4.1-5.2)), spine disorders (4.5% (4.3-4.7) vs. 2.1% 1.9-2.3) and psychiatric diseases (3.1% (3.0-3.3) vs. 1.1% (1.0-1.3)) contributed most to education gap in disability. The educational differences were equally explained by differences in the disease prevalence and in their disabling impact. Conclusion: Public health policies aiming to reduce existing socioeconomic disparities in disability should focus on musculoskeletal, pulmonary, psychiatric and ischemic heart diseases, reducing their prevalence as well as their disabling impact in lower socioeconomic groups.

Keywords: Chronic diseases, disability, socioeconomic status

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


  ISPR8-1077 Top


Territorial mobile team: A response element to ambulatory shift? Lyon’s experience

C. Minvielle, J. Luauté, F. Pineau-Arnaud, F. Fenié, S. Dojat

Hopital Henry Gabrielle, Rhône, Saint Genis Laval, France

E-mail: celia.minvielle@chu-lyon.fr

Introduction/Background: At the time of “ambulatory shift”, new modes of care are developing: this is the case of the mobile teams of physical and rehabilitation medicine (PRM) [LJ1] who participate in diversification of health care facilities. They concern disability (whatever its origin) and actions for short or medium stay, links between private and hospital practice, medico-social, care pathway and the absence of breach for this complex patient. The objective is to encourage out of hospital care, as far as possible, in all actions waged. Materials and Methods: Our mobile team “EMT3R 69” (territorial mobile team of rehabilitation, reintegration) is multidisciplinary (Physician PRM, occupational therapist, physiotherapist, social worker) and was created in January 2017. It is funded by the regional health agency “ARS” for a period of 3 years. Application for Team’s intervention must contain specific objectives. A rapid response is provided in order to found the most appropriate response. Results: After 1 year experience, 121 persons (58% of men) were included corresponding to 682 interventions, among which 193 in the living place. Other interventions comprised follow-up to the recommendations, coordination with the partners,…). Patients were heavily dependent (RANKIN 4), mainly neurologically disabled (92%), living at home (66.8%) or in a medico-social institution (27.4%). Sixty-eight percent benefited from information / recommendations on technical assistance of all types, 33% were helped / oriented in administrative procedures related to disability and 29% were redirected to medical professionals or other adapted structures. Conclusion: The creation of this team (and 6 other ones in Rhône-Alpes) allows responding to several priorities of public health: “facilitate access to an adapted and efficient healthcare offer”, “ make care pathway more fluid”. After more than a year of experience, improvement will be set up particularly in supporting caregivers and then in terms of territorial coverage and network development.

Keywords: Ambulatory shift, mobile team, rehabilitation

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

[TAG:2]B2 Cell And Tissue Adaptation and Maladaptation (E.G. Plasticity, Molecular Mechanisms and Mediators)[TAG:2]


  ISPR8-0066 Top


Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with rotator cuff tendon tear: A prospective, non-randomized, comparative, single-blind study

H. S. Lee, E. K. Kim, S. J. Kim

Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

E-mail: doctorhyosun.lee@samsung.com

Introduction/Background: We compared the clinical course of rotator cuff tears between exercise and bone marrow aspirate concentration (BMAC)-platelet rich plasma (PRP) injection to identify the therapeutic effects of BMAC-PRP on rotator cuff tears. Materials and Methods: Twenty-four patients with partial rotator cuff tear participated in this study [Figure 1]. Twelve patients underwent extraction of BMACs and PRP and received the injection of BMAC-PRP at the tear site under ultrasound guidance [Figure 2]. Twelve patients in the control group were asked to perform the rotator cuff exercise for 3 months. Visual analog scale (VAS) and manual muscle test (MMT) scores of the supraspinatus muscle were measured and the American Shoulder and Elbow Surgeons (ASES) score was recorded before, three weeks, and three months after injection. Tear size was measured by the greatest longitudinal tear length. Results: The change in the VAS differed between groups at three months (P = 0.039) but not at three weeks (P = 0.147). The ASES scores in the BMAC-PRP group changed from 39.4 ± 13.0 to 54.5 ± 11.5 at three weeks and 74.1 ± 8.5 at three months while those in the control group changed from 45.9 ± 12.4 to 56.3 ± 12.3 at three weeks (P = 0.712) and 62.2 ± 12.2 at three months (P = 0.011). The tear size decreased at three weeks or three months after the BMAC-PRP injection but was not significantly different from that in the control group [Figure 3]. Conclusion: BMAC-PRP improved pain and shoulder function in patients with rotator cuff tear.
Figure 1

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Figure 2

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Figure 3

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Keywords: Bone marrow aspirates, platelet rich plasma, rotator cuff tear

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


  ISPR8-1468 Top


Improving gait function and sensorimotor brain plasticity through robotic gait training with G-EO system in Parkinson’s disease

E. Andrenelli, M. Capecci, L. Di Biagio, L. Pepa, L. Lucarelli, C. Spagnuolo1, P. Guidoni1, P. Serafini1, F. Morgante2, M. G. Ceravolo

Department of Experimental and Clinical Medicine, Università Politecnica Marche, Ancona, 1Dipartimento di Riablitazione PPP, Istituto Santo Stefano, Porto Potenza Picena, 2Department of Clinical and Experimental Medicine, Institute of Molecular and Clinical Sciences, University of Messina/St George’s University of London, Messina, London, Italy

E-mail: m.capecci@univpm.it and elisa.andrenelli@gmail.com

Introduction/Background: Medication resistant-FOG (FOG-R) is a disabling symptom of advanced Parkinson’s Disease (PD) and it is largely untreatable. The study purpose was to examine the efficacy of robotic gait training (G-EO system) on FOG-R while analysing neurophysiological changes before and after treatment. Materials and Methods: 9 patients with advanced PD and history of FOG-R underwent G-EO training (12 sessions, 3 times/week, 4 weeks). Exclusion criteria were: dementia; change of PD medication in the last month; dyskinesias; other neurological disorders; severe orthopaedic and cardiovascular diseases; rehabilitation treatments within 3 months of enrolment. Outcome measures: number and duration of FOG episodes detected both in outpatient clinic during videotaped Timed Up and Go tests (TUG) and at home, by means of a smartphone app; Gait and Falls Questionnaire; New Freezing of Gait Questionnaire; PD Questionnaire-39; Home diary of falls, Mini-BESTest for balance evaluation, UPDRS III, Six-Minutes Walking Test. All patients were tested by Transcranial Magnetic Stimulation (TMS) before and after treatment both in OFF and ON medication states. Sensorimotor plasticity (SMP) was induced by means of the rapid paired associative stimulation (rPAS). Motor evoked potentials (MEPs) were recorded at baseline and for 15 minutes after rPAS. Results: After robotic treatment the gait performance improved in terms of speed, endurance, step rhythm and balance. At home, FOG occurrence and duration decreased by about 50%. Before rehabilitation, SMP was deficient in all subjects both in OFF and ON states. The robotic treatment restored the potentiation of MEPs amplitudes by rPAS both in OFF and ON states. An inverse correlation was found between PD duration and the improvement in MEPs amplitude induced by rPAS, after rehabilitation. Conclusion: Robotic gait training with G-EO System is an effective rehabilitation approach able to improve gait performance and reduce FOG-R in PD patients by shaping SMP.

Keywords: Gait, plasticity, robot

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


  B3 Biological Mechanism of Interventions (E.G. Pain Relief, Motor Learning) Top



  ISPR8-0129 Top


The physiological mechanism of gait improvement with rhythmic stimulation in patients with Parkinson’s disease

D. Nishida, M. Katsuhiro

Department of Rehabilitation, School of Medicine, Keio University, Tokyo Shinjuku-ku, Japan

E-mail: prix0616@gmail.com

Introduction/Background: Patients with Parkinson’s disease (PD) suffer from gait disturbance that, in some patients, can be improved by rhythmic stimulation. This effect is useful for their rehabilitation, but its physiological mechanism is not yet well understood. The purpose of this study is to investigate brain activation patterns with functional magnetic resonance imaging (fMRI) in patients with PD while they are imaging gait with and without rhythmic stimulation. Materials and Methods: The participants were 27 right-handed patients with PD (mean age: 76.3 +/- 6.6, 11 male), whose Yahr stages ranged from 2 to 3. They could walk independently, had no cognitive impairment, and could walk more smoothly with rhythmic stimulation than without it. As a control group, we examined 7 healthy 25 right-handed volunteers (mean age: 72.0 +/- 5.3, 13 males). The participants were asked to image gait with rhythmic stimulation (beep on 100 beats per minute) or with white noise during the fMRI imaging. Results: In patients with PD, with rthmic sound, the activation pattern was limited to supplementary motor area (SMA) and precentral lobule, while with white noise, the activation pattern was more widespread, including precuneus as well as SMA and precentral lobule (p < 0.001, (uncorrected)). In healthy controls, the activation was limited to SMA and precentral lobule both with rhythmic stimulation and with white noise. Conclusion: Both SMA and precentral lobule were activated while other regions including precuneus were less activated with rhythmic stimulation in patients with PD. This result may suggest that rhythmic stimulation can suppress the overactivation of precuneus to improve the attention and to correct the motor programs for the gait function in these patients. In this study, we could suggest the mechanism of the immediate effect of gait improvement with rhythmic stimulation.

Keywords: Functional magnetic resonance imaging, gait, Parkinson’s disease

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


  ISPR8-1704 Top


Using functional near infrared spectroscopy to assess the effect of transcranial direct-current stimulation on spinal cord injury patient, during robot-assisted gait

M. Simis, J. Ricardo Sato1, K. Santos, F. Fregni2, L. Rizzo Battistella

Department of Physical Medicine and Rehabilitation, University of Sao Paulo, 1Department of Neurosciences and Cognition, Federal University of ABC, Sao Paulo, Brazil, 2Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, USA

E-mail: marcelsimis@gmail.com

Introduction/Background: Neuroplasticity is believed to be an important mechanism related to motor improvement of spinal cord injury (SCI) during rehabilitation program, which may be enhanced using transcranial direct-current stimulation (tDCS). The better understanding of this process is important for the improvement of rehabilitation therapy since it can be used as a prognostic biomarker, surrogate outcome and to guide the parameters of tDCS. Functional Near Infrared Spectroscopy (fNIRS) is an instrument to measures hemodynamic responses in the brain, which allows to study functional brain connectivity reorganization. So, this study aims to demonstrate the feasibility of fNIRS to evaluate real-time activation of motor cortex SCI patients during robot-assisted gait. Besides, to compare changes induced by active vs. sham tDCS. Materials and Methods: It is a preliminary analysis of SCI patients enrolled in a randomized double-blind clinical trial, with two arms (active tDCS vs. sham tDCS). Both groups received 30 sessions of tDCS for 20 minutes immediately before gait training with robotic-assisted device Lokomat-Pro® (Hocoma). For fNIRS, 32 optodes was positioned parallel to the coronal plane. Software and hardware are from NIRX Medical Technologies. The differential hemoglobin index at rest (standing) and during movement were evaluated using paired T-test. The null hypothesis was that during gait, metabolic consumption would increase in the primary motor cortex (M1). Results: Patients had an enhanced activation of M1, next to Cz, C1 and C2 (10-20 EEG system) during gait, when compared with standing position. This activation seems to be higher in active group comparing to sham group [Figure 1]. Conclusion: This study shows the viability of use fNIRS to measure brain activity of SCI patients during robot-assisted gait. Future analyses, with a larger sample, are necessary to confirm these findings and correlate it with clinical outcomes.

Keywords: Functional near infrared spectroscopy, spinal cord injury, transcranial direct-current stimulation

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


  C1.01 Physical and Rehabilitation Medicine Diagnostics as Related to Organ Systems and Body Functions - Diagnosis and Assessment of Mental Functions (Including Neuropsychological Assessment) Top
Figure 1

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  ISPR8-1664 Top


Motor imagery ability in stroke patients with and without neglect: A pilot control case series study

J. Holé, S. Mateo, G. Rode

INSERM, Impact Team - INSERM U1028, Lyon, France

E-mail: j.hole@hotmail.fr

Introduction/Background: Individuals with stroke may experience sensory-motor deficit and/or neglect, with possible reduction in motor imagery ability (MI). To date, no study completely investigated MI ability in the same individual using measures adapted to clinical setting. This study aims to investigate MI ability in stroke patients with or without neglect as compared to aged-matched healthy individuals. Materials and Methods: We assessed explicit MI (EMI) using 3 questionnaires (Movement Imagery Questionnaire-RS – MIQ-RS, Kinesthetic and Visual Imagery Questionnaire-20 – KVIQ-20, Vividness of Movement Imagery Questionnaire-2) and 2 tests (Time Up and Go, Box and Block test), measuring i) vividness, ii) electrodermal activity and iii) temporal equivalence between MI and physical practice (PP). We also assessed implicit MI (IMI) using a hand laterality judgment task, measuring response time and percentage of correct responses. Results: We recruited a total of 12 stroke patients including one patient with neglect (experimental group, EG) and 12 healthy subjects (control group, CG). For EMI, comparison between EG and CG showed no significant decrease in vividness and electrodermal activity but an increase in MI duration regarding PP for both KVIQ and MIQ-RS. For IMI, comparison revealed similar response time but a significant decrease in percentage of correct responses for EG. Interestingly, the patient with neglect exhibited similar IMI performance to the one of other patients but the lowest vividness and the longest MI duration regarding PP for EMI. Conclusion: Stroke patients without neglect have reduced MI ability but seem still able to imagine movements. Conversely, neglect may sharply decrease EMI while sparing IMI. Although further interpretation should be formulated with caution given the small number of patients, one could likely include stroke patients without neglect in MI rehabilitation programs as suggested by other studies, but definitive exclusion from MI programs in case of neglect requires further investigations.

Keywords: Motor imagery, neglect, stroke

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


  ISPR8-2178 Top


Rey-Osterrieth complex figure tracing task for evaluating unilateral spatial neglect

R. Ohama, Y. Ohama, K. Yokoyama, S. Miura, K. Kawamura, M. Shimodozono

Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima City, Japan

E-mail: rintaro@m2.kufm.kagoshima-u.ac.jp

Introduction/Background: Unilateral spatial neglect (USN) is often observed in right brain-damaged (RBD) patients but it is a poor prognostic factor for predicting recovery of activities of daily living. In this study, we devised a convenient and quantitative test for evaluating USN, the Rey-Osterrieth Complex Figure (ROCF) tracing task, and examined its usefulness. Materials and Methods: The subjects were 40 healthy volunteers (21 males; mean age 58.9 years, SD 15.6) and 21 RBD patients (15 males; mean age 54.3 years, SD 10.1). After carrying out the task of copying ROCF, subjects underwent the task of tracing ROCF laid over carbon paper by using a chopstick so as not to leave lines directly on the ROCF. The RBD patients also carried out traditional tests for evaluating USN: the line bisection test, the line cancellation test, and a star cancellation test from the Japanese version of the Behavioral Inattention Test (BIT). We quantified results of both the copying and tracing tasks with the total score (Osterrieth, 1944) and the Laterality index (LI) (Jeffrey S 1995, 2001). We set the cut-off values for total score and LI to 2 SD below their averages in the healthy group. Results: Of the 21 RBD patients, 5 had USN as judged with the traditional tests. However, with the ROCF tracing task, the total scores of 6 patients and the LIs of 9 patients were below the cut-off values. Furthermore, with the ROCF tracing task, in one RBD patient USN was revealed that had not appeared in the ROCF copying task, and in another patient USN was revealed more clearly than with copying because of a decrease of constructive apraxia. Conclusion: The ROCF tracing task might quantify certain aspects of movement memory in the neglect syndrome and detect USN with greater sensitivity than the traditional tests.

Keywords: Rey-Osterrieth complex figure, test, unilateral spatial neglect

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


  C1.04 Physical and Rehabilitation Medicine Diagnostics as Related to Organ Systems and Body Functions - Diagnosis and Assessment Of Functions of The Cardiovascular, Haematological, Immunological, And Respiratory Systems Top



  ISPR8-1469 Top


Effects of exercise training on renal damage and renin-angiotensin system in rats with chronic renal failure

O. Ito, T. Nakamura1, S. Yamakoshi1, N. Mori1, K. Masahiro1

Department of General Medicine and Rehabilitation, Tohoku Medical and Pharmaceutical University, 1Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan

E-mail: oito@med.tohoku.ac.jp

Introduction/Background: Exercise training (Ex) is known to have antihypertensive and renal protective effects in humans and animals, but the mechanisms of these effects were unclear. Renin-angiotensin system (RAS) is associated with progression of hypertension and kidney diseases. To clarify the mechanisms of renal protective effects of Ex, the present study examined the effects of Ex on renal damage and RAS in the kidney of rats with chronic renal failure (CRF). Materials and Methods: Six-week-old male Sprague-Dawley rats were divided into three groups: 1) sham operation; 2) 5/6 nephrectomy (Nx)+sedentary; 3) Nx+Ex with treadmill running (20m/min, 60min/day, 5days/week) for 12weeks. Systolic blood pressure (SBP) and urinary excretion of protein (UP) were measured every 2weeks. The index of glomerular sclerosis (IGS), the relative interstitial volume of the renal cortex (RIV) and area of renal fibrosis (RF) were examined by using histological analyses. Protein expression of transforming growth factor (TGF)-β1 and RAS components in the renal cortex were examined by western blot. Results: Nx increased the SBP, UP and serum creatinine, but Ex decreased SBP after 8 weeks, UP after 10weeks and serum creatinine at 12weeks. Histological analysis revealed that Nx increased IGF, RIV, RF (IGS: 0.05±0.01 vs. 2.59±0.01?RIV: 4.6±0.7 vs. 19.7±0.7%?RF: 10.1±1.7 vs. 26.9±1.5%), but these parameter was improved by EX (IGS: 1.96±0.03?RIV: 12.5±1.0%?RF: 19.4±0.4%). Nx increased TGF-β1, angiotensinogen (AGT), angiotensin-converting enzyme (ACE) and angiotensin II type 1 receptor (AT1R) expressions, and Ex inhibited the Nx-increased expressions in the renal cortex. Nx decreased renin and angiotensin II type 2 receptor (AT2R) expressions, and Ex inhibited the Nx-decreased expressions in the renal cortex. Conclusion: Ex attenuated the progression of hypertension, glomerular sclerosis, and renal fibrosis in CRF rats. The antihypertensive and renal protective effects of Ex may be mediated by ameliorating the exacerbation of renal RAS.

Keywords: Exercise training, renal failure, renin-angiotensin system

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


  C1.07 Physical and Rehabilitation Medicine Diagnostics as Related to Organ Systems and Body Functions - Diagnosis and Assessment of Neurological, Musculoskeletal and Movement Related Functions (Including Gait Analysis, Posturography) Top



  ISPR8-1782 Top


Feasibility and reliability of a new three-dimensional bimanual protocol for children with unilateral cerebral palsy

B. Bouvier1,2, F. Gaillard1, G. Bouzillé1, T. Pasquet1, M. Cacioppo1, A. Crétual2, H. Rauscent1, I. Bonan1

1Department of Physical and Rehabilitation Medicine, CHU Pontchaillou, 2”Movement Sport and Health Sciences” Laboratory, Université Rennes 2, Rennes, France

E-mail: bricebouvier.fr@gmail.com

Introduction/Background: Children with unilateral cerebral palsy (uCP) have upper limb (UL) motor impairments that hinder the realization of activities of daily life, particularly in bimanual situations. The existing three-dimensional motion analysis (3DMA) protocols are limited to unimanual situations or have not been validated. This work aims at proposing a 3DMA child-friendly bimanual protocol and at assessing its feasibility and its reliability on typically developing children (TDC) and uCP children. Materials and Methods: 20 TDC (11.9±3.4 years) and 20 uCP children (12.0±3.2 years) participated by realizing 3 consecutive sessions of the protocol. The protocol consists of 4 complementary bimanual tasks that are integrated into a scenario game of “becoming an airplane pilot” [Figure 1]. It allows the exploration of all degrees of freedom of the UL. Kinematics of the non-dominant/hemiplegic UL was measured using an optoelectronic system (12 cameras). The reliability of the angular waveforms (WAVE), the maximum angles (MAX) and the range of motion values (RoM) has been assessed. Results: Results showed an excellent reliability for TDC (WAVE: CMC≥0.90 ; MAX & RoM: ICC≥0.82, SEM≤5.0°) and a very good reliability for uCP children (WAVE: CMC≥0.82 ; MAX & RoM: ICC≥0.75, SEM≤4.7°), at the exception of a few minor cases. A lower elbow extension, a lower supination and a higher wrist flexion were observed in uCP children compared to TDC. Conclusion: The very high reliability of the protocol is a very promising result. Its feasibility was excellent for TDC and uCP children, at the exception of one task for uCP children with a high level of deficit (MACS III). Future work consist of adjusting this protocol to all uCP children (MACS I, II, III) and assessing the between-day reliability, before its future deployment as a clinical routine.
Figure 1: Set-up of the protocol

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Keywords: Cerebral palsy, three-dimensional motion analysis, upper limb

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


  ISPR8-2483 Top


Plantar stimulation promotes long-term brain connectivity changes in subjects with Parkinson’s disease and freezing of gait - A randomized controlled trial

A. Pagnussat, A. Kleiner1, A. Franco2, A. P. Salazar3, R. Marchese3, C. Pinto3, C. Rieder4

Departments of Physiotherapy, 3and 4Neurology, Universidade Federal de Ciências da Saúde de Porto Alegre, 2Department of Electrical Engineering, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil, 1Dipartimento di Elettronica- Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy

Email: alinespagnussat@gmail.com

Introduction/Background: Subjects with Parkinson’s Disease (PD) and freezing of gait (FOG) may experience plantar sensory losses and decrease of brain connectivity in brain areas related to sensory-motor integration. Automated Mechanical Peripheral Stimulation (AMPS) is a technique used to deliver plantar stimulus and that is able to induce immediate positive effects on brain connectivity and functional mobility. Thus, in this study, we investigated the long-term effects of AMPS on resting state brain connectivity (rsfMRI) and gait velocity of subjects with PD and FOG. Materials and Methods: Twenty-five subjects with PD and FOG were randomly assigned to receive real AMPS (AMPS group) or placebo stimulation (AMPS SHAM group) in two target areas of both feet along four weeks (total of eight sessions). Primary and secondary outcomes included changes in rsfMRI and gait velocity, respectively. The single-subject functional connectivity maps were created using five Regions of Interest (ROI): left, right and mid sensory-motor regions, and left and right basal ganglia. Results: Nineteen patients were included in the rsfMRI analysis. The connectivity of the left basal ganglia increased with other four brain regions after real AMPS stimulation. AMPS group also showed increased connectivity between the right primary sensory-motor area and left prefrontal cortex and presented a higher increase in gait velocity. Additionally, brain connectivity between Medium Primary Sensory Motor Area and Right Primary Motor Cortex and between Right Primary Sensory Motor Area and Left Supplementary Motor Cortex were positively correlated with gait velocity (r = 0.78 and r = 0.77, respectively) [Table 1]. Conclusion: Our results showed that AMPS is able to promote long-term changes on rsfMRI, mainly in those areas related to sensory processing and sensorimotor integration. AMPS could ameliorate reduced plantar sensory abnormalities and facilitate brain compensatory pathways, and this could be the rationale behind the gait performance improvement after AMPS.
Table 1: Resting state connectivity results

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Keywords: Freezing of gait, Parkinson’s disease, sensory stimulation

Disclosure of interest: Gondola Medical Technologies SA provided the Gondola equipment. A Research contract is active since November 2015 between the Gondola Medical Technology and Politecnico de Milano. The sponsors were not involved in the design, conduct, collection, management, analysis, and/or interpretation of the study results.


  ISPR8-2612 Top


MSPMI study: Medical spastic patient machine interface: Preliminary results

M. Gahier1, D. Gamet1, K. Buffenoir2, B. Perrouin Verbe, R. Gross

Departments of Physical and Medicine Rehabilitation and 2Neurotrauma, University Hospital of Nantes, Nantes, 2Bio-mechanics and Bio-Engineering Laboratory, UMR 7338 CNRS, Research Center of Royalieu, Compiègne, France

E-mail: matthieu.gahier@hotmail.fr

Introduction/Background: Spasticity scales present poor metrologic qualities, especially concerning reliability. It allows qualitative assessement without distinction of neural and non-neural component. In 2005, the SPASM consortium published recommandations for promoting the developpement of instrumented devices devoted to spasticity assessment, recommandations renewed recently in an European consensus. The MSPMI (Medical Spastic Patient Machine Interface MSPMI) has been created in the UMR 7338 in Compiègne, designed for the study of triceps surae spasticity. The study MSPMI aims to measure the metrologic properties of this new tool. We present here the preliminary results on the first 15 patients. Materials and Methods: Interventional monocentric study with minimal risks and constraints conducted on the Nantes University Hospital. The inclusion criterion was spasticity defined as a minimal score of 1 on the modified Ashworth scale. 25 ankles were evaluated (15 subjects). Each patient was evaluated by two raters during the same session. The evaluation included passive stretch of the triceps surae according to 6 experimental conditions. The collected parameters were the Ashworth and Modified Tardieu scales and 25 kinematic, kinetic, electromyographic and mechanical parameters given by the MSPMI. Inter-observer reliability was evaluated by measuring an intra-class correlation coefficient (ICC) and the concurrent validity by a Spearman correlation test with a significance threshold set at 5%. Results: 16 of the 25 parameters have good inter-rater reliability (ICC> 0.6) and 7 of them have an ICC> 0.8. At intermediate speed, 56% of the parameters are significantly correlated to the modified modified Ashworth and Tardieu scales. Correlations are mostly moderate to good. The work variability index has an ICC of 0.85 and a good to moderate significant correlation at the clinical scales. Conclusion: The preliminary results of the IIMPS study are encouraging. The rest of this work will complete the study of the secondary evaluation criteria.

Keywords: Assessment, instrumented device, spasticity

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


  ISPR8-1856 Top


Reliability of posturographic measures obtained during instrumental assessment of trunk control using inertial sensors in individuals with spinal cord injury

A. S. Perez-SanPablo, J. Quinzaños-Fresnedo1, J. C. Lopez-Romero2, I. Quiñones-Uriostegui3

Department of Control Engineering, Human Motion Analysis Laboratory, National Institute of Rehabilitation, CINVESTAV, 1Department of Neurological Rehabilitation, National Institute of Rehabilitation, 2Department of Biomedical Engineering, Human Motion Analysis Laboratory, National Institute of Rehabilitation, Iberoamericana University, 3National Institute of Rehabilitation, Human Motion Analysis Laboratory, Mexico City, Mexico

E-mail: aisaacmx@hotmail.com

Introduction/Background: The seated position is the most frequent and fundamental for patients with Spinal Cord Injury (SCI). There are tests for clinically assessing seated postural control in SCI, most of them rely on distance related parameters. However, clinical assessment of trunk control in SCI is not enough sensitive to detect and/or describe a possible improvement. Hence, there is a need for practical, objective and reliable assessment tools to demonstrate the efficacy of different interventions in clinical practice. Therefore our objective was to establish the reliability of distance related measures obtained from inertial sensors (IMUs) to assess trunk control in SCI subjects. Materials and Methods: A cross-cutting study was performed where 15 non SCI subjects and 22 SCI subjects who fulfilled inclusion criteria were recruited. After signature of informed consent, there was held a concurrent application of the trunk control test (TCT) and the instrumental assessment (using IMUs attached to head and trunk of subjects) with repeated measures three times of static and dynamic control selected items, in an interleaved and random manner. IMUs 3D orientation was obtained during all time. Distance related parameters on transverse plane were obtained after applying IMUs 3D orientation to a biomechanical model of head and trunk segments. Dimensions were normalized to body segments. One-hundred twenty-four distance related measures were calculated. Test-retest reliability was measured by intraclass correlation coefficients (ICC) of items with repeated measures. Results: High reliability (ICC>0.5) was found on 10 distance related measures in both areas of static and dynamic equilibrium of TCT, measured on both the head and the trunk of SCI and non SCI subjects. Conclusion: It was demonstrated that the IMU usage has high reliability when measuring distance related parameters of static and dynamic control of the trunk.

Keywords: Posturography, seated posture, stability

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


  ISPR8-2581 Top


Role of spine in falls: prevention of falls and unsteadiness of gait through reeducation of proprioceptors of vertebral facet joints

M. Sinaki

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

E-mail: sinaki.mehrsheed@mayo.edu

Introduction/Background: Background and aims: The aim of this study was to determine the outcome of dynamic counterstrain and proprioceptive stimulation of specific vertebral facet joints to achieve reduction in risk of falls by reducing gait unsteadiness. Materials and Methods: Two groups were studied. Group A consisted of 39 patients who had gait disorder and propensity to falls, referred for fall prevention. All had comprehensive musculoskeletal and neurological evaluations. Subjects in this group were not able to return for follow up due to the distance from our institution. They all signed the consent form and were videotaped. Group B consisted of twelve subjects who were able to return for follow up and all underwent 2 supervised training sessions in our outpatient clinic. They had formal laboratory gait analysis and computerized dynamic posturography at baseline and follow up. They were instructed for a 4-week spinal proprioceptive extension exercise dynamic (SPEED) program to be performed at home with use of a weighted kypho- orthosis (WKO). The WKO applied properly accentuates a patient’s perception of spinal joint position. Intervention: All subjects had the trial of spinal proprioceptive extension exercise dynamic (SPEED) program. Outcome: Results of Gait lab analysis, computerized dynamic posturography, strength evaluation or videotapes were reviewed. Results: Group A was videotaped before and after SPEED and displayed noticeable improvement to their surprise. Group B, after a 4-week intervention, showed a significant change in balance (P =.003) and several gait parameters (P <.05). Mean back extensor strength improved significantly from baseline (144.0±46.5 N) to follow-up (198.6±55.2 N; P < 00l). Conclusion: Gait and risk of falls improved significantly after trial of SPEED program for reeducation of proprioception by application of mechanical counterstrain to specific areas of spine. This method of intervention might potentially lead to novel investigations for managing patients with unsteadiness of gait and propensity to falls.

Keywords: Falls, gait unsteadiness, prevention

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


  ISPR8-1621 Top


Eye-tracking technology: A quantitative approach of visual compensation during gait in patients with ataxic neuropathy

A. F. Gomes Paiva, P. Thoumie, D. Adams1

Department of Physical Medicine and Rehabilitation, ISIR-Sorbonne Universités, Rothschild Hospital, APHP, 1Department of Neurology, Univ. Paris-Sud 11, Kremilin Bicêtre Hospital-APHP, Paris, France

E-mail: gpaiva.ana@gmail.com

Introduction/Background: Proprioceptive impairment, as in the case of ataxic neuropathy, leads to visual compensation. The techniques of gaze analysis in static condition have been widely explored, but only recent technological innovations have allowed them to be associated with dynamic movements. In this context, we chose to use the eye-tracker glasses to analyze gaze and possible visual strategies established by these patients during gait. Materials and Methods: Three groups were selected: 15 health young subjects, 15 elderly subjects and 15 subjects with ataxic neuropathy. The experimental protocol consists of walk in a corridor with three different segments wearing the eye-tracker glasses. As for the gaze direction analysis we pre-defined classifications of the image called “observables”: these classifications consists on the time spent looking at the floor, the middle and the side parts of the corridor. Results: We observed a significant difference between the two groups of health subjects and the patients regarding the time spent looking at the “observables”. Fisher’s post-hoc results were: floor (F 2,132 = 37; p =<.0001); middle (F 2,132 = 9,8; p =<.0001) and the side parts (F 2,132 = 11,5; p =<.0001). We observed a better reproducibility of the evaluation in the three different segments by analyzing the time spent looking at the floor (F 4,84 = 1.4; p =.244), where no significant statistical difference on the performance of the subjects were found. Conclusion: The eye-tracker glasses have proven to be a relevant tool for the analysis of visual compensation, both reproducible and sensitive to the pathology. This technology has helped us to quantitatively characterize the visual strategy implemented by ataxic patients during gait.

Keywords: Ataxic neuropathy, eye-tracker, visual compensation

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


  ISPR8-1030 Top


Sit-to-stand movement score for the identification of a locomotive syndrome using the Nintendo Wii balance board

G. Yamako, E. Chosa1, K. Totoribe1, Y. Fukao1, G. Deng2

Mechanical Design Systems Engineering, University of Miyazaki, 2Department of Mechanical Design Systems, Faculty of Engineering, University of Miyazaki, 1Department of Medicine of Sensory and Motor Organs, Division of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

E-mail: g.yamako@cc.miyazaki-u.ac.jp

Introduction/Background: The Japanese Orthopaedic Association proposed the term “locomotive syndrome” (LS) to define people at risk of requiring nursing care because of problems with their locomotive system. There is a need to develop simple methods to quantify motor performance and the early detection of LS. Sit-to-stand (STS) movements are a mechanically demanding task in everyday activities and represent motor performance. In the present study, we have developed a novel method to quantify STS movements (STS score) using ground reaction force and center of pressure data from the Nintendo Wii Balance Board (WBB). We investigated whether the STS score can predict LS. Materials and Methods: The study enrolled 155 subjects aged over 65 years. Individuals were divided into three groups based on LS risk tests results. The subjects were instructed to stand up as quickly as possible on the WBB, and the STS score was calculated as the combination of the speed and balance indices. We also performed a timed up and go test and hand-grip strength test to evaluate the motor status. Results: There were significant differences in each test among the groups [Table 1]. Conclusion: The STS score significantly decreased with the severity of LS and thus could be used to assess LS in elder people.
Table 1: Parameters of the three groups of participants

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Keywords: Motor performance, Nintendo Wii balance board, sit-to-stand movement

Competing interests: This work was supported by Japan Science and Technology Agency, by LEXI Co., Ltd. Patent pending in Japan.


  ISPR8-2458 Top


Detection of the changes in coronal scoliotic curve profile from upright sitting to forward-bending position by ultrasound in patients with adolescent idiopathic scoliosis

W. W. Jiang1,2, C. L. K. Cheng1, J. P. Y. Cheung3, D. Samartzis3, H. Begovic1, M. K. T. To3, Y. Zheng1

1Department of Biomedical Engineering, The Hong Kong Polytechnic University, 3Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong S.A.R, 2College of Computer Science and Technology, Zhejiang University of Technology, Hangzhou, China

E-mail: harisbegovic@gmail.com

Introduction/Background: Scoliosis, a 3D-deformity, shows changes in coronal, sagittal and transverse planes. During forward bending (Adam’s test), spine shifts to either side and changes its pattern. Such a dynamic 3D change is difficult to be quantified with conventional X-ray imaging techniques due to exposure to ionized irradiation. For this reason, 3D ultrasound imaging was developed. Using a handheld ultrasound probe, we aimed to investigate measurement accuracy, detect dynamic changes during forward-bending, classify the curvatures and compare differences. Materials and Methods: A total of 72 AIS patients, age: 15.3±1.9 yrs., BMI:18.0±2.4kg/m2 were recruited. All patients received standing AP X-ray radiograph (EOS) for comparison with 3D ultrasound scanning (Scolioscan). Trunk rotation (ATR) was measured by scoliometer. Scanning was performed between L5 and C7 by a handheld probe in upright-sitting and forward-bending positions. 3D-image was reconstructed based on 2D-images, and spinal processes were used to form a spinal process angle (SPA), representing coronal plane changes. Results: Reliability of SPA measurement was found very good (ICC: 0.86) in both sitting and forward-bending positions. The SPA significantly decreased from 15.1±6.3° to 11.8±6.9° (p < 0.001) by forward-bending. Very low correlation was found between SPA change and ATR (r = 0.064, p = 0.62) and Cobb’s angle (r = 0.17, p = 0.09). The C-shape curve remained C (n = 20), while S-shape curve changed into C (n = 17) and rest of patients (n = 35) retained S-shape during forward-bending. Conclusion: Using ultrasound to construct a 3D image of the spine revealed significant changes in the coronal plane during forward-bending, where the biggest amount of flexibility, presented by a difference between two positions, happened in S-shape curvature. C-shape displayed the smallest change. This ultrasound technique, as a reliable measurement, is expected to facilitate understanding of the functionality and/or flexibility of the scoliotic curve. Hence ultrasound provided frequent scanning can potentially bypass X-ray imaging, help to follow the progress with frequent scanning and redesign the treatment accordingly.

Keywords: Forward-bending, scoliosis, ultrasound imaging

Disclosure of interest: The author Zheng Y was an inventor of a number of patents related to the 3D ultrasound imaging techniques, some of which have been licensed to Telefield Medical Imaging Limited through the Hong Kong Polytechnic University. Zheng Y was also consultant for the company to improve the function of Scolioscan. From this licensing arrangement, Zheng Y may receive royalty share from the Hong Kong Polytechnic University.


  C2.01 PRM Interventions Research - Exercise Top



  ISPR8-0865 Top


The effectiveness of affordable technology in rehabilitation to improve mobility and physical activity: AMOUNT (Activity and MObility UsiNg Technology) rehabilitation trial

C. Sherrington1, L. Hassett1,2, M. van den Berg3, R. Lindley4, M. Crotty3, A. McCluskey2, H. van der Ploeg5, S. Smith6, K. Schurr7

1Musculoskeletal Health Sydney, The University of Sydney, 2Faculty of Health Sciences, The University of Sydney, 4Westmead Clinical School, The University of Sydney, 7South Western Sydney Local Health District, Bankstown-Lidcombe Hospital, Sydney, 3Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, 6Southern Cross University, Coffs Harbour Campus, Coffs Harbour, Australia, 5Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands

E-mail: cathie.sherrington@sydney.edu.au

Introduction/Background: Technology may enable a higher dose of exercise to improve rehabilitation outcomes. Aim: to evaluate the effect of the addition of affordable technology to usual care on physical activity and mobility in people with mobility limitations admitted to inpatient aged and neurological rehabilitation compared to usual care alone. Materials and Methods: A pragmatic, assessor-blinded, parallel-group randomised trial of 300 consenting rehabilitation inpatients. The intervention group received technology-based exercise prescribed by a physiotherapist to target mobility and physical activity problems for 6 months. Technology included video and computer games/exercises, tablet applications and activity monitors. The control group received no additional intervention and both groups received usual rehabilitation care. The co-primary outcomes were objectively assessed physical activity (average minutes per day spent upright using activPAL) and mobility (Short Physical Performance Battery, SPPB, 0-3 continuous score) at 6 months after randomisation. Linear models assessed the effect of group allocation with baseline scores entered as covariates. Results: Participants (mean age 74 (SD14); 50% female; 54% with neurological conditions limiting mobility) received on average 11 (SD11) inpatient sessions using 4 (SD1) different technologies and 15 physiotherapy contacts to support technology use in the post-hospital phase. At 6-months physical activity was similar between groups (mean between group difference (95%CI) uptime in minutes: -3.1 (-39.4 to 33.2; p = 0.87)) and mobility was significantly better in the intervention group compared to the control group (mean SPPB between group change score 6-month to baseline 0.2 points (95% CI 0.1 to 0.3, p < 0.01)). Secondary outcomes of mobility also favoured the intervention group as did other aspects of physical activity (e.g. self-reported physical activity), particularly for younger participants. Conclusion: A tailored intervention using technology, targeting specific mobility limitations and promoting physical activity in addition to usual rehabilitation, improved mobility and some aspects of physical activity and appears to have greater impact in younger people.

Keywords: Mobility, physical activity, technology

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


  ISPR8-1569 Top


Safety, compliance, and efficacy of newly developed videogame based exercises using wearable sensors for aged people

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

Department of Rehabilitation Medicine, Seoul National University, Seoul, Republic of Korea

E-mail: no-gold@hanmail.net

Introduction/Background: Videogame based exercise, namely exergame, is an innovative approach to enhance physical activity in the elderly. This study was done to evaluate the safety, compliance, adherence and efficacy of exergames using wearable sensors. Materials and Methods: 60 aged people (77.5±6.4 years) played 3 exergames including abdominal bracing, Q-setting and balance training games for 12 weeks. Wearable pressure sensors were applied on the abdominal and quadriceps muscles and magnetic sensors under the soles to monitor accuracy and intensity of targeted activities [Figure 1]. Safety and compliance were assessed by dropout ratio and personal interviews. Adherence to progression of sessions was measured by calculating total exertional index, the duration of exertional pressure or step-on status, and compared between the earlier and later weeks. A simplified frailty screening battery was devised to measure skeletal muscle mass, grip strength, walking speed, unipedal stance test and short geriatric depression scale before and after the exercise program. Results: 54 participants completed. Dropout reaseons were lack of time (4), ankle fracture by unrelated activity (1) and fear of aggravating pre-existing sciatica (1). 14.8% and 5.6% of participants complained of leg pain and difficulty in exercising, respectively. The total exertional indices were significantly increased in the later phase of sessions, showing 35.9±23.9 vs 41.6±28.0 kPa·min (p = 0.013), 129.5±76.5 vs 147.4±81.2 kPa·min (p = 0.040), and 12.1±3.0 vs 13.1±2.6 steps (p = 0.018) for abdominal bracing, Q-setting and balance training games, respectively. There were statistically significant improvements in skeletal muscle index (33.7±3.7 vs 34.4±4.1%, p = 0.004), grip strength (20.0±5.6 vs 21.5±5.5kgf, p = 0.000), walking speed (0.89±0.19 vs 1.26±0.19 m/s, p = 0.000), and balance ability (10.8±7.6 vs 15.4±9.8 sec, p = 0.000) after the exercises. Conclusion: This study demonstrates that three exergames developed in this study can be safely done with high compliance for 12 weeks, improving skeletal muscle mass, muscle strength, function and balance.

Keywords: Elderly, exergame, wearable sensors

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


  ISPR8-1988 Top


Therapist-supervised compared to home-based balance training encourages a “posture first” strategy during turn-to-sit transitions in individuals with Parkinson’s disease

K. Welman, E. Atterbury

Department of Sport Science, Stellenbosch University, Stellenbosch, South Africa

E-mail: welman@sun.ac.za

Introduction/Background: Individuals with Parkinson’s disease (IwPD) tend to turn slower and with more steps than age-match healthy individuals. This poor postural control during complex transitional movements, like turning or turn-to-sit, results in increased fall risk, as well as diminished quality of life and independence. Fall risk is furthermore aggravated when IwPD attempt to perform multiple tasks at the same time (i.e. termed dual-tasking). Previous research has shown that balance training effectively improves postural control in IwPD; however, whether a therapist-supervised or home-based balance training program is more effective remains unclear. Consequently, this study endeavoured to compare the effect a therapist-supervised and home-based eight-week balance training program has on turning in IwPD. Materials and Methods: Twenty-nine men (65.7±7.1years) diagnosed with PD (Hoehn&Yahr: II-III) were randomized into a therapist-supervised (n = 15) or home-based (n = 14) group. Both groups followed an eight-week balance training program (3x week for 45-50minutes) under the supervision of a therapist or on their own with a DVD. Turn-to-Sit, Turning Velocity (TV) and Duration (TD) were assessed with a 7m Timed-Up-and-Go test and the APDM mobility lab®, during single- and dual-task conditions, over the interventions. Percentage dual-task cost (%DTC) was also determined. Results: No differences were found between the groups for TV and TD over time (p>0.05). Therapist-supervised group completed the Turn-to-Sit faster over the intervention and compare to the home-based group during single- and dual-task conditions (p < 0.05). The %DTC was poorer in the home-based compared to therapist-supervised group post-intervention (p = 0.04). Conclusion: Findings suggest that when IwPD are supervised by a therapist that they learn to prioritize postural control during the turn-to-sit transitions (i.e. ‘posture first’ strategy) as well as switch more effectively from one motor program to another. While an unsupervised home-based balance program resulted in a ‘posture second’ strategy, in which participants’ attention was divided, which may contribute to an increase fall risk.

Keywords: Exercise delivery, Parkinson’s disease, postural control

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


  ISPR8-1168 Top


Speed profiles modelization during sprint in wheelchair basketball players

D. Pradon, T. Li, T. Weissland1

Laboratoire Analyse Mouvement, Hopital Raymond Poincare, Garches, 1UFR-STAPS-Université de Picardie Jules Verne, Laboratoire de recherche Adaptations Physiologiques à l’Exercice et Réadaptation à l’Effort, Amiens, France

E-mail: didier.pradon@aphp.fr

Introduction/Background: The sprint skill is predominant in wheelchair basketball game strategy [Bloxham 2001] and need to be optimized during the training session. The development of sensors fixed to the wheelchair gives complementary and objective datas for the coach and players [van der Slikke 2017]. The aim of the study was to define a propulsive efficiency index with wearable sensor during a sprint session. Materials and Methods: Eleven wheelchair basketball players (32.5 ± 2.5 years, 70.1 ± 22.3 kg, IFWB classification 2.9 ± 1.6 points) realized 2*10m sprint trials in a straight line on taraflex floor with their basketball wheelchair. The angular velocity of the right wheel is measured by the inertial sensor fixed to the hub (50Hz, WheelPerf, AtoutNovation). A modelization of the min and max peaks of velocities for each push was defined by the computation of a 2 degree polynomial function. The propulsive efficiency is associated with the quantification of the R squared of the polynomial function. The maximum velocity (Vmax) and its location during the sprint were calculated. Results: The times between the 2 trials are similar (CV = 1.3%). Although Vmax was reached mainly at the end of the sprint (83 to 100%) and required between 8 and 10 pushes, Vmax is different between the players (3.4 to 4.7 m.s-1). The value of the R square is different between the players (0.91 to 0.64) but similar for each of the two trials (0.02). Conclusion: The variations in the peaks velocity distribution induce some elements to improve the propulsion method according to the classifications and the adjustments of the wheelchair. The use a wearable sensor to quantify motor efficiency seems to be a relevant tool for the assessment and monitoring of wheelchair basketball players.

Keywords: Sport, wearable sensor, wheelchair

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






  ISPR8-1868 Top


Investigating the effects of manual wheelchair adjustments on locomotion stability through multi-factorial numerical simulations

S. Hybois, J. Bascou1, F. Lavaste, H. Pillet, C. Sauret1

Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, 1Centre d’Etudes et de Recherche sur l’Appareillage des Handicapés, Institution Nationale des Invalides, Créteil, France

E-mail: samuel.hybois@ensam.eu

Introduction/Background: Manual wheelchair (MWC) enables people with certain disabilities to recover mobility at the expense of higher energy expenditure for the upper limbs. To reduce the risk of musculoskeletal disorders, MWC configuration has to be adapted to the user, meanwhile considering MWC stability to reduce the risk of fall. The aim of this study was to investigate the effect of various adjustments on MWC stability during locomotion. Materials and Methods: A numerical representation of the MWC was developed, allowing several tasks of daily life (start-up, propulsion, turning, etc.) to be simulated from various MWC configurations. The inputs of the model were the mechanical actions of the user on both the frame and the two handrims, and the kinematics, which enabled the computation of ground reaction forces on the wheels. Subsequently, the proportion of the normal component on both the rear and front wheels allowed calculating a locomotion index of stability, which revealed either backwards, balanced or frontwards loading of the MWC. Results: Simulation allowed investigating multiple adjustments, altering the rear wheel axle position with respect to the seat (-10 to + 10 cm) and the wheelbase (20 to 50 cm). The different combinations from these two parameters resulted in important changes in stability, ranging from -18% backward to +59% forward with respect to the balance position [Figure 1]. Conclusion: MWC settings are multiple and interdependent, and affect both mobility and stability. Multi-factorial simulations could then help to design suitable MWC configurations for users. In this study, we focused on stability but other parameters could have been studied because trade-offs have to be made between stability, mobility and energy expenditure. For that purpose, optimization procedures could be used to assist clinician in finding the most suitable MWC settings.
Figure 1: Relative stability index during a turning maneuver for different manual wheelchair configurations. Dark blue (0%) represents the most stable position, while positive (resp. negative) values account for forwards (resp. backwards) loading

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Keywords: Manual wheelchair, numerical simulation, stability

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


  C2.08 PRM Interventions Research - Heat and Cold Top



  ISPR8-0206 Top


The effectiveness of cold in the recovery post-exercise in kayak sprint

F. Laia, B. Gomes1, A. Santos1, J. Pinheiro

Department of Rehabilitation Medicine, Faculty of Medicine, University of Coimbra, 1Faculty of Sport Sciences, University of Coimbra, Coimbra, Portugal

E-mail: reabmedica@hotmail.com

Introduction/Background: Athletes in kayak sprint competitions often do several races successively with short time to recover. High performance training also involves daily training sessions with high volume and intensity. Cold is used in sports as a quick and easy recovery method therefore the current study’s goal is to analyze the impact of a cooling vest in elite sprint kayakers’ recovery. Materials and Methods: Ten elite sprint kayakers (age, 21.63 ± 2.85 years; height, 177.9 ± 7.33cm; body mass, 75.18 ± 7.33kg) completed, in kayak ergometer, on two days apart the same protocol except for the active rest, in which, randomly, in one of them they used a cold vest. Each moment was performed in a room with controlled temperature (20.93°C to 21.22°C) and humidity (66.04% to 68.90%), consisting in 15 minutes of acclimatization, warm-up, 5 times 5 minutes (at 75% maximal average power (MAP) in 4 minutes test), 15 minutes of active rest at 40% MAP, 15 minutes of passive rest and finally a 500m maximal test. On both moments it was determined, among others, the blood lactate concentration, the core temperature assessed by urine temperature and it was asked the rating of perceived exertion (Borg’s RPE Scale) and recuperation (0 to 10 scale with 10 representing completely recovered). Results: There was no significant difference between the 500m maximal test in the two moments. However the athlete’s subjective perception of recovery was significantly higher with vest (p < 0.01). The blood lactate concentration was significantly lower after the active recovery using the cold vest (p < 0.05) as well as core temperature, 15 minutes after the active rest (p < 0.05). Conclusion: Results suggest that the use of a cooling vest during active rest after training or competition can improve recovery. It has interest to test it in on-water situations.

Keywords: Cold, exercice, recovery

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


  C2.12 PRM Interventions Research - Pharmacological Interventions (E.G. Pain, Spasticity, Anti-Inflammatory Drugs) Top



  ISPR8-0143 Top


Use of local anesthetics and cortisone in pain injection therapy – A comparison of necrosis and apoptosis-induction in joint cells

A. Zhang, A. Ficklscherer, E. Kraft, V. Jansson, P. E. Mueller

Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Clinic of Munich, Munich, Germany

E-mail: anja.zhang@med.uni-muenchen.de

Introduction/Background: Ropivacaine, bupivacaine and triamcinolone are used daily in injections during surgeries and pain therapy. The purpose was to analyze the ability of local anesthetics and cortisone to induce apoptosis and necrosis in fibroblasts, tenocytes and human mesenchymal stem cells (hMSC). Materials and Methods: Fibroblasts, tenocytes and adipose-derived hMSC were seeded in T25 flasks at a cell density of 0.5x104/cm2. Ropivacaine, bupivacaine and triamcinolone were added individually to the cells using concentrations of 0.5%, 0.25% and 0.125%. No addition of specimen was used as negative control. After 30 minutes incubation and medium change the cells were harvested at 1 hour, 24 hours and 7 days of incubation. Analysis via fluorescence-activated cell sorting (FACS) using double-staining with Annexin V and PI was performed. Annexin V stains apoptotic cells while PI enables necrotic cells to be differentiated. Therefore the FACS method allows a quantitative as well as a qualitative analysis of each cell population. SPSS was used for statistical analysis to determine significant difference (p> 0.05) between specimen and control groups. Results: Bupivacaine shows necrosis-inducing effects on fibroblasts and tenocytes, the necrotic effect peaking at 0.5%. Ropivacaine and triamcinolone cause no significant necrosis. In comparison to fibroblasts and tenocytes, hMSC did not show significant necrotic or apoptotic effects after exposure to bupivacaine. Overall, no significant difference in apoptosis was detected between different cell lines, varying concentrations of the specimen or time of measurements. Conclusion: Bupivacaine 0.5% has the highest necrosis-inducing effect on fibroblasts and tenocytes in comparison to ropivacaine which causes less necrotic tissue. hMSC exhibited less necrosis compared to fibroblast and tenocytes. This may advise to prefer ropivacaine over bupivacaine for clinical practice.

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


  C2.14 PRM Interventions Research - Acupuncture and Complementary and Alternative Therapies Top



  ISPR8-1022 Top


Acupuncture for treatment of persistent disturbed sleep: A randomized clinical trial in veterans with mild traumatic brain injury and posttraumatic stress disorder

W. Huang, T. Johnson1, N. Kutner2, S. Halpin3, P. Weiss4, P. Griffiths5, D. Bliwise6

Atlanta VAMC, TBI/Extended Care, Duluth, Departments of 1Medicine and 2Rehabilitation Medicine, Emory University School of Medicine, 3Emory Prevention Research Center, Rollins School of Public Health, 5Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 6Atlanta VAMC, Geriatric Research, Education and Clinical Center, 7Department of Neurology, Emory University, Atlanta, USA

E-mail: whuang4@emory.edu

Introduction/Background: Persistent sleep disturbance is one of the most highly prevalent symptoms after mild traumatic brain injury (mTBI) and is often refractory to conventional therapies. In the presence of co-existing post-traumatic stress disorder (PTSD), it is especially hard to treat. This randomized clinical trial (RCT) is to evaluate real acupuncture, as compared to sham, in improving persistent sleep disturbance in veterans with mTBI and PTSD. Materials and Methods: This RCT was conducted at a US Department of Veterans Affairs Medical Center and included sixty veterans aged 24-55 (mean 40) with history of mTBI of at least 3-months and refractory sleep disturbance. They were randomized into 2 groups and stratified by PTSD status. Each received up to 10 treatment sessions. The primary outcome measure was change in baseline-adjusted global Pittsburgh Sleep Quality Index (PSQI) score following intervention. Secondary outcomes were wrist-actigraphy assessed objective sleep measurements. Comorbid PTSD was analyzed as a covariate. Results: Mean [SD] pre-intervention global PSQI score was 14.3 [3.2]. Those receiving real acupuncture had a global PSQI score improvement of 4.4 points (relative to 2.4 points in sham, p = 0.04), and actigraphically measured sleep efficiency (absolute) improvement of 2.7% (relative to a decrement of 5.3% in sham, p = 0.0016). Effective blinding for active treatment was maintained throughout the study. PTSD participants presented with more significant sleep difficulties at baseline; acupuncture was effective for those both with and without PTSD. Conclusion: Real acupuncture, compared to a sham needling procedure, resulted in a significant improvement in subjective and objective sleep measures for veterans with mTBI and disturbed sleep, even in the presence of PTSD. These results indicate that an alternative medicine treatment modality like acupuncture provides meaningful relief for a particularly recalcitrant problem affecting large segments of the veteran population.

Keywords: Acupuncture, mild traumatic brain injury, sleep

Disclosure of interest: The work was supported by a US Department of Veterans Affairs Rehabilitation Research and Development Career Development Award Level II (WH) (B6924W).


  C2.16 PRM Interventions Research - Virtual Reality Top



  ISPR8-0205 Top


Usability and efficacy of a virtual reality simulator for power wheelchair training

P. Archambault1, F. Routhier2, D. Gagnon3, W. Miller4

School of Physical and Occupational Therapy, McGill University, H3G 1Y5, 1Université Laval, École de réadaptation, Québec, 2Université de Montréal, École de réadaptation, Montreal, 3Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada

E-mail: philippe.archambault@mcgill.ca

Introduction/Background: Power wheelchair (PW) skills training is generally seen as insufficient by both clinicians and PW users. A virtual reality (VR) simulator may be helpful in improving PW driving skills, when used in addition to regular training. In previous work, challenging PW driving activities have been identified through interviews with expert clinicians and PW users and were then integrated in the McGill Immersive Wheelchair simulator (miWe). Our objective was to evaluate the effectiveness of VR simulator trainingon real PW driving skills. Materials and Methods: The miWe simulator included six PW driving activities (bathroom, shopping center, supermarket, elevator, street crossing and adapted transport vehicle). A computer with a joystick was installed in the participant’s home. Participants (new PW users) were randomly allocated to the simulator or control group. Participants in the control group were asked to practice on a racing videogame (also using a joystick). Participants in both groups were asked to practice for at least 20 minutes every two days, over a two-week period. We compared real wheelchair driving skills as measured by the wheelchair skills test (WST), before and after the intervention. Results: A total of 43 participants completed the study. All practiced on the simulator or computer game at least twice as much as what was minimally required. Results indicate that the WST scores in the experimental group increased by 7% on average, compared to 2% in the control group. Feedback regarding ease of use and potential usefulness of the PW simulator was very positive. Conclusion: Our preliminary results show that miWe simulator training may lead to improved wheelchair skills as compared to training with a racing videogame. A PW simulator may be helpful to new users if it promotes the practice of activities in specific environmental contexts to complement the basic skills training received in the clinic.

Keywords: Power wheelchair, simulator, virtual reality

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


  ISPR8-2574 Top


Use of immersive virtual reality to detect unilateral spatial neglect in chronic stroke

R. Ronchi1,2, D. Perez-Marcos3, A. Giroux3, M. Thomasson4, A. Serino2, 3, 5, A. Saj6, O. Blanke2,7

1Laboratory for Behavioral Neurology and Imaging of Cognition, University of Geneva, 2Ecole Polytechnique Fédérale de Lausanne, Laboratory of Cognitive Neuroscience, Brain-Mind Institute, 4Faculty of Medicine, University of Geneva, 6Department of Neurology, Neuropsychology Unit, University of Geneva, 7Ecole Polytechnique Fédérale de Lausanne, Center for Neuroprosthetics, Geneva, 3Department of Neurosciences, MindMaze SA, Lausanne, 5Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland

E-mail: daniel.perez@mindmaze.ch

Introduction/Background: Unilateral spatial neglect (USN) is a neuropsychological syndrome in which patients fail to pay attention to and represent the contralesional part of the space. Standard assessment of USN is carried out with paper-and-pencil tests, which do not capture the full range of deficits (i.e., not sensitive enough; no evaluation of “far” space) or detect compensatory learning effects in chronic patients. Here we explore interactive and ecological assessments within immersive virtual reality (IVR) to overcome these limitations. Materials and Methods: 12 chronic stroke patients (58±9.4 years; 5 female; time from stroke: 15.8±7.7 months) completed a battery of paper-and-pencil neuropsychological tests (line bisection, cancellation, reading, drawing, functional scales) and a IVR-based assessment for extra-personal USN. In the IVR tasks, participants were presented with a virtual environment representing a forest, via head-mounted display [Figure 1]. The tasks consisted of finding static objects (level 1) or moving rabbits (levels 2-4) in the scene. Difficulty was modulated with the presence of distractors and an additional auditory dual task. Participants used the embedded head tracker in the HMD to control a pointer to select the targets in the scene, and the space bar of the computer to validate the selected item.
Figure 1

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Results: Four patients presented USN in both paper-and-pencil and IVR tasks. Interestingly, two other participants showed signs of neglect in the IVR assessment without being classified as neglect patients in the paper-and-pencil tests. These patients did not show signs of USN in the items of the Catherine Bergego Scale that assesses their ability to explore the extra-personal space. Conclusion: This preliminary data suggests that IVR-based assessments represent an easy-to-use and consistent tool to investigate USN, can extend its evaluation to the far space, and can detect USN in chronic patients who do not show sign of neglect in standard assessments.

Keywords: Stroke rehabilitation, unilateral spatial neglect, virtual reality

Disclosure of interest: This work was supported by the Swiss Commission for Technology and Innovation (CTI) (project #16446). DPM and AG and AS were employees of MindMaze at the time of the study.


  ISPR8-1275 Top


Barriers and facilitators of integrating the miWe immersive wheelchair simulator as a clinical tool for training powered wheelchair driving skills

F. Routhier1,2, P. S. Archambault3,4, M. A. Choukou1,5, E. Giesbrecht6, J. Lettre1, W. C. Miller7, 8, 9

1CIUSSS de la Capitale-Nationale, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 2Department of Rehabilitation, Université Laval, 5TOPMED, Research and Development, Quebec City, 3School of Physical and Occupational Therapy, McGill University, Montreal, 4Centre intégré de santé et de services sociaux de Laval, Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Laval, 6Department of Occupational Therapy, University of Manitoba, Winnipeg, 7Department of Occupational Science and Occupational Therapy, University of British Columbia, 8GF Strong Rehabilitation Centre, 9International Collaboration on Repair Discoveries, Icord, Vancouver, Canada

E-mail: francois.routhier@rea.ulaval.ca

Introduction/Background: Training is an essential aspect of power wheelchair (PWC) service delivery, but is often insufficient and inadequate, which can lead to sub-optimal wheelchair driving skills and decreased confidence in one’s abilities. Training using a validated and portable virtual reality platform could increase access, efficiency and safety in PWC skills training. The McGill Immersive Wheelchair Simulator (miWe) was developed for this purpose and has already been validated for PWC training. Before integrating miWe into clinical practice we need input from stakeholders to optimize uptake. Therefore, the objective of this project is to investigate clinical stakeholders’ acceptance of miWe as a potential PWC skills training tool in a rehabilitation setting. Materials and Methods: A series of focus groups were used to obtain perspectives from clinical program directors and rehabilitation therapists experienced in PWC skills training from four sites in two Canadian provinces. An online survey was also conducted to obtain perspectives from therapists who were not able to attend the focus groups. Results: Thirteen occupational therapists, seven clinical program directors, two seating clinical specialists and one orthotic/prosthetic mechanic (n = 23) participated in the focus groups, and seven occupational therapists completed the survey. Participants generally expressed that use of miWe would be complementary to training in a real PWC, and that miWe could be useful for challenging situations in rehabilitation centres (e.g., clients who are anxious; when there is uncertainty around their potential to drive a PWC; tasks that cannot be assessed in a real-life environment). They also provided suggestions to improve miWe (e.g., more feedback during tasks; possibility of adjusting the parameters and adding varied control interfaces). Conclusion: MiWe has the potential to provide a robust platform for the assessment and training of complex PWC driving skills in a realistic and immersive training context. The results of this project will inform its potential distribution in rehabilitation centres.

Keywords: Power wheelchair, skills training, virtual reality

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


  ISPR8-2000 Top


Serious games in cognitive rehabilitation of spatial navigation impairment

M. van der Kuil, A. Evers, A. Visser-Meily1, I. van der Ham

Institute of Health, Medical and Neuropsychology, Leiden University, Leiden, 1Center of Excellence in Rehabilitation Medicine, University Medical Center Utrecht, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands

E-mail: m.n.a.van.der.kuil@fsw.leidenuniv.nl

Introduction/Background: Stroke patients often report navigation problems (29%). Navigation impairments have a profound impact on the quality of life, as patients experience spatial anxiety, limited mobility, and reduced autonomy. Yet, no standardized rehabilitation training is currently available. The aim of this study is to develop a rehabilitation training for navigation impaired stroke patients in the form of a serious game. Impairments often affect spatial abilities in either the egocentric (route knowledge) or allocentric (survey knowledge) domain. Patients with impairments in the allocentric domain will receive a egocentric training game and vice versa. The goal of the training is to aid patients in the development of compensatory navigation strategies. To this end, 3 exercises in 3D virtual environments are provided in each version of the application. Gaming principles are implemented to increase a patient’s motivation, introduce dynamic difficulty levels, provide feedback and to allow for unsupervised training. Materials and Methods: The feasibility of the training was investigated in a study with 86 healthy participants. Navigation strategy and abilities were assessed in pre and post-training sessions. Based on their pre-training strategy, participants played either the egocentric training (n = 21) or the allocentric training (n = 22) version of the game. Participants engaged in 4 training sessions over a period of 2-3 weeks. Participants in the control conditions (n = 43) did not play the game. Results: Results show that 42.86% of participants in the egocentric training condition adapted an egocentric strategy after the training. The percentage of participants that changed strategy after using the allocentric training, 13.63%, was comparable to that of the control groups 16.23%. Conclusion: We conclude that the rehabilitation training successfully induced strategy change. However, in a healthy population, strategy change was limited to the egocentric domain. Future research is needed to determine the effect of the training in a patient population.

Keywords: Cognitive training, navigation impairments, serious games

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


  C2.17 PRM Interventions Research - Rehabilitation Technology, Including Implants, Prosthesis, Orthoses Top



  ISPR8-2378 Top


Spatiotemporal neuromodulation of the spinal cord in combination with a gravity-assist training to improve locomotor recovery in humans with spinal cord injury

P. Séguin1,2, F. Wagner1,2, J. B. Mignardot1,2, C. G. Le Goff1,2, S. Komi1,2, R. Demaesmaker1,2, M. Capogrosso1,2, L. Maccracken1,2, M. Vat1,2, K. Minassian1,2, J. Bloch1,3, G. Courtine1,3

1Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology Lausanne EPFL, Departments of 2Clinical Neuroscience and 3Neurosurgery, University Hospital of Vaud CHUV, Lausanne, Switzerland

E-mail: perrine.seguin@outlook.fr

Introduction/Background: Over the past decade, we have developed spatiotemporal neuromodulation therapies of spinal circuits and gravity-assist training procedures in pre-clinical model of spinal cord injury (SCI) which allowed to restore supraspinal control of locomotion in rats with a SCI leading to complete and permanent paralysis. So far, human studies on epidural electrical stimulation (EES) were mainly limited to continuous neuromodulation, which has demonstrated several limitations to promote the recovery of functional movements such as walking. In this study, we aimed to assess the feasibility and the efficacy of a neuroprosthetic rehabilitation program that combines spatiotemporal EES and gravity-assist training to enhance the recovery of voluntary motor control and functional autonomy. Materials and Methods: Individuals with a chronic incomplete SCI were surgically implanted with a spinal cord electrostimulation system with 16 independent electrodes positioned over the lumbar spinal cord. The stimulator was equipped with real-time triggering capacities based on movement feedback. They then underwent 20 weeks of rehabilitation, four sessions per week, with a gravity-assist that provided a tailored, multidirectional assistance of trunk movements during gait training. Multifaceted evaluations of clinical scores, gait analysis, sensorimotor functions, urodynamics, electrophysiology, and imaging were performed before and throughout the rehabilitation program. Results: A total of 4 chronic SCI patients have been included to date, with deficits ranging from AIS-B to AIS-D. The participants who completed the study have demonstrated various types of improvements in term of muscle force, gait autonomy and quality as well as daily-life-related activities. These positive results have been observed both immediately when the EES therapy was applied and were reinforced after the long-term training. Electrophysiological and neuro-imaging analysis contributed to explaining the mechanisms underlying the long-term improvements. Conclusion: Preliminary data provides encouraging results on the ability of this therapeutic intervention to improve the recovery of motor functions and other important bodily functions after a chronic SCI.

Keywords: Neurostimulation, robotic, spinal cord injury

Disclosure of interest: This clinical study (STIMO, ClinicalTrials.gov Identifier: NCT02936453) was co-sponsored by EPFL, GTX medical and Medtronic Inc . G.C. and J.B. are founders and shareholders of GTX medical, a company developing neuroprosthetic and body-weight support systems directly related to the present work. G.C. and J.B. receive consulting fees from GTX medical for work not directly related to this study. All the other authors declare that they have no competing interests.


  ISPR8-1539 Top


ROBO-K, robot-assisted gait rehabilitation: A user focused collaborative project

P. Coignard, O. Bigot1, N. Morisset1, N. Pichot1, I. Bonan2, K. Denis2, F. Bidet2, J. L. Le Guiet, A. Gautier, J. Egault, M. L. Peuziat3, J. Cau4, G. Caverot4

CMRRF Kerpape, Morbihan, 3CMRRF Kerpape, Ille et Vilaine, Ploemeur, 1LP3C, Ille et Vilaine, 2CHU Rennes, Ille et Vilaine, Rennes,4BA Systèmes, Ille et Vilaine, Mordelles, France

E-mail: pcoignard@kerpape.mutualite56.fr

Introduction/Background: Robots-assisted gait rehabilitation are used in association with conventional rehabilitation but it’s necessary to improve their functionality. This paper presents a psychosocial intervention framework to support the development of a mobile robot for gait training: ROBO-K. The aim was to facilitate the integration of the robot in the walking rehabilitative process and thus, ensure its diffusion. Materials and Methods: The representation of the robot’s use and its evolutions (i.e., the usual trajectory) has been first studied. Then two multicenter studies were performed in 2013 and 2015. In the first one, patients (N = 34) and practitioners (N = 74) were interviewed to define acceptable functional specifications (i.e., social acceptability). After this first study, a prototype was developed in collaboration with an industrial partner. In the second one, patients (N = 36) and physiotherapists (N = 4) tested the co designed prototype in ecological situation during 1 to 6 months (i.e., acceptance and appropriation). Results: The results showed that the robot is perceived positively by the patients and the physiotherapists because it’s perceived as useful to improve balance and gait and provide safety and motivation. This perception persisted along the experimental procedure. For the physiotherapists, the robot helped to better manage their inner physical effort. In the other hand, the mental load was high. The results seemed also very encouraging in terms of clinical effectiveness. For example, the FAC (Functional Ambulation Classifications) increases by 40 % on average. Conclusion: Finally, these psychosocial approach with industrial, clinical researchers collaboration is an excellent pathway for innovation conception.

Keywords: Acceptability, gait, robot

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


  ISPR8-1786 Top


Recovery of gait function with a wearable powered exoskeleton in subacute stroke patients using surface electromyography for fine tuning: Preliminary results

G. Gasperini, M. Gaffuri, E. Guanziroli, M. Goffredo1, S. Puornajaf1, D. Galafate1, E. Russo2, S. Filoni2, M. Franceschini1, F. Molteni

Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, 1Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Roma,2Fondazione Padre Pio ONLUS, Centri di riabilitazione, San Giovanni Rotondo, Italy

E-mail: gasperini.giulio@virgilio.it

Introduction/Background: Gait recovery in post-stroke patients is one of the main goals of post-stroke rehabilitation. Wearable over-ground powered exoskeletons allow individuals with gait dysfunctions to perform an over-ground gait training. Literature lacks of clinical studies on exoskeleton-supported gait rehabilitation in stroke patients and on setting modalities. Ekso is a wearable exoskeleton equipped with 4 motors, which allows the patient to stand up, sit and walk on a flat hard surface. The aim of this study is to investigate the clinical effects of an over-ground walking training with a wearable powered exoskeleton (Ekso), after a sEMG fine tuning, in sub-acute stroke patients. Materials and Methods: This is a pilot pre-post, open label, non randomized, non controlled experimental study. 47 sub-acute stroke patients underwent a walking rehabilitation training of 15 sessions (60 min/session, 3 times/week) using Ekso. A surface electromyography (sEMG) of rectus femoris, hamstrings, tibialis anterior and soleus of both limbs was collected in order to define the best setting for each patient. Clinical evaluation was performed at the beginning of the training period (t1), and after 15 sessions (t2) using: Barthel Index, Ashworth scale, Motricity Index, Trunk Control Test, Functional Ambulation Scale, 10 meter walking test, 6 minutes walking test, and Walking Handicap Scale. Wilcoxon’s tests (p < 0.05) was used to detect significant changes between data. Results: Significant statistical improvements were found between t0-t2 in Barthel Index, Motricity Index, Trunk Control Test, Functional Ambulation Scale, 10 meter walking test, and 6 minutes walking test. Conclusion: Fifteen sessions of over-ground gait training using a powered wearable robotic exoskeleton, set with sEMG, improve ambulatory functions in sub-acute post-stroke patients. Further studies are needed to better understand the treatment effect.

Keywords: Exoskeleton, outcome, rehabilitation

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


  C2.18 PRM Interventions Research - Robots, AIDS and Devices Top



  ISPR8-1291 Top


Welwalk facilitate early improvement in walking independence of stroke patients with hemiplegia

S. Hirano, E. Saitoh, H. Kagaya, S. Sonoda1, M. Mukaino, T. Tsunoda, S. Tanabe2, J. Yamada3, A. Suzuki4, H. Konosu5

Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 2Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 3Department of Rehabilitation, Fujita Health University Hospital, Toyoake, 1Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, 4Department of Rehabilitation, Fujita Health University, Nanakuri Memorial Hospital, Tsu, 5Toyota Motor Corporation, Z-Frontier Division, Frontier Research Center, Toyota, Japan

E-mail: hirano0820@gmail.com

Introduction/Background: For stroke patients with hemiplegia, walking exercise are conventionally practiced using orthoses. For severe hemiplegic patients, knee-ankle-foot orthoses (KAFO) are frequently used to prevent giving way in the stance phase. However, it is very difficult to swing paralytic leg with KAFO. As a result, walking exercise with KAFO requires a high level of assistance and raise low exercise intensity. To solve these problems, we developed Welwalk which has a motor on the knee joint with KAFO-like framework. Welwalk can extend and flex the knee in appropriate timing. This time, we examined whether subacute stroke patients with hemiplegia using Welwalk show early improvement in walking independence compared to patients using KAFO. Materials and Methods: Fourteen patients who satisfied the following criteria were included: patients with hemiplegia caused by primary supratentorial intracerebral hemorrhage or cerebral infarction, within 60 days after onset, aged 20 to 75 years, Functional Independence Measure (FIM) walking score ≤ 3, Stroke Impairment Assessment Set (SIAS) lower extremity total score ≤ 6, and use of KAFO. Rehabilitation was conducted for a maximum of 3 hours a day, including 40 minutes of walking exercise using Welwalk. A historical control group was selected from among patients admitted to the ward for intensive inpatient rehabilitation at Nanakuri Memorial Hospital. One control patient matching the criteria of each subject was selected, with a total of fourteen in the control group. The primary outcome measure was the improvement in efficiency of FIM-walk, defined as the gain in FIM walking score from the baseline to supervised walking divided by the number of weeks required. Results: The mean improvement in efficiency of FIM- walk was 0.9 in the Welwalk group and 0.5 in the control group, and was significantly higher in the GEAR group (p < 0.01). Conclusion: Walking exercise using Welwalk may facilitate early improvement in walking independence.

Keywords: Exercise assist robot, motor learning, stroke patients with hemiplegia

Disclosure of interest: The authors declared a potential Disclosure of interest as follows: Dr. Saitoh got collaborative research fund from Toyota Motor Corporation which developed the robot discussed in this study. Mr. Imaida is a researcher in Toyota Motor Corporation.


  ISPR8-2563 Top


Hybrid robotic system combining passive exoskeleton and functional electrical stimulation for upper limb stroke rehabilitation: Preliminary results of the retrainer multicenter randomized controlled trial

G. Gasperini, M. Rossini, D. Proserpio, N. Immick1, A. Augsten1, A. Pedrocchi2, E. Ambrosini2, S. Ferrante2, J. Zajc3, W. Baccinelli4, M. Bulgheroni4, K. Krakow1, F. Molteni

Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, 2Department of Electronics, Information and Bioengineering, Politecnico di Milano, NEARLAB, Milano, 4Department of Research, Ab. Acus, Milano, Italy, 1Department of Rehabilitation, Asklepios Neurologische Klinik Falkenstein, Königstein, Germany, 3Ottobock Health Products GmbH, Health Products, Wien, Austria

E-mail: gasperini.giulio@virgilio.it

Introduction/Background: Stroke is the main cause of acquired adult disability with major impact on arm function. The combined use of Functional Electrical Stimulation (FES) and robotic technologies is strongly advocated to improve rehabilitation outcomes after stroke. We present the preliminary data of a multi-center Randomized Controlled Trial aimed at evaluating the effectiveness of this system with respect to conventional therapy for sub-acute stroke upper limb rehabilitation. Materials and Methods: The RETRAINER system consists of a lightweight and non-cumbersome passive arm exoskeleton for weight relief, a current-controlled stimulator with 2 channels of stimulation and 2 channels of EMG recordings. In this work we are presenting the preliminary results of 39 sub-acute stroke patients with a distance from the acute event between two weeks and nine months. The inclusion criteria was: age between 18 and 85 years, Motricity Index (MI) < 80%, muscular activity for arm and shoulder at least 1 Medical Research Council (MRC) with a visible contraction, no joint limitation, pain or spasticity. They were randomized in two group: 1 conventional rehabilitation methods, 2 experimental group using Retrainer System. Each participant performed 9 weeks of treatment 3 times for week. We measured MI, Action Research Arm Test (ARAT) and Motor Activity Log (MAL) at beginning (T0) and at the end of treatment (T1). Results: Results are showed in [Table 1]. Conclusion: Both groups showed statistical improvement in outcome measures. Experimental group showed a statistical better improvement regarding time and group effect.
Table 1: Results

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Keywords: Functional electrical stimulation, robotics, stroke rehabilitation Disclosure of interest: The authors did not declare any conflict of interest


  ISPR8-1564 Top


Electroencephalogram-based neurofeedback training with shoulder exoskeleton robot assistance triggered by the contralesional primary motor cortex activity in poststroke patients with severe chronic hemiplegia

K. Takasaki, F. Liu1, M. Ogura1, K. Okuyama1, M. Kawakami1, K. Mizuno1, S. Kasuga2, T. Noda3, J. Morimoto3, M. Liu1, J. Ushiba2

Graduate School of Science and Technology, Keio University, 2Faculty of Science and Technology, Keio University/Keio Institute of Pure and Applied Science KiPAS, Kanagawa, 1Department of Rehabilitation Medicine, Keio University, Tokyo, 3Department of Brain Robot Interface, Computational Neuroscience Laboratories, Advanced Telecommunications Research Institute International, Kyoto, Japan

E-mail: takasaki@brain.bio.keio.ac.jp

Introduction/Background: Recent clinical studies have shown that electroencephalogram- (EEG) based neurofeedback training promotes functional recovery of finger movements in poststroke patients (Pichiorri F et al., Ann Neurol. 2015). However, impairment of shoulder elevation in poststroke severe chronic hemiplegia is a debilitating condition with no evidence-based, accessible treatment. To verify motor recovery evidence of neurofeedback training with our shoulder exoskeleton robot, this study reports upper extremity section of Fugl-Meyer assessment (FMA-UE) associated with the evaluation of up-conditioning of contralesional corticospinal pathways. Materials and Methods: Eight poststroke patients with severe hemiplegia in the chronic stage were recruited (FMA-UE score = 16.8 ± 4.4). Patients engaged in 1 hour daily training for 7 consecutive days [Figure 1], and clinical and neurophysiological measurements were performed 1 day before and after the intervention. FMA-UE was used for the primary outcome measure. A 128-channel whole-head EEG was used to assess the hemispheric lateralization of event-related desynchronization (ERD). Single-pulse transcranial magnetic stimulation (TMS) was applied to the contralesional primary motor cortex to assess the corticospinal excitability in 6 tested patients. Results: All participants finished the intervention without adverse events. FMA-UE was significantly improved after the intervention (paired t-test, p < 0.01). All patients demonstrated improved FMA-UE (mean change = 6.6 ± 3.2) and 6 of 8 patients exceeded the minimal clinically important difference that is set to 5. From the group analysis of hemispheric lateralization of ERD, the contralesional ERD became stronger after interventions (Wilcoxon signed-rank test, p < 0.01). Motor evoked potentials became more apparent after interventions in 3 of the 6 tested patients. Conclusion: The results from this study demonstrated targeted up-conditioning of contralesional corticospinal pathways and efficacy of neurofeedback training with our shoulder exoskeleton robot.
Figure 1: EEG-based neurofeedback training with direct brain-controlled exoskeleton robotics. (a) Time scheme of the 1 hour training protocol. (b) Outline of the developed neurofeedback training system. EEG: Electroencephalogram, ERD; Event-related desynchronization, FES: Functional electrical stimulation

Click here to view


Keywords: Brain machine interface, neurorehabilitation, phase 2 clinical study

Disclosure of interest: 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).


  ISPR8-0088 Top


Abstract edited - Supplemental therapeutic conventional vs. robotic upper limb exercise in acute stroke rehabilitation: A randomized, blinded assessor study

A. Esquenazi, S. Lee, T. Watanabe, N. Alexey, K. Scheponik, C. McKee

Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, USA

E-mail: AESQUENA@einstein.edu

Introduction/Background: One objective of acute stroke rehabilitation is restoration and improvement of arm use. The aim of this study is to determine feasibility and efficiency of additional exercise in acute stroke inpatient rehabilitation facility (IRF) using the Armeo-Spring® (ARMEO) robot vs. therapist supervised Table Top (TT) exercises. Materials and Methods: Blinded, randomized, study using TT or ARMEO in addition to 3 hours of 1:1 required therapy. Participants with unilateral hemiparesis ≥ 18 years with a minimum Fugl-Meyer Assessment score of 8/66 or Modified Ashworth Scale score of <3 after acute stroke. Outcome Measures: Number of treatment sessions; serious/adverse events (S/AEs); Functional Independence Measure (FIM) efficiency; and Modified Borg Rating of therapist Perceived Exertion Scale (RPE). Results: 36 participants enrolled in the study thus far. ARMEO participants on average had more training days (6.6) than TT (5.9); number of training days was not statistically different (p =.59). FIM efficiency was not significantly different. There was statistically significant median decrease in Borg from last day of training to the first day of training in both ARMEO or TT groups, p < .005. Five ARMEO participants and eight TT participants reported AEs. No SAEs were reported. Conclusion: Acute stroke patients are able to tolerate and participate in an additional functional exercise program in an IRF without SAEs. Although the training groups did not yet yield statistical significance, FIM efficiency improved and therapist effort decreased. This study supports early recovery in acute stroke rehabilitation and ARMEO was preferred training mode and with good patient satisfaction.

Keywords: ARMEO, robotics, stroke rehabilitation

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


  ISPR8-0354 Top


Clinical and kinematic evaluation of the H-man arm robot for post stroke upper limb rehabilitation: Preliminary findings of a randomised controlled trial

K. Chua, C. Kuah, C. Ng, L. Yam1, A. Budhota2, S. Contu2, S. Kager2, A. Hussain2, L. Xiang3, D. Campolo2

Rehabilitation Centre, Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital, 1TTSH Clinical Research and Innovation Office, Tan Tock Seng Hospital, 2School of Mechanical and Aerospace Engineering, Nanyang Technological University NTU, 3School of Physical and Mathematical Sciences, Nanyang Technological University NTU, Singapore, Singapore

E-mail: karen_chua@ttsh.com.sg

Introduction/Background: The H-Man robot, a table-top, portable, 2D planar, end-effector with virtual reality feedback was designed to deliver self-paced, repetitive reaching arm movements. Preliminary results of a randomized clinical trial of 26/44 strokes with hemiparetic arm weakness are presented. Materials and Methods: Inclusion criteria included first-stroke, >4 months duration with Fugl Meyer Assessment Scale (FMA) 20-50/66) without contraindications to robot-aided therapy. Following informed consent, subjects were randomized into 2 groups: H-Man-conventional (HCT) group received 18 sessions over 6 weeks of 60 minutes of H-man training then 30 minutes of conventional therapy (CT), while control group (CG) received a similar intensity of 90 minutes of CT. Blinded outcome assessments at weeks 0 (baseline), 3, 6 (end-training),12 and 24 (follow-up). The primary outcome measure was FMA change at week 6. Parametric analysis was used and level of significance was P < 0.05. Results: Altogether, data from 26 out of 44 subjects were analyzed. (13 HCT, 13 CG). Mean age was 54.0 years (SD 10.9), 14/26 were male, 15/26 had hemorrhagic strokes, mean stroke duration 227.2 days (SD 207.2), and mean baseline FMA 38.6 (SD 11.1). The HCT group achieved significantly better FMA gains compared to CG (4.15 HCT vs 1.69 CG, P = 0.03) at week 6 (post-training), and at week 24 (5.77 HCT vs 2.61 CG, P = 0.03). There were no adverse side effects or drop outs. Robotic kinematic measures of line and circle temporal tracing correlated with FMA scores at Week 0. Conclusion: Combinatory arm rehabilitation with H-Man robot was superior to CT and well tolerated.

Keywords: Hemiparesis, robot, stroke

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


  C2.19 PRM Interventions Research - Miscellaneous Top



  ISPR8-1835 Top


Deep learning for the recognition of facial expression in the Colombian sign language

A. M. Rincon Vega, A. Vasquez, W. Amador, A. Rojas

Universidad Manuela Beltran, Vicerrectoria de Investigaciones, Bogotá, Colombia

E-mail: ana.vega@docentes.umb.edu.co

Introduction/Background: The communication of the deaf person has been considered as a set of manual movements, however many have ignored the importance of facial expression in the different communicative manifestations of this population; this is the reason because a group of Phonoaudiology, physiotherapy and engineering researchers integrate their knowledge to perform image processing and classification of facial expressions used in the Colombian Sign Language (LSC) analysis. The Objective was To establish the processing of images of facial expressions as a complementary means to manual movements for the interpretation of Colombian sign language. Materials and Methods: Qualitative study, descriptive, non-experimental design, for which four phases were considered, in the first, data collection was carried out through recordings of deaf people as linguistic models producing facial expressions corresponding to the vocabulary of the clinical scenario. In phase two, the images are processed to identify the characteristic patterns of each sign. In the third phase, two Deep Learning techniques are used to classify the captured gestures. In the fourth phase, the accuracy of the images was validated techniques used. Results: For the classification process, six facial expressions corresponding to the words pain, inflammation, fracture, irritable colon, dizziness, diabetes were analyzed. In this process, two Deep Learning techniques were validated, obtaining that the Single Shot Multibox Detector SSD technique has a precision of 94, 02% compared to the Convolutional Neural Network (CNN) technique, which has a degree of accuracy of 89.05%. Conclusion: The development of technologies of this nature allows analyzing the facial expression in the communication of the deaf person as a distinctive feature for interaction with others. The algorithms of artificial vision based on Deep learning present a high level of efficiency in the classification of facial expression, this being an important factor to generate tools that facilitate the communication of deaf and hearing.

Keywords: Deep learning, facial expression, sign language

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


  D1.03 Rehabilitation Systems and Services Research - Rehabilitation Service Organisation Top



  ISPR8-2440 Top


Home rehabilitation in France: The model of stroke

A. Schnitzler, L. Tlili1, J. Beaudreuil1, M. Jousse1, A. Yelnik2

Department of Physical Medicine and Rehabilitation, Hopital Poincaré, Garches, 1Department of Physical Medicine and Rehabilitation, GH St. Louis-Lariboisière, F. Widal, 2Department of Physical Medicine and Rehabilitation, PMR Service, GH St.Louis-Lariboisière, F. Widal, Paris, France

E-mail: alexis.schnitzler@aphp.fr

Introduction/Background: Ambulatory care is the most frequent type of rehabilitation for chronic diseases. French guidelines recommend after a stroke assessment and rehabilitation by a multidisciplinary team for all the patients with a persistent deficiency. According to the needs of each patient, different ways to provide home rehabilitation can be used in France. For simple needs targeting specific deficiency, rehabilitation can be provided by a professional alone in ambulatory care. Only Physiotherapy (PT) and speech therapy (ST) are refunded by the national health insurance. For complex needs a PRM multidisciplinary team, can be ordered either in day hospital (the patient living home and receiving rehabilitation during repeated stays) which is the main organization, or mobile rehabilitation team, the team coming each day at home like an early supported discharge team (not very developed in France). Materials and Methods: We report here the global activity base on the analysis of the national registry on the 80 000 annual new strokes (excluding transient attacks and deceased). Results: After the acute care, 37% of stroke patients received a multidisciplinary rehabilitation during a mean of 3 months (33% in an inpatient center and 4% in an outpatient center). For the patient discharge at home 30% (directly discharge from an acute center) to 50% (discharge from a rehabilitation center) receive PT and 9 to 15% ST. At the chronic phase 35% of the patients receive PT at home. Ambulatory occupational therapy and ST are less developed and less available. Conclusion: Effort is needed to improve multidisciplinary rehabilitation at home in France. Home hospital could be interesting to develop for dependent and fragile patients, mobile rehabilitation team for the rehabilitation of the instrumental activities of daily livings, and day hospital for rehabilitation requiring technical platform of a rehabilitation center.

Keywords: Care pathway, home rehabilitation, stroke

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


  ISPR8-2369 Top


Maison De Rééducation Et D’autonomie: A new model of practice in physical medicine a rehabilitation back on 3 years’ experience

Y. Mohammad

Maison De Reeducation Et D’autonomie, Val D’oise, Beaumont Sur Oise, France

E-mail: dr.y.mohammad@gmail.com

Introduction/Background: In France, Physical Medicine and Rehabilitation is practiced in the hospital. Private practice is often limited: Lack of PM&R physiciens, Absence of interdisciplinarity and very limited technical means. This results in an overload of hospital départments and difficulties in returning home. The project of the “MRA” is an innovative concept: to install in private practice an interdisciplinary structure allowing rehabilitation without hospitalization, in accordance with the conditions of practice in day hospital of PM&R. This work aims to analyze the relevance of this model, after 3 years’ experience. Materials and Methods: The MRA regroupes all professions involved in patient’s rehabilitation and rehabilitation, It offers a high level technical platform such as the motion Analysis and rehabilitation (ZEBRIS and C-MILL systems) and Virtual Reality. Patients are seen in PM&R consultation and/or in sessions of rehabilitation that can be grouped together. They are no hospitalization. Interdisciplinary staff and thematic scientific meeting open to all professionals inside and out of MRA are organized regularly. Results: On average, 200 patients, from 6 months to 100 years old, are seen daily at the MRA. 4 out of 10 patients have multidisciplinary care. The source of the patients is in order of frequency: Family doctors and liberal professionals, the direct « mouth-ear » indication and the hospital departmments. Pathologie are, in order of frequency: (1) Learning and Development Disorders. (2) Neurological and musculoskeletal disorders (3) Complex disorders with loss of autonomy. The analysis of the activity shows the relevance of this mode of operation as a complementary structure to hospitalization and isolated private practice: (1) Decrease in hospitalizations (2) maintenance of patients in their natural environment, (3) Improving the quality of care, (4) Up to 75% of reduction of expenses. The MRA federated a vast majority of extramural private professionals of the region. Conclusion: After three years of practice, the MRA is a relevant model, complementary to the hospital especially for complex pathologies.

Keywords: Development of practices, physical medicine and rehabilitation private practice, rehabilitation

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


  ISPR8-2528 Top


Portugal VS New Zealand: The rehabilitation in the antipodes - Share of experience

C. Martins Moreira

Centro Hospitalar do Porto, Hosp Santo Antonio, Serviço de Fisiatria, Porto, Portugal

E-mail: carolinafgmoreira@gmail.com

Introduction/Background: Globalization is present in all human activities, Medicine and PRM included! It’s urgent to complement our training as physiatrists with the experience of working in centers with different approaches and methods. Starting from the motto of the XII ISPRM Congress: “Share knowledge to reduce disabilities”, was born the ideia of sharing our experience and knowledge from the confrontation of two international realities of PRM. Materials and Methods: This work intends to address the main differences, whether organizational, infrastructure, of clinical practice or even of economic character existing between the Portuguese reality and the New Zealander, based on an internship carried out by a portuguese PRM resident in a rehabilitation center for patients with acquired brain injury in New Zealand (NZ). Results: Portugal (PT) and NZ are geographically antipodes, but not so in rehabilitation terms. In NZ there’s a different organization of the rehabilitation network, with focus on the rapid adaptation to community life with a pronounced role of community physiotherapy. There is no chronologic limit to the rehab process, only dictated by the clinical evolution, while in PT, regarding economic factors and the reduced number of rehab beds in relation to the needs, there is often a pressure for the patient discharge. The medical appointment is less coloquial and distant in NZ, maybe by cultural factors, with more time (1hour in NZ and 15minutes in PT), providing a better doctor-patient relationship. In PT there are other medical specialities in rehab centers like internal medicine which is a important for patients with more co-morbilities. Conclusion: The process of rehabilitation itself and the focus on achieving the greatest possible functionality, is common to both countries and to the specialty itself, so the confontration of the two realities, taking the most positive aspects of each will contribute to the PRM improvement!

Keywords: Organization, rehabilitation network, rehabilitation service

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


  D1.05 Rehabilitation Systems and Services Research - Community-Based Participation Research Top



  ISPR8-0795 Top


Evolution over 20 years of factors influencing the autonomy and quality of life of people with severe head injuries in the Lille area

O. Kozlowski, M. Blanc1, W. Daveluy, X. Molders, E. Allart

Department of Brain Injury Rehabilitation, CHRU Lille, Lille Cedex, 1Mother and Child Health Servic PMI, Unité territoriale de prévention et d’action sociale, Haubourdin/La Bassee, France

E-mail: odile.kozlowski@chru-lille.fr

Introduction/Background: In 1998, a research on severe traumatic brain injury (STBI) patients 3 years after onset highlighted many difficulties regarding autonomy and quality of live (QOL). Lack of follow-up and specialized infrastructures was clear. Since then, the follow-up has been organized around the Brain injuries 59/62 regional network. We aimed at comparing the evolution of autonomy and QOL and their influencing factors (IF) between the two periods. Materials and Methods: All STBI people in the same area were evaluated 3 years after onset using the European Brain Injury Society document. Autonomy and QOL IF were analysed and compared between the two periods (end of the 90s and 2010s). Results: On the 23 and 24 evaluated patients respectively in 1998 and 2016, the overall autonomy (especially in elaborated activities) and scores of QOL tended to be higher in 2016. According to the family, the average QOF has significantly improved (p = 0.023). Changes in the role in the family (p = 0.007) and the need for respite (p < 10-3) were minor. After discharge, the multidisciplinary follow-up was more frequent. Factors impacting negatively on the overall autonomy, respectively in 1998 and 2016, were: coma duration (p = 0.01/0.04), length of stay in acute care (p = 0.01/0.002), severity of physical deficiencies (p = 0.00/0.04) and several cognitive disorders. In 1998 as well as in 2016, the most dependent TBI people were having significantly more physiotherapy (p = 0.06/0.006) and speech therapy cares (p = 0.04/0.01). In 2016, patients were significantly more followed by the multidisciplinary team of the network (p = 0.029) and the socio-medical teams (p = 0.003). Concerning QOL, only cognitive and psycho-behavorial impairments were found in 1998 as well as in 2016. In 2016, we also found that severity of physical impairments negatively influenced the QOL (p = 0.029). Conclusion: Better support for physical, cognitive and behavioral difficulties could lead to improved autonomy and QOL in TBI patients.

Keywords: Autonomy, quality of life, traumatic brain injury

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


  ISPR8-1756 Top


Adapted physical activity network in Reggio Emilia between 2011 and 2017: Promoting regular physical activity for people dealing with chronic conditions

S. Fugazzaro, A. Fiocchi1, I. Malvarosa2, E. Iotti, C. Tedeschi2

Department of Neuromotor and Rehabilitation, Azienda Unità Sanitaria Locale-IRCCS, 1Department of Neuromotor and Rehabilitation, Azienda Unità Sanitaria Locale, 2UISP, Sportive Society, Reggio Emilia, Italy

E-mail: stefania.fugazzaro@ausl.re.it

Introduction/Background: Physical activity is a priority tool in the prevention of functional worsening. In current health services scenarios, a lot of persons deals with chronic conditions and they need training programs with structured exercise to promote healthy lifestyle, even when slight disability is present, due to aging, arthrosis, surgical intervention for hip/knee prosthesis, stroke or chronical neurological diseases such as Parkinson. Emilia-Romagna Region strongly supported the development of Adapted Physical Activity (APA) programs in the last years. Materials and Methods: In Reggio Emilia, a multidisciplinary group started a project to implement APA in 2010-2011, involving Rehabilitation Department, Local Health Care Services, General Practitioners (GPs) and sport societies. According to regional guidelines, several exercise protocols were set up and pilot APA groups started, to offer training programs to people with chronic pain for osteoarthrosis/arthritis. APA groups were supervised by instructors graduated in Physical Education. The pilot groups experience was very encouraging and a broader network was implemented between 2011-2017. Results: The local network now involves 22 community gyms (throughout the all district) and the number of persons attending regular APA programs grew from 226 in 2011 to 1223 in 2017. No significant adverse event occurred. The participants level of satisfaction and compliance are very high.The number of GPs supporting APA grew from 106 in 2011 to 578 in 2017. Every year an update event is organized, to implement education for professionists leading APA groups and to verify exercise protocols. Conclusion: The development of APA network in Reggio Emilia was a strategy to create opportunities for healthy life style. The key elements of the projects were: 1. interaction between Rehabilitation Department, Local Health Care Services, sport societies and community gyms 2. Structured training for APA group leaders (at least once a year) 3. Involvement of GPs to promote regular physical activity for people dealing with chronic conditions.

Keywords: Active life style, adapted physical activity, health promotion

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


  D2.02 Comprehensive Rehabilitation Intervention Research - Rehabilitation Programme Evaluation (E.G. Home-Based Rehabilitation) Top



  ISPR8-0835 Top


Hemipass, a multidisciplinary in-home response team for people with post-stroke disabilities.

M. Compagnat, J. C. Daviet, B. David, C. David, S. Jean Yves

Department of MPR, CHU Limoges, Limoges, France

E-mail: maxence.compagnat@icloud.com

Introduction/Background: Homecoming is a key step in the rehabilitation process with neurological sequelae after stroke. Objective: To describe the intervention and activity of Hemipass, a multidisciplinary in-home care team for people with post-stroke disabilities. Materials and Methods: Hemipass, located at the Limoges University Hospital, is composed of a doctor, a nurse coordinator, an occupational therapist, a neuropsychologist and a secretary. The team evaluates the needs of patients and caregivers at home following a request made by any caregiver to a patient with a history of stroke (patient, family, health professional, etc.). A personalized and multidisciplinary care program is developed and shared with all caregivers. The interventions were categorized by ICF items. Hemipass also conducted educational therapy on the pathology, treatment and management of stroke disabilities in everyday life. Results: 508 patients have been assisted by Hemipass since 2010. 30% of the interventions were in response to a request from a non-medical caregiver (patient, family, personal service, social), 30% by a PMR department. The reasons for the intervention were disabilities related to cognitive impairment (31%), motor impairment (21%), human and social assistance plan (20%). The means used were an assessment of cognitive impairments in the home with cognitive remediation sessions, accommodation of the home with tests of assistive devices, accommodation of care plans in collaboration with social medical organizations and. The percentage of successful interventions ranged from 79% to 82%. The educational therapy program was attended by an average of 45 individuals per year. Conclusion: This multidisciplinary team operates on environmental factors in ecological situations. Hemipass proposes an innovative and fundamental approach as part of a national plan to promote home support for patients with stroke sequelae.

Keywords: Educational therapy, home based intervention, stroke

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


  D2.03 Comprehensive Rehabilitation Intervention Research - Rehabilitation Technology Assessment (E.G. Tele-Rehabilitation) Top



  ISPR8-2436 Top


A virtual health coach application to provide psychosocial support poststroke: feasible or not?

M. van den Berg, M. Killington, C. Morris1, A. Maeder2, M. Crotty

Department of Rehabilitation, Aged and Extended Care, Flinders University, 1Flinders Medical Centre, Rehabilitation Service, 2Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia

E-mail: maayken.vandenberg@flinders.edu.au

Introduction/Background: The development of services that provide home-based rehabilitation for stroke patients has attracted increasing interest. Research has demonstrated this new rehabilitation approach should include a psychosocial component. The purpose of this study was to evaluate the use, feasibility and acceptability of virtual assistant technology to provide post-discharge psychosocial support for people with stroke receiving telerehabilitation, and their caregivers. Materials and Methods: This was a pragmatic usability study using a convenience sample from a hospital based home rehabilitation service. For four weeks Anna acted as a virtual assistant via a tablet application, and provided participants with 11 different health coaching sessions (HCS) delivering stroke-specific educational content. Other app features included daily facts, scheduling and messaging. Outcome measures were app usage, ease of use and usefulness (7-point Likert scale). Additional in-depth interviews explored participants’ perspectives on the assistive mobile technology. Results: Fifteen patients (71% male, mean age 67±11 years) and their caregivers followed the program. Adherence was high, with on average 8.4±2.9/11 HCS completed. The use of calendar and messenger functions ranged from never to frequent. Ease of use (mean 6.1±0.9) and usefulness (mean 6.2±1.3) scores were high. In the interviews, participants considered the HCS informative, relevant and comprehensive. The majority of patients evaluated Anna as supportive and encouraging. All expressed preference for an avatar based app over other ways of information provision and all believed Anna supported them in their rehabilitation program. Conclusion: The participants related to, and felt supported by the virtual health coach Anna. Virtual assistant technology seems a feasible and acceptable means of providing educational information, HCS, and support among community-dwelling people with stroke and their caregivers. Future studies are required to determine the potential benefit of this support system on health outcomes as well as costs.

Keywords: Psychosocial support, stroke, virtual health coaching technology

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


  ISPR8-0627 Top


Telecommunication and rehabilitation among patients with multiple sclerosis: Access and willingness to use

C. Remy, M. Valet, G. Stoquart, S. El Sankari1, V. Van Pesch1, A. De Haan1, T. Lejeune

Cliniques Universitaires Saint-Luc, Service de Médecine Physique et de Réadaptation, 1Cliniques Universitaires Saint-Luc, Service de Neurologie, Brussels, Belgium

E-mail: caroline.remy@student.uclouvain.be

Introduction/Background: Telerehabilitation is a promising approach for patients with multiple sclerosis (MS), but uncertainties about patients’ preferences remain. The aim of this study was to investigate the access to technologies of patients with MS and their willingness to use them to receive rehabilitation services. Materials and Methods: 200 consecutive patients with MS filled out a specific questionnaire during a follow-up visit. This 6-page paper questionnaire was built to obtain information about needs, accesses, interests and perspectives of telerehabilitation for patients with MS. Descriptive statistics, Chi-Squared tests and logistic regression analysis were used to characterize the sample and survey answers. Results: The mean age of our sample was 44(±13) years. 71% were women. 49% of the patients were unemployed. The median EDSS score was 2.5, and 77% of the patients had a score of 4 or less on this scale. 91% of the patients regularly used internet, while 73% used apps. A substantial proportion of the sample reported an interest in using telecommunication technologies to receive a program of physical exercises (62%), information and personalized advice about physical activity and MS (69%), as well as to communicate with the caregivers (75%). One third of the patients was not interested in receiving telerehabilitation interventions (32%), especially among patients with moderate or severe disability (EDSS>4) and non-workers. Conclusion: The use of technologies to provide rehabilitation services is desirable by patients with MS, and most of these patients have access to the needed technologies. However, patients with moderate-to-severe disability and non-workers have, in average, less access and ease to use these technologies in a rehabilitation purpose. Given their high needs and strong barriers to benefit from rehabilitation, a special effort should be done to promote the use of telecommunications in this perspective.

Keywords: Multiple sclerosis, technology, telerehabilitation

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


  D4.01 Rehabilitation Management and Administration - Rehabilitation Service Management (Including Integrated Care and Service Concepts) Top



  ISPR8-1280 Top


Rehabilitation Care Coordination: Awareness, Availability and Frequency of Referrals among Rehabilitation Professionals

C. Adeosun, C. Nwodo

Department of Physiotherapy, Military Hospital, Port Harcourt, Nigeria

E-mail: cyadesoun@gmail.com

Introduction/Background: Care coordination across multiple settings, health care professionals and patient groups with diverse rehabilitation needs is one of the key elements of providing quality patient-centred care and services. This is particularly important when the patient require rehabilitation from multiple professionals. Efforts are ongoing in developed countries to achieve care coordination and integration. However, this is not the case in many developing countries. Evidence indicates a lack of coordination and low proportion of medical rehabilitation professionals (RPs). This study examines RPs’ awareness of the role of other RPs in rehabilitation care, their availability and frequency of referral among them in Nigeria. Materials and Methods: Using a descriptive research methodology, survey was distributed to RPs at their annual national conferences. A convenience method of distribution was utilized. Data was collected on demographics, awareness, availability of RPs and frequency of referrals. Data on facilitators and barriers to referrals were also collected. Thematic framework analysis and descriptive statistical analysis were applied to the data. Results: All the participants (n = 147) are aware of the role of other RPs in rehabilitation care. Data showed that 83.2% were physiotherapists while 16.8% represented all other RPs. Only 27.3% occasionally refer patients to other RPs. Moreover, 53.7% practice in the South West region of the country. The major facilitators of referrals were: Patient’s condition, availability of the required RP and cost of care. Lack of access and non-availability of RPs like speech and occupational therapists were the major barriers. Conclusion: The study reveals the need for more RPs and rehabilitation care coordination in Nigeria. It adds to our understanding of the availability and frequency of referrals among RPs. It also contributes to the literature on rehabilitation care coordination in developing countries. The need to focus on improving patient access to RPs through more training, equitable distribution and deployment of RPs is emphasised.

Keywords: Care coordination, health system, rehabilitation professionals

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


  E3 Measurement of Functioning (E.G. Psychometrics of Assessment Tools; Operationalisation of ICF Categories) Top



  ISPR8-0822 Top


Linkage of self-reporting patient questionnaires for low back pain to the International Classification of Functioning, Disability and Health using machine learning algorithms

K. Tuechler, E. Fehrmann, T. Kienbacher, L. Fischer, G. Ebenbichler1, J. Kollmitzer2, P. Mair3

Karl Landsteiner Institute, Institute for Outpatient Rehabilitation Research, 1Department of Physical Medicine and Rehabilitation, Medical University Vienna, 2Department of Biomedical Engineering, University of Applied Sciences, Vienna, Austria, 3Department of Psychology, Harvard University, Cambridge, USA

E-mail: kerstintuechler@gmail.com

Introduction/Background: To facilitate the use of the International Classification of Functioning, Disability and Health (ICF), linkage rules were developed. But these rules do not provide statistical methods for the linkage process. Thus, the aim of this study was to facilitate the use of the ICF by linking patient questionnaires to the ICF categories via using machine learning algorithms. Materials and Methods: A total of 244 chronic low back pain patients (52% female; 49(±18) years) participated in interviews that assessed the activities and participation component of the ICF brief core set for low back pain and completed the Roland-Morris disability questionnaire, the Pain Disability Index, and rated their pain intensity on a visual analogue scale before and after a 6-month rehabilitative training. Random forest models with dichotomized ICF categories (no impairment versus impairment) as response variable and the predictor variables age, sex and the items of the disability questionnaires were built to capture the relationship between the predictor variables and the response variable. Results: Random forest models revealed values that indicated satisfactory performance measures (accuracy: > 0.62, AUC: > 0.70, kappa: > 0.17) for the brief core set categories d240 ‘handling stress and other psychological demands’, d410 ‘changing basic body position’, d415 ‘maintaining a body position’, d430 ‘lifting and carrying objects’, d450 ‘walking’, d540 ‘dressing’, d640 ‘doing housework’, d845 ‘acquiring, keeping and terminating a job’ and d850 ‘remunerative employment’. Conclusion: ICF linkage based on machine learning models may be successfully administered to the most relevant ICF brief core set categories for low back pain. This study proposed a new and innovative linking approach that could be further integrated in an electronic ICF sheet to facilitate the administration of the ICF in clinical practice and enable a universal and standardized language for the description of functioning, disability and health.

Keywords: International Classification of Functioning, Disability and Health linkage, low back pain, machine learning

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


  ISPR8-2695 Top


Validating a traumatic brain injury measure of participation in spinal cord injury

G. Whiteneck, J. Ketchum, J. Gassaway1, D. Mellick, S. Maunton, S. Huey, M. Philippe1

Department of Research, Craig Hospital, Englewood, 1Department of Research, Shepherd Center, Atlanta, USA

E-mail: gale@craig-hospital.org

Introduction/Background: Participation is a key concept in the International Classification of Functioning, Disability, and Health and a central rehabilitation outcome, but agreement on measuring participation is lacking. Participation Assessed with Recombined Tools – Objective (PART-O) was developed for traumatic brain injury (TBI), used in the TBI Model Systems, and endorsed as a common data element. However, the content of PART-O is not unique to TBI and the instrument may be applicable to other populations. The aim of this research is to determine the psychometric properties of PART-O in people with spinal cord injury (SCI). Materials and Methods: The PART-O items were administered to 468 people with SCI from 4 months to 40 years post injury along with the most frequently used measure of participation in SCI: the Craig Handicap Assessment and Reporting Technique (CHART). The PART-O was administered a second time, 2-4 weeks later to assess test-retest reliability. Rasch analysis was used to ensure a unidimensional linear measure and evaluate the psychometric properties of PART-O in SCI. Results: To achieve unidimensionality and maintain ordered steps within item categories, 3 competing items (hours per week spent working, in school, and homemaking) were summed into a testlet, and infrequently endorsed categories were combined. The resulting measure was unidimensional (first contrast less than 2.00) with all items fitting well (no infit or outfit above 1.40 and no disordered categories in any item), and acceptable person separation (2.00) and reliability (0.80). PART-O had a normal distribution with no ceiling or floor effects. The test-retest reliability was 0.97 and the correlation between PART-O and CHART was 0.79. Conclusion: The PART-O shows promise for expanding its use into SCI. It is highly correlated with the legacy CHART instrument, and it has advantages over CHART, of being a normally distributed linear measure without ceiling effects.

Keywords: Assessment, participation, spinal cord injury

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


  ISPR8-2109 Top


Rhythmic abilities and musical training in Parkinson’s disease: Do they help?

V. Cochen De Cock, D. Dotov1, C. Geny2, B. Bardy1, V. Driss3, S. Dalla Bella4

Clinique Beau Soleil, Neurologie, 1Euromov, Rhytm and Sync, 2Department of Neurology, CHRU de Montpellier, 3Clinical Investigation Center, CHRU de Montpellier, Montpellier, France, 4Department of Psychology, University of Montreal, Montreal, Canada

E-mail: valerie.cochen@gmail.com

Introduction/Background: Rhythmic auditory cues can immediately improve gait in Parkinson’s disease. However, this effect varies considerably across patients. The factors associated with this individual variability are not known to date. Patients’ rhythmic abilities and musicality (e.g., perceptual and singing abilities, emotional response to music, and musical training) may foster a positive response to rhythmic cues. Materials and Methods: To explore this hypothesis, we measured gait at baseline and with rhythmic cues in 39 non-demented patients with Parkinson’s disease and 39 matched healthy controls. Cognition, rhythmic abilities and general musicality were assessed. A response to cueing was qualified as positive when the stimulation led to a clinically meaningful increase in gait speed. Results: We observed that patients with positive response to cueing (n = 17) were more musically trained, aligned more often their steps to the rhythmic cues while walking, and showed better music perception as well as poorer cognitive flexibility than patients with non-positive response (n = 22). Gait performance with rhythmic cues worsened in six patients. Conclusion: We concluded that rhythmic and musical skills, which can be modulated by musical training, may increase beneficial effects of rhythmic auditory cueing in Parkinson’s disease. Screening patients in terms of musical/rhythmic abilities and musical training may allow teasing apart patients who are likely to benefit from cueing from those who may worsen their performance due to the stimulation.

Keywords: Gait, Parkinson’s disease, rhytmic auditory cueing

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

[TAG:2]E4 Functioning Epidemiology (Population-Based Comparative Studies of Functioning Across Conditions, Cultures, and Time, E.G. On Employment of People With Disability)[TAG:2]




  ISPR8-2258 Top


Heritability of physical activity in Japanese adults: A twin study

D. Matsumoto1,2, F. Inui3,4, C. Honda4, R. Tomizawa4, N. Sakai4,5, K. Nakatani3

1Department of Physical Therapy, Kio University, 2Health Promotion Center, Kio University, 3Department of Nursing, Kio University, Kitakatsuragi-gun, 4Center for Twin Research, Graduate School of Medicine, Osaka University,5Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan

E-mail: d.matsumoto@kio.ac.jp

Introduction/Background: WHO has reported that physical inactivity (PA) is the 4th risk factor of non-communicable diseases. Despite the well-known health benefits of PA, it is apparent that almost population may not be sufficiently active to derive these benefits. Recently, previous studies in western countries reported that genetic factors associated PA. However, in Asia population, that has been unclear yet. The objective of present study was to estimate the heritability of PA by using twin study. Materials and Methods: Participants were members of the Osaka University Aged Twin Registry. Our sample included 856 twins (313 men and 543 women, mean age 59.3 ± 20.1). Ethical approval for the study was obtained from the Osaka University Ethics Committee. PA and sedentary behavior were assessed by the Japanese short version of the International Physical Activity Questionnaire. Participants answered about intensity, frequency and duration of their PA for one week. Derived phenotypes were: vigorous PA (VPA); moderate PA (MPA); walking (WPA); total PA (TPA); sitting time (ST). Structural equation modelling analysis was performed to evaluate the relative importance of genes and environments for the phenotypes measured. Results: When different genetic models were compared, the additive genetic/specific environment (AE) model offered the best fit according to Akaike Information Criterion. For WPA, 42% of the variance was explained by additive genetic effects and 58% was by unique environmental (including error) effects. For ST, 19% of the variance was explained by additive genetic effects and 81% was by unique environmental effects. There were no significant additive genetic effects in VPA, MPA, and TPA. Conclusion: We conclude that walking and sedentary behavior influenced by additive genetic factors in Japanese adults. These results would help us provide an appropriate approach for people to be physically active. This work was supported by MEXT KAKENHI; 16K21530, 16K15385, 16K15978, and 16K15989.
Table 1: Results of the model's estimated values for physical activity of walking and sedentary time
Estimated values (95% CIs)


Click here to view


Keywords: Heritability, physical activity, walking time

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







Fifteen minutes daily physical activity may be a new best target in older adults: The proof cohort study

D. Hupin, V. Pichot, M. Garet, P. Edouard, J. Raffin, M. Berger, L. Féasson, J. C. Barthélémy, F. Roche

Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, France

E-mail: d.hupin@orange.fr

Introduction/Background: Aging is associated with a decrease of the activity level of the Autonomic Nervous System (ANS). With aging, the decline in activity coincides with the occurrence of deaths. It is well established that physical activity (PA) is an efficient strategy for successful aging. This work focuses on the regulation of the ANS by PA and their close relationship in the prevention of cardiovascular events. Materials and Methods: The PROOF (PROgnostic indicator OF cardiovascular and cerebrovascular events) cohort study was designed in 2001 to prospectively assess the predictive value of ANS activity level among a healthy retired French population. PA was assessed every 4 years with self-administered questionnaires and was measured in Metabolic Equivalent of Task (MET)-minutes. We looked at the associated risk of mortality for four categories of weekly PA in MET-minutes, defined as inactive (<1 MET-min/wk), low (1–499 MET-min/wk), medium (500–999 MET-min/wk) or high (≥1000 MET-min/wk). ECG recording were performed every 4 years and SDNN (standard deviation of RR intervals) reflected the regulation of the heart rate by the ANS. Results: Out of the 1011 65-year-old subjects initially included in 2001, the 15 years of follow-up has been currently completed for 688 (68%) subjects, and 89 (9%) deaths were reported. The relative risk of death (all causes) was reduced by 22% (RR = 0.78 [95% CI: 0.25-0.90], p < 0.05) for subjects achieving a low dose of PA compared with an inactive lifestyle. For active subjects even for a low dose of PA, SDNN was stable compared with inactive subjects during the follow-up. Conclusion: Our data from the PROOF cohort suggest that the positive effects of a low dose of PA could thus be, at least partially, explained by its protective impact on ANS activity. ANS up-regulation by the low dose of PA might thus be key for a successful aging.

Keywords: Autonomic nervous system, physical activity, successful aging

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



 
  References Top

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16], [Table 17], [Table 18], [Table 19], [Table 20], [Table 21]



 

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ISPR8-0350
A4.05 Internal M...
ISPR8-1076
A5.01 Paediatric...
ISPR8-1058
A5.02 Paediatric...
ISPR8-0668
ISPR8-1606
ISPR8-0463
ISPR8-0047
ISPR8-0247
ISPR8-0176
ISPR8-1970
ISPR8-1075
ISPR8-2372
ISPR8-0174
ISPR8-1858
ISPR8-1881
ISPR8-0124
A5.03 Paediatric...
ISPR8-2556
ISPR8-0439
A5.05 Paediatric...
ISPR8-0168
A6.02 Geriatrics...
ISPR8-2096
ISPR8-1937
ISPR8-1086
A6.03 Geriatrics...
ISPR8-0283
A6.04 Geriatrics...
ISPR8-2523
A6.05 Geriatrics...
ISPR8-2692
A7.01 Rehabilita...
ISPR8-2331
ISPR8-2504
ISPR8-1751
ISPR8-2115
A7.02 Rehabilita...
ISPR8-1721
ISPR8-1805
ISPR8-2530
ISPR8-1287
ISPR8-1289
ISPR8-2524
ISPR8-1719
ISPR8-1160
A7.06 Rehabilita...
ISPR8-0487
ISPR8-1123
ISPR8-2113
ISPR8-1398
ISPR8-2508
ISPR8-1418
ISPR8-1404
ISPR8-1559
ISPR8-0337
ISPR8-1185
ISPR8-0534
ISPR8-1381
ISPR8-1986
A9.01 Social Int...
ISPR8-1083
A9.03 Social Int...
ISPR8-0165
ISPR8-1077
B2 Cell And Tiss...
[TAG:2]ISPR8-0066
[TAG:2]ISPR8-0066
ISPR8-0066
ISPR8-1468
B3 Biological Me...
ISPR8-0129
ISPR8-1704
C1.01 Physical a...
ISPR8-1664
ISPR8-2178
C1.04 Physical a...
ISPR8-1469
C1.07 Physical a...
ISPR8-1782
ISPR8-2483
ISPR8-2612
ISPR8-1856
ISPR8-2581
ISPR8-1621
ISPR8-1030
ISPR8-2458
C2.01 PRM Interv...
ISPR8-0865
ISPR8-1569
ISPR8-1988
ISPR8-1168
C2.03 PRM Interv...
ISPR8-1868
C2.08 PRM Interv...
ISPR8-0206
C2.12 PRM Interv...
ISPR8-0143
C2.14 PRM Interv...
ISPR8-1022
C2.16 PRM Interv...
ISPR8-0205
ISPR8-2574
ISPR8-1275
ISPR8-2000
C2.17 PRM Interv...
ISPR8-2378
ISPR8-1539
ISPR8-1786
C2.18 PRM Interv...
ISPR8-1291
ISPR8-2563
ISPR8-1564
ISPR8-0088
ISPR8-0354
C2.19 PRM Interv...
ISPR8-1835
D1.03 Rehabilita...
ISPR8-2440
ISPR8-2369
ISPR8-2528
D1.05 Rehabilita...
ISPR8-0795
ISPR8-1756
D2.02 Comprehens...
ISPR8-0835
D2.03 Comprehens...
ISPR8-2436
ISPR8-0627
D4.01 Rehabilita...
ISPR8-1280
E3 Measurement o...
ISPR8-0822
ISPR8-2695
ISPR8-2109
E4 Functioning E...
[TAG:2]ISPR8-2258
[TAG:2]ISPR8-2258
ISPR8-2258
ISPR8-1548
A1.01 PAIN - Acu...
ISPR8-0221
A1.02 PAIN - Chr...
ISPR8-0397
ISPR8-1899
ISPR8-2315
A1.04 PAIN - Mis...
ISPR8-2720
ISPR8-1313
A2.01 Musculoske...
ISPR8-0516
ISPR8-2043
ISPR8-0358
A2.02 Musculoske...
ISPR8-1787
ISPR8-0026
ISPR8-0096
ISPR8-2286
ISPR8-0526
ISPR8-0120
ISPR8-1603
ISPR8-1644
ISPR8-0664
ISPR8-1457
ISPR8-1547
A2.03 Musculoske...
ISPR8-1008
ISPR8-1181
ISPR8-2442
A2.04 Musculoske...
ISPR8-0353
ISPR8-0167
ISPR8-0284
ISPR8-2734
A2.05 Musculoske...
ISPR8-0157
ISPR8-0862
A2.06 Musculoske...
ISPR8-0517
ISPR8-0316
ISPR8-2090
ISPR8-0226
ISPR8-2434
ISPR8-0307
ISPR8-0249
ISPR8-1878
ISPR8-0511
A2.08 Musculoske...
ISPR8-1773
ISPR8-1660
A3.01 Neurologic...
ISPR8-2289
ISPR8-1750
ISPR8-0489
ISPR8-0366
ISPR8-2209
ISPR8-0659
ISPR8-0925
ISPR8-1846
ISPR8-0352
ISPR8-2645
ISPR8-2185
ISPR8-0980
ISPR8-2569
ISPR8-0229
ISPR8-0988
ISPR8-0347
ISPR8-1219
ISPR8-1753
ISPR8-1495
ISPR8-1242
ISPR8-0242
ISPR8-0097
ISPR8-0144
ISPR8-2548
ISPR8-0818
ISPR8-1709
ISPR8-2602
ISPR8-2321
ISPR8-0731
ISPR8-2485
ISPR8-0335
ISPR8-0639
ISPR8-1014
ISPR8-2703
ISPR8-0578
ISPR8-0721
ISPR8-1596
ISPR8-2079
ISPR8-2234
ISPR8-2332
A3.02 Neurologic...
ISPR8-2254
ISPR8-1369
ISPR8-1987
ISPR8-2205
ISPR8-0695
ISPR8-2371
ISPR8-2157
ISPR8-2393
ISPR8-0374
ISPR8-0422
ISPR8-0548
A3.03 Neurologic...
ISPR8-0271
ISPR8-2106
ISPR8-1775
ISPR8-1032
A3.04 Neurologic...
ISPR8-1955
ISPR8-2199
A3.05 Neurologic...
ISPR8-2611
ISPR8-1155
ISPR8-1735
A3.06 Neurologic...
ISPR8-2619
ISPR8-0872
ISPR8-2665
ISPR8-2667
ISPR8-2165
A3.07 Neurologic...
ISPR8-2081
A3.11 Neurologic...
ISPR8-2564
ISPR8-1800
A4.01 Internal M...
ISPR8-0620
A4.04 Internal M...
ISPR8-0297
ISPR8-1567
ISPR8-0486
ISPR8-1967
ISPR8-0350
A4.05 Internal M...
ISPR8-1076
A5.01 Paediatric...
ISPR8-1058
A5.02 Paediatric...
ISPR8-0668
ISPR8-1606
ISPR8-0463
ISPR8-0047
ISPR8-0247
ISPR8-0176
ISPR8-1970
ISPR8-1075
ISPR8-2372
ISPR8-0174
ISPR8-1858
ISPR8-1881
ISPR8-0124
A5.03 Paediatric...
ISPR8-2556
ISPR8-0439
A5.05 Paediatric...
ISPR8-0168
A6.02 Geriatrics...
ISPR8-2096
ISPR8-1937
ISPR8-1086
A6.03 Geriatrics...
ISPR8-0283
A6.04 Geriatrics...
ISPR8-2523
A6.05 Geriatrics...
ISPR8-2692
A7.01 Rehabilita...
ISPR8-2331
ISPR8-2504
ISPR8-1751
ISPR8-2115
A7.02 Rehabilita...
ISPR8-1721
ISPR8-1805
ISPR8-2530
ISPR8-1287
ISPR8-1289
ISPR8-2524
ISPR8-1719
ISPR8-1160
A7.06 Rehabilita...
ISPR8-0487
ISPR8-1123
ISPR8-2113
ISPR8-1398
ISPR8-2508
ISPR8-1418
ISPR8-1404
ISPR8-1559
ISPR8-0337
ISPR8-1185
ISPR8-0534
ISPR8-1381
ISPR8-1986
A9.01 Social Int...
ISPR8-1083
A9.03 Social Int...
ISPR8-0165
ISPR8-1077
B2 Cell And Tiss...
[TAG:2]ISPR8-0066
ISPR8-0066
ISPR8-1468
B3 Biological Me...
ISPR8-0129
ISPR8-1704
C1.01 Physical a...
ISPR8-1664
ISPR8-2178
C1.04 Physical a...
ISPR8-1469
C1.07 Physical a...
ISPR8-1782
ISPR8-2483
ISPR8-2612
ISPR8-1856
ISPR8-2581
ISPR8-1621
ISPR8-1030
ISPR8-2458
C2.01 PRM Interv...
ISPR8-0865
ISPR8-1569
ISPR8-1988
ISPR8-1168
C2.03 PRM Interv...
ISPR8-1868
C2.08 PRM Interv...
ISPR8-0206
C2.12 PRM Interv...
ISPR8-0143
C2.14 PRM Interv...
ISPR8-1022
C2.16 PRM Interv...
ISPR8-0205
ISPR8-2574
ISPR8-1275
ISPR8-2000
C2.17 PRM Interv...
ISPR8-2378
ISPR8-1539
ISPR8-1786
C2.18 PRM Interv...
ISPR8-1291
ISPR8-2563
ISPR8-1564
ISPR8-0088
ISPR8-0354
C2.19 PRM Interv...
ISPR8-1835
D1.03 Rehabilita...
ISPR8-2440
ISPR8-2369
ISPR8-2528
D1.05 Rehabilita...
ISPR8-0795
ISPR8-1756
D2.02 Comprehens...
ISPR8-0835
D2.03 Comprehens...
ISPR8-2436
ISPR8-0627
D4.01 Rehabilita...
ISPR8-1280
E3 Measurement o...
ISPR8-0822
ISPR8-2695
ISPR8-2109
E4 Functioning E...
[TAG:2]ISPR8-2258
ISPR8-2258
A1.01 PAIN - Acu...
ISPR8-0221
A1.02 PAIN - Chr...
ISPR8-0397
ISPR8-1899
ISPR8-2315
A1.04 PAIN - Mis...
ISPR8-2720
ISPR8-1313
A2.01 Musculoske...
ISPR8-0516
ISPR8-2043
ISPR8-0358
A2.02 Musculoske...
ISPR8-1787
ISPR8-0026
ISPR8-0096
ISPR8-2286
ISPR8-0526
ISPR8-0120
ISPR8-1603
ISPR8-1644
ISPR8-0664
ISPR8-1457
ISPR8-1547
A2.03 Musculoske...
ISPR8-1008
ISPR8-1181
ISPR8-2442
A2.04 Musculoske...
ISPR8-0353
ISPR8-0167
ISPR8-0284
ISPR8-2734
A2.05 Musculoske...
ISPR8-0157
ISPR8-0862
A2.06 Musculoske...
ISPR8-0517
ISPR8-0316
ISPR8-2090
ISPR8-0226
ISPR8-2434
ISPR8-0307
ISPR8-0249
ISPR8-1878
ISPR8-0511
A2.08 Musculoske...
ISPR8-1773
ISPR8-1660
A3.01 Neurologic...
ISPR8-2289
ISPR8-1750
ISPR8-0489
ISPR8-0366
ISPR8-2209
ISPR8-0659
ISPR8-0925
ISPR8-1846
ISPR8-0352
ISPR8-2645
ISPR8-2185
ISPR8-0980
ISPR8-2569
ISPR8-0229
ISPR8-0988
ISPR8-0347
ISPR8-1219
ISPR8-1753
ISPR8-1495
ISPR8-1242
ISPR8-0242
ISPR8-0097
ISPR8-0144
ISPR8-2548
ISPR8-0818
ISPR8-1709
ISPR8-2602
ISPR8-2321
ISPR8-0731
ISPR8-2485
ISPR8-0335
ISPR8-0639
ISPR8-1014
ISPR8-2703
ISPR8-0578
ISPR8-0721
ISPR8-1596
ISPR8-2079
ISPR8-2234
ISPR8-2332
A3.02 Neurologic...
ISPR8-2254
ISPR8-1369
ISPR8-1987
ISPR8-2205
ISPR8-0695
ISPR8-2371
ISPR8-2157
ISPR8-2393
ISPR8-0374
ISPR8-0422
ISPR8-0548
A3.03 Neurologic...
ISPR8-0271
ISPR8-2106
ISPR8-1775
ISPR8-1032
A3.04 Neurologic...
ISPR8-1955
ISPR8-2199
A3.05 Neurologic...
ISPR8-2611
ISPR8-1155
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