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ABSTRACTS
Year : 2020  |  Volume : 3  |  Issue : 6  |  Page : 489-1157

Abstracts of Scientific Papers and Posters Presented at the 13th ISPRM World Congress, Kobe, Japan, June 9-13, 2019


Date of Web Publication09-Sep-2020

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-7904.294561

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How to cite this article:
. Abstracts of Scientific Papers and Posters Presented at the 13th ISPRM World Congress, Kobe, Japan, June 9-13, 2019. J Int Soc Phys Rehabil Med 2020;3, Suppl S2:489-1157

How to cite this URL:
. Abstracts of Scientific Papers and Posters Presented at the 13th ISPRM World Congress, Kobe, Japan, June 9-13, 2019. J Int Soc Phys Rehabil Med [serial online] 2020 [cited 2021 Apr 13];3, Suppl S2:489-1157. Available from: https://www.jisprm.org/text.asp?2020/3/6/489/294561




  No. SS25-2: Digital biofeedback system versus conventional home-based in-person rehabilitation for total hip arthroplasty: A feasibility study Top


Fernando D. Correia1,2, Andre Nogueira1, Ivo Magalhaes1, Joana Guimaraes1, Maria Moreira1, Isabel Barradas1, Maria Molinos1, Laetitia Teixeira3, 4, 5, Joaquim Pires6, Rosmaninho Seabra6, Jorge Lains7, Virgilio Bento8

1Department of Clinical, SWORD Health, SA, Porto, Portugal, 2Department of Neurology, Hospital de Santo Antonio- Centro Hospitalar do Porto, Porto, Portugal, 3Department of Population Studies, Abel Salazar Institute of Biomedical Sciences, Porto, Portugal, 4CINTESIS, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal, 5EPIUnit - Instituto de Saude Publica, Universidade do Porto, Porto, Portugal, 6Department of Orthopaedics, Hospital da Prelada- Domingos Braga da Cruz, Porto, Portugal, 7Department of Physical Rehabilitation Medicine, Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal, 8Department of Engineering, University Institute of Maia - ISMAI, Maia, Portugal

Background and Aims: With the aging population, the demand for total hip arthroplasty (THA) is on the rise. In the face of galloping healthcare costs, ensuring widespread cost-effective rehabilitation is a priority. Technologies that allow independent home-based rehabilitation under remote monitoring may help solve this problem. Methods: Single-center, prospective, parallel-group, feasibility study comparing a home-based rehabilitation program with a novel digital biofeedback system under remote monitoring by a physical therapist against conventional in-person home-based rehabilitation after THA, over an 8-week program. Patients were enrolled pre-operatively and assessed at baseline, 4 weeks into the program and at the end of the program. Primary outcome was the change in the Timed Up and Go score between baseline and the 8-week assessment. Secondary outcomes were the change in hip range of motion (ROM) and in a patient reported outcome scale (Hip Osteoarthritis Outcome Scale). Results: Fifty-nine patients completed the study (30 experimental group; 29 conventional rehabilitation). The two groups were similar at baseline. At the 8-week assessment, the results in the experimental group were superior to those of the comparison group for all outcomes except for standing hip flexion ROM and the HOOS Pain subscale. In terms of change between baseline and the 8-week assessment, the study demonstrated a superiority of the experimental group for all outcomes. Adverse events were similar in both groups. Conclusions: This is the first study to demonstrate that a digital rehabilitation solution can achieve better outcomes than conventional in-person rehabilitation after THA, while far less demanding in terms of human resources.

Keywords: Digital, telerehabilitation, total hip replacement

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. SS25-3: Medium-term outcomes a feasibility study comparing digital versus conventional home-based rehabilitation after total hip replacement Top


Fernando D. Correia1, Andre Nogueira1,2, Ivo Magalhaes1, Joana Guimaraes1, Maria Moreira1, Isabel Barradas1, Laetitia Teixeira3, 4, 5, Maria Molinos1, Joaquim Pires6, Rosmaninho Seabra6, Jorge Lains7, Virgilio Bento8

1Department of Clinical, SWORD Health, SA, Porto, Portugal, 2Department of Neurology, Hospital de Santo Antonio- Centro Hospitalar do Porto, Porto, Portugal, 3Department of Population Studies, Abel Salazar Institute of Biomedical Sciences, Porto, Portugal, 4CINTESIS, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal, 5EPIUnit - Instituto de Saude Publica, Universidade do Porto, Porto, Portugal, 6Department of Orthopaedics, Hospital da Prelada- Domingos Braga da Cruz, Porto, Portugal, 7Department of Physical Rehabilitation Medicine, Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal, 8Department of Engineering, University Institute of Maia - ISMAI, Maia, Portugal

Background and Aims: Physical rehabilitation after total hip arthroplasty (THA) is recommended to maximize outcomes. The exact composition of the ideal rehabilitation program is, however, not known, as there are very few studies comparing different interventions. Furthermore, little is known about medium and long-term outcomes of different interventions after THA. We present the follow up results of a feasibility study comparing two different home-based programs after THA: conventional face-to-face sessions versus independent rehabilitation performed through the use of an AI-powered digital rehabilitation system under remote clinical monitoring. Methods: Single-center, prospective, parallel-group, feasibility study with an 8 week active treatment stage and further assessments at 3 and 6 months post-THA. Primary outcome was the Timed Up and Go score; secondary outcomes were: hip range of motion (ROM) and Hip Osteoarthritis Outcome Scale score. Results: Fifty-nine patients completed the active treatment stage; fifty-seven completed the 3 and 6 months assessment (30 experimental group; 27 conventional rehabilitation). At the 3 and 6-months assessments, the results in the experimental group remained superior to those of the comparison group for all outcomes, except for standing hip flexion ROM (both at 3 and 6 months) and the HOOS Pain subscale at 6 months. Conclusions: This study demonstrates that the superior clinical outcomes obtained after the 8 week rehabilitation program with this AI-powered digital rehabilitation system are maintained at the 3 and 6 months assessment. This appears to indicate that maximizing short-term outcomes may have a lasting clinical impact.

Keywords: Digital rehabilitation, follow-up, total hip replacement

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. SS25-4: Medium-term outcomes after total knee replacement: Follow up results of a feasibility study comparing digital versus conventional home-based rehabilitation Top


Fernando D. Correia1,2, Andre Nogueira1, Ivo Magalhaes1, Joana Guimaraes1, Maria Moreira1, Isabel Barradas1, Maria Molinos1, Laetitia Teixeira3, 4, 5, Jose Tulha6, Rosmaninho Seabra6, Jorge Lains7, Virgilio Bento8

1Department of Clinical, SWORD Health, SA, Porto, Portugal, 2Department of Neurology, Hospital de Santo Antonio- Centro Hospitalar do Porto, Porto, Portugal, 3Department of Population Studies, Abel Salazar Institute of Biomedical Sciences, Porto, Portugal, 4CINTESIS, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal, 5EPIUnit - Instituto de Saude Publica, Universidade do Porto, Porto, Portugal, 6Department of Orthopaedics, Hospital da Prelada- Domingos Braga da Cruz, Porto, Portugal, 7Department of Physical Rehabilitation Medicine, Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal, 8Department of Engineering, University Institute of Maia - ISMAI, Maia, Portugal

Background and Aims: Physical rehabilitation is recommended after total knee arthroplasty (TKA). There is, however, no gold standard for rehabilitation programs, regarding their composition, duration and intensity. In fact, studies comparing different interventions are very scarce, and evidence on outcomes after the active treatment phases is anecdotal. Plus, there are studies stating that post-acute rehabilitation programs are not more effective than usual care. We present the follow up results of a feasibility study comparing two different home-based programs after TKA: conventional face-to-face sessions versus independent rehabilitation performed through the use of a digital biofeedback system under remote clinical monitoring. Methods: Single-center, prospective, parallel-group, feasibility study with an 8 week active treatment stage and further assessments at 3 and 6 months post-TKA. Primary outcome was the Timed Up and Go score; secondary outcomes were: knee range of motion (ROM) and Knee Osteoarthritis Outcome Scale (KOOS) score. Results: Fifty-nine patients completed the study (30 experimental group; 29 conventional rehabilitation) and follow up assessments. At 3 and 6-months, the results in the experimental group remained superior to those of the comparison group for TUG (p<.001 in both) and for KOOS, but not for knee ROM. Conclusions: These results appear to indicate that early, intensive and effective rehabilitation through this novel digital biofeedback system can maximize mid-term clinical outcomes after TKA, both in terms of patient performance and patient-reported outcomes, also confirming a poor correlation between ROM gains and clinically meaningful outcomes.

Keywords: Home-based, telerehabilitation, total knee replacement

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. SS25-7: Telerehabilitation for patients with dysphagia and dysarthria: Usefulness and satisfaction Top


Sonoko Nozaki1, Maiko Nishiguchi2, Kyoko Okuno2, Takako Tanimura1, Mika Takeichi3, Kentarou Akagi4, Yoko Nakano5, Mitsuru Furuta1, Shiro Yorifuji1

1Department of Neurology, Kansai Rosai Hospital, Amagasaki, Japan, 2Department of Rehabilitation, Kansai Rosai Hospital, Amagasaki, Japan, 3Visiting Nurse Station Tabelu, 4Ebisu Rehabilitation and Home Nursing Association Nishinomiya, 5Aiaihoumonkango Station

Background and Aims: This investigation aimed to evaluate perceptions and satisfaction of telerehabilitation for dysphagia and dysarthria in patients and medical staff. Methods: Five patients (2 Parkinson's disease (PD), 1 progressive supranuclear palsy (PSP), 1 multiple system atrophy (MSA), 1 cerebrovascular disease received visit rehabilitation by medical staff once a week and telerehabilitation (via Skype®) once a month for dysphagia. The internet communication was among the patients, hospital staffs and visiting medical staff. Another 5 patients (2 PD, 1 PSP, 2 MSA) did self-treatment with Lee Sylverman Voice Treatment at home and received telerehabilitation from hospital staff via video call on LINE® more than once a week. Perceptions and satisfaction of the patients and medical staff (hospital and visiting staff) with telerehabilitation were evaluated via questionnaire. The devices for telerehabilitation were personal computers, tablets, or smartphones. Results: All patients reported positive perceptions of telerehabilitation: comfort (100%), confidence (100%). However, 50% of patients felt resistance at first to showing the state of their homes over a webcam and 20% felt burdened by the time schedule and associated preparation for internet communication. Medical staff listed the merits and demerits of telerehabilitation. Merits: Hospital staff could observe the real-life situation of the patient between hospital visits and could observe eating habits more often. Telerehabilitation reduced the burden and anxiety of medical care for visiting medical staff and they felt information gained from internet communication was useful. Demerits: When the net environment is insufficient, communication is unstable. Communicating sudden schedule changes is difficult. Conclusions: Staff can observe the patient situation at home visually, and telerehabilitation leads to better concrete practice than a document-based rehabilitation plan.

Keywords: Dysarthria, dysphagia, telerehabilitation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  Oral Abstracts Top



  No. O1-1: Pain reported by people with cerebral palsy and families: ESPaCe, a national survey on motor rehabilitation in France Top


Javier De La Cruz1, Gwenael Cornec2, Gaelle Drewnowski3, Julia Boivin3, Philippe Toullet4, Isabelle Desguerre5, Audrey Fontaine6, Vincent Gautheron7, Yann Le Lay4, Anne-Catherine Guenier8, Eric Berard9, Maria Bodoria10, Sylvain Brochard2

1Imas12 Health Research Institute, Madrid University Hospital 12 Octubre-Sermas, Madrid, Spain, 2Department of Physical and Rehabilitation Medicine, University Hospital of Brest, Fondation Ildys, INSERM-UMR 1101, Medical Data Treatment (LaTIM), Roscoff, France, 3Expert Patient, Lyon, France, 4Institut Motricite Cerebrale, Cercle de Documentation et d'information Pour La Reeducation Des Infirmes Moteurs Cerebraux, France, 5Hopital Necker–Enfants Malades, Pediatrics-Radiology-Genetics, Paris, France, 6Department of Physiotherapy, CAMSP Paris 12 - ISIR, UPMC, Paris, France, 7Department of Physical and Rehabilitation Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France, 8Association Hemiparesie, France, 9Federation Francaise Des Associations Des Infirmes Moteurs Cerebraux, France, 10Fondation Paralysie Cerebrale, Paris, France

Background and Aims: Pain in children and adolescents with cerebral palsy is a key determinant of quality of life. The aims of this study were to describe pain occurrence in people with cerebral palsy, including adults, and to identify determinants of pain related to patient characteristics, motor rehabilitation (MR) organization and practice features. Methods: This study was part of a French national survey promoted by Fondation-Paralysie-Cerebrale aimed at documenting the views on MR of persons with cerebral palsy and their families via a questionnaire developed by a multidisciplinary group. The questionnaire included an item on frequency of pain episodes related to CP rated on a Likert scale (0-never to 5- always) which was the primary outcome of this study. Either the persons with cerebral palsy or their main carer could complete the survey questionnaire, online or post-in. Data analysis included univariate description of pain determinants across frequency of pain categories, and logistic modelling. Results: 1010 eligible participants (354 (35%) children, 145 (14%) adolescents and 511 (51%) adults) responded to the questionnaire and 785 rated the frequency of pain related item. Moderate to high frequency of pain episodes were found in 33% of children -2 to 11 years old, in 44% of adolescents and in 64% of adults-over 18 years (trend p-value<0.001). Univariate analysis suggested multiple factors were associated with frequency of pain. Multivariable sequential adjustment with more than 20 selected variables singled out aging (odds ratio (OR) 2.7;1.7-4.3) and high difficulty to find a therapist with CP training (OR, 2.6;1.4-5.2) as main patient characteristic and MR feature related to increased frequency of pain. Conclusions: Health professionals should consider the occurrence of pain in people with cerebral palsy at all ages. Patient and family views relate increased occurrence of pain episodes with aging, motor rehabilitation organization and practice features.

Keywords: Cerebral palsy, motor rehabilitation, pain

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O1-2: Pain in adults with cerebral palsy: A systematic review and meta-analysis Top


Wilma M. A. Van Der Slot1,2, Joyce L. Benner1,2, Grigorius Papageorgiou3, Prue Morgan4, Marij E. Roebroeck1,2, Pain Review Group5

1Department of Neurorehabilitation, Rijndam Rehabilitation, Rotterdam, Netherlands, 2Department of Rehabilitation Medicine, Erasmus University, MC, Netherlands, 3Department of Biostatistics, Erasmus University, MC, Netherlands, 4Department of Physiotherapy, Monash University, Australia

Background and Aims: Little is known about pain in adults with cerebral palsy (CP). The main objective was to estimate overall pain prevalence. Secondary aims were to explore variations in pain prevalence by age, gender, CP-subtype and gross motor function, and to investigate pain locations, pain severity and pain interference on daily activities. Methods: Potential datasets were identified by experts in the field, hand searches and literature search in Embase, MEDLINE, and Cochrane, from January 2000 until October 2016. Included studies were observational (or baseline trial data) with 25 or more adults with CP, a representative sample, and with 1 or more pain outcomes. Methodological quality assessment, pain prevalence estimates and logistic regression models for factor influence on pain prevalence were conducted. Results: Seventeen eligible studies were identified from 4584 publications. A meta-analysis was performed with individual participant data from 15 studies; totalling 1243 participants (mean age 34.3 (SD 12.6) years). Overall mean pain prevalence was 70.3% (95%CI 61.7-78.2%). Women were significantly more likely to have pain than men (p-value less than 0.001). A significantly higher risk was demonstrated for adults with gross motor function levels II (OR,1.92 95%CI, 1.22-3.12), and IV (OR,1.77; 95%CI, 1.03-4.29). Participants with pain, reported pain predominantly in the legs: 75.6% (95%CI 66.2-84.0), and a mean pain severity of 3.7/10 (95%CI 2.7-4.7) and pain interference of 3.5/10 (95%CI 2.5-4.5). Conclusions: This meta-analysis provides the first reliable pain prevalence estimate in a large international sample of adults with CP. The high prevalence of 70% suggests that adults with CP should be routinely screened for pain and treated accordingly.

Keywords: Adults, cerebral palsy, pain

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O1-3: Postural balance at children survived after posterior fossa tumor, acute lymphoblastic leukemia and hematopoietic stem cell transplantation Top


Dmitry V. Skvortsov1,2, Vladimir N. Kasatkin2, Serafima M. Chechelnitskaya2, Daria V. ZHuk2, Alexander F. Karelin2

1Department of Rehabilitation, Pirogov's Medical University, Moscow, Russia, 2Rehabilitation Center “Russkoe Pole,” Moscow, Russia

Background and Aims: The postural balance at oncology survived children with Posterior Fossa Tumor (PFT), Acute lymphoblastic leukemia (ALL), Hematopoietic stem cell transplantation (HSCT) is remaining unclear. Methods: We used Stabilan-01-2® stabilometric platform. The participants were instructed to stand straight with heels together and toes apart (Europe standard position). The participants completed the Romberg test (barefoot) with eyes open (EO) and eyes closed (EC) on the platform, EO on a foam placed on the platform and EO with artificial grass placed on the platform. Each trial takes 30 sec. The following groups participated in the trial: 32 PFT survivors 12 females, 20 males, ALL - 40 females, 48 males, HSCT - 14 females, 31 males, and 35 healthy controls 19 females, 19 males. Results: The control group has only significant difference for EO and EC by the increasing average speed CP for sagittal plane. They are not use visual input for balance. All patient's groups have similar and statistically significant difference to control group. For EO position oscillation at frontal plane are increased, surface of the sway path also higher for ALL and HSCT group and power of Fourier transform spectrum more for sagittal plane for group PFT. For EC position found higher amplitude of oscillation at frontal plane at PFT group. At the same time power of oscillation significantly lower the control group for all three groups of patients. EO position has difference from EC at patient's groups by significant increasing velocity of CP. Conclusions: Therefore, all three groups have decreasing balance at upright position. But, the physiological basis of balance is the same as for normal children. Two-thirds of patients at the investigated period have no postural disturbances detected by stabilometry method.

Keywords: Children, oncology, postural balance

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O1-4: Contribution of rehabilitation medicine to patients with typical form of fibrodysplasia ossificans progressiva Top


Nobuhiko Haga, Yusuke Shinoda, Sayaka Fujiwara, Ryoko Sawada, Hiroshi Mano

Department of Rehabilitation Medicine, the University of Tokyo, Tokyo, Japan

Background and Aims: Fibrodysplasia ossificans progressiva (FOP) is an extremely rare genetic skeletal disorder manifesting progressive heterotopic ossification, leading to limitation of motion and deformities in the trunk and extremities. According to “The Medical Management of FOP: A Current Treatment Considerations”, passive range of motion exercises must be avoided and rehabilitation approaches should be focused on enhancing activities of daily living. The aim of this study is to clarify the rehabilitation approaches performed for Japanese patients with FOP. Methods: e reviewed medical records of patients with typical form of FOP who visited our department from 2006 to 2018, and collected data on ambulation at initial and final visit, and experiences of rehabilitation approaches. Results: Overall, 22 patients (11 males) were surveyed. Age at initial and final visit ranged 0-39 (mean 16) and 2-51 (mean 21) years respectively. Three patients died during the follow-up period. Thirteen patients walked without assistance both at initial and final visit, and two patients who could not walk initially at the age of 0 gained unassisted ambulation at the final visit. Five patients walked with assistance indoors and used manual or power wheelchairs outdoors both at initial (mean 28 years) and final visit. One patient moved only with attendant-propelled wheelchairs, and one patient with severely deformed trunk and contracted hip joints moved with a walker at both visits. No rehabilitation approaches, including inspiratory and expiratory muscle training, were recorded in 17 patients, but one of them participated in adapted sports. One patient underwent massage during childhood. Shoes were modified in three patients, and canes were modified in other two patients. A spinal brace is being tried to prevent progression of scoliosis in one patient. Conclusions: Rehabilitation approaches were seldom performed in Japanese patients with typical FOP, excluding modification of shoes or canes.

Keywords: Fibrodysplasia ossofocans progressiva, heterotopic ossification, skeletal dysplasia

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O1-5: The using of music as complementary rehabilitation for children with autism spectrum disorder Top


Erayanti Saloko1,2, Erna Ariyanti Kurnianingsih2, Samuel Cahyo Sembodo3, Yuko Ito1, Ryuji Kobayashi1

1Department of Occupational Therapy, Tokyo Metropolitan University Hachioji, Japan, 2Department of Occupational Therapy, Surakarta Health Polytechnic, Surakarta, Indonesia, 3Gilang Ramadhan Studio Band, Surakarta, Indonesia

Background and Aims: Music is long known to have therapeutic effects. In form of rhythm, music is mainly applied to stimulate internalization. Music rhythm therapy can be used to obtain non-musical skills for children with disabilities. Music has also become rehabilitative program in improving Autism Spectrum Disorders (ASD) children's skills, since it has the potential in the form of joy as well as sensomotor, cognitive and psychosocial inputs. The aim of this study is to investigate the effect of rhythm therapy program for children with ASD. Methods: This study and its ethical clearance are conducted in Surakarta, Central Java, Indonesia, from March to November 2018. Mixed method design is applied with 30 samples of ASD ages 3 - 10 years recruited. Samples were divided into a group of rhythm therapy, and another control group using sensory integration for 12 weeks. The Test of Gross Motor Development (TGMD), Short Sensory Profile (SSP) and Gilliam Autism Rating Scale (GARS) were administered before and after intervention. The qualitative analysis is using secondary data from parents, care takers and occupational therapists. Results: Statistically, comparison tests resulted that TGMD scores 0.137 (p > 0,05), SSP scores 0,000 (p< 0,05) and GARS scores 0,001 (p< 0,05). The qualitative analysis reported that ASD children who undergo rhythm therapy showed more advanced in adaptive behavior, sleeping pattern and expressive communication. While ASD children who undergo sensory integration showed more advanced in exploratory and adaptive behavior. Conclusions: Rhythm therapy has no effects in motor development of ASD children. There is a significant effect of rhythm therapy for sensory profile and decreasing the ASD symptoms. ASD children also showed more advanced in adaptive behavior, sleeping-activity pattern and expressive communication. Rhythm therapy is recommended by occupational therapists and parents as a complementary rehabilitation as it is fun and stimulating.

Keywords: Autism spectrum disorders, complementary rehabilitation, music therapy

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.








  No. O2-2: Comparison of radial extracorporeal shock wave therapy and ultrasound-guided glucocorticoid injection in shoulder pain: A randomized control trial Top


Zhuangfu Wang, Dongfeng Xie, Juanjuan He, Wei Xin, Yiying Mai, Weijian Tang

The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

Background and Aims: This study aims to compare the effect of radial extracorporeal shock wave therapy(rESWT) with ultrasound-guided glucocorticoid injection when treating shoulder pain. Methods: The study recruited 127 participants with shoulder pain,randomly divided into two groups:Group 1 with 65 participants,who were treated with rESWT(3000 pulses each;pressure:1.5-2.0 bar;frequency:10Hz) once a week for 5weeks;Group 2 consisted of 62 participants who received ultrasound-guided glucocorticoid injection just for once.The blinded assessments were done before treatment,1 week,1 month and 3 months after the first treatment by Shoulder Pain and Disability Index(SPADI). Results: In the ultrasound-guided glucocorticoid injection group,participants showed statistically significant improvement in SPADI(p<0.05) at 1week after the treatment while there was no statistical significant changes in the rESWT group.Both groups of participants showed statistically significant improvement in SPADI(p<0.05) at 1 month and 3 months after the treatment. Conclusions: Ultrasound-guided glucocorticoid injection showed immediate effects at the first week while rESWT didn't show significant effects at the first week.This randomized control study revealed both rESWT and ultrasound-guided glucocorticoid injection for shoulder pain provide long-lasting benefits at least for 3 months after treatment.

Keywords: Glucocorticoid injection, rESWT, shoulder pain

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O2-4: A randomized, double-blind, placebo-controlled trial of efficacy of high intensity laser therapy for carpal tunnel syndrome Top


Chakarg Pongurgsorn, Nopparat Jungjaroennorasook, Phakamas Tanvijit, Kornkamol Theeparakpun, Veeravich Phanitsupasetch

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

Background: Carpal tunnel syndrome (CTS) is the condition caused by the compression of Median nerve due to the swelling and inflammation of structures forming carpal tunnel. High intensity laser therapy (HILT) is recently used to decrease inflammation and promote healing in musculoskeletal conditions, which may be useful in the treatment of CTS. Objectives: To compare the effectiveness of HILT versus sham laser on the electrophysiological benefits and clinical outcomes in patients with mild to moderate CTS by a double-blinded randomized controlled trial. Methods: Sixty CTS patients with mild to moderate degree were recruited and randomized equally into 2 groups. The HILT group received HILT 1000 J per session 3 times a week for 5 weeks. The control group received sham laser. Both groups were suggested to perform tendon gliding exercise every day. Nerve conduction study measured at baseline and 12 weeks by blinded testers were the primary outcome. Secondary outcomes, including clinical parameters which consisted of Symptoms Severity Scale (SSS), Functional Status Scale (FSS), Numeric Rating Scale (NRS) and monofilament test were assessed at baseline, 5 and 12 weeks. Results: 52 females and 8 males completed the study. Improvements in electrophysiological parameters were significantly more pronounced in the HILT group than the control group especially for compound muscle action potential (CMAP) amplitude at 12 weeks follow-up (p=0.008). Sensory nerve action potential (SNAP) amplitude significantly improved only in HILT group (p=0.011).Both groups showed a significant reduction in SSS, NRS and monofilament test. However, there was no significant difference between groups in distal sensory latency (DSL), distal motor latency (DML), SNAP amplitude and clinical parameters. Conclusion: HILT with conventional therapy in patients with mild to moderate CTS provide improvement in both electrophysiologic findings and clinical aspects. Its effect lasts 3 months. HILT can be a useful therapeutic adjunct in patients with CTS.

Keywords: Carpal tunnel syndrome, electrophysiologic parameter, high level laser therapy

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O2-6: Influence of nerve block on prevention effect of low-magnitude high-frequency vibration on disuse osteoporosis Top


Xiaoyun Wang, Peizhen Zhang, Dan Tang, Huijing Hu

Guangdong Work Injury Rehabilitation Center, Guangdong, China

Introduction: Disuse osteoporosis is defined as localized or generalized bone loss resulting from reduction of mechanical stress on bones. It's well known that the mechanical signal enhances osteogenesis, and the low-magnitude high-frequency (LMHF) vibration has been used to prevent disuse osteoporosis. However, the mechanism underlying the modulatory effect of LMHF vibration on bone metabolism remains unclear. In the present study, by using tail-suspending rat model and sciatic nerve block method, the involvement of peripheral innervation on preventive effect of LMHF vibration on disuse osteoporosis was investigated. Methods: A total of 28 three-month old male SD rats were randomly assigned to five groups: control (CON), tail suspending (SUS), tail suspending plus LMHF vibration treatment (SUS+V), tail suspending plus nerve blocking manipulation (NB+SUS), tail suspending plus nerve block and LMHF vibration (NB+SUS+V), with 4 rats in CON and 6 rats in other groups respectively. In the vibration groups, rats received a LMHF vibration (35Hz, 0.3g) treatment 20 min per day for 5 days every week. All animals were held for 8 weeks and sacrificed for radiological, histological and immunofluorescent assessments. Results: The results showed that BV/TV, Conn.D, Tb.N of tibia in SUS group rat were significantly decreased when compared with that of SUS+V group rat, suggesting LMHF could effectively prevent disuse osteoporosis. Moreover, Tb.Sp of tibia in NB+SUS group rat was significantly higher than that of SUS group rat, indicating nerve block may accelerate the development of disuse osteoporosis. However, no significant difference was observed between NB+SUS+V and SUS+V group. Immunostaining results showed that the density of CGRP expressing nerve fibers was significantly higher in vibration groups than that in non-vibration groups. Conclusion: Peripheral innervation was involved in disuse osteoporosis and CGRP expressing nerve fibers might contribute to the preventive effect of LMHF vibration.

Keywords: Disuse osteoporosis, low-magnitude high-frequencyLMHF vibration, peripheral innervation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O2-7: Nanostructured titanium dioxide coating reduces the temperature increment of muscle tissues adjacent to titanium alloy implants in microwave irradiation Top


Yuehong Bai

Department of Rehabilitation, Shanghai Sixth People's Hospital, Shanghai, China

Background and Aims: The traditional theory of physical therapy considers that microwave therapy is forbidden for patients with metal implants because microwave may cause thermal damage to the tissue surrounding the implants. The nanostructured titanium dioxide (TiO2) coating has the effect of thermal insulation. In this study, we observed the changes of tissue temperature around titanium alloy implants which covered with nanostructured TiO2 coating after microwave irradiation. Methods: Thirty-six rabbits were randomly divided into the treatment group (n=12), the control group(n=12), and the sham operation group(n=12). Model of rabbit femoral fracture was constructed in the treatment group and the control group. TiO2 encapsulated and un-encapsulated titanium alloy plates were respectively implanted in femora in the treatment group and the control group. The sham operation group had only skin incision and tissue separation. All the three groups received microwave therapy(2450MHz) three days after the operation. Continuous microwave radiation was administered at 40w (n=6) and 60w (n=6) for each group. Muscle's temperature adjacent to the implants were measured by a fiber-optic thermometer. The temperature readouts were recorded per minute for at least 20 minutes. Results: The temperature of all three groups rose dramatically when irradiated by 40W and 60W microwave. The temperature gaps of the control group were significantly higher compared with the treatment group (P<0.01) and the sham operation group(P<0.01). There is no statistically significant difference between the treatment group and the sham operation group(P>0.05). Moreover, the temperature was higher surrounding the plates' tissue after 60W microwave irradiation than 40W microwave irradiation. Conclusions: The temperature increment of muscles adjacent to the titanium alloy implants coated with TiO2 was much lower than those without a TiO2 coating. The application of a nanostructured TiO2 coating on titanium alloy implants is a potential way to reduce thermal damage while receiving microwave irradiation.

Keywords: Microwave irradiation, nanostructured TiO2 coating titanium alloy, temperature

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O2-9: The clinical efficacy of lordotic curve-controlled lumbar traction device: Randomized controlled trial Top


Chang-Hyung Lee, Sung-Jin Heo

Department of Rehabilitation, Pusan National University Yangsan Hospital, Yangsan, South Korea

Background and Aims: Lumbar traction treatment was widely used to the non-operative treatment for herniation of lumber intervertebral disc (HIVD). The conventional traction methods were used to linear-type traction devices and the usefulness is at argument. There was no study that the effect of traction method with sustaining the lumbar lordotic curve during traction. The purpose of this study was to examine the effect of lumbar traction with sustaining the lumbar lordotic curve during traction on functional status and pain in HIVD patients. Methods: This study was designed as randomized controlled trial comparing between LCCT and ST. Patients were randomly assigned into two groups (LCCT or ST). The maximum traction power of the device does not exceed 100 pounds or 50% of patients weight in order to prevent damage to patients muscle or tendon. All participants completed the Oswestry Disability Index (ODI) and Rolando&Morris questionnaire (RM) to assess their functional status. Pain in the trunk and lower extremities that was exacerbated during activities of daily living using a 10 mm visual analog scale (VAS). Changes in dependent variables before and after interventions. Results: VAS scores were significant in LCCT(p<0.001) and ST groups(p<0.01). ODI scores were significantly higher in the LCCT group(p<0.01) than in the ST(p>0.05). RM scores were significantly higher in the LCCT group(p<0.001) than in the ST(p>0.05). MRI central canal were significantly higher in the LCCT group(p<0.01) than in the ST(p>005). The results showed a significant decrease pain scale in both groups. However, In the assess functional movements, the LCCT group was effective, but the ST group was ineffective. Conclusions: This study showed that newly invented traction device with sustaining lumbar lordotic curve was more effective compared to standard type of traction device in improving functional status, pain and geometrical change in patients with herniated intervertebral disc disease.

Keywords: Lordosis, lumbar herniation, lumbar traction

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O3-1: The effect of oval shaped double balloon dilation therapy for dysphagia in lateral medullary infarction: A case report Top


Ryu Ishimoto1, Seiko Shibata1, Ryoko Akahori1, Keiko Aihara2, Yoko Inamoto3, Keiko Onogi1, Yuriko Ito1, Yoichiro Aoyagi1, Hitoshi Kagaya1, Eiichi Saitoh1

1Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake Aichi, Japan, 2Department of Rehabilitation Medicine, Fujita Health University Hospital, Toyoake Aichi, Japan, 3Faculty of Rehabilitation Medicine, Fujita Health University, Toyoake Aichi, Japan

Background: Dysfunction of the upper esophageal sphincter (UES) is commonly treated by balloon dilation therapy with a urethral catheter. It is preferably used because it is inexpensive and accessible. However, this spherical shape may not be ideal for UES dilation. We hypothesized superior outcomes with oval shaped double balloon dilation therapy for dysphagia. Methods: A 58 year-old male with dysphagia from right lateral medullary infarction was admitted to our rehabilitation ward on post stroke day 278 for ovl shaped double balloon dilation therapy. The characteristics of oval shaped double balloon catheters are shown in [Figure 1]. The daily treatment regimen consisted of three consecutive trans-UES dilations, each lasting ten seconds. Afterwards, swallowing of food boluses were performed with postural adjustment in left lateral trunk rotation and 60 degree recline. Food boluses consisted of liquid, jelly, or rice porridge. Videofluoroscopic swallow study (VFSS) and high-resolution manometry (HRM) were performed for assessments. Results: <VFSS> On day 298, the bolus did not pass through the UES before the dilation. After dilation, 2 mL of honey thick liquid passed through the left UES. By day 354, 4 ml of nectar thick liquid and rice porridge passed through the left UES before dilation, with a post dilation decrease in vallecular residuals. These results allowed diet advancement to mechanical soft with thickened soup. <HRM> On day 298, mean UES residual pressures on left side decreased from 34 to -4 mmHg after the dilation. By day 354, the pre-dilation pressure decreased to 5 mmHg, indicating a long term effect. Conclusions: Both immediate and long term effects were revealed with oval shaped double balloon dilation therapy. Dilation with this catheter resulted in a favorable outcome, likely because the inner balloon initially anchored at the UES, allowing the outer oval shaped balloon to effectively dilate along the UES lumen.
Figure 1: Oval shaped double balloon catheter

Click here to view


Keywords: Balloon dilation therapy, dysphagia, upper esophageal sphincter

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O3-2: Does severity of dysphagia affect 1-year survival and recurrence in patients with aspiration pneumonia? Top


Fumi Toda1,2, Hitoshi Kagaya1, Misa Hagino3, Ayako Inaba3, Saeka Ando3

1Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan, 2Department of Rehabilitation, Chukyo Hospital, Nagoya, Japan, 3Rehabilitation Center, Chukyo Hospital, Nagoya, Japan

Background and Aims: Patients with aspiration pneumonia in the elderly often have swallowing problems. The aim of this study was to evaluate the relationship between severity of dysphagia and 1-year survival and recurrence of aspiration pneumonia in those patients. Methods: This study was approved by the institutional review board. A total of 394 patients (mean 83±10 years) hospitalized for aspiration pneumonia were referred to Department of Rehabilitation between July 2014 and December 2016. Their swallowing function were evaluated by screening tests, videoendoscopic evaluation of swallowing, and/or videofluoroscopic examination of swallowing. The severity of dysphagia was classified by the dysphagia severity scale (DSS) that had a 7-point ordinal scale. We divided them into severe dysphagia (DSS 1; saliva aspiration, DSS 2; food aspiration, and DSS 3; water aspiration), moderate dysphagia (DSS 4; occasional aspiration), and mild dysphagia (DSS 5; oral problems, DSS 6; minimum problems, and DSS 7; within normal limits). The history of stroke, dementia, tube feeding at discharge were checked from the medial record. For survived patients who did not die during hospitalization, we examined 1-year survival and recurrence of aspiration pneumonia by using Chi-square test and Log-rank test with Bonferroni correction. Results: Fifty-nine patients in 394 died during hospitalization. Seventy-five survived patients were failed to evaluate by DSS. In 260 survivors, 42 had severe, 50 had moderate, and 168 showed mild dysphagia. The severe group had more post-stroke patients than mild group, more dementia than moderate and mild group, and had more tube feeding at discharge than mild group. Cumulative 1-year survival rate of moderate group was significantly lower than that of mild group (p=0.039), while cumulative one year readmission rate for pneumonia didn't differ among 3 groups. Conclusions: The 1-year survival after aspiration pneumonia was more in moderate group than that in mild group.

Keywords: 1-year survival, aspiration pneumonia, dysphagia

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O3-3: Is swallowing function related to ADL level and spatial extent of life space in patients with respiratory failure? Top


Masashi Zenta1,2, Risa Kiko1, Toshie Nishikawa1, Kenji Tsushima3, Tomohiro Hattori4, Hiroshi Maruoka2, Satoshi Kido2, Wataru Kakuda5

1Department of Rehabilitation Medicine, International University of Health and Welfare, Ichikawa Hospital, Otawara, Japan, 2Graduate Course of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan, 3Department of Pulmonary Medicine, School of Medicine, International University of Health and Welfare, Otawara, Japan, 4Department of Pulmonary Medicine, International University of Health and Welfare, Ichikawa Hospital, Otawara, Japan, 5Department of Rehabilitation Medicine, School of Medicine International University of Health and Welfare, Otawara, Japan

Background and Aims: It is certain that not only ADL level but also spatial extent of life space (LS) can influence quality of life in patients with some pathological conditions. We anticipate that the presence of dysphagia can lead to the worsening of ADL level and spatial extent of LS. The purpose of this study is to clarify the relationship between swallowing function and these two parameters in patients with respiratory failure. Methods: The subjects for this study were 32 patients admitted to our hospital with the diagnosis of respiratory failure during the period between February 1, 2018 and August 31, 2018 (average age at admission; 81.2±9.2 years old). After their admissions, swallowing function was investigated with Repetitive Saliva Swallowing Test (RSST). The level of ADL was evaluated with Functional Independence Measure (FIM). In addition, for the evaluation of spatial extent of life space, Life Space Assessment (LSA) was assessed using a questionnaire. Based on the results of RSST, we divided study subjects into two groups such as “dysphagic group” and “normal group”, and compared FIM and LSA sore between two groups. Results: Total score and motor score of FIM was significantly lower in dysphagic group than in normal group (all p values <0.05). LSA score was also significantly lower in dysphagic group than in normal group (p value <0.05). In addition, the grade in RSST was significantly related to not only FIM score and LSA score (all p values <0.05). Conclusions: In patients with respiratory failure, swallowing function is related to ADL level and spatial extent of LS. We can expect that the introduction of swallowing rehabilitation leads to the improvements of ADL level and spatial extent of LS.

Keywords: Life space, respiratory failure, swallowing function

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O3-4: The effect of reclining position on swallowing function in stroke with dysphagia Top


Paitoon Benjapornlert1,2, Hitoshi Kagaya1, Yoko Inamoto3, Eriko Mizokoshi1, Seiko Shibata1, Eiichi Saitoh1

1Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan, 2Department of Rehabilitation Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Salaya, Thailand, 3Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan

Background and Aims: Dysphagia is common problem in stroke patient. To treatment of this problem, reclining position is one of the commonly used compensatory technique in Japan. The aim of this study was to evaluate the effect of reclining posture, which could reduce the penetration and aspiration scale (PAS), and decrease the amount of residual in oropharyngeal area. Methods: The video fluoroscopic examination of swallowing (VF) was retrospective analyzed about the effect of reclining position compared among 90 degree upright (90DU), 60 degree reclining (60DR), and/or 45 degree reclining (45DR) position, tested with 4 ml honey thick liquid. Results: Two hundred-five VF records from ninety-eight subjects were reviewed. These included ischemic stroke 62%, hemorrhagic stroke 32%, and SAH 6%. The median dysphagia severity scale (DSS) was 3. The results showed that in more reclining position there was more decreased in PAS in 60DR than 90DU (P = 0.001), and in 45DR than 60DR (P < 0.001). The residue in valleculae and pyriform also reduced in more reclining position group (P < 0.001). The leading edge of bolus during swallowing onset was significant deeper in more upright position, (P < 0.050). There was no significant change of duration during bolus passing through oropharyngeal area including valleculae aggregation time (VAT), upper hypopharyngeal time (UHT), lower hypopharyngeal time (LHT), stage transit duration (STD), pharyngeal transit duration (PTD), and pharyngeal response duration (PRD), except the STD and PTD was significant shorter in 45DR than 60DR, (P < 0.001). Conclusions: These findings suggest that in stroke patients with dysphagia, reclining position is the effective rehabilitation treatment to reduce the risk of penetration and aspiration, and decrease the amount of residual in pharyngeal area. The deeper bolus head at the onset of swallow reflex in more upright position increase the risk of penetration and aspiration.

Keywords: Reclining position, stroke with dysphagia, video fluoroscopic examination of swallowing

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O3-5: Detection of penetration/aspiration in video fluoroscopic swallowing study by image analysis with deep learning: A pilot study Top


Seong Jae Lee1, Sang-Il Choi2, Joo Young Ko1, Hyunil Kim3

1Department of Rehabilitation Medicine, College of Medicine, Dankook University, Yongin, South Korea, 2Department of Applied Computer Engineering, Dankook University, Yongin, South Korea, 3Department of Software Engineering, Dankook University, Yongin, South Korea

Background and Aims: VFSS is one of standard diagnostic tools for evaluation of dysphagia. Penetration or aspiration can be demonstrated objectively by VFSS. However, analysis of VFSS is a delicate task that requires experiences and knowledge of the reading physicians. Sometimes it demands high level of concentration and can be time-consuming by repeated playback and visual observation. Inter-rater reliability has been reported to be not so high. This study was designed to increase reliability of VFSS by reducing human errors with a deep learning software. Methods: Two hundred video files from VFSS (one hundred normal and abnormal each) were collected for developing a deep learning application software that detects penetration and/or aspiration automatically. Each frame image was separated and adjusted by CLAHE algorithm. Totally one hundred thousand normal images and sixty eight thousand abnormal images were isolated and equalized. AlexNet, one of the Convolutional Neural Network (CNN) models, was used for deep learning. Results: Currently, accuracy of 89%, precision of 32% and recall of 60% was achieved with preliminary application software. The software detected 60% of penetration/aspiration identified visually in VFSS. Among the images judged as penetration/aspiration by software, 32% was true in visual inspection by experienced physician. In normal swallowing images, 97% of software reading coincided with human visual reading. Conclusions: The authors developed deep learning application software that detects penetration/aspiration from VFSS images. Recall of 32% was less than satisfactory but will be improved by deep learning with a larger number of images. The software reading was fairly accurate when its results were judged as normal. More accurate and easier reading of VFSS is expected to be available by this application. Acknowledgment: This research was supported by Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Education (grant number: 2018R1D1A3B07049300)

Keywords: Deep learning, swallowing, videofluoroscopy

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O3-6: Oral stereognostic ability in stroke patients with dysphagia: Investigation by oral stereognostic ability test and videofluoroscopy of swallowing Top


Mayumi Suzuki1, Rintaro Ohama2, Michihiro Ogura2, Fumio Takeda1, Megumi Shimodozono2

1Department of Nursing, Kagoshima University Hospital, Kagoshima, Japan, 2Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

Background and Aims: Oral sensory information from a food or bolus plays an important role in safety swallowing. However, the relationship between oral stereognostic ability (OSA) and swallowing function in stroke patients with dysphagia is not known. Here, we investigated that relationship. Methods: The subjects were 27 stroke patients (16 males, mean age 67.6 years [SD 12.0], with average elapsed time 65.6 weeks [SD 107.0]) after the onset of stroke, who underwent a videofluoroscopy study of swallowing due to problems in swallowing function. The OSA test was conducted with 6 test pieces having different shapes (Arndt et al., 1970). Each of the 6 items was presented to the oral cavity invisibly twice in random order, and the subjects identified the shape of the item. Each presentation was scored for correct identification to give an OSA score (0-12; worst to best), and we set the cut-off value as 2 SD below the average among healthy elderly people (Kawagishi et al., 2013). Swallowing function was evaluated by the videofluoroscopic dysphagia scale (VDS; Han et al., 2008) and the functional oral intake scale (FOIS; Crary et al., 2005). Results: OSA scores were below the cut-off value and judged as impaired OSA in 14 of the 27 subjects. Mean VDS-oral scores of the impaired-OSA and normal groups were 13.3 (SD 6.18) and 6.5 (SD 6.19), respectively (p<0.01). Furthermore, mean FOIS score differed between the impaired-OSA group and the normal group (p<0.01). One patient with impaired OSA, who was tested twice during treatment, showed improvement of VDS-oral and FOIS scores accompanied with improvement of the OSA score. Conclusions: It is suggested that OSA might be an important factor in the oral phase of swallowing and in oral intake ability in stroke patients with dysphagia, and improvement of OSA is related to improvement of dysphagia.

Keywords: Dysphagia, oral stereognostic ability, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O3-7: Successful recovery from severe dysphagia in elderly patients of wallenberg syndrome by traditional swallowing therapy and a new VitalStim® - Combinated multiple saliva swallowing practice Top


Mutsumi Fujii1, Toshiyuki Takata1,2, Hirokazu Yamamoto3, Seiko Samejima3, Tetsuro Kurashina1, Miki Ohgushi1, Takaaki Chin4

1Department of Physical Medicine and Rehabilitation, Hyogo Rehabilitation Center, Kobe, Hyogo, Japan, 2Department of Internal Medicine, Hyogo Rehabilitation Center, Kobe, Hyogo, Japan, 3Department of Rehabilitation, Hyogo Rehabilitation Center, Kobe, Hyogo, Japan, 4Hyogo Rehabilitation Center, Kobe, Hyogo, Japan

Background and Aims: Successful treatment of severe dysphagia following Wallenberg syndrome is sometimes difficult. Easy fatigability of swallowing, weakened volitional swallowing, and difficulty in repetitive deglutition can prevent departing from tube feeding to supply sufficient nourishment safely. Here we report that patients regained adequate oral intake with a new practice aimed at boosting enough endurance capacity of swallowing throughout a meal with a neuromuscular electrical stimulation, VitalStim®. Methods: Two elderly women (aged 84 and 78) with high risks of saliva aspiration in videofluoroscopy transferred our hospital within 1 month of onset without any oral intake. In addition to traditional rehabilitative swallowing therapy, a speech and language therapist performed VitalStim-CombinAted Multiple saliva swallowing Practice (Vital CAMP). During this practice, patients sucked a candy wrapped by a gauze (not to inhale accidentally) to stimulate secretion of their own saliva. The electrodes of VitalStim were mainly placed on the surface of suprahyoid musculature. Patients were indicated to swallow saliva once in a 12 slow beat; sucking the candy until 9th beat, forming the saliva bolus at the 10th beat, putting it on the back of tongue and prepare swallowing at the 11th beat, and finally trying to act their best volitional swallowing at the 12th beat. The number of swallowing trials was aimed up to 100 times. Results: The patients showed progressive improvements in their swallowing capabilities without aspiration pneumonia as the trial number approached 100 times. They acquired oral intake without feeding tube after about 4 months of onset. Conclusions: Since Vital CAMP does not need dysphagia diets, it can be initiated before direct swallowing therapy. Vital CAMP may contribute to boost endurance capacity of swallowing by many repetitive deglutitions even as much as smaller amount per swallowing, leading to increasing total food intake.

Keywords: Neuromuscular electrical stimulation, severe dysphagia after stroke, VitalStim® - Combinated multiple saliva swallowing practiceVital CAMP

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O3-8: Clinical characteristics and resumption of oral intake in acute stroke patients with the history of nasogastric tube self-removal Top


Eri Otaka1, Kazuyo Oguchi1, Sachiyo Hota1, Tomoko Kondo1, Kei Yagihashi1,2, Yohei Otaka2

1Department of Rehabilitation, Kariya Toyota General Hospital, Kariya, Japan, 2Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan

Background and Aims: Nasogastric feeding tube (NGT) is frequently used for nutrient provision in acute dysphagic stroke patients. However, patients sometimes remove the tube by themselves due to discomfort. The patients may face hazardous risks associated with violent removal; and the use of restraints may delay independence. This study aimed to elucidate clinical characteristics of acute stroke patients with a history of NGT self-removal, and to examine whether self-removal was associated with the resumption of oral intake. Methods: A total of 180 acute stroke patients who received parenteral nutrition through NGT during hospitalization between April 2015 and March 2018 were enrolled retrospectively. Demographic information, cognitive score of Functional Independence Measure, Dysphagia Severity Scale (DSS) at the first evaluation, and length of hospital stay were compared between the groups with and without a history of NGT self-removal. Furthermore, a Cox proportional hazard model was used to examine whether NGT self-removal was an associated factor for the time required to resume oral intake. Results: A total of 84 (46.7%) had at least 1 history of NGT self-removal. The DSS scores were slightly but significantly worse (2.1+-0.1 vs. 2.2+-0.1, P=0.038); and the lengths of the hospital stay were significantly longer (73.0+-49.0 vs. 53.8+-42.3 days, P=0.001) in the NGT self-removal group. After controlling for possible confounding variables, the model revealed that NGT removal was not a significant factor associated with the time required for resuming oral intake (P=0.702). Conclusions: NGT self-removal did not influence the time required to resume oral intake, although the initial dysphagia in patients with NGT self-removal was slightly worse. However, considering the high prevalence of self-removal and prolonged length of hospital stay in the removal group, the development of effective prevention is required.

Keywords: Enteral nutrition, oral intake resumption, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O3-9: Interdisciplinary care team improves dysphagia clinical outcomes in patients with acquired brain injury in rehabilitation hospital Top


Chompunut Pongakkasira

Background: Patients with acquired brain injury (ABI) have high rate of dysphagia and some of them develop pneumonia and have poor recovery status. Interdisciplinary care team consists of well-trained professionals, using instrumental investigations (Videoendoscopy and Videofluoroscopy for swallowing study) and swallowing rehabilitation had been developed and care process was launched to improve outcome. This review aimed to investigate the effectiveness of interdisciplinary care team in swallowing rehabilitation by comparing Eating Status Scale (ESS) score and pneumonia rate between before and after team corporation period. Methods: We recruited patients with ABI from our inpatient rehabilitation ward who admitted between October 2013 and January 2017. The interdisciplinary care team has been developed in June 2014. Results: We analyzed the difference of dysphagia rehabilitation outcome between the period before (92 patients) and after (114 patients) team corporation. Improvement rate of ESS score was higher in after team corporation period compare to before team corporation period (55.3 % vs. 33.7%, respectively; p=0.002). Pneumonia rate was lower in after team corporation period before and after team corporation period (3.5% vs. 10.9%, respectively; p= 0.03). Conclusions: Interdisciplinary care team effectively improved ESS score and decrease pneumonia rate in patients with ABI.

Keywords: Interdisciplinary; dysphagia: acquired brain injuries

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O4-1: Effects of long-term exercise on liver cyst formation and fibrosis in polycystic liver disease model rats Top


Yoichi Sato1, Takahiro Miura1, Jiahe Qiu1, Masahiro Kohzuki1, Osamu Ito1,2

1Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan, 2Division of General Medicine and Rehabilitation, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan

Background and Aims: Polycystic liver disease (PLD) is hereditary liver disease with progressive enlargement of fluid-filled cysts. Liver cysts cause abdominal discomfort and deteriorate the quality of life. Long term exercise (Ex) has various organ protective effects in humans and animals, but its effect on liver cyst is not clear. Therefore, the aim of this study was to investigate whether Ex attenuated liver cyst formation and fibrosis. Methods: The PCK rats, a model of PLD, were randomly divided into a sedentary group and an Ex group, which underwent treadmill running for 12 weeks. Sprague-Dawley (SD) rats were set as a control group. After 12 weeks, liver function and histology were examined. Protein expression in the liver was analyzed by western blot. Results: As compared to SD rats, PCK rats showed a low exercise capacity. Ex improved the exercise capacity without exacerbating liver function and ameliorated the liver cyst formation and fibrosis. Ex also significantly decreased the number of Ki-67 positive cells, and expressions of AQP1, TGF-be-ta and type 1 collagen and the phosphorylation of ERK in the liver. Phosphorylated AMPK increased significantly by exercise. Conclusions: Ex suppressed the liver cyst formation and fibrosis in PCK rats through the inhibition of signaling pathway responsible for cellular proliferation and fibrosis. These findings suggest that Ex may be an effective therapy for PLD.

Keywords: Exercise, fibrosis, proliferation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O4-2: Diagonal aligning sitting training on tilted surface to backward and paretic side improve trunk performance in acute stroke: A randomized controlled trial Top


Kazuhiro Fukata1,2, Kazu Amimoto2, Masahide Inoue1, Daisuke Sekine1, Mamiko Inoue1, Yuji Fujino1, Shigeru Makita3, Hidetoshi Takahashi3

1Rehabilitation Center, Saitama Medical University International Medical Center, Hidaka, Japan, 2Department of Physical Therapy, Tokyo Metropolitan University, Hachioji, Japan, 3Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Japan

Background and Aims: The effectiveness of sitting training on tilted surface for stroke has already been indicated concerning truncal function. However, these results are difficult to apply to the cases with unstable sitting posture and there were no report of focusing on the effects of movement in the diagonal direction. The purpose of this study was to clarify the effectiveness of diagonal aligning sitting training on tilted surface on trunk performances for acute stroke. Methods: This single-blind randomized controlled trial conducted in a tertiary hospital. Patients with hemiparesis were allocated into the experimental and control groups through block randomization. The patients in the both groups were asked to move their trunk diagonally forward toward the non-paretic side while looking at the vertical indicator placed at a 45 degrees angle toward the non-paretic side from the midline. The experimental group was seated on a device tilted 10 degree diagonally backward toward the paretic side, whereas the control group performed on a horizontal surface. Exercises was performed 40 times/session for seven sessions over 8 days. Trunk function was assessed by using the trunk impairment scale (TIS). The TIS comprised 3 subscales: static, dynamic, and trunk coordination was scored up to 7, 10, and 6 points, respectively, TIS was assessed before intervention and at 8 days after the intervention. Two-way ANOVA was used to calculate interaction between groups and time (p=0.05). Results: Thirty-four patients were randomly assigned to the experimental (n=17) and control (n=17) groups. TIS-static interactions were significant (P<0.05). In this outcome, the simple main effects test showed significant improvements after the intervention in the experimental group (P<0.001). Conclusions: Diagonal aligning sitting training on tilted surface improves static trunk functions for acute stroke, and can be a new therapeutic strategy in stroke rehabilitation.

Keywords: Diagonal, sitting trainig on tilted surface, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O4-3: The effect of preoperative respiratory training on the motion of the diaphragm after rheumatic heart disease surgery Top


Weijian Tang, Dongfeng Xie, Hanyue Guan, Li Jiang

Department of Rehabilitation, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

Background and Aims: Cardiac thoracotomy can decrease thoracic mobility, thereby reducing the motion of the diaphragm and affecting postoperative pulmonary function recovery. This study aims to discusse the effect of preoperative respiratory training for the diaphragmatic motion after rheumatic heart disease surgery. Methods: From October 2017 to November 2018, 58 patients with rheumatic heart disease who underwent cardiac valve prostheses in cardiothoracic surgery department of the third affiliated hospital of sun yat-sen university were selected and randomly divided into two group. The control group received preoperative education, surgical treatment and routine nursing. The experimental group received preoperative education, surgical treatment, routine nursing and 1 week of preoperative respiratory training. At the time of admission and after surgery, m-mode ultrasound was used to measure the diaphragmatic motion of patients with eupnea and deep breath in both two groups. Borg-score, blood oxygen index (PaO2) and postoperative complications also were recorded. Results: There was no significant difference in the motion of the diaphragm, blood oxygen index and Borg-score between the two groups at baseline (P<0.05). After preoperative respiratory training, the diaphragmatic motion in the experimental group was higher than that in the control group (1.98±0.26 cm and 3.75±0.62 cm in experimental group, 1.02±0.24 cm and 2.10±0.54 cm in control group, P<0.05), and Borg-score (2.9±1.9 in experimental group and 4.5±2.5 in control group, P<0.05) and PaO2 (85±6 mmHg in experimental group and 74±7 mmHg in control group, P<0.05) in the experimental group were also better than the control group. Postoperative hemothorax was found in both groups and 1 case of pulmonary infection was found in the control group. Conclusions: Preoperative respiratory training can improve the diaphragmatic motion, pulmonary function and release fatigue of patients after rheumatic heart disease surgery.

Keywords: Cardiac surgery, preoperative respiratory training, the motion of the diaphragm

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O4-4: The effect of the low frequent physical therapy to middle - Aged hemophilia cases Top


Junko Fujitani, Ikuko Saotome, Masashi Fujimoto, Tomo Muramatsu, Wataru Yoshida

Department of Rehabilitation, National Center for Global Health and Medicine, Tokyo, Japan

Background and Aims: The motor function of the middle-aged hemophilia patients is low. Development of the way to stop a further decline of their motor function is important. The aim of this study was to investigate the effects of low frequent physical therapy compared to a self-supervised home exercise program. Methods: The study was conducted by open 2 period crossover design with 2 groups, previous physical therapy (PT first group) and self-supervised home exercise group (SSHE first group). Eighteen subjects (all men; mean age, 53 years) were recruited. Subjects were randomly allocated to these two groups. Each period was 6 months. In a physical therapy period, a patient received physical therapy for 40 minutes once a month. The primary outcome measurement was the lower extremity muscle strength. The secondary outcome measurements were comfortable and fast-paced walking trials of the 10 meter walk test. Results: In the PT period, the extension of the hip joint and the muscular strength of flexion were significantly increased. On the other hand, during the SSHE period, the hip joint muscle strength did not significantly improve. In PT first group, the muscle strength of extension of the hip joint significantly improvement even after self-exercise period. In both groups, the walking speed and the walking rate during the fast walking test were significantly improved during the PT period and the whole period. Conclusions: Even at a low frequency once a month, expert guidance are more effective in improving motor function than self-supervised home exercise.

Keywords: Hemophilia, self-exercise

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.






  No. O4-5: Exergames in the prevention of fall risk in Parkinson's disease: A randomized controlled trial Top


Antonio Ammendolia, Angelo Indino, Gerardo De Scorpio, Nicola Marotta, Maria Giovanna Caruso, Lidia Fratto, Roberto Claudio Meliado, Gabriella Amendola, Maurizio Iocco

Department of Medical and Surgical Sciences, University of Catanzaro Magna Grecia, Catanzaro, Italy

Parkinson's disease (PD) is a slowly progressive neurodegenerative disease characterized by motor and non-motor symptoms associated with balance and walking disorders. To improve balance and walking in patients with PD, it was compared a classic rehabilitative treatment compared to a training with exergames. 21 patients with PD were recruited. The inclusion criteria were the following: patients with an established diagnosis of Parkinson's disease in stable therapy with levodopa (daily dose> 300 mg); degree of illness between 2.5-4 (Hoehn & Yahr scale). After obtaining informed consent, the patients were randomly divided into 3 groups of 7 subjects each:

  • Group A, individual rehabilitative treatment, including: training of static and dynamic balance and gait on the Treadmill System;
  • Group B training with the Nintendo Wii console and Balance Board device;
  • Group C did not perform any treatment.


Evaluations were performed at the beginning (T0), at the end (T1) and one month after the end of treatment (T2). At T1 in group A and group B there was a significant decrease in risk of falls [Figure 1], TCT and FIM score (P<0.05, using Wilcoxon signed rank test). At T2 there was a statistically significant worsening in both groups A and B, but with better values than the score found at the beginning of treatment (P<0.05). Moreover in T2 the values of group B were greater worsening than group A (P<0.05, using wilcoxon rank sum test). In group C there has been a progressive worsening of all the parameters examined. The study shows that patients who underwent training with exergames had benefits in preventing risk falling similar to classic rehabilitation treatment. So, through the use of exergames, patient can continue the rehabilitation treatment at his home, maintaining the results obtained with the classic treatment.
Figure 1: Risk of Fall

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Keywords: Exergames, Parkinson, risk fall

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O4-6: Association between falls and dual-task walking in individuals poststroke: A prospective cohort study Top


Marco Y. C. Pang1, Charlotte Tsang1, Huixi Ouyang1,2, Deborah A Jehu3

1Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China, 2Department of Physical Therapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, Guangdong Province, China, 3Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada

Background and Aims: Individuals with stroke sustain a higher fall rate than their aged-matched peers. Falls often occur during dual-task walking. We aimed to examine the usefulness of dual-task walking tests in fall prediction relative to single-task walking tests in the chronic stroke population. Methods: A total of 100 individuals with chronic stroke participated in this prospective cohort study. Each of the three mobility tasks, namely, forward walking for 10 meters (FW), backward walking for 10 meters (BW), and an obstacle-crossing task (walking forward for 10 meters while overcoming a series of 7 obstacles; OBS) was performed in isolation and also in conjunction with a verbal fluency task. The time taken to complete the mobility tests in single-task and dual-task conditions was measured. The dual-task effect [(dual-task walking time minus single-task walking time)*100/single-task walking time] for each mobility test was calculated. The participants were then followed up monthly for one year to collect data on fall incidence. Results: Multivariate logistic regression analysis revealed that after adjusting for the effects of age, fall history, post-stroke duration, number of medications, depression, motor recovery, and cognitive impairment, dual-task effect of walking time for the BW (OR=0.96, 0=0.04) and OBS tasks (OR=0.93, p=0.03) was useful in predicting multiple fallers. The dual-task effect of walking time for the BW test was also useful in identifying single fallers (OR=0.95, p=0.02). The single-task walking time values were not useful in predicting falls (p>0.05). Conclusions: Certain dual-task walking assessments are useful in predicting fallers post-stroke. These walking tests can be incorporated in routine stroke assessment to identify individuals at high risk of falls so that early intervention can be implemented to prevent falls and related injuries.

Keywords: Cognition, stroke, walking

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O4-7: 180 degrees turning strategies measured with inertial measurement units and fall risk in poststroke hemiparetic patients Top


Alain Pierre Yelnik1,2, Damien Ricard2,3, Laurent Oudre2,4, Alienor Vienne2, Pierre P. Vidal2, Remi Barrois2

1Department of PRM, GHU Saint-Louis-Lariboisiere-Fernand Widal, Paris Diderot University, France, 2Cognition and Action Group, Cognac-G, CNRS, Paris Descartes University, Service de Sante des Armees, 45 Rue Des Saints Peres, 75006, Paris, 3Service de Neurologie, Service de Sante des Armees, Paris, 4Institut Galilee, Paris 13 University, 99 AV. J. Baptiste Clement, Villetaneuse, France

Background and Aims: 180 degrees turning strategies is evaluated in daily clinics but quantification remains difficult without instrumentation. A global overview of the task lacks when described with single parameters. We propose a data representation (rotagram) of the 180 degrees turn measured with inertial measurement units (IMUs) and studied the association of turning strategies with risk of falls. Methods: 37 right handed post-stroke subjects with hemiparesis performed after 10 meters walking, a 180 degrees turn in an unconstrained direction wearing one IMU on both feet and one on the lower back. The task was then performed in the opposite direction. The rotagram represents, for each foot flat, the axial rotation of the lower back. Several parameters are illustrated: start and end, foot initiating the 180 degrees turn, number of steps, mean velocity, gyration rate and symmetry index. Falls in the 6 months after measurement were investigated. Results: 17 RP, mean (SD) age 57.5 (9.5) years (range 43-73), 20 LP patients, mean age 60.7 (8.8) years (range 43-63), and 15 HCs, mean age 56.7 (16.1) years (range 36-83). The LP and RP groups behaved similarly in turning patterns, but 90% of LP patients turned spontaneously to the paretic side versus 59% of RP patients. This difference increased with turning strategies: 85% of LP versus 29% of RP patients used strategy 4 (paretic turn side with paretic limb). Patients using strategy 4 had the highest rate of falls. Conclusions: The rotagram is a quantitative representation of the 180 degrees turn giving a global overview of the task and allowing parameter computation. We propose to consider spontaneous turning strategies as new indicators to evaluate the risk of fall after stroke. IMU could be routinely used to identify this risk and guide balance rehabilitation programs.

Keywords: falls, stroke, turning

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O4-8: Can home based, strength and balance training exercises program reduce risk of falling in older community dwelling adults? A randomized controlled trial Top


Nerimane I. Abazi1, Adriana S. Murtezani1, Isme Humolli2, Kaltrina Aliu3

1University Clinical Center of Kosovo, Physical and Rehabilitation Medicine Clinic, Pristina, Kosova, 2National Institute of Public Health of Kosovo, Pristina, Kosova, 3Physical and Rehabilitation Medicine Outpatient Clinic Fiziatria, Prishtina, Kosovo

Background: Falls are a major health problem among the elderly. Lack of balance, strength, and function were identified as the cause of falls in the majority of older adults. Planed, structured repetitive exercises and purposive physical activity aimed to improve balance, gait, functional mobility, physical fitness and mood increase muscle strength and reduce the occurrence of falls in older people. Aims: To assess the effectiveness and benefits of strength and balance training exerciseprogram at home for reducing of falling in older community dwelling adults with a control group of their peers who had no exercised over the same time period. Methods: A randomized controlled trial was conducted with a 40 elderly individuals, randomly allocated in to two groups. An experimental group of 24 community-dwelling older adults, age from 70 to 80 years, mean 75 (±5.5) years, 6 male and 18 female, participating in a 12-week home based exercise training program(balance exercises daily and the strength exercises three times each week) and a group of 16(3 male and 13 female older adults about same age)who had no exercises. The grip and quadriceps strength of the right side was measured using a dynamometer, flexibility and balance by Functional Reach and Berg Balance Scale. They were assessed at baseline, 3 and 6 months after. Results: Home based exercised training program participants experienced significant improvement compared with a no exercised group. Balance control as measured with BBS significance of (pp≤0.001) functional strength (p 0.001) and flexibility (p 0.035) as well as knee extensor strength (pp≤0.001) after the program. Conclusion: Older adults' participation in a Home based exercised training program may lead to improvement in strength and balance and reduce risk for fall, and fall-associated injuries. Home based exercised may be viable options in the continuum of health-related care for older adults and maintain independence.

Keywords: Balance, elderly, exercises, falling

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O4-9: Nine-square exercise could improve balance in older women at risk for falls: A prospective experimental study Top


Sasiwimon Wannapong1, Nomjit Nualnetr2, 3, 4

1Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand, 2School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand, 3Neuroscience Research and Development Group, Khon Kaen University, Khon Kaen, Thailand, 4Research and Training Center for Enhancing Quality of Life of Working-Age People, Khon Kaen University, Khon Kaen, Thailand

Background and Aims: It is well known that exercise is essential for the elderly to improve postural instability and reduce risk for falls. Presently nine-square exercise is popular among community-dwellers in Thailand. There were reports on the beneficial effects of this exercise on leg muscle strength flexibility and cardiopulmonary endurance in older persons. However evidences on the effects of nine-square exercise on balance and cognitive function were limited. This study aimed to evaluate the effects of nine-square exercise on balance and cognitive function in the elderly. Methods: Eighteen older women at risk for falls (Timed Up and Go Test > 13.5 seconds) were divided into a nine-square exercise group (experimental group n=9 average age 63.8 years) and a health education group (control group n=9 average age 63.7 years). A nine-square exercise program of 30 minutes/day 3 days/week for 5 weeks was assigned to the experimental group. Balance and cognitive function of the participants were assessed at baseline (week 0) and immediately after termination of the program (week 5) by using the Timed Up and Go Test and the Montreal Cognitive Assessment respectively. Independent t-test was applied to analyze the data. Results: At the end of the study the experimental group showed significantly greater balance performance than the control group (p<0.001 mean difference -3.00 seconds 95% CI -4.02 to -1.81 seconds). No significant difference between groups was found in the cognitive function assessment (p=0.310) [Table 1]. Conclusions: Nine-square exercise could improve balance, but not cognitive function, in older women at risk for falls. Therefore, this exercise could be an alternative exercise regimen for improving balance in the elderly.
Table 1: Mean (standard deviation) of outcomes comparisons between groups

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Keywords: Balance, elderly, exercise

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O5-1: The effect of high frequency repetitive transcranial magnetic stimulation on cognitive impairment in patients with stroke and modulation of amplitude of low frequency fluctuation and functional connectivity Top


Mingyu Yin, Xi-Quan Hu

Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

Background and Aims: Post-stroke cognitive impairment (PSCI) is a common but difficult clinical problem for patients with stroke. The effects of high frequency repetitive transcranial magnetic stimulation (rTMS) on PSCI remains controversial and the potential neural mechanism is uncertain. This study investigated the effects of rTMS on PSCI and explored the resting-state neural activities and functional connections via functional magnetic resonance imaging (fMRI). Methods: 34 patients with PSCI were randomly divided into rTMS group (n=16) and the sham rTMS group (n=18). Each patient underwent 20 consecutive 10Hz rTMS or sham treatment sessions (5 times per week for 4 weeks) over left dorsal lateral prefrontal cortex (DLPFC). Montreal Cognitive Assessment Scale (MoCA), Vitoria Stroop Test (VST) and Rivermead Behavioral Memory Test (RBMT) were used to evaluate cognitive function and Modified Barthel Index (MBI) was used to evaluate activity of daily living (ADL). Among them, 14 patients received functional magnetic resonance imaging scan before and after the treatment sessions. Amplitude of low frequency fluctuation (ALFF) and functional connectivity (FC) were used to measure the resting-state neural activities and functional connections. Results: General cognitive function, executive function and memory improved in different extents after rTMS treatment (P<0.05). Increased ALFF was found in the left medial prefrontal cortex (MPFC) and increased FC was found in the right MPFC and the ventral anterior cingulate cortex after rTMS treatment [Figure 1]. Decreased ALFF in the right posterior parietal cortex, increased FC in the left occipital lobe, the left precuneus and decreased FC in the right precentral lobule was found after sham rTMS treatmen [Figure 2]. Conclusions: High frequency rTMS on DLPFC could improve PSCI and may partly attributed to the changes of the resting-state neural activities and functional connections.
Figure 1: (a) 10Hz rTMS treatment induced change of amplitude of low frequency fluctuation (ALFF); (b) sham rTMS treatment induced change of ALFF. Color bar represents paired t-score values. The warm and cold colors represent higher and lower ALFF after rTMS treatment respectively. Significance level was defined at P<0.005, cluster size >51 (a), cluster size >53 (b), AlphaSim corrected. The left side of the image corresponds to the right side of the brain

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Figure 2: Functional connectivity (FC) difference after rTMS treatment (a) and sham rTMS treatment (b). Color bar represents paired t-score values. The warm and cold colors represent higher and lower FC difference after rTMS treatment respectively. Significance level was defined at P <0.005, cluser size >51 (a), cluster size >53 (b), AlphaSim corrected. The left side of the image corresponds to the right side of the brain

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Keywords: Poststroke cognitive impairment, repetitive transcranial magnetic stimulation, resting-state functional magnetic resonance imaging

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O5-2: The effects of repetitive transcranial magnetic stimulation on neuropathic pain after spinal cord injury: An functional near-infrared spectroscopy study Top


Xiaolong Sun, Chen-Guang Zhao, Xiang Mou, Hua Yuan

Department of Rehabilitation Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China

Background and Aims: Neuropathic pain is one of the tough problems for the patients with spinal cord injury (SCI), with limited effects of pharmacological therapy. Growing evidences suggest that the cortex hyperexcitability caused by the peripheral and central sensitization contributes to the development of neuropathic pain. rTMS is a noninvasive neuromodulation technology, emerging as a promising analgesic treatment for the SCI patients with neuropathic pain. However, the underlying mechanism remains poorly understood. Methods: Twenty patients with neuropathic pain after SCI were recruited in this study (17 completed the study). Real (n = 11) or Sham (n = 6) rTMS treatments (10 Hz; total of 1200 pulses at intensity of 80% of motor threshold) over the left primary motor cortex (M1, corresponding to the upper extremity) were performed daily for six weeks. The conventional rehabilitation intervention and medications, including antidepressants, anticonvulsants, or opioids, were not affected during the whole experiment. At T0 (before rTMS treatment), T1 (after the 1st rTMS), T2(after one week), T3(after two weeks), T4(after four weeks) and T5 (after six weeks), functional near-infrared spectroscopy (fNIRS) was used to measure the blood oxygen change in the bilateral M1, primary somatosensory cortex (S1), premotor cortex (PMC) and prefrontal cortex (PFC) during the handgrip task. Besides, the relieve pain or induce the blood oxygen change in PFC, PMC, M1 or S1. However, a series of rTMS treatment could significantly alleviate the neuropathic pain following SCI, and the analgesic effects lasted along with time. The activation of PMC and M1 were suppressed during the handgrip task after rTMS treatment. Conclusions: The analgesic effects of rTMS on neuropathic pain following SCI might be related with the amelioration of motor cortex hypersensitivity.

Keywords: Neuropathic pain, rTMS, spinal cord injury

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation. Numerical Rating Scale (NRS) was used to assess the intensity of pain. Results: One single rTMS treatment (T1) could not








  No. O5-3: Is the efficacy of repetitive transcranial magnetic stimulation influenced by baseline severity of fatigue symptom in patients with myalgic encephalomyelitis Top


De Gang Yang1,2, Rui Gu1,3, Wataru Kakuda1

1Department of Rehabilitation Medicine, International University of Health and Welfare Ichikawa Hospital, 2Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, Faculty of Rehabilitation Medicine, Beijing BoAi Hospital, Capital Medical University, Beijing, China, 3 Department of Orthopedic and Orthopedic Rehabilitation, China Rehabilitation Research Center, Faculty of Rehabilitation Medicine, Beijing BoAi Hospital, Capital Medical University, Beijing, China

Background and Aims: Recently, at some institutions, repetitive transcranial magnetic stimulation (rTMS) has been therapeutically applied for patients with myalgic encephalomyelitis (ME). However, it is still unclear which clinical factors could influence the efficacy of rTMS for ME patients. The purpose of this study is to clarify whether baseline severity of fatigue symptom would influence the efficacy of rTMS applied for ME patients. Methods: Twenty patients with ME were studied (average age at the intervention 34.2+-10.3 years old). Each patient was hospitalized to receive 6 - 8 sessions of high-frequency rTMS (2 sessions per day). In this study, high-frequency rTMS of 10 Herz was applied over prefrontal cortex. In order to evaluate the severity of fatigue symptom, Brief Fatigue Inventory (BFI) score and Visual Analogue Scale (VAS) rate were applied before and after rTMS application (higher value means more severe symptom in both of the scales). Based on the score of BFI before rTMS, the patients were divided into 2 groups such as severe group (n=9) and mild group (n=11). We compared the extent of the improvements of fatigue symptom between 2 groups. Results: In the severe group, compared to before rTMS, VAS rate was significantly lower not only at the discharge but also 2 weeks after the discharge. Similarly, the mild group also showed a significant decrease in VAS rate at the same two time points. However, the extent of VAS rate change didn't differ between 2 groups. In addition, no significant correlation between baseline score of BFI and the changes in VAS rate was indicated. Conclusions: It can be concluded that rTMS can improve fatigue symptom in ME patients regardless of the severity of fatigue symptom before rTMS. It is expected that rTMS can be a novel therapeutic intervention for ME patients.

Keywords: Myalgic encephalitis, neuromodulation, transcranial magnetic stimulation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O5-4: Therapeutic mechanisms of repetitive transcranial magnetic stimulation in in vitro and in vivo experimental models Top


Ji Seon Hong1, Ji Yoon Jang1, Sung Hoon Kim1,2, Ahreum Baek2, Jung Young Park1

1Department of Rehabilitation, WonJu Severance Christian Hospital, Wonju, South Korea, 2Department and Rehabilitation Medicine, Wonju College of Medicine, Yonsei University, Wonju, South Korea

Background and Aims: Repetitive transcranial magnetic stimulation (rTMS) can be used to treat various neurological disorders such as stroke, Parkinson's disease (PD). It is well known that high-frequency (> 3 Hz) stimulation generally results in facilitation, while low-frequency (< 1 Hz) rTMS induces reduction of synaptic efficiency. The current study examined the differential effects of rTMS regarding on frequencies and the therapeutic mechanisms in both in vitro and in vivo experimental models. Methods: Mouse neuroblastoma cells were randomly divided into three groups; sham, low-frequency(0.5 Hz) and high-frequency (10 Hz) group; stimulated over three days. Then, low-frequency and high-frequency groups were characterized by RNA-seq transcriptome analysis. Furthermore, high-frequency group induced phosphorylation of cAMP-response element binding protein(CREB), brain-derived neurotrophic factor(BDNF) transcription via activation of calcium-/calmodulin-dependent protein kinase II (CaMKII)-CREB pathway. Next, cells were differentiated with retinoic acid and established for in vitro oxygen glucose deprivation/reoxygenation(OGD/R) condition. After (OGD/R) injury, cells were randomly divided into three groups; OGD/R+sham, OGD/R+low-frequency and high-frequency groups; and stimulated with rMS on day 1. Eight-week Sprague-Dawley rats were unilaterally injected with 6-hydroxydopamine (6-OHDA) into the right striatum. High-frequency of rTMS was treated during four weeks in the PD rats. Results: High-frequency group increased cell proliferation and reduced apoptosis in OGD/R injured cells. Furthermore, high-frequency group increased BDNF expression and synaptic plasticity via activation of Ca2+-CaMKII-CREB signaling pathway in OGD/R injured cells. High-frequency of rTMS improved motor functions and preserved dopaminergic neurons from damages in the substantia nigra pars compacta and striatum by 6-OHDA administration. Furthermore, neurotrophic growth factor expression was increased in high-frequency rTMS-treated PD rats, suggesting a potential for rTMS treatment in the PD. Conclusions: These studies will provide a better understanding of the therapeutic mechanisms of rTMS. These mechanisms may also be applicable in neural stem cells and patient-derived induced pluripotent stem cells for future studies.

Keywords: Biomechanism of repetitive transcranial magnetic stimulation, neurological disorders, repetitive transcranial magnetic stimulation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O5-5: Effectiveness of repetitive transcranial magnetic stimulation on hand function and muscle recruitment in children with hemiplegic cerebral palsy: A randomized controlled trial Top


Lu He1, Yanfei Lu1, Xiaoyue Wang1, Xiaohui Hou2, Xiaohua Yan3, Hongmei Tang1, Jinling Li1, Yun Zheng1, Kaishou Xu1

1Guangzhou Women and Children's Medical Center, Guangzhou, China, 2Guangzhou Sport University, Guangzhou, China, 3Guangzhou Medical University, Guangzhou, China

Background and Aims: Repetitive transcranial magnetic stimulation (rTMS) might benefit to hand function recovery, however litter was known about its effect on children with cerebral palsy (CP). This study aimed to observe effectiveness of rTMS on hand function and muscle recruitment in children with hemiplegic CP. Methods: Children with hemiplegic CP were randomly divided into rTMS group (5Hz rTMS plus occupational therapy, n=19) and control group (sham rTMS plus occupational therapy, n=20). Both groups received a 4-week hospital-based intervention. The rTMS was applied on bimanual cerebral hemisphere with frequency of 5Hz and with an intensity of 90% of the motor threshold in the rTMS group, sham stimulation in the control group. Occupational therapy involved motor learning, strength and coordination training, sensory stimulation and task-specific training. All children underwent clinical assessment and surface electromyography at baseline and 2, 4 weeks after treatment. Clinical measures were modified Ashworth scale, nine-hole peg test, and upper extremity functional test. Surface myoelectric signals were integrated electromyography, root mean square and cocontraction ratio. Results: Both groups showed significant improvement in hand function after 2 weeks, the improvement lasted for 4 weeks (p<0.05). The mean increase in upper extremity functional test scores was 14.50 in the rTMS group and 5.94 in the control group (p<0.05). The rTMS group showed greater reduction of spasticity at 2 weeks and 4 weeks than the control group in the affected wrist (p<0.05). Both groups showed decreases in completion time of nine-hole peg test in post-treatment (p<0.05). There were no significant differences at 2 and 4 weeks after treatment in surface myoelectric signals (p>0.05). Conclusions: The rTMS plus occupational therapy is effective in reducing spasticity of affected wrist and improving the affected hand function in children with hemiplegic CP.

Keywords: Cerebral palsy, hand function, repetitive transcranial magnetic stimulation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O5-6: Enhancing mirror visual feedback with intermittent theta burst stimulation in healthy adults Top


Kenneth N. K. Fong, Jack Jiaqi Zhang

Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong

Background and Aims: Excitatory brain stimulation, in the form of repetitive Transcranial Magnetic Stimulation (rTMS), combined with mirror visual feedback (MVF), is hypothesized to promote neuroplasticity and motor performance. This study aimed to investigate the priming effects of theta burst stimulation (iTBS) combined with mirror training (MT) on MVF-induced sensorimotor event-related desynchronization (ERD) and the motor performance of the non-dominant hand in healthy adults. Methods: Eighteen healthy right-handed subjects were randomly assigned to one of three groups (Group 1: iTBS plus MT, Group 2: iTBS plus sham MT, or Group 3: sham iTBS plus MT). Participants in Groups 1 and 3 received 15 minutes of motor training for their dominant hand with MVF over four consecutive days, while participants in Group 2 received the same training without MVF. iTBS or sham iTBS was applied daily over the right primary motor cortex prior to the training. Electroencephalography (EEG) at baseline and post-training was recorded while participants performed unilateral hand movement under mirror and direct view. Motor performance was assessed at baseline and post-training. Results: Baseline comparisons demonstrated that a shift in sensorimotor ERD towards the contralateral hemisphere was induced by MVF, in alpha-1 (8-10 Hz) (p = 0.002), alpha-2 (10-12 Hz) (p = 0.004), and beta-1 (12-16 Hz) (p = 0.049) bands. After training, participants in Group 1 showed a stronger MVF-induced sensorimotor ERD in alpha-1 (p = 0.017) and alpha-2 (p = 0.009) bands than those in Group 3. No significant interaction effect was noted in motor outcomes. Conclusions: Our study shows that MVF is likely to activate the contralateral sensorimotor cortex, and that iTBS appears to have a priming effect on the subject's brain, making it more receptive to MVF. Further research will be carried out to investigate the clinical efficacy of combining both interventions in the stroke population.

Keywords: Event-related desynchronization, mirror visual feedback, Theta burst stimulation

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O6-2: Functional network topological alteration of primary motor cortex after transcranial direct current stimulation in patients with incomplete spinal cord injury Top


Yu Pan1, Wei Bei Dou2, Yun Xiang Ge2, Qiong Wu1, Quan Xu1xs

1Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China, 2Department of Electronic Engineering, Tsinghua University, Beijing, People's Republic of China

Background and Aims: Transcranial Direct Current Stimulation (tDCS) is a promising novel rehabilitation tool for motor recovery in patients following spinal cord injury(SCI).While it had been proved that anodal tDCS enhanced the corticospinal excitability, there has been no study to explore the possible alteration of functional networks for tDCS in SCI patients. The aim of this study was to investigate the impact of tDCS on topological alteration by functional connectivity analysis of resting-state fMRI in SCI patients. Methods: Sixteen incomplete SCI patients were randomized to receive 20 minutes of 2mA, or sham tDCS over the lower limb motor cortex for 10 days. Resting-state fMRI was performed before and after 10 sessions anodal or sham tDCS. We observed significantly improved lower limb motor scales on both groups after received anodal or sham tDCS and WISCI was improved in anodal tDCS group. Results: Functional network analysis demonstrated that, patients of anodal tDCS group showed increased functional connectivity among primary motor cortex and cerebellum, dorsal entorhinal cortex, somatosensory association cortex. In addition, functional connectivity was enhanced among supplementary motor area and piriform cortex, auditory cortex in anodal tDCS group. However in sham group there were only increased functional connectivity among supplementary motor area and orbitofrontal area, inferior temporal gyrus. Conclusions: These finding provide initial support that anodal tDCS induced enhance topological functional network of primary motor cortex in SCI patients. Further investigation is need to explore the potential role of tDCS on rehabilitation in SCI patients.

Keywords: Functional network, spinal cord injury, transcranial direct current stimulation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O6-3: Transcranial direct current stimulation effect on movement coordination in a grasping and lifting task in sub acute stroke patients Top


Justine Lowenthal-Raz1, 2, 3, Nachum Soroker1,3, Dario G. Liebermann2,3, Jason Friedman2,3

1Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel, 2Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel, 3Department of Physical Therapy, Sackler Faculty of Medicine, Stanley Steyer School of Health Professions, Tel-Aviv University, Tel Aviv, Israel

Background and Aims: The hemiparetic upper limb (UL) remains often poorly functional at the activity level, even when the assessment of impairment points to mild paresis (FMA score > 50), probably due to impaired motor control preventing smooth and coordinated movements. Kinematic analysis can detect deviations from the normal pattern of control. Its use in tasks that minimize strength requirements can properly isolate and quantify recovery of motor control. Transcranial direct current stimulation (tDCS), combined with behavioral training, can modulate intra- and inter-hemispheric dynamics by inducing focal excitatory/inhibitory activity that presumably enhance neural plasticity. Here we investigated tDCS effects on distal (grasp and lift) UL function. Methods: 18 healthy and 18 stroke subjects performed a grasping and lifting task before and after anodal-tDCS (excitatory), cathodal-tDCS (inhibitory), and sham-tDCS, in a randomized order. tDCS electrodes were placed over the left and right M1 hand area (C3, C4). The lifting device consists of a handle connected to a sliding mechanism that enables the subject to move the handle up and down and rotate the handle clockwise / counter-clockwise. Timing variables during lifting were calculated at base line in both groups and in stroke subjects calculated pre and post stimulation, in all stimulation modes. Results: At baseline, patients performed the task in a fragmented way and movement time was longer. Anodal-tDCS had a greater effect when applied on the lesioned hemisphere, movement was less fragmented and faster. Conclusions: Anodal-tDCS applied on the lesioned hemisphere combined with motor training shows immediate effects on movement smoothness. Subjects which were able to perform this task had higher Fugl Meyer scores at baseline and this likely implies smaller corticospinal damage in the affected hemisphere, and thus, greater likelihood that peri-lesional re-mapping is the dominant mechanism underlying recovery.

Keywords: Grasping and lifting, stroke, transcranial direct current stimulation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O6-6: Is the efficacy of neuromuscular electrical stimulation influenced by baseline severity of hemiparesis in stroke patients? Top


Shin Sato1, Mitsuhiro Sano1, Chiharu Yashima1, Junichi Eguchi1, Takeki Ishida1, Fei Zhung1, Takamasa Kitahara1, Risa Kiko1, Wataru Kakuda2

1Department of Rehabilitation, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan, 2Department of Rehabilitation Medicine, School of Medicine, International University of Health and Welfare, Ichikawa, Japan

Background and Aims: It has been reported that neuromuscular electrical stimulation (NMES) is effective for increasing muscle strength as well as resistance training for post-stroke patients. However, it is still unclear what kind of clinical factors can influence the efficacy of NMES in such patient population. In this study, therefore, we aimed to clarify whether baseline severity of hemiparesis can influence the efficacy of NMES in post-stroke patients. Methods: The study subjects were 24 post-stroke patients with hemiparesis. NMES was applied using DRIVE R100 (Denken Co. Ltd., Oita, Japan). Each patient received treatment sessions of NMES twice a day for 4 weeks. The NMESs were applied over bilateral quadriceps femoris muscles for 10 minutes in each session. During the period of NMES treatment, usual rehabilitative training such as muscle exercises is also provided. The stimulation intensity of NMES was set at the maximum stimulation intensity which the patient was able to tolerate. The muscle strength of the muscles was measured using Mobie MT-100 (Sakai Medical Co. Ltd, Tokyo, Japan) at the beginning and at the end of NMES treatment. In this study, the subjects were divided into two groups based on baseline severity of hemiparesis, such as 'severe paresis group' and 'mild paresis group'. Between these two groups, we compared the extent of the changes in muscle strength with NMES. Results: With the application of NMES, in both groups, the strength of quadriceps femoris muscle significantly increased not only in the paralyzed side but also in the non-paralyzed side. However, we found no significant difference in the extent of the changes in muscle strength between two groups. Conclusions: The efficacy of NMES was not influenced by baseline severity of hemiparesis in post-stroke patients, which means that NMES can be applied for any hemiparetic stroke patients.

Keywords: Neuromuscular electrical stimulation, rehabilitative training, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O6-7: Exploration of motor function and brain computer interface accuracy in stroke patients with hand dysfunction Top


Shugeng Chen1, Jie Jia1, Xiaokang Shu2

1Huashan Hospital, Fudan University, Shanghai, China, 2College of Mechanical and Power Engineering, Shanghai Jiaotong University, Shanghai, China

Background and Aims: BCI accuracy can be an evaluation index for stroke patients with hand dysfunction. The aim of this study was to explore the possible relation between motor function and BCI accuracy. Methods: 21 stroke patients were enrolled in our study. Patients were asked to perform motor imagery task. EEG signals of stroke patients were recorded using a BrainAmp amplifier and 32 channels of active electrodes. BCI accuracy of this system was evaluated [Figure 1]. We chose 12 and 14 channels to respectively calculate the BCI performances. They total 12 were C3, FC1, FC5, CP1, CP5, P3 in the left hemisphere and C4, FC2, FC6, CP2, CP6, P4 in the right hemisphere. In addition, we added F3 and F4 to a total 14 channels. Results: Based on the results of the 12 and 14 channels, we compared different EEG frequencies domain. We also found that the higher the BCI accuracy, the higher FMA score the patient will get (P<0.05). [Figure 2]a and [Figure 2]b In the lower alpha wave, the BCI performance of ischemia was significant higher than that of hemorrhage (P<0.05) both in the 12 and 14 channels [Figure 2]c and [Figure 2]d. And there was no statistical significance in other EEG frequencies related to motor imagery task. Besides, BCI accuracy in the left hemisphere were higher than those in the right hemisphere [Figure 3]. Conclusions: The brain activation and the BCI accuracy could be used as assessment and feedback for stroke patients during their rehabilitation process. The correlative result between FMA scores and BCI accuracies suggested that in stroke patients, the person with higher hand function, the higher BCI accuracy he might get. And the difference in BCI accuracy between ischemia and hemorrhage might be an improvement reference in BCI system. For hemorrhagic patients, the BCI feedback threshold might be lower in other to get a better interaction.
Figure 1: BCI Recording

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Figure 2: BCI Accuracy

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Figure 3: Inter-hemispheric BCI Accuracy

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Keywords: Brain computer interface, rehabilitation, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O6-8: Motor and nonmotor related brain network alternation after brain computer interface in stroke patient Top


Qiong Wu1, Yu Pan1, Weipei Dou2, Gang Liu3, Yueheng Wang2, Bo Chen3, Di Ma1, Hang Yin1, Hongliang Zhao4

1Department of Physical Medicine and Rehabilitation, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China, 2Department of Electronic Engineering, Tsinghua University, Beijing, China, 3Xian Jiaotong University, Xian, China, 4Department of Radiology, Beijing Tsinghua Changgung Hospital, Beijing, China

Background and Aims: Recovery of neurological function after stroke involves both motor (i.e. primary motor cortex,supplementary motor area) and nonmotor related brain regions(i.e. somatosensory cortex, frontal eye fields).Brain computer interface (BCI) is a relatively novel technology with a potential to restore, substitute,or augment lost motor behaviors in patients after stroke. However, the correlation between BCI and nonmotor related network in stroke patient is unclear. This study aimed to explore the alterations of whole brain functional connectivity (FC) in stroke patient after BCI training. Methods: 10 subacute stroke patients with severe upper extremity paralysis received 4 weeks BCI training. Resting state functional magnetic resonance imaging (rs-fMRI) and clinical function were assessed before and immediately after the intervention. Clinical function assessment included Fugl-Meyer upper-extremity motor assessment (FMA-UE), action research arm test (ARAT) and Wolf motor function test (WMFT). Bilateral Brodmann area 1-8,from where the movement intention was extracted, was taken as the seed point. Results: After BCI training, all clinical scores including FMA-UE, ARAT and WMFT significantly increased in stroke patients. Motor related FC between left primary motor cortex (BA4) and right supramarginal gyrus (BA41) increased. Meanwhile nonmotor related FC between left SSAC (BA5) and right retrosubicular (BA48) increased as well. Furthermore, the increased FCs between left BA4 and the right BA41, left BA5 and the right BA48 were positively correlated with FMA-UE, ARAT and WMFT score. In addition, there were increased nonmotor related FCs involved in dorsal attention network, especially visual related network. Conclusions: The results indicate that both motor and non-motor brain network involved in BCI training. This study may provide new evidence of neural plasticity mechanism and potential clinical utility of BCI therapy in stroke rehabilitation.

Keywords: Brain computer interface, resting state functional magnetic resonance imaging, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.




  No. O7-1: Effects of the Cheneau brace on the postural control in patients with idiopathic scoliosis using a platform of static posturography Top


Vendelin Avinee1, Jean F. Catanzariti2, Martin Bussiaux2, Monique Coget2, Andre Thevenon1

1Department of Physical and Rehabilitation Medicine, University Hospital Lille, Lille, France, 2Department of Physical and Rehabilitation Medicine, Marc Sautelet, Villeneuve d'Ascq, France

Background and Aims: Adolescent idiopathic scoliosis (AIS) is known to be associated with neurosensory disorders and balance instability. The purpose of this study was to know the effects of the Cheneau brace on the postural control in patients with AIS. Methods: This is a retrospective, monocentric study including 83 patients with AIS, from July 2016 to June 2017. All patients had a quantified standardized postural control assessment using a static posturography platform with and without spine Cheneau brace in different conditions: eyes opened, eyes closed, and eyes opened on a foam support. Each patient was his own control. We collected the ellipse area of the projection of the center of pressure as primary outcome. Results: We identified a significant worsening balance with the spine brace. The surface of the ellipse was significantly higher with than without brace in each tested modality: eyes opened 437,38 mm2 vs 346,50 mm2 (p<0,001); eyes closed 457,26 mm2 versus 383,87 mm2 (p<0,05); foam support 424,30 mm2 versus 356,32 mm2 (p<0,05). Furthermore, we observed a greater aggravation with a better curve reduction (over 40%) by the brace. The speed of the center of pressure was also significantly higher with the brace in each modality. Conclusions: In AIS, wearing a Cheneau brace decreases the postural control assessed by static posturography. This might be due to a primary cause of postural impairment and motivates us to continue our research on the physiopathology of AIS.

Keywords: Adolescent idiopathic scoliosis, postural control, static posturography plateform

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O7-2: A critical evaluation of energy expenditure estimates based on individual O2 consumption, heart rate curves and average daily heart rate in spinal orthosis Top


Tarit K. Datta1,2, Hasan A. Raihan1, Tithee Datta3

1Department of Prosthetics and Orthotics, National Institute for Locomotor Disabilities, Kolkata, West Bengal, India, 2Taki Thuba Rehabilitation and Welfare Society, 3Amity University, Gurgaon, Haryana, India

Background and Aims: Scoliosis is a three-dimensional deformity of the spine and has been recognized for centuries with numerous theories & etiology but still remain a mystery. All the non-surgical treatment available spinal bracing is the most commonly used method for idiopathic scoliosis (IS) and is the only one that has evidence for the efficacy in hating curve progression and prevents surgery. Aim of this study was to develop an appropriate spinal orthosis in compare with regular Boston brace in case of IS in connection with curve correction, 3-D force application, alignment of alter posture, cardio-respiratory functions. Methods: Treatment plan being done with a careful evaluation of the patient's deformity in the coronal, sagittal & transverse plane. Breathe cardio-respiratory data analysis and the metabolic data analysis done through the COSMED-Srl-Italy, K4B2 (cardio respiratory function). This analysis is important for signification of the new brace. We measure the O2 consumption level (ml/min/kg), PaO2 (mmHg), PaCO2 (mmHg),Tidal volume (TV),Heart rate, Energy cost EE/min (Kcal/min), VO2,VCO2,O2 expenditure. The above experiment is done in without brace, with Boston brace and with new design 3D brace. Results: Through the application of dynamic forces provide a new moment strategy that effects in curve correction with neuromuscular integration & creep force application (dynamic elongation of the spine) which is important with the brace in all posture. The cardio-respiratory analysis done and plot graph and table established a significant better result in new design 3D brace over the regular spinal orthosis. Conclusions: The comparison between Boston brace and newly design dynamic brace, we found better result in terms of O2 consumption, PaO2, tidal volume, O2 expenditure, CO2 expenditure and energy cost. Static & dynamic balance of the patient is improved with 3 dimension force application on scoliosis curve management.

Keywords: Energy consumption, spinal orthosis, three dimensional

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O7-5: Managing foot drop in a Sub-Saharan African country – Case series of the use of a soft ankle foot orthosis Top


Abena Y. Tannor1,2, Andrew J. Haig2,3, William Haig2

1Komfo Anokye Teaching Hospital, Kumasi, Ghana, 2International Rehabilitation Forum, USA, 3University of Michigan, Ann Arbor, Michigan, USA

Background and Aims: Sub-saharan Africa has the highest incidence prevalence and case fatality of stroke worldwide leaving survivors with disabilities including footdrop with reduced stride length and gait speed.Gait rehabilitation for footdrop includes the use of anklefoot orthosis(AFO) which prevent the foot from dropping during swing phase improving gait.Unfortunately the dearth of Physical Medicine and Rehabilitation(PMR) physician led teams and poverty result in few physical therapy sessions and prescriptions for AFOs.Currently footdrop AFOs in Ghana are locally manufactured using plasticine and plaster of Paris.Patients however complain of the high cost of bigger shoes to fit these AFOs pressure ulcers and blisters with hot climate use. Methods: A soft AFO was manufactured for four adult stroke survivors with footdrop capable of independent gait and receiving care from the first PMR clinic in Ghana.The AFO consisted of a durable washable cotton material fastened around the lower third of leg and attached to shoes.Due to lack of a gait analysis system a phone was used to record and measure gait speed and stride length in a 10-metre walk test before and after use of AFO.Patients were educated on the AFOs use alongside gait training and home exercise program. Results: The AFO improved gait and reduced locomotion deficits compared to no AFO.There was an improvement in stride length(cm) with an AFO(41.7±7.1) compared to without(36.1±8.3).Gait speed(m/min) improved with the use of an AFO(18.7±2.1) compared to none(15.9±3.4).Patients were satisfied with affordability,effectiveness,ease of use and ability to wear it with sandals and boots with laces.One soft AFO cost an equivalent of $6 compared to high resource countries models($31-$80). Conclusions: An affordable and easily accessible rehabilitation device is improving function and independence for patients with footdrop.Training and practice of PMR physicians in low resource countries should be tailored to specific need and context considering climate and resource availability.

Keywords: Foot drop, Ghana, orthotic

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O7-6: Cross-sectional international multicenter study on quality of life and reasons for abandonment of upper limb prostheses Top


Michiro Yamamoto1, Kevin C. Chung2, Hirotaka Tanaka3, Takeshi Nakamura4, Jumpei Oba5, Takaaki Chin6, Yoshiko Tobimatsu4, Hitoshi Hirata1

1Department of Hand Surgery, Nagoya University, Nagoya, Japan, 2Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, USA, 3Department of Rehabilitation, Chubu Rosai Hospital, Nagoya, Japan, 4National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Japan, 5Department of Occupational Therapy, Kobe Gakuin University, Kobe, Japan, 6Robotic Rehabiliattion Center, Hyogo Rehabilitation Center, Kobe, Japan

Background and Aims: This multicenter study aimed to examine the reasons for prosthesis rejection and assess quality of life among patients with upper limb deficiency. Methods: Three rehabilitation centers in Japan and one academic medical center in the USA participated. Patients between 12 and 75 years of age with unilateral or bilateral upper limb absence from the level of wrist to shoulder disarticulation were included. Two questionnaires were employed, an original questionnaire on prosthesis use and the EQ-5D, which were completed by both the participant and a live-in proxy. Results: Of the 367 patients with upper limb loss invited, 174 participated in this study. Male patients made up 80% of the study population. The most common amputation level was trans-radial. Trauma was the most common cause of limb loss. The prosthesis rejection rate was 9% (n=16). The most common reason for abandonment was a lack of prosthesis functionality. Ten of 16 prosthesis nonusers (63%) and 59 prosthesis users (38%) were unemployed or students. The mean EQ-5D utility score was significantly higher in prosthesis users than in nonusers (0.762 vs 0.628, p<0.01). Live-in proxies significantly overestimated QOL in male patients (0.77 vs 0.807, p=0.01). Conclusions: The current prosthesis rejection rate is low. QOL was significantly higher in prosthesis users than in nonusers. More prosthesis users were employed compared with nonusers. Care should be taken not to overestimate the QOL of male patients with upper limb loss as their proxies often did.

Keywords: Abandonment, quality of life, upper limb prosthesis

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O7-7: Sextant of otolith-a useful gadget for diagnosis and treatment of benign paroxysmal positional vertigo Top


Xin-Xian Lee1, 2, 3, 4, Hsin-Wei Lee5, Jui-Chen Chang1

1Department of Physical Medicine and Rehabilitation, Cender Hospital, Taichung, Taiwan, 2Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan, 3Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan, 4School of Medicine, Tzu Chi University, Hualien, Taiwan, 5Taichung Municipal Taichung Girls' Senior High School, Taichung City, Taiwan

Background and Aims: To develop a tool for real-time detecting the position of otolith in any different head position. It helps physicians to diagnose and treat benign paroxysmal positional vertigo (BPPV) properly. BBPV is the most common cause of peripheral vertigo. It results from otolith depositing within semicircular canals (canalithiasis) or attaching to cupulas (cupulolithiasis). To date, many illustrations and animations have been made to explain principals of diagnosis and treatment of BPPV. However, no tool can do real-time simulation of the otolith position during head movement. Methods: We used high resolution computer tomography (CT) to collect raw data of temporal bone, software InVesalius to transfer the CT data into an editable 3-dimensional model, and software Blender to edit the 3-dimensional model of vestibular labyrinth. We designed the labyrinth hollow, added a stick onto it, and used 3-dimensional printing technique to build the labyrinth into a transparent solid model. After putting five small iron balls into the labyrinth model, the gadget 'Sextant of Otolith' was accomplished. Results: We can adjust the iron balls into any semicircular canal of the gadget 'Sextant of Otolith' and connect the gadget to a head belt of a head mirror. The patient wears the gadget 'Sextant of Otolith' on the head during the examination and treatment. In this way, we can simulate the diagnosis (Dix-Hallpike maneuver, supine roll test) and treatment (canalith repositioning procedure) of BPPV by observing the movement of the otolith (iron balls) through the transparent model in any head position simultaneously. It helps us to understand the pathophysiology and treatment of BPPV. Conclusions: The 'Sextant of Otolith' is a useful tool for diagnose and treatment of BPPV.

Keywords: 3-dimensional printing, vertigo, vestibular rehabilitation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.




  No. O8-1: Effect of the robotic-assisted gait training device (Welwalk®) plus physiotherapy in improving the ambulatory function in sub-acute hemiplegic stroke patients: Preliminary study Top


Patarapol Yotneungnit1, Krisna Piravej1, Natapatchakrid Thimabut2, 3, 4, Jittima Charoenlimprasert5, Thipwimon Sillapachai5, Satoshi Hirano6, Eiichi Saitoh6

1Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 2Department of Rehablitation, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 3Department of Biomedical Engineering Program (Rehabilitation), Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand, 4Department of Prosthetics and Orthotics (Rehabilitation Medicine), Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, 5Thai Red Cross Rehabilitation Center, Thai Red Cross Society, Samut Prakan, Thailand, 6Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan

Background and Aims: To evaluate the effect of the Robotic-assisted Gait Training Device (Welwalk®) plus physiotherapy compared with the physiotherapy alone in improving ambulatory function among sub-acute hemiplegic stroke patients. Methods: The study was investigator-blinded, randomized controlled trial. Patient with 1st episode of stroke onset < 90 day and had FIM walking score ≤ 3 were recruited. Patients were randomized allocated into either the Welwalk group or the physiotherapy group. The Welwalk group received robotic training 40 min/day and routine ambulation training 20 min/day. The control group received only routine ambulation training 60 min/day. Both groups received other 60 minutes of traditional physical therapy treatment, 5 days/week for six weeks. The outcomes were the FIM walking score, gait parameters, 10-meter walk test (10 MWT), 6-minute walk test (6 MWT), and the Barthel ADL Index were recorded at baseline, end of 15th and 30th session by blinded assessor. Results: When compare with control group at 15th and 30th session, Welwalk group had higher FIM-walking score improvement (4 vs 1 and 4 vs 2), higher distance increase in 6-minute walk test (37 vs -7m and 33 vs 6m), faster gait speed (+0.14 vs -0.01 m/s and +0.10 vs 0.00 m/s) and higher increase in Barthel index (7 vs 4). Conclusions: This preliminary study suggested that training sub-acute stroke patient using Welwalk® showed trend of higher ambulation outcome compare with traditional physical therapy.

Keywords: Gait training, robotic-assisted gait training device, stroke

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O8-2: Three cases using welwalk for chronic hemiplegic patients with gait abnormalities Top


Tetsuya Tsunoda1, Satoshi Hirano1, Eiichi Saitoh1, Ikuko Fuse1, Junya Yamada2, Daisuke Katoh2, Haruki Osako2, Yuya Sawada2

1Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan, 2Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan

Background and Aims: The Welwalk WW-1000 (WW-1000), which is a one-limb type gait training assist system, was used in gait training for subacute stroke patients with hemiplegia. However, there is few study about the effectiveness of WW-1000 for chronic hemiplegic patients. The aim of this study was to use the WW-1000 for chronic hemiplegic patients with gait abnormalities, and to evaluate whether the gait patterns improve. Methods: Case 1: 64-year-old male, more than 4 years after onset of right thalamic bleeding, left hemiplegia and sensory disturbance persisted. Case 2: 49-year-old male, more than half a year after onset of left putaminal bleeding, right hemiplegia and aphasia persisted. Case 3: 53-year-old male, more than 6 years after onset of right cerebral infarction, left hemiplegia and sensory disturbance persisted. These 3 chronic hemiplegic patients underwent rehabilitation including gait training using WW-1000. Treadmill gait analysis was conducted using a three-dimensional motion analysis system, before and after the WW-1000 training period. Results: In Case 1 and 2, before WW-1000 training, there were retropulsion of the hip on affected side. We used visual and auditory feedback of WW-1000 to promote forefoot loading, thus the load on the affected side increased and the paralytic lateral leg time was prolonged gradually. In Case 3, before WW-1000 training, there was insufficient knee flexion during swing phase. We tried visual feedback of sagital plane with the knee forcibly flexed by WW-1000, therefore he was able to walk with sufficient knee flexion. Conclusions: Three chronic hemiplegic patients with gait abnormalities used WW-1000 and the gait patterns improved. The present results suggested that WW-1000 training was effective for chronic hemiplegic patients to reduce gait abnormalities.

Keywords: Chronic hemiplegic patients, rehabilitation, WW-1000

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O8-3: The experience of gait training with hybrid assistive limb in amyotrophic lateral sclerosis patients Top


Kanami Kobayashi1, Tomoyuki Ueno1, Mami Aoki1, Shunsuke Yamauchi1, Hideki Kadone2, Kayo Hiruta1, Yuriko Yashio1, Yoshitaka Okamoto1, Kensuke Nakaya1, Nobuyuki Nishimura1, Kimihisa Ishikawa1, Masakazu Taketomi1, Yukiyo Shimizu1, Yasushi Hada1

1Department of Rihabilitation, University of Tsukuba Hospital, Tsukuba, Japan, 2Center for Innovating Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan

Background and Aims: In Japan, recently gait training with HAL for some part of intractable neurological diseases is covered by insurance. In this study, we report our experience of gait training with HAL in three Amyotrophic Lateral Sclerosis (ALS) patients. Methods: Three ALS patients who could stand by themselves were selected as the subject. They received total 9 times of the gait training with HAL twice a week. One session included 40-minute walk with HAL at 1.5-4.0 km/h on a treadmill with 15-20 kg unloading by suspension. Outcome parameters are 6-meter comfort walk speed (6MCS), 6-meter fastest walk speed (6MFS) and 2-minute walk distance (2MD). Parameters were assessed pre and post training and every 6 weeks later (follow-up). Results: All patients completed 9 times gait training with HAL without major adverse reactions. They walked 1580m in one session on average. The result of 6MCS, 6MFS and 2MD increased in patient B and C at every evaluation as pictured in [Figure 1], [Figure 2], [Figure 3]. In patients A, the results are almost the same or decreased compared with pre assessment as shown in [Figure 1], [Figure 2], [Figure 3]. Discussion: The gait training with HAL in ALS patients can be performed safely. It is thought that the results of one patient decreased because he fell down before the post assessment. Other patients maintained walking ability at least 12 weeks after training even though ALS is a progressive disease. Conclusions: HAL training may be effective for maintaining the ability of independent walking to older ages in the life of ALS patients.
Figure 1: The results of 6 m comfort walk speed

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Figure 2: The results of 6 m fastest walk speed

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Figure 3: The results of 2 min walk distance

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Keywords: Amyotrophic lateral sclerosis, gait disturbance, hybrid assistive limb

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O8-5: Effect of a torque-controlled wearable robotic device in a child with incomplete paraplegia due to spina bifida Top


Hyunjin Choi1, Byeonghun Na1, Dongho Park2, Beomki Yoo2, Solrim Kim1, Dongseok Kim1, Kyoungchul Kong1,3, Young Chae Chang2, Dong-Wook Rha1,2

1Angel Robotics Co.,Ltd, Seoul, South Korea, 2Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea, 3Departmetnt of Mechanical Engineering, KAIST, Daejeon, South Korea

Background and Aims: There are various wearable robots to assist the ground walking, however, few robots use torque control methods that are more suitable for incomplete paraplegia. This study aims to determine the effect of a newly developed torque-controlled wearable robot for assisting gait of children with incomplete paraplegia. Methods: A 12-year-old girl with incomplete paraplegia caused by spina bifida who can walk shortly on the level floor only with solid AFO participated in this study [Figure 1]. She was trained 1 hour per week for 5 weeks with parallel bars and a wheeled walker to accustom herself to the torque-controlled robotic gait. Since the sixth week, she received of robotic gait training with bilateral crutches. After 10 weeks of training, the kinematics and the oxygen consumption both in robotic gait and AFO gait were evaluated based on optoelectric motion capture system (Vicon T10s, UK) and a portable oximetry (Cosmed K5, USA), respectively. After 15 weeks of robotic gait training, she got reevaluated. Results: In the test after 10 weeks of robotic gait training, the range of motions [Figure 2], gait speed, step length, and step width were improved in the robotic gait compared to the AFO gait. The oxygen cost of the AFO gait and the robotic gait were 1.93 ml/kg/m and 1.37 ml/kg/m, respectively. After 15 weeks training, the oxygen cost of the robotic gait was 1.31 ml/kg/m, and the walking distance for 6 min was increased by 13 meters compared to the 10 weeks test [Figure 3]. Conclusions: The newly developed wearable robot effectively assisted the ground walking of a child with incomplete paraplegia. The participant used the assist torques while walking, self-controlling the foot position on initial contact. The kinematics of gait was improved, and the energy expenditure in 6 minutes walking was decreased with the proposed robotic device.
Figure 1: A four-point gait pattern is shown in the pre-swing phase of the AFO gait (left) and a two-point gait pattern is shown of the robotic gait (right)

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Figure 2: The kinematic gait pattern on sagittal plane

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Figure 3: The oxygen cost of (A) AFO gait and (B) robotic gait after 10 weeks of robotic gait traning and (C) robotic gait after 15 weeks of robotic gait training

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Keywords: Gait training, torque-controlled robot, wearable robot

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O8-6: Immediate change and aftereffect of gait performance in elderly people by robot-knee-ankle-foot-orthosis (orthobot) Top


Shihomi Kawasaki1, Koji Ohata1, Yuichi Sawada2, Yoshiyuki Higashi2, Nodoka Kimura1,3, Satomi Watanabe1, Akihiro Tsuruda1, Shiori Nogi1, Tadao Tsuboyama1,4

1Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 2Department of Mechanical and System Engineering, Kyoto Institute of Technology, Kyoto, Japan, 3Jujo Takeda Rehabilitation Hospital, Kyoto, Japan, 4Department of Physical Therapy, Bukkyo University, Kyoto, Japan

Background and Aims: Most individuals loss gait function corresponding with age, which includes smaller steps and lower gait speed. In the previous study, Robot-Knee-Ankle-Foot-Orthosis (Orthobot) was able to improve gait performance of stroke patients by correcting only the paretic knee motion. The aim of this study was to examine whether the Orthobot could improve the gait performance in elderly people. Methods: 10 elderly with gait limitation in facility of long term care participated in this study. Prior to gait trials, we measured maximum voluntary isometric knee extension force as the indicator of limb function. First, subjects performed 5 meter-walk on Zebris FDM in self-selected speed. Then, they wore the robot on the weaker side of knee extensor and performed 10 meter over-ground walk without assistive torque. After adjustment of assistive intensity, 3 times of 1 minute-walk with assistive torque, and another 10 meter-walk without assistive torque were performed. Finally, subjects took off the robot and performed 5 meter-walk again. To examine the immediate change, gait speed and number of steps were measured while 10 meter-walk. Also, step length (SL) and double support time (DS) including loading response (LR) and pre-swing (PSw) phases of both limbs were measured by Zebris FDM on 5 meter walkway to examine the aftereffect. Results: Most of the elderly in this study showed asymmetry in knee extension muscle strength. Gait speed significantly increased (p<0.01) and number of steps decreased (p<0.05) by using Orthobot. As an aftereffect, on robot-side, SL significantly increased (p<0.05) and DS decreased (p<0.05) due to shortening of LR (p<0.05). Conclusions: In this study, elderly in facility of long term care with gait limitation showed asymmetry in knee extension muscle strength. By assisting the weaker side of the limb, gait performance improved and the change remained even after taking off the robot.

Keywords: Aftereffect, gait, robotics

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O8-7: Causes to contraindicate rehabilitation with Lokomat and G-EO system: Results from a randomized trial Top


Marcel Simis, Mariana Milazzotto, Linamara R. Battistella

Department of Physical Medicine and Rehabilitation, University of Sao Paulo, São Paulo, Brazil

Background and Aims: There are available different systems for robot-assisted gait training that may provide a better outcome of rehabilitation in stroke patient. Although there are several studies comparing these systems with standard care, there is a lack of studies comparing these different systems. Moreover, contraindication, tolerance and side effects of these therapies need to be better understood. Therefore, this study has the goal to report the causes for contraindicate robotic therapy, from the results of a randomized trial comparing Lokomat and G-EO System. Methods: Stroke patients with potential to receive gait training went through medical screening for accurate evaluation of contraindications to robotic therapy. After the doctor authorization, patients were stratified into 3 groups based on Functional Ambulation Categories (FAC), being severe motor impair (FAC from 0 to 1), moderate motor impair (FAC from 2 to 3) and mild motor impair (FAC 4 and 5). Patients in mild and moderate groups were randomized between G-EO System and Lokomat. Patients with severe motor impairment were not randomized and received Lokomat, because in our experience this population do not tolerate training with G-EO system. Results: From the 34 patients screened for the study, 8 were not able to perform robotic therapy. Among these, four patients (11.8%) presented cardiac alterations such as heart and coronary insufficiency, two (5.9%) had presence of spasticity that did not allow the robotic movements, one (2.9%) had deep vein thrombosis and one (2.9%) had skin ulcer. Robotic therapy from both systems was well tolerated, with no side effect, for the 26 patients (76.5%) that did not have contra-indication. Conclusions: Cardiovascular comorbidities are common in stroke patients, being the main cause of contraindication in our study. The results reinforce the need for appropriate screening before performing robotic therapy to avoid complications for the patients.

Keywords: Locomotion, robot therapy, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O8-9: Enhancement of gait coordination through robotic therapy in myelopathy patients with residual motor disturbances after decompression surgery Top


Sandra Puentes1,2, Hideki Kadone2, Shigeki Kubota3, Tetsuya Abe3, Yukiko Shimizu4, Yasushi Hada4, Aiki Marushima5, Yoshiyuki Sankai6, Kenji Suzuki6, Masashi Yamazaki3

1Department of Intelligent Interaction Technologies, Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan, 2Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Ibaraki, Japan, 3Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan, 4Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan, 5Department of Neurosurgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan, 6Center for Cybernics Research, University of Tsukuba, Ibaraki, Japan

Background and Aims: The Ossification of the Posterior Longitudinal Ligament (OPLL) of the spine is a degenerative disease which may induce motor impairment due to compressive myelopathy. When patients display severe motor disturbances, surgical decompression is the treatment of choice; however, some patients have residual motor disturbances. After surgery, there is no available intervention to improve motor function in this population. We propose the use of Hybrid Assistive Limb (HAL) robot to promote gait recovery in such patients. Methods: Twelve patients with OPLL associated to severe motor symptoms were recruited after surgical decompression. Five patients started HAL intervention within 15-30 days after surgery (acute) and 7 started after 2 years post-surgery (chronic). Both groups underwent 10 sessions of HAL intervention. Before the first and after the last session, walking performance was evaluated using the 10 meters walk test. To record segmental kinematics, a motion capture system (VICON-MX, 100Hz) was used. Data was analyzed regarding the elevation angles described for thigh, shank and foot limb segments. Kinematic data from 8 healthy volunteers was used for comparison. Results: HAL intervention improved the walking performance by increasing speed and stride length in acute and chronic groups. Kinematics evaluation showed improvement in plane fitting for acute group (PV3 mean; pre: 0.03±0.01, post: 0.02±0.007. P-value: 0.02) but not for chronic group after HAL therapy. When compared to healthy, tendency of PV3 recovery was observed for acute group only (PV3 mean; healthy: 0.009±0.002. P-values; pre-acute Vs healthy: <0.01; post-acute Vs healthy: <0.01). Comparisons between chronic and healthy did not show significant difference. Conclusions: HAL intervention improved walking performance of acute and chronic patients. Interestingly, improvement of loop planarity was only found for acute patients suggesting recovery of gait coordination. Chronic patients may have achieved a functional level of coordination through previous rehabilitation and daily life activities.

Keywords: Gait coordination, myelopathy patients, robotic intervention

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O9-1: Effect of post-CABG cardiac rehabilitation on six minute walk test parameters: A pilot study Top


Dilshad Hunain Al Arabia1, Zubair Ali Khowaja1, Nabila Najam1, Muhammad Shoaib2, Syed Imran Ahmad1

1Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan, 2Armed Forces Institute Rehabilitation Medicine, Rawalpindi, Pakistan

Background and Aims: Cardiac Rehabilitation is an integral part of standard healthcare. Beneficial effects are seen during Post-CABG patient recovery using different outcome measures at discharge. There is paucity of data on the effectiveness of Post-CABG cardiac rehabilitation using 6MWT (Six Minute Walk Test) parameters. Our study aims to compare results of 6MWT parameters of participants undergoing Phase-1 cardiac Rehabilitation with control group. Methods: A prospective study was conducted from October 2018 to December 2018. Participants were enrolled from two hospitals having Ischaemic heart disease and admitted for elective surgery for Coronary Artery By Pass Graft (CABG). Participants were divided in two groups. Control group participants were advised ambulation as tolerated and generalized range of motion exercises. At discharge, 6MWT was performed, pre and post 6MWT vitals and rate of perceived exertion were assessed for dyspnea and fatigue using Borg's scale. Results: 33 participants with median age of 57.5 years included male (26) and female (7) divided into cardiac rehabilitation group (n=16) and control group (n=17). On comparing two groups, statistically significant difference noted in 6MWT parameters including pre-test dyspnea (p=0.015) and fatigue (p=0.017) score [Table 1]. Similarly, Post 6MWT result were significant for heart rate (p=0.001) and dyspnea score (p=0.020). Control group covered greater distance than cardiac rehabilitation group (p=0.045). Positive correlation was observed between time duration on ventilator, Fatigue Score before (p=0.012) and after the 6MWT (p=0.013) and duration of stay in hospital (p=0.004). Level of hemoglobin and distance covered during 6MWT was also positively correlated. (p=0.016). Conclusions: Cardiac rehabilitation improves physiologic heart rate after 6MWT and lower subjective perception of dyspnea score on Borg's scale. Optimizing hemoglobin levels post-surgery helps ambulate greater distance. Validity of results require larger sample size and controlled trials.
Table 1: Post-6 min walk test results

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Table 2: Pre-6 min walk test results

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Keywords: Cardiac rehabilitation, cardiac surgery, physiotherapy

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O9-2: Pathological fractures in patients with secondary bone cancer during rehabilitation interventions: A short term cohort study Top


Christina May M. De Brito1,2, Laura Tabacof1,3, Marta Imamura1,3, Linamara R. Battistella1,3

1Physical Medicine and Rehabilitation, Hospital das Clinicas da Universidade de Sao Paulo, Sao Paulo, Brazil, 2Servico de Reabilitacao do Instituto do Cancer do Estado de Sao Paulo da Faculdade de Medicina da, Universidade de Sao Paulo, Sao Paulo, Brazil, 3Institute of Physical Medicine and Rehabilitation, do Hospital das Clinicas da Faculdade de Medicina da, University of Sao Paulo School of Medic, Sao Paulo, Brazil

Background and Aims: Secondary bone cancer is a common and severe complication in the oncological population. The benefits of physical activity and resistance training for cancer survivors is already well established. Despite this, based on assumptions of increased pathological fracture risk, exercise-related interventions have often been avoided in patients with secondary bone lesions. This fear of a serious event may create an unintended “vicious cicle”, consisting of immobility, pain and decline of physical performance. This study aimed to determine the incidence of pathological fractures among patients with secondary bone cancer undergoing a rehabilitation program at an university-based rehabilitation center. Method: This was an observational prospective non-randomized short-term cohort study. Patients with bone metastasis were studied during eight months under the course of a multidisciplinary rehabilitation program for cancer patients. A flow chart was specially designed in order to detect the occurrence of new pathological fractures. to be able to detect symptoms that would indicate the possibility

Patients and the multidisciplinary team were educated in order of a pathological fracture. Radiographic images were obtained when patients developed such symptoms. Results: Between May and December of 2018, out of the 552 patients undergoing the outpatient rehabilitation program, 48 had secondary bone cancer. The most common primary sites were multiple myeloma, followed by prostate and breast cancer. Almost two-thirds of the patients had previous pathological fractures diagnosed at baseline. Only one new pathological fracture was diagnosed during the study, which happened outside of the rehabilitation setting. Medium duration of the rehabilitation program was 10 weeks and sessions were held twice-a-week. Conclusion: Our findings corroborate with the available literature, on the presumptive idea that rehabilitation interventions seem to be safe in patients with secondary bone cancer. Literature is still scarce on the matter and more studies are needed to confirm our findings.

Keywords: Bone fracture, bone neoplasm, rehabilitation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.
Figure 1: Oncological diagnosis

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Figure 2: Radiological aspect

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Figure 3: Previous pathological fracture

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  No. O9-3: Survey of female athlete triad in elite female wheelchair basketball players Top


Yukiyo Shimizu1, Hirotaka Mutsuzaki2, Kaori Tachibana3, Kazushi Hotta4, Yasusyoshi Wadano5

1Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan, 2Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan, 3Department of Physical Therapy, School of Healthcare, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan, 4Department of Occupational Therapy, School of Healthcare, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan, 5Department of Orthopaedic Surgery, Miho Clinic, Miho, Japan

Background and Aims: Enhanced competitiveness in parasports has increased the importance of secondary disorder prevention. The female athlete triad (FAT) is defined as low energy availability, menstrual dysfunction, and low bone mineral density (BMD). This syndrome is well-studied in able-bodied athletes, however, reports focusing on female para-athletes are rare. The purpose of this study was to investigate FAT in female wheelchair basketball players of the Japanese national team. Methods: Eighteen female wheelchair basketball players from the 2016 Japanese national team participated in this study. We surveyed the following data: 1) Physical characteristics, including underlying diseases and medical history-such as the presence of gynecological diseases, stress fractures, data on the menstrual cycle, menstrual pain, and subjective menstrual flow; 2) athletic parameters, including class of wheelchair basketball, length of athletic career, and wheelchair usage conditions; 3) results of hematological examinations, including hemoglobin, iron, estradiol, progesterone, total P1NP, and TRACP-5b levels; 4) results of nutritional assessment, including total energy intake and total iron intake; and 5) total BMD. Results: Four (22.2%) players had gynecological histories, one had a history of stress fracture. Nine (50%) had menstrual cycle disorders, seven (38.9%) reported excessive menstrual flow, thirteen (38.5%) experienced menstrual pain, and four (22.2%) had very severe pain disturbing their activities of daily living. The mean serum iron level was 59.6 mcg/l, which is higher than the baseline level (43 mcg/l). However, six (33.3%) had iron levels below the average. Total energy intake per necessity was 90.7% and total iron intake per necessity was 57.9%. The serum iron level correlated with the degree of reported menstrual flow (p=0.016). The mean total BMD was 1.19g/cm2, equivalent to 108.6% on the young adult mean score. Conclusions: We surveyed FAT in elite female para-athletes, and thus provide important data that can be used to support these athletes.

Keywords: Female athlete triad, para-sports, wheelchair basketball

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O9-4: Physical activity and diabetes mellitus: The knowledge of physician and barriers to guideline implementation in morocco Top


Abderrazak Hajjioui1,2, Nohaila Hassanain1,2, Maryam Fourtassi3,4

1Department of Physical and Rehabilitation Medicine, University Hospital Hassan II Fez, Morocco, 2Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, University Sidi Mohammed Ben Abdellah Fez, Morocco, 3Department of Physical and Rehabilitation Medicine, University Hospital Mohamed 6, Oujda, Morocco, 4Faculty of Medicine and Pharmacy, University Mohammed 1st, Oujda, Morocco

Background and Aims: The beneficial effects of PA for the promotion of health and cure of DM have been clearly shown. This study aims to investigate Moroccan physican' knowledge on PA for patients with DM and barriers to guideline implementation. Methods: A cross-sectional study design was used. Eligibility criteria included Moroccan physician treating patients with DM. An online survey instrument was created, which included the physican' knowledge and views on the role of PA for patients with DM and the practice in prescribing exercise for DM care and barriers to such prescription. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis. Results: 91 physicians completed the study. 80% of physicians had poor knowledge of PA and diabetes and 88% stated a need for further information and training program on prescribing PA to patients with diabetes.The majority of physicians regularly recommend PA to patients with diabetes or overweight. More than 3/4 of our population are strongly agreed with the statement “ PA is a therapeutic agent and acts as a drug “ (76%) and on the effectiveness of PA in diabetic patients (87%). The three main barriers to guideline implementation of PA in the management of diabetes are: (1)lack of a multidisciplinary team specialized in PA, (2) Lack of knowledge about prescribing the PA according to the pathology (3)Lack of time in the medical practices. The three main barriers to practicing PA by diabetic patients are (1) low motivation and lack of interest (2) low level of education (3) no perception of PA. Conclusions: More education and training around the prescription of PA for DM populations are needed. Additional changes are needed in our health care system to shift from an acute to a chronic disease model to effectively support diabetes care efforts.

Keywords: Diabetes mellitus, Moroccan physican' knowledge, physical activity

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O9-5: Rehabilitation of postbariatric surgeries polyneuropathies Top


Maher Saad BenJadid1,2

1Rehabilitation Medicine and Functional Health Care Services Departments, Prince Sultan Military Medical City (Former RMH), Riyadh, Saudi Arabia, 2Saudi Board of Physical Medicine and Rehabilitation, Saudi Commission for Health Specialities

Background: In accordance to World Health Organization; 39% of adults aged 18 years and over were overweight worldwide in 2016, and 13% were obese. The prevalence in Saudi Arabia (KSA) is up to 30 %. Overweight and obesity is usually preventable. There are conservative methods in managing obesity including healthy diet and physical activities but at certain BMI , Bariatric Surgeries (BS) are proven to reduce weight , prevent cardiovascular complication, life expectancies and quality of life. Up to 15,000 BS are performed annually in KSA. Acquired deficiencies in thiamine (vitamin B1) and cyanocobalamin (vitamin B12) are the most common causes of postbariatric surgery polyneuropathies ( PBSP ) and usually because the patients had no enough education. Method: Retrospective study of 5 young patients , 1 female and 4 male , admitted for rehabilitation with BSPN during 2018 in PSMMC, Riyadh , KSA. Results: Symptoms of weakness and pain started around two months pos-op . Lower limbs were affected more than the lower limbs , all were unable to stand or walk they had neurogenic pain , no cranial nerve involvement. They underwent inpatient active rehabilitation program for average of 2 months All discharged walking and independent in activities of daily living. Conclusion: Bariatric surgery , although considered to be a solution for persons with obesity who can't practice dieting and exercise , have to be combined with patients education for taking healthy diets and supplements post-op to prevent complications . We recommend follow up by the surgeon monthly for the first 4 months . Rehabilitation of PBSP is a challenge as it is lengthy and needs full rehab specialists and cover all aspects including medical, physical , social , psychological and dietetics support . Results are always very successful with best functional outcome.

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O9-7: Rehabilitation: The missing link in improving health of refugees Top


Fary Khan1, 2, 3, Bhasker Amatya1, 2, 3

1Royal Melbourne Hospital, Melbourne, Australia, 2Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia, 3Australian Rehabilitation Research Centre, Victoria, Australia

Background and Aims: Despite strong consensus amongst healthcare authorities regarding the integral role of rehabilitation in refugee health, there is paucity of research on the rehabilitation needs in this population. This presentation will provide an overview of the medical needs of refugees, the potential challenges and gaps in refugee healthcare from the global rehabilitation perspective. Methods: Comprehensive literature review to provide an overview of current health and rehabilitation status of refugee and to highlight some of the gaps/challenges in a global context. Results: Existing reports suggest high prevalence of non-communicable diseases, such as diabetes, hypertension, coronary heart diseases and musculoskeletal problems (such as backache, non-specific body pain), compared with communicable diseases. Many refugees have complex healthcare needs, and majority have psychological issues related to trauma, violence and deleterious journey. Studies report that two-thirds of refugees experience some mental health problem (such as anxiety or depression, self-harm) and one in six have physical health problems; signifying the important role of rehabilitation in social re-integration. Further, majority continue to face effects of social determinants such as poverty, illiteracy, dependency due to lack of cohesive supports in their new country. This is compounded by language barriers, impoverishment, unfamiliarity with the local environments and health care system. In Australia, concerns have been raised about the risk of sexual and gender-based violence in off-shore detention camps. Many of these issues for this vulnerable population are relevant globally and amenable to rehabilitation. Enhanced comprehensive rehabilitation-inclusive healthcare will likely increase the chance to better health outcomes for refugees, thereby moving towards health equity in the society. Conclusions: There is a need for a strong leadership and effective action from national and international bodies for comprehensive rehabilitation-inclusive medical care for refugees. Therefore, policies and programs are required to focus on healthcare needs, including rehabilitation, of immigrant communities.

Keywords: Disability, refugee health, rehabilitation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O9-8: Efficacy of a therapeutic patient education self-management program for stroke survivors: The lay project Italian experience Top


Roberta Bardelli1, Stefania Fugazzaro1, Monia Allisen Accogli1, Monica Denti1, Alessandra Altavilla1, Enrica Cavalli2, Laura Dallolio3, Rossella Messina3, Donatella Pagliacci4, Simona Calugi3, Stefania Costi1, Stefano Cavazza5, Claudio Tedeschi1, Mariangela Taricco2

1Department of Neuromotor, Azienda Unita' Sanitaria Locale- IRCCS di Reggio Emilia, Reggio Emilia, Italy, 2Azienda Ospedaliero-Universitaria Policlinico S.Orsola-Malpighi, Bologna, Italy, 3Dibinem Università degli Studi di Bologna, Italy, 4Azienda AUSL 6 Zona Distretto Val di Cornia Livorno, Italy, 5Nuovo Ospedale Civile S.Agostino Estense Baggiovara Modena, Baggiovara, Italy

Backgrounds and Aims: The delivery of TPE programs for stroke survivors is recommended by guidelines, but the characteristics of the better type, timing and setting are not clear. Aim: to develop and evaluate the efficacy of a standardized TPE program on empowerment of self-management (SM) in post-acute phase after stroke and facilitation of social reintegration. Methods: Design: controlled clinical trial in 3 rehabilitation centers: S.Orsola Bologna (BO), Reggio Emilia (RE), Baggiovara (MO). Inclusion criteria: first stroke, >18 years, presence of caregiver, moderate-severe disability, no severe communication disability and cognitive impairment. Primary outcome: patient perceived self efficacy (SSEQ-Stroke Self Efficacy Questionnaire). Assessments: T0 (enrollment), T1 (inpatient rehabilitation discharge), T2 (50-60 days after discharge): SSEQ, MBI, Short Physical Performance Battery, Geriatric Depression Scale, SF-12, patient and caregiver's satisfaction, Caregiver Strain Index. At T2 also: % of homecoming, length of stay, territorial services use. A structured TPE intervention was set up, defining contents, timing, modality (group and individual sessions directed by rehabilitation specialists). The program is an adaptation of the Chronic Disease Self Management Program (Stanford) for stroke patients and caregivers. The focus is the training on goal setting and problem solving. Results: 82 patients enrolled in the intervention group (IG), 103 in the control group (CG). SSEQ showed better results in IG vs CG (p=0.027). Higher scores of MBI observed in IG vs CG over time (p=0.048). IG patients improved faster during inpatient rehabilitation (p=0.09). SF-12 mental score improved in IG while in CG remained stable (p=0.045). The program influenced secondary prevention behaviours (physical exercise and territorial service use). Compliance to the program was high (90.2%). Conclusions: It's time to transfer this experience into clinical practice and analyse the factors that may influence the success of a SM program in stroke survivors. Our research highlighted issues that may be barriers or facilitators.

Keywords: Empowerment, self-management, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.




  No. O9-9: Differential effectiveness of high-frequency rehabilitation in patients based on acute cerebral infarction severity: A retrospective cohort study Top


Tomoko Nakazora1, Konosuke Iwamoto2,3, Tetsuhito Kyozuka3, Toshiki Shirotani4, Yuki Uchiyama5, Kazuhisa Domen5

1Department of Rehabilitation Medicine, Hakka Hospital, Himeji, Japan, 2Department of Rehabilitation Medicine, Mishuku Hospital, Tokyo, Japan, 3Department of Neurology, Mishuku Hospital, Tokyo, Japan, 4Department of Neurosurgery, Mishuku Hospital, Tokyo, Japan , 5Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan

Background and Aims: High-frequency rehabilitation therapy can promote functional recovery in patients with acute cerebral infarctions. This study tested the hypothesis that the effect of intensive rehabilitation on the functional prognosis of patients with acute cerebral infarctions differs according to lesion severity. Methods: We analyzed patients hospitalized due to cerebral infarctions and who underwent rehabilitation between October 2010 and September 2014. We examined the association between training frequency and improvements in activities of daily living, as indicated using the Barthel Index (BI), for each severity classification. Results: In total, 586 patients with cerebral infarctions were analyzed. The BI effectiveness was highest for patients with National Institutes of Health Stroke Scale (NIHSS) scores ≤3 receiving high-frequency therapy. In addition, a multiple linear regression analysis indicated that BI effectiveness was significantly and positively correlated with high-frequency therapy (coefficient, 0.149; 95% confidence interval, 0.052-0.245; p < 0.01), in these patients. There was no significant difference in BI effectiveness between therapeutic protocols for patients with NIHSS scores ≥4. Conclusions: This retrospective cohort study demonstrated that intensive therapy can result in functional recovery in patients with mild cerebral infarctions.

Keywords: Acute stroke, early rehabilitation, functional outcome

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O10-1: Using multi-perturbation shapley value analysis to unravel the impact of lesion configuration on residual motor control after stroke Top


Shay Ofir1,2, Silvi Frenkel-Toledo1,3, Isaac Meilijson4, Nachum Soroker1,2

1Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel, 2Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel, 3Department of Physical Therapy, Ariel University, Ariel, Israel, 4Department of Mathematics, Tel-Aviv University, Ramat Aviv, Israel

Background and Aims: Following a stroke, control of the hemiparetic upper limb (HUL) is often insufficient to support activities of daily living, a state leading to severe disability despite all rehabilitation efforts. Early prognostication of patients during the rehabilitation period can both facilitate the development of novel treatment modalities and guide the prescription of existing therapies. Recent studies using voxel-based lesion-symptom mapping (VLSM) have identified several brain structures where damage exerts a marked negative effect on HUL functioning. However, most strokes involve a multitude of brain regions and VLSM is unable to detect the critical role of interactions between these regions. In the current study, we applied a novel approach derived from game theory - multi-perturbation Shapley value analysis (MSA) - to test the impact of different lesion patterns on residual control of the HUL, taking into account interactions between various components of the neural network for motor control. Methods: Ninety patients admitted to the Loewenstein Rehabilitation Hospital following a first-ever hemispheric stroke were recruited. HUL function was examined using the Upper Extremity module of the Fugl-Meyer test and the Box and Blocks test. Normalized lesion data was used for analysis of the impact of lesion configuration on residual HUL functioning using both VLSM and MSA. Results: HUL function following left-hemisphere damage (LHD) was affected by damage to the sensory-motor and premotor cortices. Among right-hemisphere damaged (RHD) patients, the critical regions were the insular cortex and the capsular-putaminal region. Additional lesioning of white matter projection and association tracts affected HUL function in both groups. MSA revealed different cortico-sub-cortical interactions in the two groups. Conclusions: The lesion patterns that affect HUL function differ between LHD and RHD. MSA provides an added value to standard VLSM procedures for assessment of lesion effects.

Keywords: Game theory, hemiparesis, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O10-2: Efficacy of EEG-functional magnetic resonance imaging neurofeedback for stroke rehabilitation in relation to the DTI structural damage: A Pilot Study Top


Isabelle Bonan1, Giulia Lioi2,3, Mathis Fleury2,3, Emilie Leveque-Le Bars1, Anatole Lecuyer3, Christian Barillot2, Simon Butet1

1Department of PRM, CHU, Rennes, France, 2???, Univ Rennes, Inria, CNRS, Inserm, IRISA, EMPENN ERL U1228, F-35000, Rennes, France, 3???, Univ Rennes, Inria, CNRS, IRISA, Hybrid Project Team, F-35000, Rennes, France

Background and Aims: The majority of Neurofeedback (NF) approaches for motor recovery have relied solely on EEG recordings. EEG advantages are practicability and high time resolution, but it suffers from a limited spatial resolution and access to deeper areas. fMRI NF (Sitaram et al., 2012) allows to more precisely identify cortical targets. Recent study (Perronnet et al., 2017) have revealed the potential of coupling EEG and fMRI to achieve a more specific regulation. Here, multisession bimodal EEG-fMRI NF for upper limb motor recovery was tested with respect to the integrity of the corticospinal tract (CST). Methods: Four chronic stroke patients (54-76 years, 2 females) were included. Diffusion tensor imaging was performed and fractional anisotropy (FA) calculated to assess the asymmetry between ipsilesional and controlesional CST (Jong et al., 2005). It has been shown that for a FA asymmetry index value greater than 0.25 limited capacity for recovery are expected (Stinear et al., 2007). The experimental protocol for NF training included an alternation of bimodal EEG-fMRI and unimodal EEG NF sessions. The NF metaphor consisted of a ball moving on a gauge proportionally to the EEG and fMRI scores. Results: The analysis of the CST integrity revealed that for 3 patients a high degree of symmetry was preserved (FA asymmetry: 0.03, 0.06 and 0.05). For one patient however, the ipsilesional CST was more affected: FA asymmetry 0.105. This patient also failed to up-regulate the brain activity in the ipsilesional motor cortex at the end of the training [Figure 1]. Whereas, 2 of the 3 other patients showed significant increased activation of the ipsilesional M1 and better ipsilesional motor and premotor BOLD activation. Conclusions: These preliminary findings confirm the critical role of the CST integrity for stroke motor recovery and its relation to functional brain regulation of the ipsilesional motor cortex.
Figure 1: Example of corticospinal tract reconstruction and primary motor cortex (M1) activation in two patients (a and b). Ipsilestional corticospinal tract is plotted in orange and controlesional corticospinal tract in green. The bar plot on the right hand side of the figure show the average (and stanard error across neurofeedback training blocks) of BOLD contrast activation in the primary motor cortex in the first (s1) and second (s2) training session, with relative statistics (Wilcoxon test, P values at the top of the barplots)

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Keywords: Neurofeedback, stroke, tractography DTI

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O10-3: Associations of diffusion-tensor fractional anisotropy and motor outcome assessments after cerebral infarction in rehabilitation Top


Yuichi Shinoda1, Sumire Ishiyama2, Masanori Maruyama3

1Department of Rehabilitation Medicine, Ibaraki Rehabilitation Hospital, Ibaraki, Japan, 2Doctoral Program in Clinical Sciences, Graduate school of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan, 3Department of Physical Therapist, Ibaraki Rehabilitation Hospital, Ibaraki, Japan

Background and Aims: This study aimed to clarify the associations between fiber tract degeneration evaluated by diffusion-tensor imaging (DTI) and the motor disability outcomes following cerebral infarction during admission of rehabilitation hospital. Methods: In total, data of 7 patients after admission in rehabilitation hospital were assessed. Fractional anisotropy (FA) maps were generated from diffusion tensor brain images obtained, and tract-based spatial statistics (TBSS) analysis was applied. Regions of interest were set within the right and left corticospinal tracts, and mean FA values were extracted from individual TBSS data. Hemiparesis motor outcome was evaluated according to Brunnstrom stage (BRS: 1-6, severe-normal) for separate shoulder/elbow/forearm, hand, and lower extremity functions after onset. Ratios between FA values in the affected and unaffected hemispheres (rFA) were assessed by BRS on admission and discharge. [Results]Analysis revealed significant relationships between rFA of BRS with upper extremity during hospitalization, lower extremity on admission, and finger on admission (R^2=0.65/0.64, 0.70, 0.61; P <0.05). Conclusions: Fiber tract degeneration affected motor-related outcomes. These findings imply that, by using DTI, outcomes of patients after cerebral infarction may be predictable by assessing fiber tract degeneration in the corticospinal tract (CST), as previous reports. Something different results compared to previous reports should be done by further study.

Keywords: Brunnstrom stage, diffusion-tensor imaging, fiber tract degeneration

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O10-4: Associations of diffusion-tensor fractional anisotropy and outcome assessments after cerebral infarction Top


Tetsuo Koyama1,2, Yuki Uchiyama2, Kazuhisa Domen2

1Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan, 2Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan

Background and Aims: The aim of study was to clarify the associations between fiber tract degeneration evaluated by diffusion-tensor imaging (DTI) and outcomes following cerebral infarction. Methods: Data of 40 cases were assessed. DTI acquisition was performed on day 14-21 and fractional anisotropy (FA) maps were generated, then tract-based spatial statistics (TBSS) was used for the analysis. Mean FA values within the corticospinal tract (CST), the superior longitudinal fasciculus (SLF), the inferior longitudinal fasciculus (ILF), and the uncinate fasciculus (UF) were extracted (see attached image) from individual TBSS data. By using multivariate regression analysis (forward stepwise method, P < 0.1), ratios of FA between lesioned and non-lesioned hemispheres were modeled to fit outcomes assessed by Brunnstrom stage (BRS) shoulder/elbow/forearm, hand/finger, and lower extremity functions and Functional Independence Measure (FIM) motor and cognition scores. The data analytical procedures were similar to those in our previous study.[1] Results: Multivariate regression analyses only took the CST data into the final models for BRS shoulder/elbow/forearm, hand/finger. and lower extremity outcomes (adjusted R2 = 0.427, 0.380, and 0.303, respectively). The UF data were taken for the final model for the FIM-motor outcomes (adjusted R2 = 0.181). Whereas, the SLF and the UF and the CST data were taken into the final model for the FIM-cognition outcomes (adjusted R2 = 0.305). Conclusions: These findings imply that outcomes of patients after cerebral infarction may be predictable by DTI-FA in the CST, the UN and the SLF.
Figure 1: Diffusion-tensor fractional anisotropy brain images were acquired 14–21 days after cerebral infarctio. The obtained fractional anisotropy brain images were transformed into the standard brain by using tract-based spatial statistics. Mean fractional anisotropy values within the corticospinal tract, the superior longitudinal fasciculus, the inferior longitudinal fasciclus, and the uncinate fasciculus were extracted from individual tract-based spatial statistics data

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Keywords: Outcome, recovery, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.

Reference

  1. Koyama, et al. J Stroke Cerebrovasc Dis 2018;27:2869-76.



  No. O10-5: Effects of protein supplementation on aerobic training induced gains in cardiopulmonary fitness, muscle mass, and functional performance in chronic stroke: A randomized controlled pilot study Top


Chih-Yang Hsu1, Yu-Hsuan Cheng1, Li Wei2,3, Heng Wang3, Shih-Wei Huang4,5, Wing P. Chan6, Yen-Nung Lin1,3

1Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan, 2Department of Surgery, Division of Neurosurgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, 3Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan, 4Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, 5Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, 6Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

Background and Aims: The beneficial effects of protein supplementation on aerobic exercise-induced gains in patients with stroke are currently unknown. This study evaluated the feasibility and potential value protein supplementation with aerobic exercise among stroke survivors. Methods: This double-blinded randomized controlled pilot study included 20 ambulatory persons with chronic (>6 months) stroke randomly assigned to either the protein (PRO) or carbohydrate (CHO) group. All participants received three 40-min cycling ergometric training sessions a week for 8 weeks. Training intensity at 60%~80% heart rate reserve was determined using cardiopulmonary exercise pretests. Immediately before and after each session, the PRO group received a 20-g protein-dominant supplement, and the CHO group received a 20-g calorie-matched carbohydrate-dominant supplement. Outcomes included changes in body composition, cardiopulmonary capacity, and clinical functional performance. Results: Those completing the protocol (n=18) received 18~24 cycling training sessions, achieving target training intensity without major adverse effects. Of the two groups, the PRO group tended to obtain greater aerobic capacity (effect size [ES]>0.5 in every cardiopulmonary index), greater improvements in functional performance (0.25<ES<1.00 in various clinical tests), and greater total lean mass versus total fat mass (ES=0.52). Conclusions: Protein supplementation with aerobic exercise training tends to improve body composition, cardiopulmonary fitness, and function among persons with stroke. This study protocol is feasible, and future trials with larger sample sizes could confirm these results.

Keywords: Aerobic exercise, protein supplementation, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O10-6: Late recovery from motor impairment following stroke Top


Nachum Soroker1, Shay Ofir1, Justine Lowenthal-Raz1, Shirley Handelzalts1, Gil Friedberg1, Silvi Frenkel-Toledo1,2

1Department of Neurological Rehabilitation, Sackler Faculty of Medicine, Loewenstein Rehabilitation Hospital, Tel Aviv University, Tel Aviv, Israel, 2Department of Physiotherapy, School of Health Sciences, Ariel University, Ariel, Israel

Background and Aims: Influential papers in recent years assert that recovery from impairment in the hemiparetic upper limb (HUL), as measured by tests insensitive to learned compensatory strategies, e.g. - the Fugl-Meyer (FM) test, is not influenced significantly by the currently available rehabilitation practices and stems almost entirely from endogenous neural processes triggered by brain ischemia, which are locked in time to the early post-stroke period. Here we examined the likelihood of delayed further HUL recovery from impairment, by comparing patients' FM test results near the end of the rehabilitation period with their FM results months and years later, looking at the impact of lesion configuration on the FM delta. Methods: Residual motor function of the HUL was examined in a group of 40 chronic (more than 6 months after onset) first-event stroke patients (20 with left- and 20 with right-hemisphere-damage; LHD, RHD), using the FM and Box and Blocks tests. Test results at this point were compared to the patients' test results near the end of the rehabilitation period in our hospital, at the subacute phase of the disease. Normalized lesion data were used for voxel-based lesion symptom mapping (VLSM) analyses of lesion impact on the delta between the two examinations. Results: An average delayed FM delta of around 8 points was gained in the time that elapsed between the first and second FM tests (on average from 1.8 months to 44 months after stroke onset). The impact of lesion configuration on the delayed FM delta was different in RHD and LHD patients. Conclusions: Motor recovery may extend beyond the early subacute period even in the impairment level. Differences in the impact of lesion configuration on delayed FM delta in LHD and RHD patients point to variant adaptive re-mapping processes in the dominant and non-dominant hemispheres.

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

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O10-7: Relationships between mechanical energy consumption and motor paralysis in sit-to-stand motion of stroke patients Top


Hiroki Hanawa1, 2, 3, Keisuke Hirata1, Taku Miyazawa4, Keisuke Kubota1, Moeka Sonoo1,5, Tsutomu Fujino1,6, Takanori Kokubun7, Naohiko Kanemura7

1Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Japan, 2Research Fellowship for Young Scientists, Japan Society for the Promotion of Science, Tokyo, Japan2, 3Department of Rehabilitation, Higashi Saitama General Hospital, Satte, Japan, 4Hasuda Central Clinic, Hasuda, Japan, 5BSI-Toyota Collaboration Center, RIKEN Brain Research Institute, Wako, Japan, 6Department of Rehabilitation, Faculty of Health Science, University of Human Arts and Sciences, Saitama, Japan, 7Department of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan

Background and Aims: The aim of this study is to clarify whether stroke patients who experienced long-term rehabilitation perform efficient motion. Chronic stroke patients have smaller peak joint moment during the sit-to-stand motion than that of healthy adults [Figure 2]. However, because these patients perform the motion slowly, we hypothesized that the joint moment impulses and the energy consumption are preserved as in healthy adults. Methods: Ten stroke patients (five years being the mean time since stroke) and eight healthy adults performed the sit-to-stand motion. We used a camera motion capture system to calculate the four parameters, as shown in the results. We performed the statistical comparison between the groups and verified the correlation between each parameter and the Fugl-Meyer Assessment Lower Extremity (FMA-LE) score. Details are described in [Figure 1]. Results: In stroke patients, (1) the peak joint moment was smaller (p < 0.001), but (2) the total duration of the motion was longer than that of healthy adults (p < 0.001). Therefore, (3) the joint moment impulse during the motion was similar between two groups (p = 0.15). However, (4) the joint moment work was smaller for stroke patients than healthy adults (p < 0.001) [Figure 3]. Parameters (1) and (4) were significantly correlated with the FMA-LE (r = 0.61 and 0.56, respectively, and both were p < 0.001). Conclusions: The more severe the motor paralysis, the smaller was the peak joint moment. However, stroke patients kept this cumulative value (i.e., joint moment impulse) the same as that in healthy adults. Contrary to our hypothesis, the more severe the motor paralysis, the smaller was the consumption of mechanical energy (i.e., joint moment work). Chronic stroke patients performed more efficient motion, thereby adapting to motor paralysis. This finding contributes to rehabilitation sought by stroke patients for efficient sit-to-stand motion.

Figure 2: Joint Moment Comparison of Healthy vs. Stroke Subjects

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Figure 3: Peak Joint Moment and Joint Moment Work

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Keywords: Mechanical energy, motor paralysis, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O10-8: Leukoaraiosis, an Invisible factor contributes to balance and gait disorders after stroke Top


Shenhao Dai1,2, Celine Piscicelli1,2, Emmanuelle Clarac1, Patrice Davoine1, Anne Chrispin1, Marie Jaeger1, Olivier Detante3,4, Andrea Kistner1, Monica Baciu1,2, Marc Hommel3,5, Dominic Perennou1,2

1Neurorehab Unit, Institute of Rehabilitation, University Hospital, Grenoble-Alpes, 38434 Echirolles, France, 2Lab Psychology and Cognition Grenoble-Alpes University, Grenoble, France, 3Department of Neurology, Stroke Unit, University Hospital, Grenoble-Alpes, Grenoble, France, 4Grenoble Institute of Neurosciences, Grenoble-Alpes University, Grenoble, France, 5AGEIS EA 7407, Grenoble-Alpes University, Grenoble, France

Background and Aims: Leukoaraiosis is associated with balance and gait disorders in elderly persons, but its effect on these disorders after stroke remains to be clarified. Our purpose is to investigate whether leukoaraiosis affects balance and gait capacities after stroke. Methods: Cohort study of consecutive participants admitted to neurorehabilitation ward after first hemisphere stroke from 2012 to 2018. Leukoaraiosis was diagnosed on MRI performed within 3 first months after stroke, using Fazekas scale. Individuals were classified into 2 groups (G1: absent or mild vs G2: moderate or severe leukoaraiosis). Clinical data systematically collected at day 30 (D30) post-stroke and at discharge were retrospectively analyzed. Balance disorders were assessed with the Postural Assessment Scale for Stroke (PASS), gait disorders with the modified Fugl-Meyer Gait Assessment, lateropulsion with the Scale for Contraversive Pushing (SCP) and independence with the Functional Independence Measure (FIM). Kaplan-Meyer survival curves were applied to analyze the recovery between two groups. Results: 184 persons met inclusion criteria: age 63.5(12.5) years, 63 females, 157 with infarction. A total of 143 (78%) persons presented leukoaraiosis with distribution:Grade 0: 41[22%]; 1:75[41%]; 2:55[30%]; and Grade 3:13[7%]. Moderate to severe leukoaraiosis (G2) was present in 68 (37%). Among initial assessments (D30), G2 had greater balance disorders (31[18-34] vs 33[26.5-36], p=0.003), gait disorders (3[0-6] vs 5[3-6], p=0.009), but not greater lateropulsion; their independence in daily life was lower (80[48.5-107] vs 100[65-116.5], p=0.004). Length of stay was much longer in G2 (91[53-158] vs 69[48-117], p=0.026). And also they showed worse recovery both in balance (p=0.002) and gait (p=0.005) disorders, 42% and 39% respectively in G2 couldn't regain monopodal stance and independent ambulation at discharge. Conclusions: Leukoaraiosis is a cause of balance and gait disorders after stroke, and also a source of dependence. Stroke consequences might be limited by early detecting and treating risk factors of leukoaraiosis.
Figure 1: Balance recovery

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Figure 2: Gait recovery

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Keywords: Balance, gait, leukoaraiosis

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O10-9: Relationship among unaffected-side items in stroke impairment assessment set in comprehensive inpatient rehabilitation Top


Kei Yagihashi1, 2, 3, Sonoda Shigeru1,2, Makoto Watanabe1,2, Sayaka Okamoto1,2, Yuko Okuyama1,2, Hideto Okazaki1,2, Kazuyo Oguchi3

1Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Toyoake, Japan, 2Division of Rehabilitation, Nanakuri Memorial Hospital, Fujita Health University, Toyoake, Japan, 3Department of Rehabilitation Medicine, Kariya Toyota General Hospital, Kariya, Japan

Background and Aims: Unaffected side and trunk functions are important in stroke rehabilitation. We tried to assess relationship among unaffected side and trunk function items in Stroke Impairment Assessment Set (SIAS). Methods: Subjects were 4001 first stroke patients who admitted to our comprehensive inpatient rehabilitation wards between 2004 and 2016. Patients who had severe comorbidity, complications, or falling accident, or showed deterioration of FIM motor subscore were excluded and 3279 patients were analyzed. We picked up the score of 4 items of the SIAS on admission, those were unaffected quadriceps and unaffected grip power as an unaffected side function, and verticality and abdominal as a trunk function. Score is rated 0 (worst), 1, 2, and 3 (best) in all 4 items. Cross tables were made each other and characteristics of the items were considered with frequent combinations of the scores. Results: Four cross tables (quadriceps-verticality, quadriceps-abdominal, quadriceps-grip, and grip-abdominal) showed diagonal pattern that pair of the same or 1 point different score were most frequent. In other words, large number of patients concentrated on score 0 versus score 0, score 1 versus score 1, score 2 versus score 2, or score 3 versus score 3. On the other hand, in the cross tables of abdominal-verticality and grip-verticality, the mode score of verticality jumped from 0 to 3 when the abdominal or grip score changes from 0 to 1. Conclusions: Since all of 4 items that were compared in this study is under the influence of immobility, diagonal pattern of cross table would be predominant according to degree of disuse state. Different pattern shown in the cross tables of abdominal-verticality might be explained by the hypothesis that minimal power of abdominal muscle is a prerequisite for verticality function. We must be cautious to the different characteristics of impairments during rehabilitation.

Keywords: Stroke, stroke impairment assessment set

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O11-1: Biomechanical properties of “volitional step” and “compensatory step” movements in people with stroke Top


Itshak Melzer1, Shirley Handelzalts1,2, Flavia Steinberg-Henn1,2, Michal Kanner-Furman1,2, Ganit Gray1,2, Nachum Soroker2,3, Guy Shani1

1Department of Physical Therapy, Ben-Gurion University of the Negev, Beersheba, Israel, 2Loewenstein Rehabilitation Hospital, Ra'anana, Israel, 3Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

Background: Falls occur in about 70% of persons with stroke (PwS) during the first 6-months after discharge from hospital. PwS who fall are twice as likely to sustain a hip fracture, usually involving the paretic side. Step movements are critical for fall prevention; they present a challenge for PwS. First, during gait initiation were leg movement expose PwS to a self-induced perturbation of posture. Second, during unexpected loss of balance, the compensatory-step are often required to prevent from falling. Aim: To compare biomechanical properties of “volitional-step” vs. “compensatory-step” in PwS. Methods: Twenty-five PwS were exposed to a forward, backward, and lateral unannounced perturbation while standing. Sixteen PwS performed forward, backward and lateral voluntary step. Step initiation time, swing time, and step time, parameters were extracted from 3D-motion analysis and force plate systems [Figure 1] and [Figure 2]. Results: Voluntary-step initiation time, swing time, and step time were 1020ms, 550ms and 1575ms, respectively, for the paretic leg and 846ms, 377ms and 1386ms, respectively, for the non-paretic leg [Table 1]. The compensatory-step initiation time, swing time and step time were 258ms, 372ms and 631ms for the paretic leg, and 316ms, 319ms and 635ms for the non-paretic leg. Conclusions: The compensatory-step of the paretic leg was faster vs. volitional-step resulted from faster step initiation duration [Table 1]. This suggests that central processing time before initiating volitional-step and luck of postural adjustments prior compensatory step resulted a faster initiation of compensatory step. The voluntary-step is attention-demanding task, while the compensatory-step movements are automatic. The swing time during compensatory-step of the paretic leg was 33% faster vs. the voluntary-step [Table 1], which may suggest that during a real treat for balance exist, PwS are able to recruit motor units and swing the paretic leg very rapidly. This highlights the importance of adding perturbation exercises as part of treatment.
Figure 1: Kinematic analysis descriptions

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Figure 2: Example of forward step execution data for a stroke survivor with the involved leg (a) and uninvolved leg (b) sides

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Table 1: Temporal effects of voluntary and compensatory stepping in people with stroke

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Keywords: Falls, people with stroke, stepping movements

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O11-2: Closed-loop rehabilitation model: An instance of the feasibility and effectiveness of camera-based mirror visual feedback for stroke patients Top


Li Ding1, Jinyang Zhuang1, Shugeng Chen1, Hewei Wang1, Zhijie He1, Jie Jia1,2

1Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China, 26National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China

Background and Aims: Based on the principle of priming, we proposed a closed-loop rehabilitation model which emphasized on optimal procedures of non-invasive brain modulation approaches, including motor imagery (MI), mirror therapy (MT), and transcranial magnetic stimulation (TMS). In this study, we aimed to explore the feasibility and effectiveness of a customized camera-based mirror visual feedback (camMVF) apparatus for stroke patients with this model. Methods: Eighty stroke patients were randomly assigned to camMVF group [MG, [Figure 1]] or conventional group (CG), each of 40. In the MG, patients received 1 h MT (including simple and task-based motor training) using camMVF prior to 30-minute task-based training on hand function. Patients in the CG received 1.5-hour dosage-equivalent (intensity and duration) rehabilitation therapies as the MG. Both interventions were daily provided, 5 days per week and lasting for 4 weeks. Clinical assessments were provided before and after the interventions. Results: Five patients did not complete the study (3 in MG and 2 in CG), so there were totally 75 subjects analysed in the end. After 4-week interventions, higher scores of the Fugl-Meyer Assessment Upper Limb (FMA_UL, pre: MG, 26.05(17.48), CG, 21.29(15.60); post: MG, 33.73(17.11), CG, 26.00(16.00)) and the modified Barthel Index (MBI, pre: MG, 66.41(21.59), CG, 60.11(22.47); post: MG, 84.68(14.84), CG, 71.13(20.85)) were investigated in the MG comparing with the CG. Conclusions: Our results demonstrated the possibility and effectiveness of applying MT with systematic procedure for stroke patients in clinics. Furthermore, the present study provides tentative evidence that the closed-loop rehabilitation model can be used as an optimal principle for the application of non-invasive brain stimulation approaches in practice.
Figure 1: Camera-based mirror visual feedback

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Keywords: Closed-loop rehabilitation, mirror therapy, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O11-3: Altered resting-state effective connectivity of the primary motor cortex in chronic stroke patients after motor imagery training Top


Hewei Wang1, Hao Yang2, Mingxia Fan2, Limin Sun1, Jie Jia1

1Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China, 2Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, People's Republic of China

Background and Aims: Motor imagery training (MIT) is an attractive noninvasive treatment technique in neurorehabilitation that involves mentally rehearsing of actions without overt body movement. However, the neural basis of MIT is still not very clear. The purpose of this study was to investigate the changes of the effective connectivity (EC) after MIT and to define the possible roles of the motor-imagery-related brain areas in MIT. Methods: A total of 28 subcortical chronic stroke patients with unilateral hemiplegic upper limb were selected and randomly divided into either the MIT group or the conventional rehabilitation therapy (CRT) group. In addition, 28 matched healthy volunteers were recruited. All stroke patients received 4 weeks of intervention and were assessed by upper limb section of Fugl-Meyer Scale (FM-UL). A voxel-wise Granger causality analysis on the resting-state fMRI data between the ipsilesional M1 and whole brain was performed to explore the changes of EC and its relationship to motor recovery. Results: Our results showed that the EC between the ipsilesional M1 and frontoparietal network, sensorimotor cortex as well as cerebellum was diminished in all stroke patients compared with healthy controls. The EC from contralesional middle temporal gyrus to ipsilesional M1 was decreased and EC from ipsilesional M1 to contralesional cerebellum was increased significantly after the treatment in the MIT group. No significant change of EC was found in CRT group. Moreover, the pre-intervention EC from ipsilesional M1 to contralesional cerebellum and visual cortex to ipsilesional M1 were significantly positively correlated with improvement of FM-UL scores in all stroke patients(p<0.05). Conclusions: This study has found abnormal causal flow of ipsilesional M1 in stroke patients and the changes of EC suggests that neural mechanism of MIT might be related to the plasticity of cerebellum and visual cortex which are important nodes in motor-imagery-related brain areas.

Keywords: Chronic stroke, motor imagery, resting-state effective connectivity

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O11-4: Assessment of motor imagery ability in stroke patients through mental rotation test with different types of visual stimulation Top


Hewei Wang1, Yunlong Wang2, Jianhui Wang2, Jie Jia1

1Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China, 2Department of Rehabilitation, Nanshi Hospital of Nanyang, Henan University, Kaifeng, China

Background and Aims: There is little consensus on how well stroke patients can perform motor imagery(MI) and how MI ability should be measured. Previous studies suggest that good MI ability is one of the key elements to ensure the effectiveness of MI training in stroke patients. The aim of this study was to measure the MI ability through mental rotation test(MRT) and to investigate the relationship between the performance level of MRT and the residual motor and cognitive function in stroke patients. Methods: A total of 15 patients with first-ever subcortical stroke between 3 months to 12 months following stroke onset and 15 age-matched healthy individuals were recruited. All subjects were right-handed and had adequate visual ability to recognize the pictures on the screen. The MRT(programmed by E-prime) with four types of visual stimulation (palm, the back of hand, Latin alphabet and Chinese characters) rotated to different degrees were used to assess to implicit MI ability in all subjects. Reaction time(RT) and accuracy of each tasks were recorded, and all stroke patients received additional cognitive and motor assessment with MoCA and Fugl-meyer Scale. Results: The RT (hand rotation tasks) gradually increased from 0 to 180 degrees in all subjects and the mean RT(all four tasks) in stroke patients was longer than healthy control (p<0.05). No significant differences of accuracy existed between two groups in each task. The mean RT of hand rotation tasks were negatively correlated with the visual-spatial scores in MoCA (p<0.05). No significant correlation was found between Fugl-meyer scores and MRT performance. Conclusions: The study suggests that the implicit MI ability is retained in subcortical stroke patients and two main strategies are used for different types of visual stimulation. The individuals' MI ability should be considered carefully for MI training in clinical decision making.

Keywords: Chronic stroke, mental rotation test, motor imagery ability

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O11-5: Psychometric properties of the reachable workspace evaluated with a kinect sensor in patients with hemiparetic stroke Top


Kohei Okuyama1, Michiyuki Kawakami1, Shohei Tsuchimoto2, Miho Ogura1, Kohsuke Okada1, Katsuhiro Mizuno1, Junichi Ushiba3,4, Meigen Liu1

1Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan, 2School of Fundamental Science and Technology, Graduate School of Keio University, Kanagawa, Japan, 3Department of Biosciences and Informatics, Faculty of Science and Technology, Keio University, Kanagawa, Japan, 4Keio Institute of Pure and Applied Sciences, Kanagawa, Japan

Background: Quantitative evaluation of upper extremity (UE) motor function is important in patients with hemiparetic stroke. Recently, Kinect sensor is sometimes used to measure kinematics data in clinical settings because of its high utility. We applied Kinect-based evaluation to quantify and visualize the reachable workspace (RWS) of the paretic UE. Objective: To verify psychometric properties of the RWS evaluated with a Kinect sensor in patients with hemiparetic stroke. Methods: The participants were 58 patients with chronic hemiparetic stroke. Kinematics data were measured with a Kinect for Windows V2 sensor (Microsoft, Redmond) during eight motor tasks for each UE. The RWSs of the paretic UE and non-paretic UE were calculated from spatial coordinate data of the wrist. The RWS ratio was calculated by dividing the RWS of the paretic UE by the RWS of the non-paretic UE. UE motor function was assessed with the Fugl-Meyer assessment UE motor score (FMA-UE). To examine the concurrent validity, correlation between FMA-UE score and the RWS ratio was examined. In 40 patients, test-retest reliability was tested with intraclass correlation coefficients (ICC) and Bland-Altman analysis. Moreover, in 32 patients, responsiveness was examined with standardized response mean (SRM) from the RWS ratio before and after a 3-week intensive training of the paretic UE. Results: The RWS ratio was highly correlated with FMA-UE (r = 0.81, p < 0.01). The RWS ratio showed excellent test-retest reliability (ICC: 0.94). There were no fixed bias and proportional bias. The value of minimal detectable change of the RWS ratio was 16.89%. The RWS ratio was significantly increased after a 3-week intensive training (p < 0.01). Its responsiveness was high (SRM: 0.83). Conclusions: The Kinect-based RWS evaluation was useful for quantifying and visualizing UE extremity motor function in patients with stroke.

Keywords: Hemiplegia, kinematics, technology

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O11-6: Comorbidity and intercurrent diseases in geriatric stroke rehabilitation: A multicentre observational study in skilled nursing facilities Top


Bianca Buijck1, Anouk D. Kabboord2, Monica Van Eijk2, Romke Van Balen2, Wilco P. Achterberg2, Raymond T. K. Oopmans3

1Department of Neurology and Rehabiliation, Rotterdam Stroke Service, ErasmusMc University Medical Centre, Rotterdam, Netherlands, 2Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands, 3Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University, Nijmegen, Netherlands

Background and Aims: Older patients often have multiple comorbidities and are susceptible to develop intercurrent diseases during rehabilitation. This study investigates intercurrent diseases and associated factors in patients undergoing geriatric stroke rehabilitation, focussing on pre-existing comorbid conditions, overall comorbidity and baseline functional status. Methods: This multicentre prospective cohort study included 15 skilled nursing facilities. Data were collected at baseline and at discharge. The primary outcome measures were presence and number of intercurrent diseases. Furthermore, their impact on change in rehabilitation goals or length of stay was examined. Comorbidity was assessed with the Charlson index, and functional status with the Barthel index (BI). Results: Of the 175 included patients, 51% developed an intercurrent disease. A lower baseline BI, a higher Charlson index, presence of diabetes mellitus (DM) and kidney disease were related to the occurrence of an intercurrent disease (p < 0.05). Moreover, a lower BI, a higher Charlson index, and particularly the presence of DM were independently associated. If both comorbidity and a lower baseline functional status were present, the odds ratio (95% CI) of developing intercurrent diseases was 6.70 [2.33–19.2], compared to 1.73 [0.52–5.72] (comorbidity only) and 1.62 [0.53–4.94] (only BI ≤ 14). Conclusions: On admission, functional impairments and comorbidity, particularly diabetes, independently contribute to developing intercurrent diseases during geriatric stroke rehabilitation. Therefore, routine evaluation of comorbidity integrated with functional status at the start of rehabilitation is essential to identify patients at risk. Finally, particular attention should be paid to patients with DM to prevent intercurrent diseases and support optimal functional recovery.

Keywords: Comorbidity, rehabilitation, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O11-7: Rasch analysis for the requirements of national agency for automotive safety and victims aid scoring system Top


Izumi Kondo1, Eiko Takano1,2, Chiho Honda3, Jun Shinoda4, Yoshihide Nagamine5, Aiko Osawa1

1National Center for Geriatrics and Gerontology, Obu, Japan, 2Institute of Aging, Toulouse University Hospital, Toulouse, France, 3Medical Centers for Prolonged Traumatic Brain Dysfunction, Kibi Hospital, Japan, 4Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Japan, 5Tohoku Medical Centers for Prolonged Traumatic Brain Dysfunction Ryogo Center, Kohnan Hospital, Miyagi, Japan

Background and Aims: The National Agency for Automotive Safety and Victims Aid (NASVA) score was developed by Medical Centers for Prolonged Traumatic Brain Dysfunction for patients with persistent vegetative state (PVS). This scoring system have been used mainly as the outcome measure to know the effectiveness of care and rehabilitation performed in medical centers. The NASVA score system is consisted of six domains (1. Motor response, 2. ingestion, 3. Fecal/urinary function, 4. Visual recognition, 5. Vocalization/ utterance, 6. Response to call /oral commands) and each domain has five grade items. The purpose of this study was to know the difficulty of each item with using the Rasch analysis. Methods: Participants were 146 patients (104 men, 42 women) who were diagnosed with PVS due to a traffic accident. The mean age of the participants at admission was 37.3 years (SD: 19.9). They had hospitalized at three Medical Centers for Prolonged Traumatic Brain Dysfunction between June 2012 to June 2014. Rasch analysis was used to produce the scaled score, the item measure of 48 sub-items, an information-weighted mean square fir statistics (infit) and an outlier-sensitive mean square fit mean square fit statistics (Outfit) of the sub-items. Results: The easiest subitem was “reflex to pain or aimless spontaneous movement” in the domain of motor response and most difficult item was “appropriate words” in the domain of vocalization/ utterance. From the results of fit analysis, 9 subitems were judged a misfit ant it is revealed that the description of them allowed the several judgments. Conclusions: Although the consideration for the item description is necessary to eliminate the misfit, it is suggested that efficient rehabilitation would be possible setting appropriate goal with application of difficulty map and each patient scaled score in the clinical setting where NASVA score is used.

Keywords: Assessment, prolonged vegetable state, rehabilitation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O11-8: Can lipid profile be associated with outcome after traumatic brain injury? Top


Sharon Shaklai1,2, Noa Eliaz-Friling3, Yaron Sacher2,4, Aviva Zeev5, Sigal Eilat-Adar5

1Department of Pediatric Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel, 2Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel, 3Beit Halochem, Beer- Sheva, Israel, 4Department of Traumatic Brain Injury Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel, 5The Academic College at Wingate, Wingate Institute, Netanya, Israel

Background and Aims: Traumatic brain injury (TBI) is a leading cause of death and disability among children and young adults. Better understanding of factors influencing recovery and outcome after TBI will enable caregivers to improve rehabilitation procedures. The brain is highly enriched in lipids, supporting structural, biochemical and cell signaling functions. Tte association between cholesterol levels and coronary heart disease is well proven. However, the association between cholesterol and outcome following stroke, is inconclusive, as well as its association with TBI outcome. The aim of the current study is to assess whether cholesterol levels in patients with TBI during sub-acute rehabilitation are associated with functional outcome. Methods: A prospective historical study of 137 adults and children (8 years old and above), with sub-acute TBI, undergoing rehabilitation between 1999 and 2017. Independent variables and universal confounders were collected from patients' files. The functional outcome was assessed using functional independence measurment( FIM) scale. Results: Using spearman correlation, in adults only, higher total cholesterol levels and LDL cholesterol at admission were associated with a better function at discharge, as expressed in the FIM scale (r=0.19, p=0.06), (r=0.21, p=0.04) respectively. No difference was observed between genders, neither with FIM change between admission and discharge. The change in total cholesterol between admission and discharge was greater in children versus adults. Cholesterol levels at admission in adults: 188+/-48mg% vs. 189+/-51 mg% in children(p=0.83). At discharge: 185+/-43 vs. 158+/-31(p<0.06). For LDL Cholesterol at admission in adults: 124+/-37 vs. children 125+/-36 (p=0.64), at discaharge: 108+/-31 vs. 91+/-20, respectively(p=0.03). Conclusions: In adults but not in children, higher cholesterol levels and LDL cholesterol at admission were associated with better function at discharge. High levels of plasma cholesterol in the sub-acute stage may reflect extensive repair of the central nervous system, or may allow for more efficient process.

Keywords: Cholesterol, functional outcome, traumatic brain injury

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O11-9: Brain injury rehabilitation experience in a territory care rehabilitation hospital in Saudi Arabia Top


Sami Ullah, Ahmad Z. Qureshi, Imad S. Moukais, Adel A. Al-Dajani

Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia

Background and Aims: Severe traumatic brain injury (TBI) is often associated with polytrauma, fractures, spinal cord injuries, peripheral nerve injuries, and limb amputations. Motor vehicle accident was the main mechanism of traumatic brain injury(TBI) in Saudi Arabia. This study was conducted to assess traumatic brain injury patient's characteristic, initial GCS, coma duration and complications and their impact on functional outcome and length of stay during inpatient rehabilitation in a territory care rehabilitation hospital. Methods: A retrospective study using medical charts (electronic and paper). Results: We identified 138 patients.Mean age was around 27 years with 92% males. TBI was caused by MVA in 95% of patients. The initial GCS post-trauma was 6 on average while the average duration of coma was 47 days. The time interval between onset of injury to inpatient rehabilitation (IPR) was 263 days while the average length of inpatient stay was 75 days. Average FIM gain during IPR was 32 with FIM of 54 and 86 at admission and discharge respectively. Almost all patients had multiple areas of the brain affected. Two-thirds of patients had fractures of bones other than the skull, and one third was diagnosed with seizure disorder post-TBI. Patients with higher age have less FIM at discharge (P<0.004). Patients who were employed before the injury have high FIM at discharge (P<0.003). patients with increase coma duration after injury has lower FIM at discharge ((P<0.001). Patients with increase time interval between onset of injury to inpatient rehabilitation (IPR) has lower FIM at discharge ((P<0.003) and lower FIM gain(P<0.003). Conclusion: Serious measures for prevention of MVA need to be ascertained in the country as it remains the major cause of TBI. This renders the need for optimizing earlier rehabilitation intervention in acute care, increasing the awareness among healthcare professionals and empowering the resources for comprehensive rehabilitation in trauma centers.

Keywords: Brain injury, outcomes, rehabilitation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O12-1: Comparison of the effectiveness of virtual reality and a home-based program following surgery for flexor tendon injuries of the hand Top


Dilsad Sindel, Gulsah Gula, Aydan Oral, Sina Esmaeilzadeh, Safiye Ozkan, Atakan Aydin

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

Background and Aims: Rehabilitation after flexor tendon repair is significantly associated with functioning outcomes. A variety of rehabilitation interventions is possible. The aim of this study was to investigate the effects of virtual reality (VR) in the rehabilitation of patients with flexor tendon repair. Methods: In this prospective, randomized controlled 3-week interventional trial 38 patients with flexor tendon repair were assigned to intervention group (IG, n=19) or control group (CG, n=19). The patients in IG received a supervised VR therapy in addition to a home-based program which the CG received, from postoperative 8th week for 3 weeks, 3 sessions per week. Hand function was measured using the ICF Core Set for Hand Conditions and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire as primary outcomes. Secondary outcomes were total active motion (TAM), evaluation by TAM method, active wrist ROM, grip and pinch strength, Box and Block Test (BBT) and Visual Analog Scale (VAS, for manual dexterity) scores and return-to-work. Results: The TAM (p<0.001), active wrist extension (p<0.05), and tip-to-tip pinch strength (p<0.001) increased significantly in the IG when compared to the CG (at both postoperative 11- and 16-week). Significant improvements were found in the DASH scores (p=0.038) and grip strength (p=0.017) at 11-week; however, there was no significant difference at 16-week following repair (p=0.058). Although active wrist flexion, BBT, and VAS scores increased significantly in IG, no significant difference was found between the two groups. Return-to-work was shorter in the IG; however, this difference wasn't statistically significant. Additionally, similar improvements were found in the ICF categories between groups. Outcomes evaluated by TAM method were excellent/good in 81.3% of the IG, while in 61.9% of the CG. Conclusions: Our data support the positive effects of VR therapy when added to a home program in hand rehabilitation after flexor tendon repair.

Keywords: Flexor tendon repair, hand rehabilitation, virtual reality

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O12-3: The effect of virtual reality rehabilitation system with wearable inertial measurement unit sensors on upper limb functions in children with brain injury Top


Ja Young Choi1,2, Sook-Hee Yi3, Lijuan Ao4, Xin Tang4, Xuan Xu4, Dain Shim5, Beomki Yoo5, Dong-Wook Rha5

1Department of Physical and Rehabilitation Medicine, Eulji University College of Medicine, Seoul, Republic of Korea, 2Department of Physical and Rehabilitation Medicine, Eulji University College of Medicine, Daejeon, Korea, 3Seoul Rehabilitation Hospital, Seoul, Republic of Korea, 4School of rehabilitation, Kunming Medical University, Kunming, China, 5Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

Background and Aims: This study investigated the effect of virtual reality rehabilitation system with wearable multi-inertial measurement unit (IMU) sensors on upper limb functions in children with brain injury. Methods: A single blind randomized controlled trial was conducted at 4 rehabilitation institutions. Eighty children (mean age 5.9 years) with cerebral palsy or static brain injury were included. The experimental group (n=40) received 30min of conventional occupational therapy (OT) and 30min of therapy using the virtual reality rehabilitation program with wearable IMU sensors, 5 days per week for 4 weeks. The control group (n=40) received conventional OT alone for 60min per day. Training program using the virtual reality rehabilitation system consisted of games promoting wrist and forearm articular movements. Melbourne Assessment of Unilateral Upper Limb Function, version 2 (MUUL-2), the Upper Limb Physician's Rating Scale (ULPRS), the Pediatric Evaluation of Disability Inventory-computer adaptive test (PEDI-CAT), and 3D motion analysis were performed at baseline, after intervention, and 8 weeks after intervention. Results: Seventy-eight subjects completed the intervention and no safety issues were reported. In the experimental group, upper limb dexterity functions measured by MUUL-2 were significantly improved after intervention compared with control group(p<0.05). Segmental movements measured by ULPRS and daily living capability of PEDI-CAT also showed significant improvements in experimental group(p<0.05). As for motion analysis, active forearm supination and wrist extension movements were significantly improved in experimental group (p<0.05). Conclusions: Virtual reality rehabilitation system with wearable IMU sensors is as effective as OT provided by therapist in the training of upper limb function in children with brain injury. In addition, virtual reality rehabilitation system remained superior for improving dexterity, performances in daily activities, and active forearm supination motion. This new therapeutic approach using virtual reality may effectively complement standard rehabilitation by providing motivation and therapeutic support for children with brain injury (Grant number: HI17C0391).
Figure 1: Study flow chart

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Table 2: Changes in clinical assessment at baseline, after intervention, amd at 8 weeks follow-up

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Table 3: Changes inmotion analysis at baseline, after intervention, and at 8 weeks follow-up

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Keywords: Children with brain injury, upper limb function, virtual reality rehabilitation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O12-4: Rehabilitation of the upper limb with adaptive serious games in sub acute stroke compared to conventional rehabilitation: A randomized controlled trial Top


Isabelle Laffont1,2, Jerome Froger1,3, Claire Jourdan2, Audrey Jaussent2, Liesjet Van Dokkum1,4, Emmanuelle Le Bars4, Arnaud Dupeyron1,3, Denis Mottet1

1Euromov IFRH, Montpellier University, Montpellier, France, 2Department of PRM, Montpellier University Hopital, Montpellier, France, 3Department PRM, Nimes University Hospital, Nîmes, France, 4Department of Neuroradiology, Montpellier University Hospital, Montpellier, France

Objective: To compare Upper Limb (UL) rehabilitation using video games (VG) to conventional rehabilitation (CR) in subacute stroke patients. Design: Randomized, controlled, single-blind, multicentric trial. Setting: PRM departments of two University Hospitals. Participants: Adults within 3 months after a first vascular cerebral accident with Upper Limb Fugl Meyer Score (UL-FMS) <30/66 and without major cognitive impairment. Intervention: Participants received either a 45 minutes additional session of conventional occupational therapy (OT) or a video game based OT session as add-on therapies to usual rehabilitation programs 5 days/week during 6 weeks. Main Outcome Measures: UL-FMS Box and Block Test (BBT) Wolf Motor Function test (WMFT) Motor Activity Log (MAL) Barthel Index (BI) and Quality of Life (SF-36). Results: We included 51 patients 27.2+/-19.4 days post-stroke (mean age 58 years [24-83] 20 women). The mean duration of the additional rehabilitation session was similar in both groups: 29.3+/-4.3 in CR vs 28.5+/-4.4 minutes in VG. Shoulder pain occurred in 4 patients in VG versus 7 in CR. At day 45 gain in UL-FMS was not significantly different between both groups (CR 17.8+/-14.6 versus VG 24.1+/-14.8; p=0.10) whereas gain in BBT was doubled in the VG group (CR 7.4+/-12.2 versus VG 15.7+/-16.3 p=0.02). At 6 months follow-up between groups differences in UL-FMS and BBT cancelled. No between groups differences were found on other criteria. Post-hoc analysis showed that gains in UL-FMS or in BBT were significantly higher in the VG group for patients included within 30 days post stroke. Conclusion: Video gaming and conventional occupational therapy lead to similar long-term sensorimotor recovery of the upper limb after subacute stroke. However when applied within the first month post-stroke video gaming could be more efficient than conventional rehabilitation on both sensorimotor recovery and gross grasping function.

Keywords: Stroke, upper limb, video games

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O12-5: Investigation of virtual reality based brain computer interface in chronic stroke patients: A feasibility study Top


Rongrong Lu1, Tianhao Gao1, Jie Li2, Gang Liu1, Songhua Huang1, Yi Wu1

1Deopartment of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai, China, 2Department of Computer Science and Technology, Tongji University, Shanghai, China

Background and Aims: Rehabilitation improves motor impairment after stroke. Patients could regain the control of their proximal extremity. But impairment of distal extremity often lasts and this remains as a difficult and important issue in rehabilitation. We designed this study to determine the feasibility of virtual reality based brain-computer-interface(BCI) in chronic stroke patients. Methods: Six chronic stroke patients were recruited in this study(disease duration:11m-36m). A 12-Channel High-Resolution EEG Systems following 10-20 international system was used to record the EEG signals which can be analyzed to evaluate participants' motor imaginary ability. Virtual reality based BCI system was used to train the stroke patients. Wrist active extending range of motion was compared before and after the whole training. Participants were asked to complete a questionnaire when they completed the whole therapy. Results: All the participants completed the whole sessions of the treatment. Three participants could extend paretic wrist after the treatment. All the participants were satisfied with the therapy and none of them complained severe adverse effects. Conclusions: Chronic stroke patients could tolerate virtual reality based brain computer interface treatment. Further randomized control study is needed to determine the effectiveness of this therapy and reveal the mechanisms behind the therapy. This paper was sponsored by Shanghai Sailing Program(16YF1415300).

Keywords: Neuromodulation, stroke, virtual reality

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O12-6: Feasibility of using eye tracking system to assess spatial neglect of stroke patients during upper limb exoskeleton training associated with virtual reality Top


Marcel Simis, Eduardo Maki, Joao P. Tavares, Linamara R. Battistella

Department of Physical Medicine and Rehabilitation, University of Sao Paulo, São Paulo, Brazil

Background and Aims: Cognitive deficit, including neglect, is a common sequel in stroke patients. There is no gold standard to assess spatial neglect being recommended a battery of evaluation to cover the different aspects of neglect (personal, peri-personal and extra-personal). Moreover, there is no standardized method to quantify the impact of cognitive impairment in the performance of the rehabilitation therapy. Eye tracking systems can map ocular movement during a specific task, which may help to identify spatial hemineglect in stroke patients. Therefore, the goal of this study is to demonstrate the feasibility of eye tracking system to assess spatial neglect, during exoskeleton training associated with virtual reality (Armeo Spring). Methods: It will be included 10 stroke patients and 10 healthy control participants. Both groups will make three days of Armeo Spring training associated with eye tracking. Besides they will be evaluated using conventional cognitive scales, including “Catherine Bergego Scale” and cancellation tasks. The information obtained from eye tracking will be processed to generate “heat maps” and the “scan path”. The quantitative index from these analyses will be used to compare groups. Moreover, correlation tests will be used to assess the association of eye tracking data with conventional scales for spatial neglect. Results: We expect to demonstrate that eye tracking can be used to assess spatial neglect in stroke patients. The use of exoskeleton will help patients to overcome a possible motor limitation that could mask the hemineglect alteration. Although the association of both systems is still relatively expensive, it may result in a more reliable way to assess cognition and it impact to perform rehabilitation training. Additionally, it has the potential to evaluate others cognitive deficit, such as attention and executive functions. Conclusions: This study has the potential to introduce a novel technique to assess cognitive impairment in stroke patients.

Keywords: Eye tracking, spatial neglect, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O13-1: Effect of exercise and rehabilitation with or without ChABC administration to microglia in rats with acute spinal cord injury Top


Kota Asano1,2, Takeshi Nakamura1, Kengo Funakoshi2

1Department of Rehabilitation Science, Yokohama City University School of Medicine, Yokohama, Japan, 2Department of Neuroanatomy, Yokohama City University School of Medicine, Yokohama, Japan

Background and Aims: In central nervous system (CNS) injury, severe inflammation occurs due to activation of residental glial cells and microglia, as well as the secretion of inflammatory cytokines, nitric oxide, excitoxic neurotransmitters, chondoroitine sulfate proteogricans (CSPGs) and matrix metalloproteinases (MMPs), and resulting in glial scarring and interference with axon regrowth. Microglia are the only immune cells in the CNS, and are classified as M1 (proinflammatory) and M2 (neuroprotective, angiogenesis and fibrosis). We investigated whether combination therapy of exercise and administration of the CSPG digestion enzyme ChABC would increase M2 microglia and improve functional recovery. Methods: The spinal cord of female Wistar rats (~10 weeks of age, n=24) was completely transected at T9/10. Exercise was started from postoperative day 2 (5 times a week) and ChABC was administrated directly to spinal cord lesion area at postoperative day 10. These rats were divided into 6 groups: Exerise for 4 weeks and ChABC administration (4wEx+Ch), 4wEx and no Ch (4wEx-Ch), no exercise for 4 weeks and ChABC (4wno Ex+Ch), 4wno Ex and no ChABC (4wno Ex-Ch), exercise for 2 weeks (2wEx) and no exercise for 2 weeks (2wno Ex). We evaluated hind limb locomotor function based on the Basso, Beattie, and Bresnahan BBB scale every week, and performed an immunohistochemical analysis at 2 or 4 weeks postoperatively. Results: Hind limb locomotor function improved in all of the exercise groups. The 4wEx+Ch group exhibited exceptional recovery. The immunohistological analysis revealed an increase of M1 microglia in all of the no Ex groups, in contrast a decrease of M1 microglia in all of the Ex groups. In 2wno Ex group, MMP-9 levels were also increased. In both the Ch groups, MMP-9 was almost diminished. Conclusions: Acute-phase exercise may inhibit inflammation and decrease M1 microglia, resulting in MMP-9 secretion and locomotor functional recovery.
Figure 1: Experimental protocol

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Keywords: Locomotor function, M2/M1 microglia, spinal cord injury

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O13-2: The amelioration of pain-related behavior in chronic spinal cord injury model mice treated with neural stem/progenitor cell transplantation combined with treadmill training Top


Syoichi Tashiro1, Soraya Nishimura2, Munehisa Shinozaki3, Meigen Liu1, Hideyuki Okano3, Masaya Nakamura2

1Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan, 2Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan, 3Department of Physiology, Keio University School of Medicine, Tokyo, Japan

Background and Aims: Although progress in regenerative medicine is realizing the possibility of neural regeneration and functional recovery in spinal cord injury (SCI), there are some states of illness which are refractory to cell replacement therapies. Recently, rehabilitation has attracted much attention in respect to the synergistic promotion of motor functional recovery in combination with neural stem/progenitor cell (NS/PC) transplantation, even in the chronic refractory phase of SCI. Nevertheless, the sensory disturbance is one of the most prominent sequelae, even though the effects of combination or single therapies have been investigated almost only in the context of motor recovery. The aim of this study was to determine how combination therapy with treadmill training (TMT) and NS/PC transplantation affects the manifestation of thermal allodynia and tactile hyperalgesia in chronic phase SCI. Methods: Four groups of severe contusive SCI model mice were used: combined transplantation and TMT therapy, transplantation only, TMT only, and controls. Interventions were started from 42 days post-injury. Pain-related behavior and histological changes were assessed. Results: Thermal allodynia and coarse touch-pressure hyperalgesia exhibited significant recovery in the combined therapy group in comparison with controls, whereas there were no significant differences with fine touch-pressure hyperalgesia and motor function. Moreover, not only a decrease in the expression of pain-related fibers but also an increase in GABAergic activity were significantly promoted at posterior horn of the lumbar enlargement in the combined therapy group compared to the control. Conclusions: The combination therapy with rehabilitation and cell transplantation therapy promoted the amelioration of pain-related behaviors accompanied by the histological recovery. Rehabilitation will broaden the door of regenerative medicine to patients with more severe or chronic illnesses.

Keywords: Neuropathic pain, regenerative medicine, transplantation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.






  No. O13-4: Chronic disease and psychological morbidity among adults with non-traumatic spinal cord injuries Top


Mark D. Peterson1, Anthony Chiodo1, Denise Tate1, Neil Kamdar2

1Department of Physical Medicine and Rehabilitation, University of Michigan-Medicine, Ann Arbor, MI, United States of America, 2Institute for Healthcare Policy and Innovation, University of Michigan-Medicine, Ann Arbor, MI, United States of America

Background and Aims: Individuals living with a spinal cord injury (SCI) are at heightened risk for a number of chronic health conditions such as secondary comorbidities, that may develop or be influenced by the injury, the presence of impairment, and/or the process of aging. However, very little is known about the development of secondary-comorbidities among individuals living with non-traumatic spinal cord injuries (NTSCIs). The objective of this study was to compare the prevalence of psychological morbidities and chronic diseases among adults with and without NTSCIs. Methods: Privately-insured beneficiaries were included if they had an ICD-9-CM diagnostic code for a NTSCI and accompanying diagnosis of paraplegia, tetraplegia, quadriplegia, or unspecified paralysis (n=10,006). Adults without SCIs were also included (n=779,545). Prevalence estimates of common psychological morbidities, chronic diseases, and multimorbidity (≥2 conditions) were compared. Results: Adults with NTSCIs had a higher prevalence of adjustment reaction, anxiety disorders, depressive disorders, drug dependence, episodic mood disorders, central pain syndrome, psychogenic pain, dementia, and psychological multimorbidity, as compared to adults without SCIs. The adjusted odds of psychological multimorbidity was 1.86 (95%CI: 1.76-2.00). Adults with NTSCIs also had a significantly higher prevalence of all chronic diseases and chronic disease multimorbidity (73.5% vs. 18%), except HIV/Aids. After propensity matching for age, education, race, sex, and the chronic diseases (n=7,419 matched pairs), there was still a higher prevalence of adjustment reaction, depressive symptoms, central pain syndrome, and psychogenic pain among adults with NTSCIs. Conclusions: Adults with NTSCIs have a significantly increased prevalence of psychological morbidities, chronic disease, and multimorbidity, as compared to adults without SCIs. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce risk of disease onset/progression in this higher risk population.

Keywords: Chronic disease, psychological morbidity, spinal cord injury

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O13-6: Electroencephalography as a biomarker of impairment and functional recovery in spinal cord injury patients Top


Marcel Simis1, Felipe Fregni2, Linamara R. Battistella1

1Department of Physical Medicine and Rehabilitation, University of Sao Paulo, São Paulo, Brazil, 2Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA

Background and Aims: Despite significant improvement of rehabilitation therapies, including robotic-assisted gait training (RAGT), the results for incomplete spinal cord injury (SCI) recovery still limited. New technologies can be better developed with the understanding of mechanisms of functional recovery and prognosis in SCI. Quantitative electroencephalography (EEG) is a promising tool to study cortical networks and neuroplasticity. Therefore, the aim of this study is to identify the longitudinal changes in brain activity measured by EEG that are related to the functional improvement in SCI patients after rehabilitation therapy. Methods: Were included 15 patients (Age mean 35.7 years old, time since injury mean 17.08 months and 3 women) with SCI that went through multidisciplinary rehabilitation program, including Lokomat therapy five times weekly for six weeks (total of 30 sessions). Resting state EEG was recorded using a 128-channel, before and after 30-session rehabilitation therapy. Data was processed using Fast Fourier transformation to calculate power specifics EEG bands. To measure gait, were used the Walking Index for Spinal Cord Injury (WISCI II) Scale, 10-Meter Walking Test (10MWT), Timed-Up-and-Go (TUG) and 6-Minute-Walking Test (6MWT), besides Berg Balance Scale (BBS) to measure balance. Results: There were statistically significant improvement post treatment in gait, measures by WISC (p = 0.009), 6MWT (p = 0.029), TUG (p = 0.037) and BBS (p = 0.007), but not in 10MWT (p= 0.093). High beta EEG activity in the central area (motor cortex) had a negative correlation with gait and balance measured at baseline, in a way that greater high beta EEG power was related to worse clinical function. Conclusions: Functional impairment and improvement in SCI patients may be predicted by cortical activity measured by EEG. It is necessary further studies with larger sample size to confirm these findings.

Keywords: Biomarker, electroencephalography, spinal cord injury

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O14-1: A comparative study on lumbar stability during static motions of low back pain patients versus healthy population Top


Cheol Ki Kim1, Beom Suk Kim1, Sung Joon Chung1, Yechan Park2, Seung Min Lee2, Kee Won Kim1, Sun Gun Chung1,2

1Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea, 2Seoul National University College of Medicine, Seoul, South Korea

Background and Aims: Lumbar stability is one of crucial mechanical factors of low back pain (LBP). Previous researches have shown that different types of motor patterns were observed between healthy individuals and LBP patients. Our aim of study was to compare lumbar stability during static motions between LBP patients and healthy controls. Methods: 30 patients with LBP and 30 healthy individuals were included. The subjects performed 10 static motions (sitting with the straight back, sitting hunched, sitting with a backrest including lumbar roll, sitting on a stool, performing keyboard/mouse tasks with a standard computer monitor, performing writing tasks on the desk, manipulating a mobile phone at the face/chest/knee-level) with three inertial sensors attached on the thoracic spine and sacrum. Relative angles between the sensors were calculated to analyze lumbar lordosis angle. Measured parameters were initial kyphosis-lordosis (KL) angle, final KL angle, delta KL angle, average KL angle, and lordosis robustness index (LoRI, average lumbar lordosis angle divided by root mean squares of angular velocity). The measurements were compared between the two groups. Results: Delta KL angles of LBP patients were significantly higher than controls when performing keyboard tasks and manipulating a mobile phone at the chest-level (p<0.05). LoRI was the highest when sitting with a backrest including lumbar roll, and the lowest when sitting hunched both in LBP and healthy subjects. Average KL angle was the highest when sitting with a backrest including lumbar roll, and the lowest when performing writing tasks on the desk. Conclusions: LBP patients showed lower capability to maintain static posture than controls when performing keyboard tasks with a standard computer monitor and manipulating a mobile phone at the chest-level. Sitting with a backrest including lumbar roll would be the best posture for maintaining lumbar stability, while sitting hunched would be the worst in both groups.

Keywords: Low back pain, lumbar stability

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O14-2: Lumbar stability during dynamic motions of low back pain patients versus healthy subjects Top


Cheol Ki Kim1, Beom Suk Kim1, Sung Joon Chung1, Yechan Park2, Seung Min Lee2, Kee Won Kim1, Sun Gun Chung1,2

1Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea, 2Seoul National University College of Medicine, Seoul, South Korea

Background and Aims: Low back pain (LBP) has been linked to the extent of lumbar stability. Prior researches of quantifying lumbar stability by evaluating postural changes during a dynamic motion revealed different types of motor patterns between LBP patients and healthy subjects. Our aim of this study was to compare lumbar stability during 8 dynamic motions between LBP patients and healthy control groups. Methods: 30 patients with LBP and 30 healthy individuals aged 22 to 67 years were included. The subjects performed 8 dynamic motions (chair stand, bend over to pick up, squat down to pick up, walk, walk up and down stairs, squat, wall-plank-and-roll, tripod stability) with three inertial sensors attached on the thoracic spine and sacrum. Relative angles between the sensors were calculated to analyze lumbar lordosis angle. Measured parameters were average lordosis angle, root mean squares (RMS) of angular velocity, range of motion (ROM), phase plot area, and lordosis robustness index (LoRI, average lumbar lordosis angle divided by RMS of angular velocity). The 5 measurements of 8 dynamic motions were compared between the two groups. Results: The RMS of angular velocity was significantly higher in LBP group than healthy subjects when performing tripod stability (p<0.05). And significantly lower ROM during walking was observed in LBP group compared with the controls (p<0.05). Conclusions: Our study reveals potential use of tripod stability and walking as a biomechanical tool to differentiate low back patients from healthy subjects. Further researches on different motor patterns between LBP patients and healthy subjects are needed to investigate pathophysiology and prevention of lumbar region pain.

Keywords: Low back pain, lumbar stability

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O14-4: Cervical pain in health professionals: A randomised cross over trial of a new postural garment versus exercises Top


Merce Avellanet1,2, Anna Boada1,2, Jean Claude Perrot1,2, Laura Loro1, David Monterde3, Josep Romagosa4, Elvira Gea2,5

1Department of Rehabilitation, Hospital N Sra de Meritxell, Escaldes-Engordany, Andorra, 2Research Group on Health Sciences and Health Services, University of Andorra, Sant Julià de Lòria, Andorra, 3Department of Health, Institut Catala de la Salut, Generalitat de Catalunya, Barcelona, Spain, 4Department of Statistics, Govern d'Andorra, 5Hospital Pharmacy, Hospital N Sra de Meritxell, Escaldes-Engordany, Andorra

Background and Aims: Among health professionals, there is a high prevalence of musculoskeletal disorders. During a one-year period, 18 % of our hospital staff was treated in the Rehabilitation Department, 50 % because of pain in the neck and back. Therapeutic approach to cervical pain should include posture modification and exercise. A new garment, PosturePlusForce-Medi, includes thoracic and abdominal tensional bands for the postural realignment. This study aims to investigate the effects of a postural garment versus exercises in nurses and allied health professionals with non-specific cervical pain. Methods: Randomised cross over clinical trial. Participants are allocated at random in two groups. Group (P+) wears the postural garment at least 4 hours per day, during 90 days. Exercise Group performs stretching and strengthening exercises (5 physiotherapy sessions to learn) at home for 90 days. After a 3-month washout period, participants cross over interventions for another 3-month period. Primary outcomes are pain intensity (visual analog scale) and posture measured with a digitalized scan (SpinalMouse) by a blinded observer. Secondary outcomes are cervical pain-related disability (validated Spanish version of Neck Disability Index), catastrophizing (Pain Catastrophizing Scale), physical activity (International Physical Activity Questionnaire), global perceived effect of treatment and evaluation of garment comfort. Measures are conducted at T0 (pre-intervention), 30, 60 and 90 days follow-up. Pharmacological treatment and sick leaves are recorded. Statistical analysis is conducted following intention-to-treat principles, and treatment effects calculated using linear mixed models. Results: 34 nurses were recruited and 29 completed the study. Pain reductions are observed for both groups although P+ rated VAS lower and needed less drugs over 3 month period. Posture (kyphosis/ inclination) improves more in P+. Treatment perception is superior in P+ although not significant differences were found. Conclusions: Positive effects are observed in all outcome measures in P+ group although low in magnitude.

Keywords: Cervical pain, exercise, posture

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O14-5: Measuring cervical range of motion with gyroscope/accelerometer eyeglasses (JINES MEME) in persons with and without neck pain Top


Kimio Saito1, Karina Del Rosario2, Nagao Masato2, Lisa Pascual2, Saam Morshed2, Yoichi Shimada1

1Department of Rehabiritation, Akita University Hospital, Akita, Japan, 2Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA

Background and Aims: Providers frequently measure active cervical range of motion (ROM) in the examination of patients with neck pain, yet the most commonly used measurement tools have been deemed inaccurate or impractical. The Cervical Range of Motion Instrument (CROM) has demonstrated high reproducibility and validity. The practicality of the device however remains questionable secondary to its large dimensions. The JINS MEME eyeglass is alightweight wearable device that contains gyroscope and accelerometer electrodes capable of detecting body motion. The primary aim of this study is to determine the reliability and validity of the JINS MEME eyeglass in evaluating active cervical range of motion (ROM) in comparison to the CROM. The secondary aim is to investigate variable ROM patterns between individuals with neck pain versus those without neck pain. Methods: 9 neck pain and 15 control subjects underwent active cervical ROM measurements with the JINS MEME eyeglass and CROM Instrument concurrently. Estimates of intra and inter-rater reliability and criterion validity were established using the Intraclass Correlation Coefficient (ICC). Results: Using the JINS MEME eyeglass, we observed good to excellent intra-rater reliability (ICC = 0.89-0.98) for measuring cervical flexion, extension and lateral bending, but poor (ICC<0.5) for rotation. For inter-rater reliability and criterion validity, ICC was excellent for cervical flexion and lateral bending (ICC>0.9), good for extension (ICC>0.75) but poor for rotation (ICC<0.5). After excluding 2 neck pain subjects with suspected hypermobility syndrome, active ROM in neck pain subjects was significantly reduced (p = 0.02) in all movements except for flexion compared to controls. Conclusions: The JINS MEME eyeglass showed good to excellent intra-rater and inter-rater reliability and criterion validity when compared to the CROM for all active cervical ROM movements except for rotation. Individuals with neck pain appear to have significantly reduced active cervical ROM in all directions except for flexion.

Keywords: Cervical range of motion, neck pain, wearable device

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O14-6: The effect of low frequency magnetic field on pain intensity in patients with diabetic peripheral neuropathy Top


Teuta Osmani-Vllasolli1, Arijana Kalaveshi2, Ardiana Murtezani1

1Physical Medicine and Rehabilitation Clinic, University Clinical Center of Kosovo, Pristina, Kosova, 2National Institute of Public Health, University Clinical Center of Kosovo, Pristina, Kosova

Background and Aims: Epidemiological studies suggest that non-pharmacological interventions such as magnetic field and exercise may be beneficial for patients with diabetic peripheral neuropathy (DPN). However, the potential effect of magnetic field on decreasing of pain remains controversial. To analyze the effect of low frequency magnetic field (LFMF) on pain intensity in patients with DPN. Methods: Thirty-one elderly women with DPN for more than two years, were distributed in the experimental group (EG) (n=16) which participated in exposure to LFMF and exercises program, and control group (CG) (n=15) which participated only in exercises. EG were exposed for six weeks, 20 min a day, three days a week (totally 18 days), while CG Patients received sham exposures to magnetic fields. Two groups participated in training program three times per week which was consisted from 10 minutes of stretching exercises; 45 minutes of aerobic endurance (gait) and 10 min with five minutes of relaxation while two times per week were included dynamic resistance exercises (involving the major muscle groups) The training sessions of resistance exercises were performed in three sets of 8 to 10 repetition of maximum. Treatment outcomes were assessed by Visual Analogue Scale (VAS), Neuropathic Pain Diagnostic Questionnaire (NPDQ) by Berg Balance Scale (BBS). Results: The EG group (age 62.6 ± 5.4 years) and the CG (63.2 ± 4.8years). Significant reduction in pain intensity after 6 weeks was found in two groups p <0.05 or p <0.01 versus pain in baseline time, in VAS and NPDQ. There was no significant difference between two groups. Significant improvements have also been reported in BBS with p<0.01. Conclusions: LFMF doesn't show an important role on reducing the pain intensity in patients with DPN. In other side, aerobic and resistance exercises had important role on improving of balance problems and intensity of pain.

Keywords: Diabetic peripheral neuropathy, low frequency magnetic field, pain

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O15-1: Effect of trailing limb angle on propulsion force and knee flexion angle during gait in community-dwelling older people Top


Takasuke Miyazaki1,2, Ryoji Kiyama3, Hyuma Makizako3, Masayuki Kawada3, Yasufumi Takeshita1,2, Yuki Nakai1, Kazunori Yone3, Takuro Kubozono4, Toshihiro Takenaka2, Mitsuru Ohishi4

1Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan, 2Tarumizu Municipal Medical Center, Tarumizu Chuo Hospital, Kagoshima, Japan, 3Faculty of Medicine, School of Health Sciences, Kagoshima University, Kagoshima, Japan, 4Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima, Japan

Background and Aims: Trailing limb angle (TLA) during gait is related to propulsion force. However, the relationship between TLA and knee flexion angle at mid-swing remains unclear. This study aimed to clarify the relationships among TLA, knee flexion angle at mid-swing, and propulsion force at late stance in older people. Methods: One hundred nine community-dwelling older people (75 female, 76.0±6.9 y) walked at a comfortable speed along a 14 m walkway. Tilt angle and acceleration of the trunk, bilateral thigh, and shank were measured using wearable sensors. The location of the lateral malleolus relative to the hip joint was estimated from the tilt angle of segments and anthropometric data. TLA was calculated as an angle consisting of a line connecting the lateral malleolus and the hip joint and the vertical axis in the sagittal plane. Maximum TLA at pre-swing was taken as a representative value. In addition, knee flexion angle at mid-swing and at the moment when TLA peaked during pre-swing were measured. Integration of anterior acceleration measured by sensors fixed on the trunk was computed during late stance as an indicator of propulsion force. The relationship among TLA, knee flexion angle at pre-swing and swing phase, and propulsion force were analyzed by correlation analysis and multiple regression analysis. Results: TLA was significantly associated with propulsion force (r=0.687, p<0.001), knee flexion angle at mid-swing (r=0.490, p<0.001), and knee flexion angle at pre-swing (r=0.318, p=0.002). Multiple regression analysis showed that TLA and knee flexion angle at pre-swing could predict knee flexion angle at mid-swing (R2 =0.578, p<0.001). Conclusions: Results showed that both knee flexion at pre-swing and TLA are needed for efficient and safe walking. Therapists should assess and then facilitate TLA with sufficient knee flexion at pre-swing in gait training for older people.

Keywords: Angular velocity, gait analysis, wearable sensor

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O15-2: Effect of ankle foot orthosis and handrail on toe clearance in hemiparetic walking Top


Kei Ohtsuka1, Masahiko Mukaino2, Kazuhiro Tsuchiyama1, Fumihiro Matsuda1, Junya Yamada3, Ryo Murakami3, Eiichi Saitoh2

1Faculty of Rehabilitation, School of Healthcare, Fujita Health University, Toyoake, Japan, 2Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan, 3Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan

Background and Aims: In hemiparetic patients, toe clearance is reduced during the swing phase of the gait due to limb paralysis. When toe clearance is insufficient, ankle foot orthosis (AFO) and handrails are frequently used. However, there have been few reports about the effectiveness of these supports, so this study investigated the effect of AFO and handrails on toe clearance in hemiparetic walking. Methods: The study included 24 hemiparetic patients capable of walking on a treadmill without AFO and 17 capable of walking on a treadmill without a handrail. A three-dimensional motion analysis system: KinemaTracer® (Kissei Comtech Co. Ltd. Japan) was used with 2 markers attached on both fifth metatarsal heads. Data were collected for 20 s. The treadmill was set at a comfortable walking speed according to each patient. The outcome measures were toe clearance (vertical height from the floor to the fifth metatarsal head) and the coefficient of variation of toe clearance for 20 s. To determine the effects of AFO and the handrail, Wilcoxon rank sum tests were calculated on the difference between using and not using each support (p < 0.05). Results: Toe clearance with a handrail was significantly higher than without a handrail. Toe clearance with AFO was significantly lower than without AFO. Both coefficients of variation significant decreased when using AFO or a handrail. Conclusions: This study determined that AFO increased toe clearance and handrail reduced toe clearance. It is possible that AFO increases toe clearance because it supports the ankle, but a handrail reduces toe clearance because it increases the safety margins. Regarding the reduction in the coefficient of variation of toe clearance when walking with AFO or a handrail, it can be presumed that AFO and a handrail increase walking stability due to their high reproducibility.

Keywords: Hemiparetic patient, toe clearance, treadmill walking

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O15-3: Changes in time factors and gait pattern transition from three-point gait to two-point gait in stroke hemiparetic gait Top


Fumihiro Matsuda1, Masahiko Mukaino2, Kei Ohtsuka1, Masahiro Hidaka3, Junya Yamada3, Shigeo Tanabe1, Eiichi Saitoh2

1Faculty of Rehabilitation, School of Healthcare, Fujita Health University, Toyoake, Japan, 2Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan, 3Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan

Background and Aims: A cane is a frequently used gait aid for hemiparetic stroke patients. There are typically two kinds of gait pattern using canes: two-point gait, in which the affected limb swings at the same time as cane advancement, and three-point gait, in which the affected limb swings after cane advancement; this second pattern is typically seen in severe hemiparetic patients. Along with functional improvement, the pattern transition from three-point gait to two-point gait could occur. To investigate the factors that relate to this transition, changes in the spatiotemporal patterns of gait were examined in patients who experienced gait pattern transition. Methods: Seven patients with hemiparesis who experienced gait pattern change from three-point gait to two-point gait participated. The videos of gait on level ground, recorded on a regular basis during inpatient rehabilitation, were retrospectively analyzed. Gait speed, time factors of paretic side, and the timing of canes placed on the floor were calculated from the videos. A comparison between the three-point and two-point gait indices was conducted. Results: Gait speed of two-point gait showed significantly greater values than that of three-point gait. The double stance phase before paretic swing and the time from a cane on to a paretic foot off (three-point support period) were significantly shorter in two-point gait than in three-point gait. Conclusions: This study explored the time pattern changes in cases where transition from three-point gait to two-point gait occurred during rehabilitation. The shortening of paretic pre-swing and use of canes at paretic toe off were seen among the time factors, possibly indicating these changes would relate to the transition of gait patterns.

Keywords: Cane, gait pattern, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O15-4: The physiological mechanism of gait improvement with rhythmic sound stimulation in patients with Parkinson's disease - Functional magnetic resonance imaging study Top


Daisuke Nishida1,2, Katsuhiro Mizuno1,2, Emi Yamada1, Meigen Liu2

1Department of Rehabilitation Medicine, Saiseikai Higashikanagawa Rehabilitation Hospital, Yokohama, Japan, 2Department of Rehabilitation Medicine, Keio University, Tokyo, Japan

Background: Patients with Parkinson's disease (PD) suffer from gait disturbance, which, in some patients, can be improved with rhythmic stimulation. This effect is useful for their rehabilitation, but its physiological mechanism is not 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 rhythmic sound stimulation(RS). Materials and Methods: The participants were 27 right-handed patients with PD (mean age: 73.8 +/- 2.5, 11 males), whose Yahr stages ranged from 2 to 3. They had no cognitive impairment, could walk independently and their gait was improved by RS. As a control group, we examined 25 healthy right-handed volunteers (mean age: 71.6 +/- 5.7, 13 males). The participants were asked to image gait with RS (beep on 100 beats per minute) or with white noise(WN) during the fMRI imaging. Results: In patients with PD, the activation patterns with gait imagery appeared in supplementary motor areas (SMAs) and cerebellum with RS, while with WN, the activation pattern was more widespread, including left parietal operculum (PO) as well as SMAs and cerebellum. In healthy controls, the activation pattern was limited to SMAs and cerebellum both with RS and with WN. The brain activation patterns with RS subtracted from those with WN showed underactivation of left PO (p < 0.001: FWE uncorrected). Discussion: One of the functions of the PO is sensory-motor hub, and its structural volume and function are decreased in patients with PD. In this study, left PO was less activated with RS than with WN in patients with PD. This result suggests that RS can suppress the overactivation of left PO and correct the sensory-motor network and the motor programs of gait function in patients with PD.

Keywords: Paradoxical gait, Parkinson's disease, rhythmic sound stimulation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O15-5: Effect of gait training using hybrid assistive limb on gait ability and the risk of exercise-induced muscle injury in patients with myopathy Top


Eiichi Tsuda1, Kazutomo Miura1, Masakazu Kogawa1, Ayaka Fujita2

1Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan, 2Department of Rehabilitation Medicine, Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan

Background and Aims: Gait training using Hybrid Assistive Limb (HAL) is effective to improve gait ability in patients with neuromuscular disease. Over-training during rehabilitation, however, causes further muscle damage and weakness in patients with myopathy. The purpose of this study was to investigate the effect of HAL therapy on gait ability and the risk of exercise-induced muscle injury in patients with myopathy. Methods: Six patients (4 with myotonic dystrophy, 1 with sporadic inclusion body myositis and 1 distal myopathy) were involved in this study. The patients were treated with HAL gait training for 20-30 minutes per day, 2 or 3 times for a week, and received consecutive 9 times for 4 weeks as 1 series of HAL therapy. Before and after HAL therapy, gait ability was evaluated with 2 minutes walk test and serum creatine phosphor kinase (CPK) concentration was measured. Wilcoxon signed rank test was used to compare pre- and post-therapeutic measurements. Results: Total of 14 series of HAL therapy was performed for 6 patients. Average of gait distance in 2 minutes walk test was significantly gained from 83.2 +/- 23.9 m to 95.5 +/- 25.5 m after HAL therapy (p = 0.011). In contrast, no significant change in CPK concentration was detected between 331 +/- 143 U/L before and 344 +/- 154 U/L after HAL therapy (p = 0.701). Conclusions: Overwork muscle weakness is one of the adverse events which should be avoided during rehabilitation in patients with myopathy. This study showed that 9 times HAL gait trainings for 4 weeks succeeded to improve gait ability safely without exercise-induced muscle injury in patients with myopathy.

Keywords: Gait, myopathy, robot rehabilitation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O15-6: Subacute stroke gait rehabilitation with an overground exoskeleton: preliminary results of a RCT multicentre study Top


Marco Franceschini1, Michela Goffredo1, Sanaz Pournajaf1, Daniele Galafate1, Silvano Baratta2, Serena Filoni3, Eleonora Guanziroli4, Carlo Damiani1, Franco Molteni4

1Department of Rehabilitation, IRCCS San Raffaele Pisana, Rome, Italy, 2USL Umbria 2, Rehabilitation Center, Trevi (PG), Italy, 3Padre Pio Onlus Foundation Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy, 4Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, LC, Italy

Background and Aims: Gait recovery is one of the main goals of stroke rehabilitation and robotic assisted practice showed positive outcomes. Recently a wearable exoskeleton (Ekso TM) has been commercialised for reenable patients to stand and walk overground. Our observational study (being published) showed significant effects and good compliance. The aim of this RCT study is assessing the efficacy of Overground Exoskeleton Assisted Gait Training (OEAGT) in subacute stroke patients. Methods: Patients conducted 15 one hour sessions (3 times for week) of OEAGT (EG) or traditional gait training (CG). Clinical assessments (Motricity Index MI; Trunk Control Test TCT; 10 meter walking test 10mWT; 6 minute walking test 6mWT; Walking handicap scale WHS; Modified Ashworth Scale at Hip MAS H, Knee MAS K and Ankle MAS A level) were performed at the beginning (T1) and at the end (T2) of the training period. Wilcoxon test (p value <0.05) was used. Results: 43 subacute stroke patients were enrolled: 20 (66.2 +or- 8.7 y.o.) in the Control Group (CG) distance from the acute event: 42.2 +or- 34.2 days; 23 (59.3 +or- 12.9 y.o) in the Experimental Group (EG) distance from the acute event: 39.6 +or- 17.5 days. All clinical scales significantly improved at T2 in both groups; no statistically significant changes were reported for MASH MASK MASA. In EG the ambulant patients showed a statistical improvement in speed measured during the 10 mwt (97%) and in the distance covered over a time of 6 minutes (231%). A similar result was registered in the CG although the percentage increases of 10 mwt (73%) and 6 mwt (119%) were lower. Conclusions: Overground gait training with a wearable powered exoskeleton allows to improve clinical and gait outcomes in subacute stroke patients compared to conventional therapy. The results pave the way to new personalised rehabilitation strategies.

Keywords: Gait, robotic, stroke rehabilitation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O16-2: Comparison of ultrasound-guided injection of corticosteroid versus hyaluronic acid in the treatment of plantar fasciitis: A 6 month randomized clinical trial Top


Seyed Ahmad Raeissadat, Farshad Nouri, Mahtab Darvish

Shahid Beheshti Univeristy of Medical Sciences, Tehran, Iran

Background and Aims: Plantar fasciitis is the most common cause of heel pain. This study was designed to evaluate the effect of Hyaluronic acid (HA) injection in reducing the symptoms, compared with corticosteroid injection as a conventional treatment. Methods: In this double blind randomized clinical trial, 75 patients who had the symptoms of plantar fasciitis for at least 3 months were randomly divided into 2 groups of 38 and 37 individuals, either received a single injection of HA with high molecular weight (1ml HA 20 mg + 1 ml Lidocaine 2%) or corticosteroids (1ml Methyl prednisolone 40 mg +1 ml Lidocaine 2 %) respectively under the guide of ultrasonography (US). Visual analogue scale (VAS) ,foot ankle ability index (FAAI), pressure pain threshold (PPT), functional foot index (FFI), and plantar thickness measured using ultrasonography (US) were evaluated at baseline, 6 weeks and 6 months after the injection. Also, at the end of the treatment period, the patients' satisfaction was measured. Results: After 6 months of follow-up, data from 60 subjects were fully obtained. In both groups, VAS, plantar fascia thickness measured by US and FFI decreased, FAAI and PPT increased significantly (p <0.001). At the baseline and the 6th month, the difference between the two groups was not observed in any of variables. But between baseline and the 6th week, the decrease in PPT and plantar fascia thickness was more prominent in the corticosteroid group compared to HA group (P= 0.019 and P= 0.031). At the end of study, the participants' satisfaction was relatively similar between the two groups (P= 0.371). Conclusions: Corticosteroid and HA are both effective treatments for plantar fasciitis and can improve pain and function with no superiority in 6 month follow up, although corticosteroid seems to have a faster trend of improvement in short term.

Keywords: Corticosteroid, hyaluronic acid, pressure pain threshold

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O16-3: Effect of ultrasound-guided drug injection of shoulder joint for the treatment of complex regional pain syndrome after stroke Top


Huixian Yu

Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Background and Aims: To investigate the clinical efficacy of ultrasound-guided drug injection in the treatment of complex regional pain syndrome (CRPS) of the shoulder after stroke. Methods: 26 stroke patients (Brunnstrom III-V) with CRPS of the shoulder joint within 1-3 months and were randomly divided into the control group (conventional rehabilitation group) and the experimental group. The experimental group was given additional treatment under the guidance of musculoskeletal ultrasound on the basis of conventional treatment. Debaosong 1 ml mixed with 5 ml lidocaine hydrochloride were used for injection. 1 month and 3 months after rehabilitation, the drainage volume method was used to evaluate the degree of swelling of the hand (volume), and the visual analogue scale (VAS) to evaluate the shoulder pain. The upper limb Fugl-Meyer (U-FMA) to evaluate the upper extremity motor function. The results of the study were analyzed by one-way anova and differences between the two groups were observed. Results: There were no significant differences in general data between the two groups before treatment. The VAS of the experimental group was significantly lower than that of the control group, and the difference was statistically significant (P<0.05). There was no significant difference in U-FMA score between the two groups. After 3 months, the swelling volume of the experimental group was less than that of the control group, and the difference was statistically significant (P<0.05). The VAS of the experimental group was lower than that of the control group, and the difference was statistically significant (P<0.05). The U-FMA score of the experimental group was higher than that of the control group, and the difference was statistically significant (P<0.05). Conclusions: On the basis of conventional rehabilitation, ultrasound-guided steroidal anti-inflammatory drugs in patients with CRPS can significantly relieve shoulder pain, reduce swelling and improve upper limb function.

Keywords: Complex regional pain syndrome, stroke, ultrasound-guided drug injection

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O16-4: Nerve hydrodissection and dextrose perineural injection for carpal tunnel syndrome Top


Yung-Tsan Wu, Ming-Jen Ke, Tsung-Yen Ho, Tsung-Ying Li, Yu-Ping Shen, Si-Ru Chen, Liang-Cheng Chen

Department of Physical Medicine and Rehabilitation, National Defense Medical Center, School of Medicine, Tri-Service General Hospital, Taipei, Taiwan

Background and Aims: Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. The technique of perineural injection therapy by using 5% dextrose (D5W) is now commonly used for peeling the nerve from surrounding soft tissue (called nerve hydrodissection), which may rescue the nerve from further ischemic damage. On 2017, we first approved PIT with D5W is benefical for patients with CTS. Here, we design another randomized, double- blind, controlled trails to survey the effect of nerve hydrodissection and furtherly compare D5W with corticosteroid injection for mild-to-moderate CTS. Methods: In trial of nerve hydrodissection, thirty-four participants were randomly assigned to an intervention or control groups. One 5-ml dose of normal saline was injected into the intracarpal and subcutaneous regions in subjects of both groups, respectively. In comparative trial, fifty-four patients were enrolled into dextrose or steroid groups and perineural injection with 5 cc D5W or 3cc triamcinolone acetonide (10 mg/ml) mixed with 2cc normal saline (total 5 cc) were administered respectively. The visual analog scale was assigned to primary outcome. The secondary outcomes included Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), cross-sectional area of median nerve and electrophysiological studies. The assessments were performed prior to injection to 6 months post-injection. Results: Compared with the control group, the intervention group showed significantly greater improvement at the 2nd and 3rd posttreatment months according to BCTQ severity score and at all time-points for cross-sectional area of the median nerve (P < 0.01). Compared with the steroid group, the dextrose group exhibited a significant reduction in pain and disability through 4th to 6th month (p < 0.01). Conclusions: Our study firstly demonstrates the therapeutic effects of nerve hydrodissection for mild-to-moderate CTS. Moreover, perineural injection of D5W is more beneficial than that of corticosteroid in patients with mid-to-moderate CTS, 4 to 6 months post-injection.

Keywords: Carpl tunnel syndrome, nerve hydrodissection, perineural injection therapy

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O16-5: Hypertonic dextrose prolotherapy in the treatment of tendinopathy: A systematic review and meta-analysis Top


Lixia Jin1, Fang Li1, Chang Jiang2

1Shanghai Huashan Hospital, Fudan University, Shanghai, People's Republic of China, 2Shanghai Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China

Background: Tendinopathy is a common disease and a major cause of pain and disability. Hypertonic dextrose prolotherapy is an emerging treatment for tendinopathy, but its efficacy is uncertain. Therefore, we conducted a systematic review with meta-analysis to synthesize clinical evidence on the effect of hypertonic dextrose prolotherapy for tendinopathy. Methods: Electronic databases were searched for articles in English published before October 2018. Randomized controlled trials(RCTs) comparing hypertonic dextrose prolotherapy with other interventions in tendinopathy treatment were included for further meta-analysis. The main outcome is pain relief. Results: Seven RCTs of moderate risk of bias were included, with data from a total of 234 patients. Three of them included the comparison of dextrose prolotherapy and non-prolotherapy. In the meta-analysis of this three studies, hypertonic dextrose prolotherapy is superior to non-prolotherapy in pain release. It is equal to other injections like corticosteroid, saline and PRP. Conclusions: Hypertonic dextrose prolotherapy conferred a positive and significant benefits in the treatment of tendinopathy. More large-scale, long-term trials with uniform end points are needed for further elucidating the efficacy of prolotherapy.
Figure 1: Flow of literature search

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Figure 2: Dextrose prolotherapy versus non-prolotherapy on pain reslilef

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Keywords: Dextrose, prolotherapy, tendinopaty

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O16-6: Automated nerve tracking in dynamic sonography using instance segmentation Top


Po-Ling Kuo1, 2, 3, Wei-Ting Syu2, Chueh-Hung Wu3,4, Meng-Ting Lin4, Mathieu Boudier Reveret5, Ming-Yen Hsiao3,4

1Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan, 2Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan, 3College of Medicine, National Taiwan University, Taipei, Taiwan, 4Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan, 5Centre Hospitalier de l'Universite de Montreal, Montreal, Canada

Background and Aims: An emerging trend in the diagnosis of entrapment neuropathy is to evaluate the spatiotemporal characteristic of the nerve as adjacent tissues move using dynamic sonography. This required manual nerve tracking in consecutive images, which however demands tons of human labor with expertise. Here we demonstrate the feasibility of automated median nerve tracking in dynamic sonography using the state-of-the-art instance segmentation method with deep learning. Methods: The sonographic images of the transverse view of median nerve at across wrist level as fingers moved were continuously acquired for 30 seconds from 14 subjects diagnosed as carpal tunnel syndrome. The system for automated nerve tracking was based on Mask Region-Convolutional Neural Network with Resnet-101 as backbone and developed using TensorFlow Object Detection API. The images of 10 and 4 subjects were chosen for training and validation of the system, respectively, with that the true nerve regions were manually labelled by the physicians. The transfer learning was done by fine tuning the Resnet-101 with pre-trained weight on MS-COCO dataset. For each image, we defined Intersection over Union (IoU) as the numbers of pixel that the prediction met and true nerve regions, divided by their union. The results were evaluated using Average Precision (AP) that averaged the precision (P) values of the prediction at IoU thresholds ranging from 0.5 to 0.95. Results: [Table 1] shows that our system tracked the nerve well with 84% IoU and about 70% AP in the validation data set. [Figure 1] exemplified the automated nerve tracking images, in which the median nerve was correctly delineated and tracked as time passed (formatted as hh:mm:ss). Conclusions: Our work demonstrates the feasibility of automated nerve tracking in dynamic sonography using instance segmentation with deep learning. Our promising results indicate the foreseeable potentialities of artificial intelligence-assisted diagnosis in ultrasound imaging.

Keywords: Deep learning, dynamic sonography, entrapment neuropathy

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.






  No. O17-1: AbobotulinumtoxinA: Adult upper limb and lower limb results in spasticity Top


Alberto Esquenazi1, Jean-Michel Gracies2, Sylvie Guillory3, Claire Vilain3, Philippe Picaut3

1MossRehab and Albert Einstein, Elkins Park, PA, USA, 2Service de Reeducation Neurolocomotrice, Hospital Albert Chenevier-Henri Mondor, Universite Paris-Est, Creteil, France, 3Ipsen, Les Ulis, France

Background and Aims: To fully assess improvements after botulinum toxin treatment for spastic paresis, it is important to measure both specific muscle spasticity and holistic functional outcomes. We report the effects of repeat abobotulinumtoxinA (aboBoNT-A) injections on muscle spasticity and limb function from 2 Phase 3 double-blind (DB) studies and their open-label (OL) extensions in adults with upper limb (UL; NCT01313312) or lower limb (LL; NCT01251367) spasticity post-stroke/traumatic brain injury. Methods: Adults (18-78 years) received repeat aboBoNT-A injections (500-1500U) over 1 year. Muscle spasticity was assessed using Modified Ashworth Scale (MAS) (measured, for UL, in the primary target muscle group [PTMG; defined as the most hypertonic muscle group among the elbow, wrist, or finger flexors], and for LL in the ankle and Tardieu scale. Active function was assessed by Modified Frenchay Scale (MFS; UL) and 10-meter comfortable barefoot walking speed (CBWS; LL). Week 4 post-injection results are reported. Results: 243 (UL) and 388 (LL) patients were enrolled in the DB phase. 254 (UL) and 345 (LL) patients were enrolled in the OL phase, including 31 de novo patients in the UL study. Improvements were observed in muscle spasticity (MAS and Tardieu Scale) and function (MFS and CBWS) over the DB and OL phases, in both UL and LL patients [Table 1]. The incidence of related adverse events (AEs) was low across cycles. Incidence, intensity and causality of treatment emergent AEs (TEAEs) were in line with the labelled AE profile. Conclusions: AboBoNT-A was well tolerated following repeated injections in adult patients, and TEAEs were consistent with previous clinical studies. These results contribute to a growing body of evidence that the treatment objectives of improving spasticity and functioning are achievable when using aboBoNT-A in hemiparetic adult patients after stroke or traumatic brain injury.

Keywords: AbobotulinumtoxinA, lower limb spasticity, upper limb spasticity

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.




  No. O17-2: OnabotulinumtoxinA treatment for spasticity reduces disability outcomes in treatment-naïve patients and reduces caregiver burden: Results from the ASPIRE study Top


Alberto Esquenazi1, Wolfgang H. Jost2, Aaron L. Ellenbogen3, George F. Wittenberg4,5, Kenneth Ngo6, Joan Largent7, Aleksej Zuzek8, Gerard E. Francisco9

1MossRehab Gait and Motion Analysis Laboratory, Elkins Park, PA, USA, 2Department of Neurology, University of Freiburg, Breisgau, Germany, 3Michigan Institute for Neurological Disorders, Farmington Hills, MI, USA, 4University of Maryland, Baltimore, MD, USA, 5University of Pittsburgh, Pittsburgh, PA, USA, 6Brooks Rehabilitation Hospital, Jacksonville, FL, USA, 7VIA Real-World Evidence Solutions, Cambridge, MA, USA, 8Allergan plc, Irvine, CA, USA, 9McGovern Medical School and TIRR Memorial Hermann, University of Texas, Houston, TX, USA

Background and Aims: Examine real-world onabotulinumtoxinA utilization and effectiveness over 2 years in patients naïve or non-naïve to botulinum toxins for spasticity from the Adult Spasticity International Registry (ASPIRE) study. Methods: International, multicenter, prospective, observational registry (NCT01930786) examining adults with spasticity treated with onabotulinumtoxinA. Assessments included onabotulinumtoxinA utilization (each treatment visit), disability assessment scale (DAS; baseline and each visit), and Bakas caregiver outcomes scale (treatment-naïve only; baseline and 5±1 weeks post-treatment). Results: 730 patients received ≥1 dose of onabotulinumtoxinA and 37% (n=269) were naïve to botulinum toxins for spasticity at baseline. Mean cumulative doses of onabotulinumtoxinA across all upper limb (UL) and lower limb (LL) treatments were less in treatment-naïve patients (888.6U and 962.2U, respectively) than non-naïve (1262.2U and 1197.2U). Across all treatments, clinicians made more adjustments at the subsequent visit to dose and muscles targeted in treatment-naïve (46% and 42%, respectively) than non-naïve patients (38% and 32%). Following onabotulinumtoxinA, cumulative mean change from baseline for all DAS subscales was higher in treatment-naïve patients (-1.7 [UL] and 1.3 [LL]) versus non-naïve (-0.9 and -0.5, respectively). Caregivers of treatment-naïve patients (n=24) reported significant improvement on five Bakas items (p<0.05 post-treatment 2 vs. baseline), including time for family activities and emotional well-being, following onabotulinumtoxinA. 261 patients reported 831 adverse events (AEs); 23 AEs in 20 patients were considered treatment-related. 94 patients reported 195 serious AEs; 3 serious AEs in 2 patients were considered treatment-related. No new safety signals were identified. Conclusions: ASPIRE demonstrates that treatment paradigms for treatment-naïve and non-naïve patients differ regarding dosing and reassessment of muscles targeted. Treatment-naïve patients, and to a lesser extent non-naïve, showed reduced disability following onabotulinumtoxinA. Caregiver-reported burden was also reduced following onabotulinumtoxinA treatment in naïve patients. OnabotulinumtoxinA is safe and effective for the individualized treatment of spasticity, resulting in decreased disability and burden of care.

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O17-3: Importance of optimal treatment with onabotulinumtoxinA to detect global improvements in pediatric upper limb spasticity Top


Darcy Fehlings1, Mark Gormley2, Heakyung Kim3, Katharine E. Alter4, Chengcheng Liu5, Emily McCusker6, Rozalina Dimitrova6

1University of Toronto, 2Gillette Children's Specialty Hospital, St. Paul, MN, USA, 3Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA, 4National Institutes of Health, Bethesda, MD, USA, 5Allergan PLC, Madison, NJ, USA, 6Allergan PLC, Irvine, CA, USA

Background and Aims: In a Phase 3 randomized, double-blind, placebo-controlled study (ClinicalTrials.gov, NCT01603602), onabotulinumtoxinA (6 or 3 U/kg) was compared with placebo as treatment for cerebral palsy in children (2-<7 years) with elbow/wrist flexor Modified Ashworth Scale-Bohannon (MAS-B) score >=2, who also received occupational therapy. Per protocol, only the wrist or elbow muscle group was treated, leaving adjacent muscles untreated. The primary endpoint, change from baseline (CFB; Weeks 4 and 6 average) in MAS-B score (elbow or wrist flexors; [Figure 1]a) was met, but the secondary endpoint, Clinical Global Impression (CGI) improvement, was not [Figure 1]b. This post-hoc analysis evaluated the hypothesis that not treating all affected muscles with moderate/severe spasticity in the same limb may hinder ability to detect clinical global improvements. Methods: The post-hoc analysis compared CGI at pre-specified Weeks 4 and 6 average for onabotulinumtoxinA (6 or 3 U/kg) versus placebo (mixed model repeated measures) in each of two subgroups: (1) patients with only a single muscle group requiring treatment (ie, mild/no spasticity [MAS-B <2] in the untreated muscle; n=134) and, (2) those with less spasticity (still MAS-B >=2) in the untreated versus treated muscle (n=171). Results: CGI significantly improved for onabotulinumtoxinA 6 and 3 U/kg versus placebo both in the subgroup of patients with only a single muscle group requiring treatment [Figure 2] and in those with less spasticity in the untreated versus treated muscle [Figure 3]. Improvements were more robust in the subgroup with mild/no spasticity in the untreated muscle. CFB in MAS-B was consistent with the primary analysis in both subgroups. Conclusions: These findings support the hypothesis that treating all muscles with a MAS-B >=2 may be necessary to obtain detectable global improvements in upper limb spasticity. Further studies are needed to assess CGI when all highly spastic muscles are treated.
Figure 1: (a) CFB in MAS-B score (weeks 4 and 6 average) of the principal muscle group in the overall population and (b) CGI by physician (weeks 4 and 6 average) in the overall population

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Figure 2: Physician CGI score average of weeks 4 and 6 in patients with only a single muscle group requiring treatment (ie mild/no spasticity in the untreated muscle)

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Figure 3: Physician CGI score average of weeks 4 and 6 in patients with less severe spasticity in the untreated versus treated muscle

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Keywords: Clinical global impression, onabotulinumtoxinA, spasticity

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O17-4: AntiCoTox: A French national survey about the management of patients under antithrombotic drugs requiring intramuscular botulinum toxin injections for the treatment of spasticity Top


Ozoua Elodie Ble1, Djamel Ben Smail1, François Boyer2, Pierre-Alain Joseph3, Bernard Parratte4,5, Dominique Perennou6, Thibaud Lansaman1, Jonathan Levy1

1Department of PMR, Service de Médecine Physique et Readaptation, Hôpital R. Poincaré, Garches, France, 2CRIBL, UMR CNRS, France, 3???, EA416 University of Bordeaux France and IFR Handicap France 4, France, 4Institute of Movement Science, CNRS, Aix-Marseille University, Marseille, France, 5Department of Orthopaedics and Traumatology, APHM, Institute for Locomotion, Sainte Marguerite Hospital, Marseill, France, 6Département de MPR, Institut de Rééducation, Hôpital Sud, CHU Grenoble-Alpes, France

Background and Aims: According to French guidelines intramuscular botulinum toxin injections (BTI) are possible under antiplatelets. Based on the presumptive hemorrhagic risk, BTI should be avoided when under anticoagulants. Both Canadian and Korean surveys have shown a wide heterogeneity of management strategies for anti-vitamin K. We aim to describe daily practices of French PMR specialists regarding the management of patients under anti-thrombotic treatment (ATT) during BTI. Methods: Three investigators, all PMR physicians involved in spasticity management, designed an online questionnaire. Four independent experts critically reviewed the overall writing, and a panel of physicians of our institution underwent the whole survey to assess its consistency. It was then e-mailed directly to targeted physicians. We estimated the overall number of injectors to be 450 nationwide and expected a 30 to 50% response rate. Results: Three hundred and thirty-eight e-mails were sent on September 3rd 2018 (302 to physicians, and 36 to pharmacists in rehabilitation centers). On November 30th, 187 responses were collected. Sixteen were excluded. Most responders inject regardless of antiplatelets, but practices are not consensual for anticoagulants.

Four approaches were identified among responders:

  • -81 withhold ATT before BTI
  • -46 ask initial prescriber for advice before discontinuing ATT
  • -43 pursuit with BTI regardless of any ATT
  • -1 refers patients to an expert center.


Thirty-five physicians reported muscle hematomas, among whom 3 have had to deal with compartment syndromes that have needed surgery, arterial embolization and/or blood-derived products transfusion. Twenty-six declared recurrent thromboembolic events (including 16 cerebrovascular events) during anticoagulant bridging or therapeutic window framing BTI. Conclusions: The variety of management strategies highlights the lack of evidence-based data to accurately evaluate the benefits and risks, either for anticoagulant bridging or intramuscular BTI under ATT. Therefore, we may have to rethink this paradigm, as bridging could expose to a substantial thromboembolic risk.

Keywords: Anti-thrombotic, botulinum toxin, intra-muscular injection

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O17-5: The effect and mechanism of microglial activation in post stroke spasticity Top


Yao Liu1, Ya Zhou1, Juan Li Ao1, Li Wen Wang2, Xian Mo Chen1

1School of Rehablitation, Kunmming Medical University, Kunming, Yunnan, China, 2Department of Rehabilitation, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China

Background and Aims: Spasticity is one of the most common symptoms in the chronic phase of cerebral or spinal disorders. Recent studies have shown that activation of microglia after neurological disease contributes to excitability of the hyperexcitability of spinal neurons is considered a possible mechanism. The aim of this study was to investigate the correlation between microglia activation in the spinal cord neurons loop and cerebral spasticity. Methods: Rat cerebral spasticiy intracerebral hemorrhage model was established by injection of collagenase in right striatum. Electromyography and behavioral tests were performed on1, 3, 7,14 days after injury and 14 dyas after the microglia inhibition. The expression of OX42 in transverse sections of the brain, neck segment, thoracic segment and lumbar spinal cord were detected by immunohistochemical method to evaluate the activation of microglia. Results: Unilateral cerebral spasticity ICH rats displayed a significant contralateral decrease in H latency, increase in H amplitude, increase in H/M ratio, and a decrease in contralateral forelimb usage detected by cylinder test from day 3 to day 14 (p<0.05) compared with control group. Elevated expressions of OX42 was respectively observed in white matters at brain, cervical and lumbar segments of spinal cord in cerebral spasticity ICH rats on day 3, 7, 14 compared with control (p<0.05). In microglial inhibition rats, these expressions were significantly reduced. Significant correlations were found between H latency (R2=0.7981, p <0.05), H amplitude (R2=0.6031, p<0.05), and the elevated expression of activated microglial cells in cervical segment after ICH injury. Conclusions: We concluded that 1) the striatum cerebral hemorrhage model can successfully induce brain-derived spasticity that could be observed by behavioral and electrophysiological tests; 2) increased expression of activated microglial cells is found in the white matter of brain and spinal cord in the spasticity model. The elevated microglial activation is significantly related to the electrophysiological changes.

Keywords: Cerebral hemorrhage, microglial cells, spasticity

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O17-6: The analysis of time course of spasticity development using quantitative spasticity measurement device Top


Masahiko Mukaino1, Shota Ito2, Hiroki Tanikawa3, Hikaru Kondo2, Kenta Fujimura3, Kei Ohtsuka3, Hitoshi Kagaya1, Eiichi Saitoh1

1Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan, 2Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan, 3Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan

Background and Aims: Spasticity is a state of increased muscle tone with exaggerated reflexes. Although spasticity is a common symptom after a stroke, the time course of the symptom and its determinants is still not well explained. For a detailed analysis of the time course for spasticity development, a quantitative measurement methodology may be needed in addition to the widely used simple clinical scales. In this preliminary study, we have tried to monitor the time course of spasticity development using a newly-developed spasticity quantification device. Methods: Study participants included 12stroke inpatients (66 years old ±16 years). The measurement was performed once per week after admission to the rehabilitation ward, using Imasen Quantitative Measure of Spasticity (iQMOS), which was developed to measure spasticity. The extent of spasticity was quantified from the ankle joint resistance force in two conditions; slow velocity (5degrees/second) and fast velocity (300 degrees/second). Clinical evaluation with the commonly used scale for spasticity, modified Ashworth scale (MAS), was also performed. Results: The measurement value in the fast velocity condition and the difference value between the fast and slow velocities showed significant increase through the measurement periods. The measurement values are significantly correlated with MAS. Conclusions: The measurement of the time course for spasticity development was successfully conducted using iQMOS, showing the process of spasticity development after a stroke. Further detailed analysis of the time course with a larger sample size is encouraged.

Keywords: Clinical evaluation, measurement device, spasticity

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O18-1: Face validity of a multiple intelligences instrument for Spanish speaking young adults with intellectual disability Top


Mario A. Giraldo-Prieto1, 2, 3, Doris Ramirez4, Carlos Quintero1, 2, 5, Diego Pereira5, Melisa Zuluaga2, Paola Soto5, Carolina Lopera1,2, Vanessa Seijas1,2, Alejandra Vanegas2, Catalina Ocampo2, Marcela Yepes2, Maria-Teresa Rugeles2, Luz Helena Lugo1, 2, 6

1Department of Physical and Rehabilitation Medicine, University of Antioquia, Medellin, Colombia, 2Health Rehabilitation Research Group, University of Antioquia, Medellin, Colombia, 3Student MSc Clinical Epidemiology, 4Grupo de Investigacion en Didactica y Nuevas Tecnologias, Faculty of Education, University of Antioquia, Medellin, Colombia, 5Comite de Rehabilitacion, Medellin, Colombia, 6Health Rehabilitation Research Group, University of Antioquia, Medellin, Colombia

Background and Aims: The assessment of cognition in people with intellectual disability (ID) is limited to diagnose the deficiency and the evaluation tools do not guide towards inclusion to society. The theory of multiple intelligences (MI) proposed by Howard Gardner is a pluralistic view of intelligence grounded on eight domains of intelligences to help people for vocational planning, but only used in people without disability. The aim of this study was to perform the face validity for a MI instrument in Spanish for young adults with ID in order to guide vocational strengths and undergraduate studies. Methods: Existing validated questionnaires were searched in PubMed, Embase and PsychInfo with multiple related terms for ID, MI, reference tools and validity. Two reviewers (cognitive rehabilitation and special education) gather all items by each intelligence domain (LogicalMathematical, linguistic, spatial, kinesthetic, musical, interpersonal, intrapersonal, naturalistic) for reduction of duplicated items. Eleven experts completed a blinded selection of items for deletion according to four criteria: not applicable to ID, not applicable to culture, difficult to be understood, semantic similarity. A quantitative deletion was done with the Content Validity Ratio (CVR) under WilsonFR2012 recalculated critical values for one tail (Binomial, N11, p 0.05), critical CVR 0,496 for each item. Two researchers analysed the results for modifications. It was again delivered to experts for deletion (N7, CVR 0,622) and approval. Results: A final version was obtained for self and proxy versions, 6 to 9 and 6 to 16 items per domain of intelligence, respectively. The CVR range was 0,71 to 1,00 except for LogicMath in self version (0,71) [Table 1]. Conclusions: The Spanish Instrument of MI for Young Adults with Intellectual Disability, self and proxy versions was Face validated in Colombia. This process would provide tools for validation to other cultures and languages.



Keywords: Face validity, intellectual disability, multiple intelligences

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O18-3: Efficacy of cognitive stimulation therapy on the cognition of patients with vascular cognitive impairment: A pilot randomized controlled trial Top


Naoki Mori1, Yohei Otaka2, Kaoru Honaga1, Kunitsugu Kondo1, Daisuke Matsuura1, Meigen Liu3

1Department of Rehabilitation, Tokyo Bay Rehabilitation Hospital, Narashino, Japan, 2Fujita Health University, Toyoake, Japan, 3Keio University, Tokyo, Japan

Background and Aims: Cognitive stimulation therapy (CST) is a non-pharmacological intervention for people with dementia, often as a group-based intervention, where different activities are used to stimulate the individuals. Meta-analyses have reported that CST improves cognition and quality of life. However, the efficacy of CST for patients with vascular cognitive impairments has not yet been established. Furthermore, no study has been conducted in the convalescent rehabilitation phase. This study aimed to examine the efficacy of CST on the cognitive function of patients with vascular cognitive impairment who underwent inpatient rehabilitation in a rehabilitation hospital. Methods: A randomized, controlled, observer-blinded, single-center trial with 2 parallel groups was conducted in a convalescent rehabilitation hospital. In total, 20 participants were randomly assigned to either the CST (n=10) or control (n=10) group. For the CST group, the participants received 2 CST sessions a day, 5 times a week for 8 weeks in addition to the usual inpatient rehabilitation program. The participants in the control group received only the usual inpatient rehabilitation program. The primary outcome was the Mini-Mental State Examination score. The secondary outcomes included the scores of the Functional Independence Measure, Dementia Behavior Disturbance Scale, Neuropsychiatric Inventory Questionnaire, Vitality Index, and short version of the Quality of Life (QOL) questionnaire for dementia. The outcomes were compared between both groups. Results: No significant differences were noted in the primary (F=0.438, P=0.649) and secondary outcomes between the 2 groups. No adverse events were observed. Conclusions: No obvious intervention effects were found on cognitive function, activities of daily living, behavioral and psychological symptoms, and QOL. However, decreased behavioral and psychological symptoms were observed in some cases during the intervention. Further studies are needed to identify persons who may benefit from this type of intervention.

Keywords: Cognitive stimulation, dementia, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O18-4: Is post-stroke lateropulsion a kind of graviceptive neglect? Top


Shenhao Dai1,2, Celine Piscicelli1,2, Camille Lemaire1,2, Emmanuelle Clarac1, Patrice Davoine1, Anne Chrispin1, Monica Baciu1,2, Dominic Perennou1,2

1Neurorehab Unit, Institute of Rehabilitation, University Hospital Grenoble-Alpes, Echirolles, France, 2Lab Psychology and Cognition Grenoble-Alpes University, Grenoble, France

Background and Aims: Lateropulsion after hemisphere stroke is interpreted as a bias in verticality representation. Lateropulsion is puzzlingly associated with spatial neglect, interpreted as a bias in the sided representation of space. Disentangling how the neural bases of these 2 behaviors overlap might help understanding their association. Methods: Cross-sectional study of individuals consecutively admitted to neurorehabilitation ward after a first uni-lateral hemisphere stroke (Cohort DOBRAS 2012-2018, clinicaltrial.gov: NCT03203109), with clinical data systematically collected one month post-stroke. Participants were classified as showing lateropulsion (Scale for Contraversive Pushing, SCP>0.5) or not, and as showing spatial neglect (2/6 tests abnormal body or non-body neglect tests) or not. MRI with anatomical sequences performed at 2 months, were analyzed in correspondence with behaviors, using Voxel-based lesion-symptom (VLSM) mapping. Results: We investigated 178 individuals, 79 with right and 99 with left hemisphere stroke, among whom 53 (30%) had lateropulsion and 81 (46%) spatial neglect. Lateropulsion and spatial neglect were strongly associated (X2=90.4, p<0.001): all with lateropulsion showed spatial neglect whereas in those upright spatial neglect was found only in 22%. Interestingly, a strong overlap was also found regarding neural bases. Almost all (95%) areas involved in spatial neglect were also involved in lateropulsion. These areas were centered on the following brain structures, with a large right hemisphere predominance: insula, putamen, temporal and parietal lobes, and posterolateral thalamus. In the right hemisphere, these areas shared by lateropulsion and spatial neglect represented 15% of the total volume, which was considerable. Conclusions: This study identifies common cortical (insula, temporal and parietal lobes) and subcortical (putamen, posterolateral thalamus) brain structures involve in lateropulsion and spatial neglect, 2 behaviors representing different spatial dimensions. Would it means that lateropulsion and spatial neglect result from a same mechanism, lateropulsion being possibly caused by a kind of graviceptive neglect?
Figure 1: (a) overlapping lesion plots of 53 individuals with lateropulsion (b) overlapping lesion plots of 125 individuals upright (c) voxelwise statistical analysis lateropulsion versus upright (d) lateropulsion areas and neglect areas overlapping

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Keywords: Lateropulsion, neuroanatomy, spatial neglect

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O18-6: Comparison of perceived post-stroke difficulties in patients with aphasia, their caregivers and the healthcare providers Top


Bertrand Glize1,2, Melanie Cogne3, Valentine Percey1,2, Pierre Charaire1,2, Helene Cassoudesalle1,2, Patrick Dehail1,2, Mathieu De Seze1,2, Antoinette Prouteau4, Christian Belio1, Igor Sibon5, Mathilde Carlsberg2,6

1EA4136 Handicap Activity Cognition Health, University of Bordeaux, Bordeaux, France, 3Department of Physical and Rehabilitation Medicine, University Hospital of Rennes, Rennes, France, 2Department of Physical Medicine and Rehabilitation, CHU de Bordeaux, Bordeaux, France, 4EA 4139 Psychologie, Santé et Qualité de vie, University of Bordeaux, Bordeaux, France, 5Neurology, Stroke Unit, INCIA CNRS UMR 5287, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France, 6Bordeaux Population Health Research Center, INSERM U1219, University of Bordeaux, Bordeaux, France

Background and Aims: Among patients who have had a stroke¸ those with aphasia are particularly affected in their activities and participations. General Practitioners are the main medical supervisors of this population after their stroke. But the disabilities of these patients could be misperceived by healthcare providers due to their communication disorders or due to the influence of patients&acute caregivers during the consultations. The aim of this study was to compare the perception of chronic aphasic patients¸ their caregivers¸ their General Practitioners (GPs) and their Speech and Language Therapists (SLTs) about their disabilities assessed by a standardised questionnaire. Methods: In this pilot study we included 16 post-stroke aphasic patients (5 women¸ mean age=59.9 y.o.¸ >1 year after the stroke outcome). During a face-to-face interview performed by a physician and a speech therapist¸ disabilities were assessed by the Grid for Measurements of Activity and Participation (G-MAP)¸ a 24-item check-list following the 6 categories of the International Classification of Functioning¸ Disability and Health. The same assessment regarding caregivers&acute¸ GPs&acute and SLTs&acute perceptions of patients&acute disabilities was performed. Results: Regarding GPs¸ a significant overestimation of disabilities was noted particularly regarding interpersonal interactions and relationships¸ whereas SLTs had a better perception. On the other hand¸ SLTs misperceived disabilities in the intimate life of their patients. Perception of disabilities of aphasic patients by healthcare providers in primary care seemed to be overestimated¸ particularly regarding interpersonal interactions and relationships¸ contrary to patients without language impairment whose disabilities in several areas could be underestimated. Conclusions: These findings suggest that healthcare providers overestimate patients&acute disabilities in several areas of the aphasic patients&acute life. Patients with post-stroke aphasia should also be considered independently. The healthcare network¸ particularly the collaboration between GPs and SLTs, should be strengthened in order to permit better care of patients&acute disabilities.

Keywords: Aphasia, disability, primary care

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O19-1: Physical performance and the evolution of depressive symptoms in community-dwelling older adults with spontaneous memory complaints Top


Eiko Takano1,2, Izumi Kondo2, Mathieu Maltais1, Philipe S. Barreto1, Bruno Vellas1

1Institute of Aging, Toulouse University Hospital, Toulouse, France, 2Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, Obu, Japan

Background and Aims: Geriatric depression or depressive symptoms in older adults may have a negative impact on quality of life. We followed depressive symptoms and physical function in older, community-dwelling individuals for 3 years. We hypothesized that a decline in physical performance would be associated with a worsening of depressive symptoms. The aim of this study was to determine the prospective relationships between performance-based physical function and the evolution of depressive symptoms in older adults with spontaneous memory complaints (SMC). Methods: We performed secondary analyses using data from the multi-domain Alzheimer preventive trial (MAPT study). Participants were 1679 community-dwelling older adults (1088 women) aged 70 or older. Depressive symptoms were assessed at baseline and at 36 months using the Geriatric Depression Scale (GDS, 15 items, score range 0-15, higher is worse); physical function, measured with the short physical performance battery, and handgrip strength was measured at the same time points. We performed a multiple linear regression for the analyses between the changes in the physical performance and GDS scores. The changes were calculated by subtracting the value at 36 months from baseline. Results: The chair stand test was the only significant predictor of change in GDS score after 3 years, with an increase in time to perform the chair stand (worse performance) associated to an increase in the GDS (B-coefficient: 0.08, 95% confidence interval: 0.04-0.12) [Table 1]. Conclusions: We found that the changes in the chair stand test were associated with the changes in depressive symptoms levels at 36 months in older adults with SMC. Thus, the chair stand was the strongest predictor of depressive symptoms evolution. This test demands on muscle strength/power and balance. It is crucial since these are targeted through preventive as well as therapeutic strategies.



Keywords: Chair stand test, community-dwelling older adults, depressive symptoms

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O19-2: Combination of cerebrolysin and occupational therapy for the rehabilitation of men and women with post-stroke depression, who refused from treatment with antidepressants Top


Aleksei Andreevich Shmonin1, Maria Nikolaevna Maltseva2, Elena Valentinovna Melnikova1

1Department of Physical Methods of Treatment and Sports Medicine, First Saint-Petersburg I.P.Pavlov State Medical University, Saint Petersburg, Russia, 2Department of Psychology and Pedagogy, First Saint-Petersburg I.P.Pavlov State Medical University, Saint Petersburg, Russia

Background and Aims: The hypothesis of the study: Use of the drug Cerebrolysin can potentiate the effects of occupational therapeutic correction by stimulating neuroplasticity, reducing the manifestation of fatigue and stress. Purpose: To evaluate the effectiveness combination therapy of Cerebrolysin and occupational therapeutic correction for men and women with post-stroke depression. Methods: The study included 24 male and 24 female patients aged 48 to 67 years with lacunar stroke 5-7 months before the start of the study, who had no motor and speech disorders. The criterion for inclusion in the study was the presence of depressive disorders and disadaptation. The Beck Depression Inventory (BDI) was applied to assess the severity of the depressive disorder. The Canadian Occupational Performance Measure (COPM) was applying for assessment of activity and social adaptation. We assessed before the rehabilitation course, immediately after infusion and on the 90th day. In the main group, during the first 14 days of training, Cerebrolysin was administered: intravenously, 10 ml daily, once a day. In the control group, a placebo preparation was administered in the same manner. The course of occupational therapy lasted for 3 months. For men and women, statistical analysis was performed separately. Results: In patients receiving Cerebrolysin were a significant decrease in the depression level estimated by BDI in comparison with the placebo group (p<0.0001 for men and women) in all end points. In the Cerebrolysin group was a faster and more complete recovery of activity in the social environment (shopping) and productive activities (work for money and cooking) of the COPM-rated performance and satisfaction compared with the placebo group after end of infusion on the 90th day. Conclusions: Combined therapy with Cerebrolysin and occupational therapy is more effective in the rehabilitation of men and women with depression than a separate course of occupational therapy.

Keywords: Cerebrolysin, occupational therapy, post-stroke depression

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O19-3: Early support for patients with cognitive impairment after brain damage to return to active driving Top


Hisaya Higashi, Toru Kawamoto, Sadaharu Esaki, Takafumi Kimura

Daiyukai General Hospital, Ichinomiya, Japan

Background and Aims: Cognitive dysfunction after brain damage may cause impaired driving ability, and driving cessation is associated with the decrease of social integration and out-of-home activities. Nevertheless, in Japan there have been few supporting systems for the patients with cognitive impairment after brain damage to return to active driving. Therefore, we organized driving-resumption supporting team for brain damaged patients, and we have supported them early at the acute phase so that the patients can fit driving safely from an early stage. In this study we report our supporting system of resumption of driving for brain damaged patients and the result of fitness to drive. Methods: Among the brain damaged patients who were hospitalized in October 2016 to December 2018 at our hospital, 80 subjects were eligible to meet the start criteria for resuming driving. We evaluated their driving ability based on screening batteries and on-road performance, and classified them into three groups, i.e. possible, impossible or considerable group. Then, we calculated the period from the onset of brain injury to judgement of fitness to drive again. In this activity, we focused on training of on-road performance where a member of family joined an instructor of driving school and an occupational therapist. Depending on the patient's symptoms, we adopted one of two training courses, one is a driving school campus course, the other a street courses. Results: Among the patients in this activity, 56 were classified possible, 6 impossible and 18 considerable group. The period until fitness of driving was 112±70 days in the possible group. Conclusions: It is significant to estimate driving ability of brain damaged patients with cognitive impairment early and support their resumption of safe driving at early stage.

Keywords: Brain damage, driving-resumption supporting, on-road performance

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O19-4: A randomised controlled trial on the effect of cognitive rehabilitation for attention in mild traumatic brain injury Top


Norhamizan Hamzah1, Nor Atikah Mustapha2, Nur Adibah Mohd Tahir2, Vairavan Narayanan3, Norlisah Ramli4, Li Kuo Tan4, Avril Drummond Drummond5, Roshan Das Nair5, Mazlina Mazlan1

1University of Malaya, Kuala Lumpur, Malaysia, 2University Malaya Medical Centre, Kuala Lumpur, Malaysia, 3Department of Surgery, Neurosurgical Unit, University of Malaya, Kuala Lumpur, Malaysia, 4Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia, 5Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK

Background and Aims: This is a unicentre, blinded, randomized, 12-week parallel group study comparing a structured cognitive specific rehabilitation with standard care cognitive therapy for mTBI adults. Methods: Recruitment was from University Malaya Medical Centre (UMMC), Malaysia (NCT03237676). Intervention group (IG) received individualised computer-based therapy and metacognitive approach. Control group (CG) received best standard care cognitive therapy. Treatment frequency were 1 hour/ week/3 months (total 12 hours). Results: 76 patients were assessed at three months (male n58; female n18; mean age 29.1SD 8.33; education year 12.58 SD 2.0). Neuropsychological Assessment Battery-Screening (NAB) impaired cutoff standard score domain is below 85. At two weeks, Attention (80 SD 17), Language (83 SD 28) and Executive Function (81 SD 17) domains were impaired. At three months, 18 patients recovered cognitively and 31 patients (male n19, female n12) continued to have mean Attention (83 SD 18) and Language (75 SD 18) deficits but improved Executive Function (85 SD 13). These participants were equally randomised. IG (n16) received a mean total of 6-hour sessions. There was significant improvement (p<0.05) in the mean Attention (94 SD 13), Language (96 SD 30) and Executive Function domains (88 SD 17) consistent with improved Goal Attainment Scaling (GAS) beyond 60%, whereas CG with mean total of 4 hour sessions had persistent mean Attention (71 SD 18), Language (71 SD 50) and Executive Function deficits (73 SD 41) despite improved functional scores at six months injury (GAS beyond 55%). 84% of the participants had returned to work within 6 weeks of injury (CG 100%, IG 69%). Conclusions: Mild cognitive deficits were detected early (2 weeks of injury).Cognitive deficits were Attention, Language and Executive Function domains. Structured individualised cognitive intervention may improve cognition and function in mTBI, however, participation and treatment compliance were the main challenges faced in this study.

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

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O19-5: Improvement of psychological disorders in patients with mild traumatic brain injury after combining cognitive rehabilitation and psychological care Top


Bertrand Glize1, Melanie Cogne2, Valerie Perdrieau3, Elodie Guillouet3, Aurelie Granger3, Helene Defferriere3, Maryame Gatineau-Sailliant4, Clemence Lefevre3, Philippe Decq4,5, Philippe Azouvi3,6

1University Hospital of Bordeaux, Bordeaux, France, 2???, University Hospital of Rennes, Rennes, France, 3Rehabilitation Unit, Raymond Poincare Hospital, AP-HP, Garches, France, 4Neurosurgical Unit, Beaujon Hospital, AP-HP, Clichy, France, 5Georges Charpak Human Biomecanics Institute, Arts et Metiers ParisTech, Rene Diderot, Paris, France, 6EA 4047 HANDIReSP, Versailles-Saint Quentin University, Versailles, France

Background and Aims: Mild Traumatic Brain Injury (mTBI) is a public health issue with approximately 42 million people worldwide affected yearly. Most patients have a favorable short-term recovery but 10-20% are likely to develop post-concussion syndrome (association of physical, cognitive, and psychological difficulties after injury). Post-concussion syndrome can be associated with Post-Traumatic Stress Disorder (PTSD). There is to date only limited evidence on the interventions&acute effectiveness to improve psychological disorders. Our study aims at evaluating the effect of combined early cognitive rehabilitation and psychological care on psychological issues in mTBI patients. Methods: Each patient referred to our center due to post-concussion syndrome after mTBI was included. They received psycho-education regarding mTBI, post-concussion syndrome, and PTSD. An initial cognitive and psychological evaluation was completed using MPAI-4, Brief-IPQ, PCL-S, HADS. Patients with cognitive and/or mood impairments were offered a program combining cognitive rehabilitation and psychotherapy (mainly based on Cognitive Behavioural Therapy), 3 sessions/week over 4 weeks after which a final evaluation was performed. Results: From July 2017 to October 2018, 18 mTBI patients benefited from our entire program (9women;mean age=36.44y.o.±13.37; on average 11 months after the injury), at the end of which there were significant improvements of standardized MPAI-4 score (42.33±14.61 versus 50.44±8.04, p<0.05), of anxiety (HADS-A: 6.72±7.37 versus 11.11±5.02, p<0.05), and of mood disorders (HADS-D: 5.22±5.69 vs 8.61±4.63, p<0.05). Although PCL-S score did not decrease significantly (39.22±19.82 versus 46.50±19.61, p=0.28), based on a cut-off of 44, 25% of patients suffering from PTSD at the inclusion did not fulfil PTSD criteria anymore. However, the brief IPQ score did not decrease significantly (39.67±17.12 vs 49.28±14.55, p=0.08). Conclusions: This combined psychological and cognitive care for patients with mTBI and post-concussion syndrome appear valuable in reducing psychological distress. The future results of the follow-up will show if this positive effect continues after 6 months.

Keywords: Mild traumatic brain injury, post-traumatic stress disorder, psychological care

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O19-6: Quantitative analysis on correlation between cognitive impairment and cerebral white matter hyperintensity on fluid attenuated inversion recovery sequence Top


Yumei Zhang, Huixian Yu, Hongyan Chen

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Background and Aims: To analyze white matter hyperintensity ( WMH ) in different brain regions in patients with cerebral leukoaraiosis using semi-automatic quantitative analysis software, and analyze the partial correlation of WMH and cognitive impairment. Methods: A total of 63 healthy community subjects ( 50-85 years ) who had a physical examination in Beijing Tiantan hospital from January 2011 to January 2017 were included in this study. The cognitive function of all subjects were assessed using mini-mental state examination ( MMSE ) and Montreal cognitive assessment ( MoCA ). We quantitatively analyzed the WMH in the whole brain, periventricular and deep cortex on fluid attenuated inversion recovery ( FLAIR ) sequence, which represented white matter lesion, and made a partial correlation analysis of the volume of white matter lesion and cognitive function score, to investigate the role of white matter lesion in the development of cognitive impairment. Results: After adjusting for age, gender and education level, the volume of whole brain white matter lesion still had a partial correlation with MMSE and MoCA scores ( R'= - 0.428, P=0.001; R'= - 0.539, P < 0.001, respectively), and so did periventricular white matter lesion (R'= - 0.427, P = 0.001; R'= - 0.559, P < 0.001, respectively ) and deep cortex white matter lesion (R'= - 0.365, P = 0.004; R'= - 0.447, P < 0.001, respectively). Conclusions: There is a positive correlation between cognitive impairment severity and cerebral white matter lesion volume, especially white matter lesion in periventricular region.

Keywords: Cognitive impairment, fluid attenuated inversion recovery, white matter hyperintensity

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O20-1: The effect of prophylactic knee taping on knee joint biomechanics and function Top


Di Xie, Wenxing Zhou, Wenjing Ma, Ning Mao, Haimei Wang, Xiao Shi Shi, Bin Ma

Institute of Sports Medicine, Taishan Medial University, Taian, Shandong Province, China

Background and Aims: The incidence of non-contact injuries in knee injury is high; Taping has the function of supporting and stabilizing muscle on joint and improving proprioception. The aim of this study was to investigate the effect of knee taping on knee joint index. Methods: Eighteen recreation athletes performed drop landings with different time after knee taping(0 minute, 15 minutes, 30 minutes). Eight-camera Vicon motion analysis system and two Kistler plate measured kinetic and kinematic data. Every participant stood on the platform 35cm high and performed right-side and left-side leg drop landing respectively. Biodex isokinetic muscle strength measure equipment was used to measure isokinetic muscle strength and knee joint position sense. Results: The right-side knee flexion angle of initial contact to the ground showed a significant difference among difference time (p=0.007). Post hoc identified the knee flexion angle of initial contact to the ground after knee taping 30 minutes to be significantly greater in comparison to that after knee taping 0 minute during drop landings(p=0.035). The knee flexion moment showed significant difference after knee taping (p=0.011). The knee flexion moment after knee taping 30 minutes to be significantly greater in comparison to that after knee taping 0 minute during drop landings(p=0.05). Knee taping significantly increased isokinetic muscle strength of knee joint compared to that before taping (p<0.01). Conclusions: By limiting motion at the knee, knee taping could provide preventive benefits for knee joint.

Keywords: Biomechanics, knee joint taping, prevention

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O20-2: Peripheral blood derived stem cells in primary osteoarthritis of knee at low resources setting: Interim report of a phase II pilot RCT Top


Moshiur Rahman Khasru1, Tangila Marzen2, Md Ashraful Islam3, Khandakar Mohammad Hossain4, Mohammad Jahir5

1Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, 2Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh, 3Department of Transfusion Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh, 4Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh, 5Module General Hospital, Dhaka, Bangladesh

Background and Aims: Osteoarthritis (OA) of the knee is one of the main causes of musculoskeletal disability. Osteoarthritis is now often considered as organ failure. Because of limitations in the effectiveness of conventional management options, alternative possibilities such as cell based therapies are approaching into vogue. Methods: This phase-II pilot RCT is being conducted after the IRB ethical clearance. Patients attending PM&R department of BSMMU having Knee Osteoarthritis (radiological grade III and IV) and those fulfilling inclusion criteria are being considered as the sample. All respondents are being divided to into two groups by using randomization technique. Control group, 15 respondents are receiving standard care for Knee Osteoarthritis. Stem Cell group, 15 cases are receiving with single dose autologous peripheral blood derived stem cells (PBSCs). Stem cells are being harvested using G-CSF 30MU and CD34 stem cells are being collected through apheresis. Quality is being ensured measuring cell viability and surface antigen. All respondents are being assessed before treatment and at week 4, week 12 and week 24 for pain reduction and for functional improvement using Visual Analogue Scale (VAS 0-10) and validated Bengali WOMAC questionnaire. Joint sonographies are being done before treatment, at 12 and 24 week after treatment commencement. Results: Among all, Female were 67%, Mean Age: 53 year Grade III: 84%. Seven patients of each group completed 12 week's follow up and 4 patients completed 24 week's follow-up. After 12 weeks of stem cell therapy, pain reduction and functional significant improvement was observed in both groups and after 24 weeks further pain reduction, functional improvement is observed and the mean cartilage thickness increased by 0.17 mm only in stem cell group. This study will completed by mid of the year 2019. Conclusions: PBSCs is promising in patients with primary OA knee. Further large scale research is warranted.

Keywords: Low resource country, osteoarthritis, stem cell therapy

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O20-3: Altered resting state functional connectivity of the anterior insula cortex in female patients with chronic severe knee osteoarthritis Top


Kai Ushio1, Kazuyoshi Nakanishi2, Yukio Mikami1, Hiroaki Kimura1

1Department of Rehabilitation, Hiroshima University Hospital, Hiroshima, Japan, 2Department of Orthopedics, Hiroshima University Hospital, Hiroshima, Japan2

Background and Aims: Resting-state functional connectivity (rs-FC) between anterior insula cortex (aIC) and frontal or limbic cortex changed in patients with chronic Knee Osteoarthritis (OA) using functional MRI (fMRI). The number of female patients with knee OA was larger than that of male. Therefore, the pathology of knee OA may differ depending on sex. We aimed to examine the rs-FC between aIC and whole brain regions and correlation with rs-FC and pain score in female patients with severe chronic knee OA. Methods: We recruited female 19 patients with a diagnosis of chronic pain with knee OA and 15 age-matched controls. We used a 3.0-Tesla MRI scanner. Rs-fMRI date were analyzed using SPM12, CONN tool box and Matlab. We evaluated the pain using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index). Spearman's correlation coefficients were calculated to investigate the relationship between pain score and strength of rs-FC with the aIC. Results: In female patients with severe chronic knee OA, bilateral aIC showed stronger connectivity with the right orbitofrontal cortex (OFC) compared with controls (p < 0.001 uncorrected peak-level and p < 0.05 cluster-level after familywise error). The correlation analyses revealed that the strength of the left aIC and right OFC was correlated with WOMAC pain scores (r=0.49, N=19, P=0.03), that of the right aIC and right OFC with WOMAC total scores (r=0.48, N=19, P=0.037), and WOMAC pain scores (r=0.46, N=19, P=0.049) in female patients with chronic knee OA. Conclusions: We showed that the rs-FC between the aIC and OFC was increased in female patients with chronic severe knee OA and was significantly associated with pain scores for knee OA using fMRI. These findings can be useful for new understanding of neuropathology and treatment in chronic knee OA.





Keywords: Chronic pain, knee osteoarthritis, resting-state functional MRI

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O20-4: The role of posture and body balance exercise towards balance and knee function in obese patients with knee osteoarthritis Top


Tirza Z. Tamin1, 2, 3, Regie Santoso1, 2, 3

1Department of Physical Medicine and Rehabilitation, Cipto Mangunkusumo Hospital, Jakarta, Indonesia, 2IDI, 3PERDOSRI

Background and Aims: Obesity is a health problem that has spread throughout the world. Abdominal fat accumulation will affect the interaction of joints and muscles, resulting in posture and body balance and functional capacity disturbances. Therefore an increase of postural muscle strength and body balance is required to maintain postural control. Balance management in obese patients with knee osteoarthritis can be done with conventional training (such as static or dynamic balance control) or latest technology like HUBER 360 equipment. The aim of this study was to measure posture and body balance exercises by assessing the posture and body balance function in obese patients with knee osteoarthritis. Methods: This research used pre-experimental design by looking at the comparison of posture and body balance before and after exercise. In this study we used HUBER; 360 equipment in 30 obese patients with knee osteoarthritis at Obesity Clinic Department of Medical Rehabilitation Cipto Mangunkusumo Hospital. Rehabilitation with posture and body balance exercise is carried out 3 times a week with each session for 15 minutes (total 30 minutes) in 8 weeks, with an increase in exercise load every 2 weeks for posture and body balance exercise and increased exercise load every 4 weeks for resistance exercise. Results: There were significant posture and body balance improvement in obese patients with osteoarthritis in 2 months exercise using HUBER 360 equipment (first month sig. 0.01 <0.05; second month sig. 0.00 <0.05). Conclusions: Based on this study, posture and body balance exercise can improve posture and body balance in obese patients with knee osteoarthritis, which in this study, using HUBER 360 equipment. Exercises mainly performed in closed kinetic chains to enhance proprioceptive information from the foot soles and to obtain co-activation of stabilizing muscles; controlling feed-forward and feedback in the involved leg; and emphasizing quality of postural orientation.

Keywords: Obese patients with knee osteoarthritis, posture and body balance exercise, static and dynamic balance control

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O20-7: The differences in physical functions necessary for discharge to home after hip fracture on pre-injury residence area Top


Yuta Suzuki1,2, Yukio Urabe1, Noriaki Maeda1, Junpei Sasadai1, Taizan Shirakawa2

1Graduate School of Biomedical and Health Sciences, Hiroshima University, Higashihiroshima, Japan, 2Matterhorn Rehabilitation Hospital, Kure, Japan

Background and Aims: Hip fracture is the most common injury threaten life prognosis in the elderly, and the incidence rate continues to rise with population aging. The aging rate of Kure city where our hospital is located is 34%, which is the highest among the cities with a population over 150,000 in Japan. The goal of patients after hip fracture is to regain walking ability and return to their own home. However, Kure city is surrounded by mountains and faces the sea. Therefore many elderly lives on sloping area or islands, as a result, patients often struggle to return home. The purpose of this study was to investigate the physical function required for patients living in a sloping area or islands to discharge to their own home. Methods: We studied 352 patients (46 males and 306 females) with hip fracture who lived at home before the injury and rehabilitated in our hospital since 2012. Patients were divided into three groups based on pre-injury residence area: flat area, sloping area and island. Patients lived in the sloping area defined as those who required to walk on slopes or stairs when going out in daily life. Discharge destination, walking ability and Functional Independence Measure score (FIM score) were measured. These variables were compared among the three groups. Results: The highest rate of discharge to home was 72% in the flat area group, and the rate in the sloping area group was 65% and in the island group was 64%. Patients discharged to the sloping area had the highest walking ability (p<0.05), and patients discharged to the island had the highest FIM score (p<0.05). Conclusions: To discharge to home in the sloping area, higher walking ability was required, and in the island, it was necessary to self-reliance of the activity of daily living.

Keywords: Elderly, hip fracture, home discharge

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O20-8: Functional outcome a half-year after hip fracture in the elderly people Top


Ai Takahashi1,2, Hiroaki Naruse2, Ippei Kitade2, Seiichiro Shimada2, Misao Tsubokawa1,2, Tomoko Yamaguchi2,3, Yasuo Kokubo1,2, Akihiko Matsumine1,2

1Department of Orthopaedics and Rehabilitation Medicine, University of Fukui, Fukui, Japan, 2Division of Rehabilitation Medicine, University of Fukui Hospital, Eiheiji, Japan, 3Department of Community Medicine, University of Fukui, Fukui, Japan

Background and Aims: Proximal femoral fracture is one of the most serious health problems that affect locomotion ability in elderly people. However, it is unclear the factors related to functional outcome. The aim of this study was to assess walking recovery after proximal femoral fractures and influence factors. Methods: One hundred and sixty-three patients (mean age 81.5 y.o.) admitted to a single hospital from January 2016 to October 2017 with hip fractures (AO/OTA 31) were identified retrospectively. Medical demographics, treatment methods, pre-operative period, length of hospitalization, walking ability (pre-injury, at discharge, six-months after injury), the day of beginning to walk using parallel bars, were extracted from the hospital record. Walking ability was assessed using Functional Ambulation Category (FAC). Results: Patients of trochanteric fractures were significantly older than neck fractures patients (mean age 83.3 vs. 79.0, p=0.004). Surgical treatment was performed for one hundred and forty-five (89.0%) patient. The period from injury to operation was 0-38 days (average 7.7), and the main reasons to undergo elective surgery were drug management (anticoagulants or immunosuppressant, 27.0%), deep vein thrombosis (24.2%), aspiration pneumonia (19.7%), and urinary tract infection (15.2%). Forty-five percent of patients got worse one or more grade in FAC six-months after injury, and the functional outcome was positively related to FAC at pre-injury, at discharge, and negatively related to patient age. Day of beginning to walk was not related to six-months functional outcome. Conclusions: Walking recovery a half-year after hip fractures was related to the patients' age, FAC score of before injury and at discharge from an acute care hospital, but not related to the day of beginning to walk using parallel bars. Pre-operative complications such as aspiration pneumonia, deep vein thrombosis, urinary tract infection, were important problems to solve for early surgery and shorter hospitalization.

Keywords: Elderly people, functional outcome, hip fractures

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O20-9: Walking with a cane provides pain relief and reduces joint loading in patients with hip osteoarthritis Top


Masayuki Tazawa1, Naoki Wada1, Minori Kurosaki1, Yoko Ibe2

1Department of Rehabilitation Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan, 2Department of Rehabilitation, Gunma University Hospital, Maebashi, Japan

Background and Aims: Patients with hip osteoarthritis complain about pain during walking and disturbed gait ability. The use of a walking cane is a self-management strategy recommended for people with hip osteoarthritis. The aim of this study is to investigate the effects of cane use on pain relief and the reduction of joint loading during walking in patients with hip osteoarthritis. Methods: Fifteen patients with severe hip osteoarthrits were recruited. Participants were evaluated using a 3-dimensional motion analysis system. They were instructed to walk along a 5-m walkway with and without a cane. Ground reaction force data were collected using a force plate located in the center of the walkway. We asked about the pain that they experienced using a 100-mm visual analog scale (VAS) after each walking trial. We compared the walking data (walking speed, cadence, step length, peak vertical ground reaction force, and peak hip adduction moment) measured during walking with and without the use of a cane. Results: The walking speed did not differ between the two measurements (with and without a cane). Cadence was significantly reduced when walking with a cane (mean, 87 steps/minute vs. 94 steps/minute). The vertical ground reaction force and hip adduction moment were significantly decreased when walking with a cane (mean, 510 N vs. 597 N, 0.61Nm/kg vs. 0.72Nm/kg, respectively). The VAS of pain during walking with a cane was also reduced in comparison to walking without a cane (mean, 27 vs. 38). Conclusions: Although the use of a cane reduced cadence, it increased the stride, and thus did not reduce the walking speed in patients with. The use of cane during walking reduced pain in patients with hip osteoarthritis. This would be due to a reduction in the vertical ground reaction force and hip adduction moment.

Keywords: 3-dimensional motion analysis, hip osteoarthritis, t-cane

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O21-1: Relationship among motor subscore of the FIM (mFIM) on admission, mFIM gain in two weeks from admission, and mFIM gain until discharge in stroke patients Top


Yoshitaka Wada1, Shigeru Sonoda2, Makoto Watanabe3, Sayaka Okamoto2, Kie Yagihashi2, Hideto Okazaki4, Eiichi Saitoh1

1Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan, 2Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan, 3Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, Tsu, Mie, Japan, 4Department of Liaison Rehabilitation Medicine, Fujita Health University, Toyoake, Aichi, Japan

Background and Aims: The purpose of this study is to assess how to influence the FIM gain in two weeks from admission on stroke outcome prediction in comprehensive inpatient rehabilitation wards. Methods: The subjects were 1418 patients with cerebral hemorrhage or cerebral infarction who admitted to and discharged from our comprehensive inpatient rehabilitation wards from September 2004 to March 2017, were over 60 years old or older, and had no severe comorbidity. The motor subscore of the FIM (mFIM) was retrospectively obtained from our database. The relationship among mFIM scores on admission, mFIM gain in two weeks from admission (mFIM-G-2w), and mFIM gain until discharge (mFIM-G-DC) was visually evaluated using a 3-dimensional contour plot. Results: mFIM-G-DC tended to be high in case of high mFIM-G-2w. Large variation of mFIM-G-DC was seen in patients with middle value of mFIM-G-2w. Reverse phenomenon that means high mFIM-G-DC with low mFIM-G-2w sometime occurred in patients with low or middle mFIM on admission, however it was rare in patients with high mFIM on admission. Conclusions: Since there were some patterns among mFIM on admission, mFIM-G-2w, and mFIM-G-DC, using mFIM-G-2w in addition to mFIM on admission might improve predicton accuracy of FIM-G-DC. Further studies concerning the effect of other factors such as cognitive functions are needed in order to apply this pattern into individual cases.

Keywords: ADL, outcome prediction, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O21-2: The baseline score of ABMS2 can be the predictor for functional outcome, length of stay and discharge destination in stroke patients Top


De Gang Yang1,2, Rui Gu1,3, Wataru Kakuda1, Shin Sato1, Mitsuhiro Sano1, Chiharu Yashima1, Junichi Eguchi1, Masashi Kawaguchi1, Takeki Ishida1, Fei Zheng1

1Department of Rehabilitation Medicine, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan, 2Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, Faculty of Rehabilitation Medicine, Beijing BoAi Hospital, Capital Medical University, Beijing, China, 3Department of Orthopedic and Orthopedic Rehabilitation, China Rehabilitation Research Center, Faculty of Rehabilitation Medicine, Beijing BoAi Hospital, Capital Medical University, Beijing, China

Background and Aims: There were only a few reports demonstrating the predictive value of the Ability for Basic Movement Scale (ABMS2) on the functional ability in acute stroke patients. However, the predictive value of this scale for stroke patients in the convalescent phase has not been investigated yet. The purpose of this study is to identify whether the ABMS2 score at admission would predict the functional status and their discharge destination from the convalescent ward in stroke patients. Methods: Seventy-four stroke patients who were admitted to convalescent rehabilitation ward were investigated (average age: 74.3 +- 10.44 years old, diagnosis: cerebral infarction in 50 patients and intracerebral hemorrhage in 24 patients). The function of each patient was evaluated by the ABMS2, FIM simultaneously at admission and discharge. Furthermore, the age, gender, diagnosis, length of stay in hospital and the destination after discharge were recorded. Discharge destination was divided into two categories such as home and facility. The patients transferred to other hospital were included in the facility group. Results: Spearman analysis showed that there were significant positive correlations between the ABMS2 score at admission and the total score of FIM in admission or at discharge for stroke patients. Moreover, a significant negative correlation between the ABSM2 score at admission and length of hospitalization was found in these patients. The average value of ABMS2 score in admission was significantly higher in patients going back to home than in those transferred to facilities. Conclusions: Higher score of the ABMS2 at admission predicted better functional recovery, shorter length of stay and more possibility to home in convalescent stroke patients. This new, easy scale is expected to be widely used for stroke patients.

Keywords: Discharge prediction, stroke, the abilitiy for basic movement scale 2

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O21-3: Adaptation and validation of the Japanese self-report version of the spinal cord independence measure Top


Sho Takeuchi1, Osamu Uemura1, Kei Unai2, Meigen Liu3

1National Hospital Organization Murayama Medical Center, Musashimurayama, Japan, 2Saiseikai Higashikanagawa Rehabilitation Hospital, Yokohama, Japan, 3Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan

Background and Aims: Spinal Cord Independence Measure (SCIM III) is an instrument that is used to assess capacity in activities of daily living in persons with spinal cord injury (SCI). SCIM III is composed of 19 items, which are grouped into three subscales, 'self-care', 'respiration & sphincter management', and 'mobility'. The total SCIM III score ranges between 0 and 100. Higher scores reflect higher levels of independence in activities of daily living. SCIM III is scored by observation by healthcare professionals. Such observations are not applicable in outpatient settings. Then, a self-report version of SCIM III (SCIM-SR) was developed in German by Fekete et al. and translated into English, French, Italian, and Spanish. The objective was to evaluate a transcultural adaptation and validation of the Japanese SCIM-SR (jSCIM-SR) as a tool to measure functional assessment in persons with SCI. Methods: The jSCIM-SR was translated from the English version. The use of the SCIM-SR was authorized by the original author. Fifty-seven inpatients with SCI were recruited. Trained and experienced nurses scored the SCIM III by observation. In addition, the patients completed the jSCIM-SR. Both scores were compared. Results: A high correlation was observed between SCIM III and jSCIM-SR (Spearman correlation coefficient rho:0.951). For the subscales, the rhos were 0.906 for self-care; 0.874 for respiration & sphincter management; and 0.908 for mobility. Bland-Altman plots showed a small bias of 0.61 (95% limits of agreement: -14.2, 15.5). The estimated bias was low in all three domains, with values of 0.74 (-4.7, 6.1), -1.56 (-11.5, 8.3) and 1.44 (-7.4, 10.3) for the self-care, respiration & sphincter management and mobility subscales. Conclusion: Our results supported the criterion validity of jSCIM-SR, and it can be administered for longer-term evaluations of independence in persons with SCI in the outpatient settings.

Keywords: Activities of daily living, spinal cord independence measure, spinal cord injury

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O21-4: Factors affecting discharge to home after surgery for spinal metastasis: Analysis using a national inpatient database Top


Ryoko Sawada1, Hayato Yamana2, Yusuke Shinoda1, Takahiro Ohki1, Hideo Yasunaga3, Nobuhiko Haga1

1Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan, 2Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, 3Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Background and Aims: Surgery for symptomatic spinal metastasis is widely accepted as an effective approach to improve patient's quality of life. One of its goals is patients' going back to home. However, there has been few previous reports about discharge status in patients undergoing surgery for spinal metastasis. The purpose of this study is to analyze factors associated with discharge to home after surgery for spinal metastasis. Methods: Using data from the Japanese Diagnosis Procedure Combination database from 2010 to 2016, we identified patients discharged alive after surgery for spinal metastasis. We extracted data on age, sex, type of surgical procedure, multiple spinal surgery, emergency admission, primary site of tumor, comorbidities, other distant metastasis, spinal cord injury, and Barthel Index at admission. Multivariable logistic regression analysis was performed to evaluate association between these factors and discharge to home. Results: Of 3184 eligible patients, 2086 (65.5%) were discharged to home. Multivariable analysis showed patients were significantly more likely to be discharged to home when they had younger age (odds radio [OR] for <60 years old [with reference to ≥80], 3.12; 95% confidence interval (CI), 2.29-4.23; p<0.001) or higher Barthel Index at admission (OR for 100 [with reference to 0-20], 4.62; 95%CI, 3.68-5.78; p<0.001). Patients were significantly less likely to be discharged to home when they had spinal cord injury (OR, 0.65; 95%CI, 0.53-0.79; p<0.001) or they received more invasive procedure such as total en block spondylectomy. Conclusion: Older age, poor activities of daily living at admission, spinal cord injury and invasive procedure may cause difficulty in discharge to home. Early consideration for the discharge destination or early utilization of resources to prepare home environment for discharge may be especially important in patients with these backgrounds.

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O21-5: Relationship between physical frailty and activities of daily living in persons with respiratory disease Top


Shigenori Hiraoka1, Yoichiro Aoyagi1, Yuji Kono2, Michiko Taya1, Kanan Yatsuya1, Eriko Mizokoshi1, Chen Hui1, Hitoshi Kagaya1, Eiichi Saitoh1

1Department of Rehabilitation Medicine I, Fujita Health University, Toyoake, Japan, 2Department of Rehabilitation, Bantane Hospital, Fujita Health University, Toyoake, Japan

Background and Aims: Ratio of elderly population is 27.7% in Japan. The ratio is estimated to exceed 33% in 2035. Frailty is the number one cause of long-term care for people of advanced age. Discussion about frailty is needed to extend healthy life expectancy and shorten the length of care required. However, few have discussed frailty for each individual disease. We focused on inpatients who underwent rehabilitation therapy and analyzed the influence of frailty on hospital stay and ADL. Methods: Data of 57 inpatients (mean age; 78 +/- 10) hospitalized in respiratory medicine of an acute hospital between April 2017 and September 2018, were collected. Principal diseases were as follows: 19 COPD, 16 pneumonia, 8 CPFE, 5 asthma, 3 pulmonary fibrosis, 3 empyema, and 3 others. Weight loss, fatigue feeling, exercise habits, muscule strength and walking speed were evaluated according to Japanese Cardiovascular Health Study (J-CHS) at the start of the rehabilitation program, and the patients were classified into non-frailty group and frailty group. We also investigated the length of hospital stay, FIM at admission, and FIM gain during hospitalization. Results: Thirty-four patients (59.6%) were classified as frailty group and 23 as non-frailty group. Average hospital stay of frailty group was 22.2 +/- 11.6 days, whereas that of non-frailty group was 16.3 +/- 10.3 days. FIM score at admission was 54.2 +/- 8.9 for frailty group and 63.5 +/- 18.7 for non-frailty group. Cognitive FIM score was significantly lower in frailty group(p<0.01). FIM gain was 14.1 +/- 20.0 for frailty group and 8.2 +/- 11.5 for non-frailty group (p<0.01). Conclusions: Up to 60% of inpatients with respiratory disease had frailty. Although inpatients with frailty had low ADL score at admission and long hospital stay, they had higher FIM gain, suggesting that rehabilitation therapy for patients with frailty is more effective.

Keywords: Frailty

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O21-6: Longitudinal study on activity monitoring for over 24 h among patients in a rehabilitation ward Top


Hirotaka Matsuura1, Masahiko Mukaino1, Yasushi Aoshima2, Ayaka Inukai2, Emi Hattori2, Yurie Yamada2, Masaki Kato2, Yuki Okochi2, Takayuki Ogasawara3, Eiichi Saitoh1

1Department of Rehabilitation Medicine 1, School of Medicine, Fujita Health University, Toyoake, Japan, 2Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan, 3NTT Device Innovation Center, NTT Corporation, Atsugi, Japan

Background and Aims: In order to interpret the effectiveness of rehabilitation, it is important to know how much influence the intervention has on patients' daily activities. The present study aimed to evaluate whether it is possible to monitor the changes in the amount of inpatients' daily activity in a rehabilitation ward through the use of a wearable heart rate (HR) measurement system (the hitoe system). Methods: The present study included 16 central nerve disorder patients from the rehabilitation ward (10 men and 4 women, with a mean age of 68.3 years). We performed the activity monitoring using the hitoe system for three days at admission and every two weeks until the sixth week after admission. The HR, %HRR (percent heart rate reserve), lying time and acceleration was monitored by the hitoe system. The daily (24 hours) sum of %HRR and acceleration-based motion index was also monitored. The motor score of functional independence measure (motor FIM) was also checked to see the improvement in the actual performance of daily activities. Results: The average daily total lying time decreased throughout the period (14.2hours at admission, 13.1hours at the 2nd week, 13.0 hours at the 4th week, 12.4 at the 6th week). The daily sum of %HRR was not statistically different at each week (13140.6%min, 13499.7%min, 14067.8%min, 14476.9%min, respectively), while the daily sum of the acceleration-based motion index increased (7.0m/S2, 8.9m/S2, 10.3m/S2, 11.3m/S2, respectively), correlating with motor FIM for each week. The average daily sum of %HRR at admission and the 2nd and the 4th weeks tended to be correlated with motor FIM gain (0.44 (P=0.07)) throughout the period. Conclusions: The activity monitoring of inpatients using a wearable HR measurement system was successfully performed. Wearable systems such as the hitoe system could contribute to understanding the effects of interventions on patients' daily activities.

Keywords: Activity monitoring, %HRR, wearable heart rate measurement system

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O21-7: Prediction of life-space mobility in patients with stroke 2 months after discharge from rehabilitation: A retrospective cohort study Top


Mari Nakao1, Shinichi Izumi1, Yuki Yokoshima2, Yoshiko Matsuba2, Yutaka Maeno2

1Department of Rehabilitation Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan, 2Yokohama Brain and Spine Center, Yokohama, Japan

Background and Aims: A patient's prognosis for life-space mobility after discharge from rehabilitation (convalescent) ward need to be predicted during their hospital stay in order to establish clear and appropriate goals for community-based rehabilitation. The present study aims to determine the predictors of life-space mobility among patients with stroke 2 months after discharge from a post-acute rehabilitation unit. Methods: The study population was 1023 patients discharged from a post-acute rehabilitation unit in Japan. We assessed the relationships between life-space mobility 2 months after discharge and age, sex, length of hospital stay, cognition and motor function (Functional Independence Measure), severity of hemiparesis, falls efficacy, physical function (Timed Up and Go test), walking distance ability and social support from family and friends. Results: Bivariate and multiple regression analyses showed that life-space mobility was predicted by sex, age, cognitive score at discharge, Timed Up and Go score < 15 seconds, length of hospital stay and falls efficacy at discharge. Taken together, these factors accounted for 54% of the variability in life-space mobility. A predictive formula was determined for clinical use. Conclusions: The predictive formula provides an objective measure of life-space mobility for stroke patients after discharge. The clinical application of this formula could help health care professionals working in stroke rehabilitation to prepare patients for discharge and to set concrete goals for in-hospital rehabilitation to improve life-space mobility after discharge.

Keywords: Community involvement, mobility limitation, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O21-8: Do family members' hospital visits influence clinical outcome of the patients admitted to a convalescent rehabilitation ward? Top


Wataru Kakuda1, Sawako Kagamizono2, Ayaka Iwato2, Kazumi Cho2, Mitsuhiro Sano2, Takeki Ishida2, Ayaka Takahashi2

1Department of Rehabilitation Medicine, School of Medicine, International University of Health and Welfare, Otawara, Japan, 2Department of Rehabilitation Medicine, IUHW Ichikawa Hospital, Ichikawa, Japan

Background and Aims: The family members of the inpatients receiving a long term rehabilitation often visit the hospitals to see and to take care of the patients. It is expected that the visits can increase patients' motivation for rehabilitation and can facilitate functional recovery. However, it still remains unclear how the visits by the family members can influence clinical outcome of such inpatients. We aimed to clarify the influence of the visits on the outcome in this study. Methods: The subjects for this retrospective study were 110 patients who were admitted to our convalescent rehabilitation ward (mean age at admission: 71 years old). Among them, 46 patients were diagnosed as stroke and 40 patients were with orthopedic disorders. For each patient, the frequency of family members' hospital visits during the hospitalization (times per day) was calculated, and the score of functional independence measure (FIM) at admission and discharge was collected. Statistically, the relationship between the frequency of the visits and the changes in FIM score during the hospitalization was analyzed. Results: The change in FIM motor score was not influenced by the frequency of the hospital visits. However, in the patients with orthopedic disorders, the increase in the frequency of hospital visits significantly correlated with the increase in FIM cognitive score. Conclusions: In some patients admitted to a convalescent rehabilitation ward, family members' hospital visits can be beneficial for the patients and can produce better clinical outcome. It seems that the visits might have a potential to improve cognitive function in the inpatients. We should encourage the visits by family members for the inpatients receiving a long term rehabilitation.

Keywords: Convalescent rehabilitation ward, functional independence measure, hospital visit

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O21-9: Do outpatient rehabilitation services save inpatient bed days? Mapping the relationship between outpatient services and inpatient rehabilitation length of stay in NSW/ACT hospitals Top


Steven Faux1,2, Angela Vrasistas-Curto1, Chrisitine Shiner1,2, Ian Harris2, Michael Pollak3, Francis Simmons4, Linda Klien5

1Department of Rehabilitation and Pain Medicine, St. Vincents Hospital Sydney, Darlinghurst, Australia, 2University of New South Wales Australia, Kensington, Australia, 3University of Newcastle, Callaghan, Australia, 4Australian Rehabilitation Outcmes Centre, Wollongoing University, Wollongong, Australia, 5University of Sydney, Sydney, Australia

Background and Aims: Outpatient services are expensive to run and so in order for the service to be cost effective, we need to inquire if they save inpatient bed days. Outpatient services and inpatient services for hip fracture and stroke were analysed from all rehab units in New South Wales, the most populous Australian state. This was done in order to establish if there is a relationship between available outpatient rehabilitation services and inpatient length of stay for patients with stroke or hip fracture. Methods: Cross sectional study of approximately 70 NSW/ACT rehabilitation hospitals. NSW/ACT hospitals that provide rehabilitation services for patients with stroke and hip fracture. Information from each NSW/ACT hospital was collected in the following areas: inpatient and outpatient services; Australasian Rehabilitation Outcome Centre (AROC) data files for inpatients with stroke or hip fracture from 2012-2015 (i.e. LOS, admission and discharge FIM, age, sex and comorbidities); and acute LOS. Results: Preliminary results show that hospitals with well functioning outpatient services defined by breadth of allied health services provided and maintenance of short waitlists, were associated with lower inpatient length of stay by over 2 days providing over $1500 AUD saving per case. Conclusions: This is the first Australian study to show a strong relationship between outpatient services and cost savings for inpatient care.

Keywords: Ambulatory rehabilitation, cost effectiveness, inpatient rehabilitation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O22-1: Characteristics of post-esophagectomy dysphagia: A videofluoroscopic study Top


Asako Kaneoka1, Haruhi Inokuchi1, Rumi Ueha2, Takao Goto2, Taku Sato2, Takaharu Nito2, Yasuyuki Seto3, Nobuhiko Haga1

1Hospital Rehabilitation Center, The University of Tokyo, Tokyo, Japan, 2Department of Otorhinolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan, 3Department of Gastrointestinal Surgery, The University of Tokyo, Tokyo, Japan



Background and Aims: Oropharyngeal dysphagia is one of the complications following esophagectomy. However, the characteristics of post-esophagectomy dysphagia have not been detailed. This study aims to identify the major changes in dysphagic symptoms in patients undergoing esophagectomy. Methods: We included 20 patients who completed videofluoroscopy before and after esophagectomy. Two researchers independently assessed dysphagic symptoms in videofluoroscopy using trials of 5mL of thin and thick liquids. The degree of airway protection was scored using Rosenbek's Penetration-Aspiration Scale (PAS). PAS>=3 was considered to be abnormal. The timing of penetration/aspiration was also noted as before, during, or after the swallow. The severity of residue in the valleculae and pyriform sinuses was graded respectively using a four-point scale. The Wilcoxon signed-rank test was performed to compare the median residue grades of thin and thick liquids before and after surgery. Results: Table 1 shows patients' demographics and treatment features. The median days from surgery to the pre-operative and post-operative videofluoroscopic studies were 68.0 (range:13-105 days) and 13.5 (range:6-63 days) respectively. All patients completed the thick- and thin-liquid trials before surgery. Three patients could not complete the thin-liquid trials after surgery due to safety concerns with the presence of very severe dysphagia with reduced ability to clear the airway. No PAS>=3 events occurred before surgery (0%); eight PAS>=3 events occurred after surgery (21.6 %). All the eight PAS>=3 events occurred during the swallow. The residue grade of thin (p=0.0020) and thick (p=0.0002) liquids for the valleculae and thin (p=0.0313) and thick (p=0.0313) liquids for the pyriform sinuses increased significantly after esophagectomy. Conclusions: This study identified two major characteristics of post-esophagectomy dysphagia: penetration/aspiration during the swallow and post-swallow pharyngeal residue. Future research is warranted to investigate pre-to-post operative changes in swallowing biomechanics which may lead to those dysphagic symptoms identified in this study.

Keywords: Aspiration, dysphagia, esophagectomy

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O22-2: Effect of a speaking valve on biomechanical properties of swallowing and the upper airway flow characteristics for tracheotomized patients after acquired brain damage Top


Zulin Dou

Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yet-Sen University, Guangzhou, China

Background and Aims: Alterations in swallowing and the upper airway flow characteristics can occur after tracheotomy and can result in varying degrees of aspiration. The study investigated the effects of a Passy-Muir speaking valve (PMV) on biomechanical properties of swallowing and the upper airway flow characteristics, explored swallowing-breathing interactions preliminarily for tracheotomized patients after acquired brain damage. Methods: Nineteen patients and ten healthy volunteers were recruited. High resolution manometry (HRM) and videofluoroscopic swallowing study (VFSS) were performed to evaluate the swallowing function of the healthy and patients without and with PMV. Three-dimensional models of the upper airway were constructed based on the CT scan data. Pressure in pharynx which was measured by HRM was used as boundary conditions. Computational fluid simulations were performed to acquire upper airway flow characteristics. Results: Three-dimensional models of the upper airway were successful constructed in 6 patients. The other 13 patients failed to reconstruct because of upper airway obstruction. The location of obstruction most often occured in the subglottic region and trachea. A statistically significant decrease between the patients and healthy subjects was observed in the volume of the whole pharynx. Futhermore, the patient group showed significantly lower upper esophageal sphincter (UES) resting pressure, shorter UES opening times and less hyoid anterior movement (HAM), but significantly higher UES residual pressure, as well as higher airflow velocity and pressure during inspiratory, expiratory, especially swallowing phase. With the PMV, higher UES resting pressure, larger hyoid superior movement (HSM) and UES opening diameter, lower airflow velocity and pressure were observed, the airflow velocity dropped to almost normal level during swallowing phase. Conclusions: The incidence of laryngotracheal stenosis and obstruction is high among tracheotomized patients after acquired brain damage. The PMV demonstrated significant effects on UES resting pressure, HSM, UES opening diameter, upper airway airflow velocity and pressure.
Figure 1: Space-time map of high resolution manometry. (a) Without the Passy-Muir speaking valve (b) with the Passy-Muir speaking valve

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Figure 2: Upper esophageal sphincter opening diameter of videofluoroscopic swallowing study. (a) Without the Passy-Muir speaking valve (b) with the Passy-Muir speaking valve

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Figure 3: Velocity contour and pressure contour in sagittal cross-section during inspiratory, expiratory and swallowing phase

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Keywords: Acquired brain damage, airflow, speaking valve

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O22-3: How viscosity and volume of a bolus affects esophageal motility during swallowing? – A study using high resolution manometry Top


Yoichiro Aoyagi1, Sayuri Imaeda2, Yuri Nakazawa3, Hiroshige Taniguchi4, Makoto Hirumura5, Hitoshi Kagaya1, Seiko Shibata1, Eiichi Saitoh1

1Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, Toyoake, Japan, 2Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan, 3Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Toyoake, Japan, 4School of Dentistry, Asahi University, Mizuho, Japan, 5Department of Rehabilitation, Bantane Hospital, Fujita Health University, Toyoake, Japan

Background and Aims: Esophageal motility is imperative for swallowing. However, effects of volume and viscosity of a bolus on esophageal motility have been rarely investigated. We examined how volume and viscosity is related to esophageal motility during swallowing. Methods: Participants were 12 healthy adults (4 males and 8 females, average age: 29.5 +- 2.0 years old). A high-resolution manometry catheter was inserted through the nostril and the tip of the catheter was placed inside the stomach. A participant swallowed 3 ml of liquid, 20 ml of liquid, 3 ml of thick water, and 20 ml of thick water 5 times respectively. We analyzed the pressure parameters associated with esophageal peristaltic activity in each volume or viscosity, using two-way analysis of variance. Results: In terms of volume, esophageal peristalsis movement during 20 ml thick water swallowing was delayed and the esophageal pressure increased (p <0.01) as compared to 3 ml thick water swallowing. There was no significant difference in liquid. In comparison of viscosity, the esophageal peristalsis movement during 20 ml thick water swallowing was slow and the esophageal pressure increased (p <0.01) as compared to 20 ml liquid swallowing. Three ml of liquid and thick water did not show any significant difference. Conclusions: It was found that volume and viscosity significantly influence esophageal pressure and peristaltic movement speed. As thick water increases in volume, it requires slow and strong peristaltic movement. Interestingly, when liquid increased in volume, the esophageal pressure did not increase probably because of assistance of gravity.

Keywords: Dysphagia, esophageal pressure, swallowing

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O22-4: Risk factors for dysphagia after cervical decompression and fusion Top


Haruhi Inokuchi1, Asako Kaneoka2, Nobuhiko Haga1

1Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan, 2Rehabilitation Center, The University of Tokyo Hospital, Tokyo, Japan

Background and Aims: Dysphagia is a well-known complication of cervical spine surgery, especially with the anterior approach. We have previously reported that patients who underwent cervical decompression and fusion, compared to laminoplasty, had a higher risk of post-surgery dysphagia. However, risk factors for dysphagia after cervical decompression and fusion remain unknown. This study aimed to identify the risk factors for dysphagia after cervical decompression and fusion. Methods: We retrospectively reviewed the electric medical records and identified patients who underwent cervical decompression and fusion from 2009 to 2018. We defined that dysphagia was present if a patient diagnosed as having dysphagia after surgery at the Dysphagia Clinic of our hospital for swallowing assessment or needed tube feeding or diet modification. We extracted the presence/absence of traumatic injury before surgery, types of surgical approach, and the range of fusion. Pre- and post-operative occipito-C2 angle and C2-C7 angle with neutral head position were measured on lateral X-rays. Results: Of 79 patients who underwent cervical decompression and fusion, 14 patients had dysphagia. Dysphagia group had a higher proportion of traumatic spinal cord injury (six in 11 patients, p<0.001) and anteroposterior fusion (six of 13 patients) compared to single anterior (three in 29 patients) or posterior fusion (five of 37 patients, p = 0.013, Table 1). No significant difference was found in the range of fusion or pre- and post-operative occipito-C2 angles and C2-C7 angles between dysphagia and non-dysphagia groups [Figure 1]. The multivariate regression model showed that the traumatic spinal cord injury (OR=47.37; p<0.001) and surgical approaches (OR= 5.95; p<0.004) were predictive of post-surgery dysphagia [Table 2]. Conclusions: We should expect dysphagia after cervical decompression and fusion if the primary disease for surgery is traumatic spinal cord injury or if the surgery includes both anterior and posterior approaches.
Figure 1: Pre- and post-operative occioito-C2 angle and C2-C7 angle of dysphagia and non-dysphagia groups

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Keywords: Cervical spine, decompression and fusion, dysphagia

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O22-5: Upper esophageal sphincter pressure at rest during magnetic stimulation of suprahyoid muscles in healthy individuals Top


Hitoshi Kagaya1, Keiko Aihara2, Mao Ogawa1, Yuki Nagashima1, Yoichiro Aoyagi1, Shino Mori1, Fumi Toda1, Seiko Shibata1, Yoko Inamoto3, Keiko Onogi4, Eiichi Saitoh1

1Department of Rehabilitation I, School of Medicine, Fujita Health University, Toyoake, Japan, 2Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan, 3Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan, 4Faculty of Nursing, School of Health Sciences, Fujita Health University, Toyoake, Japan

Background and Aims: Neuromuscular electrical stimulation has widely used in patients with dysphagia, but it is difficult to get sufficient hyoid bone movement by surface electrodes. Recently, we stimulated suprahyoid muscles by peripheral magnetic stimulation (PMS) and got enough hyoid bone movement. In normal swallow, the upper esophageal sphincter (UES) opens by the anterosuperior displacement of the hyoid bone and larynx. So our hypothesis was that UES pressure at rest decreased by PMS of the suprahyoid muscles. Methods: This study was approved by the institutional review board. The subjects were 9 heathy men who gave written informed consent. We stimulated the suprahyoid muscles by using specially designed small coil. Simultaneously, the high-resolution manometry that had 36 channels were inserted and UES pressure at rest without and with PMS were measured. The coil to simulate suprahyoid muscles was placed on the submental area of the subjects and the PMS was performed at a rate of 30 Hz for 2 s. The intensity level selected induces hyoid bone movement without causing intolerable pain to the subjects. Results: The UES pressure at rest was 173 ± 79 mmHg before PMS, 113 ± 59 mmHg during PMS, and 171 ± 83 mmHg after PMS. It was significantly lower during PMS. Conclusions: PMS of the suprahyoid muscles reduces the UES pressure at rest. This technique may be available for patients with insufficient opening of the UES.

Keywords: Dysphagia, magnetic stimulation, upper esophageal sphincter

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O22-6: A randomized controlled trial of repetitive peripheral magnetic stimulation for strengthening suprahyoid muscles Top


Mao Ogawa1, Hitoshi Kagaya1, Yuki Nagashima1,2, Shino Mori1, Seiko Shibata1, Yoko Inamoto3, Yoichiro Aoyagi1, Fumi Toda1, Eiichi Saitoh1

1Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan, 2Department of Dysphagia Rehabilitation, School of Dentistry, Nihon University, Tokyo, Japan, 3Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan

Background and Aims: We have obtained good hyoid bone movement at rest by stimulating suprahyoid muscles with peripheral magnetic stimulation. The aim of this study was to compare the effect of repetitive peripheral magnetic stimulation (rPMS) with head lift exercise (HLE) for strengthening suprahyoid muscles. Methods: This study integrated the prospective, randomized, open-label, blinded endpoint (PROBE) study model and was approved by the institutional review board. Twenty-four healthy young men were recruited and randomly assigned to the two experimental groups. The rPMS group received rPMS for suprahyoid muscles three times a day, and the HLE group performed HLE three times a day for two weeks. The exercise consisted of an isometric portion with three head lifts held for 60-s with a 60-s rest period between each one, and isokinetic portion that includes 30 consecutive head lifts of constant velocity without holding. The primary outcome was the changes in neck flexor strength, and the secondary outcomes were the changes in jaw-opening force, tongue pressure, fatigue of neck flexors, as well as pain during intervention and implementation rate of exercise. Results: Two weeks of rPMS induced a significant increase in neck flexor strength from a mean of 8.4 kgf to 9.5 kgf (P<.01), whereas two weeks of HLE did not increase it significantly. There was significantly less pain during rPMS compared with HLE (P<.05). Both groups resulted in a significant increase in tongue pressure (P<.01), but jaw-opening force, fatigue of neck flexors nor implementation rate did not show significant differences. Conclusions: rPMS was effective for strengthening suprahyoid muscles and may be better than HLE.

Keywords: Randomized controlled trial, repetitive peripheral magnetic stimulation, suprahyoid muscles

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O23-1: Statistical analyses for repetitive measures in longitudinal or randomized controlled trials, a need in rehabilitation medicine Top


Mario A. Giraldo-Prieto1, 2, 3

1Department of Physical and Rehabilitation Medicine, University of Antioquia, Medellin, Colombia, 2Health Rehabilitation Research Group, University of Antioquia, Medellin, Colombia, 3Department of Physical and Rehabilitation Medicine, Hospital Universitario San Vicente Foundation, Medellin, Colombia

Background and Aims: The basic analysis for mean differences of quantitative outcomes (t-student test) have disadvantages that are overcome by using advanced analytical methods for repetitive measures. The disadvantages include the demanding large sample size and the unawareness of the oscillations or tendency of data when using 2 measuring times: basal (t0) and only one follow-up (t1). Therefore, the study could retrieve a high (overestimated) or low (underestimated) mean score as a result of variation or chance. This oral presentation is offered to researchers who want to improve their analytical methods or academics who want to understand the magnitude and the true reach of the publications with more than one follow-up time (t0, t1, t2, tn). Methods: A review of fundamental research will analyse the differences, advantages and disadvantages of several statistical methods used for repetitive measures, in order the ease the understanding of each method, their basic mathematical and graphic expression, the impact of the correlation of the data on the variance and power, the impact on significance (p-value) and magnitude of the effect according to each analytical method and the reduction of sample size according to the number of assessments. Results: At least eight (8) analytical strategies can be used for repetitive measures when the outcome has a predictable course over time, including 1. ANCOVA, Longitudinal Data Analyses (LDA: 2. Post, 3. Fraction, 4. Change, 5. Constraint), 6. autoregression and combine methods (7. Residuals or 8. ANCOVA, plus LDA). Some examples are presented. Conclusions: LDA-constraint is theoretically similar to ANCOVA. ANCOVA tends to overestimate the effect over others. LDA-change could be used if assumptions are not possible for ANCOVA, but requires high correlation of data. LDA-Post and LDA-Fraction are the most problematic. Autoregression could underestimate the effect. The combined methods could bring advantages of their individual components.

Keywords: Follow-up assessments, longitudinal data analyses, repetitive measures

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O23-2: The concept and epidemiology of disability Top


Bryan O'Young1, 2, 3, 4, 5, 6, James Gosney7, Chulhyun Ahn1

1Geisinger Health System, Danville, Pennsylvania, United States, 2NYU School of Medicine, New York, New York, United States, 3Weill Cornell Medical College, New York, New York, United States, 4University of the Philippines School of Medicine, Manila, Philippines, 5Sun-Yat Sen University Zhongsan School of Medicine, Guangzhou, Guangdong, China, 6Peking University College of Medicine, Beijing, China, 7Eastern Virginia Medical School (EVMS), Norfolk, Virginia

Background and Aims: A profound need for rehabilitation services exists, especially in developing countries. This abstract highlights the role of the epidemiology of disability in addressing this critical need. It aims to: (1) introduce the concepts of 'disability' and 'functioning' based on the WHO International Classification of Functioning, Disability and Health (ICF); (2) address disability measurement methodology generally to include common national and international methodologies; (3) highlight specific relevant 2017 Global Burden of Disease (GBD) results; (4) profile current global demographic trends of disability related to non-communicable diseases and the aging population, and; (5) provide disability considerations for health and human rights. Methods: A semi-formal review of relevant literature was performed by the authors. Seminal references are cited. Results: (1) According to the WHO ICF, 'disability' is an integrative concept which represents the negative interaction between an individual's health conditions and personal and environmental contextual factors. 'Functioning' represents positive outcomes of these variables. (2) Common national disability measurement instruments include censuses and surveys. International methodologies which serve to standardize data comparison across countries, regions, and populations are the WHO Disability Assessment Schedule (WHODAS 2.0) and the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017). (3) GBD 2017 results show that the total burden of disability has increased by 52% between 1990 and 2017. Low back pain, headache disorders, and depressive disorders were the leading causes of disability globally in 2017. (4) Global disability rates are increasing due to increasing non-communicable diseases and the aging population. Conclusions: National and global disability epidemiology statistics inform stakeholder development of rehabilitation policies and programs necessary to meet the global need for rehabilitation, directly supporting the 'WHO Rehabilitation 2030: call for action' and United Nations Sustainable Development Goal 3 to ''ensure healthy lives and promote well-being for all at all ages”.



Keywords: Developing countries, disability, epidemiology

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O23-3: Keeping up-to-date with clinical research: An evaluation of Physiotherapy Evidence Database “evidence in your inbox” Top


Anne M. Moseley, Steven J. Kamper

Institute for Musculoskeletal Health, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia

Background and Aims: Clinicians subscribe to journals, visit medical libraries or sign up for alerts to keep up-to-date with research. However, due to the large number of journals, these options are insufficient to keep abreast of all relevant and important research. Clinicians also waste precious time finding the best and most applicable research because alerts are not filtered. The Physiotherapy Evidence Database (PEDro; www.pedro.org.au) indexes all trials, reviews and guidelines evaluating physiotherapy interventions, and now produces “Evidence in your inbox.” This free monthly service overcomes the issue of scatter because of the exhaustive processes used to identify articles. The issue of filtering is addressed by separating the articles into practice areas and ranking the articles by method and quality. The aim of this study is to describe size, subscription and engagement rates for PEDro's “Evidence in your inbox.” Methods: Data were extracted from 36 monthly feeds (October 2015 to September 2018) for 15 areas of practice (eg, cardiothoracics, gerontology, neurology). The size of each feed was recorded plus subscription and engagement (open rate and click rate) were downloaded from MailChimp. Results: The number of articles per feed ranged from 2 (whiplash) to 53 (musculoskeletal). There were 9,731 subscribers (musculoskeletal had the largest number (n=7,940) and cerebral palsy the smallest (n=648)), with rates growing steadily over time. Open rates are consistently 15-25%, with cerebral palsy having the highest (36%) and oncology the lowest (17%). The rate of clicking on one or more links within a feed is about 5%, being highest for musculoskeletal (9%) and lowest for oncology (2%). Conclusions: “Evidence in your inbox” is a valuable resource for busy clinicians. Users could increase their engagement by subscribing to a single feed and getting into the routine of reading articles. PEDro could develop the resource by testing strategies to increase engagement.

Keywords: Evidence-based practice, randomised controlled trial, research

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O23-4: Struggle for evidence in physical and rehabilitation medicine: Publication rate of randomized controlled trials and systematic reviews is growing more than in other therapeutic fields Top


Stefano Negrini1,2, William Levack3, Francesca Gimigliano4, Chiara Arienti2, Jorge Hugo Villafañe2, Carlotte Kiekens5

1University of Brescia, Brescia, Italy, 2???, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy, 3Otago University, Auckland, New Zealand, 4Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy, 5Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium

Objective: To evaluate the rate of publication of randomized controlled trials (RCTs), systematic reviews and meta analysis in Physical and Rehabilitation Medicine (PRM) and its variation over time. Design: We performed a bibliometric study and searched PubMed from inception to 2017, using National Library of Medicine 3rd level MeSH terms (Rehabilitation, Physical Therapy Modalities and Drug Therapy) and filters (Randomized Controlled Trial, Systematic Reviews and Meta-Analysis). We used descriptive statistics and we calculated the best fitting regression model for all data considered. Results: The absolute number of published papers is growing in rehabilitation as much as in other treatment fields such as drug therapy. While the rate of growth of publications for all studies relative to PubMed is bigger for drug therapies than for rehabilitation and physical therapy, the rate of growth of RCTs, systematic reviews and meta-analysis is significantly greater for rehabilitation and physical therapy. In 2017, 19.3 percent and 28.2 percent of the total production of scientific articles for rehabilitation and physical therapy (respectively) was for RCTs and systematic reviews, versus 11.3 percent for drug therapy. Conclusion: Production of the highest form of research evidence (RCTs, systematic reviews and meta-analysis) is continuously increasing in PRM at a higher rate than in other treatment fields like drug therapy. The quality and results of this evidence should be evaluated in future studies.

Keywords: Exercise, physical therapy, rehabilitation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O23-5: The material and methods section of randomized controlled trials do not provide sufficient information to allow clinical replicability of complex interventions: A cochrane rehabilitation methodological paper Top


Stefano Negrini1,2, Chiara Arienti2, Joel Pollet2, Julia Patrick Engkasan3, Gerard E. Francisco4, Walter R. Frontera5, Silvia Galeri2, Kamila Gworys6, Jolanta Kujawa6, Mazlina Mazlan3, Farooq A. Rathore7, Fabienne Schillebeeckx8, Carlotte Kiekens8

1University of Brescia, Brescia, Italy, 2???, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy, 3Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, 4The Neuro-Recovery Research Center, TIRR Memorial Hermann, Houston, Texas, USA, 5Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico, 6Department of PRM, Medical University of Lodz, Lodz, Poland, 7PNS Shifa Hospital, Karachi, Pakistan, 8University Hospital Leuven, KU Leuven, Leuven, Belgium

Background and Aims: To study if Randomized Controlled Trials (RCTs) on complex interventions published in top Physical and Rehabilitation Medicine (PRM) journals include all the practical details needed to replicate the intervention in everyday clinical practice (clinical replicability). We chose rehabilitation as a case study because the World Health Organization calls for its development within health services, and due to its intrinsic complexities. Online Survey of a pre-defined sample of clinical expert teams from different world regions with diverse rehabilitation competences. Participants. Forty seven clinicians from 7 PRM teams (Belgium, Italy, Malaysia, Pakistan, Poland, Puerto Rico, USA), including 20 physicians, 12 physiotherapists, 6 occupational therapists, 6 psychologists and 3 others. Team leaders were also researchers. Methods: All RCTs published between January and July 2017 in the top PRM journals (76 RCTs) were reviewed by each participant. Main outcome measurements. 14 questions developed using CONSORT and TIDIeR checklists through consensus and piloting. Results: The response rate was 99 per cent. Inter rater agreement was moderate/good. Overall, 12 RCTs were unanimously considered as clinically replicable and none not replicable. At least one complete team considered replicable other 55 and not replicable 55 RCTs, respectively. Analysing single answers, no study had all information: at least one absent was found by each participant in 60 RCTs, in the remaining 16 by 85 per cent of the participants. Information considered to be less well described included subject characteristics, materials, procedures, order of interventions, health care setting, intervention, and intervention details. The best described features were the classical methodological items described in CONSORT. Conclusions: This rehabilitation case study shows problems of clinical replicability of RCTs in complex interventions. There is a need to focus on some clinical items not described by classical methodological checklists like CONSORT.

Keywords: Methodology, randomized controlled trials, rehabilitation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O23-6: Introduction to the Chinese national key R and D program project – “The research for the whole period rehabilitation and information management system for the elderly” Top


Jie Jia, Qing Yang, Zhijie He, Li Ding

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

The accelerated aging of the population is a major problem faced by China. The elderly's physical and intellectual abilities decline gradually with aging, which together with multiple common diseases, can result in severe impairment of their daily living abilities. By focusing on the management of functional impairments, rehabilitation may help in improving the functional levels and quality of life of these people. However, there still exist a series of problems regarding the clinical rehabilitation of the elderly in China, including: a.What interventions and how should they be performed to improve the elderly's abilities related with both aging and chronic diseases? b.How to integrate the rehabilitation and other clinical procedures more smoothly and efficiently? And c.How to implement the “best” rehabilitation standards in districts of different developing levels. Here we describe a research plan, supported by the Chinese National Key R&D Program, to solve these problems. The plan mainly consist of three contents. The first one involves modifications of the available validated rehabilitation strategies, in adaptation for the physiological and pathophysiology features of the elderly; and it also includes research plans for several innovative techniques and products (such as virtual reality brain training games, and individualized 3D printing assistive devices). Second, our multidisciplinary team will manage to establish and validate the core clinical and rehabilitation procedures for the common diseases in the elderly (such as stroke, Alzheimer's disease, osteoarthritis), meeting the requirements of multiple levels of medical institutions. Third, our team will built an online information management platform, and an “on-cloud” rehabilitation college, to integrate and facilitate the whole research process. Furthermore, a major aim of the project is to set up a series of standards and guidelines regarding the clinical rehabilitation of the elderly in China, which will be promoted all over China.

Keywords: Elderly, information management system, whole period rehabilitation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O24-1: Exploratory ICF-BASED co-operations in rehabilitation department: A case from China Top


Feng Lin, Zhong-Li Jiang

Department of Rehabilitation, The Affiliated Sir Run Run Hospital of Nanjing Medical University, Nanjing, China

Background and Aims: In the last two decades, China developed a medical insurance system based on ICD diagnosis. However, rehabilitation practitioners want to cope with functional problems of their clients based on ICF framework. We explored a new ICF-based co-operation pattern in our department. Methods: CF categories were firstly arranged by a weighting system according to multiple diagnoses of a client. Secondly, the categories were classified for different parts including therapists (PT, OT and ST), physicians and nurses. Circle goals were suggested by each part and they were associated with several specific ICF categories. By assigning therapeutic operations into different categories, each practitioner designed their action plan to achieve corresponding goals. These goals and plans were aggregated into a report for team discussion and final decision. A computer program was designed to execute the weighting algorithm and the aggregating processes. Results: ICF core sets were established for the first diagnosis of a person. However, there are always several diseases in a same patient. By weighting ICF categories according to each ICD diagnosis, we dynamically extract and aggregate a pool of categories for a specific client. Such dynamic pools make it possible to develop personalized rehabilitation strategies. This co-operation pattern was successfully implemented in our department for one year and made a satisfied set of recordings for medical insurance system. Conclusions: The co-operation pattern based on making dynamic pool of ICF categories has its potential to associate ICF with ICD. The computer-assisted practices of this pattern provide a promising method to cope with management issues of rehabilitation department.

Keywords: ICD, ICF, teamwork

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O24-2: Use of ICF and software ICF-reader in multidisciplinary rehabilitation of acute stroke patients Top


Aleksei Andreevich Shmonin1,2, Maria Nikolaevna Maltseva3, Maria Sergeevna Prosvirnina2, Elena Vladimirovna Verbitskaya4, Elena Valentinovna Melnikova1,2

1Department of Physical Methods of Treatment and Sports Medicine, First Saint-Petersburg I.P.Pavlov State Medical University, Saint Petersburg, Russia, 2Saint-Petersburg City Hospital 26, Saint Petersburg, Russia, 3Department of Psychology and Pedagogy, First Saint-Petersburg I.P.Pavlov State Medical University, Saint Petersburg, Russia, 4Department of Pharmacoepidemiology and Biomedical Statistics, First Saint-Petersburg I.P.Pavlov State Medical University, Saint Petersburg, Russia

Aims: To assess how the use of ICF in the rehabilitation of patients with acute stroke influense on the work of a multidisciplinary team. Methods: The study was comparative with consistent design in three groups. Group 1 (n=130) - multidisciplinary team worked without the ICF and without goal setting. Patient histories were analyzed using ICF. Group 2 (n=130) - multidisciplinary team worked with the ICF in paper form with goal setting. Group 3 (n=54) - multidisciplinary team worked with the ICF in software ICF-Reader with goal setting. The assessments were made before the start of the study and at the end of the rehabilitation course. The primary endpoint was a modified Rankin scale (mRS) at the end of the rehabilitation course. Results: The total number of identified problems (ICF domains) and domains of function and structure for one patient decreased (p<0.001) in 2 and 3 groups. Most of the functions and structures described in group 1 did not affect the functioning of patients. The number of ICF domains of activity, participation and environmental factors for one patient increased in groups 2 and 3 (p <0.001). A qualitative analysis showed that in Group 3 (software ICF-reader) team used the most number of ICF domains - 283. It was 54% more domains than in the large ICF-CORE-SET for stroke (Total - 130 domains ICF). Team used many domains of ICF only for one patient in group 2 and 3 which were not related to stroke. In group 3 compared with group 1, the level of disability on the mRS scale was lower (p=0.011). There were no differences between groups 1 and 2 for mRS (p=0.12). Conclusions: Using the ICF and software ICF-Reader leads to a reduction in disability and helps to use more ICF domains of activity, participation and environmental factors.

Keywords: ICF, multidisciplinary team, stroke

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. O24-3: Back pain rehabilitation related changes in automatically predicted International Classification of Functioning, Disability and Health activity and participation categories Top


Thomas Kienbacher1, Elisabeth Fehrmann2, Kerstin Tuechler1, Patrick Mair3, Gerold Ebenbichler4

1Department of PMR, Karl Landsteiner Institute of Outpatient Rehabilitation Research, Vienna, Austria, 2Karl Landsteiner University for Health Sciences, Krems an der Donau, Austria, 3Department of Psychology, Harvard University, Cambridge, Massachusetts, USA, 4Department of Physical Medicine, Rehabilitation and Occupational Medicine, Vienna Medical University, Vienna, Austria

Background and Aims: The International Classification of Functioning, Disability and Health (ICF) is widely recommended but its feasibility in clinical practice and patients' health status benefits from therapy remain unclear. Methods: In this observational cohort study 2718 chronic low back pain patients performed a six months biopsychosocial therapy program in an outpatient referral rehabilitation center. Using a novel mapping approach the relevant activity and participation brief ICF back pain core set categories were predicted from patient reported disability questionnaires. Results: 589 (21,7%) dropped out of rehabilitation. The patient reported disability scores together with the predicted numbers of impaired patients significantly improved in all categories by the end of rehabilitation. However the relative changes varied because scores of the Roland Morris Disability Questionnaire and the Pain Disability Index improved by 35 % and 7,2 % respectively, whereas the number of impaired patients diminished by 20,9 % ('maintaining a body position' d415) to 40,5 % ('walking' d450) in the activity and 26,2 % ['work and work employment' (d859)] to 29,1 % ['Acquiring, keeping and terminating a job' (d845)] in the participation levels. Conclusions: Automatic prediction of impairment in activity and participation categories was well feasible providing complementary information for individual goal setting and treatment guidance and for evaluation of rehabilitation associated health status benefits without additional time burden on patients and therapists.

Keywords: Health status, low back pain, outcome assessment

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O24-4: Functioning and disability profile of people with various disabilities based on the framework of the ICF – A nationwide databank study Top


Chao Pen Chen, Tsan Hon Liou, Shih Wei Hwang

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

Background and Aims: People with disability often facing multiple challenges in mobility, daily activities, subsequently withdraw in social participation, mainly due to medical personnel and social workers lacking whole picture of disease related disability. We utilized international verified disease measurement tool and statistical analysis to categorize major disease related disability and disability level. By grouping diseases with similar traits, medical service and social welfares can close to people in needed. Methods: This nationwide study in Taiwan collect data of most prevalent disability related disease among eight disability chapter in the Disability Eligibility Determination Scale 2012, developed based on ICF framework. We collecting the ICD 9 diagnosis codes corresponding to the disease from the Taiwan Data Bank of Persons with Disability (TDPD) with 1, 123, 034 pieces of data form July 2012 to November 2017 allowing us to analyze the different disability domains in The WHODAS 2.0 of specific diseases in life. We analysis the similarity between each disease and disability level. Results: Based on the disability degree in The WHODAS 2.0 domains, we stratified listed diseases into four categories by radar chart of each disability domain. (1)Specific impact (2) Physical limitation (3) Interaction restriction (4) Global impact. Participation restriction group have two highest scores among the six domains, getting along and participation. Disease in global impact group has highest unemployment rate, institution staying and degree of disability score in all domains. In physical limitation group, people with chronic disease have heightened risk for decrease physical capacity significant disability as having more limitation on mobility, life activities. Conclusions: By grouping disability related disease can we rapidly have a whole picture of patient's limitation in daily life by their diagnosis. In the future, we can provide medical services, social welfare system and education close to the needs of people with physical and mental disabilities.

Keywords: Disability, ICD, ICF

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O24-5: Examination of inter-rater reliability between patients and health professionals in the evaluation of body function categories of ICF rehabilitation set Top


Yuki Senju1, Masahiko Mukaino1, Megumi Ozeki2, Yuki Okochi3, Koji Mizutani3, Makoto Watanabe4, Eiichi Saitoh1, Shigeru Sonoda5

1Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan, 2Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan, 3Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Aichi, Japan, 4Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, Tsu, Mie, Japan, 5Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan

Background and Aims: Despite international efforts for clinical implementation, the International Classification of Functioning, Disability and Health(ICF), launched in 2001 by the World Health Organization, has not been widely used in rehabilitation clinics. To promote clinical implementation, we have developed clinical tools to help with ratings. However, since the ICF is focused on evaluating problems for patients, it is necessary to verify whether evaluations by clinicians can properly reflect problems for patients. In this study, we examined the inter-rater reliability between clinical ratings by health professionals and subjective ratings by patients. Methods: A total of 104 patients undergoing rehabilitation at the Fujita Health University Hospital, Fujita Health University Nanakuri Memorial Hospital and community elderlies participated in this study. The inter-rater reliability between patients and health professionals in nine categories of body functions(b categories), included in the ICF rehabilitation set, was investigated. The patients' self-evaluations were performed using a questionnaire and a health professional rated the patients' problems using the newly creating rating reference. Weighted Kappa statistics were calculated between the ratings by patients and health professionals. Results: The values of weighted Kappa between the patients and health professionals were more than 0.6 in 8 out of 9 categories, with one of those categories at more than 0.8, which was within the range considered to be good to excellent. Conclusions: There was a relatively good agreement between patients and evaluators in recognizing patient's problems with respect to body functions and structures using the rating reference. Further investigation on the clinical feasibility of the rating reference is encouraged.

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. O24-6: A preliminary survey with the international classification of functioning, disability and health rehabilitation set in patients admitted to convalescent rehabilitation wards Top


Reisuke Funahashi1, Masahiko Mukaino1, Yohei Otaka1, Yuki Senju2, Yuki Okochi3, Kouji Mizutani3, Eiichi Saitoh1

1Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan, 2Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Toyoake, Japan, 3Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan

Background and Aims: The International Classification of Functioning, Disability and Health (ICF) not only classifies the function and disabilities, but also evaluates activities, social participation, and environmental factors. It may be worth to use ICF as a measure for patients who undergo rehabilitation programs. However, reports on patients who undergo inpatient rehabilitation are few. This preliminary survey aimed to evaluate the feasibility of using ICF rehabilitation set, an ICF core set for rehabilitation patients, for patients admitted to convalescent rehabilitation wards. Methods: A total of 180 patients (ages 17–101, 105 male) were admitted to convalescent rehabilitation wards with various diagnosis: 53 hemorrhagic stroke, 40 ischemic stroke, 13 subarachnoid hemorrhage, 19 hip fracture, 19 spinal cord injury, and 36 with other diseases. To evaluate the feasibility of using the ICF rehabilitation set for this population, the rate of missing values was calculated along with the ceiling and floor effects for each item of the set. Floor and ceiling effects were considered present if 90% or more of the patients scored the highest or the lowest point in the item. Results: Missing values were found in 22 items, and the following nine items showed missing values in 5% or more of the patients: b640 Sexual functions, d455 Moving around, d465 Moving around using equipment, d470 Using transportation, d640 Doing housework, d660 Assisting others, d770 Intimate relationships, d850 Remunerative employment, and d920 Recreation and leisure. No ceiling or floor effects were found. Conclusions: he survey showed that there were relatively few missing values and no obvious ceiling and floor effect. Therefore, the ICF rehabilitation set may be usable as a scale for this population. Future studies with longitudinal design are required to explore the clinical usefulness of ICF rehabilitation set in patients who undergo inpatient rehabilitation.

Keywords: ICF, rehabilitation, scale

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  Poster Abstracts Top



  No. P1-1: Relation between dominant leg and leg crossing velocity of inter-foot distance during leg-crossing movement from tandem stance Top


Keita Aimoto, Kazuya Usami, Miwa Oyabu, Kakeru Hashimoto, Shunpei Owaki, Nozomi Matsuoka, Izumi Kondo

Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan

Background and Aims: Some studies have reported that tandem stance is useful in identifying individuals at risk of falls. The purpose of the present study was to quantify the maximum Inter-foot Distance (IFD) to maintain a standing posture during leg-crossing movement from tandem stance in young healthy adults and examined the maximum IFD between dominant leg and leg crossing velocity. Methods: The subjects were 40 young healthy people (age: mean 29 years, 18 men). A three-dimensional motion analysis system and a split-belt treadmill were used to collect data. The subjects moved their front leg across the front of their body according to the treadmill belt movement. Maximum IFD was defined as the largest IFD such that either foot could be removed from the treadmill belt while maintaining a standing posture. Measurements were made under four conditions: the dominant and non-dominant leg placed in front of the body and treadmill belt velocities of 0.5 km/h and 1.0 km/h. Data were analyzed using a two-way analysis of variance. The level of significance was 5%. Results: Normalized maximum IFD (NMIFD) by the subject height was about 11%. There was no significant interaction between the front leg and treadmill belt velocity (p = 0.46). There was a significant main effect of the front leg on NMIFD, and NMIFD was larger when the dominant foot was in front of the body than when the non-dominant foot was in front of the body (p = 0.034). There was no significant main effect of the treadmill belt velocity on NMIFD (p = 0.84). Conclusions: The NMIFD was significantly affected by which of the two legs was placed in front.

Keywords: Inter-foot distance, lateral balance, tandem stance

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-2: The association between physical activity and predictors of Parkinson's disease dementia Top


Mohammad Alwardat1,2, Paola Sinibaldi Salimei3, Nicola Biagio Mercuri1, 2, 4, Antonio Pisani1, 2, 4

1Neuroscience PhDSchool, University of Rome Tor Vergata, Rome, Italy, 2Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy, 3Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy, 4IRCSS Fondazione Santa Lucia, Rome, Italy



Background and Aim: Parkinson Disease Dementia (PDD) is a frequent and severe complication of Parkinson Disease (PD), whose neurobiology has been partially clarified and a number of risk factors have been identified. Although effective disease-modifying therapies for PDD still lack, physical activity (PA) has gained increasing interest as potential neuroprotective strategy providing beneficial effects on the cognitive decline. Therefore, the aim of this study is to evaluate the association between PA and both biochemical and clinical predictors of PDD in a cohort of cognitively intact PD patients. Methods: The levels and intensity of PA were evaluated by the International Physical Activity Questionnaires Short Form (IPAQSF) in 128 PD patients and correlated with the Hamilton-Depression (HAM-D) and the Hamilton-Anxiety (HAM-A) scores [Table 1]. In a homogeneous subgroup of 40 patients, PA was further correlated with a panel of cerebrospinal fluid (CSF) biomarkers, including amyloid-B42, total a-synuclein, total and phosphorylated tau. The statistical model was corrected for the main potential confounding factors (motor impairment, dopaminergic treatment, disease duration, age and gender). Results: We observed that both the HAM-A and HAM-D scores, as well as the AB42 of CSF content, improved in parallel with the increase of the total weekly amount of PA. Patients practicing a high level of PA resulted having a more favourable profile of such PDD risk factors. Conclusions: Although with the limitations of an observational cross-sectional study, we preliminary demonstrate that physical exercise might reduce frailty of PD patients, as evidenced by either a lower burden of anxiety and depression or higher CSF AB42 levels are well-established predictors of PDD. Our results suggested that PA does provide a protective effect on the brain with PD. Thus, we believe that PA should be considered in the rehabilitation regimen for all PD patients who do not have specific contraindications.

Keywords: CSF biomarkers, Parkinson disease, physical activity

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-4: Posing as ascites – A case report on neurogenic lower urinary tract dysfunction Top


Maria Joao Andrade1,2, Luis Sousa1

1PMR, Centro Hospitalar Universitario do Porto, Porto, Portugal, 2Instituto de Ciencias Biomedicas Abel Salazar, Porto, Portugal

Background and Aims: Vesicosphincteric dysfunction is a frequently underdiagnosed condition, especially in cases of neurogenic lower urinary tract dysfunction where no other neurological deficits are present. The evaluation of the integrity of the spinal cord segments responsible for the neurophysiologic control of the bladder and sphincters is fundamental for correctly establishing a neurogenic aetiology. This case report demonstrates how the sacral examination allowed the diagnosis of an unexplained bladder dysfunction. Methods: A 52-year-old female was admitted with a history of fever, anorexia and weight loss. She reported three falls , with consequent trauma to the lower back. X-ray of the lumbar spine revealed a fracture of the body of the L5 vertebra, which was overlooked. Following inpatient admission to the Infectiology ward for sepsis, she developed diffuse abdominal pain with a recurrent pattern and reported new-onset urinary incontinence, increased difficulty walking and lumbar pain. She presented a distended abdomen, diffuse pain on palpation and a positive fluid wave test, which led to the investigation of possible ascites. An abdominal CT scan was obtained, showing a hyperdistended bladder. A urinary catheter was placed, draining 2000 ml of urine. Results: The sacral examination revealed absent right anal reflex, diminished anal sphincter tone, diminished voluntary anal contraction and preserved anal sensation. No new findings were detected in the remaining neurological examination. Lumbosacral CT scan revealed a fracture of L5 with posterior displacement contacting the thecal sac and inflammatory changes in L5, L4 and paravertebral tissues. The urodynamic study revealed normal bladder sensation, absent voluntary detrusor contraction and an inefficient micturition with a low-flow pattern and elevated residual volumes (240-350ml). Conclusions: Our clinical findings were compatible with a sacral cord lesion. The neurological examination of the sacral cord segments was fundamental for correctly determining the neurologic aetiology of initially unexplained bladder dysfunction.

Keywords: Neurogenic lower urinary tract dysfunction, sacral examination

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-5: Effect of physical exercise on monosodium glutamate animal model Top


Meisy Andriana1,2, Waode Sri Nikmatiah3, Imam Subadi1,2, Dewi Poerwandari1,2

1Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia, 2Dr Soetomo General Academic Hospital, Surabaya, Indonesia, 3Abdul Wahab Sjahranie, Samarinda, Indonesia

Background and Aims: Monosodium glutamate (MSG) is one of the most popular flavor agents of modern time and is widely used in many commercially packed food,restorant and household cooking. Monosodium Glutamate produces a flavor that can not provided by other foods. A taste described in Japanese as umami. It is reported brain damage induced by neurotoxicity of MSG and also obesity and metabolic effects. Physical exercise increased brain- derived neurotrophic factor (BDNF) concentration. Aims: to investigate the effect of exercise in MSG animal model by expression of BDNF. Methods: A total of 28 Rattus norvegicus strain Wistar, 6-8 weeks old, weight between 100-150 grams, randomized in 4 groups (control, MSG, treadmill exercise, MSG plus exercise). MSG exposure at a dose of 6 g / kg was administered once in 24 hour for 21 days. The exercise is done once a day, 5 days a week, 20 minutes duration (first 5 minutes at 7 m/min and last 15 minutes at 11 m/min) for 3 weeks using motorized treadmill. After 21 days of treatment, the animals were sacrified and the cerebellum was dissected for histological analysis using the immunohistochemical staining method. Statistical analysis with Mann Whitney U test and Independent sample test, SPSS 23. All the experimental procedures inv olving animals were approved by the Ethics Committee for Basic Science/ Clinical research at Dr. Soetomo General Academic Hospital ( approval number 251/Panke.KKE/IV/2017). Results: The expression of BDNF were significant differences in neuron of cortex cerebellum between control group (5.71&#61617;0.28) and MSG group (2.57&#61617;0.29; p <0.05), between MSG group and exercise group (7.14&#61617;0.40; p <0.05 ) and exercise group and MSG plus exercise group (8.28&#61617;0.74; p <0.05). Conclusions: Physical exercise increase expression BDNF in cortex cerebellum.

Keywords: BDNF, exercise, monosodium glutamate

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-6: Effect of reactive postural control training on muscle activity during anticipatory postural adjustment Top


Osamu Aoki, Kakeru Shinjo, Risa Iwashita, Hiroki Ogata, Yu Kojima, Miku Kondo, Junpei Morita

Department of Rehabilitation, Shijonawate Gakuen University, Daito, Japan

Background: Preliminary trunk muscle activation, known as anticipatory postural adjustment (APA), is commonly observed prior to trunk and/or limb movement. When the directions of body perturbation correspond, the sets of activated muscles in the APA have been reported to be the same as those in reactive postural control (RPC). Therefore, we evaluated the influence of a single session of muscle training in an RPC task on muscle activation in an APA task. Methods: Eleven healthy males (n = 6) and females (n = 5) participated in the study (age = 19.8 ± 0.4 years; BMI = 21.2 ± 1.9 kg/m2). This study was conducted in accordance with the Declaration of Helsinki and written informed consent was obtained from all participants prior to participation. Electromyographic activity of bilateral trunk muscles (multifidus and internal and external obliques muscles) was recorded during the transition from double to single leg standing as an APA task. Twenty trials were performed during one pre- and one post-training session. Training consisted of 20 unilateral pelvic drop disturbance tasks performed in a sitting position. APA time was detected by the point of muscle activity initiation from the timing of unilateral leg up, and was compared between pre- and post-training session using Wilcoxon's test. Results: Activity in the multifidus of the ipsilateral leg up side, external obliques on the contralateral leg up side and internal obliques on ipsilateral and contralateral sides occurred significantly earlier in post-training than those were observed in pre-training (p = 0.002, 0.032, 0.001 and 0.003, respectively). Conclusion: Following training, muscles which are important for sacroiliac joint stability were found to activate earlier; although this finding differed from that which has been previously reported. The results indicate that RPC training may evoke early muscle activation during APA.

Keywords: Anticipatory postural adjustment, electromyography, reactive postural control

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-7: A new fluoroscopic method for multidimensional evaluation of swallowing function Top


Nobuyuki Arai1, Kozo Hanayama1, Akio Tsubahara2, Kazuomi Sugamoto3

1Department ofRehabilitation Medicine, Kawasaki Medical School, Kurashiki, Japan, 2Kawasaki University of Medical Welfare, Kurashiki, Japan, 3Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Japan

Background and Aims: We present a multi-dimensional method for analyzing swallowing based on a pulsed, low-dose fluoroscopy technique that uses serial-shot images and evaluates the quantity, position, and temporal profile of the bolus to obtain the information from different perspectives of swallowing movement. Our purpose is to evaluate feasibility of the new method and investigate fluid behavior during swallow. Methods: Fifteen healthy adult volunteers swallowed two kinds of liquid: 20 mL of pure water followed by 20 mL of contrast medium mixture in a fluoroscopic study. Lateral view images were recorded in serial-shot images. The image from these two swallows were inverted, synchronized, and subtracted to visualize the bolus clearly in each frame. The pathway of the bolus was divided into 15 parts from the oropharynx to the upper esophagus, and the total gray value was measured in each section. The results were presented as contour graphs. Results: Contour graphs gave us information on the quantity, anatomical and temporal location of the bolus during swallowing. Two distinct swallowing patterns were observed in the subjects. The bolus showed two accumulation points in all subjects. In nine of the 15 subjects, they appeared in different frames, whereas within the same frame in the other six of the subjects. In addition, we were able to calculate the change amount of the bolus per unit time for each pattern. Conclusions: We developed a new method for quantitatively evaluating swallowing. It permits multidimensional assessment of the quantity, position, and temporal profile of the movement of the bolus across the pharynx. We recognized two types of accumulation patterns of fluid in healthy subjects. Further studies are required to clarify the variance of swallowing patterns and their clinical relevance.

Keywords: Fluoroscopy, functional measures, swallowing

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-8: Comparison of low and high intensity neuromuscular electrical stimulation to improve fibroblast and capillary formation in injured model of Achilles tendon: An animal experimental study Top


Dewi M. Ayub, Reni H. Masduchi, Martha K. Kusumawardani

Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dr. Soetomo General Hospital, Airlangga University, Surabaya, Indonesia

Background and Aims: Neuromuscular Electrical Stimulation (NMES) is one of the modalities that can be used as a treatment option in tendon injury. Unfortunately, there are no clinical studies in human because of limited number of studies in animals including the studies on the difference of the amount of electrical current used. There has been no protocol regarding the amount of electrical current used. This study aimed to evaluate the different effect of low and high intensity electrical stimulation. Methods: Thirty New Zealand White Rabbits were divided into three groups: control, low intensity and high intensity. Injured models were created in achilles tendon. NMES were given to study groups with intensity of 1 mA and 80 mA respectively. After two and four weeks, the amount fibroblast and new capillary formation were evaluated. Results: NMES increased the number of fibroblasts and new capillary formation. Low intensity stimulation showed the highest number of fibroblasts and new capillary formation compared to those of control and high intensity group. Conclusions: Higher number of fibroblast and new capillary formation with neuromuscular electrical stimulation would promote better tendon healing. NMES can be considered as a treatment option for tendon injury.

Keywords: Achilles tendon injury, low and high intensity, neuromuscular electrical stimulation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-9: Analysis of between modified foot exerciser and heel raise machine on the muscle activity of ankle joint Top


Young-Hyeon Bae

HML Human Motion Lab

Background and Aims: Recently, a modified foot exerciser for eccentric contraction of ankle joint has been developed that can be used in rehabilitation setting. Therefore, Comparison of analysis of between modified foot exerciser and heel raise machine on muscle activity of ankle joint. Methods: One healthy young female participated in this study. Subject completed 1 set of 20 repetitions with intensity of 70% RM (repetition maximum) using each modified foot exerciser and heel raise machine [Figure 1]. Surface electromyography activity was recorded during 20 repetitions of each each modified foot exerciser and heel raise machine. Electromyography activity from 5 successful repetitions was normalized to maximum voluntary isometric contraction (MVIC), ensemble averaged, and the mean amplitude determined on medial gastronemius, lateral gastronemius, soleus, tibialis anterior, peroneus longus of ankle joint. Results: Lateral gastonemius and soleus in Heel raise machine were higher than Modified foot exerciser on EMG activity. And medial gastonemius and tibialis anterior and peroneus longus in modified foot exerciser were higher than heel raise machine on EMG activity. Conclusions: As previous study, the activity of the lateral gastrocnemius and soleus in heel raise machine was higher and the activity of the medial gastrocnemius, tibialis and peroneus longus in the modified foot exerciser was higher. Therefore, it is considered that the modified foot exerciser has more stability than heel raise machine due to restoring physiology motion.

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-11: Time, touch and temperature affect perceived finger position and ownership in the grasp illusion Top


Nicolas Bayle1, Martin Heroux2, Annie Butler2, Simon Gandevia2

1Groupe Hospitalier Universitaire Henri Mondor, Créteil, France, 2Neuroscience Research Australia, Sydney, NSW, Australia

Background and Aims: Perceived body position and ownership are fundamental to our ability to sense and interact with the world. Previous work indicates that temporally congruent, repetitive multisensory stimuli are needed to alter the sense of body ownership. Methods: In the present study, 30 subjects passively grasped an artificial rubber finger with their left index and thumb while their right index finger, located 12 cm below, was lightly clamped. Fingers with varied physical characteristics were also passively grasped to determine how these characteristics influenced perceived body position and ownership. Results: Subjects immediately felt their hands to be 5.3 cm [3.4-7.3] (mean [95%CI]) closer, a feeling that remained after 3 min (6.0 cm [4.5-7.5]). By the end of the trial, perceived ownership increased by 1.2 [0.6-1.9] points on a 7-point Likert scale, with the group average moving from 'neither agree or disagree' at the start to 'somewhat agree' at the end. Compared to grasping a control rubber finger, grasping a cold, rough, oddly shaped or rectangular shaped finger-like object reduced perceived ownership. Conclusions: These results provide new insights into the role of cutaneous sensory receptors in defining these aspects of proprioception, and the speed with which these effects occur. Static touch rapidly induces large, sustained changes in perceived body position and prolonged exposure to these cutaneous inputs, alone, can induce a sense of body ownership. Also, certain physical characteristics of grasped objects influence the sense of body ownership.

Keywords: Body ownership, cutaneous receptors, proprioception

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-12: In vitro study of ultrasound-guided coracohumeral ligament injections using two different approaches Top


Mathieu Boudier Reveret1, Carl E. Majdalani1, John Pape2, Jean-Michel Brismee3, Johan Michaud1, Dien Hung Luong1, Detlev Grabs4,5, Ke-Vin Chang6, Wen-Shiang Chen6, Chueh Hung Wu6, Stephane Sobczak4,5

1Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montreal, Canada, 4Departement d'Anatomie, Universite du Quebec a Trois-Rivieres, Quebec, Canada, 2Department of Physiotherapy, University Hospital of North Tees, Stockton on Tees, United Kingdom, 3Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA, 6Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan, 5Research Unit of Clinical and Functional Anatomy, Universte du Quebec a Trois-Rivieres, Quebec, Canada

Objective: To investigate if the coracohumeral ligament (CHL) can be accurately injected with ultrasound (US) guidance using either a rotator interval (RI) or a coracoidal (CO) technique. Design: In-vitro experimental case series. Setting: Anatomy laboratory. Specimens: Right and left shoulders of thirteen Thiel-embalmed cadavers. Interventions: Each shoulder was injected randomly under US-guidance by three physiatrists with 0.1 ml of colored dye using either the RI or the CO approach. A total of six injections was performed for each cadaver. After injections, a dissection of each shoulder was carried out to determine the accuracy of both approaches. Results: The CHL was reached in 100% by the RI-approach. Concerning the CO approach, the accuracy was 94%. There was no significant differences between the three physiatrists for each approach and between the two approaches despite their different years of experience. Conclusions: US-guided infiltration of the CHL are accurate by both approaches, even though the RI approach was slightly more accurate.

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-15: Spinal motor neuron excitability of the abductor digiti minimi muscle during motor imagery of isometric thenar muscle activity Top


Yoshibumi Bunno, Toshiaki Suzuki

Kansai University of Health Sciences, Kumatori, Japan

Background and Aims: Previously, we reported increased excitability of spinal motor neurons innervating homonymous muscles during motor imagery of thenar muscle activity. However, it is unclear whether motor imagery of thenar muscle activity affects excitability of spinal motor neurons innervating heteronymous muscles. This study investigated the excitability of spinal motor neurons innervating the abductor digiti minimi muscle during motor imagery of thenar muscle activity using F-wave analysis. Methods: Eleven healthy adult volunteers (mean age, 21.9 ± 4.0 years) participated in the study. To confirm abductor digiti minimi muscle activity during actual thenar muscle activity at 50% maximum voluntary contraction, electromyography recording was conducted. F-waves were measured from the abductor digiti minimi muscle at rest, during motor imagery, and after motor imagery. During motor imagery, participants imagined isometric thenar muscle activity at 50% maximum voluntary contraction for 1 min. Concurrently with F-wave recording, electromyography activity was measured from the thenar muscle group and the abductor digiti minimi muscle. F-waves were analyzed in regards to persistence and F/M amplitude ratio. Root mean square was used to assess the electromyography activity of each task. Root mean square of each task was normalized by the root mean square during maximum voluntrary contraction (percent root mean square). Results: Persistence and F/M amplitude ratio during motor imagery were significantly increased compared with that at rest. No muscle contraction of the thenar muscle group or abductor digiti minimi muscle was detected during motor imagery. The percent root mean square value of the abductor digiti minimi muscle was increased significantly during actual thenar muscle activity compared with that at rest. Conclusions: The excitability of spinal motor neurons innervating the abductor digiti minimi muscle was increased significantly during motor imagery of thenar muscle activity. Therefore, motor imagery may simulate subliminally the mental muscle activity of actual movement.
Figure 1: F/M amplitude ratio and persistence during motor imagery

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Figure 2: RMS value of thenar and abductor digiti minimi muscle during motor imagery

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Figure 3: %RMS value of abductor digiti minimi muscle during actual thenar muscle activity at 50% maximum voluntary contraction

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Keywords: F-wave, heteronymous muscle, motor imagery

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-16: A dynamic, multi-target motor imagery training using EEG-fMRI neurofeedback: An exploratory study on stroke patients Top


Simon Butet1, Giulia Lioi2,3, Mathis Fleury2,3, Elise Bannier2,4, Anatole Lecuyer3, Christian Barillot2, Isabelle Bonan1,2

1Department of PRM, CHU, Rennes, France, 2Univ Rennes, INRIA, CNRS, Inserm, IRISA, EMPENN ERL U1228, Rennes, France, 3Univ Rennes, INRIA, CNRS, IRISA, Hybrid Project Team, Rennes, France, 4Department of Radiology, CHU Rennes, Rennes, France

Background and Aims: Recent studies have revealed the potential of neurofeedback (NF) for upper limb recovery after stroke (Cervera et al. 2018). Studies on cerebral plasticity after stroke indicates that both, ipsilesional premotor (SMA, PMC) and primary motor areas (M1) are important for recovery. Moreover, fMRI-NF studies have shown that SMA is a robust correlate of motor imagery, while the activation of M1 is more difficult to achieve (Mehler et al. 2019). Based on these results, we tested an adapted NF training more strongly rewarding SMA activation in the first NF training session and then increasing the M1 activation contribution. Methods: Four chronic stroke patients (54-76 years, 2 females) participated. The experimental protocol included an alternation of 2 bimodal EEG-fMRI NF and 3 unimodal EEG-only NF sessions. The experiment was run using a NF platform (Mano et al., 2017) performing real-time EEG-fMRI processing and bimodal NF presentation. The NF metaphor consisted of a ball moving on a gauge proportionally to the EEG and fMRI scores, this last calculated as a weighted combination of the activity in the ipsilesional SMA and M1 cortical areas [Figure 1]. Results: All the patients were able to upregulate the brain activity in the target cortical areas during the NF training. The increase in brain activation during the NF task was particularly significant for the BOLD signal, while the EEG activity was harder to modulate. Two patients showed significant increased activation of the ipsilesional M1 at the end of the training and exhibited a larger involvement of the ipsilesional motor and premotor areas in the second NF training sessions [Figure 2]. They also showed a better FMA-UE score at the end of the training. Conclusions: These preliminary results confirmed the feasibility and indicate the potential of a guided, multi-target/multimodal NF training approach on chronic stroke patients.
Figure 1: fMRI NF scores calculation schematic. The fMRI visual feedback is updated each second with the weighted sum of contrast (NF TASK>REST) activation in the SMA and M1 areas. The weights assigned to the two contributions vary from the first training session (a=0.5, b=0.5) to the second (a=0.25, b=0.75). for ease of visualization only the composite fMRI score is represented here, however during bimodal NF training the visual feedback is equal to the average of the fMRI and EEG scores

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Figure 2: Example of fMRI activation during NF training in one patient. (a) Individual contrast activation maps (NF TASK>REST; P > 0.05 FEW corrected, voxel-based analysis) during NF training in session 1 (red) and 2 (cyan) (b) contrast activation mean amplitude in SMA (left bar plot) and M1 (right bar plot) with relative standard error and statistics (*indicates statistical significant difference as assessed with a wilcoxon test across blocks of the same training session, P=10-9)

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Keywords: fMRI EEG, neurofeedback, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-17: Efficacy of extracorporeal shock wave therapy in temporomandibular disorders, a case report Top


Jose Angel Campoy Saenz1, Juan Cervera Deval2, Alberto Montalva Iborra2, Juan Vazquez Diez2, Fatima Torralba Collados2, Maria Sorianomico1

1Department of Rehabilitation, Hospital de Manises, Valencia, Spain, 2Department of Rehabilitation, Hospital La Fe, Valencia, Spain

Background and Aims: Temporomandibular disorders (TMD) is a common disease. TMD term includes trigger points (TP) of masticatory muscles and temporomandibular joint disorders; however, most patients suffer mixed patterns. Occlusive disorders, female sex, stress, depression, daytime sleepiness and obesity among others are considered the main TMD risk factors. Treatment includes self-care methods, splints for bruxism, analgesics, intraarticular infiltrations, electrotheraphy and extracorporeal shock wave therapy (ESWT). ESWT has been widely recognized in literature as a biological regulator; increasing angiogenesis, tissue regeneration and analgesic effect. We evaluate efficacy of ESWT in a case of a middle-aged woman presenting TMD and TP in masseter muscle. Methods: Patient with chronic TMD diagnosis, muscles had active TP and mouth opening was limited to 20mm, as well as lateralization and protrusion movement. On visual analogic scale (VAS) she scored 7.5 points. We used a focal ESWT Dornier AR2 model and administrated 6 sessions with 1000 impulses each at 6Hz frequency, 0.012 mJ/mm2 intensity and an energetic flow density of between 177 and 193mJ/mm2, distributed in each masseter muscles from their origin to their insertion. Results: In the 4 weeks follow-up visit, patient referred pain decrease, with a 5 VAS score. Mouth opening had increased to 30mm, clicking had diminished. Subjectively she referred an improvement during masticatory movements and was overall satisfied with the outcome. This improvement was maintained for 6 months. We repeated the treatment in the following year with similar results and without side effect. Conclusions: In our case, ESWT proved to be useful helping to improve pain, muscle atrophy recovering and mouth opening improvement and patient's quality of life. No side effects were observed during and after the treatment. Future randomized studies with a larger sample must be raised to prove this effect and determine the indications and dosage.

Keywords: Extracorporeal shock wave therapy, temporomandibular disorders

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-18: Neuroimage of patients with severe knee osteoarthritis: Brain volumetric evaluation Top


Fuad Chaim Filho1, Marta Imamura1, Paula Squarzoni2, Fabio Luis S. Duran2, Geraldo Busatto Filho2, 3, Felipe Fregni4, Linamara R. Battistella1, 5

1Centro de Pesquisa Clinica, Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil, 2do Laboratorio de Investigacao Medica em Neuroimagem Psiquiatrica (LIM-21) do Centro de Medicina Nuclear do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil, 3Departamento de Psiquiatria da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil, 4Spaulding Medical Center, Harvard Medical School, Boston, Massachusetts, USA, 5Departamento de Medina Legal, Social e do Trabalho da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil

Background and Aims: Osteoarthritis (OA) is a prevalent disorder in the adult individuals, especially in the elderly. In the last fourteen years, several authors have demonstrated a significant reduction of cortical volume of gray matter (GM) in patients who suffer the impact of chronic pain. Our objective is to compare measures of brain volume in patients in waiting list for total knee replacement due to chronic knee pain related to severe primary knee OA with healthy controls. Correlate these values with pain intensity, pain duration, functional capacity and pressure pain thresholds. Methods: Total of 57 subjects (28 healthy controls and 29 knee OA patients; mean age of patients: 70.35SD7.25; mean age of controls: 67.93SD6.27; mean duration of pain in months: 146SD121.14). We used a Voxel-based Morphometry (VMB) method. The subjects underwent brain structural magnetic resonance imaging processed and analyzed through the SPM 8 program. Then the images were processed using the toolbox “Dartel.” Results: We did not find differences between the global GM volumes between the two groups (p=0.292). However, we found decreased GM volumes in the right precuneus area of knee OA patients compared with healthy controls (p=0.014). We also found, in the comparison between controls and patients with bilateral and right knee OA with difficulty to perform exercises, a positive correlation of GM volumes in the left orbitofrontal (p=0.011), and a negative correlation in the left anterior cingulum (p=0.013). Conclusions: Our study suggests a change in the brain structure due to pain related to osteoarthritis of the knee, as well as changes in the brain structure related to the difficulties to perform exercises. Thus, variations in the aggressiveness of the treatment can be useful not only for the patient's quality of life, but also contribute to the conservation of the brain structure.









Keywords: Brain morphometry, chronic pain, knee osteoarthritis, chronic pain

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-19: HSP70-mediated exercise capable of redirecting the proinflammatory/neurodegenerative gene response toward an anti-inflammatory/neuroregenerative gene response during rat traumatic brain injurys Top


Ching-Ping Chang1, Chung-Ching Chio2, Kao-Chang Lin3, Mao-Tsun Lin1, Cheng-Hsien Lin4

1Department of Surgery, Division of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan 2Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan, 3Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan, 4Department of Medicine, Mackay Medical College, New Taipei, City, Taiwan

Background and Aims: Despite previous evidence for a potent inflammatory response in the blood after a traumatic brain injury (TBI), it is unknown whether these responses are protective, neutral, damaging, or a combination of all three over time. Exercise preconditioning (EP) might be useful for neurorehabilitation after TBI, relatively little information is available about the anti-inflammatory effects of EP on TBI outcomes. Methods: Three days after TBI or sham operation, neurological motor function, and histochemical and histopathological outcomes of these groups of rats were obtained. We did qPCR-based analyses of 84 miRNAs in the peripheral blood 3 days post-TBI. Results: The EP pretreatment increased expression of cerebral HSP70 and attenuated posttraumatic brain contusion, edema, apoptosis, and motor deficits. Twenty-three of the 84 mRNA were upregulated after the TBI. A comparison of miRNA expression profiles revealed that 9 mRNA (CxCl10, IL-18, IL-16, cd70, motif, PpbP, Ltb, Tnfrsf116, and FASLG), which are in the blood and drive proinflammatory and/or neurodegenerative processes were upregulated after the TBI. The following 14 mRNA (Ccl19, Ccl3, Cxcl19, IL-10, IL-22, IL-6, Bmp6, Ccl22, IL-7, Bmp 7, Ccl2, Ccl17, IL-1rn and GPi), which are in the blood and drive anti-inflammatory and/or neuroregenerative events, were also upregulated after a TBI. The expression of 6 (Cxcl10, IL-18, IL-16, cd70, motif, and FASLG) of the 9 genes were inhibited after EP. In contrast, the expression of 4 (Bmp6, IL-10, IL-22, and IL-6) of the 14 genes were augmented after EP. The beneficial effects exerted by EP in reducing secondary brain injury and in normalizing the gene expression in the peripheral blood were significantly abolished by prior depletion of HSP70. Conclusions: Our results demonstrated that HSP70-mediated exercise capable of redirecting the pro-inflammatory/neurodegenerative gene response toward an anti-inflammatory/neuroregenerative gene response during TBI could represent an attractive option for TBI therapy.

Keywords: Exercise preconditioning, HSP70, traumatic brain injury

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. P1-20: Low-frequency vertical vibration enhanced the stiffness of rat Achilles tendon Top


Chia-Hsin Chen1, 2, 3, Yi-Jen Chen1, Mao-Hsiung Huang1,2, Chau-Zen Wang3,4

1Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, 2Department of Physical Medicine and Rehabilitation, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, 3Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan, 4Department of Physiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Background and Aims: Vertical vibration (VV) is a whole-body vibration with mechanical loading that wildly use in rehabilitation and in sports training to increase the muscle strength of athletes. In our previous study, low-magnitude and low-frequency VV at 8-10 Hz could increase the myogenesis of myoblasts. Methods: The lower frequency of VV at 8-10 Hz would be used to study the anabolic effect on tenocytes and tendon stiffness. Results: The 10 Hz VV treatment enhance the tendonogenic marker genes expression of tenomodulin and the tendonogenic extracellular matrix type I collagen, but decreased the decorin expression in primary tenocytes. The 10 Hz VV treatment enhance the expression of TGF-b1 in tenocytes for 3 days and in Achilles tendon after 10 Hz VV treatment for 3 weeks. After 10 Hz VV treatment for 3 weeks, the rat Achilles tendon showed significantly increased stiffness and tenomodulin expression. These results indicated that 10 Hz VV stimulated the anabolic effect of tenocytes through enhanced the expression of TGF-b1 and subsequently increased the expression of tenomodulin and type I collagen, which mechanotransduction effect then increased the stiffness of Achilles tendon. Conclusions: This study shows the mechanisms of low-frequency V V treatment in improving the properties of tendons that mimics the effects of conventional exercise loading, and may decrease the risk of reinjure of tendon during rehabilitation.

Keywords: Achilles tendon, tendon stiffness, vertical vibration

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-21: Spared nerve injury increases the current densities of voltage gated sodium channels in dorsal root ganglion neurons Top


Xi Chen, Li-Ying Zhang, Xi-Quan Hu, Ling Li

Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

Background and Aims: Peripheral nerve injury often leads to neuropathic pain. The ectopic discharges observed in dorsal root ganglion (DRG) neurons following nerve injury have been attributed to functional alterations of voltage-gated sodium channels (VGSCs). Such mechanisms may be important for the development of neuropathic pain. VGSCs can be divided into Tetrodotoxin-sensitive (TTX-S) and Tetrodotoxin-resistant (TTX-R, including Nav1.8 and Nav1.9) subtypes according to their different sensitivity to tetrodotoxin. However, the pathophysiology underlying the functional modulation of VGSCs following nerve injury is largely unknown. Methods: We studied the behavioral signs, the changes of tumor necrosis factor-alpha (TNF-a) and VGSCs with use of a Spared nerve injury (SNI) model, in which the common peroneal nerve and the tibial nerve were transected while the sural nerve remained intact. Mechanical sensitivity was assessed using von Frey hairs. The concentrations of TNF-a in cerebrospinal fluid (CSF) and DRGs were assayed with ELISA, and then the corresponding concentration of TNF-a were added into medium to investigate its effect on cultured neurons. Electrophysiological studies were performed by whole-cell patch-clamp recordings. Results: We found that the paw withdrawal thresholds of both sides are decreased at different time point (1d, 7d, 14d and 21d) after SNI (p<0.01). SNI increased the current densities (pA/pF) of TTX-sensitive sodium channels as well as currents in Nav1.8 (p<0.05), but not Nav1.9 channels in DRG neurons (p>0.05). We also found that levels of TNF-a increased in CSF and in DRG tissue after SNI (p<0.01), and recombinant rat TNF (rrTNF, 100 pg/ml) enhanced the current densities of TTX-S and Nav1.8 in cultured DRG neurons (p<0.05). Conclusions: These data suggest that spared nerve injury is capable of increasing the currents of both TTX-S and TTX-R sodium channels in DRG neurons and that the increased TNF-a may be involved in the pathological change.

Figure 1: Typical biomechanical traces in the two experimental conditions for one representative participant. CTL: control; xPmax: peak of CoP backward shift; xMTO and xMFC: CoM displacement at toe-off and foot contact; xM'TO and xM'FC: CoM velocity at toe-off and foot contact; x: anteroposterior axis; F and B: backward and forward directions

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Keywords: Neuropathic pain, sodium channel, tumor necrosis factor-alpha

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-24: In patients with Parkinson disease in the off-medication state, bilateral electrostimulation of tibialis anterior improves anticipatory postural adjustments during gait initiation Top


Arnaud Delafontaine1,2, Ahmed Zemouri1,2, Matthieu Fischer1,2, Sebastien Ditcharles3, Paul Fourcade1,2, Pierre-Louis Doutrellot4, Sophie Tasseel-Ponche4,5, Eric Yiou1,2

1STAPS, CIAMS, Univ. Paris-Sud., Universite Paris-Saclay, 91405 Orsay, France, 2CIAMS, Universite d'Orleans, 45067 Orleans, France, 3ENKRE, 94410 Saint-Maurice, France, 4LNFP EA4559, Universite, de Picardie Jules Verne, CURS rue Rene, Laennec 80054 Amiens, France, 5MPR Neurologique, CHU Amiens Picardie, 80000 Amiens, France

Background and Aims: Gait initiation (GI) is a functional task that is classically used to investigate balance control in patients with Parkinson Disease (PD). GI includes dynamical phenomena before swing foot-off (the so-called Anticipatory Postural Adjustments, i.e. APAs), during which the center-of-pressure (CoP) is shifted backward and toward the swing leg. APAs are known to be bradykinetic in advanced Parkinson's disease and may be one of the factors associated with freezing. Electrostimulation is a rehabilitation method directed to improve neuromuscular activation, balance and walking speed in post-stroke patients. It is also used to attenuate freezing in PD patients. This study tested the hypothesis that electrostimulation applied bilaterally on tibialis anterior (TA) which are muscles involved in APAs improves postural control in PD patients in their OFF-medication state. Methods: Nine PD patients in OFF-medication state performed series of ten GI on a force-plate in the following randomized conditions: 1) without electrostimulation (control), 2) with 2-Hz and 3) with 40-Hz electrostimulation applied bilaterally to TA during GI. Classical biomechanical GI parameters were analysed. Results: Backward CoP shift (p<0.001), forward center-of-mass (CoM) velocity at heel-off (p<0.05) and CoM position at foot-off (p<0.001) were significantly larger in the 40-Hz than in the control condition. In contrast, APAs duration, postural stability and CoM progression velocity remained unchanged across conditions [Figure 1]. Conclusions: When exposed to 40-Hz TA electrostimulation, PD patients in OFF-medication were able to develop larger APAs amplitude within an equivalent duration, i.e. APAs were facilitated. These preliminary results may have relevant implications in the rehabilitation of APAs in PD patients in their OFF-medication state, where APAs are known to be smaller than in patients in ON-medication state and healthy control.

Keywords: Electrostimulation, gait initiation, Parkinson

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-25: Age and sex specific effects in paravertebral surface electromyographic back extensor muscle fatigue in chronic low back pain Top


Gerold Ebenbichler1, Richard Habenicht2, Patrick Mair3, Josef Kollmitzer2,4, Thomas Kienbacher2

1Department of Physical Medicine, Rehabilitation and Occupational Medicine, Vienna Medical University, Vienna, Austria, 2Karl-Landsteiner-Institute of Outpatient Rehabilitation Research, Vienna, Austria, 3Department of Psychology, Harvard University, Cambridge, MA, USA, 4Technical School of Engineering, Vienna, Austria

Background and Aims: Aging and female sex are associated with a decrease in back extensor muscle fatigability. By contrast, back muscle fatigue in chronic low back (cLBP) patients is known to increase. This study sought to compare electromyographic back extensor muscle fatigue between older and younger as well as male and female cLBP patients. Reliability of the SEMG fatigue measures was also examined. Methods: From 117 younger (58 females) and 112 older (56 female) cLBP patients who were seated on a dynamometer with their trunks 30&deg anteflexed, paraspinal SEMG activity was recorded bilaterally from the multifidus (L5) longissimus (L2) and iliolumbalis (L1) muscles during isometric sustained back extensions performed at 80% of maximum. Tests were repeated after 1-2 days and 6 weeks. The EMG variables indicating neuromuscular fatigue root mean square (RMS) and median frequency (MF) were analyzed. Results: Maximum back extensor strength was significantly higher in men than in women but comparable between younger and older cLBP patients. The RMS-EMG changes significantly increased with the duration of the sustained contraction with no significant age or sex specific differences observed in any of the recording sites. By contrast, the MF-EMG fatigue slopes decreased significantly less in older than younger cLBP patients in the L5 and L2 electrode recording sites. Furthermore MF-EMG fatigue was more pronounced in males than in females of both age groups at the L5 and L2 recording sites. Relative reliability was good to excellent for the RMS- and MF-SEMG fatigue slopes but absolute reliability was found to be high for both variables. Conclusions: The MF-EMG fatigue method is able to elucidate alterations of aging back muscles in both male and female cLBP patients. Therefore, this method might be suggested as a surrogate measure to early detect aging of back muscles both in healthy individuals and cLBP patients.

Keywords: Aging, muscle fatigue, surface electromyography

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-26: Investigation on bimodality of vertical ground reaction force during gait in community elderly: Regarding trunk posture and spinal column mobility, gait instruction Top


Hayato Enoki1, Kenji Ishida2, Shuoyu Wang3

1Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Japan, 2Department of Rehabilitation Center, Kochi Medical School Hospital, Nankoku, Japan, 3Department of Intelligent Mechanical Systems Engineering, Kochi University of Technology, Kami, Japan

Background and Aims: In our previous studies we evaluated with posture by photograph, the elderly people whose posture was deformed decreased in gait ability and some bimodality of vertical ground reaction force (VGRF) had disappeared. In this study, we objectively quantified trunk posture and spinal mobility of elderly people and investigated the relation with gait parameters in more detail. Furthermore, we studied gait instruction that bimodality of VGRF recovers instantaneously. Methods: The subjects we comprised of 200 community-dwelling elderly people aged 65 years or older (71±5 years). Objective evaluation of posture of trunk and spinal mobility was performed by Spinal Mouse (Index Ltd.). Gait analysis was performed using Gait Scan (Nitta Ltd.). We evaluated the gait parameters under the three conditions of normal gait, stride instruction that made the subject aware of stride, and body trunk instruction that made the subject aware of their trunk posture. Results: The upright angle and posterior flexion angle of the spinal column showed a significant correlation with the normal gait parameters [Table 1]. In addition, as a result of investigating factors that influence the bimodality of VGRF, step length (odds ratio; 1.079 ) and time of step (odds ratio: 0.980 ) in normal gait were selected [Table 2]. The result of examining the walking guidance effect of 41 people who did not have bimodality of VGRF during normal gait, bimodality recovered in 22 people in stride instruction and 23 in trunk instruction. But no significant difference was found effect between both the instruction. Conclusions: The results of this study suggest that it was suggested that prevention of kyphosis and maintenance and improvement of posterior flexion angle of the spinal column may lead to an increase in stride and bimodality can be maintained. Furthermore, stride instruction and trunk instruction were about the same immediate effect.

Keywords: Bimodality of vertical ground reaction force, community elderly, trunk posture

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.






  No. P1-28: Effects of the belt-electrode skeletal muscle electrical stimulation on the rectus femoris muscle thickness and the exercise tolerance in healthy young adults Top


Yuji Fujino, Yosuke Takahashi, Kohei Miura, Ayumi Toida, Shigeru Makita

Saitama Medical University International Medical Center, Saitama, Japan

Background and Aims: Belt-electrode skeletal muscle electrical stimulation (B-SES) can contract all the lower limb skeletal muscles simultaneously. However, it is unclear what the B-SES effects muscle and aerobic capacity. The present study investigated the effect of the B-SES for muscle thickness and exercise tolerance in healthy young adults. Methods: Nine healthy male volunteers (mean age, 26.1±4.3 years) were participated in this study after providing their written informed consent. Subjects wore B-SES at the waist, and distal femurs and ankles on both sides. The stimulator current waveform was designed to produce co-contractions in the lower-extremity muscle groups at a frequency of 20 Hz with a pulse width of 250 μs, and the duty cycle was stimulation for 5 seconds with a pause for 2 seconds. The output intensity was set to the tolerable maximum value. B-SES was performed for 20 minutes daily (3 sessions/week), with 18 sessions in six weeks. The rectus femoris muscle (RF) thickness was evaluated by ultrasound imaging. The exercise tolerance was assessed cardiopulmonary exercise testing and was calculated anaerobic threshold (AT) and peak VO2. These assessments were performed before and after intervention. Results: The mean RF thickness was significantly increased from 16.3±2.4 mm before to 17.1±1.9 mm after intervention (p<0.05). The mean AT was 33.3±5.0 ml/kg/min before intervention, and was 36.3±6.0 ml/kg/min at after intervention. The AT showed marginally significant difference before and after intervention (p<0.1). In the peak VO2, significant difference was observed in the before and after intervention (before; 17.0±3.5 ml/kg/min, after; 18.3±2.9 ml/kg/min, p<0.05). Conclusions: The results suggest that B-SES increased the skeletal muscle volume and aerobic capacity.

Keywords: Aerobic capacity, electrical stimulation, muscle thickness

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-29: Increase of interleukin-6 and attenuation of tumor necrosis factor-a during wheelchair half marathon in athletes with cervical spinal cord injuries Top


Yohei Furotani1, Takahiro Ogawa1, Takeshi Nakamura2, Miyuki Minakata1, Kazunari Nishiyama1, Motohiko Banno1, Yusuke Sasaki3, Yasunori Umemoto1, Ken Kouda1, Takashi Kawasaki4, Fumihiro Tajima1

1Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan, 2Department of Rehabilitation Medicine, Yokohama City University, Yokohama, Japan, 3Department of Rehabilitation Medicine, Gifu Municipal Hospital, Gifu, Japan, 4Department of Rehabilitation Medicine, Kyoto prefectural University of Medicine, Kyoto, Japan

Background and Aims: Previous studies shows that upper arm exercise in thoracic and lumber spinal cord injuries (SCI) induces an increase in interleukin (IL)-6 but not intumor necrosis factor alpha (TNF-a).However, individuals with cervical spinal cord injury (CSCI) do not have complete skeletal muscles.Therefore, the 20-min arm exercise at 60% of VO2max in CSCI did not increase IL-6.Long and intensive exercise might increase circulating IL-6 during and after exercise in CSCI. The purpose of this study was to determine the effects of long and intensive exercise on serum IL-6 in the presence of sympathetic nervous system dysfunction. Methods: Blood samples of six CSCI and eight SCI athletes in wheelchair half marathon race were collected before the race, immediately after completion of the race and 2h after the race. The blood samples were taken in all subjects to measure IL-6, TNF-a,adrenaline, and counts of blood cells. Results: Monocyte count remained stable throughout the study in CSCI but was significantly high at 2 h after the race in SCI. Plasma IL-6 concentrations were significantly elevated immediately after the race in both groups, although the levels in CSCI were significantly lower than in SCI. Plasma adrenaline was significantly elevated (P<0.01) immediately after the race in SCI but recovered at 2 h after the race. In contrast, plasma adrenaline did not change in CSCI and was significantly lower than SCI (P<0.05). Plasma TNF-a did not change in SCI compared to a significant decrease at 2h after the race in CSCI (P<0.05). Conclusions: Long and intensive exercise increased IL-6 in CSCI despite the small muscle mass and lack of sympathetic nervous system. The post-race fall in plasma TNF-a in CSCI could be related to the inhibitory effect of rising IL-6 in the presence of normal monocyte count and stable adrenaline level.

Keywords: Cervical spinal cord injuly, interleukin-6, tumor necrosis factor-a

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-30: A multi-level dynamic functional connectivity analysis method based on resting-state BOLD fMRI Top


Yun Xiang Ge1, Huiwen Luo1,2, Weibei Dou1, Yu Pan3,4

1Department of Electronic Engineering, Tsinghua University, Beijing, China, 2Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA, 3Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China, 4School of Clinical Medicine, Tsinghua University, Beijing, China

Background and Aims: Functional magnetic resonance imaging is an important technique to study the activity of human brain and functional changes following rehabilitation. Human brain is modeled as a complex, huge and effective network using functional connectivity. Most of previous researches focus on static functional connectivity, ignoring the dynamic characteristics of human brain. In this work, we proposed a method of multi-level dynamic functional connectivity (DFC) analysis in order to show functional changes of patients and aid clinicians in rehabilitation. Methods: Resting-state fMRI data of 18 spinal cord injury patients and 18 healthy controls (HC) were used to validate our method. We used sliding-window correlation based on brain regions defined in the Brodmann atlas to construct dynamic networks. Three step sizes were adopted to extract features in different time scales. Inter- and intra-region graph theory properties, including local efficiency, weighted degree and characteristic path length, were calculated and analyzed with clinical scores. Results: We found that when the step size equals 3 TRs, it can extract more features while reducing computation costs. For inter-group analysis, the DFC showed similar significantly different regions as static connectivity in inter-region local efficiency and weighted degree. The intra-region characteristic path length obtained in DFC showed more significantly different regions. The proposed method revealed the inferior frontal gyrus (BA45), the premotor (BA6) and primary motor cortex (BA4) as significantly correlated with clincal ASIA scores. The primary somatosensory cortex (BA1, BA2) was identified as significantly different from HCs. Conclusions: The proposed multi-level DFC method not only extracted more information related to alterations in functional connectivity, but also provided preliminary evidence for clinicians to diagnose and arrange rehabilitation programs. However, future works are needed to combine this method with rehabilitation progress evaluation, as well as apply the method to other central nervous system disease.

Keywords: Dynamic functional connectivity, resting-state fMRI, spinal cord injury

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-32: Dynamic changes of event-related potentials during recovery from poststroke aphasia Top


Bertrand Glize1,2, Gregoire Python3, 4, Stephanie Clarke4, Marina Laganaro3

1EA4136, HACS, University of Bordeaux, Bordeaux, France, 2PMR Department, CHU de Bordeaux, Bordeaux, France, 3Faculty of Psychology, University of Geneva, Geneva, Switzerland, 4CHUV de Lausanne, Switzerland

Background and Aims: Electrophysiological changes related to recovery from aphasia in specific language tasks seem to follow a trend to approximate healthy processes, except several divergences (Laganaro et al. 2008 & 2011). Event Related Potentials ERPs normalisation or diverging patterns over the time raises the question of reorganisation of the language networks in the brain following stroke despite the lesion and its impact on electrical properties of the cortex. In this study, we analysed for the first time changes in ERP patterns in patients with aphasia 1 and 6 months after stroke as compared to healthy matched controls using a word production task (picture naming). First, we explored the divergence of ERPs from a control group and then explored if intra-patient changes tended to approximate a normal pattern or to diverge from it. Methods: Electrophysiological correlates of recovery from aphasia were analysed in four aphasic patients. ERPs were recorded during picture naming at one month (M1) and six months (M6) post-stroke. All patients improved significantly during the study period. Waveform analyses were carried out on the ERPs of each patient, comparing intrapatient changes between M1 and M6. These changes were analysed in comparison with 8 matched healthy control subjects. Results: Normalisation as well as an increase of abnormal electrophysiological correlates accompanied recovery. Patients' ERPs tend to approximate the control group between M1 and M6 in specific time-windows suggesting a normalisation of ERPs over time [Figure 1] associated with behavioural improvement and most of intra-patient changes were related to this normalisation [Figure 2]. Conclusions: The present study explored for the first time ERPs changes over the time and findings suggest that intra-patient changes were related to normalisation. Hence, aphasia recovery might be associated with reorganisation in electrophysiological activity which might need to approximate an activity similar to that displayed by healthy subjects despite brain lesion.

Keywords: Aphasia, recovery, EEG/ERP

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.



Figure 2: ERPs of picture naming task for the four patients. Blacck ERP: average for the contol group; red ERP: average at M1; green ERP: average at M6. Blur rectangles correspond to intra patient changes that were related to an initial divergence from the control group at M1 following to a joint to the conrol group at M6, Orange rectangles dorrespond to intra-patient changes that were related to an absence of divergence from the control group at M1 following to a divergence from the control group at M6. Red rectangles correspond to intra-patient changes that were divergent from the control group at M1 and at M6. Locations of these changes are presented using the same colour code

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  No. P1-33: Adaptation among children of migrant origins: Implications to rehabilitation Top


Ivan Neil B. Gomez1,2, Cynthia Y. Y. Lai1, Hector W. H. Tsang1

1Department of Rehabilitation Science, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, 2Center for Health Research and Movement Science, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines

Background and Aim: Worldwide, there are approximately 30 million children of migrant origins. Previous researchers have identified behavioral and physiological problems prevalent among these population. In this research, it is intended to determine how children of migrant origins have adapted to their current host country in comparison to children from their host country and country of origin. Methods: 113 typically developing children (31 Chinese children in Hong Kong; 28 Filipino children in Hong Kong; and 54 Filipino children in the Philippines) ages 7-12 years old, were subjected to a sensory laboratory paradigm (SLP) while consecutively measuring heart rate variability (HRV) and electrodermal activity (EDA). The SLP comprised a resting, auditory sensory stimulation and recovery conditions. HRV and EDA were recorded and measured using the Polar H2 heart rate monitor and eSense GSR sensor respectively. Parents were asked to complete the Sensory Profile questionnaire. Results: Chinese and Filipino children living in Hong Kong showed similar behavioral and physiological regulation in response to sensory stimuli. However, when Filipino children living in Hong Kong were compared with their peers from the Philippines, results suggest significantly different behavioral (p= 0.01) and physiological (p= 0.00 - 0.05) outcomes. Conclusions: Prolonged exposure to a new environment promoted behavioural and physiological adaptation among children of migrant origins. Children of migrant origins have adapted and display similar adaptive abilities with children from their new host environment. Whether this adaptation is healthy or not is yet to be fully understood. Rehabilitation professionals and researchers should focus on the long-term effects of migration of on children in order to support healthy adaptation. Nevertheless, our findings here have implications for further understanding the impact of migration on children's health and functioning.

Keywords: Adaptation, children, migration

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-34: Microstructural brain changes following mild traumatic brain injury in adults: A comparative study of multiple neuroimaging metrices Top


Norhamizan Hamzah1, Prasath Swaminathan2, Norhamimah Mohd Noor2, Li Kuo Tan2, Aditya Hernowo3, Mazlina Mazlan1, Vairavan Narayanan3, Norlisah Ramli2

1University of Malaya, Kuala Lumpur, Malaysia, 2Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia, 3Department of Surgery, Neurosurgical Unit, University of Malaya, Kuala Lumpur, Malaysia

Background and Aims: A comparative study of Diffusion Tensor Imaging (DTI), Neurite Orientation Dispersion and Density Index (NODDI) and cortical thickness parameters to detect microstructural changes for adults with mild traumatic brain injury (mTBI) at three months post injury. Methods: Participant recruitment was from University Malaya Medical Centre (UMMC), Malaysia within 72 hours of injury and underwent neuropsychological assessment at two weeks and at three months. Based on the assessment result, participants were divided into two groups: recovered cognition (RC) and impaired cognition (IC). Each participant then underwent neuroimaging studies. Outcome measures: 1) Neuropsychological Assessment Battery-Screening 2) DTI parameters,3) NODDI parameters: Orientation Dispersion Index (ODI), Neurite Density Index (NDI) and Isocellular volume Fraction (Viso). 4) Subcortical Segmentation (volume) 5) Cortical Automatic Parcellation (surface area) based on the Desikan/Kiliant Atlas. Results: 36 patients were selected at three months injury period (IC n=22; RC n=14) with mean age 29.4 SD 8.88 years and mean education years of 12.57 SD 1.5. There was significant deficit in Attention (IC 83 vs RC 101), Language (IC 78 vs RC 92) and Executive Function (IC 85 vs RC 90) domain deficits. TTBSS and DTI parameters showed no statistical significance between groups. NODDI parameters showed significantly higher OD in left corticospinal tract and bilateral posterior corona radiata, lower NDI in bilateral cingulum and higher Viso in right external capsule values in the RC compared to IC. Volume analysis reported significantly higher bilateral amygdala volume values in the IC. They also had significantly higher surface area mean values predominantly for frontal lobe including Broca and Wernicke areas and occipital lobe. Conclusions: DTI findings suggested intact white matter fibres' direction for both groups following trauma. However, the RC had increased dispersion, vasogenic oedema and thinner cortices than the IC group which may suggest active synaptic pruning/synaptogenesis process.

Keywords: Cognitive deficits, diffusion Tensor imaging, mild traumatic brain injury

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-35: The effects of anodal transcranial direct current stimulation on long-term potentiation in transgenic mice Top


Jae-Young Han1, Wang-In Kim1, Min-Keun Song1, Hyeng-Kyu Park1, Jihoon Jo2

1Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea, 2Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea

Background and Aims: Transcranial direct current stimulation is fragmentarily reported to be beneficial to improve cognitive function in Alzheimer's disease (AD). The aim of this study was to investigate effect of tDCS on long term potentiation in AD mice model. Methods: AD mice model was used only in male mice that were mated with C57BL / 6J male of five familial AD mutations (5xFAD) and C57BL / 6J wild-type female and DNA sequencing was performed to confirm dementia model. Male mice that had been infected with dementia were placed on both frontal lobes with tDCS for 20 minutes to 200uA. After that, mice were sacrificed by cervical dislocated to obtain hippocampus and then the neuronal activity of hippocampus was confirmed by excitatory postsynaptic potential (EPSP) and molecular biology was examined by Western blot with the rest of the organization. Results: As a result, it was confirmed that EPSP was increased compared to the 5xFAD experimental group in which the tDCS stimulus did not stimulate. And wild type was confirmed that EPSP was not changed each group. Western blot showed that Brain-derived neurotrophic factor (BDNF), cyclic AMP response element binding (CREB) and phosphorylation of cyclic AMP response element binding (pCREB) was increased in 5xFAD with tDCS treated groups compared 5xFAD without treated groups. Conclusions: This study revealed that the both frontal lobe stimulation of tDCS affects the long -term potentiation and have the possibility of improving the memory with Alzheimer's dementia disease.

Keywords: Alzheimer's disease, long-term potentiation, transcranial direct current stimulation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-36: Optimization the conditions of Prolotherapy using Sluka's chronic muscle pain model Top


Der-Sheng Han1, Chih-Cheng Chen2

1Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan, 2Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan

Background: Prolotherapy is widely used in pain control and tissue repair in the field of physical medicine and rehabilitation. The classical mode is injection with hypertonic dextrose in muscle or perimysium. However, its analgesic mechanism and optimal injectant setting is still inconclusive. Materials and Methods: We employed the chronic hyperalgesia mouse model proposed by Sluka et al. and determined the optimal prolotherapy injectant settings, including substrate, concentration, and amount. The withdrawal response of mouse hind paws was defined as foot lifting when a 0.2-mN von Frey filament was applied. Mice were injected with pH 4.0 saline on days 0 and 1. The withdrawal responses shown before and after i.m. acid injection confirmed acid-induced mechanical hyperalgesia for the following prolotherapy. Results: Dextrose at concentration of 5% and 25% both had greatest analgesic effect. Injectant amount at 15ul and 20ul had better analgesic effect than 10ul and 5ul. There is amount-dependent effect in terms of therapeutic effect of prolotherapy. When we change injectant to saline or fructose at the same osmotic pressure as 5% dextrose, the analgesic effect diminished significantly. Conclusion: Intramuscular injection of 5% dextrose at amount of 20ul had the maximal analgesic effect in mouse model of chronic muscle pain. Future studies employing specific inhibitors and knock-out mice will delineate the mechanism of analgesia.

Keywords: Dextrose, fibromyalgia, prolotherapy

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.




  No. P1-37: Voluntary neck rotation enhances ulnar nerve F-wave Top


Motohiko Hara1,2, Saori Kawakami2, Emi Ohishi2, Hiromi Thomas-Nakamura2, Kyoko Maeda1, Yoko Yamanouchi1, Mitsuru Majima1, Hitoshi Kurabayashi1, Jun Kimura3

1Department of Rehabilitation Medicine, Saitama Medical University, Saitama, Japan, 2Deparment of Health Sciences, Saitama Prefectural University, Koshigaya, Japan, 3Department of Neurology, University of Iowa, Iowa City, Iowa

Background and Aims: We examined the effect of active and passive neck rotation on the persistence of F-waves recorded from the first dorsal interosseous muscle. Methods: In 6 healthy subjects, each 20 F-wave was recorded in the 3 following stages: i) at rest with the subject in spine position on the bed, ii) while the neck rotated to right side passively and iii) during voluntary neck rotation to right side with 10% maximal voluntary contraction (MVC). We monitored surface EMG on sternocleidomastoid muscle in each stage, which confirmed no muscle activities at rest and during neck-rotated posture. Results: F-wave persistence changed from 41.6±24.2% (mean±SD) at rest to 42.5±29.4% (p>0.05) during neck-rotated posture to 60.0±32.2% during voluntary contraction (p<0.05, ANOVA). The trial average of F-waves changed from 21.5±29.7μV at rest to 21.0±31.7μV (p>0.05) neck-rotated posture to 31.5±35.0μV (p<0.05) during voluntary contraction. The F-wave minimum latency revealed no significant changes. Conclusions: We have previously shown that voluntary contraction of the target muscle enhances F-wave persistence and amplitude. The current study indicates contraction of some non-target muscle can also cause a transient increase in distant motoneuron excitability, and there is no influence of posture or position of neck for the motoneuron excitability.

Keywords: F-wave, spinal excitability

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-39: Differences in serum interleukin-6 levels response after 1 rise in core temperature in individuals with spinal cord injury during lower body heat stress Top


Takamasa Hashizaki1, Yukihide Nishimura2, Yasunori Umemoto1,

Ken Kouda1, Yuuki Mukai1, Daisuke Kozima1, Tokio Kinoshita1, Takashi Moriki1, Fumihiro Tajima1

1Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan, 2Department of Rehabilitation Medicine, Iwate Medical University, Iwate, Morioka, Japan

Background and Aims: Passive rise in core temperature achieved by head-out hot water immersion (HHWI) results in acute increases in serum interleukin (IL)-6 instead of no responses of plasma adrenaline in patients with cervical spinal cord injury (CSCI). The purpose of the present study was to detect the major factor of increase in serum IL-6 during lower body heat stress. Methods: The study subjects were 9 with CSCI, 10 with thoracic and lumbar spinal cord injury (TLSCI) and 8 able-bodied (AB) subjects. Time since injury was 16.1years in TLSCI and 16.4 years in CSCI. Subjects were lower-body heat stress (LBH) by wearing a hot water-perfused suite until 1degree increase in core temperature. The levels of serum IL-6, plasma adrenaline, tumor necrosis factor (TNF), C-reactive protein (CRP), and counts of blood cells were measured at normothermia and after LBH. Results: Serum IL-6 concentrations increased significantly immediately after LBH in all the three groups. IL-6% was lower in CSCI subjects compared with AB subjects. Plasma adrenaline concentrations significantly increased after LBH in AB and TLSCI subjects, but did not change throughout the study in CSCI subjects. Conclusions: Regardless of same increase in core temperature among all group, IL-6% of the CSCI subjects were lower than those of the subjects with AB. These findings suggested that IL-6 elevation during hyperthermia would involve adrenaline.

Keywords: Heat stress, myokine, spinal cord injury

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-40: Effects of muscle resistive training on acetabular dysplasia by finite element analysis Top


Kazutoshi Hatakeyama1, Hiroaki Kijima2, Takehiro Iwami3, Akira Komatsu3, Kimio Saito1, Motoyuki Watanabe1, Yusuke Takahashi1, Kazuki Okura1, Tomohiro Suda1, Hikaru Kikuchi1, Ryo Higuchi3, Kotaro Suzuki3, Yu Igarashi3, Toshiki Matsunaga1, Yoichi Shimada2

Rehabilitation Division, Akita University, Akita, Japan, 2Department of Orthopedic Surgery, Akita University Graduate school of Medicine, Akita, Japan, 3Akita University Graduate School of Engineering Science, Akita, Japan

Background and Aims: Hip dysplasia does not adequately cover the femoral head. In hip dysplasia, the hip is unstable, may become painful, and may eventually develop osteoarthritis. We previously reported reduction of maximum stress of the acetabular margin by weight reduction and pelvic anteversion by finite element analysis. In clinical practice, muscular strength training of the hip joint muscle is commonly performed. The aim of the present study was to analyze the influence of strength training of the hip joint muscle on stress of the acetabular margin in acetabular dysplasia patients. Methods: We calculated the hip centralizing force using a three-dimensional musculoskeletal model (ANYBODY modeling system) while standing. The standing posture was measured using a 3D motion analysis device (VICON MX). The coordinate position data were reflected in the musculoskeletal model. The muscle force value was changed in the musculoskeletal model, and the femoral head centripetal force was analyzed. We used Mimics/3-matic (Materialise, N.V., Leuven, Belgium) for finite element model and Marc Mentatfinite element analysis software (MSC Software Co.) for stress analysis. Results: When the gluteus medius muscle strength was 100% (Normal), the hip centralizing force was 58.1 N. At 50% (Weak) it was 56.7 N and at 150% (Increase) it was 59.5 N. The medial vector increased according to the gluteus muscle strength. Maximum stress was 0.415 MPa at 100% (Normal) and 0.458 MPa at 150% (Increase). Conclusions: Overall, the hip centralizing force increased with gluteus medius muscle strength. Strength training significantly affected stabilization of the hip joint; however, the maximum stress also increased. These findings demonstrate the importance of pelvic anteversion in a comprehensive approach to muscle strengthening and weight reduction.

Keywords: Acetabular dysplasia, hip centralizing force, muscle strength

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-41: Symmetry of hip movement on a split-belt treadmill in poststroke Top


Keisuke Hirata1, Hiroki Hanawa1,2, Taku Miyazawa3, Keisuke Kubota1, Moeka Sonoo1,4, Tsutomu Fujino1,5, Takanori Kokubun1, Naohiko Kanemura1

1Saitama Prefectural University, 2Japan Society for the Promotion of Science, Japan, Koshigaya, Japan, 3Hasuda Central Clinic, Hasuda, Japan, 4RIKEN Brain Research Institute, Wako, Japan, 5University of Human Arts and Science, Saitama, Japan

Background and Aims: When left and right belts move at different speeds on split-belt treadmill, able-body people adapt the walking step length to re-establish symmetry. Stroke survivors also have this adaptability. We recently clarified that the hip flexion angle at heel strike also re-established symmetry. The aim of this study was to investigate whether post-stroke patients re-established symmetry of the hip flexion angle. Methods: 14 chronic stroke patients with hemiparesis and 15 healthy young adults walked on a treadmill at belt settings that were tied- and split-belt [Figure 1]. At first, both belts were half of the maximum walking velocity of each subject. Next, only a side belt accelerated till the maximum walking velocity in suddenly. We used a VICON Nexus 2.7 (VICON Corp.) and double-belt treadmill (Bertec Corp.), as shown in [Figure 2]. We calculated the symmetrical index (Slow-Fast/0.5(Slow+Fast) %) of step length and hip angle. In this study, we divided post-stroke subjects by the symmetry in step length of mean of all healthy adults (22.6%). In the adaptation period, subjects whose step length was greater than 22.6 were defined “responder”(six), while subjects with a step length under 22.6 were defined “non-responder”(eight). Results: In responders, the step length re-established symmetry (tied-belt vs. adaptation periods, p=0.29), but the hip flexion angle remained asymmetry. In non-responders, the step length remained asymmetry, but the hip flexion angle showed no significant difference from symmetry in the tied-belt period (p=0.15). Conclusions: Healthy young adults re¯established step length and hip flexion angle at heel strike. Conversely, chronic post-stroke survivors could not re-establish hip flexion angle symmetry regardless of re-establishing step length symmetry. The symmetry of step length is known as a spatial adaptive parameter. In responders, decreased paretic knee extension in the swing phase due to hamstrings spasticity could prevent the hip flexion angle from re-establishing symmetry.
Figure 1: Treadmill setting

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Figure 2: Experimental set-up

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Keywords: Poststroke, split-belt treadmill, walking

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-42: Reliability of rehabilitative ultrasound imaging for subscapularis muscle at rest and during contraction Top


Hisashi Homma1,2, Mitsuhiro Aoki1, Yuji Sasaki1, Takeshi Iizawa1, Masahiro Yamane1, Kazuhiro Sugawara1, Tomoya Hayashi1

1Graduate School of Rehabilitation Sciences, Health Sciences University of Hokkaido, Tobetsu, Japan, 2Department of Rehabilitation, Sapporo Hachiken Orthopedic Clinic

Background and Aims: Reports on muscle function evaluated by rehabilitative ultrasound imaging (RUSI) have been increasing. By evaluating the active/contracted state of the subscapularis muscle by RUSI, it becomes possible to observe its dysfunction, contributing to improvement of the quality of rotator cuff muscle exercise. The purpose of this study is to use RUSI to measure muscle thickness at rest and contraction of the subscapularis muscle, determine the reliability of the method and clarify whether it is clinically feasible. Methods: Twenty-two healthy adult males were employed and all non-dominant shoulders were used. In supine position, the shoulder was kept 90° flexion in neutral rotation, inserting a wedge behind the scapula keeping the scapula anterior inclination by 30 degrees. This position helps to keep the lateral edge (1 cm width platform) of the scapula upward. The transducer is placed at the position of lower part of the subscapularis muscle on the edge. Distance from the edge to surface fascia of the muscle is defined as muscle thickness. The thickness of the muscle at rest and isometric contraction 10-40% were measured. For reliability, ICC and Bland-Altman plots were used within one examiner. Statistical analysis was performed by R2.8.1. Results: The thickness of the subscapularis muscle was 23.7mm at rest, 25.1mm at 10%, 25.5mm at 20%, 25.8mm at 30%, 26.1mm at 40% contraction. ICCs ranged from 0.95 to 0.99. Bland-Altman analysis showed neither fixed nor proportional bias. Minimal detectable change ranged from 3.0 to 4.8mm. Repeated ANOVA showed statistically significant increase in muscle thickness from at rest to 40% contraction. Conclusions: The reliability within the examiner of the subscapularis muscle thickness was disclosed, and the thickness increased significantly by muscle contraction. Therefore, it is suggested that the subscapularis muscle thickness measurement obtained by RUSI is a useful measuring tool for clinical physiotherapy evaluation.

Keywords: Muscle thickness, subscapularis, ultrasound imaging

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-44: Secretome from pluripotent stem cell-derived neural precursor cells promote neural tissue repair and behavioral function in a rat stroke model Top


Ji Seon Hong1, Ji Yong Lee1, Han-Soo Kim2, Ji Hyun Kim1, Ji Yoon Jang1

1Department of Rehabilitation, Won-Ju Severance Christian Hospital, Wonju, South Korea, 2Department of Biomedical Sciences, Catholic Kwandong University College of Medicine, Incheon, Korea

Background and Aims: We previously showed that the transplantation of pluripotent stem cell-derived neural precursor cells (NPCs) improve functional outcomes in a rat model of ischemic stroke. NPCs exerted the beneficial effects, in part, through paracrine mechanism. Methods: In this study, we investigated the ability of NPC secretome to improve behavioral function in a rat stroke model. Results: Data showed that rats administrated with NPC secretome are superior to those treated with blank in behavioral function throughout time points. To investigate its underlying events, immunohistochemical (IHC) analysis was performed on rat ischemic brains. IHC analyses showed that NPC secretomes reduced inflammation, enhanced angiogenesis with increased endogenous neurogenesis in rat injured brain. Conclusions: In conculsion, NPC secretome promotes the functional recovery of damaged stroke brain via modulation of anti-inflammation, angiogenesis and neurogenesis. Thus, NPC secretome closely recapitulateds the effects seen upon NPC transplantation.

Keywords: Neural tissue repair, pluripotent stem cell stem cell

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-46: Novel animal model of entrapment neuropathy induced by ultrasound-guided injection Top


Ming-Yen Hsiao1, Ya-Wen Wu1, Chueh-Hung Wu1, Po-Ling Kuo2, Wen-Shiang Chen1

1Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan, 2Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan

Background and Aims: Entrapment neuropathy is the most prevalent mononeuropahty, with carpal tunnel syndrome being the representative form. The etiology is commonly hypothesized to be increased pressure and nerve compression. However, adhesion of nerve and surrounding connective tissue causing excessive gliding resistance and shear strain of the nerve during motion play an important role. Established animal models includes perineural silicone cuff and angioplasty balloon compression. These models require surgical procedure and induce neuropathy by mechanical compression, which is quite different from the condition of adhesion. Herein, we aim to establish a novel and easily applicable animal model of entrapment neuropathy, featuring adhesion-predominant pathology, by ultrasound-guided peri-neural injection of adhesives. Methods: Different types and concentrations of injectates, including methacrylate adhesives, hydrogel/collagen mixture, or hypertonic dextrose, were tested to identify the optimal regimen of inducing perineural adhesion. The injection was performed under ultrasound-guidance (long-axis view, in-plane approach), targeting at right sciatic nerves of Sprague-Dawley rats at mid-thigh level. The left sciatic nerves serve as control group. The nerve conduction studies were performed before injection and at 14, 21 and 28 days after injection. At day 28, the nerves were harvested for histology analysis. Results: The groups injected with methacrylate adhesives and hydrogel/collagen mixture revealed decreased nerve conduction velocities at 21 and 28 days after injection. The nerve specimen at day 28 revealed decreased axon diameter, thinning of myelin sheath, and prominent perineural fibroblast proliferation, with increased expression of TGF&#61538;1 and Caspase 3/7. The dextrose injection group did not show significant changes both electrophysiologically and histologically when compared with control group. Conclusions: Ultrasound-guided perineural injection is an easily applicable method to induce adhesion-predominant neuropathy, which might better characterize entrapment neuropathy. The proposed model serves as a platform for future research of pathophysiology, as well as the effect of hydrodissection in entrapment neuropathy.

Keywords: Animal model, entrapment neuropathy, ultrasound-guided injection

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-47: The effect of mirror visual feedback on motor cortex excitability in patients with subacute stroke: An magnetoencephalography study Top


Yu-Wei Hsieh1, 2, 3, Jun-Ding Zhu1, Chia-Hsiung Cheng1, 2, 4, Tzu-Hsuan Peng1, Chih-Chi Chen3,5

1Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, 2Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan, 3Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan, 4Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan, 5College of Medicine, Chang Gung University, Taoyuan, Taiwan

Background and Aims: Mirror therapy has emerged as a promising rehabilitation approach. It uses mirror reflection of the unaffected hand to create a mirror visual feedback (MVF) to enhance the affected hand's movement in stroke patients. However, few neuroimage studies of MVF were conducted on stroke patients and its neural mechanism is still unclear. This study aimed to clarify the effect of MVF on motor cortical activity in stroke patients using the Magnetoencephalography (MEG). Methods: Sixteen patients with subacute stroke were recruited to conduct the 3 experimental conditions. “Resting” condition: the participants were asked to fixate on a crosshair on the screen. “Mirror” condition: the participants were asked to grip two soft balls by their hands simultaneously, and to observe the mirror reflection of movement performed by the unaffected hand and imagine the movement performed as if the affected hand. “No mirror” condition: the participants had to grip with the balls by their hands simultaneously and directly observe their movement of affected hand. The beta rebound in primary motor cortex (M1) were analyzed based on MEG recordings. The Wilcoxon signed-rank test was used to examine the differences between the conditions. Results: The data showed that beta rebound was significantly decreased in the “Mirror” (P<0.001) and “No mirror” (P<0.001) conditions compared with the “Resting”. It revealed that the M1 was activated strongly in the “Mirror” and “No mirror” conditions than “Resting” condition. Moreover, a significant decrease of the beta rebound of “Mirror” condition compared with “No mirror” condition was found (P=0.044), indicating that providing MVF led to greater activations in stroke patients. Conclusions: We found a stronger motor cortex excitability while providing MVF than no mirror condition, which provides neuroimaging evidence of MVF and supports the use of mirror therapy in patients with subacute stroke.

Keywords: Magnetoencephalography, mirror visual feedback, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-49: Changes of leg and joint stiffness of the lower extremities in children with spastic hemiplegic cerebral palsy during gait Top


Hsing-Po Huang1, Chien-Chung Kuo2, Ting-Ming Wang3, Shih-Wun Hong4, Horng-Chaung Hsu3, Weng-Pin Chen5, Tung-Wu Lu1,3

1Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, 2Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan, 3Department of Orthopedic Surgery, National Taiwan University, Taipei, Taiwan, 4Department of Physical Therapy, College of Medicine, Tzu Chi University, Taiwan, 5Department of Mechanical Engineering, National Taipei University of Technology, Taipei, Taiwan

Background and Aims: Hemiplegic cerebral palsy (HCP) is an irreversible and non-progressive disorder, results in weakness and spasticity on the affected side. Individual joint deviations often develop during growth in children with HCP. Evaluation and interpretation of the measured HCP gait could be complicated. A measure for quantifying the control of the lower limb as a whole would be very helpful in a clinical setting. The current study aimed to compare the leg and joint stiffness in children with HCP during level walking. Methods: Twelve children with spastic HCP performed level walking in a standard gait lab. The leg stiffness was calculated as the ratio of the change of the effective ground reaction force and the change in the effective leg length [Figure 1] while the joint stiffness as the ratio of the change of joint moment and the change of the joint angle. Stiffness values were averaged over loading response (LS), mid-stance (MS), terminal stance (TS), and pre-swing (PS) phase. A paired t-test was performed to compare the variables between the affected (AF) and sound (SN) sides of CP group (α = 0.05). Results: Compared to the sound side, the affected side of the HCP showed increased leg stiffness during MS and TS, but decreased ones during PS [Table 1]. The affected side of the HCP also showed decreased hip joint stiffness and increased ankle joint stiffness during PS, and decreased knee joint stiffness during MS [Table 1]. Conclusions: This study showed that children with HCP required increased leg stiffness during single limb support to prevent collapse. Reduced leg stiffness of the affected limb during PS indicates that they relied more on the ankle joint muscles during weight release. The current study suggests that these variables may be used to uncover the control strategy of the locomotor system.

Keywords: Hemiplegia cerebral palsy, joint stiffness, leg stiffness

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.

Figure 1: Stick figure of a lower limb during stance phase of gait showing the definitions of the effective GRF (Fe) and the effecive leg length (Le)

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  No. P1-50: Effects of pemberton combined with femoral varus osteotomy on biomechanics of the pelvis-leg apparatus in children with legg-calve-perthes disease during gait Top


Hsing-Po Huang1, Kuan-Wen Wu2, Ting-Ming Wang2, Tung-Wu Lu1,2

1Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, 2Department of Orthopaedic Surgery, National Taiwan University, Taipei, Taiwan

Background and Aims: Legg-Calve-Perthes disease (LCPD) is a hip disease defined as necrosis of the femoral head with unclear etiology. The disease will cause long-term femoral head and acetabular deformities, which may lead to early hip degenerative joint diseases. One of the most performed surgery on LCPD is Pemberton osteotomy combined with proximal femoral varus osteotomy (VO), aiming to change the joint morphology and loading condition. The purpose of this study was to evaluate the lower-limb biomechanics during level walking in children with LCPD after Pemberton combined with VO osteotomy using computerized gait analysis. Methods: Twelve children diagnosed with LCPD and 12 age-matched healthy controls performed level walking while their motions measured by a motion capture system (Vicon, UK), and the ground reaction forces measured by 2 forceplates (AMTI, USA). The angles and moments of the hip, knee, ankle, and pelvic motion were calculated. A mix-model one-way ANOVA was utilized to find differences between the LCPD group before operation (Pre-OP), after operation (Post-OP), and the control groups (α =0.05). Results: No significant difference in temporal-spatial parameters was found between groups (p > 0.05) [Table 1]. Compared to the controls, the Pre-OP showed smaller hip adduction angles, abductor moments of the involved side, and greater pelvic downward hiking and counter-lateral rotations of the non-involved side during single limb support (p < 0.05) [Figure 1]. Compared to the controls, the Post-OP showed greater pelvic lateral rotations to the non-involved side (p < 0.05) [Figure 2]. Conclusions: Patients with LCPD were found to have more similar joint kinematics and kinetics to the controls after surgery except for the hip lateral rotation. This suggests that the surgery could alter positively the morphological and loading conditions of the joints during gait. The results will be helpful for clinical decision-making in LCPD treatment.

Keywords: Femoral varus osteotomy, Legg-Calve-Perthes disease, Pemberton osteotomy

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.

Figure 1: Ensemble-averaged hip joint angles and moments, and pelvic motion before the surgery

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Figure 2: Ensemble-averaged hip joint angles and moments, and pelvic motion after the surgery

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  No. P1-53: The effects of leg motor imagery combined with peripheral nerve electrical stimulation on corticospinal excitability and spinal reciprocal inhibition Top


Yusuke Idogawa1, Yoko Takahashi1,2, Tomofumi Yamaguchi2,3, Shigeo Tanabe4, Kunitsugu Kondo1, Michiyuki Kawakami2

1Tokyo Bay Rehabilitation Hospital, Chiba, Japan, 2Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan, 3Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan, 4Department of Rehabilitation Medicine, Fujita Health University, Aichi, Japan

Background and Aims: Motor imagery combined with electrical stimulation (MI + ES) enhances upper-limb corticospinal excitability. However, its after-effects on both of lower-limb corticospinal excitability and spinal reciprocal inhibition (RI) remain unknown. The aim of this study was to investigate the effects of MI + ES on the plasticity of the lower-limb corticospinal excitability and RI. Methods: Seventeen healthy adults (mean age: 24.6±2.1 years) performed following three tasks; MI alone, ES alone, and MI + ES. All participants performed each task for 20 min (200 trials in total) in different days. The MI task consisted of repetitive kinesthetic imaging of right ankle dorsiflexion. The ES task was applied to the common peroneal nerve at a frequency of 100 Hz and intensity of 120% of the sensory threshold of the tibialis anterior (TA) muscle. We examined changes in motor-evoked potential (MEP) of the TA (as a task-related muscle) and of the soleus muscle (SOL; as a task-unrelated muscle) using transcranial magnetic stimulation. We also examined RI from the TA to the SOL using a soleus H-reflex conditioning-test paradigm. MEP and RI changes were assessed at baseline, immediately after, 10, 20, and 30 min after the task. Results: MI + ES significantly increased TA MEPs immediately after and 10 min after the task as compared the baseline, while SOL MEPs were not changed. MI + ES showed a significant increase in the magnitude of RI immediately after and 10 min after the task compared to the baseline. MI and ES alone did not affect MEPs or RI before and after the task. Conclusions: Combination of MI and ES enhances plasticity of both corticospinal excitability and RI in the lower limb.

Keywords: H-reflex, mental practice, motor-evoked potential

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-54: Change of lumbar and hip joint alignment during downward – Reaching from a standing position Top


Takumi Ikeda1,2, Kenji Suehiro3, Takashi Ishihama4, Toshiaki Suzuki2

1Department of Rehabilitation, Tanabe Central Hospital, Kyotanabe, Japan, 2Graduate School of Health Sciences, Graduate School of Kansai University of Health Sciences, Osaka, Japan, 3Headquarters of Medical Corporated Group Sekitetsukai, 4Department of Rehabilitation, Medical Corporated Group Sekitetsukai, Japan

Background and Aims: In this study, we clarify the lumbar, pelvic, and hip joint changes during downward-reaching from a standing position. Methods: Eight healthy adult men participated in this study. At first, subjects looked to their feet in a standing position, and pointed their fingertips towards their toes. From this position, they were instructed to reach for their toes with random 2 cm increments up to 16 cm. They were instructed to maintain each position for 5 seconds. Markers were fastened to the 1st, 3rd and 5th lumbar vertebrae, anterior superior iliac spine, posterior superior lilac spine, greater trochanter, and femoral lateral epicondyle, and postural images were taken with a digital camera on the sagittal plane during the task. From these images, marker position was plotted and the angles associated with lumbar, hip, and forward pelvic flexion were calculated using Image J which was developed by National Institutes of Health. Based on the data, 3 subjects with a greater pelvic forward flexion angle in the starting position were assigned to group A, and 5 subjects with a smaller flexion angle were assigned to group B. Results: Hip joint flexion angles in group A greatly increased as the reaching distance increased. On the other hand, in group B, the angle gradually increased and changed less than in group A. The lumbar flexion angle tended to increase gradually in all subjects, but no obvious difference in pattern was observed between groups. Conclusions: This study indicates that focusing on the pelvic forward flexion angle in the starting posture is useful for understanding changes in the hip angle during downward reaching from a standing position.

Keywords: Downward-reaching, lumbar, pelvic

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-55: Influences of dual-task on jump-landing motion Top


Satoshi Imai1,2, Kengo Harato3, Yutaro Morishige3, Takeo Nagura3, Ryoji Hayakawa4, Tetsuya Tsuji2, Meigen Liu2, Morio Matsumoto3, Masaya Nakamura3, Toshiro Otani5, Hideo Matsumoto1

1Institute for Integrated Sports Medicine, Keio University, Tokyo, Japan, 2Department of Rehabilitation Medicine, Keio University, Tokyo, Japan, 3Department of Orthopaedic Surgery, Keio University, Tokyo, Japan, 4ArchiveTips, Inc., 5Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan

Background and Aims: Inattentiveness is one of the risk factors for body injuries during living and sporting activities. The purpose of this study is investigate the influence of dual-task on jump-landing motion by analyzing biomechanics of the lower extremities during Drop Vertical Jump (DVJ). Methods: Twenty female college athletes (ages; 20.2 ± 1.3 yers) were participated in this study. An informed consent was obtained from each participant, which is approved by Institutional Review Board of our University. Each participant performed (A) simple DVJ (single-task) [Figure 1] and (B) DVJ while calculating mental arithmetic of 2-digid addition (dual-task). Hip, knee and ankle joint angles and moments, and vertical ground reaction force (vGRF) were recorded using motion capture system. The difference in each parameters between single-task and dual-task was analyzed using paired-t test. Results: Main findings were shown in Table 1. Noteworthy differences in dual-task with respect to single-task were as follows; 1) Increase in vGRF, 2) Decreases in flexion angles of bilateral knees at initial contact, Decrease in flexion angles of bilateral knees and hips within 40 milliseconds (ms) after the initial contact, 4) Increases in extension, abduction, internal-rotation moments of the knee, and 5) Increases in extension and adduction moments of the hips. These changes were more obvious in the non-dominant lower extremity (pivoting side when kicking the ball). Discussion and Conclusions: From the results, cognition seriously affects biomechanics of the lower extremities during DVJ. Among them, stiff landing (decrease in flexion angle), increases in abduction and internal-rotation moments of the knee joint are known as the risk factors of the ACL injury. Thus, cognition may be one of the important factors for the ACL injury.

Keywords: Drop vertical jump, dual-task, sports injury

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.

Figure l: Experimental set-up

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  No. P1-56: Analysis of finger motion using motion capture sensor Top


Atsuyuki Inui, Yutaka Mifune, Hanako Nishimoto, Takeshi Kataoka, Takashi Kurosawa, Kyohei Yamaura, Shintaro Mukouhara, Yoshitada Sakai, Ryosuke Kuroda

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan

Background and Aims: Motion capture system is a widely used technology to analyze the motion of a human body. In the present study, we used the infrared camera system to analyze the finger abduction motion. Methods: Normal healthy volunteers (N=12) were enrolled in the study. Finger adduction-abduction motion was performed in front of the camera five times. The angle of maximum finger abduction was calculated using the software. The angle calculated by software was compared to the angle measured by goniometer then statistically analyzed. Results: The angle between the middle finger was 47, 22, 20, 38 degrees in the thumb, index, ring, and small finger, respectively in goniometer measurement. The angle between the middle finger was 41, 15, 13, 27 degrees in the thumb, index, ring, and small finger, respectively in the motion capture system. The correlation coefficient was 0.83 which was statistically significant. However, the thumb motion has a larger measurement error compared to the other fingers. Conclusions: Using the motion capture system, we could perform real-time analysis of the finger abduction angle. The system is useful for hand rehabilitation. However, the system tends to underestimate the thumb motion since the thumb has a larger range of motion compared to other fingers. Correction of the software is needed to analyze the thumb motion.

Keywords: Finger, hand therapy, motion capture

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-57: Towards the use of a multifactorial analysis of the biomechanics of cycling for injury prevention Top


Giovanni Iolascon1, Angela Palomba1, Teodorico Caporaso2, Stanislao Grazioso2, Giuseppe Di Gironimo2, Antonio Lanzotti2, Raffaele Gimigliano1, Francesca Gimigliano3

1Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy, 2Department of Industrial Engineering, Fraunhofer JL IDEAS, University of Naples “Federico II”, Naples, Italy, 3Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy

Background and Aims: The high prevalence of overuse injuries in cycling (mainly involving neck, back, hand, knee and ankle) underlines the need to understand associated risk factors and possible prevention strategies. Despite several available studies about injuries and biomechanical aspects, currently there is lack of information regarding how the biomechanical analysis of cycling might improve injury preventive strategies. Therefore, the aim of this study is to propose a multifactorial analysis, based on the biomechanics of cycling, to obtain useful information to help decision making in planning the most appropriate functional training to prevent potential injuries. Methods: The methodology was tested on one male recreational cyclist with no history of overuse injury. The evaluation of cyclists began with a detailed history collection using a questionnaire and clinical evaluation. A specific marker set was chosen to obtain kinematic information and six muscles were identified for electromyographic evaluation [Figure 1]. A stationary bike, placed on a force platform, was set according to the athlete anthropometric characteristics, to achieve weight distribution during the test. The cyclist was asked to perform an incremental exercise on the bicycle with different gears at fixed cadence to exhaustion. The proposed protocol allowed to assess biomechanical risk factors related with the main overuse injuries [Table 1] during the test in order to underline the critical ones according to literature. Results: In Table 2 main results are shown. Based on these data we set a three-month customized prevention programme (including individualized strength and endurance exercises). Conclusions: A multifactorial analysis might be useful for assessing the biomechanical “red flags” that might cause injuries and for prescribing a specific prevention strategy. We need to check the effects of the proposed exercises at the end of the training programme and to experiment this methodology with several athletes to verify its reliability and reproducibility.

Figure 1: On the left the marker set placement; on the right EMG surface placement

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Keywords: Biomechanics, cycling, injury prevention

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-58: A-randomized-controlled trial of central and peripheral simulations electrical stimulations in patients with subacute stroke Top


Hideaki Itoh, Mitsuhiro Ochi, Yasuyuki Matsushima, Satoru Saeki

Department of Rehabilitation Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan

Background and Aims: Recent evidence has suggested that central electrical stimulation such as transcranial direct current stimulation (tDCS) is associated with a significant motor function improvement in stroke patient. Integrated Voitional control electrical stimulation (IVES) has been applied to stroke patients to improve their motor function. Prior research suggests that brain derived neurotrophic factor (BDNF) and BDNF Val66Met genotype may moderate response to tDCS. tDCS seems to alter brain-derived neurotrophic factor (BDNF) and such effect is influenced by BDNF gene pormorphism. The aim of this study was to examine tDCS and IVES training efficacy in subacute stroke hemiparesis and assess if BDNF and BDNF genotype are associated with recovery response to tDCS. Methods: 18 participants with subacute stroke were randomly assigned to 1 of 3 groups: group A received bilateral tDCS (2mA, 20min), group B received IVES training (40min), group C received combination therapy (bilateral tDCS was simultaneously applied during IVES training). Fifteen sessions of treatment over a 3-week period. Main outcome measure was Fugl-Meyer assessment upper extremity motor score (FM-U) and Wolf Motor Function Test (WMFT) were used to assess UE function. To evaluate daily living, Barthel Index and FIM were used. All outcome measure were performed before and immediately after treatment. Blood samples were collected for analysis of BDNF polymorphism and measurement of BDNF. Results: All groups significantly improved FM-U score, but no significant differences were found between groups. BDNF genotype was unrelated to outcome. Conclusions: The results of the present study do not support an effect of tDCS as an adjuvant treatment in functional impairment of upper extrimities after subacute stroke. BDNF genotype did not moderate outcome.

Keywords: Brain derived neurotrophic factor, subacute stroke, transcranial ranscranial direct current stimulation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-59: Auditory accessory stimulus facilitates and stepping time for choice reaction tasks with cognitive elements Top


Hiroyasu Iwatsuki, Yuki Fukumoto

Graduate School of Aomori University of Health and Welfare, Aomori, Japan

Background and Aim: It's known that reaction time (RT) to a visual stimulus is faster when an auditory accessory is presented at the same time. The congruent and incongruent conditions contained in the Simon task can be used to investigate such executive functions as response selection and postural preparations during the task. The purpose of this study was to investigate differences in stepping motions both with and without auditory accessory stimuli during Simon tasks. Methods: Fifteen healthy persons participated in the experiment. The protocol for the presentation of visual stimuli was the following: a visual imperative stimulus of a blue arrow was displayed at the center of a white screen at 9 second intervals that appeared on a screen set at eye level at a 3 m distance from the participant. Participants were required to maintain a standing posture on a force plate with their bare feet and to step forward in response to a visual imperative stimulus. Each participant performed Simon tasks in each 10 trials, which consisted of congruent (SC) and incongruent (SI) conditions with or without auditory stimulus. The RT was defined as time from the baseline to foot-lift. EMG discharges of both tibialis anterior and gastrocnemius muscles were recorded simultaneously and the latencies from visual stimulus to muscles discharge were also measured. Result and Discussion: The RT and the EMG latencies prior to two muscle discharges in SI Simon tasks with auditory accessory stimulus were significantly shorter than those without auditory accessory stimulus. Both visual and auditory accessory stimuli produces synergistic effects when the SI task demands more central processing of these stimuli. Conclusion: These results suggest that the cooperation and relationship between visual recognition and auditory stimulus and correct motor response during stepping under spatial incompatibility activates an automatic response which assists in fall prevention.

Keywords: Electromyography, Simon task, step motion

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.

Figure 1: (A) Experimental setting. (B) Visual imperative stimuli, (a) congruent condition: sequential congruent, (b) incongruent condition: sequential incongruent

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  No. P1-60: Relationship between resting heart rate variability and heart rate recovery after submaximal arm cycle exercise in sitting and semi-supine postures Top


Hiroyasu Iwatsuki, Yuki Fukumoto

Graduate School of Aomori University of Health and Welfare, Aomori, Japan

Background and Aims: It is known that the rate of heart rate recovery (HRR) in the early phase after exercise is dependent primarily upon cardiac vagal reactivation. Difference in posture during exercise in sitting and half lying position was expected to affects HRR in the early phase after exercise. The purpose of this study was to investigate the relationship between resting heart rate variability (HRV) and HRR after submaximal exercise in sitting and semi-supine postures. Methods: Twelve healthy young women performed submaximal arm cycle ergometer tests (60% age-predicted maximum heart rate) in the upright seated and semi-supine positions. Each test included 15 minutes of rest, 20 minutes of cycling, and 15 minutes of recovery. HRV was measured in a supine position before and for 15 min after a submaximal exercise test on arm cycle ergometer. HRV was assessed in the time (SDRR) and the power spectrum of HRV was quantified by determining the spectral area (power) in two frequency bands, LF power (0.04-0.15 Hz) and HF power (0.15-0.4Hz), and their ratio. Heart rate was recorded at submaximal exercise (MHR), and at 1- (HR1), 2- (HR2) and 3-(HR3) min of the recovery period. HRR was determined from the differences between MHR and HR1, HR2 and HR3. Results: HF and SDRR were statistically significantly higher in semi-supine position than in sitting position, but other resting HRV parameters were not statistically different between postures. The resting HRV parameters in time and frequency-domains were correlated with HRR during the first 1 and 2 min after cessation of exercise. HRR was statistically significantly faster in semi-supine than in sitting. After 1, 2 and 3 min of recovery, HRR correlation with LF/HF was positive in both postures. Conclusions: These findings suggested that HRR early after submaximal exercise in semi-supine is related to parasympathetic reactivation at rest.

Keywords: Heart rate recovery, parasympathetic reactivation, spectral analysis

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.




  No. P1-61: The effects of repetitive neck-muscle vibration on postural disturbances after a chronic stroke Top


Isabelle Bonan1,2 Karim Jamal1,3, Stephanie Leplaideur1,4, Chloe Rousseaux5, Frederique Lebranche1, Lucie Chochina4, Annelise Raillon-Moulinet6, Simon Butet1

1Physical and Rehabilitation Medicine Department, University Hospital of Rennes, Rennes, France, 2Unit VisAGeS – U1228, INSERM, INRIA, University of Rennes 1, Rennes, France, 3M2S Laboratory – EA 1274, University of Rennes 2, Rennes, France,4Neurology Physical and Rehabilitation Medicine Department, CMRRF KERPAPE, Ploemeur, France, 5Department of Clinical Pharmacology, Clinical Investigation, Center INSERM 1414, University Hospital of Rennes, Rennes, France, 6Physical and Rehabilitation Medicine Department, Hospital of Saint Vallier

Introduction: Weight-bearing asymmetry (WBA) is more prominent in right brain damage patients (RBD) after stroke, possibly due to body misrepresentation of space. Objective: To test a repeated program of vibration sessions of the neck muscles (rNMV) on postural disturbances and space perception in patients with right (RBD) versus left (LBD) brain damage. Methods: Thirty-two chronic stroke patients (mean age 60.9&#61617;10 y and mean time since stroke 4.9&#61617;4 y), 16 RBD and 16 LBD, underwent a program of 10 sessions of NMV over two weeks. Posturography parameters (WBA, Xm, Ym, and surface), balance rating (Berg Balance Scale (BBS), time up and go (TUG), space representation (subjective straight ahead (SSA), longitudinal body axis (LBA), subjective visual vertical (SVV)), and characteristics of hemiplegia (motricity index, sensitivity, and spasticity,) were tested and the data analyzed by ANOVA or a linear rank-based model, depending on whether the data was normally distributed, with a lesion side and time factor (D-15, D0, D15, D21, D45). Results: There was a significant shift towards the paretic lower limb in the RBD patients only (p=0.0001), whereas there was no effect in the LBD patients (p=0.98). Neither group showed a significant modification of space representation. Nonetheless, there was a significant improvement in motricity (p=0.02), TUG (p=0.0005), and BBS (p<0.0001) in both groups at the end of treatment and afterwards. Discussion: rNMV appeared to correct WBA in RBD patients only. This suggests that rNMV could be effective in treating sustainable imbalance due to spatial cognition disorders.

Keywords: Neck muscle vibration, postural balance, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-62: Changes of muscular activity during balance tests of different difficulty levels Top


Malgorzata Kalinowska, Ewa Szczerbik, Malgorzata Syczewska

Department of Rehabilitation, Children's Memorial Health Institute, Chennai, Tamil Nadu, India

Background and Aims: Keeping body position and balance control requires proper muscular strength and coordination. The role of muscle activity levels during various balance tests is still not fully investigated. The Aim of study: to assess the level of muscle activity during 9 balance tests and the their involvement in centre of mass (COM) movements. Methods: 17 healthy women between 50 and 62 without balance problems were recruited to the study (age of first signs of disbalance). They did not suffer from any neurological or orthopaedic problems and on regular basis (two to five times /week) train some sport activity (cycling, nordic walking, yoga, etc). All subjects performed 9 balance tests on BIODEX BALANCE SYSTEM SD with unstable platform [list –Table 1]. The COM was measured with VICON system (full body Plug-In-Gait model). Simultaneously the surface EMG (MotionLab) was recorded bilaterally from: rectus femoris, biceps femoris, lateral gastrocnemius, tibialis anterior, gluteus maximus, erector spinae, peroneus longus, soleus. From raw EMG signals RMS value was calculated. The STATISTICA was used for data analysis. Results: Presented in Tables 1 and 2 and [Figure 1]. Conclusions: The levels of muscular activities differ between the muscles. In tests: PS4EO, PS4EC, LOS, LOS8 tibialis anterior was the most active. Peroneus longus and soleus were generally more active then other muscles [Figure 1], their activity affects COM movements in frontal plane (the same as erector spinae). In sagittal plane dominate activities of rectus femoris and biceps femoris and tibialis anterior or gastrocnemius. Surprisingly the movements of the COM do not depend only on the lower leg muscles but they are controlled by the upper leg muscles too. This finding can be of importance for the rehabilitation programs.
Figure 1: Changes of muscular activity in balance tests

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Acknowledgement: The study was prepared within project STRATEGMED3/306011/1/NCBR/2017.

Keywords: Balance, muscular activity

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-63: Skin sympathetic nervous components activities in hyperthermia are suppressed by hypovolaemia and hyperosmolality but the suppressions are released by rapid saline infusion and/or drinking Top


Yoshi-Ichiro Kamijo1, Tadashi Sumiya2, Chika Sato3, Fumihiro Tajima1

1Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan, 2Department of Rehabilitation Medicine,

Wakayama Medical University Kihoku Hospital, Katsuragi, Japan,

3Department of Rehabilitation Medicine, Wakayama Medical

University Kihoku Hospital, Katsuragi, Japan

Background and Aims: Skin sympathetic nerve activity (SSNA) involved components synchronised and non-synchronised with the cardiac cycle. In hyperthermia, plasma hyperosmolality suppresses both cutaneous vasodilation and sweating responses and these suppressions are removed by oropharyngeal stimulation; drinking. Hypovolemia suppresses only cutaneous vasodilation in hyperthermia. Skin blood flow is enhanced by rapid infusion during exercise. Our aims were to assess whether plasma hyperosmolality and hypovolemia suppressed SSNA components in hyperthermia and the suppressions would be removed by drinking and rapid infusion. Methods: Subjects were devided in to normovolemia and iso-osmolality (C), hypovolemia and iso-osmolality (LPVIOS) incuded by diuretics, nomovolemia and hyperosmolality (NPVHOS) induced by diuretics and hypertonic saline infusion. Subjects took a semi-recunbent position while wearing a tube-lined suit, first 34-degree water infused. After 10-min thermoneutral measurements, 47-degree water was infused. After esophageal temperature increased by at least 0.5degree, another 30-min infusion was performed at 0.7mL/kg/min (Rapid infusion) or 0.1mL/kg/min (Time control) in LPVIOS, and subjects drank a 200-mL water within a minute and continured measurements more 20min in NPVHOS and some of C. SSNA (microneurography), skin blood flow (laser-Doppler flowmetry), and mean arterial pressure (MAP; Korotkoff's Method) were collected while monitoring Tes and mea skin temperatures (thermocouples). SSNA components synchronised and non-synchronised with the cardiac cycle were analized from raw SSNA signal and by autocorrelograms triggering R-wave of ECG. Results: SSNA involved components synchronised and non-synchronised, plasma hyperosmolality suppressed both components, drinking removed the hyperosmolality-induced suppressions, simultaneously with increases in cutaneous vasodilatation and sweating with not altering plasma volume and osmolality. Hypovolemia suppressed only synchronised SSNA comoponet simulanously with cutaneou vasodilation in hyperthermia and a rapid saline infusion increased synchronised component and cutaneous vasodilatation in hypovolaemic and hyperthermic humans. Conclusions: SSNA components synchronised and non-synchronised with the cardiac cycle are associated with an active vasodilator and a sudomotor, respectively.

Keywords: Cutaneous vasodilation, skin sympathetic nerve activity, sweating

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-64: Influence of insoles on healthy young women's foot motion and knee adduction moment during walking Top


Junpei Katoh1,2, Takumi Yamada1, Takehiro Ohmi1,3, Yoshinao Satoh1,4

1Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Hachioji, Japan, 2Taito Hospital, Tokyo, Japan, 3Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Tokyo, Japan, 4Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan

Background and Aims: The purpose of this study was to investigate the changes in foot motion and the Knee Adduction Moment (KAM) when insoles were inserted in different foot alignments. Methods: Nineteen healthy young women participated, and thirty-eight feet were evaluated in this study. For the gait analysis, the combined model with Plug-in-gait and Oxford Foot Model was created, and a three-dimensional motion analysis system and four force plates were used. Foot alignment measurements were conducted on both feet for all subjects using the Foot Posture Index.Subjects were tested under four conditions, i.e., barefoot condition and wearing three types of insoles, namely the lateral wedge insole, arch support, and the lateral wedge insole with arch support. This study was conducted by the Tokyo Metropolitan University Arakawa Campus Research Safety Ethics Committee. Results: The walking rate decreased significantly with no reduction in KAM when using the three insoles, as compared to the barefoot condition, in the normal-foot and pronation-foot groups For the normal foot group, the peak angle of subtalar joint pronation and supination significantly increased and the peak angle of the first metatarsophalangeal joint dorsiflexion decreased on using the three insoles. In the pronation foot group, the peak of subtalar joint pronation angle significantly increased on using the Lateral Wedge Insole with or without arch support. Conclusion: Foot kinematics differed in the normal-foot and pronation-foot groups when young women inserted insoles. However, the insoles didn't significantly reduced the peak KAM as compared to the barefoot condition, in the both of groups.





Keywords: Foot motion, insoles, knee adduction moment

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-65: Biomechanical gait analysis for a hip disarticulation prosthetic – Power source for the swing phase of a hip disarticulation prosthetic limb Top


Tsukasa Kawaguchi, Takumi Yamada, Kodai Iwashita

Department of Physical Therapy, Graduate School of Human Health Sciences, Tokuo Metoropolitan Univercity, Hachioji, Japan

Background and Aims: The purpose of this study was to clarify the power source for the swing phase of a hip disarticulation prosthetic limb using biomechanical gait analysis. Methods: Six subjects having undergone hip disarticulation and 7 healthy adults were recruited for this study. The gait of 6 hip disarticulation subjects and 7 healthy adults were assessed using a 3-dimensional motion analysis and 4 force plates. Results: From pre-swing to initial swing, the angle of the lumbar spine changed by 9 agree from the flexion to extension positions. The flexion angle of the hip joint on the intact side was 22 agree, which was greater than that in healthy subjects. The peak value of joint moment and power of hip joint on the intact side were 1 nm/kg and 0.7 w/kg, respectively. Because the hip joint of the prosthetic limb becomes stable at the full hip extension position, the extension of the lumbar spine compensates for the extension of the hip in the late stance phase. From pre-swing to initial swing, the prosthetic limb is pushed forward by extension of the hip joint on the intact side, while the spine returns to the flexion direction. Conclusions: Understanding of the mechanism of gait in cases involving hip disarticulation prosthetics is useful for therapeutic exercise and gait modification in subjects having undergone hip disarticulation.

Keywords: Biomechanics, gait, hip disarticulation prosthetics limb

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-66: The influence of posture for the glenohumeral joint motion during rotator cuff exercise Top


Tomonori Kenmoku1, Yu Sasaki2, Toshiyuki Nakazawa1,3, Michinari Fukuda3, Naonobu Takahira1, Masashi Takaso1

1Department of Orthopaedic Surgery, Kitasato University, Tokyo, Japan, 2Department of Orthopaedic Surgery, Seirei Sakura Citizen's Hospital, Sakura, Japan, 3Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan

Background and Aims: The purpose of this study was to investigate differences in shoulder kinematics and shoulder muscle activities during axial shoulder rotation in healthy subjects between the standing and supine positions. We hypothesized that subacromial space in the supine position was larger, and scapula motion in the supine position was restricted than those in the standing position. Methods: This study included eleven healthy shoulders. Fluoroscopic images during shoulder axial rotation in the standing and supine positions were recorded, and muscle activities of the anterior and posterior deltoid, infraspinatus, and biceps brachii were simultaneously recorded with surface electromyography. 3D/2D model-image registration techniques were used to determine scapular and glenohumeral kinematics, and subacromial distance was measured as the closest distance between the humeral head and the acromion. Muscle activities were assessed with %MVC. Scapular kinematics and %MVC were compared between the standing and supine positions. Results: We could confirm there was no significant difference in the rotation angle of the GH joint between standing and supine positions with elbow flexion. Subacromial distance in the supine position is significantly wider than that in the standing. Scapula in the supine position is more posteriorly tilted and downward rotated than the standing position with significance. However, the movement pattern of the scapula in the supine position was almost the same as that in the standing position. The activity of infraspinatus increases with the degree of external rotation significantly, although there was no significant difference of %MVC between two postures. Conclusions: Our results suggested the exercise of axial shoulder rotation with arm adducted in the supine position is more useful than that in the standing for at the beginning of the rehabilitation, because of the wide subacromial distance with no difference in the infraspinatus activity without scapula kinematics restriction.

Keywords: Kinematics, rotator cuff, shoulder

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.




  No. P1-67: Fast speed walking exerts detrimental effect on unaffected side intra-limb coordination for postacute phase stroke Top


Yu Kitaji, Shinnosuke Ishida, Hiroaki Harashima, Satoshi Miyano

Department of Rehabilitation, Tokyo General Hospital, Tokyo, Japan

Background and Aims: It has been suggested that fast speed walking induces marked speed-related improvements in body and limb kinematics. However, the effects related to walking speed on intra-limb coordination has not known yet. The purpose of this study was to investigate the effects walking speed change on intra-limb coordination. Methods: Participants were 18 hemiparetic post-acute phase stroke survivors (Female 6, male 12, Age 61.0 SD9.9 years, From onset 86.3 SD53.8 days). Eligible criteria were able to walk independently, that is Functional Ambulation Category is 3. Participants were walked their comfortable and maximum speed on 16m straight walkway, while they were recorded on videos using smartphone (1080p*30fps). Recorded videos were analyzed by means of ImageJ. Intra-limb coordination was analyzed by the Average Coefficient of Correspondence (ACC) for hip and knee joints. A comparison of the ACC between affected and unaffected side, a comparison of the ACC between comfortable and maximum speed walking was analyzed Wilcoxon signed-rank test. Results: In comfortable speed, the mean ACC of participants were 0.52 for affected side and 0.60 for unaffected side, and in maximum speed, 0.54 for affected side and 0.59 for unaffected side. In comfortable speed, the ACC of unaffected side was significantly higher compared to affected side. In maximum speed however, there was no significant difference between affected and unaffected side of the ACC. To changes in walking speed, the ACC of unaffected side in maximum speed walking was significantly lower compared to comfortable speed walking. Conclusions: Fast speed walking might exert detrimental effect on intra-limb coordination of unaffected side. However, to reach a conclusion, we need to further study which have more profound statistical procedure and participants.
Figure 1: Comparison of the average coefficient of correspondence

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Keywords: Gait, intra-limb coordination, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-68: Five days of aerobic exercise when coupled with noninvasive positive pressure ventilation increases serum brain-derived neurotrophic factor in healthy young men Top


Ken Kouda1, Takeshi Nakamura2, Takashi Moriki1, Tokio Kinoshita1, Yohei Furotani1, Yoshi-ichiro Kamijo1, Yukihide Nishimura3, Fumihiro Tajima1

1Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan, 2Department of Rehabilitation Medicine, Yokohama City University, Yokohama, Japan, 3Department of Rehabilitation Medicine, Iwate Medical University, Morioka, Iwate, Japan

Background and Aims: Exercise and noninvasive positive-pressure ventilation (NPPV) are known to independently alter Brain-derived neurotrophic factor (BDNF) levels in patients with depression, dementia, type 2 diabetes, chronic obstructive pulmonary disease, and obstructive sleep apnea syndrome. However, the combined effects of exercise and NPPV on serum BDNF in normal subjects are unknown. The purpose of this study was to determine the effects of acute aerobic exercise performed under NPPV on serum BDNF level in healthy adults. Methods: Ten healthy young men (28.3 +/- 3.1 years of age) were included in this study. The subjects exercised on a cycle ergometer at 60% of pretraining maximal oxygen uptake (VO2max) for 30 minutes daily for 5 consecutive days with or without NPPV (12 cmH2O). The 5-day exercise protocol was repeated after a 3-week washout period with or without NPPV. Serum BDNF, plasma cortisol, and platelet, lymphocyte, and monocyte counts were measured at 24 hours before the first day exercise with or without NPPV and 24 hours after last day exercise with or without NPPV at resting condition. Results: The 5 days of aerobic exercise when coupled with NPPV resulted in a significant increase in BDNF levels, with a P value <.05. The 5-day exercise protocol also significantly (P < .05) decreased monocyte count without NPPV, but not with NPPV, relative to baseline. Changes noticed immediately after the first day of exercise included significant (P < .05) increase in serum BDNF compared with immediately before the exercise, with or without NPPV. Conclusions: The results showed that 5 days of aerobic exercise at 60% of pretraining VO2max for 30 min/day increased serum BDNF levels when performed with NPPV, whereas no such effect was noted by the same exercise alone, suggesting that exercise combined with NPPV is a potentially beneficial training protocol for health benefits.

Keywords: Brain-derived neurotrophic factor, exercise, noninvasive positive-pressure ventilation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-69: The use of low-level laser irradiation in regenerative medicine based on molecular research and scientific reports Top


Jolanta Kujawa, Kamila Pasternak-Mnich

PRM Department, Medical University of Lodz, Lodz, Poland

Background and Aims: Mesenchymal Stem Cells (MSCs) are self-renewing, multipotent and non-hematopoietic adult cells that can differentiate into different types of tissues. Their paracrine mechanisms lead to natural repair processes and immunomodulation, therefore, they are widely used in regenerative medicine. Several authors suggest that Low-Level Laser Irradiation (LLLI) could be a stage in preliminary in vitro MSCs preparation prior to cell transplantation under clinical conditions as it increases cellular attachment, osteocalcin synthesis and TGF-beta1 production. The aim of the present study was to investigate the influence of low intensity laser irradiation emitted by a multiwave-locked system (MLS M1) on the viability and proliferation of bone marrow human mesenchymal stem cells, depending on the parameters of the irradiation used. To date, synchronized radiation has scarcely been investigated, though some authors consider it has better therapeutic effects than traditional laser therapy. Methods: Cells were identified by flow cytometry and cell differentiation assays. For MSC irradiation, two wavelengths emitted simultaneously, 808 nm in continuous emission and 905 nm in pulsed emission were applied. The following parameters of laser irradiation were used: power density 195, 230 and 318 mW/cm(2), in energy density 0,93 - 6,27 J/cm(2), frequencies: 1000 and 2000Hz. MSCs morphology was visualized under a confocal microscope, viability was assessed by fluorometry (Alamar Blue test) and spectrophotometrically, proliferation was determined using an inverted microscope. Results: There were statistically significant increases of cell viability and proliferation after irradiation at 3 J (CW; 1000 Hz), 10 J (1000 Hz) and 20 J (2000 Hz). Conclusion: Irradiation with the MLS M1 system can be used in vitro to modulate MSCs in preparation for therapeutic applications, but further studies will be needed to optimize the radiation parameters and to elucidate the molecular mechanisms of actions of MLS laser radiation.

Keywords: Human mesenchymal stem cells, low-level laser irradiation, regenerative medicine

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-70: Performance improvements of obstacle-crossing in patients with advanced Parkinson's disease after bilateral subthalamic deep brain stimulation: Preliminary results Top


Mei-Ying Kuo1, Chi-Chung Kuo2, Guan-Chou Chen3, Yang Chieh Fu3, Tung-Wu Lu3,4

1Department of Physical Therapy, China Medical University, Taichung, Taiwan, 2Department of Neurology, Taichung Tzu Chi Hospital, Taichung, Taiwan, 3Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, 4Department of Orthopaedic Surgery, National Taiwan University, Taipei, Taiwan

Background and Aims: Parkinson's disease (PD) is characterized by motor dysfunction and postural disturbances. Subthalamic Deep Brain Stimulation (DBS) has been shown to be an effective surgical procedure to improve gait performance. However, its influence on the performance of more challenging activities such as obstacle-crossing remains unclear. The current study aimed to evaluate the performance of obstacle-crossing in patients with advanced PD before and following bilateral subthalamic DBS. Methods: Eight adults with advanced PD and ten healthy controls participated in the study with informed written consent. All patients had undergone medication and received bilateral DBS surgery. Each subject walked at a self-selected pace on an 8-m walkway and crossed obstacles of 10%, 20% and 30% of each subject's leg length. All subjects with PD were tested under two conditions: (1) medication on before DBS surgery (pre-DBS) and (2) medication on and 3-4 months after DBS surgery (post-DBS). Gait spatiotemporal variables were obtained and statistically analyzed. Results: Post-DBS, the subjects with PD showed increased leading and trailing crossing speeds and stride lengths, but decreased leading and trailing crossing step widths on both sides when compared to those pre-DBS. Leading and trailing crossing speeds also showed decreasing trends with increasing obstacle heights for pre-DBS, post-DBS and Controls. Compared to the Controls, the patients with PD increased their leading and trailing toe-clearances whether the major or minor affected limb was leading, but less so post-DBS. Conclusions: Pre-DBS, increased leading and trailing toe-clearances with reduced crossing stride lengths and widths in subjects with PD indicate that they crossed obstacles with a more conservative strategy. Post-DBS, the patients PD showed leading and trailing toe-clearances and heel-clearances closer to those of the controls. These results suggest that bilateral DBS was effective in improving performance of obstacle-crossing in PD.

Keywords: Bilateral subthalamic deep brain stimulation, obstacle crossing, Parkinsons disease

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.




  No. P1-72: Neuroprotective effect of rhodiola crenulata in D-galactose-induced aging mouse model Top


Shin-Da Lee1, 2, 3, Hsiu-Chung Ou2

1School of Physical Therapy, China Medical University, Taichung, Taiwan, 2Department of Occupational Therapy, Asia University, Taichung, Taiwan, 3College of Rehabilitation Medicine, WeiFang Medical University, Weifang, Shandong, China

Background and Aims: Medicinal plant Rhodiola crenulata grows at high altitudes in the Arctic and mountainous regions, and is commonly used in phytotherapy in Eastern European and Asian countries. In the present study, we investigated the anti-apoptotic effect of Rhodiola crenulata and its neuroprotective mechanism of action in a rat model of D-galactose-induced aging. Methods: Two groups of twelve-week-old male Wistar rats received a daily injection of D-galactose (150 mg/kg/day, i.p.) and orally administered Rhodiola crenulata (0, 248 mg/kg/day) for eight weeks, while a control group received saline injection (1 ml/kg/day, i.p.). The expression levels of apoptotic and anti-apoptotic proteins of excised brains from three groups of rats were analyzed by using Western blot. Results: Our findings indicated that D-galactose activates both extrinsic-dependent and mitochondrial-dependent apoptotic pathways. Compared with control group, the protein levels of Fas receptor, Fas ligand, Fas-associated death domain (FADD), activated caspase-8 (Fas-dependent apoptotic pathways), as well as t-Bid, Bax, cytochrome c, activated caspase 9, and activated caspase-3 (mitochondria-dependent apoptotic pathways) were significantly increased in D-galactose treated group. In addition, D-galactose impaired the phosphorylation of PI3K/Akt which is an important survival signaling in neurons. Rhodiola crenulata, however, protected against all these neurotoxicity in aging brains. Conclusions: The present study suggest that neuronal survival promoted by Rhodiola crenulata may be a potentially effective method to enhance resistance of neurons to aged-related diseases.

Keywords: Aging, brain, rhodiola

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-74: Static and dynamic balance differences in athletes after anterior ligaments cruciate reconstruction Top


Reny Dwi Lestari1, Damayanti Tinduh1, I Putu Alit Pawana1, Dwikora Novembri Utomo2

1Departement of Physical Medicine and Rehabilitation, Dr Sutomo General Hospital, Surabaya, Indonesia, 2Department of Orthopedic, Dr Sutomo General Hospital, Surabaya, Indonesia

Background and Aims: Anterior cruciate ligament injury (ACL) is very common in sports, leading to knee joint instability and functional impairment. The rehabilitation role is needed to maximize the return to sport function and prevent another injury. The purpose of this study was to evaluate the difference in both static and dynamic balance after ACL reconstruction in athletes. Methods: 15 male athletes after 6-24 months of anterior cruciate ligament reconstruction (ACLR) compared to 15 healthy athletes as control, age17-39 years, evaluated static and dynamic balances, in single leg standing test of involved and uninvolved legs, double leg standing test, double leg standing test on wobble board, with both open and closed eyes. Measurements using Huber system 360, 50 seconds for each protocols, as much as 3 times the measurement then taken average. The parameters are center of pressure/COP (length, area, speed) and stability quotient/SQ. Results: The mean age of ACLR group is 24&middot87 &plusmn 7&middot9 years; control group is 28&middot2 &plusmn 6&middot2 years. Body mass index of ACLR group is 24&middot82 &plusmn 4&middot1 kg/m2; control group is 22&middot49 &plusmn 1&middot66 kg/m2. Tegner score in the ACLR group is 7&middot27 &plusmn 1&middot3; control group is 6&middot73 &plusmn 0&middot7. The results of COP measurements significantly difference in single leg standing with closed eyes on involved leg (length p=0&middot04; area p=0&middot01) and uninvolved leg (length p=0&middot02; area p=0&middot006); double leg standing with closed eyes at all parameters (COP length p=0&middot009; area p=0&middot000; speed p=0&middot009; SQ p=0&middot01); double leg standing test on wobble board with closed eyes on length parameter (p=0&middot03). Conclusions: This study shows that there is static and dynamic balance differences in male athletes after 6-24 months of ACLR compared with healthy athletes in single leg standing test, double leg standing test, and double leg standing test on wobble board.

Keywords: Anterior cruciate ligament reconstruction, athletes, balances

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-75: Behavioral and event-related potential correlates of selective and divided attention modulating sensorimotor control of speech production with the mid-age Top


Jingting Li, Peng Liu, Hanjun Liu

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

Background and Aims: To investigate behavioral and neural correlates of selective and divided attention modulating sensorimotor integration and detect the interaction of age and gender factors. Methods: 28 young adults (7 males 21 females, aged 18-25 years) and 41 mid-aged adults (19 males 22 females, aged 40-52 years) were asked to produce 40 consecutive vocalizations in each task: Baseline, Auditory Attention (A), Visual Attention (V) and Divided Attention (AV). During each vocalization, participants heard their voice pitch-shifted +200 cents 1-4 times and saw the red indicator light flashing 4-7 times randomly. They were asked to count nothing or only number of pitch shift or only number of light flashing or both in four tasks. We measured and compared accuracy of counting and event-related potential (ERP) responses to the pitch perturbations. Results: For the accuracy, the main effect of age reached significant (F(1, 69)=51.677, p<0.001), the mid-aged adults performed worse. The amplitude of P2 response showed an interaction between age and gender, the mid-aged elicited significantly smaller P2 amplitudes in female adults only (F(1, 41)=4.793, p=0.034) rather than in males (F(1, 41)=1.406, p=0.243). As for four tasks, a significant main effect of attention condition (F(3, 108)=5.392, P=0.002) was found in young adults. Post hoc Bonferroni comparison tests showed that the Auditory Attention condition elicited larger P2 amplitudes than the other three attention conditions (P<0.028), and the order is A>V>Baseline>AV. When it comes to the mid-aged adults, there was no significance of attention condition (F (3, 160)=0.848, P=0.47), the order of P2 amplitudes in different tasks is A>Baseline>AV>V. Conclusions: People suffer a decline in attention ability from early mid-age and it's important to notice the interaction between age and gender when studying the neural mechanisms underlying sensorimotor integration for speech production.

Keywords: Mid-age, selective and divided attention, sensorimotor integration

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-76: Neck posture and electromyographic assessment on muscular fatigue during continuous usage of mobile phones Top


Huey-Wen Liang1, An-Chun Chen2, Tse-Yu Lin2, Shih-Yao Wei2, Shao-Yu Chi1

1Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, 2Institute for Information Industry, Taipei, Taiwan

Background and Aims: Increased risks of neck and shoulder pain has been reported among sedentary tasks, including using mobile phones. Low-intensity and prolonged muscle loading can cause muscle fatigue and subsequently pain. The application of wearable inertial sensor units (IMUs) has enable an ambulatory and long-duration evaluation of body motion. Our study goal is to use surface electromyography (EMG) and wearable IMUs to demonstrate the temporal change of muscular fatigue and neck flexion angle during continuous usage of mobile phones and explore the association between neck posture and muscle fatigue. Methods: Twelve participants (73% male, 25.9 years old) used a mobile phone in seating for 90 minutes, with muscle activities of left upper trapezius (UT) and cervical erector spinae (CES) recorded by EMG and neck flexion angle recorded by wearable IMUs at C7 and left ear level. Each of the IMU is composed of a tri-axial accelerometer, a tri-axial gyroscope, and a tri-axial magnetometer, with sampling rate of 30Hz. EMG signs of fatigue were determined by the joint analysis of spectrum and amplitude for every 5-minute periods. Subject fatigue of eyes and 10 body parts was self-reported with rating from 0 to 10 before and after the task. Results: The mean neck flexion angle was 11.4 to 36.9 degree, with a trend of reduction (slope: -0.14, p=0.03). All subjects had muscular fatigue in at least one 5-minute period, with the highest proportion at 35-40 minutes(63.6%) and 55-60 minutes(45.5%). CES had a higher proportion of fatigue than UT, but the post-testing fatigue rating was the highest at shoulders (3.5), followed by neck(3.2). Conclusions: It is feasible to record neck flexion with wearable IMUs during a prolonged and static task. EMG showed a periodic occurrence of muscle fatigue during the static task. The results can help to design work-rest schedule during sedentary tasks.

Keywords: Electromyography, inertial sensor, posture

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-77: Stimulation of cerebral heat shock protein 20/brain-derived neurotrophic factor signaling axis by exercise rehabilitation as a basis for cognitive recovery in rats with neurotrauma Top


Mao-Tsun Lin1, Chung-Ching Chio2, Ching-Ping Chang1, Kao-Chang Lin3, Cheng-Hsien Lin4

1Department of Surgery, Division of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan, 2Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan, 3Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan, 4Department of Medicine, Mackay Medical College, New Taipei City, Taiwan

Background and Aims: Exercise rehabilitation (ER) attenuates cognitive deficits by stimulating hippocampal brain-derived neurotrophic factor (BDNF)/ tropomyosin receptor kinase B (TrkB) activation. ER improves the outcomes of traumatic brain injury (TBI) in rats by increasing heat shock protein (HSP)-20-containing neurons with unknown mechanisms. We aim to ascertain whether ER attenuates TBI-induced cognitive deficits via modulating HSP20/BDNF pathways. Methods: We used fluid percussion injury in rats to simulate mild TBI. For rats, we used both passive avoidance learning and the Y-maze tests to evaluate cognitive function. we investigated whether ER attenuated cognitive deficits in rats with TBI and determined the contribution of hippocampal and cortical expression of HSP20 to ER-mediated cognitive recovery. Results: In addition to increasing hippocampal and cortical expression of HSP20, BDNF, and TrkB ratio, ER significantly attenuated brain contusion and improved cognitive deficits in the rat model. Furthermore, reducing hippocampal and cortical expression of HSP20 with an intracerebral injection of HSP20 small interfering RNA significantly diminished the ER-induced overexpression of hippocampal and cortical BDNF and the TrkB ratio and also reversed the beneficial effect of ER in reducing neurotrauma and cognitive deficits. A positive Pearson correlation was found between HSP20 and BDNF, as well as between HSP20 and TrkB in the hippocampal and cortical tissues. Conclusions: We thus conclude that post-neurotrauma ER improves cognitive recovery in neurotrauma rats by stimulating the cerebral HSP20/BDNF/TrkB signaling axis.

Keywords: Exercise rehabilitation, cognitive function, neurotrauma

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. P1-78: BDNF-mediated exercise rehabilitation improves motor and cognitive performance and decreased amyloid in Alzheimer's disease rats Top


Kao-Chang Lin1, Chung-Ching Chio2, Ching-Ping Chang3, Mao-Tsun Lin3, Cheng-Hsien Lin4

1Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan, 2Department of Surgery, Division of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan, 3Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan, 4Department of Medicine, Mackay Medical College, New Taipei City, Taiwan

Background and Aims: Exercise rehabilitation (ER) appears as a noninvasive and effective strategy to counteract neurological and cognitive deficits. We aimed to ascertain ER improves cognitive performance and decreased amyloid in Alzheimer's disease (AD) rats. Methods: Amyloid-Beta protein fragment 25-5 (ABeta25-35) was administrated to bilateral cerebral ventricle of rats to make the AD model in vivo. A tropomyosin-related kinase (TrkB) receptor antagonist (ANA12) was implanted subcutaneously at an amount of 40 mg/kg/day or vehicle (1% DMSO in phosphate buffer saline) via ALZET osmotic mini-pump for 1 month to antagonize TrkB receptors. ER was adopted 1 week after ABeta administration and continued daily for 28 days. Cognitive and/or functional motor endpoints were monitored during ER. Pathology was quantified biochemically and immunohistochemically. Results: Thirty-five days post-Ab injection, ER was able to attenuate both cortical cell degeneration and cognitive deficits in the AD rats. ER also inhibited the endogenous levels of ABeta in brain tissues. However, the beneficial effects of EP in treating AD injury could be significantly attenuated by ANA12 therapy. Conclusions: Our data suggest that ER improves neurological and cognitive performance and decreased ABeta accumulation in AD rats via stimulating BDNF/TrkB signaling.

Keywords: Amyloid, BDNF, exercise rehabilitation

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. P1-79: The effects of hindlimb unloading and reloading on the soleus and plantaris muscles in diabetic rats Top


Sachiko Madokoro, Pleiades Tiharu Inaoka, Shoji Tanaka, Toshiaki Yamazaki

1Faculty of Health Sciences, Kanazawa University, Kanazawa, Japan

Background and Aims: The efficacy of exercise intervention in diabetic animal models with disuse muscle atrophy remains unknown. This study aimed to induce disuse muscle atrophy in Goto-Kakizaki rats, a type 2 diabetes model, to investigate the effects of reloading on the soleus and plantaris muscles. Methods: Wistar and Goto-Kakizaki (GK) rats were divided into 6 groups: Wistar Control (WC), GK Control (GC), Wistar Tail suspension (WS), GK Tail suspension (GS), and Wistar Reload (WR), GK Reload (GR). After the completion of the experiments, samples of the soleus muscle and plantaris muscle were surgically resected. Hematoxylin-eosin (HE) staining was performed and the samples were observed using an optical microscope.We used the image analysis software ImageJ to measure the cross-sectional areas. As an index for muscle damage, we calculated the onset rate for whole fibers that were subjected to centrally nucleated fiber and myofiber necrosis measurement. The value of each measurement item in the Control, Suspension, and Reload groups were subjected to one-way ANOVA and Tukey test to assess sub effects. The onset rates for myofiber necrosis and core fiber formation were subjected to the chi-squared test and Bonferroni correction. The significance level was set at 5%. Results: Investigation of myofiber cross-sectional area for GK rat soleus muscle indicated that the GS group had significantly lower values than the GC and GR groups. No significant differences were observed between the GC and GR groups. However, investigation of plantaris muscles in GK rats indicated that the GS and GR groups had significant decreases compared to those in the GC group. No significant differences were found between the GS and GR groups. Conclusions: The differences in the degree of atrophy and recovery in terms of myofiber cross-sectional area observed in Goto-Kakizaki rat plantaris muscles may be influenced by the myofiber type and diabetes.

Keywords: Diabetic rat, reloading, tail suspension

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-80: Deficit in sensorimotor adaptation in children with cerebral palsy Top


Philippe Marque1,2, Claire Cherriere1,3, Yannick Lagarrigue1, Catherine Donskoff3, Valerie Lambert2,3, Martin Lemay4, Jessica Tallet1

1iDream Team, Inserm UMR1214 TONIC, 2Department of Neurorehabilitation, Rangueil Hospital, Toulouse, France, 3Paul Dottin Pediatric Rehabilitation Center, Ramonville Saint-Agne, France, 4University of Quebec UQAM, Montreal, Canada

Background and Aims: The literature suggests that auditory rhythmic stimulations (RAS) provide motor benefits in children with Cerebral Palsy (CP). However, little is known about sensorimotor synchronization in CP, that is their capacity to intentionally synchronize to RAS and continue to produce the required rhythm. Methods: 10 children with CP, 9 typically-developed (TD) children and 9 TD adults were required (1) to produce spontaneous tempo with their dominant hand tapping on a buzzer, (2) to synchronize tapping of their dominant hand with RAS and (3) to continue to produce the specified tempo after the withdrawal of the RAS. ANOVAs Group (CP, TD, AD) x Tempo (Same, Different) x RAS Withdrawn (Synchronization, Continuation) were performed on the mean error of tempo and its variability. Results: For the Different tempo, the mean error of tempo was significantly larger for the Group of children with CP than for the Group of TD children. Moreover, the mean tempo error was significantly larger in Continuation than Synchronization for all Groups. Conclusions: Despite a preserved ability to intentionally synchronize and continue with a tempo similar to their spontaneous tempo, children with CP seem to present an impaired ability to synchronize and continue with a different tempo. These results suggest a specific impairment of sensorimotor adaptation mechanism. Clinical implications for future rehabilitation programs should be considered.

Keywords: Cerebral palsy, sensorimotor integration

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-81: Repetitive transcranial magnetic stimulation of cerebellum modulates the effect of gaze stabilization exercise Top


Akiyoshi Matsugi1, Naoki Yoshida2,3, Satoru Nishishita2,3, Nobuhiko Mori4,5, Yohei Okada6,7, Shinya Douchi8, Rikiya Hasada9, Koichi Hosomi4,5, Youichi Saitoh4,5

1Faculty of Rehabilitation, Shijonawate Gakuen University, Daito, Japan, 2Department of Research, Institute of Rehabilitation Science, Japan, 3Department of Rehabilitation, Kansai Rehabilitation Hospital, Toyonaka, Japan, 4Department of Neuromodulation and Neurosurgery, Osaka University, Suita, Japan, 5Department of Neurosurgery, Osaka University, Japan, 6Faculty of Health Science, Kio University, Koryo, Japan, 7Neurorehabilitation Research Center of Kio University, Koryo, Japan, 8Department of Rehabilitation, Kyoto Medical Center, Japan, 9Department of Rehabilitation, Nagahara Hospital, Higashiosaka, Japan

Background and Aims: Gaze stabilization exercise (GSE) in vestibular rehabilitation is often used to improve dynamic gaze stabilization, postural balance, and dizziness. It is unclear, however, whether there is a cerebellar contribution to the improvement of gaze stabilization, which requires eye-head coordination. In this study, we employed low-frequency repetitive transcranial magnetic stimulation of cerebellum (rTMSC) , which reduces cerebellar activity, to investigate a cerebellar involvement in the improvement of gaze stabilization. Methods: Twenty-five healthy adults (real-crTMS group: n = 12, sham-crTMS group: n = 13) participated in the study. Subjects were placed under the magnetic stimulator in a prone position, and real-crTMS or sham-crTMS was conducted for 15 minutes (1Hz, 900 stimulations). The center of the butterfly coil was set at 1 cm below the inion in real-crTMS, and stimulation intensity was set to 50% of the maximum output. Following stimulation, ten trials of GSE were conducted at intervals of one min. In GSE, subjects were standing upright, and instructed to horizontally rotate the head according to a sound beep of 2 Hz with gaze a point ahead of them. During GSE trials, electro-oculogram to estimate the horizontal eye position, and gyroscope to estimate the horizontal head angular velocity were used. The peak range of gaze and head rotation was calculated each time. To assess the improvement of eye-head coordination, gaze/head range ratio was calculated. Friedman test was conducted to estimate the main effect of GSE on these parameters. Results: The Friedman test revealed that there was a significant effect of GSE following sham-rTMSC on head range, gaze range, and Gaze/Head range ratio, but not following real-rTMSC. Conclusions: GSE can modulate the eye-head coordination, and the cerebellum may be associated with the trainability of eye-head coordination for dynamic gaze during head movement.

Keywords: Eye-head coordination, cerebellum, transcranial magnetic stimulation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-82: The relationship between the longitudinal changes in spinal pathways after stroke and leg motor function or gait pattern in patients with sub-acute stroke Top


Rena Mikami1, Yoko Takahashi1,2, Toshiya Nakajima1, Kunitsugu Kondo1, Michiyuki Kawakami1,2

1Tokyo Bay Rehabilitation Hospital, Narashino, Japan, 2Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan

Background and Aims: The relationship between longitudinal changes in spinal pathways after stroke and improvement of leg motor function remain unknown. We investigated the relationship between longitudinal changes in heteronymous facilitation (HF) or inhibition (HI), or reciprocal inhibition (RI) and motor function or gait pattern in patients with sub-acute stroke. Methods: Twelve patients with sub-acute stroke who could walk with less than a moderate assistance participated (mean age: 63.1±2.4 years). Spinal pathways were evaluated using a soleus H-reflex conditioning-test paradigm. The H-reflex was elicited by stimulating the tibial nerve in the affected side. The conditioning stimulus were applied to femoral nerve (HF and HI) and common peroneal nerve (RI). The interstimulus intervals (ISI) were set at -5, -6, and -7 ms in HF, 10 and 20 ms in HI, and 2 and 20 ms in RI. Clinical assessments included Fugl-Meyer Assessment (FMA), modified Ashworth scale (MAS), and Gait Assessment and Intervention Tool (G.A.I.T.). The value of spinal pathways was defined as: mean conditioned H-reflex amplitude/mean test H-reflex amplitude. All assessments were evaluated at admission (mean days since stroke onset: 51.2±13.3) and at discharge (121.9±26.3). Spearman's rank correlation coefficient was performed to examine correlations between clinical assessments' amounts of improvement and the amounts of changes in spinal pathways calculated as follows: (the value at admission) – (the value at discharge). Results: The change in RI of ISI 20 ms was positively corelated with the improvement of FMA total score and FMA sub-score of coordination. We found positive correlation between the change in HI and the improvement of G.A.I.T. sub-score of stance phase. Conclusions: The longitudinal changes in HI and RI may be associated with the improvement of hemiparetic leg coordination and gait in patients with sub-acute stroke.

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-83: Comparison of gait analysis before and after double level osteotomy for osteoarthritis of the knee: A case report Top


Takafumi Mizuno1, Kei Setogawa1, Kazuhisa Kajihara1, Shota Imamura1, Yuki Uchiyama2, Norihiko Kodama2, Hiroyuki Fujioka3, Hiroshi Nakayama4, Shinichi Yoshiya4, Kazuhisa Domen2

1Department of Physical Medicine and Rehabilitation, Hyogo College of Medicine Hospital, Nishinomiya, Japan, 2Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan, 3Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan, 4Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan

Background and Aims: In recent years, double level osteotomy (DLO) has been increasingly indicated for knee osteoarthritis with severe varus deformity. Although the postoperative clinical outcome has been sporadically reported, changes in gait pattern following DLO have not been clarified. In this study, we report the comparative results of gait analysis before and at 6 months after DLO in a patient with osteoarthritic knee. Methods: A 64-year-old man with varus knee osteoarthritis underwent DLO. Analyses of the gait at a self-selected speed were performed before and at 6 months after surgery. The analytical system used in the study consisted of a force plate (Kistler), two digital video cameras (Panasonic), and an AD conversion & video total measurement system (TRAIAS system manufactured by DKH). In addition, two-dimensional motion analysis for the walking speed and angle of the knee joint as well as calculation of external knee joint moment during the stance phase were conducted using Frame-DIAS V (DKH). Results: The walking speed did not change after surgery; however, the peak knee adduction angle and peak external knee adduction moment during the early stance phase decreased postoperatively, and the knee flexion angle and external knee flexion moment increased throughout the stance phase in the postoperative assessment compared to the preoperative analytical results. Conclusions: The decrease in the peak knee adduction angle and peak external knee adduction moment during the early stance phase could be due to the improvement of dynamic alignment on the coronal plane achieved by correction of varus alignment after DLO. The postoperative increases in knee flexion angle and external knee flexion moment were thought be induced by the changes in gait pattern associated with effective activation of the quadriceps muscle. However, normal gait pattern was not restored even after the correction of coronal plane alignment by DLO.

Keywords: Double level osteotomy, gait analysis, knee osteoarthritis

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-84: Effects of visual cues on subjective visual vertical in unilateral neglect patients might be limited to a slight improvement in postural balance Top


Kimihiko Mori1,2, Kae Nakamura2, Shingo Hashimoto1, Masanori Wakida3, Kimitaka Hase4

1Department of Physical Medicine and Rehabilitation, Kansai Medical University Hospital, Hirakata, Japan, 2Department of Physiology, Kansai Medical University, Hirakata, Japan, 3Department of Physical Medicine and Rehabilitation, Kansai Medical University Kori Hospital, Neyagawa, Japan, 4Department of Physical Medicine and Rehabilitation, Kansai Medical University, Hirakata, Japan

Background and Aims: A distorted perception of verticality that affects upright posture may be compensated by visual cues such as vertical frames. Such compensation may, however, be affected by unilateral spatial neglect (USN). Thus, we investigated 1) the effects of a visual frame on subjective visual perception of verticality - visual vertical (VV) - in unilateral neglect patients and 2) the relationship between postural disorders and VV with and without a visual frame. Methods: Forty-three acute stroke patients and 33 age-matched healthy subjects were examined. Seventeen and 26 patients were judged as patients with USN (USN+) and without USN (USN-), respectively, by three neglect tests. VV was measured by the angle of deviation from the actual vertical of a luminous line judged to be vertical subjectively. VV was measured 10 times with and without a frame. Mean (VVm), absolute values of the mean (VVm-abs), and intra-individual variability (VVv) of VV were then computed. Postural balance was assessed using the Trunk Impairment Scale (TIS) and the Scale for Contraversive Pushing (SCP). Results: While VVm did not show significant differences between groups, VVm-abs and VVv were significantly larger without a frame than with a frame. Both statistics were significantly larger in USN+ subjects than in USN- and healthy subjects, indicating an unstable VV. Scores for balance were significantly correlated with VVm-abs with a frame (TIS (r=-0.32), SCP (r=0.41)), VVv without a frame (TIS (r=-0.31), SCP (r=0.52)), and VVv with a frame (TIS (r=-0.31), SCP (r=0.49)) (Spearman rank correlation coefficients, p<0.05). Scores for balance were not significantly correlated with VVm. Conclusions: A visual frame improved VV-abs and VVv, the stable perception of verticality, for stroke patients. However, stroke patients with USN take significantly less advantage of visual information from their environment, which leads to severe postural imbalance.

Keywords: Postural balance, unilateral spatial neglect, verticality

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-85: Hindlimb unloading leads brittle motor nerve function in vivo Top


Masanobu Murao1, Yasufumi Sakaue2, Junichi Akiyama1, Teruhiko Kawakami1, Masaaki Nakajima1

1Graduate School of Health Science Studies, Kibi International University, Takahashi, Japan, 2Nariwa Hospital, Okayama, Japan

Background and Aims: Many patients feel unexpected weakness or experience delay the reflection of their limbs after the long term bed rest. A much of degenerative effects on muscles of unloading have founded. However, it is impossible to explain all the weakness of physical function after long term bed rest by the muscle function alone. Meanwhile, the influence of unloading on the peripheral nerves has not clarify. This study was made to evaluate in vivo function of efferent impulse propagation system in disuse extremity. Methods: Male adult wistar rats (n = 20) were divided into two groups, control group or 14 days hindlimb unloading group. After the unloading, motor conduction velocity and the repetitive stimulated wave were measured from the left leg using electrophysiological method. Sciatic nerve and soleus were collected from the right hindlimb for histological evaluation. After fixation of the sciatic nerve, toluidine blue staining was performed to measure the ratio of the axon diameter to the nerve fiber diameter (g ratio) (Image 1). The unpaired t test was using to statistics analysis. Results: The cross sectional area of soleus of the hindlimb unloading group were significantly lower than that of the control group (Control; 1048.6 ± 328.0 um2, Hindlimb unloading; 2161.5 ± 190.6 um2). Motor conduction velocity of the hindlimb unloading group were significantly lower than that of the control group (Control; 65.5 ± 1.8 m/sec, Hindlimb unloading; 52.2 ± 4.6 m/sec). There were no significant change the fatiguability of neuromuscular junction. Conclusions: This study revealed that unloading causes not only abnormality of muscle tissue but also decrease of peripheral motor nerve conduction velocity in vivo, and the unloading not affect the fatigability of the neuromuscular junction.



Keywords: Disuse, hindlimb unloading, motor conduction velosity

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-86: Influence of verbal instructions on postural change in heavy lifting Top


Hideaki Muraoka1,2, Toshiaki Suzuki1

1Graduate School of Health Sciences, Graduate School of Kansai University of Health Sciences, Osaka, Japan, 2Department of Rehabilitation, Kansai Medical University Kuzuha Hospital, Hirakata, Japan

Background and Aims: According to the Ministry of Health, Labour and Welfare, heavy lifting is associated with a high incidence rates of injury and low back pain. Many reports have compared the stoop and squat methods of heavy lifting. However, only few research studies have compared these methods with freestyle lifting. The purpose of the study was to compare postural changes in the squat method with those in freestyle lifting. Methods: Fifteen healthy male volunteers (mean age, 23.8 years) participated in this study. They were instructed to lift a 10-kg barbell from the floor. Two measurement conditions were set up. The first was freestyle lifting (non-verbal support), and the second was squat lifting (with verbal support).The verbal support was an instruction to extend the lumbar spine and flex the knee joint. The joint angles of the trunk and legs were calculated when the barbell was lifted and the joint angles were compared between the conditions when verbal or non-verbal support was provided. The correlation between the lumbar vertebral and lower limb joint angles was investigated with respect to the pelvic angle. Results: The vertebral angle in the lower lumbar region and the pelvic angle did not show any significant differences between the two conditions. Verbal support increased the extension angle of the thoracic vertebrae, upper and lower thoracolumbar transitional vertebrae, and upper lumbar vertebrae; the flexion angle of the hip and knee joints; and the dorsiflexion angle of the ankle joint. The pelvic angle correlated with both angles of the knee and ankle joints under the two conditions. Conclusions: The postures of the trunk and lower limbs were changed with the verbal support (extend the lumbar and flex the knee joints). Knee and ankle joint positions were involved in the determination of the pelvic position in both groups.

Keywords: Lifting, low back pain, trunk

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-87: Back and hip muscle activity during heavy lifting Top


Hideaki Muraoka1,2, Toshiaki Suzuki1

1Graduate School of Health Sciences, Graduate School of Kansai University of Health Sciences, Osaka, Japan, 2Department of Rehabilitation, Kansai Medical University Kuzuha Hospital, Hirakata, Japan

Background and Aims: The Ministry of Health, Labor and Welfare reports that heavy lifting is associated with a high injury rate and lower back pain. As a general rule, lower back pain occurs between the bottom of the ribs and the gluteal fold. For this reason, it is necessary to know the muscle activity patterns of the back and hip muscles. When compared to healthy individuals, individuals with lower back pain display differences in back and hip muscle activity. Lower back pain often occurs during heavy lifting when low back pain patients reach for an object from a standing position. The purpose of this study is to compare muscle activity patterns with postural changes from standing at rest to reaching for an object. Methods: Eleven healthy male volunteers (mean age 22.5 years) were instructed to lift a 10 kg barbell from the floor. This study analyzed the lifting starting from standing and terminating with object contact. During this movement, longissimus, lliocostalis, multifidus, multifidus of the sacrum, upper and lower gluteus maximus, medial and lateral hamstring muscle activity patterns were recorded using surface electromyograms. In addition, videos were concurrently filmed using a digital single-lens reflex camera for motion analysis. Results: Muscle activity of the sacrum multifidus was faster than in the other back muscles. Muscle activity of the medial hamstrings was faster than in the other hip muscles. Contrastingly, upper and lower gluteus maximus and lateral hamstring activity was not noted in several subjects. Conclusions: The sacrum multifidus was involved in lumbar flexion braking. The medial hamstrings were involved in anterior pelvic tilt braking. This study lays a foundation for evaluating patients with lower back pain.

Keywords: Back muscles, hip muscles, lifting

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-88: Histological changes of cartilage layers in the anterior cruciate ligament insertion in growth on rabbits Top


Hirotaka Mutsuzaki1, Hiromi Nakajima2, Maika Someji2, Masataka Sakane3

1Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, Ami, Japan, 2Department of Agriculture, Ibaraki University, Mito, Japan, 3Department of Orthopaedic Surgery, Tsukuba Gakuen Hospital, Tsukuba, Japan

Background and Aims: A detailed evaluation focusing on the cartilage layers in the anterior cruciate ligament (ACL) insertion is necessary to consider regeneration of the insertion. This study examined the histological changes of cartilage layers in the ACL tibial insertion in growth on rabbits. Methods: Forty-eight male Japanese white rabbits were used, with six animals euthanized at each age (1 day, 1, 2, 4, 6, 8, 12, and 24 weeks). Proliferation rate, chondrocyte number, Safranin O-stained glycosaminoglycan (GAG) areas, tidemark length, ACL insertion width, and ACL length were evaluated. Results: High levels of chondrocyte proliferation continued until 4 weeks of age, and then gradually decreased. The chondrocyte number, ACL insertion width and safranin O-stained GAG areas gradually increased up to 12 weeks. The ACL length gradually increased up to 6 weeks. The tidemark slowly became longer up to 24 weeks. Conclusions: Chondrocytes that displayed chondrocyte proliferation, and GAG production increased until 12 weeks of age, in accordance with development of the ACL length and its insertion width. Finally, ACL insertion development was complete at the time that tidemark formation had reached completion, at 24 weeks of age. Since, anatomical structural differences accompanying growth of the ACL insertion were clarified in the present study, an appropriate treatment and rehabilitation strategy based on age could be considered.

Keywords: Anterior cruciate ligament insertion, cartilage layer, growth

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-89: Asymmetry of anticipatory postural adjustments during gait initiation in Parkinson's disease Top


Atsushi Nagai1,2, Masakado Okinishi1, Kenta Shimizu1, Nao Yamanaka1, Kota Ohata1, Kohei Marumoto3, Hideki Moriyama2

1Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan, 2Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Japan, 3Department of Physical Medicine and Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan

Background and Aims: Patients with Parkinson's disease (PD) have high risk of falls. Falling is commonly seen during transition movements and gait initiation (GI). GI is accompanied by anticipatory postural adjustments (APAs) which may be a factor for preventing falls. Previously, impaired APAs during GI in patients with PD and a correlation between asymmetry and freezing of gait (FOG) have been reported; however, asymmetry of APAs during GI as well as its correlation with FOG are still unclear. The objective of this study was to investigate whether PD patients display increased asymmetry of APAs during GI and to clarify its possible relationship with FOG. Methods: Twenty-six PD patients and 11 controls participated in this study. Subjects were instructed to walk forward on force plate after a verbal cue was provided. APAs parameters were measured by the changes vertical force (Fz). The amplitude of APAs [APAs(Fz)] was defined as the Fz of stepping limbs reached the maximum value from the baseline before the stepping. Dominant side was determined by larger side of APAs(Fz). The asymmetry index between the variables of the dominant and opposite was used to express the asymmetry. We analyzed the differences between variables of two groups with Man-Whitney U test, and a correlation between FOG questionnaire (FOGQ) and both sides of APAs(Fz) with Spearman's rank correlation coefficients. Results: APAs(Fz) in both sides were significantly smaller in PD patients than that in healthy controls. Asymmetry of APAs in PD patients was large compared to healthy controls. FOGQ was significantly negatively correlated to APAs(Fz) of dominant side in PD patients. Conclusions: APAs of dominant side stepping was related to FOG. The new findings of increasing the asymmetry of APAs during GI in PD patients may guide rehabilitation intervention such as selection of the first step to prevent falls.

Keywords: Asymmetry, gait initiation, Parkinson's disease

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-90: Effects of combined exercise training and Olmesartan on renal renin-angiotensin system in rats with chronic renal failure Top


Takahiro Nakamura1, Seiko Yamakoshi1, Nobuyoshi Mori1, Masahiro Kohzuki1, Osamu Ito2

1Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan, 2Division of General Medicine and Rehabilitation, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan

Background and Aims: Exercise training (Ex) and olmesartan (OLM) are known to have renal protective effects, and the combination of Ex and OLM provided greater renal protective effects. To clarify the mechanisms of renal protective effects of combined Ex and OLM, the present study examined the combination effects of Ex and OLM on renal damage and renin-angiotensin system (RAS) in rats with chronic renal failure (CRF). Methods: Six-week-old male Sprague-Dawley rats were divided into five groups: 1) sham operation; 2) 5/6 nephrectomy (Nx); 3) Nx + Ex with treadmill running (20 m/min, 60 min/day, 5 days/week); 4) Nx + OLM (10 mg/kg/day); 5) Nx + Ex + OLM. After 12 weeks, renal function, histology and protein expressions of RAS components in the renal cortex were examined. Results: Nx increased the systolic blood pressure, urinary excretion of protein and serum creatinine, but Ex and OLM decreased these parameters. Nx increased the index of glomerular sclerosis (IGS) and the relative interstitial volume of the renal cortex (RIV), but Ex and OLM decreased these parameters. Combination of Ex and OLM further improved IGS and RIV. Nx increased angiotensinogen (AGT), angiotensin-converting enzyme (ACE) and angiotensin II type 1 receptor (AT1R) expressions. Ex and OLM inhibited the Nx-increased AGT and ACE expressions, and OLM inhibited the Nx-decreased AT1R expression. Nx decreased renin and angiotensin II type 2 receptor (AT2R) expressions. Ex and OLM inhibited the Nx-decreased renin and AT2R expressions. Combination of Ex and OLM further inhibited the Nx-decreased AT2R expression. Conclusions: Combination of Ex and OLM attenuated the progression of hypertension, glomerular sclerosis and renal fibrosis more than Ex alone and OLM alone in CRF rats. The renal protective effects of combined Ex and OLM may be mediated by ameliorating the exacerbation of renal RAS.

Keywords: Chronic renal failure, exercise, renin-angiotensin system

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-91: Effects of exercise training on renal interstitial fibrosis in rats with chronic renal failure Top


Takahiro Nakamura1, Seiko Yamakoshi1, Nobuyoshi Mori1, Masahiro Kohzuki1, Osamu Ito2

1Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan, 2Division of General Medicine and Rehabilitation, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan

Background and Aims: Exercise training (Ex) has renal protective effects in humans and animals, but the mechanisms of these effects were unclear. To clarify the mechanisms of Ex on the renal interstitial fibrosis, the present study examined the effects of Ex on renal collagen turnover in the kidney of rats with chronic renal failure (CRF). 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 (20 m/min, 60 min/day, 5days/week). After 12 weeks, renal histology and protein expressions of collagen type I, transforming growth factor (TGF)- beta1, matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) in the renal cortex were examined by western blot. Results: Nx increased the systolic blood pressure (SBP), urinary excretion of protein (UP) and serum creatinine, and Ex decreased them. Histological analysis revealed that Nx increased the index of glomerular sclerosis (IGS) and the relative interstitial volume of the renal cortex (RIV), and Ex improved them. Compared with the Sham operation group, Nx significantly increased the collagen type I, TGF-beta1 and TIMP-1 expressions 6.0-, 5,0- and 7.0-fold, and Ex significantly inhibited the Nx-increased collagen type I, TGF-beta1 and TIMP-1 expressions 4.0-, 2.2- and 3.0-fold. Nx significantly increased the MMP-2 and MMP-9 expressions 9.0- and 3.3- fold, and Ex significantly enhanced the Nx-increased MMP-2 and MMP-9 expressions 6.2- and 5.3- fold. Conclusions: Ex attenuated the progression of hypertension, glomerular sclerosis, and renal interstitial fibrosis in CRF rats. The renal protective effects of Ex may be mediated by ameliorating the renal collagen turnover.

Keywords: Chronic renal failure, collagen turnover, exercise

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-92: Core body temperature of an amputee triathlete during swimming wearing a wetsuit: A case report Top


Daigo Nakashima1, Hiroaki Kimura2, Kouki Fukuhara1, Kazuhiko Hirata1, Yukio Mikami2, Nobuo Adachi3

1Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan, 2Department of Rehabilitation, Hiroshima University Hospital, Hiroshima, Japan, 3Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Higashihiroshima, Japan

Background and Aims: Athletes participating in triathlons are particularly susceptible to heat stroke. According to previous studies, in a triathlon, the core body temperature after swimming is the highest. However, there are no reports on the core body temperature in a paratriathlon. An amputee could have decreased heat dissipation capacity due to the reduced body surface area. Therefore, measuring the core body temperature of amputees and taking measures against heat stroke are necessary. The purpose of this study was to measure the core body temperature and dehydration rate of an amputee athlete and to ascertain the effect of ice slurry (IS). Methods: The subject was a male athlete in his sixties who had an above-the-knee amputation due to a traffic accident at the age of 18 years. The subject swam 1500m wearing a wetsuit in an indoor pool (30.5 degrees C). The subject consumed normal temperature-fluid (NF) or IS that amounted to 7.5% of his body weight before swimming. We continuously recorded the core body temperature (degrees C) during swimming by a pill sensor. In addition, the swimming time, heart rate (bpm), and body weight (kg) before and after swimming were measured. The change in body weight was determined as the dehydration rate (%). Results: The swimming time, core body temperature at rest, before starting swimming, and after swimming, dehydration rate, and average heart rate were (NF/IS) 26'07”/25'50”, 37.2/37.3, 36.9/35.1, 38.7/38.5, 2.9/1.5, and 141/131, respectively. Conclusions: The core body temperature after drinking the IS was lower than that with NF, but there was no difference after swimming. However, the dehydration rate with the NF was higher than with the IS, which placed the subject at risk of developing symptoms of dehydration. The IS was effective in suppressing dehydration without causing deterioration of the subject's performance during swimming wearing a wetsuit.

Keywords: Amputee athlete, core body temperature, paratriathlon

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-93: The changes in spinal reciprocal inhibition during motor imagery in lower extremity Top


Hideto Nakayama1, 2, 3, Michiyuki Kawakami3,4, Yoko Takahashi3,4, Tomofumi Yamaguchi4,5, Kunitsugu Kondo3, Eiji Shimizu2

1Yatsu Hoken Hospital, Narashino, Japan, 2Department of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, Chiba, Japan, 3Tokyo Bay Rehabilitation Hospital, Chiba, Japan, 4Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan, 5Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan

Background and Aims: Motor imagery (MI) has known that improve motor function due to enhancement of motor cortex activity. Spinal reciprocal inhibition (RI) is modulated by motor cortex activity, therefore MI may change RI. Previous studies have reported the changes of RI after repetitive MI, however there are no reports that examined the real-time changes in RI during MI in lower extremity. The aim of this study is to examine the changes in RI during MI in lower extremity. Methods: Eleven healthy subjects participated in this study. They performed the following three tasks; resting, MI of ankle dorsiflexion, and MI of ankle plantarflexion. The order of tasks was randomly assigned. One trial of MI tasks was consisted of rest period for 7 sec and MI period for 3 sec, all participants repeated 10 trials per each MI task. We assessed RI during MI period in MI tasks and during rest in resting task. RI from the tibialis anterior muscle to the soleus muscle was assessed using a soleus H-reflex conditioning-test paradigm. The interval between the conditioning and the test stimulus was set at 2 ms and 20 ms. Results: A one-way repeated analysis of variance revealed significant main effects of tasks in both intervals of 2 ms and 20 ms. The post hoc paired t-test revealed that RI during MI of ankle plantarflexion was significantly decreased compared with that in resting in both stimulus intervals. RI during MI of ankle dorsiflexion showed no significant change compared with that in resting in both stimulus in tervals. Conclusions: RI during MI of ankle plantarflexion was decreased, while RI during MI of ankle dorsiflexion was not changed. We suggest that real-time changes in RI during MI in lower extremity may vary depending on the direction of motion.

Keywords: Lower extremity, motor imagery, reciprocal inhibition

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-94: The effect of exercise for denervated muscle atrophy in a mouse model of sciatic nerve transection Top


Junji Nishimoto1,2, Yuki Minegishi1, Minori Uto1, Kenji Murata3, Takanori Kokubun3, Naohiko Kanemura3

1Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan, 2Department of Rehabilitation, Saitama Medical University, Saitama Medical Center, Kawagoe, Japan, 3Department of Physical Therapy, Faculty of Health and Social Services, Saitama Prefectural University, Saitama, Japan

Background and Aims: Denervated muscle atrophy occurs after peripheral nerve injury. In clinical practice, the range of motion exercise, orthosis preparation, electric stimulation is mainly focused for secondary disability prevention. However, the effect of exercise on the denervated muscle is not clear. The purpose of this study was to clarify the effect of exercise on denervated muscle after sciatic nerve transection on muscle atrophy. Methods: This study was approved by the Ethics Committee of Saitama Prefectural University (approval number: 29-8). A total of 44 ICR mice (ten-week-old) were obtained for use in this study. Mice were divided into three groups: a sham group (Sham, n=16: the mouse did not undergo sciatic nerve transection), a ST group (ST, n=14: right sciatic nerve was excised), a STex group (STex, n=14: the mouse subjected to exercise by treadmill after right sciatic nerve transection). The soleus muscle (SOL) and extensor digitorum longus muscle (EDL) were harvested at 2 and 4 weeks postoperatively, and stained by Hematoxylin-Eosin. The mean muscle fiber cross-sectional area (CSA) of each group was calculated. These data were analyzed using the one-way ANOVA with the Sheffe's test for multiple comparisons. Results: At 2 weeks postoperatively, the STex group had significantly larger muscle fiber CSA than the ST group (SOL: p<0.05, EDL: p<0.01). At 2 weeks and 4 weeks postoperatively, the muscle fiber CSA of the Sham group's SOL and EDL were significantly larger than those of the STex group and the ST group. At 4 weeks postoperatively, the muscle fiber CSA of SOL and EDL in STex group and ST group were not significantly different. Conclusions: This study shows that exercise is effective for suppressing denervated muscle atrophy in mice if it is up to 2 weeks after sciatic nerve transection.

Keywords: Denervated muscle atrophy, exercise, sciatic nerve transection

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-95: Reproducibility of the indexes of muscle tone abnormality calculated from time series torque-angle data with an instrument to spasticity in poststroke patients Top


Satoru Nishishita1, 2, Naoki Yoshida1, 2, Tatsuya Arakawa2, Mitsuru Ishihara2, Soji Ono2, Yuta Somei2, Yuji Wakatake3, Kenji Matsumoto2, Tomosaburo Sakamoto2, Yuki Uchiyama4, Kazuhisa Domen4

1Institute of Rehabilitation Science, Tokuyukai Medical Corporation, Toyonaka, Japan, 2Kansai Rehabilitation Hospital, Tokuyukai Medical Corporation, Japan, 3Sakamoto Hospital, Tokuyukai Medical Corporation, Toyonaka, Japan, 4Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan

Background and Aims: Abnormal muscle tone, such as spasticity or rigidity, is often seen in patients with central nervous system lesion and has been assessed by several measures. However, measures commonly used in clinical settings are more or less subjective. Instruments for objective assessment have been developed and in recent years some became commercially available. We started using a newer one for post-stroke patients with spasticity and evaluated the reproducibility of indexes about muscle tone calculated by the instrument. Methods: A physiotherapist used the instrument, “Muscle Tone EMG” (MTM-06) (Medicalnics Co., Ltd, Japan), to assess muscle tone of the elbow flexors and extensors in 16 post-stroke patients. The instrument has not only electromyography system but also two force sensors and a gyroscope to obtain torque-angle data for following indexes. The ''Elastic Coefficients (EC)'' is the slope of the regression line of the torque-angle curve. The ECs of flexion (FlexEC) and extension (ExtEC) are calculated in all (a) (10-110°) , distal (d) (10-60°) , and proximal (p) (60-110°) ranges. The “sum of the difference of Bias (SDB)” is the sum of the difference of the bias, which is the mean value of torque at each joint angle, of flexion and extension at 30, 60, and 90°. The “Maximum Value of Integral (MVI)” is an index about the shape of the torque-angle curve associated with Clasp-knife response. Assessments were done twice in a row to test the reproducibility of the above-mentioned indexes. Results: The intraclass correlation coefficients (ICCs) are FlexECa = 0.94, FlexECd =0.91, FlexECp = 0.87, ExtECa = 0.94, ExtECd = 0.84, ExtECp = 0.87, SDB = 0.96, FlexMVI = 0.65, and ExtMVI = 0.94. Conclusions: The reproducibility evaluated by ICCs of the indexes was high, which shows the instrument system is reliable for assessment of spasticity.

Keywords: Assessment, reliability, spasticity

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-96: Joint unloading followed by reloading accelerates aging-related destruction of articular cartilage in mice Top


Masato Nomura1,2, Yoshio Wakimoto1, Shota Inoue1, Takumi Yakuwa1, Changxin Li1, Sae Kinoshita3, Toshiya Tsubaki3, Junpei Hatakeyama3, Taisei Wakigawa3, Hideki Moriyama4

1Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Japan, 2Research Fellow of Japan Society for the Promotion of Science, Japan, 3Kobe University School of Medicine Faculty of Health Sciences, Japan, 4Kobe University, Life and Medical Sciences Area, Health Sciences Discipline, Japan

Background and Aims: Articular cartilage are known to exhibit atrophic changes after mechanical unloading, as well as muscle and bone. However, its response to mechanical reloading is poorly understood. The aim of this study was to investigate the effect of joint reloading on articular cartilage atrophied by joint unloading. Methods: Sixteen 8-week-old male C57BL/6 mice were equally divided into the following 4 groups: (1) 8 weeks of normal housing, (2) 16 weeks of normal housing, (3) 8 weeks of hindlimb unloading, (4) 8 weeks of hindlimb unloading followed by 8 weeks of normal housing. Both sides of the knee joints were harvested and weight of periarticular muscles was measured. The joints were scanned by micro-computed tomography and then sectioned for histomorphometric analysis of cartilage thickness and fibrillation. Results were compared with one-way ANOVA followed by Tukey's post hoc test. Results: Decrease in muscle weight after hindlimb unloading fully recovered by reloading [Figure 1]. Joint unloading led to loss of subchondral bone and subsequent reloading not only restored the bone atrophy but resulted in subchondral bone thickening [Figure 2]. Thinning of articular cartilage by joint unloading persisted after reloading [Figure 3]a. Mice without intervention developed spontaneous cartilage fibrillation with aging and those underwent joint unloading followed by reloading exhibited more severe and extensive damage [Figure 3]b. Conclusions: Unloading-induced thinning of articular cartilage was difficult to recover after reloading at least more than atrophy of muscle and bone. The thinned cartilage combined with the thickened subchondral bone might increase the load on the cartilage through the reduction of its shock absorbing ability, possibly contributing to the acceleration of aging-related cartilage fibrillation. Therefore, we need to pay attention to the possibility that joints underwent mechanical unloading and subsequent reloading may be at high risk for the development of aging-related destruction of articular cartilage.

Keywords: Aging, articular cartilage, joint loading

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.

Figure 1: Muscle Weight After Hindlimb Unloading and reloading

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Figure 2: Subchondral bone changes with unloadin and reloading

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Figure 3: Articular Cartilage Changes

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  No. P1-97: Changes in posture and electromyogram pattern during forward weight shifting in standing Top


Koji Nose1, Toshiaki Suzuki2

1Neyagawa Hikari Hospital, Japan, 2Kansai University of Health Science, Kumatori, Japan

Background and Aims: We often come across patients who cannot shift their weight forward during standing without trunk flexion. Therefore, we examined postural changes and muscle activity necessary for maintaining posture during forward weight shifting in standing. Methods: Participants were 10 healthy men (mean age 25.1 years). They were asked to move from the hindfoot to forefoot in standing. Joint angles by video image, electromyogram (EMG), and center of pressure (COP) of the foot were recorded and analyzed. Joint angles were recorded on video using body markers affixed to the spinous processes of the thoracic (Th6/Th12) and lumbar(L1/L3/L5) vertebrae as well as the anterior and posterior superior iliac spines and the greater trochanter, lateral epicondyle of the femur, head of the fibula, lateral malleolus, and base of the fifth metatarsal of both lower limbs. EMG was used to record the activity of the multifidus, longissimus, iliocostalis, rectus abdominis and gastrocnemius. Joint angles were analyzed by dividing the video recording to capture every 20% of the movement beginning from the hindfoot to the COP of the foot and moving forward on to the forefoot. EMG data were analyzed in a pattern and root mean square (RMS). Results: Posture changes were observed with tilts of the pelvis, lower legs, and third lumbar vertebra (L3). Initially, the lower started to tilt forward, and then pelvis tilted forward after. The L3 was tilted backward against the pelvis. In the initial stage, the EMG pattern showed increased muscle activity in the following order the gastrocnemius, multifidus(S1), and multifidus(L4). The RMS showed increased muscle activity in all the muscles except the rectus abdominis. The multifidus (S1) showed more activity than the multifidus(L4). Conclusions: We observed that during forward weight shifting, the muscle activity of the multifidus(S1/L4) increased from the initial stage with the anteversion of the lower leg and pelvis.

Keywords: Electromyogram, forward weight shift, posture change

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-98: Increased regional volume of the brain after mild traumatic brain injury is associated with cognitive recovery: A tensor-based morphometry study Top


Byung-Mo Oh1, Eunkyung Kim1, Han Gil Seo1, Hyun Haeng Lee1, Seung Hak Lee1, Seung Hong Choi2, Roh-Eul Yoo2, Won-Sang Cho3, Seo Jung Yun1, Min-Gu Kang1

1Department of Rehabilitation, Seoul National University Hospital, Seoul, South Korea, 2Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea, 3Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea

Background and Aims: This study aimed to investigate regional brain volume changes after mild traumatic brain injury (mTBI) and examine the relationship of brain volume changes to time post injury and cognitive deficits using a tensor-based morphometry, which identifies regional structural differences in the brain from the gradients of the deformation fields that align images to a common anatomical template without a prior hypothesis. Methods: In total, 29 mTBI patients and 30 controls were included in this study. Volume contraction and expansion were compared between groups using a two-sample t-test, and the association between time post injury or neurocognitive function and the volumetric changes was examined by a regression analysis in mTBI patients. Results: The individuals with mTBI showed volume contraction in the brainstem and cerebellum [Figure 1]. The volumetric changes were not associated with time post injury but were significantly associated with the neurocognitive function, preferentially with the performance of the verbal learning tests [Figure 2] and executive card sorting test [Figure 3]. Conclusions: The volume contraction observed in the brainstem and cerebellum may indicate vulnerability of the brain to traumatic injury. The significant positive correlation between the volume changes of the cerebral cortices and neurocognitive function supports that volume expansion may related with the cognitive recovery.

Keywords: Magnetic resonance imaging, neuropsychological tests, traumatic brain injury

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.

Figure 1: Volume contraction in the brainstem and cerebellum

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Figure 2: Volumetric changes with verbal learning test

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Figure 3: Volumetric changes with executive card sorting test

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  No. P1-99: Kinematic evaluation of gait smoothness in patients with hemiparetic stroke Top


Kohsuke Okada, Kohei Okuyama, Michiyuki Kawakami, Koshiro Haruyama, Takuya Nakamura, Kengo Tsujimoto, Meigen Liu

1Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan

Background and Aims: Gait patterns are widely variable in patients with hemiparetic stroke, depending on the severity of brain lesions and the compensatory strategies adopted by them. Additionally, the smoothness and coordination of each joint movement is lost. Angular jerk, the time derivative of acceleration, is used in some studies as an index of gait smoothness. We consider that the angular jerk might be applicable to quantify and characterize gait smoothness in post-stroke patients. The aim of this study is to investigate gait smoothness evaluated with the angular jerk among healthy controls and patients with hemiparetic stroke. Methods: Participants were 8 patients with chronic stroke and 8 healthy controls. Participants walked on the floor at their preferred speed without any gait aids and orthosis. Kinematic data were measured using a three-dimensional motion capture system. The angular jerk was calculated by the third time derivative of angle data in the sagittal plane of the ankle joint. We calculated angular jerk score (AJS) by integrating angular jerk normalized by each of 10 gait cycles. One-way analysis of variance (ANOVA) was used to assess differences among the paretic AJS, the nonparetic AJS in post-stroke patients and healthy control AJS. Bonferroni post hoc tests were performed for follow-up analyses. Results: There were significant differences in AJS among the groups (paretic limb: 1.88 × 105 ± 1.05 × 105, nonparetic limb: 3.18 × 105 ± 1.80 × 105, healthy control: 4.41 × 105 ± 0.44 × 105, F = 7.54, p < 0.01). Post hoc tests revealed that paretic ankle AJS was significantly lower than healthy controls (p < 0.01). Conclusions: The angular jerk might be useful for quantifying and characterizing gait smoothness in patients with hemiparetic stroke.

Keywords: Evaluation, gait, kinematics

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-100: Association between variation in gait cycle time and physical and mental function after total knee arthroplasty using accelerometer Top


Kunihiro Onishi1, 2, 3, Yoshiro Hori2, Yasushi Miura1, Yuichi Kurita3, Osamu Aoki4

1Kobe University Graduate School of Health Sciences, Kobe, Japan, 2Tsukazaki Hospital, Himeji, Japan, 3Hiroshima University Graduate School of Engeering/JST PRESETO, Japan, 4Shijonawate Gakuen University, Daito, Japan

Background and Aims: We have reported that gait speed was decreased by muscle weakness after total knee arthroplasty (TKA). Unsteadiness of gait is associated with poor physical function in healthy elderly individuals. The magnitude of change in the Pain Catastrophizing Scale score after TKA is reportedly related to balance and gait speed. This study measured the standard deviation (SD) of gait cycle time after TKA, and investigated the association with physical and mental function. Methods: Ten patients who underwent TKA participated in this study(age:76.4 year 1 male and 9 females). We calculated the SD for gait cycle time based on 10 cycles, using an accelerometer placed on the third lumber vertebra. We investigated the correlations between the SD of gait cycle time and the following outcomes using Spearman's rank correlation test at p<0.05 significance: (1) time to independent walking after TKA (days), (2) pain in the operative knee during walking, (3) WOMAC stiffness score, (4) isometric knee extensor muscle strength on the operative and nonoperative side, (5) 5-Minute Walk Test distance, (6) Timed Up and Go test, (7)Pain Catastrophizing Scale score. All measurements were performed 1 week after TKA. Results: The SD of gait cycle time was strongly correlated with WOMAC stiffness score and nonoperative knee extensor muscle strength (r = 0.75 and r = -0.83, respectively, both p < 0.01). There was no significant correlation between the SD of gait cycle time and other outcomes. Conclusions: Strong correlations were observed between the SD of gait cycle time and some outcomes in this study. Our results indicated that subjective knee stiffness and nonoperative knee extensor muscle strength play an important role in keeping the gait cycle steady.

Keywords: Accelerometer, gait cycle steady, total knee arthroplasty

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. P1-101: Examination of frequently used upper limb movement patterns in activities of daily living Top


Hirofumi Ota1, Masahiko Mukaino2, Yuki Okochi3, Yuka Sassa3, Yukari Inoue3, Ai Shibakusa3, Nozomi Hokimoto1, Kasumi Nagasaka3, Kenta Fujimura1, Suzuka Umemoto3, Yota Obayashi3, Eiichi Saitoh2

1Faculty of Rehabilitation, School of Healthcare, Fujita Health University, Toyoake, Japan, 2Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan, 3Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan

Background and Aims: There is increasing number of studies on newly developed and promising technologies for upper limb rehabilitation after neuronal or musculoskeletal diseases. However, there is sometimes a substantial discrepancy between improvement in motor performance measured by the clinical scales and the actual improvement in the amount of extremity use in the home. To address this gap, a precise understanding of the patterns of daily upper limb use is important. In this study, we have analyzed the pattern of joint movements and the range of hand movement during the activities of daily living (ADL). Methods: Five healthy individuals participated in this study. All subjects performed clothing removal, tooth brushing, dressing, use of the toilet, facial cleansing and body washing with Xsens MVN Awinda, a wearable three-dimensional motion analysis device. The positional data of the hand was analyzed in the sagittal plane, dividing the hand-using space into 12 parts. The joint movements were analyzed using the angle data for the shoulder, elbow, forearm and wrist. The time percentages for each combined joint motion pattern were calculated. Results: The positional data of the hand showed that the hand mainly moves in the area closer than the length of the forearm in the sagittal direction and lower than the jaw in the vertical direction, occupying 93.7% of right hand movements and 96.2% of left hand movements. The three longest joint movement patterns were keeping still, single movement of the elbow joint and single movement of the wrist joint. Conclusions: Frequently seen movement patterns and the range of hand movements during the frequently seen ADL tasks were clarified in this study. These findings may contribute to further understanding the use of upper limbs in ADL.

Keywords: Activities of daily living, motion analysis, upper limb

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-102: A new approach to study of neurorehabilitation and neuroplasticity: Bilateral hippocampus infarction model made by photochemical induction method in rats Top


Huijuan Pan1, Ling Li2,3, Wei Liu3

1Department of Rehabilitation, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China, 2Department of Rehabilitation, First Affiliated Hospital of General Hospital of PLA, Beijing, China, 3Department of Rehabilitation, The First Affiliated Hospital of PLA Air Force Military Medical University, Xi'an, Shanxi, China

Background and Aims: Our previous study has shown that the unilateral hippocampal infarction model induced by Rose Bengal associated with cold light irradiation has a good stability, excellent repetition, and high survival rate in rats. On this study, we want to observe the changes in learning and memory as well as histopathology in the rats with photochemically-induced bilateral hippocampus infarction, so as to provide an animal model for studying the effect of rehabilitation training on learning and memory. Methods: Thirty rats were divided into two groups at random: a photochemically-treated group and a normal group. A photochemically-induced infarction was produced by intravenous injection of Rose Bengal (70 mg /kg) combined with immediate cold light irradiation (0. 37 W/cm2) of bilateral hippocampus. Three days later the neuroethological and histopathological changes were observed. Results: Cerebral infarctions were induced by intravenous injection of Rose Bengal plus cold light irradiation. The sizes of infarction in bilateral hippocampus were stable and the neuroethological and histopathological changes of the rats were significant. Conclusions: The model rats demonstrated decreased function of learning and memory after thrombosis of bilateral hippocampus induced by photochemical technique, and corresponding pathomorphological changes. The model of infarction was stable and reliable.

Keywords: Cerebral infarction, hippocampus, photochemistry

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-105: Three-dimensional upper limb movement characteristics in children with brachial plexus birth palsy Top


Christelle Pons1, 2, 3, Mathieu Lempereur2, 3, 4, Katharine Alter5, Diane Damiano5, Sylvain Brochard1, 2, 3, 4

1Pediatric Rehabilitation Department, Fondation ILDYS, LaTIM, Brest, France, 2Laboratory of Medical Information Processing, INSERM U1101, Brest, France, 3PMR Department, CHRU de Brest, Hopital Morvan, Brest, France, 4Universite de Bretagne Occidentale, Brest, France, 5Rehabilitation Medicine Department, Functional and Applied Biomechanics Section, National Institutes of Health, USA

Background and Aims: Obstetrical brachial plexus birth palsy (OBPP) is an upper limb paresis secondary to brachial plexus injury during birth delivery. We investigated which kinematic and spatiotemporal parameters differentiate upper-limbs movements in children with OBPP from age-matched typically developing children (TDC). Methods: 12 children with unilateral OBPP (mean age = 11.7 years (SD 4.2) years) and 11 TDC (10.9 years (SD 2.5)) participated. 3D motion of both upper limbs of children with OBPP and of the non-dominant limb of TDC were collected during 5 shoulder amplitude tasks and 3 functional tasks. Spatio-temporal parameters, 3D upper-limb joint kinematics and Arm Profile Score (APS) were calculated and compared between upper-limb groups. Results: Spatio-temporal parameters did not differ between groups for most of the tasks. Statistically significant changes were found during all the tasks at the gleno-humeral joint, especially in the rotation plane, but also on all the other joints (trunk, scapulo-thoracic, elbow, wrist). For all tasks, children with OBPP had significantly higher APSs compared to TDC. In the unimpaired side of children with OBPP, significant kinematic differences compared to TDC were found, especially in the shoulder rotation plane. Conclusions: Effective movements with good motor control but with atypical patterns of movements were highlighted on the impaired upper limb of children with OBPP. The major involvement of the gleno-humeral joint was confirmed, large compensatory movements were found on the other joints. Differences were also found on the unimpaired limb, in favor of a bimanual evaluation of children with OBPP.

Keywords: Brachial plexus birth palsy, motion analysis, upper limb

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. P1-106: The relationship between 3D lower limb bone morphology and 3D gait parameters in children with uni and bilateral cerebral palsy Top


Rodolphe Bailly1,2, Mathieu Lempereur1, 2, 3, Matthias Thepaut4, Christelle Pons1, 2, 3, Laetitia Houx1, 2, 3, Sylvain Brochard1, 2, 3

1LaTIM, INSERM UMR1101, Brest, France, 2Universite de Bretagne Occidentale, Brest, France, 3Service de Medecine Physique et de Readaptation, CHRU Brest, France, 4Service de Chirurgie Infantile, CHRU Brest, France

Background and Aims: The relation between 3D gait parameters and 3D lower limb bone morphology is little studied in children with cerebral palsy (CP). The aim of this study was to quantify the relationship between 3D femur and tibia morphology and 3D gait analysis data in children with uni and bilateral CP. Methods: In a group of 122 children with uni (n=64, 10.2 +/- 3.4yo) and bilateral (n=58, 10.5 +/- 3.6yo) CP a 3D gait analysis and a biplanar X-rays (EOS system) were carried out. For each type of limbs (more impaired of Bilat-CP, impaired of Uni-CP, unimpaired of uni-CP serving as a control group) multiple Linear Regressions were conducted to predict 50 selected gait parameters based on 9 selected 3D bone parameters. Results: The main results are: - 31.7% (Unilat_CP) to 23% (Bilat_CP) of gait speed variability was explained by bone models- The variability of hip and knee sagittal active ranges of motion was moderately explained by bone models in both CP groups (RE=0.40) and weakly in Control (R2=0.13) - Bone morphology model explained 50% of foot progression variability in Control group, while its explicated 36% in Unilat-CP group and 26% in Bilateral_CP group. Conclusions: These results suggest that specific gait parameters are related to femur and tibia 3D morphology and this relationship depends on the type of CP alerting us to the necessity to adjust our bone morphology assessments as well as our interventions to CP type.

Keywords: Bone morphology, cerebral palsy, gait

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-107: Exercise training decreases the enhanced soluble (pro) renin receptor expression in the kidney of spontaneously hypertensive rats Top


Rong Rong1,2, Osamu Ito3, Pengyu Cao4, Masahiro Kohzuki4

1School of Rehabilitation Medicine, NanJing Medical University, Nanjing, China, 2Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, NanJing, China, 3Division of General Medicine and Rehabilitation, Faculity of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan, 4Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan

Background and Aims: The antihypertensive effect of exercise training (Ex) has been showed in many epidemiological studies and animal models with hypertension. (Pro) renin receptor (PRR), a newest member of renin-angiotensin system, has two forms: the full length (f-PRR, 37kDa) and the soluble form (s-PRR, 28kDa). PRR bound (pro)renin enhances the enzymatic activity to generate angiotensin II and associates with hypertension and renal disease. Thus the aim of the present study is to determine whether the antihypertensive effect of exercise training is related to the two forms PRR expression in the kidney and plasma. Methods: Five-week-old Wistar-Kyoto rats (WKY) and SHR were submitted to a control group and an exercise group (a moderate Ex with treadmill running: 20m/m; 60min/day; 6times/week) for 8 weeks and the systolic blood pressure (SBP) was measured. The expression of PRR in the renal cortex and plasma was analyzed by Western blots. Results: PRR mRNA was expressed in various nephron segments of the cortex and medulla; f-PRR protein was highly expressed in the medullary TAL (MTAL), and s-PRR protein was highly expressed in the proximal tubule. After 8 weeks, SBP in SHR was significantly lowered by exercise training in SHR (223.8±3.0 vs. 212.8±3.0mmHg). Compared to WKY, the s-PRR expression in plasma in SHR was lower (21.9%), but both the s-PRR and f-PRR expression in the renal cortex are higher in the SHR (s-PRR: 64.0%, f-PRR: 11.9%). Ex significantly decreased the s-PRR expression of renal cortex both in WKY and SHR (WKY: 30.0%, SHR: 33.8%), but did not affect the f-PRR expression. Ex did not affect s-PRR expression of plasma both in WKY and SHR. Conclusions: The Ex decreases the enhanced s-PRR in the kidney of SHR. This may be involved in the antihypertensive effect of the Ex.

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-108: Changes in functional stretch reflex and postural sway to a repetitive ankle dorsiflexion while standing Top


Hiroshi Saito1, Satoshi Kasahara2, Hiroshi Goto1

1Department of Rehabilitation, Tokyo Kasei University, Tokyo, Japan, 2Faculty of Health Sciences, Hokkaido University, Sapporo, Japan

Background and Aims: A functional stretch reflex (FSR) as a kind of long-latency muscle response is evoked in triceps muscle when dorsiflexion of the ankle joint occurs suddenly while standing. The FSR cause postural sway backward with risk of falling. It is known that a repetition of ankle dorsiflexion stimulation inhibits the FSR (Nashner, 1976). Therefore, we examined how much a repetitive ankle dorsiflexion decreases postural sway backward and how long the inhibition of the FSR retains. Methods: Fourteen healthy subjects (22 years) participated in this study. Subjects stood on a tilting platform to induce ankle dorsiflexion and were asked for maintaining an upright standing posture [Figure 1]. The tilting perturbation was set in 10 degree and 10 degree/sec. The tilting tasks were composed of pretest (10 trials), adaptation training (100 trials), the first posttest after 10 min (10 trials), and the second posttest after 30 min (10 trials). The maximum displacement of the center of mass (COM) as an indicator of postural sway was calculated using three-dimensional motion analysis. The integrated electromyograms (IEMG) as an indicator of the FSR were calculated using muscle responses of gastrocnemius (GAS). Each task was compared using a one-way repeated measures ANOVA and a Bonferroni post hoc test. Results: The maximum displacement of the COM decreased significantly during adaptation training (p<0.05). Similarly, the IEMG of GAS decreased significantly in the first and the second posttest compared to pretest (p<0.05, respectively) [Figure 2]. Conclusions: These findings suggest that a repetitive ankle dorsiflexion task while standing leads to a decrease in postural sway and retains inhibition of muscle activity including reflex response such as the FSR. The inhibitory effects may retain at least 30 minutes.

Keywords: Functional stretch reflex, muscle activity, postural control

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.

Figure 1: Experimental setup

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Figure 2: Effects of repetitive ankle dorsiflexion

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  No. P1-109: Analysis of the relationship between gait motor imagery and physical function in stroke patients Top


Katsuya Sakai, Yumi Ikeda

Graduate School of Human Health Sciences, Tokyo Metropolitan University, Hachioji, Japan

Background and Aims: Motor imagery was reported to show brain activity similar to motor execution. Also, the image time of gait (MI) and the measured value of gait (gait) are similar. It is hypothesized that gait motor imagery may be related to other physical functions. The purpose of this study was to determine if there is a relationship between gait motor imagery and physical function in stroke patients. Methods: A total of 16 stroke patients (mean age: 59.1 ± 14.8, 11 had left hemiplegia) were assessed in this study. Patients were asked to imagine walking 10 m along a path at a comfortable speed. Subjects were provided with a stopwatch in order to measure the time it took them to accomplish this task. The task was performed twice and the average time was calculated from the two measurements. Physical function outcomes included measured gait, lower limb Brunnstrom recovery stage (BRS), and the Functional Independence Measure (FIM). Spearman correlation coefficient was used to determine associations between MI, gait, BRS, and FIM. Results: MI was average 23.36 ± 22.14 sec. Gait was average 24.87 ± 21.41 sec. A significant correlation was revealed between MI and gait was significant positive correlation (r = 0.96, p < 0.05). Significant negative correlations were observed between MI and BRS as well as FIM (r = -0.51, r = -0.84, p < 0.05, respectively). Conclusions: This study revealed an association between MI was relationship and physical function with in stroke patients. MI outcomes may be used as an outcome reflecting may reflect improvements in the physical function.



Keywords: Motor imagery, physical function, stroke patients

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-110: Characteristics of the intrinsic foot muscle in the flatfoot Top


Kodai Sakamoto1, Shintarou Kudo1,2

1Morinomiya University of Medical Sciences, Osaka, Japan, 2Graduate School of Health Science, Morinomiya University of Medical Science, Osaka, Japan

Background and Aims: Foot muscles contributed to supporting the medial longitudinal arch (MLA), and the imbalance of the muscle activity in foot muscles as decreased in activity of the peroneus longus which abducted forefoot and increased activity of the tibial posterior which adducted it was occurred in the flat foot. It is known that the intrinsic foot muscle (IFM) was involved in supporting the MLA and however, there are few evidences to individually assess each IFM. The purpose of this study is to clarify change of the IFM in the flatfoot. Methods: The seventy-four feet of the thirty-seven young healthy volunteers were recruited. All subjects were classified into 43 asymptomatic flat feet and the 31 normal feet using Foot posture index six item version. The thickness and the cross-sectional area (CSA) of the abductor hallucis (AH), the abductor digiti minimi (ADM), the flexor digitorum brevis (FDB) and the thickness of adductor hallucis oblique head (ADHO) were recorded using B-mode ultrasonography (Aplio 300, Canon co, Tokyo, Japan) with 18MHz linear probe. The both thickness and CSA of four muscles were normalized by the height. The thickness and CSA of the IFM were compared between two groups using unpaired t-test. This study was approved by the Local University of Medical Science ethics committee. There is no COI to disclose. Results: The muscle thickness of AH was significantly larger in the flat feet group (p<0.05). Muscle thickness of both ADHO and ADM, the CSA of ADM were significantly smaller in flat feet group (p<0.05). Conclusions: We found that the adductor of forefoot located inside of the MLA as the AH might get hypertrophy and the abductor of forefoot located outside of it as the ADM and the ADHO might get atrophy in flat foot using ultrasonography.

Keywords: Flatfoot, intrinsic foot muscle, ultrasonography

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-111: Multifidus activity decreases with the descent of highly elevated lower extremities in the bird-dog exercise: Surface electromyographic analysis Top


Yasufumi Sakaue1, Masanobu Murao2, Masaaki Nakajima2

1Department of Rehabilitation, Nariwa Hospital, Okayama, Japan, 2Kibi International University, Okayama, Japan

Background and Aims: In recent years, it has been demonstrated that selective lumbar multifidus (LM) atrophy occurs in patients with back pain. Selective LM exercise is necessary for patients with lower back pain (LBP) to strengthen and reinforce their atrophied LM activities. Selective LM activity is obtained from the bird-dog exercise. In the clinical setting, some patients assume the position with insufficient use of the lower extremities. This position might have an inhibitory influence on LM activities. We analyzed electromyography (EMG) results to clarify the effect of the angle of elevation of the lower extremities on muscle activity in the bird-dog exercise. Methods: Thirty healthy young volunteers participated in this study (21.0±0.9 years old). They performed the bird-dog exercise in the following hip flexion angles: 0, 15, and 30 degrees. EMG activities were recorded using surface electrodes on the LM and thoracic part of the iliocostalis lumborum (ICLT) on the left side and normalized to values derived from maximal isometric trials (percentage of maximum voluntary isometric contraction, %MVIC). In addition, the LM/ICLT ratio was calculated to compare the selectivity of LM activity. Results: The %MVICs of the LM were 29.7±11.4% at 0 degrees, 22.6±9.6% at 15 degrees, and 18.2±7.5% at 30 degrees. The LM/ICLT ratio was 2.6±2.2 at 0 degrees, 2.8±2.2 at 15 degrees, and 2.7±2.1 at 30 degrees. Conclusions: LM activity decreases although LM selective activity was maintained at a constant level while lowering the elevated extremity. The decrease in LM activity with lowering of the elevated extremity was attributed to the decrease in the pelvic backward tilting moment generated by the elevated lower extremity. It is advisable to assume an elevated extremity horizontal position for patients with LBP when performing the bird-dog exercise.

Keywords: Electromyography, exercise, lumbar multifidus

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-112: Objective evaluation method of dynamic balance function by simultaneous measurement of center of gravity and center of pressure Top


Ryoma Sassa1,2, Masahiko Mukaino3, Fumihiro Matsuda4, Kei Ohtsuka4, Nobuhiro Kumazawa4, Shigeo Tanabe4, Eiichi Saitoh3

1Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan, 2Department of Rehabilitation, Fujita Health University Hospital Bantane, Nagoya, Japan, 3Department Rehabilitation Medicine, Fujita Health University Hospital, Toyoake, Japan, 4Faculty of Rehabilitation, School of Healthcare, Fujita Health University, Toyoake, Japan

Background and Aims: Although posturography is commonly used for the objective evaluation of static balance function, dynamic balance function is usually evaluated only with clinical scales. Simplified objective measurement systems for the evaluation of dynamic balance function need to be developed. The purpose of this research is to develop an objective evaluation index of dynamic balance function from the movement of the center of gravity (COG) and the center of pressure (COP) during stepping movement. Methods: Participants included 12 healthy adults and 30 patients with hemiplegia. Subjects wore 12 markers and performed 10 steps. Kinema Tracer(Kissei Comtec), a 3-dimensional motion analysis device, and force plates were used for measurement. The lateral distance of the COG and the COP (COG-COP distance) was calculated from COG and COP X coordinates. In order to exclude compensatory movements, the values of COG-COP distance were adjusted by step width. A comparison between healthy subjects and patients (paralyzed side / non-paralyzed side) was conducted by Mann-Whitney's U test. Spearman's rank correlation coefficient of the index values and BBS score were calculated. The level of significance was set to less than 5%. Results: The indices showed significantly smaller values for patients than those of healthy subjects on both the paralyzed and non-paralyzed sides. The correlation coefficient between BBS and the index value showed a significant positive correlation with 0.61 on the paralyzed side and 0.75 on the nonparalyzed side. Conclusions: The COG-COP distance was significantly correlated with BBS. This may suggest the possible availability of the COG-COP relationship as an index reflecting the dynamic balance function.

Keywords: Center of gravity, center of pressure, dynamic balance function

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-113: Association between hamstring antagonist coactivation during isokinetic quadriceps strength testing and knee cartilage worsening over 24 months Top


Neil A. Segal1, Na Wang2, David T. Felson2, Michael C. Nevitt3, Cora E. Lewis4, Laura Frey-Law5

1Department of Rehabilitation Medicine, The University of Kansas, Lawrence, Kansas, 2Boston University, Boston, MA, United States, 3University of California San Francisco, San Francisco, CA, United States, 4University of Alabama at Birmingham, Birmingham, AL, United States, 5The University of Iowa, Iowa City, IA, United States

Background and Aims: Knee osteoarthritis (OA) is a painful chronic disease and its severity impacts patients' physical function, mental health, and quality of life. Previous work revealed that greater hamstring coactivation is associated with lower knee extensor strength and that lower strength confers elevated risk for knee OA worsening. Thus, our aim was to determine the extent to which antagonist muscle coactivation may impact knee deterioration. We hypothesized that greater coactivation of the knee flexor muscles during a maximal extension task increases the risk of 1) worsening cartilage morphology (CM) in knees with pre-existing knee OA and 2) total knee replacement (TKR) in knees with preexisting, moderate severity radiographic OA. Methods: Baseline for this study was the 60-month visit of the Multicenter Osteoarthritis Study (MOST). Knee flexor and extensor muscle activity were measured with surface electromyography (sEMG) on community-dwelling participants, while they completed a maximal extension task on an isokinetic dynamometer. Magnetic resonance imaging (MRI) was read for knee CM at baseline and 24-month follow-up. Generalized estimating equations were used to assess for associations between coactivation and outcomes. Results: Analysis of 373 women (mean±SD age and BMI: 67.4±7.3 years; 29.7±5.0 kg/m2) and 240 men (66.5+/-7.8 years; 29.9±4.5 kg/m2) revealed no relationship between medial hamstring coactivation and medial cartilage worsening (p=0.5018), nor between lateral hamstring coactivation and lateral cartilage worsening (p=0.9264). Sex-specific multivariable analysis revealed age (p=0.0157) and history of injury (p=0.0369) predicted lateral cartilage worsening in women. Lateral hamstring coactivation was associated with TKR (p=0.0410). However, there were no associations between combined hamstring coactivation (p=0.3269) or medial coactivation (p=0.6149) and TKR. Conclusions: These findings do not provide consistent evidence of associations between antagonist hamstring coactivation during isokinetic knee extensor testing and risk for compartment-specific CM worsening or TKR over a 24-month period in people with knee OA.

Keywords: Cartilage, muscle activation, osteoarthritis

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-114: Effectiveness of intensive and distributed constraint induced therapy on upper limb motor performance in children with unilateral cerebral palsy Top


Tsai-Yu Shih1, Kai-Jie Liang1, Lu-Chi Hsiao1, Jeng-Yi Shieh2, Tien-Ni Wang1,2, Hao-Ling Chen1,2

1School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, 2Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan

Background and Aims: Upper extremity (UE) motor impairment in children with unilateral cerebral palsy (UCP) lead to limitation in daily activities and participation. The constraint induced therapy (CIT) shows promising effects on improving UE motor function and has been commonly delivered in two types, namely Intensive Camp-based CIT (ICCIT) and Distributed Home-based CIT (DHCIT). Each program has its own advantages and disadvantages, but the treatment effect of each program on UE motor function has not been directly compared, which may limit the application of CIT. Therefore, this study aimed to compare the treatment effects of ICCIT and DHCIT on motor performance in children with UCP. Methods: Thirty Children with UCP were recruited to receive 36 hours CIT intervention in either ICCIT (6 hours/day, for 6 days) or DHCIT (2 to 2.5 hours/day, 2 days/week, for 8 weeks) intervention. The outcome measures were assessed at 0th, 1st, and 8th week in ICCIT group and 0th and 8th week in the DHCIT group. The endpoint variables(i.e., movement time (MT), peak velocity (PV), time to PV (PPV) and movement unit (MU)) of reaching kinematics obtained from motion analysis system (Vicon MX, Oxford Metrics Group, U.K.) were used to quantify motor control strategies. The Pediatric Motor Activities Log (PMAL) and ABILHAND questionnaire were used to assess UE function of daily activities. The analysis of covariate was used to compare the difference between groups. Results: MT was reduced and PV in planar plane was increased significantly in both group after intervention (p<0.05). The value of PMAL and ABILHAND were also significantly improved (p<0.05). Furthermore, the ICCIT group demonstrated more improvement on the ABILHAND than DHCIT group (p=0.05). Conclusions: Both CIT interventions can improve UE motor performance in children with UCP. Further, the ICCIT can elicit extra benefits on acquired UE function of daily activities.

Keywords: Cerebral palsy, constraint induced therapy, upper limb

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-115: Quantitative evaluation of center of pressure trajectory during walking in patients with poststroke spasticity Top


Ryuta Shindo1, Yoichiro Aoyagi2, Wataru Kikuchi1, Ryoma Sassa1, Ryuzo Yanohara1, Eiichi Saitoh2

1Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan, Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan

Background and Aims: This study aims to examine the characteristics of the center of pressure (COP) trajectory of the hemiplegic limb during the stance phase of gait. Methods: Seventeen post-stroke patients with spastic hemiplegia (10 men and 7 women, 57+/-16 years old) and 20 healthy adults (10 men and 10 women, 22+/-2 years old) participated in this study. All participants walked on a seat type load meter (Walkway MW-1000, Anima Co., Japan) six times with a comfortable speed without any orthosis. We evaluated gait speed and COP trajectory during the stance phase of the hemiplegic limb. COP trajectory was normalized with the foot length and width. We divided patients into two groups according to the presence of COP movement to posterior direction in the early stance phase; with posterior COP shift (P-COP) group and without posterior COP shift (without P-COP) group. Spatial, temporal, and COP parameters were analyzed by using the one-way analysis of variance. The relationship between the amount of posterior and medial shift was analyzed by the spearman correlation coefficient. Results: The amount of posterior movement of COP was significantly larger in patients than in healthy adults (20.8+/-20.3 percentages versus 0.1+/-0.6 percentages). Eleven out of 17 patients belonged to P-COP group. The amount of medial COP movement of P-COP group was significantly larger than that of the without P-COP group (p <0.01). MAS was not Gait speed tended to be slower in P-COP group (p =0.078). The relationship between the amount of posterior and medial shift of COP showed a strong correlation (r=0.93, p <0.01). Conclusions: Patients with post-stroke lower-limb spasticity are likely to have posterior movement of COP which is rarely recognized in normal walking. The COP movement to the posterior direction during early stance phase is closely related to the movement to medial direction.

Keywords: Center of pressure, hemiplegia, spasticity

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-116: Using animal classification of functioning for rats with experimental stroke for comparison with the limitation of functioning assessed with ICF in acute stroke patients Top


Aleksei Andreevich Shmonin1, Maria Nikolaevna Maltseva2, Elena Valentinovna Melnikova1

1Department of Physical Methods of Treatment and Sports Medicine, First Saint-Petersburg I.P. Pavlov State Medical University, Saint Petersburg, Russia, 2Department of Psychology and Pedagogy, First Saint-Petersburg I.P.Pavlov State Medical University, Saint Petersburg, Russia

Background and Aims: Using the principles of the ICF, we have developed an animal classification of functioning, adapted for Wistar rats. Coding in the animal classification of functioning is applied as in the ICF, which allows to compare impairment and limitation in rats and humans. This is necessary for translational studies in rehabilitation. Aim: to compare the clinical manifestations in humans with acute stroke in left middle cerebral artery (LMCA) with the manifestations of the focal cerebral ischemia in rats with LMCA occlusion. Methods: The study enrolled patients (n = 27) with acute stroke in LMCA with mRS >3 points. Patients were evaluated by a multidisciplinary team using the ICF. For stroke in rats, we used a Koizumi model of the 30-minut filament LMCA occlusion (n=12) and Zhao model of LMCA ligation with 40-minute two common carotid arteries occlusion (n=12). All animals were evaluated by scales and animal classification of functioning 48 hours later after surgery. Results: In humans, with cerebral ischemia, only 170 ICF domains were detected, which is significantly more than in rats subjected to experimental ischemia using two models - 120 and 116, respectively (p <0.01). Using of ICF and animal classification of functioning allowed to identify impairment and limitations of functioning associated with 1. Symptoms of stroke, 2. Causes of stroke in humans, 3. Comorbidity in humans, 4. Technique of stroke modeling in rats, 5. Environmental factors and 6. Specificity of the type of organism. Using of animal classification of functioning allows to reveal more significant impairment and limitations of functioning than in scales. The Koizumi model allows demonstrate more cerebral ischemic dysfunctions than in Zhao model. Conclusions: Animal classification of functioning allows comparing experimental models of stroke in rats and comparing limitation of functioning in humans and animals during cerebral ischemia.

Keywords: Animal classification of functioning, cerebral ischemia, ICF

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-117: Genetic polymorphisms in intracerebral hemorrhage and alcohol dehydrogenase 7 (class IV), Mu or sigma polypeptide (ADH7) gene in Korean population Top


Yunsoo Soh, Hee-Sang Kim, Jong Ha Lee, Dong Hwan Yun, Jinmann Chon, Yong Kim

Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital, Gangdong-gu, South Korea

Background: Intracerebral hemorrhage (ICH) is the second leading subtype of stroke following ischemic stroke (IS) high mortality or serious sequelae. Risk factors of ICH hypertension, current smoking, excessive alcohol consumption, hypocholesterolemia, and drugs. Single nucleotide polymorphisms (SNPs) observed with a frequency of 1% or more in the general population. Previous studies contribute to functional outcomes and clinical manifestation in stroke. This study aimed to investigate the association between alcohol dehydrogenase 7 (ADH7) and occurrence of ICH in Korean population. Methods: ICH healthy control subjects. Five SNPs in ADH7 were finally selected and analyzed: rs284787, rs894369, rs3805331, rs971074, rs17537595. The frequencies of the genotypes and alleles of phenotype were evaluated. Results: The of ICH 56.3 +- 14.1 49.2 +- 11.4 years three of five SNPs (rs284787, rs3805331, and rs17537595) in ADH7 showed association with ICH. In allele frequency analysis, the G alleles of rs3805331 and rs17537595 were associated with an increased risk of ICH (p<0.05). Conclusion: This is the first report association between the SNPs (rs284787, rs3805331, and rs17537595) ADH7 and development of ICH in the Korean population. This association showed that these SNPs ICH.

Keywords: Alcohol dehydrogenase 7, intracerebral hemorrhage, polymorphism

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-118: Analysis of postural movement during gait with lower limb orthosis with trunk belt in hemiparetic stroke Top


Toshio Soma1, Nobuhito Tampo2, Kazuhito Nishikata3

1Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan, 2Department of Rehabilitation, Takeda General Hospital, Aizuwakamatsu, Japan, 3Niigata Prefectural Rehabilitation Center for Persons with Disabilities, Japan

Background and Aims: Orthosis therapy for stoke patients has been an efficient method to enhance gait ability. The function of lower limb orthosis with trunk belt (CVAid) is to increase swing of the hemiplegic side of lower extremity in stoke patient during gait. The aims to this research is to clarify the center of gravity (COG) and postural movement during CVAid gait in post-stroke hemiparetic patient, as well as to discuss the effectiveness of CVAid gait in terms of orthosis therapy. Methods: Subjects were 10 post-stroke hemiparetic patients. All subjects received informed-consent and agreed to participate in this research. The measurements were obtained during gait with the CVAid equipped on their hemiplegic lower limb. The tensile force of the body trunk belt of CVAid was set to 2.0kg using a tension meter. The postural movement was measured by a 2-ponit gait oscillometer with acceleration sensors stuck to 2 places: the breast and waist. A three-dimensional motion analysis system was used to measure the COG. Results: The postural movements of CVAid gait was significantly larger compared to normal gait in horizontal direction. The COG of CVAid gait was also significantly larger compared to normal gait in horizontal direction. The postural movements and COG were shifted to the hemiplegic side during middle stance phase. Conclusions: The COG would shift to the hemiplegic side with increased weight bearing to lower extremity during CVAid gait. This indicates that it is benefit for CVA patient to increase weight bearing to hemiplegic lower extremity during gait training. In general, it is more energy consumption with larger postural movements; therefore, it might not be benefit considering energy efficiency for hemiparetic patient with CVAid gait. CVAid might be an effective lower limb orthosis for post-stroke patient to improve function in both stance phase and swing phase during gait.

Keywords: Gait, orthosis, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-119: Analysis of standing postural control on the unstable board with the cane Top


Toshio Soma

Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan

Background and Aims: The cane is used for the purpose of improving standing balance ability. The purpose of this study is to clarify the effect of standing postural control on the unstable board with the different loading force of T-cane. Methods: Ten healthy adults, who received informed consents and agreed to participate, were recruited to this study. They were asked to stand on the unstable board with T-cane on their right upper extremity. The value of loading force of T-cane was set to 5 to 30% of their body weight. The value of loading force of T-cane was measured with a force plate. The ability of standing postural control was calculated by the center of gravity (COG) with a three-dimensional motion analysis system. The measurements of the right tibialis anterior and soleus co-contraction activity were also obtained. Results: The values of COG sway and co-contraction muscle activities were the largest in standing without T-cane and were significantly decreased with less than 10% loading force of T-cane. The more increased loading force of T-cane as 20% to 30%, the more significantly increased the value of COG sway. Conclusions: When you use T-cane with more loading force, it will increase the strain to the upper extremity due to the characteristics of T-cane structure. The results showed that the functional use of T-cane was the largest with small loading force. Therefore, using T-cane with the loading force less than 10% of the body weight is the best loading force to improve the ability of standing postural control.

Keywords: Cane, electromyography, postural control

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-120: Effects of subjective memory impairment on auditory sensory gating in cognitively normal elderly Top


Hua-Hsuan Sun1,2, Pei-Ning Wang3, 4, 5, Chia-Hsiung Cheng1, 2, 6, 7

1Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan, 2Laboratory of Brain Imaging and Neural Dynamics (BIND Lab), Chang Gung University, Taoyuan, Taiwan, 3Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, 4Brain Research Center, National Yang-Ming University, Taipei, Taiwan, 5Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan, 6Healthy Aging Research Center, Chang Gung University, Taoyuan,Taiwan, 7Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan

Background and Aims: Evidence has indicated subjective memory impairment (SMI) is a pre-mild cognitive impairment (MCI) condition in the continuum of Alzheimer's disease (AD) course. Notably, elderly with SMI showed higher allelic frequencies of ApoE4 and higher risks of conversion to AD than those without SMI. Sensory gating (SG), referring to the pre-attentive inhibition of neural response to the second identical stimulus, is essential to prevent redundant information from reaching higher cortical centers and optimize cognitive processing. Although studies demonstrated AD and MCI presented deficient SG, few studies explore this neurophysiological function in SMI population. In this study, we aimed to compare SG in elderly with and without SMI and to explore potential effects of the presence of memory complaint, ApoE4, and age on SG. Methods: 29 older adults (more than 60 years) without measurable cognitive impairments according to the results of standard assessments were allocated to control (n=14) and SMI (n=15) groups. SMI participants had memory complaints confirmed by their informants. SG of M50 component was measured with auditory paired-click paradigm through magnetoencephalographic recordings and calculated by the amplitude ratio of response to the second click over that to the first click. A higher ratio indicates worse SG ability. Two-way ANOVA (group x hemisphere) was used to compare group difference of SG in bilateral superior temporal gyrus, middle temporal gyrus, inferior frontal gyrus and inferior parietal gyrus (IPG). Linear regression analysis was performed to determine the association of risk factors and M50 SG. Results: M50 SG ratio in IPG was significantly higher in SMI than control group (p=0.014). Regression analysis showed SG was associated with presence of memory complaints (p=0.013) and ApoE4 (p=0.025). Conclusions: Asymptomatic SMI participants presented deficiency of filtering irrelevant information. Unexpectedly, presence of ApoE4 was associated with better SG, suggesting other factors might modulate the association.

Figure 1: Effect of memory complaints and hemispheres on SG ratio among specific brain regions in control and SMI group. The chart displayed group means and standard deviations for SG ratio of bilateral superior temporal gyrus, middle temporal gyrus, inferior frontal gyrus and inferior parietal gyrus (to left columns refer to bilateral SG ratio of control group; on the right side were those of SMI). A significant group main effect was found in inferior parietal gyrus, which demonstrated that SG ratio of SMI was significantly higher than that of control group (P = 0.014). * P < 0.05 (two-tailed test)

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Table 1: Demographic variables and neuropsychological measures as mean±standard deviation

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Table 2: Multiple linear regression model with sensory gating ratio of inferior parietal gyrus as the dependent variable

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Keywords: ApoE4, auditory sensory gating, subjective memory impairment

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-121: Dependence between the angle of the unstable platform and muscular activity in different balance tasks Top


Malgorzata Syczewska, Ewa Szczerbik, Malgorzata Kalinowska

Department of Rehabilitation, The Children's Memorial Health Institute, Warsaw, Poland

Background and Aims: Keeping proper balance on unstable platforms is a demanding task. The dynamic balance require proper vestibular, visual, proprioceptive systems, proper muscular coordination and strength. Aim of the study: to assess the dependence between the angle of the unstable, moving platform and muscular activity in four balance tasks. Methods: 17 healthy women between 50 and 62 without balance problems were recruited to the study (age of first signs of disbalance). They do not suffer from any neurological or orthopaedic problems and on regular basis (two to five times per week) train some sport activity (cycling, nordic walking, yoga, etc). All subjects performed 4 balance tests on BIODEX BALANCE SYSTEM SD with unstable platform [list in Table 1]. The angle of the platform was measured with VICON system (markers mounted on the platform). Simultaneously the surface EMG (MotionLab) was recorded bilaterally from: rectus femoris, biceps femoris, lateral gastrocnemius, tibialis anterior, gluteus maximus, erector spinae, peroneus longus, soleus. From raw EMG signals the envelopes were calculated. The correlations between angles of the platform in sagittal and frontal planes and muscular activity (taken from envelope) were calculated. The correlation coefficients higher than 0.4 (moderate correlation) were assumed to be important for the strategy of balance task. Results: Presented in [Table 1]. Conclusions: During the easiest task only few subjects control the balance by increasing/decreasing muscular activity in response to the movement. The increasing difficulty of the dynamic task resulted in the increasing number of muscles which activity depended on the mobility of the platform. In majority of the subjects such dependence was present in either left or right leg muscle. The muscle in which such dependencies were present most often was peroneus longus. Full order of involved muscles and therapy useful conclusions are presented in [Table 2].
Table 1: Statistically significant dependence between angle of the unstable platform and muscular activity in sagittal and frontal plane in 4 different tasks first number–subject in whom such dependence occurred, number in brackets –subject in whom muscles in both legs showed the dependence, percentage of subject in a groups showing the dependence. The column second from right shows total number of subjects whose muscles were active separately in sagittal or frontal plane. The last column from right shows the number of subject with muscle activity during all tests in both planes

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Table 2: Summary of different evaluation categories that can be useful in clinical practice. I–IV: Order of muscles according to their involvement in balance tests [based on Table 1]

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Acknowledgement: Project STRATEGMED3/306011/1/NCBR/2017.

Keywords: Balance, muscular activity, unstable platform

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. P1-122: Kinematic strategies used to maintain balance during various balance tests on biodex balance system SD Top


Ewa Szczerbik, Malgorzata Syczewska, Malgorzata Kalinowska

Kinesiology Lab, Children Memorial Health Institute, Warsaw, Poland

Background and Aims: It is assumed that the corrective movements during balance tasks occur mainly in ankle joints. The aim of this study was to assess the kinematic strategies used to maintain balance during various balance tests. Methods: 17 healthy women between 50 and 62 without balance, neurological or orthopaedic problems were recruited to the study (age of first signs of disbalance). They systematically train sport activity (e.g. cycling, nordic walking, yoga). All subjects performed 9 balance tests on Biodex Balance System SD [listed in Table 1]. The kinematic data were collected using 12 camera VICON system, Full Body Plug-In-Gait marker set with extra 2 markers mounted on the platform to measure temporary angle of the platform. The ranges of pelvis, hip, knee, ankle joints and COM xyz (except mCTSIB test), platform angle and overall index of Biodex results were analysed. The Symmetry Index was calculated to assess the asymmetry of the patient's movement during all tasks. Statistica was used for statistical calculations. Results: The results are presented in Tables 1-3. Conclusions: Ranges of movement depend on the difficulty of the balance test. Test mCTSIB's analysis revealed that ankle joint is most engaged in frontal plane in all cases, as in sagittal plane during mCTSIB_foamEO and mCTSIB_foamEC (also higher body segments had lower range of motion), but during mCTSIB_EO and mCTSIB_EC correction was mostly performed by pelvis and lower body segments had lower range of motion. The conclusions of remaining tests are summarised in Table 3. Application of Biodex Balance System SD tests allowed simulation of different every-day balance disturbance situations. The corrective movements appear in all joints, and all planes i.e. whole body is used to keep posture within safety limits to avoid fall.

Acknowledgement: The study was prepared within project STRATEGMED3/306011/1/NCBR/2017.

Keywords: Balance, biomechanics, kinematics strategies

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.








  No. P1-123: The impact of bilateral and unilateral mirror therapy on motor cortical activations in patients with stroke Top


Ruei-Yi Tai1, Tu-Hsueh Yeh1,2, Jun-Ding Zhu3, Yu-Wei Hsieh3, 4, 5

1Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan, 2School of Medicine, Taipei Medical University, Taipei, Taiwan, 3Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, 4Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan, 5Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan

Background and Aims: Mirror therapy (MT) is a beneficial intervention to improve motor function after stroke. During MT, patients were often asked to perform bilateral hand movements simultaneously (i.e., bilateral MT). However, for the patients with severe motor deficits, they had no or minimal movement of the affected hand, which leads to develop another type of MT (i.e., unilateral MT). During unilateral MT, the patients do not need to perform any movement by their affected hand. To date, the difference of neural activations between unilateral and bilateral MT remains unknown. This study was to examine whether primary motor cortex (M1) shows differential activation strength between the 2 treatment protocols of MT by using magnetoencephalography (MEG). Methods: Fourteen stroke patients were recruited to execute the 3 conditions, including: (1) resting condition: the patients were instructed to watch a centrally presented crosshair; (2) bilateral MT condition: the patients were asked to grip two soft balls by their hands simultaneously, and (3) unilateral MT condition: the patients were asked to grip a soft ball by their unaffected hand. In both MT conditions, the patients had to look at the mirror reflection of the unaffected hand's movement and imagine it as the affected hand. The beta oscillation activities were recorded in the 3 conditions by MEG. Results: The beta oscillation activities of bilateral MT condition (P=0.001) and unilateral MT condition (P=0.002) were significantly declined compared with resting condition, indicating both bilateral and unilateral MT facilitate the excitability of ipsilesional M1. Furthermore, bilateral MT condition showed greater activations compared with unilateral MT condition (P=0.011). Conclusions: Both bilateral and unilateral MT could facilitate the M1 activations of patients, which supports the application of bilateral and unilateral MT in stroke rehabilitation. Both MT protocols can be delivered to patients according to their different levels of motor function.

Keywords: mirror therapy, neural activity, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-124: Effect and after-effect of light finger touch on postural sway during continuous perturbation Top


Makoto Takahashi1, Yuki Azuma2, Hiroaki Hayashi1, Masaki Sanada1, Koichi Shinkoda1

1Graduate School of Biomedical and Health Sciences, Hiroshima University, Higashihiroshima, Japan, 2Program of Health Sciences, School of Medicine, Hiroshima University, Higashihiroshima, Japan

Background and Aims: Light touch (LT) reduces postural sway during quiet standing. However, it is still unknown the benefits of LT for adaptations of balancing behavior during continuous perturbations. We investigated the effect and after-effect of light finger touch on postural sway during a continuous, perturbation of stance consisting of 30-sec anterior and posterior horizontal sinusoidal oscillations of the support base. Methods: Twenty young healthy subjects participated in the experiments. We randomly divided the subjects up evenly into 2 groups [No touch (NT) and LT]. Subjects attempted to maintain an upright standing position with eye closed on a force plate (BASYS, Tec Gihan, Japan) during continuous perturbation (Frequency: 1 Hz, Amplitude: 30 mm) for 30-sec in the anterior-posterior direction. In the first trial, both groups conduct under NT condition, and then nine trials were conducted under each condition (NT or LT). Thereafter, in the last trial, NT and LT groups were conduct under LT and NT conditions, respectively. We measured and compared the total path length of center of pressure (COP) in the anterior-posterior direction. Results: In LT group, the total path of COP decreased significantly in the second trial, whereas significantly decreased in the third trial in NT group. The total path of COP in LT group from the second to tenth trials were significantly lower than that in NT group. In the last trial, the total path of COP in LT group under NT condition was increased from the tenth trial under LT condition, but that was identical to that in the NT group in the tenth trial. Conclusions: LT reduces postural sway in the adaptation process of balancing behavior during continuous perturbations. More importantly, this adaption under LT condition is observed after LT withdrawal, indicating the benefit of LT for adaptation during balance training.

Keywords: Light touch, perturbation, postural sway

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-125: Change in cortical activity during chopsticks practice using the non-dominant hand Top


Sayori Takeda1, Reiko Miyamoto2, Kaoru Honaga1

1Department of Rehabilitation, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan, 2Graduate School of Human Health Sciences, Tokyo Metropolitan University, Hachioji, Japan

Background and Aims: Many patients use their non-dominant hand instead of paretic dominant hand to accomplish practical daily tasks. However, differences in learning processes regarding how the brain responds to practice between the dominant and non-dominant hand remain unclear. We aim to characterize variances in cortical activity during chopstick practice using the dominant and non-dominant hands. Methods: The subjects were 34 right-handed healthy adult volunteers who performed nine cycles of block design practice (15s of rest, 30s of task) according to the fNIRS measurement protocol. In each cycle, they moved three types of nine small blocks every 3s. The 49 channels fNIRS measurement were assessed, and we analyzed the relative value of oxyhemoglobin in the DLPFC, FEF, PMC, and M1 in both hemispheres during practice. We also evaluated the number of blocks that they moved to their mouth successfully and the %IEMG of the extensor digitorum communis muscle before and after practice. Results: The skill in using chopsticks improved significantly after each hand practice. Cortical activities significantly increased in the early- to mid-term, and remained unchanged during the mid- to late-term period. In the non-dominant hand practice, the DLPFC, FEF, and PMC in both hemispheres and the right M1were significantly activated. In the dominant hand practice, the DLPFC in both hemispheres, and left PMC and left M1 were significantly activated. There was a significantly negative correlation between performance change and the left PMC change in the non-dominant hand practice. Conclusions: Activation of the FEF area in the non-dominant hand practice may indicate that the subjects subconsciously but intensely use their eyes during practice. Additionally, there is a possibility that the activity of the left PMC plays an important role in the process of learning how to use chopsticks with a non-dominant hand.

Keywords: Brain activity, motor learning, non-dominant hand

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-126: Relationship between spring ligament thickness using ultrasonography and arch height index and arch height flexibility Top


Kenji Tanaka1,2, Shintaro Kudo1,3

1Graduate school of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan, 2Tatue Clinic, Shinjuku, Tokyo, Japan, 3Morinomiya University of Medical Sciences, Osaka, Japan

Background and Aims: The spring ligament (SL) supporting the talar head (TH) is located on the medial longitudinal arch. Several researchers reported that thickness of the SL can be highly reliable measured using ultrasonography (US) in recently. Moreover, we found that measurement at the head of the talus is the highest reliability. However, there are no evidence that thickness of the SL can be estimated any functional role. The purpose of this study is to determine the relationship between medial longitudinal arch and the thickness of the SL. Methods: The seventy-four feet of the thirty-seven healthy young volunteers were participated in this study. The long axis of the SL were recorded using US (Aplio 300, Canon) with 18MHz linear transducer. The thickness of the SL was defined as the high echo bundle on the TH and was measured from superficial of the cartilage of the TH to deep border of the gliding layer of the tibialis posterior using digital caliper [Figure 1]. The thickness of the SL were normalized by dividing by body weight (SL/BW). The arch height index (AHI) was measured according to Williams's method (10% and 90% weight bearing (AHI10, AHI90). The arch height flexibility was calculated by modifying Zifchock's method (MAHF) [Figure 2]. We investigated the relationship between thickness of the SL, SL/BW, MAHF and AHI. Results: The thickness of the SL and SL/BW were 2.3(SD0.5) mm and 3.75(SD0.66), respectively. SL/BW had significantly correlations with MAHF(r=0.372, p<0.01) and AHI10 (r=0.315, p<0.01). Thickness of SL had significantly correlation with AHI10 (r=0.34, p<0.01) [Table 1]. Conclusions: The thickness of the SL may be related to the height of the arch, and SL/BW may affect the flexibility of the foot.

Figure 1: Unable to resolve

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Figure 2: Arch height flexibility

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Keywords: Spring ligament, the medial longitudinal arch, ultrasonography

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-127: The role and mechanisms of Nogo-a pathway through the constraint-induced movement therapy for hemiplegic cerebral palsy mouse Top


Hongmei Tang, Liru Liu, Lu He, Kaishou Xu

Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China

Background and Aims: Constraint-Induced Movement Therapy (CIMT) could significantly improve the hand function of children with hemiplegic cerebral palsy (HCP). The negative regulator Nogo-A plays an important role in synapse regeneration and brain remodeling have been confirmed. However, whether the Nogo-A pathway participate in the improvement of hand function in children with cerebral palsy induced by CIMT is not yet clear. Methods: HCP models were induced by left common carotid artery ligation with 7-10 days old C57BL/6 mice and 8%O2+92%N2 hypoxia for 2 h, then lenti-Nogo-deta20-inhibitor was injected into lateral ventricle in HCP mouse 2 w later. Subjects were classified into control group, HCP group, HCP+Nogo-A-shRNA group, HCP+CIMT group, HCP+Nogo-A-shRNA+CIMT group. Open field test and beam walking test was applied to detect the motor ability of the mice of all groups. Besides, the Nogo-A and related pathway proteins of the left cortex were detected by immunofluorescence staining and Western blot. And axon regeneration related proteins were detected by immunofluorescence staining. Results: HCP mouse had a worse performance than control group according to the open field test and beam walking test. CIMT and inhabitation of Nogo-A significantly increased the behavior performance. The expressions of Nogo-A/Nogo receptor and RhoA/ROCK proteins were lower in HCP+CIMT group than HCP group, Meanwhile, these proteins were much lower in HCP+Nogo-A-shRNA+CIMT group than HCP+CIMT group. CIMT and inhabitation of Nogo-A notably increased the expression of SY38, NF-L, PSD95 in HCP mouse. Meanwhile, these axonal related proteins were much higher in HCP+Nogo-A-shRNA+CIMT group than HCP+CIMT group. Conclusions: CIMT promoted HCP synaptic plasticity and axonal regeneration by inhibiting Nogo-A pathway, which provides a new opportunity for understanding the mechanism of CIMT in HCP.

Keywords: Cerebral palsy, constraint-induced movement therapy, Nogo-A

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-128: Focal transcranial alternating current stimulation of the motor hand area: Impact of stimulation frequency on transcranial alternating current stimulation-induced effects on corticospinal excitability Top


Syoichi Tashiro1,2, Leo Tomasevic2, Mitsuaki Takemi3,4, Hartwig R. Siebner2

1Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan, 2Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Copenhagen, Denmark, 3Division of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan, 4Precursory Research for Embryonic Science and Technology, Japan Science and Technology Agency, Saitama, Japan

Background and Aims: In the field of neurorehabilitation, non-invasive transcranial brain stimulation has emerged as the interventional tool to modify the brain function. Transcranial alternating current stimulation (TACS) has been used to modify endogenous oscillatory brain activity. TACS-induced cortical plasticity is thought to depend on the relation between exogenous TACS frequency and the frequency of targeted endogenous brain oscillations. Non-focal TACS, applied through two distant electrodes, can induce the frequency-dependent lasting changes in corticospinal excitability. Yet it remains to be explored whether a pseudo-monopolar montage, producing more focal cortex stimulation and mainly radial currents, has similar effects. Methods: Seventeen healthy participants (right-handed, 23.2 +/- 2.6 years) underwent focal TACS targeting the left motor hand area (M1-HAND) with a center-ring montage [Figure 1]. TACS was applied at three personalized frequencies corresponding to the endogenously expressed peak frequency in the theta, alpha, and beta band and two fixed frequencies in the high-gamma range at 80 and 140 Hz. TACS intensity was set to 0.5 mA and continuously applied for 5 minutes. Lasting changes in the mean amplitude of the motor evoked potentials (MEPs) were assessed by comparing post-interventional amplitudes with pre-interventional baseline. Results: Personalized beta TACS led to an increase in mean MEP amplitude (baseline: 0.72 +/- 0.39 mV, 10 min after TACS: 0.89 +/- 0.62 mV; P = 0.018, two-tailed t-test), while no consistent differences were induced by TACS at the other frequencies [Figure 2]. Conclusions: Our results suggested that focal TACS given at individual beta frequency up-regulates corticospinal excitability when using a montage that mainly produces radially-oriented current distribution. The results are useful to guide future neurorehabilitative interventions to induce lasting increases in excitability of M1-HAND. This study was supported by a synergy grant from NovoNordiskFonden (grant number NNF14OC0011413).
Figure 1: Center -ring montage setting

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Figure 2: Motor evoked potential at various transcranial alternating current stimulation frequencies

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Keywords: Non-invasive transcranial brain stimulation, plasticity, TMS

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. P1-130: Analysis of three-dimensional spinal movement during trunk flexion in patients with adolescent idiopathic scoliosis Top


Michio Tojima1, Haruhi Inokuchi2, Naoshi Ogata3, Nobuhiko Haga2,4

1Tokyo International University, Kawagoe, Japan, 2Department of Rehabilitation, University of Tokyo Hospital, Tokyo, Japan, 3Department of Rehabilitation, Teikyo University, Tokyo, Japan, 4Department of Rehabilitation Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

Background and Aims: Adolescent idiopathic scoliosis (AIS) causes three-dimensional (3D) curvature of the spine. For screening, medical doctors check the rib and/or lumbar hump during trunk flexion. The aim of this study was to assess 3D spinal movement during trunk flexion in patients with AIS. Methods: We recruited eight patients with AIS (two males; mean, 14 years-old; mean Cobb angle, 32°) and 15 healthy participants (11 males; mean, 32 years-old) as a control group. All patients with AIS showed right convex curvature of thoracic spine. We put the spherical markers on cervicothoracic spine, thoracolumbar spine, pelvis, and femur, and measured their movement using VICON system with 100 Hz. Participants were asked to move their trunk from rest with standing to the maximum flexed position for three times. We calculated angles of thoracic and lumbar spines during trunk flexion. Unpaired t-tests were used to compare the spine angles between both groups. Results: In rest position [Figure 1], compared with control group, AIS group showed their thoracic spine bended 17.3° to the concavity side (p = 0.009), lumbar spine bended 17.0° to the convex side (p = 0.024), and 13.2° smaller lumbar lordosis (p = 0.002). During trunk flexion [Figure 1], AIS group flexed their lumbar spine 20.9° smaller than control group (p < 0.001). Compared with control group, AIS group showed their thoracic spine bended 6.0° to the convex side (p = 0.018) and lumbar spine bended 8.1° to the concave side (p = 0.073), and lumbar spine rotated 8.1° to the convex side (p = 0.016). Conclusions: During trunk flexion, AIS group showed their thoracic and lumbar spine bended laterally to the opposite directions, and lumbar spine rotated excessively and restricted flexion. Our method for measuring spine movement using VICON will be a useful for assessing spinal movement for AIS.

Keywords: Adolescent idiopathic scoliosis, spinal movement, trunk flexion

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.




  No. P1-131: Effect of the stroke patients' self-efficacy on life functions after discharging the convalescent rehabilitation ward Top


Hidenori Tomoda1, Natsumi Oozono1, Kayoko Kitazato1, Rieko Inoue1, Yosikazu Takahashi1, Mitsuhiro Tatemaru1, Kei Koshido1, Tsukasa Abe1, Naomi Sunagawa1, Masaki Nakatake1, Kouki Koizumi1, Mieko Yamamoto1, Ryuuzo Kawazu1, Yuichi Umezu1, Akinori Hamamura1, Taisei Yamamoto2

1Kokura Rehabilitation Hospital, Fukuoka, Japan, 2Kobe Gakuin University, Kobe, Hyogo, Japan

Purpose: The purpose of this study was to investigate how the life functions would be influenced on the stroke patients self-efficacy after discharged from the convalescent rehabilitation. Methods: The subjects were 16 patients ( mean age 61.1 years; males=9 ) who were able to participate in 12 months follow-up after discharge. Their self-efficacy and life functions were assessed using the modified Stroke Self-efficacy Questionnaire (SSEQ) at the time of discharge and its 12 months after. They were divided into two groups which of them was improved group and decreased group based on their SSEQ score over the 12-month period. Then the states of self-efficacy of subjects were characterized by attribute comparison and analyzed by principal component analysis. Results: Participants exhibited higher score on their activity level and lower score on the social participation as compared to those at the time of admission. The 9 male subjects appeared to be show improvements in their SSEQ score and their FIM score was also improved drastically at the time of discharge. Furthermore, the principal component analysis revealed that patients experienced surrogate modeling during hospitalization, such as I could learn from other patients' rehabilitation story. Conclusions: Many patients exhibited positive effects of the rehabilitation and they had high self-efficacy at the time of discharge. At the 12-month follow-up, they exhibited much more confidence in their activity level, but they were still on their way for rehabilitation restructuring in their life stage. These findings suggest that the experience of surrogate modeling in convalescent rehabilitation wards influence patients' life function after discharge.

Keywords: Convalescent rehabilitation ward, self-efficacy, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-132: Movement variability in female after anterior cruciate ligament reconstruction during squat motions Top


Minoru Toriyama1, Nana Okada2, Risa Ota3

1Department of Tokyo Physical Therapy, Teikyo University of Science, Uenohara, Japan, 2Department of Rehabilitation, Yagi Hospital, Tokyo, Japan, 3Department of Rehabilitation, Miyakojima rehabilitation hot spring Hospital, Miyakojima, Japan

Background and Aims: Anterior cruciate ligament (ACL) injury occurs lower limb coordination pattern which may have a potential increased risk for osteoarthritis. The variability of parameters is one of the measures used to assess movement coordination. This study aimed to investigate whether the coordination variability of the lower extremity during squat motion in individuals with ACL reconstruction is different and less stable compared to healthy subjects. Methods: This study included 17 healthy females (17 limbs) and 6 females with ACL reconstruction (7 limbs). The subjects performed 100 squat motions with a tempo of 60 bpm. The trials were collected using a 3-dimensional motion analysis system with 6 infrared cameras and 2 force plates. Coupling angles of hip flexion-knee abduction and hip adduction-knee flexion during squats were calculated using the vector coding method. Coupling angle variability (CAV) in each coupling angles during the 100 squat motions were calculated. Independent t tests were used to determine group differences in variability for each coupling (p < 0.05). Results: Lower limbs after ACL reconstruction had grater CAV of hip adduction-knee flexion compared to lower limbs of healthy participants (0.19 ± 0.08, 0.14 ± 0.04, respectively, p = 0.03). The CAV of hip flexion-knee abduction showed no significant difference in between 2 groups (0.77 ± 0.14, 0.77 ± 0.19, respectively, p = 0.96). Conclusions: This finding indicated that individuals with ACL reconstruction, even obtained mechanical knee stability, had differences in lower extremity coordination compared to healthy subjects. Developing this research of altered lower extremity coordination variability after ACL reconstruction will prove more effective rehabilitation programs.

Keywords: Anterior cruciate ligament, movement variability, squat

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-133: Influence of the bone defect on the tibial component stability in cementless total knee arthroplasty Top


Koji Totoribe1, Etsuo Chosa1,2, Go Yamako3, Koki Ouchi3, Yoichiro Yamaguchi1, Yukiko Mukaiyama1, Hiroaki Hamada2, Hiromi Kuroki1, Gang Deng3

1Rehabilitation Unit, University of Miyazaki Hospital, Miyazaki, Japan, 2Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan, 3Department of Mechanical Design Systems, Faculty of Engineering, University of Miyazaki, Miyazaki, Japan


Background and Aims: Tibial bone defects in total knee arthroplasty are often managed with various types of bone grafts. Whether or not the patient is able to walk safely in the postoperative period is one of the important concerns in the rehabilitation program. We investigated the biomechanical effects of bone grafts on the stability of the tibial component in the immediate postoperative phase. Methods: An appropriate modular tibial component was considered in this study. Geometric data for the proximal tibia were obtained from computed tomography scans of the right tibia of an adult woman. Using the standard model, twelve types of bone graft models of varying sizes and material properties were prepared. To develop these models and perform analyses, we used the finite element analysis software MARC/Mentat. The posteromedial portion of the tibial component was used to simulate a varus alignment. Each model was loaded, and maximum liftoff, subsidence, and von Mises stress distribution were analyzed and compared. Results: Medial loading resulted in subsidence of the loaded medial tibial plate and liftoff at the periphery on the opposite, unloaded side. The stress around the contact area adjacent to the bone graft was higher in the posteromedial asymmetrical graft model than in the contained graft model. Relative micromotions in the posteromedial asymmetrical graft model were higher than in the contained graft models. The highest relative micromotion was observed in the posteromedial asymmetrical graft model with increased bone graft volume and lower stiffness of bone graft material. Conclusions: The tilting motion of the tibial components observed in this study implies instability of the initial fixation. Avoidance of lower stiffness of bone graft and use of higher stiffness of bone graft will produce better clinical outcomes especially for larger, posteromedial asymmetrical defects.

Keywords: Bone graft, finite element analysis, total knee arthroplasty

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-134: Kinematic differences of the locomotor system between children with or without avascular necrosis post osteotomy for developmental dysplasia hip during obstacle-crossing: A preliminary study Top


Yu Lin Tsai1, Tsan Yang Chen2, Wei Chun Lee2,3, Yang Chieh Fu2, Hsiang Ho Chen4, Tung-Wu Lu2,5

1Graduate Institute of Nanomedicine and Medical Engineering, Taipei Medical University, Taipei, Taiwan, 2Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, 3Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, 4School of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan, 5Department of Orthopaedic Surgery, National Taiwan University, Taipei, Taiwan

Background and Aims: Developmental dysplasia of the hip (DDH) is the main cause of childhood hip disability. After the osteotomy, avascular necrosis (AVN) is one of the major complications. Obstacle-crossing requires higher mechanical demands than level walking does, so has the potential to identify more sensitively the mechanical differences between patients with or without AVN after osteotomy for DDH. This study aimed to investigate the kinematic differences of the lower extremities between children with DDH with or without AVN during obstacle-crossing. Methods: Four children who developed AVN after DDH osteotomy (AVN group, age: 6.5+-1.3 years) and four without AVN (Non-AVN group, age: 5.2+-1.3 years) were recruited with informed written parental consent. Each subject walked at a self-selected pace and crossed a height-adjustable obstacle at 20% of his/her leg length. Reflective markers were placed on the bony landmark of each lower limb segment. Marker trajectories were measured with VICON motion capture system (200Hz). Unequal variance t-tests were used to compare the differences between groups with a significance level at alpha=0.1 due to small sample size. Results: Compared to the non-AVN, while with affected limb leading, the AVN showed significantly decreased toe-clearance [Figure 1]a, reduced knee abduction as the leading toe and heel above the obstacle [Table 1]. While leading with the sound limb, the AVN showed decreased heel clearance and slower crossing speed [Figure 1]b and [Figure 1]c, and reduced knee abduction at the instance of leading toe crossing the obstacle [Table 1]. Conclusions: The AVN showed decreased toe-clearance and knee abduction with the leading affected limb crossing. Since there was no difference between groups in the sagittal plane joint kinematics, the reduced toe-clearance may be explained by the reduced knee abduction. Although the relationship between toe-clearances and joint kinematics need further study, the current findings may be a basis for further clinical considerations.
Figure 1: Mean leading (a) toe and (b) heel crossing clearance, and (c) crossing of avascular necrosis and non-avascular necrosis groups while affected or sound side as leading limb during obstacle crossing. Asterisk mark indicateds P < 0.1 between avascular necrosis and nonavascular necrosis groups

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Keywords: Avascular necrosis, developmental dysplasia of the hip, three-dimensional motion analysis

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-135: Changes of prefrontal cortex oxygenation laterality during 20 min of moderate-intensity cycling exercise Top


Atsuhiro Tsubaki, Shinichiro Morishita, Yuta Tokunaga, Weixiang Qin, Sho Kojima, Hideaki Onishi

Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan

Background and Aims: A recent study showed that cognitive function improved after a single moderate-intensity exercise episode. We previously showed that a 20-min moderate-intensity exercise induced left dominant prefrontal cortex oxygenation in the last 5 min. However, the cortical oxyhemoglobin (O2Hb) laterality changes that result from the exercise remain unknown. We evaluated O2Hb laterality changes in the prefrontal cortex (PFC) over 20 min of moderate-intensity cycling exercise. Methods: Twelve healthy volunteers (9 women) participated. After a 3-min rest, a 20-min exercise was performed at 50% VO2peak workload. Right (R-PFC) and left (L-PFC) prefrontal cortex O2Hb levels were measured using a multi-channel near-infrared spectrometry system. The O2Hb levels in each area were expressed as changes from the mean pre-exercise rest phase values and were averaged every 5 min over the 20-min exercise period in both regions. The laterality index (LI) was calculated using the formula (L-PFC O2Hb - R-PFC O2Hb)/(L-PFC O2Hb + R-PFC O2Hb) every 5 min. A positive LI indicated that the O2Hb increase in the L-PFC was larger than in the R-PFC; a negative LI indicated the opposite. To compare the LIs, one-way analysis of variance was used. Statistical significance was set at p < 0.05. Results: O2Hb levels increased during the first 10 min and were maintained over the latter half of the exercise period in both R-PFC and L-PFC. The LI of each period was -0.40 ± 0.21, -0.03 ± 0.12, 0.14 ± 0.15, and 0.16 ± 0.10 (1st, 2nd, 3rd, and 4th 5-min period, respectively, p < 0.05). Conclusions: PFC laterality changed over the 20-min moderate-intensity cycling exercise, and L-PFC-dominant O2Hb increases were observed in the latter half of the exercise. L-PFC plays an important role in executive functions and verbal working memory, which might increase after 10 min during 20 min of exercise.

Keywords: Laterality, moderate-intensity exercise, prefrontal cortex oxygenation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-136: Cardiovascular changes in anesthetized rats after the traumatic brain injury Top


Yasunori Umemoto, Koki Ueda, Takahiro Ogawa, Fumihiro Tajima

Department of Rehabilitation, Wakayama Medical University, Wakayama, Japan

Background and Aims: Traumatic brain injury (TBI) leads to cardiovascular complications and negative impact on the recovery of these patients. There are not much published reports regarding the alterations in brain areas controlling cardiovascular function in TBI. Methods: In this study, we investigated the effects of severe, moderate and mild TBI on systemic blood pressure, heart rate, greater splanchnic nerve activity (GSNA) and baroreflex. The experiments were done in anesthetized, male Wistar rats. Fluid percussion injury (FPI) was applied to induce TBI. Results: Application of severe, moderate and mild FPI resulted in 100%, 40% and 10% mortality, respectively. In moderate and mild FPI, apnea was observed for 38.2 +-17.3 and 14.8+-3.6 sec, respectively, however, no apnea was seen in severe FPI treated rats, since most of the rats in this group died just after the injury. The decreases in MAP and HR at 30 minutes, 1, 2, 4 and 6 hours after the moderate and mild FPI were significantly attenuated when compared with sham control rats. The GSNA and baroreflex sensitivity were significantly attenuated after moderate and mild FPI. In these rats, microinjections of L-glutamate and gabazine into medullary areas elicited altered cardiovascular responses. Conclusions: These results indicate that both moderate and mild FPI elicit cardiovascular changes.

Keywords: Fluid percussion injury, greater splanchnic nerve activity, medulla

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-137: Trans cranial colour coded duplex sonography findings in stroke survivors undergoing rehabilitation: A descriptive study Top


Srikant Venkatakrishnan, Meeka Khanna, Anupam Gupta

Department of Neurological Rehabilitation, NIMHANS, Bengaluru, Karnataka, India

Background: Prognostication in stroke patients is necessary for effective use of rehabilitation resources. Clinical indicators for functional recovery are useful but may lack sensitivity. Transcranial colour coded duplex sonography is an accessible, potential tool for rehabilitation physicians to predict stroke outcomes. Aim: To describe TCCD findings in patients with a first MCA territory infarct, admitted for rehabilitation and correlate TCCD findings with clinical outcomes for the paretic upper limb. Methods: Patients between 18 to 65 years with a first MCA territory infarct of less than 6 month duration are recruited in a study spanning from October 2018 to June 2019. Clinical Outcome measures are Scandinavian Stroke Scale, Modified Rankin Scale, Fugl Meyer Upper Extremity (FMA) Motor score at admission and after 14 rehabilitation sessions. TCCD findings include, MCA peak systolic, end diastolic and mean flow velocities, asymmetry index. Statistical analysis will include measures of central tendency. Correlation of outcome measures with MCA velocity parameters will be done with the Mann Whitney U test. Results: Data for 7 patients are available. All are males with a mean age of 61.1. years, two with right-sided infarcts and 6 with left-sided infarcts. Mean FMA ( motor) scores at mentioned time points are 10 and 16.3. Mean Scandinavian Stroke Scale scores at the time points are 32.7 and 47.8. Mean flow velocities of right and left MCA at the time points are 51.5, 49.4 cm/sec and 50.8, 45.1 cm/sec respectively. Statistical analysis will be attempted at study completion. We anticipate 14 patients to be recruited by June 2019. Conclusion: The feasibility of TCCD use in a rehabilitation unit has been demonstrated. The inclusion of additional patients will allow for statistical analysis of TCCD parameters and clinical outcome measures.

Keywords: Prognostication, stroke, transcranial-sonography

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-138: Comparison of Microsoft kinecttm and VICON during gait analysis of normal Filipino participants: A pilot study Top


Johannes Lorenzo A. Villespin1, Angelo R. Dela Cruz2, Consuelo B. Suarez1, Maria Belinda C. Fidel1, Edison A. Roxas2, Jason Jake E. Tan2, Mary Monica B. Bueno1, Christine Grace V. Ogerio1, Cyril R. Ong1, Ma. Roxanne L. Fernandez3, Christopher G. Cruz3

1Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines, 2Department of Electronics Engineering, Faculty of Engineering, University of Santo Tomas, Manila, Philippines, 3College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines

Gait assessment can be used as a measure for patient management. Basic clinical gait assessments are mainly observational. But, dynamic movement assessment such as gait is best analyzed by a camera-based motion capture. At present, the VICON system has been widely accepted as the gold standard. However, due to its cost and tedious set-up, including placement of body markers, the system may not be applicable at the Philippine clinical setting. Microsoft Kinect&#61668; is also a camera-based motion capture system that utilizes depth perception without the use of body markers. The aim of the study is determine the differences in the results of VICON and Kinect in certain spatio-temporal parameters.

This is a concurrent validity study in which the data is obtained from a Phase I study by the co-authors. The data from VICON and Kinect were retrieved from thirty-two normal Filipino participants with ages 20-70 years old regardless of any gender. Gait parameters that were analyzed were: each extremity's step & stride time, stance & swing time, single & double support time, step & stride length, cadence and speed. Only 1 specific gait cycle in one unit of time was examined except for cadence. T-test was used to analyze the difference. Results show that 16 out of 18 parameters measured by Kinect were statistical different from VICON. Only the step & stride lengths had no difference. These differences may be attributed to the less sensitivity of the Kinect to track the desired body point during gait. Also, the need of a software update or the application of a filter or algorithm is need for data adjustment that may match with VICON. Therefore, the use of Kinect for gait analysis may require further adjustments prior to its use at the clinical setting.

Keywords: Gait analysis, Microsoft Kinect, VICON

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-139: The comparison of spinal force at L2 Level between stationary and outdoor bicycling with different positions and riding power Top


Timporn Vitoonpong1, Attarit Sarinkapaibulaya2, Chatkaew Pongmala1, Kittigorn Sihaboot1

1Department of Rehabilitation, Chulalongkorn Hospital, Bangkok, Thailand, 2Thai Red Cross Rehabilitation Center, Bang Pu, Samut Prakan, Thailand

Background and Aims: To compare the spinal force loading at L2 level between stationary and outdoor cycling with different cycling power and positions. Methods: The study design is repeated measure experimental design. Fifteen participants were assigned to perform cycling with both stationary and outdoor in the recreational and sporty positions with power output of 0.5 and 1.0 watt/kilogram body weight for 200 meters with 3 repetitions. The saddle force during cycling measured by a pressure mat (CONFORMat®), the back angle measured by 3D motion capture cameras and the acceleration recorded by the accelerometer, were calculated to the spinal force at L2 level in Newton (N). Results: Comparing riding with different positions, places and riding intensities, the total spinal forces at L2 level are not significantly different. When compare each of the following forces, we found that the compression force at L2 level while sitting city bike position is significantly higher than trekking position (P-value = 0.001), meanwhile, muscle and total forces at L2 spine when sitting in trekking position is significantly higher than city bike position. (P-value= <0.001, 0.035). Conclusions: During riding, the total forces to L2 spine are not different when compare between trekking and city bike position, stationary and outdoor riding, and higher and lower power of riding.

Keywords: Bicycling, riding, spinal

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.
Figure 1: L2 spinal force during riding in different riding conditions

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  No. P1-140: Evaluation of stiffness characteristics of the soft tissues around the knee joint as an outcome parameter in physical therapy using strain ultrasound elastography Top


Surangika Wadugodapitiya1,2, Makoto Sakamoto1, Masaei Tanaka3, Yusuke Morise4, Yuta Sakagami4, Koichi Kobayashi1

1Health Sciences, Niigata University, Niigata, Japan, 2University of Peradeniya, Peradeniya, Sri Lanka, 3Niigata Institute for Health and Sports Medicine, Niigata, Japan, 4Graduate School of Science and Technology, Niigata University, Niigata, Japan

Background and Aims: B-mode ultrasonography is a critical tool for diagnosing soft tissue pathologies. Strain ultrasound elastography (SE) is an easily available, non invasive stiffness imaging technique. SE combined with B-mode US is able to provide quantitative and qualitative information about stiffness characteristics of soft tissues. Generally, progression to return to play following a soft tissue injury or reconstruction surgery is determined by evaluating pain, range of motion, muscle strength and endurance. Nevertheless, mophostructural features of the soft tissue or the biological graft are not being assessed or compared with intact limb. Therefore this study aimed at evaluating the feasibility of SE as an outcome parameter in routine use. Methods: Ten knee medial collateral ligaments and knee capsules were examined in healthy males (mean age 22.7 years). SE with an acoustic coupler as a reference was used to measure the relative stiffness of the soft tissues while placing the knee in varying flexion angles. The relative stiffness was obtained using strain ratio (SR = target tissue strain/reference strain). Lower SR indicated higher tissue stiffness. Reliability of this method was assessed using intraclass correlation coefficient (ICC). Results: Intra-rater (ICC 1, 3) and inter-rater (ICC 2, 3) for the knee capsule were 0.95 and 0.94, respectively, and for the MCL, they were ranged between 0.6-0.9 and 0.7-0.9, respectively. The SR of the MCL was increased with knee flexion and it was decreased in the joint capsule [P < 0.01, [Figure 1] and [Figure 2]. Conclusions: SE is a feasible and reproducible method to assess the stiffness characteristics enabling quantitative evaluation and colour visualization of soft tissue structure. Our findings suggest that SE can be used as an additional tool to evaluate the progression of the injured or reconstructed soft tissue during follow-up sessions of rehabilitation and when return to play.
Figure 1: Strain ratio of the (a) sMCL and (b) dMCL with knee flexion

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Figure 2: Strain ratio of the knee capsule with knee flexion

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Keywords: Knee joint, soft tissue, ultrasound elastography

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-141: Effect of ankle taping on knee joint biomechanics and function in sporting tasks Top


Haimei Wang, Di Xie, Xu Ma, Wenjing Ma, Ning Mao, Xiao Shi, Bin Ma

Institute of Sports Medicine, Taishan Medial University, Tai'an, Shandong Province, China

Background and Aims: Based on the theory that kinematic or kinetic changes in one joint will cause changes to other joints within the kinetic chain. Ankle taping may alter biomechanical trait of proximal joints. In this study, we investigated whether ankle joint taping is effective for preventing knee joint injury, it provides theoretical basis and reasonable measures for the prevention of knee joint injury. Methods: Every participant stood on the platform 35cm high and performed the dominant foot landing before and after ankle taping (restriction ankle inversion, dorsiflexion and plantar flexion); Eight-camera Vicon motion analysis system and two Kistler plate measured kinetic and kinematic data; Biodex isokinetic muscle strength measure equipment was used to measure isokinetic muscle strength and knee joint position sense. A one-way repeated measures analysis of variable was performed among different time after taping (0 minute, 15 minutes, 30 minutes). Paired t-tests were used to determine significance difference in isokinetic muscle strength and knee joint position sense between before and after taping. Results: At different time after ankle joint restriction taping , knee valgus moment during drop landing was altering with the use of ankle tape (F= 6.606, p=0.007); Post hoc identified the knee valgus moment after ankle taping 0 minute to be significantly greater in comparison to that after ankle taping 15 minutes (p=0.036); the knee valgus moment after ankle taping 30 minutes to be significantly greater in comparison to that after ankle taping 15 minutes (p=0.042). Ankle taping (0 minute) significantly increased isokinetic muscle strength of knee joint compared to before taping (p=0.04). Conclusions: Ankle taping provided protective benefits for knee joint during drop landing. The greatest preventive effect was at taping 15 minutes later.

Keywords: Ankle joint taping, biomechanics, prevention

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-142: Kinematic analysis for understanding functional changes over time and correlations between functional and histomorphometric data following sciatic nerve crush injury in rats Top


Tianshu Wang1, Akira Ito2, Ryo Nakahara2, Akihiro Nakahata2, Xiang Ji1, Jue Zhang2, Hideki Kawai2, Naoko Kubo2, Hiroshi Kuroki2, Tomoki Aoyama1

1Department of Development and Rehabilitation of Motor Function, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 2Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan

Background and Aims: Functional assessment in the rat sciatic nerve crush injury model is meaningful to realizing functional changes over time. Investigating whether there is a correlation between functional and histomorphometric data would contribute to revealing the relationship between both changes and assessing the nerve regeneration state accurately. Kinematic analysis is considered a decent method for functional assessment, and the ankle angle is most commonly utilized; studies focusing on other parameters are scarce and their changes following sciatic nerve injury remain unclear. This study investigated multiple kinematic parameters, aiming to understand their changes following sciatic nerve crush injury and determine which parameters most accurately reflect histomorphometric changes over time. Methods: Six rats were designated as the control group; 30 rats received surgery, six of them were randomly selected on the first, second, third, fourth, and sixth week after surgery for measurements of the ratio of stance to swing phase, toe angle at toe-off, terminal swing phase, ankle angle at toe-off, midstance, midswing phase and pelvic tilt angle. We investigated these changes of these parameters over time, as well as correlations between them with histomorphometric data including the number and diameter of myelinated nerve fibers, axon diameter and myelin sheath thickness. Results: Changes of all parameters were consistent, and highly correlated with histomorphometric changes except ankle angle at midswing phase and pelvic tilt. Only in the toe angle at toe-off phase and ratio of stance to swing phase, there were significant differences between all adjacent groups. Conclusions: Functional recovery trend generally was as similar as nerve regeneration trend. The toe angle at toe-off phase and ratio of stance to swing phase, which most accurately reflected histomorphometric changes over time, were expected to be reliable and sensitive kinematic parameters used in future studies involving physical therapy interventions.

Keywords: Kinematic analysis, over time, sciatic nerve crush injury

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-144: Protecting against rat stroke by HSP72 neurons-mediated exercise Top


Yu Lin Wang1, 2, 3, Cheng Hsien Lin4, Chi Chun Chen5, Ching-Ping Chang6, Kao Chang Lin7, Fong Chin Su1,8, Willy Chou2,9

1Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan, 2Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan, Taiwan, 3Center of General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan, 4Department of Medicine, Mackay Medical College, New Taipei, Taiwan, 5Department of Electronic Engineering, National Chin-Yi University of Technology, Taichung, Taiwan, 6Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan, 7Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan, 8Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan, 9Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan

Background and Aims: Exercise preconditioning (EP) is an effective and important measure for prevention of stroke. We aimed to ascertain whether EP protects against ischemic stroke by preserving the heat shock protein (HSP) 72-containing neurons in ischemic brain tissues. Methods: Adult male Sprague-Dawley rats (240 in number0 were used to assess the contribution of HSP72-containing neurons in the EP-mediated neuroprotection in brain focal ischemia caused by transient middle cerebral artery occlusion. Results: Significant (P<0.05) increase of the percentages of both the old HSP72-containing neurons (or NeuN+HSP72 double positive cells) (18~20% vs. 40~50%) and the newly formed HSP72-containing neurons (or BrdU+NeuN+HSP72 triple positive cells); (2~3% vs.16~20%) after 3 weeks of exercise coincided with significant (P<0.05) reducation in brain water infarct volume (250 mm3 vs. 100 mm3), brain edema (78% vs. 74% brain water contents), blood-brain barrier disruption (1.5 μg/g vs. 0.7 μg/g tissue Evans Blue dye extravasation) and neurological motor deficits (neurological severity scores 12 vs. 6 and maximal angles 60 ° vs. 20 °) in ischemic stroke rats. Reduction of the percentages of both the old (from 40~50% to 10~12%) and the newly formed (from 18~20% to 5~7%) HSP72- containing neurons by gene silence with intracerebral injection of pSUPER small interfering RNA showed a significant (P<0.05) reversal in the neuroprotection. Conclusions: The percentage of both old and newly-formed HSP72-containing neurons inversely correlated with the outcomes of ischemic stroke. Additionally, preischemic treadmill exercise improves outcomes of ischemic stroke by preserving both the old and newly formed HSP72-containing neurons in rats.

Keywords: Exercise, heat shock protein 72, stroke

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-145: The effects of different training patterns on the motor and cognitive dysfunction in tMCAO at the recovery stage and the regulation of Nogo-A signaling pathway Top


Hongmei Wen, Ruifang Sun, Ju Sun, Chao Li, Yan Zeng

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

Background and Aims: To compare the effects of running wheel exercise and skilled reaching training on the motor and cognitive function the possible mechanism at the recovery stage of tMCAO. Methods: 100 adult SD rats after pre-training and handedness filtering were divided into eight groups: 28d skilled reaching group (n=6), 28d running wheel group (n=9), 28d control group (n=7), 28d sham group (n=6), 56d skilled reaching group (n=7), 56d running wheel group (n=8), 56d control group (n=6) and 56d sham group (n=6) were included in the final behavioral study according to Bederson score. Each group was assessed with mNSS and the forelimb grip strength. Morris water maze test was carried out on day 28 and 56 after operation. Results: The swimming distance of the first and the fourth day of water maze test were shorter in the SRT group as compared with that in the RWE group and the control group (P<0.05) on day 56 post tMCAO. The times of crossing the platform of the SRT group and the RWE group were more than that in the control group (day 28 and 56, P<0.05, respectively). The expression of ROCK in the peri-infarct cortex, contralesional cortex, hippocampus and thalamus in exercise groups was less than that in control group (P<0.05), and SRT group was less than RWE group (P<0.05) on day 56 post tMCAO. The expression of LOTUS, LGI1 in the peri-infarct cortex, contralesional cortex, hippocampus and thalamus in SRT group was more than that of RWE group (P<0.05) on day 56 post tMCAO. Conclusions: Skilled reaching training is better than running wheel exercise in improving motor and cognitive functions of tMCAO rats at recovery stage probably by reducing the expression of Nogo-A signaling pathway molecules and increasing the expression of the endogenous antagonist of NgR1.

Keywords: Exercise training, Nogo-A, transient middle cerebral artery occlusion

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-147: Perlecan effect on proliferation of skeletal muscle stem cell through adjusting downstream signal pathways of IGF-1 Top


Zhuo Xu, Shoujun Yang, Hongfeng Shi

China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China

Background and Aims: To investigate the effects of perlecan that is a component of the basement membrane regulate IGF-1 signal transduction pathway on the proliferation and skeletal muscle stem cell (MSC) in mice. Methods: In vitro, The MSC component in the skeletal muscle was cultured,different concentrations of perlecan (5, 10, 20umol/L) were given to the incubation with MSC and real time PCR assay was used to test the effect of perlecan on the expression of IGF's downstream signal pathways as AKT,p-AKT in MSC. Results: By real time PCR analysis showed that different concentrations of perlecan significantly reduced expression of p-Akt mRNA (P<0.05) .The expression of AKT mRNA in perlecan treatment MSC was not significantly different (P>0.05). In 72 hour, the expression of p-Akt mRNA in perlecan treatment groups was lower than that in model group (P<0.05) in a dose-dependent inhibition with perlecan. Conclusions: Consequently,perlecan may regulate the balance of proliferation in MSC of mice through adjusting IGF's downstream signal pathways in MSC.

Keywords: IGF-1, MSC, perlecan

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-148: Peripheral nerve regeneration in a rat crushed sciatic nerve model: using a bio 3D sheets generated from human iPSC-derived mesenchymal stromal cells Top


Naoki Yamada1,2, Chengzhu Zhao2, Akira Ito3, Tianshu Wang3, Akihiro Nakahata3, Nan Liang3, Taiki Nakajima2, Mai Tanaka2,3, Shizuka Akieda4, Koichi Nakayama5, Masahiro Abo1, Tomoki Aoyama3, Makoto Ikeya2

1Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan, 2Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan, 3Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 4Cyfuse Biomedical K.K., University of Tokyo Entrepreneur Plaza, Tokyo, Japan, 5Department of Regenerative Medicine and Biomedical Engineering, Faculty of Medicine, Saga University, Saga, Japan

Background and Aims: Peripheral nerve injury is one of the most common traumas (2.8% in trauma patients), and axon regeneration occurs at a rate of 1-3 mm/day. It leads to muscle atrophy, chronic pain, and functional disability. Although there are effective treatments (decompression or neurolysis) to regain the function of the damaged nerve, these are often associated with poor outcomes. Therefore, additional treatments are required to cure the injury. Several types of artificial transplant sheets have been developed, but they possess a high risk of infection and have low biocompatibility. To overcome this problem, we have designed a biological, scaffold-free Bio-3D sheet using a novel Bio-3D printer (Regenova®), and used mesenchymal stromal cell (MSC) through a neural crest lineage that might have the potential ability to cure most effectively. Methods: MSCs obtained from human induced pluripotent stem (iPS) cells were induced through a neural crest lineage, and MSC Bio-3D sheets were developed using the 3D printer. Regenova®, a novel robotic system facilitates the fabrication of 3D cellular structures when cellular spheroids are placed in fine needle arrays using the Kenzan method and according to the pre-designed 3D data. The MSC Bio-3D sheets were transplanted into a rat model with sciatic nerve crush injury (N=6-7) and its efficacy was evaluated by comparing those to control rats (N=6-7). Results: Preliminary observations showed early recovery of the crushed sciatic nerve function by foot print and motion analysis techniques using the kinema tracer. Electrophysiological and histological analyses, by immunohistochemistry and electron microscopy were performed. The observations supported the improved recovery of the damaged nerve. Conclusions: Preliminary study showed that the MSC Bio-3D sheets could be a potential high-quality clinical treatment for peripheral nerve injury. We will investigate using naïve MSCs and other transplanting methods going forward.

Keywords: Bio-3D printer, mesenchymal stromal cell, peripheral nerve crush injury

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.




  No. P1-149: Influence of different speed patterns of the treadmill on corticospinal excitability Top


Takahito Yasui1,2, Yoshihiro Kai3, Masahito Sugiyama3, Shusuke Otaki3, Kurodo Yamaguchi3, Masayuki Tsuchida1, Shunya Hikichi1, Tomotaka Suzuki1, Kunitsugu Kondo2, Kenichi Sugawara1

1Kanagawa University of Human Services, Yokosuka, Japan, 2Tokyo Bay Rehabilitation Hospital, Narashino, Japan, 3Tokai University, Tokyo, Japan

Background and Aims: Treadmills are widely used to improve walking ability. The effects of treadmills on the corticospinal tract are documented; however, conventional treadmill studies have used constant speed settings. Therefore, we investigated the effect of different treadmill speed patterns on corticospinal tract excitability in healthy individuals. Methods: Twenty-three healthy volunteers participated in this randomized controlled trial. The treadmill tasks were conducted under three conditions for 30 minutes: (1) constant speed (CS) at 4.0 km/h, (2) speed change with constant pattern (SCP) at 2.0-4.5 km/h in a 15-second cycle, and (3) random speed change (RSC) at a randomly varying speeds within 2.0-4.5 km/h. To assess changes in corticospinal excitability, we applied single-pulse stimulation to the primary motor cortex using transcranial magnetic stimulation. The hotspot of the primary motor cortex was confirmed based on induction of the largest motor-evoked potentials (MEPs) in the right tibialis anterior muscle (TA) at rest. The stimulation intensity was 1.1 times the motor threshold. The MEPs of the TA were compared with peak-to-peak amplitudes for 10 times before and after tasks. In statistical analysis, the average MEP was calculated by dividing the MEPs by the maximum M wave. Two-way repeated-measures analyses of variance (ANOVA) were performed to investigate the effects of time (before and after) and task (CS, SCP, and RSC), followed by the simple main effect test. The significance level was set at 5%. Results: Two-way repeated-measures ANOVA of MEPs only revealed a significant interaction. The simple main effect test revealed significant MEP increase for CS and significant MEP decrease for RSC at after vs before task; no significant difference was found for SCP. Conclusions: Differences in treadmill speed patterns affect the corticospinal tract.

Keywords: Corticospinal excitability, speed, treadmill

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-150: Effects of motor relearning program on neurological functions of rhesus monkeys with cerebral ischemia Top


Yong Yin

2nd Hospital of Yunnan Province, Kunming, Yunnan, China

Background and Aims: Motor relearning program (MRP), as an advanced modern technology, has become an important method of treatment for ischemic cerebrovascular diseases. However, the underlying mechanisms are not yet very clear. It is speculated that this treatment may involve neurogenesis and/or angiogenesis. In order to verify this hypothesis, this study selected rhesus monkeys to establish a model of cerebral ischemia. The successfully modelled monkeys were then treated with MRP, and the expression levels of NF (neurofilament protein), GFAP (glial fibrillary acidic protein), VEGF (vascular endothelial growth factor), and bFGF (basic fibroblast growth factor) were detected in injured and non-injured areas and comparatively analyzed by immunohistochemical staining. This study may help reveal the mechanisms underlying MRP, and determine whether MRP can promote nerve repair, nerve regeneration and/or angiogenesis. Methods: The monkeys had an occlusion of the M1 segment of the right middle cerebral artery (MCA) by using electrocoagulation, and the three successfully modelled monkeys were treated with MRP on the third day after surgery (1 hour per day, lasts for 60 days). At the end of treatment, these monkeys were sacrificed for brain samples collection. Results: Compared with non-injured areas, the positive cells of NF, GFAP, VEGF and bFGF were mainly concentrated in the brain areas around ischemia. The expression levels of NF, GFAP, VEGF and bFGF were significantly increased in the ischemic side, especially in the motor area of the anterior central gyrus of the cerebral cortex (P < 0.001). Conclusions: MRP can significantly increase the expression levels of NF, GFAP, VEGF and bFGF in the brain 5areas around ischemia.

Keywords: Cerebral ischemia, motor relearning program, rhesus monkey

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-151: Relationship between fractional anisotropy of the posterior limb internal capsule and motor function in patients with chronic post stroke demonstrating severe upper extremity hemiparesis Top


Masaki Yoneta1, Fuminari Kaneko1,2, Megumi Okawada1,2, Katsuya Sakai1,2, Keiichiro Shindo1,2, Kazuto Akaboshi1,2, Meigen Liu1,2

1Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan, 2Department of Rehabilitation, Shonan Keiiku Hospital, Fujisawa, Japan

Background and Aims: The corticospinal tract (CST) is frequently affected by damage to the posterior limb of internal capsule (PLIC), with fractional anisotropy (FA) values in the PLIC being related to the extent of CST damage. Because the CST mediates upper extremity motor function, we hypothesized that PLIC FA values are associated with the extent of upper extremity motor dysfunction. The purpose of this study was to clarify the relationship between PLIC FA values and motor function in patients with chronic post stroke demonstrating severe upper extremity hemiparesis. Methods: Thirteen patients with stroke-related hemiparesis participated, who could not extend their fingers due to severe upper extremity paralysis. They underwent motor function assessments including the Fugl-Meyer Assessment for the upper extremities and Modified Ashworth Scale (MAS) assessments of the elbow flexor muscles, elbow extensor muscles, and wrist flexor muscles. The participants also underwent diffusion tensor imaging (DTI) with a 1.5-T magnetic resonance imaging device. The DTI data were preprocessed to correct for eddy current-induced distortions and standardized to the Montreal Neurological Institute 152 template space. Using boundaries in the International Consortium for Brain Mapping DTI-81 atlas (Mori et al., Neuroimage, 2008), we identified the PLIC in both hemispheres. We then quantified PLIC FA in the affected and unaffected hemispheres and the ratio of affected hemisphere PLIC FA to unaffected hemisphere PLIC FA. We calculated Spearman rank correlation coefficients to assess relationships between FA variables and motor function scores. Results: Higher PLIC FA values in the unaffected hemisphere correlated with higher MAS scores (r = 0.562; p = 0.046), which indicate greater motor dysfunction severities. No other correlations between FA variables and motor function scores were detected [Figure 1]. Conclusions: Our findings suggest that unaffected hemisphere PLIC FA is related to motor dysfunction in patients with severe hemiparetic stroke.

Keywords: Diffusion tensor imaging, motor function, stroke

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.

Figure 1: Relationship between fractional anisotropy value and motor function

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  No. P1-152: Application of the centroid of a spherical polygon for selecting an appropriate center point of a plane graph of the shoulder complex sinus Top


Naoki Yoshida1,2, Satoru Nishishita1,2, Kenji Matsumoto2, Tomosaburo Sakamoto2, Kazuhisa Domen3

1Institute of Rehabilitation Science, Tokuyukai Medical Corporation, Toyonaka, Japan, 2Kansai Rehabilitation Hospital, Tokuyukai Medical Corporation, Toyonaka, Japan, 3Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan

Background and Aims: The joint sinus of the shoulder complex is defined as the total range of angular motion of the upper arm [Figure 1]. The range can be represented not by a plane angle, but by a solid angle which is an area on a sphere [Figure 1]b. In making a plane graph of a sinus, selection of the point on the sphere as the center of the graph is important, because the shape and location of a sinus area on a graph appear very different with different center points as with a world map [Figure 2]. For proper evaluation or comparison of sinuses, it is needed to use a common and appropriate center point. In this study, we employed the centroid of the sinus of healthy participants for an objective basis to select the center point. Methods: We found the centroid of the sinus of both shoulders of eleven healthy male participants (26.2 ± 3.4 years) by an algorithm to calculate the centroid of a spherical polygon using MATLAB (The MathWorks). The centroids inside the sphere were projected on the sphere and represented by azimuth and elevation angle, which are equivalent to longitude and latitude of the earth [Figure 1]c. Results: [Figure 3] shows the centroids of the shoulder complex sinus of all subjects. Azimuth and elevation (mean ± SD) of them are as follows: right -32° ± 6.5, -32° ± 7.3 and left 49° ± 12.6, -35° ± 8.5. Conclusions: From these results and for ease of comparison between both shoulders, the azimuth of an appropriate common center point can be -45° for right and 45° for left and the elevation of that can be -30° [as [Figure 1]d, 0° may be also reasonable to understand arm motion easily].

Figure 1: (a) Joint sinus cone (b) solid angle corresponding to the sinus (c) shoulder complex sinus (d) sinus shown in a plain graph

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Figure 2: Graphs of an identical shoulder sinus area shown with differenct center points (viewpoints) of the sphere. Figures in parentheses represent the azimuth and elevation angle of the center point of the graphs

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Figure 3: Borders (blue line), centroids (blue dot) and the mean of the centroids (red circle) of the shoulder sinus of all subjects. Figures in parentheses represent the azimuth and elevation angle of the center point of the graphs

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Keywords: Multiaxial joint, range of motion, visualization

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-153: The effect of obesity on thoracolumbar flexion control ability of jewett brace Top


Pattarapol Yotnuengnit1, Nantawan Koonlintip2

1Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 2King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

Background and Aims: Jewett brace is a common thoracolumbar hyperextension-control orthosis. The more contact between the orthosis and bony landmarks, the better in control achieved. Obesity makes an increment of distance between the orthosis and bony landmarks so that the orthosis cannot completely control spinal motion and may contribute to the failure of treatment in spinal disorder. The purpose of the study is to investigate the effect of obesity on thoracolumbar flexion control of Jewett brace. Methods: Fifty volunteers were stratified into obese and non-obese groups using BMI. After wearing the Jewett brace and adjusting by the certified orthotist, the lateral plain film of the thoracolumbar spine was done in standing and in full trunk bending position. The lateral Cobb angles from T9 to L3 spine were measured and the outcome is the difference of angles between standing and bending position. Results: The difference in flexion control of Jewett brace of the obese group is 11.73 (1.45) degree and non-obese groups are 13.50 (1.95) degree and there was no statistical difference. (P = 0.472) The factor that showed significantly different was gender which the flexion angle in male group was 8.05 (5.84) degree and the female group was 15.37 (8.36) degree (P = 0.001). Conclusions: Obesity is not compromising the flexion control ability on the thoracolumbar spine of Jewett brace. Female gender is the factor that decreases the control ability of Jewett brace.

Keywords: Jewett brace, obesity, thoracolumbar orthosis

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-154: Ultrasound-guided balloon catheter urethral sphincter dilatation for the treatment of neurogenic urinary dysfunction Top


Yong Yu, Zhaocong Chen, Na Li, Min Xue, Weiping Pan, Jianshan Huo, Zulin Dou, Weihong Qiu

Department of Rehabilitation, The Third Affiliated Hospital of Sun Yet-Sen University, Guangzhou, China

Background and Aims: to explore the safety and feasibility of ultrasound-guided balloon dilatation for external sphincter of urethra and provide a new, practical and effective treatment for patients with external sphincter dysfunction caused by neurogenic bladder after spinal cord injury. Methods: A patient with dysuria diagnosed as neurogenic bladder due to spinal cord injury was recruited. We used ultrasound to locate the urethral sphincter and guide the balloon in real-time. After inserting the double lumen catheter, we injected 2.0~3.0 ml water into the balloon. During process of dragging out the balloon, we increased pulling strength to expand urethral sphincter when resistance met. Then we extracted water and removed the catheter. The whole procedure was repeated 4 times as one session per day. After each session, dexamethasone sodium phosphate was injected into the urethra to prevent edema. We assessed changes of urination including frequency and volume of autonomic micturition, amount of residual urine, and number of intermittent catheterization. Results: Urinary function of the patient significantly improved after dilation. Frequency and volume of autonomic urination increased with treatment sessions. Also decreased residual urine and number of intermittent catheterization were observed. After seven sessions, patient could wean off urethral catherization changing from intermittent catheterization to no catheterization. Conclusions: Ultrasound-guided balloon dilatation of the external sphincter of urethra may effectively improve dysuria in patients with neurogenic bladder after spinal cord injury. The technology is safe, feasible and easy to operate.

Keywords: External sphincter dysfunction, neurogenic bladder, ultrasound-guided

Disclosure of interest: I confirm that I am aware of conflicts of interest in my presentation. I agree to declare this conflict of interest at the beginning of my presentation during the meeting.


  No. P1-155: Functional and morphological analysis of the transverse arch of the foot by using precise pressure sensors and 2D ultrasound Top


Hala Zeidan1, Yusuke Suzuki1, Kengo Nakai1, Hirotaka Iijima2, Ryo Eguchi2, Koji Fujimoto3, Tomoki Aoyama1

1Department of Human Health Sciences, Kyoto University, Kyoto, Japan, 2Department of Science and Technology, KEIO University, Tokyo, Japan, 3Human Brain Research Center, Kyoto University, Kyoto, Japan

Background and Aims: The transverse arch (TA) of the foot is formed by the 5 metatarsal heads (MTH). It absorbs and propels forces during gait and prevents from injuries. Hallux Valgus (HV) is a deformity that alters foot function, loading patterns, and the forefoot shape; causing pain. Therefore, we seek to understand the difference of TA structure and force distribution in HV feet compared to normal feet, and in HV with and without pain. Our aims are to: 1) compare the TA structure in HV feel with normal feel, 2) compare the force under the 5 MTH between the groups, 3) compare the structure and the force of HV feet with and without pain. Methods: Feet were divided into two groups: 1) Normal Feet (NORM) and 2) HV Feet (HV). The force under the MTH was measured using individual sensors attached directly on the skin, connected to a computer. The TA structure and the height of the MTHs were measured using a weight-bearing ultrasound device. Measurements were done in standing and 90% weight shift (90%WS) positions. Furthermore, we divide the HV group into: Pain (-) and Pain (+) and compare the structure and force. Results: Ultrasound data show that the TA height increased in HV compared to NORM. Force data show concentration of the force on the medial aspect of the foot in all groups; with lower force under the 1MTH in Pain (-) compared to NORM and higher 1MTH and 2MTH forces in Pain (+) compared to Pain (-). Conclusions: In this study, we conclude that the TA of HV feet is more rigid than normal feet. As for force distribution, HV Pain (-) seem to transfer forces from 1MTH to the lesser toes while Pain (+) is receiving more force on the 1MTH.

Keywords: Hallux valgus pain, transverse arch, weight bearing ultrasound

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-157: Assembly for supporting children with specialized care is needed at home Top


Yuko Abe1, 2, 3, Yasuko Higashi2, Hiroshi Ikeda2,3, Akira Tsuzuki1, 2, 3, Yoshikiyo Kanada1, 2, 3

1Faculty of Rehabilitation, Fujita Health University, Toyoake, Japan, 2Comprehensive Community Care Core Center, Fujita Health University, Toyoake, Japan, 3Toyoake-Togo Medical and Welfare Support Center, Toyoake, Japan

Background and Aims: Fujita Health University Comprehensive Community Care Core Center is taking a role of managing the visiting nursing station, home care support office, Fujita Machikado Infirmary, and Toyoake-Togo Medical and Welfare Support Center. This time, as a movement of Medical and Welfare Support Center,we report the outcome of assembly for children with specialized care at home,those family members and several fields of experts such as medical staffs,city officials, and welfare staffs. In Japan, the system of medical home for children is step behind compared to its in seniors. It is important to build appropriate and concrete systems for children as well as seniors'. Methods: Participants are living near Toyoake city and Togo city. Several fields of experts are also participated. Purpose of this assembly is to make some places and friends which can share the perspectives and information. It also can ensure the patients and the public have the information they need to make decisions that reflect their desired lives and minimize the fears and concerns. Results: We conducted to show a documentary video the cases need mechanical ventilation daily for the first assembly. Secondary,a lecture of social systems and community resources in our living area was introduced by a case manager. For the third,we had a recreation event which was held by some facilities supporting those children and families. The numbers of participants are 52, 73, and 121 respectively. This number growth is mainly made by those children and family members. Conclusions: There are lots of problems and conflicts living in the community with specialized care. As a result of the improvement of technology,more and more babies are saved. It is important to acknowledge the situation and to share the information and skills each other's.

Keywords: Assembly, children of disability, comprehensive community care

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-159: Daily routine intervention to increase steps in frail older adults Top


Suguru Ando1,2, Yumi Higuchi1, Tomomi Kitagawa1, Tatsunori Murakami1, Emiko Todo1, Ryota Hatanaka1, Tetsuya Tamura1, Wataru Kohzuki1, Mai Nagai1

1Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Sakai, Japan, 2Department of Physical Therapy, Faculty of Health Science, Aino University, Ibaraki, Japan

Background and Aims: The aim of this study was to investigate whether the number of steps taken by frail older adults increased after intervention in daily routine continued at home for 12 weeks. Methods: Participants were 26 frail older adults aged 83.6 ± 6.4 years who attended three day-care centers. The participants were assigned either to the lifestyle intervention group (LI; n = 13) or the control group (CON; n = 13). The usual services of the day-care center were provided equally to the both groups. Additionally, participants in the LI group carried out the daily routine based on interviews with them for 12 weeks. Both groups underwent assessment at baseline, 6 weeks, and 12 weeks. The primary outcome was daily steps measured by a wrist-worn accelerometer. Secondary outcomes were the Functional Independence Measure (FIM), knee extension strength, and the Timed Up and Go (TUG) Test. To compare the rate of change in the two groups after the intervention, the Mann-Whitney U test was performed. Results: The average number of steps per day at baseline, 6 weeks, and 12 weeks was 1,592, 1,778, and 1,830 in the LI group and 1,540, 1,333, and 1,110 in the CON group, respectively. The average knee extension strength (Nm/kg) was 0.8, 1.0, 1.0 in the LI group and 0.9, 0.9, 0.8 in the CON group, respectively. After a 12-week intervention, there were greater changes in the LI group for steps per day (rate change, 25%) and for knee extension strength (rate change, 15%) than in the CON group (effect size r = 0.51, 0.42, P = .010, .033). There was no significant difference for TUG and FIM between the two groups. Conclusions: In frail older adults, a daily routine maintained over a 12-week period significantly increased the number of steps and knee extension strength.

Keywords: Daily routine, frail older adult, step count

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-160: Setting up a tele practice system for elderly people who live on an isolated island in Japan Top


Hirokazu Ashiga1,2, Atsushi Sato1, Keizo Takahashi1, Masako Fujiu-Kurachi2

1Niigata University of Rehabilitation, Murakami, Japan, 2International University of Health and Welfare, Narita Campus, Otawara, Japan

Background and Aims: In this study, we attempted setting up a tele practice system for those who live on an isolated island in Japan, to offer preventive interventions to the elderly residents there. Methods: In our project, we selected Awashima in the Sea of Japan, which is a small and distant island with the population of 325, located approximately 35 km from a port on the main island of Japan. First, we discussed about the tele practice system, including hardware and software, several times with a person in charge in the municipal branch office on the island. Second, we assessed physiological functions including swallowing of the elderly people on the island. Third, we created training programs based on the results of the physiological assessment. Fourth, place and frequency of the training were decided through the discussion with the municipal staff on the island. Fifth, the training program was finalized and the trial tele practice started. Results: Elderly people on the island participated in the training program at their day care center regularly. The number of the participants in each training session was usually around 4 people. FaceTime was used for communication between the clinician and the participants. Up to date, the intervention was carried out without any instrumental problems. The participants could participate in the program without any trouble and became familiar with the use of the instruments. Conclusions: Effective preventive health care intervention for the elderly is important, particularly for those who have limited access to hospitals and doctors. Our tele practice project should be beneficial for those who live in a small community on a small and distant island. As the next step, we are going to analyze the effects of the tele practice training on physiological parameters of the elderly participants including swallowing.

Keywords: Isolated Island, preventive intervention, tele practice

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-161: Disability-related rehabilitation in Uganda: The existing services and unmet needs Top


Joseph Kimuli Balikuddembe

Department of Disaster Health, Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu - China and the Hong Kong Polytechnic University, Chengdu, China

Background and Aims: Based on the World Health Organization International Classification of Functioning, Disability and Health (ICF) definition of disability, one billion (15%) of the world population is estimated to suffer from some forms of disability, and 19% of this consists of Persons with Disabilities (PWDs) in Uganda - a country located in the Eastern Africa. In this case, effective rehabilitation care (physical, occupational and speech and language therapies) is desirable to help to improve the quality of live, restores dignity, relieve pain and stigma and uphold the most fundamental rights of PWDs. Therefore it is necessary to identify the existing services and unmet needs as far as the disability-related rehabilitation is concerned in Uganda and other developing settings where the prevalence of disability is predicated to escalate with time due to increased frequencies of natural disasters, ageing population, chronic diseases and rapid motorization etc. Methods: The study is based on a review of published and grey literature in the past decade which is mainly retrieved from the online sources and supplemented by the secondary analysis of data. Results: Both government and non-government affiliated stakeholders are engaged in providing a wide variety of rehabilitation services to PWDs. The challenges limited not only to lack of unified policies, inadequate government support and funding; poverty; dependency; brain-drain of health workers; negative cultural beliefs; and poor infrastructure etc., seriously impede effective delivery of rehabilitation care to PWDs especially in the remote and isolated parts of Uganda. Conclusions: Uganda is commended for promoting the rights of PWDs by establishing relevant legislation, policies and socioeconomic programmes - which are in line with the Convention on the Rights for Persons with Disabilities. However, much more is still required so as to enhance their health-related rehabilitation needs.

Keywords: Disability, rehabilitation, Uganda

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-163: The PROMISE trial - Implementation and evaluation of an extended perioperative process-optimized interdisciplinary and cross-sectoral approach in hip and knee replacements Top


Ulrich Betz1, Matthias Buettner2, Michael Clarius3, Manfred Krieger4, Peter Lindemer5, Lukas Schollenberger6, Johannes Schroeter7, Philipp Drees8

1Institute of Physical Therapy, Prevention and Rehabilitation, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany, 2Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany, 3Orthopaedie, Orthopaedische Chirurgie und Unfallchirurgie, Vulpius Klinik GmbH, Bad Rappenau, Germany, 4Orthopaedische Klinik (GPR), Gesundheits- und Pflegezentrum Ruesselsheim, Rüsselsheim, Germany, 5Ambulantes Rehabilitations- und Gesundheitszentrum Mainz-Mombach GmbH, Mainz, Germany, 6Interdisciplinary Center for Clinical Trials, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany, 7MEDIAN Rehaklinik Aukammtal, Wiesbaden, Germany, 8Department of Orthopedics and Trauma Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany

Background and Aims: The implementation of perioperative process-optimized protocols, such as the ERAS-Society one's, has tremendously improved patient's postoperative outcome and costs. By including the rehabilitation-sector, a perioperative approach could be extended to a cross-sectoral treatment concept. The PROMISE trial introduces this new approach for patients with hip and knee replacements in a cooperative network of diverse facilities and evaluates effects on a broad basis. Methods: An interdisciplinary and cross-sectoral process-optimized approach was implemented in three German hospitals covering different settings and five in- and out-patient rehabilitation facilities. The protocol focuses on: the patient is incorporated as an active partner in therapy, optimized preparation, reduction of “stress Response” to surgery, and elimination of postoperative mobility barriers to promote early and extensive postoperative activity. Treatment aims at a preoperatively defined individual goal of functioning, activity, and participation. The network is extended by partners from project implementation and external Evaluation, from a health insurance company (generating data of the control group) and a patient representative. Patients will be followed for one year postoperatively. An extensive test battery including pre-operative parameters, functional level, anxiety and depression values, expectations, quality of life indicators, complications and costs are recorded in a database. The aim is to enroll 5000 patients until 12/2019. The project is granted by the “Innovationsfond” of the Federal Joint Committee (G-BA) with 5.1 million Euros. Results: The implementation process has been completed and the first patients have already been included (hip n=205; knee n=214; age: mean=66.7 years, SD=9.6). Response rates of the follow-up questionnaires are high (3 months=78%; 6 months=70%). Conclusions: It is feasible to implement an interdisciplinary and cross-sectoral process-optimized extended perioperative treatment approach in hip and knee replacements in hospitals and rehabilitation facilities of different kind. The prospective and multicentric evaluation of the various effects will be published in 2021.

Keywords: Cross-sectoral process-optimization, hip and knee arthroplasty, postoperative outcome

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.




  No. P1-164: Community based training in primary health care for undergraduate physiotherapy students in KwaZulu-Natal: Perceptions of participating physiotherapists Top


Sithembiso B. Blose1, Verusia Chetty1, Nomzamo C. T. Chemane1, Stacy Lawler1, Pragashnie Govender2

1University of KwaZulu-Natal – Physiotherapy, Durban, South Africa, 2University of KwaZulu-Natal – Occupational Therapy, Durban, South Africa

Background and Aims: The shifting healthcare dynamics have affected healthcare education at tertiary level globally. The increasing intake and shortage of clinical placement facilities further influenced healthcare education. Novel approaches to clinical education have been necessitated which includes a move away from traditional training methods of urban health facility use, towards decentralized clinical training method that incorporated Primary Health Care (PHC). The University of KwaZulu-Natal (UKZN), an institution in KwaZulu-Natal, South Africa, has introduced a Decentralized Training programme (DCT), which was one of responses to address clinical education in the prospect to prompt curriculum reform. Physiotherapy disciple in the School of Health Sciences has implemented this approach in undergraduate programme. An investigation is required to optimise the implementation as this was the first year of roll out. Therefore, the study aimed at exploring the perception of physiotherapists supervising undergraduate physiotherapy students on DCT platform in order to influence the roll out of this novel training approach. Methods: An explorative qualitative, semi-structured interviews with ten physiotherapists employed at healthcare training facilities were purposively selected. Data were transcribed and analysed using thematic analysis. Rigour was maintained in the study within the context of relevant ethical principles. Results: The discussions of data revealed seven themes which relate to curriculum redress, organisational factors, stakeholder dynamics, barriers and enablers to DCT, perceived preparedness for practice and recommendations. Conclusions: There is a need to increase healthcare professional in-order to respond effectively to the country's healthcare needs. An option in the transforming health system is DCT as a platform which has a valuable framework to incorporate competencies required for PHC practice as explored within this study. Alignment of curriculum to include community-based approach and strengthening of partnership between clinicians and academic staff were identified to be imperative for optimal clinical education of undergraduate physiotherapy students.

Keywords: Clinical education, community - primary health care, physiotherapy, South Africa

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-165: Equal rights for people with disabilities in the world of health Top


Orly Bouni1,2

1Ministry of Health, Jerusalem, Israel, 2Occupational Therapy Services

In 1996, Israel passed the “Equal Rights law for People with Disabilities”. The law defined various areas of equality rights for people with disabilities such as: legal representation, employment and access to services and buildings. Mainly, the law outlined the obligation to prevent discrimination, and to enable disabled people equal opportunities in every aspect of life. In 2005, amendment no. 2 to the law dealt with accessibility to public areas and services. It defined accessibility as the “ability to move about, access, and use all public places and services; access full information regarding devices, services or environments; use all facilities and participate in all activities on an equal basis - independently, safely, with dignity and respect”. The legislation raised awareness to the fact that everyone, including the disabled, is equally entitled to accessibility, and that accessibility must be incorporated in each and every public service. The 2nd amendment to the law, authorized the Health Minister to revise and reform special regulations regarding accessibility to health services and facilities. These regulations will require all health services to modify their facilities and services in order to provide equal access opportunities to all citizens - including people with disabilities. The implementation process of these regulations requires combining clinical reasoning and social reasoning. This paper will present the challenges facing the implementation process. A process that calls for tactical bridging abilities among three social tiers that normally do not bear direct communication channels: The government, the service providers, and people with disabilities. Implementing the 2nd amendment, will have an impact on medical and health policy and lead to a meaningful change within a decade. This transformation will influence social attitudes and norms, prevent stigmas and promote discrimination free services.

Keywords: Accessibility, equal rights law, people with disabilities

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-166: Sex, socioeconomic and nationality differences in outcomes of rehabilitative care in Germany, 2006–2014 Top


Patrick Brzoska

Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany

Background and Aims: Diversity characteristic such as sex, socioeconomic position and migration status may be associated with disadvantageous health care outcomes. Measures implemented by health care providers aiming to reduce these disparities are not always successful. The present study provides empirical insights from Germany. It illustrates the need for evaluated diversity-sensitive measures by means of a trend analysis of disparities in health care outcomes over a nine-year period. Methods: The analysis is based on routine data on completed rehabilitative treatments in Germany during 2006-2014 (n=617,683). The outcome of interest was the persistence of impairment after medical treatment (no, yes). It was compared between sex, nationality and occupational position groups, the latter of which were considered a proxy for socioeconomic status. Logistic regression was used to adjust for other demographic confounders. Differences in disparities over time were examined by means of interaction analysis. Results: As compared to men, women had a 17% higher chance of impairment despite treatment (adjusted odds ratio [aOR]=1.17; 99%-CI=1.13,1.20). Also, patients who worked in a semi-skilled or unskilled position had a 30% higher chance of a poor outcome than those in skilled occupational positions (aOR=1.30; 99%-CI=1.26, 1.35). Differences also existed with respect to nationality with Turkish and Former Yugoslavian nationals being at a higher chance of a poor health care outcome than Germans (aOR=1.69; 99%-CI=1.55,1.83 and aOR=1.60; 99%-CI=1.44,1.78 respectively). Disparities did not significantly differ between the years in which services were utilized. Conclusions: Although differences in health care become evident with respect to several diversity characteristics and also providers of health care increasingly provide services which aim to address the needs of a diverse population, disparities do not decrease over time. This calls for an increased and coordinated transfer from research into practice as well as more targeted, thoroughly evaluated and sustainable diversity-sensitive health care strategies.

Keywords: Disparities, health care outcomes, migrants

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-167: Prevalence of occult lower extremity deep vein thrombosis and identification of clinically relevant factors in patents admitted to an inpatient acquired brain injury rehabilitation program Top


David T. Burke1, Joseph Porter1, Leila Ettefagh1, Mairin A. Jerome1, Andrew C. Dennison2

1Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA, 2Shepherd Center, Atlanta, Georgia, United States

Background: Patients admitted to inpatient rehabilitation facilities, in particular those with brain injury diagnoses, are at increased risk of having occult lower extremity deep vein thrombosis (LE-DVT) and consequently higher morbidity and mortality. Despite this risk, it is not currently standard of care to screen patients for DVT on admission to inpatient rehabilitation units. The aim of the present study is to better understand the prevalence of occult LE-DVT among patients admitted to an acquired brain injury inpatient rehabilitation program and to identify clinical factors associated with increased risk. Methods: This is a retrospective observational cross-sectional study of all consecutive patients admitted to a single, free-standing acquired brain injury inpatient rehabilitation program between October 2017 and March 2018. It is common practice in this program for many patients to receive a screening doppler ultrasound (US) study to assess for DVT on admission. Results: Of 124 patients admitted, 24 were excluded: 8 with no LE ultrasound screening on admission, 10 with known LE-DVT on admission, 5 under age 16, and 1 refused participation in research studies upon admission. Out of 100 remaining patients, 4 patients were found to have previously unidentified LE-DVTs with positive screening doppler US on admission. The most common admission diagnoses were traumatic brain injury (85%), anoxic brain injury (5%), brain tumor status post resection (3%), and encephalopathy (3%). The prevalence of occult LE-DVT and the total prevalence of LE-DVT including those diagnosed prior to admission were 4% and 12.7%, respectively. Patients with lower extremity fractures were 2.57 times more likely to have a DVT compared to patients without fractures, however this association did not meet criteria for statistical significance (P=0.07). Conclusion: Our study demonstrates ultrasound screening upon admission to inpatient rehabilitation for individuals with acquired brain injury identifies occult DVTs that may otherwise go unrecognized.

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-168: Hospital without falls Top


Tiago E. Carvalho

Department of Physical Medicine and Rehabilitation, Hospital Cascais, Lisboa, Portugal

Background and Aims: At the initiative of the Board of Directors of Hospital de Cascais (HC), the “Hospital Without Falls” project was launched with the goal of involving and making all professionals accountable in the pursuit of this objective. The objectives were to have a hospital without falls and to reduce the severity of falls that occur. Methods: The Fall Prevention group was reformulated: it was directed by a Physiatrist and a Nurse, an executive board was created and elements were appointed for all services including all professional classes; this was done in coordination with the Risk Management area and in a patient safety culture perspective. An in-depth analysis of all the issues concerning falls in the HC was carried out and a strategic plan was drawn up which was presented to the HC board of directors; later the plan was presented to the whole HC on the launch date of the project. Indicators and their datasheets were defined, allowing the follow-up of the results. This plan included several lines of action:

  • Risk assessment
  • Prevention
  • Post-fall procedures
  • Monitoring of data
  • Communication.


For each of these areas, a set of actions / projects was defined and implemented according to a previously defined schedule. Results: During the period 2016-2017 there were 9 sentinel events related to falls of patients. In the year 2018 there was none. Between 2017 and 2018 there was a reduction of 11.01% in the total number of falls in the HC and a reduction of 15.52% in the number of inpatients falls. (Updated data will be presented). Conclusions: The implementation of a structured project that involves and takes responsibility to all professionals working in a hospital reduces the number and severity of falls in a hospital environment, contributing to a safety culture.

Keywords: Fall risk assessment, falls in hospitals, prevention

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-169: Does inpatient satisfaction reflect quality of care and service in rehabilitation? Top


Amiram Catz1,2, Adi Kfir1, Keren Elkayam1, Aida Dinia1, Dianne Michaeli1, Vadim Bluvshtein1,2

1Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel, 2The Rehabilitation Department, Faculty of Medicine. Tel-Aviv University,

Tel-Aviv, Israel

Background and Aims: Health organizations use to measure patient satisfaction to assess quality of care and service. Some studies, however, showed a possible effect of patient clinical, demographic, or social characteristics on this measurement. The aim of this study was to examine the relationship between personal characteristics and inpatient satisfaction in rehabilitation. Methods: Fifty-two inpatients of a spinal rehabilitation department participated anonymously in a large patient satisfaction survey, in 2017. Thirty-four other inpatients of that department, whose personal details are known, with spinal cord injuries (SCI) or with extensive polyradiculoneuropathy, completed the same questionnaires. Findings of the questionnaires were compared between the two groups using Student's t-test. The relationship of individual characteristics and satisfaction were examined in the group of identified patients, using Pearson's correlation test. Results: The differences between the scores of the two groups were non-significant (p>0.05), both for general satisfaction and for specific sub-categories. The general score was 85.40 for the anonymous group and 85.90 for the identified patients. In the sub-categories, for example, the scores were 84.16 vs. 89.10 for staff attitude, 87.23 vs. 89 for transmission of information, and 76.61 vs. 75.60 for environmental conditions, respectively. A weak negative correlation was found between years of education and patient satisfaction (r=-0.355, p<0.005). The correlation between age, gender, admission AIS grade, admission and discharge ASIA motor score (AMS), ASIA sensory score (ASS), Spinal cord independence measure (SCIM III) score, and gains on AMS, ASS, SCIM III, and Spinal cord ability realization measurement index (SCI-ARMI) and patient satisfaction were non-significant (p>0.05). Conclusions: The similarity in findings between the groups supports the validity of the questionnaires. Lack of a significant relationship between most of the examined patient characteristics and satisfaction indicates that satisfaction scores reflect mainly quality of care and service in the examined spinal rehabilitation department.

Keywords: Clinical and demographic characteristics, patient satisfaction, rehabilitation

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-170: Community-based primary healthcare training for physiotherapy undergraduates: Perceptions of physiotherapy academics Top


Nomzamo C. T. Chemane, Geneshree Govender, Verusia Chetty, Saul Cobbing

Department of Physiotherapy, University of KwaZulu Natal, Durban, South Africa

Background and Aims: Traditionally, clinical education for undergraduate physiotherapy students has been centred around acute services in large teaching hospitals. During the critical final year of clinical education physiotherapy students need to be given an opportunity to be engaged actively in the workplace including the community setting to learn practices, norms and values that are essential for developing as an independent practitioner. Currently there is a lack of an integrated model guiding clinical education for physiotherapy clinical education in South Africa. Aim: To explore the perceptions of physiotherapy academics on a novel community based primary healthcare approach to clinical education for students at a South African University in order to inform the roll out of an evidence based model for physiotherapy education. Methods: A qualitative explorative approach using semi-structured interviews with physiotherapy academics at the institution was used to explore their perceptions of the community based primary healthcare training platform. Data was analysed using conventional content analysis and was classified into themes and categories. Results: Four overarching themes emerged namely: curriculum review, constraints to decentralised learning, community based clinical education benefit and recommendations for learning platform. Academics believed that community based primary healthcare training was an approach that influences students to be socially responsive while addressing access to healthcare services such as rehabilitation in resource poor communities in SA. Conclusions: The perceptions of academics was crucial in understanding the implementation clinical education of physiotherapy students, in a Primary Health care setting. The benefits of the community based primary healthcare approach included the development of core competencies of undergraduate students in preparation for independent practice as well as a call for students to be more socially responsive as future healthcare practitioners. The study also assumes that the improved collaboration between stakeholders will curb barriers to the community based learning platform.

Keywords: Clinical education, community-based primary healthcare, physiotherapy

Disclosure of interest: I declare that there are no conflicts of interest or support that may cause bias in my presentation.


  No. P1-171: Community based primary healthcare training for physiotherapy: Students perceptions Top


Nomzamo C. T. Chemane, Vijaya Misra, Verusia Chetty, Stacy Maddocks, Levin Chetty

Department of Physiotherapy, University of KwaZulu Natal, Durban, South Africa

Background and Aims: South Africa is faced with an over-burdened public healthcare system and physiotherapists need to be equipped to address the challenges. Community- based primary healthcare clinical education offers the physiothe