Poster 20: Community integration after traumatic brain injury

Objective: To determine the level of community integration after traumatic brain injury (TBI) and its association with clinical inpatient outcome measures. Design: The Community Integration Questionnaire (CIQ) was used to conduct telephone interviews with either the patient or a proxy who lived with the patient. Setting: Community. Participants: 77 patients with TBI who were 5 to 34 months postdischarge from an acute rehabilitation hospital. Interventions: Not applicable. Main Outcome Measure: The CIQ. Results: The CIQ total score had an inverse correlation with age (r=−.300, P<.008) and length of stay (r=−.290, P<.011). There were low but statistically significant correlations with discharge cognitive skills on the FIM™ instrument (r=.451, P<.0001), discharge FIM total score (r=.366, P<.001), and FIM efficiency (r=.367, P<.001). There were significant differences between subjects who were not currently working or attending school versus those who were. The latter group scored higher on home integration (5.6±3.0 vs 3.6±2.9), social integration (8.9±2.1 vs 6.6±2.8), productivity (5.4±0.8 vs 1.5±1.1), and CIQ total scores (20.0±3.7 vs 11.8±5.8). Conclusion: Consistent with previous findings, community integration correlated with functional outcome at discharge from rehabilitation. Patients who return to work or school exhibit better social and home integration.     

Abstract 21: Treadmill with partial body-weight support versus conventional gait training after stroke.

Objective: To test the hypothesis that stroke patients treated with treadmill training and partial body-weight support walk faster 90 days after stroke than patients treated with conventional gait training. Design: Block randomized, 2 treatment arm trial. Outcome measurement was performed blind to treatment group. Setting: Inpatient rehabilitation hospital. Participants: 83 patients randomized to the treadmill (n=42) or conventional (n=41) treatments within 30 days of stroke. Patients were stratified by initial walking speed (0, >0, <.25, ≥.25m/s) and stroke location (cortical, subcortical). Eligible patients had first stroke, hemiparesis, required at least contact guard to walk, and were not ataxic. Interventions: Subjects received 12 once-daily 30-minute treatments over a 3-week period and received equal study treatment time in addition to their normal therapy. Treadmill subjects started treatment with average unweighting of 30% body weight and treadmill speed set at 1.1 miles/h. Conventional treatment included standing, walking, sit to stand, standing with activity, and walking with activity. Main Outcome Measure: The primary outcome was velocity 90 days after stroke. Secondary outcomes included 6-minute walk distance, FIM™ instrument mobility subscale score, National Institutes of Health Stroke Scale score, Fugl-Meyer Assessment leg motor score, and Tinetti score. Results: All demographic, medical, and other risk factors showed no difference except for mean age (treadmill group, 69.4±10.6y vs conventional group, 62.0±12.9y). 90-day walking speed did not differ significantly (treadmill group, .71±.50m/s vs conventional group, .83±.50m/s), nor was there a difference in change in walking speed between initial measurement and 90 days. There was no significant difference in the 6-minute walk distance at 90 days or in any of the other secondary outcomes. Conclusions: Both treatment groups made improvements in walking velocity and clinical measures during rehabilitation, but treadmill training with partial body-weight support conferred no additional benefit compared with conventional training. Age may be a contributing factor to the results.     

Abstract 23: Selective serotonin reuptake inhibitors in acute ischemic stroke patients during inpatient rehabilitation

Objective: To examine the safety of selective serotonin reuptake inhibitor (SSRI) antidepressants after stroke and their effect on rehabilitation. Design: Chart review study. Setting: Community-based rehabilitation hospital. Participants: 147 ischemic stroke survivors admitted between August 1, 2001 and May 31, 2002. Interventions: Not applicable. Main Outcome Measures: Evidence of SSRI-related adverse events and FIM™ instrument score. Results: 85 patients received an SSRI for depressive symptoms. +SSRI and −SSRI patients did not differ in age, gender, length of stay (LOS) in the acute care hospital (9.5±7.6d vs 8.2±5.9d, P=.065), or change FIM score (22.1±13.2 vs 20.5±16.2, P=0.5). +SSRI patients had longer LOS in rehabilitation (20.1±9.1d vs 13.7±8.0d, P<.0001), lower FIM score at admission (55.6±20.7 vs 73.8±20.2, P<.0001), and lower FIM efficiency (1.2±1.0 vs 1.8±1.5, P=.01). 16 +SSRI (18.8%) and 6 −SSRI (9.7%) patients experienced 1 or more bleeding episodes, most commonly: gastrointestinal bleed (including occult bleeding), bleeding from a recently inserted gastrostomy tube or pacemaker, nose bleeds, hematuria, or easy bruising. Only 1 +SSRI and 1 −SSRI patient with bleeding required acute medical care. No hemorrhagic transformations of ischemic strokes were noted. Altered mental status occurred in 2 +SSRI and 6 −SSRI patients. Worsening neurologic symptoms occurred only in 4 −SSRI patients. All patients with abnormal bleeding received ≥1 anticoagulant or antiplatelet agents (n=21) or had recently undergone a surgical procedure (renal stent placement, n=1). Conclusions: Bleeding complications were more common in +SSRI patients despite equivalent anticoagulant and antiplatelet treatment, emphasizing the importance of monitoring for bleeding complications during SSRI treatment. +SSRI patients experienced a similar improvement in FIM score, but had lower FIM efficiency, possibly reflecting the underlying effect of depressive symptoms.     

Article 11: Aerobic exercise improves work capacity and functional mobility in spinal cord injury above T6

Objective: To determine if adults with low-cervical and high-thoracic spinal cord injury (SCI) significantly improve work capacity and functional mobility after a structured aerobic exercise. Design: Pre- and posttest interventional trial. Setting: Exercise laboratory. Participants: 6 subjects (4 men, 2 women; mean age ± SD, 37.7±12.1y; mean weight, 74.1±21.2kg; mean time since injury, 5.9±5.6y) with motor complete SCI between C7 and T5 completed the intervention. Interventions: Subjects performed arm crank ergometry at 70% of peak power output for 30min/d, 3d/wk for 10 weeks. Main Outcome Measures: Peak oxygen consumption (Vo₂peak), peak power output, and 12-minute wheelchair propulsion (12WCP). Results: Vo₂peak significantly increased, from 10.8±3.6mL·kg⁻¹·min⁻¹ to 12.6±4.2mL·kg⁻¹·min⁻¹ (P<.05) after the intervention, while peak power output and 12WPC increased from 40.8±15.3W to 54.2±18.9W and 1260±344ft to 1358±312ft, respectively (P<.005). Conclusions: Structured aerobic exercise can significantly improve work capacity and functional mobility in persons with motor complete SCI between C7 and T5.     

Abstract 13: Use of electromyography to predict functional outcome after epidural spinal injections for lumbar radiculopathy.

Objective: To determine if electromyographic diagnostic evaluation can predict functional outcome in patients undergoing lumbar spinal injections. Design: Retrospective study of functional outcome in patients undergoing lumbar interforaminal epidural spinal injections (ESIs) after electromyographic testing. Setting: Clinic. Participants: 39 subjects with low back pain with radicular symptoms into the lower extremity were evaluated for functional improvement after electromyography and ESI. Interventions: Fluoroscopic guidance of interforaminal ESI in the lumbar region was performed where positive clinical or electromyographic levels were suspected. Main Outcome Measures: Oswestry Disability Index (ODI) and Verbal Rating Scale (VRS) for current pain severity. Results: Electromyography diagnosed 18 patients with a radiculopathy; 21 had a normal or negative examination. Patients were followed postinjection on average for 10.8±3.9 weeks. Pretreatment ODI scores ± SD did not differ significantly between groups showing positive radiculopathy (72.3±12.7) or negative electromyographic findings (65.9±18.6) (P>.05). There was significantly greater improvement of ODI rating for electromyography positive radiculopathy (7.11±9.5) compared with negative electromyography (3.2±17.4) (P<.05). Positive radiculopathy subjects complained of more pain as measured on the VRS before ESI (8.1±1.0) than subjects with negative electromyographic findings (7.3±0.8) (P>.05). The VRS mean improvement did not differ significantly between the positive electromyography group (1.8±1.2) and the negative electromyography group (1.2±1.2) (P>.05). Conclusions: Subjects undergoing interforaminal ESI, who had a positive radiculopathy by electromyography prior to injection, showed significant improvement in functional outcome as measured by the ODI but not as measured by current pain intensity on the VRS. This study showed the importance and diagnostic value of electromyography for radiculopathy evaluation prior to spinal procedures and the difficulty of pain evaluation outcome by using the VRS.     

Article 14: Effect of a wheelchair-mounted robotic arm on functional outcomes in persons with spinal cord injury

Objective: To determine the effect of a wheelchair-mounted robotic arm (WMRA) on function in persons with spinal cord injury (SCI). Design: Participants enrolled in the 2-week protocol. Setting: Veterans Affairs medical centers in Houston and Pittsburgh. Participants: 11 men (mean age, 42±12y) with cervical SCI (C3-4 to C6-7). All used power wheelchairs with joystick controls. Intervention: Training took place for 6 hours over 3 days. Subjects practiced activities of daily (ADL) tasks for 14 hours over 7 days. Tasks were timed and subjects were classified functionally as dependent (0), needs assistance (1), or independent (2). After 2 weeks, they were reevaluated for functional improvement with the WMRA. Main Outcome Measures: Number and time to complete tasks were calculated. Results: Mean ADL scores (independence) at reevaluation were significantly higher (P<.02) than at baseline. Average ADL performance times decreased from 226 to 171 seconds, a statistically significant reduction in time (P<.0001). Data revealed significant differences in subjects’ functional independence and time to complete tasks with the WMRA in 7 activities (P<.05). Conclusions: The WMRA has the potential to enable persons with SCI to perform functional tasks that would otherwise be impossible for them. However, design problems (ie, added wheelchair width when WMRA is installed) interfered with maximum utilization and satisfaction.     

Poster 1: Pulmonary vest therapy to prevent pneumonias in quadriplegic cerebral palsy

Objectives: To extend our previous observations (J Am Med Directors Assn 2002;3:318-21) on the effectiveness of high-frequency chest wall oscillation vest therapy, with the Advanced Respiratory vest, for preventing pneumonias. Design: Quantitative research using before-during treatment data. Setting: 2 pediatric skilled nursing facilities for children with severe cerebral palsy (CP). Participants: 11 subjects (6 men, 5 women), with severely quadriplegic CP and frequent pulmonary infections, were identified (age range, 1-28y; median, 17y). All were fed by gastrostomy tube; 9 had a tracheostomy; and 6 had epilepsy. Interventions: Not applicable. Main Outcome Measures: Data were collected for the 12 months prior to initiation of vest therapy and for the 12 months of vest therapy. Results: The number of pneumonias decreased from 52 to 27 per year (P<.05). The number of hospitalizations due to pneumonia decreased from 13 to 3 (P<.05). The frequency of effective suctioning of pulmonary secretions was significantly increased (P<.001) and the frequency of seizures decreased (P<.05). Conclusion: Vest therapy resulted in a statistically significant reduction in the incidences of pneumonias, number of hospitalizations for pneumonia, and seizure frequency. Vest therapy was tolerated well, without side effects.     

Abstract 7: Outcomes of a day feeding program in children with cerebral palsy

Objective: To examine the effectiveness of a pediatric feeding program for children with cerebral palsy (CP) and dysphasia. Design: Case series. Setting: Pediatric specialty hospital. Participants: 26 children admitted to a feeding program between 1999 and 2001. All participants were consuming inadequate diets and had failed traditional outpatient therapies. Interventions: The feeding program consisted of a day treatment program during which participants received 4 therapeutic meals. Attendance was 5 days a week for 4 to 6 weeks. Therapeutic interventions included the use of oral motor facilities techniques simultaneously with behavioral strategies. Main Outcome Measures: Anthropometric (weight, height, ideal body weight) data was collected on admission, discharge, and at 1, 4, 7 and 12 months posttreatment. Percentage of bites accepted was measured at time of admission and discharge from the program. Results: Participants showed improvements in both weight (mean, .767±.675; P≤.001) and height (mean, 1.028±0.675; P≤.001) from admission to discharge. Weight z scores also increased (mean, .446±.505; P≤.001) during this period. Percentage of bites accepted at discharge was significantly greater than the percentage accepted at admission (mean, 31.65±24.12; P≤.001). Improvements were maintained after discharge from the program. Although the weight gain between discharge and 1 month follow-up and between 1 and 4 months follow-up were not statistically significant, there were significant increases in height during these periods (mean, 1.378±1.237, P≤.001; mean, 1.954±1.696, P≤.001). Statistically significant weight and height gains were seen between 4 and 7 months and between 7 months and 1 year postdischarge. Conclusions: Poor nutrition in children with CP has been associated with increased health care costs, decreased functioning, and poorer social interaction. This study provides evidence of the effectiveness of a pediatric feeding program for this population.     

Poster 29: Functional outcomes of liver transplant patients treated in an acute rehabilitation setting

Objective: To determine associations between categorical and continuous variables that characterize liver transplant patients and outcome variables measuring resource utilization and functional gains during inpatient rehabilitation. Design: Retrospective review. Setting: Inpatient acute rehabilitation unit and community follow-up. Participants: 13 liver transplant patients undergoing initial acute rehabilitation. Interventions: ≥3h/d of acute multidisciplinary rehabilitation treatment. Main Outcome Measures: Rasch-converted FIM™ instrument scores, and categorical and continuous clinical variables. Results: Patients of a mean age of 52±12.35 years were admitted at a mean of 34.77±18.27 days after transplant. 9 of 13 patients were discharged to a residential setting, with mean rehabilitation length of stay (LOS) of 15.9±13.1 days. The median hospital charge was $21,500 (range, $7137-$107,568). These patients had a mean Model for End-Stage Liver Disease (MELD) score of 24.17±11.26 and serum ammonia averaged 104.46±73.08μmol/L. The Wilcoxon signed-rank assessment of paired t tests for differences between time points (admission, discharge, follow-up) showed that motor scores (P<.001) improved for all timed comparisons, but cognitive scores did not improve (P<.99). Motor function at admission correlated with hypoalbuminemia (Spearman P=.01), while cognitive function correlated with low levels of total protein (Spearman P=.014) and low globulin (Spearman P=.059). Despite this, these patients did not differ in the degree of cognitive or motor gains across their stay. Subgroups characterized by other clinical characteristics (eg, alcoholism, gender, cigarette use, diabetes) did not differ in rehabilitation outcomes, although LOS varied by group. Conclusion: Patients with end-stage liver disease are among the most medically complex and debilitated in the hospital. Despite this, we found that liver transplantation patients demonstrated significant reduction in motor disabilities when rehabilitation was provided in an inpatient rehabilitation unit setting. Cognition did not improve during the study period.     

Poster 13: Validation of the assessment of motor and process skills among older adults in the community

Objective: To assess the validity of the Assessment of Motor and Process Skills (AMPS), an occupational therapy tool, for epidemiologic research. Design: Population-based sample. Setting: Northern New York City. Participants: 217 elders aged ≥70 years were recruited from Medicare beneficiary files. Interventions: Not applicable. Main Outcome Measures: The AMPS composite motor and cognitive process scores. Results: In this sample of nondemented older people (32% men; mean age, 78.5±5.6y; two thirds minorities), motor scores correlated highly with gait speed (.53), grip strength (.34), and tandem stand time (.36) (P<.001). Process scores were significantly lower in people with mild cognitive impairment relative to those with normal cognition (P<.001). Correlations between process scores and physical indicators, and motor scores and cognitive performance, were much lower, indicating discriminant validity. 25% of participants scored in the impaired range in motor skills, 10% in process skills, and 7.5% in both. Self-reported deficits were related to both motor and process scores. Conclusions: The AMPS appears to be a valid tool for epidemiologic research.     

Poster 28: Comparison of hemi-field fresnel prisms versus patching for visual neglect after stroke

Objective: To assess the effect of bilateral hemi-field prisms versus patches for treatment of visual neglect after stroke. Design: Randomized, prospective, controlled trial. Setting: Inpatient stroke unit. Participants: 38 patients with stroke, visual neglect defined by the Behavioral Inattention Test (BIT), and visual acuity ≥20/200. Interventions: The prism group received 15 diopter Fresnel prisms over the affected hemi-field bilaterally; patch group received black tape of the unaffected visual hemi-field bilaterally; controls received no visual intervention. The interventions lasted 14 days. Main Outcome Measures: 3 subtests of BIT were recorded at baseline and on days 2, 7, 14, and 16. Results: Admissions demographic were similar for all 3 groups. There were no significant differences in BIT scores while wearing the optical devices. The prism group showed a trend for improvement in all 3 BIT scores 2 days after removal of the optical device. This reached statistical significance for the line bisection scores (prism group ± SEM, 1.5±0.3; patch group, .12±.12; controls, .33±.33; P=.004). Dropouts were highest for prism group (10/16) versus patch group (4/12) and controls (1/10) (P=0.2). Conclusion: Hemi-field Fresnel prisms showed a beneficial effect on visual neglect 2 days after their removal.     

Poster 39: Total body reciprocal training improves hand function in chronic stroke survivors

Objective: To examine changes in hand function of chronic stroke survivors participating in exercise using a total body recumbent stepper (TBRS). Design: Case series. Setting: University medical school. Participants: 11 participants (8 men; age, 61.3±11.0y) >6 months poststroke with mild to moderate hemiparesis (6 with right side involvement). Intervention: An 8-week exercise program using TBRS 3 times a week for 30 minutes per session. Main Outcome Measures: Functional Rating Score (FRS) from the Wolf Motor Function Test and bilateral grip strength measured by dynamometry. Results: Statistical analyses were conducted using a repeated-measures 2×2×4 factorial analysis of variance for factors of gender and the more affected side along with time. Results indicated a significant interaction of the intervention with left grip strength. Left grip strength increased from 13.44±8.92lb to 16.72±7.23lb after intervention. Values were significant at P<.05. The average for right grip strength did not demonstrate significance after intervention. FRS improved, but not significantly. Conclusion: Improvements in function and strength are possible for chronic stroke survivors participating in exercise involving a TBRS.     

Abstract 22: Acute neuroradiograhic predictors of rehabiliation costs.

Objective: To examine acute neuroradiographic and injury predictors of rehabilitation costs in a large traumatic brain injury (TBI) population. Design: Multiple regression-based within-group design. Setting: Urban university-based neurotrauma center and rehabilitation hospital. Participants: 293 persons presenting to a level 1 trauma center with a primary diagnosis of moderate or severe TBI who required inpatient rehabilitation. Interventions: Not applicable. Main Outcome Measures: Multiple variables derived from demographics, injury characteristics, ratings of various computed tomography (CT) scan indicators of neuropathology, and charges for rehabilitation services. Results: Several key variables that are predictive of rehabilitation outcome (including age, cause of injury, admission Glasgow Coma Scale [GCS] score) and several CT-derived neuroradiographic variables were entered into a multiple regression model to predict the total dollar charges for all rehabilitation services. The variables that emerged as statistically significant were (in order of amount of variance accounted for in the predictive model: presence of subarachnoid hemorrhage (SAH) (F change=17.89; P<.0001), admission GCS total score (F change=13.59; P<.0001), presence of frontal lobe contusion (F change=8.26; P<.004), presence of left parietal contusion (F change=7.15; P<.008), presence of right epidural hemorrhage (F change=4.51; P=.035), and presence of a punctate hemorrhage (F change=4.89; P=.028). Conclusions: Charges for TBI rehabilitation are an important consideration. The ability to predict the relative cost of rehabilitation can facilitate planning and may be helpful in more accurately determining the allocation of resources. The presence of SAH was an important predictor of charges and may reflect a risk factor for secondary brain injury not captured by other measures.     

Abstract 20: Rehabilitation outcome for patients requiring percutaneous endoscopic gastrostomy after stroke: a case-matched control study.

Objective: To test the hypothesis that percutaneous endoscopic gastrostomy (PEG) placement, while signaling an increased risk of medical complications and death, allows survivors to achieve functional recovery and home discharge rates similar to those of case-matched controls. Design: Retrospective case-matched control study. Setting: Acute stroke rehabilitation inpatient unit. Participants: 364 patients admitted for stroke rehabilitation, 182 with PEG tubes in place and 182 case controls without PEG were matched at the time of admission for sex, age, FIM™ instrument score (mean, 2.5), and interval poststroke (mean, 1.5d). Interventions: Not applicable. Main Outcome Measures: Outcomes of interest were change in FIM scores, length of rehabilitation hospital stay, need for intercurrent transfer back to the acute hospital, final discharge destination, and survival status. All data were recorded concurrently in a computerized stroke rehabilitation data bank by rehabilitation team members unaware of the study hypothesis. Statistical analyses were as follows: the Student t test for linear data, Mann-Whitney U test for ordinal data, the chi-square test for categorical data. Variances are provided as mean ± SEM. Results: Outcomes for the 2 groups, PEG versus controls, respectively, were as follows: change in FIM scores from admission to discharge (17.3±1.3 vs 20.5±1.2, P=.07); length of rehabilitation hospital stay (45.4±1.8d vs 44.1±1.5d, P=.57); need for intercurrent transfer back to the acute hospital (51/182 vs 22/182, P=.0001); final discharge destination home/institutional care (92/74 vs 97/80, P=.91); and survival status dead/alive (16/166 vs 5/177, P=.01). Conclusions: Patients who require PEG placement are at increased risk for medical complications and death. Those who survive, however, show similar functional recovery and rate of home discharge as case-matched controls.     

Poster 31: Value of a fitness program after completion of rehabilitation therapy poststroke

Objective: To assess the value of a fitness program after completion of formal stroke rehabilitation. Design: Randomized, controlled, prospective study. Setting: Community wellness center. Participants: 39 subjects with stroke randomly assigned to immediate (n=20) versus deferred treatment (n=19). Interventions: The immediate group (IG) was enrolled in a 12-week exercise program. The deferred group (DG) was deferred from the exercise program for 12 weeks. Main Outcome Measures: Fugl-Meyer motor and balance subscores, 2- and 6-minute timed walk tests, FIM™ instrument, number of falls, number of hospitalizations, Mini-Mental State Examination, Beck Depression Scale, Community Integration Questionnaire, and Burke Handicap Scores were obtained at baseline and at 12 weeks postenrollment. Results: Preliminary analysis showed that the change in Fugl-Meyer motor score from baseline to 12 weeks was the only significant outcome variable (IG score ± SEM, 5.3±1.5 vs DG score, −1.7±2.1; P=.01). Subject dropouts differed significantly between the 2 groups (1 in IG, 6 in DG; χ²=4.0, P=.04). Conclusions: Structured exercise after completion of formal stroke rehabilitation has a significant effect on impairment. Subject dropouts in the DG indicated the strength of patient demand for a structured exercise program.     

Poster 24: Relationship of independent living status, vocational outcome status, and satisfaction with life after traumatic brain injury

Objective: To determine whether independent living status or vocational outcome status predicts satisfaction with life for patients after moderate to severe traumatic brain injury (TBI). Design: Prospective cohort study. Setting: Acute care, rehabilitation hospital. Participants: 26 men and 23 women with moderate to severe TBI. Interventions: Not applicable. Main Outcome Measures: Satisfaction with Life Scale (SWLS), Vocational Outcome Scale (VOS), and Independent Living Scale (ILS) collected at hospital discharge and at 1- and 2-year follow-up. Results: Discharge SWLS predicted 1-year SWLS score (n=49; r=.51, P<.001); 1-year SWLS score predicted SWLS score at 2 years (n=28, r=.60, P<.001). Discharge ILS and VOS scores did not predict SWLS score at 1 year. 1-year SWLS score correlated mildly (r=.39, P<.01) with 1-year VOS and with 1-year ILS (r=.38, P<.01) scores. 78% indicated positive life satisfaction (SWLS score, >19) at discharge and 61% at 1 year. Of those satisfied at discharge, 79% remained satisfied at 1 year. Of those dissatisfied at discharge, 82% remained dissatisfied at 1 year. Conclusions: SWLS score appears relatively stable over time. Life satisfaction may be less dependent on vocational and independent living status than on longstanding personality or social factors.     

Poster 26: Temperament characteristics and adaptive behavior of school-aged children with myelomeningocele and shunted hydrocephalus

Objective: To describe the relationship between temperament characteristics and adaptive behavior skills acquisition among children with myelomeningocele and shunted hydrocephalus. Design: Consecutive cohort study. Setting: Tertiary-level, university-affiliated, interdisciplinary spina bifida program. Participants: Primary caregivers of 23 children with myelomeningocele and shunted hydrocephalus (age range, 5-12y). Interventions: Not applicable. Main Outcome Measures: Primary caregivers completed age-appropriate Carey Temperament Scales (CTS) and the Adaptive Behavior Evaluation Scales (ABES) as part of a larger developmental study. Temperament characteristics assessed by the CTS (adaptability, mood, intensity, attention/persistence, distractibility, rhythmicity/predictability) correlated with adaptive behavior skills, as reported on the ABES (self-care, home-living, social, community use, health, functional academics, leisure). Results: Distractibility and attention/persistence factors correlated negatively with activities of home living and functional academics (r range, −.52 to −.65; P<.001). Children with negative mood, poor adaptability, and poor attention/persistence demonstrated lower social scores (P<.00105). Conclusions: Temperament characteristics within each child are important features when parents, educators, and health care professionals interacted with youth. Understanding of social and functional characteristics underlies successful strategies for supporting self-directed skills. Implications for home and school rehabilitation are discussed.     

Abstract 4: Acupuncture analgesia and electromyography

Objectives: To evaluate the analgesic effect of a simple acupuncture protocol with needle electromyography and to validate independently a telescopic sham acupuncture needle. Design: Randomized, double-blinded, controlled study. Setting: University-based electrodiagnostics laboratory. Participants: 38 subjects referred for electrodiagnostic evaluation. Intervention: Before the electromyographic examination, an independent provider applied either real acupuncture needles or telescopic sham needles to the acupuncture points Large Intestine 4 and Liver 3 bilaterally. Main Outcome Measures: 100-mm visual analog scale (VAS) of the subjects’ pain before electromyography as well as pain and unpleasantness related to electromyography after 3 muscles were examined. Subjects were also asked if they thought they had received true acupuncture or sham needles. Pretest pain was subtracted from electromyography-related pain to give a measurement of pain attributable to the electromyography. Results: 21 subjects were randomized to the treatment group and 17 to the sham group. The subjects in the two treatment arms did not differ by age (P=0.9) or gender (P=0.4). The pain attributable to electromyography in the treatment group (mean, −5.38±27.6) was significantly less than the pain attributable to electromyography in the control group (mean, 11.3±17.3) (P=.037; 95% CI, −32.3 to −1.1) The percentage of subjects who thought they had received real needles in the acupuncture group (67%) did not differ from the proportion in the control group (53%) (Fisher exact test, P=.51). Conclusion: Acupuncture may represent an effective form of analgesia for electromyography. This is the first study of which we are aware that independently validates the telescopic sham acupuncture needle as an effective control.     

Abstract 9: Maximal bladder capacity as the predictor of response to desmopressin on nocturnal enuresis in patients with spinal cord injuries.

Objectives: To evaluate the efficacy of intranasal desmopressin inhalation on nocturnal enuresis in patients with spinal cord injury (SCI) and to investigate the validity of maximal bladder capacity as the predictor of response to intranasal desmopressin inhalation. Design: Before and after interventional trial. Setting: University-affiliated hospital. Participants: 22 adults SCI with nocturnal enuresis were divided into 2 groups: the large bladder capacity group (bladder capacity, >250mL; n=11) and the small bladder capacity group (bladder capacity, <250mL; n=11). Intervention: All participants were treated with intranasal desmopressin, 10μg daily at bedtime for 4 weeks. Main Outcome Measures: Total volume of daily nocturnal incontinence and serum electrolytes. Maximal bladder capacities were measured by urodynamic evaluation. Results: After intranasal desmopressin inhalation, mean volume of nocturnal incontinence decreased significantly in the large bladder capacity group (P<.05), but not in the small bladder capacity group (P>.05). The mean maximal bladder capacity of responders was larger than that of nonresponders (P<.05). Neither hyponatremia nor serum electrolytes abnormalities occurred. Conclusions: Intranasal desmopressin inhalation is safe and effective in symptomatic management of neurogenic bladder dysfunction in selected patients with SCI. Maximal bladder capacity is a valuable predictor of response to desmopressin.     

Poster 2: Postural control in elderly women with knee osteoarthritis

Objective: To examine the effect of painful knee osteoarthritis on baseline balance and the relationship between balance measures and clinical measures. Design: Cross-sectional, observational, and controlled study. Setting: Sports medicine laboratory. Participants: 22 healthy women and 26 women with unilateral knee pain (age range, 60-80y). Interventions: Not applicable. Main Outcome Measures: Outcome measures included 6 force platform measures, ambulatory and transfer knee-pain intensity score (visual analog scale [VAS]), and disease burden (Kellgren-Lawrence score). The force platform measures obtained using the Balance Master System, which included weight-bearing symmetry, sway, and movement time during performing 6 tasks: weight bearing and squat, unilateral stance with eyes open, rhythmic weight shift, sit to stand, tandem walk, and step up and over. Results: On-axis velocity (deg/s) and directional control (%) in front and back rhythmic weight shift, and rising index (% body weight) in sit to stand were lower in women with unilateral knee pain (P<.05). Center of gravity (COG) sway velocity (deg/s) during unilateral stance in painful legs was greater than that in subjects’ other legs. The weight of women with unilateral knee pain loaded less on the painful side during 30° and 60° squats and during sit to stand (P<.05). Movement time during step up and over on the painful side was longer than that on the pain-free side (P<.05). Ambulatory knee-pain intensity (VAS) had a linear relationship with the movement time during step up and over on the painful side (r=.42). Conclusion: Avoidance of pain associated with limb loading and decline in postural control ability were demonstrated in elderly women with unilateral knee pain. Based on these results, further studies should be carried out to correlate the avoidance and decline with the falls in patients with painful knee osteoarthritis.