Poster Abstracts

doi:10.4103/2349-7904.330163

Users Online: 171

ABSTRACTS

Year : 2021 | Volume : 4 | Issue : 5 | Page : 11-220

Poster Abstracts

Date of Web Publication

09-Nov-2021

Correspondence Address:

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/2349-7904.330163

How to cite this article:
. Poster Abstracts. J Int Soc Phys Rehabil Med 2021;4, Suppl S1:11-220

How to cite this URL:
. Poster Abstracts. J Int Soc Phys Rehabil Med [serial online] 2021 [cited 2023 May 28];4, Suppl S1:11-220. Available from: https://www.jisprm.org/text.asp?2021/4/5/11/330163

VIRTUAL ISPRM 2021 CONGRESS

Virtuale, 12/06/2021 - 15/06/2021

Topic: 6. Health Policy and Systems

Sub Topic: 6.5 Rehabilitation A cross the Continuum of Care

Gendered experiences of providing informal care for older people: A systematic review and thematic synthesis

I. Zygouri¹, F. C², A. P³, M. G⁴, S. M⁵

¹Faculty of Medicine, University of Ioannina, Ioannina, Greece, ²School of Nursing and Midwifery, Birmingham City University, Birmingham, United Kingdom, ³Faculty of Medicine, University of Ioannina, Ioannina, Greece, ⁴Department of Nursing, University of Ioannina, Ioannina, Greece, ⁵Department of Nursing, University of Ioannina, Ioannina, Greece

Background and Aims: The caregiving’s impact on informal carers’ quality of life and gender-based stereotypes make older individuals’ informal care a complex process for which our knowledge is still limited. The purpose of this review is to identify how gender relates to informal carers’ experiences of providing care for people aged 60 years and over with mental and physical health needs by synthesising the available empirical data published between 2000 to 2020. Methods: The systematic method for reviewing and synthesising qualitative data was performed using the Preferred reporting items for systematic review and meta-analysis. (PRISMA) guidelines. The Critical Appraisal Skills Programme (CASP) was used to examine the quality of the included papers. Thematic synthesis was used as the methodological framework. Results: While informal caregivers share motivators, a linkage between traditional gender stereotypes impacts women’s and men’s caregiving burden and coping strategies. Informal carers’ experiences entail a constant pursuit of self-agency after acquiring the caregiver role. Cultural values and their intersection with gender appear to influence caregivers’ healthy adjustment into their new caregiving identities. The flexibility to move beyond gender boundaries could mediate caregivers’ negotiations between self and society on developing their new caregiving identity.

Conclusions: Transgressing gender lines and expanding gender possibilities can ease the caregiving burden and strengthen caregivers coping potentials. Health professionals can empower informal careers to challenge gender binaries and expand gender possibilities by intentionally injecting the language of diversity in caring information and caring processes. The review findings outline a path for research on gender identity development in older people’s care.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Association between the severity of stress urinary incontinence and pelvic floor, trunk, hip and respiratory muscles strength in non-active women

S. Ghroubi¹, Y. Zribi¹, S. Abidi², H. Ben Ayed³, M. Chlif^4,5, M. H. Elleuch¹

¹Department of Physical Medicine and Rehabilitation, Habib Bourguiba University Hospital, Sfax, Tunisia, ²Research Unit Education, Motricité, Sport et Santé, High Institute of Sport and Physical Education of Sfax, Sfax, Tunisia, ³Department of Preventive Medicine and Hospital Hygiene, Hedi Chaker University Hospital, Sfax, Tunisia, ⁴EA 3300 APS and Motor Patterns: Adaptations-Rehabilitation, Picardie Jules Verne University, Amiens, France, ⁵Tunisian Research Laboratory Sport Performance Optimization, Tunis, Tunisia

Background and Aims: Interactions between pelvic floor muscles (PFM), trunk, hip and respiratory muscles have been established. The aim of this study was to assess the strength of pelvic floor, trunk, hip and respiratory muscles using objective methods and to study their association with the severity of stress urinary incontinence (SUI). Methods: Twenty five women with SUI were enrolled. The severity of SUI was assessed using one-hour Pad test. Pelvic floor muscles function was assessed using the modified Oxford Scale, and electromyography. Trunk and hip muscles strength was assessed using a Cybex Norm II ® dynamometer. The respiratory muscles were assessed using the maximal inspiratory and expiratory pressures. Results: The severity of SUI was associated to the Oxford scale measures (P=0.004, r =-0.55), PFM motor activity measured by electromyography (P=0.002, r= -0.58), trunk flexors pic torque at 60°/sec (P=0.022, r=-0.45),the ratio of the right hip flexors pic torque on extensors pic torque at 60°/sec (P=0.041, r=-0.41). Multivariate linear regression analysis revealed that the independent factors associated with the severity of SUI were PFM strength (P=0, β=-0.73), trunk flexors pic torque at 60°/s(P=0.013 β=-0.73), right hip flexors pic torque at 60°/sec (P=0.033, β=-0.22) and the ratio of trunk flexors pic torque 60°/sec on the women weight (P=0.004, β=0.95). Conclusions: We found that incontinent women with greater pelvic floor, abdominal and hip flexor muscles strength had a less severe SUI. Anatomical connections and co-activation between these muscles can explain our findings.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

Application of neuroelectrophysiological techniques in the evaluation of spasticity after stroke

X. Zhu¹, H. Wang²

¹Zhongda Hospital Affiliated to Southeast University, Nanjing, China, ²Nanjing Sport Institute, Nanjing, China

Background and Aims: To explore the neuromuscular physiological characteristics of patients with spasticity after stroke, to analyze the correlation among spasticity,neuroelectrophysiological parameters and Brunsstrom functional stage. Methods: Study was performed in 41 patients with unilateral hemiplegia and finger flexor spasticity after stroke, including 12 cases of stage 1, 17 cases of stage 2 and 12 cases of stage 3 according to Brunsstrom stage. We evaluate the modified Ashworth scale (MAS),the compound muscle action potential(CMAP) amplitude of the median nerve, the latency of F wave, the amplitude and occurrence rate of F wave, F/M(the ratio of F wave amplitude to CMAP amplitude), F-patient / F-health (the ratio of F amplitude of affected side to F amplitude of healthy side).} Results: The amplitude of CMAP wave of the median nerve in the affected side was significantly lower than that in the healthy side (p<0.001), and the latency, amplitude, occurrence rate and F/M of F wave in the affected side were significantly higher than those in the healthy side (p= 0.035; p=0.006; p=0.005; p=0.001). The MAS grade of finger flexor muscle was positively correlated with amplitude of F wave, F/M and F-patient/F-health (r=0.507, p =0.001; r=0.518, p<0.001; r=0.617,p<0.001), From stage 1 to stage 3, Brunsstrom was positively correlated with MAS grade of finger flexor muscle, F-patient/F-health, and median nerve CMAP amplitude (r=0.380, p=0.014; r=0.421, p=0.006;r=0.369,p=0.018). Conclusions: Neuroelectrophysiological parameters can reflect the state of spasticity, degree of nerve injury and function.

Topic: 5. Engineering and Technology

Sub Topic: 5.1 Assistive Products

The effectiveness of a computerized cognitive training program for children with intellectual and developmental disabilities

J. Zhu¹, J. Peng^1,2, Z. Li^1,2, J. Song^{1, 2, 3}, Y. He^1,2, J. Huang^{1, 2, 3, 4}, J. Tao^{1, 2, 3, 4}, L. Chen^{1, 2, 3, 4}, J. Wu^{1, 2, 3, 4}

¹Fujian University of Traditional Chinese Medicine, Fuzhou, China, Fuzhou City, Fujian Province, China, ²Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation, Fuzhou City, Fujian Province, China, ³Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China, Fuzhou city in Fujian Province, China, ⁴TCM Rehabilitation Research Center of SATCM, Fuzhou, China, Fuzhou City, Fujian Province, China

Background and Aims: Children with intellectual and developmental disabilities (IDD)experience heightened attention, which have been linked to poorer cognitive, academic and social outcomes. Computerised cognitive training(CCT),an effective means for children’s cognitive function. However,limited studies have assessed whether CCT could be utilised for attention disorder in children with IDD. We performed a pilot double-blind randomized controlled trial to evaluate the efficacy of CCT for attention diffificulties in children with IDD.

Methods: 60 qualified participants were randomized to computerized cognitive training group (CCT) and traditional cognitive training group (TCT), receiving 5 weeks (20 min per day, 5 days every week), follow-up after 3 months. The scale used for attention evaluation was Conners’ Parent Rating Scale-Revised. The effectiveness of interventions between groups were evaluated using an intention-to-treat analysis. Results: The baseline was no statistical difference between the two groups. After intervention, there was a greater effect in CCT.

From baseline to post-training,CCT had an descending effect on total score, impulse-restlessness and abnormal restlessness index scores. From baseline to follow-up,CCT had a descending effect on total score, learning problems, impulse-restlessness and abnormal restlessness index scores.

From post-training to follow-up,had a descending effect on total score and abnormal restlessness index scores, while had an ascending effect on Conduct problems. Conclusions: Our data suggest that Computerised cognitive training could alleviate the attention problems, and the improvement of impulse-restlessness and abnormal restlessness index could last 3 months.

Topic: 3. Clinical Sciences

Sub Topic: 3.9 Cardiac/Pulmonary Rehabilitation

Effects of pulmonary rehabilitation based eras program on postoperative pulmonary complications in patients undergoing lung cancer surgery: primary results from the phase III multicenter random

Y. Zheng¹, M. Mao¹, F. Li², L. Wang^1,3, X. Zhang¹, X. Zhang¹, H. Wang⁴, H. Zhou⁵, M. Ji⁶, Y. Wang⁷, L. Liu⁸, Q. Zhu², X. Lu¹

¹Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China, ²Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China, ³Department of Rehabilitation Medicine, Qingdao Municipal Hospital, Qingdao, China, ⁴Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, ⁵Department of Rehabilitation Therapy, Taizhou Enze Medical Center, Enze Hospital, Taizhou, China, ⁶Department of Rehabilitation Therapy, the Second Affiliated Hospital of Hainan Medical University, Haikou, China, ⁷Department of Rehabilitation Medicine, Shenzhen Dapeng New District Nanao People Hospital, Shenzhen, China, ⁸Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medica, Nanjing, China

Background and Aims: Lung cancer surgery is associated with a high incidence of postoperative pulmonary complications (PPCs). This trial was designed to investigate the effects of pulmonary rehabilitation based ERAS program (PREP) on PPCs and length of hospital stay (LOS) following lung cancer surgery. Methods: The PREP trial is a pragmatic multi-center, randomized controlled, parallel group, phase III clinical trial. Eligible patients with lung cancer were randomly assigned to 1) the PREP group, followed a pathway with pulmonary rehabilitation components implanted into generic thoracic ERAS pathway or 2) the control group, followed the routine thoracic ERAS pathway. Results: The primary outcome was incidence of PPCs within 14 postoperative days. A total of 428 patients were listed for lung cancer surgery, and 374 were randomized with 168 in the PREP group and 163 in the PREP group completed the trial. PPCs incidence was 18.7% (35/187) in the PREP group and 33.2% (62/187) in the control group (ITT hazard ratio 0.523, 95% confidence interval 0.348 to 0.786, p=0.002). Significant risk reduction was detected in secondary complication outcomes including pleural effusion, pneumonia and atelectasis. LOS were not significantly shortened with the application of pulmonary rehabilitation while higher adherence rate to the PREP pathway was significantly associated with lower PPCs and atelectasis incidence. Conclusions: In a representative population of patients listed for lung cancer surgery, the PREP pathway halved the incidence of PPCs. Implantation of pulmonary rehabilitation components into the generic thoracic ERAS pathway should be considered a primary step in PPC prophylaxis.

Topic: 3. Clinical Sciences

Sub Topic: 3.2 Pain Osteoporosis - Osteoarthritis

Clinical effects of warm acupuncture combined with herbal fumigation in the treatment of rheumatoid arthritis of the knee joint

S. Zhao

Shaanxi University of Traditional Chinese Medicine, Xi’an, China

Background and Aims: To explore the clinical effect of warm needling moxibustion combined with traditional Chinese medicine fumigation in the treatment of rheumatoid arthritis of the knee. Methods: Seventy patients with rheumatic knee arthritis with cold-dampness obstruction type were randomly divided into control group and observation group, each with 35 cases. The control group was given conventional treatment combined with traditional Chinese medicine fumigation treatment; the observation group was given warm needle moxibustion on the basis of the treatment of the control group. Continuous treatment for 2 months, observe the changes in HSS scores, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and C-reactive protein (CRP) levels before and after treatment in the two groups. Results: After treatment, the levels of ESR, RF and CRP decreased significantly (P<0.05), HSS score significantly decreased (P<0.05), and HSS score significantly decreased (P<0.05). Compared with the control group, the ESR, RF and CRP levels of the observation group decreased significantly after treatment (P<0.05), and the HSS score was significantly reduced (P<0.05). The total effective rate of the observation group was 92.1%, and the total effective rate of the control group was 75.3%. There was a statistically significant difference in the clinical efficacy between the two groups (P<0.05). Conclusions: Warm needle moxibustion combined with traditional Chinese medicine fumigation can significantly reduce the CRP and HSS scores of patients with rheumatoid knee arthritis of cold-dampness blockage type, improve their inflammatory response, and improve the treatment efficiency.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

A follow-up study on the functional level of patients one year since stroke

Y. Zhang¹, J. Jia^1,2

¹Fujian University of Chinese Traditional Medicine, Fuzhou, China, ²Department of rehabilitation medicine, Huashan Hospital, Fudan University, Shanghai, China

Background and Aims: Follow up in stroke rehabilitation is of great value especially in patients without medical care. This study aims to perform a follow-up in patients one year since stroke. Methods: Through the hospital information management system, we obtained the phone numbers of stroke patients who met the research criteria. Then we asked the patients or their families on telephone to obtain the patient’s current medical status, dysfunction, exercise habits, walking ability and so on. Results: All patients with transient ischemic attack (TIA) reached an independent level of activity of daily living and the same situation in cerebral infarction and cerebral hemorrhage patients accounting for 55.4% and 36.4%. The type of dysfunction that most affects the quality of life is dyskinesia, accounting for 48.9%, followed by cardiopulmonary dysfunction, accounting for 8.85%. Among the patients who prefer exercise, 82.35% of them have a rating of 5 in the Holden Walking Ability Scale. While there are only 45.57% for the patients who do not like exercise. Conclusions: Among all types of stroke, TIA patients have the best prognosis. The biggest problem for patients at this stage is motor dysfunction, and it may also be accompanied by other problems such as cardiopulmonary function and mental psychology. Patients who do more exercise tend to have better walking ability.

Reference

Fan Q, Jia J. Translating research into clinical practice: importance of improving cardiorespiratory fitness in stroke population. Stroke 2020:51:361-7.

Topic: 4. Therapeutics

Sub Topic: 4.6 Neurostimulation (rTMS, tDCS, etc.)

Effect of transcranial direct current stimulation combined with melodic intonation therapy on image naming in patients with aphasia

Z. Qian, X. Qian, C. Yunjia, X. Jiayi, W. Ping, L. Ningining, Q. Jun, S. Chunlei

Rehabilitation Medicine, Shanghai, China

Background and Aims: To investigate the effect of tDCS combined with MITon image naming in patients with aphasia. Methods: 5 patients with poststroke aphasia were selected for four weeks of training. Patients received classical MIT for the first 2 weeks (stage A) and transcranial tDCS for the second 2 weeks (stage B). The stimulation site of tDCS was the Broca region on the left, the stimulation intensity was 1.5mA. MIT is a speech therapist who instructs aphasia patients to sing the target words together, and at the same time lets them tap the table rhythmically to beat, inducing the patients’ language expression. 30 minutes each time, 5 times a week, 20 minutes of tDCS treatment at the same time of MIT training in phase B. At week 0, weekend 2, and weekend 4, the patients were evaluated using the named part of the western aphasia test suite and the black-and-white line graphs of randomly selected nouns and verbs, and the results were recorded. Results: The data showed that there was no significant improvement in the nomenclature of patients evaluated after phase A treatment. The evaluation after stage B treatment showed A significant improvement compared with stage A. The treatment showed significant improvement in image naming in patients with aphasia after stroke by transcranial direct current stimulation combined with MIT. Conclusions: tDCS junction and MIT can improve the accuracy and fluency of image naming in aphasia patients. The potential mechanism may be that the combination of tDCS and MIT can better activate the speech expressive-related cortex.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

Electro-acupuncture suppresses pulmonary vascular remodeling in rats with chronic obstructive pulmonary disease via VEGF/ PI3K/ AKT pathway

L. Zhang¹, Y. Tian^{1, 2, 3}, P. Zhao^{1, 2, 3}, F. Jin^1,2, Y. Miao^1,2, Y. Liu^1,2, J. Li^1,2

¹Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Minis, Zhengzhou, Henan, China, ²Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Zhengzhou, Henan, China,³Academy of Chinese Medicine Science, Henan University of Chinese Medicine, Zhengzhou, Henan, China

Background and Aims: Purpose: This study aimed to explore the effect in regulating pulmonary vascular remodeling of electro-acupuncture (EA) on chronic obstructive pulmonary disease (COPD) and investigate its underlying mechanism. Methods: Methods: 48 sprague-dawley rats were randomly divided into normal, model, EA and sham acupuncture (SA) groups. The COPD model was established in all rats except the normal group. The EA group was bundled and given EA treatment for three times a week at Dazhui, Feishu and Shenshu for 8 weeks. Meanwhile, the SA group was given the same bundling. The pulmonary function, lung tissue histology, levels of IL-6 and IL-10 in lung tissue, levels of angiogenesis related factors, as well as the activation of VEGF/PI3K/Akt pathway were measured and evaluated. Results: Results: Compared with the model and SA groups, FVC and FEV 0.1 were significantly increased (P<0.01), EA could improve the pathological structure of small airway and pulmonary vessels in rats. WT%, WA% and BWT decreased significantly (P<0.01), and MAN increased significantly (P<0.05). Immunofluorescence showed that the expression of CD34 in EA group was significantly decreased (P < 0.01). VEGF, VEGFR2 and ET-1 mRNA levels in the EA group were decreased (P<0.01). The protein expression of VEGF, VEGFR2, p-vegfr2, p-Akt and p-mTOR in the EA group was lower than the model group (P<0.05, P<0.01). There was almost no difference between SA group and model group. Conclusions: Electro-acupuncture has curative effects in COPD rats, and the mechanism may involve down-regulating VEGF/PI3K/Akt pathway.

Keywords: Chronic Obstructive Pulmonary Disease, Electroacupuncture, pulmonary vascular remodeling, VEGF/PI3K/Akt pathway

Topic: 5. Engineering and Technology

Sub Topic: 5.3 Robotics

Effect of ankle intelligent stretching training on improving mechanical properties of ankle and balance performance

X. Zhai¹, Y. Pan^1,2, Q. Wu^1,2, X. Li^1,2, Q. Xu^1,2, Y. Zhang^1,2, S. Fan^1,2, D. Cheng^1,2

¹Beijing Tsinghua Changgung Hospital, Beijing, China, ²School of Clinical Medicine Tsinghua University, Beijing, China

Background and Aims: Stroke patients show abnormal balance ability due to spasticity of the ankle. Passive stretching of the ankle could improve balance due to change the mechanical properties of the joint. This study aimed to observe the differences between the manual and intelligent training post-stroke on mechanical properties of ankle and balance function. Methods: Inpatients post-stroke (n=40) with ankle spasticity were randomly assigned to the control group (n=20) or the study group (n=20). The study group received the intelligent stretching used a robot and the control group received manual stretching (5sessions/week, 20 minutes/session, 2-week). Outcome measures included mechanical properties [muscle strength, passive ranges of motion, and stiffness of dorsiflexor and plantarflexor (DF, PF)]and clinical evaluations [Berg Balance Scale (BBS), Modified Barthel Index (MBI)]. Results: There were no significant between-group differences in baseline before training. After training, significant improvements were found in both groups in DF and PF muscle strength, DF PROM, PF PROM, BBS, MBI (P<.05). Besides, significant decreases were found in DF MAS, DF Stiffness in the study group (P=.001, .001), but not in the control group (P>.05). Between-groups differences were not found after training (P>.05). Conclusions: The manual and intelligent stretching training could both improve the mechanical properties of the ankle post-stroke, further improving the balance function and activities of daily living. Besides, the intelligent stretching of the ankle had additional positive effects on reducing the stiffness and spasticity of the ankle, which may be a feasible, efficient, and labor-saving training in the rehabilitation of the ankle function and balance post-stroke.

Topic: 7. Functioning and Disability

Sub Topic: 7.4 Impairment Rating, Disability Evaluation and Certification

The Portuguese version of the musculoskeletal pain intensity and interference questionnaire for musicians (MPIIQ-PT): Translation, cultural adaptation, and multicenter validation study

A. Zão^1-5, E. Altenmüller⁵, L. Azevedo^{3, 4, 6}

¹Department of Physical and Rehabilitation Medicine, Pain Medicine Unit, Hospital Senhora da Oliveira Guimarães - Guimarães, Portugal, ²International Center of Arts Medicine, Instituto CUF Porto, Porto, Portugal, ³???, Faculty of Medicine University of Porto, Porto, Portugal, ⁴Center for Health Technology and Services Research, Cintesis, Porto, Portugal, ⁵???, Institute for Music Physiology and Music Medicine, Hannover, Germany, ⁶Department of Community Medicine, Information and Health Decision Sciences - Medcids, Porto, Portugal

Background and Aims: Playing-related pain and functional disability are a major health problem among musicians. Until now, there is no validated instrument to evaluate these outcomes among Portuguese musicians. Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM) is a self-administered multidimensional questionnaire based on the biopsychosocial principle, with excellent psychometric properties. The aim of our study was to translate and culturally adapt the MPIIQM for European Portuguese population of professional orchestra musicians (MPIIQM-Pt) and to assess its applicability, reliability, internal consistency, and validity.

Methods: MPIIQM-Pt was created through a process of translation, back translation, expert panel evaluation and a pilot and validation studies. It was administered to 134 musicians from 3 Portuguese professional orchestras, at baseline and after 7 days. Internal consistency and test–retest reliability were assessed by Cronbach’s alpha (alpha) and intraclass correlation coefficient (ICC). Construct validity was assessed based on a set of previously developed theoretical hypotheses about interrelations between the MPIIQM-Pt and other measures. Results: The internal consistency and test–retest reliability coefficients for each respective subscale (pain intensity/pain interference) were alpha = 0.896/0,879 and ICC = 0,997/0,999. Exploratory factor analysis revealed a two-factor structure (pain intensity and pain interference) that explained 75,5% of the variance. Concerning construct validity, MPIIQM-Pt shown strong correlations with the other measures (more than 90% of the previously defined hypotheses regarding interrelations were confirmed).

Conclusions: The MPIIQM-P has excellent reliability, internal consistency, and validity. It may contribute to a better pain assessment among Portuguese musicians and is suitable for research and clinical use.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Playing-related pain and functional disability among professional orchestra musicians in Portugal: A multicentre study

A. ZÃO^1-5, E. Altenmüller⁵, L. Azevedo^{3, 4, 6}

¹Department of Physical and Rehabilitation Medicine, Pain Medicine Unit, Hospital Senhora da Oliveira Guimarães, Guimarães, Portugal, ²International Center of Arts Medicine, Instituto CUF Porto, Porto, Portugal, ³Faculty of Medicine University of Porto, Porto, Portugal, ⁴Center for Health Technology and Services Research, Cintesis, Porto, Portugal, ⁵Institute for Music Physiology and Music Medicine, Hannover, Germany, ⁶Department of Community Medicine, Information and Health Decision Sciences - Medcids, Porto, Portugal

Background and Aims: The prevalence of playing-related pain (PRP) among musicians has shown to be high (about 70-86%). Few studies had evaluated pain among Portuguese musicians, and there is no published study that used validated instruments. We aim to evaluate PRP and functional disability among Portuguese professional orchestra musicians using a validated tool specifically designed for this population. Methods: Out of 183 musicians from 3 Portuguese professional orchestras, 134 (73,2% response rate) completed the self-report Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians, Portuguese version (MPIIQM-Pt) and the Portuguese version of Medical Outcomes Study Short Form 36-Item Health Survey (SF-36). Results: The average time of playing the instrument was 20,56 ± 8,7 years (mean ± SD). There was a slight male predominance (51,5%), with an average age of 30 years. Life-time prevalence of PRP was 86,6% and point prevalence was 47,0%. The main pain locations were neck and lower back. The average pain intensity score was 14,98±7,27 (out of 40) and the average pain interference score was 17,46±10,79 (out of 50), increasing significantly with the number of reported pain locations and the number of hours played per week (p<0,01). Higher pain intensity and interference scores were significantly correlated with lower quality of life (SF-36). Conclusions: Our results corroborate the high prevalence of PRP among professional orchestra musicians described in literature and its significant negative impact in musician’s performance and quality of life. This is the first study using a validated tool for Portuguese musicians, which highly contributes to more accurate and robust knowledge concerning PRP.

Topic: 4. Therapeutics

Sub Topic: 4.2 Injections (Joint. Spine, etc.,)

Ultrasonographic assessment of safe zone for carpal tunnel intervention: A case-control study

J. H. Lee¹, J. S. Yoon²

¹Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, South Korea, ²Department of Medical Sciences, Korea University Medical College, Seoul, South Korea

Background and Aims: This study aimed to identify the transverse safe zone (TSZ) and longitudinal safe zone (LSZ) of the median nerve in the carpal tunnel using ultrasonography in healthy individuals and patients with carpal tunnel syndrome (CTS). Methods: This is a prospective observational case-control study. 40 wrists of 20 healthy individuals and 40 wrists of 24 patients with CTS were observed. Patients with CTS were classified into 3 groups based on electrodiagnostic findings - mild, moderate, and severe. With ultrasound, we measured cross-sectional area (CSA) and the distance between the median nerve and ulnar vessels to identify a TSZ. Also, we checked distance between the distal flexor retinaculum and superficial palmar artery arch to confirm a LSZ. We used independent t-test, analysis of variance (ANOVA) and Pearson’s correlation coefficient for analysis. Results: The TSZ was 6.44±1.18mm in the healthy group and 4.73±2.45mm in the CTS group. The LSZ was 8.24±2.74mm in the healthy group and 6.39±3.20mm in the CTS group. The TSZ and LSZ were significantly different between healthy subjects and patients with CTS (P=0.001 and P=0.007, respectively). The TSZ showed significant difference between the mild and severe CTS groups (P<0.05); the LSZ was not significant different among groups.

Conclusions: The TSZ and LSZ were narrower in patients group than in healthy individuals, especially TSZ showed difference depending on disease severity.

Acknowledgement

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2020R1A2C009024)

Topic: 3. Clinical Sciences

Sub Topic: 3.3 Diagnosis

Gold standard? method of citric-acid-solution swallowing test as a screening test for patients with tracheostomy

J. A. Yoon, J. W. Hong

Pusan National University Hospital, Busan, South Korea

Background and Aims: The purpose of our study was to apply various range of citric acid concentration mouth and T-cannula to compare the validity against instrumental measures of aspiration in patients with tracheostomy.

Methods: 61 patients completed citric acid cough reflex test (CRT) and videofluoroscopic swallowing study (VFSS) at the same day. Delivery of citric acid was via facemask and T-cannula with three incremental concentrations (0.4 mol/L, 0.6mol/L, 0.8mol/L) of citric acid solution. For each test, amount of coughing reflex were counted and presence of two or more (C2) and five or more (C5) coughs were recorded. Results: The sensitivity and specificity were optimized at 0.8 mol/L C2 for mouth inhalation and 0.8 mol/L C5 for T-cannula inhalation. Only CRT via facemask at 0.4 mol/L C2, 0.6 mol/L C5, 0.8 mol/L C2 and C5 were significantly associated with presence of tracheal aspiration during VFSS. The coughing count during CRT showed statistically significant difference between patients with or without tracheal aspiration during VFSS in 0.4 mol/L and 0.8 mol facemask inhalation. There was no statistical significance during T-cannula inhalation. Conclusions: Citric acid CRT via mouth inhalation showed was significantly associated with tracheal aspiration and coughing reflex during VFSS. There was no superiority of T-cannula over mouthpiece inhalation as supplemented method to perform CRT for tracheostomy patients.

References

Perry L, Love CP. Screening for dysphagia and aspiration in acute stroke: A systematic review. Dysphagia 2001;16:7-18.
Monroe MD, Manco K, Bennett R, Huckabee ML. Citric acid cough reflex test: Establishing normative data. Speech Lang Hear 2014;17:216-24.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

Ultrasound-guided suprascapular nerve block for hemiplegic shoulder pain: An audit of practice in a tertiary rehabilitation centre

E. Yilmaz KARA¹, A. Saif², A. Pick²

¹Royal Berkshire Hospital, Reading, United Kingdom, ²Oxford Centre For Enablement, Oxford, United Kingdom

Background and Aims: Hemiplegic Shoulder pain (HSP) is a common condition following stroke and traumatic brain injury. Suprascapular Nerve Block (SSNB) is an invasive procedure used to manage HSP in Rehabilitation practice. SSNB requires a trained clinician to inject local anesthetics (LA)+/-steroids under a guidance The procedure includes not only the injection itself but also assessment of HSP, patient selection, taking consent, safety checks, and documentation in patients’ records. Methods: The local standard used in this audit had been previously created to enable optimizing SSNB practice and documentation at the Oxford Centre for Enablement. All SSNBs were compared to this standard; including the type of guidance, the content of the injections, safety checks, documentation on patients’ medical records. Only inpatient injections are included. Demographics are recorded and analyzed. Moreover, pre and post-injection assessments and any additional injections e.g botulinum toxin for HSP management were evaluated retrospectively from the medical records. Clinician and patient feedback were noted as other outcome measures when available. Results: 16 injections for 14 patients were performed out of 118 inpatients between February 2019 and July 2020. All injections were ultrasound-guided using an aseptic technique. Safety checks in line with WHO guidance were done in all injections. Difference in Shoulder ROM pre-injection and post-injection were noted as follows: change of abduction:+ 32.7 degrees (+10- +50), change of flexion: +18.6 degrees (0-+50). Conclusions: Results indicated high adherence to the local standards and positive outcomes. Pre and post-injection assessments and patient/clinician feedback could be standardized to improve outcome measurement.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Review the therapeutic parameters of mirror therapy in stroke

Z. Yan¹, J. Jia²

¹Xinxiang Medical University, Xinxiang, China, ²Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China, Shanghai, China

Background and Aims: Mirror therapy (MT), as a rehabilitation treatment for the central nervous system, has been widely studied and applied in clinic. However, there are still some problems about the specific treatment parameters. Our objective is to review the technology paradigm, frequency, and duration of MT in stroke rehabilitation, so as to give reasonable suggestions for clinical and family application. Methods: We searched the PubMed, Embase, Cochrane, Web of Science, and Scopus to find relevant studies was performed. Results: We totally included 24 studies that compared MT with other interventions, in terms of upper and lower limbs of motor function and sensory function, children with hemiplegia, complex regional pain syndrome (CRPS). Therapeutic parameter selection from once a day to twice a day, 3 to 7 days a week, 15 to 60 minutes per session, lasting for 2 to 12 weeks. The duration ranged from 300 minutes to 1800 minutes. The average treatment duration was 1026 minutes in 12 studies involving upper extremity motor function, 600 minutes in 2 studies involving lower extremity motor function, and 960 minutes in 3 studies involving sensation. 19 studies with positive results used central combined with peripheral interventions. There were no serious adverse events in all the included studies.

Conclusions: Mirror therapy is a safe treatment for stroke patients. The recommended program is central intervention combined with peripheral intervention, the improvement of upper limb function lasts longer than that of lower limbs, and the treatment of sensory recovery is recommended to last about 6 weeks.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Factors related to daily step counts of stroke patients during hospitalization in a convalescent rehabilitation ward

R. Yamada^1,2, S. Shimizu ¹, S. Yasuhara¹, R. Shimose³, S. Tsunoda¹, M. Ogura¹, N. Takemura², K. Taira², M. Goya², M. Shimabukuro², T. Yamazato², S. Shinzato², Y. Nakamura², T. Nakanishi², A. Matsunaga¹

¹Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan, ²Department of Rehabilitation, Okinawa Rehabilitation Center Hospital, Okinawa, Japan, ³Department of Physical Therapy, Okayama Healthcare Professional University, Okayama, Japan

Background and Aims: Decreased physical activity is associated with an increased risk of cardiovascular events and death. However, factors related to physical activity of stroke patients during hospitalization in a convalescent rehabilitation ward are still unknown. This study aimed to clarify the factors related to daily step counts. Methods: Eighty-nine stroke patients (60.8±14.4 years; 55 males) with hemiparesis who were hospitalized in a convalescent rehabilitation ward were enrolled. The inclusion criteria were: walking independently within the ward; and a walking speed of 24 m/min or faster. Data on clinical characteristics (age, sex, body mass index, stroke type, affected side, time since stroke onset), motor function (Stroke Impairment Assessment Set [SIAS]), independence of ADL (Functional Independence Measure [FIM] motor items), and cognitive function (FIM cognitive items) were collected. Daily steps were counted using a Fitbit Flex2. The number of steps taken outside rehabilitative activities (non-rehabilitation steps) were counted. Results: The non-rehabilitation steps were 4,523±2,339 steps per day. The hierarchical multiple regression showed that there was a significant interaction effect of SIAS×FIM cognitive items on the non-rehabilitation steps. The simple slope analysis demonstrated that the slope of SIAS was greater at lower levels of FIM cognitive items than at higher levels of FIM cognitive items for the non-rehabilitation steps. Conclusions: In stroke patients with a high cognitive function, there was no association between the level of physical impairment and the non-rehabilitation steps, but in stroke patients with low cognitive function, the non-rehabilitation steps were less at greater levels of impairment.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

The effect of comprehensive rehabilitation treatment on wassel 4 polydactyly deformity after repair and reconstruction

Q. Xunhan¹, S. Quanwei², L. Hongyuan³, M. Ji⁴

¹Shanghai Renji Hospital, Shanghai, China, ²Shanghai Yangpu Central Hospital, Shanghai, China, ³Shanghai Guanghua Hospital, Shanghai, China, ⁴Shanghai Shidong Hospital, Shanghai, China

Background and Aims: To study the effect of comprehensive rehabilitation treatment on Wassel 4 polydactyly deformity after repair and reconstruction. Methods: 16 patients with Wassel 4 polydactyly deformity after repair and reconstruction were randomly divided into observation group (8 cases) and control group (8 cases) by random number table method. The control group began to wear the ulnar fixed support orthopedic brace for 24 hours immediately after the operation for 6 weeks, until the Kirschner wire was removed. After removing the Kirschner wire, adjust the brace, and then continue to wear the brace for 3-6 months. During the day, remove the brace and move freely, and wear the brace at night before going to bed. In the observation group, on the basis of the control group, the patient’s thumb were treated with rehabilitation techniques such as passive joint movement techniques, joint mobilization techniques and circulatory resistance training techniques, as well as physical factor therapy such as ultrasound therapy equipment. recovery treatment. The MMT scores and ROM of patients were compared between the two groups. Results: The MMT score and ROM of the observation group after intervention were higher than those of the control group. The MMT score and ROM of the two groups after intervention were higher than those before the intervention, and the observation group was better than the control group. The difference was statistically significant (p <0.05). Conclusions: In patients with Wassel 4 polydactyly deformity after repair and reconstruction, the muscle strength and ROM have been significantly improved after comprehensive rehabilitation treatment.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

Correlation analysis of lower limb function and surface myography in stroke patients at different recovery stages

W. Xu¹, H. Wang², M. Wang³

¹Bengbu Medical University, Bengbu, China, ²Zhongda Hospital Affiliated to Southeast University, Nangjing, China, ³The First Affiliated Hospital of Bengbu Medical University, Bengbu, China

Background and Aims: To investigate the characteristics and regularity of the surface EMG of tibialis anterior muscle, gastrocnemius muscle and soleus muscle of lower limbs in stroke patients at different recovery stages.

Methods: Forty patients with stroke were selected and divided into three groups according to stages 3, 4 and 5. Under the maximum voluntary contraction, EMG was used to collect the EMG signals of lower limbs and calf muscles, and then the data were collated and analyzed. Results: The average myoelectric value (AEMG), root mean square value (RMS) and integral myoelectric value (IEMG) of the affected side of stroke patients under different stages; The difference of AEMG, RMS and IEMG between gastrocnemius muscle and tibialis anterior muscle on the affected side were all lower than those on the healthy side (P<0.01). There were significant differences in AEMG, RMS, IEMG, AEMG, RMS and IEMG of the affected side among the three groups (P<0.05), while there were no significant differences in AEMG, RMS and IEMG of the gastrocnemius tibialis anterior muscle in the healthy side under different stages (P>0.05). The lower limb function Fugl-Meyer score was correlated with the tibialis anterior muscle, gastrocnemius muscle and soleus muscle. Conclusions: Ankle joint stability in stroke patients is closely related to functional recovery of lower limbs, strengthening tibialis anterior muscle training and increasing coordination training with gastrocnemius muscle will help stroke patients to recover. Surface EMG has potential application value in clinical evaluation of lower limb function in stroke patients.

Topic: 4. Therapeutics

Sub Topic: 4.6 Neurostimulation (rTMS, tDCS, etc.)

Meta-analysis of the ameliorative effect of functional magnetic stimulation on neurogenic bladder after spinal cord injury

W. Xu¹, H. Wang², M. Wang³

¹Bengbu Medical University, Bengbu, China, ²Zhongda Hospital Affiliated to Southeast University, Nangjing, China, ³The First Affiliated Hospital of Bengbu Medical University, Bengbu, China

Background and Aims: To systematically evaluate the therapeutic effect of functional magnetic stimulation on patients with neurogenic bladder after spinal cord injury, and to explore the therapeutic effect of clinical magnetic stimulation on patients with neurogenic bladder after spinal cord injury.

Methods: To search PubMed, CNKI, VIP and Wanfang databases to date on randomized controlled trials of functional magnetic stimulation in the treatment of neurogenetic bladder after spinal cord injury in both Chinese and English. The search strategy is determined by subject words, title, keywords, etc. Key words include’ magnetic/functional stimulation, magnetic innervation, extracorporeal magnetic stimulation, magnetic field therapy, Spinal cord injury, SCI, Neurogenic bladder, DNB, Neurogenic bladder, NB, Bladder dysfunction, Detrusor Hypermotility, etc’. Chinese search terms are’ magnetic stimulation, functional magnetic stimulation, pelvic floor magnetic stimulation, spinal cord injury, bladder, neurogenic bladder, bladder dysfunction, detractor hyperactivity, etc’. Results: A total of 7 literatures and 7 randomized controlled trials involving 410 patients (experimental group n=203, control group n=207) were included excluding reviews, systematic reviews, meta-analysis, conference papers, etc. Meta-analysis results showed that [MD=6.9, 95%CI (2.77, 11.02), P=0.0007]. Conclusions: Functional magnetic stimulation is effective in improving bladder function and quality of life in patients with neurogenic bladder after spinal cord injury compared to controls.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

The effect of radial extracorporeal shock wave therapy in the treatment of mild to moderate carpal tunnel syndrome

Y. Wu, Y. A. Jiang, S. S. Luo, Y. N. Zhang

Yangpu Hospital,Tongji University, Shanghai, China

Background and Aims: Carpal tunnel syndrome (Carpal tunnel syndrome, CTS) is one of the common peripheral nerve compression diseases, and its incidence is still rising. Because the muscle atrophy caused by CTS is irreversible, early diagnosis and early treatment are necessary. Among them, mild to moderate patients are given conservative treatment. At present, there are many conservative treatment methods used in clinic, but the curative effect is uneven. This study explored the effect of Radial Extracorporeal Shock Wave Therapy (RESWT) on the treatment of mild to moderate carpal tunnel syndrome (CTS). Methods: A total of 40 CTS patients were divided into two groups with 20 cases each according to the random number table method. Both groups of patients were given oral mecobaltamine and regular rehabilitation training. The observation group added REAWT once a week for 4 weeks. The VAS and the Boston Carpal Tunnel Questionnaire (BCTQ) were used to evaluate the clinical efficacy of the patients at the 4 and 8 weeks. Results: After treatment, the VAS scores and The BCTQ scores of the observation group was more significant than that of the control group (P <0.05); while the BCTQ scores of the control group was significantly different only after 8 weeks of treatment. Conclusions: RESWT can further improve the clinical efficacy of mild to moderate CTS, reduce pain, and improve wrist symptoms and function. In clinical practice, RESWT can be recommended as a conservative treatment for patients with moderate CTS.

Topic: 2. Social sciences

Sub Topic: 2.4 Psychology

Living with stigma and low self-esteem: Burns in china - A cross-sectional study

X. Wu¹, Z. Wang¹, Y. Li¹, L. Chen¹, Y. Hu², A. Hu²

¹Sun Yat-Sen University, Guangzhou, China, ²The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

Background and Aims: The burn was a significant public health burden globally, and the psychological problems left by burn are worth paying more attention. Research has shown that eliminating the stigma of burn patients and improving their self-esteem were the effective means to promote social reintegration. The study aims to explore the relationship between stigma and self-esteem among Chinese burn survivors. Methods: A cross-sectional study was conducted among 146 burn survivors in Guangzhou, using Social Impact Scale (SIS), Rosenberg Self-Esteem Scale (SES), and a Socio-Demographic questionnaire. The non-probability purposive sampling technique was used for this study. Results: The mean score of SIS was 57.03±6.762. Among those 2.7% had mild stigma, 66.7% had moderate stigma, 30.8% had severe stigma. Among the four components of SIS, the highest mean score was on social rejection, followed by internalized shame, and the lowest one was financial insecurity. The mean score of SES was 21.05±2.492, which was a marked difference from the norm. Moderate positive correlation(r=0.49) was found between stigma and self-esteem among burns. Furthermore, stepwise regression analysis identified occupation, itching, and score of SES as significant influencing factors, accounting for 34.5% of the total stigma variance. Conclusions: The burn patients have a certain degree of stigma and low self-esteem. Self-esteem is an independent factor that affects patients’ stigma. In order to promote the physical, psychological, and social recovery of patients, it is necessary to make efforts to eliminate stigma and improve self-esteem.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Clinical study of sacral nerve magnetic stimulation in the treatment of primary nocturnal enuresis in children

J. Wu

Xuzhou Rehabilitation Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China

Background and Aims: To explore the clinical value of sacral nerve magnetic stimulation in the treatment of primary nocturnal enuresis in children. Methods: Methods A total of 40 children treated in Xuzhou Central Hospital, Rehabilitation Hospital and Children’s Hospital from October 2019 to September 2020 were diagnosed with primary nocturnal enuresis in children and randomly divided into control group and observation group according to the treatment plan There were 20 cases in each group. Both groups took bladder function training, awakening training, and life and psychological intervention. The observation group added sacral nerve magnetic stimulation based on the first three methods. Before and after treatment, the degree of enuresis, the frequency of enuresis, curative effect evaluation and bladder capacity were evaluated and compared. Results: The two groups of children were improved after 1 month of treatment, and the treatment effect and bladder capacity of the observation group were significantly improved compared with the control group, the difference was statistically significant (P<0.05). Conclusions: Sacral nerve magnetic stimulation can be used as a method to treat primary nocturnal enuresis in children, and it is worthy of clinical application.

References

But I, Faganeij M, Sostaric A. Functional magnetic stimulation for mixed urinary incontinence. J Urol 2005;173:1644-6.
Yamanishi T, Homma Y, Nishizawa O, Yasuda K, Yokoyama O; SMN-X Study Group. Multicenter, randomized, sham controlled study on the efficacy of magnetic stimulation for women with urgency urinary incontinence. Int J Urol 2014;21:395-400.
Suzuki T, Yasuda K, Yamanishi T, Kitahara S, Nakai H, Suda S, et al. Randomized, doubleblind, sham controlled evaluation of the effect of functional continuous magnetic stimulation in patients with urgency incontinence. Neurourol Urodyn 2007;26:767-72.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

The dose-response relationship of subacromial corticosteroid injection in hemiplegic shoulder pain

R. Wissner, R. Wilson, J. Chae

MetroHealth/Case Western Reserve University, Cleveland, USA

Background and Aims: The aim of this study is to determine the dose response of subacromial triamcinolone injection for the treatment of hemiplegic shoulder pain (HSP). Methods: Randomized, double-blind controlled trial of stroke survivors with HSP randomized to subacromial injections of anesthetic plus 20mg(n=9), 40mg(n=9), or 60mg(n=10) triamcinolone and followed for 12 weeks. The primary outcome measurement is the worst pain in the last week. Secondary outcome measures include the upper-extremity Fugl-Meyer score, pain-free shoulder abduction range of motion, and pain-free shoulder external rotation range of motion. Results: There was statistically significant pain reduction in the pooled analysis of all three groups (p = 0.002), however there was no statistically significant difference between groups. Mean (SD) change in Worst Pain from baseline to 12-week period: 1.7 (3.8); 2.2 (3.1); 4.4 (3.1). Eighty percent of participants experienced a >30% reduction in pain in the 60mg group, compared to 55% in the 20mg and 40mg groups. (p = 0.4). Mean (SD) change in upper extremity Fugl-Meyer score between groups was 5.1 (6.2), 5.9 (7.9), and 2.3 (5.1). Mean (SD) change in pain-free shoulder abduction was 33.3 (50.2), 15.4 (18.3), and 28.2 (27.0) degrees; Mean (SD) change in pain-free external rotation was 26.7 (39.0), 14.0 (13.1), and 9.4 (10.6) degrees. Conclusions: Subacromial corticosteroid injection is associated with improvement in pain, upper-extremity Fugl-Meyer Assessment, and pain-free shoulder abduction/external rotation. Although the responder rate with respect to pain reduction was 25% higher with the 60mg dose compared to 20mg or 40mg, this difference did not reach statistical significance, possibly due to limited sample size.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

Baclofen withdrawal symptoms due to spinal CSF leak in a patient with established intrathecal therapy

T. Win¹, S. Balakrishnan¹, A. Mahmood¹, R. Chelvarajah²

¹Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom, ²University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom

Background and Aims: Intrathecal Baclofen Therapy (ITB) is effective in the management of severe spasticity. ITB withdrawal is a potentially life-threatening complication. There are established algorithms to identify potential causes of withdrawal. We would like to share our experience in managing spinal CSF leakage in a patient with spinal cord injury and troublesome neuropathic pain and spasms who was managed initially on intrathecal morphine and subsequently using combination of intrathecal baclofen and morphine.

Methods: A case report based on medical records and investigations. Results: Patient had been managed by local pain team for 18 years and was stable on therapy for 2 years after the last pump revision. After a holiday abroad, patient experienced return of the spasms. Patient was reviewed by local team, ruled out hardware malfunctions and transferred to the implanting centre for further investigations. Catheter aspiration and dye test with CT scan were normal. The baclofen dose was increased and morphine was weaned off and the care was transferred to our service for spasticity follow-up. Patient presented with severe symptoms and abdominal collection and later on with symptoms of low CSF tension. MRI of the whole neuraxis did not show any features of low CSF pressure. However, the abdominal collection on 2 occasions proved positive for CSF. Paraspinal CSF leakage was diagnosed based on that. The whole system was revised and the catheter was re-sited at a different level. Conclusions: This case report highlights the possibility spinal CSF leakage in an established system. We suggest this should be part of the diagnosis algorithm.

Topic: 3. Clinical Sciences

Sub Topic: 3.7 Rehabilitation of Individuals with Post COVID-19 Impairments and Sequalae

Predicting participation and quality of life in covid-19 rehabilitation patients 3 months post-ICU

C. Wiertz¹, S. Sep^1,2, D. A. Lechner³, B. H. M. Michielsen^1,4, J. A. Verbunt^{1, 2, 3}

¹Adelante Zorggroep, Hoensbroek, The Netherlands, ²Research School CAPHRI, Maastricht University, Maastricht, The Netherlands, ³Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands, ⁴Department of Rehabilitation Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands

Background and Aims: Objectives: Describe changes in and predictors of quality of life and participation up to three months after ICU-discharge due to COVID-19. Methods: Participants: Post-ICU COVID-19 patients, referred for inpatient rehabilitation, aged 18y or older. Methods: In this prospective cohort study, data of 67 patients (age 62 ± 11y, 78% male) were collected at 1 and 3 months post-ICU. Self-administered questionnaire outcomes were : quality of life (EQ5D-5L) and participation restrictions (USER-P). Potential predictors analysed by backward linear regression included demographics, retrospective ICU-specific data, and self-reported physical function (PROMIS), breathlessness (MRC), pain (NRS), fatigue (MFI), anxiety and depression (HADS), psychotrauma (GPS) and cognitive complaints (CLC-IC). Results: Subjective health status (p=0.02) and participation (p<0.01) improved between 1 and 3 months post-ICU, whereas changes in generic quality of life were not statistically significant (p=0.19). Higher age, better physical function, less fatigue and less breathlessness were associated with better quality of life, whereas the a longer ICU-stay, thromboembolic complications, pain, anxiety and depression and cognitive complaints were positively associated with participation restrictions at 3 months. Conclusions: A considerable part of post-ICU COVID-19 patients experience restrictions in participation after ICU-discharge indicative for rehabilitation treatment. Although our findings indicate subtle improvement of participation in the first 3 months, quality of life does not improve. Several variables are predictive of quality of life and participation, offering opportunities for personalized care. More research is necessary regarding long term participation and quality of life post-covid-19 to optimize rehabilitation treatment.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (I,e., Spasticity, Immobilization and Frailty)

The spasticity-related quality of life 6-dimensions tool (sqol-6d) in upper limb spasticity: a first psychometric evaluation

J. Whalen¹, L. Turner-Stokes², K. Fheodoroff³, J. Jacinto⁴, J. Lambert⁵, C. de la Loge⁵, P. Maisonobe¹, S. Ashford²

¹Ipsen Biopharm, Slough, United Kingdom, ²Regional Hyper-Acute Rehabilitation Unit, Northwick Park Hospital, London, United Kingdom, ³Gailtal-Klinik, Hermagor, Hungary, ⁴Centro de Medicina de Reabilitação de Alcoitão, Serviço de Reabilitação de adultos, Estoril, Portugal, ⁵Patient-Centered Outcomes, ICON plc, Lyon, France

Background and Aims: To describe the psychometric properties (validity, reliability, responsiveness) of SQoL-6D, a tool designed to assess disease burden and change after focal upper limb spasticity (ULS) therapy. Methods: Multicentre prospective study in adults (>=18 years) with ULS. Patients completed the SQoL-6D at enrolment (Visit [V]1), 8(±2) weeks (V2) and 1–4 days after V2 (re-test). SQoL-6D covers 6 dimensions (pain/discomfort, involuntary movements/spasms, restricted range of movement, caring for the affected limb, using the affected limb, mobility) each rated from 0–4 (4=worse outcome) and a total score (TS) calculated from 0–100 (100=better outcome). Standard ULS measures were also recorded. Results: The SQoL-6D was shown to be unidimensional and demonstrated adequate construct validity, allowing the calculation of a TS. The internal reliability of the SQoL-6D was supported by Cronbach’s alpha (>0.70), while the intraclass correlation coefficient supported the test-retest reliability (0.82). Correlation coefficients with established instruments supported convergent validity, while significant differences between known-groups (of differing clinical severity of weakness) in SQoL-6D TS confirmed its sensitivity. Significant differences in mean SQoL-6D TS change and effect sizes across patients rating ‘Some benefit’ and ‘Great benefit’ (0.51 and 0.88 respectively, Table) supported its sensitivity to clinical change.

Conclusions: SQoL-6D is a promising new measure of patient-reported disease burden and health status in ULS.

Funded by Ipsen.

Topic: 2. Social sciences

Sub Topic: 2.4 Psychology

Difference between short-term and long-term visual memory is greater in individuals with non-alcoholic fatty liver disease

L. de Avila¹, A. Weinstein^1,2, J. Price¹, J. Hakeem², M. Namman², G. Ganganaboina², P. Golabi¹, C. Escheik¹, L. Gerber^{1, 2, 3}, Z. Younossi^1,3

¹Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, United States, ²Center for the Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, United States, ³Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, United States

Background and Aims: Visual memory (VM) is the ability to store and retrieve previously experienced visual sensations and perceptions. Although the neural underpinnings of VM are not well-established, it is likely to be a key to understanding impaired cognitive abilities. The relationship between NAFLD and VM has not been previously examined and therefore the aim of the current project was to determine if individuals with and without NAFLD demonstrate differences in short- and long-term VM. Methods: Individuals between the ages of 25-69 were enrolled in a prospective data collection study at a community hospital. Individuals with excess alcohol consumption or viral liver disease were excluded. NAFLD was diagnosed by sonographic assessment. VM was assessed by the Wechsler Memory Scale (4th Edition) Visual Reproduction test. Results: There were 98 individuals included, 63 individuals with NAFLD (62% male, age:53.5±11.0, BMI:33.6±5.8) and 35 individuals without NAFLD (51% male, age:51.2±13.8, BMI:25.7±4.1). When looking at performance on the immediate and delayed recall trials, there were no statistically significant differences between individuals. However, when comparing delayed to immediate recall performance within each group, individuals with NAFLD had a statistically significantly worse delayed to immediate recall performance (change in score: -7.6±7.3) compared to those without NAFLD (change in score: -4.6±4.80, p<0.05). Conclusions: Individuals with NAFLD were less likely to convert short-term into long-term VM. The ability to achieve VM consolidation may be impacted in individuals with NAFLD. This potential difference in performance needs further study, as impacts on the VM system may be a first indication of additional cognitive performance issues.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Effects of robot-assisted training on cognitive and motor function after stroke: a randomized controlled study

Y. Wang, J. Rong, C. Geng

Shanghai First Rehabilitation Hospital, Shanghai, China

Background and Aims: Cognitive and motor dysfunction are common complications and often coexist after stroke. The effects of robot-assisted therapy on cognitive and motor function are inconclusive. The aims of the study are to examine the effects of robot-assisted training on cognitive and motor function after stroke. Methods: Sixteen stroke patients were randomized assigned into the experimental group (N = 8) or control group (N = 8). In addition to conventional therapy, the experimental group received robot-assisted training, for 20 min/day and 7 days/week for 3 weeks. Before and after intervention, the MoCA, Fugl-Meyer Assessment Upper Limb subscale, the modified Barthel Index were measured. Results: All measurements improved significantly in experimental group following intervention (p<0.05). In addition, the control group showed a certain improvement trend, but did not reach statistical significance (p>0.05). The MoCA score was improved significantly in the experimental group compared with the control group (p<0.05). No serious adverse events were reported. Conclusions: Robot-assisted training can significantly improve cognitive and motor function in stroke patients. The finding supports the application of robot-assisted training as provided in this trial in routine clinical practice.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

Observation on the effect of low-temperature impact analgesia on knee joint pain and swelling after total knee arthroplasty

Y. Wang

Shanghai Yangpu District Central Hospital, Shanghai, China

Background and Aims: TKA is an effective treatment for knee joint diseases that are ineffective in conservative treatment. However, after knee replacement, joint swelling and pain are often accompanied by problems. TST is an effective treatment measure to solve the above problems. The research is to explore the clinical effect of TST on knee joint pain and swelling after TKA. Methods: Selected from December 2019 to December 2020 in our hospital, 48 cases of knee replacement patients were divided into observation group and control group with 24 cases each according to the random number table method. Both groups were given general rehabilitation training. The observation group was treated with TST and used once/day, 1 Min/time after rehabilitation training; the control group was added with ice packs and used once/day after rehabilitation training. 10Min/time. Both groups were treated for 1 week. Before and after treatment, the visual analogue scale (VAS) was used to evaluate the knee joint pain; the knee circumference was compared before and after the knee joint circumference, and the circumference was measured at the midpoint of the suprapatella when the knee was flexed at 5°. Results: After treatment,compared with the control group at the same time after treatment, the observation group’s VAS score was significantly lower, the knee circumference decreased more significantly, and the difference was statistically significant. Conclusions: TST has a good clinical effect on knee joint pain and swelling after TKA.

Topic: 7. Functioning and Disability

Sub Topic: 7.2 Classification Systems (ICD, ICHI, ICSO-R)

A model for assessing knee joint health: contribution of principle component analysis and weighted rank-sum ratio method for pain and function in elderly patients with knee osteoarthritis

M. Wang¹, H. Chen¹, X. Zheng², Y. Wang¹, S. Shang¹, K. Chen¹, Y. Wang³

¹Peking University School of Nursing, Beijing, China, ²The Open University of China, Beijing, China, ³Peking University School and Hospital, Beijing, China

Background and Aims: Knee osteoarthritis (KOA) is one of the top ten disabling diseases. Accurate evaluation is the basis for the treatment of KOA and is of great significance to clinical practice. However, there is a lack of more objective comprehensive evaluation criteria for symptoms and functions. Therefore, the purpose of this study is to explore the comprehensive evaluation and grading of symptoms and functions in patients with KOA. Methods: A total of 5 indicators from the baseline data of three studies conducted during 2014-2020 were selected, including pain, Five-Times-Sit-to-Stand Test (FTSST), Timed Up and Go test (TUG), Six-Minute Walk Test (6MWT) and Five-Stairs Climb Task (5SCT). Principal component analysis (PCA) was performed to calculate the weight of each indicator, and the weighted rank-sum ratio (WRSR) method was performed to determine the three-level grading thresholds. Results: The baseline data of 200 elderly patients with KOA were analyzed. PCA identified two components explaining 86.91% of the variance. According to the eigenvalue, explained variance and loading value, the weights of each parameter are 22.26%, 19.85%, 19.69%, 20.63% and 17.57%, respectively. The obtained weight was introduced into WRSR method to obtain the WRSR fitting value =-16.428+5.118*Probit (F=4345.925, P<0.001), and the three-level grading thresholds are 4.044 and 14.28. 200 patients were judged as grade 1 with 31 patients, grade 2 with 137 patients and grade 3 with 32 patients. Conclusions: PCA and WRSR method can be used to comprehensively evaluate and grade the symptom and function of KOA, which provides a low-cost and effective model for assessing knee joint health.

Topic: 3. Clinical Sciences

Sub Topic: 3.3 Diagnosis

Clinical study on correlation the functional status of upper limb motor neurons with motor function in patients with stroke

Z. Shao^1,2, T. Zhou¹, W. Chen¹, B. Liu¹, X. Zhu¹, Y. Gong¹, J. Huang¹, Y. He¹, J. Xiang², H. Wang¹

¹Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University, Nanjing, China, ²Department of Rehabilitation Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China

Background and Aims: To explore the correlation between the functional status of upper limb motor neurons and motor function in stroke patients, and to provide guidance for rehabilitation assessment and functional prognosis. Methods: Motor unit number estimation (MUNE) and F wave were examined in forty-two stroke patients to evaluate the functional status of motor neuron. Fugl-Meyer Assessment (FMA) and modified Ashworth score (MAS) were used to evaluate upper limb motor function, and the correlation between electrophysiological parameters and FMA score, MAS score were analyzed respectively. Results: The MUNE of the abductor pollicis brevis on the affected side was lower than the unaffected side (P<0.01); the percentage of F waves with different shapes on the affected side was lower than the unaffected side (P<0.001); the F/M ratio on the affected side was higher than the unaffected side (P<0.001); the F wave latency and amplitude on the affected side were not statistically significant compared with the unaffected side; The affected/unaffected side ratio of the percentage of F waves with different shapes was positively correlated with FMA score (P<0.05). The correlation analysis between the affected/unaffected side ratio of MUNE and FMA score was not statistically significant; in patients with flexor carpi MAS score >=1+, the affected/unaffected side ratio of the F/M ratio was positively correlated with MAS score (P< 0.05). Conclusions: Stroke may result into the number of functional motor neurons of the upper limbs of the hemiplegic side decreased and the excitability of motor neurons increased simultaneously, which were related to motor function and muscle tone.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

The effects of transcutaneous electrical acupoint stimulation on upper-limb impairment after stroke

H. Wang¹, J. Jia¹, Y. Chen², Y. Xiang², C. Wang³

¹Rehabilitation Department, Huashan Hospital, Shanghai, China, ²Rehabilitation Department, Shanghai Third Rehabilitation Hospital, Shanghai, China, ³Shanghai University of Sports, shanghai, China

Background and Aims: To investigate whether transcutaneous electrical acupoint stimulation (TEAS) can improve upper limb motor recovery in post-stroke rehabilitation. Methods: Two hundred and four stroke patients with unilateral upper limb motor impairment were recruited in this prospective, multicenter, double-blinded randomized trial. Patients were randomized 1:1 to receive TEAS or sham TEAS therapy. TEAS therapy was applied to two acupoints (LI10 and TE5) with a pulse duration of 300 µs at 2Hz on the affected forearm 30min/day, 5days/week, for 6 weeks. The sham group received identical treatment, while the electrical circuit was disconnected internally. The upper-extremity section of the Fugl-Meyer assessment (FMA-UE), Manual Muscle Testing, Modified Ashworth Scale, Lindmark hand function score, and Barthel Index were evaluated at baseline, every 2 weeks during the treatment period, and 4 and 12 weeks after completion of treatment. Results: Ninety-nine patients in the TEAS group and 97 patients in the sham group completed the 6 weeks of intervention. No statistical difference was observed at baseline assessment for all outcomes. At 18 weeks, the TEAS group showed greater improvements in wrist extension strength than the sham group (P<0.05). A favorable trend for better improvement of the distal part of FMA-UE in the TEAS group was also observed, albeit not significant. Beyond that, there were no significant differences in all other outcomes between the two groups.

Conclusions: This study suggests that TEAS therapy applied to hemiplegic forearm contributes to muscle strength improvement, and provides potential benefits for motor recovery of hand and wrist.

Topic: 5. Engineering and Technology

Sub Topic: 5.3 Robotics

Effects of transcranial direct current stimulation combined with rehabilitation robot on hand function in patients with subacute stroke

C. Wang¹, J. Jie²

¹Chinese Association of Rehabilitation Medicine, Beijing, China, ²Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China

Background and Aims: Hand motor dysfunction after stroke is one of the most serious disorders affecting the daily life of stroke patients, and there is still less effective rehabilitation methods to solve this problem. In recent years, transcranial direct current stimulation (tDCS)combined with rehabilitation robot has become a new combination therapy for hand function rehabilitation after stroke, but the effectiveness of this therapy still needs further clinical research to prove. Therefore, the purpose of this study is to study the rehabilitation effect of tDCS combined with hand functional rehabilitation robot on subacute stroke patients. Methods: 40 patients with subacute stroke were randomly divided into two groups. The experimental group received tDCS for 20 minutes and then received rehabilitation robot therapy for 30 minutes, while the control group received sham stimulation for 20 minutes and rehabilitation robot therapy. Hand function was evaluated Before and after 4 weeks treatment, including Fugl Meyer assessment upper extremity scale (FMA-UE),, box and block test (BBT), action research arm test (ARAT), and modified Barthel index, MBI), grip strength and pinch strength of affected hand. Results: After statistical analysis, the indicators of the two groups before and after the intervention were statistically significant progress. The scores of FMA-UE, MBI and grip strength in the experimental group were significantly different from those in the control group after intervention, and no statistical significance was found in the other indexes. Conclusions: tDCS combined with rehabilitation robot has rehabilitation effects on hand function of patients with subacute stroke.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Bladder management assistance predisposing factor analysis in spinal cord injury patients in the subacute rehabilitation period

P. Vorobjovs¹, A. Nulle¹

¹National Rehabilitation Center Vaivari, Jurmala, Latvia, ²Riga Stradins University, Riga, Latvia

Background and Aims: Neurogenic bladder dysfunction is one of life-threatening conditions in spinal cord injury patients. The aim of the study collect and analyze data about bladder management methods and assistance predisposing factors for patients with spinal cord injury in the subacute rehabilitation period. Methods: Information was collected in 2020 from the medical records of 125 patients with a spinal cord injury admitted for primary rehabilitation course. The data regarding assistance necessity, bladder management method, spinal cord injury clinical manifestation, injury etiology, completeness of spinal cord injury was analyzed. Results: At the moment of the discharge from the rehabilitation center 87 (69,6%) patients were able to performe bladder management without assistance, 38 patients (30,4%) needed assistance. Assistance necessity showed statistically significant difference in spinal cord injury etiology subgroups (p = 0,021), completeness of spinal cord injury subgroups (p = 0,001), clincal manifestation subgroups (p = 0,001), bladder management subgroups (p <0,001). The most significant bladder management assistance prediction factors were shown the association of clinical manifestation factor – tetraplegia (p <0,001) and completeness of injury factor – complete injury (p = 0,001). Conclusions: Research findings suggest that bladder management assistance predominantly associated with traumatic spinal cord injury etiology, complete spinal cord injury (ASIA scale A), tetraplegia clinical manifestation. Among bladder management methods assistance predominantly was needed in patients group who perform clean intermittent catheterization, use an indwelling and suprapubic catheter and external collection devices. The most significant bladder management assistance prediction factors were tetraplegia and complete injury spinal cord injury.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Plasmablastic myeloma: Unusual cause of peripheral facial paralysis

J. P. Vieira Dias¹, D. Costa², V. Marques¹, L. Dias¹

¹CHMAD - Serviço de Medicina Fisica e de Reabilitação., Vila Real, Portugal, ²CHP - Serviço de Medicina Fisica e de Reabilitação., Porto, Portugal

Background and Aims: Peripheral Facial Paralysis is the most common mononeuropathy. Most cases are idiopathic; however, some have rare etiologies such as neoplasms. The purpose of this study is to raise awareness of less common causes of Peripheral Facial Paralysis. Methods: The authors present the clinical case of a 60-year-old patient, evaluated in the Emergency Service as a left Bell’s Paralysis case with one day of evolution, grade VI of House-Brackmann. No significant alterations were observed in the complementary diagnostic exams. He started therapy with corticosteroids and acyclovir and was referenced to the Physiatrics consultation. During the course of physiatric treatment, and in a reevaluation consultation, he presented asthenia, anorexia and weight loss and improvements at the level of neurological deficits were not identified. On physical examination, he presented icteric skin and icteric mucous membranes, left retroauricular swelling was visible and palpation was painful, so he was referred to the ORL. On computerized tomography were seen space-occupying lesions with bone invasion, periaortic adenopathic conglomerate, globose liver and pancreas conditioning obstructive jaundice. Ears and neck magnetic resonances revealed infiltrative formation of the parotid gland, neck muscles and infiltration of the holes at the base of the skull. The mastoid apophysis was clearly invaded. Results: This patient was transferred to the Hematology Service, where bone marrow and supraclavicular mass biopsies revealed plasmablastic myeloma. Conclusions: Plasmablastic myeloma is a morphological subtype of multiple myeloma with poor prognosis. Early diagnosis is challenging as the symptoms develop later in the course of the disease.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Post stroke cognitive impairment after minor to moderate stroke

A. Vieira¹, P. Martins¹, J. Ramos¹, F. Rodrigues¹

¹Hospital Central do Funchal, Funchal, Portugal, ²Hospital S. João, Porto, Portugal

Background and Aims: Stroke is an important cause of cognitive impairment and dementia. with prevalence of post stroke cognitive impairment (PSCI) ranging from 25 to 81% of patients. There is an association between PSCI and poor rehabilitation results after stroke. MoCA is a reliable cognitive instrument that can be used to screen for PSCI. Methods: We selected patients admitted to the stroke unit of São João Universitary Hospital Center, from November to December 2020, and applied the Montreal Cognitive Assessment Test. Results: The population was composed of 25 individuals. The average NIHSS score at unit admission was 4.12 and 4 had underwent thrombolysis. MoCA score had mean=21, 28, the most impacted domain was the short-term memory (mean=1.08) with spatial and temporal orientation being fairly preserved (mean= 5.72). After normalizing the score for their age and education there were 16% (n=4) that had score significantly inferior to what would be expected for them. Conclusions: This study has some important limitations, such as the small number of patients evaluated, lacking of a pre-stroke cognitive status evaluation, additionally the tests were done in a stroke unit that can have several distractions and weren’t assessed for depression. Yet, after normalizing for age and educational, there were some patients that screened with cognitive impairment and therefore were signaled for cognitive rehabilitation. As cognitive symptoms are not always necessarily detected before discharge, and can have an impact in the rehabilitation process, it is important to implement screening tests after stroke.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Chopart amputation revision: “Please Cut Here” - A case report

X. Verraest¹, B. Lopes², I. Ferro¹, F. Ermida¹, F. Carvalho¹, J. Laíns¹

¹Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, Tocha, Portugal, ²Centro Hospitalar Tondela-Viseu, Viseu, Portugal

Background and Aims: The primary goal after limb amputation is to maximize function. In children, it is useful to preserve length and growth plates, perform disarticulation and stabilize limb’s proximal portion. Chopart amputation excises a greater portion of the midfoot and disarticulates the talonavicular and calcaneocuboid joints. Methods: A 38-years-old men, with a history of bilateral Chopart amputation after a severe burn at age one, is a recurrent outpatient in our Rehabilitation Center for prosthetic evaluation. Seven years ago, he developed a pressure ulcer in the stub distal extremity and after 2 years, also in the contralateral side. Considering the functional repercussion, incapacity of ambulation and prosthesis use, he required an amputation revision. A transtibial bilateral amputation was performed in 2016, followed by an individualized rehabilitation program for prosthesis use. The patient experienced an improvement in life quality, functional status and gait pattern, with no further skin lesions or stub pain. Results: Historically, the utility of traditional midfoot amputations is considered to be low, given the high rates of subsequent proximal revision amputations. This amputation level allows the patient to place their stub on the ground, making short distance ambulation possible with low metabolic walking cost, especially in small children. Nonetheless, it’s commonly associated with equinovarus contracture, with consequent subtalar joint instability, excessive anterior weightbearing and distal ulceration. Conclusions: There are multiple determinants involved in a successful prothesis. It’s crucial to understand the functionality potential that can be achieved with different levels of amputation, in order to limit prosthesis complications and improve patient’s life quality.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Ultrasound-guided barbotage for rotator cuff calcific tendinitis in physical medicine and rehabilitation Clinics

E. Vaquero Ramiro¹, J. De Lamo Rovira², C. Tafur Urueña¹, J. Santana Canchanya¹, R. Sancho Loras¹

¹Department of PMR, Hospital Virgen de La Luz, Cuenca, Spain, ²Department of Orthopaedic Surgery, Hospital Virgen De La Luz. Cuenca, Spain

Background and Aims: Calcific tendinopathy is a common disease associated with shoulder pain. This study describes the results of ultrasound-guided barbotage for rotator cuff calcific tendinitis in PMR clinics.

Methods: Patients were included who had painful calcific deposits >5mm in the supraspinatus tendon, confirmed on radiologic examination. Exclusion criteria were other shoulder diseases, use of anticoagulants, or previous extracorporeal wave shock therapy. After administration of local anesthesia (10ml 1% mepivacaine), US-guided needling and lavage of calcifications were performed using a single needle. All patients received a subacromial steroid after the barbotage. Size and Gartner classification were measured on radiographs, before the procedure and 8 weeks afterward. Reduction of the calcific deposit was graded as none, partial or complete. Results: 22 patients were included (mean age 55.2 ± 9.6 years SD), 72,7 % female. The dominant arm was affected by 66.0 %. Calcium deposits were Gartner I in 86.4% and Gartner II in 13.6%. The average area size of the calcification before treatment was 58.8 mm2 (range 119.3mm2-23.5 mm2). Calcic material was obtained in 81,8% of procedures. The mean size of the deposits decreased to 26.6 mm2 (p<0.05). Calcifications disappeared completely in 45.5% and partially in 27.7% of the patients. No adverse events were recorded. Two patients underwent an additional procedure during the follow-up period because of persistent symptoms and no resorption. Conclusions: Ultrasound-guided barbotage is a safe and effective procedure that can be performed by physical medicine and rehabilitation specialists in outpatient clinics.

Topic: 3. Clinical Sciences

Sub Topic: 3.2 Pain Osteoporosis -Osteoarthritis

Prevalence of neuropathic pain in osteoarthritis

I. Urbano, M.E. Zuluaga, C. Baena

¹Universidad del Valle, Cali, Colombia

Background and Aims: Different factors contribute to severely decrease quality of life in patients with osteoarthritis. Historically, osteoarthritic pain has been the most important reported symptom, and usually has been classified as somatic pain. However, recent studies have shown that neuropathic pain may play an important role in the underlying pathological mechanisms of the disease. Despite that effective tools are currently available for the diagnosis of neuropathic pain in daily clinical practice, the prevalence of neuropathic pain in osteoarthritis is still unknown. Objective: To determine the prevalence of neuropathic pain in patients with osteoarthritis who received medical attention in an outpatient pain clinic in southwestern Colombia.

Methods: A cross-sectional study was carried out, using The Leeds questionnaire for the Evaluation of Symptoms and Signs of Neuropathic Pain on telephone versions and the perception of the general state of health. Results: The prevalence of neuropathic pain in our sampled population of patients with osteoarthritis was 28%, of which 84% were women. Symptoms associated with neuropathic pain, such as dysesthesias and paroxysmal pain were present in 92% of patients. 60% of the patients perceived their general state of health as ‘fair’. Conclusions: Neuropathic pain in osteoarthritis is a very frequent condition that is poorly recognized. More studies are needed and with a greater number of patients.

References

Schaible HG. Osteoarthritis pain. Recent advances and controversies. Curr Opin Support Palliat Care 2018;12:148-53.
Thakur M, Dickenson AH, Baron R. Osteoarthritis pain: Nociceptive or neuropathic? Nat Rev Rheumatol 2014;10:374-80.

Topic: 1. Biomedical sciences

Sub Topic: 1.1 Biomechanics

Direction-dependent differences in the movement characteristics of horizontal reaching in patients after stroke

S. Uehara¹, A. Yuasa², K. Ushizawa², S. Kitamura¹, Y. Obayashi³, K. Ito³, Y. Otaka²

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

Background and aims: Reaching function is often impaired in patients after stroke. It remains unclear, however, whether reaching characteristics differ depending on aiming directions and how they change along with functional improvement. The present study aimed to elucidate direction-dependent kinematic differences of reaching in post-stroke participants. Methods: Twelve and 10 patients with mild-to-moderate (score of Fugl-Meyer Assessment, 40 to 66) and severe (4 to 30) hemiparesis performed horizontal reaching with their affected and unaffected sides on a robot (KINARM). They performed rapid reaching toward targets displayed in one of eight positions arrayed radially at 10 cm from a central starting position. We analyzed data at admission (time after onset, mean of 36.4 and 44.8 days for each group) and at discharge (60.3 and 103.0 days). As proxies for kinematic parameters, we computed the movement time, path length, and the number of velocity peaks for the mild-to-moderate group while the total amount of displacement separately for mediolateral and anteroposterior directions for the severe group. Results: Mild-to-moderate cases showed decreases in movement parameters when reaching toward anteroposterior directions irrespective of the hands or functional improvement over time. As if significantly affected by this direction-dependent difference in the level of difficulty, severe cases tended to exhibit a greater amount of mediolateral movement at admission and then expand their movement toward the anteroposterior direction along with functional improvement. Conclusions: The performance of reaching tends to degrade in the anteroposterior direction irrespective of the hands, which may impact the pattern of movement appearance specifically for patients with severe hemiparesis.

Topic: 3. Clinical Sciences

Sub Topic: 3.9 Cardiac/ Pulmonary Rehabilitation

Efficacy and safety of the awake prone positioning in patients with COVID-19 related respiratory distress: A scoping review

T. Uddin¹, N. Siddiquee², A. Khandaker¹, M. Bashar³, H. Rahim⁴, S. Islam¹, B. Amatya⁵

¹Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, ²United Hospital, Dhaka, Bangladesh, ³Shaheed Ziaur Rahman Medical College Hospital, Bogra, Bangladesh, ⁴Combined Military Hospital, Dhaka, Bangladesh, ⁵Royal Melbourne University Hospital and the University of Melbourne, Victoria, Australia

Background and Aims: COVID 19 pandemic overwhelmed the health care facilities globally. Patients with COVID-19 presents with mainly respiratory problems and the treatments are mostly supportive. Prone positioning (PP) is emerging as important treatment modality for the management of COVID-19 related respiratory distress syndrome. The aim of this review was to evaluate effectiveness and safety of awake PP in non-intubated patients with COVID-19 related acute respiratory distress at different care settings. Methods: The study was conducted during December 1, 2019 to August 30, 2020 using health science electronic databases and grey literature. PRISMA flow chart was used for preparing the manuscript. 338 studies were identified initially and after careful screening and eligibility check finally 06 studies with 187 patients were included for review.

Results: All the 06 studies were done in developed countries. Male patients were predominating with the mean age of approximately 55yrs. Oxygenation was improved in 79.14% patients. 157 (83.95%) patients with COVID-19-related hypoxemic respiratory distress tolerated the procedure. 25.41% of the patients required intubation or mechanical ventilation and 06(3.2%) patients expired. Number of patients in the reported studies could tolerate more than 03hrs of pp without a major side effect.

Conclusions: Awake proning improved oxygenation of the patients suffering from COVID-19 related respiratory hypoxia in different care settings. Early instituted prone positioning may be an effective alternative method of treating COVID-19 related respiratory distress particularly while waiting for positive pressure ventilation. Patient compliance, heterogeneity and small size cohort studies are the limitations of this review. Multicenter controlled studies are therefore recommended.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Recent trends on the role of physical modalities in the rehabilitation program for patients with rheumatoid arthritis

I.-.A. Tzanos¹, P. Tsatsani², E. Koutsantoni², D. Moshou², G. Fragoulis³, E. Grika⁴, A. Tsilioni⁴, G. Liantinioti³, M. Tziafalia⁴, S. Gazi², A. Kotroni¹

¹Department of PRM, KAT General Hospital, Athens, Greece, ²Department of Rheumatology, KAT General Hospital, Athens, Greece, ³Department of Rheumatology, LAIKO General Hospital, Athens, Greece, ⁴Department of Rheumatology, EVAGGELISMOS General Hospital, Athens, Greece

Background and Aims: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that affects mainly women. Its’ main clinical course includes symmetrical and destructive polyarthritis. The small joints of the hand and feet are predominantly affected. Additionally to pharmacological treatment, various rehabilitation protocols have been proposed including functional assessment, therapeutic patient education, exercise therapy, physical agents, orthoses, assistive devices, dietary interventions and balneotherapy. The aim of this study is to document the recent data regarding the efficiency of physical modalities as a component of a rehabilitation program for patients with RA. Methods: We conducted bibliographic research of the last 8 years in the scientific search engines, PubMed and Cochrane Library. Keywords used were rheumatoid arthritis, rehabilitation, physical modalities and physical agents. Results: Nineteen original studies regarding physical modalities conservative treatment for rheumatoid arthritis patients were included in this review. It was reported that the appropriate and individualized use of thermotherapy, including paraffin baths, cryotherapy and ultrasound, has potential beneficial effects on pain, range of motion, function and activity. Electrical stimulation for muscle atrophy of the hand, and Transcutaneous Electrical Nerve Stimulation (TENS) – conventional or acupuncture-TENS – for pain alleviation have also been reported as effective rehabilitation options. Low-level Laser Therapy (LLLT) has been also highlighted as a possible measure to increase flexibility and to reduce pain and stiffness. Intermittent Whole-Body Vibration (WBV) has been also proposed for preventing bone mass loss and fatigue occurrence. Conclusions: Thermotherapy (deep and superficial), electrotherapy, LLLT and WBV are the main effective physical agents for patients with RA.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Plantar fasciitis: A current literature review of the conservative interventions

I.-.A. Tzanos, S. Sivetidou, E. Tzani, A. Anamorlidis, E. Damianakis, O. Nikolaidou, S. Migkou, A. Sabanis, A. Papaspyrou, E. Simopoulou, A. Kotroni

Department of PRM, KAT General Hospital, Athens, Greece

Background and aims: Plantar fasciitis is a common cause of musculoskeletal foot pain among adults and especially women. The aim of this study is to highlight the various effective conservative measures for this syndrome that have been identified by recent research. Methods: Bibliographic research of the last 5 years in the scientific search engines, PubMed, Google Scholar, Uptodate and Cochrane Library. Keywords used were plantar fasciitis conservative and plantar fasciitis treatment. Results: The database search featured 41 original studies that were relative with conservative treatment for plantar fasciitis. We excluded 17 studies for several reasons. Analyzing the rest studies, it was generally approved that rest, ice, NSAIDS, passive stretching, orthotics (mainly silicon cups) and night splints are the main globally used treatment options at the initial stage. For patients that do not respond to the these measures, the application of corticosteroid, platelet rich plasma or autologous blood injections and the extracorporeal shock wave therapy have been identified as the most effective options. Conclusions: Since there are various effective conservative therapeutic options for patients with plantar fasciitis, it is important to utilize at first all the applicable alternatives before considering surgery as a mandatory.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Timed up and go test and fall history in older adults during COVID-19 pandemic

Z. Turan, O. Ozyemisci Taskiran

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

Background and Aims: In pandemic, physical activity of people was affected due to curfew. The aim of this study was to evaluate the gait and fall history in older patients who admitted to the PMR outpatient clinic during the pandemic. Methods: Among 120 patients, 98 patients (72 women, 26 men) aged >=65 years were enrolled to this retrospective study between July and December 2020. The patients with severe orthopedic or neurologic diseases or history of COVID-19 were excluded. Diagnosis, comorbidities, fall history, timed up and go test (TUG) and SARC-F questionnaire were recorded from hospital medical records. Results: Median age, TUG duration and SARC-F was 73 years, 8.4 seconds, and 2, respectively. The prevalence of fall was 26%. Patients with SARC-F >=4 had longer TUG duration, higher prevalence of lower extremity problems and fall history (p<0.001, p=0.013 and p=0.003, respectively). Although, TUG was positively correlated with age and SARC-F, prevalence of fall history did not differ between patients with TUG>=13.5 and <13.5 (p=0.577).

Conclusions: Prevalence of fall history during pandemic was similar to that of community dwelling people. It was interesting to note that median TUG duration of all patients was lower than the cut-off value for an increased fall risk (>=13.5). Prevalence of fall history was not higher in patients with longer TUG. Since the study was conducted in patients attending to outpatient clinic, these results cannot be generalized to the general population.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Comparison of peak oxygen consumption during exercise testing between sexes among children and adolescents in southern Taiwan

S. Tuan¹, G. B. Chen², I. H. Liou³, K. L. Lin³

¹Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung City, Taiwan, ²Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan, ³Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan

Background and Aims: Studies among Western children observed that boys’ peak oxygen consumption (peak VO2) values are higher than those of girls, and this difference increases as children progress through adolescence. However, the process of maturation and the social expectation toward boys and girls in Eastern are much different from Western countries. We aimed to provide baseline information on cardiopulmonary fitness of children and adolescents in relation to age and sex in Taiwan. Methods: We conducted a retrospective study among children and adolescents aged 4 to 18 years in Taiwan. The participants were classified to 4 groups based on age (group 1 from 4 to 6, group 2 from 7 to 9, group 3 from 10 to 13, and group 4 from 14 to 18 years old). All the participants completed symptom-limited exercise test by treadmill and anthropometric measurements by bioelectrical impedance method. Results: 897 (448 males, 449 females) were analyzed at final. Boys had higher peak VO2(all p < 0.01) and peak metabolic equivalent (all p < 0.05) than girls in all the four groups. Sex differences in fat-free mass index was significant in all the 4 groups while a significant difference in fat-mass index and body mass index between sexes was observed only in group 2 to 4 and group 3, respectively. Conclusions: We found that the difference of peak VO2and anthropometry-body composition between sexes was observed earlier in Taiwan children than those in Western countries.

No.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Using progressive resistance training with elastic band to treat sarcopenia among older people in the daycare center ~ An experience from southern rural Taiwan

S. Tuan¹, C. H. Lee¹, S. Y. Chen¹, I. H. Liou²

¹Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung City, Taiwan, ²Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan

Background and Aims: Progressive resistance exercise improve muscle strength and function in elders with sarcopenia. We aimed to assess the clinical effectiveness of progressive resistance training by using the elastic band (ERT) in the treatment of sarcopenia. Methods: We recruited elders with sarcopenia, participating in rural daycare center prospectively. The ERT lasted for 12 weeks, two times per week, and thirty-minutes per time, with the aim at strengthening the main muscle groups in the trunk and four extremities. Criteria of sarcopenia including (1) handgrip strength of dominant hand (HGS),(2) walking speed, and(3) appendicular skeletal muscle mass index (ASMI), were primary outcomes. (1) Range of motions in dominant upper extremities (ROM), (2) maximal voluntary isometric contraction of biceps/triceps brachial muscles of dominant side (MVC of biceps/triceps), (3) box and block test (BBT), and (4) circumference of mid-arm and mid-calf, were secondary outcomes. Results: Data from 25 elders were analyzed at the end. There were significant improvements in (1) MVC of biceps, (2) BBT score,(3) circumference of mid-arm and mid-calf, (4) ROM of shoulder flexion, external rotation and abduction (all p<0.05). Though there was a trend of increased in the other outcomes, no significance reached. No major adverse events like fall or fracture was occurred during the whole course of ERT. Conclusions: ERT is manpower-sparing and might be helpful in treatment of sarcopenia in elders in daycare center. Studies with longer intervention and larger participants are warranted to show the effectiveness of ERT in the change of body composition.

No

Topic: 3. Clinical Sciences

Sub Topic: 3.6 Preventive Rehabilitation

Longitudinal change in life-space mobility and its influencing factors among chronic community-dwelling post-stroke patients

S. Tsunoda^1,2, S. Shimizu², Y. Suzuki², A. Tsunoda³, R. Yamada², R. Shimose⁴, M. Ogura², A. Matsunaga²

¹Department of Rehabilitation, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan, ²Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan, ³Department of Rehabilitation, Chigasaki Tokushukai Hospital, Chigasaki, Japan, ⁴Department of physical therapy, Okayama Healthcare Professional University, Okayama, Japan

Background and Aims: Limited life-space mobility leads to less frequent participation in social activities, a decline in the quality of life and an increased risk of adverse health outcomes such as hospitalization. However, the yearly change in life-space mobility in post-stroke patients has not yet been reported. This study aimed to identify the longitudinal change in life-space mobility and its influencing factors among chronic stable post-stroke patients. Methods: This prospective study comprised 75 Japanese post-stroke patients (median age, 74 years at baseline; time from onset, 75 months at baseline) who received day-care rehabilitation services in the community and could be assessed for life-space mobility three times (at baseline, 12 months and 24 months), during a period of over two years. Life-space mobility was evaluated using the Life-Space Assessment (LSA) tool. Self-selected comfortable gait speed (CGS) and cognitive function (Mini-Mental State Examination [MMSE]), and Functional Independence Measure Motor subscales [FIM-M] were collected as time varying variables in addition to clinical characteristics including age, gender, time from onset, stroke type, and comorbidity. A multivariable linear mixed effects model examined the longitudinal change in LSA scores and its associated factors. Results: LSA scores were significantly declined during two years. In a multivariate linear mixed effects model that adjusted for clinical characteristics, only CGS was significantly associated with the change in the LSA score, independently of FIM-M and MMSE. Conclusions: These findings suggest that life-space mobility may persistently decline and gait function may be a determinant factor influencing its change in chronic community-dwelling post-stroke patients.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Effects of exergames combined with exercise training on physical performance for elderly living in long-term care facilities: A meta-analysis

R. T. Tsai¹, I. T. Hsu², J. J. Luh¹, Y. Y. Lee¹

¹Chool and Graduate Institute of Physical Therapy, National Taiwan University, College of Medicine, Taipei, Taiwan, ²Department of Rehabilitation, Taipei Municipal Hoping Hospital, Taipei, Taiwan

Background and Aims: The population of elderly residents living in long-term care facilities is increasing with the trend of aging. These residents are frail and disable, and immediate intervention to maintain their physical function is urgently needed. As technology progress, exergame systems have been used widely for people with handicaps and have been conceived and studied to improve physical function for older adults, including the aged nursing home residents. The purpose of this study was to conduct a meta-analysis to determine whether an exergame program helped improve physical function in these residents. Methods: The RCTs evaluating the effects of exergame programs (Wii, kinetic, or virtual reality) for nursing home residents would appraise by searching in Pubmed. Quality assessments of included articles and data extraction were conducted independently by two reviewers. Results: The search strategy identified 98 records, of which 7 studies were thought to be eligible. Pooled results showed significant differences in BBS (mean difference [MD]: 0.93, 95% CI: 0.58 to 1.27), TUG (MD: -1.06, 95% CI -1.84 to -0.28), muscle strength of lower extremity (SMD: 0.62, 95% CI: 0.28 to 0.96), and gait velocity (SMD: -0.43, 95% CI: -0.81 to -0.05) between groups. Conclusions: This review provides limited evidence for exergame programs on the physical function of these residents. Compared with conventional programs alone, the exergame with regular training showed superior effects in improving the balance, mobility, muscle strength, and gait speed of residents in long-term care facilities. Further research of RCTs in this domain is ungently required to extend and concrete the evidence base.

Topic: 4. Therapeutics

Sub Topic: 4.6 Neurostimulation (rTMS, tDCS, etc.)

Functional near infrared spectroscopy-guided target localization for rtms treatment in poststroke hemiplegia

P. W. Chang¹, C. F. Lu^2,3, P. Y. Tsai^1,4

¹Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ²Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan, ³Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan, ⁴School of Medicine, National Yang-Ming University, Taipei, Taiwan

Background and Aims: Repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to enhance long-term effects of upper extremity motor recovery in stroke survivors, but there existed a high variability in treatment responsiveness. The conventional target determination by means of motor evoked potential is not consistently obtained. Recently, near-infrared spectroscopy (NIRS) has been used for brain mapping and cortical activity monitoring after stroke by measuring cortical hemodynamic activation. The purpose of the study was to assess the efficacy of fNIRS-guided target localization for rTMS treatment in stroke patient with upper-limb motor deficits. Methods: Thirty-five participants with ischemic or hemorrhagic stroke participated in this randomized, sham-controlled study. The patients were randomly assigned to two groups: fNIRS-Theta burst stimulation (TBS, n=20) and sham (n=15) group. Motor assessments, including Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT) and strength of grasping, were evaluated at baseline and after 10-session treatment. Results: fNIRS-TBS group exhibited significant improvements in FMA total score (p<0.001), WMFT total score (p<0.001), and grip strength (p=0.001) compared to the baseline levels. This group also yielded significant improvements in FMA, WMFT scores, and grasp strength in comparison with the sham group. Conclusions: In this RCT, we demonstrated that fNIRS-guided target detection leads to superior motor recovery after rTMS intervention in comparison with the sham group. This novel method exhibits high spatial resolution in target detection which could be utilized in future neuromodulation setting to refine rTMS protocol.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Effectiveness of physical therapy interventions for women with dysmenorrhea: A systematic review

A. Tremback-Ball, H. Witmer, E. Hammond, E. Caldwell, A. Applegate

Misericordia University, Dallas, USA

Background and Aims: Primary dysmenorrhea, or painful menstruation, is common in menstruating females. However, in some it can cause intense pain, disrupt activities of daily living and impact quality of life. The treatment of dysmenorrhea does not traditionally include physical therapy. A systematic review was conducted to explore the role of physical therapy in treating dysmenorrhea.

Methods: A search was performed in August 2020 and January 2021 using EBSCOhost, Academic Search Ultimate, CINAHL Complete, and MEDLINE. Search terms included exercise or physical activity or fitness AND dysmenorrhea or menstrual pain or painful menstruation. Inclusion criteria were articles that were peer-reviewed, published in the last 10 years, and available in full text in English. All articles included in the review were analyzed for quality on a hierarchy of evidence scale. Results: 22 results were included in this systematic review. 19 articles were level 2 and 3 articles were level 3 on the hierarchy of evidence scale. The Visual Analog Scale and Menstrual Distress Questionnaire were the widely utilized outcome measures used to determine the effectiveness of the interventions. Interventions including aerobic exercise, stretching, kinesio taping, aquatic therapy, acupressure, yoga, core stability, positional activities, spinal manipulation and patient education have shown to be effective. Conclusions: Physical therapy can assist in the reduction of pain and other symptoms associated with dysmenorrhea. Overall, articles indicated that aerobic exercise, stretching and core stability yielded the greatest improvement in patient symptoms of dysmenorrhea. Physicians should consider recommending physical therapy to patients with symptoms that disrupt their activities of daily living.

See attached

Topic: 3. Clinical Sciences

Sub Topic: 3.2 Pain Osteoporosis -Osteoarthritis

Telerehabilitation in patient with type 2 diabetes mellitus and knee osteoarthritis

R. Traistaru¹, C. Kamal¹, D. Kamal^2., O. Rogoveanu¹, A. Bumbea¹

¹University of Medicine and Pharmacy, Craiova, Romania, ²MedLife Clinic, Craiova, Romania

Background and Aims: In 2020, to minimize the rate of new infections with SARS-CoV-2, most rehabilitation programs in Romania hospitals were postponed. Our prospective randomized controlled trial is to compare the outcomes of telerehabilitation program and conventional treatment in patients with type 2 diabetes mellitus (T2DM) and knee osteoarthritis (KOA) during the COVID-19 lockdown. Methods: Between April and June 2020, 42 patients with known KOA and T2DM, who had been postponed for inpatient rehabilitation because of COVID-19, were randomly divided into experimental group (EG 22 patient - underwent telerehabilitation program: pharmacotherapy, educational measures, home web-based exercise program for entire body) and control group (CG 20 patients) received only drugs. We choose easy scales to assess the outcomes – VAS for pain and WOMAC index for functional status. Patients were evaluated by telephone interviews during baseline, in the fourth and eighth weeks. Results: The pain in EG decreased compared with that in CG both at the fourth week (p< 0.003) and at the eighth week (p<0.05). The self-reported WOMAC score in EG was significantly lower than that in the CG at the fourth week (p< 0.001), but not at the final (p >0.05). Conclusions: Decrease of physical activity in pandemic period is associated with an increase in pain and loss of lower limb joint function in patients with T2DM and KOA. Telerehabilitation program may improve daily functioning during prolonged rest period, but should involve the patient and his family (especially in the elderly), with focus on his preferences and daily needs.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Outpatient rehabilitation in elderly with lower limb osteoarthritis

O. Fugaru¹, R. Traistaru¹, A. Kamal¹, D. Kamal², C. Kamal¹

¹Univeristy of Medicine and Pharmacy, Craiova, Romania, ²MedLife Clinic, Craiova, Romania

Background and Aims: Today, therapeutic exercise is the widely recommended nonpharmacological intervention in patients with lower limb osteoarthritis (LLOA). We evaluated the efficacy of a complex 8 weeks outpatient rehabilitation program (TENS, laser therapy, functional task-oriented and aerobic exercises) for reducing symptoms and improving the quality of life in elderly patients with LLOA. Methods: The study was a randomized controlled trial including two groups of old patients (G1 – study group, who followed complete rehabilitation program and G2 – control group, who received only TENS and laser therapy), homogeneous in terms of biographical, clinical and functional features. All patients were complete assessed – clinical, imagistic and functional (Up and Go test, 6 MWD and WOMAC subscales for pain and function). Results: We found that for the G1 there were very significant differences between the initial and the final values for all studied parameters (with Mann-Whitney test, p < 0.05 for Up and Go test, 6 MWD and WOMAC subscales), while for the control group the differences were not significant. Comparing, at baseline, we found that the differences are almost non-existent for all parameters. Finally, differences between lots become significant, with a Mann-Whitney test result pMW = 0.011. Also, G1 patients obtained an improvement over a 20% minimal response to intervention that are functional important and not just statistically significant. Conclusions: Standard physiotherapy procedures combined with kinetic program may considerably improve the level of pain and overall functional performance in patients with LLOA. All kinetic recommendations should focus on patient preferences and daily needs.

Topic: 3. Clinical Sciences

Sub Topic: 3.3 Diagnosis

Correlation between clinical and videofluoroscopic findings in patients with neurogenic dysphagia

S. Tomé, J. Barreto, B. Guimarães, J. Almeida, J. Leal

Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal

Background and Aims: Dysphagia is a common complication of Neurological conditions. It is usually assessed clinically (CA), eventually followed by Videofluoroscopy (VFS), the gold standard exam. The aim of this study was to analyse the correlations between CA and VFS findings in neurogenic dysphagia (ND). Methods: Retrospective assessment of CA and VFS records of patients with suspected ND, from March 2019 to January 2021, both performed by the same Physical and Rehabilitation Medicine specialist. VFS findings were divided in non-thickened liquids (NTL) and thickened liquids (TL). Results: 40 patient (12 female, 28 male) reports were analysed. The mean age at referral was 63,5 years. Stroke was the most prevalent etiology (45%). All patients were orally fed, 25 of them on a modified diet (TL and/or texture modification). 87,5% of patients had altered CA and 92,5% had an impaired VFS. The most relevant correlations (p < or =0,05) found between CA and VFS are summarized in [Table 1]. 4 patients showed aspiration and 15 penetration of liquid on VFS, based on the 8-Point Penetration-Aspiration Scale. In 62,5% of the cases the same feeding approach was recommended after CA and VFS.

Conclusions: Currently, it is not possible to rely only on CA to accurately determine dysphagia. In this study we found that dysarthria and absent oropharyngeal reflexes relate to aspiration and voice quality change relates to the presence of penetration with NTL. These are simple items to measure at bedside that should not be overlooked and may help stratify patients that should prompt a more urgent evaluation by VFS.

Topic: 6. Health Policy and Systems

Sub Topic: 6.9 Big Data and Cohorts

Carbapenemase producing enterobacter carriage: Is there an impact on functional improvement in rehabilitation units

V. Tiffreau, N. Loukili, J. Jusot, G. Celani, E. Allart, A. Blanchard, V. Pardessus, A. Thevenon

University Hospital of Lille, Lille, France

Background and Aims: Carbapenemase producing Enterobacter (CPE) carriage justifies specific hygienic procedures that may impact access to rehabilitation facilities and delay functional improvement. This study aimed at evaluating the impact of CPE carriage on functional improvement in a rehabilitation hospital (RH). Methods: This retrospective cohort study include all CPE carrier (CPE +) inpatient of three rehabilitation units between January 2016 and December 2018. CPE- inpatients were drawn from hospital stay during the same period, according to a stratification including age, gender and diagnosis. Primary outcome was the Functional independence Measure change (FIMC) between admission and discharge. Associate factors were Age, gender, the rehabilitation unit, Charlson comorbidity index at admission, the number of physiotherapy sessions, bladder and venous catheterization, and length of stay. Results: 25 CPE+ and 72 CPE- patients were included. Compared to CPE-, CPE+ patients had a lower FM motor (FIMm) at admission of 12 (p=0.04), more venous catheterization (p=0.021) and a length of stay 2.1 longer. Bivariate analysis revealed association between number of physiotherapy sessions, skin dressing, and length of stay (p<0.05). Conclusions: Despite no significant impact of CPE+ on FIMC, CPE+ patients were less independent at admission and required a longer hospitalization than CPE- patients to recover. RH are now facing the COVID epidemic, with an increasing number of long stay post intensive care CPE+ carriers. Such studies should help to a better organization of rehabilitation care involving restrictive hygiene procedures.

Topic: 7. Functioning and Disability

Sub Topic: 7.4 Impairment Rating, Disability Evaluation and Certification

Observation of therapeutic effect of scalp acupuncture combined with hyperbaric oxygen on cognitive impairment after cerebral apoplexy

R. Tian

Rehabilitation Medicine Department, Pukou Branch, Jiangsu Provincial People’s Hospital, Nanjing, China

Background and Aims: To observe the effect of indwelling scalp needle combined with hyperbaric oxygen therapy on cognitive impairment after cerebral apoplexy. Methods: 60 patients were divided into experimental group and control group by randomized control method, with 30 cases in each group. The experimental group received in-cabin scalp acupuncture combined with hyperbaric oxygen, while the control group received routine rehabilitation combined with hyperbaric oxygen, once a day, 5 times a week, for 4 consecutive weeks. The scores of Simple Intelligence Scale (MMSE), Montreal Cognitive Assessment Scale (MOCA) and Adl were observed before and after treatment. Results: The total effective rate of scalp acupuncture combined with hyperbaric oxygen group was higher than that of conventional rehabilitation combined with hyperbaric oxygen group (P < 0.05), and MMSE, MOCA and ADL were significantly increased (P < 0.05). Conclusions: Cabin scalp acupuncture combined with hyperbaric oxygen can improve the cognitive function of patients after stroke.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Rehabilitation outcome after acute subarachnoid haemorrhage: the role of earlyfunctional predictors and complications

J. Thio¹, K. Chua¹, J. Loke², C. Lim³, R. Krishnan¹

¹Tan Tock Seng Rehabilitation Centre, Singapore, Singapore, ²Lee Kong Chian School of Medicine, Singapore, Singapore, ³Tan Tock Seng Hospital, Singapore, Singapore

Background and Aims: Spontaneous subarachnoid haemorrhage (SAH) is associated with significant morbidity and disability. This study investigated the relationships between acute neurosurgical predictors and, early and rehabilitation medical complications, with functional independence during inpatient rehabilitation for non-traumatic SAH. Methods: A retrospective cohort study of electronic records and a functional database at a single rehabilitation hospital was conducted over a 4-year period. All eligible SAH admitted within 6 months for inpatient rehabilitation were included. The Functional Independence Measure (FIM) score at rehabilitation discharge was the primary outcome measure. Results: The records of 96 patients were analyzed; 75% (72) were female with a mean (SD) age of 57.1 (11.2) years. Single aneurysmal ruptures occurred in 88 patients (91.7%); 37 patients (38.5%) were classified as having poor grade SAH. Mean ± SD total FIM score at discharge was 91.5 ± 28.3 points, while the mean ± SD FIM gain was 28.09 ±16.43 points after a median (IQR) rehabilitation stay of 24 (26) days [95% CI, 24.77 to31.42; P < 0.001]. Of the 60 patients (62.5%) with at least 1 rehabilitation complication, urinary tract infection occurred in 29 patients (30.2%). Lower admission total FIM score(P < 0.002), lower admission cognitive FIM score (P < 0.001) and emergency transfers off the rehabilitation ward (P < 0.001) negatively predicted discharge FIM score. Post-rehabilitation, 85 patients (88.5%) discharged home. Conclusions: An acute inpatient neurorehabilitation programme significantly improves functional outcome after SAH. Preventing medical complications can potentially improve rehabilitation outcome.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Beneficial effects of a supervised and individualized training circuit on physical capacities and quality of life of patients suffering from multiple sclerosis

O. Bouquiaux¹, C. Beaudart¹, A. Thibaut¹, G. Dorban², J. Kaux¹

¹University Hospital of Liege, Liege, Belgium, ²Haute École Robert Schuman of Libramont, Libramont, Belgium

Background and Aims: Rehabilitation strategies using adapted physical activities in multiple sclerosis (MS) have been poorly studied. The purpose of our study is to evaluate the impact of an 18-week program of adapted-training sessions (i.e., task-oriented circuit training, TOCT) on physical capacities and quality of life of patients suffering from MS. Methods: The program was composed of 3 sessions per week, one supervised by two physiotherapists which consisted of TOCT of 75 minutes; and two other sessions which consisted of an independent walking exercise of 30 minutes. Primary outcomes were walking abilities and quality of life. Secondary outcomes were handgrip strength, finger dexterity, lower limb strength endurance, fatigue, depression/anxiety and cardiorespiratory endurance. Results: 14 patients were included in analyses. TOCT significantly enhanced patients’ ability to perform the walking tests and improved the mental component scale of the SF-36 questionnaire (p values<0.05). Some secondary outcomes also improved following TOCT: dexterity of the non-dominant hand (p=0.024), the 30-second chair stand test (p=0.002) as well as the cardiorespiratory endurance (p=0.02). No difference of handgrip strength, fatigue and depression/anxiety was notified. Conclusions: Despite not using a controlled design, this interventional pilot study suggests the feasibility and potential beneficial effects of an adapted training program in multiple sclerosis patients.

NA

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Dance training and performance in patients with Parkinson disease: Effects on motor functions and patients’ well-being

O. Bouquiaux¹, A. Thibaut¹, C. Beaudart¹, G. Dorban², J. Kaux¹

¹University Hospital of Liege, Liege, Belgium, ²Haute École Robert Schuman of Libramont, Libramont, Belgium

Background and Aims: Background: Dance is an emerging therapeutic approach for patients with Parkinson Disease (PD) which shows promising effects on patients’ motor functions. Objective: Evaluate the effects of a 16-week a specific dance training program on motor function and well-being in patients with PD. Methods: Patients were allocated either to the experimental group or to the control group (no intervention). In the experimental group, patients practiced dance once a week for a total of 16 sessions. Dance sessions consisted of a choreography with the aim of performing a dance performance at the end of the 16-week dance program. At baseline and after 16 weeks, motor functions, patients’ feeling of happiness and cognitive functions were collected. Differences between the two groups were calculated for each tested measure. Results: 8 patients in the experimental group and 6 in the control group completed the study. A significant difference between the two groups was found for the 10-meter test as well as for the feeling of happiness. No differences were found for the other outcomes. Conclusions: Weekly sessions of dance improve motors capacities and the feeling of happiness in patients with PD. The motivational aspect of learning a choreography and presenting a dance performance may have induced additional benefits of the training program.

NA

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

Delusional jealousy, a case of possible othello syndrome

W. S. Teo¹, P. P. Tan¹, R. R. Krishnan¹, J. A. Fuentes¹, L.R. Koay¹, J. Kaur¹

¹National Health Group - Tan Tock Seng Hospital, Novena, Singapore

Background and Aims: This case report describes a patient with delusional and pathological jealousy after a severe frontoparietal intracranial haemorrhage. Methods: A case report. Results: The patient is a 59-year-old gentleman. He had a large right frontoparietal haemorrhage, which a craniotomy and evacuation of blood clot was performed by neurosurgeon. He was transferred to Tan Tock Seng Hospital Rehabilitation Centre for rehabilitation. About 8 weeks after stroke, he started to develop delusion where he accused male medical staffs including nurses and doctors for having an affair with his wife. One of the male doctors who were accused, was not involved in his medical care, however patient insisted that his accusation was correct and started scolding vulgarities at him whenever he passed by. There were episodes of both verbal and physical aggression where patient started punching, required physical restraint and pharmacological intervention. Moreover, he also thought that his water was poisoned by the medical staffs, and confabulation, in which he described that he was being “locked up” in the hospital so that he won’t be able to see his wife. His case was discussed with psychiatrist and started on anti-psychotic – olanzapine 5mg twice a day. He responded to the treatment well. Conclusions: Paranoia and delusional jealousy is an uncommon phenomenon post-stroke. However, patients with right frontal lobe lesion who develop such symptoms, requires high index of suspicion to start appropriate treatment.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

A complex case of a patient with penetrating neck injury at a tertiary rehabilitation centre

W.S. Teo, W. L. W. Chan, W. L. Lui ¹, R. J. M. Tay, Z. Y. V. Ng, P. V. Poulose, K. W. S. Quek

National Health Group - Tan Tock Seng Hospital, Novena, Singapore

Background and Aims: The incidence of penetrating neck injuries in Singapore is rare. We present our experience with complex management of a 29-year-old gentleman with a penetrating neck injury. Methods: A case report. Results: A 29-year-old gentleman sustained a penetrating neck injury during a road traffic accident. He drove his car into a metal rail (or central divider?) resulting in a metal rod piercing into his right neck. This led to dissection of the right common carotid artery with resultant right middle cerebral artery territory infarct. The patient sustained a complex facial trauma, laryngeal fracture and had significant oedema of vocal cords, requiring a tracheostomy and a nasogastric tube. Imaging of the neck revealed that the metal rod was lodged at the level of C3/4 vertebral body with C3 transverse process fracture and cord oedema. He was transferred to a tertiary rehabilitation centre to continue rehabilitation. His rehabilitation issues include left hemispatial neglect, dysphagia, tracheostomy management, upper limb weakness and numbness due to central cord syndrome. He required intensive rehabilitation therapy. Multiple discussions were held with the otolaryngologist and speech therapist regarding his tracheostomy and swallowing plans. He was deemed not suitable for decannulation but was able to tolerate honey-thick fluid and the nasogastric tube was weaned off. Moreover, patient experienced post-traumatic stress symptoms and was supported by on-site psychologist. Conclusions: This case illustrates the complexity of a penetrating neck injury which requires a multidisciplinary approach in a tertiary rehabilitation centre. Further plans about decannulation, community re-integration and return-to-work should be discussed in a specialised outpatient setting.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Quality of life in young adults with previous adolescent idiopathic scoliosis

A. Teixeira¹, A. Pereira¹, M. Martins¹, M. Pires²

¹Department of Physical Medicine and Rehabilitation, Central Lisbon University Hospital Center, Lisbon, Portugal, ²Department of Physical Medicine and Rehabilitation, Dona Estefânia Pediatric Hospital, Lisbon, Portugal

Background and Aims: Adolescent idiopathic scoliosis (AIS) is defined as a three-dimensional deformity of the spine. Long-term quality of life (QoL) is often compromised in scoliosis. Our goal is to evaluate the QoL in patients with different severities of AIS. Methods: Retrospective observational study including patients diagnosed with AIS in a Rehabilitation Department at a Pediatric Hospital, between january 2012 and december 2013. Patients were divided in two groups based on scoliosis severity, low to moderate and moderate to severe. Patients were contacted by telephone in order to assess QoL using experimental version of the revised questionnaire of the Scoliosis Research Society (SRS-22r). Data was analyzed with SPSS Statistics for Windows, Version 26.0. Results: A total of 14 patients, with a medium age of 21,3 years, were analyzed. SRS-22r mean score was 3,84 ± 0, 41, in a total score of 1 to 5. Patients with moderate to severe scoliosis (n=6) had a statistically significant lower score in SRS-22r (p=0.002), in pain, function and self-image domains. Self-image and mental health domains had the lowest scores in all groups (3,30± 0,61 and 3,80± 0,62). Disease progression and use of trunk orthosis were not related with SRS-22r score. Conclusions: Our results suggest that AIS severity may affect QoL in several dimensions specially pain, function and self-image. Mental health is globally reduced in AIS patients, indicating the need to be aware of this domain with early psychological intervention.

Topic: 4. Therapeutics

Sub Topic: 4.2 Injections (Joint. Spine, etc.,)

Bertolotti’s syndrome in a young patient: A case report

H. Tavares, M. Oliveira, D. Reis, J. Ramos, H. Amorim

Centro Hospitalar Universitário de São João, Porto, Portugal

Background and Aims: A 24-year-old healthy female volleyball player presented with low back pain after falling in a game in March 2019. The pain had mechanical characteristics, non-radiating, with maximum intensity of 7 in 10. She presented pain on palpation of lower lumbar and the left sacroiliac joint, reduced range of motion of trunk flexion due to severe pain and no other findings. Methods: Initially it was considered as muscle strain, and she was medicated with oral anti-inflammatory medication, with partial pain relief. Due to pain persistence, she underwent a lumbosacral MRI that revealed an hypersignal in T2 and hyposignal in T1 in the left wing of sacrum, suggesting further imaging reevaluation of the sacroiliac joints. She underwent an intramuscular injection of ketoprofen, with significant pain relief (intensity of 3 in 10). There was recurrence of pain complaints, mainly with trunk flexion, occasionally radiating to the left lower limb, with significant gait claudication. A sacroiliac MRI was performed and showed a fusion of a left mega transverse process of lower lumbar vertebrae with the sacrum, with extensive bone marrow hypersignal, and confirmed a diagnosis of Bertolotti’s syndrome. Results: The patient received a steroid and local anesthetic injection in the anomalous lumbosacral articulation. One month later, she was asymptomatic and returned to her sports activity. At one-year follow-up, she was doing well with no active complaints. Conclusions: Bertolotti’s syndrome is a congenital condition which can be related to lower back pain. In refractory cases and with an intense level of pain, interventional treatment can be an alternative.

Topic: 4. Therapeutics

Sub Topic: 4.3 Integrative Medicine

Examination of factors leading to home discharge of patients who underwent femoral head replacement or total hip arthroplasty

Y. Tanaka¹, M. Wakao²

¹Hokkaido University of Science, Sapporo, Japan, ²San-ikukai Hospital, Tokyo, Japan

Background and Aims: Postoperative physical therapy for proximal femoral fracture and osteoarthritis of hip is expected to improve hip function, return to safe daily life, and improve quality of life. In this study, we examined differences in invasion methods, Barthel Index (BI), length of hospital stay, and destination of discharge in patients who underwent femoral head replacement (FHR) or total hip Arthroplasty (THA).

Methods: Subjects were 40 patients who underwent FHR or THA surgery and received physical therapy, average age 76.2 ± 11.1 years, 9 males and 31 females. Surgical methods were anterior invasion with minimally invasive surgery THA in 20 cases and posterior invasion THA or FHR in 20 cases. Results: About surgical method, BI at start of physical therapy was significantly higher in anterior invasion group than in posterior invasion group, and BI at discharge showed same tendency. Length of hospital stay was significantly shorter in anterior invasion group than in posterior invasion group. 28 patients discharged to homes and 12 discharged to non-homes. Surgical procedure in home discharge group was 18 in anterior invasion group and 10 in posterior invasion group. As a result of analysis by chi-square test, number of home discharge of anterior invasion group was significantly higher. Conclusions: It was found that anterior invasion group had a high BI at start of physical therapy and at discharge, and tended to discharge to home early. In addition, it was shown that BI at discharge is important as a factor that determines discharge destination.

Topic: 4. Therapeutics

Sub Topic: 4.3 Integrative Medicine

Examination of activities of daily living and discharge destination after surgery for proximal femoral fracture

Y. Tanaka¹, M. Wakao²

¹Hokkaido University of Science, Sapporo, Japan, ²San-ikukai Hospital, Tokyo, Japan

Background and Aims: Purpose of treating proximal femoral fractures is to gain stability of lower extremities in stance phase, prevent complications and disuse syndromes from occurring and exacerbating, and aim for pre-injury life as soon as possible. Therefore, bone fusion, femoral head replacement (FHR) and total hip arthroplasty (THA) are recommended. Purpose of this study is to examine discharge destination, Barthel Index (BI) at the time of discharge, and presence or absence of dementia in patients undergoing surgery due to proximal femoral fracture with complications.

Methods: The subjects were 88 patients who underwent surgery due to proximal femoral fracture and underwent physical therapy, average age 79.7 ± 10.6 years, 21 males, 67 females. Surgical procedures were FHR in 20 patients, THA in 20 patients, Hanson pin in 7 patients, and gamma nail in 41 patients. We collected examination items such as gender, age, length of hospital stay, surgical procedures, discharge destination, BI at the start of physical therapy (PT) and discharge, pre-hospital ADL, presence or absence of dementia, and complications from medical records during hospitalization, and analyzed these. Results: About discharge destination, BI at start of PT and BI at discharge of home-discharged group were significantly higher than non-home-discharged group. Pre-hospital ADL independence rate was significantly higher in home-discharged group, and dementia rate was significantly higher in non-home-discharged group. Conclusions: It was found that patients who underwent proximal femoral fracture had high pre-hospital ADL ability, BI at start of PT and BI at discharge, and tended to discharge to home if they did not have dementia.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Premier highland dancers sports injuries

M. Tan¹, U. Azuike², F. Chiou-Tan³

¹Baylor University, Waco, USA, ²Regenexx, Houston, USA, ³Baylor College of Medicine, Houston, USA

Background and Aims: International competitive Scottish Highland dance is a high-impact sport. Vertical jumps with a series of extensions, perfect splits in midair, and complex footwork form qualifying dances. Highland dance sports injuries have not been well documented in the literature. The aim of this case series is to report injury types and locations in these unique dancers. Methods: This is a case series of adult premier Highland dancers registered with the Scottish Official Board of Highland Dancing. Current age, gender, ethnicity, type, location, and age at time of injury(ies) were collected from elite dancers who self-reported their medical results. Action or type of dance being performed was also noted. Results: In the hip region: apophysitis at the anterior superior iliac spine is common if all joints are not properly aligned in external rotation. In the knee/calf region: knee effusions, shin splints, and hairline stress fractures of the tibia were found. In addition, less common injuries in sports such as tibialis anterior and plantaris tendon injuries were noted. In the ankle/foot region: sprains and tears of anterior tibiofibular, calcaneofibular, and posterior talofibular ligaments, fractured metatarsals, and plantar fasciitis were observed. Conclusions: Competitive international premier Highland dancers sustain several injuries in their lower extremities. In review of the literature, some of these overlap with both ballet and gymnastics dancers. However, the unusual footwork required of this type of dance and high vertical jumps results in a few less commonly reported sports injuries including those to the tibialis anterior and plantaris tendon.

Topic: 4. Therapeutics

Sub Topic: 4.6 Neurostimulation (rTMS, tDCS, etc.)

Synchronous oscillatory entrainment of neural activity between bilateral motor cortices alter intermanual transfer

N. Takeuchi, A. Mizoe

Akita University Graduate School of Health Sciences, Akita, Japan

Background and Aims: It is well known that the effect of unilateral motor training transfers to the contralateral hand. This phenomenon is called intermanual transfer of learning. Although the underlying neural mechanisms of intermanual transfer remain elusive, there is evidence that plasticity within the primary motor cortex ipsilateral to the trained hand might play an important role in mediating performance improvements of the untrained hand. Using transcranial alternating current stimulation (tACS), we investigated whether the synchronous oscillatory entrainment of neural activity between the bilateral motor cortices alters the intermanual transfer. Methods: The participants performed the mirror drawing task during synchronous tACS. The participants were assigned to receive 20 Hz, 70 Hz, or sham tACS between the bilateral motor cortices in a randomized order. Results: Application of synchronous 20 Hz tACS over the bilateral motor cortices during the mirror drawing task significantly improved the same task performance in the untrained hand after tACS. Sham and 70 Hz tACS did not affect a bimanual transfer. Conclusions: Our results demonstrated that transcranially inducing oscillatory modulation over the bilateral motor cortices improved the task performance in the untrained hand. These results may be explained by an increased in-phase synchronization of motor oscillations, which potentially promotes the long-range interhemispheric interaction for bimanual transfer. This is the first study that elucidates the causal role of the synchronous neural oscillation in both motor cortices on intermanual transfer.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Identifying the preoperative cut-off value of muscle strength for predicting good walking ability after total knee arthroplasty

D. Takamura¹, K. Iwata^1,3, T. Shimogai¹, H. Nishihara¹, H. Moriyama⁴

¹Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan, Kobe, Japan, ²Department of Rehabilitation Science, Graduate School of Health Science, Kobe University, Kobe, Japan, Kobe, Japan, ³Department of Public Health, Graduate School of Health Science, Kobe University, Kobe, Japan, Kobe, Japan, ⁴Kobe University, Life and Medical Sciences Discipline, Kobe, Japan, Kobe, Japan

Background and Aims: The purpose of this study was to identify the cut-off values of preoperative knee extensor strength (KES) and hip abductor strength (HAS) for predicting postoperative good walking ability in total knee arthroplasty (TKA) patients. Methods: A retrospective analysis was conducted on patients who have undergone primary unilateral TKA. Involved side of maximal isometric KES and HAS were measured preoperatively and Timed Up and Go test (TUG) was measured at 2 weeks after TKA. The patients were divided into 2 groups according to the TUG as Good (< 13.5 seconds) and Poor (>= 13.5 seconds). Multivariate logistic regression analysis was used to control for the potentially confounding factors. The dependent variable was postoperative TUG (Good or Poor) and the independent variables were age, sex, KES and HAS. In addition, receiver operating curve (ROC) analysis was used to identify cut-off values of preoperative muscle strength for classifying the patients into the 2 groups, and to calculate the area under the curve (AUC). Results: Total 127 patients were included. Multivariate logistic regression analysis indicated that age (P = 0.04), KES (P = 0.01), and HAS (P = 0.03) were significant predictors of TUG. ROC analysis showed that the cut-off values of KES and HAS were 0.80 Nm/kg and 0.61 Nm/kg. This model had moderate prediction accuracy, with AUC of 0.75 for KES, and 0.72 for HAS. Conclusions: The cut-off values of KES (0.80 Nm/kg) and HAS (0.61 Nm/kg) may be useful indicators for screening of patients who have poor walking ability 2 weeks after TKA.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Rehabilitation for atypical femoral fractures in the patients with rheumatic diseases

Y. Takakubo¹, A. Narita¹, I. Yuki¹, H. Sagae¹, K. Sasaki², S. Kobayashi³, M. Takagi¹

¹Department of Rehabilitation, Yamagata University Faculty of Medicine, Yamagata, Japan, ²Department of Orthopaedic Surgery, Yamagata Saisei Hosipital, Yamagata, Japan, ³Department of Orthopaedic Surgery, Shiseido General Hosipital, Yamagata, Japan

Background and aims: Atypical femoral fractures (AFFs) have been associated with long-term use of bisphosphonates (BPs) and collagen diseases. AFFs were known to show delayed union or non-union of those fracture sites. Methods: Through radiographic examination, we performed a blind analysis of AFFs in patients with rheumatic disease in our prefectural area of super-aging society. Results: We found 118 patients with a total of 136 AFFs between 2009 and 2017. Of these 136 AFFs, 14 rheumatic patients had 17 AFFs. The mean age of patients was 61.1 years. All fourteen patients received BPs for a mean duration of 69 months. Surgical intervention of intramedullary nail fixation was performed in 16 AFFs but one patient for whom a locking plate was used. After operative wounds were healed, teriparatide was administered with low-intensity pulsed ultrasound was performed in 11 cases. All patients had started to walk with partial weight bearing the day after surgery. Mean duration of starting to walk with full weight bearing was 7 months after surgeries. In 17 complete AFFs, 14/17 femurs were healed at the fracture site after a mean duration of 10.9 months, other three had received a second operation due to their complications. Conclusions: Careful management with rehabilitation of AFFs in rheumatic patients is required even after surgery, because most of our cases showed delayed union or non-union of their fracture sites.

Reference

Takakubo Y, Ohta D, Ishi M, Ito J, Oki H, Naganuma Y, et al. The Incidence of atypical femoral fractures in patients with rheumatic disease. Yamagata prefectural committee of atypical femoral fractures (YamaCAFe) study. Tohoku J Exp Med 2017;242:327-34.

Topic: 1. Biomedical sciences

Sub Topic: 1.1 Biomechanics

Relationship between isokinetic evaluation and range of motion

I. Taggazi¹, N. Hammami¹, N. Kefi¹, H. Jdidi¹, A. Talbi¹, C. Hannechi¹, L. Ghidaoui^{2 3}, M. Khezami^2,3, A. Bousassida¹, F. Ben Salah^2,3, C. Dziri^2,3

¹High Institute of Sport and Physical Education of Kef, University of Jendouba, Tunisia, KEF, Tunisia, ²MPRF Department, Mohamed Kassab Institute of Orthopedics, Manouba, Tunisia, ³Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia

Background and Aims: Muscle balance must be assessed by angular sectors, particularly in the range of instability corresponding to the middle of the range of motion ROM. The objective of our research was therefore to study the reproducibility of angular amplitude as a method for the isocenitic assessment of knee flexor and extensor muscles in healthy active women. Methods: A prospective study in the external physical medicine department of the Kassab Institute including women aged 18 to 40 years over a period of two months. Isocinetic tests in concentric mode at a low Velosity of 60°/s are performed for both dominant and non-dominant lower limb knee. Results: Statistic alanalysis shows a non-significant difference in peak torque in 12 healthy active women during isocinetic tests for both left and right limbs at p<0.05. Conclusions: Angular range of motion is a reproducible method for isokinetic assessment of knee flexor and extensor muscles in healthy active women.

Topic: 3. Clinical Sciences

Sub Topic: 3.2 Pain Osteoporosis - Osteoarthritis

USA veteran outcomes after opioid weaning

E. Stockwell¹, R. Roig², A. Raines², K. Kunefke¹, J. Cordova¹

¹Louisiana State University Health Sciences Center, New Orleans, USA, ²Veterans Affairs Medical Center, New Orleans, USA

Background and Aims: The misuse of and addiction to opioids have caused a public health crisis. The opioid overdose rate is twice as high in USA veterans compared with the general population. Little is known about the effects of stopping long-term opioid therapy (LTOT) in this population. The aim of this study was to examine the effectiveness of a brief interdisciplinary pain evaluation program (PEP) on anxiety, depression, and pain. 317 patients attended 3 appointments where opioid weaning schedules were developed. During these appointments, veterans met with a social worker, pharmacist, physician assistant, and physician to develop an individualized pain management. Methods: Data were gathered on self-report indices including the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Pain, Enjoyment of Life, and General Activity Scale (PEG). Data assessed at initial, 3, and 12-month appointments. Chi-square tests for independence and a series of mixed between-within subject ANOVAs were conducted to examine group differences in daily morphine milligram equivalent (MME), anxiety, depression, and pain. Results: 52% of patients were considered to be treatment completers if they attended all three appointments for weaning goals. Results showed sustained improvements (p < 0.001) in anxiety, depression, and pain over time with no group differences. Effect sizes ranged from medium to large. Conclusions: When clinicians discuss the risks and benefits of opioid weaning, these results suggest that opioid weaning has long-term benefits in anxiety, depression, and pain. Future research should focus on opioid wean rates, long-term outcomes, and guidelines to expand individualized evidence-based opioid weaning.

Topic: 3. Clinical Sciences

Sub Topic: 3.3 Diagnosis

Modified gait parameters in knee joint measurements in women suffering from osteoarthritis

C. Statescu, R. M. Traistaru, A. Deaconu

¹University of Medicine and Pharmacy of Craiova, Craiova, Romania

Background and Aims: Gait is used along with clinical examination in order for the physicians to diagnose a patient suffering from neurological and musculoskeletal diseases such as osteoarthritis (OA). Video goniometry is one of the new tools used for assessing two dimensional measurements made at the joints during walking or other kinetic activities. Methods: Out of 154 participants, we have evaluated 136, out of which 89 were women with the right side as dominant side and were divided into 4 groups: women suffering from hip OA, women suffering from knee OA, women with hip and knee OA and a control group. They were clinically and functionally evaluated, after which they were asked to walk 6 times, being filmed 3 times on each side and analysed using AnglesApp. Results: The women with hip OA have a more extended knee joint during midstance on the right side than the women with knee OA and than the control group. The knee extension in hip OA presents itself most likely as a compensation mechanism. The significant results are on the right side since it is the dominant side. Conclusions: A thorough analytic clinical and functional evaluation must be carried out for a complete diagnosis. We consider that midstance has to be attentive analysis gait moment since it is known to be the first part of the single-leg support period, being based on the patient’s stability. One must put an emphasis on stability in a rehabilitation program to prevent falls.

Topic: 6. Health Policy and Systems

Sub Topic: 6.9 Big Data and Cohorts

Countries response for people with disabilities during the COVID-19 pandemic

M. Spir, L. Lugo, K. Cruz, J. Velasquez, V. Ospina, M. Gonzalez, A. Posada, L. Mesa, R. DI Dio, P. Ramirez, C. Velez, D. Patiño

University of Antioquia, Medellín, Colombia

Background and Aims: During the Coronavirus (COVID-19) pandemic, isolation and prevention measures to reduce COVID-19 contagions are essential for the care of all people; these measures should comply with the principles of inclusion and accessibility for people with disability (PWD), with all kinds of functioning compromises and levels of dependency. Thereby, the aim of this article is to present the measures adopted for PWD and with rehabilitation needs, for containment, mitigation, or suppression of COVID-19 virus in different countries of all continents and of all income levels. Methods: We used a rapid review approach to identify countries’ responses for PWD and with rehabilitation needs during the COVID-19 pandemic. Results: First, we identified the non-pharmacological general interventions for PWD that included informative measures and general recommendations during the stay at home, isolation and biosecurity measures, contagion prevention, detection of positive cases, mobilization measures, and measures implemented in institutions or residences of PWD. Second, we identified the economic and social benefits provided to PWD during the pandemic. Finally, we identified the measures taken by countries according to the type of impairment (visual, hearing, physical, mental and cardiopulmonary impairment) during the COVID-19 pandemic. Conclusions: In response to the COVID-19 pandemic, different countries of all continents created and implemented specific measures for PWD to contain, mitigate, or suppress the COVID-19 virus. Thereby, PWD was involved and taken into account during the COVID-19 response, and this was a challenge that each country assumed independently.

Topic: 6. Health Policy and Systems

Sub Topic: 6.5 Rehabilitation Across the Continuum of Care

Cancer rehabilitation in Australia and New Zealand: A pilot cross-sectional survey

K. Song, B. Amatya, F. Khan

The Royal Melbourne Hospital, Melbourne, Australia

Background and Aims: We report findings of a pilot survey highlighting current service delivery of cancer rehabilitation programs and health professionals’ perspectives on barriers and facilitators to implementation of these programs in Australia and New Zealand. Methods: A cross-sectional pilot survey of rehabilitation health professionals in hospital and ambulatory care settings in Australia and New Zealand, evaluating current availability of cancer rehabilitation programs, health professional workforce, core components delivered and barriers and facilitators to provision and delivery of cancer rehabilitation programs. Results: Respondents (n=60) included rehabilitation physicians and advanced trainees, with majority of respondents working in non-dedicated cancer rehabilitation programs. Most programs are led by rehabilitation physicians, followed by allied health. The most common tumour streams referred included: central nervous system, haematological and breast cancers. Patients are usually most frequently referred during post-treatment phase. The core components included management of complications, provision of education (mood, exercise, fatigue management), with exercise prescription comprising mainly of strengthening exercises, mobilization and gait training. Common barriers included inadequate funding and lack of appropriate staffing with expertise, whilst facilitators reported were encouraging better collaboration and integration of rehabilitation within acute cancer care services and specialty teams. Conclusions: The pilot survey identified current service provision amongst rehabilitation programs providing care to cancer patients and highlighted preliminary gaps and facilitators to implementation of formal cancer rehabilitation programs. These findings need further confirmation in a larger study to assess further outcome measures and the impact of barriers and facilitators for care quality.

Topic: 3. Clinical Sciences

Sub Topic: 3.6 Preventive Rehabilitation

The effectiveness of tai chi on the depressive symptom of young adults with subthreshold depression: A pilot randomized controlled trial

J. Song¹, X. Xie^1,2, M. Han^1,2, Y. He^1,2, J. Huang^1.2.3.4, J. Tao^1.2.3.4, L. Chen^1.2.3.4, J. Wu^1.2.3.4

¹Fujian University of Traditional Chinese Medicine, Fuzhou, China, ²Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation, Fuzhou, China ³Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China, ⁴TCM Rehabilitation Research Center of SATCM, Fuzhou, China,

Background and Aims: The incidence of subthreshold depression is 7 ~ 23%, and 10 ~ 20% of subthreshold depression will be converted to major depression. Subthreshold depression symptoms include persistent fatigue, insomnia, etc. Subthreshold depression as the early stage of depression, early prevention and rehabilitation is very important. Tai Chi, as a traditional Chinese body and mind therapy, may become one of the alternative therapies for subthreshold depression. Tai Chi has been used in the rehabilitation treatment of mental diseases. However, the effect of Tai Chi in the treatment of subthreshold depression in young adults is still unclear, which limits its further promotion and application. Methods: This study uses a double-arm, randomized, parallel controlled trial with allocation concealment and evaluation blindness. The 130 qualified participants were randomly divided into a Tai Chi group and a waiting-list group. Tai Chi group had 12 weeks of Tai Chi training, three times a week, 60 minutes each time. Participants in the waiting-list group maintained their daily routines. The primary outcome measure was the Center for Epidemiological Studies Depression Scale (CES-D) score; the secondary outcome was the Pittsburgh Sleep Quality Index (PSQI) score. Results: After the intervention, the total scores of the two groups on the CES-D (P=0.01) was statistically significant. Moreover, there were significant differences in the total score of the Pittsburgh Sleep Quality Index(P=0.02) and its subitems of daytime function(P=0.01). Conclusions: Tai Chi training can improve depressive symptoms and sleep quality in young adults with subthreshold depression.

Topic: 2. Social sciences

Sub Topic: 2.4 Psycholog

Psychological assessment and disability in patients with chronic non specific low back pain

M. Soltani¹, M. A. Khezami^1,2, I. Aloulou¹, L. Ghidaoui^1,2, I. Miri^1,2, S. Lebib^1,2, F. Z. Ben Salah^1,2, C. Dziri^1,2

¹Department of Physical and Rehabilitation Medicine, National Institute of Orthopedy Mohamed KASSAB, La Mannouba, Tunisia, ²Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia

Background and Aims: Chronic nonspecific low back pain is a common heath issue. It is one of the major contributors to the global burden of disease. Therefore, assessment and treatment of this condition is crucial. Many pilot studies recommend the bio-psycho-social model as an efficient approach in managing chronic nonspecific low back pain. The aim of this study was to evaluate the psychological dimension of low back pain, the physical disability and their correlation. Methods: An observational and cross-sectional study conducted within the department of physical medicine and rehabilitation in KASSAB’s Institute over a period of 3 months. Two self-administrated questionnaires in local dialect were used to collect data: The Hospital Anxiety and Depression Score (HADS) and the Oswestry Disability Index (ODI). Results: Our study sample included 18 participants with a mean age of 37.33 +/-11.33. 94.4 % of study subjects had a minimal to moderate disability on the ODI. Over 80% of participants had a borderline to abnormal score in the Anxiety HADS subscale compared to 66.7 % in the Depression subscale. We found a significant positive correlation between the Anxiety HADS subscale and ODI. No significant correlation was found between Depression HADS subscale and ODI in our study sample. Conclusions: Our study concludes that anxiety is an important dimension among patients with chronic nonspecific low back pain which is consistent with literature findings. The systematic psychological assessment as well as adapted care may improve the prognosis in this population.

Topic: 2. Social sciences

Sub Topic: 2.2 Disability Studies

Health-related quality of life in patients with chronic non specific low back pain

M. Soltani¹, M. A. Khezami^1,2, I. Aloulou¹, N. Hammami³, L. Ghidaoui^1,2, H. Jdidi³, C. Hannachi³, I. Tagazi³, N. Kefi³, A. Talbi³, I. Miri^1,2, S. Lebib^1,2, F. Z. Ben Salah^1,2, C. Dziri^1,2

¹Department of Physical and Rehabilitation Medicine, National Institute of Orthopedy Mohamed KASSAB, La Mannouba, Tunisia, ²Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia, ³Institute of Sport and Physical Education of Kef, University of Jendouba, KEF, Tunisia

Background and Aims: Chronic non specific low back pain (CNLBP) is a major health issue. It’s one of the major causes of years lived with disability. Thereby, researches about life quality are important to establish an efficient patient-centered health strategy. The aim of this study was to investigate the impact of CNLBP on the multiple domains of health-related quality of life (HRQOL). Methods: A case-control study conducted within the department of physical medicine and rehabilitation in KASSAB’s Institute over a period of 6 months. Anamnesis and clinical examination were used to determine confounding factors. We assessed different domains of HRQOL with a validated Tunisian version of the Medical outcome study short form 12 (SF-12). Results: Our study sample included 2 groups with 11 participants each. The mean age in CNLBP group was 31.36 +/- 7.42 compared with 35.27+/-10.5 in the control group. CNLBP group scored significantly lower values in the Physical scale. No significant difference was noted in the Mental Scale. The mainly affected domains were body pain and limitations in usual daily activities because of emotional and physical health problems. Within CNLBP group, a significant positive correlation was found between mental health and general health perceptions’ subscales and between emotional role, physical role, and vitality’s subscales. Conclusions: Our study concluded that HRQOL in patients with CNLBP is mainly affected in the physical domain. However, the positive correlation between mental and physical domains implies the need for a multidimensional therapeutic approach.

Topic: 4. Therapeutics

Sub Topic: 4.2 Injections (Joint. Spine, etc.,)

Case study: Relaxation treatment for incontinence of the ligamentum teres uteri sin

N. Solovjova, D. Pecarski

¹Academy of Applied Studies Belgrade College of Health Studies, Belgrade, Serbia

Background and Aims: Background - Incontinence due to weakening of the pelvic musculoskeletal system in women may be resistant to various physical and medical treatments, and may persist for years. Aim: To demonstrate on a particular case the significance of diagnosing etiology persistent incontimentio for its efficient management. Methods: A female patient was enrolled into the project and committed to central lymph drainage on the big toe of her right foot due to left lower leg edema which persisted for ten years. Once the edema was removed /cured by virtue of central limphage drainage technic, the female patient reported difficulties and complained to incontinence. The activation of deep stabilizing muscles was innefective. By performing deep, tender manual palpation the scrambling of the ligamentum teres uteri sin was ascertained. The technique aimed at relaxation of the shortened ligament and normalization of the tone achieved the elimination of the symptoms of incontinence, and the control of the bladder sphincter was achieved with the treatment of 12 daily therapies. Abbreviations of the Lig teres uteri sin were managed (removed) by the manual massage of the abbreviated connections. It is important to understand that the smooth muscles of the above connection react by stretching only after 20 min of a stable uniform stretching procedure so the technique takes a minimum of 20 minutes per 1 connection. Results: Urinary incontinence / incontinence ceased after 12 therapies. Conclusions: We demonstrated that a single manual examination, as well as targeted relaxation Lig teres uteri by tender manual massage yield therapeutic effect.

Topic: 4. Therapeutics

Sub Topic: 4.4 Pharmacological agents

Abobotulinumtoxina: Evidence for long duration of response from 5 patient populations

A. Esquenazi¹, M. Delgado², R. Hauser³, A. Lysandropoulos⁴, S. Page⁵, J. Gracies⁶

¹MossRehab and Albert Einstein Medical Center, Elkins Park, USA, ²University of Texas Southwestern Medical Center and Texas Scottish Rite Hospital for Children, Dallas, USA, ³University of South Florida, Tampa, USA, ⁴ Ipsen, Boulogne-Billancourt, France, ⁵Ipsen, Slough, United Kingdom, ⁶Université Paris-Est, Créteil Val de Marne, France

Background and Aims: For many patients treated with botulinum toxin A (BoNT-A), the symptom relief afforded by an injection wears off earlier than the minimum injection interval, leaving patients to experience symptom recurrence until their next injection. Methods: In this analysis of data from Phase 3 clinical trials (RCT and respective open-label extensions), we assess treatment intervals over repeat cycles for abobotulinumtoxinA in the management of cervical dystonia (CD), adult lower-limb [ALL] & upper-limb [AUL] spasticity, and paediatric lower-limb [PLL] & upper-limb [PUL] spasticity. Flexible study designs allowed patients to be reinjected after Week-12 (or, for PUL, Week-16) according to clinical need. Results: At doses tested, a long duration of response was observed. Pivotal studies of abobotulinumtoxinA reveal a large proportion of patients did not require retreatment for >12/16 weeks (% patients injected Week-16 or later): CD study: 72.6–81.5%, ALL study: 20.1–32.0%, AUL study: 24.0–36.9%, PLL studies: 72.8–93.8%; % children injected Week-22 or later in PUL study: 19.6–67.0%). Safety was as expected for BoNT-A and rates of seroconversion for neutralising antibodies were low (<=4.3%), with no evidence of secondary non-responsiveness. Conclusions: AbobotulinumtoxinA, when dosed optimally, offers many patients a long duration of response. This may give patients sustained symptom relief between injections and decrease the chance of patients experiencing a waning of effect before the next injection can be provided. We hypothesise that this observed long duration of response with abobotulinumtoxinA may be a result of the amount of active BoNT-A at approved doses.

Reference

Truong et al 2005/2010; Gracies et al, 2015/2017/2018; Delgado et al, 2016/2017/2020.

Topic: 4. Therapeutics

Sub Topic: 4.4 Pharmacological agents

Impact of abobotulinumtoxina treatment on the assisting hand assessment in children with hemiparesis due to cerebral palsy: Results from an international, phase 3, pivotal study

A. Shierk¹, W. Pyrzanowska², M. Bonikowski², B. Regnault³, S. Page⁴, M. Delgado¹

¹University of Texas Southwestern Medical Center and Texas Scottish Rite Hospital for Children, Dallas, USA, ²Mazovian Neuropsychiatry Center, Zagorze, POLAND, ³Ipsen, Les Ulis, France, ⁴Ipsen, Slough, United Kingdom

Background and Aims: When used in conjunction with occupational therapy, the aim of botulinum toxin treatment in children with upper-limb spasticity is to produce a selective reduction in muscle spasticity while optimising the effects of therapies used for improving range of motion, enhancing motor ability and functional skills. We assessed effect of a single abobotulinumtoxinA injection cycle on bimanual performance in children with hemiparesis due to cerebral palsy (CP). Methods: This was a double-blind, repeat-treatment (<=4 cycles over 1 year) study (NCT02106351). During Cycle 1, children (2-17 years) with CP and spasticity in >=1 upper-limb were randomized to injections of abobotulinumtoxinA 2U/kg (low-dose), 8U/kg and 16U/kg into the primary target muscle group (PTMG; elbow or wrist flexors). All children participated in an individualized home-exercise therapy program. For the subset of children with hemiparesis treated at certified centers, the Assisting Hand Assessment (AHA) was performed at Baseline and Week 6. Results: Overall 212 children were enrolled, of which 160 had hemiparesis and 92 had AHA assessments at baseline. Mean±SD baseline AHA scores (2U/kg, 8U/kg, 16U/kg) were 43.8±20.5, 46.2±16.7 and 49.3±17.1, respectively. Adjusted mean±SE [95%CI] changes in the AHA scores from baseline to Week 6 of Cycle 1 (n=83) were 4.6±1.8 [1.0, 8.2], 4.8±1.6 [1.6, 8.0] and 3.7±1.6 [0.4, 6.9], respectively. There were no significant differences between higher doses and the 2U/kg low-dose. Conclusions: By Week 6 post-treatment, abobotulinumtoxinA combined with an individualized home-exercise therapy program provided some improvement in bimanual performance in children with hemiparesis due to CP.

Reference

A. Esquenazi M. Delgado R. Hauser A. Lysandropoulos S. Page J. Gracies, DMCN 2020;[doi: 10.1111/dmn.14733].

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Predictors of sexual activity after spinal cord injury

B. Silva Lopes ¹, X. Verraest ², V. Ermida ¹, J. Caldas ¹, J. Laíns ², P. Margalho²

¹Centro Hospitalar Tondela-Viseu, Viseu, Portugal, ²Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, Tocha, Cantanhede, Portugal

Background and Aims: Spinal cord injury (SCI) is a distressing event generally associated with loss of motor, sensory and autonomic functions with relevant impact in quality of life. Furthermore, SCI often affects sexual function depending on the level and severity of the lesion and on personal aspects, such as the previous relationship with partners, sexual experiences and openness to sexual experimentation. This study aimed to identify the factors that influence sexual activity in patients with SCI. Methods: Study design: cross-sectional. Population: Outpatients previously admitted to a Rehabilitation Centre due to SCI between January 2015 and December 2016. Participants were invited to answer a telephone-structured survey addressing sexuality, socioeconomic factors and medical conditions. Sexual activity is considered when sexual intercourse, masturbatory activity or the use of sex utensils were reported in the last 4 weeks. Results: A total of 112 individuals completed the survey, of whom 49 (43,8%) were sexually active. Sexual activity was associated with younger current age, younger age at the time of SCI, male gender, higher educational level and active employment status. Significant differences among groups were also observed according to vesical drainage regimen.

Conclusions: In SCI patients, age and socioeconomic factors (e.g. education level and employment status) seems to have a greater impact on sexual activity than neurologic level or the AIS classification of the lesion. The impact of previous sexual experiences, coping and empowerment strategies and the openness to sexual experimentation are factors that can contribute to explain these results, constituting new approaches that might be considered in further studies.

Topic: 4. Therapeutics

Sub Topic: 4.6 Neurostimulation (rTMS, tDCS, etc.)

Motor imagery (home-based) effect in functional mobility in patients with multiple sclerosis: A case series

R. Carvalho^1,2, B. Silva¹, A.C. Sousa¹, C. Brandão¹, M. Teixeira¹, S. Lopes^1,2

¹Superior Health School of Vale do Sousa - IPSN CESPU, Paredes, Portugal, ²Diagnostic and Therapeutic Techniques Department, Superior Health School of Vale do Sousa - IPSN, Paredes, Portugal

Background and Aims: Multiple sclerosis patients present several symptoms such as lack of mobility, which interferes with functionality and availability to participate in face-to-face sessions. Motor imagery has been used to improve gait in neurological conditions, however, little research has been carried out in patients with MS. Therefore, this study aims to explore the effect of a home-based motor imagery intervention, in MS patient’s functional mobility.

Methods: A small sample research design with a n of 5 using a pre-post test design was carried out. Patients with a rating on Expanded Disability Status Scale less than or equal to 5.5, were selected. Exclusion criteria involved: MS progressive type; motor imagery inability; cognitive deficits ; severe orthopedic, visual, psychiatric and/or neurological comorbidity and/or if a relapse occurred during the intervention. Patients underwent motor imagery training, with two different scenarios, 15min, 3 days/ week for four weeks. Mobility were assessed using TUG. Results: Patients age range between 30 and 54 years. Relatively to mobility, all patients, except P1 (which baseline value is within the normative reference values for her age and gender), had a decrease in TUG execution above the MCID. Furthermore, there was an increase in movement readiness during sit-to-stand and stand to sit, after intervention. Conclusions: These results suggest that motor imagery may be able to improve speed and distance covered during gait in people with MS.

Reference

Page SJ, Levine P, Sisto SA, Johnston MV. A randomized efficacy and feasibility study of imagery in acute stroke. SAGE 2001;15:233-40.

Topic: 7. Functioning and Disability

Sub Topic: 7.4 Impairment Rating, Disability Evaluation and Certification

Prevalence and risk factors of insomnia in discharged paraplegic patients with spinal cord injury from the Philippine orthopedic center from January 2018 to November 2020

A. C. Silva

Philippine Orthopedic Center, Quezon City, Philippines

Background and Aims: A spinal cord injury can affect a person’s quality of life and manifest as insomnia. Inability to obtain adequate sleep and can affect the rehabilitation process. Detection of insomnia in SCI patients may be instrumental in improving a patient’s quality of life. The purpose of this study is to identify the prevalence of insomnia in local paraplegic SCI patients. Methods: This was an epidemiological study covering paraplegic SCI patients discharged from Philippine Orthopedic Center. A modified Bergen Insomnia Scale (BIS) was selected as a screening tool for insomnia. Validation studies for the translated tool were then accomplished. Correspondents were contacted and phone interviews were administered. Descriptive statistics were used to summarize the general and clinical characteristics of the participants. Statistical analysis was done in order to determine the difference of mean, median and frequency between groups, respectively. Odds ratios and the corresponding 95% confidence intervals from binary logistic regression was computed to determine possible associations. Results: 91 patients were included in the study, with a median age of 37 years. Of the sample population, 36% reported waking up due to spasticity, 40% experiences regular body pain that disrupts sleep, with 13% reporting to have co-morbidities that disrupt sleep. Conclusions: This study shows the prevalence of insomnia among paraplegic SCI patients to be at 71.4% (95% CI 61.0% to 80.4%). Trauma as a cause of SCI, spasticity, and regular body pain were risk factors with high association with insomnia.

Reference

Bollu PC, Kaur H. Sleep medicine: Insomnia and sleep. Mo Med 2019;116:68-75.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

A case of symptomatic bilateral ledderhose disease

A. Silva, N. Albuquerque, B. Lopes, D. Coutinho, E. Moreira, R. Evangelista, T. Félix, I. Peixoto, M. Vaz, J. Caldas

Department of Physical Medicine and Rehabilitation, Tondela-Viseu Hospital Center, Viseu, Portugal

Background and Aims: Ledderhose disease (LD), or plantar fibromatosis, is a rare benign disorder characterized by localized proliferation of fibrotic tissue and nodular formation in the medial portion of plantar aponeurosis. Its etiology remains unknown. Symptoms include pain and plantar swelling, and in advanced cases, retractions and fascial contractures. The diagnosis of LD is primarily clinical, but ultrasound and MRI can be useful confirmatory imaging exams. Conservative treatment is recommended as the first approach. Surgical treatment has a high recurrence rate, being reserved for refractory cases. This case intends to evaluate the outcome of several treatment options.

Methods: Clinical case description based on patient interview and the clinical process. Results: A 46-year-old man presented frequent bilateral pain and plantar swelling for 4 years. Symptoms were more exuberant on the right foot and with orthostatism, affecting ambulation. There was no family history of LD, and he did not have other comorbidities as Dupuytren or Peyronie diseases. Physical examination did not show palpable nodules. The patient was treated with anti-inflammatory drugs, physiotherapy, orthopedic insoles, cortisone injections, radial extracorporeal shock wave therapy, and finally, bilateral fasciotomy 3 years after onset, without satisfactory improvement. MRI revealed changes in both plantar aponeuroses, compatible with LD. Conclusions: LD usually evolves slowly, can cause pain, functional disability, and decreased quality of life. Treatment should be individualized, and the optimal management starts with conservative therapies, progressing as needed.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Depression, anxiety and phobia of COVID 19 in post-stroke patients during COVID-19 pandemic

A. D. Silte Karamanlioglu, A. Atici, G. Ozturk, P. Akpinar, F. Unlu Ozkan, I. Aktas

Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey

Background and Aims: The current COVID-19 outbreak has brought physical, psychological, social and economic challenges. Depression and anxiety are known mental health issues in post-stroke patients. Coronaphobia may be defined as a persistent and extreme fear of the coronavirus. We aimed to assess the depression, anxiety and phobia of COVID-19 in post-stroke patients and to explore the potential influencing factors. Methods: The study included patients aged over18 years who had clinical diagnosis of stroke with mini mental state examination (MMSE) score over 24 and were able to communicate in Turkish on the telephone. The patients with MMSE score under 24, those with aphasia and those declined phone interview were excluded. The health and social status of the patients was questioned with the form we prepared during the COVID-19 pandemic period. The phobia of COVID 19 was assessed with the COVID-19 phobia scale (CP19-S), while anxiety and depression were evaluated with the hospital anxiety and depression scale (HADS). Results: The study included 35 women and 42 men. The HADS scores showed that 45.5% of patients had severe risk for depression while 19.5% had severe risk for anxiety. There was a positive, significant correlation between HADS anxiety subscale and all C19P-S subscales. There was only significant relationship between HADS depression subscale and C19P-S somatic subscale. Conclusions: Post-stroke patients are psychologically affected by the COVID-19 pandemic. In particular, younger, physically independent or partially dependent, unemployment patients are affected more extensively.

There is no conflict of interest regarding the publication of this paper

Topic: 3. Clinical Sciences

Sub Topic: 3.6 Preventive Rehabilitation

Associations between health literacy and exercise behavior changes during the COVID-19 state of emergency among middle-aged Japanese adults

D. Shiratsuchi¹, H. Makizako², S. Akaida¹, S. Shono^1,3, R. Shiiba^1,3, Y. Taniguchi^1,4, K. Tomioka^1,3, N. Sato¹, A. Wada¹, Y. Kiuchi^1,5, M. Tateishi¹, Y. Nakai²

¹Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan, ²Department of Physical Therapy, Faculty of Medicine, Kagoshima University, School of Health Sciences, Kagoshima, Japan, ³Department of Rehabilitation, Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Tarumizu, Japan, ⁴Department of Physical Therapy, Kagoshima Medical Professional College, Kagoshima, Japan, ⁵Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan

Background and Aims: High health literacy (HL) may be associated with the practice of exercises that takes into account the risk of infection during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to examine the associations between each domain of HL and exercise behavior changes during the COVID-19 state of emergency among Japanese adults aged 40 to 64 years. Methods: Data for this study was collected from an online survey panel administered through the sampling of Y cloud systems among Japanese adults. The online survey was conducted in October 2020. The analytic sample consisted of 2,697 middle-aged Japanese adults (mean age, 49.3 ± 6.1 years; women, 37.2%). HL was assessed using the 14-item HL scale, which is further divided into three different levels (functional, interactive, and critical). Participants answered questions regarding the execution status before and during the COVID-19 state of emergency of exercises such as walking or jogging, and resistance training at home. Results: The results of the multivariate logistic regression analysis are shown in [Figure 1]. Adjusted for potential confounders, high interactive HL (OR 1.47, 95% CI 1.08–2.00) was significantly associated with walking or jogging before the pandemic but not doing so during this period. High interactive HL (OR 1.58, 95% CI 1.13–2.20) was also significantly associated with indoor training before the COVID-19 state of emergency, and this association had been continued through this period.

Conclusions: These results suggest that high interactive HL is associated with changes in exercise behavior, considering the risk of infection among Japanese middle-aged adults.

Topic: 6. Health Policy and Systems

Sub Topic: 6.8 Rehabilitation Responses to Infectious Diseases and Infection Control

The Corona-19 pandemic temporary over day prediction in Ibaraki prefecture by Trix

Y. Shinoda¹, M. Maruyama²

¹Department of Rehabilitaion, Ibaraki Rehabilitaion Hospital, Ibaraki Prefecture, Moriyashi, Japan, ²Division of Rehabilitaion, Ibaraki Rehabilitaion Hospital, Ibaraki Prefecture Moriyashi, Japan

Background and Aims: Using the Triple Exponential Average of oscillators (TRIX), developed by Jack Hutson and applied to artificial intelligence algorithms, we predicted the date when the number of covid-19 positive patients in Ibaraki Prefecture are diminished temporary. Methods: Using the Triple Exponential Average of oscillators (TRIX) developed by Jack Hutson and applied to artificial intelligence algorithms, we predicted the date when the number of corona-positive patients in Ibaraki Prefecture are diminished. Results: March 17th 2020 is the first identified in Ibaraki prefecture. According to the number of reports by PCR in the prefecture, we counted during every 7 days. Max was 43 virus positive patients from March 30th to April 4th as the peak week. The forecast was examined on May 2nd. TRIX predicted that it would be May 3rd to May 13th. In fact, it was May 5th. Conclusions: This method could show very useful indicator for community public health.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Effect of rolling over pattern and caregiver’s perception on prevalence of plagiocephaly in Korean infants

Y. B. Shin, H. E. Park

Pusan National University Hospital, Pusan, South Korea

Background and Aims: This study aimed to clarify the cause of the reversal of developmental milestones in rolling and to identify the relationship among skull deformity, position of infants, and caregivers’ awareness of normal development of children.

Methods: Group comparisons were performed Based on a questionnaire survey of the main caregivers of infants, a total of 97 subjects were divided into groups based on the diagnosis of plagiocephaly and the direction of the first rolling over. Results: The proportion of caregivers who answered that the child rolled over supine-to-prone first showed statistically significant differences between plagiocephaly and normocephaly group (p=0.008). Moreover, there was no statistical difference in the perception of the caregivers regarding the order of rolling over between the two groups (p=0.084). Conclusions: “Back to Sleep” campaign might have spread negative perception of prone position and caregivers were unaware of the importance of their babies’ in prone position. It might increase the prevalence of plagiocephaly and even cause the reversed order of rolling development.

References

American Academy of Pediatrics Task Force on Infant Positioning and SIDS. Positioning and SIDS. Pediatrics 1992;89:1120-6.
Persing J, James H, Swanson J, Kattiwinkel J. Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surg. and Section on Neurological Surg. Pediatrics 2003;112:199-202.
Athanasakis E, Karavasiliadou S, Styliadis I. The factors contributing to the risk of sudden infant death syndrome. Hippokratia 2011;15:127-31.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Effect of balance function training combined with virtual reality technology on patients with cerebral apoplexy

F. Shi

Jilin University, Changchun, China

Background and Aims: To observe the difference in the degree of functional improvement between patients receiving balance training of virtual reality technology and conventional rehabilitation therapy and traditional rehabilitation therapy. Methods: Thirty-six stroke patients admitted in the Rehabilitation Department of the first Hospital of Jilin University were randomly divided into control group and treatment group. Both the control group and the treatment group received the same degree of routine rehabilitation treatment. The control group received 30 minutes dynamic balance training with Balance-Trainer dynamic balance training instrument, and the treatment group received balance training 30 minutes based on Virtual Reality technology. Both groups were trained twice a day for 4 weeks. Berg balance scale (BBS), simplified Fugl-Meyer Motor function scale (FMA), FAC and modified Barthel Index (MBI) were used to evaluate the balance function, lower limb motor function, walking function and activities of daily living (ADL) of the two groups. Results: There was no significant difference between the control group and the treatment group before training (P < 0.05). In the fourth week of training, the average scores of BBS, FMA, FAC and MBI in the control group and the treatment group were significantly higher than those in the control group, and the curative effect in the treatment group was significantly better than that in the control group (P < 0.05). Conclusions: Balance function training combined with virtual reality technology can improve the function of stroke patients, and the effect is better than that of traditional rehabilitation therapy.

Topic: 4. Therapeutics

Sub Topic: 4.3 Integrative Medicine

The effects of electroacupuncture on working memory and electrophysiology

J. J. Xu^1,2, M. Ren^1,2, Y. L. Li^{1, 2, 3}, J. J. Zhao^1,2, S. C. Zhang¹, S. T. Xu^2,3, Z. Q. Zhou^1,2, X. X. Chen^1,2, C. L. Shan^{1, 2, 3}

¹Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China, ²School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China, ³Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China

Background and Aims: Previous studies showed that electroacupuncture (EA) could improve cognitive function. However, there are few reports about the electrophysiological effects of EA on the cerebral cortex. Theta and gamma band in cortical neural oscillations are closely related to the working memory (WM) performance. Corresponding to this theory, we chose 6 Hz-EA (theta) and 40 Hz-EA (gamma), at DU20 and DU24 acupoints and to compare the effects of different EA frequencies on WM and electrophysiology. Many previous WM studies found a larger negative slow wave (NSW) amplitude has a certain correlation with the successful memorization of the measured information. Therefore, we applied the change of NSW amplitude as the observation index. Methods: Each participant (N=18) attended three different sessions in accordance with a within-subject crossover design. We performed 6 Hz-EA, 40 Hz-EA, and sham-EA in a counterbalanced order, conducting the WM task both pre- and post-intervention. We evaluated WM performance using visual 3-back WM task with digital and recorded the participants’ EEG signals during the tasks. Results: (1) Behavior results: d-prime and reaction times for hits under all three stimulatory conditions (pre vs. post) had no significance (p > 0.05); (2) For NSW: A significant interaction of stimulation types × time × electrode (p < 0.05). Post hoc test showed the amplitude of electrodes F3 and Fz after 6 Hz-EA intervention was significantly stronger than before (ps < 0.05).

Conclusions: Active 6 Hz-EA significantly improved NSW amplitude during performance on the 3-back tasks in the anterior cortex compared to 40 Hz-EA and sham-EA.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

Comparison of sensory observation and sensory stimulation based on mirror neuron and embodied perception: A task-based functional magnetic resonance imaging study

Z. Q. Zhou^1,2, S. M. Chen^2,3, Y. L. Li^1,2, S. C. Zhang¹, S. T. Xu^2,4, Y. W. Wu^1,2, X. X. Chen^1,2, X. L. Shi^1,2, J. J. Xu^1,2, M. Ren^1,2, C. L. Shan^{1, 2, 4}

¹Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China, ²School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China, ³Rehabilitation Department, Shanghai No.3 Rehabilitation Hospital., Shanghai, China, ⁴Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China

Background and Aims: Mirror therapy (MT) and action observation treatment(AOT), based on the theory of mirror neuron and embodied perception, have been adopted to improve motor function for post-stroke patients. However, if sensory observation(SO) training can also be used to facilitate sensory recovery? There are no answers yet. This study was to compare the cortical activations by sensory observation(SO) and sensory stimulation(SS) with functional magnetic resonance imaging (fMRI), in order to find the evidence that SO may be used to promote sensory recovery after stroke.

Methods: Fourteen right-handed healthy subjects (21±4 years, 8 female and 6 male) were enrolled in this study. All subjects were evaluated with task-based fMRI to discover the difference of brain activation between SO and SS. The basic fMRI experimental scheme can be seen in the following. Results: The task-based fMRI has showed that inferior parietal gyrus, middle frontal gyrus, middle temporal gyrus, insula, postcentral gyrus and precentral gyrus were significantly activated during SS. While, middle temporal gyrus, calcarine fissure and surrounding cortex, lingual gyrus, superior parietal gyrus and middle occipital gyrus were found to be activated during SO. Conclusions: In our research, different from SS, there were no sensorimotor cortex activations induced by SO in healthy participants. Therefore, SO training itself may not be available to improve sensory dysfunction recovery for stroke patients. Further research and a larger sample size are needed to verify this finding.

Topic: 3. Clinical Sciences

Sub Topic: 3.2 Pain Osteoporosis -Osteoarthritis

Effects of actvities of daily living instractions on the patients with chronic low back pain

M. A. Shakoor

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Background and Aims: Low Back Pain (LBP) is very common. It has been estimated to affect around 80% of individuals sometimes in their life, and is a leading cause of disability under the age of 45 years. In some studies, rehabilitation treatment like SWD, exercise, ADLs were found effective in reducing disability of the patients with Chronic LBP. ADLs also found effective in O A knee in some experiment in Bangladesh. So, the aim of this study was to find out the effects of ADLs on the patients with chronic LBP to improve the condition of the patients with LBP. Methods: A randomized controlled trial was done including 117 patients with chronic LBP. They were divided into two groups. Group-A: treated with ADLs & Group-B (without ADLs). The patients were followed up weekly for six weeks and the outcome were assessed by Visual Analogue Scale ,Modified Zung Index, Schober’s test, and Oswastry Disability Index. The data were analyzed statistically. Both paired and unpaired Student’s ‘t’ test and Chi-squired test were done. And p < 0.05 was considered as the level of significance. Results: After treatment, both the group showed improvement individually (P<0) and in comparison between groups ADLs receiving group showed more improvement. Parameters ie Visual Analogue Scale ,Modified Zung Index, Schober’s test, nd Oswastry Disability Index all showed significance improvement after six weeks (P<0) ADLs group. Conclusions: It may be concluded that activity modification is beneficial to improve the condition of the patients with chronic LBP.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Management of degenerative lumbar spinal stenosis in the elderly

A. Haj Salah¹, S. El Arem¹, M. Sghir¹, M. Maraoui¹, W. Said², I. Ksibi¹, W. Kessomtini¹

¹Taher Sfar Hospital, Mahdia, Tunisia, ²Military Hospital, Tunis, Tunisia

Background and Aims: Lumbar spinal stenosis (LSS) can cause symptomatic neurogenic claudication alongside radicular pain and weakness. It is frequent in the elderly. The aim of this study was to describe the epidemiological profile, radiological aspects as well as therapeutic modalities of lumbar stenosis in the elderly. Methods: A retrospective study carried out over a period of 3 months on patients aged over 65 years, followed in physical medicine for LSS. Clinical, radiological, and therapeutic data were collected. Results: Eighteen patients were included in this study with a sex ratio-ratio of 0.5. Their mean age was 73 years. In their medical history, 55.8% were hypertensive, 77.6% diabetic and 33% had dyslipidemia. All patients had a history of chronic low back pain evolving since an average of 2 years. Lumbar pain was the most frequent reason for consultation (80%): unilateral in 45% of patients and bilateral in 55% of the cases, associated with radicular claudication in 80% of cases and urinary disturbances in 25% of the cases. Physical examination showed spinal syndrome in 75% of cases, radicular syndrome in 48% of cases and pathological neurologic signs in 22% of cases. On imaging, LSS had varied etiology: disc herniation (35%), facet hypertrophy (45%), cyst formation (25%) and ligamentous hypertrophy.

All patients received medical treatment associated with an individualized rehabilitation program. Epidural corticosteroid injection was done in 55% of cases. Conclusions: Lumbar spinal stenosis (LSS) is a debilitating condition associated with degeneration of the spine with aging. It requires multidisciplinary management based on conservative treatment in the first line.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Musculoskeletal disorders risk factors in a population of Tunisian dentists

A. Haj Salah¹, S. El Arem¹, M. Khouaja¹, W. Said¹, I. Ksibi², M. Sghir¹, W. Kessomtini¹

¹Taher Sfar Hospital, Mahdia, Tunisia, ²Military Hospital, Tunis, Tunisia

Background and Aims: The aim of this study was to determine the personal and professional risk factors for musculoskeletal disorders (MSDs) in a group of Tunisian dentists. Methods: A Cross-sectional study was conducted over a period of 7 months (July 2019 to January 2020). A self-administered questionnaire carried out among dentists of the regions of Mahdia and Monastir and among dentists who attended the 2nd International Congress of the National Association of Interns and Residents in Dental Medicine (NAIRDM). Results: One hundred and fifty-seven dentists responded to the questionnaire. The mean age was 33 years with a sex-ratio of 0.58. A history of psychiatric disorders was noted in 50% of the cases. The mean length of dental practice was 6 years. The majority of dentists (81.5%) spent less than 8 hours at work daily with a mean break time of 60 minutes. The prevalence of MSDs was 82.2%. The most common disorders were neck pain (61.2%), shoulder pain (56.6%) and low back pain (52.7%). A statistically significant association was found between MSDs and following factors: laterality (p = 0.004), marital status (p = 0.002), repetitive movements (p = 0.001) and uncomfortable position during work (p = 0.02). In the multivariate analysis, MSDs were influenced by length of breaks, repetitive movements, uncomfortable work position and marital status. Conclusions: The prevalence of MSDs is high among Tunisian dentists and working conditions in terms of worktime and ergonomics are the most common risk factors.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Are col4a1 and col4a2 gene polymorphisms associated with cerebral palsy?

O. Guvener¹, M. Sezgin¹, O. Tezol², I. O. Barlas³, A. A. Ozdemir⁴, E. A. Kanik⁴

¹Department of Physical Medicine and Rehabilitation, Medical Faculty Hospital, Mersin University, Mersin, Turkey, ²Department of Pediatrics, Medical Faculty Hospital, Mersin University, Mersin, Turkey, ³Mersin University Medical Faculty, Medical Biology and Genetics, Mersin, Turkey, ⁴Department of Biostatistics and Medical Sciences, Mersin University Medical Faculty, Mersin, Turkey

Background and Aims: Recent studies increasingly claim that genetic factors can be held responsible in CP. To investigate the COL4A1 and COL4A2 gene polymorphisms association with susceptibility to disease and severity of CP. Methods: This study included patients with CP and healthy controls. After obtaining genomic DNA from peripheral blood, genotyping was performed for COL4A1 (rs1961495) and COL4A2 (rs9521733) gene polymorphisms by Real Time-PCR. Genotype distributions and allelic frequencies were compared between patients and control subjects. The Gross Motor Function Classification System, type of involvement, accompanying conditions, and MRI data were used to evaluate the disease severity and relationship with gene polymorphisms. Results: The study population consisted of 176 (75 girls, 101 boys, 71.8 ± 37.9 months) patients and 178 (88 girls, 90 boys 69.3 ± 55.2 months) controls (p> 0.05). The genotype distribution of the groups was in the Hardy - Weinberg balance (p> 0.05). There weren’t significant differences between patients and controls with respect to genotype distribution and allele frequency (p>0.05). In addition, there was no statistically significant difference between the clinical severity of CP and the genotype distribution and allele frequency of gene polymorphisms (p>0.05). Only, a significant association was detected between COL4A2 gene polymorphism and growth retardation in CP, TT genotype and T allele were higher (p=0.03 and p=0.01, respectively) in patients with growth retardation. Conclusions: COL4A1 and COL4A2 gene polymorphisms are not related to susceptibility to disease and severity of CP in a group of Turkish populations, but COL4A2 gene polymorphism may be associated with growth retardation in CP.

Topic: 4. Therapeutics

Sub Topic: 4.2 Injections (Joint. Spine, etc.,)

Bont-a injection in children with cerebral palsy for hip adductor spasticity; is it clinically and radiologically effective?

E. Sarigecili¹, M. Sezgin², U. Hanbaba², D. Derici Yildirim³, C. Okuyaz⁴

¹Department of Pediatric Neurology, Adana City Hospital, Adana, Turkey, ²Department of Physical Medicine and Rehabilitation, Mersin University Medical Faculty Hospital, Mersin, Turkey, ³Department of Biostatistics and Medical Informatics, Mersin University Medical Faculty, Mersin, Turkey, ⁴Department of Pediatric Neurology, Mersin University Medical Faculty Hospital, Mersin, Turkey

Background and Aims: The spasticity of hip adductor muscles in children with cerebral palsy (CP) causes gait and sitting difficulties, pain, and progressive hip subluxation and dislocation. To investigate the clinical and radiological effects of botulinum neurotoxin-A (BoNT-A) injection in CP with hip adductor spasticity. Methods: The CP patients with bilateral hip adductor spasticity were included. Those who previously had hip surgery, selective dorsal rhizotomy, or hip dislocation were excluded from the study. While clinical evaluations of the patients were made with gross motor function classification system (GMFCS), hip adductor spasticity (Modified Ashworth Scale), and distance between knees, radiological evaluations were made with acetabular index (AI) and colladiaphizer angle (CDA) measurements. BoNT-A injections (3-5 U/kg/muscle) were applied to the bilateral hip adductor muscles of all patients. The evaluations of the patients were done before the injection and the 3rd and 12th months after the injection. Results: The average age of 20 patients (male: 12, female: 8) participating in the study was 84.8 ± 20.9 months (min-max:48 -120 months). The spasticity and GMFCS scores significantly reduced at 3 and 12 months after injection (right p = 0.007, left p = 0.005, p= 0.002). Similarly, the distances between knees significantly increased at 3 and 12 months compared to before injection (p <0.001). However, AI and CDA measurements were not statistically different at the 3rd and 12th months after treatment (p> 0.05). Conclusions: BoNT-A injections may provide clinical improvement and prevent radiological progression of the hip in children with CP with bilateral hip adductor spasticity.

Topic: 7. Functioning and Disability

Sub Topic: 7.1 ICF

Developing Clinfit COVID-19: An Isprm initiative to scale up rehabilitation in a new world

F. Gimigliano ¹, M. Selb ^2,3, M. Mukaino ⁴, J. Li ^5,6, L. Li ⁷, G. Stucki ^3,8

¹Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Napoli, Italy, ²ICF Research Branch, Nottwil, Switzerland, ³Swiss Paraplegic Research, Nottwil, Switzerland, ⁴Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan, ⁵Department of Rehabilitation Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing, China, ⁶Jiangsu Geriatric Rehabilitation Hospital, Nanjing, China, ⁷University of Hong Kong, Hong Kong, Hong Kong, ⁸Department of Health Sciences and Medi, Center for Rehabilitation in Global Health Systems, WHO Collaborating Center, Lucerne, Switzerland

Background and Aims: Health systems worldwide are challenged to address the healthcare needs of persons with COVID-19. The COVID-19 pandemic not only challenges Physical and Rehabilitation Medicine (PRM) to treat patients, it also offers an opportunity to further rehabilitation in a new world. After the immediate need to mitigate the spread of COVID-19, PRM professionals are tasked to scale up rehabilitation to address the functioning limitations experienced by COVID-19 patients/survivors. Methods: To meet this challenge, the ISPRM ClinFIT Task Force has undertaken a project to develop an ICF-based tool for the assessment and reporting of functioning of COVID-19 patients/survivors - ClinFIT COVID-19, to assist health professionals in optimally addressing patients’ healthcare needs. Results: The first step has already been taken, i.e. identification of the ICF categories that ClinFIT COVID-19 should cover in settings across the continuum of care, that considered, among other things, the experience of countries first hit by COVID-19 including Japan. Conclusions: This talk will present the methodology and results of the multi-step process to develop the ClinFIT COVID-19 category list as well as introduce the next steps (operationalizing each category into items/questions and developing a scoring system for rating the patient’s status in each item) to finalize the acute, post-acute, and long-term care versions of ClinFIT COVID-19.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Prevalence and risk factors of nonspecific low back pain among paramedical personnel

A. Sehimi^1,2, C. Kandouci^1,3, I. Mohammedi¹, A. Hamdadou¹, M. Bedjaoui^1,2, O. Bensaber^1,2

¹Faculty of Medicine, Djillali Liabes University, Sidi Bel Abbes, Algeria, ²PRM Department, Hassani Abdelkader University Hospital, Sidi Bel Abbes, Algeria, ³Occupational Medicine Department, Hassani Abdelkader University Hospital, Sidi Bel Abbes, Algeria

Background and Aims: Nonspecific low back pain (NSLBP) is common in paramedical personnel (PP) and have adverse consequences on several levels; these consequences are more important in chronic nonspecific low back pain (CNSLBP). The objective of this study was to determine the prevalence and to identify risk factors of NSLBP and CNSLBP in PP. Methods: A cross-sectional study was conducted among PP in Sidi Bel Abbes city during the period from november 1st to december 31st, 2019. The data were collected using a pre-established questionnaire. Univariate and multivariate logistic regression was performed to analyze the association of eight personal and five professional factors with NSLBP and CNSLBP. Results: 398 PP individuals were included. The prevalences of NSLBP and CNSLBP were estimated at 66.2% (CI 95%: 61.4–70.9) and 15% (CI 95%: 11.6–18.9), respectively. Multivariate analysis revealed that extra-professional activity (p=0.02, OR= 3.20, CI 95%: 1.20-8.51) and carrying heavy loads (P=0.004, OR= 2.66 CI 95%: 1.36-5.22) were risk factors for NSLBP, while physical activity (p= 0.02, OR= 0.42 CI 95%: 0.21-0.86) and smoking (p = 0.04 or = 0.27 CI 95%: 0.08-0.94) were protective factors against it. It also revealed that depression (p< 10-3, OR = 4.52 95% CI:1.71-11.98) was a risk factor for CNSLBP while job satisfaction (p<10-3, OR= 0.84 CI95%:(0.75-0.95) was a protective factor against it. Conclusions: The high prevalence of low back pain on one hand and its heavy medical and socio-economic consequences on the other, encourage preventive measures against the risk factors identified in our study.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Peripheral vestibular dysfunction – The role of vestibular rehabilitation

C. A. Sara, V. Marques, R. Araujo, N. Ramalhao, R. Brito, M. Ribeiro, R. Figueiral

Centro Hospitalar Universitário do Porto, Porto, Portugal

Background and Aims: Vestibular Rehabilitation (VR) consists of an individualized program, with multiple phases composed by specific exercises. The objective of the program is to treat acute alterations, compensate irreversible or chronic deficits, improve balance, decrease the risk of falling and dizziness, and finally, promote patient independence and confidence in daily living activities.

The aim is to assess the effectiveness of vestibular rehabilitation in people with symptomatic peripheral vestibular dysfunction (PVD). Methods: Analysis of the clinical process and results of six selected patients that participated in the vestibular rehabilitation program at the Centro Hospitalar Universitário do Porto (CHUP). For a better understanding of the subject, a review of the literature published in the main medical databases until 2020 was made. Results: The examined patients completed the VR program established in CHUP. Although it wasn’t reported a complete recovery of the symptoms presented initially, all of them described and improvement in confidence performing their activities of daily living, improvement in balance and a decrease in dizziness. They were evaluated using the berg balance scale, confidence in the daily living activities scale and computerized posturography, in the first and final session. It was observed an improvement in the final results of all tests applied. Conclusions: Despite the absence of a reported complete recovery, the VR program leaded to a significant improvement of all patients symptoms and confidence. These obtained results are consistent with the conclusions of previous published literature, reinforcing the effectiveness of VR in patients with PVD.

Topic: 5. Engineering and Technology

Sub Topic: 5.6 Telerehabilitation

Telerehabilitation program for chronic shoulder rotator cuff tendinopathy: A successful pioneer project within the portuguese national health service

R. Santos¹, J. B. Ferreira¹, S. Serrano¹, F. Januário¹, L. Luís¹, M. Bernardino¹, S. Luís¹, F. Correia²

¹Centro Hospitalar de Leiria, Serviço de Medicina Física e de Reabilitação, Leiria, Portugal, ²Sword Health, Portugal

Background and Aims: Background: Rotator cuff tendinopathy represents a main cause of musculoskeletal pain and functional impairment. Physical exercise is a fundamental component in the management of this pathology with beneficial effects in pain release and functionality. Telerehabilitation home-based program included a user-friendly exercise platform and a tight supervision, accomplishing a structured patient-centered approach and empowering the patient to perform exercises on a daily continuous basis. Study´s aim: Evaluate the beneficial effects of a home-based telerehabilitation program on patients with chronic shoulder rotator cuff tendinopathy. Methods: Longitudinal prospective study was conducted, including patients from january 2017 to june 2018. Inclusion criteria: diagnostic criteria for rotator cuff tendinopathy and shoulder pain with 3 months of evolution. Telerehabilitation was applied using SWORD Health® platform, including therapeutic exercise sessions monitored by movement sensors (5 weekly sessions of 40 minutes, 4 weeks) with biofeedback through mobile application and remote surveillance. Patient education and treatment readjustment were performed. Patients completed QuickDash Score before and after the program and at 3 and 6-month of follow up. Results: 57 patients, mean age 60 years, 77% female, 58% right-sided pathology. Median compliance was 93% and total treatment time was 16h29min. QuickDASH results improved after program (52.61 vs 37.88) and at 3 (39.68) and 6 months (39.66) (p-values <0.05). Conclusions: We obtained improvements on functional capacity in patients with rotator cuff tendinopathy who completed the program. Rigorous inclusion criteria, patient structured education and an individualized approach are probably mandatory to rehabilitation success. Telerehabilitation may be a particularly useful approach at pandemic contexts.

Topic: 8. Specialty Development

Sub Topic: 8.4 Development Research in Low and Middle Developed Countries

Conceptualizing occupational development model for individuals with autism spectrum disorders from Indonesians’ perspectives: A grounded theory study

E. Saloko¹, l. Harumi², E. Sumaryanto², R. Kobayashi¹, Y. Ito¹

¹Department of Occupational Therapy, Faculty of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan, ²Department of Occupational Therapy, Surakarta Health Polytechnic, Ministry of Health, Surakarta, Indonesia

Background and Aims: Occupational therapists put endeavor to focus on occupation as a valid pursuit especially those who work in pediatric medical settings in Indonesia, in which body functions have been primary concerns. Although services for Individuals with Autism Spectrum Disorders (IASD) in medical and school settings are available; communities rarely discuss how occupational therapy is advantageous for adult IASD. Subsequently, Indonesian occupational therapists are often hesitant to share lifespan perspectives. The present study aimed to develop a model of practice for IASD within the Indonesian context. Methods: Implementing the grounded theory of Charmaz, this study employed theoretical sampling to recruit 19 participants and conducted individual semi-structured interviews. The main data were comprised of interview transcriptions. Photographs of occupational therapy activities and facilities for IASD were collected and registered as secondary data. The constant comparative method was used to develop concepts from data by coding and analyzing at the same time. Results: Seven categories were emerged, comprising a theoretical model of occupational development for IASD. A diagram then was created to illustrate the relationships between the categories. This model is grounded in enabling IASD empowerment, translates occupation-centeredness and lifespan tenets in IASD interventions within the values of Indonesian culture.

Conclusions: The model is significant for occupational therapists since it is consistently focusing on occupation, moreover, its lifespan perspective emphasizes that IASD intervention is beyond pediatric issues. It also provides a way to investigate occupational potentials and develop occupational milestones within the Indonesian context.

Topic: 6. Health Policy and Systems

Sub Topic: 6.6 Team Work: Rehab Professionals

Differences in awareness and behavior by occupations regarding seating support

R. Saito¹, K. Inoue², M. Kida²

¹Kajiwara Clinic, Arakawa-Ku, Japan, ²Tokyo Metropolitan University, Arakawa-Ku, Japan

Background and Aims: It is important to support poor posture for the elderly, and I realize the importance of seating support. Therefore, the purpose of this study was to clarify the current status of seating support by care workers, nurses and rehabilitation workers. And this study was to consider issues for occupational therapists to promote seating support of the elderly. Methods: Based on the question items of the research by Yamashita et al., We created a questionnaire. The target facilities were randomly selected from the Internet searches, and we obtained agreement by e-mail or telephone. Results: Responses were obtained from 53 people from 6 facilities. We analyzed 47 responses, excluding 6 who had missing or duplicate responses. The subjects of this study were 31 rehabilitation workers and 16 care workers and nurses. As a result, it was shown that the need for seating support was similarly recognized in all occupations. On the other hand, it was clarified that the recognition of the way of thinking and the daily consciousness are different, and that there is a difference in the viewpoint and the difficulty of support to pay attention to in implementing it. Conclusions: In promoting seating support of the elderly, it is important to be able to collaborate and practice with care workers and nurses. In the future, it is necessary to consider specific methods and means for that.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Level of satisfaction of occupational therapy telerehabilitation program among outpatients and hospital discharged patients during COVID-19 pandemic: A pilot study

S. Saha, S. Gangopadhyay, M. Sengupta, A. Chakraborty, A. K. Baljogi, J. Patra, P. Majumdar Dutta, R. Mahapatra

Institute of Neurosciences Kolkata, Kolkata, West Bengal, India

Background and Aims: Telerehabilitation is the need of the hour in COVID-19 pandemic, but it is undefined that how satisfactory method it is for the delivery of rehabilitation therapy in Indian scenario. The present study aims at evaluating the satisfaction of Occupational Therapy (OT) Telerehabilitation treatment program among outpatients and hospital discharged patients. Methods: It is a survey type pilot study started in July 2020, in the department of Neurorehabilitation at Institute of Neurosciences Kolkata, using the tool ‘Institute of Neurosciences Kolkata Occupational Therapy Telerehabilitation Satisfaction Questionnaire’ which is constructed and validated by the authors. It is a 14 item questionnaire in which responses are recorded in a 5 point Likert scale. Google Forms platform was used to apply the same. Results: The questionnaire is applied on 23 subjects, most of them were patients of Cerebrovascular accident. The results show that 47.8% of the subjects rated the OT Telerehabilitation Service provided by the hospital as ‘Very Satisfactory’. OT Telerehabilitation saved travelling time and money, so 60.9% subjects were very satisfied, whereas 77.3% of the subjects were very satisfied by using OT Telerehabilitation from their own place in view of the comfort & safety, in comparison to the same during hospital visit. Conclusions: The promising new tool can help us to assess how much we are being able to help our patients through Telerehabilitation in this pandemic situation.

References

Khanna M, Gowda GS, Bagevadi VI, Gupta A, Kulkarni K, Shyam RP, et al. Feasibility and utility of tele-neurorehabilitation service in India: Experience from a quaternary center. J Neurosci Rural Pract 2018;9:541-4.

Topic: 7. Functioning and Disability

Sub Topic: 7.4 Impairment Rating, Disability Evaluation and Certification

Voice Quality in Vocal Fold Scars

M. D. M. Saenz de Tejada Sanchez, C. Cordero García, S. Muñoz Mora, M. Lopera Martinez, A. M. Sanchez Guerrero

Department of Physical Medicine and Rehabilitation, Juan Ramón Jimenez University Hospital, Huelva, Spain

Background and Aims: The impact of dysphonia on the quality of life measured by the patient himself should be included in the basic protocol for voice assessment, since it allows evaluating aspects that cannot be measured by objective parameters. The goal of this study is knowing the impact on voice quality of patients with vocal fold scar after speech therapy, as well as the improvement of GRBAS scale and averaged phonation air flow (S/E). Methods: Retrospective descriptive observational study. The sample size is 35 patients undergoing vocal fold surgery for different pathologies that presented dysphonia, assessed in our Rehabilitation Voice Department, since 2018 until 2020. The patients were evaluated for the first time before speech therapy and they were reviewed 6 months after, collecting the following variables: Vocal disability index (VHI-10), GRBAS scale and averaged phonation air flow (S/E). Results: Using Wilcoxon signed-rank test, the difference obtained between the VHI-10 before and after speech therapy is statistically significant (p < 0.01), which translates as a perceived improvement in voice quality. As well, the difference in the results of the GRBAS scale has also been statistically significant (p < 0.01), both in its total score and in its items independently; just like the difference in the S/E index (p < 0.05). Conclusions: VHI-10 is a useful tool to evaluate the efficacy of speech therapy in patients with vocal fold scars. The total score of the VHI-10 in the study is correlated with the perception of voice measured by the GRBAS scale and the S/E index.

Topic: 6. Health Policy and Systems

Sub Topic: 6.4 National Policy and Law

Telemedicine guidelines in south East Asia

I. Sabrina¹, I. R. Defi²

¹Hospital Rehabilitasi Cheras, Kuala Lumpur, Malaysia, ²Hasan Sadikin General Hospital, Bandung, Indonesia

Background and Aims: Guidelines on telemedicine would assist health-care providers in delivering health-care services based on local circumstances. Aim of the Study: To explore and compare guidelines on telehealth and telemedicine in South East Asia (SEA). Methods: Electronic databases such as Google, PubMed and Cochrane reviews were searched for articles using keywords such as “telemedicine” OR “telehealth” OR “eHealth” OR “telemedis” AND “guidelines” AND “South East Asia” OR “Malaysia” OR “Singapore” OR “Indonesia” OR “Thailand” OR “Vietnam” published up to 2020. Inclusion criteria were full articles and gray materials related to telemedicine guidelines. Exclusion criteria were abstracts, duplicate publications, blogs and telemedicine projects unrelated to telemedicine guidelines. Results: A total of 62,300 articles were identified through the search engines (Google 62,203, PubMed 77 and Cochrane 20) and six articles from additional sources. Sixty-eight full-text articles fulfilled the inclusion criteria, but only 24 articles contained some form of guidelines on telemedicine. There were six laws, six advisory guidelines, five policy statements, and two circulars issued by either the Ministry of Communication and Multimedia, Ministry of Health, or Medical Councils from the SEA countries. The Singapore National Telemedicine Guidelines contained the most domains compared with other guidelines. Conclusions: Although there can be no “one-size-fits-all” telemedicine guideline, there should be a universal telemedicine guideline for any country to adapt based on the local context. Details on cyber security and ways to overcome the limitations of telemedicine should be outlined clearly to ensure uniformity of telemedicine service and patient safety.

References

National Telemedicine Advisory Committee. National Telemedicine Guidelines of Singapore. National Telemedicine Advisory Committee; 2015.

Topic: 7. Functioning and Disability

Sub Topic: 7.4 Impairment Rating, Disability Evaluation and Certification

Stroke - Shoulder pain and upper limb function

P. SÁ¹, I. Ferro¹, A. Pascoal¹, A. Lourenço¹, B. Mendes¹, J. Constantino¹, M. Reis², I. Campos¹, J. Laíns¹

¹CMRRC - Rovisco Pais, Tocha, Portugal, ²Department of Chemical Engineering, University of Coimbra, CIEPQPF, Coimbra, Portugal

Background and Aims: Background stroke causes disability and pain, especially shoulder pain. Often, shoulder pain, has a not completely known mechanism and evolution. Aim: Assess shoulder pain and its impact in upper limb function, in patients who had suffered a stroke within 6 months. Methods: Observational study. Included patients at discharge from an inpatient rehabilitation centre, from November 2019 until February 2020. Assessment was done using validated Portuguese versions of the Brief Pain Inventory (BPI) and Fugl Meyer Assessment Scale (FMAS). Results: Of 32 patients screened, 26 fulfilled the inclusion criteria, 7 were females (26,9 %), with mean age of 60,7±10 years. Mean values of BPI Severity and Interference were 3,2±1,6 and 2,4±1, 8, respectively. The mean values of the FMAS Motor Function and Passive Articular Movement were 38,8±23,2 and 20,3±2, 3, respectively. Analysing the association between both subscales of BPI and both Subscales of FMAS negative correlations were found to be statistically significant with a confidence interval of 95% but there was no correlation between BPI Severity and FMAS passive articular movement. 6 patients (23%) received a local injection for shoulder pain. Analysing both groups, BPI Interference and both subscales of FMAS showed a statistically significant difference (p values of 0,0083, 0,0031 and 0,0056, respectively) for a Wilcoxon/Kruskal -Wallis test with a confidence interval of 95%. Conclusions: Patients with voluntary upper limb movements after a stroke tend to have less shoulder pain. Local injection was an effective intervention for shoulder pain. The greatest limitation of this study is the small sample size.

Topic: 5. Engineering and Technology

Sub Topic: 5.6 Telerehabilitation

Serious game training at home improves the upper limb function of patients in the chronic phase of stroke

S. Rozevink¹, C.K. van der Sluis¹, A. Garzo², T. Keller², J. M. Hijmans¹

¹Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands, ²Health Division of Tecnalia, Basque Research and Technology Alliance, Neurorehabilitation Area, San Sebastian, Spain

Background and Aims: Patients in the chronic phase of stroke may have difficulties with using their arm/hand in daily life. Home rehabilitation using training devices is emerging to provide intensive therapy in order to improve the upper limb function. HoMEcare aRm rehabiLItatioN (MERLIN) is a combination of an unactuated device to train the upper limb at home and a telerehabilitation platform based on serious games. The aim of the study was to investigate the effectiveness and usability of MERLIN. Methods: Stroke survivors in the chronic phase of stroke trained for 6 weeks, 3 hours per week at home with MERLIN. Serious games were used to train shoulder, elbow and hand movements. Using telerehabilitation, the games were assigned and progress was monitored. Measurements were performed 6 weeks prior intervention (T0), at start (T1), end (T2), 6 weeks (T3) and 6 months after the intervention (T4). The primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcomes were other arm function tests, quality of life and user satisfaction and motivation. Results: Twelve participants were included in the study, two dropped out prematurely. A significant and clinically relevant improvement between T0-T2 (5.4 points, p=0.025) and T1-T3 (4.2 points, p=.048) on the WMFT was found. No effect on quality of life was observed. Usability and motivation were satisfactory according to the participants’ feedback. Conclusions: Stroke survivors in the chronic phase of stroke were able to significantly improve their arm/hand function after intensive training with MERLIN.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Rehabilitation after knee arthroplasty: How long does it take to patients get back to their normal activities?

D. Roxo, A. Fernandes, B. Allan, M. Bettencourt, G. Pereira, T. E. Carvalho

Department of Physical and Rehabilitation Medicine, Cascais Hospital, Cascais, Portugal

Background and Aims: With this study, we aim to identify the average time that our patients took to return daily life activities after knee arthroplasty. Methods: Retrospective observational study between January 2016 and March 2020. Demographic, clinical and functional outcomes were collected from the medical records and with the patients responses contacted by phone call. The patients aged <= 65 years at the time of surgery were included. Patients with previous contralateral knee arthroplasty, patients submitted to surgery for arthroplasty revision and patients who underwent new surgery in the 6 months following arthroplasty were excluded. The final sample included 40 patients (10 men and 30 women). Results: Patients were able to walk again without walking devices about 6, 5 weeks after surgery (4,5 for male and 7,26 for female). The return to driving occurred 9 weeks after surgery and, in average, patients started to work after 12,2 weeks. Patients submitted to surgery for unicompartmental gonarthrosis have shorter recovery times compared to patients with bi/tricompartmental gonarthrosis. Also noteworthy is the longer recovery times for patients undergoing knee arthroplasty in late 2019 and early 2020. Conclusions: The results show longer recovery times for women compared to men. The average times of return to activities are similar to those previously known in literature. Highlight for the delays in patients undergoing surgery in late 2019 and early 2020 due to the Covid19 pandemic that led to a lockdown and longer recovery times.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

Traumatic rib fractures and rehabilitation: evidence-based review

L. Rovisco Branquinho¹, J. Malta¹, A. M. Ferreira¹, C. Amaral¹

Physical and Rehabilitation Medicine Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

Background and Aims: Rib fractures often occur following blunt thoracic trauma. Respiratory care, including pulmonary toilet and chest physiotherapy is often prescribed in the post-traumatic period to prevent pulmonary complications, including atelectasis and hemothorax, and reduce the need for further interventions. This study aims to provide an up-to-date review of the current evidence in traumatic rib fractures’ rehabilitation. Methods: PubMed, the Cochrane Library, Web of Science and MEDLINE were searched up to August 2020. Search keywords included “rib fractures” and “physical therapy”, “physiotherapy”, “deep breathing”, “assisted cough”, “active cough”, “mobilization” or “incentive spirometry” in all fields. This literature review focused on clinical interventions such as deep breathing exercises, active coughing, incentive spirometry or other chest physiotherapy techniques applied after traumatic rib fractures to prevent pulmonary complications or improve pulmonary function. Outcomes, including morbidity and mortality, length of hospital stay, prevalence of pulmonary complications and quality of life were investigated. Results: There is a clear lack of clinical and randomized controlled trials regarding the non-surgical treatment of traumatic rib fractures besides the pain management. Some small trials indicate that a rehabilitation intervention may improve recovery and prevent pulmonary complications of traumatic rib fractures; however, there is conflicting evidence regarding the cost-effectiveness and even usefulness of some techniques. Conclusions: Although the prescription of such interventions in a multidisciplinary approach is widely recommended, there is a huge lack of consensus, as the actual evidence is still scarce, and mostly based on experts’ opinions.

Topic: 6. Health Policy and Systems

Sub Topic: 6.7 Disaster Health Related Rehabilitation (Man-made/Natural disasters/After Effects)

Physician associates in rehabilitation medicine

A. Rouse¹, S. Guo², J. Mamo³

¹National Spinal Injuries Centre, Stoke Mandeville, United Kingdom, ²Department of Rehabilitation Medicine, Southmead Hospital, Bristol, United Kingdom, ³Department of Rehabilitation Medicine, Royal Berkshire Hospital, Reading, United Kingdom

Background and Aims: Our article seeks to explore the practice of PAs in multiple rehabilitation units within a region in order to assess the successes and challenges experienced with the implementation of PA roles in Rehabilitation Medicine (RM) and thereby provide suggestions for further work to develop the role. Methods: Structured qualitative input was sought from colleagues across the region working in a variety of settings and from a variety of clinical backgrounds who had MDT experience of delivering care alongside the PA role, including the views of PAs themselves. Results: Patients within the Rehabilitation Medicine setting can have complex medical and non-medical needs, as well as injuries that can result in barriers to understanding and longer admissions. The combination of a medical training model and the non-rotational nature of the PA role lends itself to improving communication within teams and with patients. PAs can also support the development of medical trainees by completing appropriate medical tasks, allowing trainees time to complete academic, managerial or educational endeavours. PAs can also complete multiple cycles of quality improvement that a trainee would find difficult in one rotational post. Conclusions: The role of PAs is in its nascency and better definition of the role, including expected or achievable competencies relating to Rehabilitation Medicine would benefit MDT understanding of the role, PA career development and patient care.

Topic: 6. Health Policy and Systems

Sub Topic: 6.3 Infrastructure and Resources

Need of rapid growth of rehabilitation medicine in Mexico – A brief report

M. Poudel^1,2, E. C. Miguel Reyes^1,3, M. T. Romo Rosas^1,4

¹Internacional Society of Physical Medicine and Rehabilitation, World Youth Forum Task Force, Rome, Italy, ²Department of Physical Medicine and Rehabilitation, University of Miami, Jackson Health System, Miami, Florida, United States, ³Hospital Regional 1° de Octubre, Mexico City, Mexico, ⁴Universidad Nacional Autónoma de México, Mexico City, Mexico

Background and Aims: Nearly 8 million population (6-8%) are living with disability, so we aim to describe the current situation of rehabilitation. Methods: A survey form developed by the author was filled by the ISPRM-World Youth Forum members from Mexico. Results: In 1960, Mexico got its first physiatrist. The national society, Sociedad Mexicana de Medicina Física y Rehabilitación, was established in 1966. Currently there are nearly 2,300 physiatrists practicing in 12 teaching hospitals, more than 300 Mexican Social Security System with 184 PRM services and private practice. Physiatrists provide brain injury, spinal cord injury, pediatric, cancer, musculoskeletal, pain, electrodiagnosis and other interventional procedures, cardiopulmonary, geriatric, orthopedics, and burn services. The national society has been publishing its journal, Revista Mexicana de Medicina Física y Rehabilitación since 1989. The national PRM conference is organized biennially. Mexico has organized numerus regional international conferences and 8th ISPRM World Congress. There are about 15,000 physical therapists, 2,000 occupational therapists and, 300 speech language pathologists. In 1974, residency programs were started with national recognition. There are 12 residency programs and postgraduate programs in Pediatrics, Geriatrics, Sports, Professional Rehabilitation, Cardiac Rehabilitation, Pulmonary Rehabilitation, Neurological Rehabilitation, Electrodiagnosis and Electromyography. Each year about 80 residents graduate after a 3-4 years of training. The main challenges faced by Mexico are inability to increase the number of physiatrist and rehabilitation services with national increase national demand and to provide rehabilitation services to COVID-19 patients. Conclusions: There is an imminent need to increase the number of physiatrists and services provided by them in Mexico.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Effects on exercise capacity, cognition, mood, quality-of-life and cardiovascular risk factors of a supervised exercise training program for ischemic stroke patients

J. Romano, R. Costa, P. Ribeiro, R. Vilela

Department of Physical Medicine and Rehabilitation, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal

Background and Aims: Ischemic stroke survivors are physically limited after the event and frequently previously deconditioned. This, adding to the shared etiology and risk factors with cardiac ischemic disease, provides the rational for exercise training applied to cerebrovascular disease. We aim to assess the overall outcomes of the modified rehabilitation protocol for ischemic stroke patients implemented in 2017 at our hospital. Methods: Intervention consisted of supervised, ECG monitored, training (minimum 8 weeks, 2 days/week, 90 minutes) with aerobic, resistance and flexibility training, for a low-moderate level of effort, with nutritional education (protocol elaborated using the Consensus on Exercise Reporting Template). Comparisons between the beginning and the end were made using the Wilcoxon singed-rank test. Results: Twenty-eight participants (90%) completed the program. Patients significantly increased exercise capacity by 1,33MET in the Naughton test (>23%, p0.004). Percentage of maximum distance expected in the 6-MWT (>6), MoCA test score (>0,72) and HADS score (<2,30; HADS anxiety <2,20) improved. Paradoxically, Short-Form36 results were worse at end-program (>1,44). BMI (<0,5), LDL (<15mg/dL), systolic (<9mmHg) and diastolic BP (<1mmHg) changed favourably. These differences were non-significant. Increases on HDL (>4mg/dL, p0.017) were statistically significant. At discharge, 52% and 72% had normal LDL and HDL, respectively. Three months after program suspension, 20 (71%) patients reported maintaining exercise, with 6 reporting walking more than 30minutes/daily. Conclusions: Intervention significantly improved exercise capacity and HDL levels in ischemic stroke survivors. The program did not improve quality-of-life but appears to have a positive impact in other modifiable risk factors, mood, cognition, and in promoting exercise practice after discharge.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

Risk factors and morbidity of breast cancer related lymphedema: 5-year multicentric cohort study

J. Romano¹, F. Rocha², O. Romano², C. Gomes³, L. Prates⁴, F. Antunes⁵, F. Gabriel⁶, C. Ângelo⁷, J. Rodrigues^8,9, T. Amaral¹⁰

¹Department of Physical Medicine and Rehabilitation, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal, ²Department of Physical Medicine and Rehabilitation, Instituto Português de Oncologia do Porto FG, EPE, Porto, Portugal, ³Department of Physical Medicine and Rehabilitation, Instituto Português de Oncologia de Coimbra FG, EPE, Coimbra, Portugal, ⁴Department of Physical Medicine and Rehabilitation, Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal, ⁵Department of Physical Medicine and Rehabilitation, Hospital de Braga, EPE, Braga, Portugal, ⁶Department of Physical Medicine and Rehabilitation, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal, ⁷Department of Physical Medicine and Rehabilitation, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal, ⁸Instituto Português de Oncologia do Porto FG, EPE - Cancer Epidemiology Group, Porto, Portugal, ⁹Center of Mathematics, Universidade do Minho, Braga, Portugal, ¹⁰Department of Physical Medicine and Rehabilitation, Instituto Português de Oncologia de Lisboa FG, EPE, Lisboa, Portugal

Background and Aims: Breast cancer related lymphedema is a chronic condition and requires lifelong management. We aim to evaluate lymphedema risk factors and impact on functionality. Methods: Five-years Prospective Multicentric Nationwide Cohort of patients referred to PMR after breast cancer surgery. Lymphedema was assessed by circumference and diagnosed for an asymmetry higher than 2cm. Other impairments were recorded regularly. Univariate and multivariate binary logistic regression models were performed. Results: Of the 132 women, 39 had lymphedema (29,6%). Lymphedema’s cumulative incidence was 66.7% and 97.4% at third and fourth postoperative years, respectively. Mean time until diagnosis was 23.8 ± 16.0 months. Univariate regression analysis showed that higher TNM-T, higher TNM-N, higher number of nodes removed, seroma formation, chemotherapy, radiotherapy and immunotherapy increased lymphedema rate, while breast reconstruction decreased. Multivariate model showed an increased risk for lymphedema among women with 20 or more lymph nodes removed (OR=19.2; p=0.043) or neoadjuvant chemotherapy (OR=8.3; p=0.041), and a decreased risk in those with breast reconstruction (OR=0.1; p=0.009). At end follow-up shoulder limitation prevalence, pain prevalence and DASH score results were higher in the lymphedema group, with significant difference only for shoulder limitation prevalence. Conclusions: We identified removal of twenty or more nodes and neoadjuvant chemotherapy as risk factors for lymphedema, in our population. Breast reconstruction was a protective factor. Given lymphedema’s growing cumulative incidence, the possibility of late onset and associated morbidity, follow-up should continue throughout life.

Topic: 5. Engineering and Technology

Sub Topic: 5. 3. Robotics

Feasibility of the Honda walking assist (HWA) through users’ intrinsic motivation

S. Roggeman¹, M. Firouzi², N. Lefeber², E. De Keersmaecker², L. Cuypers², E. Kerckhofs², E. Swinnen², E. Joos¹, S. Hatem¹

¹Department Physical Medicine and Rehabilitation, UZ Brussel, Jette, Belgium, ²Vrije Universiteit Brussel, Research Group Rehabilitation Research (RERE), Jette, Belgium

Background and Aims: Regaining the ability to walk is one of the major goals of patients hospitalised at the rehabilitation department. The inability to walk independently affects the individual’s social capabilities. This is also true for the elderly where gait disorders exist with a higher risk of falls, institutionalisation and even death. In the past decade, the use of robotics in gait rehabilitation has gained considerable interest. In this study, we aimed to examine patients’ perception of using a portable exoskeleton for assisted walking, the Honda Walking Assist (HWA). Methods: Patients were recruited in the Rehabilitation department of UZ Brussel from the in-patient ward and out-patient clinic. They walked with the HWA for 30 minutes during one therapy session (1 hour) supervised by a physiotherapist and completed the Intrinsic Motivation Inventory (IMI) afterwards. Results: In total, 23 participants completed the questionnaire: 5 hospitalised patients (aged 29-79 years), 7 outpatients with stroke (aged 56-83 years) and 11 community dwelling elderly (aged 79-95 years). Both rehabilitators and elderly had high scores on the IMI, with an total score of 87.7% (75.5-93.9) for Interest/enjoyment. Perceived competence of walking and value/usefulness of the HWA scored high with respectively a median score of 83.3% (73.8-90.5) and 89.8% (71.4-100). Conclusions: The HWA was considered as a valuable waking aid by a majority of participants, eliciting a high degree of motivation and enjoyment. Future studies need to focus on the cost-effectiveness of this tool as well as determining which patients may benefit the most from using it for gait rehabilitation.

Topic: 8. Specialty Development

Sub Topic: 8.1 Education (Medical Student, Residency and Post-graduate)

Experience of the implementation and start-up of a training course in oncological rehabilitation in adults for rehabilitation teams

M. Rios, C. Celedon, X. Neculhueque, C. Castro, R. Valenzuela, R. Jimenez, K. Hrzic

Ministry of Health (MINSAL), Santiago, Chile

Background and Aims: Chile’s health strategies place cancer as a fundamental strategic line to be developed, since according to the National Cancer Plan 2018-2028, in Chile cancer is the second cause of death of the population and the first source of disease burden. Methods: An online course was developed by the Department of Rehabilitation and Disability using the SIAD-SPS (Distance Learning System) platform of the Department of training, education and continuing education, both belonging to the Ministry of Health (MINSAL), Chile. It was a 120-hour course, divided into 12 weeks. Each module contained a written and multimedia resources, as well as complementary reading documents and ended with an evaluation of the topics reviewed in each module. Results: There were 231 registered participants who completed the course. 83% of the participants obtained a grade above 6.0, on an evaluation scale that ranged from 1.0 to 7.0. Results of the evaluation survey: Of the participants, 93% would recommend the completion of this course to other co-workers, and 97% (n= 211) consider that the content was applicable in their work. Conclusions: It seems that an online course about oncological rehabilitation might be interesting for rehabilitation healthcare professionals. It is necessary to advance in continuous training in oncological rehabilitation.

References

Ministry of Health, National Cancer Plan 2018-2028. Chile: Ministry of Health (MINSAL) Chile; 2018.
Technical Guidance Rehabilitation of People with Cancer Aged 15 and Over. Chile: Ministry of Health (MINSAL) Chile; 2021.

Topic: 6. Health Policy and Systems

Sub Topic: 6.9 Big Data and Cohorts

Impact of the COVID-19 pandemic on Portuguese inpatient rehabilitation in acute-care hospitals

S. Ribeiro¹, R. Santos¹, G. Almeida¹, A. R. Raposo¹, F. Martins Pereira¹, M. Macedo², N. Ramalhão³, A. Silva⁴, E. Moreira⁴, J. Caldas⁴

¹Department of Physical and Rehabilitation Medicine, Hospital de Braga, Braga, Portugal, ²Department of Physical and Rehabilitation Medicine, Centro Hospitalar Universitário do Algarve, Faro, Portugal, ³Department of Physical and Rehabilitation Medicine, Centro Hospitalar do Porto, Porto, Portugal, ⁴Department of Physical and Rehabilitation Medicine, Centro Hospitalar Tondela - Viseu, Viseu, Portugal

Background and Aims: The COVID-19 pandemic led the Portuguese government to implement state of emergency in March 2020, and Portuguese hospitals had to restructure teams to deal with COVID-19. This study aims to evaluate the impact of the measures taken during the state of emergency period on Physical Medicine and Rehabilitation acute-patient infirmaries (PMR-ApI).

Methods: We analysed all hospitalized patients in PMR-ApI of four Portuguese hospitals (among seven with PMR-ApI) between March 23rd and May 2nd 2020 (state of emergency period – “2020 group”), and compared this sample with the same period of the previous year (“2019 group”). Results: In the analysed period of 2020, 36 patients were hospitalized in the PMR-ApI studied, compared to 57 patients hospitalized in the same period of 2019. There was a statistically significant difference between groups (p=0.004) concerning the destination after discharge. Only 14% of patients of the 2020 group were forwarded to Rehabilitation Centers (RC), while 48% of patients in the 2019 group were forwarded to RC. Conclusions: Despite that during the state of emergency period PMR-ApI had less patients hospitalized and a shorter hospital stay comparing to the same period of the previous year, the functional evolution achieved during hospitalization was similar, which means that COVID-19 pandemic didn’t affect the quality of care in PMR-ApI. However, RC received much less patients after discharge from the four hospitals studied, with the majority of patients being discharged to home. This may have had a negative impact in their functional evolution, once the continuity of care may have been insufficient.

Topic: 3. Clinical Sciences

Sub Topic: 3.2 Pain Osteoporosis -Osteoarthritis

Bone health and osteoporosis in amyotrophic lateral sclerosis – A retrospective assessment of care

A. M. Ribeiro, R. Araujo, D. Costa, N. Ramalhao, S. Afonso, L. Sousa, R. Figueiral

Centro Hospitalar Universitario do Porto, Oporto, Portugal

Background and Aims: There is an association between neurodegenerative disorders and osteoporosis and the pathophysiologic basis of neuromuscular diseases may have it’s own unique effect on bone quality. Literature is scarce resulting in lack of awareness on preventing and treating osteoporosis. The aim of this study was to evaluate the prevalence of fragility fractures, diagnosis and treatment of osteoporosis in a cohort of ALS patients. Methods: An anonymous questionnaire was sent to the website and headquarters of a Portuguese foundation for ALS patients. Questionnaire had 19 questions, including demographic, anthropometric data, information about de disease and functionality level. Questions about dietary supplementation, osteoporosis medication, rehabilitation treatment, falls and bone fractures were added. SPSS statistics was used for analysis. Results: Preliminary Results: Up to now, 15 patients participated. Sample had predominantly female gender and most individuals were in de 51-60 years-old age group. Mean BMI was 24,2 kg/m2. Most had dysphagia and needed non invasive ventilation (53%). A third had high or total dependency in daily life activities and needed a wheelchair for ambulation. Number of falls per/month was 1-5 on most patients. The majority were on rehabilitation programs but seldom or never (80%) stayed in orthostatic position. 40% were on vitamin D or calcium supplementation. Four patients had done DEXA study and two were being treated for osteoporosis. Two fractures were documented. No statistically significant associations were found between variables and fracture occurrence. Conclusions: Although most patients had risk factors few were evaluated and were receiving treatment. Authors await further participation for final conclusions.

Topic: 5. Engineering and Technology

Sub Topic: 5.6 Telerehabilitation

Telerehabilitation in urinary incontinence – A useful alternative in times of pandemic?

C. Reis Lima¹, S. Moreira²

¹Centro Hospitalar Universitário do Algarve, Physical and Rehabilitation Medicine Service, Faro, Portugal, ²Centro Hospitalar Universitário São João, Physical and Rehabilitation Medicine Service, Porto, Portugal

Background and Aims: Urinary incontinence (UI) is a common problem, particularly in women. The first line approach for UI is conservative, which includes lifestyle changes, bladder training strategies and pelvic floor muscle training (PFMT). PFMT programmes can be held in different formats: individual supervised sessions, group classes or home exercises according to an individualized plan. The SARS-Cov2 pandemic in 2020 caused the loss or delay of rehabilitation care in many patients, and telerehabilitation has gained importance. The aim of this review is to analyse the effect of different telerehabilitation methods used for UI. Methods: We performed a research on Pubmed, using the terms “telerehabilitation”, “telemedicine”, “app”, “smartphone”, “mobile health” or “videoconference”, combined with “pelvic floor” or “UI”. Nine articles were used. Results: The analysed methods were: mobile applications, with or without biofeedback device, group classes via videoconference, a website-based PFMT programme and a smartphone-based reminder system. Group classes via videoconference showed similar results to supervised individual PFMT sessions, and an app-guided programme showed superiority to the absence of treatment. Website-based or app-guided PFMT programmes seem to obtain similar clinical results to simple instructions for home exercises. There is no additional benefit to adding a biofeedback device. However, using technologies seems to increase adhesion and satisfaction with the programmes. In men after prostatectomy, an app-guided PFMT programme appears to accelerate the improvement of UI. Conclusions: Telerehabilitation in UI seems to be a useful alternative in the absence of supervised hospital-based programmes. More studies are needed regarding its applicability in elder populations and their long-term results. (Optional).

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Sudden sensorineural hearing loss in stroke patient. Presentation of a clinical case and literature review

A. R. Raposo¹, A. Lobarinhas¹, S. Ribeiro¹, G. Almeida¹, E. Amorim¹, R. Santos¹, P. Marques¹, F. Rodrigues², M. Mendes², O. Pires², R. Carvalho², G. Castro³

¹Hospital de Braga - Serviço de MFR, Braga, Portugal, ²Hospital de Braga - Serviço de Medicina Interna, Braga, Portugal, ³Hospital de Braga - Serviço de Dermatologia, Braga, Portugal

Background and Aims: Stroke is one of the causes of sudden sensorineural hearing loss (SSNHL). However,it has a lack of relevant evidence precludes the formulation of clear recommendations with regard to clinical practice. In order to draw attention to the theme, this work aims to present a clinical case of a patient who suffered SSNHL after stroke. Methods: Presentation of a clinical case and literature review. Results: The clinical case reports to a male patient, 24 years old, diagnosed with hemiparesis and a deficit in the central auditory processing, sequels to the protuberant hemorrhage. The patient underwent a rehabilitation program that includes a auditory training exercises. The incidence of SSNHL in stroke patients is unknown and possibly underestimated. A deeper understanding of SSNHL risk in stroke patients is required, although occurrence of the stroke in the vertebrobasilar territory and/or low brainstem is one possible etiology.

A study identified that patients with ischemic stroke faced an 80% increase in the risk of developing SSNHL; and some studies case reports of central hemorrhage have also documented auditory dysfunction in patients. Also, SSNHL is more frequent in stroke patients who underwent steroid therapy during hospitalization. SSNHL can hinder communication between patients and healthcare professionals, thereby restricting participation in rehabilitation programs and limiting improvements in physical performance. So, a screening patient’s hearing it becomes necessary in order to obtain better clinical outcomes. Conclusions: Recommendations pertaining to the identification, assessment, and rehabilitation of hearing deficits in stroke patients was needed. Auditory dysfunction may impact long-term patient outcome after stroke.

Topic: 7. Functioning and Disability

Sub Topic: 7.4 Impairment Rating, Disability Evaluation and Certification

Meta-analysis of strength training effect on walking endurance in patients with chronic obstructive pulmonary disease (COPD)

J. Ferte¹, F. Boyer¹, C. Barbe¹, C. Pineau¹, R. Taiar², A. Rapin¹

¹Reims Champagne Ardennes University Hospital, Reims, France, ²GRESPI-EA 4694, Reims University, Reims, France

Background and Aims: Strength training is part of rehabilitation program in Chronic Obstructive Pulmonary Disease (COPD), but its impact on functional abilities is not clear. We aim to explore strength training impact on the Six-minute walking test (6MWT) in COPD patients. Methods: A systematic review was performed on Clinicaltrials.gov, Cochrane Central Register, EMBASE, PubMed and Scopus from the beginning of the databases until September 1, 2019. Randomized controlled trials (RCTs) were selected and evaluated by the PEDro scale. Meta-analysis was performed on the mean difference (MD) of the 6MWT distance before and after rehabilitation program. RCTs with PEDro score above 6 were selected for sensibility analysis. Results: Twenty-three studies with 690 patients met the inclusion criteria. Information on 6MWT distance pre- and post-rehabilitation program was collected for 6 RCTs, with a total of 114 patients. Meta-analysis was in favor of an improvement of the 6MWT with a MD of 37.25 meters, CI 95% [9.81; 64.68] (I2 = 86%, p < 0.01). Sensibility analysis was performed with 5 RCTS, 104 patients, and confirm this trend with a MD of 46.11 meters, CI 95% [11.86 ; 80.36] (I2 = 8%, p < 0.01). Conclusions: The results of the meta-analysis tend to show a significant improvement in walking ability measured by the 6MWT. Compare to other studies, our meta-analysis is the only to use MD to analyze the results. The main limitation is the significant heterogeneity of the results (differences in the methodological quality of studies, population, testing mode and diversity of rehabilitation programs).

Topic: 7. Functioning and Disability

Sub Topic: 7.4 Impairment Rating, Disability Evaluation and Certification

Relationship between dynamometry measures of muscle strength and functional capacity

J. Ramos¹, T. Moreira¹, J. M. Cabral¹, F. Costa¹, D. Fonseca², H. Tavares¹, M. J. Festas ¹, J. Barroso¹

¹Department of Physical Medicine and Rehabilitation, Centro Hospitalar Universitário São João, Porto, Portugal, ²Department of Rheumatology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal

Background and Aims: Patients in PMR often have diseases that compromise theirs functional capacity (FC), culminating also in the development of muscle weakness. The FC is subjective and difficult to measure in a clinical setting due to it being very time consuming. Thus objective measures like handheld or isokinetic dynamometer, the first being less time consuming, could be very useful to estimate some FC measures. The purpose of this poster is to review articles that study the validity and reliability of the relationship between dynamometry values and FC measures.

Methods: The search was conducted in the Pubmed database, including articles published until 01/02/21 and using the following query: “(knee OR quadriceps OR hamstrings) AND (‘ Muscle strength ‘[Mesh] AND (‘ Muscle Strength Dynamometer ‘[Mesh] OR dynamometer OR isokinetic) AND (Validity OR reliability OR reproducibility)’. The search found a total of 224 articles, including those that compared objective muscle strength at knee level by IKD and HHD. Pathology, language, age, other clinical or demographic characteristics were not exclusion criteria. Results: 200 articles did not meet the inclusion criteria and were therefore excluded. 24 articles were included in a table with contents, with a total of 2945 participants. Most studies showed a moderate (0.30-0.50) correlation coefficient (r) between HHD or IKD and FC tasks/scales such as timed up and go, WOMAC, Sit-to-stand, eMETs and others. Conclusions: Since medical appointments have a limited time it is important to find objective ways of estimating functional capacity and its variations with time. Therefore, dynamometers seems to be a viable alternative.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Analysis of prognostic risk factors determining poor functional recovery after MI-BCI training in stroke patients

W. Qiong

Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China

Background and Aims: Upper limb (UL) motor function recovery, especially distal function is one of the main goals of stroke rehabilitation. The efficacy of Motor-Imagery brain-computer interface (MI-BCI) has been demonstrated in stroke patients. The present study was intended to investigate the independent risk factors that might lead to inadequate distal UL recovery of stroke patients after comprehensive rehabilitation including MI-BCI. Methods: This prospective study recruited stroke patients who undertook MI-BCI. MI-BCI training was performed 60 min per day, 5 days per week for 4 weeks. The primary outcome was improvement of wrist and hand part of Fugl-Meyer Assessment (i-FMA-WH). The improvement was classified into efficient group (EG, i-FMA-WH more than 2) and inefficient group (IG, iFMA-WH less than 2). Clinical and demographic data were analyzed by binary logistic regression, including aphasia, spasticity of affected hand (assessed by Modified Ashworth Scale [MAS-H]), initial UL function, age, gender, time since stroke (TSS), lesion hemisphere and lesion location. Results: A total of 73 patients completed this study. After training, all patients showed significant improvement in FMA-UL, FMA-SE, and FMA-WH. There were 35 cases in the IG group and 38 cases in the EG group. At multivariate analysis, presence of aphasia, initial FMA-UL score less than 30, and MAS-H more than level I+ were risk factors for inadequate distal UL recovery in patients with stroke after MI-BCI. Conclusions: We concluded that inferior initial UL function, significant hand spasticity and presence of aphasia were identified as independent risk f.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Observation on the effect of deep muscle stimulator (DMS) combined with Kinesio taping in the treatment of Temporomandibular joint disorder (TMD)

Q. Yunpeng, J. Rongan

Yangpu District Central Hospital, Shanghai, China

Background and Aims: Purpose: TMD is a common disease of the oral cavity. It is related to the abnormal function of the temporomandibular joint and masticatory muscles. It is mostly caused by temporomandibular joint, mandibular abnormalities and joint rebound. The research is to explore the clinical efficacy of DMS combined with Kinesio taping in the treatment of TMD. Methods: Methods: 54 patients with temporomandibular joint disorders were divided into DMS therapy group (group A) and Kinesio taping therapy group (group B) according to the random number table method. DMS combined with intramuscular sticking therapy (group C), 18 cases in each group. All 3 groups were treated for 2 weeks. Before and after treatment, the Visual Analogue Scale (VAS) was used to evaluate the patient’s pain degree; the maximum mouth opening before and after the comparison. Results: Results: After treatment, the VAS scores of the three groups were significantly reduced; after treatment, the VAS scores of groups B and C were significantly lower than those of group A, and the maximum mouth opening of group C (34.31±2.01) mm is greater than that of group A (30.01 ± 1.88). The VAS and maximum mouth opening of group C are significantly better than those of group B. The clinical efficacy of group C was significantly higher than that of group A and group B. Conclusions: Conclusion: DMS combined with Kinesio taping has a good clinical effect in the treatment of TMD,which can reduce the patient’s pain and improve the maximum mouth opening.

Keywords: DMS, Kinesio taping, TMD

Topic: 7. Functioning and Disability

Sub Topic: Feeding and swallowing evaluation process in the paediatric population: Review

M. Pyrgeli¹, A. Zarkada^1,2, A. Zavlanou¹, K. Theodorou¹, T. Germani¹, R. Dimakopopulos²

¹ELEPAP- Rehabilitation for the Disabled, Athens, Greece, ²Motivaction- Rehabilitation Center for Children with Neurodevelopmental Disabilities, Athens, Greece

Background and Aims: Dysphagia is a condition that may present in the peadiatric population. Early recognition and accurate evaluation can prevent adverse effects on the child’s health.

AIM: The review of the evaluation process of paediatric dysphagia, in order for the speech and language pathologist (SLP) to conduct appropriate evaluation and to make an accurate diagnosis for every child. Methods: A bibliographic research of studies that examine the evaluation processes of paediatric dysphagia and have been published in the period between 2000 and 2019 was performed in the electronic databases Pubmed, Google Scholar, EMBASE and Science Direct. Results: Nineteen published studies were used to extract data on the evaluation process of paediatric dysphagia and the role of the SLP. The SLP is required to follow the International Classification of Functioning, Disability and Health (ICF) framework and to perform clinical and instrumental evaluation of dysphagia when necessary. Clinical evaluation of dysphagia includes history taking, pre-feeding evaluation, oral structure and function assessment, examination of cranial nerves function. The two most frequently used instrumental evaluations of swallowing are the Videofluoroscopic Swallowing Study (VFSS) and the Flexible Endoscopic Evaluation of Swallowing (FEES). The decision regarding which instrumental evaluation of swallowing is most adequate depends on the function and anatomical structures that need to be assessed. Conclusions: The role of the SLP, in collaboration with the multidisciplinary team, is to evaluate and diagnose feeding and swallowing disorders in the paediatric population. Proper evaluation of dysphagia provides vital information for the diagnosis and treatment planning.

Topic: 3. Clinical Sciences

Sub Topic: 3.7 Rehabilitation of Individuals with Post COVID-19 Impairments and Sequalae

Short bouts of aerobic exercise improves activity intorelance in patient after severe COVID-19 case: A case report

J. C. Profita¹, A. Nazir¹, R. Z. Goesasi¹

Department of Physical Medicine and Rehabilitation, Universitas Padjadjara, Bandung, Indonesia

Background and Aims: Fatigue and dyspnea are common and persistent symptoms in patient recovered from acute COVID-19 that will impact functional capacity. We report the effect of low intensity aerobic exercise given in short bouts along with breathing exercise on activity intolerance in patient after severe COVID-19 case. Methods: A 51-years-old male came for phase 2 of cardiopulmonary rehabilitation (CPR) with activity intolerance problems that presented as fatigue, dyspnea, and activity-induced oxygen desaturation. The patient was given hospital-based CPR twice a week and home-based once a week. CPR programs consisted of low intensity aerobic exercise in bouts of 5 minute with 5 minute rest starting with 4 bouts per session. Sustained maximal inspiration exercise with incentive spirometry was given twice a day, in 3 sets, and 10 repetitions. Exercise bouts and repetitions were increased gradually as tolerated. Before and after CPR program, Fatigue Severity Scale (FSS), Modified Medical Research Council (mMRC) scale, Metabolic Equivalent (METs) and 6-Minute Walk Distance (6-MWD) was recorded as outcome measure. Results: After four weeks, there were improvement of symptoms and signs of activity intolerance. FSS and mMRC decreased from 47 to 33 and 4 to 1 respectively. METs increased from 3.9 to 4.4 and 6-MWD increased from 324 to 384 meters. There were no oxygen desaturation or symptoms and signs of exercise intolerance during either hospital- or home-based CPR. Conclusions: Short bouts of low-intensity aerobic along with breathing exercise improves activity intolerance in patient after severe COVID-19 case.

Topic: 8. Specialty Development

Sub Topic: 8.1 Education (Medical Student, Residency and Post-graduate)

Participation of youth in the ISPRM world congresses in japan and the USA: Efforts of ISPRM world youth forum

M. Poudel¹, A. de Sire², F. Gimigliano³, W. Frontera⁴

¹University of Miami/Jackson Health System, Miami, United States, ²University of Catanzaro Magna Graecia, Catanzaro, Italy, ³University of Campania Luigi Vanvitelli, Napoli, Italy, ⁴University of Puerto Rico School of Medicine, Puerto Rico, United States

Background and Aims: ISPRM World Youth Forum (ISPRM-WYF) was established in June 2019 and now is represented in 40 countries around the world. This study describes the participation of youth at ISPRM World Congresses – 2019 and 2020 in association with Japanese Association of Rehabilitation Medicine (JARM) and Association of Academic Physiatrists (AAP) respectively. Methods: Description of the experiences of ISPRM-WYF in the ISPRM World Congresses. Results: PRM youth participated in the scientific sessions – oral/poster presentations, and were engaged in the discussions on cultural diversity, patient care, issues of people living with disability, PRM specialty, curriculum & training, international exchange, research collaboration, technological advances, global expansion of PRM and the role of ISPRM. ISPRM/JARM Conference, 9-13 June 2019: The first official Central Board Meeting of ISPRM-WYF was held on 11 June 2019. A panel discussion session was attended by youth from ~20 countries and ISPRM-WYF collaborated with JARM residents to organize a social function (attended by about 50 youth). ISPRM-WYF leaders observed and volunteered in the Assembly of Delegates of ISPRM. ISPRM/AAP Conference, 4-9 March 2020: Leadership of ISPRM-WYF participated in pre-committee meeting of ISPRM, Annual General Meeting of ISPRM-WYF and Assembly of Delegates of ISPRM. ISPRM-WYF collaborated with AAP’s Resident-Fellowship Council to organize round-table discussions for medical students and PRM residency program directors. A panel discussion was attended by youth from ~25 countries. Conclusions: Youth, under the leadership of ISPRM-WYF, have actively participated in the ISPRM World Congresses. The conferences have provided opportunities for teaching-learning, leadership development, idea sharing and networking activities for PRM youth.

Topic: 6. Health Policy and Systems

Sub Topic: 6.9 Big Data and Cohorts

Global impact of COVID-19 pandemic on physical medicine and rehabilitation residency: The ISPRM world youth forum point-of-view

M. Poudel¹, A. de Sire², S. Yi Lee³

¹University of Miami/Jackson Health System, Miami, United States, ²University of Catanzaro - Magna Graecia, Catanzaro, Italy, ³Royal Melbourne Hospital, Parkville, Australia

Background and Aims: Background and Aims: The Coronavirus Disease 2019 (COVID-19) pandemic has adversely impacted on the Physical and Rehabilitation Medicine (PRM) residency programs. In this context, the International Society of Physical and Rehabilitation Medicine- World Youth Forum Task Force (ISPRM-WYF) aimed at investigating how the COVID-19 pandemic had changed training, education, and activities of residents in PRM across the world. Methods: Methods: A worldwide cross-sectional survey was completed by Country Ambassadors of the ISPRM-WYF to assess the COVID-19 impact on PRM trainees across the Americas, Europe, Asia, Eastern Mediterranean, and Oceania. The data obtained were analysed as a point-of-view study. Results: Results: PRM residents from 24 countries across the regions reported similar challenges including training program disruption, limited practical skills training, examination postponement, negative psychological consequences, PRM service delivery restructuring, and deployment to acute services. Telemedicine, video-conferencing and virtual lectures were introduced to help support patient care, and PRM residency training and education during the pandemic. Despite the challenges, the residents took it as a privilege to take care of COVID-19 patients both in acute care and rehabilitation settings creating a learning, giving, resilience building, and growing opportunity for PRM residents. Conclusions: Conclusions: COVID-19 pandemic adversely impacted on the training of PRM residents in the Americas, Europe, Asia, Eastern Mediterranean and Oceania. Every country and training program should continue to evolve to adapt to the crisis and anticipate additional challenges in the near future. In this scenario, PRM National Societies, ISPRM, and the ISPRM-WYF should play a crucial role to support trainees during this pandemic.

Topic: 6. Health Policy and Systems

Sub Topic: 6.5 Rehabilitation Across the Continuum of Care

Evidence based recommendations for the rehabilitation of people with low vision

A. Posada¹, M. Oviedo-Cáceres², L. Lugo-Agudelo¹, C. Velez¹, J. Suarez-Escudero³, E. Astudillo³, M. Hernández¹, P. Ramírez³

¹Universidad De Antioquia, Medellin, Colombia, ²Universidad Santo Tomás, Bucaramanga, Colombia, ³Universidad Pontificia Bolivariana, Medellin, Colombia

Background and Aims: The development and implementation of a clinical practice guideline for the rehabilitation of people with low vision may reduce unwanted variability in care, access barriers and the negative impact of disability in daily life. Aim: To develop evidence-based recommendations for the comprehensive rehabilitation of people older than 7 years with low vision. Methods: We identified relevant PICO questions and critical outcomes in rehabilitation. Then we performed a systematic literature review to identify supporting evidence. The quality of evidence was evaluated using the GRADE system. Recommendations were made with the GRADE Evidence to decision Framework. Results: We strongly recommend the use of multidisciplinary and multicomponent rehabilitation in patients with low vision to improve health-related and vision-related quality of life, basic and instrumental activities of daily life, and reading ability (Moderate level of evidence). Multicomponent rehabilitation includes low vision education and information exchange, problem-solving skills training, relaxation techniques, and training on the use of optical and non-optical devices. For people between 7 and 16 years old with low vision, we strongly recommend rehabilitation interventions that include physical training, group programs, and training in the use of optical and non-optical devices to improve performance in fitness, daily life activities, participation and quality of life (Low level of evidence). More research is needed as there is scarce and low-quality evidence. Conclusions: Evidence-based recommendations are proposed to improve rehabilitation in people with low vision. It is necessary to increase the number of institutions and health professionals trained to carry out these recommendations in the country.

Topic: 6. Health Policy and Systems

Sub Topic: 6.4 National Policy and Law

Integral pathway of health care for people with lower limb amputations, to improve the functioning and quality of life

J. Plata Contreras, L. Lugo Agudelo, A. Posada Borrero, L. Giraldo Castaño, J. Pinto Maquilon, J. Velasquez

University of Antioquia, Medellin, Colombia

Background and Aims: To build an Integral Health Care Pathway for the care of patients with lower limb amputation due to traumatic, vascular or diabetes mellitus causes, in order to implement the recommendations of the CPG for amputee patients and guarantee comprehensive health care for this population in Colombia. Methods: This study is a strategy to improve health care. Carried out by a review of the Methodological Manual for the Development and Implementation of Comprehensive Health Care Pathway, then the pathway’s development group was created. A process of prioritization and description of required individual interventions was developed based on health care. Evaluation of current care practice with focus groups, formulation of milestones and development of the intervention diagram. Results: 25 individual interventions were prioritized and characterized according to the responsible actor, target population and environment. Expected results in health, quality of service delivery, issues related to equity, as well as the perspective of patients and actors involved with care are shown. Indicators were built for monitoring and implementation of the pathway. Conclusions: with the previous results, the first Integral Health Care Pathway for the Lower Limb Amputee Patient due to traumatic and neurovascular causes was developed. It intends to guide the actors involved, when executing individual interventions for the diagnosis, treatment and rehabilitation, to impact outcomes in health and equity of this group.

Topic: 5. Engineering and Technology

Sub Topic: 5.6 Telerehabilitation

Telepresence robot usability to deliver music therapy and peer-support for inpatients in neuro-rehabilitation during the COVID-19 pandemic

S. Plamondon¹, P. Wright², K. Leavitt², M. Rashead³, S. Viala³, K. Aiello², M. Zingelar⁴, J. Dollimont⁵, M. Wood⁵, S. Robinson⁵

¹Department of Clinical Neurosciences, University of Calgary, Calgary, Canada, ²Alberta Health Services, Patient and Family Centred Care, Calgary, Canada, ³Alberta Health Services, Virtual Health, Calgary, Canada, ⁴Alberta Health Services, Information Technology, Calgary, Canada, ⁵JB Music Therapy, Calgary, Canada

Background and Aims: The COVID-19 pandemic has required inpatient rehabilitation units to restrict and adapt music therapies (MT) and peer visitation to limit spread of the virus. Inpatient iPad visits have been adopted, however, hospital staff workload is negatively impacted to schedule and assist with access, support, sanitation and transfer of iPads between patients. In our institution, the pandemic has resulted in less than a third of the prior total 2019 MT and peer support visits. We aim to test the usability of a remotely controlled telepresence robot (TR) to deliver peer support and music therapy to reduce staff burden, increase patient access, and maintain high-risk peer volunteer safety. Methods: Music therapists and peer support staff began with monitored test drives of a TR to ensure safety on the neuro-rehabilitation unit. Patients are referred by staff or self-refer. Providers and patients are surveyed using validated versions of the Telehealth Usability Questionnaire (TUQ) and detailed visit logs are recorded. Patients also rate impact on emotional well-being, motivation and satisfaction using a 5-point Likert scale. Staff are surveyed to determine impacts to workflow, and perceived safety through focus groups. Results: Preliminary results suggest providers find the TR easy to learn and use independently. Good audiovisual quality, reduced travel time and improved patient access are reported. Hospital wifi connectivity with the App-based TR system used for this QI initiative was one challenge. Initial patient impressions are positive during 20-45 minute visits. Conclusions: Telepresence robots show promise as an acceptable virtual tool to deliver music therapy and peer-support.

Topic: 3. Clinical Sciences

Sub Topic: 3.3 Diagnosis

Young man taking methylphenidate with fasciculations and dysphagia - Coincidence or causation? A case report

C. Pires, I. Ferro, C. Lourenço, A. Paiva, F. Carvalho, P. Amorim, J. Laíns

Centro Médico de Reabilitação da Região Centro Rovisco Pais, Tocha, Portugal

Background and Aims: Concurrent fasciculations and oropharyngeal dysphagia (OD) can be presenting signs of motor neuron disease (MND). However, there are other causes for OD (neoplasms, surgery, gastroesophageal diseases, among others), and fasciculations (anxiety, benign or iatrogenic) are an uncommon side effect [<1%] of methylphenidate. To our best knowledge, there are no published articles similar to this case report. Methods: Case report. Results: A thirty-year-old man who, in November 2019, noticed fasciculations in both gastrocnemii, reporting gradual cranial progression, culminating in diffuse fasciculations with facial involvement in February 2020. One month later, he reported OD for solids and occasional cough for liquids. He denied weakness, fatigue or weight loss. No relevant personal history, apart from Attention Deficit Disorder diagnosed in January 2019 and since then medicated with methylphenidate 40mg id. He had no abnormal findings on neurological examination. Electromyography (EMG), and sinus-CT were normal. Upper GI endoscopy (EGD) showed reflux esophagitis grade C, which could explain OD, and he started esomeprazole 40mg id. As there were no findings on EMG, an iatrogenic etiology for fasciculations was considered. He suspended methylphenidate for a month and, two months later, reported a substantial improvement in fasciculations as well as resolution of the OD. Conclusions: Two simultaneous symptoms don’t mean they’re related. In this specific case OD was the first symptom of gastroesophageal reflux disease and fasciculations happened as a side effect of methylphenidate. This must be taken in consideration, as it can represent a confounding factor making the differential diagnosis more difficult.

Topic: 5. Engineering and Technology

Sub Topic: 5.1 Assistive Products

Reliability of the subcomponents of the electronically augmented timed up and go (EATUG) in adults with traumatic brain injury

S. Pinto¹, N. Habet², T. Roomian², K. Williams³, K. Werts³, L. Chandler¹, S. Sims², M. Newman¹

¹Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, NC, United States, ²Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, United States, ³Department of Inpatient Therapy, Carolinas Rehabilitation, Charlotte, NC, United States

Background and Aims: Wearable sensors can be used to electronically augment the TUG (EATUG) to quantify performance on different complex components of the TUG test (sit-to-stand and stand-to-sit transitions, walking, and turning subcomponents). The primary objective of this study was to determine the within session test-retest reliability of the electronically augmented timed up and go (EATUG) in adults with moderate to severe traumatic brain injury (TBI) and healthy controls (HC). Methods: 15 adults with moderate to severe TBI and 15 age and sex-matched HC completed 2 separate trials of the EATUG. Intraclass correlation coefficients (ICCs) were calculated to measure the within session test-retest reliability. Paired t-tests or Wilcoxon signed rank tests were used to determine differences between TBI and HC. Results: There is excellent within session test-retest reliability for total TUG time in TBI and HC. There is fair-to-good or excellent within session test-retest reliability for the EATUG subcomponents for adults with moderate to severe TBI and HC except total time for sit-to-stand transition in HC (ICC 0.325). Adults with moderate to severe TBI took more time to complete the TUG, had slower maximum chest angular velocity during the sit to stand, and had slower mean and peak angular velocities during the turn compared with HC [Table 1].

Conclusions: The EATUG test is a reliable measure for adults with moderate to severe TBI. The EATUG identified significant differences between TBI and HC in certain subcomponents that would not be apparent from evaluating total time alone.

Topic: 3. Clinical Sciences

Sub Topic: 3.3 Diagnosis

A rare case of shoulder pain in a young recreational athlete

S. Pinho¹, J. Portela²

¹Department of Physical and Rehabilitation Medicine, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal, ²Department of Orthopaedics, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal

Background and Aims: Shoulder pain is one of the most common musculoskeletal complaints and affects people of all ages. Although the usual causes of shoulder pain are benign, other inflammatory, neoplastic and systemic diseases must be considered. We present a case of eosinophilic granuloma in the humeral shaft which is a rare cause of shoulder pain. Methods: Report of one rare case of shoulder pain and review the current literature of this condition. Results: A 27-year-old male tennis player presented with a 2-month history of posterior shoulder pain and arm weakness with no history of trauma. On physical examination he had tenderness on palpation of the posterior upper third of the arm, with no limited passive shoulder range of motion. Active abduction, external and internal rotations triggered severe pain. Magnetic resonance imaging (MRI) revealed a central medullary lesion measuring about 24x14x18 mm of the proximal humeral shaft with no disruption of the cortical bone. A CT-guided biopsy was performed and confirmed an eosinophilic granuloma. An intra-lesional 80mg methylprednisolone injection was performed under fluoroscopy guidance with immediate pain relief. Serial X-rays showed reduction in size of the lytic lesion. One year after initial onset, the patient had complete shoulder pain relief and no functional disability, restoring his physical activity without any limitation. Conclusions: Eosinophilic Granuloma may be a rare but important cause of shoulder pain. Physical examination of shoulder does not always rule out a specific shoulder disease. Therefore, it is necessary to have a high degree of clinical suspicion, especially in patients with persistent shoulder pain.

Topic: 4. Therapeutics

Sub Topic: 4.4 Pharmacological agents

Cerebellar cognitive affective syndrome improvement with selective serotonine reuptake inhibitors

I. Perez Saborido¹, J. Pinel Rios²

¹Department of Physical Medicine and Rehabilitation, Hospital Universitario Virgen de la Victoria, Málaga, Spain, ²Department of Neurology, Hospital Universitario Virgen de la Victoria, Málaga, Spain

Background and Aims: Cerebellar cognitive affective syndrome (CCAS) is characterized by alterations at the cognitive level (dysexecutive syndrome, visuospatial deficit, language …), associated with affective / emotional changes. Its pathophysiology is not well known and there is currently no specific treatment.

Methods: We describe a 64-year-old man with a rare condition of cognitive-behavioral disorder after an infarction in the left middle cerebral artery, dominated by executive dysfunctions, predominantly oral apraxia, interrupted divided attention, disturbed visuospatial organization and affective abnormalities with great apathy, and whose symptoms improved with a selective serotonin reuptake inhibitor (SSRI). In absence of cerebellar structural damage, a perfusion brain single photon emission computed tomography using 99mTc-hexamethyl-propylene-aminoxime (SPECT-HMPAO) showed left frontotemporal and parietoccipital hypoperfusion of known vascular etiology, and hypoperfusion in the right cerebellar hemisphere compatible with the phenomenon of crossed diaschisis. We hypothesize that cognitive and affective deficits are aggravated by the functional disruption of the reciprocal cerebellar interconnections with areas of cerebral association and paralimbic cortex, altering the contribution of the cerebellum to cognitive and affective processing and modulation. Results: In the case described, both the clinical situation and the functional control images improved after treatment with SSRI, which raises the possibility that there is connectivity of some projections with serotonergic transmission between the cerebellum and the contralateral association cortices, and that said connectivity dysfunctional is involved in the pathophysiology of CCAS. Conclusions: Although more studies are required to confirm our findings, it appears that SSRIs are worth considering for the treatment of some patients with CCAS.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

D11 Brown Tumor: A rare etiology for paraplegia

P. Pereira, S. Ribeiro, A. Matias

Serviço de Medicina Física e Reabilitação do Hospital de Braga, Braga, Portugal

Background and Aims: Brown tumors are benign bone lesions rarely seen in clinical practice, reported in approximately 3% in primary hyperparathyroidism and 2% in secondary hyperparathyroidism.^[1] As far as we know, few cases of spine lesions were described, but thoracic spine was the most affected part and almost all the patients were presented with major neurologic deficit.^[2] Methods: We report a case of a 41-year-old Angolan woman with a poor medical support, who presented to our hospital with a 6-month history of low back pain, paraplegia and gait impairment. She had no history of trauma. Her past medical history included an end stage renal disease treated with chronic hemodialysis. Imaging studies showed a pathologic fracture of D11 with myelopathy and multiple expansible mass lesions located in the vertebral body of D11 and in other bones that were assumed as secondary lesions. A metastatic tumor was excluded with an extent study and she was diagnosed with secondary hyperparathyroidism. Results: This patient presented a motor incomplete paraplegia AIS grade C at the level of D12 and started a rehabilitation program. She had poor trunk control, painful lower limb spasms and was totally dependent on daily living activities, except for eating and grooming. After 3 months of rehabilitation programme, she gained trunk control, controlled a wheelchair for dislocations, transferred with modified independence from bed to chair and could assume orthostatism with help. Conclusions: Axial brown tumors are an extremely rare condition that could cause severe functional impairment which can be decreased with tailored PRM intervention.

Topic: 6. Health Policy and Systems

Sub Topic: 6.3 Infrastructure and Resources

Impact of the first COVID-19 pandemic wave on caregivers of stroke survivors in Portugal

A. Pereira, R. Silva, M. Pais de Carvalho, J. Jacinto

Centro de Medicina de Reabilitação de Alcoitão, Lisboa, Portugal

Background and Aims: Stroke is one of the most common causes of death and acquired disability worldwide. The huge impact of the COVID-19 pandemic on rehabilitation services. The purpose of this study was to assess the impact of the resulting interruption of outpatient rehabilitation programs, on caregivers of stroke survivors during the first lockdown in Portugal. Methods: A telephone questionnaire was specifically designed for caregivers of stroke patients. Eligible respondents were caregivers of stroke patients who saw their outpatient treatments suspended, from March to May 2020, due to the COVID-19 pandemic. The variables evaluated were caregiver burden, absence from work, financial concerns, and anxiety. Results: A total of 89 caregivers responded to the questionnaire. 71.1% experienced a moderate to extreme increase in the burden of assistance to the patient. 29.4% of caregivers needed to be absent from work to care for the patient and 46.3% of caregivers felt anxious all or most of the time, regarding the ability to care for the patient. 50.6% of caregivers reported financial concerns about patient care during this period.

The interruption of rehabilitation treatments during pandemic led to a greater notion of a burden for caregivers of more dependent patients, with lower Functional Independence Measure scores (p = 0.038). Conclusions: There was a strong relationship between discontinuation of rehabilitation and the deterioration of the level of independence and an increase of the need for caregiver assistance. This study underlines the importance of rehabilitation and follow-up of stroke patients as outpatients, even after the post-acute phase.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Predictors of functional outcome in patients with traumatic brain injury sequelae at a European rehabilitation center

A. Pereira, R. Silva, J. Capelo, I. Andrade, M. Pais de Carvalho, J. Jacinto

Centro de Medicina de Reabilitação de Alcoitão, Lisboa, Portugal

Background and Aims: Traumatic Brain Injury (TBI) is recognized as a leading cause of disability that leaves patients with temporary and/or permanent cognitive, physical, and psychosocial sequelae. This study aims to evaluate the effect of an inpatient rehabilitation program on the functional independence level of patients with TBI and to identify the clinical features at admission that predict key outcomes upon discharge. Methods: Retrospective cohort study performed during 2014-19 in a Rehabilitation Center (RC). The Functional Independence Measure (FIM) at admission and discharge was used to assess functional recovery. FIM gains and possible predictive factors were assessed. Results: 95 patients (76 males, mean age at TBI 41±15.9 years) were admitted to inpatient rehabilitation at a RC a mean of 178.83±17 days after the event; 81.1% of patients with severe TBI; mean length of stay was 72.92±3 days. There was a significant improvement in FIM scores - admission (62.39 ± 3.38) and discharge (77.47±3.62). At admission, patients were categorized into functional subgroups: 41.4% totally dependent (18>=FIM<60), 40.0% mild/moderately dependent (60<=FIM<100) and 15.8% mostly independent (FIM>=100); 51.6% of patients went up at least one functional subgroup during the rehabilitation program. There was a statistically significant association between the longer injury to rehabilitation gap and lesser FIM gain (p=0.006). The 60<=FIM<100 subgroup of patients at admission showed greater FIM gain at discharge (p=0.003). Conclusions: Our results suggest that rehabilitation is effective for functional improvement after TBI. The time from the TBI to rehabilitation and admission FIM scores are important statistical predictors of functional improvement during intensive, multimodal inpatient rehabilitation.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Short duration of oral contraceptive pill-use resulting in cerebral venous sinus thrombosis complicated with Haemorrhagic infarction: A rare case report and literature review

H. Ohnmar¹, E. T. Hnin², H. Zaid³, G. Punganan⁴, Y. Y. Leong⁵, N. Y. Khin⁶, E. K. S. Sam⁷, H. S. Peh¹, A. S. Naicker¹

¹Department of Orthopaedic and Traumatology, Rehabilitation Medicine Unit, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia, ²Department of Research and Innovation, Lincoln University College, Selangor, Malaysia, ³Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates, ⁴Department of Orthopaedic and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia., Kuala Lumpur, Malaysia, ⁵Department of Radiology, Hospital Canselor Tuanku Muhriz (HCTM), Pusat Perubatan University Kebangsaan Malaysia, Kuala Lumpur, Malaysia, ⁶Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu, Malaysia, ⁷Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Background and Aims: Prolonged oral contraceptive pill (OCP) usage has been associated with high risk of cerebral venous sinus thrombosis (CVT). We report a case of 43 year old women diagnosed with CVT associated with OCP usage for a short duration (3 weeks). Methods: She presented with sudden onset of focal seizure over right upper limb which aborted spontaneously. She had headache and vomiting 1 day prior to the epileptic episode. She is a non-smoker and has background history of hypertension which is controlled with medications. She had history of consuming oral contraceptive pills 3 weeks prior to the symptoms. Upon clinical examination, her GCS was 15/15 and afebrile. The right upper limb was hypotonic and areflexic with the power of 2/5 on Medical Research Council’s Scale and other neurological examination findings were unremarkable. Results: Plain CT brain showed hyperdense lesion over the left frontoparietal and right parietal lobe. Magnetic resonance venography (MRV) showed cerebral venous sinus thrombosis involving superior sagittal sinus, right transverse sinus and sigmoid sinus associated with left parietal venous haemorrhagic infarct. Antithrombin, anticardiolipin and antiphospholipid antibody were negative. Serum protein C, protein S and antithrombin III were within the normal range. She was started on antiepileptic treatment and anticoagulants (subcutaneous enoxaparin 60mg BD, Warfarin 4.5mg OD) and structured rehabilitation program. Two weeks later, she was discharged well with full recovery. Conclusions: Clinicians should be aware of the possible CVT even with a very short duration of OCP usage. A prompt diagnosis and treatment leads to a full recovery.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Ulnar nerve palsy as a complication of conservative treatment of a distal radial fracture: A case report

A. Pascoal, A. Lourenço, I. Ferro, P. Sá, X. Verraest, J. Constantino, J. Lains

CMRRC-Rovisco Pais, Tocha, Portugal

Background and Aims: Peripheral nerve palsy may be a complication of a distal radial fracture because of increased pressure, contusion, traction, and laceration. Ulnar nerve palsy is a rare complication. Methods: Description of the clinical features and outcome of a patient with compressive motor and sensory ulnar nerve palsy associated with the casting after a fracture of the distal radius. Results: A 30-year-old man presented himself to an emergency room after a fall from a roof. He was diagnosed with a right distal radius fracture. He underwent manual reduction and cast immobilization for 6 weeks. He presented to an outpatient rehabilitation centre 5 days after cast removal, with range of movement limitation complaints and hand weakness. The patient experienced an episode of sudden intense hand pain with rapid resolution after the cast removal, in the first days after immobilization. The physical exam revealed active and passive range of motion limitations, Wartenberg’s sign, claw hand and sensation deficit in the ring and little finger, signs of ulnar motor and sensory deficit. To corroborate the clinical diagnosis, one week later, a nerve conduction and needle electromyography was performed. The result was compatible with a moderate to severe subacute demyelinating sensory and motor ulnar neuropathy. We admit a compressive aetiology related to the cast immobilization. After 3 weeks of rehabilitation treatment, the patient recovered for most of the range of motion limitations, sensation deficit and strength against manual resistance in all segments, except for finger adduction. Conclusions: Physicians should thoroughly evaluate nerve function both before and after cast immobilization.

Topic: 4. Therapeutics

Sub Topic: 4.4 Pharmacological agents

A phase IV, randomized, double-blind, crossover study comparing the clinical safety, efficacy and duration of abobotulinumtoxina with onabotulinumtoxina in adults with upper-limb spasticity

A. Esquenazi¹, Z. Ayyoub², M. Verduzco-Gutierrez³, P. Maisonobe⁴, J. Otto⁵, A. Patel⁶

¹MossRehab and Albert Einstein Medical Center, Elkins Park, Pennsylvania, United States, ²Rancho Los Amigos National Rehabilitation Center, Downey, California, United States, ³The Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, United Kingdom, ⁴IPSEN, Cambridge, Massachusetts, United States, ⁵IPSEN, Boulogne-Billancourt, France, ⁶Kansas City Bone and Joint Clinic, Kansas City, Missouri, United States

Background and Aims: The DIRECTION study aims to evaluate the safety and efficacy of abobotulinumtoxinA in comparison to onabotulinumtoxinA for upper-limb spasticity (ULS) when used at optimized doses in approved muscles common to both products’ US FDA labels. Methods: The DIRECTION study is a phase-IV, international, randomized, double-blind, crossover study comparing abobotulinumtoxinA with onabotulinumtoxinA in the management of ULS. Participants (18-75y) will be randomized (1:1) to two treatment sequences – either one cycle of abobotulinumtoxinA (900U) followed by onabotulinumtoxinA (360U) or vice versa. To maintain study blinding, a fixed volume (3.6mL) will be injected into the target upper-limb muscles (4 palmar flexors and biceps brachii) using guidance techniques. Participants will begin the second treatment cycle at Week-12 if retreatment criteria are fulfilled. If not, participants will be reassessed every 4 weeks (at Weeks 16, 20 and 24) until they require retreatment. The primary hypothesis is that the safety profiles of both products are comparable (non-inferiority will be tested based on TEAE rates from injection to Week-12). A secondary hypothesis is that abobotulinumtoxinA has longer duration of effect than onabotulinumtoxinA; this hypothesis will be based on superiority tests associated with secondary efficacy endpoints analyses (including injection cycle duration, Modified Ashworth Scale, Disability Assessment Scale and Physician Global Assessment). Results: The DIRECTION study will complete in 2023. Conclusions: Using clinically relevant dosing, the DIRECTION study will be the first to prospectively compare abobotulinumtoxinA with onabotulinumtoxinA for ULS to allow informed decisions for care optimization, including use of optimized dosing- according to the approved prescribing information.

References

Simpson DM, Hallett M, Ashman EJ, Comella CL, Green MW, Gronseth GS, et al. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2016;86:1818-26.

Topic: 4. Therapeutics

Sub Topic: 4.4 Pharmacological agents

Real-life data from the ULIS-III study on the time to retreatment with botulinum toxin a in upper limb spasticity management

J. Jacinto¹, S. Ashford², K. Fheodoroff³, A. Brashear⁴, P. Maisonobe⁵, A. Lysandropoulos⁵, L. Turner-Stokes²

¹Centro de Medicina de Reabilitaçãode Alcoitão, Serviço de Reabilitação de Adultos, Estoril, Portugal, ²Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London, United Kingdom, ³Neurorehabilitation, Gailtal-Klinik, Hermagor, Austria, ⁴University of California Davis School of Medicine, Sacramento, California, United States, ⁵IPSEN, Boulogne-Billancourt, France

Background and Aims: The ULIS-III study aims to describe the real-life management of upper-limb spasticity within an integrated approach, including repeat botulinum toxin-A (BoNT-A) injection cycles. One way to understand the duration of BoNT-A benefit is to evaluate the time to reinjection, which is often tailored to patient needs. Methods: ULIS-3 (NCT02454803) was a prospective, international, multicentre, observational study that examined longitudinal outcomes in adult (>=18y) patients with upper-limb spasticity. A multivariate additive linear regression model was built to evaluate treatment intervals adjusting on multiple baseline and treatment covariates. Results: Of the 1004 enrolled patients, 828 remained on the same BoNT-A product during the study and had their injection intervals assessed. Across the study (cycles 1-9), the mean ±SD [range] injection interval (all BoNT-A products) was 177.6 ± 81.9 (57-644) days. By product, the mean raw injection interval was 188.6 ±83.0 [57–644] for abobotulinumtoxinA, 156.4 ±79.9 (81-476) for onabotulinumtoxinA, and 152.3 ± 61.5 [81–397] days for incobotulinumtoxinA. Analysis of cycles 1-4 showed that patients treated with abobotulinumtoxinA had, on average, a significantly longer interval between the first and second injection than patients treated with both onabotulinumtoxinA and incobotulinumtoxinA. Conclusions: These real-world injection data from a large, observational study support the clinical experience that there are clinical differences between BoNT-A products that should be taken into account when designing patient treatment plans.

References

Turner-Stokes L, Jacinto J, Fheodoroff K, Brashear A, Maisonobe P, Lysandropoulos A, et al. Longitudinal goal attainment with integrated upper limb spasticity management including repeat injections of botulinum toxin A: Findings from the prospective, observational Upper Limb International Spasticity (ULIS-III) cohort study. JRM 2021;53:jrm00157.

Topic: 4. Therapeutics

Sub Topic: 4.4 Pharmacological agents

Are you my sunshine? Hypercalcaemia in the prevention of vitamin d deficiency and osteoporosis in the neurorehabilitation setting

E. Parsons, S. Frey, A. Pick, J. Haider

Oxford Centre for Enablement, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom

Background and Aims: Patients with neurological injury are at risk of osteopenia and osteoporosis. Additionally, individuals receiving inpatient rehabilitation often experience prolonged hospitalisation, presenting increased risk for vitamin D deficiency. Deficiency in vitamin D can cause fatigue, muscle weakness and osteomalacia, impacting on rehabilitation goals. To ameliorate these factors, neurorehabilitation patients are often routinely prescribed calcium and colecalciferol (vitamin D) supplementation. Such supplements are not free from potential for patient harm. Calcium supplementation may cause hypercalcaemia, whilst vitamin D treatment has potential to unmask hyperparathyroidism, also leading to hypercalcaemia. This is compounded in a patient population already predisposed to hypercalcaemia secondary to immobility and neurological injury. This study aimed to understand potential for harm of administration of calcium and colecalciferol supplementation in an inpatient neurorehabilitation population. Methods: This retrospective study assessed monitoring of serum calcium levels and incidence of hypercalcaemia in 48 rehabilitation patients receiving combination calcium/colecalciferol supplementation at the Oxford Centre for Enablement from August 2019-2020. Results: 38% of patients receiving combined calcium/colecalciferol supplement had a serum calcium level taken during their inpatient stay. In those monitored, instance of hypercalcaemia occurred in 47%. Conclusions: This study highlights potential for hypercalcaemia in the inpatient rehabilitation population and potential for harm when prescribing additional calcium. Recommendations were made for enhanced monitoring of patients receiving calcium/colecalciferol supplementation, and for prescription of colecalciferol monotherapy as an alternative to a combined calcium/colecalciferol supplement.

Topic: 5. Engineering and Technology

Sub Topic: 5.6 Telerehabilitation

Real-time exercise feedback through a convolutional neural network technology: A machine learning-based motion-detecting mobile exercise coaching application

J. Park, J. PARK, S. Chung

Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea

Background and Aims: Recently, machine learning-based motion-detecting techniques have been applied in the health-care market. This study aimed to prove the hypothesis that exercise using a machine learning-based motion-detecting mobile exercise coaching application (MDMECA) is superior to the video streaming-based exercise for improving quality of life and decreasing low-back pain. Methods: The same 14-days of daily-workout consisting of five exercises was performed by 104 participants using the MDMECA and 72 using video streaming [Table 1] and [Figure 1] and [Figure 2]. The Medical Outcomes Study Short Form 36-Item Health Survey (SF-36) and low-back-pain scores were used in the pre- and post-workout assessments. The scores for the treatment-satisfaction subscale of the visual analog scale (TS-VAS), intention to use a disease-oriented exercise program, intention to recommend the program to others, and the available expenses for a disease-oriented exercise program were determined after the workout. Results: The MDMECA group showed a higher increase in SF-36 score (MDMECA, 9.10; Control, 0.37; P < 0.01) and greater reduction in low-back-pain score (MDMECA, -0.96; Control, -0.26; P < 0.01) [Table 2]. The scores for the TS-VAS, intention to use a disease-oriented exercise program, and intention to recommend the program to others were all higher (P < 0.01) in the MDMECA group. However, the available expenses for a disease-oriented program were not significantly different between the two groups [Table 3]. Conclusions: The MDMECA is more effective than video-streaming in increasing exercise adherence, improving QoL and reducing low-back pain. It is a promising tool in the health-care market with better medical outcomes and higher treatment satisfaction.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Functional problems related to home working during COVID-19 health emergency: A cross-sectional analysis

M. Paoletta¹, A. Moretti¹, S. Liguori¹, M. Aulicino¹, L. Peschi¹, F. Gimigliano², G. Iolascon¹

¹Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, Naples, Italy, ²Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy

Background and Aims: Health emergency due to Covid-19 has led to an extensive implementation of work from home. To date, there is a lack of evidence characterizing both work results and physical issues in remote workers. The aim of this cross-sectional study was to assess the impact of home working on the individuals in terms of perceived productivity, satisfaction and work stress as well as on the onset of musculoskeletal disorders. Methods: Our research involved 51 remote workers who were asked to fill a questionnaire. Data about perceived productivity, stress and organization of the workplace at home were collected. Job satisfaction was assessed using the Utrecht Work Engagement Scale (UWES), while work-related musculoskeletal pain was evaluated using the Brief Pain Inventory (BPI) and the Fear Avoidance Beliefs Questionnaire (FABQ). Results: Employees reported lower perceived productivity (39.2%), lower stress (39.2%) and equal job satisfaction (51%) when comparing home working with work in the office. Low back pain and neck pain were reported in 41.2% and 23.5% of smart workers, respectively. Remote working led to a worsening of neck pain in 50% of smart workers, while low back pain did not get worse in 47.6% of cases. Conclusions: An uncomfortable workstation at home can increase musculoskeletal pain mainly involving the spine. Using ergonomic equipments and suitable postures can significantly reduce these risks, with positive effects on productivity and job satisfaction.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Case report: A novel case of neurologic residual deficits secondary to decompression illness from scuba diving

J. S. Palmer, H. Ayyala

Baylor College of Medicine, PM and R, Houston, Texas, United States

Background and Aims: Decompression Illness is generalized barotrauma due to a rapid decrease in pressure of either air or water. Rapid symptom onset differentiates type I (DT1) from type II (DT2). DT1 presents with localized joint pain, pruritus, and lymphadenopathy. DT2 is more severe, with paresthesias, weakness, sphincter control loss, risk of progression to paraplegia, and venous gas embolism. With treatment (hydration, hyperbaric oxygen and Trendelenburg positioning) in the acute setting, DT2 resolution is seen in 75% of patients, increasing to 84% at 3 months. However, treatment delayed more than 12 hours reduces the recovery rate to 57%. Methods: We present a case of DT2 with neurological deficits after a SCUBA diving incident seen in the acute inpatient rehabilitation setting. Results: A 72-year-old avid SCUBA diver developed nausea, vomiting, weakness and tingling in both legs after ascending too quickly from a dive. On admission to an acute care facility, symptoms progressed to significant muscle weakness and urinary retention. MRI was negative for myelopathy or myelitis in thoracic and lumbar spine. After five days of hyperbaric oxygen treatment, he was transferred to inpatient rehabilitation to address residual functional impairments. His rehabilitation course was complicated by AKI, UTI, persistent neurogenic bladder and bowel. He progressed clinically and functionally, but was noted to have mild residual gait deficits two weeks later on discharge. Conclusions: Decompression Illness type II can progress quickly to permanent neurological injury if not treated. When recognized in the acute phase, as in the vast majority of cases, complete or near complete recovery can be expected.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

Multidisciplinary management of complex regional pain syndrome – A case report

A. Paiva¹, B. Ferreira², I. Ferro¹, J. Constantino¹, B. Mendes³, S. Serrano^2,4, J. Lains¹, M. Bartolo²

¹Centro de Medicina Física e de Reabilitação da Região Centro, Rovisco Pais, Tocha, Portugal, ²Centro Hospitalar de Leiria, Leiria, Portugal, ³Centro Hospitalar Baixo Vouga, Aveiro, Portugal, ⁴Unidade de Dor Crónica, Centro Hospitalar de Leiria, Leiria, Portugal

Background and Aims: Complex regional pain syndrome (CRPS) is characterized by regional pain, disproportionate to causal stimulus, accompanied by sensory, trophic, vasomotor, or motor changes. Methods: Case Report. Results: A 45-year-old female suffered a left ankle grade II talofibular ligament sprain and underwent conservative treatment. Three months later, she could not do weight bearing and the orthopedic surgeon decide to immobilize the ankle with a plaster cast, was removed four weeks later. On the PRM evaluation, she presented varus foot with marble skin and trophic changes, namely Achilles tendon retraction, severe strength deficit of the fibular muscles and antero-lateral leg amyotrophy. EMG was normal. The rehabilitation included physiotherapy, hydrotherapy, and medication with deflazacort, duloxetine, tapentadol, calcium and vitamin-D. She begun being followed by psychiatry and psychology. Although there was some symptomatic improvement, six months after she was presenting CPRS-related dystonia with overactivation of the tibialis anterior (TA) muscle and claw toes deformity. She was then referred to a Rehabilitation Center where BoNT-A was performed at the TA and flexor digitorum brevis muscles, as well as the tibiotalar joint. At follow-up, six weeks later, despite maintaining a left cavum foot deformity, she reported a very significant improvement of pain. Now, she could walk without pain, do cycling and work. Conclusions: Management of mild CRPS may not require a multidisciplinary team, however, severe CRPS must call for a coordinated and multiprofessional care. Referral to a specialized PRM center is appropriate for refractory patients, hence offering comprehensive management that may include BoNT-A.

Topic: 3. Clinical Sciences

Sub Topic: 3.7 Rehabilitation of Individuals with Post COVID-19 Impairments and Sequalae

The relationship between vitamin d levels, inflammatory parameters and disease severity of COVID-19 infection: A retrospective study

G. Ozturk¹, B. Eraslan², P. Akpinar¹, D. Karamanlioglu¹, F. Unlu Ozkan¹, I. Aktas¹

¹University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey, ²Kartal Dr. Lütfi Kirdar Training and Research Hospital, Istanbul, Turkey

Background and Aims: Vitamin D deficiency increases the susceptibility to respiratory virus infections and the severity of infections. Inflammation plays a key role in pathogenesis in COVID19 while identifying clinical course and prognosis COVID19. The aim of this study was to determine the relationship between 25OH vitamin D levels, inflammatory laboratory parameters of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), C-reactive protein (CRP) levels and disease severity of COVID19 infection. Methods: In this retrospective study 300 patients diagnosed with COVID19 were included. According to clinical classification of cases with COVID19 the patients were divided into three groups; mild, moderate and severe/critical. The 25OH vitamin D values below 20 ng/ml were defined as deficiency, 21–29 ng/ml were defined as insufficiency, and 30 ng/ml and above were defined as normal. Patients’ age, gender, comorbid diseases and laboratory values were recorded. Results: Of the 300 (100%) patients included in the study, 130 (43.3%) were mild (Group1), 132 (44%) were moderate (Group2), and 38 (12.7%) were severe/critical (Group3). The mean age, mortality and comorbidities in Group3 were higher compared to those in Group1 and 2 (p<0.05). There was no statistically significant difference in distribution rates of 25OH vitamin D levels between the groups (p>0.05). CRP values, PLR and NLR of Group3 were statistically significantly higher compared to in Group1 and 2 (p<0.05). Conclusions: Our findings do not support the relationship between severity of COVID19 infection and 25OH vitamin D deficiency. Conversely, CRP values, PLR and NLR are associated with severity of COVID19 infection.

Topic: 3. Clinical Sciences

Sub Topic: 3.8 Diagnostic Imaging

Proposal for a new scoring system for spinal degeneration: MO-FI-disc

E. E. Ozcan Eksi¹, M. S. Eksi², O. Orhun², V. U. Turgut³, M. N. Pamir²

¹Bahcesehir University School of Medicine, Istanbul, Turkey, ²Acibadem University School of Medicine, Istanbul, Turkey, ³Antalya Ataturk State Hospital, Istanbul, Turkey

Background and Aims: We aimed to develop a new scoring system for spinal degeneration including Modic changes, fatty infiltration (fi) in the paraspinal muscles, and intervertebral disc degeneration (IVDD), briefly Mo-fi-disc, using current radiological classification systems. We also aimed to understand whether Mo-fi-disc could predict patients with more intense low back pain (LBP). Methods: We conducted a cross-sectional analysis of a retrospective database between March 2018 and July 2020. We evaluated patients in terms of Modic changes, fatty infiltration in the paraspinal muscles, and IVDD at all lumbar levels on lumbar spine MRI. We grouped patients based on their LBP intensity. Visual analog scale (VAS) scores were used for LBP intensity. Results: We evaluated 134 patients (female: 66, male: 68; mean age: 35.44±6.5 years). Patients with higher VAS scores had significantly higher ‘Mo-disc’ scores and higher ‘fi’ scores compared to those with lower VAS scores (3.54±2.7 vs. 2.55±2.8, p=0.0075; 6.85±3.2 vs. 5.25±2.9, p=0.0092). Patients with higher VAS scores had significantly higher ‘Mo-fi-disc’ scores compared to those with lower VAS scores (10.4±4.2 vs. 7.94±3.8, p = 0.0003). The most significant predictor for patients with higher VAS scores was ‘Mo-fi-disc’ scoring system with an OR of 1.193 (95 % CI: 1.055–1.349, p = 0.005). Conclusions: Patients with more intense LBP had higher ‘Mo-fi-disc’ scores. This scoring system suggests an easy and objective classification to evaluate the spinal degeneration.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Reciprocal relationship between multifidus and psoas at l4-l5 level in women with low back pain

E. E. Ozcan Eksi¹, M. Eksi², V. U. Turgut³, C. Canbolat², M. N. Pamir²

¹Bahcesehir University School of Medicine, Istanbul, Turkey, Acibadem University School of Medicine, Istanbul, Turkey, ³Antalya Ataturk State Hospital, Antalya, Turkey

Background and Aims: Low back pain (LBP) may originate from intervertebral disc degeneration

(IVDD), vertebral end-plates and paraspinal muscle changes. We aimed to explore the relevance of fatty infiltration in the paraspinal muscles in women with LB. We also aimed to identify twhether fatty infiltration in the paraspinal muscles associated with IVDD and Modic changes. Methods: Consecutive female patients presenting with chronic LBP to the outpatient clinics were included.

Patients were evaluated in terms of IVDD, vertebral end-plate changes, and fatty infiltration in the paraspinal muscles at all lumbar levels on lumbar spine magnetic resonance imaging (MRI). Visual Analogue Scale (VAS) scores were recorded using our prospectively collected database. Results: Patients with higher VAS scores were more fatty infiltration in the multifidus and less fatty infiltration in the psoas at L4-L5 level(69.1 vs. 31.8%, p=0.003). To predict LBP, fatty infiltration in the multifidus and psoas had OR of 4 (p=0.010), and 0.3 (p=0.013), respectively; whereas disc degeneration had an OR of 0.5 (p=0.028). Conclusions: This is the first clinical cross-sectional study suggested that women with chronic LBP could have less fat-infiltrated psoas to compensate more fat-infiltrated multifidus at L4-L5 disc level.

References

Ozcan-Eksi EE, Eksi MS, Akcal MA. Severe lumbar intervertebral discdegeneration is associated with modic changes and fatty infiltration in the paraspinal muscles at all lumbar levels, except for L1-L2: A crosssectional analysis of 50 symptomatic women and 50 age-matched symptomatic men. World Neurosurg 2019;122:e1069-77.
Pfirrmann CW, Metzdorf A, Zanetti M, Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 2001;26:1873-8.

Topic: 7. Functioning and Disability

Sub Topic: 7.4 Impairment Rating, Disability Evaluation and Certification

Influences on neuropsychological function by the retrieval impairments of the remembering to remember and the remembering the contents in the prospective memory task

N. Ota¹, J. Tanemura¹, K. Hanayama²

¹Kawasaki University of Medical Welfare, Kurashiki, Japan, ²Kawasaki Medical School, Kurashiki, Japan

Background and Aims: Prospective memory (PM) is to encode future events and to retrieve and to perform spontaneously. In the PM tasks, remembering to remember (RR) is recognition of the PM cue, and remembering the contents (RC) is to retrieve what to perform. We studied the influences on neuropsychological test performances by these two retrievals. Methods: We studied 67 subjects with brain damage (31 of CVAs, 37 of TBIs, average age 45.8 year-old). Analysis was two-way of ANOVA. Independent variables were the scores of RR and those of RC of “Appointment” task in the Rivermead Behavioral Memory Test (RBMT), and dependent variables were scores of assessments of attention, memory and executive function. Results: No impairments in both RR and RC groups were 32 subjects, impairments in RR groups were 17, impairments in RC groups were 7 and impairments in both RR and RC groups were 11. Each impairment of the retrieval showed lower scores of BADS “Zoo Map” test and WMS-R “delayed recall”. Additionally impairment in RR showed lower scores in WAIS-3VIQ, and impairment in RC showed lower scores in the story task in letter cancelation test. No interaction effects were showed. Conclusions: Impairment of the “Appointment” task in the RBMT influenced the delayed recall and organization of executive function. Additionally, impairments in RR influenced the active retrievals after the timer alarm and in verbal memory, and impairments on RC influenced encoding and divided attention to retrieve what to do with the PM cue.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Evaluation of anthropometric measurements of patients with osteoporosis above 65 years of age: A controlled study

B. Ordahan

Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University Faculty of Meram Medicine, Konya, Turkey

Background and Aims: Fall in osteoporotic elderly causes fractures. Especially with age, there is a decrease in muscle mass and muscle strength. With aging, lean body mass decreases, sarcopenic obesity develops. In this study, it was aimed to evaluate the anthropometric measurements of patients over 65 years old with osteoporosis. Methods: 30 female patients diagnosed with osteoporosis with DXA over 65 years old, and 30 patients without osteoporosis over 65 years old were included in the study. Mid upper-arm circumference, waist circumference, hip circumference and calf circumference were measured by tape measure in accordance with anthropometric measurement standards. Results: The mean ages were 69.13 ± 4.03 and 68.11 ± 4.28 years, respectively. There was no significant difference between the height, weight, BMI, mid upper-arm circumference, waist circumference, hip circumference, waist / hip circumference ratio between the groups. Calf circumference was significantly lower in patients with osteoporosis compared to patients without. Conclusions: Low calf circumference in patients with osteoporosis may be associated with sarcopenia, falling and disability.

References

Aspray TJ, Hill TR. Osteoporosis and the ageing skeleton. Subcell Biochem 2019;91:453-76.
Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing 2019;48:16-31.

Topic: 3. Clinical Sciences

Sub Topic: 3.2 Pain Osteoporosis -Osteoarthritis

Osteoarthritic manifestations of ochronosis: A case report

B. Ordahan, N. Sak

¹Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University Faculty of Meram Medicine, Konya, Turkey

Background and Aims: Ochronosis is the accumulation of homogentisic acid and its metabolites in connective tissues due to the deficiency of the homogentisic acid oxidase enzyme. Ocronotic spondylosis and peripheral arthropathy with frequent hip, knee and glenohumeral joint involvement may develop. Cardiovascular involvements such as aortic stenosis may occur with pigment accumulation. Methods: A 56-year-old male patient was admitted to our outpatient clinic with extensive joint pain and difficulty in walking. On physical examination, waist and neck joint range of motion were limited. Dorsal kyphosis was present. Bilateral total knee arthroplasty was applied. Echocardiographic examination revealed severe calcific aortic stenosis. Lateral lumbar radiographs revealed narrowing in the lumbar intervertebral disc space, calcifications in the intervertebral discs, osteophytic degenerative changes in the vertebral fronts and marginal subchondral sclerosis. An examination of the urine revealed a black color when exposed to air. Homogentisic acid was found in the urine. Results: Ochronosis is a rare autosomal recessive disorder. It should be kept in mind in the differential diagnosis of degenerative joint diseases. Conclusions: Ochronosis is a rare autosomal recessive disorder. It should be kept in mind in the differential diagnosis of degenerative joint diseases.

References

Harun M, Hayrettin Y, Serhat M, Cuneyt M. A rare cause of arthropathy: An ochronotic patient with black joints. Int J Surg Case Rep 2014;5:554-7.
Zmerly H, Moscato M, Di Gregori V. Arthroplasty in alkaptonuric ochronosis. J Popul Ther Clin Pharmacol 2019;26:e20-4.

Topic: 6. Health Policy and Systems

Sub Topic: 6.2 Economics (Cost-Effectiveness)

Cost of rehabilitation in critically ill COVID-19 survivors – A little goes a long way

P. L. Ong, M. R. J. Tay, S. L. Tham

Tan Tock Seng Hospital, Singapore, Singapore

Background and Aims: The Coronavirus disease 2019(COVID-19) pandemic has imposed an immense economic burden on healthcare systems, which may result in affected patients not receiving adequate post-acute rehabilitative care. We therefore conducted a pilot study investigating the cost of rehabilitation in critically ill COVID-19 survivors. Methods: We retrospectively reviewed 27 critically ill COVID-19 patients admitted to the intensive care unit (ICU) of the National Center for Infectious Disease, Singapore from January 1 to May 31, 2020. Patients who developed acute respiratory distress syndrome requiring mechanical ventilation were included. All patients received inpatient rehabilitation therapy until they were medically fit for discharge. We then calculated the cost of all rehabilitative sessions. Results: The average duration of mechanical ventilation was 15 days in this study. We found that critically ill COVID-19 survivors underwent a mean of 17.3 physiotherapy sessions, 6.11 occupational therapy sessions and 4.81 speech therapy sessions. The average cost of these therapy sessions was S$2438.63(US$1835.25). Following inpatient rehabilitation, 85.2% (n=23) achieved independence in ambulation and ADLs upon discharge. Multivariate analysis of the data revealed that a longer duration of mechanical ventilation was associated with an increased need for therapy sessions (RR 2.34, 95% CI 0.868-3.82, p=0.003). Conclusions: Although rehabilitation service is often required for critically ill COVID-19 survivors even after their ICU stay, it appears to be relatively low cost, especially when compared to the cost of intensive care. Nonetheless, rehabilitation seems to be effective in optimizing the functional outcomes of these patients.

References

Ho, et al. Outcomes of patients requiring prolonged mechanical ventilation in Singapore. J Emerg Crit Care Med 2020;4:32.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

Physical medicine and rehabilitation approach to a bilateral hypoglossal palsy after orotracheal intubation – A case report

M. Oliveira, A. Vaz, A. Caldeira, N. Pinto

Centro Hospitalar Universitário de São João, Porto, Portugal

Background and Aims: Isolated hypoglossal nerve palsy (HNP) is a rare occurrence, usually unilateral, and typically associated with other cranial nerves or neurologic structural lesions. Bilateral HNP is an unusual finding, with few cases reported. Methods: Case report written in accordance to CARE guidelines. Results: 34-year-old man, hospitalized on a tertiary-care-center with a community acquired pneumonia, with progressive respiratory distress, demanding invasive mechanical ventilation for 48 hours, after which a tongue paresis was reported, with absolute inability to mobilization in any quadrant, alongst with dysphagia (FOIS 3) and dysarthria. Diagnostic work-up did not reveal an etiology for the deficits, so isolated cryptogenic bilateral HNP was assumed. A rehabilitation program was started and continued after hospital discharge. When he restarted the program, presented tongue atrophy with inability to elevate, protrude, or lateralize the tongue, dysarthria, and increased oral transit time associated to compensatory cervical extension when asked to swallow (FOIS 4). Four months after starting the program, an improvement of tongue atrophy and mobility were found, accompanied by a clinically relevant reduction on dysphagia severity, total oral intake of pureed consistency and thin liquids (FOIS 6). About 10 months after starting the program, he presented an almost normal tongue mobility and was apt to general diet with less limitations (FOIS 7), having been discharged from the program. Conclusions: Nonetheless the infrequency of bilateral HNP, this entity is associated to relevant functional impairments. A multidisciplinary approach for diagnosis and tailored rehabilitation programs are advantageous to these patients’ orientation.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Quality of life in adolescent idiopathic scoliosis patients undergoing conservative treatment

M. F. K. Ola¹, Y. H. Labrada Rodríguez², L. Monleón Llorente¹, L. Garvin Ocampos¹, B. A. Rodríguez Damiani¹, C. Cuenca González¹

¹Department of Physical Medicine and Rehabilitation, Hospital Universitario Clínico San Carlos, Madrid, Spain, ²Physical medicine and Rehabilitation Unit, Hospital de Guadarrama, Madrid, Spain

Background and Aims: During the management of Adolescent Idiopathic Scoliosis (AIS), patient’s quality of life (QoL) is scarcely considered among treatment objectives. Assessing QoL might pose a challenge for health professionals. It is important to record this parameter for a best clinical practice. Aim: To evaluate QoL through the SRS 22 questionnaire in adolescents undergoing conservative treatment with AIS. Methods: Descriptive postprective study from January 2019 to May 2020. 40 adolescents with AIS undergoing conservative treatment that meet inclusion and exclusion criteria were included in the study. Parameters analyzed were: age, sex, Cobb Angle, daily/night use and type of brace and QoL through SRS 22 questionnaire. SRS 22 questionnaires were conducted by telephone. Remaining variables were recorded from the clinical history. Results: Cobb angle was 20-29° in 37.5% of patients and 30-39° in 37.5% as well. The most frequent types of braces used were Cheneau and Providence. Patients scored lower in the self-image perception and mental health domains. The brace treatment group revealed worse results in the self-image perception and mental health sections in comparison with the non-braced group (p 0.006 and p 0.04 respectively). The overall SRS 22 questionnaire score was worse in patients with greater angle of deviation (p 0.019). No statistically significant correlations were found between QoL and the variables sex, daily/night brace and type of brace. Conclusions: AIS has a negative impact in patient’s quality of life, specifically in their body image and mental health. The magnitude of the impact is related with a greater angle of deviation and the use/non-use of brace.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Unusual presentation of axillary web syndrome: A case report

M. F. K. Ola¹, M. Martín López de Abajo²

¹Department of Physical Medicine and Rehabilitation, Hospital Universitario Clínico San Carlos, Madrid, Spain, ²Department of Physical Medicine and Rehabilitation, Hospital Asepeyo Coslada, Madrid, Spain

Background and Aims: Axillary web syndrome (AWS) is defined as a cord-like structure extending from the axilla to the medial arm that can lead to pain and/or restricted motion of the shoulder. Although most studies describe this condition following breast cancer surgery, there are exceptional cases reported after other processes. Currently there is limited knowledge regarding the pathogenesis and etiology of AWS. Aim: To describe the diagnosis and treatment process of AWS in a man after a traumatic event. Methods: A 32 year old north African male security guard presented to our rehabilitation clinic because of persistent shoulder pain and restricted motion despite treatment: physiotherapy and shoulder injections. Symptoms onset: 13 months ago after a fall. No medical history. During examination, a 12cm cord is seen in arm abduction from the right axilla to the medial arm. Cord is painful and with hard consistency on palpation. Range of motion is limited 15º in flexion and abduction. Absence of lymphedema. Shoulder Doppler ultrasound is normal. MRI is compatible with an old pectoral major partial muscle tear. After employing all conservative treatment methods available the patient finally undergoes surgery. Results: The patient has full range of motion right after surgery (minimal cord incisions) and two months follow up the patient is pain-free. Conclusions: Axillary Web Syndrome is a significant cause of morbidity and its important to raise awareness about its management and its possible ways of presentation. Although AWS is a self-limited condition, some cases require surgery because of persisting intolerable symptoms.

Topic: 4. Therapeutics

Sub Topic: 4.3 Integrative Medicine

Safety and efficacy of MLC601/MLC901 (Neuroaid) amongst people who sustain severe spinal cord injury (Saturn study)

H. Ohnmar¹, R. Kumar¹, A. Baharudin¹, H. Ariffin¹, M. Gsangaya¹, H. Harun¹, K. Kandar¹, M. Balan²

¹University Kebangsaan Malaysia, Kuala Lumpur, Malaysia, ²Hospital Serdang, Kajang, Selangor, Malaysia

Background and Aims: Spinal cord injury has been considered an incurable condition and it often causes devastating sequelae. Hence the growing emphasis on the need for multimodal therapeutic approaches. MLC601/MLC901 (NeuroAiD) are natural formulations demonstrated to enhance neurological recovery after injury and extensively studied in stroke and traumatic brain injury. This pilot study aims to evaluate the safety and efficacy of MLC601/MLC 901 among subjects with moderately-severe to severe SCI. Methods: This prospective, phase I trial (ClinicalTrials.gov Identifier: NCT02537899) includes subjects with moderately-severe to severe SCI: American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades A and B. Subjects received open-label MLC601/MLC901 for 6 months in addition to standard care and followed up for 24 months. Rates of adverse events, progression of neurological status (AIS) and functional outcome (SCIM), Short Form (SF-8) Health Survey were evaluated at month 1, 3, 6, 12, 18 and 24. Results: This analysis included 30 patients with the mean age of 42.2 years old, the median time from injury at 15.5 days, and median time to first dose at 16.5 days. The most common reasons for injury were Motor Vehicle Accident (MVA) (43.3%). SATURN met its primary endpoint of showing improvement in total motor score at 6 months compared to baseline (19.4 SD± 24.5, 95% CI, 9.1 to 29.7; P < 0.001). There were 4 patients (13.3%) who reported at least one adverse event. Conclusions: MLC601/MLC901 shows remarkable promise as a safe adjunctive intervention for aiding recovery in our cohort of subjects with moderately-severe to severe SCI.

Topic: 1. Biomedical sciences

Sub Topic: 1.4 Neuroscience

Extending the proportional recovery rule (PRR) in aphasia to the subacute phase

Authors

S. Ofir Geva¹, T. Levi^1,2, O. Granot^1,2, C. Serfaty^1,2, C. Edelstein^1,2

¹Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, ²Loewensein Rehabilitation Medical Center, Raanana, Israel

Background and Aims: The prediction of recovery from post-stroke aphasia at the individual patient level is crucial for effective rehabilitation. The extent of recovery from aphasia was shown to correlate with the acute impairment. However, the correlation with impairment assessed during the subacute (first 6 months post-stroke) was not studied. Methods: Medical records of patients with first-ever left-hemispheric stroke causing aphasia and two or more picture-naming (SHEMESH, Biran & Friedman, 2005) test scores were analyzed. The relationship between score differences and initial scores was calculated using linear regression analysis. Results: Twenty-seven patients were suitable for analysis Regression analysis revealed a high correlation between final and initial naming scores for 21 patients (R2 = 0.81, p < 0.001), which improved by 60%±20% of their potential (maximal score – initial score). A group of 6 patients, characterized by lower initial scores (38±25% vs. 63±18%, p = 0.057), demonstrated a poor correlation (R2 = 0.16) and virtually no improvement (2±8% of potential). The time interval between the initial and follow-up test was similar between fitters and non-fitters. Conclusions: The PRR valid even when applied at heterogenous times during the subacute post-stroke phase. In concordance with motor recovery studies were able to demonstrate a group of non-fitters to the PRR. Neuroanatomical features might be useful in differentiating between the groups.

Topic: 6. Health Policy and Systems

Sub Topic: 6.5 Rehabilitation Across the Continuum of Care

Rehabilitation nutrition in poststroke patient with myasthenia gravis and post permanent pacemaker insertion

A. Noer Dewi¹, V. Biben², T. Prabowo², V. Margaretha Miguna¹

¹Department of Physical Medicine and Rehabilitation, Padjadjaran University, Bandung, Indonesia, ²Department of Physical Medicine and Rehabilitation, Hasan Sadikin General Hospital, Bandung, Indonesia

Background and Aims: Nutrition is a vital source of energy. Doing rehabilitation nutrition can maximize the functions, activities, and participation of persons with disabilities. This case presented the management of a malnutrition patient with multiple comorbidities that halt rehabilitation programs. Methods: A 21 years old female, already diagnosed with Myasthenia Gravis suffered a Stroke and Total AV block causing weakness on her left extremities and need of permanent pacemaker insertion. She was also diagnosed with feeding problem, inability to mobilize and do activity daily living independently. As she had oropharyngeal dysphagia and low endurance for chewing and swallowing, nutrition had slowly become inadequate. Patient was given lingual range of motion, shaker exercise and diet modification (feeding per oral with pureed and soft food consistency, interspersed with solid food, and drink liquids slowly, under supervision). While improving nutritional intake, patient also underwent therapeutic standing, flexibility, balance, functional task training and mirror therapy exercises twice a week. Results: There was improvement in Gugging Swallowing Screen (from slight dysphagia with low risk aspiration to minimal risk aspiration), Body weight (from 22,6 to 25 kilogram), and Stroke Specific Quality of Life Scale (from 138 to 160) after two months rehabilitation program. Conclusions: Functional recovery is a complex process. In a stroke, recovery process is based not only on the brain reorganization or neuroplasticity but also on nutritional status improvement. Rehabilitation is a holistic approach; evaluation and improvement of nutritional status needs to be addressed as a priority.

Topic: 5. Engineering and Technology

Sub Topic: 5.6 Telerehabilitation

Telerehabilitation of frail elderly with recurrent stroke, fragility fracture and geriatric syndrome during COVID-19 pandemic

A. Noer Dewi¹, I. Ruslina Defi², F. Arisanti², V. Margaretha Miguna¹

¹Department of Physical Medicine and Rehabilitation, Padjadjaran University, Bandung, Indonesia, ²Department of Physical Medicine and Rehabilitation, Hasan Sadikin General Hospital, Bandung, Indonesia

Background and Aims: During COVID-19 pandemic, telemedicine has been used widely. Telerehabilitation, a type of telemedicine, is the application of telecommunication technology for supporting rehabilitation services. It is a realistic solution to reduce hospital visit and risk of infection from COVID-19. This case presented the application of telerehabilitation in geriatric patient. Methods: A 74 years old male was diagnosed with closed fracture right intertrochanter femur post proximal femoral nail antirotation, right shoulder subluxation and recurrent stroke infarct. Patient has been discharged from hospital for 2 weeks. Chief complaint was weakness at right arm and leg. He was unable to mobilize and do daily living activities independently. Based on comprehensive geriatric assessment, patient has frailty, sarcopenia, and geriatric syndrome (inanition, instability, immobility, insomnia, intellectual impairment, depression). Patient was given teleconsultation (physiatrist, physiotherapist, occupational therapist, psychologist, and social worker), tele-education (rehabilitation program using videos and photo), tele-exercise (flexibility, resistance, balance, cognitive, and aerobic exercise twice a week) and telemonitoring (monitor exercise outcomes and compliance). Results: A month following telerehabilitation program, patient showed improvement on Barthel index (from 7 to 12), Functional Independence Measurement (from 63 to 70), Mini Mental State Examination (from 22 to 24), Mini Nutritional Assessment (from malnourished to normal nutritional status) and Psychological status (from moderate to mild depression). Conclusions: Telerehabilitation is feasible, safe and effective for use in home-based program for frail geriatric patient. Protecting elderly patient from COVID-19 is important, thus we strongly recommend telerehabilitation of geriatric patient in new normal era.

Topic: 2. Social sciences

Sub Topic: 2.4 Psychology

Psychosocial barrier in rehabilitation of frail elderly with neglect osteomyelitis due to pandemic COVID-19

E. Nirmala

Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia

Background and Aims: Psychosocial barrier often becomes obstacle for geriatric rehabilitation. This case report presented delayed wound healing and became neglected osteomyelitis due to pandemic COVID-19. Methods: A 72-years-old female with chief complaint stiffness on right knee and ankle since post ORIF plate and screw at right tibia and right fibula in February 2020. She diagnosed osteomyelitis, but she did not go to the hospital for proper treatment because fear of COVID-19. She was unable to walk due to ankle pain with bone and implant exposed at right distal cruris. Her ADL was partially dependent. She had psychosocial barrier include fear of COVID-19, did not have caregiver to take her to the hospital, lives only with her disability son, she was his son caregiver, and neighbour limitation as her caregiver, made her never come for rehabilitation treatment. She was given counselling and education from rehabilitation team about the importance of rehabilitation program. The rehabilitation program includes the use of assistive device, gait training, modalities, stretching, and strengthening exercise. Results: Three months after comprehensive rehabilitation programs, she was able to walk independently with walker, do all her ADL independently, and back to community. She showed improvement on Barthel index, Berg Balance Scale, Falls Efficacy Scale, Clinical Frailty Scale, and The Zarit Burden Interview. Conclusions: Psychosocial barrier is an obstacle for rehabilitation program compliance. We strongly recommended to overcome at the patient’s psychosocial constraints in adherence to rehabilitation program. Rehabilitation treatment was challenging in geriatric patient at pandemic COVID-19 situation.

Topic: 3. Clinical Sciences

Sub Topic: 3.9 Cardiac/Pulmonary Rehabilitation

Introduction of rehabilitation diagnostics for the use by doctors of physical and rehabilitation medicine nesterak RV, vakaliuk IP, sovtus VI, savchuk NV, grygoryshyn RS to determine the possibilities

R. Nesterak, I. Vakaliuk, V. Sovtus, N. Savchuk, R. Grygoryshyn¹

IvanoFrankivsk National Medical University, IvanoFrankivsk, Ukraine

Background and Aims: To determine the possibilities of rehabilitation and taking into account the individual characteristics of the patient’s condition, it is necessary to use the rehabilitation potential.

To develop a model of rehabilitation diagnostics taking into account the medical, functional and psychological components of the rehabilitation of patients with coronary heart disease. Methods: There was performed a study of 450 patients with coronary heart disease during rehabilitation period. Patients’ complaints, anamnesis of the disease were analyzed; a 6-minute walk test, treadmill test, bicycle ergometry were performed; such questionnaires were used: Hospital Anxiety and Depression Scale; Spielberg-Hanin Scale; Seattle Angina Questionnaire; The 36-Item Short Form Health Survey. Results: During the transition to the stages of rehabilitation, it is recommended to conduct rehabilitation diagnostics taking into account the components of the rehabilitation potential [Table 1]. We have developed a model of rehabilitation diagnostics of cardiac patients. This model includes:

Results of clinical-functional diagnosis of coronary heart disease: age, presence of risk factors, FC SEA, the nature of coronary artery disease, the result of the disease course
Functional capabilities of the patient according to the tests with physical activity (6-minute walking test, bicycle ergometry, treadmill test), the physical component of life quality
Psychological state of the patient: the level of depression, personal and situational anxiety, the mental component of life quality.

Conclusions: The developed model of rehabilitation diagnostics of patients with ischemic heart disease will allow to realize medical, physical, psychological components of rehabilitation.

Topic: 8. Specialty Development

Sub Topic: 8.1 Education (Medical Student, Residency and Post-graduate)

First steps in developing a comprehensive spasticity management program: identifying current practices for spasticity management in african countries

M. E. Nelson¹, S. Kambou², B. Quao³, S. Dhugasa⁴, J. McGuire¹, N. Ketchum¹, E. McGonigle¹

¹Department of PM and R, Medical College of Wisconsin, Milwaukee, USA, ²St. Cecile Clinic, Physiotherapy Unit, Yaounde, Cameroon, ³Ankaful Leprosy and General Hospital, Central Region, Ghana, ⁴St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Background and Aims: Identify current practice patterns for spasticity management in Ghana, Ethiopia and Cameroon (GEC) to assist in developing a robust training program and standards of care for spasticity management in Sub-Saharan Africa. Methods: United States experts in spasticity management collaborated with past and current International Rehabilitation Forum PM&R fellows in GEC to identify spasticity management standards in their respective countries. Published standards were reviewed to identify gaps and opportunities to enhance training and standards formation. Results: PM&R is not currently an established discipline in GEC. No published standards for spasticity management exist. Current practices in GEC include referral to therapy for stretching, oral baclofen, tizanidine, and diazepam. Comparatively, in the US standardized spasticity treatments include interventional therapies, oral antispasmodic medications, focal injections including chemical neurolysis, intrathecal baclofen pumps and surgical treatments.^[1] Conclusions: Vastly different resources are available to African and US PM&R providers to gain education/experience in the treatment of spasticity. African spasticity management does not include chemical neurolysis, or systematic identification of spasticity. A lack of access to training on, availability and cost of treatments, and lack of guidelines were cited as barriers to spasticity identification/management. The lack of PM&R specialists in GEC creates a gap between simple physiotherapy and specialized interventions. Specialized PM&R physicians can fill that gap and integrate inexpensive/effective treatments such as chemical neurolysis. Future training directions include development of robust spasticity identification/treatment educational programs; formation of treatment protocols; guideline development with key stakeholders to help form policy/future practices in PM&R based spasticity management programs in GEC.

Topic: 8. Specialty Development

Sub Topic: 8.1 Education (Medical Student, Residency and Post-graduate)

Strengthening global rehabilitation medicine: Enhancing pedagogy of an innovative PM and R fellowship for Ghanaian and Ethiopian physicians

M. E. Nelson¹, H. K. Steere², M. M. S. W. Chun³

¹Medical College of Wisconsin, Milwaukee, Wisconsin, USA, ²Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA, ³International Rehabilitation Forum, Middlebury, Vermont, USA

Background and Aims: In Africa, expertise in PM&R is insufficient to meet the population’s needs.^[1] In 2018, the International Rehab Forum (IRF) collaborated with Ghanaian and Ethiopian governments to establish an African PM&R fellowship training program, successfully graduating four fellows. With the entry of the second cohort, efforts to improve the pedagogy of the training program were undertaken. Methods: IRF members and graduated fellows collaborated to develop/implement a revised curriculum format. A standardized schedule of topics was created based on the ISPRM core curriculum and competency.^[2] An online learning portal of recorded lectures and resources was established. Content experts pre-recorded lectures for the portal prior to live session. Live sessions focused on interactive discussion and clarifying concepts. Pre and post-tests were developed to gauge learning and adapt training. Results: Content experts successfully pre-recorded and uploaded lectures. Increased interactive discussion between fellows and teachers resulted during live sessions. Partnerships with established PM&R programs are ongoing for training of hands-on skills. Conclusions: The IRF successfully shifted curriculum format from livestream lectures to a combined on-demand online platform and interactive live discussion with international experts. The new format diversifies teaching methods to accommodate various learning styles/schedules and creates a more dynamic and focused learning environment. Standardization of the program improved sustainability and alignment with program goals. Providing specialized training in PM&R improves expertise and access to care for persons with disabilities. Future directions include strengthening partnerships for in person hands-on training and increasing involvement of African trained experts to enhance and grow PM&R in Africa.

Topic: 6. Health Policy and Systems

Sub Topic: 6.5 Rehabilitation Across the Continuum of Care

A rehabilitation definition useful for research purposes: results of the Cochrane rehabilitation project

C. Kiekens¹, T. Meyer², C. Arienti³, A. Pollock⁴, M. Selb ^5,6, G. Stucki^{5, 6, 7}, S. Negrini^8,9

¹Spinal Unit, Montecatone Rehabilitation Institute, Imola, Italy, ²School of Public Health, University of Bielefeld, Bielefeld, Germany, ³IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy, ⁴Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom, ⁵Swiss Paraplegic Research, Nottwil, Switzerland, ⁶ICF Research Branch, Nottwil, Switzerland, ⁷Department of Health Sciences and Medicine, University of Luzern, Luzern, Switzerland, ⁸Department of Biomedical, Surgical and Dental Sciences, University La Statale, Milan, Italy, ⁹IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

Background and Aims: Often the term “rehabilitation” is imprecise, equivocal, or inappropriate in respect to the context in which it is used. Indeed, the current available definitions of rehabilitation appear to fall short on the purpose of exactly defining what we need for our scientific purposes. Specifically, it is not really possible to deduce inclusion and exclusion criteria for what is rehabilitation and what is not. For this reason, Cochrane Rehabilitation has launched the Rehabilitation Definition project, an international project aimed to develop a new definition of rehabilitation that might be useful for scientific research purposes. Methods: A first consensus meeting was held in February 2020 in Milan, where the first version of a rehabilitation definition for scientific purposes was developed following the PICO structure. A special issue of all preparatory material has been published in the European Journal of PRM. During an online meeting in June 2020, the promoters developed a second version of rehabilitation definition, and a first survey was sent out to the Milan Meeting participants to collect a consensus on the proposal. Results: In December 2020, the promoters analysed and discussed the first survey results to develop a third version of the definition. This version will be submitted to all stakeholders represented in the Cochrane Rehabilitation Advisory Board. Conclusions: Conclusions: When the final consensus is reached, the rehabilitation definition for scientific purposes will be published and disseminated to all rehabilitation stakeholders.

Topic: 6. Health Policy and Systems

Sub Topic: 6.5 Rehabilitation Across the Continuum of Care

The randomized controlled trial rehabilitation checklists (Rctrack) project

S. Negrini¹, C. Arienti², S. Armijo-Olivo³, P. Cote’^{4, 5, 6}, A. Heinemann^7,8, D. Kumbhare⁹, W. Levack¹⁰, T. Meyer¹¹, C. Kiekens¹²

¹Department of Biomedical, Surgical and Dental Sciences, University La Statale, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy, ²IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy, ³University of Applied Sciences, Faculty of Business and Social Sciences, Osnabrück, Germany, ⁴Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), Ontario, Canada, ⁵UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College, Ontario, Canada, ⁶Faculty of Health Sciences, University of Ontario Institute of Technology, Ontario, Canada, ⁷Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA, ⁸ShirleyRyan AbilityLab, Chicago, Illinois, USA, ⁹Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada, ¹⁰Department of Medicine, Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand, ¹¹School of Public Health, University of Bielefeld, Bielefeld, Germany, ¹²Spinal Unit, Montecatone Rehabilitation Institute, Imola, Italy

Background and Aims: Several research activities have highlighted the need to improve the quality of conduct and reporting in rehabilitation research. Issues such as low replicability of randomized controlled trials and desired items relevant in reporting have been underlined in many studies. To answer these needs, Cochrane Rehabilitation launched the Randomized Controlled Trial Rehabilitation Checklists (RCTRACK) project in 2019 to produce a specific reporting guideline in rehabilitation. Methods: We followed a specific methodology, adapted from the CONSORT Group and the EQUATOR Network suggestions, and considered the specific needs of rehabilitation. The project was divided in five phases. Results: The kick-off was concluded during the Second Cochrane Rehabilitation Methodology Meeting in Kobe on June 8th, 2019. In the second phase, each of the 8 RCTRACK Working Groups prepared systematic reviews and methodological studies on the eight topics related to the RCTACK Reporting Guideline items: patient selection; blinding; treatment group; control groups and co-interventions; attrition, follow-up, and protocol deviation; outcomes; statistical analysis and appropriate randomization; and research questions. In the third phase, a list of items to populate the RCTRACK Guideline was developed during a Consensus Conference held during the Fourth Cochrane Rehabilitation Methodology Meeting in Orlando on March 3rd and 4th, 2020. A first Delphi Round took place in December 2020 for the fourth phase. Its results were discussed during two online consensuses of the core developers in January and March 2021. Conclusions: The fifth and last phase will be performed before the end of the year to reach the final publication.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

A matched case-control study of modular mi/brace vs the classical custom-made sforzesco brace in 120 consecutive high-degree female AIS

S. Negrini^1,2, F. Tessadri³, F. Negrini^2,4, M. Tavernaro⁴, F. Zaina⁴, A. Zonta⁴, S. Donzelli⁴

¹Department of Biomedical, Surgical and Dental Sciences, University La Statale, Milano, Italy, ² IRCCS Istituto Ortopedico Galeazzi, Milano, Italy, ³Orthotecnica, Trento, Italy, ⁴ISICO (Italian Scientific Spine Institute), Milano, Italy

Background and Aims: In very-rigid brace (VRB), we introduced the “Free Pelvis” (FP) (semi-rigid material) to improve comfort, sagittal balance, and brace adaptability. We also introduced the “Adjustable Posterior Closure” to improve correction and adaptability. These two innovations converged in a new modular VRB, the MI/brace (Modular Italian brace) (MIB). Objective: compare the new MIB to the classical custom-made Sforzesco VRB for adolescents with idiopathic scoliosis (AIS). Methods: Matched Case-Control Study. We extracted from our prospective database all MIB and VRB at first consultation in our Institute: AIS, age 10-16, VRB 23 hours/day, x-rays available, 36-65°, 7-23° Bunnell. We matched for Risser, menarche, weight, height, BMI, aesthetics (TRACE), plumbline distances, referred brace use. We randomly chose a subset of VRB to keep a 1:10 ratio between the groups. We checked in-brace results (one month), and short-term out-of-brace (first control). We used descriptive statistics and unpaired/paired t-test according to variables and distribution. Results: We included 11 MIB (13±1 y, 50±11°) and 110 VRB (age 13±1, 47±7°) with no baseline differences. All parameters improved in both groups (p<0.001). MIB group improved more in-brace (-20±7° vs -16±6°), but we found no short-term differences for scoliosis (-9±7° vs -8±5°), ATR (-4±3° vs -4±3°) and aesthetics (-4±3 vs -4±2), and some in the sagittal plane. Conclusions: While better in-brace, MIB results in the frontal plane are not different from VRB in the short term. Results could change in the future with a bigger MIB group or in the medium-, long-term.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

A matched case-control study of the free pelvis vs the classical very-rigid sforzesco brace in 436 high degree AIS not previously braced

S. Negrini^1,2, F. Tessadri³, F. Negrini^2,4, M. Tavernaro⁴, F. Zaina⁴, A. Zonta⁴, S. Donzelli⁴

¹Department of Biomedical, Surgical and Dental Sciences, University La Statale, Milano, Italy, ²IRCCS Istituto Ortopedico Galeazzi, Milano, Italy, ³Orthotecnica, Trento, Italy, ⁴ISICO (Italian Scientific Spine Institute), Milano, Italy

Background and Aims: Very-rigid braces, like the Sforzesco brace (VRB), have shown promising results also in high-degree surgical curves of Adolescents with Idiopathic Scoliosis (AIS). We recently introduced the “Free Pelvis” (FP) innovation, semi-rigid material to improve comfort, sagittal balance, and brace adaptability. Nevertheless, these changes could also harm the corrective forces on the trunk. Objective: verify if the FP innovation impacts the efficacy of the Sforzesco VRB for high-degree AIS. Methods: Case-Control Study. We extracted from our prospective database all FPB and VRB at first consultation in our Institute. Inclusion criteria: AIS, age 10-16, VRB 23 hours/day, x-rays available, 36-65° Cobb, 7-23° Bunnell. We matched for Risser, menarche, weight, height, BMI, aesthetics (TRACE), plumbline distances, brace use. Post-hoc we excluded previously braced patients. We checked in-brace (one month), and short-term out-of-brace results. We used descriptive statistics and unpaired/paired t-test according to variables and distribution. Results: We included 416 VRB (12% males, age 13±1, 46±7°) and 20 FP (10%, 13±1, 49±10°). At baseline brace use (+12’/day FP) and compliance (+1% FP) were different. All parameters improved statistically (p<0.001) and clinically, without differences among groups in-brace (FP -17±8° vs VRB -15±6° Cobb) and at short-term (5±2 months) for scoliosis (-8±6° vs -8±5° Cobb), ATR (-3±2° vs -4±4° Bunnell), aesthetics (-3±2 vs -3±2 points), S1 (-6±11 vs -4±15 mm) and C7+L3 (-8±17 vs -4±19). Conclusions: FPB results were not different from those of the classical VRB in-brace and in the short-term. The FP innovation does not impair the mechanical correction of VRB.

Topic: 7. Functioning and Disability

Sub Topic: Biopsychosocial factors associated with chronic low back pain patients in Burundi

I. Nduwimana¹, F. N^1,2, A. S², J. T¹, Y. B¹, O. K^3,4

¹Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium, ²National Center of Reference in Physiotherapy and Medical Rehabilitation, University Hospital Roi-Khaled, Bujumbura, Burundi, ³Unit of Rehabilitation, University Hospital of Parakou, Parakou, Benin, ⁴Department of Rehabilitation, Faculty of Public Health and Epidemiology, University of Parakou, Parakou, Benin

Background and Aims: Chronic low back pain (CLBP) is an increasing burden worldwide which is associated with several factors. However, biopsychosocial factors associated to chronic low back pain has not yet been investigated in Burundi. We aimed to investigate the biopsychosocial factors linked to CLBP in Burundian population. Methods: We carried out a cross-sectional study of adults with CLBP. Trained physical therapists and medical student collected Biopsychosocial factors including sociodemographic characteristics, depression, fear avoidance beliefs, and physical fitness and CLBP outcomes including pain intensity, activity limitations and restrictions of participation. We used SPSS.27 software for data analyses. Results: 58 individuals were recruited. Biopsychosocial factors associated to CLBP were BMI, study level, gender, sex, depression, trunk muscle endurance and perceived exertion. The pain were significantly associated to study level of education (p<0.001), depression (Rho=0.40; p<0.01), perceived exertion (Rho=0.30; p<0.05), spine extensors endurance (Rho=-0.29; p<0.05) and abdominals endurance (Rho=-0.36; p<0.01). The activity limitations were associated to education level (p<0.001), gender (RMDQ; p<0.01, COPM; p=0.001), healthcare coverage (p<0.05), BMI (Rho=0.27; p<0.05), depression (Rho=0.48; p<0.01), perceived exertion (Rho=0.47; p<0.01), abdominals endurance (Rho=-0.52; p<0.001) and spine extensors endurance (Rho=-0.57; p<0.001). The restrictions of participation were significantly higher with female (p<0.01), no healthcare coverage (p<0.05), high BMI (Rho=0.27; p<0.05), high depression (Rho= 0.45; p<0.01), high perceived exertion (Rho=0.44; p<0.01); l(Rho=-0.33; p<0.05) and spine extensors endurance (Rho=-0.47; p<0.01). Conclusions: This study highlighted biopsychosocial factors associated to CLBP in Burundi. We suggested that such factors may need to be taken into account in CLBP management by applying a biopsychosocial-based therapy.

Topic: 8. Specialty Development

Sub Topic: 8.1 Education (Medical Student, Residency and Post-graduate)

Digital pain: Clinical rehabilitation applications

A. Nasir¹, S. Mahmood²

¹Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, United States, ²Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States

Background and Aims: The objective of this manuscript is to initiate a discussion about digital pain intervention educational needs of residents in Physical Medicine and Rehabilitation (PM&R). We hope that this serves as a launching pad to determine learning opportunities in and how to modify current residency training, and prioritize the best care for patients. Methods: A Likert scale-format multi-institutional survey was prepared in an electronic format and shared with all 1389 trainees in 96 PM&R residency programs in the United States. Results: 102 responses were received. 60% agreed and a further 31% strongly agreed that they were eager to learn more about digital pain interventions. Most participants disagreed (56% disagreed, 17% strongly disagreed) about being comfortable using digital pain interventions. Most participants (78%) were unsure if there was sufficient evidence to support digital pain interventions. Further, 45% were unsure if there was faculty interest/support for learning digital pain interventions. Regarding if their program’s faculty had sufficient expertise in digital pain interventions, 35% disagreed and 15% strongly disagreed. Most participants (46% agreed and 8% strongly agreed) identified initial cost or inadequate resources as a potential barrier to the implementation. Conclusions: The apparent gap between the willingness of trainees to learn about digital pain interventions and the education they receive poses a significant challenge to the successful implementation of digital pain interventions. Acknowledging the central role of our future physiatrists, our findings support a call for stakeholders to collaborate on creating preparatory experiences adapting to the latest scientific and technological developments in digital pain interventions.

Topic: 6. Health Policy and Systems

Sub Topic: 6.1 Community Based Rehabilitation

Procedures in physical medicine and rehabilitation: Improving the patient experience

A. Nasir, S. Guha

Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, United States

Background and Aims: Nerve Conduction Studies (NCS) and Electromyography (EMG) are studies that may aid in the diagnosis of certain neuromuscular conditions. Testing usually takes between 30 to 90 minutes depending on the condition being tested. In a resident-led quality improvement (QI) project, our aim was to provide patients scheduled for NCS and EMG studies with instructions for their respective procedure, and understand if providing pre-procedure instructions decreases pre-procedure set up time and improve patient satisfaction during visit. Methods: From January 1st to January 31st 2021, we contacted patients scheduled for NCS/EMG and shared pre-procedure instructions. Results: 52 patients scheduled for NCS/EMG appointments were contacted via telephone, and 46 patients chose to participate. Patients perceived available information on NCS/EMG to be limited and of poor quality. More than half of patients (52%) did not know what an NCS/EMG was and how it was performed (83%). Participants who were aware of the procedure were mostly individuals who have had a prior NCS/EMG or had a family member who had the procedure. Although the pre-procedure time varied between patients due to patient characteristics, patient education level, complexity of disease, use of language interpreters, we found that generally pre-procedure flow was greatly improved. Conclusions: Providing pre-procedure instructions regarding EMGs is a quick and cost-effective way to reduce pre-procedure set up time, improve patient adherence to EMG appointments, and improve patient satisfaction. As a follow up to this project, formal standardized instructions and informational brochures were designed and provided to patients scheduled for these studies.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Weber syndrome ^{More Details}"> Posterior cord syndrome in the context of spinal arteriovenous malformation in a 17 year old patient with klippel-trenaunay-weber syndrome

L. Nascimento Medeiros¹, E. Alves², S. Antunes³, V. Reis¹, I. Batalha¹

¹Centro de Medicina de Reabilitação de Alcoitão- Pediatrics and Development Rehabilitation Service, Alcabideche, Portugal, ²Hospital de Santa Maria CHULN- PRM Service, Lisbon, Portugal, ³Hospital Garcia de Orta-PRM Service, Almada, Portugal

Background and Aims: Klippel-Trenaunay-Weber Syndrome (KTWS) is a rare neurovascular condition that causes overgrowth in affected limbs. An association between KTS and spinal arteriovenous malformations (AVM), has neither been reliably proved in the published literature nor encountered in a large cohort, but this subject remains controversial amongst specialists. Methods: We present a 17 year-old male patient with KTWS syndrome (overgrowth of right lower limb) with sudden paraparesis and urinary dysfunction. MRI revealed a spinal AVM from T10 to L4 with vascular ectasia without contrast enhance. After endovascular embolization, image control showed vascular voids in the posterior region and conus medullaris edema. The patient was integrated in an intensive rehabilitation program in our center one month after the onset of symptoms with neuromotor status of paraplegia AIS C NL T12 unable to assume orthostatic position and with urinary retention requiring intermittent catheterization. Results: A recovery of muscular strength and neuromotor status (AIS D NL T12) was achieved, despite persistent deficits in deep sensibility that affected gait capacity. Strategies directed to sensorial reeducation were adopted with gradual improvement and the patient was able to walk with bilateral sticks. Vesical training leaded to bladder function improvement, enabling voluntary urination without residual retention. Conclusions: Posterior cord syndrome is a rare type of incomplete spinal cord injury and there is no present data in the literature showing the prevalence of this condition amongst spinal AVM and KTWS patients. Decreased deep sensory perception can have impact in recovery and gait autonomy in spinal cord injury patients.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

Effect of extracorporeal shock wave and Botulinum toxin on sciatic nerve injury rats: Pilot study

K. Nam

Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea

Background and Aims: The aim of this study is to investigate whether extracorporeal shock wave therapy(ESWT) or botulinum neurotoxin A(BoNT/A) improves the regeneration of injured sciatic nerves in an experimental rat model. Methods: After sciatic nerve crush, intranerve delivery of BoNT/A or ESWT were applied, axonal regeneration was measured by gait analysis, electrophysiologic studies at different days. Two experimental groups were set up: the group 1 animals received intranerve delivery of BoNT/A(15pg) whereas group 2 animals received ESWT (400 impulses, 4 Hz) immediately after nerve injury. A group 3(control group) received only nerve injury. The survival time was 3weeks. Regeneration of myelinated fibers was assessed by immunofluorescence and western blot. The antibodies used were GFAP, GAP43, NF200, ATF3, S100. Results: We observed a higher expression of all antibodies in the distal portion of BoNT/A-injected or ESWT received nerves 3 weeks after nerve injury compared to the control group. When the mean of the first and third week amplitudes of the 5 rats in each group were compared, the amplitude increased by 2.64 times in the ESWT group. The amplitude was improved by 1.54 times in the BoNT/A injection group, and 1.18 times in the control group. When comparing the first and third week of the Sciatic nerve Functional Index results, ESWT group showed the greatest improvement +49.93 from -57.86 to -8.926 and BoNT/A injection group showed a +31.00 improvement. Conclusions: Both the BoNT/A injection group and the ESWT group had an effect on nerve regeneration, but the ESWT group was more effective than the BoNT/A group.

Topic: 5. Engineering and Technology

Sub Topic: 5.1 Assistive Products

Survey of rehabilitation physicians’ attitudes toward education on assistive device development in the education of rehabilitation professionals

M. Nakao¹, H. Onishi², I. Asakawa³, M. Tagami⁴, S. Izumi¹

¹Tohoku University Graduate School of Medicine, Sendai, Japan, ²NIigata Medical Welfare University, NIigata, Japan, ³Ibaraki Medical Welfare University, Ibaraki, Japan, ⁴Ministry of Economy and Industry, Tokyo, Japan

Background and Aims: Design thinking is attracting increased attention in various types of development and regions such as Silicon Valley. Despite the diverse range of professionals that need to be involved in developing assistive devices, the lack of human resources capable of practicing needs identification and a lack of medical–industrial collaboration have hindered development progress. This study aimed to survey rehabilitation physicians’ attitudes on competencies they consider necessary for physicians and therapists in developing such devices. Methods: Questionnaires were sent to 644 facilities designated for certified rehabilitation physicians’ training registered with the Japanese Association of Rehabilitation Medicine. The questionnaires were collected by mail after a designated response period. The results were set out in descriptive statistics and analyzed in detail. Results: Completed questionnaires were collected from 366 certified rehabilitation physicians (collection rate: 15%). Of the respondents, 26% had been involved in developing assistive devices, and of these, 86.4% had experienced challenges in the development process. Responses indicated that respectively for physicians and therapists, “communication skills” (76.1% and 74.2%) and the ability to “gain deep insight into patients’ needs” (78.6% and 87.1%) were required in device development. Conclusions: The survey results showed the importance of content emphasizing communication skills and the ability to gain deep insight into patients’ needs for a device when creating new educational programs on assistive device development for rehabilitation physicians and therapists.

Topic: 5. Engineering and Technology

Sub Topic: 5.5 Virtual Reality

Development and clinical application of a rehabilitation training system using immersive VR

Y. Nakahara, T. Tokunaga, Y. Honda, N. Ogata

Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Teikyo, Tokyo, Japan

Background and Aims: The purpose of this study is to develop a rehabilitation training system for upper limb function using immersive VR and to evaluate the system in healthy subjects. Methods: We set up a VR environment with Windows Mixed Reality Headset, and created a training software using development engine and programming. We implemented Virtual Reality Rehabilitation (VRR) training contents that enable users to manipulate objects by reflecting upper limb movements in the virtual space wearing Head-Mounted Display. The VRR upper limb functional training was conducted once for 8 healthy subjects (5 males, 3 females, ages 28-48), and the Physical Activity Enjoyment Scale (PACES) and Simulator Sickness Questionnaire (SSQ) were evaluated. Results: The total score of PACES was 73.1±5.2 points before training and 116.2±4.6 points after training, and there was a significant difference in the change of PACES (p<0.001). SSQ-TS, which indicates the overall trend of SSQ, was 2.2±5.0 points before VR training and 9.0±8.6 points after training, and there was no significant difference in the change of SSQ-TS (p=0.18). As for the subscales of SSQ (pre-training to post-training), the scores were as follows: Nausea (1.8±4.1 to 1.8±4.1), eye fatigue (Oculomotor) (3.1±6.6 to 16.2±10.4), and disorientation (0±0 to 7.2±4.2), with the most increase in the scores for the Oculomotor item. Conclusions: We developed a rehabilitation training system using immersive VR that enables upper limb function training in a virtual space. In the study of healthy subjects, training while feeling enjoyment was possible, and further studies will be conducted in the future.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Comparison of decannulation outcomes in acquired brain injury with and without prolonged disorders of consciousness in a level 1 specialist rehabilitation unit -A prospective study

S. Muradia, S. Vandabona, R. Prasad

University Hospital Leicester, Leicester, United Kingdom

Background and Aims: Patients with Acquired Brain Injuries (ABI) often have impaired consciousness and require Tracheostomy to maintain their airway. Patients with impaired consciousness for over 4 weeks are deemed to have Prolonged Disorders of Consciousness (PDOC). 1 In this study we evaluated if there was any difference in the success of decannulation in patients with (PDOC) when compared to Acquired Brain Injury patients without PDOC. Methods: A prospective analysis was done for all the tracheostomy patients admitted to our Level 1 Neuro Rehabilitation Unit and Brain Injury Unit (BIU) from May 2019 to May 2020. Data collection included clinical outcomes of weaning process of tracheostomy in Acquired Brain Injury patients. Results: We analyzed 32 tracheostomised ABI patients admitted to BIU over one year,25 patients were ABI patients without PDOC and 7 were PDOC patients. 88% (22 out of 25) of patients without PDOC were successfully decannulated. 3 were discharged with long term tracheostomy. 7 patients were in PDOC state, of which 86% (6 Out of 7) were decannulated successfully. 70% ABI patients without PDOC were successfully decannulated in first 4 weeks of admission to BIU in comparison to 66%(5 out of 9) PDOC patients. Conclusions: There is no significant difference in the success rate of decannulation in Acquired Brain Injury patients with or without PDOC. The time taken for the weaning of the tracheostomy following admission to BIU was found to be similar in these two groups.

Topic: 6. Health Policy and Systems

Sub Topic: 6.9 Big Data and Cohorts

The interesting complex experience of a Balneary and rehabilitation top Romanian sanatorium during the COVID19 pandemic

C. Munteanu¹, E. V. Ionescu^2,3, L. Stanciu^2,3, D. Oprea^2,3, S. Demirgian^2,3, M. Iliescu^2,3, M. Minea^2,3, R. E. Almasan², C. Popescu⁴, G. Dogaru^5,6, G. Onose^4,7

¹Department of Biomedical Sciences, University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania, ²Balneal and Rehabilitation Sanatorium Techirghiol, Constanta, Romania, ³Ovidius University of Constanta, Constanta, Romania, ⁴Teaching Emergency Hospital Bagdasar-Arseni, Bucharest, Romania, ⁵Clinical Rehabilitation Hospital Cluj-Napoca, Cluj-Napoca, Romania, ⁶University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania, ⁷Department of Physical and Rehabilitation Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

Background and Aims: The experience mentioned in the title entails distinct periods and situations: the first one regards the suspended specific activity of the Sanatorium, during the emergency national sanitary status, when the Sanatorium was designated as a host for quarantined persons, suspected as positive for SARS CoV2 infection, Romanian citizens arrived back in our country from abroad, for whom the Sanatorium personnel provided status monitoring, hosting and medical and psychological counseling. Methods: The Sanatorium needed and succeeded to develop the safest and most appropriate prophylactic epidemiological protection circuits for both, the hosted people and the staff; the second dimension/pattern refers to the activity after the end of the lockdown hosting state and restart (but on very strict and safe conditions), of the balneal and rehabilitation activity. Results: The areas of care for the hosted quarantined people were: physical, psychological and social, support, and health education. Commendably this elite medical unit has optimally, within the harsh related limitations and challenges (many of them out of its specific activity), responded to the pandemic challenges: 1590 quarantined persons (of whom 172 pre-existing medical conditions); the over 500 staff members of the Sanatorium, during the first above-mentioned situation/ paradigm, none of them developed COVID-19. For the second paradigm (July – December 2020), 3558 patients were admitted in the Sanatorium, only 3 were infected, and the number of infected people from the staff: 22 from about 500. Conclusions: Although unexpected and undesired, the tough challenge elicited a most professional response of this Sanatorium, including lessons to be learned and collateral knowledge.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Role of breathing exercises and incentive spirometry training in pulmonary rehabilitation post acute COVID-19 severe case: a case report

M. Mukhlis¹, S. B. Sastradimaja², F. Arisanti²

¹Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia, ²Hasan Sadikin General Hospital, Bandung, Indonesia

Background and Aims: A severe case of COVID-19 can damage the lung tissue and result in sequelae such as pulmonary fibrosis which leads to restrictive lung disease. Survivors also reported having impaired ADL performance, and anxiety disorder. This case presented the role of breathing. Methods: A 48 years old male diagnosed with severe case COVID-19. CT-Scan examination shown pulmonary fibrosis in almost all of his lung segments. The chief complaint was shortness of breath on relatively light activity. Physical examination showed reduced chest expansion, desaturation, and tachycardia. He has moderate ADL dependence and moderate anxiety with fear of suffocation when doing an activity. The patient was given breathing exercises with incentive spirometry besides flexibility and endurance exercise. Incentive spirometer training is given daily with frequency 4 times a day, 3 sets, 10 repetitions with rest interval 3 minutes each set. The rehabilitation program was done for 1 month. Results: There is an improvement in chest expansion (from 2cm to 3cm), maximal inspiration volume on incentive spirometer (from 300cc to 1500cc), anxiety (DASS anxiety score from 12 to 7), Modified Medical Research Council (MMRC) Dyspnea scale (from +4 to +2), Barthel index (from 14 to 20) after 1 month of the rehabilitation program. Conclusions: Breathing exercise and incentive spirometer training are feasible, safe, and effective programs for post-acute severe COVID-19 patients. The benefits shown are improved functional lung capacity followed by improvement of physical function, ADL performance, and anxiety reduction in COVID-19 survivors.

Topic: 5. Engineering and Technology

Sub Topic: 5.5 Virtual Reality

The magic glass system: An immersive virtual reality device for tele-rehabilitation in chronic post-stroke patients. final results.

S. Moriconi¹, M. Millevolte², M. Coccia², R. Carlino¹, S. DI Gregorio¹, S. Grafeo¹, C. Chiatti³, F. Covotta³, A. Borioni³, S. Bolognini³, M. Capecci¹, M. G. Ceravolo¹

¹Department of Clinical and Sperimental Medicine, Politecnica delle Marche University Ancona, Italy, ²AOU Ospedali Riuniti di Ancona, Neurorehabilitation Clinic, Ancona, Italy, ³Tech4Care SRL, Ancona, Italy

Background and Aims: The “Magic-Glass” device is an immersive virtual reality-based system, that offers upper limb training through serious games, also exploiting the mirror therapy paradigm. Primary study objective was to test feasibility and acceptability of integrating the Magic-Glass solution in the current home care for people with stroke over six-months, looking into factors of treatment adherence in terms of total training duration. Methods: The study enrolled stroke survivors free from dementia, motor impairment in the healthy side, neglect, apraxia or epilepsy. Feasibility was inferred by the mean daily use (minutes), while acceptability by the System Usability Scale-SUS. Patients’ ADL-IADL independence, quality-of-life, upper limb function and caregiver’s burden (Zarit scale) were also recorded. Results: Out of 93 people screened (58M; Age: 60,4±10.5 years; Stroke latency: 7,2±7,6 years; Left hemiparesis in 53 cases), 84 were deemed eligible and presented SUS score 81,5%±15; MoCA 22,4±1,8; BIM 73,36±24,22% at the baseline. Seventeen subjects (20%), dropped out by one month. The mean daily use decreased from 10 (first 3 months) to 6 minutes-per-day (last 3 months). Conversely, the patients progressively gained confidence with the device (SUS increased from 81% at baseline to 86% at 6 months). The only long-term predictor of utilization is the initial adherence: the total of minutes per day spent using the device in the first month were correlated to the total utilization. Conclusions: The “Magic Glass” system can be integrated into current chronic post-stroke home care, guaranteeing over 1 hour/week of additional training, even at distance from the event and in presence of severe disability.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Rehabilitation approach to a nail-patella syndrome submitted to surgery: Case report

T. Moreira, A. Vaz, R. P. Costa, J. Pires, J. Barroso

Centro Hospitalar e Universitário de São João, Serviço de Medicina Física e de Reabilitação, Porto, Portugal

Background and Aims: Nail-Patella Syndrome (NPS) is a rare autosomal disease, characterized by a myriad of findings namely fingernail abnormalities, patellae hypoplasia, amongst others. We present this case report highlighting successful patellar stabilization after surgical and subsequent rehabilitation treatment. Recurrent dislocation of the patella is common on those patients and can be a cause of pain and important functional limitations. The rehabilitation management of NPS is challenging and literature is scarce on this subject. Methods: This report was written in accordance to CARE guidelines. We also aimed to perform a scoping review regarding rehabilitation programs on NPS. Results: 17-year-old boy with NPS underwent reconstruction of lateral and medial tibiopatellar ligaments with a gracillis graft of the left knee on February/20 to improve patella stabilization due to recurrent dislocations. He presented in our department, 7 weeks after surgery, with moderate left knee pain, bilateral quadriceps amyotrophy, left knee range of motion (ROM) of -5 to 140º and marked unsteadiness under monopodal support. A tailored PRM program was performed with the main aims of pain control, knee stabilization including controlled strengthening of the quadriceps, static and balance training, and gait training. Six months later, despite maintaining significant quadriceps bilateral atrophy, no knee patellar pain was reported. Conclusions: Patellar stabilization is challenging in NPS. Pathophysiological mechanism for quadriceps atrophy persistence in this patient is unknown which may hinder stabilization based on conservative rehabilitation strategies. However, surgical stabilization followed by a tailored PMR program was successful in reducing patellofemoral symptoms and dislocation of the patella in this case.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

The return of the hated limb - A rare case of misoplegia

E. Moreira¹, M. Veloso², M. Branco³

¹Tondela-Viseu Hospital Center, Viseu, Portugal, ²Luanda Military Hospital, Luanda, Angola, ³Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal

Background and Aims: Misoplegia is a rare condition in hemiplegic patients with right hemispheric lesions. It can be defined as an excessive aversion towards the disabled limb with hatred of paralysis and verbal or physical mistreatment against the paralyzed limbs. Methods: Research in medical databases and clinical case description. Results: An 85-year-old man, with complete functional independence and multiple cardiovascular risk factors, was admitted to hospital because of loss of strength on the left side with gait imbalance, lasting more than 24 hours. On admission, he was conscious and fully oriented, presenting a multimodal hemineglect with anosognosia, left homonymous hemianopsia, left hemiparesis and hemi-hypoesthesia. Brain imaging showed right acute occipital infarction. During the hospital stay, he developed misoplegia: an aggressive attitude towards the paretic limb, verbalizing a desire to remove it from the body: “cut me this crap that isn’t doing anything here, it isn’t mine, it’s just getting in the way”. He started a rehabilitation program aiming to increase the awareness of his deficit. Initially the patient was not very cooperative, but over time his perception of his own limb improved, and he started to recognize the paralysis. At discharge, 30 days after admission, he was able to integrate his left upper limb into some functional actions, such as brushing his hair or washing his face. Conclusions: The lack of awareness of deficits makes the rehabilitation more difficult. In this case, anosognosia was complicated with misoplegia, an extra challenge, especially because little is known about the treatment/management of this neurological phenomena.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Treatment of complex regional pain syndrome in a pediatric patient using the 8% capsaicin patch: A case report

M. Montes Comino¹, L. Gracia Delgado², E. de la Torre López¹, P. Casado Adam¹, F. Piaggio Muente¹

¹Hospital Universitario Reina Sofia, Cordoba, Spain, ²Empresa Publica Hospital Alto Guadalquivir, Andujar, Spain

Background and Aims: Complex regional pain syndrome (CRPS) is a multisymptomatic condition, which usually affects one or more extremities. The early diagnosis is crucial to improve the prognosis and the effectiveness of the treatment, which is based on kinesitherapy and symptomatic relief.

Methods: An 11-year-old patient is brought in for consultation after being diagnosed with a left ankle sprain 3 months ago, with increased pain and functional impotence in the last month. The previous X-ray did not show significant findings. MRI is requested, which describes extensive bone oedema in the tibia and tarsus, suggesting a reflex sympathetic dystrophy along with mild inflammatory signs in the anterior and posterior peroneo-talar ligament. Results: Physiotherapy treatment with kinesitherapy is started for 6 weeks without clinical improvement. It was decided not to use magnetotherapy because the patient’s age is a relative contraindication. Compasive treatment with 8% capsaicin patch is decided. The patcht is applied in the area of the foot and ankle referred to by the child. The patient is reviewed at 2 weeks and clinical improvement is verified, with pain reduction (previous VAS 8, current VAS 2). Conclusions: Despite the lack of studies in the pediatric or adolescent population of the treatment with the 8% capsaicin patch, in this case it was applied as the last alternative in a patient with CRPS with failure of conservative treatment. Furthermore, it is a single case, so universal conclusions cannot be drawn. However, it is proposed that its use should be studied in these types of patients.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

From apparent scoliosis to the diagnosis of PISA syndrome

D. Moniz Costa, R. Brito, S. Afonso, A. Ribeiro, R. Araujo, P. Barros

Centro Hospitalar e Universitário do Porto, Porto, Portugal

Background and Aims: Pisa syndrome is defined as a reversible lateral bending of the trunk with a tendency to lean to one side. It is a frequent and often disabling complication of Parkinson’s disease, and has also been described in several atypical forms of Parkinsonism ^{More Details} and in neurodegenerative and psychiatric disorders after drug exposure and surgical procedures. The aim of this work is to report a clinical case of a 77 year old woman with Pisa Syndrome, misdiagnosed by Orthopedics for scoliosis and sent to our consultation for rehabilitation. Methods: Case report. Results: Woman, 77 year old with personal background of hypertension. Complaints of low back pain and progressive tiredness with 4 years of evolution. Also referred to paresthesias and difficulty in gripping objects. With some memory changes, changing names of people and objects. On objective examination had a lateroflected posture to the left, which improves with sedation and decubitus. With slight postural tremor, also present at rest and bradykinesia in repetition tests. She had a predominantly right appendicular stiffness, walking in small steps, with poor balance of the right upper limb and with a bent posture to the left. Due to the clinical suspicion of Parkinsonism, she was referred to the Neurology consultation where she was diagnosed with Pisa Syndrome. Conclusions: Pisa syndrome is a complication of PArkinson disease that can mimic postural scoliosis. In this case, we can verify the importance of Physiatry in the Diagnosis and Treatment of this pathology, due to its range of knowledge at the musculoskeletal and neurological level.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Injuries in crossfit, an overview

D. Moniz Costa¹, R. Brito¹, V. Marques¹, N. Caria¹, P. Cantista¹

Centro Hospitalar e Universitário do Porto, Porto, Portugal

Background and Aims: Crossfit is a high-intensity functional training sport, which is growing in popularity and practicing all over the world. However, since it is a sport created in 2000, the scientific data regarding risk of injuries in this sport is very sparse

The aim of this work is to analyze the findings of scientific literature related to injuries and risks of CrossFit, and comparing it to other high-intensity sports. Methods: Methods: A Pubmed, Scielo and PeDro database research performed with the key terms: “crossfit”, injuries”, “risks”, “training” “epidemiology”, published in the last 10 years written in English. The type of articles included systematic reviews, meta-analisis, reviews and clinical trials. Qualitative synthesis of the data was performed. Results: We selected 19 articles after duplicate removal, abstract screening and full-text eligibility assessment, from 45 articles idientified through database searching. The most common injuries caused by Crossfit reported in studies are in the knee, lower back and shoulder. The majority of injuries are caused by overuse. Sprains and tendinitis were the most common injury type. Very few significant differences in any of the injury outcomes were observed as a function of age, sex, competitive standard, or bodyweight class. Conclusions: CrossFit is comparable to other high-intensity exercise sports and programmes with similar injury rates and health outcomes. Since it is a recent sport, further investigation on risk of injury and more comparative studies to other sports are needed.

Topic: 4. Therapeutics

Sub Topic: 4.3 Integrative Medicine

The impact of lower limb amputations on the quality of life (QOL) and functional recovery of patients with type ii diabetes

B. Molloy¹, J. Macfarlane²

¹University College Cork, Cork, Ireland, ²Mercy University Hospital, Cork, Ireland

Background and Aims: Lower extremity amputation (LEA) is common consequence of Type II diabetes and includes Trans-Metatarsal Amputation (TMA), Trans-Tibial Amputation (TTA) and Trans-Femoral Amputation (TFA).^[1] Mortality post amputation high with studies documenting 60-80% rates five years post-surgery.^[2] Quality of Life (QoL) and functional recovery increasingly being identified as important parameters in this population’s rehabilitation and prevention of recurrent amputations. To assess the impact lower limb amputations have on the QoL and functional recovery in the type II diabetic population. Methods: Observational cross-sectional

Mercy University Hospital (MUH)

Type II diabetics who underwent LEA in MUH from 2017-19.

Primary outcomes:

Short-Form-12 -> QoL - Mental Component Score (MCS) Physical Component Score (PCS)

Modified-Rivermead Mobility Index

Post-Traumatic Growth-Inventory

Two secondary outcomes.

Results: 33 amputees recruited.

Mean age 72 (SD = 11).

Amputation type -> 22 TMAs, 5 TTAs and 6 TFAs.

Case fatality rate -> 27.3% (n = 9).

Significant differences observed in MCS QoL scores between TMA - TFA cohorts (p 0.023); Negative correlations noted between MCS and level of amputation (r= -.641). No difference in PCS across-groups. Significant differences in functional recovery between TMA -TTA (p = 0.013); TMA -TFA (p = 0.01). No difference between TTA -TFA, p 0.838. Resilience didn’t play role in amputee recovery, p = >0.05. Conclusions: Type II diabetics who underwent major LEA had greater negative impact on QoL and functional recovery than those who underwent minor LEA. Further well-powered studies required to confirm external validity of findings and establish role resilience plays in recovery.

References

Available from: https://pubmed.ncbi.nlm.nih.gov/26185603/.
Available from: https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.12532.

Topic: 5. Engineering and Technology

Sub Topic: 5. 3 Robotics

End-effector or exoskeleton in finger-hand stroke rehabilitation: Which is the best choice?

L. Moggio¹, N. Marotta¹, A. Demeco¹, C. Marinaro¹, A. Petraroli¹, I. Pino¹, R.C. Meliado’², L. Fratto², A. Ammendolia^1,2

¹Department of Surgical and Medical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy, ²A.O.U. Mater Domini, Catanzaro, Italy

Background and Aims: A new proposal for treating stroke outcomes is robot-assisted therapy. Gassert and Dietz classified upper limb rehabilitation robots into end effectors (EE) and exoskeletons (EXO). This study aimed to compare the relative effects of EE and EXO devices in motor recovery and disability and its impact on the quality of life of patients with finger-hand motor impairment post-stroke. Methods: We conducted a search to select randomized controlled trials (RCTs) on PubMed, Embase, MEDLINE, the Cochrane library. We considered as outcomes: motility index (MI), quick version of the arm, shoulder and hand disability questionnaire (QuickDASH) and evaluation Fugl-Meyer for the upper extremity (FMAUE). To compare efficacy, we performed a network meta-analysis and a surface under cumulative ranking analysis (SUCRA). Results: Five RTCs and 149 subjects were included. A significant decrease in QuickDASH (p <0.05) was observed in the EXO group (ES: -6.71; CI: -9.17, -4.25). FMAUE showed a significant increase (p <0.05) in the EE group (ES: 3; CI: 1.97, 4.04). The SUCRA analysis of MI demonstrated that robotic rehabilitation is more likely to be the best alternative for motor recovery (97.3% EXO probability; 48.3% EE; 4.4% control). Conclusions: EXO devices appear to be a better option than EE devices in the treatment of finger-hand motor disability associated with traditional rehabilitation, with important implications in hand motor recovery and reduction of disability. More research is needed focusing on direct comparison of the two devices.

References

Gassert R, Dietz V. Rehabilitation robots for the treatment of sensorimotor deficits: A neurophysiological perspective. J Neuroeng Rehabil 2018;15:46.
Verbeek JM, Langbroek-Amersfoort AC, van Wegen EE, Meskers CG, Kwakkel G. Effects of robot-assisted therapy for the upper limb after stroke. Neurorehabil Neural Repair 2017;31:107-21.

Topic: 3. Clinical Sciences

Sub Topic: 3.6 Preventive Rehabilitation

Effect of purposeful activity-based electrical stimulation in severe hemiplegic stroke survivors in a convalescent ward: A randomized controlled trial

S. Minami^1.2, R. Kobayashi³, Y. Fukumoto^4.2, H. Aoki⁵, M. Hida⁶, K. Takeuchi⁷, K. Yoshihara⁷, T. Aoyama²

¹Gunma Paz University, Takasaki, Japan, ²Kyoto University, Kyoto, Japan, ³Tokyo Metropolitan University, Tokyo, Japan, ⁴Kansai Medical University, Hirakata, Japan, ⁵Wakayama Medical University, Wakayama, Japan, ⁶Osaka Kawasaki Rehabilitation University, Kaizuka, Japan, ⁷Kyoto Ohara Memorial Hospital, Kyoto, Japan

Background and Aims: The purpose of this study was to investigate the effect of purposeful activity-based electrical stimulation therapy (PA-EST) on the daily activities and quality of movement in stroke survivors with severe hemiplegic upper limbs, who were hospitalized in a convalescent ward. Methods: This study used a randomized controlled design: stroke patients who met the selection criteria were randomly assigned to the PA-EST or functional occupation therapy group using random numbers and received an 8-week intervention. The outcomes were Fugle Meyer Assessment [FMA], Motor activity log [MAL], and Functional Independence Measure [FIM]. For each outcome, changes from pre- to post-intervention were calculated, and comparison of the change between these groups were performed using the Mann Whitney U test. Participants: Sixteen participants (13 men, 3 women; age, 68.1 ± 13.1 years; the PA-EST group, n=8; the functional occupational therapy group, n=8) completed the intervention, and the results were analyzed. Results: The MAL-quality of movement (p = 0.004) and total FIM (p = 0.049) showed significantly greater improvement after PA-EST than functional occupational therapy. Conclusions: The findings from this study suggest that PA-EST improves the quality of movement and activity of daily living compared to functional occupational therapy.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

Clinical study on the effect of air pressure therapy combined with wax therapy on patients with increased muscle tension after cerebral apoplexy

J. Min, H. Lu, Q. Shao, X. Qiu

Background and Aims: To study the effect of air pressure therapy combined with wax therapy on patients with increased muscle tension after cerebral apoplexy. Methods: 50 patients with increased muscle tension after cerebral apoplexy from January 2019 to December 2020 were selected and randomly divided into control group and treatment group. The control group uses conventional drug treatment and air pressure treatment, and the treatment group adds wax therapy on the basis of the control group for a period of 6 weeks. The patients were assessed with the modified Ashworth scale (MAS) and FIM scale at 2 weeks, 4 weeks and 6 weeks after treatment. Results: After 6 weeks of treatment, the muscle tone and daily living ability of each group were improved, and the improvement in the treatment group was more obvious than that in the control group, with statistical significance (P <0.05). Conclusions: Air pressure therapy combined with wax therapy can effectively improve the dystonia of stroke patients with increased muscle tension, and it is helpful to their daily living ability.

Topic: 3. Clinical Sciences

Sub Topic: 3.6 Preventive Rehabilitation

Are we wearing the correct shoe size?

A. Miliani¹, H. Cherid², M. Rachedi³

¹Department of PRM, University of KM Ouargla, Ouargla, Algeria, ²Department of PRM, EHS Azur Plage, Algiers, Algeria, ³Department of PRM, University of Algiers, Algiers, Algeria

Background and Aims: A problem of mismatch between the shoe and the foot can be the cause of many foot disorders. The objective of this work is to verify if the shoe that we wear corresponds to the real size of the foot in an Algerian male population. Methods: This is a descriptive comparative study carried in 2019, at a national training school in Touggourt, Algeria on healthy subjects. Two podiatric parameters were collected: firstly, we studied the declared sizes of the shoes worn by the participants. Then, we measure the shoe size using a plastic pedometer. finally, we made an intra-individual comparison between these two parameters. Results: 384 trainees participate in this study. The age range varies from 17 to 21 years with an average age of 19.5 years. The sizes declared vary from 38 to 46. Size 42 is the most common (26.76%). Foot size measurement by the pedometer shows that size 41 is the most popular (22.4%), with extremes ranging from 37 to 48. The intra-individual comparison shows that the difference between the declared size and the measured size is statistically significant, p = 0.004. Conclusions: This work shows that a large part of our population does not wear the right size, hence the need to know your true size before having your shoe.

Topic: 4. Therapeutics

Sub Topic: 4.2 Injections (Joint. Spine, etc.,)

Improvement of refractory shoulder girdle myosfacial pain with incobotulinumtoxina. Dr. Carolina Miguel, Dr. Alejandra Cirera. Hospital de la vega lorenzo guirao

C. Miguel Bellvert, A. Cirera Tortosa

Hospital De La Vega Lorenzo Guirao, Cieza, Spain

Background and Aims: Myofascial pain syndrome is a localized skeletal muscle painful condition defined by the presence of trigger points. Botulinum toxin type A injections may be a useful treatment for myofascial pain. This study reports on the experience with IncobotulinumtoxinA (IncoNBoT-A) in a series of patients with myofascial shoulder girdle pain. Methods: Retrospective case series study on 37 patients with cervical pain refractory to other pharmacotherapy, who received intramuscular injections of IncoNBoT-A in the affected muscles. Mean age: 53.6 (range 36-75) years; gender distribution: 4 (10.8%) / 33 (89.2%) male/female. Pain assessment using the Visual Analogue Scale (VAS, 0-10) was performed before and 4 weeks after injections. Paired-Student t-test was used for statistical analysis. Results: Mean total dose was 87.6 (range 35-158) units in a mean of 6.9 (range 2-17) injection points per patient. The muscles most frequently (% patients) injected were transverse trapezius (97.3%), levator scapulae (86.5%) and splenius (78.4.0%). Mean duration of effects was 3.8 (range 0-14) months. Mean pain VAS score was 7.9 (±1.3) before injection and 3.2 (±2.2) 4 weeks after treatment. Mean reduction of 4.7 (CI95%: -5.6 - -3.8, p=0.001) in EVA score. Pain post-injection was reported by 7 patients, assessed as causally related to the injection technique. Conclusions: The results show a significant improvement in cervical pain. In consequence, IncoNBoT-A, a highly purified botulinum neurotoxin free from complexing proteins, injection into the shoulder girdle muscles could be an effective and well-tolerated treatment in patients with refractory myofascial cervical pain.

Topic: 3. Clinical Sciences

Sub Topic: 3. 3 Diagnosis

The evaluation of spasticity by using ankle foot orthosis with magneto-rheological fluid brake as ankle joint

H. Metani¹, K. Hanayama¹, Y. Okada², S. Seki¹, H. Abe¹, N. Arai¹, S. Yamamoto¹, M. Yasunaga¹, S. Kanemaru¹, H. Nishitani¹, T. Hiraoka¹

¹Kawasaki Medical School, Kurashiki, Japan, ²Kawasaki Junior College of Rehabilitation, Kurashiki, Japan

Background and Aims: Spasticity is one of the most frequent impairment seen in hemiplegic patient after stroke. Although modified Ashworth Scale is often used for spasticity evaluation, it is just static evaluation method so that it is difficult to measure the increase in muscle stretch reflexes in motion. We developed spasticity evaluation system applicable for during standing motion using the special ankle foot orthosis (AFO) with Magneto-Rheological Fluid Brake as ankle joint (MR-AFO®, Hashimoto Artificial Limb Manufacture Co.), which can measure the ankle moment, angle and angular velocity. Methods: Three hemiplegic patients and three healthy volunteers were recruited. All subjects were male. MR-AFO were made and worn to fit the paralyzed leg of the patients and the right leg of the healthy volunteers. The subjects were comfortably seated, and then were ordered to stand up five times with the break of some seconds between each trial. The all data of degree of ankle, ankle moment and angular velocity obtained from MR - AFO were recorded and sampled using the dedicated software by 100Hz. The timing of the start and the end of standing motion was confirmed from recorded movies. Results: There were the peak moment around the start of standing motion among in the healthy volunteers, however, it was not observed in hemiplegic patients. Conclusions: The moment of ankle during standing motion observed in healthy subjects was not maintained in the hemiplegic patients.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Prognostic factors of functional outcomes after surgery in pressure ulcers in spinal cord injury

I. Mendes Andrade, F. Melo Correia, C. Pereira, R. Sousa, G. Baptista, A. Ferreira, F. Faria

Centro de Medicina de Reabilitação de Alcoitão, Lisboa, Portugal

Background and Aims: StageIII/IV Pressure Ulcers(PU) are a serious complication following spinal cord injury (SCI) and surgery is often indicated. This study aims to assess predictors that influence functional independence measure(FIM) in adults with SCI with stage III/IV PU who underwent plastic surgery. Methods: Retrospective study. Enrolment occurred between 2006 and 2020 at a Rehabilitation Center who integrated interdisciplinary post-operative rehabilitation program. Results: Forty-two patients were enrolled. At admission, most patients had an American Spinal Injury Association Impairment Scale grade of A (90,5%) and the most frequent neurological level of injury was thoracic(66,7 %). Only 7,1 % had academic degree and 76,2% were male. Almost, 90,5% had traumatic spinal cord injury, only 4,8% were able to walk and 26,2% performed intermittent bladder catheterization. The most frequent ulcer location was the sacral region. The mean length of stay was 102 days. The mean initial FIM was 76,42 and final FIM was 87,39. Linear regression analysis revealed that older age at the time of SCI was associated with lower initial FIM(adjusted R2=0,364;p<0,001). Furthermore, 29,5% of variance in final FIM was predicted also by patient’s age at time of SCI and length of stay in the center(adjusted R2=0,295;p<0,001). Conclusions: Pressure ulcers can be life-threatening and can devastate patients’health and quality of life. The favourable prognostic factors of final FIM after post-operative pressure ulcer surgery were younger age at the time of SCI and shorter length of stay. In fact, younger patients at the time of SCI are more likely to learn strategies to overcome the disabilities. Large prospective studies could provide more evidence.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Is hand and wrist flexion imperative to elbow flexion in rehabilitation protocol after neurotization in braquial plexus injury?

I. Mendes Andrade¹, P. Negrão Ramos², A. Barbosa Pereira¹

¹Centro de Medicina de Reabilitação de Alcoitão, Lisboa, Portugal, ²Centro Hospitalar Universitário de São João, Porto, Portugal

Background and Aims: Brachial plexus injury is devastating. A functional hand requires elbow flexion to reach objects,^[1] so restoring elbow flexion is a priority.²However, in some patients, after double fascicular nerve transfer (DFT),gain in elbow flexion is associated with wrist and fingers. Methods: This report introduces a case of right C5- C7 avulsion injury. A healthy 26 -year-old male, right-hand dominant suffered motorcycle accident. Medical Research Council (MRC) grade of elbow flexion was 0/5. The patient had MRC 4/5 wrist flexion and MRC 3/5 extension wrist and finger flexion, preserved pinch and DASH score was 86,7/100. To restore elbow flexion was treated with DFT which involves transferring fascicles from the median and ulnar nerves (fascicle from flexor carpi ulnaris and flexor digitorum) to the musculocutaneous nerve.^[3] Results: Initially, the patient was only able to elbow flexion if he had wrist and fingers flexion. Once reinnervation had occurred, rehabilitation was focused on strengthening, but also motor re-education to stimulate cortical remapping to be able to elbow flexion with wrist and finger extension. By now elbow flexion improved to MRC grade 2/5 and DASH score to 66,7/100. Conclusions: Despite the effectiveness of elbow flexion, this phenomenon damages the limb’s functionality.¹ The dissociation of movement seems to improve DASH score.^[1] To open a door requires elbow flexion combined with wrist and fingers extension,then the hand gripping. This is a challenge in the rehabilitation protocol which aim is to dissociate these movements to have a functional arm.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Urinary tract infections in spinal cord injury. What we do in clinical practice?

B. Melo, M. Saavedra, B. Moreno, M. Cunha, M. J. Azevedo, J. Cunha, B. Moreira da Cruz

Hospital da Senhora da Oliveira, Guimarães, Portugal

Background and Aims: Urinary tract infections (UTI) are responsible for major morbidity and mortality in spinal cord injury (SCI) and their diagnosis and treatment are challenging. The aim of this work is to investigate the current clinical practice of portuguese physiatrists in the treatment of UTI in SCI. Methods: A questionnaire, evaluating the individual modalities for diagnosis and treatment of UTI in SCI, was sent by email, in May 2020, to all physiatrists associated to the Portuguese Society of Rehabilitation Medicine. Results: The questionnaire was answered by 85 physiatrists. According to the results, most frequently symptoms leading to the diagnosis of symptomatic UTI are increased spasticity (84.7%) and new onset or worsening of incontinence or retention (70.6%). Most of them request urinalysis and urine culture (75.3%). Whereas 65.9% of responders treat every symptomatic UTI, 34.1% based their decision on symptoms and leukocyturia. According to 49.4% of the physiatrists, they always initiate the empirical treatment before the result of the microbiological exams. Antibiotics most frequently used for empiric treatment are amoxicillin and clavulanic acid, cotrimoxazole and fluoroquinolones. Mean treatment interval for UTI without fever is 7-10 days, whereas this time is extended to 10–14 days if fever is present. Antibiotic prophylaxis is used by 16.5% of responders. Conclusions: Although the sample is small, we conclude that there are different approaches to the diagnosis and treatment of UTI in SCI and they are based mainly on recommendations from neurogenic bladders. Considering the specificity of this disease, it’s important to develop guidelines toward a unification of the different treatment strategies.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

The effect of postural control training on stroke- associated pneumoniain patients with dysphagia after stroke

Z. Mei Hong, S. Mei Fang, Z. Ming, Z. Ye Ping, F. Xiong Wei, B. HongJing, W. Wen Qi

The Second Affiliated Hospital of Jiaxing University, Jia Xing, China

Background and Aims: To investigate the effects of postural control training in the prevention of related pneumonia in patients with dysphagia after stroke. Methods: We used clinical assessment of swallowing function to determine dysphagia and severity degrees.100 patients with different degrees of dysphagia were randomly divided into the control group (n = 50) and the experimental group (n = 50). Control group: Vitalstim electrical stimulation was used to treat dysphagia on the basis of routine rehabilitation training. Experimental group: neck control training was conducted on the basis of the control group, including: Neck bending training based on PNF technique ;Personalized postural control training was provided in combination with the patient’s function oral intake scale and VFSS. The incidence of aspiration pneumonia and the swallowing function effects evaluation were recorded in the two groups. Results: After treatment, the swallowing function of patients in two groups was significantly better than that before treatment, and the improvement of the experimental group was more significant than that of the control group.the incidence of pulmonary infection was significantly lower in the experimental group,the PSA scores of control group and experimental group was compared,the difference within groups was statistically significant. Conclusions: postural control training on the basis of Vitalstim electrical stimulation in stroke patients with dysphagia can significantly improve the swallowing function of patients, reduce the incidence of post-stroke associated pneumonia.

Topic: 3. Clinical Sciences

Sub Topic: 3. 2 Pain Osteoporosis -Osteoarthritis

Interest of isokinetic evaluation in the management of patellofemoral syndrome

S. Mdarbi, H. Boutalja, F. Lmidmani, A. El Fatimi

Department of Physical Medicine and Rehabilitation, Ibn Rochd University Hospital Center, Casablanca, Morocco

Background and Aims: Patellofemoral syndrome (PFS) is described as anterior knee pain caused by abnormal friction of the patella in the throat of the femoral trochlea, resulting from biochemical and/or physical changes in the patellofemoral joint. The interest of the study is to evaluate muscular strength and endurance in PFS by isokinetism. Methods: This is a descriptive retrospective study of 40 patients followed in the Physical Medicine and Rehabilitation Department for patellofemoral syndrome over a period of 18 months. Results: The average age was 34.2 years [17-55] with a sex ratio of 0.57. Knee pain was bilateral in 76% of cases with a slight dominance of the right side, obesity was found in 30% of patients. The isokinetic evaluation showed a significant difference in:

The maximum torque peak of the quadriceps and and the hamstrings between dominant and non-dominant limbs at 60°/s and 180°/s
The total work of the quadriceps between the dominant and non-dominant side
hamstring fatigue index for dominant and non-dominant side The isokinetic evaluation showed no significant difference in
The hamstring/quadriceps ratio at 60°/s between the two dominant and non-dominant limbs
The total work of the Ischio jambers on the dominant and non-dominant side
The quadriceps fatigue index on the dominant and non-dominant side.

Conclusions: The study of the different isokinetic parameters showed a decrease in the muscular strength of the extensor and flexor muscles of the knee, as well as an imbalance between the agonist/antagonist muscles of the knee in relation to the appearance of PFS.

Topic: 2. Social sciences

Sub Topic: 2.2 Disability Studies

Driving after traumatic brain injury and the changes in driving patterns

M. Mazlan¹, N. F. Basri²

¹Department of Rehabilitation Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia, ²Department of Rehabilitation Medicine, Ministry of Health, Malaysia

Background and Aims: Ability to drive is affected in many ways after a traumatic brain injury (TBI). This study is aimed to examine the ability to return to drive after TBI and to explore the changes in their driving patterns in local population in Malaysia. Methods: This is a cross sectional study conducted in a tertiary hospital in Malaysia. All patients with TBI of more than six months, with valid driving licenses prior to the injury; and attended the outpatient rehabilitation specialist clinic follow-up within the study period, were recruited. Their demographic, injury and functional data were collected and a face-to-face interview using a structured questionnaire was conducted to ascertain driving history and pattern. Results: A total of 52 patients were interviewed with the average age of 39.4 years and mean duration of TBI of 3.5 years. 46% of the patients returned to drive, with 71% underwent a formal driving assessment and training program. Factors significantly associated with return to drive were cognitive status (p < 0.05) and functional status (p < 0.05) whilst Cohen’s effect size value (d = 1.09) suggested high practical significance of return to drive in having completed a primary education. Changes in driving patterns were reported in 71% of the drivers, which include reduced frequency of driving (26.9%), avoidance of rush hours (29.2%); and driving during daytime only (25%). Conclusions: The rate of return to driving among persons with TBI is low. There is a need to address the underlying barriers to return to drive in a comprehensive driving rehabilitation program post-TBI.

Topic: 3. Clinical Sciences

Sub Topic: 3.8 Diagnostic Imaging

Ultrasound and X-ray assessment for grading calcific tendinopathy of the shoulder: An inter-rater reliability study

M. Pérez-Cuesta Llaneras, A. Fernández López, A. Fernández-Bravo Rueda, P. Núñez de Aysa, J. Fernández-Jara, B. Gutierrez San José, M.D. Martín Ríos, E. Calvo Crespo

Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

Background and Aims: Introduction: The aim of this study is to evaluate the inter-observer variability between two musculoskeletal radiologists when performing diagnostic ultrasound and x-ray in calcific tendinopathy of the shoulder. Methods: A total of 21 patients were included to assess inter-observer variability of the type classification and localization of calcifications of the rotator cuff tendons. Two experienced musculoskeletal radiologists performed an ultrasound examination and x-ray evaluation of the shoulder. They defined the localization (supraspinatus, infraspinatus, teres minor or subscapularis), type of the calcification and the size. The Kappa index was used to asses reliability when studying both calcification type and localization. Results: The inter-rater reliability when studying the calcification type and its location was found to be almost perfect in both cases. Kappa index of 0.83 was obtained for type classification by x-ray and 0.76 when using ultrasound. When studying location, Kappa index of 0.91 was obtained for x-ray and 0.72 for ultrasound. Conclusions: These findings confirm that x ray and US imaging is a reliable, non-invasive, cost-effective instrument for evaluating the type and localization in calcific tendinopathy. The homogeneity of the diagnostic criteria, both radiological and by ultrasound has a direct influence in the therapeutic plan.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Effect of traditional Liuzijue phonation training combined with pelvic floor muscle exercise in postpartum women with stress urinary incontinence

Ziling Lin^1,2, Xueling Chen³, Xiangbin Wang^1,2, Yanping Liu⁴, Yanjun Hou⁴

¹College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China, ²Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation, Fuzhou, China, ³Rehabilitation Department of the Affiliated 3rd Peoples’ Hospital, Fujian University of Traditional, Fuzhou, China, ⁴Fujian University of Traditional Chinese Medicine Affiliated Rehabilitation Hospital, Fuzhou, China

Background and Aims: The pelvic floor muscle (PFM) exercise is the most effective therapy for stress urinary incontinence (SUI), but some postpartum patients are difficult to activate PFM. Though PFM training with the abdominal breathing has certain benefits for core muscle activation and adjustment of breathing pattern, combination with pronunciation training seems better activation for PFM in clinical practice. The study aimed to investigate if Chinese traditional Liuzijue phonation training combined with PFM exercise is more efficient than PFM exercise alone for SUI treatment in postpartum women. Methods: The study was performed between September 2020 and April 2021. Eighteen women with SUI participants were randomly allocated to twogroups. Addition to 10 sessions of PFM biofeedback therapy, the trial group (TG) adopted Liuzijue phonation training combined with PFM exercise; whereas the control group (CG) only underwent PFM exercise. Exercise for 20 minutes everyday with supervision by a physical therapist. All interventions lasted for 4 weeks. The outcome measures included average Root-Mean-Square (RMS) of PFM by surface electromyography (EMG) with Glazer protocol in fast flick contraction, tonic contraction, enduration contraction, pre-and post-baseline resting stages. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was also measured. Results: All the outcome data didnft show significant difference between the two groups. Compared with those before treatment, the average RMS of fast flick and endurance contraction were increased in both two groups (P< 0.05). The ICIQ-SF score were significantly reduced in both two groups (TG: 7.78} 2.91 vs 2.06} 0.68GCGF6.22} 2.73 vs 2.0} 3.28, P=0.001). While the average RMS of tonic contraction was significantly improved only in the TG (Figure). Conclusions: Though the combination exercise of Chinese traditional Liuzijue phonation strenghthened both fast and endurance fibers of PFM, this integrated therapy didnft show better effect than PFM exercise alone in SUI in postpartum women.

Topic: 5. Engineering and Technology

Sub Topic: 5.2 Prosthetics and orthotics

Patient perspectives on digital versus traditional fabrication of transtibial prosthetic sockets – A qualitative study

A. Mayo¹, S. Gould¹, S. Cimino¹, S. Hitzig¹

¹St. John’s Rehab, Sunnybrook Health Sciences Centre, Toronto, Canada, ²Department of Rehabilitation Sciences, University of Toronto, Toronto, Canada, ³Department of Medicine, University of Toronto, Toronto, Canada

Background and Aims: Prosthetic sockets for lower extremity amputations have traditionally been made using plaster casting methods. Digital fabrication involving scanning residual limbs and 3D socket printing is an emerging practice. This study explores patient’s expectations and experiences with digital vs traditional prosthetic fabrication techniques. Methods: Individuals with unilateral transtibial amputations were included. Each participant was fit with a traditionally made socket and a 3D printed socket concurrently. After fittings, participants completed semi-structured interviews exploring comparisons between the two fabrication techniques. The interviews were audio-recorded, transcribed, and thematically analyzed. Results: 9 adult male participants with recent unilateral transtibial amputations participated in the study. Most patients had no previous experience with 3D printing nor knowledge of material/print options. Positive experiences with digital fabrication included elimination of mess, and no pain during the fabrication. Key patient themes of patient expectations of digital fabrication were: (a) Improved accessibility and less wait times (b) Better precision (c) Reduced costs for patients and (d) Potential for less personalized care with increased automation and less face-face time with prosthetists. Patients felt prosthetists were integral to the prosthetic fabrication process and appreciated prosthetist expertise. There were also concerns about the durability and appearance of the 3D printed socket. Conclusions: Patients are excited about prosthetic socket digital fabrication possibilities. Patient expectations of increased precision, reduced cost and less fitting wait times must be considered as digital fabrication techniques develop. The prosthetist-patient relationship is valuable, and felt to be essential in patient’s prosthetic care regardless of fabrication method.

Topic: 6. Health Policy and Systems

Sub Topic: 6.9 Big Data and Cohorts

Effects of the ultrasound and sonic toothbrushes on oral hygiene and dysphagia in convalescent post-stroke patients: A randomized controlled study

S. Matsumoto¹, T. Hoei², T. Matsubara², Tojo³, T. Nakamura³, T. Ikegami⁴, K. Toyama⁵

¹Center of Medical Education, Faculty of Health Sciences, Ryotokuji University, Urayasu City, Chiba, Japan, ²Department of Rehabilitation, Nippon Medical School Chiba Hokusoh Hospital, Inzai City, Chiba, Japan, ³Department of Rehabilitation, Acras Central Hospital, Kagoshima City, Kagoshima, Japan, ⁴Department of Rehabilitation, Kikuno Hospital, Minami-Kyushu City, Kagoshima, Japan, ⁵Department of Comprehensive Rehabilitation, Faculty of Allied Health Sciences, Yamato University, Suita City, Osaka, Japan

Background and Aims: Oral care is often overlooked during stroke rehabilitation. Physical weakness, lack of coordination and the cognitive problems that can accompany a stroke may prevent a person from maintaining good oral hygiene on their own. The objectives of this study was to investigate the effects of the ultrasound and sonic toothbrushes (UST) in patients after stroke. Methods: The study design was a randomized, controlled study, and the setting was four convalescent rehabilitation hospitals. Thirty-four post-stroke patients were randomly allocated to control or experimental group. The experimental group used with the UST, and the control group used toothbrushes with power off. Oral care was performed three minutes per session, twice a day, seven times per week, fore twelve weeks. Main outcome measures were oral Hygiene Index (OHI), Plaque Index (PI), Gingival Index (GI), Saxon test, Functional Oral Intake Scale (FOIS) and questionnaire were recorded before, and 12 weeks after each intervention. Results: At baseline, oral hygiene status in post-stroke patients was poor. And also, the amount of saliva was small, dysphagia was remarkable. In both groups, all outcome measures were improved after the intervention. However, there were significant differences between the experimental and control group for OHI, PI, GI, Saxon test, FOIS and patient satisfaction, 12 weeks after the intervention. Conclusions: These findings demonstrate that the use of UST effectively decreased the poor oral hygiene, and increased saliva secretion. Professional prophylaxis was required to improve gingival status. Oral care with UST, is superior to conventional treatment alone for post-stroke patients.

Topic: 4. Therapeutics

Sub Topic: 4.6 Neurostimulation (rTMS, tDCS, etc.)

Effects of neuromuscular electrical stimulation for treatment of dysphagia in acute stroke patients: A randomized controlled trial

S. Matsumoto¹, T. Hoei², R. Tojo³, T. Nakamura³, T. Ikegami⁴, K. Toyama⁵

¹Center of Medical Education, Faculty of Health Sciences, Ryotokuji University, Urayasu City, Chiba, Japan, ²Department of Rehabilitation, Nippon Medical School Chiba Hokusoh Hospital, Inzai City, Chiba, Japan, ³Department of Rehabilitation, Acras Central Hospital, Kagoshima City, Kagoshima, Japan, ⁴Department of Rehabilitation, Kikuno Hospital, Minami-Kyushu City, Kagoshima, Japan, ⁵Department of Comprehensive Rehabilitation, Faculty of Allied Health Sciences, Yamato University, Suita City, Osaka, Japan

Background and Aims: The purpose of this study was to compare the effects of a novel neuromuscular electrical stimulation (NMES) versus conventional treatment in patients with dysphagia after stroke. Methods: In total, 60 patients were randomly divided into the NMES (n = 30) and control (n = 30) groups. The NMES group received the NMES intervention followed by conventional treatment, which included thermal-tactile stimulation with intensive repetition of a dry-swallow task. The control group received conventional treatment without NMES. NMES was delivered using a high-voltage pulsed-current device at a fixed pulse duration of 50 µs and a frequency of 50 Hz over the skin above the motor point of the target muscles, namely, the bilateral geniohyoid, mylohyoid/anterior belly of the digastric, and thyrohyoid muscles. Both groups received 40 min of treatment once a day, 5 days per week, for 2 weeks. The outcomes were assessed at baseline and 2 weeks after treatment using the videofluoroscopic dysphagia scale (VDS), the anterior- superior displacement of the hyoid bone and larynx, pharyngeal transit time (PTT), Rosenbek penetration-aspiration (PAS) scale, and the functional oral intake scale. Results: Both groups exhibited improvement, but the NMES group exhibited more significant improvement in the displacement of the hyoid bone and larynx, VDS-total score, PTT, and PAS score than the control group. Conclusions: The results suggest that NMES combined with conventional treatment is superior to conventional treatment alone in patients with dysphagia following stroke. Further investigations are necessary to examine the effects of NMES in patients with more varied disease types.

Topic: 4. Therapeutics

Sub Topic: 4.4 Pharmacological agents

Nusinersen therapy in adults SMA Type III: Two single cases studies

M. Massier, C. Pineau, C. Benoit, T. Poitou, A. Rapin, J. B. Ferte, F. C. Boyer

PRM Department, NMD Reference Center, Reims Champagne Ardennes University, Sebastopol Hospital, Reims, France

Background and Aims: The antisense oligonucleotide nusinersen is a first line treatment in spinal muscular atrophy (SMA) type I, II and III. Up to now, nusinersen is still under evaluation in adults SMA; no study versus group control were performed yet. In this report, the monthly follow-up of two adults SMA, during the first five months of Nusinersen treatment, are compared to their previous baseline follow-up. Methods: In this retrospective observation study performed in Reims, from April 2019 to February 2021, we assessed the motor function of two SMA type III patients with different scales including the Motor Function Measure 32 (MFM) with 96 points being the highest score, indicating the best motor function. From April 2019 to September 2020, for both patients, ten evaluations were performed for baseline determination, before the treatment. From September 2020 to February 2021, patients received four initial doses of nusinersen and five follow-up evaluations were carry out. Results: The first person is an ambulant 45 years-old woman, the second is a wheelchair dependent 21 years-old man. Both have a stable baseline of MFM scores, with an apparent increase of the mean score of respectively 9 points and 5 points, after the treatment initial doses. Conclusions: Rigorous and repeatedly evaluations allowed to set the baseline of motor function before therapy. These personalized baselines were used as reference for the assessment of nusinersen’s effect in these adults SMA. Mean MFM scores increased for both patients, however we need to continue monitoring patients’ motor function to assess long term impact of the treatment.

Topic: 5. Engineering and Technology

Sub Topic: 5.5 Virtual Reality

Influence of the virtual reality environment on the psychoemotional state of patients after stroke

I. Maryenko¹, S. Likhachev¹, N. Usava², M. Mozheiko¹

¹Republican Research and Clinical Center of Neurology and neurosurgery, Minsk, Belarus, ² Gomel State Medical University, Gomel, Belarus

Background and aims: One of the most effective approaches to neurorehabilitation is using of virtual reality (VR) technologies. To assess the dynamics of psychoemotional state of patients in early recovery period after stroke under the influence of balance training in VR. Methods: Training of patients in VR involves controlling the object proposed in VR (game character) by arbitrarily moving him torso along the trajectory set by the VR object at speed that subject is able to develop. The training (8-10 procedures) conducted in 28 patients in early recovery period after stroke, aged from 27 to 78 y.o. (average age 54.96±14.81), including 13 women and 15 men. Neuropsychological status assessed with the Mental Status Assessment Scale (MSAS) and Beck’s scale. The assessment of the daily activity of patients carried out according to the Bartel’s index, balance disorders by the Berg’s scale. Results: Cognitive functions of patients according to MSAS - 29.0 [26.0; 30.0] points. After training cycle in VR: the average score on the Rankin’s scale decreased from 2 [1.0; 3.0] to 1 [0.0; 3.0] (no symptoms); daily activity of patients on Bartel’s index increased from 90.0 [80.0; 100.0] points to 100.0 [90.0; 100.0] points; in Berg’s scale the score statistically significantly improved from the 49.0 [34.0; 53.0] and increased to 51.0 [45.0; 55.0] (p<0.05) points on. Conclusions: VR is a promising method for the formation of new motor stereotypes with the integration of the projection of the postural axis into the body diagram of patients, as well as cognitive and multisensory stimulation of mental processes.

Topic: 6. Health Policy and Systems

Sub Topic: 6.7 Disaster Health Related Rehabilitation (Man-Made /Natural Disasters/After Effects)

Proposal for the prevention of falls after analyzation among 35 fall cases in rehabilitation hospital

M. Maruyama¹, Y. Shinoda²

¹Division of Rehabilitation Ibaraki Rehabilitation Hospital, Moriya, Ibaraki Prefecture, Japan, ²Department of Rehabilitation, Ibaraki Rehabilitation Hospital, Moriya, Ibaraki Prefecture, Japan

Background and Aims: We proposed prevention of falls in hospital room due to act alone in Ibaraki Rehabilitation Hospital. Methods: Collecting from the reports of 481 inpatients in our hospital from April to September 2019, we extracted 35 cases of falls in the hospital room due to act alone. We divided 4 groups (Group A in ADL independence and intentionally behavior/ B is ADL independence and unintentionally behavior/ C is ADL dependence and intentionally behavior / D is ADL dependence and unintentionally behavior) for statistical analysis. Results: There were 10 cases in group A, 14 cases in group B, 9 cases in group C, and 15 cases in group D. We conducted a Chi-square test and the results revealed significant differences among conditions (x2(1) = 8.670, p=0.003), therefore, it was considered necessary to take measures against falls for each of these four items. Conclusions: We proposed the prevention of those each group. Group A should receive detailed guidance. Group B should be prepared the surrounding environment around the bed. Group C has fallen trying to go to the bathroom and needs regular toilet guidance. The reason for Group D to act alone was unknown. Groups C and D require individual fall prevention measures at each stage of cognitive level. The appropriate of those methods should be investigated by further study.

Topic: 5. Engineering and Technology

Sub Topic: 5.6 Telerehabilitation

Telerehabilitation allowing early discharge and successful follow-up during the COVID-19 pandemic - A case of Guillain-Barré syndrome

R. Martins Da Silva, A. Barbosa Pereira, A. Sousa, I. Pessoa Amorim, J. Jacinto

Serviço de Reabilitação de Adultos 3. Centro de Medicina de Reabilitação de Alcoitão, Alcabideche - Cascais, Portugal

Background and Aims: Guillain-Barré Syndrome (GBS) is the most common cause of acute self-limited neuromuscular paresis in developed countries. Patients’ rehabilitation is often complex, requiring inpatient programs. Telerehabilitation has been a valuable resource in avoiding that patients went out of reach during the COVID-19 Pandemic. Aim: To assess feasibility and effectiveness of telerehabilitation, through a case of GBS. Methods: Male, 27 years old, professional dancer. Admitted to hospital with muscle weakness (MW), decreased tendon reflexes and myalgia. After clinical workout was assumed axonal type GBS. At admission to the Rehabilitation Center (RC), presented with MW 2/5 for shoulders and hips; 3/5 for other segments. Standing/gait impossible. Partly dependent for ADLs - FIM:96/126. Upon discharge, was put on a telerehabilitation program - MW 4/5 shoulders, elbows and hips; 5/5 other segments. Able to stand and walk (200m), squatting impossible and stairs done without alternation - FIM:124/126. Was provided with demonstration videos with the home self-administered program recommended: exercise type, series, reppetitions, 5/7. Monitored through video-call every 2 weeks, to coach/adjust home program. Results: Shorter than usual inpatient stay (42 versus >70 usual days). After 8 weeks, muscle strength was 5/5 in all segments. Could squat, walk >5000m, started running and alternating stairs. Fully independent - FIM:126/126. Professionally reinstated after reconversion and dancing for leisure. Conclusions: Telerehabilitation made it possible to reduce the hospitalization time of a GBS young patient, with full clinical and functional recovery, at a stage when access to an outpatient regimen was impossible. In selected cases, telerehabilitation should be encouraged.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Rehabilitation following reverse shoulder arthroplasty after proximal humeral fractures - A review and future considerations

P. Martins¹, R. Claro², A. Vieira¹, F. Rodrigues¹, G. Fernandes¹, B. Jardim¹

¹Physical Medicine and Rehabilitation Department, Hospital Central Do Funchal, Funchal, Portugal, ²Orthopedics Department, Shoulder Unit, Centro Hospitalar E Universitário Do Porto, Porto, Portugal

Background and Aims: Proximal humeral fractures are the third most common fractures in adults over 65 years old. The reverse total shoulder arthroplasty (rTSA) has been increasingly used for its management. Successful outcomes of rTSA depend on several factors, including postoperative rehabilitation. Healing of tuberosities has been observed to show better functional outcomes, and the impact of rehabilitation on it has not been studied yet. We aim to review protocols on rehabilitation following rTSA after proximal humeral fractures and to point out what we believe that may be the best approach. Methods: We searched PubMed (MEDLINE) library database from inception to February 2021, for reports on rehabilitation following rTSA after proximal humeral fractures. Results: We found 6 reports on rehabilitation following rTSA after proximal humeral fractures. They mentioned an immobilization period ranging from 3 to 6 weeks, starting passive range of motion (ROM) exercises from day 1 postoperatively, to 6 weeks. The start of active ROM exercises ranged from 3 to 6 weeks postoperatively, and the strengthening program beginning ranged from 6 to 12 weeks postoperatively. Conclusions: Although there are not many modifications to the original protocol described for rTSA, a longer immobilization period was considered, and radiographic appearance of the tuberosities was taken into account in order to start active ROM exercises. In addition to biophysical stimulation, these modifications must be taken into consideration towards the prevention of non-union of tuberosities, in order to achieve a better functional outcome.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)APPROACH to Musculoskeletal Changes in Head and Neck Cancer

J. Marques Dos Santos, J. Gonçalves, A. Campolargo

PMR Department, Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova de Gaia, Portugal

Background and Aims: HNC is a worldwide public health problem with an important impact on the individual’s health and functionality, as a consequence of the disease and/or the treatments to which the individual is subjected. The CHVNG /E has a multidisciplinary team, where PMR is included, that meets weekly to discuss the orientation for each patient. Musculoskeletal changes are one of the main sequelae reported that need PMR intervention. Methods: Research in Pubmed and Chochrane limited to the last 5 years, in English. We included articles that exclusively addressed these sequelae resulting from the disease itself and/or the treatments, and that addressed their PMR treatment. Only articles with individuals over 18 years old were included. Articles that addressed other sequelae resulting from this pathology were excluded. Results: Of the 257 articles found, according to our inclusion and exclusion criteria, we selected 21 articles. We reported methods to evaluate the anatomical structures that are more affected like the mouth, neck and shoulder. The decreased mobility of these structures is often cause of pain. We describe the treatment options suggested, according to the sequels, using Physiotherapy, Speech Therapy, Occupational Therapy and pharmacological treatment, which should always be prescribed by the Physiatrist, after evaluating the patient. Conclusions: Early orientation of these individuals by PMR is mandatory in order to obtain better results. Late or nonexistent orientation can have important consequences on the functionality and quality of life, with repercussions on physical and psychological well-being and impact in their family, social and professional life.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Amputation is not a limitation

J. Marques Dos Santos, J. Gonçalves, A. Campolargo

PMR Department, Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova de Gaia, Portugal

Background and Aims: The majority of amputations are of vascular cause, affecting older Patients but during the PMR consultation we consulted young patients, amputated in the context of trauma. One of these patient’s frequently asked questions was related to the return to sports. We performed a bibliographic research on how to integrate an amputee in sports and the type of prostheses suitable for different sports. Methods: Research on Pubmed, Scielo and Cochrane on this topic limited to the last 20 years, including only articles with adult individuals. Weselected articles that addressed integration in sports, prescription of physical exercise and the type of prostheses appropriate to different sports after amputation of the upper and/or lower limbs. A research was performed on prostheses related to sports pratice on the websites of orthopedic brands like Ottobock, Ossur, TRS Prosthestics. Results: Cardiorespiratory stress tests should be performed before thetraining program that include s muscle strengthening, aerobic and flexibility training. The modalities with more relevant information found were athletics, cycling, golf, skiing, snowboarding, swimming, sport fishing and gym training. We found several options in terms of prostheses, for both upper and lower limb amputees, which we describe in the paper. Conclusions: Few articles were foundon the prescription of physical exercise for amputees as well as on the prosthetic material for different sports according to the type of amputation. It would be important to establish protocols on how to integrate amputees into sports in order to standardize the approach to this type of patient.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Case report: Treating fecal incontinence in a cerebral motor disorder setting with pelvic floor rehabilitation

V. Marques, A. Trêpa

Department of Physical Medicine and Rehabilitation, Centro Hospitalar Universitário do Porto, Porto, Portugal

Background and Aims: Fecal incontinence (FI) has a prevalence reported up to 19% carrying a high burden, significant disability and low self-esteem. In patients with neurologic disorders its frequency is higher and the management more difficult, with more invasive therapies applied. Pelvic floor rehabilitation (PFR) is a non-invasive alternative, but seldom data is available on its use for FI in the neurological patient. With this is mind, we present a case of therapy-resistant FI in a patient with a cerebral motor disorder and spina bifida, resolved with PFR. Methods: The clinical files of the patient were searched for previous treatments as well as diagnostic and imaging studies. A follow-up consultation was made to evaluate the clinical improvement. Results: A 24-year old male, being managed for FI through anterograde colonic enemas (ACE) without success, was evaluated in our consultation. He started a comprehensive PFR program at our center, with regular follow-ups. After 6 months the patient reported a 50% reduction in incontinence episodes, continuing the program at our center. At the 18 month mark, he reported a complete resolve of FI, still needing the use of enemas for its management. 2 years in, the patient was able to discontinue the enemas without any episode of FI, and was discharged for a home-base program. No more incontinence episodes have been reported. Conclusions: This successful approach highlights the role of PFR in fecal incontinence for neurologic patients, and we hope it helps generate interest for its early application providing a more robust evidence of its effectiveness in this setting.

Topic: 4. Therapeutics

Sub Topic: 4.6 Neurostimulation (rTMS, tDCS, etc.)

Transcranial electrical stimulation and balance training for postural instability improvement in patients with multiple sclerosis: A pilot study

C. Marinaro¹, A. Petraroli¹, I. Pino¹, L. Moggio¹, A. Demeco¹, N. Marotta¹, L. Fratto², R. C. Meliado², A. Ammendolia¹

¹Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy, ²Physical and Rehabilitation Medicine Unit, A.O.U. Mater Domini, Catanzaro, Italy

Background and Aims: Multiple Sclerosis (MS) patients frequently report balance problems during their disease reflecting fear of falling and reduced participation. Transcranial direct current stimulation (tDCS) can be used as treatment tool. The aim of the study is the evaluation of tDCS and balance training combination efficacy in postural instability in MS patients. Methods: Fourteen Relapsing-Remitting MS patients with EDSS1-4 and balance alterations were enrolled and randomly assigned to the experimental group (n=9), performing 10 sessions of anodic tDCS applied to M1 cortex contralateral to the most affected side, and sham control group (n=5). A balance training was carried out at the end of each stimulation session. All patients underwent functional instrumental evaluation at the baseline (T0), at the end of treatment (T1), 15 (T2), 30 (T3), and 45 days after treatment (T4). Results: The experimental group showed a significant improvement in TimedUp&Go execution with a reduction of performing time between T0 and T1, reaching the maximum effect at T2; in the control group, a significative reduction was observed at T1. The fall risk was reduced in the experimental group at T2; no difference in the sham group. Platform-posturography highlights a reduction of sway in stance with eyes open and closed in the treatment group at T2 and T3, no statistically significant difference in the control group. Conclusions: The combination of tDCS and balance training has a beneficial effect on MS postural instability that persists even after the end of the treatment, improving the patient’s independence in ADL.

Topic: 7. Functioning and Disability

Sub Topic: 7.1 ICF

The challenges of a goal-setting process in lance Adams syndrome with refractory myoclonus

M. Mariappan, P. Mathews, P. Sinha

¹The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom

Background and Aims: Lance Adams Syndrome (LAS) is a rare occurrence of a constellation of symptoms and signs, with the unknown pathophysiology, after hypoxic brain injury. The course and symptomatology is so unique in that multi-disciplinary, individual-focused, realistic goal-setting process poses a huge challenge to neuro-rehabilitation. Methods: We are keen to share our reflective journey by reporting a case of a 56-year- old policeman, admitted with out-of-hospital cardiac arrest following a collapse. Unfortunately, he has had hypoxic encephalopathy following a massive bilateral pulmonary embolism with a downtime of 21 minutes. He presented to us with the following impairments: a) refractory myoclonus, b) dysphagia, c) dysarthria and d) truncal ataxia. Favorably, his cognition and mood were normal. His EEG showed generalized excess of asynchronous slow wave activity with normal MRI brain. The neurology opinion confirms the diagnosis of LAS. Results: This gentleman’s functional and participative long-term strategic goals were initially laid out as per the ICF framework. However, the challenges of refractory myoclonus management along with the side-effects of anti-epileptics used made our MDT to rethink and reconfigure our realistic goal-setting process. Both the person with the impairment and his family were involved throughout the process. We are pleased to say that both his subjective and objective outcomes (FIM/FAM splat from 64 to 102) were improved and he has been successfully reintegrated into the community. Conclusions: The goal-setting process should be carried out on a case-by-case basis in bespoke way and the MDT should be adaptive and flexible in their approaches during the journey of comprehensive neurorehabilitation.

Topic: 6. Health Policy and Systems

Sub Topic: 6.3 Infrastructure and Resources

Reconfiguration of rehabilitation services in the amidst of redeployed workforce during COVID-19 pandemic

M. Mariappan

The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom

Background and Aims: Reconfiguration of ‘Rehabilitation Services’ in the organizations are essential and has to be prioritized due to the current challenges and demands of the COVID-19 pandemic. The skill-mix of the existing workforce could be better utilized in the critical and acute care setting rather than in the community rehabilitation setting. Nonetheless, the employee’s perceptions and the impact on the services should be considered. Methods: A gap analysis was done to explore the key areas of rehabilitation services that require transformation and to highlight the difference from the current to the desired workforce to meet the pandemic crisis. Collaborative working strategies through contemporary human resources practices were practiced with the involvement of multi-disciplinary team leads. Throughout the whole outbreaks, our managers and leaders ensured that the quality of service was not compromised. Regular performance reviews (key performance indicators) and integrated communications were in place within our rehabilitation unit. Special attention was given to maintain mental health and well-being through dedicated webinars, mindfulness sessions and occupational health support. Results: Service reconfiguration triggered different emotions within our team which posed a huge challenge. However, through the above methodology, positive emotions were upheld resulted in the right attitude and behaviors’ which has influenced our working culture. As a result, the fellow workers were motivated intrinsically, engaged well with a commitment to deal with the pandemic. Conclusions: Even though the reconfiguration of our services seems a daunting task, with the innovative multi-dimensional approach, our colleagues indeed embrace the change and continue to face the pandemic with optimism and hope.

Topic: 4. Therapeutics

Sub Topic: 4.4 Pharmacological agents

The effect of food supplement with calcium and Vitamin d3 on calcium homeostasis and falls incidence in patients with high fracture risk undergoing medical rehabilitation

L. Marchenkova, V. Vasileva

National Medical Research Center of Rehabilitation and Balneology, Moscow, Russia

Background and Aims: Purpose: To evaluate the effect of long-term calcium and vitamin D3 intake on calcium homeostasis and fall’s rate in patients with high fracture risk starting rehabilitation. Methods: The study enrolled 119 men and women aged 50-80 y.o. with high absolute fracture probability by FRAX who started medical rehabilitation. 41 patients have been receiving antiresorptive therapy already comprised group 1, other patients were randomized into groups 2 (n=39) and 3 (control, n=39). In groups 1 and 2, a food supplement containing calcium citrate 1000 mg and vitamin D3 600 IU was prescribed for 12 months. All patients undergo laboratory examination and fall assessment at baseline, in 6 and 12 months. Results: An increase in 25(OH)D level was noted in groups 1 and 2 after 6 and 12 months (p<0.01). Patients in group 1 showed an increase in serum osteocalcin and calcium levels after 6 and 12 months (p<0.05). In group 3, there was an increase of PTH level after 6 (p<0.05) and 12 months (p<0.01), CTx and alkaline phosphatase after 12 months (p<0.05). In group 1, there was a decrease in proportion off fallen at least once patients after 6 months (p = 0.026) and in the total falls cases after 12 months (p =0.027). Group 2 showed a decrease in fallen patients number after 6 and 12 months (p=0.0034) and in total falls number after 6 months (p=0.0142). Conclusions: Prescription of dietary supplements containing calcium and vitamin D3 should be recommended as a part of complex rehabilitation of patients with high fracture risk.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Short-and long-term impact of multi-sensory interactive training on upper and lower limb motor function recovery in patients with subacute ischemic stroke - A randomised controlled trial

Y. Mao², D. Chen², D. Huang²

¹Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, China, ²Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, ³Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

Background and Aims: This study aimed to compare the short- and long-term impact of multi-sensory (MS) training and conventional physical therapy for lower and upper limbs function recovery in ischemic stroke patients. Methods: One hundred and six subacute stroke patients were randomly allocated to either conventional therapy with MS training or conventional training groups using neurodevelopmental therapy (NDT). Outcome measures of Fugl-Myer Assessment (upper, lower limbs and total motor function) (FMA) and Berg Balance Scale (BBS) were recorded at pre-intervention, 3 weeks, 3, 6, 12 months follow-up. Two-way ANOVA and Tukey’s test were conducted to assess the between-groups difference. Results: Improvements of the total motor, lower, and upper limbs functions (FMA) were observed from both groups at the interval of 3-weeks to 3-month follow-up (p<0.0001) and at 6-month to 1-year (p=0.0004). There was no significant difference (p=0.6221) between the two groups on upper, lower, and total motor function measurements over the five different time frame measurements. There was no difference on BBS between the two groups (p=0.2268) observed from the five different time intervals. Conclusions: The combination of MS and CT is as effective as the CT treatment in the total motor, upper and lower limbs functioning recovery measured from the 5 evaluation periods. The early intervention of MS +CT or/and CT at 3 weeks post-stroke generated beneficial impacts, which, can be concluded over the one-year follow-ups for both groups.

Appendix

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Postural control in dual task of dyslexic children: A cross-sectional study

C. Ceret¹, E. Raynaud², J. Bellanger³, J. Rouzier⁴, A. Perrochon⁵

¹I.F.M.K APSAH, Limoges, France, ²ILFOMER, Limoges, France, ³Junien-Rigaud Health Center, St Junien, France, ⁴I.F.M.K APSAH, Limoges, France, ⁵HAVAE, Limoges, France

Background and Aims: Kindly check and provide department if applicable. Dyslexia is a reading disability associated with a postural disorder (1). Dual task causes an unstable balance for dyslexic children during a silent reading situation (2), but there are no studies about reading out loud. Our objective was to analyze the impact of a DT of reading out loud on postural control in dyslexic children. Methods: Ten young subjects (11.1 ± 1.3 years old) realized three randomized tasks: i) eyes open while standing on a posturographic platform for 30 seconds, ii) standing and reading out loud for 3 minutes on the platform, and iii) standing on the platform repeating the word Bla for 30 seconds. We studied the surface area and mean speed of the CoP, the length in function of surface (LFS) and the parameter derived from the velocity variance and the anteroposterior mean position of the body (VFY). Results: We didn’t find any differences between the parameters except between eyes open and the DT of reading for LFS (p= 0,005) and the VFY (p= 0,001). We also noticed a difference between eyes open and the task Bla for the LFS (p= 0,04). Conclusions: This experiment reveals that there is no impact on the most common parameters but a cognitive task of reading out loud have more impact on the energy expenditure dedicated to keep standing than a speaking task. We also noticed an increase in muscle strain and the fact that subjects go from a CoP tactic to a center of gravity tactic which needs more energy.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Relationship between daily physical activity level and the level of physical load during physiotherapy sessions in private practice in chronic post-stroke

M. Le Bourvellec, S. Goncalves, L. Lacombe, A. Perrochon, S. Mandigout

Université de Limoges - Laboratoire HAVAE, Limoges, France

Background and Aims: The objective of our work is to study the possible relationship between the daily physical activity level of post-stroke patients in chronic phase and the level of physical effort during physiotherapy sessions in private practice. Methods: This is a cross-sectional observational study. The study population was composed of chronic post-stroke patients undergoing rehabilitation in private physiotherapy practices (France). For each patient, the following evaluations were performed: Recording of one week of activity (Armband Sensewear, Bodymedia). The parameter retained was total daily energy expenditure (Kj.h-1); Recording of 2 physiotherapy sessions. The parameters retained were the exergy expenditure (MET), the mean heart rate (Polar) and the Borg scale. Results: Our current sample consisted of 18 post stroke patients (mean age 59±9year; post stroke delay 104±112months). 36 physiotherapy sessions were recorded. Our results report a good correlation between daily energy expenditure (369±161kj.h-1) and energy expenditure recorded by the Armband (1.7±1.0 METs, r=0.36, p=0.03), mean heart rate (92±11Bpm, r=0.5,p=0.003). No correlation was found with the Borg scale (2.6±1.7, r=0.1, p=0.5) and with the post-stroke delay (r=0.28, p=0.10). Conclusions: Our results show that physical activity during physiotherapy sessions in private practice, measured with activity trackers, is correlated with the daily physical activity level of the post-stroke patient in the chronic phase. This correlation was not found with the subjective measure (Borg scale). Also we do not report any correlation between the level of physical activity during the sessions and the post-stroke delay. Professionals would therefore focus on clinical criteria to define the patient’s load threshold.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

Benefits of treatment with onabotulinumtoxina in naive and non-naive patients with cervical dystonia are sustained over time: Preliminary completer analysis from cd probe

P. Agarwal^1,2, M. Schwartz³, A. Zuzek⁴, A. Patel⁵

¹Evergreen Medical Center, Kirkland, USA, ²University of Washington, Seattle, USA, ³MS Biostatistics LLC, Clermont, USA, ⁴Allergan, an AbbVie company, Irvine, USA, ⁵Kansas Institute of Research, Overland Park, USA

Background and Aims: OnabotulinumtoxinA is a level-A treatment for cervical dystonia (CD) due to its proven efficacy and safety. This analysis evaluated the sustained effects of onabotulinumtoxinA in patients with CD who were naïve or non-naïve to botulinum toxin at enrollment in CD PROBE (CD Patient Registry for Observation of BOTOX® Efficacy), a multi-center, prospective, observational study of up to three onabotulinumtoxinA treatments. Methods: For this analysis, patients were included if they completed all treatment cycles and had accompanying data. Assessments included CD severity, Cervical Dystonia Impact Profile (CDIP-58), Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), treatment interval, and total dose. Adverse events (AEs) were also recorded. Results: Changes in severity following each onabotulinumtoxinA treatment were generally similar between naïve (n=212) and non-naïve (n=138) patients. Severity scores were maintained or improved in most patients with mild to moderate symptoms, while 30.0-66.7% with the highest severity scores shifted to a lower severity score across the three treatments. Similarly, sustained improvements were seen in all CDIP-58 subscales and in TWSTRS total scores irrespective of CD severity and toxin status at baseline. The median time interval between injections was similar in naïve (93.0–98.0 days) and non- naïve patients (96.0–97.0 days); doses tended to be lower in naïve patients. The most common AEs (dysphagia, muscular weakness) were similar. Conclusions: CD severity was attenuated by repeat onabotulinumtoxinA treatments at consistent intervals regardless of prior botulinum toxin exposure as seen in this preliminary completer analysis. Treatments were well tolerated.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

Onabotulinumtoxina dosing is consistent over time regardless of treatment interval: Analysis from the adult spasticity international registry (ASPIRE)

A. Esquenazi¹, W. Feng², G.F. Wittenberg^3.4, P. Gallien⁵, A. Baricich⁶, K. Fanning⁷, A. Zuzek⁸, G.E. Francisco^9,10, D.S. Bandari¹¹

¹MossRehab Gait and Motion Analysis Laboratory, Elkins Park, USA, ²Duke University School of Medicine Comprehensive Stroke Center, Durham, USA, ³University of Maryland, Baltimore, USA, ⁴University of Pittsburgh, Pittsburgh, USA, ⁵Pôle MPR Saint Hélier Rennes MS Clinic, Rennes, France, ⁶ Universitá del Piemonte Orientale, A. Avogadro, Novara, Italy, ⁷Vedanta Research, Wilmington, USA, ⁸Allergan, an AbbVie Company, Irvine, USA, ⁹University of Texas McGovern Medical School, Houston, USA, ¹⁰TIRR Memorial Hermann, Houston, USA, ¹¹Multiple Sclerosis Center of California, Newport Beach, USA

Background and Aims: To evaluate the relationship between dosing and treatment intervals of onabotulinumtoxinA for real-world treatment of adult spasticity, data were evaluated from the prospective, observational, international Adult Spasticity International Registry (ASPIRE; NCT01930786). Methods: Data were collected over 2 years (N=730 patients). Treating physicians determined dosing and treatment intervals of onabotulinumtoxinA. Patients were separated into treatment interval groups (N=2373 intervals): <12, 12-14, 15-17, 18-20, and 21+ weeks. Patients who received 3 or more treatment sessions with onabotulinumtoxinA over 2 years were treatment-adherent. Assessments were patient/clinician satisfaction items and adverse events (AEs). Results: OnabotulinumtoxinA doses were generally consistent among the treatment interval groups, ranging from mean doses of 335U (for 21+ weeks) to 387U (for 12-14 weeks). Most patients (63-76%) across all treatment interval groups received doses within the approved range (400U or less). Dosing slightly increased over treatment sessions, from 355U at session 2 to 453U at session 8. High rates of satisfaction were reported over treatment sessions: 81-92% treatment-adherent patients stated that onabotulinumtoxinA treatment helped in managing their spasticity, 73-82% were satisfied/extremely satisfied with the duration of effect, and 91-96% planned to continue use of onabotulinumtoxinA; clinicians reported similar rates, with 93-99%, 84-94%, and 99-100% answering in the affirmative, respectively. Fall (5.5%), urinary tract infection (2.6%), and muscular weakness (2.6%) were the most commonly reported AEs. Conclusions: Consistent dosing of onabotulinumtoxinA for adult spasticity was seen irrespective of treatment interval. Most patients received approved dosing levels of onabotulinumtoxinA. High patient/clinician satisfaction was reported, with no new safety signals.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Acute paraplegia as a manifestation of metastatic pulmonary neuroendocrine tumor

J. Malta, L.R. Branquinho, A. Coelho, A. Azenha

Centro Hospitalar e Universitário de Coimbra - Serviço de Medicina Física e de Reabilitação, Coimbra, Portugal

Background and Aims: Case report of a 54-year old male diagnosed with metastatic pulmonary neuroendocrine tumor. Methods: A 54-year old male construction laborer with a history of hypertension and psoriasis presented to the emergency ward with unrelentless low back pain and oliguria. Pain gradually evolved since two months despite nonsteroidal anti-inflammatory drug therapy and there was associated involuntary weight loss. Physical examination was unremarkable except for cervical lymphadenopathy. He was admitted to the ward and initiated further low back pain diagnostic evaluation. Hospital stay was complicated with an unintentional fall. The next morning the patient presented with acute flaccid paraplegia with preserved sensation. Magnetic resonance imaging revealed endocanalar epidural lesion with severe medullary compression at T8 level. After further investigation the patient was diagnosed with metastatic pulmonary neuroendocrine tumor. Results: Low back pain usually has mechanical characteristics and nonspecific etiology. However, there are several other causes that should be excluded. There must be taken attention to red flags and prompt further diagnostic evaluation must be proceeded in their presence. Acute paraplegia is usually associated with severe conditions with poor prognosis and demands prompt and detailed neurological evaluation. In this patient, acute paraplegia was the turning point towards diagnosing a rare metastatic tumor. Conclusions: This case report shows an unusual etiology of acute paraplegia and highlights the importance of an accurate clinical assessment and prompt diagnostic evaluation to distinguish a rare etiology with poor prognosis from an extremely common condition such as nonspecific lower back pain.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Rehabilitation management of late functional recovery in multiple lacunar infarct patient with fear of COVID-19 and family conflict issue

E. Maklun¹, F. Arisanti², R. Z. Goesasi²

¹Physical Medicine and Rehabilitation Department, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia, ²Hasan Sadikin General Hospital, Bandung, Indonesia

Background and Aims: Lacunar infarction has relatively good functional and neurological recovery. This case report presented unusual delayed functional recovery in lacunar infarct patient. Methods: A 65-years-old male with the chief complaint cannot walk independently since the hemorrhagic stroke, epilepsy, and knee osteoarthritis in April 2020. He could not walk due to knee pain and become inactive besides drowsiness’s effect of phenytoin. In July 2020, he had recurrent lacunar infarcts and suspected of COVID-19, being treated in an isolation room until the swab result came negative. He got rehabilitation in October 2020, but fear of COVID-19 made him rarely come for treatment. He could only sit and stand up independently by holding a walker and under supervision just for a while. He cried whenever he remembered the COVID-19 isolation room and family problem. Re-education and personal approaches to rehabilitation improved his compliance to rehabilitation programs. Depression Anxiety Stress Scale (DASS) showed moderate depression. Results: By providing an intensive and comprehensive neurorehabilitation program regularly, after five weeks, patients showed functional improvements. He was able to stand independently and walk with a walker. Sometimes he still remembered the experience in the COVID-19 isolation room, but he rarely cries, and his family problem is resolved. Depression Anxiety Stress Scale (DASS) showed a normal score. Conclusions: The patient had a good functional outcome, although having a postponed rehabilitation treatment. COVID-19 fears can delay regular rehabilitation programs. Psychological factors often become problems and sometimes forgotten. Rehabilitation services present challenges in this COVID-19 pandemic situation.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Effect of the abdominal draw-in maneuver and bracing on abdominal muscle thickness and the associated subjective difficulty

S. Madokoro, M. Yokogawa, H. Miaki

Kanazawa University, Kanazawa, Japan

Background and Aims: The purpose of this study was to clarify the relationship between the subjective difficulty of performing Abdominal draw-in maneuver (ADIM) and abdominal bracing (AB) exercises and the lateral abdominal muscle thickness during exercise. We evaluated the trunk abdominal muscle thickness while performing different exercises to identify the most training and to investigate the subjective difficulty associated with exercising. Methods: Twenty-eight men (mean age: 21.6 ± 0.9 years) without orthopedic diseases were enrolled. Ultrasonic imaging was used to measure the thickness of the transversus abdominis (TA), internal oblique, and external oblique muscles while at rest and while performing the abdominal draw-in maneuver and abdominal bracing. Measurements were made in the supine and sitting positions, and the subjective difficulty in performing each exercise was examined using a 5-level evaluation scale. Results: The TA and internal oblique muscle thicknesses were significantly greater during the abdominal draw-in maneuver (ADIM) than during bracing or resting, in the supine and sitting positions. The subjective difficulty of abdominal bracing (AB) was graded significantly higher than that of ADIM. Additionally, a correlation between subjective difficulty and muscle thickness was found for the TA and IO. Our results may contribute to the choice of more effective exercises for spinal stability. Conclusions: Based on the results and those of previous studies, ADIM is considered an inner muscle training exercise that includes the pelvic floor muscles and is relatively easy to perform. Our results may contribute to suggest more effective exercises for cases of spinal stability.

Topic: 3. Clinical Sciences

Sub Topic: 3.2 Pain Osteoporosis -Osteoarthritis

Study regarding rehabilitation in patients with degenerative low back pain using natural therapeutic factors

I. Madalina, M. Iliescu, A. Lupu, L. Stanciu, E. Ionescu

Ovidius University, Constanta, Romania

Background and Aims: The salty water and the sapropelic mud of the lake Techirghiol have been the subject of numerous research studies in rehabilitation field. The aim of our study is to evaluate the impact of hydro-kinetotherapy in the salty water of Techirghiol lake, on patients withdegenerative low back pain. Methods: We evaluated 73 patients, aged between 30 and 65 years, with chronic degenerative low back pain, hospitalized for rehabilitation treatment in Balneal and Rehabilitation Sanatorium of Techirghiol for a period of 2 weeks. The patients were divided into 2 groups, one group had hydro-kinetotherapy in the lake (hydro-kinetotherapy group – HKT), and the other group had no kinetotherapy (control group – CG). Both groups had electrotherapy (low, medium and high frequency currents, magnetic therapy, ultrasound therapy, laser therapy) and massage. All patients were evaluated using the analog visual scale, lumbar disability questionnaires (Roland-Morris questionnaire), the Back Performance Scale and the Short-Form 36 questionnaire (SF-36) before and after the treatment. Results: We discovered statistically significant differences between the values of the questionnaire at admission and at discharge (p<0.001). Conclusions: So, we can say that hydro-kinetotherapy in salty water among special rehabilitation treatment decrease the pain and dysfunction for patients with this pathology, with big improvement of quality of life.

Reference

Iliescu MG, Lupu AA, Ionescu EV, Tica I, Almasan RE, Oprea C. Water, nature, techirghiol- long-term therapeutic benefits for patients with degenerative low back pain. J Environ Prot Ecol 2019;20:1505-16.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Real-life effectiveness of rehabilitation treatments in the Italian thermal environment on pain perception and quality of life of musculoskeletal disorders patients

S. Masiero¹, G. Magro², M. C. Maccarone², C. Finamoni³, G. Barbetta⁴, D. Minuto⁵, S. Marcoli⁵, C. Sigurtà⁵, S. Barone⁵, C. Castaldelli⁵, L. Tognolo¹

¹Department of Neuroscience, Rehabilitation Unit, University of Padova, Padova, Italy, ²Physical Medicine and Rehabilitation School, University of Padova, Padova, Italy, ³University of Padova, Padova, Italy, ⁴Struttura Termale La Contea, Battaglia Terme, Padova, Padova, Italy, ⁵Terme di Sirmione, Brescia, Sirmione, Italy

Background and Aims: In vitro studies have demonstrated thermal waters to be effective on musculoskeletal disorders. In Italy, there are numerous thermal structures exploiting waters and muds with specific physicochemical characteristics for treatment, prevention and rehabilitation of several diseases. This multicentre observational study aims to investigate the impact of rehabilitation treatments conducted in the spa setting in patients suffering from subacute and chronic/degenerative musculoskeletal diseases. Methods: Through the involvement of six spas located throughout the country, 151 patients have been enrolled (104 females and 47 males with an average age of 64,55 years). To them a questionnaire designed to mainly assess pain and Quality of Life (QoL) before rehabilitation and after the treatment has been given. Evaluation scales considered in the questionnaire were Numerical rating scale (NRS), Short form health survey (SF-12), and EuroQol-5D (EQ-5D), administered in the Italian validated version. Results: Data analysis has highlighted that rehabilitation carried out in the spa environment leads to a statistically significant improvement in pain perception and QoL: on average NRSp improves by 2.50, SF-12 Physical Component Summary (PCS) by 4.22, SF-12 Mental Component Summary (MCS) of 7.03, and EQ-5D of 0.25. No statistically significant differences were identified between the inpatients and outpatients. Conclusions: This study seems to suggest an important role of the rehabilitation treatments in the spa setting on pain and QoL of musculoskeletal disorders patients. Further studies are desirable in order to evaluate in real life the medium and long-term benefits of rehabilitation treatments conducted in the spa environment.

Topic: 4. Therapeutics

Sub Topic: 4.4 Pharmacological agents

Impact of patient input on the study execution of an observational study assessing the effectiveness of abobotulinumtoxina treatment in leg spasticity management in adults

A. Esquenazi¹, P. Maisonobe², C. Durán Sánchez², A. Lysandropoulos², S. Ashford³

¹MossRehab and Albert Einstein Medical Center, Elkins Park, USA, ²Ipsen, Boulogne-Billancourt, France, ³Regional Hyper-Acute Rehabilitation Unit, Northwick Park Hospital, London, United Kingdom

Background and Aims: It is increasingly accepted that people living with long-term conditions should be involved in the design, conduct and dissemination of research that affects them. Methods: A one-day structured workshop was conducted with a small focus group of patients with leg spasticity. The day was split into presentations and discussions about the study design, the process of goal setting in spasticity, and an open feedback session. Results: Key learnings were that the clinical research process can be confusing for patients who do not clearly understand medical terminology. For example, when reviewing the informed consent process, patients emphasised the need for clear, jargonless explanations of the study objective to enable participation. The AboLiSh study aims to assess the longitudinal attainment of person-centred and function-related goals following repeat treatment cycles with abobotulinumtoxinA for spasticity management. Patient feedback was that, for optimal engagement with the process, they require training on appropriate goal setting, and that this could be delivered by a well-designed leaflet they can read in advance of their visit. Finally, patients noted that they can feel undervalued when not kept informed of study results. Conclusions: Following the patient workshops, a goal-setting leaflet has been produced to aid patient and caregiver understanding of the process. Patients will receive regular updates by newsletter (digital and paper), and will be invited to review the results once the study completes.

Reference

Smits E, Boon W. The role of users in innovation in the pharmaceutical industry. Drug Discov Today 2008;13:353–9.

Topic: 4. Therapeutics

Sub Topic: 4.3 Integrative Medicine

Electroacupuncture prevents synovitis, inhibits cartilage degeneration and ameliorates subchondral bone deterioration by inhibiting mitogen-activated protein kinases in a rat model of osteoarthritis

F. Luo, Y. Liao, P. Zhong, J. Tan, T. Peng, P. Ning, L. Zhou, J. Zhou

The First Affiliated Hospital of University of South China, Hengyang, China

Background and Aims: The therapeutic effects of electroacupuncture (EA) on osteoarthritis (OA) are well documented, however, the precise mechanisms of action have not yet been fully elucidated. The present study aimed to investigate the effect of EA on synovium, cartilage and subchondral bone in an experimental animal model of OA induced by anterior cruciate ligament transection (ACLT) and to examine concomitant changes in the expression of mitogen-activated protein kinases pathway in the articular cartilage. Methods: Thirty 3-month-old male Sprague Dawley rats were randomly divided into the following three groups (n=10 each): sham operated group, ACLT without treatment, and ACLT with EA treatment. One week after ACLT, rats in the EA group received 12 weeks of EA treatment. Histological analysis, micro-CT imaging and quantitative real-time polymerase chain reaction were used to investigate the effects of EA on synovitis, cartilage morphology, the microstructure of the subchondral bone and mRNA expression of expression of MAPKs (p38, c-Jun), and extracellular signal regulated kinase (ERK)1), respectively. Results: Mankin scores in the EA group were significantly lower than the ACLT group. In the EA group trabecular bone volume ratio, trabecular thickness and trabecular number increased, and trabecular separation reduced compared with the ACLT group. The increase in mRNA expression of p38, c-Jun, and ERK1 observed in cartilage after ACLT was significantly inhibited by EA. Conclusions: Electroacupuncture appears to prevents synovitis, inhibits cartilage degeneration and ameliorates subchondral bone deterioration, at least partly, through inhibiting mitogen-activated protein kinases pathway in the cartilage of rats with ACLT-induced OA.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Rehabilitation of a patient with beriberi neuropathy a case report

W. L. Lui, Y. H. Low, W. L. W. Chan

Department Of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore

Background and Aims: Dry beriberi is a nutritional neuropathy resulting from thiamine deficiency and is common in alcoholism. We present our experience in the rehabilitation management of a lady with beriberi neuropathy. Methods: Case report. Results: A 33-year-old lady, who consumed 70 units of alcohol a week, presented with progressive weakness over 2 months and had gradually lost her ability to ambulate. Examination showed predominantly distal weakness, absent reflexes and impaired sensation. Investigations revealed electrodiagnostic evidence of a length dependent sensorimotor axonal polyneuropathy. Given the strong history of alcohol use, she was diagnosed with beriberi and started on thiamine supplements and multivitamins. On admission to the rehabilitation centre, her motor power was 4-5 in the upper limbs and 1-2 in the lower limbs on the Medical Research Council (MRC) scale. She was unable to ambulate. Her rehabilitation programme included strengthening, balance, ambulation and endurance training. A psychologist reviewed her regularly given her emotional distress resulting from the functional deficits and loss of independence. Her nutritional status was optimised with inputs from a dietician. She continued to show improvement in her strength and achieved independence in the activities of daily living and homebound ambulation with a rollator frame. 6 months after discharge, she was able to ambulate in the community with an elbow crutch and made plans to return to work. Conclusions: This case illustrates the importance rehabilitation of patients with beriberi neuropathy. This patient, who was initially functionally dependent, was able to achieve independence in community ambulation and is ready to return to work.

Topic: 7. Functioning and Disability

Sub Topic: 7.4 Impairment Rating, Disability Evaluation and Certification

Based evidence recommendations for the diagnosis and rehabilitation treatment of people older than 7 years with low vision

L. H. Lugo Agudelo¹, M. P. Oviedo Cáceres², A. M. Posada Borrero³, C. M. Velez³, J. C. Suárez Escudero⁴, E. Astudillo⁵, M. L. Hernández¹, P. A. Ramírez¹

¹Universidad de Antioquia, Medellín, Colombia, ²Universidad de Santo Tomas, Bucaramanga, Colombia, ³University of Antioquia, Medellín, Colombia, ⁴Universidad Pontificia Bolivariana, Medellín, Colombia, ⁵Universidad Pontificia Bolivariana, Medellín, Colombia

Background and Aims: Systematically develop evidence-based recommendations for the diagnosis, functional rehabilitation and, follow-up of people with low vision between 7 and 18 years and over 18 years which serve as support to health personnel and patients in comprehensive treatment of people with this condition. Methods: An interdisciplinary group formed by thematic experts, optometrists, physiatrist, neuropsychological rehabilitator, Ph.D in health policies and, methodological experts in Clinical practice guidelines (CPG) based on GRADE. There was participation of a group of patients. PICO research questions were agreed, outcomes were defined and prioritized, a structured search was carried out, included studies were selected, the quality of evidence of each study was evaluated and evidence of whole studies was rated with GRADE. Recommendations were made with the Grade Evidence to decision Framework (EtD). These were validated with a group of national experts (clinicians, academics, and researchers. Results: The results are presented in the [Table 1]. Conclusions: There is the first CPG for people with low vision in Colombia. It is important to improve the quality of care, diagnosis, and rehabilitation treatment for people whit this condition, improve functioning and quality of life. This guideline was supported by: Universidad Santo Tomas de Bucaramanga, Instituto de las desigualdades de Barcelona, Universidad de Antioquia, Colombia y Universidad Pontificia Bolivariana de Medellín, Colombia.

Topic: 6. Health Policy and Systems

Sub Topic: 6.9 Big Data and Cohorts

Adaptations for rehabilitation services during the COVID-19 pandemic proposed by scientific organizations and rehabilitation professionals

L. H. Lugo Agudelo¹, K. M. Cruz², M. A. Spir³, J. C. Velasquez⁴, A. M. Posada⁵, L. F. Mesa⁶, R. Di Dio⁷, P. A. Ramirez⁸, C. M. Velez⁹, D. F. Patiño¹⁰, C. Gutenbrunner¹¹

¹University of Antioquia, Medellín, Colombia, ²Hannover Hospital, Hannover, Germany

Background and Aims: To describe adaptations in the provision of rehabilitation services proposed by scientific rehabilitation associations to avoid interruption in patient´s rehabilitation process and delays for starting rehabilitation in patients with COVID-19. Methods: We used a rapid review approach to identify the recommendations of scientific and professional organizations in the area of rehabilitation. We performed a systematic search in the main databases and in 78 international and regional web portals of rehabilitation organizations. Publications of 21 associations of physical medicine and rehabilitation and other related professions were identified and selected. Results: Findings are presented in four categories: Adequacy of inpatient services, including acute care services and intensive care unit (ICUs) for patients with and without COVID-19; adequacy of outpatient services including home-based rehabilitation and tele-rehabilitation; recommendations to prevent the spread of COVID-19 and regulatory standards and positions during COVID-19 pandemic expressed by associations for protecting the rights of health workers and patients. Conclusions: Rehabilitation care should involve vulnerable populations, such as older people, people with disabilities and people living in poverty. It is necessary to improve the access to rehabilitation in people with disabilities and other vulnerable populations with COVID-19, who live in low- and middle-income countries (1). Actions aimed at the reorganization of rehabilitation services for active patients in the process of recovery from acute or chronic conditions and the rapid response to the rehabilitation of survivors of COVID-19, as well as all efforts in the prevention of contagion of those who provide the services (2,3).

Topic: 4. Therapeutics

Sub Topic: 4.3 Integrative Medicine

Clinical study of electroacupuncture combined with occupational therapy on postoperative hand dysfunction in patients with cervical spondylotic myelopathy

H.Y. Lu¹, Q. Shao¹, J. Min¹, X. Qiu¹

¹Shanghai GUANGHUA Hospital, Shanghai, China, ²Shanghai CHANGHAI Hospital, Shanghai, China, ³Shanghai SHIDONG Hospital, Shanghai, China, ⁴Shanghai No.9 Hospital, Shanghai, China

Background and Aims: To investigate the effect of electroacupuncture combined with occupational therapy on hand dysfunction in patients with cervical spondylotic myelopathy after surgery. Methods: From April 2018 to August 2020, 60 patients with cervical spondylotic myelopathy who underwent anterior cervical decompression and internal fixation were selected and randomly divided into a control group and a treatment group. The control group was treated with conventional drugs and electroacupuncture, and the treatment group was combined with occupational therapy on this basis for a total of 2 weeks. The Lindmark wrist motor function score, DHI hand function index, and modified Ashworth scale (MAS) were used when patients were enrolled, Intervention for 1 week, 2 weeks after the start of treatment, and 6 weeks after the end of the treatment. Results: Six weeks after the end of treatment, the Lindmark score, DHI index and MAS score between the two groups were significantly improved. Compared with the same group before treatment, the differences were statistically significant (P<0.05). The Lindmark score, DHI index and MAS score of the treatment group were significantly better than those of the control group (P<0.05). Conclusions: The use of electroacupuncture combined with occupational therapy can promote the improvement of hand dysfunction in patients with cervical spondylotic myelopathy after surgery, and improve the quality of daily life of patients.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Intermittent hypoxia in incomplete spinal cord injury – A review

C. Lourenço, A. Pascoal, C. Pires, R. Correia, F. Morais, J. Lains, P. Margalho

Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, Tocha, Portugal

Background and Aims: In an incomplete Spinal Cord Injury (SCI) some synaptic connections are preserved. Some studies suggest that exposure to low levels of oxygen may stimulate spinal cord plasticity improving strength and functionality months or even years after the injury. The aim of this paper is to review the evidence of intermittent hypoxia in muscle strength and functionality after SCI. Methods: A bibliographic search was conducted in Pubmed with the keywords: “spinal cord injury” and “intermittent hypoxia” and respective MeSH terms. We included randomized clinical trials in humans that studied the effect of intermittent hypoxia in motor functions after SCI; and excluded ongoing trials. Results: A total of 9 articles were found. After criteria application 6 randomized clinical trials were selected. All of them selected chronic motor incomplete SCI patients and had small samples. The intermittent hypoxia protocol used in the studies was similar (15 periods of 90 seconds of 9% O2 with 60 seconds interval of normoxia) and the most commonly evaluated outcome was walking speed and endurance. The maximum follow-up was 2 weeks; most of the studies evaluated the subjects immediately after the procedure. All the studies reported immediate favorable outcomes with intermittent hypoxia and no side effects were observed. Conclusions: Intermittent hypoxia is a recent non-invasive and safe method to induce plasticity in spinal cord. The studies found suggest that this technique may improve several motor functions; however there are no long-term follow up studies. As such, larger samples and long-term studies are necessary to establish the efficacy of this treatment.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Drop-foot as anorexia nervosa presentation

C. Lourenço¹, A. Pascoal¹, F. Morais¹, P. Figueiredo²

¹Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, Tocha, Portugal, ²Centro Hospitalar e Universitário de Coimbra - Hospital Pediátrico, Coimbra, Portugal

Background and Aims: Drop foot has a variety of causes in any point of the pathways that control dorsiflexor muscles. Lesion location is important for diagnosis and prognosis. Common fibular nerve compression on the fibular head is the most common location and is mostlycaused by direct pression. Methods: 17-year-old female goes to ER with progressive strength loss of right ankle dorsiflexors and paresthesia in the foot and leg in previous week without any trauma. At observation she presented muscle strength G2 (MRC scale) in ankle dorsiflexion and eversion and hallux and finger extension; hypoesthesia in posterolateral leg and dorsal side of foot; and steppage on gait. Anamnesis revealed a restrictive eating pattern with an increase in physical activity in the last 7 months. She had lost 21kg (46lb), 3 months of amenorrhea and hair loss. Therefore anorexia nervosa was suspected and later confirmed. Results: EMG showed a right common fibular nerve neuropraxia and she started physical therapy oriented to ROM maintenance and analytic muscle strengthening to avoid excessive caloric consumption. Conclusions: Although rare, drop foot my occur as a complication after rapid weight lost as in anorexia and after bariatric surgery. Etiology is unclear but subcutaneous cellular tissue reduction may diminish nerve protection. Lesion prognosis is good with full recovery in most. In this case we’re before an adolescent with anorexia nervosa without previous suspicion that could have been missed without a careful anamnesis. As such, the authors pretend to alert to this diagnostic hypothesis of drop foot etiology.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Efficacy of transdermal scopolamine for sialorrhea in neurological pathology – Our hospital center experience

C. L. Lopes Martins, C. Lima, A. Gomes, D. Martins, A. Santos, N. Mota, R. Madureira, J. Brochado, E. Afonso

PMR Department, Centro Hospitalar Universitário Algarve, Faro, Portugal

Background and Aims: Sialorrhea is a common in neurological conditions, with physical and psychological consequences. The treatment is complex. Our goal was to evaluate the efficacy and safety of transdermal scopolamine (TS) in neurological patients undergoing treatment at our center. Methods: This study included neurological patients treated for sialorrhea with TS in rehabilitation appointment, from january/2019 to september/2020. Sociodemographic data and underlying pathology were recorded. Treatment efficacy was assessed by Drooling Severity and Frequency Scale(DSFS) and Modified Teacher Drooling Scale(mTDS). Side effects were investigated. Data were obtained from clinical files and a descriptive statistical analysis was performed. Results: 5 patients were included, 80% female, mean age of 66.4 years. 2 were previously taking amitriptyline, which may have therapeutic effect on sialorrhea, but the dose remained stable during this study. According to DSFS, 80% improved the severity of sialorrhea, with an average decrease of 1.4 out of 5. 40% improved the frequency, with an average decrease of 1 out of 4. According to mTDS, the decrease in sialorrhea had an average value of 2 out of 8. We had 1 case of local disk allergy and 1 case of dry mouth. All patients maintained the treatment, and the dose was adjusted as needed. Conclusions: In our experience, sialorrhea’s treatment with TS was effective. 2 patients had minor side effects. As limitations, we point out the small number of patients, the short follow-up and the absence of validated scales for portuguese population. Larger scale studies and longer follow-up are needed to optimize TS results and safety.

optional

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Neuroendocrine dysfunction after traumatic brain injury - A case report

C. L. Lopes Martins¹, A. Gomes¹, R. Espírito-Santo², J. Riosa²

¹PMR Department, Centro Hospitalar Universitário Algarve, Faro, Portugal, ²Endocrinology Department, Centro Hospitalar Universitário Algarve, Faro, Portugal, ³Centro de Medicina de Reabilitação do Sul, São Brás de Alportel, Portugal

Background and Aims: Neuroendocrine dysfunction is a recognized complication of Traumatic Brain Injury (TBI). It can cause both short and long-term morbidity resulting in cognitive, physiological, and behavioral decline, which increases burden of the disease and health care costs. Evaluation of pituitary function on an ongoing basis after TBI is a paramount. Our aim is to review this frequent and underdiagnosed entity. Methods: Case report. Results: A healthy 28-year-old man presented to the rehabilitation department with a 5-month history of cognitive, communication, motor and postural alterations after a severe TBI, had been medicated with levetiracetam, quetiapine, diazepam and propranolol. At admission, his free testosterone was very low (0.8pg/mL, reference range 19,8-51,7pg/mL), with normal gonadotropins levels. Cortisol level was slightly low: 2 µg / dL (reference range 5-25µg/dL), while serum Prolactin (PRL) was elevated (41.9ng/mL, reference range 3.46-19.4ng/mL). All other results were normal (free T4, TSH, serum osmolarity, sodium, random glucose). Magnetic resonance imaging showed no abnormalities. After our study, hyperprolactinemia was considered iatrogenic and resolved with quetiapine and levetiracetam weaning. Since gonadotropins were normal, hypogonadism was interpreted as secondary do hyperprolactinemia. Adrenal Insufficiency was medicated with corticosteroid. Analytic changes resolved in 1 month. Cognitive impairment and psychomotor slowing also slightly improved. Conclusions: Neuroendocrine dysfunction after TBI is readily treatable, ensuring a remarkable reduction in morbidity and improvement in quality of life. Regular assessment and monitoring of pituitary functions after severe TBI should always be considered, even in asymptomatic patients.

References

doi: 10.1089/neu.2012.2494.
doi: 10.1097/HTR.0b013e318250eac6.
doi: 10.1007/s11102-006-6053-1.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Lumbar spine in Cespu office workers group: Risk factors

S. Lopes, A. Bento, E. Citarella, P. Monteiro, F. Araújo, G. Brochado

Escola Superior de Saúde do Vale do Sousa, Paredes, Portugal

Background and Aims: Work-related Skeletal Muscle Injuries have been increasing over the last few decades. Long time sitting position, induces the adoption of inappropriate postures and resulting in an overload in the structures of the skeletal muscle system. The objective is to characterize and evaluate the lumbar disability of the office workers of CESPU’s groups and analyze the individual, psychosocial and physical risk factors. Methods: A cross-sectional study was conducted with a sample of 22 office workers. The characterization questionnaire and the Oswestry Index on Lumbar Disability (version 2.0) was applied via institutional email. Descriptive and inferential statistics were performed, with a significance level of 0.05. Results: The sample consists mainly of females (n = 20), with a median (interquartile range) of 45 (13) years. In the score of the lumbar disability index, the sample presents a moderate disability. The association between the low back pain disability with the sociodemographic data, health and well-being status, professional information and working conditions, does not present statistically significant results. Only association with smoking habits was found (p = 0.040), discomfort during work (p= 0.024) and absences due to discomfort (p = 0.024) with lumbar disability index. Conclusions: The office workers of CESPU present a moderate disability in the lumbar. There was only an association with smoking habits, discomfort during work and absenteeism with low back disability.

Reference

Ye S, Jing Q, Wei C, Lu J. Risk factors of non-specific neck pain and low back pain in computer-using office workers in China: A cross-sectional study. BMJ Open 2017;7:9-11.

Topic: 6. Health Policy and Systems

Sub Topic: 6.9 Big Data and Cohorts

Validation of a Covid risk detection questionnaire – 19 in external consultation

P. Loeza Magaña, A. Davila Tejeida, M. Martinez Tagle, G. Resendiz Garcia, J. Arteaga Martinez, I. Lucatero Lecona

National Medical Center 20 de Noviembre, ISSSTE., Ciudad de Mexico, Mexico

Background and Aims: In order to care for outpatients in health services, it is necessary to havetools to reduce the risk of transmission of SARS-Cov2 between users and health personnel. Observational, cross-cutting, descriptive study to determine the validity of a questionnaire for risk detection of COVID – 19 in outpatients. Methods: The current health status questionnaire (self-administered) was published in the Colombian Journal of Physical Medicine and Rehabilitation (1), transferred to google forms and sent through electronic means to different groups of people ages and professions, requesting to answer it. A copy of the form was generated, and the next day it was sent in the same way to the same people. For statistical analysis, the intraclass correlation coefficient was determined. Results: 280 subjects answered the first request; 189 answered the second. The data was collated to obtain those who had fully answered both. The final sample was 110 subjects from 39.6 + 9.6 years old. High correlation was found in all 10 responses. 1: 0.959, 2: 0.923, 3: 0.898, 4: 0.771, 5: 0.836, 6: 0.868, 7: 0.835, 8: 0.821, 9: 0.918, 10: 0.909. Conclusions: The answers obtained to verify that the CURRENT HEALTH STATUS QUESTION (self-administered) for the risk detection of COVID-19 detects what it intends, is understandable and has adequate reproducibility, so we suggest its implementation in medical consultations.

Reference

Loeza P, Martínez M, Dávila AB, Arteaga JR, Reséndiz GM. Questionnaire of current health status (self-administered) for a detection of risk of transmission of Covid-19 in ambulatory patients. Rev Col Med Fis Rehab 2020;30:171-3.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Influence of lifestyle on cognitive function after stroke in the elderly: A cross-sectional study

Z. Liu

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

Background and Aims: Stroke has become the first fatal disease in China. Post-stroke cognitive impairment (PSCI) not only seriously affects the daily living ability and social function of patients but also increases the mortality rate of patients. The risk factors have been identified in the current PSCI study including stroke-related factors, age, education level, pre-stroke cognitive status,cardiovascular risk factors, or other factors. However, it is not clear whether obesity, depression, and other factors can increase the risk of PSCI. So our study aims to examine the cross-sectional association between lifestyle, hobbies, and cognitive function among elderly stroke patients in China who are in the rehabilitation hospital. Methods: A total of 124 individuals aged 60 years or older stroke patients, living in the rehabilitation hospital, Shanghai,China, were assessed cognitive function and collected basic information such as Body Mass Index(BMI), hobbies, smoking, drinking,The Pittsburgh Sleep Quality Index(PSQI), Function Independent Measure(FIM). We analyzed the correlations between these factors and cognition. Results: MMSE was positively correlated with the number of hobbies(r=0.407, P<0.01) and FIM (r=0.692, P<0.01)but not with PSQI (r=-0.08,P=0.383), BMI (r=0.059,P=0.512) smoking (r=0.166,P=0.064)and drinking(r=0.129,P=1.51). Conclusions: Our study suggests that previously more number hobbies may protect the cognitive function of elderly stroke patients. The mechanism may be related to cognitive reserve. There was no significant correlation between cognition to depression degree, obesity,smoking ,and drinking in elderly stroke patients, but there was a positive correlation with FIM. We still need to increase the sample volume and categorize hobbies and analyze the relationship between the types of hobbies and cognitive function in further time.

Topic: 3. Clinical Sciences

Sub Topic: 3.9 Cardiac/ Pulmonary Rehabilitation

ECC-BYF III combined with exercise rehabilitation suppress oxidative stress in copd rats: Via Ppar<GAMMA>/RAGE/NOX4 pathway

K. Chen¹, H. R. Dong², D. Zhao¹, R. S. Rui¹, K. X. Xu¹, R. L. Lu¹, M. M. Yan², J. S. Li³

¹HUTCM-Department of School of Basic Medicine, Zhengzhou, China, ²HUTCM-Department of First School of Clinical Medicine, Zhengzhou, CHINA, ³HUTCM, Zhengzhou, China

Background and Aims: Effective-component compatibility of Bufei Yishen formula III (ECC-BYFIII) combined with Exercise Rehabilitation (ER) have beneficial effect in treatment of chronic obstructive pulmonary disease (COPD). Oxidative stress is a pathological process in COPD, and therefore we hypothesized that ECC-BYFIII and ER would modify oxidative stress in COPD via PPARγ/RAGE/NOX4 pathway. Methods: The rats were randomly divided into Control, Model, ECC-BYFIII, ER, ECC-BYFIII+ER and APL groups, A model of COPD was established by cigarette exposure combined with klebsiella pneumoniae

repeated infection method. Once established, some were treated for a further 8 weeks with ECC-BYF, ER (exercise training, 20min/d) and their conbination. Lung function, tissue structure by histology, indicators of oxidative stress (SOD,GPX,MDA) and PPARγ/RAGE/NOX4 signaling were measured. Results: COPD rats had reduced lung function (FVC, FEV0.1), serious emphysema, increased oxidation factors (MDA), decreased antioxidant (SOD1, SOD2, GPX), as well as PPARγ. All the treatment groups can improve lung function and histopathology, ECC-BYF+ER was better than other group in improving FEV0.1 and the alveolar structure. ECC-BYF,ER and ECC-BYF+ER groups can increased SOD1,SOD2, GPX and PPARγmRNA and protein in lung tissue (P<0.01), meanwhile decreased RAGE, NOX4 mRNA and protein (P<0.05), ECC-BYF+ER was better than ER group in increasing SOD1 and PPARγmRNA(P<0.05, P<0.01). Conclusions ECC-BYFIII, ER and their combination have beneficial effect and anti-oxidation effects, especially ECC-BYFIII combined with ER. the mechanism maybe involved in regulating PPARγ/RAGE/NOX4 signaling.

Topic: 3. Clinical Sciences

Sub Topic: 3.9 Cardiac/ Pulmonary Rehabilitation

The effect characteristics of ECC-byfiii combined with acupuncture in copd rats: Based on the onset time and long-term effects

Y. Liu¹, Y. F. Miao¹, L. Liu¹, R. Wang³, F. Yang¹, L. L. Cui², X. C. Wang¹, J. S. Li²

¹HUTCM-Department of School of Basic Medicine, Zhengzhou, China, ³HUTCM-Department of First School of Clinical Medicine, Zhengzhou, China, ⁸HUTCM, Zhengzhou, China

Background and Aims: To evaluate the effect characteristics of effective-component compatibility of Bufei Yishen formula III (ECC-BYFIII), acupuncture and its combination in rats with chronic obstructive pulmonary disease (COPD) at different treatment time points. Methods: The COPD model was prepared by SPF SD rats. Once prepared, from week 13-20, some rats were given ECC-BYF, acupuncture, ECC-BYF combined with acupuncture. Aminophylline was used as a control. The rats were sacrificed at week 14, 16, 20, 24 and 28. Lung function was assessed by PFT pulmonary function system, tissue structure by histology, Antioxidants (T-AOC, T-SOD), Oxidant (LPO), and the markers of pulmonary vascular remodeling (VEGF, ET-1) were observed. Results: COPD rats had reduced lung function, and increased oxidative stress, emphysema, and vascular remodeling. ECC-BYF and its combination with acupuncture were effective in improving lung function and pulmonary pathology in rats after 1 month treatment and in improving oxidative stress and pulmonary vascular remodeling after 2 weeks treatment, and still had the beneficial effect after 2 months of drug withdrawal. While acupuncture had a short duration of improvement of lung function, a late onset of pathological improvement, and an early onset of improvement of pulmonary vascular remodeling, but a short duration of maintenance. The improvement of lung function and oxidative stress by the ECC-BYF combined with acupuncture was better than that by acupuncture. Conclusions: ECC-BYF, acupuncture and their combination all have good effect in COPD rats. ECC-BYF combined with acupuncture have better effect and long-term effect than acupuncture in improving lung function and oxidative stress.

Topic: 1. Biomedical sciences

Sub Topic: 1.4 Neuroscience

Focal vibration enhances decreasing of human digital sensory nerve action potentials in spastic hands: A pilot study

F. Liu¹, Y. Zhu², R. Weber², M. Shi¹, Z. Zhang¹, Y. Yao¹, J. Fu¹, X. Gu¹

¹Department of PM and R, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China, ²Department of PM and R, State University of New York Upstate Medical University, Syracuse, USA

Background and Aims: We studied the impact of vibratory stimulation on the electrophysiological features of digital sensory nerve action potentials (SNAPs) of median nerve in spastic hands. Methods: The antidromic digit 3rd SNAPs were recorded in 6 stroke patients (3 male, 3 female, 51 to 67 years old) before, during and after applying a vibration to dorsal 3rd metacarpal phalangeal joint (MCPJ) at 60 Hz and amplitude of 2 mm. 100% supramaximal stimulus intensity were performed in all the 6 subjects of median nerves in the middle of the wrists, the SNAP sizes were recorded on digit 3rd using the adhesive ring electrodes. Results: The amplitude of digit 3rd SNAP declined 35.6%±2.97% when a vibration was applied to dorsal MCPJ digit 3 of spastic hands. These impacts did not change by increasing the electrical stimulus intensity. SNAP regained its baseline value immediately after the cessation of vibration stimulation. The magnitude of size reduction of dorsal digit 3rd SNAP was less (14.7%±4.57%) when vibration was moved to the non-spastic dorsal MCPJ of digit 3. Conclusions: The marked drop of the SNAP size during vibratory stimulation in spastic hands more than non-spastic hands reflects the decreased responsiveness of A beta afferent nerve fibers to electrical stimulation, which may relate to tonic vibration reflex that enhanced vibration stimulus to the spastic hands. This mechanism deserves further investigation in the study of focal vibration in neural rehabilitation of decreasing muscle tone.

Topic: 3. Clinical Sciences

Sub Topic: 3.2 Pain Osteoporosis - Osteoarthritis

The effect of tai Chi wave-hand-in-cloud movement on the dynamic stability of females with knee osteoarthritis

Z. Lin¹, X. Wang^1.2, B. Liu^1,2, M. Hou^2,3

¹College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China, ²Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fuzhou, China, ³National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional, Fuzhou, China

Background and Aims: Tai Chi, especially the “mother” form Wave-Hand-in-Cloud (WHIC), is considered as a therapeutic exercise for patients with KOA. However, it is controversial whether lateral walking and squatting movement may increase the instability. This study aimed to compare the dynamic stability of patients with KOA and the healthy control group in the process of WHIC movement. Methods: Fifteen patients with KOA and fifteen age-matched subjects without KOA were recruited from local communities. All were Tai Chi beginners and no daily exercise habits. They learned the WHIC movement followed an experienced Tai Chi master for 2 days. The biomechanics parameters including kinematic and kinetic, dynamic stability indicators were collected with a Qualisys 3D motion capture system and analyzed by Visual3D software. The COM-COP (center of mass–center of pressure) inclination angle (IA) and the peak distance of COM to COP were calculated to assess the dynamic stability. The kinematic and kinetic variables were also investigated. Results: The patients with KOA had significantly smaller IACOM-COP in the medial-lateral direction (1.45±0.30 for the KOA group, 1.74±0.35 for the control group, P = 0.02). The peak and mean ankle dorsiflexion ROM were significantly smaller in the patients with KOA than the controls (P = 0.01). The peak knee flexion moment was significantly higher in patients with KOA than the controls (P = 0.04). Conclusions: Patients with KOA may adjust their gait pattern through ankle and hip joints for more lateral dynamic stability when performing the WHIC movement. WHIC is suitable for patients with KOA to improve their stability.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

The efficacy of upper-extremity robot-assisted therapy on hemiplegia limbs: A multi-center randomized clinical trial

Y. Lin, J. Jia

Huashan Hospital, Fudan University, Shanghai, China

Background and Aims: Our aim was to investigate the efficacy of upper-extremity robot-assisted therapy with a novel system on hemiplegia limbs compared with the enhanced upper-extremity therapy by therapists during poststroke rehabilitation. Methods: Prospective, randomized, single-blinded, multicenter exploratory clinical trial in China of 172 individuals with 7 days to 2 years post-stroke to receive 30 minutes of upper-extremity robot-assisted therapy or enhanced therapy in addition to standard rehabilitation for up to 4 weeks(15 sessions). Upper extremity impairment before and after the intervention was measured using the Fugl-Meyer assessment and Modified Barthel Index. Results: Robot-assisted therapy improving upper-extremity Fugl-Meyer assessment was not inferior to enhanced upper extremity therapy ([CI], -0.71 to 3.37), while was precede in lower-extremity Fugl-Meyer assessment (3.35±3.00 versus 2.12±2.54, p<0.05). No significant changes in upper-extremity Fugl-Meyer assessment and modified Barthel index between groups were observed (p>0.05 for both). Conclusions: Upper-extremity robot-assisted therapy as a substitution of enhanced therapy may improve upper and lower extremity recovery in poststroke patients.

Topic: 7. Functioning and Disability

Sub Topic: 7.1 ICF

Using functioning scale of the disability evaluation system-child version in people with learning disabilities: A 3-year follow-up

L. Lin, T. Liou, C. Wu, H. Chen, S. Huang

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

Background and Aims: The ability to learn and to acquire knowledge and skills had become increasingly important, while learning disabilities had drawn more attentions in recent years. Functioning Scale of the Disability Evaluation System-Child version (FUNDES-Child) was developed and modified from the Child and Family Follow-up Survey, and was provided with evidence of good validity by Hwang et al. in Taiwan.[1] There was scarcity of large-scale study investigating learning disabilities among populations with various diagnosis. This study aimed to assess the disabilities of people with learning disabilities in Taiwan by using FUNDES-Child score.

Methods: We included people with specific learning disability, attention deficit/hyperactivity disorder, autism, epilepsy, and intellectual disability for analysis. The FUNDES-Child score was adopted for disability assessment through a 3-year follow up. The chi-square test, logistic regression and generalized estimating equations were applied for statistical analysis. Results: Data of 3,854 people were acquired from the Taiwan Data Bank of Persons with learning disabilities. All five groups of people exhibited improvement in all domains throughout the 3-year period. We noticed people with specific learning disabilities demonstrated worse improvement in learning, and people with epilepsy displayed worst performance in nearly all domains. Conclusions: Although specific learning disabilities had been identified and studied for years, the effectiveness of current management remained questionable under healthcare system of Taiwan. More active intervention may be required.

Reference

Hwang AW, et al., Structural Validity of an ICF-Based Measure of Activity and Participation for Children in Taiwan’s Disability Eligibility Determination System. Int J Environ Res Public Health 2020;17:6134.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Effects of combined sensory training on upper limb function and activities of daily living in elderly patients with chronic stroke

J. Lin

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

Background and Aims: Sensory disturbance is one of the reasons for the slower recovery of upper limb function after stroke, especially complex sensory impairment. The complex sensory function is closely related to the patients’ activities of daily living and quality of life. Our hypothesis is that complex sensation therapy has the potential to improve the upper limb function and activities of daily living with chronic in elderly patients. Methods: The study was be conducted as a multicenter, randomized, double blind controlled trial. Participants (n=30) were be randomized into two groups to compare the effect of the complex sensation group (n=15) against task-oriented training group(n=15). Outcome measures are the Semmes Weinstein monofilaments examination (SWME), two-point discrimination test (2PD) test, Action Research Arm Test (ARAT), Modified Barthel Index (MBI). Outcome measures were be evaluated at baseline and post treatment. The elderly received treatment at the same intensity (60 min, 5 days a week, 4 weeks). Results: After treatment, there were significant differences in 2PD and ARAT between the two groups. However, there were no significant differences in MBI and SWME. Conclusions: Our findings indicate that the elderly receiving complex sensory training, were significantly improved the complex sensory function and fine motor function. However, the improvements have not been found in ADL and tactile function. In the future, large-scale studies will be further conducted to explore the relationship between multiple sensory function and other functions.

Topic: 3. Clinical Sciences

Sub Topic: 3.9 Cardiac/ Pulmonary Rehabilitation

Effects of exercise training on skeletal muscle PPAR<Beta> /<Delta>expression in rats with spontaneous hypertension

C. Lin¹, M. Yang¹

¹Department of Rehabilitation Medicine, Fujian Medical University, Fuzhou, China, ²Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China

Background and Aims: Exercise therapy can reduce arterial blood pressure in rats with spontaneous hypertension. However, the mechanism of exercice on reducing hypertention has not been fully elucidated. We investigated the effects of PPARβ /δactivation on the arterial blood pressure. Methods: 6 weeks of male rats with spontaneous hypertension (SHR rats) and 6 weeks of male normal rats (WKY rats) were included in the test. The quiet group was given general diet for 8 weeks, and the exercise group was given exercise platform training for 8 weeks ,1 hour a day ,5 days a week. The blood pressure of each group was measured every week. 8 weeks later, the rats were killed, and the skeletal muscle tissue was taken immediately. The expression and protein contents of PPARβ/δmRNA were detected by PCR and western blot, the protein contents of VEGFA,SOD-2,eNOS were detected, and the microvascular density and area of gastrocnemius muscle were observed and analyzed by positive white light microscope. Results: The PPARβ/δmRNA expression and protein contents, the protein contents of SOD-2 and VEGF, the microvessel density and area of skeletal muscle in the exercise group were significantly higher than those in the quiet group. Interestingly, before and after the experiment, the arterial blood pressure increased significantly in the exercise group of SHR rats compared with the quiet group, but there was no difference in the arterial blood pressure increased in the exercise group of WKY rats compared with the quiet group. Conclusions: PPARβ /δmay be a potential target for the spontaneous hypertension.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Influence of non-motor impairments on walking kinematics in Parkinson’s disease

S. Liguori¹, A. Moretti¹, M. Paoletta¹, A. Palomba¹, C. Improta¹, F. Gargiulo¹, F. Gimigliano², G. Iolascon¹

¹Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, Naples, Italy, ²Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy

Background and Aims: Non-motor symptoms affect up to 50% of patients with Parkinson’s disease (PD), even 4-6 years before the onset of motor symptoms, and are often underestimated. A possible interaction between motor and non-motor impairments has been hypothesized, underpinning poor walking efficiency in PD patients. The aim of this study is to assess the impact of non-motor impairments on walking kinematics in early stage PD patients. Methods: In this cross-sectional study, we included patients with early PD (Modified Hoehn and Yahr Scale score < OR = 2) and provided several scales for motor and non-motor symptoms’ evaluation. Kinematic parameters were assessed by an inertial sensor during walking, timed-up and go (TUG) and dual task TUG (TUGdt). Cognitive function was evaluated using neuropsychological tests, including Montreal Cognitive Assessment (MoCA), dividing the population into two groups: normal cognition (PD-NC) and mild cognitive impairment (PD-MCI). Results: In a sample of 26 patients, our results showed that fatigue is related to worse step cadence and gait duration (p<0.01); also pain seems to affect negatively gait duration (p<0.01), as well as anxiety does on cadence and gait duration (p<0.05). MoCA scores is related with lower TUGdt duration (p<0.05). Significant differences have been found between PD-MCI and PD-NC in gait duration; higher fatigue and pain are observed in the PD-MCI group (p<0.05). Conclusions: Non-motor symptoms may influence walking performance. Our results suggest that it is necessary to evaluate and treat mood and cognitive impairments in early stages PD patients, to reduce their impact on motor phenotype.

Topic: 5. Engineering and Technology

Sub Topic: 5.1 Assistive Products

Individual and environmental factors for children with intellectual and developmental disabilities after computerized cognitive training intervention

Z. Li¹, J. Zhu^{1, 2, 4}, J. Peng^1,4, J. Song^{1, 2, 4}, Y. He^1,4, J. Huang^{1, 2, 3, 4}, J. Tao^{1, 2, 3, 4}, L. Chen^{1, 2, 3, 4}, J. Wu^{1, 2, 3, 4}

¹Fujian University of Traditional Chinese Medicine, Fuzhou, China, Fuzhou City, Fujian Province, China, ²Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China, Fuzhou City, Fujian Province, China, ³TCM Rehabilitation Research Center of SATCM, Fuzhou, China, Fuzhou City, Fujian Province, China, ⁴Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation, Fuzhou City, Fujian Province, China

Background and Aims: The individual and environment factors, are regarded as a potential risk factor for development of cognitive function on children with intellectual and developmental disabilities. The computerised cognitive training,has been proved to be an effective means for children’s cognitive function. However, what specific individual and environment factors may affect the cognitive training efficacy is still unclear, which limits the rehabilitation outcome. Methods: 60 participants were divided into computerized cognitive training and traditional cognitive training, performed in 20-minute sessions, five/week for 5 weeks. The baseline information included individual factors (child’s gender,disorder,chronological age,intellectual and adaptive function), environment factors (multiple births, second child or above, go to kindergarten, parents’ education level, parental marital status, parents’ childbearing age). Chinese Conner Parent Rating Scale-Revised was used to evaluate. Results: The conduct problems were negatively associated with intellectual function; learning problems were positively associated with children’s age and multiple births, and negatively associated with the second or more children in the family and mother’s education level;impulse-restlessness was positively associated with intellectual function, single-parent families, and negatively associated with adaptive function and the second or more children in the family; abnormal restlessness index was positively associated with intellectual function, and negatively associated with adaptive function. Conclusions: Both the individual factors and environmental factors have a certain influence on the effect of the children’s cognitive training. Among all factors, as children grow older, their intellectual and adaptive functions are improved, which could inhibit the attention behavior problems of the children.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

Clinical observation of cervical spondylolysis in the treatment of temporomandibular disorders

J. Li¹, F. Yang²

¹Department of Rehabilitation Medicine, School of Stomatology, Air Force Medical University, Xi’an, Shaanxi Province, ²State Key Laboratory of Military Stomatology National Clinical Research Center for Oral Diseases Shaanxi Key Laboratory, Xi’an, Shaanxi Province, China

Background and Aims: Temporomandibular disorders (TMD) is characterized by joint pain and limited mouth opening. TMD patients with cervical spondylosis often develop intractable maxillofacial pain. This study aims to observe the clinical efficacy of joint mobilization in the treatment of cervical spondylosis. Methods: 60 patients with TMD combined with CS were selected and divided into two groups by envelope method, 30 cases in each group. Group A was treated with ultrasound (1 Hz, 50%, 3 minutes), manual release and exercise training; group B was treated with joint mobilization on the basis of group A. 3/week,and after 3 weeks, the degree of pain at the end of mouth opening and chewing (by Visual Analogue Scale (VAS)) and mouth opening (mm) before and after treatment were evaluated. Analyze with SPSS-25 in paired and independent sample t-test. Results: There was no significant difference between the two groups before treatment (P>0.05). After treatment, there were significant differences in VAS score and mouth opening (mm) between the two groups (groupA,VAS6.3±1.66 vs 2.13±0.82,VAS3.8±1.35 vs 1.43±0.68 and VAS 13.93±5.31 vs 40.27±0.79; groupB, VAS 6.23±1.55 vs 0.23±0.5, VAS 3.8±1.35 vs 1.43±0.68 and VAS 13.93±5.31 vs 40.27±0.79). There were significant differences in VAS scores between the two groups (P<0.01),but there was no significant difference in the degree of mouth opening (mm) (P = 0.274). Conclusions: The two groups have the same effect in improving mouth opening, but group B is better than A in relieving pain. The research results provide new evidence for the clinical application of Spine-Jaw treatment thinking method in maxillofacial pain.

Fund Project: Project supported by the National Natural Science Foundation of China (81570938)

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

Efficacy of deep muscle stimulation combined with Kinesio taping on patients with shoulder-hand syndrome in stage i after stroke

H. Li

General Hospital of Ningxia Medical University, Yinchuan, China

Background and Aims: To observe the effect of DMS combined with KT on local swelling, pain and motor function of upper limbs in patients with SHS stage I after stroke. Methods: From January 2019 to December 2019, 40 SHS patients were randomly divided into a control group and an experimental group with 20 cases each. On the basis of conventional rehabilitation treatment, the experimental group was treated with DMS combined with KT for 4 weeks. Before and after treatment, the shoulder-hand syndrome assessment scale (SHSS) was used to comprehensively assess the upper limbs, the visual analog scale (VAS) was used to assess the pain, the Fug1-Meyer scale (FMA-UE) was used to assess the upper limb motor function, and the Modified Barthel Index Rating Scale (MBI) was used to assess the activities of daily living (ADL). Results: 20 cases in the experimental group and 19 cases in the control group completed the study. After treatment, the edema score and VAS score of the two groups were lower than before treatment (P<0.05), and the FMA and MBI scores were higher than before treatment (P<0.05). The sensory and shoulder abduction scores of the experimental group were lower than before treatment (P<0.05). Comparison between groups showed that the edema score and VAS score of the experimental group were significantly lower than the control group (P<0.05). Conclusions: DMS combined with KT has better benefits of edema and pain in SHS patients, but benefits of patient’s sensation, range of motion, upper limb motor function and ADL are equivalent to conventional rehabilitation.

Topic: 7. Functioning and Disability

Sub Topic: 7.4 Impairment Rating, Disability Evaluation and Certification

Analysis of rehabilitation evaluation of an elderly case of small cell lung cancer with bone metastasis

L. Chong, T. Shiliu

Shanghai University of Sport, Shanghai, China

Background and Aims: Lung cancer is divided into small cell lung cancer(SCLC) and non-small cell lung cancer(NSCLC). Small cell lung cancer accounts for 15% to 25% of lung cancer. 70% to 90% of patients with SCLC are in advanced stage when they are diagnosed with SCLC. SCLC with bone metastasis will accelerate the progression of the disease. The level of modern medical treatment and efficacy is very limited. The median survival time of patients with SCLC is only 10 months, and the 5-year survival rate is less than 2%. In this paper, 10 functional rehabilitation evaluations were carried out in an elderly case of small cell lung cancer with bone metastasis to understand the functional status of the patient and to explore the feasibility of rehabilitation treatment. Methods: Ten major functions were evaluated in an elderly patient with small cell lung cancer with bone metastasis in Zhongshan Hospital affiliated to Fudan University. The evaluation included motor function, sensory function, cognitive function, language function, mental psychology, swallowing, defecation, pain, heart function and lung function. Results: The TUGT time was 8’28, upper limb muscle strength was 5, lower limb muscle strength was 4, PS score was 90, monofilament examination was 3.4, SDS was 37, SDS was 40, Moca score was 19. The patients had good motor function, decreased sensory function, mild anxiety and depression, and decreased cognitive function. Conclusions: Rehabilitation evaluation of elderly patients with lung cancer can understand the overall functional status of patients, and the rehabilitation of lung cancer patients needs further development.

Topic: 8. Specialty Development

Sub Topic: 8.3 Research

Researches of stroke sensory rehabilitation in recent 25 years: A visualization analysis using citespace

L. Chong, J. Jie

Shanghai University of Sport, Shanghai, China

Background and Aims: To analyze the research status and hotspots of sensory rehabilitation of stroke in recent 25 years, and provide reference for the better development of sensory rehabilitation of stroke in China.C. Methods: Using Web of Science and CNKI databases as literature sources, the literatures related to sensory rehabilitation of stroke from January 1996 to December 2020 were searched, and the cooperative network maps of authors, countries and institutions were analyzed by CiteSpace. The keywords were analyzed by co-occurrence analysis, cluster analysis and burst analysis. Results: The number of articles about sensory rehabilitation of stroke in foreign countries showed an upward trend in the past 25 years. No article was published in China before 2000, and then more attention was paid to the sensory rehabilitation of stroke. The United States has the most research on sensory rehabilitation of stroke, while China ranks second. In terms of hot research, the international community pays more attention to the etiology and pathology of sensory rehabilitation of stroke, while our country focuses more on rehabilitation treatment. The frontier results show that foreign researches on sensory rehabilitation of stroke tend to focus on community and family support, while our country focuses on rehabilitation nursing convergence and TCM acupoint therapy. Conclusions: In the past 25 years, the research on sensory rehabilitation of stroke in China has been paid more and more attention, but the depth and breadth of the research still need to be improved, and the connotation of sensory rehabilitation of stroke should be further enriched in the future.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health Conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary Conditions, Vascular and VESTIBULAR Impairments

Visual feedback improves movement illusions induced by tendon vibration after chronic stroke

S. Le Franc^1,2, M. Cogné^1,2, M. Fleury^2,3, S. Butet^1,3, C. Barillot³, A. Lécuyer², I. Bonan^1,3

¹Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France, ²Hybrid Unity, Inria, University of Rennes, Irisa, Umr Cnrs, Rennes, FCrance, ³Empenn Unity, Inserm, Inria, University of Rennes, Irisa, Umr Cnrs, Rennes, France

Background and Aims: Illusion of movement induced by tendon vibration is commonly used in rehabilitation and seems interesting for motor rehabilitation after stroke. The aim of our study was to investigate which modalities of visual cues administered using Virtual Reality (VR) associated with a tendon vibration of wrist could induce the best illusion of movement among participants with stroke. Methods: We included 20 chronic stroke participants. Tendon vibration inducing illusion of movement (wrist extension, 100Hz) was applied on their wrist during 3 VR visual conditions: a moving virtual hand (Moving condition); a static virtual hand (Static condition); or no virtual hand at all (Hidden condition). After each trial, the participants were asked to quantify the intensity of the illusory movement using a Likert scale, the subjective degree of extension of their wrist and to answer a questionnaire about their preferred condition. Results: The Moving condition induced a higher intensity of illusion of movement (p<0.001) and a higher sensation of wrist’s extension (p<0.001) than the Hidden condition and that of the Static condition. The participants’ preferred condition to facilitate the illusion of movement was the Moving condition (for 70% of them). Two participants did not feel any illusion of movement. Conclusions: This study demonstrated the interest of using congruent visual cues in VR in order to improve the consistency of the illusion of movement induced by tendon vibration among participants after stroke. This visuo-proprioceptive feedback appears to be useful in motor rehabilitation to support clinical improvement after stroke, regardless of the clinical severity of these participants.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

A comparison between the lokomat® and conventional gait exercises as supplemental interventions in acute stroke rehabilitation: A randomized single blind study

S. Lee, A. Esquenazi, N. Cao

MossRehab, Physical Medicine and Rehabilitation, Elkins Park, United States

Background and Aims: The greatest recovery post stroke occurs within the first three months. This emphasizes the need for early intervention rehabilitative approach. We aim to 1). determine the feasibility of supplemental gait training in an inpatient rehabilitation facility and 2). compare the outcomes of using robotic (Lokomat®) vs. conventional gait exercises (CGE). Methods: Thirty acute post-stroke participants with unilateral hemiparesis (at least 18 years of age with at least 3 MAS) randomly assigned to Lokomat or CGE (30 minutes, up to 4 days a week). Number of sessions; adverse events; length of stay (LOS); functional independence measure (FIM motor) efficiency; functional ambulation category (FAC); passive range of motion (PROM); modified Ashworth scale (MAS); 5 times sit-to-stand (5x-STS); 10-meter walk test (10MWT); 2-minute walk test (2MWT) were assessed before (pre) and after training (post). Results: Data were available from twenty-five subjects and stratified by trunk control test. Five participants discontinued participation. In the high level, conventional group the 2MWT, 10MWT and FIM were statistically different post intervention (p = .018, .028, .012, respectively). In the high level Lokomat group the 2MWT, 10MWT, 5x-STS and FIM were statistically different post intervention (p = .018, .018, .011, .005, respectively). Conclusions: Training acute stroke patients who presented higher level of trunk control showed larger improvement than patients with limited trunk control. The Lokomat group showed improvement with a fewer number of training sessions and may be a more efficient tool to train acute stroke patients.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Etiological spectrum and functional outcome of first onset transverse myelitis in Hong Kong

J. Lee¹, T. K. Kwok¹, K. H. Chan²

¹Tung Wah Hospital, Hong Kong, Hong Kong, ²The University of Hong Kong, Hong Kong, Hong Kong

Background and Aims: Transverse myelitis (TM) is an inflammatory disorder of the spinal cord with heterogeneous underlying pathologies. It can present with sensory, motor or sphincter dysfunction and result in long-term disability. Compared to Caucasian population, multiple sclerosis (MS) is less common in our locality and should only accounts for a small proportion of TM. This study aims to explore the etiology and functional outcome of first onset TM in Hong Kong. Methods: Records of adult patients admitted from 2002 to 2019 for TM were reviewed. Diagnosis of TM and underlying disorders was made based on international criteria. Minimum follow up period was 6 months, except for patients who died of the episode of TM. Patients with known history of central nervous system inflammatory demyelinating disorder (CNS IDD) were excluded. Functional outcome was measured with modified Rankin scale (mRS). Poor outcome was defined as mRS >2. Results: 87 patients were included in the study. Most common causes of TM were idiopathic 43.7%, neuromyelitis optica spectrum disorder (NMSOD) 26.4%, MS 9.2%, connective tissue disease related 8% and other CNS IDD 4.6%. 33.3% patients had poor outcome at 6 months. In multivariate logistic regression, predictors for poor outcome include higher mRS at nadir, involvement of conus medullaris and higher CSF protein. Conclusions: More than 40% of patients with TM have no identifiable cause found after extensive workup. NMOSD is much more common than MS as cause of TM in Hong Kong. One-third of TM patients had poor functional outcome at 6 months.

Topic: 3. Clinical Sciences

Sub Topic: 3.8 Diagnostic Imaging

Unsupervised skeletal posture analysis device by 3d rgb-d camera can provide medical diagnosis presented by conventional EOS: An observational validity and reliability study

H. J. Lee¹, M. S. Kim^2,3, S.Y. Chung^2,3, H. E. Cho^2,3, J. H. Park^2,3

¹Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Seongnam-si, South Korea, ²Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Seoul, South Korea, ³Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea

Background and Aims: This posture analyzing and virtual reconstructing device (PAViR) quickly analyzed the whole posture from multiple repetitive shots without radiation exposure and provided a virtual skeleton within seconds. In people with somatic dysfunction, is PAViR reliable when shooting repeatedly? When applied as diagnostic imaging, is PAViR valid compared to parameters of EOS? Methods: Prospective, observational study. PAViR assessment was performed twice within 2 minutes by an experienced physician to determine the intra-rater reliability. PAViR used an RGB-D camera as sensor and skeleton reconstruction images were produced. 100 patients with musculoskeletal pain, who underwent full-body low-dose X-ray (EOS) to obtain whole body coronal and sagittal images. The primary outcome was human posture parameters, which were divided by standing plane in both EOS and PAViR as follows: (1) coronal view (asymmetric clavicle height, pelvic oblique, bilateral Q-angles of knee, and center of 7th cervical vertebra-central sacral line (C7-CSL)); (2) sagittal view (forward head posture) (Fig. 1). Secondary outcomes included data comparison between PAViR and EOS. Results: All intra-rater correlation coefficients for coronal and sagittal view parameters were above 0.69. Results for validation of PAViR compared to those of EOS revealed that C7-CSL showed moderate positive correlation with that of EOS [Table 1]. Forward head posture, asymmetric clavicle height and pelvic oblique compared to those of EOS had slight positive correlations. Conclusions: This study presents a novel device to evaluate human posture for diagnostic imaging based on an RGB-D camera, human pose estimation, and artificial intelligence technology withoutradiation exposure.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Detection of post stroke dementia with short Iqcode in a Chilean cohort

C. Leal¹, L. Vergara¹, M. J. Arredondo², A. Castro³

¹Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Chile, ²Servicio Medicina Física y Rehabilitación, Hospital Dr. Luis Tisné Brousse, Santiago, Chile, ³Unidad de Apoyo a la Investigación Científica, Hospital Clínico Universidad de Chile, Santiago, Chile

Background and Aims: Post stroke cognitive decline that leads to dementia is a prevalent condition that is often left unattained. The aim of this study is to detect post stroke dementia in a Chilean hospital based cohort using the short IQCODE. Methods: Inclusion criteria: patients with 18 or more years of age hospitalized after Stroke in the rehabilitation unit of Hospital Clínico de la Universidad de Chile, between January 2016 and December 2019 (patients between 1 to 4 years after stroke). Exclusion criteria: patients with pre stroke dementia or neurological conditions other than stroke (degenerative, tumors, infectious, autoimmune). For every patient that met the criteria a close family member was contacted and invited to answer the short version of the IQCODE after telephonic consent was obtained. Also, medical electronic records were reviewed to obtain sociodemographic, clinical and functional data regarding the stroke hospitalization. According to previous studies short IQCODE has a sensitivity of 0.81 and specificity of 0.83 for post stroke dementia detection. Results: 75 patients were included, aged between 32 to 95, mean age 68.7, 50.6% female and 49.3% male, 25.3% had less than 8 years of education, 80% had ischemic and 20% hemorrhagic stroke, 58.6% had left hemisphere, 34.6% right hemisphere and 6.6% bilateral lesions, 32% had depressive symptoms after stroke. Short IQCODE results revealed that 49.3% had dementia and 50.6% no dementia. Conclusions: According to this study 49.3% of patients had dementia after 1 to 4 years after stroke. Sociodemographic, clinical and functional data will be further analyzed to make associations with this outcome.

Topic: 6. Health Policy and Systems

Sub Topic: 6.3 Infrastructure and Resources

Current situation and challenges of physical and rehabilitation medicine specialty in chile – A brief report

M. Poudel^1,2, C. Leal^1,3

¹International Society of Physical and Rehabilitation Medicine World Youth Forum Task Force, Milan, Italy, ²Department of Physical Medicine and Rehabilitation, University of Miami/Jackson Health System, Miami, United States, ³Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Chile, Santiago, Chile

Background and Aims: About 11.7% of the population have mild-moderate disability and 8.3% have severe disability. We aim to describe the situation of physical and rehabilitation medicine (PRM) in Chile. Methods: A survey form developed by the author was filled by the Country Ambassador of Chile to ISPRM-World Youth Forum. Results: Around 200 physiatrists are serving 4 million people with disability. There are about 30,000 physical therapists, 7,000 occupational therapists and 13,500 speech language pathologists according to the national registries. Currently 45 hospitals provide PRM-related services, which are mainly concentrated in Santiago. The services provided are rehabilitation of brain injury, spinal cord injury, pediatrics, cancer, musculoskeletal, pain medicine, electrodiagnosis, interventional procedures, cardiopulmonary, amputee, burn, critical care and pelvic floor rehabilitation. The national society, Sociedad Chilena de Medicina Física y Rehabilitación organizes a national conference every 2 years. Chile has not organized any ISPRM conferences, but hosted the 1983 and 2014 AMLAR. Rehabilitación Integral is the PRM journal published in the country. PRM residency started in 1962 and there are currently 4 programs with approximately 18 residents graduating each year after 3-years of training. The specialty has been growing due to the increasing number of new specialists, public health interest in rehabilitation and appropriate management of resources. Conclusions: The PRM specialty has been growing in Chile due to the increasing number of new specialists, public health interest in rehabilitation and appropriate management of resources. However, the government should develop policies to spread the PRM services outside the capital city.

Topic: 6. Health Policy and Systems

Sub Topic: 6.9 Big Data and Cohorts

A case of cervical pott’s disease - Rehabilitation point of view

L.M. Leahu, A. Gierasimowicz-Fontana, V. Crapanzano Minichello, B. Michel

CHU Brugmann, Bruxelles, Belgium

Background and aims: Tuberculosis of the spine, Pott’s disease (PD) is one of the oldest and harmful disease caused by Mycobacterium tuberculosis. Characteristically it involves the destruction of the intervetebral disk space and the adjacent vertebral bodies, collapse of the spielements, anterior wedging leading to kyphosis and gibbus formation. Despite all the medial advances, spinal tuberculosis still is a medical challenge. Methods: We present a case of lymph node tuberculosis with Pott’s disease in C1 and in the left atlanto-occipital joint, retropharyngeal abscess and infectious epiduritis. This 30-years-old patient presented the following complaints: neck pain resistant to pain killers for more than 6 weeks, difficulties of swallowing, very mild dyspnea, cough and a mass on the left side of the anterior triangle of the neck. The patient did not present a neurological involvement. Early diagnosis, fine needle aspiration, anti-TB chemotherapy and braces (Halo vest) prevented long time disability, deformity and life-threatening complications. Results: After the medical treatment the patient presented a complete resolution of the retropharyngeal abscess, partial ossification of the lateral mass of the C1 vertebra and consolidation with probable fusion of C1 to the occiput. Conclusions: Tuberculosis of the cervical spine and especially atlanto-axial region are very rare. This disease remains a medical challenge and due to the migration phenomenon, we can say that nowadays tuberculosis can occur in every part of the world. The multidisciplinary approach and close collaboration between disciplines facilitated in this case an accurate diagnostic and instauration of adequate treatment.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Incidence of deep vein thrombosis between 3 and 12 months after spinal cord injury: A monocentric prospective study

M. Le Fort¹, O. Espitia², B. Reiss¹, C. Lefevre¹, B. Perrouin-Verbe¹

¹Neurological PRM Department, Spinal Unit, University Hospital, Nantes, France, ²University Hospital, Nantes, France

Background and Aims: Venous thromboembolism (VTE) is a major issue after a spinal cord injury (SCI), with a prevalence of 47 to 80% against 10 to 20% in the general population. The risk of deep vein thrombosis (DVT) would decrease after the first weeks with a prevalence slightly higher than the general population after 12 weeks. There is no prospective DVT incidence study in SCI after 3 months. We aimed to calculate the incidence of DVT during the first year after SCI and to define the associated risk factors. Methods: We performed doppler ultrasonography (DUS) at 6, 9 and 12 months after the occurrence of SCI, associated with clinical data (age, gender, body mass index, neurological assessment, WISCI, 10 MWT, spasticity, standing time, compression stockings, joints stiffness, muscles contractions, infection, time in wheelchair). Inclusion criteria were post-trauma or medical paraplegia or tetraplegia, NLI: C2-S1, age>18, stable respiratory status with absence of chronic hypoxemia. Results: 82 patients were included, 67% men, mean age of 48 years and mean BMI = 23.5 kg/m2. The incidence of DVT occurrence between 3 and 12 months after SCI was 13.4% [7.6-22.4]. The multivariate analysis with variables from the univariate analysis (UA) with p-value < 0.20 (‘stepwise’ method) showed as significant risk and protective factors: age (+1 year, HR = 1.8, p<0.01) and walk (HR = 0.02, p<0.01). BMI >30 kg/m2 was a significant associated factor in UA. Conclusions: Our results may precise recommendations for longer preventive management of VTE after an SCI and advocate for a DUS control before stopping thromboprophylaxis.

Topic: 4. Therapeutics

Sub Topic: 4.4 Pharmacological agents

Analysis of us commercial claims to understand patient treatment pathways in spasticity

A. de Pierre¹, A. Lamontagne², Y. Darhi¹

¹Ipsen, Boulogne-Billancourt, Paris, France, ² Ipsen, Cambridge, USA

Background and Aims: Botulinum toxin type A (BoNT-A) treatment is considered as first-line treatment for focal spasticity in adults (Simpson et al. 2016). We sought to use 2 US commercial claims databases to establish the proportion of patients with spasticity who receive BoNT-A treatment. Methods: Two databases were interrogated for this research: the MarketScan database (IBM Watson) and the IQVIA APLD database. Eligible patients were defined as adults with at least one confirmed diagnosis of spasticity between 1-Jan-2010 and 31-Jun-2020 (MarketScan) or 1-Nov-2017 and 31-July-2020 (IQVIA), and one diagnosis in the last year (1-Jun-2019 to 31-Jun-2020 or 1-July-2019 to 31-July-2020). Patients with a recent diagnosis of spasticity (within 90 days of 31-Jun-20/31-July-20) were excluded. Spasticity was identified using ICD codes for spastic conditions (eg. monoplegia/diplegia/hemiplegia/contracture/etc.). Results: In the MarketScan database, 131,222 patients with spasticity were identified (mean age: 47;60% female). At most recent visit, the most common treatment was physical therapy, which was administered to 88,793 patients (68%). 40,254 (31%) patients received myorelaxants: 11,610 (9%) received baclofen and 9,421 (7%) received tizanidine. Only 5,299 (4.0%) were treated with BoNT-A. In the IQVIA database, of 1,095,402 patients identified with spasticity (mean age: 55;53% female), only 32,346 (3%) were treated with BoNT-A. Conclusions: Data from 2 commercial claims indicate that, in spite of being a recommended first-line treatment, BoNT-A is only used in a small proportion of patients with spasticity. Further research into factors correlating with treatment decisions would be valuable to better understand the patient journey in spasticity.

Reference

Simpson DM, Hallett M, Ashman EJ, Comella CL, Green MW, Gronseth GS, et al. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2016;86:1818-26.

Topic: 5. Engineering and Technology

Sub Topic: 5.3 Robotics

Voluntary rehabilitation training using single joint shoulder hybrid assistive limb for patients suffering from shoulder elevation dysfunction

M. Lafitte¹, H. Kadone², S. Kubota³, Y. Shimizu⁴, Y. Hada⁴, K. Suzuki², M. Yamazaki³

¹Artificial Intelligent Laboratory, Tsukuba, Japan, ²Center for Cybernics Research, Tsukuba, Japan, ³Department of Orthopedic Surgery, Tsukuba, Japan, ⁴Department of Rehabilitation Medicine, Tsukuba, Japan

Background and Aims: Shoulder elevation impairments can result from various pathologies and are often very detrimental in everyday life, still lacking efficient rehabilitation methods. We evaluated here the feasibility and efficiency of rehabilitation training using the shoulder type single-joint Hybrid Assistive Limb (HAL) robot in patients suffering from upper-limb motor impairment. Methods: 4 patients (3 men, 1 women), mean age 58 ± 7.5 years old suffering from post-operative spinal cord disorders resulting in difficulties in upper-limb elevation undertook several sessions (11 ± 3.3 on average) of rehabilitation training using the HAL robot over the course of several weeks. Interventions consisted of voluntary shoulder elevation assessment followed by shoulder elevation training using the HAL robot. Activity of shoulder muscles was recorded via EMG surface electrodes and movement was recorded using a 3D motion analysis system. Results: We report a two-steps significant improvement of the elevation performances of all patients. Range of motion of the shoulder joint increased by 4.5 fold (from 39° before intervention to 106° after). The HAL decreased both deltoid and trapezius activity levels, by 34% and 59% on average, respectively. Conclusions: The progression of range of motions suggests that active repetitive robot-assisted training might promote shoulder motion recovery. The diminution of muscular activity might imply a reduction of trapezius-mediated compensatory motion. Altogether, the findings indicate the efficiency of HAL therapy for rehabilitation of various upper-limb pathologies.

Topic: 4. Therapeutics

Sub Topic: 4.4 Pharmacological agents

Comparison of efficacy of duloxetine and pregabalin on mixed pain and related factors in patients with knee osteoarthritis: a randomized, prospective clinical study

O. G. Illeez¹, K. N. Kurt Oktay², I. Aktas¹, F. Unlu Ozkan¹, T. Nazligul³, F. Akan Begoglu¹, M. Yilmaz Kaysin¹, A. Atici¹, P. Akpinar¹

¹Department of Physical Medicine and Rehabilitation, UHS Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey, ²Department of Physical Medicine and Rehabilitation, Yeditepe University Hospital, Istanbul, Turkey, ³Department of Physical Medicine and Rehabilitation, UHS Van Training and Research Hospital, Van, Turkey

Background and Aims: Investigating the effects of duloxetine and pregabalin primarily on mixed pain and functional status in patients with knee osteoarthritis (OA), and secondarily on quality of life, depression, anxiety, and sleep disturbance. Methods: 66 patients (11 men, 55 women, mean age 55.65±7.22) with knee OA admitted to our clinic were randomized to use duloxetine 60 mg/day or pregabalin 300 mg/day. Patients were evaluated by visual analog scale (VAS), Neuropathic Pain Diagnostic Questionnaire (DN4), Short Form-36 (SF-36), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Pittsburg Sleep Quality Index (PSQI) before the treatment, after 4 and 12 weeks of treatment. Results: Improvements occurred in VAS, DN4, WOMAC, SF-36, BDI, and BAI scores in both groups from four weeks after baseline. PSQI total scores started to improve on the 4th and 12th week in both groups. No difference was observed in VAS, BDI, BAI, or PSQI between weeks 4 and 12 in either group. However, DN-4, WOMAC-pain and stiffness scores at 4 weeks (p<0.0001, p=0.038, and p=0.016) and 12 weeks (p =0.0001, p=0.020, and p=0,002), WOMAC function and total scores at 12 weeks (p=0.042 and p=0.022), SF-36 mental health subgroup scores at four weeks (p=0.014), and SF-36 general health perception subgroup scores at 12 weeks (p=0.021) differed significantly in favor of pregabalin. Conclusions: OA pain, a complex outcome with nociceptive and neuropathic components, leads to central sensitization in a chronic phase. Adding of centrally acting drugs in the control of pain and associated symptoms would increase treatment success.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Vocational rehabilitation for the brain injured by occupational therapists in Japan

R. Kurihara¹, T. Nagao², R. Tanemura²

¹Doctoral Program, Kobe University, Graduate School of Health Sciences, Kobe, Japan, ²Department of Rehabilitation Science, Kobe University, Life and Medical Sciences Area, Health Sciences Discipline Kobe, Japan

Background and Aims: Returning to work for brain injuries is an important theme for the quality of life and their livelihood. Occupational therapists(OTs) are suitable occupations for return-to-work support. However, that’s role has not been established as a common understanding yet. The purpose of this study was to clarify the specific support method, content, and approach by conducting a questionnaire and an interview survey for OTs who provide returning to work support for clients with brain injury. Methods: We selected the subjects based on their presenting at some academic conferences, some academic papers, or the introduction of acquaintances of us. The interview survey was recorded and written using an IC recorder, and the text data recorded verbatim was organized and analyzed using a case study-code matrix. Results: There were twenty subjects. The average number of years of OT experience of the subjects was 17 years, and the average number of years of vocational rehabilitation experience was 9 years. Eight focused codes of the contents of the OT’s return-to-work support existed. The codes were Support for disease, disability, and awareness, Support for daily living, Support for utilization of compensatory means, Support for interpersonal communication skills, Support for employment, Collaboration with the other supporting institutions and Support using of social resources, Establishment of goal, and Interaction with brain injuries considering the characteristics of disabilities. Conclusions: In the work-readiness support, OTs provided various support for brain injuries. On the other hand, OTs worked on other support organizations for vocational evaluation, approaching companies, and the medical treatment in cooperation with them.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

The efficacy of complex rehabilitation of patients with multiple sclerosis

S. Kotov, R. Ponomarev, A. Gevorkyan, E. Isakova

Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia

Background and Aims: Imbalance and weakness in the lower extremities are some of the common symptoms of multiple sclerosis (MS). Rehabilitation measures are necessary to reduce movement disorders and return patients to their usual society. The combined effect of various technologies for rehabilitation will increase the effectiveness of the treatment. However, there are insufficient data on the combined use of an exoskeleton for the lower extremities and a stabilometric platform in the rehabilitation of patients with MS, which requires further study. The aim - study the efficacy of rehabilitation measures using lower limb exoskeleton and stabilometric platform in patients with MS. Methods: There were involved 30 patients with MS. EDSS was varied from 4.5 to 6.5 points. The average age of patients was 44±1,5 years. The outcome measures included The Montreal Cognitive Assessment (MoCA), 6-minute walk test (6MWT), Timed 25-Foot Walk (T25FW) and Berg balance scale (BBS). Patients were conducted 10 sessions on exoskeleton and 10 sessions on stabilometric platform. Results: We obtained: an 1,2 sec (p<0,02) improvement in the T25FW score. 6MWT improved by 9 meters (p<0,02). The improvement in BBS was 1,3 points (p<0,001). Improvement was found in the assessment of cognitive functions on the MoCA test, which was 1,2 points (p<0,001). Conclusions: The study showed the efficacy of the combined use of an exoskeleton and a stabilometric platform with biofeedback in the rehabilitation of patients with multiple sclerosis. There was a significant increase in all the studied indicators.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

The improvement of motor function of the arm in poststroke patients using the arm exoskeleton with a brain-computer interface

S. Kotov¹, E. Slyunkova¹, E. Isakova¹, A. Kondur¹, E. Biryukova²

Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia, ²Pirogov Russian National Research Medical University, Moscow, Russia

Background and Aims: The using of brain-computer interface with hand exoskeleton (BCIE) demonstrated high efficiency in restoring motor function of hand. It is necessary to use both clinical scales, and biomechanical analysis for assessment the efficacy of treatment. Methods: 11 patients received repeated BCIE training courses in late recovery period of cerebral stroke. Recovery of motor function was assessed using biomechanical analysis of movements and Action Research Arm Test (ARAT) scale. Study was supported by the Russian Foundation for Basic Research (Grant No. 19-015-00192). Results: Patients with moderate paresis had a statistically significant improvement on ARAT scale both after first and second course of treatment (p <0.05). Comparison of standard deviations of angular velocities (DV) - before and after first course showed increase for movements in elbow joint - flexion-extension (p = 0.04) and pronation-supination (p = 0.02). Comparison of DV values before and after second course showed a increase for movements in the wrist (p = 0.001) and shoulder (p = 0.02) joints. Comparison of the DV values before the first course and after the second one shows increase in all degrees of hand freedom: flexion / extension of the wrist joint - p = 0.01, pronation / supination in the elbow joint - p = 0.04, flexion / extension in the elbow joint - p = 0.02, abduction / adduction in the shoulder joint - p = 0.02. Conclusions: The study revealed a positive effect of repeated rehabilitation courses using BCIE on improving motor function of the hand.

Topic: 5. Engineering and Technology

Sub Topic: 5.3 Robotics

Development and first clinical validation of speaking robot for reminiscence exercise

I. Kondo¹, A. Osawa¹, I. Ueda¹, K. Aimoto¹, K. Kato¹, W. Kaku¹

¹National Center for Geriatrics and Gerontology, Obu, Japan, ²Toyota Motor Company, Toyota, Japan

Background and Aims: The three major tasks in the aging society are dementia, frailty, and care for end of life. Considering these three tasks, especially for dementia, it is essential to introduce robot to support older adult life under the decline in the working population. In our institute, we are developing speaking robot that is expected to be applied to reminiscence exercise. Methods: Seven older adults (six women and a man, average age 83.2, SD 5.59) were recruited from the rehabilitation ward in our center to the trial study for speaking robot. They had 20 minutes conversation for five days with robot and assessed at first and final days during the trial term. Main outcome measure was the reaction scale developed in our center to assess the degree of participation to robot conversation. Familiarity, interest and future prospect to robot of participants were also assessed with using VAS. Results: The participants showed full participation being assessed by reaction scale. Appearance of robot met with favorable reception. There were trends that resistive feeling decreased and familiarity increased. The timing of nod sound tended to delay or be irrelevant because of unstable speech recognition and the paucity of contents in reminiscence talk, user might feel stress to have a conversation with robot for long time. Conclusions: From the result of first clinical validation study, it was suggested that it was necessary to facilitate technological innovation of speech recognition and diversity of topics in conversation in order to improve smoothness of talking between the user and speaking robot.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Activity-oriented rehabilitation program for people with cognitive impairment: A case series

S. Kitamura¹, Y. Otaka², M. Suzuki¹, A. Maeda¹, C. Kato³, H. Yoshino⁴, H. Takechi⁴

¹Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan, ²Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan, ³Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan, ⁴Department of Geriatrics and Cognitive disorders, School of Medicine, Fujita Health University, Aichi, Japan

Background and Aims: Dementia is a major cause of disability and dependency among older people worldwide. Owing to the limited benefits of symptomatic drugs, non-pharmacological interventions can play important roles. Little attempt, however, has been made to develop activity-oriented rehabilitation programs that focus on activities rather than cognitive impairment. We developed such a program for individuals with mild cognitive impairment and mild dementia, and examined its effectiveness in several cases. Methods: An interdisciplinary team conducted the program consisting of eight 1-hour sessions weekly or biweekly in an outpatient setting. It involved the patients and their families, activity modification based on the patients’ and their families’ thoughts, identification of the problems in behaviors and activities, teaching coping skills to the patients and their families, home-based exercises, and appropriate care management. Measures of cognitive/physical function, activities of daily living, quality of life, depression, and the Zarit Burden Interview score were evaluated before and after the program. Results: Five male and three female patients aged 71 to 82 years, and their spouses completed the program. Scores in the Montreal Cognitive Assessment ranged from 16 to 25. During the program, all the patients could modify their activities, such as keeping regular hours, making exercise a habit, and enjoying a hobby again. Regarding the changes in the spouses, the depression and the Zarit Burden Interview scores decreased after the program. Conclusions: The activity-oriented rehabilitation program could modify the activities of individuals with mild cognitive impairment and mild dementia, and reduce their families’ burdens.

Topic: 1. Biomedical sciences

Sub Topic: 1.5 Physiology

Skeletal muscle response to resistance training with different intensity in mice

Y. Kimura¹, T. Wakigawa ¹, Y. Wakimoto¹, S. Inoue¹, S. Li¹, J. Hatakeyama¹, D. Takamura^1,2, T. Tsubaki¹, S. Kinoshita¹, R. Tajika¹, T. Akisue³, H. Moriyama³

¹Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan, ²Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan, ³Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Japan

Background and Aims: Resistance exercise is the most effective approach for skeletal muscle hypertrophy. Skeletal muscle hypertrophy depends on the balance between muscle protein synthesis and breakdown. Despite the importance in determining the intensity of resistance exercise, the effects of its intensity on this balance are unclear. The aim of this study was to assess the effect of exercise intensity on the balance between muscle protein synthesis and breakdown. Methods: Male C57BL/6J mice were divided into control group and resistance training groups subjected to a single bout of ladder training with 5 different intensities (n = 4). Each session consisted of 12 climbing series with a load fixed 0, 40, 80, 120, and 160% of the animal’s total body mass. At 6 hours after resistance exercise, the mice were harvested gastrocnemius. We evaluated protein synthesis and breakdown by western blotting and polymerase chain reaction (PCR). Results: Muscle protein synthesis of the 80% group was significantly higher than the control group. Expression of protein degradation genes such as Atrogin1 and MuRF1 in all exercise groups were significantly lower than that of the control group. Conclusions: Our findings indicate that high intensity resistance exercise is the most beneficial to skeletal muscle and suggest that such intensity is the most moderate in resistance exercise. However, excessive high intensity of resistance exercise is less beneficial than the moderate one.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

Paroxysmal sympathetic hyperactivity in an acute inpatient rehabilitation setting

N. Kim^1,2, E. Trovato^1,2, A. Nasir^2,3

¹Burke Rehabilitation Hospital, White Plains, United States, ²Albert Einstein College of Medicine, The Bronx, United States, ³Montefiore Medical Center, The Bronx, United States

Background and Aims: 44-year-old female patient was admitted to an acute inpatient rehabilitation hospital for right thalamic intracerebral hemorrhage with intraventricular hemorrhage s/p bifrontal external ventricular drain. Throughout hospital stay, she had multiple episodes of increased blood pressure, tachycardia, tachypnea, diaphoresis, and hyperthermia which was attributed to paroxysmal sympathetic hyperactivity (PSH). Methods: Upon admission, patient was aphasic with left hemiparesis and left facial droop. She also had left elbow and knee spasticity. The treatment team was aware of her PSH and closely monitored symptoms and managed pharmacologic treatment accordingly. Baclofen was started for both spasticity and PSH. Propranolol, clonidine, and gabapentin were given to treat and prevent PSH episodes. During hospitalization, patient received intensive inpatient rehabilitation services including daily physical, occupational, and speech therapies as well as frequent therapeutic recreation and neuropsychological assessments. Secondary stroke prophylaxis measures were implemented. Patient was discharged in stable condition with markedly improved function. Results: The incidence of PSH following TBI range from 8 to 10.5%, and approximately 95% of PSH cases result from TBI (80%), hypoxia (10%), and stroke (5%). Given the association between TBI/stroke and PSH, physiatrists are amongst those in the forefront of treating patients with PSH. Although PSH is a serious complication of acute brain injuries, it is also a treatable condition. Therefore, monitoring the symptoms of PSH and effectively managing PSH would subsequently improve the prognosis of PSH patients in rehabilitation. Conclusions: Physiatrists should be vigilant in detecting PSH and manage the symptoms to improve prognosis of patients in rehabilitation.

Topic: 6. Health Policy and Systems

Sub Topic: 6.7 Disaster Health Related Rehabilitation (Man-Made /Natural Disasters/After Effects)

Collaboration within a rehabilitation network for a patient with multiple fractures

N. Kim^1,2, E. Trovato^1,2, A. Nasir^2,3

¹Burke Rehabilitation Hospital, White Plains, United States, ²Albert Einstein College of Medicine, The Bronx, United States, ³Montefiore Medical Center, The Bronx, United STATES

Background and Aims: 54-year-old female with a history of scoliosis admitted after TBI and multiple fractures secondary to motor vehicle accident. This patient was admitted to acute inpatient rehabilitation (AIR) with sustaining basilar skull, sternal, spinal and pelvic fractures s/p external fixation, and right pneumothorax. Patient was treated in multiple rehabilitation facilities with varying levels of care. This case is an example of effective collaboration amongst different rehabilitation settings. Methods: During initial admission at an AIR, the weight-bearing (WB) status of the left lower extremity (LLE) was restricted to toe-touch. She was discharged to a subacute rehabilitation (SAR) until cleared to be WB as tolerated (WBAT) on LLE. Teams in AIR and SAR collaborated effectively to optimize the rehabilitation course. After advanced to WBAT on LLE, she was subsequently referred back to the AIR to continue rehabilitation for persistent physical, cognitive and functional deficits. Patient was discharged to home modified independent in ambulation and stair negotiation which were originally barriers due to her WB precautions. Results: Patients admitted to AIR after sustaining TBI and polytrauma typically involve WB precautions which can be barriers to advancing functional independence, and cannot be lifted within the AIR course, leading to discharge to SAR instead of home. As evidenced in our case, the rehabilitation course may entail temporary stepdown level of rehabilitation to restore certain functioning followed by re-admission to higher level of rehabilitation to resolve remaining sequelae. Conclusions: Collaboration across different levels of care is fundamental in assisting patients receive comprehensive rehabilitation and gain maximum functional improvement.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Sexuality of woman with acquired neurological pathology

M. A. Khezami^1,2, L. Ghidaoui^1,2, E. Bahlouli^1,2, I. Aloulou¹, I. Miri^1,2, S. Lebib^1,2, F. Z. Ben Salah^1,2, C. Dziri^1,2

¹Department of Physical and Rehabilitation Medicine, National Institute of Orthopedy Mohamed KASSAB- La Manouba, Tunisia, ²Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia

Background and Aims: Sexual disorders are common in pathologies affecting the central and peripheral nervous system. Nevertheless, complex female sexual dysfunction is still poorly studied compared to male sexuality. The objectives of our work were to study sexuality in women with acquired neurological pathology and to determine the factors limiting sexuality among this population. Methods: Retrospective, transversal and descriptive study conducted in the Kassab physical medicine department over 20 months. Sexual function was evaluated in its various domains by the FSFI (FEMALE SEXUAL FUNCTION INDEX) reference questionnaire. Factors limiting sexuality were sought through interrogation and evidence collected at the clinical examination. Results: Thirty-three female patients were retained. The mean age was 47.52 years ± 10.96. Our study confirms the alteration of overall sexual function in 94% of our patients. The areas most affected were satisfaction in 51% of cases, the sensation of orgasm in 45% of patients and lubrication in 36%. The factors that most limited sexuality among our patients were doubts about sexual abilities in 54% of cases, the lack of interest in sexuality in second place with a frequency of 48%. In third place are the fear of urinary leakage and the non-cooperating partner with a frequency of 39%. Conclusions: Our work underlines the underestimation of sexual function in neurological patients found in the literature. A systematic evaluation of this dimension is interesting to integrate systematically in our files. Especially since there are simple, specific and sensitive means validated in Arabic.

Topic: 4. Therapeutics

Sub Topic: 4.2 Injections (Joint. Spine, etc.,)

Lateral epicondylitis in rehabilitation department

A. Haj Salah¹, H. Kerkeni¹, A. Ben Abdallah ¹, W. Said¹, I. Ksibi², M. Sghir¹, W. Kessomtini¹

¹Department of Rehabilitation, University Hospital Tahar Sfar, Mahdia, Tunisia, ²Department of Rehabilitation, University Military Hospital, Tunis, Tunisia

Background and Aims: Lateral epicondylitis typically affects the dominant upper extremity and is often an overuse injury. This disease has a self-limiting course of between 6 and 12 months, but insome patients, symptoms can be persistent and refractory to treatment. The aim of our study is to evaluate epidemiological, clinical and therapeutic profile of patients followed in the Physical Medicine and Rehabilitation (PMR) department, for lateral epicondylitis. Methods: This was a retrospective study during 4 years (2016-2020) about patients referred to our PMR department for lateral epicondylitis. Sociodemographic characteristics, clinical profile and therapeutic modalities were assessed. Results: Fifty-six patients were included in our study with a female predominance (71%). The mean age was 42.60 years. Half of our patients were active and the majority (65%) performed office-type work. The right upper limb was the most affected region. Symptom duration was 13.6 months. The mean visual analogic scale was 5.8. Epicondylitis was clinically diagnosed in all patients. The X-Ray exam was realized for 10 patients and ultrasound exam for 9 patients. All patients received analgesic treatment, 86% non-steroidal anti-inflammatory drugs and only 9 patients received corticosteroid injection. Physical therapy was prescribed for all the patients. Total improvement was noticed in 45% of the cases, 48% reported a transient improvement and 14% evolved towards chronicity. Conclusions: Lateral epicondylitis is a is a common self-limiting condition. The treatment is essentially non-operative including drugs and functional rehabilitation used alone or in combination.

Topic: 3. Clinical Sciences

Sub Topic: 3.3 Diagnosis

French translation and validation of the identification of functional ankle instability tool

C. Beaudart¹, K. Mehmetti¹, S. Bornheim¹, J. Van Beveren², A. Stenhouse³, C. Demoulin⁴, J. Kaux^1,4

¹Department of Physical Medicine and Rehabilitation, Liege University Hospital Center, University of Liège, Liège, BELGIUM, ²HEL (Haute Ecole de la ville de Liège), Liège, Belgium, ³ Private Practice, Profondeville, Belgium, ⁴ Physical Medicine and Sports Traumatology Department, University Hospital of Liège, University of Liège, Liège, Belgium

Background and Aims: The Identification of Functional Ankle Instability (idFAI) is a questionnaire developed to assist in the diagnosis of ankle sprains. has. The objective of the present study was to translate the IdFAI into French (idFAI-F) and to evaluate its psychometric properties. Methods: The translation part was articulated in five stages: (i) two initial translations from English to French; (ii) synthesis of the two translations; (iii) backward translations; (iv) expert committee to compare the backward translations with the original questionnaire and (v) pre-test. To validate the idFAI-F, we assessed its validity (discriminative power, construct validity), reliability (internal consistency, test–retest reliability, Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC)) and floor/ceiling effects. Results: The idFAI was translated in French without any major difficulties. A total of 116 pathological subjects and 44 healthy subjects were included in the study (mean age of 24.4±4.5 years, 62% of men). Results of the psychometric validation indicated a good validity of the idFAI-F, with a significant discriminative power (mean of 2.11±4.15 for healthy subjects vs 14.3±6.05 for pathological subjects, p<0.001) and a strong correlation with the CAIT questionnaire (r=-0.63, p<0.001). The idFAI-F has been shown to be reliable, with a good internal consistency (Cronbach’s alpha of 0.72) and a strong test-retest reliability (ICC=0.95). A SEM of 1.37 and a MDC of 3.8 has been found. No floor, neither ceiling effects has been found. Conclusions: A valid idFAI-F is now available and can be used by health practitioners to identify and measure functional ankle instability in the French-speaking populations.

Topic: 5. Engineering and Technology

Sub Topic: 5.3 Robotics

Experience of MR robotic Kafo in a patient with cerebral infarction

S. Kanemaru¹, A. Tsubahara², K. Hanayama¹, T. Hiraoka¹, M. Abe¹, S. Yamamoto¹, N. Arai¹, M. Yasunaga¹, H. Nishitani¹, S. Sato¹

¹Kawasaki Medical Shool, Kurashiki, Japan, ²Kawasaki University of Medical Welfare, Kurashiki, Japan

Background and Aims: There are several kinematic problems in gait training using knee ankle foot orthoses (KAFO) with fixed knee joints for hemiplegic patients with inadequate knee extension muscle strength. Recently, we have an experience of gait training using a wearable robot for a stroke patient with severe hemiplegia. Methods: We used a MR (magneto-rheological) robotic KAFO to a right hemiplegic patient who admitted to the Kaifukuki (convalescent) Rehabilitation Ward. MR fluid brake (Hashimoto Artificial Limb Manufacture Co.) that was developed for ankle joints of ankle foot orthoses (AFO) was attached to the lateral side of the knee joint of the MR robotic KAFO. Force of the MR fluid brake was variable in 8 steps from 0 to 7 for each phase of walking cycle: early stance phase, mid-stance phase (1 and 2), late stance phase, and swing phase. The braking force set by the PC was designed to be remotely controlled using Bluetooth. In addition to the MR damper, the knee joint had extension assistance with a spring. Foot switches were attached to the front foot and heel to distinguish the timing of heel contact, toe contact, heel off, and toe off. Results: The patient was able to bend the paralyzed knee joint easily at the toe off. Smooth swinging of the paralyzed leg was obtained. Conclusions: The MR fluid brake was sufficient to prevent excessive flexion in the paralyzed knee joint. It is suggested that the improvement of swinging of the paralyzed leg was based on smooth knee extension and toe off.

Topic: 3. Clinical Sciences

Sub Topic: 3.2 Pain Osteoporosis - Osteoarthritis

Poststroke shoulder pain relationship with upper limb peripheral nerve conduction changes

F. Juanjuan, F. Hui, L. Lizhi, Z. Xiuwu, P. Huaping

Jiangning Hospital of Nanjing Medical University, Nanjing, China

Background and aims: To observe the changes of peripheral nerve conduction of hemiplegic shoulder pain (HSP) in patients with stroke, in order to investigate the usefulness of screening nerve conduction studies in patients with hemiplegia for finding poststroke shoulder pain. Methods: 50 stroke inpatients who met the inclusion criteria were divided into HSP group (n= 28) and without HSP group (n= 22) according to digital pain score (numerical pain rating scale,NPRS). The peripheral nerve conduction of bilateral upper limbs was examined respectively. Results: There was significant difference in the compound muscle action potential (CMAP) amplitude of suprascapular nerve between the hemiplegic side of the HSP group and without PSP group (P < 0.05).. The CMAP amplitudes of median nerve, ulnar nerve, radial nerve, musculocutaneous nerve and axillary nerve on paralyzed shoulder of the two groups were significantly different from those of the sound shoulder in the same group (P < 0.05). The sensory nerve action potential (SNAP) amplitude of median nerve, ulnar nerve and radial nerve on paralyzed shoulder of the two groups were significantly different from those of the sound shoulder in the same group (P < 0.05). Conclusions: Stroke patients are often accompanied by upper limb peripheral nerve injury,and the occurrence and development of poststroke shoulder pain is related to hemiplegic suprascapular nerve injury.

Topic: 7. Functioning and Disability

Sub Topic: 7.4 Impairment Rating, Disability Evaluation and Certification

Motomed VIVA2 combined with balance instrument to evaluate the effect of sling exercise training on gross motor function in children with spastic cerebral palsy

G. Jin, M. Hou, Z. Dai, Y. Li, S. Wang

Qingdao Women and Children’s Hospital, Qingdao, China

Background and Aims: The aim of this study was using MOTOmed viva2 combined with balance instrument to evaluate the effect of sling exercise training on gross motor function in children with spastic cerebral palsy. Methods: Forty children with spastic cerebral palsy were included in this study. The children were randomly assigned into two groups: control group A and study group B. The children in both groups received traditional physical therapy program, 1h per day for group A and 30 mins followed by 30 mins of sling exercise training for group B. The two groups were assessed with MOTOmed viva2 test, D and E domains of the Gross Motor Function Measurement (GMFM), the Berg Balance Scale (BBS) and balance instrument test before and after treatment. Results: The total mileage and symmetry of MOTOmed viva2, the GMFM scores, the BBS score and balance instrument test level of the two groups were both improved than before treatment (P < 0.05). The results also showed significant differences in all measured parameters in favor of group B, when compared with those in group A (P < 0.01). Conclusions: The sling exercise training could effectively improve the gross motor function of children with spastic cerebral palsy.

References

Abd El-Kafy EM, El-Basatiny HM. Effect of postural balance training on gait parameters in children with cerebral palsy. Am J Phys Med Rehabil 2014;93:938-47.
Lee JS, Lee HG. Effects of sling exercise therapy on trunk muscle activation and balance in chronic hemiplegic patients. J Phys Ther Sci 2014;26:655-9.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

ECC-BYF III combined with electroacupuncture inhibit inflammation in chronic obstructive pulmonary disease rats via SIRT1/NF-KB pathway

F. Jin¹, K. Chen^1,2, J. Zhai^1,2, G. Zhao^1,2, D. Shao^1,2, X. Yan^1,2, J. Li^1,2

¹Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Minis, Zhengzhou, China, ²Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Zhengzhou, China

Background and Aims: Objective: To explore the mechanism of effective-component compatibility of Bufei Yishen formula III (ECC-BYF III) and acupuncture in treatment of chronic obstructive pulmonary disease (COPD) rats and its effect on SIRT1/NF-kB pathway. Methods: Methods: 84 rats were randomly divided into Control group, Model group, ECC-BYF III group, Electroacupuncture (EA) group, ECC-BYF III + EA group, Aminophylline (APL) group, Sham elctroacupuncture group (SA). The COPD rat model was established in 1-12 weeks. From week 13 to 20, ECC-BYF III group and APL group were given corresponding drugs, EA group was given acupuncture therapy after binding (3 times a week), and Dazhui, Feishu and Shenshu points were selected. ECC-BYF III + EA group was given formula by gavage combined with electrocupuncture. SA group was only bound. The expression of SIRT1/NF-kB pathway related mRNA and protein were detected by PCR and WB After treatment. Results: Compared with the model group, pulmonary function in each group was significantly improved (P<0.01). The protein expression of IL-10, SIRT1 in lung tissue was increased, and IL-6, TNF-a, NF-kBp65, Ac-NF-kBp65 decreased (P<0.01, P<0.05). The mRNA levels of IL-10, SIRT1 were increased, and IL-6, TNF-a, NF-kB p65 were decreased (P < 0.01). Compared with other treatment groups, the effect of ECC-BYF III + EA group was better in improving lung function, alleviating pathological injury and inflammation of lung tissue (P < 0.01, P < 0.05). Conclusions: Conclusion: ECC-BYF III combined with electroacupuncture can reduce inflammation in COPD rats, and the mechanism may be involved in regulating SIRT1/NF-kB pathway.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

Effects of isokinetic strength training for lower extremity motor function in post-stroke patients: A systematic review and meta-analysis

L. Jiang, R. Qi, L. Zhao, Y. Liu, J. Zhang, Z. Li

Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and West, Shanghai, China

Background and Aims: Post-stroke muscular dysfunction seriously affects the recovery of lower extremity motor function, balance function and walking ability. Isokinetic strength training (IST) is relatively quantitative muscle training therapy. The steady speed training does not result in too much accelerated motion, thus reducing muscle pain and tired because of this training condition in which it ensures an intuitive scientific muscle strength training. To investigate whether IST improves lower extremity motor functions in stroke patients with hemiplegia. Methods: PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials, Chinese Biomedical Literatures database, Chinese National Knowledge Infrastructure, Wan-Fang Database, and Chinese Scientific Journals Database were researched from the earliest records to January 2021. Randomized controlled clinicals that examined effects of IST versus conventional rehabilitation training (CRT) in stroke patients with hemiplegia were identified. Study quality was evaluated using the PEDro scale. Review Manager 5.3 software was used for meta-analysis of all included study. Results: In total, 13 studies with 827 patients with hemiplegia met inclusion criteria were included in this review. Meta-analysis showed that there existed statistically significant improvements in the Fugl-Meyer assessment scale-Lower extremity (WMD=7.40, 95%CI 4.87~9.92, P<0.00001), Peak Torque of knee flexors (WMD=5.48, 95%CI 4.43~6.53, P<0.00001), Peak Torque of knee extensors (WMD=8.95, 95%CI 5.28~12.62, P<0.00001), Berg Balance Scale (WMD=9.33,95%CI 7.99~10.68,P<0.00001) and Timed 10-Meter Walk Test (WMD=11.89,95%CI 3.07~20.71,P=0.008) were all improved when CRT was associated with IST for motor function recovery of the lower extremity. Conclusions: IST seems to be a effective physicotherapeutics for improving lower extremity motor function,muscle strength, balance function and walking ability in post-stroke patients.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Exercise prescription in full cycle stroke rehabilitation: The acute, subacute and chronic phases

J. Jia

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

Background and Aims: Stroke is the second cause of mortality and disability in the world, and causing high disability. In 2016, there were over 80 million people living with disability globally. Exercise prescription as cost-effective approach should be implemented after stroke. Aim: to investigate the implementation of exercise prescription in acute, subacute and chronic phases after stroke. Methods: Randomized controlled trials were searched from databases of PubMed, Embase, Scopus, and Web of Science from the inception to December 19, 2020. Results: 100 studies were identified. No studies were found in acute phase. 40 and 60 studies were found in subacute and chronic phase respectively. The average time of initiating exercise program since stroke was 48.01±31.84 days and 32.27±25.72 months in subacute and chronic phase. The average duration of running the program was 2.05±1.21 (n=38). Overall attendance rate for intervention was 85%±10% (n=49). Overall, the average VO2peak was 15.83 ± 4.85 mL/kg/min, and 12.05±2.21 mL/kg/min and 17.23±4.83 mL/kg/min in subacute and chronic phase. Conclusions: Exercise prescription was delayed in current stroke rehabilitation. We proposed our new model for exercise prescription in acute, subacute and chronic phases.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Correlation between neuron-specific enolase, and spirometric indices (forced expiratory volume in first, forced vital capacity), cognitive function and walking ability for lung cancer in the elderly patients

J. Jia

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

Background and Aims: Respiratory dysfunction is the most important complication affecting the quality of life with lung cancer in elderly patients. Meanwhile, severe lung cancer also affects cognitive and walking ability. However, the underlying and clinical mechanisms associated with cancer mechanisms are still unclear. Therefore, we hypothesized that the mechanism of respiratory system is related to cognition and walking ability in elderly patients. Methods: The study was conducted as a multicenter, and based on prospectively collected data. A total of 22 elderly patients were included and evaluated by two respiratory therapists. Lung function was measured by pulmonary function test equipment, walking function was measured by stopwatch, and cognitive function was assessed by scale. Outcome measures: Neuron-Specific Enolase (NSE), Forced Expiratory Volume in First Second (FEV1), Forced Vital Capacity (FVC), FEV1/FVC, Montreal cognitive assessment scale (MoCa), Timed Up-and-Go Test(TUGT). Statistical analysis was performed using the Spearman correlation test. Results: There was good correlation between FEV1 and FVC(p<0.05), FEV1 and FEV1/FVC(p<0.05), FEV1/FVC and Moca (p<0.05). There was, however, poor correlation between others (p>0.05). Conclusions: Our findings indicate that respiratory function is associated with cognitive ability for lung cancer in elderly patients. However, there is no strong even no correlation between the indicators in this study. In future, a larger sample size will be included to explore the relationship between lung cancer and other somatic functions.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

Rehabilitation of chronic neck pain with strengthening deep cervical flexor muscles protocol

A. Hadj Salah¹, A. Jemni¹, I. Haddada¹, E. Toumi², S. Belhaj Khalifa², M. Sguir¹, W. Kessomtini¹

¹Department of Rehabilitation, University Hospital Tahar Sfar, Mahdia, Tunisia, ²UPSAT, Sousse, Tunisia

Background and Aims: Neck pain is a major health problem with high rates of recurrence. It presents with a variety of altered sensorimotor functions. Exercise is a cornerstone of rehabilitation and many training methods are used. The aim of this study was to assess the effect of DCF muscles strengthening in patients with chronic neck pain. Methods: A prospective comparative study over a period of 3 months was conducted. It included patients presenting to physical medicine and rehabilitation (PMR) department for chronic neck pain. Patients were randomly divided into 2 groups: group A underwent a conventional rehabilitation program, and group B underwent conventional rehabilitation exercises associated with strengthening DCF muscles protocol. Evaluation was performed at baseline and after 18 rehabilitation sessions. Pain was assessed using the Visual Analog Scale (VAS), cervical function and disability using the Neck Disability Index (NDI). Results: At the end of the protocol, patients in group B had a greater significant decrease in neck pain. NDI in group B was significantly inferior to NDI in group A which means better functional improvement with strengthening DCF muscles protocol. Conclusions: The strengthening of DCF muscles reduced pain, improved strength and cervical function in patients with chronic neck pain

Topic: 3. Clinical Sciences

Sub Topic: 3.2 Pain Osteoporosis -Osteoarthritis

Impact of an eccentric isokinetic rehabilitation program on knee muscle strength, pain tolerance and quality of life in overweight/obese women with knee osteoarthritis

H. Jdidi¹, N. Hammami¹, M. A. Khezami^2,3, I. Aloulou², C. Hannachi¹, I. Tagazi¹, N. Kefi¹, A. Talbi¹, I. Ghidaoui^2,3, E. Bahlouli^2,3, M. Soltani², I. Ben Jeddou², I. Miri^2,3, S. Lebib^2,3, A. Bousassida¹, F. Z. BN Salah^{2, 3, 4}, C. Dziri^{2, 3, 4}

¹High Institute of Sport and Physical Education of Kef, University of Jendouba, Kef, Tunisia, ²Department of Physical and Rehabilitation Medicine, National Institute of Orthopedy Mohamed KASSAB, Manouba, Tunisia, ³Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia, ⁴LARS 03 Reaserch Laboratory of Disability Study, University of La Manouba, Manouba, Tunisia

Background and Aims: Knee Osteoarthritis leads to the degradation of articular cartilage which promotes bone friction causing pain. Many studies suggest that quadriceps weakness promotes knee pain worsening. All these factors contribute to physical limitations and disability, contributing to a huge decline in life quality. The aim of our study is to assess the effectiveness of eccentric isokinetic training on muscle strength, quality of life, and knee pain in overweight/obese women with knee osteoarthritis. Methods: It’s about a single-blind controlled and randomized trial. Women age 30 years or older, who experienced unilateral or bilateral knee pain during daily living activities were recruited. Eighteen participants were randomized into 2 groups. Patients in both groups were treated 2 times a week for 6 weeks. The control group (GC) executes the usual knee osteoarthritis rehabilitation program. The experimental group (EC) performs the usual knee osteoarthritis rehabilitation program combined with an eccentric isokinetic muscle strengthening. Knee extensor Peak Torque (EPT), Knee flexor Peak torque (FPT), knee pain, and knee-related quality life were evaluated. Results: There were no significant differences between baseline groups (p>0.05). There were significantly greater improvements in EPT, FPT, knee pain, and quality of life (p<0.05) in the EC more than the CG. Conclusions: Our study indicates that isokinetic eccentric muscle strengthening with the standardized rehabilitation program has clinically significant superiority to standardized rehabilitation programs alone.

Topic: 4. Therapeutics

Sub Topic: 4.2 Injections (Joint. Spine, etc.,)

Clinical applications of autologous conditioned serum in the treatment of musculoskeletal disorders; a narrative review

S.A. Raeissadat, S.M. Rayegani, N. Jafarian, M. Heidari

Department of Physical Medicine and Rehabilitation, Shahid Beheshti Medical University, Tehran, Iran

Background and Aims: Musculoskeletal disorders (MSKDs) are among the most variable, prevalent, and disabling diseases; despite various therapeutic options, no definitely-curative treatment has been approved for many of these pathologies. Autologous conditioned serum (ACS) is gaining attention for its potentially disease-modifying effects. Its safety and effectiveness have been shown in several studies on animal models. The present study aimed to collect the available current data on the applications of ACS in MSKDs to ease the clinical decision-making on the subject. Methods: Following a comprehensive search of the major databases (PubMed, Scopus, Web of Science, Cochrane, etc.) in the period of 2000-April 2020, the titles and then abstracts were screened. The most relevant studies were assessed for methodological quality and those with the level of evidence I or II were finally enrolled and discussed in different sections based on the focused application of the treatment. Results: The primary search resulted in 3735 studies of which, after screening and deduplication, the final number of 23 studies investigating the applications of ACS for musculoskeletal disorders with the level of evidence I or II, performed on human subjects - in vivo- with no concomitant treatments applied, were enrolled and assessed. Conclusions: This study showed a major focus of the literature on the effectiveness of ACS in OA, in which there is several high-quality evidence suggesting its safety and efficacy. Also, some of the available experiments are assessing its application in tendinopathies and radiculopathies, which, despite positive results, recommend further evaluations on this topic.

Topic: 4. Therapeutics

Sub Topic: 4.2 Injections (Joint. Spine, etc.,)

Effectiveness of intra-articular autologous conditioned serum injection in patients with knee osteoarthritis: a systematic review and meta-analysis

S.A. Raeissadat¹, S.M. Rayegani¹, M.R. Sohrabi², N. Jafarian¹, M.N. Bahrami³

¹Department of Physical Medicine and Rehabilitation, Shahid Beheshti Medical University, Tehran, Iran, ²Department of Community Medicine, Shahid Beheshti Medical University, Tehran, Iran, ³Department of Orthopedic Surgery, Shahid Beheshti Medical University, Tehran, Iran

Background and aims: Osteoarthritis (OA) is the most common form of disabling arthritis, with no curative treatment options available yet. As the newly introduced regenerative therapies such as intra-articular (IA) injection of Autologous Conditioned Serum (ACS), have gained attention, this study seeks a more reliable answer regarding the effectiveness of ACS in knee OA.

Methods: An extended systematic search was carried out on major electronic and non-electronic databases for studies (period of 2000-Sept2020). After the screening and filtering process, 8 articles were included in data extraction and statistical analyses. The pooled effect of VAS and WOMAC variables was evaluated using SMD (Standardized Mean Difference) and WMD (weighted mean difference) before and after the intervention. A random-effects model was used when there was evidence of heterogeneity.

Results: The combined SMD for the global WOMAC score (evaluated in six studies, with a total number of 306 patients) was -2.44 (p<0.000) and the combined WMD was -22.92 (p<0.000). The combined SMD for the VAS score (evaluated in seven studies, with a total of 409 individuals) was -3.77(p<0.000); with the combined WMD was -32.37 (p<0.000). Begg’s funnel plot showed no evidence of publication bias in these studies (p=0.532).

Conclusions This meta-analysis resulted in favor of the intervention, reporting that the IA injection of ACS can reduce pain and improve function (indicated by VAS and WOMAC outcome measures respectively) therefore can be considered as an appropriate option for patients with OA.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Relationship between prefrontal cortex activity and dual tasks load on parameters of gait during treadmill walking

H. Iwatsuki, H. Haba, T. Urushihata

Department of Physical Therapy, Aomori University of Health and Welfare, Aomori, Japan

Background and Aims: The purpose of this study was to clarify the relationship with changes of gait parameters when some tasks are applied to the prefrontal cortex activation while walking on a treadmill. Methods: 10 healthy young people with an accelerometer attached to the 3rd lumbar vertebra walked (2 km/h) for 60 seconds on a treadmill with two force plates. At same time prefrontal cortex activities were measured using a near-infrared photoimaging device. In the Edinburgh handedness test, there were 8 right-handed people and 2 left-handed people. The tasks were no load, verbal fluency task (VFT), and 2-digit subtraction, each task was performed twice with a break. A 16-channel probe was placed on the prefrontal cortex to record changes in oxygenated hemoglobin (oxyHb), and divided into three regions. This study was approved by the Research Ethics Committee at Aomori University of Health and Welfare. There is no conflict of interest for all authors. Results: OxyHb and trunk sway increased on right and left parts immediately after the start both VFT and subtraction tasks, and sustained high values during walking, but no change was observed in the central part. The lateral component while walking was significantly increased in the other two tasks compared to no load. During the VFT, a positive correlation was found between oxyHb in bilateral sides parts and both trunk sway and lateral components. Conclusions: These results indicated the walking performance changed even during constant-speed walking when the activities of the prefrontal cortex increased.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Effects of activation of prefrontal cortex on postural sway while standing

H. Iwatsuki, H. Haba, T. Urushihata

Department of Physical Therapy, Aomori University of Health and Welfare, Aomori, Japan

Background and Aims: In this study, we clarified the relationship between the postural sway and the activation of the prefrontal cortex when the verbal fluency task (VFT) was performed while standing. Methods: Ten healthy young persons were measured while standing on a force plate (GP-7, Anima Inc) for 60 seconds each under open and closed eye conditions. The displacement and velocity parameters extracted from the center-of-pressure (COP), and prefrontal cortex activity were measured with a near-infrared optical imaging device. The tasks were no-load, VFT, and recall of Japanese syllabary, each of which was carried out twice with a break. A 16-channel probe was placed on the prefrontal cortex to record changes in oxygenated hemoglobin (oxyHb), and divided into three regions. This study was approved by the Research Ethics Committee at Aomori University of Health and Welfare. There is no conflict of interest for all authors. Results: During the VFT, oxyHb increased on the side of the non-dominant hand immediately after the start and remained high, but no change was observed in the central part or the side of the dominant hand. In the recall of the Japanese syllabary, an increase in oxyHb was observed on the side of the dominant hand. The relationship between oxyHb and the COP parameters were found to have a positive correlation on the side of the non-dominant hand during the VFT under the closed eye condition.

Conclusions: These results suggested that the task of increasing prefrontal cortex activity impairs the stability of the standing posture.

Topic: 7. Functioning and Disability

Sub Topic: 7.4 Impairment Rating, Disability Evaluation and Certification

A case of surfer’s myelopathy and severe paraplegia showing independent walking with active rehabilitation

S. Iwasa, Y. Uchiyama, S. Hyotani, H. Nakagawa, M. Ichikawa, T. Yasukawa, N. Kodama, K. Domen

Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan

Background and Aims: Surfer’s myelopathy, reported by Thompson et al. in 2004, is a non-traumatic myelopathy that involves sudden paraplegia during or shortly after surfing in beginners. Methods: 17-year-old girl. She had taken a first surfing lesson in Bali and experienced discomfort in the lower back and lower limbs. She found it difficult to walk, and thus, she was transported by ambulance to a hospital in Bali. Steroids were administered, and she returned to Japan 3 days after injury. She was introduced to our department 4 days after injury. At the first medical examination in Bali, her American Spinal Injury Association Impairment Scale (AIS) grade was B, and magnetic resonance imaging showed a high intensity change in the spinal cord at T8–11. On admission to our hospital (4 days after injury), her AIS grade was C. Results: Urination independence was achieved 17 days after injury, with the use of uravidil. When she was transferred to a convalescent hospital 19 days after injury, her AIS grade had improved to D. She was discharged from the convalescent hospital 108 days after injury. At discharge, her AIS grade was E, and she could walk independently. Conclusions: In surfer’s myelopathy, if the peak AIS grade is A or B, the walking prognosis is considered poor. However, in rare cases, as in this case, independent walking can be achieved. Thus, patients should receive active rehabilitation.

References

Thompson TP, Pearce J, Chang G, Madamba J. Surfer’s myelopathy. Spine 2004;29:E353-6.
Robertson CE, Brown RD Jr., Wijdicks EF, Rabinstein AA. Recovery after spinal cord infarcts: Long-term outcome in 115 patients. Neurology 2012;78:114-21.
Brett A, et al. Neurosurgery 2016.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Clinical factors influencing the dynamics of the rehabilitation of stroke patients during virtual reality training

G. Ivanova, A. Aizenshtein, M. Shurupova

Department of Medical Rehabilitation, Federal Center of Brain and Neurotechnologies, Moscow, Russia

Background and Aims: Stroke patients experience neurological, motor, cognitive, and affective disorders. Rehabilitation methods based on virtual reality (VR) have some key points over traditional approaches: simulating real-life situations, ecologically more valid training and assessment of patients' functionality, immediate dynamic feedback, stimulation of cognitive functions. Our study aimed to investigate the effect of VR training depending on the clinical characteristics of stroke patients. Methods: Thirty-four patients (age 51.9±12.5; 17 females, <3 for Modified Rankin Scale, >25 scores on MoCA) who survived stroke were examined. Participants received ten sessions of VR training using the GRAIL system (Motekforce, Netherlands). Training applications were based on the therapeutic goals for every patient. Clinical motor and psychological assessments and VR-diagnostic (postural stability tests, PST) were conducted before and after training. Multiple linear regression analysis was used. Results: According to motor functions, the female gender contributed significantly (p=0.03) to the regression model of balance recovery on the Berg scale (R2=0.11, p=0.03). Ischemic type (p<0.01) and left side of stroke (p=0.02) predicted better functional outcome in PST on one leg with eyes open (R2=0.39, p=0.01). According to the psychological sphere, on the contrary, the hemorrhagic type of stroke contributed significantly (p=0.02) to the decrease of state anxiety on the State-Trait Anxiety Inventory (R2=0.13, p=0.05). Early recovery period time after stroke (p<0.01) predicted a significant decrease of depression symptoms on the Beck Depression Inventory (R2=0.33, p<0.01). Conclusions: The obtained data allow physicians to determine the criteria for patients' appointment to rehabilitation in the VR, depending on their clinical characteristics.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Assessment of risk factors for axillary web syndrome in breast cancer women referred to an oncological rehabilitation unit: A retrospective case-control study

A. de Sire¹, L. Losco², C. Cisari¹, N. Fusco³, E. Cigna², M. Invernizzi¹

¹Department of Health Sciences, University of Eastern Piedmont, Novara, Italy, ²Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy, ³Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

Background and Aims: Axillary web syndrome (AWS) is a common complication of breast cancer (BC) surgery, characterized by functional impairment and pain with long-term disabling sequelae (1). An early identification of BC patients at risk for AWS development might improve their rehabilitative management. Thus, aim of this retrospective study was to characterize the risk factors associated with AWS in BC women. Methods: We retrospectively collected data of patients with BC undergone axillary surgery referred to an Outpatient Service for Oncological Rehabilitation. All these women have been evaluated two weeks after the surgical procedure for their clinicopathologic features, type of therapeutic interventions, AWS presence, laterality, pain, localization, cords number and type. Results: A sample of 177 BC patients (aged 60.65 ± 12.26 years) was enrolled and divided into two groups: BC women with AWS (n=52) and without AWS (n=125). Patients with tumor N>=1 (OR=3.7; p<0.001), subjected to mastectomy, axillary lymph node dissection (ALND) and chemotherapy showed significant correlations with AWS onset (p<0.05). Moreover, the range of shoulder motion limitation (OR=11.2; p<0.001) and the presence of BC related lymphedema (OR=3.5; p=0.020) were associated with AWS. Conclusions: We reported that the main risk factors for AWS onset were: mastectomy, ALND, chemotherapy, low staging tumors, shoulder range of motion limitations and BCRL. Realizing new strategies for assessing the individual risk of AWS is a crucial to improve quality of life of BC survivors.

Reference

de Sire A, Invernizzi M, Lippi L, Cisari C, Özçakar L, Franchignoni F. Blurred lines between axillary web syndrome and Mondor’s disease after breast cancer surgery: A case report. Ann Phys Rehabil Med 2020;63:365-7.

Topic: 3. Clinical Sciences

Sub Topic: 3.2 Pain Osteoporosis -Osteoarthritis

Bone and oral health screening in breast cancer women before anti-osteoporotic treatment start: A cross-sectional study

A. de Sire¹, M. Ferrillo², C. Cisari¹, A. Gennari³, P. L. Foglio Bonda⁴, M. Migliario⁴, M. Invernizzi¹

¹Department of Health Sciences, University of Eastern Piedmont, Novara, Italy, ²Department of Surgical Sciences, University of Turin, Turin, Italy, ³Division of Medical Oncology, University Hospital Maggiore Della Carità, Novara, Italy, ⁴Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy

Background and Aims: Adjuvant therapy could lead to an increase of the survival rate of breast cancer (BC) women with incidence of disabling complications. Tamoxifen and aromatase inhibitors (AIs), that block estrogens activity on breast tissue, could have a detrimental impact on bone health in BC women (1). Thus, we aim to assess bone and oral health in BC women before anti-osteoporotic treatment start. Methods: In this cross-sectional study, we recruited post-menopausal BC women, undergoing tamoxifen or AIs treatment. Before prescribing an anti-osteoporotic treatment, we evaluated bone health in terms of: previous femoral and vertebral fractures; bone mineral density; serum levels of 25-hydroxy-vitamin D (25(OH)vit. D) and calcium. Furthermore, all the participants underwent a specific dental evaluation, including oral hygiene parameters: Oral Hygiene Index (OHI), for presence of debris on the dental elements; Periodontal Screening and Recording Index (PSR), to assess periodontal status. Results: Of the 122 BC women (aged 55.6±10.4 years) enrolled, 23% had osteoporosis and 52.5% had osteopenia. Moreover, the 72.9% had hypovitaminosis D. OHI index showed that only 11.5% had good oral hygiene and 53.2% had insufficient oral hygiene. PSR index showed that 63.1% had a moderate periodontitis; 15.6 % had a serious periodontitis. Conclusions: These findings showed that BC women had a high prevalence of osteopenia/osteoporosis, hypovitaminosis D and mild/moderate periodontitis. An adequate bone health and oral hygiene screening should be routinely performed in in BC survivors.

Reference

Migliaccio S, et al. Approach in aromatase inhibitors – Induced osteoporosis: Results from an Italian multicenter observational study. Clin Cases Miner Bone Metab 2018;15:334-9.

Topic: 1. Biomedical sciences

Sub Topic: 1.4 Neuroscience

Environmental enrichment improves motor coordination and increases brain weight in healthy young mice

S. Inoue¹, Y. Wakimoto¹, C. Li¹, J. Hatakeyama¹, D. Takamura^1,2, T. Wakigawa¹, T. Tsubaki¹, S. Kinoshita¹, R. Tajika¹, Y. Kimura¹, T. Akisue³, H. Moriyama³

¹Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan, ²Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan, ³Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Japan

Background and Aims: Acquisition of motor competence is a key developmental task of childhood and is influenced by the environment in which a child is reared. The environmental enrichment (EE) paradigm is a natural strategy involving sensory, motor, and social stimulation. Many animal studies have demonstrated that EE has protective effects in various disease. However, whether EE affects the motor and brain development of healthy children remains largely unclear. Here, we aimed to verify the effect of EE on motor coordination and brain weight in healthy young mice. Methods: A total of 20 male B6D2F1 mice at 4 weeks of age were housed in either standard (control group) or EE conditions (EE group), which equipped with wheels, tunnels, and shelters, until 12 weeks of age. Motor coordination was assessed with rotarod and balance beam test at 2-week intervals. At the end of the experimental period, the cerebrum and cerebellum were removed and weighed. Statistical significance was established by an independent t-test or two-way ANOVA followed by a Bonferroni test. Results: EE increased rotarod latency at 6 and 8 weeks after exposure. EE mice exhibited shorter latency to cross the beam at 4, 6, and 8 weeks. EE slightly, but significantly, increased cerebrum and cerebellum weights. Additionally, a negative correlation was found between cerebellum weight and latency to cross the beam in the EE group.

Conclusions: Our findings indicate that EE improves motor coordination and increases brain weight in healthy young mice. We also believe that neuroanatomical changes in the cerebellum may contribute to improved motor performance.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Effect of effortful swallow on pharyngeal contraction - Kinematic analysis using 3d dynamic computed tomography

Y. Inamoto¹, Y. Ito², K. Aihara¹, S. Shibata², M. Gonzalez-Fernandez³, E. Saitoh²

¹Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan, ²Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, Toyoake, Japan, ³Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, United States

Background and aims: Effortful swallow (EF) is a common maneuver used for dysphagia patients in attempts to improve safe and efficient bolus passage. Although many kinetic studies have been performed, there are still limited number of kinematic analysis in related to tongue-base and pharyngeal wall movement during EF. This study measured the volume of pharyngeal cavity to elucidate the kinematical effect of EF. Methods: Eight healthy volunteers swallowed 10 ml honey-thick boluses (1700 mPa) with EF and with no maneuvers (control swallow) under CT. Upper and lower volumes (bordered by valleculae) of the pharyngeal air column and the bolus were measured at every frame. Maximum volume (Vmax), minimum volume (Vmin), volume at the onset of anterosuperior hyoid movement (Vonset) were compared in each upper and lower pharyngeal cavity between EF and control swallows. Duration between Vonset and Vmin was also measured. Results: During EF, Vmax (EF=13.2 cm³, control 16.3 cm³, EF= p=0.008) and Vonset of upper volumes was significantly smaller (EF=12.4 cm³, control 16.2 cm³, EF= p=0.008) than control. Vmin was not different between two swallows. For lower volumes, neither Vmax, Vonset, nor Vmin were not were not significantly different in two swallows. Duration from Vonset to termination of Vmin was significantly longer in EF than in control in both upper and lower pharynx (p=0.016, p=0.027). Conclusions: Reduction of upper pharyngeal volume and longer duration of pharyngeal obliteration during EF indicated that EF enhances the contact of tongue-base and pharyngeal wall (horizontal upper pharyngeal contraction) from the beginning and throughout the swallow.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Effect of robot-assited end-effector-based gait training on spasticity in children with cerebral palsy

M. Gonkova, A. Ilieva

Department of Physical and Rehabilitation Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria

Background and Aims: Cerebral palsy (CP) is a diverse group of neurological disorders and a leading cause of childhood disability of which spastic CP is the most common type. Spasticity management and gait training play a major role in the rehabilitation of children with CP. Studies and systematic reviews find positive effects of treadmill training with partial body-weight support (PBWS) on some gait parameters in these patients. The aim of the study is to evaluate the effect of an electromechanical gait-training system based on the “end effector” principle with PBWS on spasticity in children with spastic CP. Methods: 21 children with spastic diplegia and spastic hemiplegia were included in this pilot study, age 7.09±0.64 (mean±SE). All children underwent 10 sessions of gait training (LokoHelp, Woodway). Pedobarometric evaluations before and after the treatment were performed, as an indirect sign of spasticity of the plantar flexor muscles (RS foot scan system). Results: No significant improvement in the observed parameters was found. The pressure in the medial part of the heel changed from 4.49±0.53 to 4.72±0.49 (p>0.05); pressure in the lateral part – from 4.91±0.42 to 5.09±0.54 (p>0.05); contact plantar surface area – from 103.92±4.01 to 104.34±4.09 (p>0.05). Conclusions: The preliminary results of this study demonstrate that although the electromechanical gait training system with PBWS improves some gait parameters according to the available literature, it does not have statistically significant effect on spasticity. May be a different protocol with more sessions is needed or it should be applied in combination with conventional physical therapy.

Topic: 6. Health Policy and Systems

Sub Topic: 6.5 Rehabilitation Across the Continuum of Care

Implementing environmental enrichment for individuals with stroke in an inpatient rehabilitation setting: What, why, how and what’s next?

N. Hussein, E. E. Squad

Department of Rehabilitation Medicine, Neurological Rehabilitation Unit, Hospital Rehabilitasi Cheras, Kuala Lumpur, Malaysia

Background and Aims: Environmental Enrichment (EE) is an intervention which is designed to provide a stimulating environment which facilitates motor, sensory, social, and cognitive activities. EE have been investigated extensively in animal models and found to promote neuroplasticity in animal models of stroke; thus potentially enhance post-stroke recovery in human. This paper aims to describe the phases of implementing EE and outline the narrated EE benefits in an inpatient stroke rehabilitation setting. Methods: Descriptive report on EE implementation using the EPIS (Exploration-Preparation-Implementation- Sustainment) Framework. Results: Based on the EPIS Framework, Exploration Phase consists of needs assessment and potential of implementing EE via roundtable discussions with stakeholders. EPIS’s Preparation Phase emphasize on ‘buy-in’ strategies, staffs’ readiness, training and acquisition on EE apparatus. Motor, sensory, cognitive and social benefits of EE apparatus and activities are identified in EE workshops. An EE Squad was formed to implement the EE activities. EPIS’s Implementation Phase involve devising a system to provide access to EE apparatus for individual and communal use. EE apparatus and engaging activities are designed to be multifaceted and incorporate self-directed tasks. EE Trolley, EE Kit and EE Information Package are initiatives to ensure effective EE implementation. Recommendations for Sustainment Phase involve data collection, fidelity assessment, project expansion and devising sustainability plans. Narrative responses revealed increased activity participation and improved self-directed activities in the ward. Conclusions: Environmental Enrichment is a value-based initiative which complements the recovery phase for individuals undergoing concurrent structured stroke rehabilitation. EE concept is feasible and potentially emulated in other settings including the acute stroke care.

Topic: 3. Clinical Sciences

Sub Topic: 3.8 Diagnostic Imaging

Applications of thermography in patients with myofascial trigger points: A review of literature

N. Hussain, T. Kiymaz, B. Habibi, B. J. O Young, S. S. H. Wu

Department of Physical Medicine and Rehabilitation, Temple University Health System, Philadelphia, USA

Background and Aims: Myofascial trigger points (MTP) are tender nodules located in taut bands of skeletal muscle. Although the diagnosis of MTP is clinical, no validated diagnostic criteria exists, which has led to a wide prevalence reported in the literature ranging from 23-93%. This high estimated prevalence with unclear defining criteria underscores the difficulty in diagnosing MTP. Infrared thermography (IRT) presents a unique opportunity to objectively and consistently diagnose MTPs. This investigation aims to review the current literature regarding the use of thermography in the evaluation of MTP. Methods: A systematic literature review was performed using the MEDLINE database via PubMed for key terms related to thermography and myofascial pain. Articles focused on using IRT to diagnose MTP were identified based on a set of pre-established inclusion and exclusion criteria. 10 full-text articles were identified and were then reviewed. Results: These terms yielded articles evaluating various aspects of thermography use in MTP. Active MTP produced more thermographic changes than their latent counterparts. IRT had a sensitivity of 63% and specificity of 71% for MTP diagnosis. Thermographic findings have been used to compare different treatments for MTP, and have also correlated with changes identified by other testing methods. Lastly, there was excellent inter- and intra-rater reliability observed when using IRT to diagnose MTP. Conclusions: MTPs result in heat emission changes that can be measured objectively by IRT. With excellent inter- and intra-rater reliability, there is promising evidence IRT can be utilized as a reliable and efficient method for diagnosing MTP.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Impact of chronic pain on upper extremity disability in breast cancer patients

D. Hunain Al Arabia

Department of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan

Background and Aims: The role of Chronic Pain in Upper Extremity Disability(UED) and impaired quality of life, in breast cancer patients is often undermined & not studied in our patients. The aim of this study is to determine the effect of pain on upper limb disability in breast cancer patients. Methods: 93 breast cancer patients were surveyed at an average of 25 months after diagnosis from August-October 2019 in a Tertiary Care Hospital, Karachi, Pakistan. UED was measured on QuickDASH (Disabilities of Arm, Shoulder & Hand) questionnaire. Additionally, socio-demographic information, details of treatment, presence of chronic pain, intensity on numeric scale of 0-10,frequency & character was also noted. Results: 87.4% of the participants reported chronic pain, mean QuickDASH score was 25.86 & numeric rating of pain intensity 3.45. Paresthesia was most frequent type of pain(67.8%)while operated breast was the most common site(62.1%). QuickDASH score positively correlated with pain intensity(p=0.000) and radiotherapy treatment(p=0.021). Pain intensity was positively correlated with difficulty in opening jar(p=0.000),ability to carry a bag or briefcase(p=0.00),do heavy household work(p=0.000),wash back(p=0.006),use of knife(p=0.000),indulging in recreational activities(p=0.001),performing regular daily activities(p=0.000),effect on social life(p=0.000),severity of pain(p=0.000),tingling(p=0.000) in shoulder, arm or hand and difficulty in sleeping(p=0.000). Conclusions: Chronic pain in breast cancer patients, significantly compromises functionality and quality of life evident from higher mean QuickDASH scores despite mild-moderate pain intensity. Treatment modality like radiotherapy can contribute to higher disability scores. Prioritizing earlier pain evaluation and management is crucial to reduce the long term negative impact and financial burden associated.

Topic: 4. Therapeutics

Sub Topic: 4.2 Injections (Joint. Spine, etc.,)

Predicting efficacy of echoguide corticosteroid injecton for rotator cuff tendonitis by critical shoulder angle

S. Huang^1,2

¹Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, ²Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

Background and Aims: Rotator cuff tendonitis presented shoulder pain and limited daily activities. Echo guide corticosteroid injection usually taken as an effective treatment for these patients. However, some patients presented the limited effects of this treatment. Previous studies mentioned the critical shoulder angle (CSA) was associated with rotator cuff tendinopathy. The aim of this study was to investigate the influence of CSA on predicting the efficacy of echo guide corticosteroid injection for rotator cuff tendonitis. Methods: This prospective study enrolled rotator cuff tendonitis patients. Before injection, the CSA was measured. One session of Triamcinolone (40mg/ml) through ultrasound guidance was performed. The visual analog scale (VAS), and Shoulder Pain and Disability Index (SPADI) were evaluated before intervention and at 2, 6, and 12 weeks after injection. The associated the effect of analyzed by linear logistic regression and Pearson’s test. Results: There were 42 patients enrolled in this study. The mean age was 56.3 years old and 24 of them were male patients. The mean CSA was 38.2 degrees. The CSA was associated with the VAS and SPADI at 6 and 12 weeks after injection. Our study found the CSA had a positive correlation with VAS and SPADI especially at the 12th week of evaluation. Conclusions: The CSA of the shoulder is associated with the clinical outcome after echo guide corticosteroid injection among rotator cuff tendonitis patients. Our study demonstrated that rotator cuff tendinitis patients with higher CSA will present less effect of echo guide injection.

Topic: 4. Therapeutics

Sub Topic: 4.2 Injections (Joint. Spine, etc.,)

Effects of hypertonic dextrose injection for chronic subacromial bursitis: A pilot study for randomized controlled trial

S. Huang^1,2

¹Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, ²Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

Background and Aims: Subacromial bursitis is one of the major causes of chronic refractory shoulder pain. Corticosteroid injection was often used for intervention, but the adverse effects should be considered. Hypertonic dextrose injection was taken as an alternative treatment for chronic subacromial bursitis. The aim of this study is to compare the effect of hypertonic dextrose and corticosteroid for chronic subacromial bursitis patients. Methods: Patients with diagnosed chronic subacromial bursitis were recruited in this double-blind randomized controlled trial. Patients in the study group were treated with one dose of ultrasound-guided hypertonic dextrose (20%) injection at the bursa, whereas comparison group patients received one session of Triamcinolone (40mg/ml) through the same method. The visual analog scale (VAS), and Shoulder Pain and Disability Index (SPADI) were evaluated before intervention and at 2, 6, and 12 weeks after intervention. Results: In total, 23 patients completed the study (12 in the study and 11 in the control groups). With comparing baseline, the study group indicated a significant improvement in the VAS (P =.043) and SPADI (P =.037) at the second week after the injection. However, the effect did not sustain until the 6th and 12th week after the injection. The comparison group had a significant effect on VAS and SPADI with comparing baseline and study group at the 2, and 6 weeks. No difference of pain effect on the 12th weeks after injection. Conclusions: The ultrasound-guided hypertonic dextrose injection presented less effect of corticosteroid for chronic subacromial bursitis patients.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Effect of balance training based on virtual reality technology on balance function of stroke patients

L. Huang

Jilin University, Changchun, China

Background and Aims: Background and aims: According to statistics, the overall prevalence of stroke in China continued to rise significantly from 2007 to 2017, and the mortality showed a downward trend. Balance dysfunction is one of the common post-stroke dysfunctions, which is the main factor limiting the walking and activity of patients. The aim of this study was to observe the effect of virtual reality technology combined with balance training on balance function of stroke patients. Methods: Methods: 36 cases of stroke patients from 2020 to 2021 were randomly divided into control group (n=18, age=59.25±8.64) and training group (n=18,age=60.33±8.56). Both groups received routine balance training. The control group adopted Balance-Trainer dynamic balance training instrument, while the treatment group participated in the 3D video game-based VR training program for 30 minutes a day, five times a week, for 4 weeks. Before treatment and four weeks after treatment, outcome measures were compared between two groups and included Berg balance scale (BBS), Modified Barthel index scale (MBI). Results: Results: After treatment, the BBS and MBI scores of the two groups were improved, and the score of the training group was higher than that of the control group, the differences were statistically significant (P < 0.05). Conclusions: Conclusion: Balance training based on virtual reality technology can effectively improve the balance function of stroke patients.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Incobotulinumtoxina injection for the treatment of a patient with anismus. A case report

S. Hijazi Vega, M. Martínez Sánchez², V. Fuentes Santos³, L. Azcue Muñoz

Complejo Hospitalario Universitario De Albacete, Albacete, Spain

Background and Aims: Chronic constipation is one of the most common gastrointestinal problems worldwide. Patients always complain of extremely difficult and painful defecation. The aim of this case report is to show the efficacy of incobotulinumtoxinA injection to the external sphincter in the treatment of a patient with anismus. Methods: Woman, 71 years attended for symptoms compatible with anismus. Persistent constipation for more than 10 years, with important discomfort and a sensation of a hard ball in the rectum with significant pain on defecation (VAS score: 9) that remains after defecation. Anal hight tone was palpated, verified by anal electromyography. Due to the high tone of the anal canal 75 U of IncobotulinumtoxinA (25 IU in external anal sphincter (1 site) and 50 IU (2 sites) in the central nucleus of the perineum were injected. Results: Follow-up was conducted several times. At the six months follow-up, the patient clinical improvement reached a maximum. She showed great satisfaction with the treatment. No difficulty in defecation or pain (VAS score: 0). Canal anal hypertonia was not palpable. No adverse effect reported. The beneficial clinical effects of incobotulinumtoxinA lasted for 14 months, when the patient reported the reappearance of symptoms, anismus and pain at rectal palpation. A new injection of incobotulinumtoxinA was conducted with the same good results as the first injection. Conclusions: In this patient, IncobotulinumtoxinA injection seems to be an effective and long-lasting treatment of severe constipation and anismus.

Topic: 7. Functioning and Disability

Sub Topic: 7.4 Impairment Rating, Disability Evaluation and Certification

Assessment of pain in patients with lower extremity amputations caused by ballistic trauma

M. hfaidh, N. Mouhli, J. Bahri, H. Attia, H. Rahali, I. Ksibi, R. Maaoui

Military Hospital of Instruction of Tunis, Tunis, Tunisia

Background and Aims: Pain is well known to be an important cause of morbidity and disability. Pain assessment is particularly important in amputees because of the different types of pain reported such as phantom limb sensation, residual limb pain and low back pain. Our objective is to assess pain in this population. Methods: We conducted a descriptive study in the Physical Medicine and Functional Rehabilitation Department of Military hospital of Tunis, over a period between Septem