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 Table of Contents  
Year : 2022  |  Volume : 5  |  Issue : 6  |  Page : 119-411

Poster Presentations

Date of Web Publication19-Jul-2022

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

DOI: 10.4103/2349-7904.351394

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How to cite this article:
. Poster Presentations. J Int Soc Phys Rehabil Med 2022;5, Suppl S2:119-411

How to cite this URL:
. Poster Presentations. J Int Soc Phys Rehabil Med [serial online] 2022 [cited 2022 Sep 29];5, Suppl S2:119-411. Available from: https://www.jisprm.org/text.asp?2022/5/6/119/351394

  Biomedical Sciences: Biomechanics Top

  6909 - QUEST satisfaction with RAFO, an innovative ankle-foot orthosis for pes planovalgus in children with cerebral palsy Top

Julie Dohin, Lisa Viallard

Médecine Physique et de Réadaptation, CHU Rennes, Rennes, France

E-mail: [email protected]

Background and Aims: Pes planovalgus (PPV) is common in children with cerebral palsy and can cause pain and gait alterations over time. Initial treatment of flexible PPV includes orthotics, despite a lack of consensus on how to deliver them. Methods: We developed an innovative ankle-foot orthosis (Rennes AFO: RAFO). RAFO is a one-piece orthosis designed to correct PPV by straightening the hind foot and recreating the medial arch. Above malleolar height enables a moderate anti equinus effect. We conducted a satisfaction study through a telephonic QUEST (Quebec User Evaluation of Satisfaction with Assistive Technology) survey analyzing the device and the process in children and parents. 20 parents, whose child was wearing RAFO daily for at least 4 months, were called. Results: 20 subjects answered the questionnaire. Mean QUEST satisfaction was 4.25/5 (4.18/5 for the device and 4.38/5 for the process). Avantages reported concern weight and dimensions (95%), although 45% reported the necessity to change to a shoe size above, as well as easiness to use (90%) and comfort (80%). Parent's satisfaction regarding perceived effectiveness was 80%. Conclusion: Parents were overall very satisfied with the orthosis. Further studies are planned to assess observational and quantified gait improvement related to RAFO orthosis.

  6796 - High intensity interval exercise in the prevention of cardiorespiratory dysfunction caused by the use of anthracyclines: A review Top

Nuno Caria Ramalhão

Centro Hospitalar Universitário do Porto, Porto, Portugal

E-mail: [email protected]

Background and Aims: The use of anthracyclines is associated with higher cardiovascular mortality in cancer patients. The most significant clinical effect is the late cardiac damage leading to Congestive Heart Failure. High intensity interval training (HIIT) involves alternating high and low intensity training. This method may have the ability to optimise cardiorespiratory function in cancer patients who are under treatment with Anthracyclines. This review aims to summarize the ability and effectiveness of a HIIT program in these patients. Methods: A literature review was performed using the following databases: Medline, ISI Web of Science and CENTRAL. The following MESH terms were used: 'High intensity interval exercise'; and 'Anthracycline-Induced Cardiotoxicity'. Results: Four RCT and five reviews conducted within the last 10 years were included. Adherence rates of 70%–80% were reported for patients in the intervention groups. There was no statistically significant change in VO2max in the intervention group, but a reduction in the control group was observed in one trial, in which patients maintained their usual level of activity (18.7 - 16.1 ml/kg/min). Significant improvements were also observed in the 6-minute walk test ( (+11.6%) and in the Margaria-Kalamen stair climb test (- 3.39%). Conclusion: The introduction of a HIIT programme has good adherence rates in patients treated with anthracyclines with the maintenance of various determinants of cardiorespiratory capacity throughout treatment, compared to patients in the control group in which patients did not participate in any exercise protocol. Despite the promising evidence that HIIT programmes seem feasible to integrate in patients receiving treatment on anthracyclines, RCT's comparing these programmes with other continuous aerobic exercise protocols will be needed.

  6898 - The evolution of an innovative rehabilitation program in Dominican Republic: Education, training and integrative community health Top

Sara Pullen1, Tiernan Damas2, Lucia Rodriguez Vargas2

1Department of Rehabilitation Medicine, Emory University, Atlanta, USA, 2Emory University, Atlanta, USA

E-mail: [email protected]

Background and Aims: The World Health Association estimates that 1 in 7 people in the Dominican Republic (DR) require at least one assistive device for functional independence, and that 12.3% of the Dominican population lives with a disability. Despite the clear need for rehabilitative services, the infrastructure of the Dominican health system does not formally include physical rehabilitation. Since 2010, the Emory University Doctor of Physical Therapy program annually sends a team of PTs and students to work collaboratively with local health clinics, providing PT services to community members at local clinics and providing home visits in the corresponding neighborhoods. Methods: Data were collected between the years 2016-2020 documenting each patient's visit location, cause of injury, interventions provided, and assistive devices given. Results: Between 2016–2020, 497 patients were seen at 9 locations. The mean age of the patients seen was 51 years (range: 4 months -107 years old). 60% identified as female, 71% were seen in clinic sites, and 29% were seen in home visits. Diagnoses included: 23% joint pain, 15% back pain, 14% lower extremity impairments, 9% upper extremity impairments, 10% sequelae of motor vehicle accidents, and 3% neurologic conditions. 103 assistive device items were distributed to individual patients or clinics. Conclusions: Globally, there is a significant need for physical rehabilitation in communities where these services are scarce or non-existent. The described program promotes not only individual mobility and health but also provides support and resources to local community clinics. This sustainable, collaborative care model has potential for expansion to other communities with similar resources and demographics to support global education, training and integrative community health.

  6518 - Joint hypermobility in faulty posture children: Case control study Top

Barbara Dobies-Krzesniak1, Beata Tarnacka2, Agnieszka Werblinska3

1Rehabilitation Clinic, Medical University of Warsaw, Spartanska, Warsaw, Poland, 2Department of Rheumatology and Rehabilitation, Rehabilitation Clinic, National Institute of Geriatrics, Warsaw, Poland, 3Medical University of Warsaw, Warsaw, Poland

E-mail: [email protected]

Background and Aims: Joint hypermobility (JH) refer to an excessive range of motion of the joints. It may be related to a systemic disease or may not have a specific diagnosed cause. Faulty posture (FP), on the other hand, refers to objectively observable deviations from normal posture encompassing mild changes as well as defined disease entities. Etiology of FP is still under investigation with JH as one of the possible etiologies. The aim of this study was to assess JH prevalence in children with FP. Methods: This case-control study enrolled 98 children (aged 7-18 years (mean 12.7 ± 2,3; boys 34 (34,7%) diagnosed with FP. The control group included 96 age and sex matched volunteers. Beighton score[1] and Hakim and Graham questionnaire (H and GQ)[2] were used to determine JH. Data were statistically analyzed, p < 0.05 was considered statistically significant. Results: JH was diagnosed by Beighton score in 45 (459%) faulty posture patients and in 37 (385%) control group children. The difference found was not statistically significant (p = 0.298). Also, no significant difference (p = 0,877) was found by H and GQ diagnosis with JH in 52 (531%) of FP patients and 52 (542%) controls [Table 1]. Conclusion: This study shows that JH prevalence is not more common in children with FP diagnosis.

Table 1

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  6857 – Ghana's journey to respond to the rehabilitation needs of its population Top

Abena Tannor1,2

1Rehabilitation Programme, World Health Organization, Geneva, Switzerland, 2Center for Disability and Rehabilitation Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

E-mail: [email protected]

Background and Aim: Ten percent (10%) of Ghana's population has a disability as estimated by the World Health Organization due to trauma-related injuries and non-communicable diseases. There is an increasing unmet need for rehabilitation in Ghana. In well-developed countries, the proven way of solving this need is through multidisciplinary rehabilitation services coordinated by a Physical and Rehabilitation Medicine(PRM) physician. Methods: The journey to provide PRM services began in Ghana in 2015 with the establishment of the first locally-led multidisciplinary service.Together with the International Rehabilitation Forum(IRF), a curriculum for a 2-year fellowship program for Family Physicians in PRM was developed for the Ghana College of Physicians and Surgeons.This included both online lectures and hands-on practicals by PRM physicians from other countries Results: The official PRM fellowship program in Ghana began in 2018 with one fellow who despite delays in the training due to the COVID-19 pandemic graduated in 2021.This huge feat was achieved with support from the IRF (human resource) and ISPRM which provided sponsorships to ISPRM congresses as part of continuous medical education. Currently, there are four other fellows being trained to expand the care being provided.One major challenge has been getting adequate trainers for hands-on and practical training. Conclusion: Ghana is on course to increase the number of PRM physicians required to meet the rehabilitation needs of its population. This can be replicated in some Low to Middle-Income Countries (LMICs) where there are similar needs. ISPRM is strategically placed to support the training of PRM physicians in LMICs through the provision of learning materials, coordination of human resources for training, and sponsorship to ISPRM congresses to improve knowledge.

  6785 - Comparison and validation of pressure and acceleration time domain waveform models of a smart insole for accurate step counting in healthy people Top

Armelle-Myriane Ngueleu1, Charles Sèbiyo Batcho2, Martin Otis3

1Université Laval, Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada, 2Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, (CIRRIS), Canada, 3Department of Applied Science, Automation and Interactive Robotic Laboratory, UQUAC, Saguenay, Canada

E-mail: [email protected]

Background and Aim: Several studies have shown good accuracies for step counting based on pressure signals of smart insoles in people walking at different speeds. Although smart insoles are often equipped with pressure sensors and accelerometer, no study has focused on comparing the accuracy of step counting separately based on pressure and acceleration signals in healthy people. The objectives of this study are to design a waveform model of acceleration and pressure sensors and then compare with other devices for step counting. Methods: Eight healthy participants (mean age = 39.8 ± 17.56 years old) wore a pair of smart insoles, a Gait-Up, and a StepWatch, and performed the six-minute walking test at walking speeds from 1.27 to 2.22 m/s. To determine their accuracy, step counts obtained from these devices were compared to a manual step count. Suggested waveform models have 1Hz of width and 41 points of length in order to represent at least one portion of the step. Results: Four pressure and one acceleration waveform models were designed and used for the detection of 341 to 412 steps, with maximum differences of 2 to 6 steps depending on the waveform models, 6 steps for Gait-Up and 28 steps for StepWatch compared to manual count. All pressure and acceleration waveform models yielded step count accuracies from 99.67% ± 0.63% to 99.97% ±1.38% (with ICC from 0.993 to 1.0). There was not statistically significant difference (F=2.853; p=0.091) in step count accuracy based on pressure and acceleration waveform models. Spearman correlations showed a weak but significant relationship between step counting accuracies and walking speeds (r= 0.268; p=0.016). Conclusion: These results suggest there is at least one waveform for each sensor reducing error and improving step count accuracy.

  6560 - Assessment of motion and muscle activation related to low back pain during pregnancy by musculoskeletal model Top

Saori Morino1, Masaki Takahashi2

1Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan, 2Keio University, Tokyo, Japan

E-mail: [email protected]

Background and Aims: Specific postural and movement change during pregnancy impose excessive strain on muscles, such as erector spinae (ES), contributing to low back pain (LBP). Sit-to-stand (STS) motion can potentially cause LBP during pregnancy. The purpose is to investigate the relationship between muscle load and intensity of LBP in STS using musculoskeletal model for pregnancy. Methods: At first, STS motion analysis was conducted for 11 pregnant women to obtain motion, force, and electromyogram data. Then, pain intensity of LBP in STS was investigated by a Numerical Rating Scale (NRS). Subsequently, ES muscle torque was estimated from obtained data by musculoskeletal model. Based on the value, root mean square of ES muscle torque (RMS-MT) was calculated as an evaluation index of muscle activation. The bigger values indicate the greater activation. Then, the difference of the RMS value in STS and at standing position (DRMS-MT-Stand) was also calculated to remove individual differences of muscle activation in rest position. At last, the correlation analysis was conducted using the two indices and NRS score to investigate the correlation between the muscle activation and LBP by the data from pregnant women who have LBP in STS. Results: Among the participants, 9 women had LBP. No significant correlation between RMS-MT and NRS score was observed (r=0.38, p=0.32). On the other hand, significant positive correlation was observed between DRMS-MT-stand and NRS score (r=0.74, p=0.02). Conclusions: Greater ES muscle activation in STS motion compared with rest position might indicate a higher relationship with LBP during pregnancy. Therefore, the assessment and approach to muscle activation during motion and also rest position might be effective for the management of LBP in STS motion during pregnancy.

  6548 - Intrathecal drug delivery system (IDDS) safety and clinical accuracy: Interim registry data Top

Klemen Grabljevec1, Sam Eldabe2, Iris Smet3, Tom Theys4, Vidal Samso5, Bianca Papi6, Pauline Pierlovisi7, Robert Spencer8

1Univerzitetni Rehabilitacijski Inštitut Republike Slovenije Soca, Ljubljana, Slovenia, 2The James Cook University Hospital, South Tees Hospitals NHS, Middlesbrough, UK, 3AZ Nikolaas, Campus, Sint-Niklaas, Belgium, 4UZ Leuven Campus Gasthuisberg, Leuven, Belgium, 5Fundación Guttmann, Hospital de neurorrehabilitación, Badalona, Spain, 6Medtronic, 7Metronic, 8Medtronic, Inc Clinical Minneapolis, MN, USA

E-mail: [email protected]

Background and Aims: IDDS utilization in the treatment of chronic pain and severe spasticity involves intrathecal delivery of minute volumes of drug, with system reliability and accuracy key factors in patient safety and therapy effectiveness. Published clinical accuracy for available IDDS is currently limited to 1 year, whereas available systems have implant lives or 7 years or more. Methods: An EU Post Market Clinical Follow-up (PMCF) study was executed within the prospective, long-term, multi-center Product Surveillance Registry established by Medtronic in 2003. Data are collected on product-performance following EC approval at respective sites; patients providing informed consent are enrolled at initial system implant or pump replacement. Patients are followed prospectively for events related to the device, procedure, and therapy. Investigators provide event descriptions, patient symptoms, and patient outcomes. The primary study endpoint is clinically-measured infusion accuracy, with a secondary outcome of freedom from product performance events; both assessed at 4 years post-implant. Results: A total of 209 subjects were enrolled across 15 EU clinical sites between Feb 2017 and Aug 2019. All patients will have completed their 2-year visits by Dec 2021, allowing for assessment of pump accuracy and safety. These interim outcomes will be presented. Conclusion: Availability of IDDS clinical accuracy and an understanding of expectations for any given device allow for clinician assessment of device performance, assisting in determination of when a more thorough evaluation may be needed. Data presented here will add to available, short-term data for IDDS.


  1. Rauck R. Neuromodulation 2010;13:102-8.
  2. Rauck R. Neuromodulation 2013;16:163-7.
  3. Wesemann K. Reg Anesth Pain Med 2014;39:341-6.

  6538 - Limb amputation complication relation to Saudi geographic region, a tertiary healthcare center population review Top

Mohammed Alhayyan1, Mohammed Alatwi1, Jinan AlRashoud1, Atheer Alrasheed2, Reem Alshahrani1, Fayez Alshehri1

1Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia, 2King Saud University, Riyadh, Saudi Arabia

E-mail: [email protected]

Background and Aims: Amputation rehabilitation (AR) has improved care and complication management. Our research aims to evaluate limb amputation complications for each geographical region in Saudi Arabia (SA). Methods: A retrospective chart review study at AR program from 2013-2019 for adults aged above 17 at King Fahad Medical City, Riyadh, SA. Results: 369 Saudi adults were included. Mean age was 50.4 (SD ± 18.3) years. A significant 284 (77%) more involved males than 85 (23%) females (P = 0.014). A significant more vascular amputations in the central region and traumatic amputations in northern and southern regions (P = 0.002). Post amputation pain was due to stump pain (12%), phantom pain (9%), and musculoskeletal pain (5%). Other complications include muscular contracture (8%) and dermatological complications (5%). The highest stump pain was among amputations secondary to tumor (19%) and phantom pain with dysvascular amputation due to PVD (13%). Contracture was detected in (12%) of vascular amputations secondary to diabetes. 205 (58%) patients required close amputation clinic visit to address complication. 53 (15%) were referred for medical or surgical evaluation to manage related complication. A significant 213 (60%) required prosthetist evaluation (P = 0.032). The highest outpatient evaluations were among southern region 49 (73%) but wasn't statistically significant (P = 0.08). Conclusion: Data regarding amputation complications is lacking locally. This study reports acquired amputation complications. For adult amputee, age, gender, and amputation cause do not influence the occurrence of complications, but when occurs, patient will require close physical evaluation and management. Physiatric interventions must begin early to manage factors that affect patient function.

  6010 - Short-term functioning follow-up in lower-limb amputees using low-cost exoskeletal prostheses Top

Jesus A. Plata Contreras1, Leandro Guillermo Realpe Cisneros1, Felipe Canastho Rodriguez1, Juan Ricardo Lopez Posada2

1Universidad de Antioquia, Antioquia, Colombia, 2Corporacion Mahavir Kmina Artificial Limb Center, Antioquia, Medellín, Colombia

E-mail: [email protected]

Background and Aims: To describe the Functioning of lower limb amputees who were given a low-cost exoskeletal prosthesis in an orthopedic workshop in Medellín-Colombia from January 2018 to March 2021. Methods: A 6-month follow-up was carried out by phone call in lower limb amputees for any cause to determine the adaptation to the prosthesis using the Houghton scale as a functional evaluation instrument. Results: A follow-up was made out six months after adjusting the orthopedic device to 336 patients who were using the prosthesis were included by phone call, 183 lower limb amputees (54.4%) donning their first prosthesis and 153 (45.6%) patients had already used a prostheses in the past, 76% were men with an average age of 47.4 years (SD +/- 20.6 years). In 136 patients the Houghton scale had a score of less than 8 points, this means that despite using the prosthesis they still did not manage to have the minimum score to adapt, while 200 patients had a score greater than or equal to 8 points which it means they are working properly. 46.4% of the people who use the prosthesis for the first time, were well adapted in the first six months of use, compared with 75.1% of the old users. Conclusions: The observed results show that the majority of patients are well adapted to exoskeletal lower limb prostheses, according to the Houghton scale score. We were also able to demonstrate the differences that exist in the prosthetic adaptation in the first six months of use by those people who have their first prosthesis compared to old users, These results are expected and show a greater possibility of adaptation to the exoskeletal prosthesis when compared with the endoskeletal prosthesis. The prostheses were donated by the Mahavir Kmina artificial limb center corporation in Medellín, Colombia.

  5979 - Approach to the fallskip tool in the prevention of falls in our clinical practice Top

Clara Cagigas1, Elena Romero2, Alejandro Chicharro1, Francisco Luna Cabrera1

1HRU de Málaga, Medicina Física Y Rehabilitación, Málaga, Spain, 2HUVV de Málaga, Medicina Física Y Rehabilitación, Málaga, Spain

E-mail: [email protected]

Background and Aims: Falls are among the most serious problems of the ageging population, with high mortality and morbidity rates. As a consequence of falls one of the most common types of fractures within older people is hip fracture, which implies enormouscosts. In this context, the development of fall risk assessment tools is of great importance to properly identify individuals with a high fall risk, allowing to implementate preventive strategies and target resources better. Fallskip is a novel software application that assigns a person's risk of falling when performing a modified protocol of the “Timed up and Go” test. The aim of this study was to test the relationship between a history of fracture and the risk of a new fall through the analysis of the gait pattern using Fallskip. Methods: A descriptive study was made in a sample of 16 people aged between 31 and 92 in the hospital area of the HRU de Málaga, with a history of fracture. FallSkip provides four fall risk levels: low, moderate high or very high. Results: Among the patients with lower limb fractures, 50% presented a very high risk of falling, 25% a high risk, and 12.5% a moderate risk and a low risk, whereas among the patients with upper limb fracture, 12.5% had a very high risk of falls, 12.5% a high risk, and 37.5% a moderate and a low risk. Conclusions: Fallskip is a device that allows the detection of patients with any alteration in their gait pattern early before events of falls.We can conclude that in our sample of people, those patients with lower limb fractures were generally associated with a higher risk of falling than those with upper limb fractures. However, given the small sample size it would be advisable to enlarge the sample before obtaining definitive conclusions.

  5930 - Time course response after single injection of botulinum toxin to treat muscle hypertonia after stroke: Pharmacodynamic model-based meta-analysis Top

Etienne Ojardias1,2, Edouard Ollier3, Ludovic Lafaie1, Thomas Celarier1, Pascal Giraux4, Laurent Bertoletti5

1Department of Clinical Gerontology, University Hospital of Saint-Étienne, Saint-Étienne France, 2University Hospital of Saint-Étienne, Saint-Etienne, France, 3Clinical Research, Innovation and Pharmacology Unit, North Hospital, University Hospital of Saint-Étienne, Saint-Étienne, France, 4Department of Physical Medicine and Rehabilitation, University Hospital of Saint-Étienne, Saint-Étienne, France, 5Department of Vascular and Therapeutic Medicine, North Hospital, University Hospital of Saint-Étienne, Saint-Étienne, France

E-mail: [email protected]

Background and Aims: Few data provide a comparative description of the dose-response and time course effect for all Botulinum toxin (BoNT) to treat muscle hypertonia. We addressed a pharmacodynamic model-based meta-analysis. Methods: We searched Medline, PeDro and Google Scholar databases up to March 2020, selecting randomized controlled trials of post-stroke and traumatic brain injury patients with arm or leg muscle hypertonia, comparing BoNT to placebo, or different BoNT preparations. The main outcome was change in Modified Ashworth Scale (MAS) score. A non-linear mixed effect model was used to estimate maximal toxin and placebo effects (Emax and EPlacebo), the effect disappearance half-life (T1/2off) of BoNT and the doses achieving 50% and 80% of Emax (D50 and D80). The equivalence ratios between different BoNT preparations were calculated from D50 values. Results: 2236 unique records were screened, 35 eligible trials including 3011 patients were identified. For all BoNT preparations, the BoNT Emax of -1.11 (95% credible interval -1.31; -0.29) was reached at 5 weeks; the maximal placebo effect was -0.30 (-0.37; -0.22). Both D50 and D80 differed significantly by muscle volume. At D50, the equivalence ratio was significantly higher for abobotulinumtoxinA (3.35) than onabotulinumtoxinA and lower for letibotulinumtoxinA (0.41). T1/2off was longer for abobotulinumtoxinA than for onabotulinumtoxinA and the other preparations (13.1 weeks [95% credible interval 7.7; 19.3] vs 8.6 weeks [7.1; 10.1]). Conclusions: This first pharmacodynamic model-based meta-analysis supports a common maximal effect on MAS score at 4-5 weeks for all the different BoNT preparation on muscle tone but also revealed significant differences in effect duration.

  5783 - Smart watch-based functional assessment for upper extremity impairment Top

Hyung Seok Nam

Department of Rehabilitation Medicine, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, UAE

E-mail: [email protected]

Background and Aims: Wearable sensors are experimentally applied during rehabilitation to analyze upper extremity movement; however, simple and clinically relevant applications of such data are scarce. We aimed to investigate potential sensor-based clinical outcome parameters of upper extremity impairment. Methods: Ten patients with unilateral shoulder pain and range-of-motion limitation due to traumatic injury were enrolled. The participants were equipped with wrist-worn smartwatches on each wrist. They were instructed to perform 3 upper extremity movement domains: (1) gross activities-of-daily-living (ADL) tasks; (2) Wolf Motor Function Test (WMFT) items; and (3) selected tasks from the Upper Extremity Functional Index (UEFI). The acceleration and angular velocities were acquired and analyzed using the algorithm developed using the MATLAB®. Motion segment size (MSS) for acceleration and joint motion angles were extracted. Correlation analyses were performed between the extracted parameters and the clinical outcome measures: WMFT and UEFI. Results: For gross ADL tasks, the maximum (R = 0.695, P = 0.038) and average (R = 0.787, P = 0.012) MSS for elbow flexion/extension showed significant correlation with the WMFT scores. For the WMFT tasks, average MSS for angle of forearm supination/pronation (R = 0.815, P = 0.007) and shoulder external/internal rotation (R = 0.873, P = 0.002) showed significant correlation with the WMFT score. For UEFI tasks, total performance time (R = -0.742, P =0.014) and average MSS for elbow flexion/extension demonstrated significant correlation with both the WMFT (R = 0.871, P = 0.001). Conclusions: Accelerometer and gyrosensor data processed from a single smartwatch demonstrated significant correlations with the clinical outcome measures.

  5565 - Urinary and fecal incontinence in high-impact sport in women Top

Tania Morán Augusto, Omar Halil Rodríguez, Henar María López Rico López Rico, Iria Bascuas Rodríguez, María Teresa Jorge Mora

Hospital Montecelo, Servicio de Medicina Física Y Rehabilitación, Pontevedra, Spain

E-mail: [email protected]

Background and Aims: The purpose of the study was to determine the prevalence of urinary and/or fecal incontinence in women who practice high-impact sport, as well as to obtain preliminary data on related factors. Methods: A cross-sectional observational study was employed. In July 2021, we designed our own self-administered online questionnaire. Female athletes more than 18 years of age who regularly practice medium-high level sports were invited to participate. Results: We obtained the participation of 57 women from several athletics and volleyball clubs in the area. Age, number of vaginal deliveries, recurrent urinary tract infections, type and frequency of training were considered, as well as the existence of urinary and fecal losses and their characteristics. According to replies, 44.6% of participants were between 18 and 24 years old and 28.6% were over 40 years old. 78.6% of the athletes were nulliparous and only 16.1% had 2 or more children. 55.4% trained 3-4 days a week. 28.6% reported they had urine leaks and that in 17.9% urine leakage occurred while training. 69.6% did not include any pelvic floor exercise program in their training routines. 45.6% reported some degree of minor fecal incontinence (gas leaks). Conclusion: Incontinence is frequent in female athletes and there is no established plan for a comprehensive approach to the problem in the sports field.

  5703 - Changes in response to displacement by different frequencies of compression in the distal radioulnar joint Top

Hiroshi Yuine1, Naoki Yoshida2, Yuichi Yoshii3, Hideki Shiraishi1

1Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan, 2Department of Occupational Therapy, Okayama Healthcare Professional University, Okayama, Japan, 3Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Japan

E-mail: [email protected]

Background and Aims: In testing distal radioulnar joint (DRUJ) instability, its elasticity is perceived by manual resistance but this is subjective. We hypothesized that if factors other than elasticity (such as viscosity and inertia) are influenced, different input frequency changes the apparent elasticity value and causes a phase shift between the force and the radioulnar displacement (RD). Our aim was to design an assessment method of response to displacement of DRUJ using force-monitor ultrasonography. Methods: The ulnar head was displayed at the DRUJ level and periodically compressed using an ultrasonographic transducer attached to a cyclic compression apparatus incorporating a force sensor [Figure 1]. The RD was measured from the resulting ultrasound image and synchronized with the pressure data. The elastic modulus was obtained by the slope of the regression line of force and displacement. For the phase shift, the peak of the waveform of the RD and pressure was estimated, and the average time delay was calculated. Compressions were applied to the left and right DRUJ of a healthy volunteer at different frequency conditions (0.5 Hz, 1.0 Hz, 1.5 Hz). Results: The elastic modulus changed by varying the frequency of the input force [Table 1]. Conclusion: Factors other than elasticity such as viscosity and inertia may be important for the assessment of DRUJ instability.
Figure 1: Pressure-monitor ultrasonography

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Table 1: Results of the elastic modulus and the mean phase shift

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  5543 - Rehabilitation in extrapulmonary tuberculosis: Case report Top

Luz Miriam Leiva Pemberthy, Isabel Londoño

Universidad del Valle, Cali, Colombia

E-mail: [email protected]

Case Diagnosis: Disseminated tuberculosis with pulmonary, cerebral, medullary, and musculoskeletal compromise. Case Description: 9-year-old indigenous girl, on admission with malnutrition, weight loss, and encephalopathy. Tuberculosis (TB) was confirmed by molecular testing in cerebrospinal fluid. A diagnosis of disseminated TB was established: pulmonary, cerebral (meningitis, tuberculomas, and hydrocephalus), medullary (leptomeningeal collections and radiculitis), and musculoskeletal (synovitis, bursitis, myositis), hence treatment with antituberculous drugs and steroids was prescribed. She presented highly disabling motor and cognitive neurological sequelae, flexion contractures of the hips and knees due to myositis and synovitis. Rehabilitation aimed at palliative care was carried out. Discussion: Pulmonary TB is the most common type of TB in children and 30-40% of cases present extrapulmonary TB.[2] Disseminated infection and central nervous system involvement are the most frequent manifestations.[3] Conclusions: TB of the central nervous system is the most serious complication, causes mortality between 15-32% and high disability; approximately 80% of survivors will have neurological sequelae.[2] The spectrum of musculoskeletal manifestations due to TB is wide, early diagnosis of bone and joint disease is important to minimize the risk of deformity and improve functional outcome.


  1. Kritsaneepaiboon S, Andres MM, Tatco VR, Lim CC, Concepcion ND. Extrapulmonary involvement in pediatric tuberculosis. Pediatr Radiol 2017;47:1249-59.
  2. Niederbacher Velásquez J. Neumol Pediátr (Online) 2015;10:160-8.
  3. Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ. Extrapulmonary tuberculosis: Pathophysiology and imaging findings. Radiographics 2019;39:2023-37.

  5616 - Total knee arthroplasty: Fast-track rehabilitation protocol Top

Irene Pinto, Vilma Marques, Lúcia Dias

Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal

E-mail: [email protected]

Background and Aims: A specific rehabilitation program named fast track rehabilitation (FTR) can be applied to Total Knee Arthroplasty (TKA). The fast track modality presupposes multimodal opioid-sparing analgesia and early mobilization, allowing patients to fulfill functional discharge criteria within 2–3 days, reducing the length of stay in hospital. The aim of this study is to propose a FTR protocol based on first three days after TKA in our institution. Methods: The authors' aim is to implement a fast track institutional protocol for TKA. The FTR protocol includes activities to enhance performance of patients proposed to TKA, both in pre and post-operative setting. In the preoperative period, the objective is to reduce muscle amyothrophy, teaching active mobility exercises in bed and the use of walking aids and preventing falls. The fast-track modality premises multimodal opioid-sparing analgesia and perioperative local infiltration analgesia, facilitated early recovery, allowing patients to ambulate within 2–3 hours after surgery. During the early post-operative phase (day 0-3) the goals of FTR are to decrease swelling, increase range of motion, enhance muscle control and strengthen the lower extremity and maximize patients' mobility leading to functional independence. Walking capacity will be encouraged on the first hours and stair climb performance on the second day. Hospital discharge is scheduled on the third hospital day with reintegration into outpatient rehabilitation program. Conclusions: Reports suggest that the FTR seems to reduce he duration of hospital stay, when compared to patients who integrated a standard care rehabilitation. Consequently, the authors have elaborated a tailored institutional protocol to optimize patient's functional status after TKA.

  5598 - Altered central and peripheral neuromuscular characteristics of the shoulder complex in people with frozen shoulder Top

Yi-Fen Shih1, Ting-Yu Chen2, Chun-kai Tang2

1Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan, 2National Yang Ming Chiao Tung University, Taipei, Taiwan

E-mail: [email protected]

Background and Aims: Frozen shoulder (FS) is a common musculoskeletal condition, characterized by chronic pain and mobility deficits. With emerging evidence showing that the central nervous system might reorganize in patients with chronic musculoskeletal pain, this study was design to investigate the changes in neuromuscular characteristics of the upper trapezius (UT), infraspinatus (Ifs), and pectoralis major (PM) in patients with FS, and to examine the relationship between pain, central excitability, and muscle activation. Methods: Thirteen participants with FS and 13 controls were recruited. The outcome measures included central excitability (active motor threshold (AMT), motor evoked potential (MEP), cortical silent period (CSP), short interval intracortical inhibition (SICI), and short interval intracortical facilitation (SICF)), shoulder kinematics, muscle tone, and muscle activation of the UT, Ifs, PM. Multivariate analysis of variance and Mann Whitney U were used to examine the between-group differences with α=0.05. Results: The FS group had higher AMT (p=0.041), longer CSP (p=0.008), and fewer SICI (p=0.021) of the UT than the control group. During scaption and hand to sacrum, the FS group had higher activation of the PM (p=0.014), and lesser range of GH elevation, scapular upward rotation, and internal rotation (p<0.05). In addition, lower elasticity of the infraspinatus (<em>p=0.046) was found in the FS group. Pain intensity had moderate to high correlations with AMT of the three muscles, and moderate correlations with muscle activation of the PM and Ifs. Conclusions: Patients with FS showed altered central and peripheral neuromuscular control characteristics, which should be addressed when evaluating and treating FS.

  5529 - Twenty one day systemic rehabilitation in patients after knee or hip arthroplasty increases the level of plasma interleukins, VEGF, TNF-α, PDGF-BB, and eotaxin Top

Maciej Idzik1, Dominika Stygar2, Bronislawa Skrzep-Poloczek2

1Independent Public Health Care, Opole Cancer Center, Opole, Poland, 2Medical University of Silesia, Katowice, Poland

E-mail: [email protected]

Background and Aims: The study aimed to determine the effect of 21-day systemic rehabilitation of patients after knee or hip arthroplasty on the levels of interleukins and pro-inflammatory and anti-inflammatory cytokines: vascular endothelial growth factor (VEGF), tumor necrosis factor alpha (TNF-α), platelet-derived growth factor (PDGF-BB), and eotaxin. Methods: We included 41 patients after total knee (n = 12.29%) or hip (n = 29.71%) replacement: 19 women, and 22 men (46% and 54%, respectively), aged 61.0 ± 8.1 years. The first examination was performed on patients 89.6 ± 9.7 days after the surgery. Around 90 days after the endoprosthesis implantation, all patients started a rehabilitation protocol. Daily sessions, from 8:00 am to 8:45 am, were held for 21 consecutive days. Blood samples were taken before the first and after the last physiotherapy session in the morning, before breakfast at 8:00 am. 5 ml of blood was collected from the ulnar vein, and the serum was prepared for analysis. Enzyme immunoassays were performed according to the manufacturer's guidelines (The Human Cytokine Bio-Plex, VEGF, TNF-a, PDGF-BB, Eotaxin; Bio-Rad, USA). Results: A statistically significant increase (p < 0.001) was observed for IL-4 (0.83 ± 1.21; 95% CI: 0.41-1.26), IL-5 (3.10 ± 6,35; 95% CI: 0.80-5.39), IL-10 (0.45 ± 0.52; 95% CI: 0.26-0.63), VEGF (32.64 ± 46.04; 95% CI: 16.05-49.25). After rehabilitation, eotaxin values were higher than before rehabilitation by an average of 40.79 ± 37.17 (95% CI: 27.39-54.20). After rehabilitation, the FGF basic values were lower than before rehabilitation by an average of 3.03 ± 6.53 (95% CI: 0.71-5.34). Conclusion: The proposed systemic rehabilitation protocol increased the levels of selected anti-inflammatory interleukins and cytokines in patients after knee or hip arthroplasty.

  5415 - A qualitative assessment of CITI training from researchers with different experience levels Top

Lillian Nguyen1, Mark Hirsch1, Vu Nguyen2

1Atrium Health, Charlotte, North Carolina, USA, 2University of Alabama, Birmingham, USA

E-mail: [email protected]

Background and Aims: To assess effectiveness and experience of participating in the Collaborative Institutional Training Initiative ethics certification program (CITI) from the perspective of a research naïve, non-academic team member and their leader. Methods: Case study. CITI certification is required education for conducting research. Non-academic research team members may become discouraged from pursuing a career in rehabilitation research because they perceive traditional human subject protection training as lacking in relevance (Kue, 2017; Pearson et al., 2014). Content comprehension was assessed with the CITI training post-test. The student maintained an observational journal during CITI Training, which was analyzed using a phenomenological approach (Hammond et al., 2016). Results: The student achieved 100% on Good Clinical Practice and 91% on Basic Course Human Subjects Research post-test. 3 journaling themes emerged from the student's experience: (1) CITI Training has complex vocabulary and difficult concepts; (2) modules can be frustrating and confusing; and (3) it was a beneficial learning process. The research leader noted the student had good energy, punctuality, and preparedness during their regular meetings to discuss project progress. The research leader also observed the student's professional behavior and effective communication skills. Conclusions: CITI training is useful, complex, and frustrating to research naïve, non-academicians aspiring to become rehabilitation researchers. Adjustments could be made to CITI program including tailoring content to young learners; lessen complex vocabulary; add basic and concise concepts; integrate video webinar education to allow interactive learning; and create vocabulary keys. More research warranted.

  5409 - Physical functions and length of stay with early and high-intensity rehabilitation in patients after simultaneous bilateral total knee arthroplasty Top

Jun Hwan Choi1, Beom Su Kim2

1Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, South Korea, 2Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju, South Korea

E-mail: [email protected]

Background and Aims: Physical functions and length of stay after total knee arthroplasty (TKA) are related to the timing and intensity of post-operative rehabilitation. To determine the effectiveness of early and high-intensity rehabilitation after simultaneous bilateral TKA. Methods: Prospective cohort data of 156 patients (11 men and 145 women; average age 72.0 ± 5.6 years) who underwent simultaneous bilateral primary TKA were analyzed. The intervention group (n=82) underwent a high-intensity rehabilitation (phase II) after early postoperative standard rehabilitation (phase I) between June 2019 and May 2021. The control group (n=74) underwent a lower-intensity rehabilitation (phase II) after phase I rehabilitation between July 2017 and May 2019. The timed up-and-go (TUG) test, timed stair climbing test (SCT), 6-minute walk test, isometric knee extensor and flexor strength of both knees, knee flexion and extension range of motion, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) for pain, stiffness, and functional level were assessed preoperatively and 6 weeks after TKA. Results: The average length of hospital stay was shortened by 2.7 days (p<0.001). Phase II rehabilitation started earlier in the intervention group than in the control group (7.7 ± 1.3 vs. 13.5 ± 2.0, p<0.001). Compared with the control group, the intervention group showed significant improvements in the measures of mobility (WOMAC-function and SCT) and strength (isometric strength of both knee extensors and flexors) 6 weeks after TKA by statistically controlling for age and preoperative functional status. Conclusions: This study demonstrated that early and high-intensity rehabilitation could achieve functional improvement and shorten the length of hospital stay.

  5376 - Topical cutaneous CO2-treatment alters alkaline pH on chronic wounds: A new mechanism that explains the wound healing effect of CO2? Top

Alexander Ranker, Christoph Gutenbrunner

Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany

E-mail: [email protected]

Background and Aims: Topical application of CO2 is an effective treatment for chronic wounds. Vasodilatation and improved microcirculation by CO2 is a well known physiological effect and has been stated as the underlying mechanism in its wound-healing effect. Furthermore it is known, that the acidic pH of our skin changes during wound-healing in a characteristic matter. It initially gets more acidic and turns alkaline to get to the starting point again. Chronic wounds, however, are trapped in the alkaline pH. Topical CO2 and moisture (H2O) are reacting to H2CO3 (carbonic acid). This could decrease the alkaline pH of chronic wounds and help the body to trigger physiological wound healing cascades. The aim of this explorative pilot-study was to evaluate the effect on pH of topical CO2-Gas-Therapy on chronic wounds and intakt skin. Methods: From April to October 2020, the skin and wound pH was measured before and after CO2 therapy in all patients of a physical medicine university hospital outpatient clinic, who received CO2 therapy due to wound healing disorders. Measurements were taken using a surface probe at 3 measuring points: Wound centre, intact skin in CO2-exposure area (control1), intact skin without CO2 exposure (control2). All patients received CO2 gas baths with 12 therapy sessions of 20min each. Results and Conclusion: The measurements of n=13 patients (n=936 measurements) were evaluated. The total therapy time was 5.38±1.67 weeks. All patients initially had an alkaline pH at the wound site (7.22±0.81). On average, CO2 therapy was able to significantly shift the alkaline values towards acidic values (p=0.009). Mean pH before was 7.2±0.8 and after 6.2±0.3. The pH shifted towards a physiological pH.

  5361 - Evaluation of spinal cord stimulation combined with rehabilitation Top

Hiroyuki Maeda1, Mutsuhiro Maeda2, Takahiro Maeda2

1Maeda Hospital Orthopaedics and Rehabilitation, Tokyo, Japan, 2Maeda Hospital Orthopaedics, Tokyo, Japan

E-mail: [email protected]

According to the 2019 National Survey on Basic Living Conditions by the Ministry of Health, Labor and Welfare, low back pain is a common disease with the complaint rate ranking the first for men and the second for women. Relating the orthopedic diseases of low back pain, many patients visit medical institutions, with thoracolumbar compression fracture and lumbar spinal canal stenosis caused by osteoporosis. However, many patients do not respond to analgesics and nerve block injections, and hesitate to undergo surgery with consideration of the risks associated with age and underlying diseases. Spinal cord stimulation therapy is noted as a new treatment option for the orthopedic diseases of low back and leg pain. This study reports the clinical results of the new DTM Workflow at our clinic.

  4418 - Reliability and validity of the 2-minute walk test in people after stroke Top

Mariusz Druzbicki, Agnieszka Guzik, Andzelina Wolan-Nieroda, Edyta Janusz

University of Rzeszow, Rzeszów, Poland

E-mail: [email protected]

Background and Aims: The 2-minute walk test (2MWT) is generally used in the evaluation of people with neurological diseases, but it has never been validated in patients with stroke. The purpose of this study was to examine the reliability and validity of the 2MWT in patients in subacute phase after stroke. Methods: Twenty-four patients participated in the inter-rater and intra-rater reliability study. The validity was investigated using the Timed Up and Go Test, 6-minute walk test (6MWT), 10-meters walk test (10MWT) and cadence. The validity was examined using Spearman's correlation coefficient which should amount at least to 0.70 to reflect good criterion validity of the 2MWT. Results: The distance walked in 2MWT ranged from 20.0 to 132.0m (mean 72.6m, SD 26.49m). The result of the 2MWT was repeatable, no statistically significant difference was found (p=0.471). The 2MWT was significantly correlated with the 6MWT (r = 0.98), usual gait speed (r = 0.96), the Timed Up and Go test (r = −0.95), and other functional measures. Conclusions: The validity of the 2MWT appears to be confirmed for individuals after stroke in subacute phase. The 2MWT can be a good practical alternative for 6MWT, especially in patients with subacute stroke.

  7038 - Partnership between PRM, university and industry to create an orofacial mask for COVID-19 patients with dysphagia Top

Catarina Branco1, João Silva2, Rosa Henriques Henriques2, Daniela Ferreira2, Ana Vieira2, Jullio Grilo3, Sandra Melo3, Miguel Pais Clemente4, A. Amarante4, Joaquim Gabriel4

1Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal, 2Department of PRM, CHEDV, Santa Maria da Feira, Portugal, 3Enterprise Simondes, Oliveira de Azemeis, Portugal, 4Faculty of Medicine, University of Porto, Porto, Portugal

E-mail: [email protected]

Background and Aims: COVID-19 brought new challenges in PRM patient's evaluation in intensive unit care (IUC), other services, with health professional's protection needed. Dysphagia is common in patients with/after endotracheal intubation, tracheostomy, including COVID-19 (with or without the previous conditions or others, as stroke).The need to develop a proper “orofacial individual protective equipment (mask)” that allow health professionals (PRM Doctor, Speech therapist) to be protected from aerosol emission and let oral structures visualization, evaluation and swallowing test , was decisive. Patient could use the mask at dysphagia assessment and rehabilitation. The aim of this project was to create and develop an orofacial mask for dysphagic COVID-19 patients (hospitalized/ambulatory). Methods: A PRM hospital department team (PRM, Speech Therapy) with Dental/Medicine and Engineering faculties developed an orofacial prototype mask, relating clinical assessment, swallowing testing, health professional's and patient's individual protection, aerosol aspiration, and design criteria (as comfort, materials, functionality) needs. Prototype mask was tested in 60 IUC, other services, ambulatory COVID-19 patients and in a control group. A patent was given by University to the PRM and Academic team. Industry companies were contacted for a partnership between PRM hospital department and University. Further testing were performed, to improve design. Results and Conclusion: After a 6 month process, a dysphagia orofacial mask for hospitalized and ambulatory COVID-19 or other infectious respiratory patients was created. All clinical, protective swallowing assessment and testing criteria were achieved.

  7000 - Content validity of COVID-19 anxiety scale for Brazil Top

Fabiana Orlandi1, Layana Giselly Ferreira Silva2, Diana Gabriela Mendes dos Santos2, Vanessa Almeida Maia Damasceno2

1Universidade Federal de São Carlos, São Paulo, Brazil, 2Federal University of São Carlos, São Carlos, São Paulo, Brazil

E-mail: [email protected]

Background and Aims: Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by the novel coronavirus (SARS-CoV-2). With high transmissibility, a vertiginous increase in the number of cases and clinical severity, it is impossible to disregard its psychological effects, such as anxiety. In this context, the use of instruments that measure anxiety related to COVID-19, reliably and validly, is relevant. Chandu et al. (2020)[1] constructed the COVID-19 Anxiety Scale (CAS) to measure anxiety related to COVID-19. The objective of this study was to carry out the translation and cultural adaptation of the CAS for Brazil. Methods: This is a cross-sectional and methodological study, which followed the steps of initial translation, synthesis of translations, back-translation, review by an expert committee and pre-test. All ethical precepts will be respected. Results: The initial translation step of the CAS, from English into Brazilian Portuguese, was performed by two independent translators. Then, the consensual version of the scale was established, which was back-translated into the original language by a third translator. Subsequently, the CAS versions were reviewed by a committee composed of eight specialists, who carefully analyzed all the items of the scales, adapting two CAS items, obtaining the pre-final version of the scale. Then, the pre-test was carried out with 47 people. Respondents considered the scale clear and understandable. Conclusions: It is concluded, therefore, that the final Brazilian version of the CAS is translated and culturally adapted to the Brazilian context.


  1. Chandu VC. Indian J Public Health 2020;64:201-4.

  6995 - Combining physiotherapy techniques: Treatment of plantar fasciitis with nesa neuromodulation and electrolysis Top

Raquel Medina1, Fabiola Molina-Cedrés2, Mario González-González2, David Álamo-Arce2, Marina Contreras3

1University of Las Palmas, Las Palmas, Spain, 2Faculty of Health Science Physiotherapy, University of Las Palmas, Las Palmas, Spain, 3University Illes Balers, Palma, Spain

E-mail: [email protected]

A 62-year-old patient comes to the consultation referring pain in the calcaneus, especially in the area of insertion of the fascia and limited walking capacity, although without needing external aids. She presents MRI with a finding of bone edema in the right calcaneus and thickening of the plantar fascia on that side. Previously, 14 physiotherapy sessions have been carried out in which vacum, radiofrequency, laser, manual therapy and shock waves are applied. The patient reports no improvement after 2 months of treatment. In the initial assessment she presents: Pain VAS 8; Questionnaire EQ5D 0.2676; Ultrasound: angiogenesis, loss of fibrillar pattern and thickening of the fascia compared to the fascia on the healthy side. A passive conservative treatment is started with the aim of improving the pain and reducing its sensitivity. During the treatment we progressed with the directing electrode from central, to metameric in L5, then in the Posterior Tibial Nerve and finally in the Baxter Nerve (Local), in successive sessions. Two weeks after starting treatment and having performed 8 NESA microcurrent sessions, we performed percutaneous electrolysis focused on the insertion of the fascia. We continue with neuromodulation with NESA microcurrents and after a week we repeat the electrolysis. During this week, the patient reports notable improvement in support. Two weeks later, a third EPI treatment is performed. The patient with pain in the sole of the foot went from VAS 8 to VAS 2. The patient's perception of quality of life improved from limited (0.2676) to much better (0.7947). The ultrasound shows disappearance of the initial neovascularization, improvement of the fibrillar pattern, but not of the thickening. NESA microcurrents are presented as a new possibility to enhance and complement conventional fasciosis treatments.

  6955 - Case report: Unilateral vocal cord paresis in a multitrauma patient – The rehabilitation pathway Top

Joannis Alexandros Tzanos1, Vasiliki Spyropoulou1, Sofia Sivetidou1, Damiani Tsiamasfyrou1, Elisavet Tzani1, Vasileios Marouglianis2, Ioulia-Eleni Panagiotopoulou1, Nefeli-Anna Papageorgiou1, Spyridon Pneumatikos2, Aikaterini Kotroni1

1Clinic of Physical Medicine and Rehabilitation, KAT General Hospital, Kifissia, Athens, Greece, 2Third Orthopedic Clinic of the University of Athens, KAT General Hospital, Kifissia, Athens, Greece

E-mail: [email protected]

Introduction: We present the case of a multitrauma patient with unilateral vocal cord paresis and its rehabilitation process. Patient Information and Clinical Findings: A 25-year-old patient with complete paraplegia and a severe right brachial plexus injury due a two wheel road accident was admitted to a Rehabilitation Department. One month post-injury he was evaluated by a speech therapist due to voice hoarseness. The orofacial structures were normal, the respiratory capacity was marked as thoracic, the use of the respiratory system was characterized by poor laryngeal control and both vocal frequency and voice intensity were lower than normal. He was further evaluated by ENT through laryngeal endoscopy and he was diagnosed with right vocal cord paresis. The patient followed daily therapeutic sessions with relaxation exercises, synchronization of vocal breathing, gentle onset of vocalization, production of vocalization with words, phrases and sentences - gradually increasing difficulty - and reading exercises. Four months later, he reported an improvement in voice intensity and a more comfortable speech, while the reevaluation by ENT showed an improvement in laryngeal sensitivity with moderate stagnation of secretions and food, adequate cleansing with voluntary cough and a mild laryngopharyngeal reflux. He was instructed to continue the therapeutic sessions. Discussion and Conclusions: This report emphasizes the value of assessing the self-reported symptoms of the multitrauma patients. As no correlation of vocal cord paresis with the brachial plexus lesion was established, this may be due either to the damage of the recurrent laryngeal nerve during the initial injury or the intubation or to the concomitant traumatic brain injury.

  6922 - Knee rehabilitation monitoring after anterior cruciate ligament reconstruction in a healthy young volleyball player Top

Joana Cerqueira1, Fernando Almeida2, Alcino Silva2, Catarina Aguiar Branco3, Joaquim Mendes1

1Faculdade de Engenharia da Universidade do Porto, Porto, Portugal, 2Hospital da Luz Arrábida, Porto, Portugal, 3Hospital da Luz Arrábida, Faculdade MD Universidade do Porto, Porto, Portugal

E-mail: [email protected]

Introduction: This study Aims to objectively monitor the patient's performance after knee surgery and compare it with the healthy knee, by describing kinematics and thermal patterns changes of the knee joint, as well as the electrical activity, during knee rehabilitation. Patient Information and Clinical Findings: The participant recruited for this study was a 18-year-old female volleyball player who suffered a complete rupture of the anterior cruciate ligament (ACL) and underwent a 20 day rehabilitation program before the ligamentoplasty of the ACL using a hamstring tendon graft (semitendinosus). The functional assessment measurements, obtained with two motion tracking devices, a thermal imaging camera (FLIR E60) and surface EMG sensors, have started one week after surgery and have been repeated in 15 day intervals. The results show that the mean surface temperature of the operated knee decreased from 34.8°C to 29.7°C after 67 days since the knee reconstruction surgery, while the contralateral knee temperature reduced from 32.9°C to 29.1°C. Relatively to the maximum knee flexion angles, the injured knee presented an initial value of 69.5 that has continually increased throughout rehabilitation, reaching 135° in the 5th assessment, in comparison with the healthy knee (146.9°). Although the electrical activity of the quadriceps and hamstring muscles has demonstrated less exuberant variations, it has increased over time, with the rectus femoris showing greater progress. Discussion and Conclusions: The results are all in agreement, demonstrating a decline in the differences between the operated knee and its contralateral over time until becoming almost null. Accordingly, this monitoring system allows to evaluate patient's functional recovery.

  6684 - The electromyopraphy as diagnostic in lumbar radiculopathy Top

Pablo Emilio Ballesteros

Universidad Nacional de Colombia, Bogotá, Colombia

E-mail: [email protected]

Introduction: The lumbar lain followed by radiculopathy is self-limiting, the work and cognitive capacity seems to decrease. In order to get a diagnoctic, neurophysiology studies that indicate the cause level affectation may be required, they can confirm it through imaging studies. It is important to mention that the physical exMination constitutes the main diagnostic tool. Objective: Report a case of radiculopathy in a Physical Medicine and Rehabilitation student. Case Report: A 45 years old man, with a clinical profile of lumbar pain with an evolution of six months, the patient has presented increase of the pain during the las month, it is characterized y dysesthesia in the lower left limb with seated limitations. During the physical examination it was found: Limitation and strength decrease on the left plantiflexers and sensitive alteration on the same limb. The intramuscular electromyography showed active denervation signs ans insertion activity in the gastronemio and hallucis longus left muscles compatible with incipient radiculopathy in L5 and S1. Conclusion: The electromyography (EMG) is a current study for the radicular injury diagnose with any type of origin and in some cases it is the only way to confirm the diagnose. Although the high sensivity of the magnetic resonance and its frequently use as radiculopathy diagnose, the EMG is a funtional exam that can be diagnostic, complementary and a track form the holistic management of this pathology.

  6619 - Randomized control trials of consumable eastern medicines: EMIR Top

David Burke, Eduardo Lamas, Gina Bell

Emory Rehabilitation Medicine, Atlanta, GA, USA

E-mail: [email protected]

Complementary and alternative medicines are increasingly being used for preventative and treatments for a variety of conditions. Many of these treatments have insufficient data or design to advocate for their use. Many have come from countries and cultures which have used them in practice for generations and therefore have a strong clinical history without good, controlled evidence of their efficacy or safety. The editors of this paper reviewed the literature for Eastern medicines that were studied in a randomized controlled manner. We excluded dietary supplements and topically applied objects and reviewed the herbs and other consumables that have been used in these traditional medicines. The 26 manuscripts were summarized into a review journal in the style of Rehab in Review. that covered substances with good evidence of treatment effects for cardiovascular, metabolic, osteoarthrosis, pain, sleep and affect. An 8-page surveillance journal of the best of these articles will be produced outlining these studies.

  6445 - Rehabilitation of a locked-in syndrome: Case report Top

Sofia Moreira, Sandra Assunção, André Ribeiro, João Constantino, Inês Lucas, Jorge Laíns

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

E-mail: [email protected]

Introduction: Locked-in syndrome is a catastrophic condition resulting in quadriplegia, anarthria and preserved consciousness. The majority of cases are caused by stroke affecting corticospinal, corticopontine and corticobulbar tracts in the brainstem; structures that control eye movement and consciousness are preserved. Patient Information and Clinical Findings: 29-year-old man admitted to our rehabilitation centre after brainstem hemorrhagic stroke of undetermined origin. At admission he presented right eye movement, occasional left-hand movement and lower limb active movements. He reacted to family's pictures and voices by moving his eye and blinking. Due to dysphagia and breathing difficulties he needed oxygen, tracheostomy and a nasogastric tube. He started a rehabilitation program and currently presents occasional head movement, left arm elevation and lower limb movement. He no longer needs oxygen and a percutaneous gastrostomy was placed. A few weeks after admission he successfully communicated through an augmentative communication system (GRID 3). Discussion and Conclusions: Rehabilitation of locked-in syndromes is complex, involves a multidisciplinary approach and many hours of therapy, resulting in small but precious gains. Despite a grim prognosis, our patient is slowly improving and we are aiming for a return home. Our main concern is the development of respiratory infection and humor lability, which interferes with the program. Limitations include lack of data regarding rehabilitation in these cases. Few patients like this were admitted to our hospital, limiting program development and information given to family on what to expect. However, we're searching for the latest scientific research to provide best possible care. CARE guidelines were applied in this report.

  6442 - Intermittent priapism in lumbar stenosis: Case report Top

Sofia Moreira, Sandra Assunção, André Ribeiro, Ana Raquel Correia, Paulo Margalho, Jorge Laíns

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

E-mail: [email protected]

Introduction: Priapism is a rare persistent erection not associated with sexual stimulation or desire. Most cases are idiopathic; secondary causes include sickle cell disease, spinal shock, drugs, malignancy and others. Priapism related to spinal cord injury (SCI) is infrequent and few cases have been reported. Innervation of the penis is autonomic and somatic: the sympathetic pathway (T11-L2) accounts for tumescence and the parasympathetic (S2-S4) for detumescence. Patient Information and Clinical Findings: Elder male presented with lumbar and sciatic pain irradiating to the right lower limb with shock sensation but no numbing. Hypoesthesia in the L4-S1 dermatomes and right patellar hyperreflexia were present. Symptoms were accompanied by episodic priapism and urinary incontinence that prevented him from engaging in social interactions. CT showed discal hernias and bulging from L2-S1 and anterolisthesis in L4-L5. Lumbar stenosis was suspected. The patient was admitted in a rehabilitation program and referred to Neurosurgery. Pregabalin was introduced with good response. MRI confirmed stenosis and radiculopathy between L3-L4 with compaction of cauda equina roots; vertebrae instability, listhesis and canal stenosis between L4-L5 were present. Degenerative findings in L5-S1 were found. Urodynamic testing and electromyography (EMG) are pending. Discussion and Conclusions: Despite being rare, patients with intermittent priapism may have SCI and it must be ruled out. Literature is scarce and the mechanisms are not understood. We propose compression of cauda equina roots and disruption of the autonomic pathways to be responsible for the findings in this case. Limitations to the diagnosis include pending exams and follow up in multiple hospitals which hardens data retrieval. CARE guidelines were applied in this report.

  6219 - Botulinum toxin type A for a congenital muscular torticollis on an adult: A case report Top

Pedro Martins1, José Luís Carvalho2, André Vieira3, Fabiana Rodrigues3, Sara Caldas Afonso4

1Department of Physical Medicine and Rehabilitation, Hospital Central do Funchal, Av. Luís de Camões Funchal, Funchal, Portugal, 2Centro de Reabilitação do Norte, Vila Nova de Gaia, Portugal, 3Hospital Central do Funchal, Funchal, Portugal, 4Centro Hospitalar Universitário do Porto, Porto, Portugal

E-mail: [email protected]

Introduction: Congenital muscular torticollis is a postural deformity of the neck that is usually evident in early stages of life, generally weeks. It is characterized by lateral neck flexion and contralateral neck rotation. Although it may resolve spontaneously, untreated persistent congenital muscular torticollis may lead to cosmetically significant craniofacial and cervical asymmetry. Patient Information and Clinical Findings: A 43-year-old female with a history of congenital muscular torticollis and a myomectomy of the sternal head of the right sternocleidomastoid (SCM) muscle at the age of 19, came to Physical Medicine and Rehabilitation (PM and R) department. At the appointment, she complained about pain on the right anterolateral side of her neck alongside limited range of motion. At examination she had thickening and pain at palpation of the clavicular head of the right SCM, alongside pain at palpation of the right splenius capitis and left upper trapezius. An ultrasound was performed, demonstrating an increase on the echogenicity of muscular tissue of the clavicular head of the SCM, in favour of fibrotic changes along the muscle. Botulinum toxin type A (BtA) injection was performed on the clavicular head of the SCM muscle, splenius capitis and left upper trapezius. The patient began physical therapy on the following weeks to enhance the effect of BtA injection. Discussion and Conclusions: At the moment, there is no evidence from randomized controlled trials on the optimal treatment intervals and doses or the duration of treatment effect of BtA on a severe complication of congenital muscular torticollis. In this case, three months after a single BtA treatment session, we were able to achieve clinically relevant reduction of cervical impairment and pain.

  6215 - Rehacom software application in training of visual-spatial perception in right hemisphere stroke patients during subacute phase after stroke Top

Sofia Sivetidou1, Stavroula Bakatsi2, Eleni Michailidou2, Tzanos Ioannis- Alexandros1, Aikaterini Kotroni1

1Clinic of Physical Medicine and Rehabilitation, KAT General Hospital, Kifisia, Athens, Greece, 2Department of Occupational Therapy, KAT General Hospital, Kifisia, Athens, Greece

E-mail: [email protected]

Background: Stroke patients with left hemiplegia demonstrate a reduced ability performing functional daily activities (self-care, balance, walking) during rehabilitation programm. Objective: To investigate effectiveness of RehaCom cognitive rehabilitation software in training of visual-spatial perception in right hemisphere stroke patients during subacute phase after stroke. Methods: Fifty one patients (men and women) with left hemiplegia and visuospatial deficits participated in the RehaCom cognitive rehabilitation program for a period of twelve weeks, including 5 sessions per week, 30 minutes each. The neuropsychological intervention included therapeutic activities for attention and concentration, reaction behavior, visuo-spatial ability and visuo-motor exploration. Patients were evaluated using Montreal Cognitive Assessment (MoCA) psychometric screening test and Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery (assessment of the following areas: Visual Perception, Spatial Perception and Visuomotor Organization). Evaluation was performed in beginning, midterm and at the end of the rehabilitation program. Results: The initial evaluation in Moca test is ranging from 6 to 9 and in LOTCA battery in visual perception area is ranging from 3 to 5 and in visual motor organization area from 6 to 10. The final evaluation in Moca test is ranging from 22 to 30 and in LOTCA battery in visual perception area is ranging from 9 to 12 and in visual motor organization from 19 to 24. Conclusion: In our study patients were gradually improved thanks to timely detection of visual deficits and early intervention through RehaCom computerized cognitive training program.

  6072 - How strong is too strong?: Case of secondary virilization confounding motor exam in lumbar spinal stenosis Top

Rick Schneider1, Roger Luo2

1Rutgers NJMS, Newark, New Jersey, USA, 2Kessler Institute for Rehabilitation, New Jersey, USA

E-mail: [email protected]

Low back pain has numerous causes; it is important to review all medical conditions that may play a role in its pathology. 38 year-old female with active androgen-secreting ovarian tumor presented to Physical Medicine and Rehabilitation clinic with achy low back pain. Pain was described as burning with radiation posteriorly on right lower extremity to the foot with perineal numbness. Inspection revealed virilization with increased muscle bulk and deepened voice. Dural tension signs positive on right. MR lumbar spine showed large right L5 disc extrusion with inferior migration and severe canal and right lateral recess stenoses. She underwent salpingo-oophorectomy and resection of tumor; testosterone level dramatically decreased as a result. Neurosurgery then performed L5-S1 hemilaminectomy, foraminotomy, and microdiscectomy. Radicular pain and virilization were resolving on follow-up. This case highlights the importance of detailed history and physical exam in the musculoskeletal evaluation. Manual motor exam in this patient was profoundly strong in all extremities despite severe pain with clear radicular pattern. Exogenous strength from an androgen-secreting tumor is an uncommon but important exam finding in this context. Resolution of pain, perineal numbness, and secondary virilization manifestations indicated the initial findings were confounded by gynecologic disease. Physiatrists must routinely perform a thorough history and physical exam in the musculoskeletal realm. This practice is imperative as a handful of conditions routinely diagnosed can vary in presentation among patients. This case highlights a medical disease masking potential positive musculoskeletal findings and serves as a reminder to evaluate patients in a thorough manner.

  5797 - Is a patient-tailored rehabilitation plan effective in reducing dyskinesias in a Parkinson's disease patient abusing therapy with levodopa-carbidopa intestinal gel? Top

Annalisa Petraroli, Annalisa Petraroli, Cinzia Marinaro, Ilaria Pino, Vera Drago Ferrante, Alessandro de Sire, Antonio Ammendolia

Department of Surgical and Medical Sciences, University of Catanzaro, “Magna Graecia,” Catanzaro, Italy

E-mail: [email protected]

Introduction: Levodopa-carbidopa intestinal gel (LCIG) has been shown to reduce levodopa-associated motor complications in Parkinson's diseases (PD) patients. However, the LCIG infusion, being self-administered, might lead to an abuse of dopaminergic drugs with the onset of disabling dyskinesias. Thus, the purpose of this paradigmatic case report was to describe the role of a patient-tailored rehabilitation plan on reducing dyskinesias in a PD patient abusing LCIG therapy. Patient Information and Clinical Findings: A 77-year-old male PD patient referred to a Rehabilitation Outpatient of a University Hospital in December 2020, reporting dyskinesias due to LCIG therapy abuse. In order to reduce the daily infusion of LCIG, we plan a 20-day rehabilitation protocol, consisting of 5 sessions/week for 3 weeks. After the treatment, the patient showed a remarkable decrease of dyskinesias, improvement in gait, balance, and autonomy in activities of daily living, with a noteworthy reduction of Duodopa daily dose (43.6 ±4.8 ml/day at the baseline vs 37.6±2.8 ml/day after 20 days). Discussion and Conclusions: Rehabilitation treatment led the PD patient to have a lower number of dyskinesias, correctly adhering to the LCIG intake protocol. To date, there is still a scarce literature on this intriguing topic and further studies are warranted to confirm the effects of rehabilitation on dyskinesias reduction in PD patients abusing LCIG therapy.

  6657 - Comparison of post-COVID ultrasound muscle architecture between the original virus and omicron strain Top

Paloma Galán1, Gema Flores2, Maria Victoria Redondo3, Antonio López-Román3

1Virgen de la Poveda Hospital, Carretera del Hospital, Villa del Prado, Madrid, España, 2Hospital Virgen de la Poveda, Carretera del Hospital, Villa del Prado, Madrid, España, 3Universidad Alfonso X El Sabio, Madrid, España

E-mail: [email protected]

Background and Aims: Muscle weakness are very common in patients with SARS-CoV 2 infection. In the first patients with post-COVID physical deconditioning, an alteration in muscle architecture was detected. The objective of this work is to assess the same ultrasound parameters in post-COVID patients with the omicron variant and to compare the findings obtained between both cohorts. Methods: An observational study was carried out of the first 60 patients admitted to a mid-stay hospital for rehabilitation treatment due to physical deconditioning after SARS-CoV-2 infection at the beginning of the pandemic and of the first 60 patients admitted for the same reason after the omicron variant of COVID. Thickness (cm) and cross-sectional area (cm2) of rectus femoris (RF), vastus medialis (VM) and lateralis (VL) and medial gastrocnemius (MG), and pennation angle(°) of VL and MG, were measured by ultrasonography. Values were compared in both groups of patients. Statistical analysis was performed using the SPSS version 23 program. Results: The results obtained in both groups are shown below (original virus/omicron variant): Gender (% male:female): 61.3:38.7/46.7:53.3 Average age: 76.3/82.1 Average thickness: RF 2.13/2.24; VM 0.81/1.01; VL 1.14/1.36; MG 1.77/1.93 Average cross-sectional area: RF 4.10/4.53; VM 2.94/3.02; VL 3.09/3.26; MG 2.88/3.07 Average pennation angle: VL 18.02/18.41; MG 16.43/16.8 Pennation angle/thickness: VL 15.80/13.54; MG 9.28/8.72 Conclusions: COVID affects muscle architecture, decreasing muscle thickness and increasing the angle of pennation in relation to muscle thickness, but this affectation is significantly less in the omicron variant than in the original virus (p<0.05).

  6617 - Guillain-Barre following COVID-19 infection Top

David Burke, Daniel Sok

Emory University School of Medicine, Atlanta, Georgia, USA

E-mail: [email protected]

Gullian Barre Syndrome (GBS) is an inflammatory disease of the peripheral nervous system characterized by rapid progression of ascending weakness of the limbs. In January 2020 the first case of GBS due to COVID was reported in China. There have been few cases of post-viral GBS with confirmed antecedent Covid 19 infection, likely resulting from the lack of viral confirmation near the time of the symptom onset. This case study describes the medical course of a 66-year-old unvaccinated female who developed symptoms of Guillain-Barré Syndrome one week after testing positive (antigen and PCR) and being hospitalized for COVID-19.She had no significant past medical history, presenting to the emergency department following eight days of cough, fatigue, hypoxia, and malaise. She had a positive COVID-19PCR at admission. She was discharged 9 days later. The next day she noted numbness and tingling sensations in her bilateral feet and extremities with weakness beginning in the lower extremities followed by upper extremities, with strength 2-4/5. She was treated with IVIG for 5 days, and sent to rehab. There her strength and ADLs improved. She was follow in outpatient clinic and make sontinued imrovements in ADLs, mobility and endurance. Sequence and magnitude of recovery continued for the following 4 months.

  6559 - A usability study of a hand rehabilitation robot with air pressure system Top

Mitsuhiro Ochi, Satoru Saeki

Department of Rehabilitation Medicine, UOEH, Kitakyushu, Japan

E-mail: [email protected]

EsoGLOVE is a new hand training support robot developed in Singapore, consisting of a glove and a portable actuator. The peripheral fingers are fixed to the glove, which has a flexible framework along the back of the hand, and the glove can perform flexion and extension motions around the MP and IP joints of the five fingers using air pressure. Two types of assisted movements can be selected, i.e., passive and assisted. Some exercises can be selected, mainly the basic grasp and pinch. It is lightweight and portable, and can be used not only for passive exercises at the bedside but also for elaboration exercises in the training room using the attached software. We will report on the usability of this system. EsoGLOVE is a new hand training support robot developed in Singapore, consisting of a glove and a portable actuator. The peripheral fingers are fixed to the glove, which has a flexible framework along the back of the hand, and the glove can perform flexion and extension motions around the MP and IP joints of the five fingers using air pressure. Two types of assisted movements can be selected, i.e., passive and assisted. Some exercises can be selected, mainly the basic grasp and pinch. It is lightweight and portable, and can be used not only for passive exercises at the bedside but also for elaboration exercises in the training room using the attached software. We will report on the usability of this system.

  6531 - Intratendinous ganglion cyst of the extensor indicis: A rare case in the literature Top

João Pedro Vieira Dias, Tiago Pimenta

Centro Hospitalar De Trás-Os-Montes E Alto Douro, Vila Real, Portugal

E-mail: [email protected]

Introduction: Intratendinous ganglion cysts (IGC) of the hand are uncommon and only a few cases have been reported so far. The etiology of IGC is uncertain: The ganglion cysts they may arise “internally” from mucoid degeneration of the tendon ground substance, forming cavities full of viscous fluid, or “externally” as the result of tendon invasion by tenosynovitis. Despite its benign character, the lesion can be locally aggressive and impair tendon and hand function. The aim of this poster is to raise awareness for this rare disease, that can be misinterpreted and lead to inappropriate therapeutics. Patient Information and Clinical Findings: 50-year-old woman, right-hand dominant, followed at the department of Physical Medicine and Rehabilitation for degenerative osteoarthritis of both hands, who reported a 3-month history of a palpable soft-tissue mass at the dorsal aspect of the right hand that caused progressive pain in finger movements. The subcutaneous mass moved in concert with the 4th extensor compartment. An ultrasound was performed, which showed a cystic formation at the extensor indicis, measuring 9 x 4 mm, indicating an IGC. Given its location, no invasive procedure was performed and the patient was referred to the Orthopedics consultation for evaluation and orientation. Discussion and Conclusions: Definitive diagnosis of an IGC is challenging due to its rarity and the unawareness of clinicians. As with other types of ganglions, observation can be an acceptable treatment in some cases. However, as IGC frequently weaken the structure of the affected tendons, prompt diagnosis is essential, not only because invasive procedures are not usually recommended as they can impact tendon structure and function, but also because surgical excision may be required.

  6530 - The importance of neuromuscular scoliosis management: A case report Top

Enrique Cano Lallave1, Adrián Cascales Martínez1, Jose Antonio Fidalgo González2, Javier Nieto Blasco1

1Hospital Universitario de Salamanca, Salamanca, Spain, 2Hospital Universitario Central de Asturias, Oviedo, Spain

E-mail: [email protected]

Introduction: Scoliosis in patients with neuromuscular diseases is complex to manage. Rett Syndrome is a neurological disorder with a genetic basis. It affects almost exclusively females. It associates in a high number of patients, scoliosis that can affect the cardiopulmonary system. Patient Information and Clinical Findings: We present an 11-years-old female patient diagnosed with Rett Syndrome. At the previous physical examination at the age of 10 years, the left waistband crease more pronounced and an Angle of Trunk Rotation (ART) in the Adams test of 5° were appreciated in the vertebral statics in sedentary position. Standing and walking were assisted by a third person. The posteroanterior tele-radiography showed a right thoracolumbar curve T6-L2 of 25° with rotation at T12 +/+++, with Risser 0. In the following revisions an increase of the ART to 10° was observed and in the tele-radiography the curve became 38°. It was therefore decided to prescribe a soft Boston type brace, which she could tolerate. At the last revision, the ART was 8° and the patient walked with it with more stability and less support. Respiratory related issues were not documented. Discussion and Conclusions: In Rett Syndrome, psychomotor regression appears in the 1st-2nd year of life. It is associated with ataxic gait, stereotyped movements and language impairment. Scoliosis is of neurogenic type, being a diagnostic support criterion. The treatment is symptomatic and supportive, requiring a multidisciplinary approach. Scoliosis should be monitored periodically at clinical and radiological level to make decisions on its prevention and treatment.

  6521 - Inappropriate supplementation of iron at IRF admission Top

David Burke, Regina Bell

Department of Rehabilitaiton Medicine, Emory University School of Medicine, Atlanta, GA, USA

E-mail: [email protected]

Anemia has been estimated to occur n 40% of hospitalized patients. The appropriate treatment for anemia during hospitalization depends on the etiology of the condition. Studies have shown that the causes of anemia in hospitalized patients include chronic inflammation, blood loss and iron deficiency. Treatment with supplemental iron is known to cause constipation, GI distress, and GI reflux. We reviewed successive patients admitted to an inpatient rehabilitation hospital identify those admitted from the acute care hospitalization with oral iron supplement. For these patients we ordered a Ferritin level to determine whether the patient had iron deficiency as a cause of their anemia. Of the patients admitted with iron supplements, Ferritin levels were within the normal range in 75%, and in the middle to upper tertile in 50%. These data suggest that the supplements of iron at admission to a rehabilitation hospital may not be indicated and may introduce unnecessary comorbidities.

  6458 - The role of multidisciplinary day-rehabilitation center at distant low socioeconomic population Top

Afif Saaida

Clalit Health Services, Tel Aviv, Israel

E-mail: [email protected]

Background and Aims: Clalit health services in Northern Israel, insuring 750K population, with around 2000 new yearly referrals for acute rehabilitation centers and around 800 yearly conservative rehabilitation, established community rehabilitation treatment model , divided into home rehabilitation, multidisciplinary day rehabilitation centers covering this district of low socioeconomic status and distant from central Israel rehabilitation centers. In this study we are viewing our model of community based rehabilitation and the impact of first year of newly established multidisciplinary day rehabilitation center “mevoot hermon” on that area population in terms of rehabilitation services. our aim is to present our community rehabilitation model and organization and its impact on improving the activity, dependence and overall health of our patients. Methods: All the patiens treated in “mevoot hermon” day rehabilitation centre between july.2020 to july 2021, devided into 3 groups (intensive, sub intensive and chronic phase) rehabilitation program. In each group we took physical and cognitive measures at discharge from hospital, beginning of ambulatory program and eng of rehabiliatation program. Results: All groups showed further improvements in their physical and cognitive measures. Conclusions: The availability and access for multidisciplinary rehabilitation services an distant rural areas of Israel including establishment of the new centre “mevoot hermon” had and amazing impact on the population of the area, helped lowering the hospital rehabilitation stay, continuing the rehabilitation process and offering a good follow up and conserving treatment for chronic rehabilitation patients.

  5944 - Effect of pelvic assisted lower limb robot on knee motion recovery of hemiplegia on stroke patients Top

Bai Hefeng

Rehabilitation Center of the Second Hospital of Jiaxing City, Zhejiang Province, China

E-mail: [email protected]

Background and Aims: To investigate the difference between the effects of robot-assisted walking training and conventional rehabilitation on the recovery of kinematics in the hemiplegia side of stroke patients. Methods: Totally forty stroke and hemiplegia patients were taken from the rehabilitation center and randomly divided into a robotic treatment group (40 cases) and a control group (40 cases). All patients received standardized clinical treatment and rehabilitation training. Pelvic assisted lower limb robot training was added based on the treatment plan. At the beginning and end of treatment, all patients in both groups used the threshold of TDPM to measure the kinematics of the knee on the affected side and compared them. Results: After different treatments were grouped, the TDPM (5.4±1.67) of knee extension and TDPM (4.3±0.83) of knee flexion were found in the treatment group. Knee kinematics in the affected side of the robot group was obviously.

  5915 - Functional rehabilitation of a patient with neuromyelitis optica after COVID-19 vaccination: Case report Top

Abdelhakim Kabil1, Hasnaa Boutalja1, Zaineb Tahri1, Mouad Yazidi1, Hakim Bourra1, Hajar Abouihsane1, Abdellatif El Fatimi1, Fatima Lmidmani1, Saloua Khalfaoui2, Nada Kyal1

1Department of Physical Medicine and Functional Rehabilitation, University Hospital Center of Casablanca, Hassan II University, Casablanca, Morocco, 2Department of Physical Medicine and Functional Rehabilitation, University Hospital Center of Rabat, Rabat, Morocco

E-mail: [email protected]

Introduction: The neuromyelitis optica or Devic's disease is a rare auto-immune disease characterized by inflammatory lesions and demyelination of the spinal cord and the optic nerve caused by specific anti-bodies attacks with likely relapses. Rehabilitation is primordial to correct physical deficencies. Patient Information and Clinical Findings: We report the case of a 32-years-old patient with a history of bipolar disorder, that was presented with loss of vision, paraplegia and acute urinary retention(AUR) one week after receiving the second dose of the Sars-cov-2 vaccine (Sinopharm). The patient was initially admitted in the neurological department of the university hospital Ibn Rochd of Casablanca where he was diagnosed and treated for post vaccination neuromyelitis optica. The patient was then referred to the physical medicine and functional rehabilitation department of CHUIR for post acute phase care. Intial examination found a conscious patient oriented to time and space, with paraplegia of lower limbs, hypoesthesia below D4,and total incontinence. The evolution at the 47th day of hospitalisation was marked by clinical and functional. Neuromyelitis optica post anti-COVID-19 vaccination is a rare complication of the recent vaccine. Discussion and Conclusions: The relationship between vaccination and demyelination diseases and in particular neuromyelitis optica (NMO) is rare and not fully understood. The place of rehabilitation is primordial in the following up of the patients in post acute phase to procure to them functional and neurological improvement.

  5904 - Effects of physiotherapy in posttraumatic epicondilitis with ulnar nerve subluxation: Case report Top

Diana Jimbu1,2, Renata Czego3, Madalina Gabriela Iliescu4, Emre Sarikaya1, Elena Valentina Ionescu4, Doinita Oprea4

1Department of Fizical Medicine and Balneology, Balneal and Rehabilitation Techirghiol Sanatorium, Techirghiol, Romania, 2Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Constanta, Romania, 3Miercurea Ciuc Emergency Hospital, Miercurea Ciuc, Romania, 4St. Andrew Emergency Hospital of Constanta, Constanta, Romania

E-mail: [email protected]

Introduction: Medial epicondylitis is a tendinopathy of the medial part of the elbow caused by biomechanical abnormalities, training errors or traumas of the elbow and which has as clinical manifestations: pain in the medial epicondyle, exacerbated by flexion of the fist or pronation and supination of the forearm, as well as decrease in muscle strength when grasping. Case Report: A clinical case study was performed on a 16-year-old patient with history of an internal condylar fracture of the right humerus, conservatively treated with cast, presented for neurological evaluation and rehabilitation treatment, with clinical suspicion of medial epicondylitis with subluxation and injury of the right ulnar nerve. Local examination of the patient shows pain on joint palpation in the area of the medial epicondyle of the right elbow. Neurological examination reveals cutaneous hypoaesthesia and paresthesias on the territory of the ulnar nerve. After performing 10 sessions of kinetotherapy, 10 sessions of anti-inflammatory laser therapy and galvanic treatment at the level of the right elbow, clinical evolution is favorable with the remission of pain symptoms and sensorial disorders. Conclusions: The good clinical evolution was favorized by the early start of the rehabilitation treatment, the young age of the patient and the absence of structural lesions of the ulnar nerve.


  1. Braddom RL. Physical Medicine and Rehabilitation. 4th ed., Vol. 3. Philadelphia, PA, USA: Elvesier; 2015. p. 886-9.
  2. Ollivierre CO, Nirschl RP, Pettrone FA. Resection and Repair for Medial Tennis Elbow: A Prospective Analysis. The American Journal of Sports Medicine 1995;23:214-221. doi:10.1177/036354659502300215.
  3. Descatha A, Leclerc A, Chastang JF, Roquelaure Y. Incidence of ulnar nerve entrapment at the elbow in repetitive work. Scand J Work Environ Health. 2004;30:234-40. doi: 10.5271/sjweh.784.

  5612 - Knee disarticulation: Obstacles to prosthesis adherence Top

Irene Pinto, Lúcia Dias, Vilma Marques

Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal

E-mail: [email protected]

Backgroud and Aims: When transtibial amputation is impossible, knee disarticulation can be an alternative to transfemoral amputation. Knee disarticulation has advantages such as a long lever arm, muscle preservation, resulting in a reduced metabolic cost. However, the elongation of the residual limb after prosthesis seems to have a negative impact on the patient's self-image and potentiate long-term imbalance in the axial skeleton, leading to prosthesis non-adherence. The aim of this case report is to evaluate predictive factors of adherence vs non-adherence to the prosthesis. Patient Information and Clinical Findings: Male, 47 years old, self-employed, submitted to amputation due to knee disarticulation after trauma. The patient started a rehabilitation plan to help maintain range of motion and improve muscle strength in the lower limb and residual limb in preparation for using the prosthetic limb. The prosthesis for a knee disarticulation consists of a foot, shank, knee unit, socket, and suspension. A hydraulically controlled multi-axis knee joint with a flexion angle of up to 155° with a moveable hypobaric membrane liner with vacuum system was selected for the prosthesis assignment process. A long foot-carbon base was chosen. After prosthesis attribution, the patient continued rehabilitation, aiming for independent donning and doffing of the prosthetic limb, gait re-education, progressing to maximum independence with activities of daily living and mobility. Discussion and Conclusions: Knee disarticulation is rarely preferred to transfemoral amputation. However, reports suggest numerous advantages in predicting adaptation to the prosthesis when compared to transfemoral amputation.

  Biomedical Sciences: Genetics Top

  4485 - Rare case of a Klippel Trenaunay syndrome Top

David Coutinho1, Tiago Felix1, Rui Ferraz2, Ana Torres1, Bruno Lopes1, Nelson Albuquerque1, Elisa Moreira1, Andreia Silva1, Jorge Caldas1

1MFR, CHTV, Viseu, Portugal, 2USF Tondela-ACeS Dão Lafões, Rua Dr Manuel de Arriaga, Tondela, Portugal

E-mail: [email protected]

Klippel-Trenaunay syndrome (KTS) is a complex vascular syndrome occurring as a result of somatic mutations in the PIK3CA gene. The estimated incidence of KTS is 0.02–0.05 per 1000 live births. Patients are diagnosed based on two major features which are, congenital vascular malformation (capillary, venous, arteriovenous and lymphatic malformations) and bone and soft tissue growth disorder (hypertrophy or hypotrophy). The severity of malformations and degree of limb overgrowth is variable among patients, requiring multi-professional team care with regular follow-up. The extremities affected often suffer hypertrophy due to lymphedema and hyperplasia of underlying soft tissue or adipose tissue. Although any part of the body can be involved, the lower limbs are affected in 95% of cases. Management is usually conservative and includes compression or intermittent pneumatic stocking, manual decongestive therapy, orthopaedic devices, laser ablation, embolization and sclerotherapy. The subject in this case study is a 16-year-old male who was referred to a Physical Medicine and Rehabilitation appointment for presenting leg length discrepancy (LLD), displaying hypertrophy on his left leg, due to various vascular malformations, and a 15° sustained flexion contracture of the left knee, caused by shortening of the posterior chain muscles. His right limb did not show any abnormalities. The patient used walking aids and exhibited unsteady gait wide base. The standing full length radiograph confirmed a 5cm (LLD). Based on these findings, we prescribed 5cm height compensated shoe, compression stockings and physiotherapy, that showed excellent results.

  6803 - Motor disorders in neurofibromatosis 1: Case report Top

Elhanafi Asma, Bourharbal Mereim, Elabbady Lamiae, Chgoura Karima, Abdelfettah Youness

Department of Physical Medicine and Rehabilitation, University Hospital Center Mohammed 6, Marrakesh, Morocco

E-mail: [email protected]

Introduction: Neurofibromatosis type 1 (NF1) is associated with skeletal abnormalities such as short stature, scoliosis and long bone fracture with pseudarthrosis. Adults with NF1 have decreased muscle strength and gripping problems in the hand. Aim: The aim of our observation is to highlight motor damage in neurofibromatosis 1 and the interest of early management to avoid progression to complications. Observation: 05-year-old child followed in the pediatric department for neurofibromatosis Type 1, address in our department for a deficit of the right upper limb, the clinical examination of the right upper limb objectified: attitude of the right upper limb in internal rotation and retropulsion, no muscular atrophy, overall muscle strength is preserved; segmental muscle strength is reduced with muscle testing 4/5 proximo-distal at the level of the right upper limb; ROT preserved, superficial, vibratory and deep tactile sensitivities are present, the rest of the clinical examination was unremarkable, in particular no scoliosis or other articular disorders, apart from cafe au lait spots, our management: motor rehabilitation, occupational therapy and follow-up. Conclusion: Von Recklinghausen's disease or neurofibromatosis type 1 is the most common phacomatosis. Its frequency is about 1/3000 births. Bone lesions are frequent and characteristic. Hence the importance of screening and diagnosis for early treatment.

  Biomedical Sciences: Molecular and Cellular Biology Top

  5591 - Myonuclear apoptosis via cleaved caspase-3 upregulation is associated with macrophage accumulation underlying immobilization-induced muscle fibrosis Top

Natsumi Tanaka1, Yuichiro Honda2, Yasuhiro Kajiwara3, Hideki Kataoka4, Tomoki Origuchi2, Junya Sakamoto2, Minoru Okita2

1School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Japan, 2Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan, 3Department of Rehabilitation, Nagasaki University Hospital, Nagasaki, Japan, 4Department of Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, Japan

E-mail: [email protected]

Background and Aims: Our previous study showed that interleukin (IL)-1β/transforming growth factor (TGF)-β1 signaling via macrophage accumulation promotes the differentiation of fibroblasts into myofibroblasts in immobilized skeletal muscles, thereby affecting the incidence of muscle fibrosis. However, the mechanism underlying macrophage accumulation remains unclear. Recent studies have shown that muscle fiber atrophy and muscle fibrosis occur simultaneously during immobilization, and that myonuclear apoptosis via cleaved caspase-3 led to muscle fiber atrophy. We hypothesized that this myonuclear decrease via cleaved caspase-3 upregulation led to macrophage accumulation for phagocytosis of unnecessary muscle cytoplasm, and these lesions were related to the development of immobilization-induced muscle fibrosis. Therefore, we aimed to verify this hypothesis using immobilized rat soleus muscles. Methods: Wistar rats were divided into immobilization (n = 10) and control (n = 10) groups. In the immobilization group, both ankle joints were fixed in full plantar flexion for 1 and 2weeks. After each experimental period, the soleus muscles were selected for various analyses. Results: The levels of collagen, IL-1β, TGF-β1, and cleaved caspase-3 and number of myofibroblasts, macrophages, apoptotic myonuclei, were significantly higher in the immobilization group than in the control group at 1 and 2 weeks. In addition, the number of myonuclei and cross-sectional area of muscle fibers were significantly lower in the immobilization group than in the control group at both time points. Conclusions: The results indicate that myonuclear apoptosis via the upregulation of cleaved caspase-3 induces macrophage accumulation, which may be associated with immobilization-induced muscle fibrosis.

  Biomedical Sciences: Neurosciences Top

  6919 - The influence of combination therapy with non-immersive virtual reality systems and t-DCS in patients after stroke Top

Eleftherios Stefas, Vasiliki Kouvelioti, Ekaterini Gesou, Emmanuil Kandylakis, Myrto Kesidou

Evexia Rehabilitation Center, Thessaloniki, Greece

E-mail: [email protected]

Background and Aims: Transcranial direct current stimulation (t-DCS) is an established rehabilitation method that improves motor and cognitive deficits in post stroke patients by promoting neuronal plasticity. Data has demonstrated the effectiveness of virtual reality (VR) in patients after stroke. The therapy involves the use of special computer programs designed to simulate actual activities of daily living. Virtual Reality may have some advantages over traditional treatment approaches, as they may give patients the opportunity to practice everyday activities that cannot be exercised within the environment of a rehabilitation center. Our aim was to investigate the effects of non-immersive VR systems in combination with t-DCS in patients after stroke. Evidence exists regarding the application of each intervention per se, but not in combination. Methods: 24 post stroke patients (16 males, 8 females; age: 61.4 ± 6.8 years). All the participants were in a post-acute phase. Prerequisites for inclusion in the study were the lack of visual and cognitive deficits and the presence of subtle movement in all four limbs. Patients were assessed using the Barthel scale, the Berg Balance Scale, and the Independent Living Scale. All patients followed a specially designed VR program while t-DCS was applied for fifteen sessions. A Kinect sensor was used, combined with a display connected to a computer. Results: All patients showed improvement in functionality, balance, and independence index (p< 0.0.1), thereby improving their abilities in activities of daily living. No side effects were detected. Conclusions: Non-immersive Virtual Reality systems combined with t-DCS seem to be effective and provide a better clinical outcome. Their use should be established in rehabilitation centers, as they are low-cost equipment.

  6828 - Contribution of personal egocentric spatial reference frame and unilateral spatial neglect on weight bearing asymmetry after a right middle artery stroke: A cross-sectional study Top

Aurélien Hugues1,2, Stéphanie Leplaideur3, Pascal Roy4, Mathieu Fauvernier5, Etienne Allart6, François Boyer5, Jean Paysant6, Alain Yelnik7, Julien Barra8, Dominic Perennou9, Gilles Rode10, Isabelle Bonan11

1Médecine Physique et de Réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, France, 2Equipe “Trajectoires”, CRNL, Inserm Université de Lyon, Université Lyon, Villeurbanne, France, 3MPR, CHU Rennes, Rennes, France, 4Univ Rennes, Team, CNRS, Inria, Inserm, IRISA, Rennes, 5Service de Biostatistiques, Hospices Civils de Lyon, 6LBBE UMR CNRS, Villeurbanne, France, 7MPR, CHU de Lille, 8Université Lille, ILille Neuroscience and Cognition, Lille, France, 9Médecine Physique et de Réadaptation, Sebastopol Hospital, Reims Champagne Ardenne University, Reims, France, 10Institut Régional de Médecine Physique et de Réadaptation, Nancy, France, 11Médecine Physique et de Réadaptation, F. Widal, AP-HP, Université de Paris, Paris, France

E-mail: [email protected]

Background and Aims: After stroke, patients frequently suffer from weight-bearing asymmetry (WBA). The influence of egocentric spatial reference frame misperceptions such as longitudinal body axis (LBA) and subjective straight-ahead (SSA), but also of unilateral spatial neglect (USN) on WBA is strongly suspected. The aim of this study was to determine the independent contribution of LBA, SSA, and USN on ipsilesional WBA of patients after right stroke, and to explore a potential interaction effect. Methods: A cross-sectional study from a multicentric RCT including patients with a right unilateral sustentorial stroke dating from 9 months and having a weight-bearing on the paretic lower limb ≤40% was conducted. The main outcomes included the type of stroke lesion, motor weakness, spasticity, superficial and kinaesthetic sensibility, WBA and body sway in standing position, lateropulsion, SSA, LBA, and different components of USN. A variable selection was performed by Elasticnet approach, then multivariate linear and non-linear regressions were used. Results: Eighty-one patients with a right middle artery stroke (age: 59.4 years, delay post-stroke: 7 days) were analyzed. The mean WBA was 18.0 (SD 9.3), without significant difference between with and without vision. The multivariate regression (54.7% of deviance explained) found that gender (p=0.004), time post-stroke (p<0.001), perceptive component of USN (bissection test, p=0.02), LBA (p=0.02) and the interaction between LBA and perceptive component of USN (p<0.01) were significant. Conclusion: After subacute right stroke, ipsilesional WBA could be the result of a contribution of both personal egocentric spatial reference frame and USN, the influence of each of which is likely to depend on the other.

  6717 - Cerebellar transcranial direct current stimulation on sensory-motor recovery of the upper limb and its effects on cognitive functions in chronic stroke patients: A randomized controlled trial Top

Valentina Varalta1, Mirko Filippetti2, Cristina Fonte2, Elisa Evangelista2, Ylenia Gallinaro2, Valentina Cirio3, Rita Di Censo2, Orsi Qehaj2, Giulio Balestro2, Nicola Smania2, Alessandro Picelli2

1Department of Neurosciences, Physical and Rehabilitation Medicine, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Center Section of University of Verona, Verona, Italy, 2Department of Physical and Rehabilitation Medicine, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Italy, 3Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy

E-mail: [email protected]

Background and Aims: Primary aim of this double-blind, randomized controlled study is to compare the effects, on a sensory-motor recovery of the upper limb, of a treatment with an end-effector MOTORE® (Humanware Srl, Pisa, Italy) combined or not (sham) with a cerebellar tDCS. Secondary aim is to evaluate the effects of the two treatments on cognitive functions. Methods: Chronic stroke outpatients that fulfilled the inclusion and exclusion criteria were randomized in two groups (simultaneously MOTORE®+cathodal ipsilesional tcDCS 2mA or MOTORE®+sham) and evaluated before (T0) and after (T1) the treatment ad after one month of follow-up. All patients underwent ten sessions (20' daily for 5 days/week for 2 weeks). Primary outcome: Fughl-Meyer. Secondary outcomes: sensory-motor functions (Action Research Arm Test; Motricity Index; Modified Ashworth Scale; Nine Hole Peg test); cognitive functions (Trail Making Test; Digit and Corsi Span Forward e Reversal; Modified 5-Point Test; Digit Symbol - WAIS-R). Results: To date, 16 patients have been enrolled and equally allocated to the two groups. The between-group analysis didn't show statistical significance for the primary outcome measure. At intra-group analysis, MOTORE®+tcDCS group demonstrated a better performance in information processing speed (Digit Symbol - WAIS-R), short-term memory (Digit and Corsi Span Forward) and working memory (Digit and Corsi Span Reversal). The same group also demonstrates to maintain this variation at follow-up. Conclusions: Based on the available data, a robotic treatment with MOTORE® coupled with tcDCS didn't give a significant gain, compared to the robotic treatment alone, on sensory-motor functions. Instead, the same treatment should be more investigated for the positive effects demonstrated on cognitive functions.

  6247 - Changes in resting-state functional connectivity with short-term motor learning to use chopsticks with the non-dominant hand Top

Sayori Takeda1, Reiko Miyamoto2

1Graduate School of Human Health Sciences, Tokyo Metropolitan University, Hachioji, Tokyo Japan, 2Tokyo Metropolitan University, Hachioji, Tokyo, Japan

E-mail: [email protected]

Background and Aims: Many patients use their non-dominant hand instead of paretic dominant hand to accomplish daily tasks. However, the neural basis for short-term motor learning of chopstick use is still unclear. We examined changes in resting-state functional connectivity (RSFC), an index of plastic changes in the brain, before and after learning to use chopsticks with the non-dominant hand. Methods: Eighteen healthy right-handed adults were randomly assigned to the practice group or the control group. The practice group performed the task of moving a small block for nine minutes, while the control group simply held chopsticks. We compared the number of blocks successfully moved to the mouth before and after the practice. After measuring resting-state brain activity using fMRI, we performed functional connectivity analysis of the sensorimotor and cerebellar networks, and calculated changes in RSFC using the right primary motor cortex (M1) as a seed. Results: The skill in using chopsticks improved significantly after practice period in both groups (p<0.05), and the effect size was larger in the practice group. In RSFC with the right M1, both groups showed increased RSFC with the left M1 and the Supplementary motor area, while RSFC with cerebellum (CB) increased only in the practice group (p<0.001, FDR-corr). Conclusions: In the unfamiliar left hand, motor learning occurred even after a short assessment task, and the practice group learned more. Previous studies reported the strong RSFC between the CB and the M1 after motor learning (Philip and Frey,2016). Compared to the control group, the practice group may have strong RSFC with the CB for more elaborate motor coordination. We will perform a detailed analysis with more subjects in the future.

  6403 - Chemotherapy-induced peripheral neuropathy and motor synergies: NEUPER study Top

Miryam Mazzucchelli1,2, Paola Alberti3, Cristiano Alessandro1,2, Giorgio Amato1,2, Cesare Maria Cornaggia1,2, Cecilia Perin1,2, Daniele Piscitelli1,2, Guido Cavaletti3

1School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy, 2Istituti Clinici Zucchi, San Donato Group, Carate Brianza, Italy, 3Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

E-mail: [email protected]

Background and Aims: Chemotherapy-induced peripheral neuropathy (CIPN) may cause deficit of postural stability and increase fall incidence. Rehabilitation intervention can provide strategies to remediate or compensate for deficits. Multimuscle synergy index (SI) are a new measure of postural stability and a proxy of multi-muscle coordination. NEUPER study Aims to characterize SI organization in relation to postural stability in individuals with peripheral neuropathy (PN) and to assess the effectiveness of a rehabilitation program driven by SI findings on clinical outcomes. Methods: Participant were assessed at baseline, after a 20 session 2-3/week rehabilitation program and at 3 months after treatment. Outcome measures were: Total Neuropathy Score–clinical version (TNSc), nerve conduction studies, Short Form Health Survey 36 (SF-36), Functional Independence Measure (FIM), SixMinuteWalkingTest (6MWT), MiniBalanceEvaluation SystemTest (MiniBESTest), TimedUpandGotest (TUG) and postural evaluation recording center of pressure displacement and surface electromyography. Results: Three individuals with CIPN were enrolled (mean age(ds):64.08(10.06)). At baseline all subjects had a grade 2 PN according to TNSc. Summary scores of SF-36 were above the mean compared to sex ad age matched reference population. FIM indicated a modified/complete functional independence. 6MWT showed a decreased aerobic capacity. Two subjects were at risk of fall at MiniBESTest, while none at TUG. Muscle-modes were heterogeneous compared to a healthy subject. Results after rehabilitation program are still under analysis. Conclusion: CIPN patients seem to have disrupted multi muscle synergies. We expect to detect an influence of SI impairments on clinical outcome following the rehabilitation treatment.

  6374 - Assessment of the reproducibility of the iTUG and iWalk in healthy young adults Top

Anaick Perrochon1, Bastien Vieillescazes2

1Laboratory HAVAE, University of Limoges, Limoges, France, 2ILFOMER, University of Limoges, Limoges, France

E-mail: [email protected]

Background and Aims: Motor imagery performance is often assessed by different temporal congruence tests including an imagined version of the Timed Up and Go (iTUG) and a walking task (iWalk). Despite their strong clinical interest, they have no clinimetric indication. Aim of the study was to determine the reliability of iTUG and iWalk tests in healthy young adults. Methods: Participants were recruited to perform three identical recording sessions (S1, S2, and S3). S1 and S2 were separated by 30 minutes, whereas S3 was performed 24 hours after S1. Reliability was assessed by calculating intraclass correlation coefficients (ICC), standard error of measurement (SEM), and agreement limits for each measured variable. Results: We recruited 16 participants who completed all tests. The tests in their physical version (TUG and Walk) presented a good relative and absolute reliability. In their imagined version (iTUG and iWalk), the reliability of the tests was good only in S1-S3. This trend was also visible for the temporal congruence scores (ΔTUG and ΔWalk), with moderate relative reliability in S1-S3. Conclusion: This study reveals: i) differences in reliability over time; ii) better reliability of imagined tests and temporal congruence scores in S1-S3 compared with S1-S2.

  6235 - The association between resting state neural oscillations and executive functions in pediatric ADHD Top

Ornella Dakwar-Kawar1, Tal Mentch-Lifshits2, Noam Mairon2, Pragathi Balasubramani3, Jyoti Mishra3, Itai Berger4, Roi Cohen Kadosh5, Mor Nahum2

1The Hebrew University of Jerusalem, Jerusalem, Israel, 2School of OT, Faculty of Medicine, Hebrew University, Jerusalem, Israel, 3Department of Psychiatry, University of California San Diego, San Diego, USA, 4Paul Baerwald School of Social Work and Social Welfare, Hebrew University, Jerusalem, Israel, 5School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK

E-mail: [email protected]

Background and Aims: Deficits in executive functions (EFs), including working memory (WM) and processing speed (PS), as well as abnormal resting-state (RS) neural oscillations, especially in the theta and beta frequency bands, have been documented in pediatric ADHD. However, the clinical utility of these neural markers for ADHD and their potential association to EF deficits in ADHD is unclear. Here, we examined differences in RS oscillations between children with and without ADHD and their potential association to EF in ADHD. Methods: 31 unmedicated children (6-12y/o) with ADHD and 25 age-matched neurotypical controls were included. RS EEG was recorded using an eyes-open paradigm. EF measures of WM (digit span test subscale of the WISC) and PS (measured by MOXO-CPT), as well as parent-reported EFs (the BRIEF scale) and ADHD symptoms (the ADHD-RS), were also measured. Results: RS EEG oscillations were higher for the ADHD compared to the control group in both theta and beta frequency bands, in central and frontal electrodes. In addition, increased theta and beta activity was associated with reduced ADHD symptoms (theta: r = −0.53, p=0.001; beta: r=-0.54, p=0.001) and with better EF performance (WM: theta: r=0.55, p=0.001; beta: r=0.63, p=0.0001; PS: beta: r=0.54, p=0.001), but not with parent-reported EF. Conclusions: The results of this study further elucidate the associations between abnormalities in neural oscillations and in EF in ADHD. Importantly, confirm the suggestion that TBR may not be a reliable neural marker differentiating between ADHD and neurotypical children. Furthermore, suggesting that theta and beta oscillations may be used as metrics evaluating ADHD symptoms and EF performance. These results may have further implications for the diagnosis and treatment of pediatric ADHD.

  6190 - Shoulder weakness induces trunk compensation after a stroke Top

Germain Faity1, Denis Mottet1, Karima Bakhti2, Isabelle Laffont2, Jérôme Froger3

1EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France, 2EuroMov DHM, Univ Montpellier, IMT Mines Ales, CHU Montpellier, Montpellier, France, 3EuroMov DHM, Univ Montpellier, IMT Mines Ales, CHU Nîmes, Grau du Roi, France

E-mail: [email protected]

Background and Aims: Most stroke patients do not use their paretic limb even when they are able to do so, often resulting in secondary loss of function. Healthy people adapt their elbow-shoulder-trunk coordination to minimize the torque at the shoulder. The aim of this study is to evaluate how shoulder weakness after stroke impacts elbow-shoulder-trunk coordination. Methods: Patients with stroke (> 1 month) and healthy participants performed a reaching task in 2 conditions: high and low shoulder torque. In each condition, the reaching task was first performed spontaneously and second with minimal trunk movement. Elbow-shoulder-trunk coordination was recorded using motion capture, and muscle activation was recorded using EMG. Results: Firstly, most patients had proximal arm non-use and compulsory trunk compensations. Secondly, all patients had lower antigravity shoulder function, leading to saturation of the anterior and medial deltoids when reaching. Third, an antigravity device 1) allows for a more normal level of muscle activation and 2) leads to a decrease in trunk compensations. Conclusions: The observed compensation is not merely a 'poor coordination', but more likely a 'good adaptation' to the weakness of the shoulder after the stroke. Given the beneficial effect of the antigravity device, future work may evaluate the effect of strength training on reducing compensations.

  6011 - Dorsal root ganglion macrophage activation in nude rats and wistar rats developing autotomy after peripheral nerve injury Top

Xiang Xu1, Xijie Zhou1, Jian Du1, Blake Johnson2, Xiaofeng Jia3

1Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, USA, 2Department of Industrial and Systems Engineering, School of Neuroscience, Virginia Tech, Virginia, USA, 3University of Maryland School of Medicine, Maryland, USA

E-mail: [email protected]

Background and Aims: Autotomy, self-mutilation of a denervated limb, is common in animals after peripheral nerve injury (PNI) and is a reliable proxy for neuropathic pain in humans. Understanding the occurrence and treatment of autotomy remains challenging. The objective of this study was to investigate the occurrence of autotomy in nude and Wistar rats and evaluate the differences in macrophage activation and fiber sensitization contributing to the understanding of autotomy behavior. Methods: Autotomy in nude and Wistar rats was observed and evaluated 6 and 12 weeks after sciatic nerve repair surgery. The numbers of macrophages and the types of neurons in the dorsal root ganglion (DRG) between the two groups were compared by immunofluorescence studies. Immunostaining of T cells in the DRG was also assessed. Results: Nude rats engaged in autotomy with less frequency than Wistar rats. Autotomy symptoms were also relatively less severe in nude rats. Immunofluorescence studies revealed increased macrophage accumulation and activation in the DRG of Wistar rats. The percentage of NF200+ neurons was higher at 6 and 12 weeks in Wistar rats compared to nude rats, but the percentage of CGRP+ neurons did not differ between the two groups. Additionally, macrophages were concentrated around NF200-labeled A fibers. At 6 and 12 weeks following PNI, CD4+ T cells were not found in the DRG of the two groups. Conclusion: The accumulation and activation of macrophages in the DRG may account for the increased frequency and severity of autotomy in Wistar rats. Our results also suggest that A fiber neurons in the DRG play an important role in autotomy.

  6172 - Altered EEG activity in adolescent idiopathic scoliosis Top

Francesca Cantele1, Margherita Bertuccelli2, Maria Rubega1, Roberto Di Marco1, Federica Gottardello1, Michela De Giuseppe1, Emanuela Formaggio1, Stefano Masiero1

1Department of Neuroscience, Section of Rehabilitation, University of Padova, Padova, Italy, 2Padova Neuroscience Center, Padova, Italy

E-mail: [email protected]

Background and Aims: The pathophysiology of Adolescent Idiopathic Scoliosis (AIS) has not been yet completely understood, but multi-factorial hypotheses have been proposed including defective central nervous system control of posture and alterations of body schema. The aim of our study was to compare the electroencephalography (EEG) activity in AIS subjects and controls, to examine the brain oscillatory changes related to balance control and inquire possibly related body schema representational alterations. Methods: We recorded EEG and balance data during standing and arms up conditions (with eyes open and closed) in 14 healthy subjects and in 14 subjects with AIS. A re-adaptation of the Image Marking Procedure was used to assess the body schema. Results: Our results revealed no balance control difference between groups; higher EEG alpha relative power over sensorimotor areas ispilateral to the side of the curve and a significant increase of theta relative power localized over the central areas in AIS participants compared to controls. The delta body perception index (BPI) score (BPI shoulder minus BPI waist) resulted significantly different between the two groups. The inclinations of the perceived interacromial axes in girls having thoracic principal curve, and bisiliac axes in girls with lumbar principal curve, was opposite to the real inclination. Conclusions: Our results provide evidence of an increased theta activity and a lateralized alpha activity in AIS subjects, as if postural control were more challenging for them. This eventually results in the observed body schema alterations. The identification of an abnormal EEG pattern may describe a much more complex physiopathology of AIS and promote new multidomain treatment approaches to improve patients' care quality.

  6025 - Analysis of subjective straight ahead pointing at the frontal plane in spatial neglect: A study in two cases and healthy subjects Top

Taku Numao1, Kazu Amimoto2, Kyohei Ichikawa3

1Department of Physical Therapy, Japanese School of Technology for Social Medicine, Tokyo, Japan, 2Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan, 3Department of Rehabilitation, Niiza Hospital, Saitama, Japan

E-mail: [email protected]

Background and Aims: In patients with unilateral spatial neglect (USN), the subjective straight ahead in the horizontal plane is biased to the right. Recently, it has been suggested that USN patients experience cognitive shifts not only in the horizontal plane but also in the frontal plane. We measured the deviation of the subjective straight ahead in the frontal plane, including left, right, superior and inferior. We also compared two methods in which the eyes were closed and opened in the frontal plane. Methods: The subjects were two patients with USN (Age: 53, 74. Lesion site: Thalamus, Middle cerebral artery region. Catherine Bergego Scale: 19, 14) and seven healthy adults aged 25-30 years. The subjects were asked to touch a 32-inch touch panel with their index fingers with their eyes closed and with their eyes open, and the touch positions were measured. Results: The two USN cases showed positions to the left horizontally from the median in both conditions, but in the vertical direction, the results were different. Healthy adults showed a position horizontally left of the median and vertically up from the xiphoid process in the eyes open condition. On the other hand, the eyes were closed, the horizontal position was to the right and the vertical position was below. Conclusion: The results of the USN patients were different in vertical cognition, a trend that needs to be observed by increasing the number of cases. The horizontal results in healthy adults were the same as those reported by Sarri et al. It was shown that there was no significant deviation in the vertical direction between the closed and open eye condition.

  5992 - 3D motion analysis in different neurological syndromes Top

Saikal Ismailova1, Mariia Abroskina1, Vera Ondar1, Aleksandra Khomchenkova1, Elena Mozhejko2, Pemen Prokopenko1

1Department of Nervous Diseases with a Course of Postgraduate Education, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia, 2Department of Physical and Rehabilitation Medicine, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia

E-mail: [email protected]

We made an attempt to determine clinical features of gait impairment against the background of ataxia, hemiparetic gait and Parkinson's disease (PD). The study involved application of Vicon Motion Capture Systems. Tempo-rhythmic characteristics of gait during the stride were determined, the data on angular indices of lower extremity movement in hip, knee and ankle joints were obtained. General changes in the gait parameters in all patients were found: decrease in the gait tempo, gait velocity, the length of the stride and the step, increase in the time of the stride and the step. Among the technical advantages of the method is the possibility of separate assessment of tempo-rhythmic indices for the right and the left lower limbs. Very frequently, pathological changes in PD, the syndrome of central hemiparesis and ataxia only affect one half of the body. This let us objectively evaluate the degree of asymmetry during movement. The following peculiarities were revealed: the left-sided hemiataxia patient demonstrated a later lift of the intact foot from the support surface. The patient with right-sided hemiparesis showed increased time of single support on the paretic right limb. The patient with PD stage 3.0 according to the Hoehn and Yahr scale was observed to have bilateral symptoms, but with certain asymmetry of the right-sided manifestations. Analysis of angular parameters of gait in patients with neurological pathology revealed asymmetry of flexion/extension in the hip, knee and ankle joints in comparison with a healthy person. As a result of the study, peculiarities in gait stereotype alteration against the background of neurological syndromes have been determined. We recommend application of the method of three-dimensional video analysis of movements in expert assessment of gait function impairment.

  5984 - The effect of intensive finger-individuation training on recovery of manual dexterity following stroke Top

Shay Ofir Geva1, Ohad Rajchert2, Silvi Frenkel-Toledo3, Osnat Granot4, Tomm Caspi5, Jusine Lowental-Raz4, Orit Wonderman Bar-Sela5, Corinne Serfaty4, Nachum Soroker5, Firas Mawase4

1Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel, 2Faculty of Biomedical Engineering, Technion Israel, Institute of Technology, Haifa, Israel, 3Department of Physical Therapy, Ariel University, Israel, 4Loewenstein Rehabilitation Medical Center, Ra'anana, Israel, 5Department of Neurological Rehabilitation, Israel

E-mail: [email protected]

Background and Aims: Motor impairment of the hemiparetic upper limb (HUL) is a leading cause of disability following stroke. One of the most prominent deficits in hand dexterity is increased finger enslaving, or unintended force produced by the uninstructed fingers.6 Recent studies in animal models suggest that highly-repetitive training, focused on movement quality, may lead to improved motor recovery. We aimed to test whether intensive training of finger individuation during the subacute period post-stroke (< 3 months) can improve upper limb motor impairment. Methods: 20 first-ever stroke patients with clinically evident upper limb motor impairment were divided randomly into two groups. Both groups received robotic therapy in addition to standard care using an end-effector robot (AMADEO, TyroMotion, GmbH) for 10 one-hour sessions, 5 days a week for two weeks. Group A received individuation-focused robotic training, while group B received non-individuation robotic training, i.e., finger-individuation was not encouraged specifically. Fugl-Meyer Assessment for the upper extremity (FMA-UE), Arm Research Action Test (ARAT), Maximal Voluntary Contraction (MVC) and Individuation Index (II) measurements were done immediately before (baseline), at the end of the 2w treatment period and after a 4w follow up period. Results: The outcome measures, especially MVC and II, improved in both groups. Training effects showed a large inter-personal variance among patients reflecting differences in stroke lesion topography and baseline impairment level. Conclusions: Short-term Intensive robotic therapy focused on finger-individuation improves fingers' force and manual dexterity in subacute stroke patients.

  5929 - Prospective / experimental exogenous hydrogen sulfide based therapies as: Including physiatric-rehabilitation: Interventions in stroke Top

Constantin Munteanu1, Gelu Onose2

1Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa”, Iaşi, Romania, 2Department of PRM, Faculty of Medicine, the University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

E-mail: [email protected]

Background and Aims: A stroke or cerebral vascular attack occurs when blood flow to the brain stops/is interrupted or severely reduced. As a result, neurons are deprived of oxygen and nutrients and, consequently, enter into pathophysiological cascades, possibly culminating in necrosis or apoptosis. Hydrogen sulfide (H2S) serves as a gasotransmitter in regulating organ development and maintaining homeostasis in tissues. H2S neuroprotective effect is dose-dependent. Abnormal levels are associated with multiple human diseases Only when its concentration is relatively low H2S can it yield neuroprotection, while a high dose may lead to neurotoxicity. H2S is also an essential biochemical component within the mud, and sulfurous waters, used in balneotherapy – induces a wide range of physiological responses such as blood pressure modulation, neuromodulator in the brain and within the vasculature protective against ischemic reperfusion injury, and anti-inflammatory reactions. H2S can penetrate the skin and mucosae and act at the cell level in the skin and internal organs. Methods: This paper relies, as documentation, on a PRISMA approach. Results: We have found initially 22 articles. After fulfilling the steps of the PRISMA, remained 9 papers. We have also used some free identified related works. Conclusions: Although H2S is a toxic substance, increasing evidence has indicated that H2S plays an essential role in neuroprotection in stroke, while its neurotoxicity cannot be neglected. Therefore, future research directions mainly include experiments using such kind interventions on different animal models of ischemic stroke, CVA “cocktail treatments, well-designed clinical trials, and studies on intimate biological and pathophysiological mechanisms. H2S may offer a new promising application for the therapy of stroke.

  5928 - Prospective/experimental exogenous hydrogen sulfide based therapies in spinal cord injury Top

Gelu Onose1, Constantin Munteanu2,3

1Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila,” Bucharest, Romania, 2Division of Neuromuscular Rehabilitation Clinic, the Teaching Emergency Hospital “Bagdasar- Arseni,” Bucharest, Romania, 3Faculty of Medical Bioengineering, the University of Medicine and Pharmacy “Grigore T. Popa”, Iaşi, Romania

E-mail: [email protected]

Background and Aims: Spinal cord injury (SCI) usually causes severe and often permanent impairment or even loss of essential functions, such as voluntary/ active motility, sensitivity, urinary and/or defecation control, erection/ejaculation/lubrication/fertility. These are, in most cases, devastating, severe and frequently irreversible, without yet, an effective cure. Prospective/experimental interventions were proposed using exogenous hydrogen sulfide (H2S), an essential gaseous messenger with neuroprotective effects in many neurological disorders, including at the intimate geno-molecular level. H2S plays an essential role in combating oxidative stress, inflammation, neuropathic pain, apoptosis, and respectively influences autophagy, angiogenesis and cardiovascular protection. Moreover, H2S has a neuroprotective effect against oxygen-glucose deprivation-induced neuron injury. The protective effects of inhaled hydrogen sulfide were associated with inhibition of glial activation and upregulation of antioxidant and detoxification proteins, preventing the systemic inflammation induced by lipopolysaccharide. Methods: This paper relies, as documentation, on a PRISMA approach. Results: We have found initially 13 articles. After fulfilling the steps of the PRISMA, remained seven papers. We have also used some free identified related works to strengthen our documentation base. Conclusions: H2S has been shown in experimental studies on animal models to exert neuroprotective actions in SCI by mainly: improving spinal cord oxygen tension, decreasing apoptosis, reducing inflammation, attenuating oxidative stress and promoting angiogenesis and autophagy. Anyway, H2S medical significance, although it is included in actual therapeutic mud or balneary used sulfurous waters, is not still fully understood.

  5876 - Neuroprotective effect of macrophage migration inhibitory factor (MIF) in ischemic stroke mice model Top

Jiae Kim, Seunghak Lee, Dae Yul Kim

Department of Rehabilitation Medicine, Asan Medical Center, Seoul, South Korea

E-mail: [email protected]

Macrophage migration inhibitory factor (MIF) is multifunctional immune cytokine which is known to play neuroprotective role in in vitro ischemic stroke models, however the neuroprotective effect in vivo model is not yet clear. This study aimed to investigate if the MIF promotes neurological recovery in vivo stroke mice model. The group was allocated to sham vehicle (n=15), sham MIF (n=11), middle cerebral artery occlusion (MCAO) vehicle (n=14), and MCAO MIF (n=14). Transient middle cerebral artery occlusion is performed to male mice in MCAO groups. Vehicle and MIF was administered through intracerebroventricular route. We evaluated the neurological functional scale, rotarod test, and T2-weighted magnetic resonance imaging. The neurological scale was significantly higher in MCAO MIF group compared to MCAO vehicle group [Figure 1]a. MCAO vehicle group exhibited significantly poorer performance on the rotarod test than MCAO MIF group [Figure 1]b. MCAO MIF group had significantly reduced total infarct volume compared with MCAO vehicle group in T2-weighted MRI image [Figure 2]. Expression levels of BDNF, Bcl2, and MAP2 tend to be higher in MCAO MIF group than MCAO vehicle group. This study suggests that MIF has neuroprotective effect on in vivo ischemic stroke model. MIF seems to facilitate neurological recovery, and protect the brain tissue from ischemic injury.
Figure 1: Behavioral test

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Figure 2: Infarction volume

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  5819 - A computerized evaluation system 'CogEvo' may detect specific cognitive domain declines in early-stage mild cognitive impairment Top

Tetsuya Takaoka, Keiji Hashimoto, Nobuyuki Kawate

Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan

E-mail: [email protected]

Background and Aims: Dementia affects about 50 million people in the world today and is projected to affect 152 million by 2050.[1] It is important to develop tools to screen for cognitive decline at an earlier stage. In this study, we assessed cognitive function in healthy middle-aged and elderly people using CogEvo (Total Brain Care, Kobe, Japan) and Japanese version of the Montreal Cognitive Assessment (MoCA-J). CogEvo is a cognitive function test battery performed on a tablet device. Methods: Twenty middle-aged and elderly individuals (14 women and 6 men) aged between 42 and 79 years (mean: 63.5±11.0 years) were enrolled in this study. The subjects had never been diagnosed with dementia or mild cognitive impairment (MCI) and were able to perform basic daily activities independently. The test items included basic profile information and past medical histories, social histories of the participants, CogEvo, and MoCA-J. Results: No correlation was found between MoCA-J and CogEvo total scores, but there were weak correlations among age, executive, and attention functions scores.[2] [Table 1]. Conclusions: It was suggested that cognitive decline may begin with executive and attention function deterioration. Detection of a slight decline in executive and attention function may be possible with CogEvo. We believe that CogEvo is an effective device for detecting early-stage cognitive decline.
Table 1: Correlation coefficients for age, Japanese version of the Montreal Cognitive Assessment, and CogEvo domains (=r)

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  1. Patterson C. Alzheimer's Disease International. London. 2018.
  2. Mukaka MM. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J 2012;24:69-71.

  5817 - Influence of a cognitive task on postural stability during standing in virtual heights Top

Huey-Wen Liang1, Bi-Ru Jiang2, Ying-Chun Chen3, Yaw-Huei Hwang2

1College of Medicine and Rehabilitation, National Taiwan University, Taipei, Taiwan, ROC, 2Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC, 3Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan, ROC

E-mail: [email protected]

Background and Aims: Standing in height has negative impact on trunk control and increased fall risks. Adding a cognitive task has a mostly stabilization effect on postural stability, which is not well-studied in virtual height. Our purpose was to test the change of postural stability in different virtual heights, with or without an added-on cognitive task. Methods: Thirty young and healthy participants volunteered the study after signing informed consents. The tasks included standing in real world and three virtual heights (0, 5 and 12 meters) simulated by VIVE Pro (HTC, Inc.). The above tests in 3 virtual heights were repeated with or without an added simple reaction time task built in the VE. Their postural stability was measured with a FDM-SX system (Zebris Medical GmbH, Germany) to obtain the center of pressure (COP) parameters throughout the tests. Several COP parameters were calculated to and compared between four standing conditions (real-world and 3 virtual heights) with or without the presence of cognitive tasks. Results: Several postural parameters were significantly different in four standing conditions only in standing without cognitive tasks, but not with cognitive tasks, by Freidman's test. Moreover, the post-hoc analysis in four standing conditions showed that the difference was only between the real world and 3 virtual conditions, but not within three virtual heights. Paired comparison within each height showed an increased postural stability with cognitive tasks. Reaction time was similar in three virtual heights. Conclusions: We observed a postural stabilization effect of adding a cognitive task in virtual environments, but a height-dependent effect on the postural stability and reaction time of the cognitive task was not observed.

  5575 - Kinesthesic and visual imagery of movements modulate the alpha rhythm Top

Martha-Rocio Torres-Narvaez1, Oliver Müller1, Diego Alejandro Gonzalez Carmona1, Maria Fernanda Manrique Barbosa1, Cristina Jácome Duran2

1Universidad del Rosario, Bogotá, Colombia, 2Universidad El Bosque, Bogotá, Colombia

E-mail: [email protected]

Background and Aims: Physiotherapy uses different approaches to improve persons' functionality. In some cases patients have a passive role, but active approaches involve attention and the activation of motor function. Motor Imagery (MI) is a cognitive process that activates the representations of movements without actual movement execution and is used in rehabilitation and sports training. However, persons vary in their ability to perform MI and due to its covert nature, MI is difficult to monitor objectively. Electroencephalopgraphy (EEG) allows to measure brain activity related to MI. Studies have identified specific brain areas involved in MI. Visual Motor Imagery (VMI) activates the spatial coordinates of a movement whereas Kinesthesic Motor Imagery (KMI) involves propioception. The objective of this study is to explore EEG activity for different types of movements in persons who vary in their subjective ability for MI. Methods: This study employed a convenience sample of 40 participants (33 women) without neurobehavioral alterations. Participants answered questionnaires about handedness and their ability to use VMI and KMI. The task included three movements (moving a ball with the right hand, putting both hands together, moving a foot) in three modalities (execution, VMI, KMI) with 40 repetitions per condition. EEG was recorded during the task. Results: Analyses of the event-related desynchronization/synchronization showed changes in the alpha band (8–12 Hz) at central scalp sites after the start of movement execution, VMI and KMI, respectively. These changes were detectable at an individual level for most participants. Conclusions: We could identify characteristic changes in brain activity related to MI in different modalities and movement types.

  5587 - Feasibility of using the co-op approach in adult cerebral palsy: Initial results of a SCED study Top

Sabrina Maurel Techene, Xavier De Boissezon, Philippe Marque

CHU de Toulouse, Toulouse, France

E-mail: [email protected]

Background and Aims: The management of cognitive impairements in brain damage people is an issue in the quality of interdisciplinary intervention. Cognitive strategies to promote the person's participation are recomended by evidence based practice. The main goal is to evaluate the improvement of performance in daily life significant activities of people with dysexecutive disorders in chronic phase after stroke. Methods: The methodology is Single-Case-Experimental-Design (SCED) in multiple baselines combined across patients and behaviors. It is composed of 18 intervention sessions with replications across participants (n=3). Treatment focuses on 3 participant-selected goals and 1 control goal. Principal evaluation criterion is the change in performance on the Canadian Occupational Performance Measure (COPM), combined with the Performance Quality Rating Score (PQRS). To measure effect size, visual analysis is performed with Dual-Criterion and Two-Standard-Deviation-Band, and statistical analysis by Non-overlapping for All Points. Results: All 3 patients completed their baseline, but COVID-19 crisis stopped the protocol. So that, the 3 patients worked on only one goal. Analysis showed the effectiveness of CO-OP to improve performance (NAP=1; p=0.0528; CI 90% 0.151< >1. There was also a strong correlation between MCRO and PQRS scores (Spearman 0.889; p<0.001). Conclusions: This feasibility study confirms the relevance of CO-OP to increase motor performance for people with executive function disorders after stroke. Positifs effects on cognitive functions, transfer of knowledge skills, self-efficacy in adults after stroke should be validated by the pursuit of this study.

Keywords: Cognitive impairment, CO-OP, occupational therapy, single-case-experimental-design, Stroke

  6480 - Evaluation of cortical activation during functional movements at baseline of a post-stroke rehabilitation (ReArm project) Top

Camille Muller1, Makii Muthalib2, Denis Mottet1, Gérard Dray1, Binbin Xu1, Marion Delorme3, Jérôme Froger3, Stéphane Perrey1, Isabelle Laffont2, Karima Bakhti2

1EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France, 2Department of Physical Medicine and Rehabilitation, Montpellier University Hospital, Montpellier, France, 3Department of Physical Medicine and Rehabilitation, Nîmes University Hospital, Le Grau du Roi, France

E-mail: [email protected]

Background and Aims: In post-stroke rehabilitation unit, upper limb (UL) function recovery is a subject of major interest to facilitate patient's autonomy in everyday life. This recovery is deeply linked to plastic brain reorganisation. A better understanding of the brain-movement characteristics could help for guiding therapeutic interventions. Two neuro-imagery methods can be used for brain-movement evaluation: functional near-infrared spectroscopy (fNIRS) and electroencephalography (fEEG) respectively based on haemodynamic response and electrical activity of brain regions. Used together they could lead to a better spatiotemporal mapping of the brain lateralisation and reorganisation linked to UL recovery. This study aims to develop methods to evaluate post-stroke brain activations during specific UL movement. Methods: Stroke patients in chronic stage following an intensive UL rehabilitation were evaluated on two functional tasks (i.e. reaching target task and circular tracing task). A combined fNIRS-fEEG system was used to record motor cortex activations during each task. Results: With 3 pilot patients we showed that performances with the paretic arm were lower than those with the non-paretic. With the fNIRS we showed a bi-hemispheric activation during paretic movement and a contralateral one during non-paretic. The fEEG confirm the brain lateralisation, highlighting power modification in the alpha rhythm occurring at movement. Conclusions: The first results showed the feasibility of using these methods to evaluate UL movement brain activation. The quick setup needed to evaluate the patient is another benefit for developing them in rehabilitation units. With the complete data we want to show that used together they could provide linked information's about brain activation and be used as a routine evaluation.

  Biomedical Sciences – Physiology Top

  Clinical Sciences – Complications – Other Top

  6003 - Insufficiency of the striated sphincter in urogenital prolapse: Interest of urodynamic exploration (About 125 cases) Top

Ryme El Beloui, Hajar Abouihsane, Hajar Idam, Nada Kyal, Fatima Lmidmani, Abdellatif El Fatimi

Department of Physical Medicine and Rehabilitation, CHU Ibn Rochd, Casablanca, Morocco

E-mail: [email protected]

Background and Aims: The aim of our study is to focus on the value of urodynamic exploration in the evaluation of insufficiency of striated sphincter linked to urogenital prolapse to offer the best therapy options. Methods: Retrospective study on two series of cases:first includes 100 cases and second 25 cases, having done an urodynamic exploration, with a urogenital prolapse. Study was done over 2 periods: from November 201 to-December 2014 and January 2015-December 2019. Results: The average age was 51 years in 1st series, 56.44 years in the 2nd. Hysterectomy rate in 2nd series was 16%. Average parity was 5.2 children in 1st series and 4 in the 2nd. Vaginal delivery rate was 84% in 1st series, 96% in the 2nd. Urinary disorders 1st: UUI in 31% of cases, SUI in 28%, MUI in 26.4%, pollakiuria in 15%, dysuria in 24.3% of cases; 2nd: UUI in 64% of cases, SUI in 56%, MUI in 44%, pollakiuria in 64%, dysuria in 48% of cases. Prolapse: 1st: Grade 1 cystocele in 9% of cases, a Grade 2 in 31%, Grade 3 in 26.5% of cases; 2nd: Grade 1 cystocele in 28% of cases, Grade 2 in 28%, Grade 3 in 44% of cases. Uroflowmetry: dysuria in 32% of cases in 1st series, 68% of cases in the 2nd. Cystometry: Bladder capacity reduced: 13% of cases in 1st series, 40% of the 2nd; Hypocompliance: 13% of cases in 1st series, 12% in the 2nd; Overactive bladder: 18% of cases of 1st series, 12% of the 2nd. Bladder hypersensitivity: 17% of cases in 1st series, 32% in the 2nd. Profilometry: Sphincter insufficiency: 22% of cases in 1st series, 16% in the 2nd; Urethral hypertension: 37% of cases in 1st series, 26% in the 2nd. Conclusion: Urodynamic assessment is a complementary tool that can't replace clinical examination. It is of precious help, allowing to understand and to evaluate sphincter and bladder disorders related to prolapse, in order to guide the therapeutic decision.

  7010 - Pulsed CT-guided radiofrequency for pudendal neuralgia Top

Maria Baca Baier1, Maria Boldó Alcaine1, Ricard Pérez Andrés2, Rosa María Rincón Párraga3, Cristina Lozano Domínguez1, Pilar Pérez Pérez1

1Department of Physical Medicine and Rehabilitation, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain, 2Department of Radiology's, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain, 3Department of Anaesthesiology and Pain, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain

E-mail: [email protected]

Background and Aims: The aim of this study is to evaluate the efficacy and safety of pulsed CT-guided radiofrequency (PRF) as a treatment for chronic pelvic pain (CPP) secondary to pudendal neuralgia (PN). Methods: Retrospective cohort study including patients visited in the Pelvic Floor consultation between 2016 and 2022 for CPP that had been treated with CT-guided PRF of pudendal nerve. The response to treatment was evaluated by comparison on VAS of pain, percentage of improvement and the need for drug use. The statistical analysis included descriptive analysis of variables and comparison of the results after the intervention. T-Student for paired data was performed for variables with normal distribution, Wilcoxon test if they did not follow normaldistribution and McNemar test for dichotomous variables. Statistical significance was considered when p<0.05. Results: 15 patients were included; 11 women and mean age of 52.5 years (SD 12.5). The mean time of evolution from the onset of pain was 42 months (SD 60). 60% could identify a traumatic or surgical event as the cause of their pain. The mean duration of PRF modulation was 176 seconds per point (ligamentous clamp and Alcock) (SD 53). 46% patients received bilateral treatment. No serious side effects were observed. The mean VAS was 6.1 (SD 17) before PRF and 3.4 (SD 26) after treatment (P = 0.001). The mean percentage of improvement was 44.8% (SD 34%). 33% patients did not return to pain. 53% took two or more drugs prior to the intervention and only 26% did after treatment (P = 0.03). The most important reduction occurred in the need of neuromodulatory drugs. Conclusion: CT-guided pulsed radiofrequency is a safe and effective technique for the treatment of pudendal neuralgia.

  6872 - Validation of the French version of the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 Top

Devis Marine1, Stoquart Gaetan2, Van Pesch Vincent3, London Frédéric4

1Department of Health Sciences, Institute of Experimental and Clinical Research, Neuromusculoskeletal Lab, Catholic University of Louvain, Brussels, Belgium, 2Department of Health Sciences, Institute of Experimental and Clinical Research, Neuromusculoskeletal, Brussels, Belgium, 3Institute of Neuroscience, Cellularet Molecular Pole, Catholic University of Louvain, Brussels, Belgium, 4Institute of Neuroscience, Clinical Neuroscience, Catholic University of Louvain, Brussels, Belgium

E-mail: [email protected]

Background and Aims: Patients with multiple sclerosis (PwMS) suffer from various symptoms, including sexual dysfunction (SD). The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) is a scale that explores the impact of MS on sexual activity and satisfaction. This study aimed to provide a validated, cross-cultural, French version of the MSISQ-19 in PwMS. Methods: The original version of MSISQ-19 was translated into French according to standardized guidelines. Internal consistency was evaluated using Cronbach's alpha. Construct validity was checked by the exploratory factor analysis with principal component analysis. Concurrent validity was assessed by performing Pearson' correlation coefficient with the Female Sexual Function Index (FSFI), the Male Sexual Health Questionnaire (MSHQ),the Multiple Sclerosis International Quality of Life questionnaire (MusiQoL), and the Expanded Disability Status Scale (EDSS). Test-retest reliability was assessed two weeks later. Responsiveness was assessed by standard error of measurement (SEM) and minimum detectable change (MDC). Results: We enrolled 71 PwMS (49 female, 22 male). The mean age was 42.6 ± 9.7 years with a mean disease duration of 10 ± 8.4 years. French MSISQ-19 showed a Cronbach's alpha coefficient of 0.89. MSISQ-19 scores correlated significantly between each other and correlated significantly with scores on the FSFI, MSHQ, MusiQoL and EDSS. Reproducibility was excellent with intraclass correlation coefficients > 0.80. SEM was 4.55 and MDC was 12.6 (13.3%). A three-factor solution was adopted giving eigenvalues higher than 1, supporting the primary, secondary and third dimension of SD. Conclusion: This study provides validation of the French version of the MSISQ-19 which is a reproducible and reliable instrument to assess sexual dysfunction in PwMS.

  6825 - Recommendations for the management of vertebral fractures in cancer patients Top

Carolina De Miguel Benadiba1, Juana Josefina Delvalle González Gallardo1, Luis Álvarez Galovich2, Santos Santos Castañeda Sanz3, Jacqueline Usón Jaeger4, Guillermo Martínez Guerra5, Carmen Navarro6, Esteban Gomez Martin7

1Hospital Universitario Ramón y Cajal, Madrid, Spain, 2Hospital Universitario Fundación Jimenez Díaz, Madrid, Spain, 3Hospital Universitario de La Princesa, Madrid, Spain, 4Hospital Universitario de Móstoles, Madrid, Spain, 5Hospital Universitario 12 de Octubre, Madrid, Spain, 6Hospital Universitario Severo Ochoa, Leganés, Spain, 7Consultorio Zulema Alcalá de Henares, Madrid, Spain

E-mail: [email protected]

Background and Aims: Osteoporosis (OP) is the cause of fragility fractures, that is an event that changes the life of the individual. On the other hand, the management of a cancer patient with a vertebral fracture varies widely among the various scientific societies. Aim of this study was to reconcile the main available guidelines regarding osteoporotic vertebral fracture (OVF) in cancer patients and issue a series of consensus recommendations by a multidisciplinary point of view. Methods: It was established a committee of experts in OP selected based on their experience in this field belonging to different scientific societies. A selection of the main clinical practice guidelines (CPG) was made. The experts drew recommendations for the management of OVF in cancer patients. Results: Regarding the tests necessary for diagnosis, a general consensus was reached, such as clinical and analytical evaluation. There was no agreement regarding the use of DXA, MRO, or FRAX risk assessment. They recommend the addition of calcium and vitamin D. And in treatment, unlike other situations such as in the elderly patient, in patients taking glucocorticoids, postmenopausal women, and in men, where teriparatide followed by denosumab or bisphosphonates would be indicated as the first option . In cancer patients, the initial treatment would be with denosumab / zoledronate , if we suspect possible poor adherence to weekly bisphosphonates. It is suggested follow-up through the e-consultation. Conclusions: There is multidisciplinary agreement on the recommendations regarding diagnosis, calcium and vitamin D intake, and starting treatment with denosumab / zoledronate in the event of poor bisphosphonate adherence. There are still many areas where the care of patients with osteoporotic vertebral fractures can be improved.

  6852 - Impacts on pulmonary functions, physical mobility and performance of personal adls among patients with severe COVID-19 receiving inpatient post-COVID rehabilitation in Sabah Top

Fatimah Ahmedy1, Muhamad Faizal Zainudin2, Cha Mei Yee2, Alicia Dixie Abraham2, Mohd Razali Hasim Liasa2, Thor Ju An2, Jamie Joseph2, Syahiskandar Sybil Shah2

1Rehabilitation Medicine Unit, Faculty of Medicine Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia, 2Department of Rehabilitation Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia

E-mail: [email protected]

Background and Aims: COVID-19 negatively impact pulmonary functions, physical mobility and performance of personal ADLs (PADLs). The aim of the study was to evaluate impacts of severe COVID-19 presentation on pulmonary functions, physical mobility and performance of PADLs among patients receiving Inpatient Post-Covid Rehabilitation (IPCR) and compare these impacts based on the ventilatory requirement. Methods: Cross-sectional study among patients with COVID-19 Stage 4 and 5 receiving IPCR between October-December 2021 at Queen Elizabeth Hospital, Sabah. Outcomes include pulmonary functions, physical mobility and performance of PADLs. Results: Out of 97 patients, 27 and 70 were categorised as Stage 4 and 5 respectively. The mean age was 57 years with male:female ratio of 48:49. [Table 1] showed reduction across all outcomes in both stages with significant differences on ventilatory requirement (p-value <0.001) and Intensive Care Unit (ICU) length of stay (LOS) (p-value = 0.031). None with Stage 4 required ventilation. Comparison between ventilattory requirements [Table 2] demonstrated that non-ventilated patients performed better in pulmonary functions, physical mobility and PADLs performances (p<0.05). Conclusions: Severe Covid-19 reduced pulmonary functions, physical mobility and PADLs performances with longer ICU LOS and higher risk of intubation for Stage 5. Focused rehabilitation is warranted for ventilated patients to improve overall functions.
Table 1: Correlation coefficients for age, Japanese version of the Montreal Cognitive Assessment, and CogEvo domains (=r)

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Table 2: Comparison between nonventilated and ventilated patients with COVID-19 Stage 5 receiving ICPR on physical mobility and performance of activities of daily livings

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  6836 - Brachial plexopathy in cancer survivor patients: A descriptive study from a general university hospital Top

Emira Ortega-Magan, D. Susana Gil, Pilar Crespo

Hospital General Universitario Gregorio Marañon, Madrid, Spain

E-mail: [email protected]

Background and Aims: Brachial plexopathy is seen in cancer survivors, either because of radiation therapy or neoplasm. Both radiation-induced brachial plexopathy and tumor recurrence can coincide, and this requires an exactly clinical-radiological diagnosis to initiate an early and appropriate antineoplastic therapy to avoid debilitating symptoms. Despite several powerful analgesics and anticonvulsants, no medical treatments are effective against this plexopathy. Physical and occupational therapy focuses on helping patients maximize their strength and develop adaptive strategies. We report a case series. Methods: We analyzed data from a descriptive retrospective study of patients with cancer and brachial plexopathy seen in a General Hospital's Lymphedema Unit from 2007 to 2022. Results: Nineteen patients were enrolled. The characteristics of cancer and the features and plexopathy treatment were reviewed [Table 1]. The most relevant findings were the presence of plexopathy in women with breast cancer treated with surgery and, in the etiology, radiation-induced brachial plexopathy. Almost 90% of patients received rehabilitation therapy. Conclusions: The cancer survivors are susceptible to brachial plexus injuries. Cancer can cause nerve injuries by directly affecting tumors, metastasis, and treatment. Earlier understanding and diagnosis of these complications is essential before the lesions become progressive and irreversible.
Table 1: Branchial plexopathy in cancer survivor patients: A description study from a General University Hospital

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  6821 - Isokinetic profile of repetitive strain injury of shoulder Top

Nada Kyal, Hasnaa Boutalja, Sanaa Mdarbi, Fatima Lmidmani, Abdellatif El Fatimi

Department of Physical Medicine and Rehabilitation in CHU Ibn Rochd, Casablanca, Morocco

E-mail: [email protected]

Background and Aims: Isokinetic is a reference method for the assessment of muscle strength. It helps to establish a functional diagnosis by specifying the levels of disability of shoulders suffering from repetitive strain injury (RSI). The aim is to establish the isokinetic profile of RSI shoulders in comparison with a healthy population and evaluate the impact on the function and quality of life of patients. Methods: It's a prospective, descriptive and analytic study of 45 patients with shoulder Rotator Cuff Tendinopathy compared to 20 healthy subjects, recruited in the department of Physical Medicine and Rehabilitation in CHU Ibn Rochd in Casablanca. Both groups received clinical and paraclinical evaluation in addition to isokinetic evaluation. Results: The mean age was 34 +/- 4.4 years, with a female predominance (72%). The isokinetic evaluation found a significant difference in the muscle strength of medial and lateral rotators between the two groups evaluated as well as between left and right shoulders in patients with RSI. Conclusion: The deficit of strength of Shoulder muscles is a predictive factor of occurrence of tendinopathy of the rotator cuff leading to a serious impact on quality of life. Stretching and strengthening are important to treat RSI of shouders.

  6818 - Sexual dysfunction in multiple sclerosis: A taboo subject for Moroccan patients Top

Nada Kyal, Sanaa Mdarbi, Zaineb Tahri, Fatima Lmidmani, Abdellatif El Fatimi

Department of Physical Medicine and Rehabilitation, CHU Ibn Rochd, Casablanca, Morocco

E-mail: [email protected]

Background and Aims: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, that generates many deficits such as sexual dysfunctions. The aim of this study is to determine the prevalence of sexual dysfunctions and showcase the difficulties for Moroccan patients to talk about this issue. Methods: This is a prospective, descriptive and analytical study of patients suffering from MS followed in the department of Physical Medicine and Rehabilitation of CHU Ibn Rochd of Casablanca. To evaluate sexual dysfunctions, we used the International Index of Erectile Function (IIEF-5) for men and the Female Sexual Function Index (FSFI-6) for women. Results: 85 patients were recruited. The mean age was 39.4±9.8 years with a female predominance. The average duration of MS evolution was 7.2±4 years. Clinical forms were remittent in 60.3%, progressive remittent in 15.2% and progressive form in 24.5%. The prevalence of sexual dysfunctions estimated with the total of IIEF-5 was 100% for sexually active men, with FSFI-6 of 53.8% for women. It was less difficult to convince maried patients to talk about sexual dysfunctions than single ones. Conclusion: Sexual dysfunctions in MS were common in the sexually active population in Morocco. These dysfunctions were more likely to occur in men than in women.

  6817 - Osteonecrosis: A new pandemic Top

Luisa Pinto, Filipa Gouveia, Sónia Tomé, Joana Ramalho, Sofia Toste, Jorge Moreira, Catarina Aguiar Branco

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

E-mail: [email protected]

Introduction: SARS_CoV2 infection can affect different body systems and continue after the patient has recovered from COVID-19. This phenomenon is known as Long COVID-19. There are a few cases describing SARS_CoV2 infection as a potential risk factor(RF) for osteonecrosis(ON), but none yet in the shoulder joint. Patient Information and Clinical Findings: A 59-year-old male patient was diagnosed with COVID-19. He was admitted in intensive care with acute respiratory distress syndrome; CT reported a 40% lung involvement. During his hospitalization, he was administered intravenous methylprednisolone for 17 days (an equivalent to 1525mg of prednisolone). The patient progressed to oral prednisolone for 10 days (total 130mg). 6 weeks after the diagnosis, when he was an inpatient at the PMR service, the patient developed non-traumatic left shoulder pain. Radiograph and CT of the shoulder showed ON of the humeral head. Discussion and Conclusion: The patient received a total of 1655mg of prednisolone equivalent, which is less than the mean cumulative dose of around 2000mg steroid, documented in the literature as RF for the development of ON. It is also documented that the delay between the beginning of the corticosteroid treatment and the diagnosis of ON of the humeral head averaged 15 months (range, 6–24 months), which is longer than in our case. There are already a few reported cases of patients who developed ON after COVID-19 infection and did not receive corticotherapy. It is thought that COVID-19 may itself be a RF for ON. Hypercoagulability and bone resorption mechanisms induced through ACE-2 receptor were pointed as possible causes. Several RF may contribute to precipitating ON in patients with Long COVID-19, with SARS-CoV2-related mechanisms being one of them. ON should be a differential diagnosis of shoulder pain in these patients.

  6576 - Results of early rehabilitation of patients after SARS COV-2 infection Top

Biljana Kalchovska, Marija Gocevska, Maja Manoleva, Cvetanka Gerakaroska Savevska, Valentina Koevska, Biljana Mitrevska, Erieta Nikolik-Dimitrova

PHI UC for Physical Medicine and Rehabilitation, Medical Faculty, “Ss. Ciryl and Methodius” University, Skopje, North Macedonia

E-mail: [email protected]

Background and Aims: Countries all across the world are in various stages of the pandemic with many countries now entering the “day after” COVID-19 phase. Many people who have suffered from the effects of this disease might now be at risk of long-term impairment and disability. The extent of this impairment and disability is yet unknown, but it is clear from early research that these patients need a rehabilitation in all phases of the disease - acute, post-acute and long-term. The aim of this study is to present our results of rehabilitation of post-acute COVID-19 patients. Methods and Results: Our study included a total of 50 patients (35 men and 15 women) after COVID-19 infections, most of them still oxygen dependent from 2 to 5 liters, with impaired lung ventilation function, reduced exercise tolerance and muscular weakness. Respiratory exercises, active exercises for the upper and lower extremities, walking exercises were applied to the patients. The evaluation was done with the Barthel index and the Borg scale at the beginning and at the end of the rehabilitation treatment. Conclusions: It was reached objectively improving of the functional independence and also in the physical activity intensity level at the patients.

  6741 - Secondary health conditions and mental status in persons with long-term spinal cord injury in South Africa: Comparison between public and private sectors Top

Conran Joseph1, Charlotte Thurston2, Eugene Nizeyimana3, Ernst Scriba4, David Moulaee Conradsson2, Anthea Rhoda5

1Department of Health and Rehabilitation Sciences, Stellenbosch University, Francie Van Zijl Drive, Cape Town, South Africa, 2Karolinska Institutet, Stockholm, Sweden, 3Stellenbosch University, Stellenbosch, South Africa, 4Spescare Hospital, Cape Town, South Africa, 5University of the Western Cape, Bellville, South Africa

E-mail: [email protected]

Background and Aims: Secondary health conditions, including mental problems, are common after a spinal cord injury (SCI), while access to quality SCI care is not freely available to all citizens of South Africa. This study set out to determine the prevalence and treatment rates of secondary health conditions (SHCs) and mental health states in persons with long-term SCI receiving public compared to private healthcare services. Methods: A cross-sectional, cohort study was employed for the study purpose. A cross-sectional survey, including 200 community-dwellings persons with long-term SCI; 156 from public and 44 from private health sectors. The following modules of the International Spinal Cord Injury (InSCI) community survey were used: I) demographic and injury characteristics; II) SHCs and treatment rates and III) vitality and emotional wellbeing. All statistical analyses were stratified according to healthcare sector. Results: Pain, sexual dysfunction and muscle spasms were the most common SHCs in both cohorts, and the period-prevalence was significantly higher for sleeping problems (41% vs. 25%) and contractures (42% vs. 20%) in the public compared to private cohort. Persons with SCI in the private cohort were treated more often for sleeping problems (100% vs 45%), autonomic dysreflexia (75% vs. 27%) and pain (56% vs. 33%) than their counterparts with public insurance. Negative mental health states were prevalent in both groups. Conclusion: SHCs and negative mental health states were common in persons with SCI in South Africa, whereas those receiving public care reported a higher occurrence of sleep problems and contractures, as well as lower treatment rates. Overall, a need exists to better support persons with SCI in the long-term context to facilitate improved functioning and wellbeing.

  6738 - Questionnaire validation study in patients with post-COVID condition according to ICF Top

Konstantina Petropoulou1, Maria Micha2, Athanassios Tsivgoulis3, Filomeni Armakola4, Eirini Mouza5, Panoraia Mitsostergiou6, Ioannis Iliakis6, Maria-Eleni Manola6, Xanthi Michail7

1National Rehabilitation Center, Athens, Greece, 2Department of PRM, University Hospital “Attikon,” Athens, Greece, 3PRM Private Center “Animus”, Thessalia, Greece, 4Department of Pediatric Rehabilitation, Pediatric Hospital “Aglaia Kyriakou”, Athens, Greece, 5PRM Private Center “Anagennissi,” Thessaloniki, Greece, 6Department of 2nd PRM, National Rehabilitation Center, Athens, Greece, 7Honorary President of Hellenic PRM Society

E-mail: [email protected]

Background and Aims: The effect of COVID-19 on the morbidity of the Greek population , recording the symptoms that persist or appear after COVID-19 disease, and the impact on activities of daily living and social and professional reintegration according to the ICF. Methods: Multicenter study with hospitalized patients in a Rehabilitation center. Sample consisted of 90 patients (58.9% males), with mean age 61.1 years (SD = 15.1 years). Most patients thought as good their health before symptoms start, with the percentage being 34.4%. Median time from symptom start to diagnosis was 2 days (IQR: 0-3 days). Moreover, 76 patients (84.4%) were hospitalized and specifically 52.2% were hospitalized in ICU. Median hospitalization duration was 30 days (17.5-44 days). The majority of the patients went to a specialized doctor (64.4%) during the infection. Results: [Table 1]. Post COVID symptoms. Conclusions: Patients hospitalized in ICU had significantly worse functionality than patients who were not hospitalized (p=0.002). After Bonferroni correction it was found that patients with Good/Very good health had significantly better functionality than patients with Very poor/Poor health (P = 0.013). Also, significantly better Comprehension/Communication had patients with Good/Very good health in comparison to patients with moderate health (P = 0.004).
Table 1: Information for patient's activity/functionality

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  6510 - Rumination syndrome: The role of physical medicine and rehabilitation Top

Sara Afonso, Raquel Figueiral

Centro Hospitalar Universitário do Porto, Porto, Portugal

E-mail: saracaldas[email protected]

Background and Aims: Rumination syndrome (RS) is a functional gastrointestinal disorder characterized by the post-prandial repeated regurgitation of food into the oral cavity. An unperceived post-prandial contraction of the abdominal wall could be a key mechanism. Our aim was to identify which is the appropriate treatment plan for patients with the diagnosis of RS seen in the clinical practice by PMR. Methods: A literature review was conducted using electronic databases. We used the following keywords: RS, treatment, rehabilitation. Results: 16 articles were retrieved, from which 9 articles were selected on the basis of applicability. 2 RCT, comparing placebo vs baclofen and placebo vs biofeedback (BF) therapy, both demonstrating effectiveness in the reduction of regurgitation episodes when compared to placebo. The other were review articles, in which all concluded that the most studied and effective therapy for RS is diaphragmatic breathing. It is also added that diaphragmatic breathing can be taught with or without BF, but it is usually taught without it, due to the practicality and easiness to apply in any consultation. Pharmacological and surgical treatment could be an option if failure of conservative measures, but rarely used, especially surgery. Conclusion: The use of pharmacological and surgical therapies have very little role in the management of rumination syndrome, and behavioral therapy, via diaphragmatic breathing is the most used form of therapy. However, the current studies are limited by small sample size, significant variability in therapeutic regimens, and short duration of follow-up, leading to the necessity of further studies to determine the ideal method and duration of therapeutic delivery. In the meanwhile, authors conclude that long term DB can be continued due to its benign nature.

  6502 - Post-COVID clinical care Top

David Burke1, Regina Bell1, Melanie Harris2

1Department of Rehabilitaiton Medicine, Emory University School of Medicine, Georgia, USA, 2Emory University, Atlanta, Georgia, USA

E-mail: [email protected]

While most patients diagnosed with COVID-19 recover within a few weeks, some have persistent symptoms, labelled long COVID. The rehabilitation needs of these patients are just now emerging. Our Rehabilitation Department has established a coordination between the medical clinics and the outpatients therapy clinics to address the needs of patients hospitalized with COVID-19. This paper reports on the comorbidities, demographics and progression of patients seen in our clinics. During the period January 2021 thru August 2021 our clinics treat 139 patients with an average age of 56 years, of whom 55% were male and 45% female. By race 55.4% were African American, 34% were White and 3.6% were Hispanic. The primary diagnosis for which they had been hospitalized was stroke (46%), Stroke (23%), Neuro Conditions (13.7%). The length of treatment, functional and subjective gains were recorded and assessed by comorbidity, age, gender and primary diagnosis at hospitalization.

  6475 - The effect of comprehensive rehabilitation on quality of life and functionality in post-COVID-19 syndrome: Preliminary results Top

Bilge Kesikburun, Pinar Borman, Elif Esen Ozdemir, Ayse Merve Ata, Elif Becenen, Nurdan Metin, Ebru Alemdaroglu

Department of PMR, City Hospital Bilkent, Ankara, Turkey

E-mail: [email protected]

Background and Aims: The post-COVID-19 syndrome, also called prolonged COVID-19, describes a pathological process that includes persistent physical, medical, and cognitive sequelae following COVID-19.Pathological fibrosis of organs and vessels causes increased mortality and severe deterioration in quality of life. The comprehensive rehabilitation programs is needed to accelerate the return of patients to social life, to reduce sequelae, to regain lost function, to increase quality of life and to remove obstacles. Therefore, we aimed to investigate the effect of a comprehensive rehabilitation program on quality of life, anxiety, fatigue and functional status in post-COVID-19 patients. Methods: A total of 12 post-COVID-19 patients participated in the study. Functional status, dyspnea levels, mobility, fatigue, quality of life, activities of daily living (ADL), anxiety and depression levels and oxygen (O2) requirement were assessed before and after rehabilitation. Results: 11 patients (61.1%) were pulmonary involvement, 2 patients (11.1%) serebrovascular disease, 4 patients (22.2%) myopathy, 1 patients (5.5%) polyneuropathy. The mean age was 55.5 (43-83) years. Mean of length of hospital stay was 28 (19-40) days at outpatients postcovid clinic. After rehabilitation, quality of life (p = 0.038), anxiety (P = 0.002) and depression level (p = 0.002), fatigue (p =0.003), dispne level (p=0.002) and functional status (p = 0.003) significantly improved in post-COVID-19 patients. Conclusions: It is clear that most of patients discharged from hospital and intensive care require rehabilitation program recovering from COVID-19.While preliminary, comprehensive rehabilitation care for COVID-19 survivors significantly affect on quality of life, fatigue anxiety, depression and functional level.

  6328 - Presbyphagia to dysphagia in older patients: A narrative review Top

Alexandra Isabel Paredes Coelho1, João Nuno Malta2, Lurdes Rovisco Branquinho2, Carla Hovenkamp2, João Faria2, Joana Santos Costa2

1Centro Hospitalar e Universitário Coimbra, Serviço de Medicina Física e de Reabilitação, Coimbra, Portugal, 2Centro Hospitalar e Universitário de Coimbra, Portugal

E-mail: [email protected]

Background and Aims: Aging is accompanied by multiple changes which may affect swallowing. The onset of these changes, called presbyphagia, still implies a preserved swallowing function, however impaired by the consequences of the physiological aging process. Dysphagia is an impairment of swallowing safety and/or swallowing efficiency. It is necessary to distinguish between them to avoid over-diagnosing and over-treating presbyphagia. The main goals were to understand how early recognize and distinguish presbyphagia from dysphagia. Methods: The authors conduct a narrative literature review to find articles studying swallowing disorders in older patients. Results: Presbyphagia is usually asymptomatic and results from oropharyngeal, esophageal, and sensory function changes, that occur in the normal aging process. Presbyphagia is not a disease in itself but contributes to diminished functional reserve, making older adults more susceptible to dysphagia. Evidence suggests that the secondary effects of the disease are necessary to disrupt normal swallowing in older individuals. Dysphagia cannot be attributed to normal aging alone, and its presence suggests the need for further investigation. Overmanaging older adults with presbyphagia could lead to unnecessary restrictions on nutritional intake and quality of life. Likewise, undermanagement dysphagia could lead to consequences, such as aspiration, dehydration, and malnutrition. Conclusions: Presbyphagia is the progression of changes that contribute to swallowing alterations in healthy older adults, and it may progress resulting in a continuous course from presbyphagia to dysphagia. Further prospective studies should be carried out with a significant number of subjects, across the subjects' life span, to recognize the progression from presbyphagia to dysphagia earlier.

  6316 - Fatigue and quality of life in cancer patients with breast cancer during the pandemic Top

Anita Demenyi1, Evren Atabas2

1Top-Life Gesundheitszentrum Benz KG, Berghaupten, Germany, 2Oncology Sportscenter, Bonn, Germany

E-mail: [email protected]

Background and Aims: Breast cancer is the most commonly diagnosed neoplastic disease in menopausal women. The aim of this study was to use validated questionnaires to examine the aspect of fatigue and its influence on the life satisfaction of patients with breast cancer in comparison to healthy control group during a pandemic. Methods: A total of 83 patients were recruited. 32 patients were randomised into the breast cancer group, 16 patients to the breast cancer / pre-coronary disease and 35 to control. In order to evaluate the influence of fatigue symptoms on quality of life, the subjects were given four validated questionnaires (2 questionnaires to record fatigue and 2 questionnaires to record quality of life). Results: Average age were 6312±11,514 (cancer), 6325±5,106 (cancer-precorona) and 6251±10,942 (healthy control). Breast cancer and breast cancer with a pre-existing corona disease (n=48), showed no significant difference in fatiguescores compared to the healthy control group. There was a moderate/linear correlation with a decrease in energy with an increase in fatigue. In terms of life quality, only the breast cancer group with a coronavirus disease was able to differ significantly from the healthy control group. Individual items of quality of life (global health status and symptom scale) showed not a significant difference in both groups from the healthy control group. Conclusion: All three groups did not differ significantly from one another in many areas of fatigue, quality of life and life satisfaction during a pandemic, but the reference value shows a restriction in the quality of life in all patients.

  6284 - COVID-19-induced limb ischemia: A report of two cases Top

Marwan Taher, Jaber Al Daod

Ministry of Health, Amman, Jordan

E-mail: [email protected]

Case 1: A 54-year-old male patient, known to have Diabetes mellitus for the last 11 years on oral medications, admitted to isolation after developing respiratory symptoms associated with fever. He tested positive for COVID-19. On day 5 evidence of right lower limb ischemia was established, trans-femoral amputation was done next day, but on day 7 the patient passed away. Rehabilitation was consulted on day 5 and follow-up on day 6. Case 2: A 34-year-old male patient, previously healthy, admitted to isolation for developing respiratory symptoms and testing positive for COVID-19. On day 4 evidence of right lower limb ischemia was established, amputation was performed in tans-femoral approach on day 5. Rehabilitation was consulted on day 4, follow-up regularly, after discharge, the patient was followed-up for prosthesis fitting, an above-knee prosthesis was prescribed. During training and post-fitting the patient was noticed to have respiratory deconditioning, to which rehabilitation interventions were also provided. Significant improvement was noticed since week 7 post discharge.

  6263 - What to do if a lower limb amputee has symptomatic heterotopic ossification (HO) Top

Adriana Pascoal1, Carolina Lourenço1, António Paiva1, Sérgio Pinho2, João Constantino1, Jorge Lains1

1CMRRC - Rovisco Pais, Tocha, Portugal, 2Department of Physical and Rehabilitation Medicin, Hospital Garcia de Orta, Almada, Portugal

E-mail: [email protected]

Background and Aims: HO affect almost 1 in 4 individuals with lower limb amputation and has been associated with poorly fitting prostheses and postamputation pain. The aim of this study is to review the information about treatment of HO on lower limb amputees. Methods: Narrative literature review of the studies evaluating the management of lower limb amputees with HO. It was performed through an electronic search using PUBMED/Medline/Cochrane with the keywords “Lower Limb Amputation” AND “Heterotopic Ossification” or respective MESH terms. Studies about treatment of humans with lower limb amputation and HO were defined as inclusion criteria. Results: The literature search yielded 36 results. After applying the inclusion criteria, 2 retrospective studies, 2 case reports, 2 comparative studies and 1 revision study were selected. Mentioned conservative treatments for symptomatic HO include activity modification, bisphosphonates, nonsteroidal anti-inflammatory drugs, and prosthetic modification (addition of liners, selective padding, hard socket modifications). Approximately 10% of amputees with OH undergone surgical resection of the HO. In one retrospective study, if the initial conservative measures failed, patients often undertook 3D computed tomographic modeling of the residual limb while wearing the socket, providing information regarding the proximity of the symptomatic regions of OH with loadbearing areas that could be changed. In fact, only 6.7% were associated with the need for surgery. Conclusions: Prosthetic socket production, considering the location of the HO, seems to be relevant for therapeutic success. Yet, proper management for these patients has yet to be established with more studies.

  6233 - Relationship between forward and backward digit span and token test performance: Preliminary findings from a right hemisphere stroke patients Top

Benedetta Basagni, Silvia Pancani, Leonardo Pellicciari, Paola Gemignani, Emilia Salvadori, Sara Marignani, Antonello Grippo, Bahia Hakiki, Maria Pia Viggiano, Fabio Giovannelli, Claudio Macchi, Francesca Cecchi

Fondazione Don Gnocchi, Milan, Italy

E-mail: [email protected]

Background and Aims: The Token Test is one of the most used tests to examine comprehension disorders in aphasic patients. Nevertheless, given the increasing complexity and length of the commands of the test, abilities other than language may affect the patient's performance. This study aimed to explore the correlation between verbal short-term memory and working memory, and the Token Test subtest performance, using a sample of right-hemisphere stroke patients without aphasia. Methods: Forty-one patients with a first-right-hemisphere stroke at admission were consecutively enrolled from four intensive rehabilitation units of Fondazione Don Carlo Gnocchi. The Token Test (in the widespread version for aphasia composed of five parts), and forward and backward digit span were administered. Spearman correlation was used to assess the association between the number of errors made on the Token Test, and forward and backward digit span. Results: Some of the patients made mistakes in the Token Test (32%: 3 to 11 mistakes, 29%: more than 11 mistakes), mostly concentrated in parts IV and V. Both forward and backward digit span scores showed a weak to moderate correlation with errors recorded in parts II to V of Token Test (p<0.05), but not between part II and forward digit span (r = -0.307; p=0.051) and part IV and backward digit span (r=-0.308; p=0.050). Conclusions: These findings show a moderate correlation between auditory verbal span/auditory working memory and Token Test scores on subparts from II to V, in patients with right brain lesion and without aphasia.

  6149 - 'The road to recovery': Setting up an integrated long-covid assessment and rehabilitation service in the UK Top

Ahmad Saif1, Emily Fraser2, Anton Pick3

1Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom, 2Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom, 3Oxford Centre for Enablement, Oxford University Hospitals NHS Foundation Trust, UK

E-mail: [email protected]

Background and Aims: Post-COVID syndrome or “Long-COVID” is a complex, multi-system condition that can result in prolonged disability. Sufferers require a holistic service that integrates medical expertise, diagnostic investigations and rehabilitation. The current study lays out a data-driven service development approach taken to meet the needs of this patient population. Methods: A dual-centre retrospective audit was carried out of all patients seen within a respiratory clinic with ongoing symptoms more than 12 weeks after their initial illness. Data on demographics, symptoms, investigations, occupation and impact on employment was collected. A working group was then established to design and deliver a service able to address the medical and rehabilitative needs of Long-COVID sufferers. Results: 100 patient records were studied, analysing both symptom presentation and disease impact. Symptoms were wide-ranging, most commonly fatigue (81%) and breathlessness (78%). 25% of patients had been unable to return to work and 33% remained on reduced duties. The working group created 2 service pathways based on level of complexity and disability. The Assessment Pathway was led by respiratory and rehabilitation physicians with support from sports medicine, psychiatry, psychology, physiotherapy, and access to specialty expertise as needed. The Multidisciplinary Rehabilitation Pathway included rehabilitation medicine, physiotherapists, occupational and vocational therapists, and psychologists. Conclusion: This integrated approach provided a streamlined pathway for Long-Covid sufferers offering both assessment and individualised biopsychosocial rehabilitation. This iterative, multidisciplinary service development approach is applicable to existing and emerging complex disease presentations.

  6124 - The impact of prehabilitation on morbi-mortality after cephalic duodenopancreatectomy (CPD) - A comparative study Top

Elmir Siham1, Ahmed Amine El Oumri2

1Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Pharmacy, Immunohematology/Cellular Therapy Laboratory Adults and Children (LIHTC), University Mohammed First Oujda, Oujda, Morocco, 2Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Pharmacy, LIHTC, University Mohammed First Oujda, Oujda, Morocco

E-mail: [email protected]

Background and Aims: Cephalic duodenopancreatectomy (CPD) is a major and very heavy procedure in bowel surgery. It is a very heavy and major surgery. In this work, we will analyze the cases of patients who have benefited from a preoperative pre-operative habilitation program before CPD surgery, for 3 weeks. The aim was to study the postoperative morbi-mortality by comparing it with patients without a prior rehabilitation program. Methods: This is a descriptive analytical cross-sectional study of 35 cases, divided into 2 groups (G1,G2) : with and without pre-operative habilitation program. Results: The mean age of patients in G1 was 58.6 years versus 54 years in G2. The sex ratio of men to women was 2.3 versus 2.The etiologies were dominated by pancreatic head cancer. Preoperative evaluation revealed a mean BMI of 16 kg/m2 in G1 versus 22kg/m2. Perioperatively, 3 patients in G1 presented hemorrhagic shock with a favorable outcome. Postoperatively, the preoperative habilitation group had significantly lower rates of pulmonary and cardiac complications with earlier restoration of functional status and shorter hospital stay. While the impact of preoperative habilitation on postoperative mortality and surgical site infection in our study was not significantly associated with lower rates. Conclusion: Preoperative pre-habilitation seems likely to improve postoperative follow-up, it reduces surgical complications and accelerates functional recovery. Preoperative habilitation programs have been implemented to optimize both the physical and psychological well-being of patients before elective surgery.

  6118 - Quality of life in post-COVID 19 patients that required critical care in Cartagena Top

María José Llópez García1, David Jiménez Medina2, Amina Dzenanovic Arnautovic2, Sofía Amorós Rivera2, Jesús Campos Albert2, Francisco Pérez Fernández2, María Magdalena Albaladejo Vergara2, David Roca Manzanares2

1Department of Rehabilitation, Hospital General Universitario Santa Lucía, Cartagena, Spain, 2Hospital General Universitario, Cartagena, Spain

E-mail: [email protected]

Background and Aims: The emergence of COVID-19 pandemic has been a global challenge. This infection is associated with bilateral pneumonia that can lead to respiratory failure. The purpose of this study is to evaluate the quality of life after SARS-CoV-2. Methods: A cross-sectional descriptive study was designed and approved by the hospital's ethics committee. Inclusion criteria: patients who had been admitted to the ICU between March 2020 and January 2021 due to SARS-CoV-2 and who had been assessed by the Rehabilitation consultant during the hospitalization. A survey was designed and was used along with the SF36 health survey questionnaire. Results: A total of 50 patients were included (64% men), with a median age of 58 years. 48% required high-flow oxygen and 52% invasive mechanical ventilation. The average length of stay in the ICU was 17 days. The mean result for the SF-36 was 32%, 12% considered that their health remain the same that the previous year, while the rest reported some degree of worsening. The sections of climbing stairs and sleep disorders were the most affected. On the survey the patients highlighted the positive impact of the attentions received from the health care workers. All patients required rehabilitation during the hospitalization and 38% required ambulatory rehabilitation. A statistically significant and inverse relationship was found between the two questionnaires. Conclusions: The prolonged hospitalization affects muscle strength, causing limitations in daily life activities such as climbing stairs. The isolation seems to be associated with emotional and sleep disturbances. Generic quality of life scales such as SF 36 address part of these limitations, but, due to the clinical peculiarities of COVID-19, it would be desirable to have specific questionnaires for a better assessment of this pathology.

  6020 - Is there a need for physical and rehabilitation medicine for pelvic floor dysfunction in transgender patients? Top

Mafalda Cunha, Bruna Melo, Vitor Sousa, Marco Silva, Maria João Azevedo, Bárbara Moreira da Cruz

Department of Physical and Rehabilitation Medicine, Hospital Senhora da Oliveira, Guimarães, Portugal

E-mail: [email protected]

Background and Aims: Treating transgender patients requires knowledge regarding their body changes spectrum. Vaginoplasty is a gender-affirming surgery that requires specific postoperative care. The aim of this study is to review the current evidence of management of pelvic pain, pelvic floor dysfunction (PFD) and postoperative vaginoplasty care. Methods: A narrative review of all literature published in major medical databases until November 2021 was performed. Results: Pelvic pain in transgender male can be provoked by atrophic vaginitis, infection, ovarian torsion, pregnancy, trauma, PFD, neurogenic pain and musculoskeletal changes. Some of them can be caused by testosterone treatment or hypoestroenic state. Commonly transgender females perform tucking, a technique to hide male sexual characters. This can result in mechanical or neuropathic pain, urinary reflux, prostatism or lower urinary tract infection. The pain´s treatment is dictated by the ethiology. Gender-affirming vaginoplasty requires a dissection through pelvic floor muscles, which can affect rectal and urinary function. In the preoperative, patients must be refered to a PMR specialist to rule out and treat bowel or PFD, whose incidence is 37% and 42%, respectively. In the postoperative, patients must undertake a multi-modal intervention with educative measures, pelvic floor rehabilitation, neuromuscular reeducation, exercises, stretches and other modalities if needed. As with any pain syndrome, patients should be evaluated for depression and post-traumatic stress disorder. Conclusion: Since PMR manage PFD, pain, bowel and bladder disorders and address sexual function, it seems important that specialists have an adequate knowledge of the physical and physiological changes of transgender patients, as well as of the possible therapeutic modalities that PRM has to offer.

  6008 - An unusual complication of extracorporeal shockwave therapy: Case report Top

Madjer Hatia, Sergio Pinho, Jorge Barbosa, Duarte Calado, Frederico Moeda, Eduardo Gonçalves

Department of Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal

E-mail: [email protected]

Extracorporeal shockwave therapy (ESWT) has been widely used in the treatment of various musculoskeletal disorders with remarkable efficacy, with no relevant severe complications being reported. The most frequently reported side-effects are transitory skin redness, swelling, and subcutaneous ecchymosis that can recover spontaneously. In this study, we report a rare case of a skin reaction following ESWT. It has been previously reported once an acute irritant contact dermatitis following ESWT with serious skin damage. A 65 year old male with a relevant history of atopic eczema and ocasional episodes of acute urticaria associated with papules and pruritus with no clear trigger. He was diagnosed with calcific tendinitis of the rotator cuff on the right shoulder and was proposed to undergo 4 sessions of ESWT. The first session of ESWT (0.3 mJ/mm2, 5 Hz, and a total of 2,000 impulses) with use of coupling gel, underwent without complications. However, on the second day after the treatment, the patient presented with papules, macules and erythema, without ictching or pain, on the local skin of the right shoulder. Based on these manifestations the patient was treated with an oral antihistamine combined with topical corticoesteroid. This episode might have been a irritant contact dermatitis due to a strong physical stimulation of ESWT or an acute urticaria, possibly vibratory, precipitated by ESWT. Either way, everything points to a complication following ESWT. This case report shows us that there are potencial complications of ESWT that are not well established and we should be aware of them. The physicians should be more aware of such complications in the future and further studies regarding ESWT side-effects are needed.

  5969 - Prediction of response to therapy with cross-sectional area measured by lower-limb computed tomography in patients with gynecologic cancer-related lower limb lymphedema Top

Wonsik Moon, Hyejoon Ahn, Jaeyong Jeon

Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

E-mail: [email protected]

Background and Aims: To determine whether cross-sectional areas (CSA) of subcutaneous fat and muscle of the lower limb measured by computed tomography (CT) can be predictive factors for response to complex decongestive therapy (CDT) in patients with gynecologic cancer-related lower limb lymphedema (LLE). Methods: This retrospective observational study enrolled patients with unilateral gynecologic cancer-related LLE who underwent lower limb CT prior to initiation of a 2-week course of CDT. We correlated CSA of subcutaneous fat and muscle at mid-femur and mid-tibia levels with change in circumference after therapy at the level with the highest degree of lymphedema. And correlation between extracellular fluid (ECF)/total body water (TBW) ratio (affected limb : unaffected limb) and change in circumference was determined in patients who underwent bioimpedance analysis (BIA) before CDT. Results: A total of 35 patients were enrolled in this study. A larger subcutaneous fat CSA at mid-femur (r = 0.462, p=0.006) and mid-tibia (r=0.340, p=0.049) levels of affected limb, as well as a larger difference in CSA of subcutaneous fat of affected and unaffected limbs at mid-femur (r = 0.441, p=0.008) and mid-tibia(r = 0.358, p-0.035), significantly correlated with a greater reduction in limb circumference after CDT. On the other hand, there was no significant correlation between muscle CSA and change in limb circumference. In 24 patients who underwent BIA, a higher ECF/TBW ratio (affected limb : unaffected limb) was shown to correlate with a greater reduction in limb circumference after CDT (r = 0.485, p=0.001). Conclusion: This study shows that subcutaneous fat CSA of affected limb and difference in subcutaneous fat CSA of affected and unaffected limbs at mid-femur and mid-tibia levels as well as ECF/TBW ratio are useful tools for predicting the response to CDT.

  5831 - Bone–patellar tendon–bone and hamstring tendon grafts complications after ligamentoplasty of the anterior cruciate ligament Top

Omaima Jelassi, Sofien Benzarti, Wafa Ajlani, Mohamed Amine Triki, Mohamed Laaziz Ben Ayache

Sahloul Hospital, Sousse, Tunisia

E-mail: [email protected]

Background and Aims: Ligamentoplasty of the anterior cruciate ligament (ACL) has been associated with several complications. Their identification and management are crucial, as they could hinder functional status and patient's quality of life. Our study aimed to analyze these complications after primary ACL reconstruction using two type of grafts. Materials and Methods: We conducted a retrospective study of 320 patients over a period of nine years. Our patients had an isolated ACL injury. They were divided into two groups according to the type of ACL reconstruction: bone–patellar tendon–bone (BPTB) or hamstring tendon (HT) graft. Data collected included pre- and post-operative clinical and radiological findings, and intra-operative findings. The Lysholm score and International Knee Documentation Committee (IKDC) evaluation system were used for pre- and post-operative assessment. Results: The mean follow-up was 12 months. We observed statistically significant improvement after surgery in each group, as assessed by IKDC and Lysholm scores. There was no statistically significant difference between Lysholm and IKDC scores of two groups. The intraoperative incidents were observed in both groups, in relation to graft harvesting (n=3), tunnel placement (n=3), and graft fixation (n=4). Postoperative complications included infections (four cases in BPTB group), anterior knee pain only in BPTB group, stiffness (n=85), residual laxity (n=11), thromboembolic complications (n=1), Cyclops syndrome (n=1), calcification of the patellar tendon (n=2), and bone tunnel enlargement (n=5). Conclusion: Anterior knee pain was higher in BTPB group, while HT graft technique is more likely to expose to graft harvesting incidents leading to conversion of the technique.

  5854 - Prevalence of mechanical pain among resident doctors at the Ibn Rochd University Hospital in Casablanca Top

Hasnaa Boutalja, Sanaa Mdarbi, Fatima Lmidmani, Abdellatif El Fatimi

Department of PMR, University Hospital Ibn Rochd of Casablanca, Casablanca, Morocco

E-mail: [email protected]

Introduction: Mechanical pain is a major health problem in the workplace. In addition, resident doctors are in the heart of the health care system in Morocco, and are subjected to various types of stress during training, which can have adverse effects on their physical and mental health, affecting the quality of care provided to patients. The objective of our study was to describe the prevalence of mechanical pain and the associated factors among resident physicians at the Ibn Rochd University Hospital in Casablanca. Methods: We conducted a cross-sectional study with resident physicians in medical and surgical specialties from the first to the fifth year of residency, practicing at the Ibn Rochd University Hospital in Casablanca during 6 months (from October 2020 to March 2021) The main variables studied were related to mechanical pain and rating scales (VAS and Saint Antoine), workload, type of specialty, body mass index, physical activity, toxic habits as well as the consequences of mechanical pain. Data were collected through an electronic self-questionnaire. Results: The prevalence of mechanical pain was 57.7% 95% CI [52% -63.1%], it was predominant in the lumbar spine (44.3%), cervical spine (38.7%) and shoulder (37.7%). The main variable statically associated with mechanical pain was anxiety-depressive state (p <0.001), then residency specialty (p = 0.006), body mass index (p = 0.017) and age (p = 0.023). Conclusion: This survey allowed us to clarify a set of risk factors harmful to the health of medical residents.

  5822 - Retrospective study regarding clinical monitoring after rehabilitation treatment in balneal sector for post COVID-19 sequelae: Our experience Top

Madalina Iliescu1, Liliana-Elena Stanciu1, Carmen Oprea1, Doinita Oprea1, Alexandra-Ecaterina Ciota1, Elena-Roxana Tucmeanu2, Elena-Valentina Ionescu1

1Department of Rehabilitation, Faculty of Medicine, Ovidius University of Constanta, Romania, 2Balneal Sanatorium, Techirghiol, Romania

E-mail: [email protected]

Background and Aims: The Techirghiol Balneal Rehabilitation Hospital from Romania, the most large balneal unit from our country, developed a special compartment dedicated to the rehabilitation for post Covid 19 patients, in which the natural aerosolization specific to Techirghiol Lake area is associated with conventional therapies. Methods: Patients are specifically monitored and evaluated, at admission and discharge, using: functional assessment, ADLs, degree of dependence, cognitive assessment, exercise tolerance, respiratory parameters, as well as data related to coagulation profile and previous treatments. We did a retrospective study during 12 months, and the data obtained were centralized and statistically analyzed. Results: State-of-the-art research suggests that integrated medical rehabilitation services with the care of patients with sequelae of SARS CoV-2 infection offer benefits for both the patient and the medical system in general. Conclusions: Studies on post-COVID-19 medical rehabilitation services are preliminary, the pandemic generated by COVID-19 being a complex situation, little known for health systems. At the same time, numerous clinical trials offer recommendations on interventions and principles for organizing rehabilitation care for this category of patients. In conclusion, we can thus make a portrait of these patients, and perfect the therapeutic approach, contributing with clear and specific data to research conducted worldwide.

  5775 - Predictive factors for the home discharge of rehabilitation patients with cancer bone metastasis Top

Ryosuke Ikeguchi, Manabu Nankaku, Rie Yamawaki, Hiroki Tanaka, Ryota Hamada, Takumi Kawano, Masanobu Murao, Takashi Noguchi, Maki Ando, Koichi Yoshimoto, Daichi Sakamoto, Shinichi Kuriyama, Akio Sakamoto, Shuichi Matsuda

Kyoto University, Kyoto, Japan

E-mail: [email protected]

Background and Aims: The purpose of this study is to investigate the predictive factors for the home discharge of cancer patients with bone metastasis. Methods: Cancer patients with bone metastasis who underwent rehabilitation were retrospectively enrolled. Data on discharge destination were collected from medical records as outcomes. Multiple regression analyses were carried out to investigate the predictive factors of home discharge. Results: Ninety-eight patients were included in this study. 50 patients were discharged home, 38 patients were discharged to other facilities, and 10 patients died. There were no skeletal-related events. The receiver-operating curve for the predictive factors for home discharge of Barthel Index at admission and Performance status at admission were 60 points (AUC = 0.74, sensitivity = 0.6400, 1-specificity = 0.2766) and 2 score (AUC = 0.65, sensitivity = 0.5400, 1-specificity = 0.2222). Conclusions: The home discharge of cancer patients with bone metastasis depends on the patients' level of activities of daily living at the time of hospital admission.

  5699 - Impact of adjuvant endocrine therapy on sleep in premenopausal breast cancer patients: Observational study over 12 months Top

Seung Mi Yeo1, Ji Hye Hwang1, Chea Min Hwang1, Jonghan Yu2, Jai Min Ryu2

1Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Seoul, Republic of Korea, 2Department of Surgery, Division of Breast, Samsung Medical Center, Seoul, Republic of Korea

E-mail: [email protected]

Background and Aims: We aimed to exam patterns of sleep and quality of life (QoL) associated with the adjuvant endocrine therapy (ET) for premenopausal breast cancer (BC). Methods: This was an observational study of 22 patients with BC in premenopausal women. Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Scale (PSQI), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) and total sleep time/sleep efficiency measured by actigraphy obtained at enrollment (T1, after surgery, prior to ET), 2 months (T2), 5 months (T3), 8 months (T4) and 11 months (T5) later. ISI and PSQI data of T0 were also obtained by recalling the state before BC treatment. Results: Fourteen patients received tamoxifen plus ovarian function suppression by drug (T+OFS) and 8 patients received tamoxifen alone (T). There were no significant differences in baseline data. [Table 1] In contrast to the T group, insomnia and hot flush significantly worsened in the T+OFS group in T2. Total sleep time showed a significant difference in T3 between the two groups, but there were no differences according to time or between groups in sleep efficiency, sleep quality, and QoL. Conclusions: When the OFS was added to tamoxifen for BC treatment, hot flush and insomnia occurred more at the beginning of ET.
Figure 1: Longitudinal changes of parameter about sleep hot flush severity and quality of life

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Table 1: Baseline characteristics and baseline values for sleep quality, quality of life

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  5653 - Contributing characteristics and factors to swallowing disorders and their prognosis amongst children with acquired brain injury in the sub-acute stage Top

Suhad Bishara, Sharon Shaklai

Loewenstein Rehabilitation Hospital, Ra'anana, Israel

E-mail: [email protected]

Background and Aims: Few studies present prognostic factors and course of recovery of swallowing disorders in children with acquired brain injury (ABI). The aims of the present study are to characterize these deficiencies and prognosis for recovery in the sub-acute stage. Methods: A prospective historical study in a tertiary rehabilitation center included consecutively all children admitted with ABI. Data was collected from patient's medical records. Results: 100 children aged 2-17.75 years were included. 60% had swallowing disorders at admission, regardless of injury location.Prognostic factors for swallowing disturbances at time of admission were: Etiology x^2 (7,N=100)=14.47, p=0.016, Respiration x^2 (1,N=100)=6.34, p=0.017, State of consciousness (x^2 (2,N=100)=17.282, p=0.000, Injury Brain Side x^2 (2,N=100)=8.064, p=0.015, Voice Disorder x^2 (1,N=100)=17.368, p=0.000), Cranial Nerves Injury x^2 (1,N=100)=20.915, p=0.000, Oral Motor Movement x^2 (1,N=100)=15.129, p=0.000, Sensory Impairment in Oral Cavity and Pharynx x^2 (1,N=100)=17.184, p=0.000, Cognitive Impairment x^2 (1,N=100)=6.554, p=0.016. Moreover, 57.4% of patients who admitted with swallowing disorder totally recovered and discharged without swallowing disorder. Conclusions: Our knowledge of the characteristics and causes of swallowing disorders in pediatric population and their prognosis is important as it can assist therapists in defining the appropriate treatment in the subacute phase.

  5636 - Effectiveness of the telerehabilitation program in the treatment of patients with moderate-severe post COVID sequels after hospitalization Top

Maria Gisela Rodriguez1, Maria de Lourdes Dergal2, Paulina Iñiguez3, Alejandra Edith Gamiño4, Victor Hugo Lopez5, Carlos Alvarez6

1Departamento de Rehabilitacion, IMSS/Universidad de Guanajuato, Rie Bajio, Celaya Gto, Mexico, 2Fisiomedics, Estado de Mexico, Mexico, 3Universidad de Guanajuato, Guanajuato, Mexico, 4Universidad de Gto, Fisioterapia, Celaya, Mexico, 5Universidad de Guanajuato, Rie Bajio, Fisioterapia Celaya, Mexico, 6Universidad de Guanajuato, Fisioterapia, Celaya, Mexico

E-mail: [email protected]

Background and Aims: In December 2019, an outbreak of pneumonia whose etiology was unknown was registered in Wuhan, China, shortly afterwards it was attributed to SARS-CoV-2 and a global pandemic was declared in March 2020. Patients discharged from the hospital with a diagnosis of SARS-CoV-2 face a long recovery process associated with multiple complications and sequelae of the disease. The main findings after hospitalization for moderate-severe COVID-19 are: pain, fatigue, myocarditis, ischemia, dyspnea, cough, hypoxia, weakness, sarcopenia, muscle contractures, myopathies, polyneuropathies, pressure ulcers. Given the lack of personnel to care for the consequences of COVID-19, telerehabilitation has become a useful tool for their care. Methods: Quasi-experimental prospective, longitudinal, non-randomized, hospital and home clinical trial. Patients hospitalized for COVID-19 with 2 and 4 weeks of hospitalization with severe to moderate musculoskeletal and cardiopulmonar sequelae, unable to get out of bed, were evaluated with validated tests. They received an individualized 12-week program based on warm-up exercises, calisthenics, strength and breathing exercises from May to August 2021 through tele-rehabilitation during their recovery phase at home. Results: 60 patients were studied, 48 (80%) had dyspnea, fatigue, pain and inability to get out of bed as associated sequelae, 12 (20%) had muscle weakness, fatigue, pain and were unable to get out of bed but without associated dyspnea. After 15 sessions of the individualized program, a statistically significant improvement was observed in strength progress (p = 0.015), pain reduction (p = 0.001) and dyspnea. Conclusions: The telerehabilitation program positively impacts patients with sequelae of SARS, VOC 2 to reduce dyspnea, pain and increase muscle strength.

  5567 - Non-pharmacological strategies for preventing and treating osteoporosis after spinal cord injury: A systematic review Top

Gonçalo Engenheiro, Filipa Gouveia, Joana Ramalho, Maria Inês Táboas, Catarina Aguiar Branco

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

E-mail: [email protected]

Background and Aims: Bone mineral density (BMD) loss occurs in 75% patients with spinal cord injury (SCI). Our aim is to review the evidence on non-pharmacological strategies on managing BMD loss after SCI. Methods: Systematic review. PubMed, Web of Science, and Scopus were searched. Primary outcome was changes in BMD. Quality assessment was made using Spinal Cord Injury Rehabilitation Evidence (SCIRE) classification. Results: Fifty studies included. The majority were pre-post trials (SCIRE level 4), conducted in adults (18-70 years), except for 1 pediatric randomized controlled trial (RCT). Interventions were mainly performed after the first year of injury, and consisted of electrical stimulation (n=27), standing and/or walking (n=13), body vibration (n=3), physical activity (n=1), pulsed electromagnetic fields (n=1), ultrasound (n=1), or combined modalities (n=4). In the first year after SCI, functional electrical stimulation (FES) assisted cycling significantly attenuated BMD loss in distal femur, but the benefits disappeared after suspension. In an RCT, early mobilization after injury with more than 5 hours/week of standing alone or plus treadmill walking showed minimal BMD loss at the tibia. In chronic patients, including children, studies of 3 days/week of FES-cycling or FES-rowing had mixed results. Instead, 5 or more days/week of FES-cycling during 6 or 12 months significantly improved BMD at the proximal tibia and distal femur in 2 non-RCTs. The benefits attenuated 6 months after discontinuation. Results were relatively poor for the other modalities. Conclusions: Although the quality of evidence is low, FES and standing/walking interventions may be considered. Higher volume and longer programs seem to provide the best results in managing BMD loss after SCI.

  5537 - Cancer-related fatigue and activities of daily living during COVID-19 pandemic Top

Iveth Marcela Urbano Chamorro1, Julio César de la Torre Montero2

1Universidad Rey Juan Carlos, Universidad Comillas, Madrid, Spain, 2Universidad Comillas, Madrid, Spain

E-mail: [email protected]

Introduction and Aims: Cancer-related fatigue is a prevalent condition in all stages of oncologic disease, poorly diagnosed, with a negative impact on physical function of ADL. Fatigue is also one of the main manifestations in post-COVID-19 syndrome and there are few studies that explore the functionality of cancer patient after infection by the new coronavirus. Aim of this study was to assess cancer-related fatigue symptoms and their implication on quality of life in cancer patients during the pandemic. Methods: An observational study with a cross-sectional survey in cancer patients ≥18 years of age was conducted. The FACIT-F scale, the ECOG scale and the perception of asthenia by VAS were used to evaluate the differences between groups according to the history of COVID-19. Results: A total of 60 cancer patients with an average age of 335±10,11 years, 733% were female and 98,3% had an ECOG level <2. Severe fatigue was found in 433% and an average of FACIT-F scale was 335±1011. The proportion of coronavirus infection was 13,3% and had lower values on the scale compared to the group without infection (25±1040 vs. 34,81± 9,50 [p=0,009]). There was a significant correlation between VAS values and FACIT-F scale (Pearson's r = -0.76). Conclusion: SARS-Cov-2 infection increases cancer-related fatigue symptoms, limiting the ADL performance and impairing quality of life.

  5523 - Amantadine overdose post hypoxic ischemic encephalopathy: Case report Top

Lihi Mansano, Adi Levi, Sharon Shaklai

Loewenstein Rehabilitation Center, Ra'anana, Israel

E-mail: [email protected]

Amantadine is an antiviral agent with dopaminergic properties.[1] It has been in use for parkinsonism,[2] also was proven as helpful in cases of altered consciousness[3] and is used as a stimulating drug in patients post brain insults.[4] O.T, a 12-years-old post cardiac arrest, was hospitalized in our department with anoxic brain damage that led to low initiatives in everyday activities. We started his amantadine treatment on August 2020 with 50 mg*1/day and gradually escalated until dosage of 200 mg X2/day. Just before that, on July 3rd, he had another event of cardiac arrest that went his pacemaker on. He was hospitalized in cardiac intensive care unit, and there started his treatment with Quinidine, an antiarrythmic drug.[5] Quinidine interacts with more than 500 medications,[6] one of them is amantadine. When amantadine accumulation began, phenomena were all out: catatonia, hallucinations, livedo reticularis, preservative, slurred speech, aggressiveness and seriously impaired motor control. After quitting Amantadine, resolution of symptoms took a few months. We will present the clinical characteristics of amantadine overdose, treatment possibilities and our clinical experience with clonidine and guanfacine.


  1. Wu L. Amantadine. In: Poisoning and Drug Overdose. 6th ed., Ch. 6. 2012.
  2. Schwab RS, England AC Jr, Poskanzer DC, Young RR. Amantadine in the treatment of Parkinson's disease. JAMA 1969;208:1168-70. PMID: 5818715.
  3. Giacino JT, Whyte J, Bagiella E, Kalmar K, Childs N, Khademi A, et al. Placebo-controlled trial of amantadine for severe traumatic brain injury. N Engl J Med 2012;366:819-26.
  4. Yamada K. J Med 1990;24:853-69.
  5. Okada K. Clin Case Rep 2020;8:1053-6. Available from: https://www.drugs.com/drug-interactions/quinidine.html.

  5497 - Characterization of cognitive impairment in cancer rehabilitation using functional independence measure Top

Naohito Saito

Department of Physical Medicine and Rehabilitation, Sunagawa City Medical Center, Sunagawa, Japan

E-mail: [email protected]

Background and Aims: Cancer-related cognitive impairment (CRCI) is frequently reported in patients treated for non-central nervous system cancers, particularly during and after chemotherapy, and there is a growing demand from patients for CRCI management. Methods: In this retrospective study from January 2017 through December 2020, we compared activities of daily livings (ADL) of cancer patients using Functional Independence Measure (FIM) that physical therapists, occupational therapists and speech-language physiologists assessed at the start of rehabilitation intervention. Patients' mortality was observed three months after the FIM assessment. Patients with history of brain diseases and encephalomyelitis were excluded. Results: We analyzed 141 mortal cases. Median FIM of mortal cases was 64, motor FIM was 36, and cognitive FIM (cFIM) was 28. Numbers that needed helper, rated from level 1 to 5 of cFIM items, were 64 (45%) cases in comprehension, 54 (38%) in expression, 47 (33%) in social interaction, 105 (74%)) in problem-solving, and 71 (50%) in memory. Conclusions: Cognitive function was deteriorated among mortal cancer patients within three months. Social cognition (problem-solving and memory) was deteriorated compared with communication such as comprehension and expression.

  5411 - Computed tomography-based quantitative analysis of fibrotic changes in subcutaneous tissue in lower extremity lymphedema following gynecologic cancer surgery Top

Donggyu Lee1, PSoyoung Lee2, Kyoung Tae Lim2, Jang Hyuk Cho2

1Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, South Korea, 2Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University, Daegu, South Korea

E-mail: [email protected]

Background and Aims: Lymphedema produces protein-rich fluids that aggravate inflammation within subcutaneous tissue. Inflammation then induces fibroadipose tissue deposition and fibrosis. However, few methods have been developed to evaluate the severity of fibrosis. Therefore, we aimed to evaluate the subcutaneous fibrotic changes in lower extremity lymphedema following gynecologic cancer surgery using an image analysis tool, the FIJI software. Methods: Seventy-four patients who had lymphedema following gynecologic surgery were enrolled in this study. We quantitatively analyzed the cross-sectional area of soft tissue compartments, including subcutaneous tissue with skin, muscle, fibrotic change of subcutaneous tissue, and perimeter of skin boundaries. Results: The limb circumference and cross-sectional area of subcutaneous tissue and skin on the affected side were significantly larger than those on the unaffected side. Fibrotic changes showed the same trend. However, muscle volume showed a different pattern from other compartments. Some patients showed less muscle volume on the unaffected side than on the affected side. Circumference and cellulitis significantly affected the extent of fibrotic changes in the skin and subcutaneous tissues. Age and duration of lymphedema did not affect the fibrosis. Conclusions: Fibrosis of subcutaneous regions with skin can be quantitatively calculated using an image analysis tool in lower extremity lymphedema following gynecological cancer surgery. Edema and cellulitis increase fibrotic change of subcutaneous tissue with skin.

  5366 - Hemoglobin and fasting blood glucose as predictors of sarcopenia on the elderly Top

Maria Rachmawati1, Magdalena Wartono2, Dian Mediana2, Debora Pranata3

1University of Gunadarma, Jakarta, Indonesia, 2University of Trisakti, Jakarta, Indonesia, 3University of Pelita Harapan, Tangerang, Indonesia

E-mail: [email protected]

Background and Aims: Simple examination of sarcopenia predictors needed to prevent chronic diseases as comorbid of COVID-19. Anemia and diabetes have higher incidence in elderly. Aim of this study was to evaluate whether haemoglobin (Hb) and fasting blood glucose (FBG) could be as the predictors of physical performance. Methods: Study design was cross sectional and analytic descriptive, conducted on 209 elderly subjects in Banten and Jakarta Indonesia on Januari-June 2020. Physical performance obtained by assessing skeletal muscle index (SMI), hand grip (HG), and gait speed (GS). Normal values of SMI, HG, GS in both men and women by Asian Working Group for Sarcopenia. Physical activity evaluated by Physical activity scale for the elderly (PASE). Results: There were 93 (44.5%) men and 116 (55.5%) women. The mean of age was 69 (±7.5) y.o. Physical activity by PASE were 49 (16-542) in men and 52 (17-874) in women.The value of SMI, HG, GS both men and women were 8.4 (5-15) and 6.9 (4.9-11) kg/M2, 24 (9-40) and 15.7 (2.5-31) Kg, 1.4 (0.5-2.7) and 1.2 (0.3-2.4) M/S. While the level of Hb and FBG both M and W were 13.4 (6.4-17.3) and 12.5 (8-15.3) g/dL, 113.5 (65-255) and 111.7 (67-279) mg/dL. Statistic test by the regression ANOVA was obtained that Hb levels has effect to SMI (p =0.01, R2=0.05,C=0.2), as well as to HG (p<0.001,R<sup>2 =0.08,C=1.5), and GS (p=0.04,R2 =0.04,C=0.06). While FBG levels has no effect to SMI (p=0.238), also to GS (p=1.78), nor to HG (p=0.17). Conclusion: Subjects were inactive, however almost all physical performance were normal except the women HG. Hb levels can be as a predictor of sarcopenia in elderly.

  5364 - Does spinal deformity effect on walking outcome in post-stroke hemiplegic patients Top

Mindae Kim

Akabane Rehabilitation Hospital, Tokyo, Japan

E-mail: [email protected]

Background and Aims: Previous study[1] have reported altered spinal motion patterns in post-stroke hemiplegic patients. So, the aim of this study is to reveal the association between spinal deformation and walking ability with moderate hemiplegia after stroke. Methods: A total of thirty one patients with moderate hemiparesis (Brunnstrom stage 3 to 4) due to stroke were selected for this study. We retrospectively investigated their medical records include Functional Independence Measure score (FIM score) and chest radiograph. Patients were divided into a non-deformation group and a deformation group according to the presence or absence of deformation with osteophytes between the thoracic vertebra on the radiograph. To avoid the effect of cognitive dysfunction, participants with Cognitive FIM score under 18 points were excluded. The difference and ratio of the probability of walking achievement between two group was calculated with Markov Chain Monte Carlo simulation. Results: A total of eighteen patients achieved independent walking (58%). Fifteen patients had no deformation in the thoracic spine on radiograph and all of them achieved independent walking while sixteen participants had deformation in thoracic spine and only three had achieved independent walking. The difference of probability of achieving independent walking was 41% higher in non-deformity group (95%), the ratio was over 1.8 times (95%) and odd ration was over 11 times (95%). Conclusions: This study suggest the presence or absence of thoracic spine deformation on the radiograph may predict the post-rehabilitation walking outcome in post-stroke moderate hemiplegic patients.


  1. Syczewska M. J Hum Kinet 2006;16:39-56.

  5359 - Haemoglobin and fasting blood sugar as the predictors of physical performance on the inactive elderly Top

Maria Regina Rachmawati1, Magdalena Wartono2, Debora Pranata3

1Department of Physical Medicine and Rehabilitation, University of Gunadarma, Jakarta, Indonesia, 2Department of Anatomy, University of Trisakti, Jakarta, Indonesia, 3University of Pelita Harapan, Tangerang, Indonesia

E-mail: [email protected]

Background and Aims: Physical performance and physical activity have relation to the immune system. Simple examination predictors of physical performance are needed. The aim of this study was to evaluate whether haemoglobine (Hb) and fasting blood glucose (FBG) could be predictors of physical performance on elderly. Methods: Study design was cross sectional on inactive elderly subjects in Banten Indonesia. Physical activity measured by PASE. Physical performance obtained by assessing skeletal muscle index (SMI), gait speed (GS), and hand grip (HG). Normal values of SMI, GS, HG in both men (M) and women (W) by AWGS, as follows; 7 and 5.7 kg/M2, 1.0 M/S, 28 and 18 Kg respectively. Results: The subject consists of 93 (44.5%) M and 116 (55.5%) W. The mean of age was 69 (±7.5) y.o. The PASE was 69 (50-95). The value of SMI, GS, HG both M and W were 8.5 (5-15) and 6.8 (5-11) kg/M2, 1.4 (0.5-2.7) and 1.2 (0.3-2.4) M/S, 24 (9-40) and 16 (2.5-31) Kg, while the level of Hb and FBG both M and W were 13.6 (6.4-17.3) and 12.6 (8-15.3) g/dL, 103 (65-255) and 100 (67-279) mg/dL respectively. Statistic test by the regression ANOVA was obtained that Hb levels has effect to SMI (p =0.01), as well as to GS (p=0.04) and HG (p<0.001). While FBG levels has no effect to SMI (p=0.238), also to GS (p=1.78), nor to HG (p=0.17). Conclusions: Subjects physical performance were normal, except the HG on women. The Hb levels can be use as a predictor of physical performance in elderly. Regular Hb evaluation is necessary to maintain physical performance, and subjects need to be active, so it is expected to boost the immune system to prevent infection.


  1. da Silveira MP, da Silva Fagundes KK, Bizuti MR, Starck É, Rossi RC, de Resende E Silva DT. Physical exercise as a tool to help the immune system against COVID-19: An integrative review of the current literature. Clin Exp Med 2021;21:15-28.
  2. Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc 2020;21:300-7.e2.
  3. Tsai KZ, Lai SW, Hsieh CJ, Lin CS, Lin YP, Tsai SC, et al. Association between mild anemia and physical fitness in a military male cohort: The CHIEF study. Sci Rep 2019;9:11165.
  4. Norton L, Norton K, Lewis N. Exercise training improves fasting glucose control. Open Access J Sports Med 2012;3:209-14.

  4578 - Lung function, functionality, fatigue, sarcopenia, frailty and emotional aspects of adults and older adults post-hospitalization by COVID-19 Top

Danielle Brancolini de Oliveira, Jose Eduardo Pompeu, Erika Gouveia e Silva, Caroline Godoy

Universidade de São Paulo, São Paulo, Brazil

E-mail: [email protected]

Background and Aims: COVID-19 may lead to the need for prolonged hospitalization with negative impacts. The knowledge of the deleterious effects after hospitalization is extremely relevant to outline rehabilitation measures. We aim to verify the impacts on lung function, functionality, fatigue, sarcopenia, frailty and emotional aspects of adults and older adults post-COVID-19. Methods: Preliminary study that evaluated 180 adults and older adults, men and women, affected by COVID-19, recruited 30-45 days after discharge from the High Complexity Hospital of São Paulo. The study measures were: 1. Lung Function, spirometry; 2. Functionality, Barthel Index (BI); 3. Fatigue, FACIT-F; 4. Sarcopenia, SARC-F; 5. Frailty, CFS; 6. Anxiety and Depression by HADS. Repeated measure ANOVA was used to compare the results between adults and older adults. A significance level of p <0.05 was adopted. Results: 180 individuals were evaluated, 97 (53%) adults and 83 (46%) older people of both gender. We found a prevalence of restrictive pattern 57% (45/97) in adults and 57% (41/83) in older adults (p=0.851). The BI showed functional disability in 44% (30/97) of adults and 55% (37/83) of older adults, affecting mostly the women 57% (49/68) (p=0.049). 40% (35/97) of adults reported fatigue and 50% (36/83) of the older adults (p=0.190). 34% (29/97) of adults developed sarcopenia and 36% (27/83) older adults (p=0.709). Frailty was found in 78% (66/97) of the adults and 82% (60/83) of older adults (p=0.573). Finally, 32% (29/97) of adults had symptoms of anxiety and depression and 34% (24/83) of older adults (p=0.540). Conclusion: Post hospitalization by COVID-19 patients showed impaired lung function, mostly with restrictive pattern. Most older adults had functional disability, mostly were women.

  4580 - Effects of COVID-19 on lung function, functionality, fatigue, sarcopenia, frailty and emotional aspects in adults and older adults post hospitalization Top

Danielle Brancolini de Oliveira, Jose Eduardo Pompeu, Erika Gouveia e Silva, Caroline Godoy

Universidade de São Paulo, São Paulo, Brazil

E-mail: [email protected]

Background and Aims: Post-COVID-19 patients will most probably have negative consequences that may be correlated. We aim to verify the correlation among lung function, functionality, fatigue, sarcopenia, frailty and the emotional aspects of adults and the older adults affected by COVID-19. Methods: Preliminary study that evaluated 180 adults and older adults, men and women, affected by COVID-19, recruited 30-45 days after discharge from the High Complexity Hospital of São Paulo. The study measures were: 1. Lung Function (LF), spirometry; 2. Functionality, Barthel Index (BI); 3. Fatigue, FACIT-F; 4. Sarcopenia, SARC-F; 5. Frailty, CFS; 6. Anxiety and Depression by HADS. The statistical analysis was performed using the JASP software and the Pearson Correlation Test was used to analyze the possible correlations between the variables. A significance level of p <0.05 was adopted. Results: 180 individuals were evaluated, 97 (53%) adults and 83 (46%) older people of both gender. There was a negative and weak correlation: LF x HADS (r=-0.214; p=0.014) and SARC-F (r=-0.205; p=0.019). Negative and strong correlation: LF x CFS (r=-0.455; p<.001) and FACIT (r=-0.405; p<.001); BI x HADS (r=-0.337; p<.001), CSF (r=-0.613; p<.001) and SARC-F (r=-0.645; p<.001). There was a positive and weak correlation: BI x LF (r=0.178; p=0.044); Positive and moderate correlation: FACIT x CFS (r=0.249; p=0.002) and SARC-F (r=0.245; p=0.002); Positive and strong correlation HADS x FACIT (r=0.342; p<.001), CFS (r=0.402; p<.001) and SARC-F (r=0.502; p<.001). Lung function was correlated with all other variables. Conclusion: The higher the lung function and functionality, the lower symptoms of anxiety and depression, sarcopenia, frailty and fatigue. So there is a great importance of holistic care to prevent or treat the cascade of sequelae.

  4466 - Covid-19 critical care rehabilitation: Experience from a Portuguese physical medicine and rehabilitation department Top

Eva Alves, Pedro Ferreira, Madalena Carvalho, Ricardo Henriques, José Esteves da Costa

Centro Hospitalar Universitário Lisboa Norte, Hospital Santa Maria, Lisbon, Portugal

E-mail: [email protected]

Background and Aims: The Physical Medicine and Rehabilitation (PMR) role on COVID-19 critical patients approach, integrated in the pandemic response, is fundamental to reduce the impact of functional disability at individual and collective levels. We aim to describe and analyze the data collected since the beginning of the pandemic, stemming from our institution's COVID-19 patient-specific-rehabilitation protocol application and to ascertain whether its delay influences functional outcomes. Methods: We conducted an observational study of ICU-COVID-19 patients who received physical therapy (PT) and/or occupational therapy (OT) between March 12th and August 28th. Inclusion according to clinical and safety criteria based on the Action Plan for the Rehabilitation of Patients admitted to the Intensive Care Unit with COVID -19, published by the Portuguese PMR Society in March 2020. Descriptive analysis was used based on data retrieved from medical files concerning gender, age, type of rehabilitation (OT, PT or both), length of stay (LOS), time until initiation of rehabilitation, time of orotracheal intubation (OTI), muscle strength (MRC scale), and functional status (Barthel Index). Results: Seventy-three patients, 69,9% male and 30.1% female, were included from a total of 110 ICU admissions. Median age of 67 years, median LOS was 25 days, median time to initiate rehabilitation was 4 days, median time of mechanical ventilation was 16.9 days. There was no association between previous co-morbidites and death (p-value>0,05). Most patients showed an improvement in functional independence and strength under rehabilitation. There was no difference, in our study, between early and delayed start of rehabilitation. Conclusion: An interventional prospective study is in progress to assess short and long term rehabilitation impact.

  4433 - A rare case of multiple liver transplants in an infant with ornithine transcarbamylase (OTC) deficiency Top

Sindhoori Nalla, Lauren Woo, Charles Sisung

Department of Physical Medicine and Rehabilitation, Shirley Ryan AbilityLab, Northwestern University, Chicago - IL, USA

E-mail: [email protected]

Background and Aims: OTC deficiency is a rare X-linked genetic disorder with estimated global prevalence of 0.001-0.007%. It is characterized by hyperammonemia with neurological complications, acute liver failure (ALF), and coagulopathy. Liver transplantation is a curative treatment, but requires lifelong immunosuppression and can result in numerous complications such as organ rejection. This rare case highlights the rehabilitation of an infant requiring multiple liver transplants within one month given associated complications. Methods: A male infant with OTC deficiency, developmental delay, hypotonia, coagulopathy, seizures, and ALF underwent an orthotopic liver transplantation (OLT) at age 10 months. The OLT failed due to severe hepatic artery thrombosis (HAT), requiring a repeat OLT with aortic conduit two weeks later. This was again complicated by recurrence of HAT despite use of conduit for arterial revascularization. He had a third, reduced size OLT one week later which was ultimately successful, but complicated by bowel perforation, prolonged intubation, diaphragm hemiparesis, pulmonary artery stenosis, deep venous thrombosis, and vasopressor induced ischemia of digits. He was admitted to acute inpatient rehabilitation (AIR) at age 15 months, requiring total assistance for sitting and supported standing. After two months of AIR, he was discharged home with minimum assistance for rolling, moderate assistance for sitting and transitional movements, and improved fine motor coordination with play. Results: Despite a rare and complex medical course, patient tolerated AIR with notable improvements in function. Conclusions: OTC deficiency is a rare genetic disorder with life-threatening complications, but patients can successfully progress in function with comprehensive AIR.

  4075 - Effects of laser therapy for the management of lymphedema induced by breast cancer treatment: A systematic review Top

Beatriz Nascimento Motta1, Gabriela Nogueira Priore1, Magda Miele Abate1, Mariana Bernardes Batista Monteiro1, Filipe Danilo das Neves1, Rebeca Boltes Cecatto2

1Faculdade de Medicina da Universidade Nove de Julho, São Paulo, Brasil, 2Instituto de Cancer ICESP Fac, Medicina Univ Sao Paulo e Fac, Medicina University, Nove de Julho, São Paulo, Brasil

E-mail: [email protected]

Background and Aims: Rehabilitation of lymphedema after Breast Cancer (BRCL) includes manual lymphatic drainage, exercises and complete decongestive physiotherapy (CDT) among other therapies. Different kinds of Laser Therapies (LT) are used for medical conditions as diabetic neuropathy and pain.But only few studies investigate LT for rehabilitation after BRCL. The aim of this study was to evaluate the current literature regarding the effect of LT in the treatment of lymphedema after Breast Cancer. Methods: in 2020 a systematic review was performed according to the Preferred Reporting Items for Systematic Reviews (PRISMA) statement searching for randomized clinical trials in humans following the P.I.C.O. strategy (P= breast cancer, I= Laser Therapies C= sham Therapy, control no treatment group or other treatment, and O = clinical and/or laboratory amelioration) at PubMed, EMBASE, LILACS, PeDro and Open Gray database. No restriction of age, gender, stage of disease, time of injury, associated complication or outcomes will be imposed. The quality assessment of studies was analyzed by NIH Quality Assessment Criteria and Cochrane Review Criteria. Results: a total of 2862 papers were first identified but only 18 studies were selected to results including 338 patients (11 RCT ) and 07 Systematic Reviews. About RCT, 2 of them have a high risk of bias and 9 have a moderate risk of bias. Low to moderate-strength evidence supports LT in the management of BCRL, with clinically relevant reductions in pain. Greater reductions in volume were also found with the use of LT than in treatments without it. No adverse effects were related but no study has evaluated long-term effects of LT on tumor recurrence. Conclusions: LT is safe and it confers clinically meaningful reductions in arm volume and pain in women with BCRL.

  7025 - Late periprosthetic joint infection: A case report Top

César Pires, António Paiva, Xenia Verraest, Pedro Sá, Paula Amorim, Jorge Laíns

Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, - Rovisco Pais, PMR, Quinta da Fonte Quente, Tocha, Portugal

E-mail: [email protected]

Introduction: Loosening is a possible complication after total knee arthroplasty (TKA). There are several causes, infection being one of them. Late periprosthetic joint infection (PJI) can is one of the most devastating complications after TKA. Patient Information and Clinical Findings: 76-year-old male is referred to a PMR consultation due to left knee pain spanning 4 weeks with progressive worsening. It had a mechanical nature with great knee instability sensation. No recent trauma, fever, weight loss or other constitutional symptoms. He had no recente X-Ray. No relevant personal history, except of left TKA 12 years ago for which his last consultation was three years ago. He had bilateral varum deformity that aggravated during gait; positive patelar tap; active range of motion 0-100° with considerable pain on the last degrees of flexion and his muscle strenght was preserved. His left knee had considerable medial-lateral instability and pain. An ultrasound guided arthrocentesis was performed with drainage of 20cc of hematic and cloudy liquid with fetid smell. Due to a high suspicion of prosthetic loosening with possible PJI, we referred the patient to the urgent care that confirmed our hypothesis. He is currently awaiting revision of the prosthesis. Discussion and Conclusions: PJI can be a medical urgency and its early recognition is key, which is why a good anamnesis and physical are imperative. The role of PMR in the diagnosis field is progressively gaining weight, specialty due to our holistic and function driven approach.

  7015 - Metastatic paraplegia in male breast cancer: A case report Top

Monica Pinto1, Maura Tracey2, Benedetto Di Maio3, Matilde Pensabene4, Michelino De Laurentiis4

1Department of Strategic Health Services, Rehabilitation Medicine Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy, 2Rehabilitation Medicine Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy, 3Department of Surgical Sciences, Orthopedic Unit, AORN Santobono-Pausillipon, Naples, Italy, 4Breast Oncology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy

E-mail: [email protected]

Introduction: Male Breast Cancer (BC) often has a delayed diagnosis and a poor prognosis. The spine is a frequent site of bone metastasis and spinal cord injury (SCI) can occur. SCI severely impacts on function, activity and participation as well as on quality of life. Rehabilitation is essential to avoid complications, promote the neurological recovery and quality of life along with cancer treatments. We present the case of a male BC patient with metastatic SCI treated with concomitant oncological and rehabilitation treatments. Patient Information and Clinical Findings: A 69 year old male, with metastatic BC and no significant comorbidities, underwent mastectomy plus axillary lymphadenectomy in October 2021 (pT2N1a, G3), adjuvant Chemotherapy (CHT), Hormonal Blockade, Radiation Therapy on the D2-D6 vertebrae with neoplastic epidural space invasion. In December 2021 SCI occurred with paraplegia The patient was admitted and undewent multidisciplinary team evaluation including rehabilitation consultation within 72 hours: he started 1st line CHT and intensive inpatient rehabilitation concomitant with CHT, then home-base rehab during the CHT interval plus inpatient rehab during CHT for 2 months. The Individualized Rehabilitation Project included pulmonary and motor rehabilitation, neurorehabilitation, mobility aids, nutritional support, pharmacologic neuroprotection (steroids), pain control, psychological support. The Table shows the improvement of scores in VAS, ASIA, SCIM, Karnofsky, Tokuhashi and SF12 (T0, 72 hours after paraplegia; T1, 2 months later). Discussion and Conclusions: The malignant SCI could have a satisfactory recovery even without laminectomy. Early rehabilitation, concomitant with CHT, is essential to get optimal results. Our preliminary evidence may be confirmed in a larger study.

  7011 - Guillain Barré syndrome post SARS-CoV-2 infection Top

Maria Cristina Lozano Domínguez, Jose Ramon Simarro Parreño, Valentin Jimenez Vilchis, Cristina Ampurnales Villar, Maria Jose Dura Mata

Department of Physical Medicine and Rehabilitation, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain

E-mail: [email protected]

Introduction: Association of symptoms compatible with Guillain-Barré syndrome (GBS) and vaccination has been previously described, usually with tetravalent type influenza vaccines. With the appearance of the SARS-CoV-2 pandemic, cases of GBS have been reported in numerous centers and are active or resolved COVID-19 positive, increasing the association between the two. The extent of the SARS-CoV-2 virus has not yet been determined, since it has been observed that it not only affects the respiratory system, but also other systems such as the nervous system, among others. Several authors have concluded that patients with GBS and COVID-19, most of them, are of advanced age with more severe clinical manifestations. Clinical Observation: We report 3 cases who came to the emergency department with the following clinical manifestations: progressive ascending paresis, peripheral facial paralysis, glove and sock paresthesias, global areflexia and gait disturbance. The previous days had presented respiratory symptoms of COVID-19. Complementary tests were performed and all of them were negative, except the electromyogram that showed an acute demyelinating polyneuropathy. They were oriented as idiopathic acute demyelinating polyneuropathy versus GBS post SARS-CoV-2 infection. All of them underwent immunoglobulin therapy, in addition to rehabilitation treatment with physiotherapy, occupational therapy and speech therapy, presenting a favorable evolution and improvement of their deficits. Conclusion: Studies show a clear association between both pathologies, pointing to the SARS-CoV-2 virus as a potential trigger for GBS. We would like to emphasize that with adequate multidisciplinary treatment, clinical improvement of these patients can be achieved.

  6861 - Ethical dilemma in neurological rehabilitation: A case report Top

Irene Aguirre Sánchez

Departamento de Medicina Física Y Rehabilitación del Hospital Nostra Senyora de Meritxell, Les Escaldes, Andorra

E-mail: [email protected]

Introduction: Multiple sclerosis (MS) is a neurologic disorder that is more common young adults and can progress to physical and cognitive disability. Spinal Cord Injury (SCI) is associated with health, economic and social consequences. Without proper awareness, both pathologies together can lead to ethical concerns. Patient Information and Clinical Findings: A 22-year-old male patient, diagnosed in august 2019 with MS, suffered an incomplete SCI C5 ASIA D after a traffic accident in December 2019. Clinically he had left hemiparesis, fine motor difficulties and a gait disorder. During the hospitalization in a SCI Unit, he presented a trachea-esophageal fistula, which resolved with surgery. Despite previous multiple MS relapses such as repeated optic neuritis, he refused to get treatment. After the rehabilitation process, the patient continued to refuse MS treatment and cognitive assessment and did not allow anyone to contact his family. The physiatrist consulted the Ethical Committee that prioritized the principle of autonomy. They also recommended to contact his general practitioner, who had no more information about the patient nor the family. The patient contacted again with the physiatrist presenting dysphagia. A video fluoroscopy was arranged but he did not attend, with no explanation. Discussion and Conclusions: The principle of autonomy needs good understanding to be respected. When patients do not allow appropriate cognitive evaluation, providing an answer to ethical dilemmas is far from clear. Rehabilitation in neurologic patients is a complex physical and psychological challenge, especially when there is no awareness of disease. An important call is the ethical approach to cases that do not wish to receive treatment, but their lives are at risk.

  6757 - The missing link in medical school: Perimenopause impact on sexual health Top

Ivanka Simic Stanojevic1, Jennifer Piatt2, Debra Herbenick3, Thian Shields4, Talia Harnoy5, Hailey Loftin4

1Indiana University, Bloomington, Indiana, USA, 2Department of Health and Wellness Design, School of Public Health, Indiana University, Bloomington, Indiana, USA, 3Department of Applied Health, School of Public Health, Indiana University, Bloomington, Indiana, USA, 4College of Arts and Science, Indiana University, Bloomington, Indiana, USA, 5School of Public Health, Indiana University, Bloomington, Indiana, USA

E-mail: [email protected]

Background and Aims: Perimenopause can adversely impact sexual health among women and is often dismissed by health care professionals. The purpose of this study was to understand how health care professionals are addressing sexual health needs among women currently going through perimenopause. Methods: This study employed semi-structured interviews with 25 women currently experiencing perimenopause to examine how their sexual health needs were being addressed by their health care professionals. Women were identified as going through perimenopause by completing the Menopause Rating Scale (MRI) . Phenomenological data analysis was employed with the reduction of data into themes. Results: Findings indicate there is a lack of sexual education for patients. Women reported learning about perimenopause only after experiencing symptoms and, even then, most were provided with insufficient sexual health information from their health care providers. Furthermore, while our participants shared that they would like to discuss sexual health during annual visits, they also indicated that health care professionals were not addressing perimenopause during preventative care. Finally, our results revealed concerns regarding medical education and training on how to approach the sexual health conversations. Finally, women experiencing perimenopause felt dismissed by their medical providers. Conclusions: Findings demonstrate that women who are going through perimenopause often have unmet sexual health needs in relation to their healthcare visits. It appears that there is a need for more training in medical school to address this important component of women's health.

  6748 - Guillain Barre syndrome rehabilitation and recovery Top

Panoraia Mitsostergiou, Ioannis Iliakis, Georgios Neochoritis, Margarita Eleni Manola, Konstantina Petropoulou

Second Department of PRM, National Rehabilitation Center, Athens, Greece

E-mail: [email protected]

Background and Aims: Assessment of degree of handicap and prognosis signs in patients with Guillain Barre syndrome. Methods: The study involved 16 inpatients with confirmed Guillain Barre syndrome, of which 10 men and 6 women, in the period of 2015-2021. They underwent an investigation and rehabilitation program and their duration of hospitalization ranged from 26 days to 18 months and 21 days. Results: From the patients with Guillain Barre syndrome who were treated in our PRM department, 62.5% were male. The average length of hospitalisation was 5 months and 28 days. The 43.75% of patients required re-admission. 68.75% of patients with Guillain Barre who took part in the study, are systematically followed up as outpatients. 93.75% presented with incomplete tetraplegia, while 6.25% with incomplete paraplegia. 18.75% have also cranial nerve lesions. These patients needed a temporary tracheostomy and had an extended length of stay on inpatient rehabilitation. Conclusions: Guillain Barre syndrome is a demyelinating disease, which mainly affects men, usually manifests itself in the form of incomplete tetraplegia and needs a long hospitalisation and time of recovery.

  6701 - Mononeuritis multiplex in polyarteritis nodosa: Case report Top

Nathalia María Pérez Becerra, Jorge Arturo Diaz

Departamento de Medicina Física Y Rehabilitación, Universidad Nacional de Colombia, Bogota, Colombia

E-mail: [email protected]

Introduction: Multiplex mononeuritis is a neuropathy in which 2 or more non-contiguous nerves are affected at the same time and has its origin in various etiologies, the main one being vasculitis, with polyarteritis nodosa (PAN) being the least common. We present the case of a patient diagnosed with PAN and mononeuritis multiplex managed with immunosuppressive therapy in addition to escharectomy and debridement with adequate response. Case Report: 76-year-old female patient with chronic alteration of sensation in lower limbs with subsequent acute appearance of skin lesions, skin biopsy with fibrin thrombi in small and medium caliber vessels and electrophysiology studies with signs compatible with an asymmetric axonal sensory motor polyneuropathy in chronic phase, managed with good results with prednisolone, methotrexate and cyclophosphamide. Discussion: Polyarteriritis nodosa is a low prevalence disease with a variety of signs and symptoms that manifests depending on the affected territory, causing descending ischemia and fibrinoid necrosis, in addition to injury of the vasa nervorum that may involve the peripheral nervous system, so it is necessary an interdisciplinary study to establish a prompt treatment and avoid fatal outcomes.

Keywords: Mononeuritis multiplex, polyarteritis nodosa, vasculitis (DeCS)

  6668 - Left transfemoral amputation as a consequence of COVID-19-coagulopathy: A case report Top

Oliver Acosta, Adriana Valbuena Valecillos, Robert Irwin

Department of Physical Medicine and Rehabilitation, University of Miami / Jackson Memorial, Miami, FL, USA

E-mail: [email protected]

Introduction: While recent studies have confirmed a high incidence of thromboembolic events among patients with COVID-19, arterial thrombosis is less common and more likely to occur in severe disease. Acute limb ischemia secondary to COVID-19-associated-coagulopathy has been shown to have a high mortality rate. Early acute rehabilitation, however, can lead to good functional outcomes. Patient Information and Clinical Findings: A 68-year-old male with no medical history presented to the hospital with shortness of breath and left leg pain and was subsequently diagnosed with COVID-19. His respiratory symptoms resolved with appropriate treatment but one day later he reported worsening left leg pain, and an ultrasound showed complete occlusion of the left external iliac and common femoral arteries. He required thromboembolectomy, left knee disarticulation for unsalvageable acute limb ischemia, 3-compartment fasciotomy of the left thigh and finally transfemoral amputation. On hospital day 42 he was transferred to inpatient rehabilitation, during which his hospital course was significant for residual limb pain controlled with oral agents, no further vascular complications while on oral anticoagulation, and COVID-19-related autonomic dysfunction. Discussion and Conclusions: Therapists' evaluation revealed ambulation of 50 feet with a standard walker, minimal assistance for bed mobility, transfers, and activities of daily living. He had excellent functional progression and was discharged home at a supervision to modified independence level. Acute limb ischemia and amputation are rare complications of COVID-19 that can present in mild cases. Rehabilitation should emphasize adequate post-amputation care, as well as attention to any post-COVID-19 symptoms to best prepare patients for reintegration back to the community.

  6511 - Axillary cords after breast surgery: An underdiagnosed pathology Top

Enrique Cano Lallave, Victoria Eugenia Rivera García, Elena González Abarquero, Beatriz Rodríguez García

Hospital Universitario de Salamanca, Salamanca, Spain

E-mail: [email protected]

Introduction: Breast cancer is the most prevalent neoplasm in the world. Patients who undergo surgery for this type of tumor, associated or not with axillary lymphadenectomy (AL), may develop Axillary Web Syndrome (AWS) in the postoperative period. Patient Information and Clinical Findings: We present a 49-year-old female patient who underwent mastectomy and axillary lymphadenectomy (12 nodes) for infiltrating ductal carcinoma of the right breast. She was referred to our deparment for lymphedema screening. At the first visit, the patient reported difficulty in raising her right shoulder. On physical examination, a subcutaneous fibrous cord at axillary level was palpated [Figure 1], which caused a painful limited shoulder flexion and abduction to 95° and 90°, respectively. The clinical diagnosis of AWS was performed. We prescribed manual lymphatic drainage and kinesitherapy. In the follow-up visits, the cord was not palpable and she had complete painless joint balance. Discussion and Conclusions: The AWS in an underdiagnosed disease, although its incidence has been reported between 36% and 72% after AL. Cord forms in the subcutaneous tissue extending from the axilla, along the medial aspect of the arm and may reach the elbow, causing painful mobility of the shoulder. It usually appears from the 1st to the 8th postoperative week. Prothrombotic state and radiotherapy were described as a risk factors. This disease has a It approach should be multidisciplinary. Rehabilitation treatment shortens the natural course up to 6-8 weeks, and therefore has a clinical benefit in these patients.
Figure 1: subcutaneous fibrous cord at axillary level

Click here to view

  6437 - Scoliosis management in Prader Willi syndrome: Case report from Algiers, Algeria Top

Bahloul Afaf1, Mechiki Badredine2, Meliani abdelghani3, Lemai Soumia4, Cherid Hocine2

1EHS Azur Plage, Staoueli, Alger, Algérie, Algeria, 2Department of PRM, EHS Azur Plage, Algiers, Algeria, 3Department of PRM, University of KM Ouargla, Ouargla, Algeria, 4Department of PRM, University of Constantine, Constantine, Algeria

E-mail: [email protected]

Introduction: Prader Willi syndrome (PWS) is a rare genetic disorder that affects one in 10,000 to 20,000 people characterized by hypothalamic-pituitary dysfunction; caused by abnormalities of chromosome 15. Patients with this syndrome show a lack of satiety resulting in overeating leading to obesity. The orthopedic disorders of PWS include scoliosis that occurs in 15 to 86%. The aim of our work is to report a case of this syndrome and to demonstrate the important place of Physical and Rehabilitation Medicine in the management of this syndrome. Patient Information and Clinical Findings: It is the child G M, of sex female, aged 11 years, the eldest of a family of 2 living and healthy children; enrolled in 5th primary; sent by his pediatrician for the management of an orthopedic disorder such as spinal deviation secondary to PWS; diagnosed for 2 years, where she was put on norditropin at a minimum dose of 0.032 mg / kg / day. The child presented a right thoracic scoliosis from T5 to T12 with a Cobb angle of 40. We instituted orthopedic treatment and the child was placed under Corset type CTM (Cheneau / Toulouse / Munster), with regular check-ups every six months. It should be noted that the corset was changed 3 times because of the patient's weight gain. In addition, we have carried out a good therapeutic education of the patient based on the rules of hygiene of life.2 years later, the evolution was marked by the decrease in the Cobb angle, which passes to 33 °, as well as a decrease in obesity with the BMI, which goes from 34.31 to 31.86 kg / m2 Discussion and Conclusions: PWS is one of the rare and unrecognized causes of scoliosis. PRM complements the role of pediatrics. However, the importance of obesity and associated disorders make this management complex.

  6389 - Multidisciplinary rehabilitation for paraplegia with neurogenic bladder caused by a COVID-19 related transverse myelitis: A case report Top

Afifa Arfaoui, Leila Ghidaoui, Sonia Ben Achour Lebib, Bochra Mahmoud, Rihab masstouri, Imen Miri, Amani Khezami, Emna Bahlouli, Hana Zakhama, Ines Aloulou, Catherine Dziri, Fatma Zohra Ben Salah

Mohammed Taieb Kassab Institute of Orthopedics, Manouba, Tunisia

E-mail: [email protected]

Introduction: The aim of this study is to report a case of multidisciplinary rehabilitation for paraplegia with a neurogenic bladder due to an acute transverse myelitis related to COVID19. Patient Information and Clinical Findings: A 67-year-old tunisian man, with no medical history, diagnosed with COVID-19, was presented with weakness and loss of movement in lower limbs and urinary retention in April 2021.Cerebral and spinal MRI, performed in Mai 2021, with gadolinium contrast showed extensive increased T2 signal involving central gray matter, within the thoracic cord. The patient was hospitalized in the physical medicine ward for a flaccid paraplegia, classified ASIA D level L2, neurogenic bladder, respiratory muscle fatigue and decline in the functional capacities in August 2021. Multidisciplinary rehabilitation programs including Intermittent catheterization were adopted. Three weeks after admission, with regular and thorough rehabilitation sessions, he was discharged home asymptomatic in September 2021. The patient gained spontaneous miction, better respiratory and functional state. Discussion and Conclusions: We found few studies reporting acute transverse myelitis as a possible COVID-19 complication. One of them stated it as a rehabilitative challenge. Sharing the experience of dealing with these rare cases is crucial. Hereby, we proved the effectiveness of the multidisciplinary rehabilitation strategies when it comes to COVID 19 related neurological manifestations including the neurogenic bladder management.

  6350 - Saphenous neuropathy after endovenous thermal ablation of great saphenous vein Top

Raquel Branco, Clemente Almeida, Sabrina Pimentel, Sandra Morgado

Department of Serviço de Medicina Física e Reabilitação, Hospital do Divino Espírito Santo, Ponta Delgada, Açores, Portugal

E-mail: [email protected]

Introduction: Endovenous thermal ablation by radiofrequency, also known as Radiofrequency Ablation (RA) is a minimally invasive percutaneous technique that uses thermal energy to ablate incompetent veins, such as in peripheral venous insufficiency. One of the veins frequently treated is the great saphenous vein, anatomically related to saphenous nerve. Nerve injury is reported in up to 16% of patients. Patient Information and Clinical Findings: A 34-year-old female patient, with a history of peripheral venous insufficiency, underwent RA of great saphenous vein of left lower limb. In the immediate postoperative period, she started allodynia and neuropathic pain in the posterior aspect of the left leg, in a path compatible with saphenous nerve territory. She performed Doppler ultrasound which excluded deep vein thrombosis (DVT). She did local analgesic measures, relative rest and started gabapentin and a vitamin complex aimed at nerve regeneration, with resolution of the clinical condition in about 1 month after RA. Discussion and Conclusions: This case report describes a saphenous neuropathy as a non-negligible complication of RA of great saphenous vein, due to their close anatomical relationship. Iatrogenic damage to saphenous nerve is a known incapacitating complication of endovenous thermal ablation of great saphenous vein. The use of ultrasound guidance and micropuncture technique diminishes the incidence of this complication. Most cases have a good prognosis (as in this case), but correct diagnosis is important so that targeted medication can be introduced. It is also essential to keep this diagnostic hypothesis in mind, especially after ruling out DVT as a cause of pain following this procedure.

  6331 - Rehabilitation after scapular osteocutaneous flap for mandibular reconstruction: A case report Top

Ady Correa-Mendoza1, Diana Molinares2

1Department of Physical Medicine and Rehabilitation, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA, 2Department of Physical Medicine and Rehabilitation, University of Miami, Florida, USA

E-mail: [email protected]

Patients with head and neck cancer may require mandibular reconstruction due to cancer invasion or osteoradionecrosis, for which the fibula or iliac crest were traditionally used as donors. Scapular osteocutaneous flaps have become popular due to multiple advantages including higher skin quality and superior skin color match, the natural scapular curvature does not require osteotomy for lateral mandibular defect, there is less risk of donor site complications and early post op ambulation. However, patients may develop shoulder dysfunction after scapular osteotomy for which early rehabilitation is essential to prevent sequelae such as adhesive capsulitis and chronic pain syndrome. 68 year old female with tongue carcinoma and mandibular necrosis who underwent floor of mouth resection, glossectomy and left scapular osteocutaneous flap for right mandibular reconstruction. During surgery, the latissimus dorsi, teres major, infraspinatus and subscapularis muscles were incised along with 8cm osteotomy of the left lateral scapula used as a donor. Post op, she presented left arm edema, pain, shoulder paresis, mostly medial rotation and impaired coordination. She completed inpatient rehabilitation for ICU related myopathy, focusing on ambulation and ADLs performance but also management of left upper extremity edema reduction, range of motion and strengthening. She achieved modified independence in ADLs and mobility. Scapular osteocutaneous flaps are advantageous, often performed when there is short mandibular defect <10-14cm, unfortunately affecting independent ADLs performance. Main shoulder medial rotator muscles are affected during the procedure. Intensive rehabilitation within post op weeks 3-5 is essential, especially encouraging shoulder extension and trunk rotation exercises in addition to general reconditioning.

  6324 - A case of bilateral brachial plexus injury following prolonged intensive care admission with COVID-19 Top

Rebecca Haigh, Anita Suthanthira-Singh

North Staffordshire Rehabilitation Centre, Haywood Hospital, Stoke on Trent, UK

E-mail: [email protected]

A case of bilateral brachial plexus injury and intensive care accquired weakness in a previously well 35 year old male patient with raised body mass index. Initally admitted with respiratory failure secondary to COVID-19 requiring intensive care admission for intubation and ventilation. Patient required proning for periods spanning a two month period with a total of 18 prones during the first 25 days. Patient went on to develop multiorgan failure with requirement for haemodialysis and insertion of IVC filter due to clot burden. On sedation wean patient was found to have profound motor and sensory weakness of both upper limbs initially felt to be caused by critical illness myopathy. During his rehabilitation period there was significant improvement in symptoms affecting his lower limbs and his non-dominant hand. 6 months following initial diagnosis there is now gradual improvement in the dominant upper limb. Previous guidance regarding avoiding brachial plexus injury during proning was followed during patients admission. Further review of guidance now being completed as to relevance of use in obese patients.

  6283 - Spinal cord injury and heterotopic calcification – A clinical case in an in-patient rehabilitation unit Top

André Freitas Santos1, Maria Paz Carvalho2, Rui Martins da Silva2

1Centro Hospitalar Universitário do Algarve, Rua Leão Penedo, Faro, Portugal, 2Centro de Medicina de Reabilitação de Alcoitão, Alcoitão, Portugal

E-mail: [email protected]

Introduction: Heterotopic ossification occurs most commonly after joint arthroplasty, neurological injuries and other traumas. Depending on several factors, the rate of HO varies between 0.2 after burn injury and 90% on some hip arthroplasty or acetabular fractures. For SCI rates range from 10%-53%. Risk Factors include severity and level of injury severe spasticity, impaired cognition, tracheostomy, pneumonia and urinary tract infection (UTI). There are also differences related to sex, with males more commonly being affected. Elevated CRP, CPK levels and body temperature (38.5°C) as a combination are currently under study to raise awareness for an early diagnosis of HO as it mimics an infection.The role for Alkaline Phosphatase (AP) serum and bone as a screening tool are still unclear. Patient Information and Clinical Findings: We found this case of a 32-year-old male interesting, for the rapid onset and progression of the left hip heterotopic ossification, after a thoracic SCI. The patient suffered a bicycle crash fracturing and luxating the T9 vertebra, resulting in paraplegia AIS C with a T7 neurological level. The patient developed tenderness and oedema in the left thigh subacutely. On admission to the Intensive rehabilitation center the patient presented with a marked limitation of ROM in the left hip and the X-ray showed a grade 4 heterotopic ossification on the Brooker classification. Discussion: This case was brought up to raise the level of awareness in a SCI injury, with polytrauma and infectious intercurrences, for the development of heterotopic ossification that could lead to a decrease in the overall health and well-being of the SCI patient. Conclusion: HO detection at grade 4 level has no line of treatment established. That raises the need for early detection and to consider prophylactic treatment.

  6228 - Rehabilitation 101 - Back to basics Top

João P. Fonseca1, Alexandre Afonso2, João Malta1, António Azenha1

1Department of Physical and Rehabilitation Medicine, Coimbra Hospital and University Centre, Praceta Professor Mota Pinto, Coimbra, Portugal, 2Department of Occupational Medicine, Coimbra Hospital and University Centre, Praceta Professor Mota Pinto, Coimbra, Portugal

E-mail: [email protected]

Introduction: Physical and Rehabilitation Medicine (PRM) is the medical specialty responsible for addressing impairments to facilitate functioning and participation. Despite technological development in different conditions, the physician must know basic rehabilitation techniques, as they are the foundation and sometimes the only treatment possible. Patient Information and Clinical Findings: A 72-year-old male with a history of poliomyelitis in infancy, causing dystrophy of the left lower limb. He used a left axillary crutch daily to walk. In November 2019, he reported a pulsatile mass in the left axillary region. He was diagnosed with a 5x3cm humeral saccular aneurysm and referred for vascular surgery. Given the relationship between the aneurysm and crutch usage, surgery depended on axillary discharge, essential daily life. The patient was referred to PRM for a walking alternative to enable surgery. He had a dystrophic left lower limb, with a knee flexum of 60°. Overall muscle strength of the left lower limb was 1 (MRC). The patient started a rehabilitation program to gain joint ROM, muscle strength, and gait training using kinesiological techniques, thermotherapy, electrotherapy using a dynamic joint angle fixation orthosis, and orthopedic boot. Over time, the patient progressively reduced the initial flexum currently at 25°, walking independently with crutches. The patient is awaiting surgery for aneurysm repair. Discussion and Conclusions: Rehabilitation must be focused on the person and not on a specific disease or setting. With technological evolution, we tend to look at more invasive techniques, forgetting the basics of rehabilitation. These cheap and easy to apply techniques make the difference in the patient's functionality, quality of life, and participation.

  6216 - Patients with cervical or high thoracic level spinal cord injury (SCI) infected by COVID-19: Specific issues of treatment Top

Asterios Kanakis, Sofia Sivetidou, Maria Nianiarou, Antonios Gkountoulas, Antonios Papaspyrou, Aikaterini Kotroni

Clinic of Physical Medicine and Rehabilitation GNA KAT, Kifissia, Athens, Greece

E-mail: [email protected]

Introduction: Patients with cervical or high thoracic SCI infected by COVID-19 are considered as a special care group in respect of the differential diagnosis and treatment of Sars-Cov-2 infection compared to the general population. Purpose: Emphasis on the diagnosis and treatment of patients with high SCI infected by Covid-19. Methods: We compare 2 patients of our clinic infected with Covid-19 during their hospitalization and bibliography review. Results: In high SCI, typical symptoms of a Covid-19 infection may be absent. Patients show reduced ability of cough, difficulty to manage pulmonary secretions, radiological imaging of atelectasis. Fever may be absent due to thermoregulatory disturbance. In case of fever, differential diagnosis from other infections, deep vein thrombosis and dysautonomia is necessary. Exacerbation of existing spasticity, constipation and mental stress can also lead to decreased respiratory capacity. In case of infection, patients need intensive respiratory physiotherapy and immediate mobilization. There is possible inability (reduced hands dexterities) to call for help, increased need for frequent position changes to avoid pressure ulcers, management of neurogenic bladder and bowel, while the absence of a caregiver in Covid clinics worsens the situation. In terms of treatment, no differentiation is proposed compared to the healthy population. Conclusions: Patients with high level SCI infected by Covid-19 constitute a special care group in relation to the general population, need vigilance in both the differential approach and treatment. Their peculiarities require special knowledge, instant reaction and sufficient number of staff. Special operations sometimes cause to increased exposure the health professionals, despite adherence to safeguards.

  6110 - Hypertrophic olivary degeneration: Cause of new neurological symptoms after stroke: Case report Top

António Paiva, Ana Carolina Lourenço, Luís Gil Andrade, Lilia Martins, Inês Lucas, Jorge Laíns

Centro de Medicina de Reabilitação da Região Centro, Rovisco Pais, Portugal

E-mail: [email protected]

Introduction: Hypertrophic olivary degeneration (HOD) is a very rare transsynaptic degeneration that affects the inferior olivary nucleus. It mostly develops secondary to a destructive lesion in brainstem or cerebellum, frequently caused by stroke, tumors, neurosurgical interventions, and gamma knife treatment of brainstem cavernoma. HOD is usually associated with palatal tremor and rarely with Holmes tremor. We report here one unusual case of Holmes tremor and HOD without palatal tremor. Patient Information and Clinical Findings: A 59-year-old male, suffered a right posterior paramedian pontomesencephalic hemorrhage, 4 weeks before admission in a Rehabilitation Center. He developed head tremor while lying down, which increased in amplitude when seated. Holmes tremor in the upper extremities and severe gait disturbances, as well as strabismus, were also present. No palatal tremor was observed. Although the patient did not show strength deficits, the change in coordination and the tremor greatly conditioned his autonomy, despite the intensive and multidisciplinary rehabilitation plan. MRI performed 2 months after the event revealed a hypersignal lesion, located inferiorly to the left in the bulb, in the location of the inferior olivary nucleus, arriving to the diagnosis of hypertrophic left olivary degeneration, secondary to the primary lesion. Discussion and Conclusions: Classically, palatal tremor usually develops many months after the primary lesion, although not all patients with HOD develop this symptom. According to the location of the lesion, different neurological manifestations may be present. MRI is the golden standard for demonstrating HOD. Unfortunately, knowledge is still limited. Rehabilitation therapy and symptomatic treatment can greatly enhance quality of life and prevent or mitigate early disability.

  5998 - Case report: Relapsing polychondritis and spondylarthropathy Top

Ryme El Beloui, Hajar Abouihsane, Sara Hadir, Fatima Lmidmani, Abdellatif El Fatimi

Department of Physical Medicine and Rehabilitation, CHU Ibn Rochd, Casablanca, Morocco

E-mail: [email protected]

Introduction: Relapsing polychondritis (RP) is a rare systemic disease in which recurrent bouts of inflammation, in some cases followed by destruction, affect the cartilage of the ears, nose, larynx, and tracheobronchial tree. Pathogenesis of RP involves an autoimmune response to as yet unidentified cartilage antigens followed by cartilage matrix destruction by proteolytic enzymes.[1] Patient Information and Clinical Findings: The patient is 18 diabetes type 1 insulin dependant. Medical history: goes back to the age of 8 and consists of 1 episode of nose chondritis, multiple episodes of chondritis and hypoacusis of the left ear, polyarthritis, recurring mouth ulcers and reduced visual acuity. The diagnosis of relapsing polychondritis associated to a non radiological spondylarthropathy rested on: Chondritis, HLA B27, The improvement with non-steroidal anti-inflammatory drugs, Polyarthritis Inflammatory arthralgia of the spine. Patient is taking Methotrexate + Non-steroidal anti-inflammatory drugs. Clinical exam: Intact ear and nose cartilages, Range of motion in cervical spine is limited (flexion+rotations) limited ROM in right ankle in flexion, Disctraction test and thigh thrust test: negative, Podoscopic examination: grade I Pes Planus+increased pressure on left heel. Orthopaedic insoles were prescribed, Hypertrophy of anterior tibial tuberosity on knees consistent with Osgood-Schlatter disease. Discussion and Conclusion: Replapsing polychondritis comes in various clinical symptoms, arthrisis is one of the most common ones. A concomitant autoimmune disease is present in 1/3 of patients with RP.The diagnosis rests on clinical grounds The drug regimen should be tailored to each individual patient based on disease activity and severity.

  5824 - Bilateral COVID-19 induced Achilles tendon shortening: A case report of successful rehabilitation Top

Iuly Treger1, Alon Friedman1, Michal Vered1, Elkrinawi Sliman1, Lena Lutsky Treger2

1Department of Rehabilitation, Soroka University Medical Center, Beer Sheva, Israel, 2Department of South, Clalit Medical Services, Beer Sheva, Israel

E-mail: [email protected]

Introduction: Musculoskeletal symptoms, such as fatigue, back pain, arthralgia, myalgia, low back pain, and neck pain are recognized complications of COVID-19 infection. Patient Information and Clinical Findings: We present the case of a 33-year-old female admitted to our rehabilitation department ward after 6 weeks in the corona ward, including intubation and ECMO. Upon admission, she presented severe bilateral Achilles tendon tightness. In light of the severity of the shortening, it was decided together with the Department of Orthopedics to perform Achilles tendon tenotomies. 2 days after the surgery she returned to the rehabilitation department in bilateral leg casts and non-weight bearing status for 2 weeks. Once the casts were removed, within days, she was able to ambulate with a rolling walker. At the admission after a 65-day stay in corona acute department: FIM–74. After 34 days in the Rehabilitation department before tendon extension surgery: FIM–106, BERG-37/56, TUG–40 sec. with wheeled walker, Ankle ROM – Lt-PF-70 degrees, Rt–DF–0. 61 days in the Rehabilitation department after tendon extension surgery: FIM–119, BERG–55/56, TUG-14.6 sec, DGI–20/24, Ankle ROM – Lt-full ROM, Rt-full ROM. The patient was hospitalized in rehabilitation department for 95 days and was discharged home. 63 days after discharge: BERG 56/56, TUG-13 SEC with crouch, DGI 21/24 with crouch. Discussion and Conclusions: COVID-19 infection can lead to tendon shortening among other musculoskeletal complications. This case demonstrates the importance for vigilance and an aggressive approach to resolving by interdisciplinary cooperation COVID-19 complications for achieving optimal rehabilitation potential.

  5693 - Buried bumper syndrome, a rare and severe complication of percutaneous endoscopic gastrostomy: Importance of early diagnosis in post-stroke patients Top

André Ribeiro, Adriana Pascoal, Sofia Moreira, Sandra Assunção, Filipe Neves, Xenia Verraest, João Constantino, Jorge Lains

Centro de Medicina de Reabilitação da Região Cento, Rovisco Pais, Portugal

E-mail: [email protected]

Introduction: Percutaneous Endoscopic Gastrostomy is considered a low-risk procedure, however passive of complications, with the majority been of mild severity. Among the severe complications, cases intitled “Buried bumper syndrome” (BBS) have been described. BBS corresponds to the migration of the internal fixation along the stoma tract, becoming lodged between the external wall of the stomach and the skin, which can be associated with local infection, peritonitis and/or necrotizing fasciitis. Case Description: On 06/03/2021 a 29 years old male patient, with no relevant medical history is admitted to the São João Hospital with an extensive midbrain and brainstem haemorrhagic lesion, shown on CT scan. The patient lost is oral route and ability to communicate. Due to insufficiency of the oral route, a PEG was placed on 05/31/2021, without complications. On 9/06/2021, the nursing team reported peri-stomal food losses and local inflammation. Due to the recurrence of complaints, CT was performed on June 23, reporting: “PEG, whose balloon is located between the median abdominal wall and the anterior surface of the left hepatic lobe”, compatible with the complication described as “ buried bumper syndrome.” The PEG was removed. On August 30th, a new PEG was placed. The nursing team reported the same complications as before, 3 days after the procedure. A control CT was requested, which reported the exteriorization of the PEG, with its inner end located in the epigastric abdominal wall. Discussion: The present case emphasizes the importance of correctly identifying the complications after undergoing PEG, as well as the risk factors and consequences associated with this syndrome, namely in patients with post-stroke status, whose communication is often compromised.

  5676 - A novel pediatric case report of facial palsy after spine surgery Top

Marzie Babaii1, Sara Maleki Kahaki1, Seyed Mansoor Rayegani1, Abdurrreza Farzan2

1Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, 2Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

E-mail: [email protected]

Introduction: A few facial palsy cases due to pressure have been reported in adults but not in children. This is the first case report. Patient Information: A 4-year-old girl complaining of lower limbs weakness was scheduled for thoracolumbar spine tumor resection. After the anesthesia induction, the surgery started with placing the patient in a prone position with the head (left side) on a jelly-like pillow. Operation time was 320 min. The left side of face edema and impaired motion of facial muscles was detected at the post-anesthetic care unit. Physical examination revealed impaired grimacing over ipsilateral forehead, incomplete left eye closure and mouth deviation to the right side. The EMG-NCS which was performed 14 days later, without any clinical improvement, showed low amplitude, prolonged CMAPs and no MUAPs in left side facial muscles with PSWs and fibrillations. Discussion: Etiologies of facial nerve palsy are numerous including idiopathic (most common), infection, trauma and neoplasm. Iatrogenic nerve injury, a type of traumatic injury, can result from many nonoperative and operative causes such as excess pressure against body parts or extensive pull. A temporary interruption of the blood supply to a nerve by mild compression results in a conduction block. More severe compression will lead to demyelination, axonal loss and denervational changes. This patient's electrodiagnostic study revealed a combination of these. A few similar cases have been reported in adults but not in children. We want to extend concerns about poor posture during anesthesia because proper padding could not eliminate the risk of nerve injury. In order to reduce such complications, pressure relief is recommended by changing the patient's position a few times during surgery.

  5590 - Multiple proximal right upper extremity nerve injuries associated with right upper arm hematoma following peripherally inserted central catheter placement Top

Yeseul Kim, Chulhyun Ahn

Department of Physical Medicine and Rehabilitation, Geisinger Health System, Danville, PA, USA

E-mail: [email protected]

Introduction: Approximately 1.6% of central venous catheter (CVC) placements a common hospital-performed procedure (over 5 million/year in the U.S.) are complicated by nerve injuries. Nerve injuries following CVC e.g. peripherally inserted central catheter (PICC) insertions can result from direct needle advancement into nerve branches or from post-insertion hematomas. There are a few reports of isolated nerve injuries associated with PICC insertion involving e.g. median and anterior interosseous nerves. However, to the best of our knowledge, this is the first reported case of complete nerve palsies of the median, radial and ulnar nerves after PICC insertion. Patient Clinical Presentation: We present a case of a 62-year-old male who developed complete loss of sensorimotor function at and below his right wrist 5 days after PICC insertion in his right upper arm. His initial complaint was right arm pain radiating down to his hand. Subsequent to PICC removal, patient reported acute loss of motor and sensory functions of his right hand and wrist. An MRI right arm revealed a proximal arm hematoma measuring 6.7x6.7x9.7cm. An EMG performed 4 days after the onset of neurologic deficits was consistent with a median neuropathy proximal to the origin of nerve branch to pronator teres, a right ulnar neuropathy proximal to the origin of nerve branch to flexor digitorum profundus, and a right radial neuropathy with lesion site between the origins of nerve branches to brachioradialis and triceps. His neurological deficits have improved slightly 3 months after symptom onset. Discussion Conclusions: Given CVC insertions are a common hospital-performed procedure, it is crucial to become aware of their potential complications including nerve injuries and the associated clinical presentations.

  5501 - Unique presentation of delayed cerebrospinal fluid leak in recurrent large volume peri-incisional hematoma following thoracic spine fracture and subsequent fusion: A case report Top

Erin Mundy1, John Lin2, Giorgio Negron1

1Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA, 2Shepherd Center, Spinal Cord Injury Program, Atlanta, GA, USA

E-mail: [email protected]

Introduction: Cerebrospinal fluid (CSF) leakage is a hazardous complication of dural tears resulting from spinal fractures. With sensitivity of 94%-100% and specificity of 98%-100%, beta-2-transferrin is the gold standard in detection of CSF leakage. However, its use is not frequently described in large volume body fluid samples, although it has been shown to be detectable in samples diluted eightfold by other fluids. Patient Information and Clinical Findings: This is a case of a 26 year old male who was involved in a tree falling accident, found to have severe acute dislocation of T11-T12 vertebral column resulting in complete paraplegia, and underwent laminectomy with posterior fusion of T9-L3. Patient was admitted to rehabilitation hospital on post-op day (POD) 9, where a peri-incisional hematoma was detected. The hematoma was aspirated, yielding 500 mL serosanguinous fluid. The hematoma required repeat aspiration on POD 15, yielding 540 mL serosanguinous fluid. A sample of the aspirated fluid was sent for beta-2 transferrin despite the large volumes of collection and otherwise asymptomatic presentation. The presence of beta-2 transferrin was confirmed, indicating the presence of CSF in the peri-incisional hematoma. The patient was placed on flat bedrest with abdominal compressive management, then had lumbar drain placed for definitive management, which was removed after 7 days without any further CSF leakage. Discussion and Conclusions: Given the risks associated with CSF leaks, even when clinical suspicion is low, beta-2 transferrin is a valuable tool for the detection of CSF in spinal incisional fluid collections.


  1. Haft GF, Mendoza SA, Weinstein SL, Nyunoya T, Smoker W. Use of beta-2-transferrin to diagnose CSF leakage following spinal surgery: A case report. Iowa Orthop J 2004;24:115-8.
  2. Normansell DE, Stacy EK, Booker CF, Butler TZ. Detection of beta-2 transferrin in otorrhea and rhinorrhea in a routine clinical laboratory setting. Clin Diagn Lab Immunol 1994;1:68-70.
  3. Marshall AH, Jones NS, Robertson IJ. An algorithm for the management of CSF rhinorrhoea illustrated by 36 cases. Rhinology 1999;37:182-5.

  Clinical Sciences – Complications – Spasticity Top

  6429 - Effects of extracorporeal shock waves on spasticity after stroke Top

Najia Hajjioui1, Abderrazak Hajjioui2

1Department of Pharmacy and Odontology, Faculty of Medicine, University Sidi Mohamed Ben Abdellah, Fez, Morocco, 2Department of Pharmacy and Odontology, Faculty of Medicine, Clinical Neuroscience Laboratory, University Sidi Mohamed Ben Abdellah, Fez, Morocco

E-mail: [email protected]

One of the major challenges in medical practice is the therapeutic management of spasticity as a frequent symptom after stroke. Its treatment when it is indicated can include several therapeutic aspects with several challenges, as such the development of the effectiveness of extracorporeal shock waves on the spastic muscle is necessary as a non-invasive technique and less expensive than According to numerous medical publications, this therapy is generally considered to be effective. The Therapeutic Protocol as well as the evaluation methods and several parameters vary according to the authors which require careful interpretation with more specific work based on the results of previous studies to have a standard therapeutic protocol.

  6982 - Protocol for the smart study: Effectiveness and safety of smart BoNT-A therapy with abobotulinumtoxin-A in patients with post-stroke chronic upper limb spasticity in real-life setting Top

Axel Schramm1, Emma Zaragatski2, Pascal Maisonobe3, Tobias Bäumer4

1Neurological Practice Fürth, Rudolf-Breitscheid-Straße, Fürth, Germany, 2Ipsen, Einsteinstraße, München, Germany, 3Ipsen, 65 Quai Georges Gorse, Boulogne-Billancourt, France, 4CBBM, Institut für Neurogenetik, Universität zu Lübeck, Lübeck, Germany

E-mail: [email protected]

Background and Aims: Current DGN (German Society for Neurology) guidelines recommend botulinumtoxin-A (BoNT-A) injections for patients with focal spasticity. However, only about 10% of patients with disabling spasticity after stroke are treated according to these guidelines.[¹] The SMART (spastic muscle palpation by anatomic landscape for BoNT-A injection to reduce muscle tone) injection concept is designed for abobotulinumtoxin-A (aboBoNT-A, Dysport®) treatment in pre-selected patients living with simple patterns of adult upper limb spasticity (ULS) with mainly passive goal setting. Using this approach, the injection can be simplified making BoNT-A treatment more accessible, especially for office-based neurologists. The study will assess the effectiveness of aboBoNT-A SMART therapy for ULS by evaluating Disability Assessment Scale (DAS) in the Principal Target of Treatment (PTT), Modified Ashworth Scale (MAS) at the Primary Target Muscle Group (PTMG), pain and quality of life. The use of aboBoNT-A SMART therapy and its safety in real life setting will also be described. Methods: The SMART study (NCT05224349) is a prospective, multicentre, observational study that will include 116 patients suffering from post-stroke chronic ULS. It will cover two injection cycles and will be conducted in Germany. The primary endpoint will be the change of DAS in PTT for the upper limb at Visit 3 (12-16 weeks after injection at Visit 1) versus. baseline. Results: Full results of the SMART study will be available in 2024. Conclusion: The SMART study will be the first prospective observational study to evaluate the effectiveness and safety of aboBoNT-A SMART therapy for ULS and it aims to provide proof of concept for the SMART injection for ULS.


  1. Potempa C. MVF 2019;12:65-72.

  6653 - Spasticity in children with cerebral palsy: How badly does it affect quality of life Top

Marwa Ghanmi 1, Sahbi Mtawaa2, Nedra El Feni2, Toulgui Emna1, Walid Wannes1, Sonia Jemni1

1University Hospital Sahloul, Sousse, Tunisia, 2University Hospital Kairouan, Kairouan, Tunisia

E-mail: [email protected]

Background and Aims: Cerebral palsy (CP) is secondary to a lesion of the central nervous system when still developing often associated with tonus disorders such as spasticity. The objective of this work is to evaluate the quality of life (QOL) by a self-administered questionnaire with mothers and their children and to determine the impact of spasticity on it. Methods: This is a cross-sectional study concerning children followed in rehabilitation functional for cerebral palsy. Quality of life was assessed by a questionnaire validated in its Arabic version: the Cerebral Palsy Quality of Life Child questionnaire (CP-QOL child). Results: We included 68 children. Spasticity was present in 63 CP children (i.e. 92.5%). it was not associated with a significant alteration in the QOL of the CP children when compared to other presentations of CP ( 0.485) Discussion: Contrary to some other studies, we did not find any correlation between the presence of spasticity and QOL in CP children. This discrepancy is explained by the use of different questionnaires for the evaluation of the QOL and by the fact that neither the clinical characteristics of spasticity nor its impact has been evaluated on this work. Conclusion: The evaluation of spasticity must be completed with the search for pain and functional impacts to better guide treatment.

  6310 - Utilising ultrasound guidance to improve patient outcomes from botulinum toxin injections into Psoas major Top

Rebecca Haigh, Clive Bezzina

North Staffordshire Rehabilitation Centre, Haywood Hospital, Stoke on Trent, UK

E-mail: [email protected]

North Staffordshire rehabilitation centre previously completed Botulinum Toxin injections to Psoas Major utilising a posterior approach as described by Prof. Ward.[1] This procedure requires use of spinal needle utilising anatomical landmarks and can be uncomfortable for the patient occasionally leading to significant spasms during the procedure. New point of care ultrasound availability has allowed us to further develop this technique and procedure can now be completed with greater comfort to the patient using a 1.5 cm length needle. Initial outcomes show significant improvement including improved tolerance of procedure, improved efficacy of injections in achieving patient goals and improved longevity of injection affect. The procedure is also favoured by AHPs who feel more confident in completing this injection. No complications from either anatomical or ultrasound guidance have been reported at the centre but theoretical risk of complications such as psoas haematoma should be reduced by use of Ultrasound Guidance.


  1. Ward AB. Eur J Neurol 1999;6 Suppl 4:s91-3.

  6385 - Sudden increase of spasticity in a patient with spinal cord injury: An unusual case report and its comprehensive approach Top

Rafaela Evangelista1, Vera Ermida1, Tiago Félix1, Bruno Lopes1, David Coutinho1, Elisa Moreira1, Andreia Silva1, Jorge Caldas1, Daniel Cardoso2, Marta Dias2, Pedro Leonel Almeida1

1Department of Physical Medicine Rehabilitation, Centro Hospitalar Tondela-Viseu, Viseu, Portugal, 2Department of Radiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal

E-mail: [email protected]

Introduction: Spasticity is a disabling sequelae of SCI, but also an important physiologic response to illness or other stressors. The physiatrist has a key role in recognizing, treating, and developing an effective plan focused on patient's individual goals. Patient Information and Clinical Findings: An active 22-year-old man with T8 complete paraplegia reported sudden increase of spasticity, interfering with transfers and ADLs. No history of trauma, signs/symptoms of urinary infection or altered skin integrity. Bladder and bowel programs remained stable. Had equal neurologic level, with marked hyperreflexia, clonus and frequent extensor spasms. Labs were unremarkable. Rest was recommended (he stopped practicing wheelchair handball), oral antispasmodics dosing was increased and administration of botulinum toxin anticipated, without clinical improvement. One month later, he noticed slight swelling of the left knee. Normal knee X-ray. On ultrasound, there was obvious thickening of the left sciatic nerve involving its full length, until the subgluteal space, where an important change was also noticed in the structural organization of the subgluteal muscles (haematoma?). Hip MRI showed marked inflammatory changes of the left subgluteal space with unquestionable signs of sciatic nerve compression and left iliac and acetabulum edema. Anti-inflammatory therapy was introduced, with clinical improvement. Discussion and Conclusions: This unusual case is presented for its diagnostic difficulties and challenging therapeutic choice. Altered spasticity is often a symptom as much as a warning sign and quick management is crucial to achieve satisfactory results. In this case, the increased spasticity was probably due to traumatic compression of the sciatic nerve related to high impact transfers.

  6275 - Clinical assessment and muscle ultrasound in post-stroke spasticity: Preliminary results from a prospective observational study Top

Davide Dalla Costa1, Edoardo Pisani2

1Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy, 2ASST Santi Paolo e Carlo, Milan, Italy

E-mail: [email protected]

Background and Aims: Spasticity due to the upper motor neuron syndrome (UMNS) may lead to muscle stiffness as disease-related alterations in tissue properties. Ultrasonography (US) reveals morphological changes in spastic muscle architecture. The aim of this study is to evaluate the association between US muscle modifications and clinical assessment, presuming its predictive role to estimate spasticity onset in post-stroke patients. Methods: This is a prospective observational study. US echointensity (EI) was examined by Modified Heckmatt Scale (MHS). It is a 4-point ordinal scale in which normal muscle is grade 1 whereas grade 4 shows extreme fibrosis (hyperechoic like bone). Grade 2 estimates increase of 10-50% of EI tissue, grade 3 a marked EI increase (50-90%) with reduced distinction of bone echo from muscle. Clinical spasticity was assessed with Modified Ashworth scale (MAS). US images of extremities were taken using standardized locations and positioning for each muscle. Included muscles were flexors of elbow, wrist and fingers, rectus femoris, triceps surae. Clinical and US measurements were recorded 3-12 days after stroke, then 3, 6, 12 months later. Spearman's coefficient correlation was applied between MAS and MHS. Results: 26 participants were enrolled in this study. 16 ischemic, 10 hemorrhagic stroke. MAS and MHS scores were found to be correlated considering upper limb flexors (p< 0,00005), rectus femoris (p<0,0005) and plantarflexor muscles (p<0,0001). Conclusions: These preliminary results suggest that US may be a valid approach to study spasticity from the early UMNS stage. The HMS can reliably evaluate echogenicity in spastic muscle, indicating the level of fibrotic change, according to MAS assessment. These tools can be effective identifying individuals needing treatment for spasticity.

  6264 - Evaluating muscle changes with ultrasound implications for clinical management: A narrative review Top

Eve Boissonnault1, April Hyon2, Michael C. Munin2, Mirko Filippetti3, Alessandro Picelli3, Rajiv Reebye4

1Department of Physical Medicine and Rehabilitation, Edouard-Montpetit, Université de Montréal, Montréal, Canada, 2Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, USA, 3Department of Physical Medicine and Rehabilitation, University of Verona, Verona, Italy, 4Department of Physical Medicine and Rehabilitation, UBC Faculty of Medicine, Kelowna, Canada

E-mail: [email protected]

Background and Aims: Botulinum toxin (BoNT) injection using ultrasound (US) guidance for spasticity has led to research evaluating changes in muscle fibrosis and whether this may affect outcomes. We aim to provide a narrative review of US muscle architecture changes following central nervous system (CNS) lesions, describe their relationship to spasticity and explore how US can be used for evaluation of echo-intensity (EI). Methods: Medline, CINAHL and Embase databases were searched with keywords: ultrasonography, muscle tonus, hypertonia, spasticity, fibrosis and Heckmatt. 3 physicians reviewed results of the search to select relevant papers. 3 others added known key papers to complete the literature overview. Results: 61 papers were included. 3 themes were identified: histopathological muscle changes post CNS lesions, effects of BoNT and analysis of muscle changes using US. Histopathological studies revealed muscle atrophy and increase in fatty tissue and extracellular matrix after CNS lesions in animals and humans. Several papers described BoNT injections contributing to muscle atrophy, increase in collagen and decrease in myosin heavy chains on histological slides. These changes translated in decrease in muscle thickness and increase in EI on US images. Two studies suggested a reduced efficacy of injections in muscles with increased EI. One study validated the modified Heckmatt scale (MHS) for grading muscle EI in spasticity. Conclusions: Animal and human studies describe muscle changes post CNS lesions. Muscle fibrosis may affect spasticity treatment outcomes. The use of US and the MHS may be an important tool to assess the level of muscle fibrosis in spasticity and delivery of BoNT. Further epidemiological studies are needed to determine the incidence of these EI changes and how they affect function and treatment outcomes.

  6207 - Functional changes in ambulant children with cerebral palsy after selective dorsal rhizotomy Top

Julian Enrique Caro Moreno, Juan Camilo Mendoza Pulido

Universidad Nacional de Colombia, Bogotá, Colombia

E-mail: [email protected]

Background and Aims: Cerebral palsy (CP) is the main cause of childhood motor disability. They are classified according to the Gross Motor Functional Classification System (GMFCS): in levels of I - V. The spastic form is the most common form of CP. Selective dorsal rhizotomy (RDS) reduces spasticity in the lower extremities with the potential for functional improvement. The Gross Motor Function Measure-66 (GMFM-66) is an outcome measure of gross motor abilities. Objectives: To describe the functional motor outcomes of ambulatory children with spastic form of CP, using the GMFM-66, who underwent RDS in a single referral institution, compared to matched controls without RDS. Methods: Retrospective data from 2009 to 2021 were reviewed. 13 children undergoing RDS were identified. For comparability, the matching criteria were age, GMFCS and GMFM-66 scores at baseline assessment, and time of follow-up. 2 control grous were obtained. Results: The SDR group was made up of 4 girls (F) and 9 boys (M), while the 2 control groups were made up of 5 (F) and 8 (M), and 7 (F) and 6 (M), respectively. The distribution of GMFCS was the same for the three groups: 3 children with GMFCS level I (GMFM-66 percentiles 15-50 Vs 10-30 and 15-60), 6 children of level II (40-80 percentiles Vs 35- 75 and 30-60) and 4 level III children (45-80 percentiles Vs 45-80 and 30-60). Conclusions: The intervention group presented higher values in the motor functional outcome scores, with a statistically significant difference in the absolute value of the first group and with a close trend in the second group.

  6148 - The place of botulinum toxin A in the management of spasticity in the pediatric population with cerebral palsy: Experience of the department of Physical Medicine and Functional Rehabilitation, Mohammed VI University Hospital, Oujda, Morocco Top

Elmir siham1, Ahmed Amine El oumri2

1Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Pharmacy, Immunohematology/Cellular Therapy Laboratory Adults and Children (LIHTC), Mohammed First University, Oujda, Morocco, 2Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco

E-mail: [email protected]

Background and Aims: Cerebral palsy (CP) is the leading cause of motor disability in children and is a public health problem in Morocco. The spastic form is the most frequent condition. The aim of this work was to objectify the effects of botulinum toxin A on the functional and orthopedic plan as well as on the comfort, hygiene and dressing after injection. Methods: Retrospective descriptive study of 54 children with cerebral palsy over a 2-year period. Patients underwent clinical and analytical evaluation, assessment of spasticity severity using the modified Ashworth scale and the modified Tardieu scale. Results: The mean age of our patients was 4 years. Clinical examination classified our patients as: hemiplegia (23) 42%, quadriplegia (17) 31.4%, diplegia (10) 18% and unclassified (4) in 7% of cases. The clinical results were satisfactory in (85%) of the children, whose clinical and analytical evaluation after botulinum toxin A injection found an Ashworth score of 3-4 to 2, a Tardieu score of 3-4 to 2, resulting in a significant decrease in muscle tone facilitating passive mobilization. Unsatisfactory results in 8 cases of patients who had not followed a post-injection motor rehabilitation program (for family reasons). Functionally in the group of walking children, the injection of the sural triceps muscle had an effect in addition to increasing the passive amplitude of ankle dorsiflexion, it resulted in a measurable improvement in walking through the use of specific scales to analyze walking in PC children. Conclusion: The use of botulinum toxin coupled with rehabilitation appears to be more effective. It is a safe therapeutic tool to improve the quality of life and functional recovery of children with cerebral palsy.

  6147 - Characterising the various clinical presentations and phenomenology of upper motor neurone syndrome associated muscle overactivity: Implications for management Top

Ahmad Saif1, Siobhan Barrie2, Anton Pick2

1Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom, 2Oxford Centre for Enablement, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom

E-mail: [email protected]

Background and Aims: Spasticity, a positive feature of the upper motor neurone (UMN) syndrome, can reduce function and impact quality of life. Oral anti-spasmodics and Botulinum toxin (BoNT) injections are well-established treatments, but outcomes vary. Our study aimed to explore factors that might shape treatment outcomes. Methods: 3 months of prospectively collected data from a specialised multidisciplinary spasticity clinic was analysed. Positive features of the UMN syndrome were categorised as spasticity, spasms, associated reactions, co-contraction and dystonia. Results: 121 patient encounters were analysed (54% male, mean age 47±19.7years). The most common aetiologies were Stroke 35%, Cerebral Palsy (CP) 25%, Multiple Sclerosis (MS) 15%, Traumatic Brain Injury (TBI) 6% and Spinal Cord Injury (SCI) 4%. UMN presentation differed between aetiologies. BoNT injections to the upper limb were most frequently used in Stroke (77%) and TBI (72%), with lower limb injections predominant in CP (76%), MS (74%) and SCI (60%). Outcomes from BoNT injections were best in those with MS (92% rating as 'a little better' or 'much better') followed by CP (85%) then stroke (83%). More patients with TBI (25%) and SCI (25%) rated 'no effect' or 'slight worsening'. Patients with MS were most frequently taking more than 1 anti-spasmodic medication (22%). Conclusion: The variability in presentation of the UMN syndrome may explain inconsistent treatment outcomes. Some presentations appear to require a combination approach with oral anti-spasmodics and BoNT injections such as spasms in MS, others, such as pure spasticity appear to be best treated with focal injections. More research is required to study tailoring treatment approaches to the different positive features of the UMN syndrome.

  5895 - Real world post stroke spasticity management including shoulder muscles: Which muscles and how much botulinum toxin? Top

Sérgio Pinho1, Luísa Medeiros2, Filipa Correia2, Adriana Pascoal3, Ricardo Sousa2, Jorge Jacinto2

1Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal, 2Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal, 3Centro de Medicina de Reabilitação da Região Centro, Rovisco Pais, Portugal

E-mail: [email protected]

Background and Aims: Botulinum toxin type A (BoNTA) is an effective therapeutic strategy to post-stroke spasticity (PSS). This study aims to analyze most frequently treated shoulder muscles and assess doses used, according to limbs or segments treated per session. Methods: Retrospective analysis of prospectively, non-interventionally collected data of PSS patients treated with BoNTA in 2001-2021. Treatment sessions that involved shoulder muscles were analyzed and divided in 2 groups, according to segments treated per session (upper limb: G1 vs upper + lower limbs: G2). Groups were compared for total and shoulder BoNTA doses as well as shoulder percentage of total dose (SPSS v.25). Results: A sample of 1183 treatment sessions was analyzed. Mean patient age was 57.02 years, 51.6% males, 56.8% ischemic strokes, treated with: 68.4% Abobotulinum BoNTA, 15.5% Incobotulinum, 16.1% Onabotulinum. Most frequently injected shoulder muscles were: Subscapularis (61.3%), Pectoralis Major (60.5%), Deltoid (26.6%), Supraspinatus (7.6%), Trapezius (7.1%) and Latissimus Dorsi (6.5%). G1 included 387 sessions and G2 796 sessions. Total doses were within label for Abobotulinum and Incobotulinum and up to 25% above label for Onabotulinumm toxin. Doses per muscle were within label per brand, when applicable. Mean total doses were higher in G2 in all 3 BoNTA formulations (p<0.001). However, mean percentage shoulder/total doses were significantly higher in G1 (p<0.001). Conclusions: Shoulder muscles received 20-28.5% of total doses, when only upper limb was treated and 15-17.5%, when both upper and lower limb were treated. This is not surprising as most literature available describes a reduction of dose per muscle when more muscles are injected per session.

  5789 - Design of a global inter-rater reliability study of the post-stroke spasticity referral tool Top

Jorg Wissel1, Paul Winston2, Gerard E. Francisco3, Ganesh Bavikatte4, Rhoda Allison5, Barry Rawicki6, John McGuire7, Alessandro Picelli8, David M. Simpson9, Maria de Mello Sposito10, Nabilah Alibhai11

1Vivantes Klinikum Spandau, Berlin, Germany, 2University of British Columbia, Vancouver, Canada, 3UT Health, McGovern Medical School, Houston, USA, 4The Walton Centre NHS Foundation Trust, Liverpool, UK, 5Department of Stroke Rehabilitation, Torbay and Southern Devon NHS Foundation Trust, Torbay, UK, 6Monash Children's Hospital, Clayton, Australia, 7Medical College of Wisconsin, Milwaukee, WI, USA, 8University of Verona, Verona, Italy, 9Icahn School of Medicine at Mt. Sinai, NY, USA, 10Hospital Regional de Sorocaba, Hospital Dr Adib Domingues Jatene, Sao Paulo, Brazil, 11AbbVie, Irvine, CA, USA

E-mail: [email protected]

Background and Aims: Post-stroke spasticity (PSS) occurs in ≈58% of stroke survivors. The simple, 1-page PSS Referral Tool was developed to facilitate PSS early identification and referral by clinicians involved in stroke rehabilitation. Red, yellow, and green colors indicate urgent referral to a spasticity specialist, routine referral with a recommendation for multidisciplinary team consult, or periodic monitoring, respectively. To validate the PSS Referral Tool use in clinical practice, an inter-rater reliability (IRR) study will be conducted. Methods: This 3-part observational, prospective study will use the PSS Referral Tool to assess and classify patients with varying degrees and types of spasticity. Part A will consist of investigators at 2 sites recording 30 clinical assessment videos using a semi-structured script based on PSS Referral Tool categories. In Part B, 4 clinicians will select 15 videos (5 each for red, yellow, and green) for IRR assessment. In Part C, stroke rehabilitation clinicians recruited from 6 global regions will classify 5 randomly assigned videos into appropriate categories in 3 separate sessions. Results: This study will report the intraclass correlation coefficient (ICC) for IRR of the PSS Referral Tool, using a 2-way random effect model ICC with 95% confidence intervals. Sample size calculation for 80% power (alpha=0.05) determined a need to recruit 270 clinicians stratified by 2 categories or 540 for 4 categories of PSS Referral Tool experience. ICC values range from 0.0 to 1.0, with higher scores indicating a more stable instrument. Conclusions: This study aims to ensure that the PSS Referral Tool possesses sufficient sensitivity and specificity for meaningful use by clinicians regardless of experience.

  5694 - Non-pharmacological treatment of spasticity in cerebral palsy Top

Meriam Hfaidh, Zeineb Mrizak, Najla Mouhli, Kais Ben Amor, Hajer Rahali, Imene Ksibi, Rim Maaoui

Department of Physical and Rehabilitation Medicine, Military Hospital, Mont Fleury, Tunis, Tunisia

E-mail: [email protected]

Background and Aims: Spasticity is one of the main causes of disability in children with cerebral palsy. The management of spasticity associates pharmacological and non-pharmacological treatments. The aim of our work is to study non-pharmacological treatments of spasticity in cerebral palsy. Methods: This is a retrospective, descriptive study including children who were followed in the Physical Rehabilitation Medicine Department of the Military Hospital of Tunis between the year 2000 and 2016. We studied the non-pharmacological treatments for spasticity used during the follow-up of the patients. Results: 67 files were treated, 61 children had spastic form. The mean age was 7.8±4.7 years. The sex ratio was 1.23. Inhibition of spasticity by motor rehabilitation was based mainly on stretching and antispastic postures, repetition of functional tasks,aerobic exercices, muscle training and progressive resistance exercices. Physiotherapy was prescribed for all patients and was performed on a regular basis at a rate of 3 times/week for 78% of cases and 2 times/week for 22%. Occupational therapy management of spasticity (29% of cases) was based on constraint-induced movement therapy (CIMT) and mirror therapy (MT). Self-rehabilitation was prescribed in all patients with 66% compliance. Postural orthoses were also prescribed, notably knee ankle foot orthoses in 60% of cases, Ankle-foot orthoses in 51% of cases and wrist-hand orthoses in 4.5% of cases. Conclusion: Stretching, postures, CIMT, MT, orthoses and self-rehabilitation are the main non-pharmacological treatments used in our department to fight spasticity in cerebral palsy.

  4495 - Functional outcomes in ambulatory children with cerebral palsy intervened with selective dorsal rhizotomy in a children's rehabilitation hospital in Bogotá Top

Julian Enrique Caro Moreno, Javier Rubio Delgado Martínez

Universidad Nacional de Colombia, Bogotá D.C, Colombia

E-mail: [email protected]

Background ans Aims: Selective dorsal rhizotomy (SDR) is a surgical treatment for spasticity in ambulant children with cerebral palsy (CP), that may improve functional outcomes after surgery. The aim of the study was to describe the functional outcomes of a sample of children with spastic CP functional levels GMFCS I, II and III, who were treated with SDR in a reference institution. Methods: Prospective data from children intervened between 2010 and 2020 were reviewed. Inclusion criteria were age <18 years old with independent walking ability. Functional scores of GMFM-66, 6MWT and PEDI were analyzed before and after SDR. </em>. Results: 10 patients (8 males) were included, with mean age 5.01 years (±1,38), functional GMFCS levels I=2 (20%), II=6 (60%) and III=2 (20%). Results of the functional tests before and after surgery were 58.04% (±5.2) and 65.17% (±6.64) for the GMFM-66; 245m (±77.4) and 289m (±35.7) for the 6MWT; and 62.4% (±11.01) and 736% (±7.45) for the PEDI mobility. The average times between pre- and post-operative assessments were 16.5 (±15.6), 11.2 (±5.5) and 16.4 months (±2.9). GMFM-66 difference before and after surgery was significant (Friedman test p=0.008). Spasticity index based on the modified Ashworth scale in the lower limbs showed a decrease from 1.75 (right) and 1.66 (left) to 1.05 and 1.25, respectively. No statistical comparisons were made for the other functional tests due to missing data. Conclusions: Improvement in functional motor skills and decreased spasticity were found in ambulatory children who underwent SDR.

  4492 - Treatment of focal spasticity with botulinum toxin in more than one member in adults post traumatic brain injury or stroke Top

José Vítor Gonçalves1, João Capelo2, Margarida Costa Pereira1, Joana Marques dos Santos1, Jorge Jacinto2

1Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal, 2Centro de Medicina de Reabilitação de Alcoitão, Alcoitão, Portugal

E-mail: [email protected]

Background ans Aims: Spasticity is a complication that occurs in traumatic brain injury (TBI) and stroke. Botulinum toxin type A (TB) is an effective and safe treatment for focal spasticity. Our goal was to characterize our clinical practice regarding the management of spasticiy using TB in a Rehabilitation Center in adult patients with sequels of TBI or stroke, needing treatment in more than one limb, and to describe dose distribution per limb while respecting the maximum recommended dose. Methods: Data collected from records, regarding TB treatment sessions conducted between January 2012 to December 2017. Results: TBI - 223 treatment sessions in 101 patients. TB used: Abobotulinum (ABO) in 63%, Onabotulinum (ONA) in 23% and Incobotulinum (INCO) in 14%. The mean total dose, as a percentage of the maximum dose approved on label was: ABO 75% (1125/1500U), ONA 97% (388/400U), INCO 61% (305/500U). One or more members treated per session: 1 - ABO (55%), ONA (75%), INCO (40%); 2 - ABO (100%), ONA (125%), INCO (20%); 3 - ABO (67%) and INCO (100%); 4 - ABO (116%). Stroke with 1057 therapeutic sessions in 117 patients. TB used: ABO in 69%, ONA in 13% and INCO in 17%. The mean total dose, expressed as a percentage of the maximum dose on label was: ABO 74% (1110/1500U), ONA 92% (368/400U), INCO 80% (400/500U). One or more members treated per session: 1 - ABO (56%), ONA (69%), INCO (54%); 2 - ABO (81%), ONA (100%), INCO (86%). Conclusion: To more limbs/muscles treated per session, corresponded higher total doses. The doses used per muscle were usually within the recommended ranges.The percent differences between INCO and ONA are mostly due to the different doses approved in Portugal. The dose distribution for the different toxins was similar in TBI and stroke patients.

  4432 - Iatrogenic intrathecal baclofen (ITB) pump overdose mimicking multiple sclerosis (MS) exacerbation: A case series Top

Sindhoori Nalla, Christopher Reger

Department of Physical Medicine and Rehabilitation, Northwestern University/Shirley Ryan AbilityLab, Chicago, IL, USA

E-mail: [email protected]

Background and Aims: ITB pumps are often used to treat spasticity in neurological diseases such as MS. Management requires specialized training and a thoughtful approach in balancing spasticity and function. Common signs of ITB overdose are respiratory depression, seizures, and coma, but subtle findings such as truncal instability, hypotonia, and weakness can be confounded by preexisting neurological disorders, and difficult for physicians unfamiliar with ITB pump management to recognize. We highlight two rare cases where neurological decline thought to be from MS progression was determined by physiatry to be due to iatrogenic ITB pump overdose, with notable improvements after dose reduction. Methods: Two patients with MS and ITB pump for spasticity were evaluated by physiatry for rehabilitation of MS relapses. Both patients, one on complex flex dosing ITB and the other on simple continuous dosing ITB, presented with years of progressive truncal weakness and functional decline to the point of being nonambulatory and requiring slide board for transfers. Adjustments in disease modifying agents did not result in clinical improvement. Exam revealed postural abnormalities and profound lower extremity weakness without notable spasticity, raising concern for iatrogenic ITB toxicity. In both cases, ITB pump was set to simple continuous rate and slowly decreased over months, with both patients progressing to modified independence for ambulation/transfers. Results: Both patients' function improved with a decrease in ITB pump dosing, despite previous suspicion that neurological decline was from MS. Conclusions: It is important for physiatrists to be aware of subtle signs of iatrogenic ITB pump overdose in spasticity patients who present with an unexplained decline in functional status.

  4362 - Rapid improvement of upper limb function and walking speed by botulinum toxin treatment for spasticity in a chronic stroke patient Top

Takayuki Mori, Shin-Ichi Izumi

1Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan

E-mail: [email protected]

Background and Aims: A 62-year-old Japanese man developed cerebral hemorrhage from the left parietal lobe to corona radiata 14 years ago. He gradually recovered the ability to walk with the support of a cane and orthosis, and continued to receive rehabilitation twice a week. However, the patient had spasticity of the right elbow and ankle. He was admitted to our hospital for ten days to improve upper and lower limb function. Methods: He received botulinum toxin injection into the upper and lower limb muscles. We identified the muscles using ultrasound. We evaluated the upper limb function using the Wolf Motor Function Test (WMFT). His gait performance was evaluated using the ActiGraph accelerometer during the 6-min walk test. We analyzed the acceleration using the vector magnitude for each minute. It was calculated as the square root of the sum of the squares of the three axes.[1] Furthermore, three-dimensional gait motion analysis was conducted before and eight days after the injection of botulinum toxin. Results: The spasticity of the right elbow, finger, and ankle was reduced after treatment. During WMFT performed eight days after the injection, the patient could lift a pencil, and fold a towel. In the vector magnitude, the average for each one minute improved. In the three-dimensional movement analysis, stride length and walking speed improved. Conclusions: Within the short hospitalization period, the spasticity decreased, and upper limb function and walking speed improved. This short term improvement could be attributed to the accurate identification of the muscle by ultrasound and continued intensive rehabilitation.


  1. Koster A, Shiroma EJ, Caserotti P, Matthews CE, Chen KY, Glynn NW, et al. Comparison of sedentary estimates between activPAL and hip- and wrist-worn ActiGraph. Med Sci Sports Exerc 2016;48:1514-22.

  6987 - Cryoneurolysis of the femoral nerve for the treatment of focal spasticity in an ambulatory patient Top

Fraser MacRae1, Mahdis Hashemi2, Paul Winston3, Eve Boissonnault4

1University of Victoria, Victoria, BC, Canada, 2Vancouver Island Health Authority, 1 Hospital Way, Victoria, BC, Canada, 3University of British Columbia, Vancouver, BC, Canada, 4University of Montreal, Montreal, QC, Canada

E-mail: [email protected]

Background and Aims: Spasticity of the lower limb, common amongst patients with Multiple Sclerosis (MS), may lead to reduced knee flexion impairing gait. Cryoneurolysis is an emerging technique for the management of spasticity. Our aim was to demonstrate cryoneurolysis of the femoral nerve for the longer-term management of spasticity, as seen in MS. Methods: A 71-year-old woman with a history of MS undergoing lower limb spasticity, sensory axonal distal polyneuropathy and degenerative musculoskeletal problems is followed. She had previously undergone a cryoneurolysis to the right tibial nerve. Cryoneurolysis of the right femoral nerve was performed under ultrasound and e-stimulation guidance. 3 lesions were created at different places along the nerve by freezing for 106 seconds at each site. Results: One month after the procedure, muscle tone improved as per the Modified Ashworth Scale (MAS) from 3 to 2. Maximum knee extension passive angle and catch angle (V1 and V3 respectively - Tardieu Scale) remained the same as baseline (115°, 70°). Catch angle against gravity (V2 - Tardieu Scale) improved from 35° to 45°. Time on the 10m walk test improved from 20.14s to 12.55s with hip flexion assist brace and from 21.15s to 13.17s without a brace. After 3 months, MAS remained at 2; V1, V2, and V3 increased to 125°, 55°, and 75° respectively; and the 10m walk test improved to 12.49s with a brace and slowed to 14.82s without. She is approaching her goal of increasing gait confidence, and has met her goals relating to gait speed and positioning of the foot during gait. Conclusion: Cryoneurolysis is effective as a novel treatment for lower limb spasticity in MS. This treatment may be considered for patients presenting with lower limb spasticity resulting in reduced knee flexion.

  6721 - Acutely worsened dystonia and spasticity following liver transplant in a patient with Wilson's disease: Inpatient rehabilitation and intrathecal baclofen management Top

Oliver Acosta, Majaliwa Mzombwe, Lauren Cuenant, Nicole Pontee, Joslyn Gober

Department of Physical Medicine and Rehabilitation, Jackson Memorial Hospital, University of Miami, Miami, FL, USA

E-mail: [email protected]

Introduction: Wilson's disease is an autosomal recessive disorder defined by impaired copper metabolism in which toxic copper deposits in the liver and brain result in the clinical manifestations of liver failure and cirrhosis, and a range of neurological conditions including dystonia, Parkinsonism, seizures, and others. It can be treated medically, but once patients reach hepatic failure, orthotopic liver transplantation (OLT) is appropriate, with most cases having improvement in both liver and neurologic manifestations. Patient Information and Clinical Findings: A 20-year-old male diagnosed with Wilson's disease in August 2020 developed cirrhosis and required OLT in December 2020. His initial post-operative period went well with improvements noted in his weight and degree of neurologic impairment. However, by September 2021 he developed a decline in his functional status, with worsening spasticity, dysarthria, and inability to ambulate. He was hospitalized in November 2021 and despite maximum doses of multiple medications these movements persisted. He responded well to an intrathecal baclofen trial and underwent pump implantation in December 2021. Afterward, he was admitted to acute inpatient rehabilitation for intrathecal baclofen management and dosing optimization. Discussion and Conclusions: While most patients who require OLT show significant improvement in both their hepatic and neurologic symptoms, this case illustrates a rare, acute worsening of his spasticity with severe functional decline, resulting in the novel application of intrathecal baclofen treatment. While he continues to require optimization and may benefit from further interventions, such as deep brain stimulation, he experienced significant improvements in spasticity and activities of daily living after pump placement and inpatient rehabilitation.

  6674 - Barriers to upper extremity reconstruction for patients with cerebral palsy Top

Scott Loewenstein1, Francisco Angulo Parker2

1Medical College of Wisconsin, Milwaukee, Wisconsin, USA, 2Riley Hospital for Children, Indianapolis, IN, USA

E-mail: [email protected]

Background and Aims: Reconstructive surgery for upper extremity manifestations of cerebral palsy (CP) has been demonstrated to be safe and effective, yet many potential candidates are never evaluated for surgery. The purpose of this study was to determine barriers to upper extremity reconstruction for patients with CP in a cohort of upper extremity surgeons and nonsurgeons. Methods: We sent a questionnaire to 4167 surgeons and nonsurgeon physicians, aggregated responses, and analyzed for differences in perceptions regarding surgical efficacy, patient candidacy for surgery, compliance with rehabilitation, remuneration, complexity of care, and physician comfort providing care. Results: Surgeons and nonsurgeons did not agree on the literature support of surgical efficacy (73% vs 35% agree or strongly agree, respectively). Both surgeons and nonsurgeons felt that candidates exist, yet there was variability in their confidence in identifying them. Most surgeons (59%) and nonsurgeons (61%) felt comfortable performing surgery and directing the associated rehabilitation, respectively. Neither group reported that patient compliance, access to rehabilitation services. Both groups agreed that surgical treatments are complex and should be performed in the setting of a multidisciplinary team. Conclusions: Surgeons and nonsurgeons differ in their views regarding upper extremity reconstructive surgery for CP. Barriers to reconstruction may be addressed by performing higher level research, implementing multispecialty educational outreach, developing objective referral criteria, increasing surgical remuneration, improving access to trained upper extremity surgeons, and implementing multidisciplinary CP clinics.

  5919 - The effect of cryoneurolysis on a spastic upper limb in a patient with myasthenia gravis (MG) and facioscapulohumeral dystrophy (FSHD): A case report Top

Mahdis Hashemi1, Paul Winston2, Fraser MacRae3, Eve Boissonnault4

1Vancouver Island Health Authority, Victoria, BC, Canada, 2Department of Physical Medicine and Rehabilitations, University of British Columbia, Victoria, BC, Canada, 3University of Victoria, Victoria, BC, Canada, 4University of Montreal, Montreal, QC, Canada

E-mail: [email protected]

Introduction: Spasticity may lead to functional impairment, discomfort, and skin integrity issues. Though Botulinum toxin is generally used for managing spasticity, due to its relative contraindication in myasthenia gravis (MG), a safer procedure is favourable.Cryoneurolysis is a mini-invasive percutaneous procedure causes Wallerian degeneration while preserving epineurium and perineurium and has recently been utilized in spasticity management. Patient Information and Clinical Findings: A 78-year-old hemiplegic man due to CVA with history of MG and facioscapulohumeral dystrophy (FSHD), presented with adducted and internally rotated shoulder, flexed elbow, flexed and pronated wrist and clenched fist with skin maceration and untrimmed fingernails. After ultrasound guided diagnostic nerve blocks (DNB) to the targeted nerves, he underwent lateral pectoral nerve, musculocutaneous branches to brachialis and biceps brachii, and median nerve above the elbow cryoneurolysis, using the “iovera” handheld machine under ultrasound and electrical nerve stimulation guidance. The follow up in 1 and 3 months showed a significant improvement in shoulder and elbow range of motion and a meaningful decrease in spasticity. Also, this allowed him to actively flex and extend his fingers. The increase in fingertip-palm distance improved comfort, hand hygiene and decreased palm maceration significantly. No adverse event was associated by this procedure. Discussion and Conclusions: DNB is a safe way to assess motor improvement and sensory disturbance expected from cryoneurolysis. We propose cryoneurolysis as a novel treatment option for spastic patients in which botulinum toxin is not possible.

  5684 - Botulinum toxin injection in a woman with Dandy-Walker syndrome: Case report Top

Frederico Moeda, Madjer Hatia, Sérgio Pinho, Duarte Calado, Eduardo Gonçalves, Nuno Tomás, Suzana Gouveia, Cristina Ângelo

Centro Hospitalar Lisboa Ocidental, Serviço de Medicina Física e de Reabilitação, Lisboa, Portugal

E-mail: [email protected]

Introduction: Dandy-Walker syndrome is a rare developmental anomaly of the cerebellar vermis with an abnormal closure of the fourth ventricle. Therefore, the cerebellar hemispheres and corpus callosum are usually abnormal and there are also hydrocephaly, malformations of the limbs, heart and face. This case highlights a patient with this syndrome with marked spasticity with a good response after botulinum toxin injection. Patient Information and Clinical Findings: We present a case of a 24-year-old woman with Dandy-Walker syndrome with intellectual diasability with no other medical history or medication. She was referred to our Physical Medicine and Rehabilitation Department by a Neurologist for functional evaluation and improvement. She was totally dependent in hygiene and eating altough she was partially dependent in transfers and walking. On physical examination, we highlight a spastic tetraplegia more pronounced in the lower limbs with a grade 2 spasticity of the hip adductors and plantar flexors in Modified Ashworth Scale with a tip toe walking. We decided to perform local abobotulinumtoxinA injections, with 1000 units divided between the adductor magnus, longus and brevis muscles and 300 units divided between medial and lateral gastrocnemius and soleus muscles between both legs. One month later, there was an improvement of the lower leg spasticity, gait pattern and the family also reported an ease of perineal hygiene. Discussion and Conclusions: Dandy-Walker syndrome is a rare heterogeneous disorder with a wide range of associated congenital anomalies that may cause marked spasticity. Botulinum toxin injections can improve the patients functional status, including spasticity and gait pattern and help formal.

  5548 - Spectacular improvement in autonomy after neuro-orthopedic treatment: He leaves the nursing home! Top

Salomé Le Franc1, Antoine Geffrier2, Charles Guignans1, Simon Butet1, Laurence Le Mestric3, Isabelle Bonan1

1Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France, 2Orthopaedic Surgery Unit, University Hospital of Rennes, Rennes, France, 3Rehabilitation Center of Plémet, Bodiffé, Plémet, France

E-mail: [email protected]

Introduction: Spasticity can become severe in neurological diseases. Surgical procedures may be offered to cure and relieve the patients in such situation. We report a case of severe spastic paraparesis who benefited from neuro-orthopedic surgery with an impressive clinical and functional improvement. Patient Information and Clinical Findings: A 74-year-old man with Strumpell-Lorrain disease had a spastic paraparesis rapidly worsening. Severe neuro-orthopedic deformities were observed: bilateral hip and knee flessum, bilateral hip adductum and equinus, complicated of eschars and diffuse pain. Depression with apathy was associated. He lost the ability to walk, leading to total dependence on nursing care and his institutionalization. A Functional Independence Measure (FIM) was estimated at 54/126. He benefited from multiple tenotomies, phenolization of the obturator nerves, coxo-femoral infiltration of cortisone. He spent several months in a rehabilitation center for postural work. The aim of the surgery was to relieve pain and facilitate nursing care. Discussion and Conclusions: Immediately after the surgery, he was relieved of pain, eschars and acquired a more comfortable lower limb position. After 6 months, he was able to walk over ten meters with orthopedic shoes. The FIM was 112/126. We observed an improvement in joint amplitudes, motor skills, mood and cognitive awareness and the disappearance of eschars and pain. He went back home after 17 months in a retirement house without assistance at home. This clinical case highlights the additional and interactive character of the multidisciplinary approach in neuro-orthopedic care.[1]


  1. Genêt F, Kulina I, Vaquette C, Torossian F, Millard S, Pettit AR, Sims NA. Annals of Physical and Rehabilitation Medicine 2019;62:189-92.

  Clinical Sciences – Diagnostic Approaches – Electrodiagnostics Top

  7028 - Electro-diagnostic features and variants of post infectious Guillian Barre syndrome in patients with history of COVID-19 infection: A single center observational study Top

M. Tawab Khalil Tawab, Umer Younas, Uzma Akhlaque, Imran Irshad

Armed Forces Institute of Rehabilittaion Medicine, Rawalpindi, Pakistan

E-mail: [email protected]

Background and Aim: Guillian-Barre Syndrome is one of the common neuromuscular disease associated with SARS-COV-2. Clinical features and disease outcomes has been previously described but electro-diagnostic features and variants of post infectious GBS secondary to COVID-19 infection are understudied. We aim to describe electro-diagnostic features and variants of GBS in patients with prior history of COVID-19 infection. Methods: All patients of GBS who had history of COVID-19 infection in the past 3 months reporting for NCS/EMG test were included. Demographic data and result of electro-diagnostic tests were documented. Statistical analysis was done by SPSS version 21. Results: A total of 16 patients with GBS met inclusion criteria. Median age was 49.5 years (IQR 40-68.7 years). 10 (62.5%) were male, 6 (37.5%) were female. 6 (37.5%) of patients had prior history of ICU admission because of COVID-19. Most common variant of GBS was Acute Motor and Sensory Axonal Neuropathy (AMSAN) 8 (50%) followed by Acute Motor Axonal Neuropathy (AMAN) 6 (35%) and Acute Inflammatory Demyelinating Polyneuropathy (AIDP) 2 (12.5%). Abnormal Nerve Conduction parameters in variants of GBS patients are shown in [Table 1] and [Table 2] (attached as image). Conclusion: Electro-diagnostic features of post infectious GBS secondary to COVID-19 resemble non-COVID-19 GBS. AMSAN is a common variant of post infectious GBS secondary to COVID-19 infection. Absent, prolonged and impersistant F-Response helps in the diagnosis of GBS.
Table 1: Frequency of abnormal nerve conduction parameters in nerves of Guillain-Barré syndrome patients

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Table 2: Frequency of abnormal F responses in Guillain-Barré syndrome patients

Click here to view

  6972 - Association between heart rate variability and consciousness state Top

Piergiuseppe Liuzzi, Bahia Hakiki, Anna Maria Romoli, Maenia Scarpino, Claudio Macchi, Andrea Mannini, Antonello Grippo, Francesca Cecchi, Silvia Pancani

IRCCS Fondazione Don Carlo Gnocchi Onlus, Firenze, Italy

E-mail: [email protected]

Background and Aims: Disorder of Consciousness (DoC) diagnosis is improved combining clinical and instrumental assessments. Studies showed association between clinical responsiveness and sympathetic/parasympathetic homeostasis. Heart Rate Variability (HRV) indicates the modulation of HR in response to environmental changes and result in non-invasive proxies of modulation capabilities of visceral states. This study investigates the relationship between autonomous nervous system correlates and DoC. Methods: In this prospective study, all adult patients admitted to the Intensive Rehabilitation Unit of the IRCCS Fondazione Don Carlo Gnocchi after a severe acquired brain injury were enrolled. Consciousness state at admission was obtained via the Coma Recovery Scale–Revised stratifying the sample into two groups: DoC and No-DoC. Electrocardiographic recordings were extracted from 20' polygraphy recordings performed at admission. After R-peaks detection, the coefficient of variation of successive differences between NN-intervals (CVNN) was computed (ratio between median absolute deviation of successive differences of NN-intervals and the median absolute value of the related differences) and correlated with the DoC diagnosis via logistic regressions before/after age-sex correction. Results: 155 patients were included (72 DoC, 87 males, median CRS-R=8 [IQR=9], median age=65 yrs. [IQR=21]). Higher CVNN correlated with the DoC before (p=0.008, OR=0.028, 95% CI=0.002-0.398) and after age-sex correction (p=0.009, OR=0.030, 95%CI =0.002-0.412). Conclusions: These results suggest a strong association between clinical diagnosis of consciousness and higher HRV. Quantitative HR analysis in patients with DoC might offer a complementary tool to be integrated to the multimodal consciousness assessment reducing consciousness misdiagnosis.

  6749 - Nerve conduction study of the phrenic nerve in patients after COVID-19 diagnosis Top

Helena Nics1, Karin Vonbank2, Ralf Harun Zwick3, Tatjana Paternostro-Sluga1

1Department of Physical Medicine and Rehabilitation, Klinik Floridsdorf, Vienna, Austria, 2Klinik Pirawarth in Wien, Vienna, Austria, 3Therme Wien Med, Oberlaa, Vienna, Austria

E-mail: [email protected]

Background and Aims: Respiratory muscle weakness with higher ventilatory demands were reported even in patients recovering from only mild COVID-19 symptoms. Aim of this study was to assess if patients after COVID-19 infection have impaired phrenic nerve function. Methods: In this observational study, electrophysiological examination of the phrenic nerve, inspiratory muscle capacity as well as lung function test have been performed in 22 patients with post COVID-19 infection (post-CoVG). Complete data have been collected for 21 patients. One patient had to be excluded, as the patient did not endure supramaximal stimulation of the phrenic nerve. Results: In 6 of the 21 patients the electrophysiological response of the phrenic nerve was pathologically decreased. Phrenic nerve latency was within the normal range in all but one patient who had type 2 diabetes. Maximum inspiratory pressure, Wpeak and VO2peak were significantly lower in these patients as well as PEF and FVC compared to the post COVID patients with normal electrophysiological response to the stimulation of the phrenic nerve. Conclusions: Phrenic nerve neuropathy was not present in patients after COVID-19 infection. The amplitude of the phrenic nerve was decreased in 6 out of 21 patients and correlated with decreased Wpeak and VO2peak as well as PEF und FVC. Phrenic nerve amplitude can be used as an indicator of inspiratory muscle strength.

  6307 - Ultrasound guided EMG ensures diagnosis accuracy Top

Habib Elleuch1, Wafa Elleuch1, Fatma Elleuch2, Sameh Ghroubi1

1Department of Physical Medicine and Rehabilitation - Research Laboratory, Habib Bourguiba Hospital, Tunisia, 2Department of Physiology and Functional Exploration, Habib Bourguiba Hospital, University of Sfax, Tunisia

E-mail: [email protected]

Background and Aims: Nowadays, physical medicine and rehabilitation (PMR) practitioners still have practical difficulties, whatever their experience, in electromyographic detection of small or deep muscles. The latter may be key muscles the exploration of which is crucial for a definite diagnosis. Thus, any technical error in their electromyographic detection constitutes a real handicap. The musculoskeletal ultrasound guidance (USG) is obviously of a considerable and valuable help to overcome the technical difficulties and explore these key muscles in an easy and a certain way. Methods: In this study we will show how the USG helped us to locate with certainty 4 key muscles that are hardly and dubiously detected by standard EMG. Results: The first muscle is the extensor indicis proprius muscle that is innervated by branches of the radial nerve originating from the C8-T1 roots. Its functional impairment, in case of hand atrophy, signs a C8-T1 radicular lesion, otherwise, a medio-cubital truncal lesion should be suggested. The second is the flexor carpi radialis muscle that is innervated by the C7 branches of the median nerve. Therefore, its involvement, in case of a hand and fingers extension deficit, means a C7 root damage and rules out a radial nerve damage. And in case of a steppage gate, the neurologic impairment can be localized either at the level of the L5 root or at the level of the peroneal nerve. Taking into account that the posterior tibial muscle or the flexor hallucis longus muscle are innervated by the L5 root but does not depend on the peroneal nerve, their impairment means certainly a radicular (L5) lesion. Conclusions: These deep muscles are obviously hardly detected by standard EMG with a high risk of placing the EMG needle in a wrong muscle. Thus, USG facilitates their detection and guarantees the contribution of the EMG data to the diagnosis.

  5398 - Evaluation test of taste and smell disorders Top

Pilar Molina Artero, Jean Pierre Crudo

Centre Bouffard Vercelli, Perpignan, France

E-mail: [email protected]

Background and Aims: Taste and smell disorders can be associated to common neurologic disorders (head trauma, Parkinson disease…) and they can lead to malnutrition. An adequate testing could facilitate diagnosis and rehabilitation programs. Validated tests are usually expensive for clinical practice. A low-cost test evaluation was searched. This test has been validated in French people. Methods: Based on smell popular odorants and basic taste thresholds, we have made à 2 steps evaluation test. The first step includes: personal medical history with food behaviors and a screening smell test (4 alimentary odorants). The second step includes a blind taste evaluation of 6 basic flavors (salty, sweet, sour, bitter, umami) with 2 intensity levels made with and without smell help. 54 healthy French people participated for the validation of this test. Results: European diet and sweet preferences were the most important food behaviors. One mistake was usually find in nonsmoking people smell-test and 2 mistakes were usually find in smoking people smell-tests. The 'umami' flavor can't be identified by French population. Taste score test was considered normal with 2 misidentifications. Conclusions: Taste and smell evaluation test has been validated for healthy French population. This unexpensive test can be used in daily clinical practice. The general use of this test could lead to better prevalence reports of this impairments in rehabilitation patients.

  5897 - Electromyoneurography (ENMG) and clinical examination – Available assessment strategies for timely nerve surgery of obstetric brachial plexus injury (OBPI): A case report Top

Jasmina Milovanovic-Arsic, Sladjana Markovic, Bozana Markovic

Specialized Rehabilitation Hospital, Banja Koviljaca, Serbia

E-mail: [email protected]

Introduction: Based on the available literature it is considered that for a well-selected group of patients with OBPI nerve surgery is beneficial. The children with Narakas Group 3 and 4 should be examined with MRI to look for nerve root avulsion at the age of 2-3 months. This case report confirms the diagnostic value of ENMG and clinical findings in absence of a “gold standard” (Malessy, 2009). Patient Information and Clinical Findings: The first child, prolonged labor with umbilical cord wrapped around the neck. First examination (32 days): left arm in adduction without active movements, forearm in pronation, elbow in extension, wrist in volar flexion. The absent reflexes, Horner was present (Narakas IV). Age three months: No signs of biceps recovery were registered. ENMG findings: absent SNAP and pathological CMAP for n. radialis. Needle EMG: denervation potentials in m. biceps and m.EDC. Conclusion: Severe, dominant C7 lesion. Age 5 months: Surgical exploration of the brachial plexus. Avulsion lesion of C7 was confirmed. Neurolysis and paraneurotomiam of truncus superior, C5, C6 and peripheral nerve fiber transfer was done. The outcomes: complete recovery of the elbow flexion and hand function and impaired shoulder function. Discussion: Prediction based on early ENMG about root continuity was consistent with operative findings. Accordingly, a useful hand function recovery was achieved despite the facts that prognosis at infants with a Group 4 lesion is poor (Al-Qattan, 2009). Conclusion: Clinical findings and early ENMG can identified severe cases of OBPL so that the decision for surgical exploration can be made in timely manner. Since the outcome in cases of root avulsions without treatment is poor, the nerve surgery to improve the final results is justified.

  5839 - Digital biomarkers in evaluation of duchennes muscular dystrophy Top

Sunder Subramaniam, Shyam Ramamurthy

Department of Rehabilitation, JOGO Biofeedback Clinic, Chennai, Tamil Nadu, India

E-mail: [email protected]

Background and Aims: Various markers are used to determine the diagnosis, progress and endpoints of treatment. In health care.These markers may be biological or digital. Digital biomarkers are a network of patient-worn smart devices (e.g., electronic skin patches), with sensors and software connected to the cloud that enable collection, analysis and transmission of personal health data in real time. EMG Biofeedback: Can be used in rehabilitation as a digital biomarker for clinical trials, or as monitoring devices for progress in rehabilitation. Duchennes Muscular dystrophy [DMD] is a progressive loss of muscle mass and strength due to lack of secretion of enzyme dystrophin which is essential for repairing muscle fibres damaged due to physical activity. Exercise in DMD can become harmful, if rest is not given at the time of setting in of fatigue. Methods: The portable EMG Biofeedback digital therapeutic device transcribes the resting and active muscle potentials elicited during movement in a graph format wirelessly from wearable surface EMG sensors. Seeing this, we can ensure when to stop exercises so muscle tears are prevented. Results: A cohort of DMD patients were subjected to a medication and EMG biofeedback was done pre and post administration to measure the outcomes. The study also gave insights into measurement of fatigue of the muscle as a factor to structure the exercise program. Conclusions: JOGO portable biofeedback device functions as a Digital Biomarker in DMD by providing information on endurance levels, suggesting how many repetitions of movement can be performed without fatigue. It can also function as a biomarker to evaluate the efficacy of a drug and structure exercises in a rehabilitation program to prolong existing functional abilities.


  1. Rodarte C. Pharmaceutical perspective: How digital biomarkers and contextual data will enable therapeutic environments. Digit Biomark 2017;1:73-81.

  5643 - Neurophysiological evidence of intravenous methylprednisolone effect during spinal surgery Top

Jinyoung Park, Seok Young Chung, Yoon Ghil Park

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

E-mail: [email protected]

Background and Aims: With no previous study, this study aimed to secure the neurophysiological evidence of high dose intravenous methylprednisolone (IVMP) through intraoperative neurophysiological monitoring (IONM). Methods: IONM data were screened in patients who had a decrease ≥ 50% in motor evoked potential (MEP) amplitude during spinal surgery in a tertiary hospital from 2017 to 2020. Among 61 patients, 46 (steroid group) were administered IVMP (125-250 mg) immediately after MEP reduction and 15 were not (non-steroid group). The MEPs were obtained at 10, 30, 60 minutes, and at the end of IONM based on the point of MEP reduction. The correlation between MEP recovery after IVMP administration (ΔMEP) and motor recovery in postoperative day1 (ΔMotor) were analyzed according to the amount of MEP reduction percentage: -100%, ≤ -50%, -50% < and < 0%, and 0%. Results: When the amount of MEP reduction ≤ -50%, the MEP showed larger amplitude in steroid group in time point of 0, 10, 30 minute and the end of IONM (P < 0.01). The MEP recovery was significantly higher in steroid group when the amount of MEP reduction ranged ≤ -50% (P < 0.01) [Figure 1]. There showed significant correlation between ΔMEP and ΔMotor only in steroid group when MEP reduction ranged ≤ -50% [Table 1]. Conclusions: The IVMP increases the amplitude of MEPs and increase in MEPs showed positive correlation with the postoperative motor outcome.
Figure 1: Motor evoked potential progress after intravenous steroid administration during spinal surgery

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Table 1: Correlation between motor evoked potential recovery and motor outcome after intravenous steroid administration

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  5439 - Multiple mononeuritis and renal failure as a manifestation of multisystem inflammatory syndrome associated with SARS-CoV-2: A case report Top

Maria Alejandra Guerra1, Gustavo Andres Cadena1, Jorge Arturo Diaz2,3

1Universidad Nacional de Colombia, Bogotá, Colombia, 2Universidad Nacional de Colombia, Bogotá, Colombia, 3CIFEL, Bogotá, Colombia

E-mail: [email protected]

Introduction: COVID-19 infection can induce a hyper-inflammatory syndrome with dysfunction of different organs without the presence of respiratory failure. We present the case of a patient in whom Covid-19 infection facilitated small vessel vasculitis with renal and peripheral nerve involvement. Patient Information: 57-year-old man, without significant antecedents, presented Covid-19 infection confirmed by positive serology for SARS - COV-2 (igG) without respiratory compromise, who 2 weeks later presented neuropathic pain in the left foot, with intense allodynia at the foot sole. Two months later, he was hospitalized for worsening pain and progressive deterioration in kidney function. On physical examination, he presented stocking pattern numbness in the left foot, diminished left achilles tendon reflex, strength and muscle trophism were normal. Rapidly progressive glomerulonephritis and small vessel vasculitis were confirmed by renal biopsy, with positive ANCAS Anti-PR3 (Churg Strauss syndrome). Electrodiagnostic studies were compatible with multiple mononeuritis, with greater involvement of the left tibial nerve [Figure 1]. He received intensive immunosuppressive therapy (corticosteroids, cyclophosphamide, and rituximab) with good results. Discussion and Conclusions: The clinical manifestations satisfy the criteria for multisystem inflammatory syndrome associated with SARS-CoV-2. The inflammatory response provoked by the Covid-19 infection is considered to be the precipitating factor for the small-vessel vasculitis, which secondarily caused the mononeuritis multiplex and rapidly progressive glomerulonephritis.
Figure 1: Nerve conduction velocities of the left and right medial plantar nerves

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  4475 - Visual feedforward and neuromuscular timing of the thigh muscles on different tennis courts Top

Nicola Marotta1, Andrea Demeco1, Lucrezia Moggio1, Marcello Marotta1, Pasquale Paola2, Antonio Ammendolia1

1University of Catanzaro, Catanzaro, Italy, 2Scarborough University of Toronto, Toronto, Toronto, Canada

E-mail: [email protected]

Background and Aim: Non-injured tennis athletes with reduced EMG pre-activity during a stressful knee situation are at increased risk of non-contact anterior cruciate ligament (ACL) rupture. Additionally, injuries to the lower limbs are more common on clay and hard courts than on grass. This study Aims to evaluate the difference in pre-activation of the quadriceps and hamstrings during a landing on hard, clay, and grass tennis courts and consequently indirectly verify the risk of anterior cruciate ligament injury. Methods: Twenty male tennis players were enrolled. To stress the ACL, all athletes dropped off from a 32cm platform by landing on one foot. Four surface EMG probes determined the activation time of the rectus femoris (RF), vastus medialis (VM), semitendinosus (ST), and hamstring (BF). An inertial motion sensor connected to the probes measured the pre-activation time of each muscle. Late activation of the thigh muscles exposes the knee to the risk of injury. Results: On the grass courts, quadriceps and hamstrings were recruited significantly later before ground contact compared to concrete and clay. Early muscle recruitment protects tennis players' knees on less secure surfaces like concrete and clay. Conclusion: As we have seen, visual conditioning affects neuromuscular recruitment on different tennis surfaces, demonstrating less risk protection on grass courts. These results would suggest more proprioceptive training on soft surfaces to trainers.

  6957 – A Guillain-Barré syndrome-like neuropathy associated with arsenic trioxide treatment Top

Ana Costa1, Filipa Rocha2, Ilídia Moreira2, Augusto Ferreira2, Otília Romano2

1Centro de Reabilitação do Norte, Vila Nova de Gaia, Portugal, 2Instituto Português de Oncologia do Porto FG, Porto, Portugal

E-mail: [email protected]

Introduction: Peripheral neuropathy is a common finding of arsenic poisoning. However, reports of rapidly progressive and severe peripheral neuropathy from patients treated with arsenic trioxide (AT) for acute promyelocytic leukemia (APL) are very limited in literature. Patient Information and Clinical Findings: A 39-year-old man was diagnosed with APL in september 2017. In August 2020, due to APL relapse, the patient was given AT and cytarabine, followed by AT as consolidation treatment. After 2 weeks of consolidation, he was admitted in the hospital presenting a 3-week progressive muscular weakness with paraesthesia. Clinical examination revealed symmetric arreflexic tetraparesis, with altered sensibility and impaired verticalization and gait. Spinal fluid showed albumin-cytologic dissociation. Electrodiagnostic study revealed the presence of severe motor and sensitive demyelinating polyneuropathy, with axonal commitment. Conduction blocks and spontaneous activity was present. The diagnosis of a Guillain-Barré syndrome-like associated with AT exposure was considered. He suspended AT, received immunoglobulin and thiamine supplementation. During hospitalization and after discharge, the patient was enrolled in a rehabilitation program. The evolution was positive, with overall muscle strength improvement and functionality. A secure gait pattern and independency in activities of daily living were achieved. Discussion and Conclusions: This case emphasizes the need to consider arsenic intoxication in patients treated with AT, who subsequently developed severe peripheral polyneuropathy mimetizing a Guillain-Barré syndrome. Early treatment, AT suspension and implementation of an individualized rehabilitation program were key factors for patient´s successful recovery.

  6838 - Acute intermittent porphyria: An atypical presentation with polyneuropathy Top

Gustavo Cadena, Maria Guerra, Carlos Rueda

National University of Colombia, Bogotá, Colombia

E-mail: [email protected]

Introduction: Porphyrias are genetic disorders caused by deficiency in heme biosynthesis. Its clinical presentation is varied and polyneuropathy is rare, being a diagnostic and therapeutic challenge. We present the case of a patient with symptoms of acute abdominal pain and hematuria, who developed rapidly progressive weakness. Subsequently confirming the diagnosis of acute intermittent porphyria (AIP), without improvement after treatment. Case Report: A 30-year-old man with no significant history presented with abdominal pain initially treated as intestinal obstruction without improvement, then presented weakness in the upper limbs that progressed to the lower limbs. On physical examination generalized hyporeflexia, predominantly proximal weakness. Spine imaging showed bilateral and symmetrical thickening and enhancement of the thoracolumbar roots. Guillain-Barré Syndrome (GBS) was suspected without improvement with immunoglobulin. The electrodiagnostic study showed acute sensorimotor axonal polyneuropathy, due to changes in urine color, porphobilinogen compatible with porphyria was requested, intravenous hemantine was started without recovery in motor function. Discussion and Conclusions: IAP has an incidence of 0.5-1 in 100,000 population, it rarely manifests with polyneuropathy, the presentation is like GBS, however, with a proximal and descending onset. In nerve conductions studies, findings are axonal compromise without evidence of conduction blocks or conduction slowing. Electromyography may be normal or show signs of denervation and reinnervation. Most patients have complete recovery, but a small group persists with chronic polyneuropathy despite treatment, with a poor prognosis for rehabilitation.
Figure 1: Absence of response right median motor nerve and very low amplitude in left median motor nerve

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  6788 – A traumatic thoracic radiculopathy: Case report Top

David Eliécer Rodríguez, Liliana Elizabeth Rodríguez, Jorge Aruro Díaz

Universidad Nacional de Colombia, Bogotá, Colombia

E-mail: [email protected]

Introduction: Thoracic radiculopathy (TR) is the least common location for nerve root compression. Clinical presentation is often atypical, with nonspecific symptoms which leads to a delay in its diagnosis. Present case shows a TR secondary to a lumbar fracture. Patient Information and Clinical Findings: A 60 years old man suffered a fracture in L1 vertebral body. Arthrodesis T12-L2 was realized, after surgery the patient develops band pain in the lower abdomen and distention. Physical examination did not find neurological impairment and abdominal pathology was ruled out. Pain distribution followed a thoracic dermatome, therefore electrodiagnostic studies (EDX) were requested. Ultrasound-guided (US) electromyography was performed in paraspinals and abdominal wall muscles, which showed abundant signs of denervation. Also, alterations in somatosensory evoked potentials (SEP) of the iliohypogastric nerve were found. A TR with axonal involvement at lower thoracic levels (T11-T12) was diagnosed. The patient is currently being managed with analgesics and neuromodulators. Discussion and Conclusions: The clinical diagnosis and electrodiagnosis of TR is difficult due to the muscles' location of the thoracic roots (paraspinals and abdominal wall muscles) and it is there where the US gives us a high precision to find the searched structures. Although, SEP are not routinely requested in the study of radiculopathy, they provide us with valuable information related to large caliber pathways. The integrated use of the different electrophysiological studies and US allows us to achieve greater diagnostic accuracy, which will be of help to the physician and beneficial for the patient.

  6539 - Spontaneous entrapment of the posterior interosseous nerve in a 27-year-old young woman: A case report Top

Sandra Milena Cortes Soto, Nixon Calambas

Universidad Nacional de Colombia, Bogotá, Colombia

E-mail: [email protected]

Introduction: The posterior interosseous nerve is the deep branch of the radial nerve, it is responsible for the motor innervation of the posterior part of the forearm and the fourth dorsal compartment of the wrist to innervate the dorsal capsule. Compressive neuropathy in this nerve is secondary to trauma, rheumatoid arthritis, brachial neuritis, and spontaneous compression. The most common compression site is the arch of Frohse. More frequent in men and in the right upper limb. It is followed up with electrophysiological studies and conservative or surgical treatment can be performed. Patient information and clinical findings. A 27-year-old patient who works with a clinical picture of onset with sudden pain at the level of the left elbow and progressively with a sensation of paresthesia and weakness for wrist extension, the physical examination found paresis of the elbow extensors and dysesthesias in the territory innervation of the left radial nerve, under conservative management with orthosis. NC and EMG were performed that reported a partial lesion of the axonal type of the left radial nerve at the level of the elbow of a moderate to severe nature in an acute phase without signs of active reinnervation, mild elbow MRI with signal irregularity of the muscle fibers of the compartment radially with slightly hyperintense signal with changes due to neuropathy. A musculoskeletal ultrasound was performed, which reports the ultrasound findings suggested entrapment of the left posterior interosseous nerve at the level of the arch of Frohse. Discussion and Conclusions: The combination of electrophysiological studies with musculoskeletal ultrasound allows us to make a precise location of the lesion, in a rare pathology like this.

  5798 - Bilateral peroneal palsy after severe COVID-19 infection: A case report on an electrodiagnostic differential diagnosis problem Top

Nefeli Anna Papageorgiou, Ioannis Alexandros Tzanos, Ioulia- Eleni Panagiotopoulou, Aikaterini Kotroni

KAT General Hospital, Kifisia, Athens, Greece

E-mail: [email protected]

Introduction: Severe COVID-19 has been associated with polyneuropathy, most often of the demyelinating type. However, long-term hospitalization in the Intensive Care Unit (ICU) is associated with peroneal nerve entrapment at the fibular head. This case report study underlines the importance of an accurate electromyographic (EMG) diagnosis when both syndromes are suspected. Patient Information and Clinical Findings: A 69-year-old patient was referred to our EMG Laboratory for electrodiagnostic test due to bilateral foot drop (more severe in the left) and loss of sensation of the dorsal surface of the left foot (milder in the right), two months after a 3-month stay in the ICU due to SARS-CoV-2 infection. The EMG study showed spontaneous activity in tibialis anterior and extensor digitorum brevis muscles bilaterally (more abundant in the left side). At the voluntary contraction effort, there was no signal in these muscles in the left side and a decreased recruitment in the right. The nerve conduction studies showed low amplitude of the compound motor action potential of the right peroneal nerve with no response in the left side. Motor conduction velocities of tibial and ulnar nerve were bilaterally low (near borderline). Sensory nerve action potentials of superficial peroneal and sural nerves were bilaterally not recorded and sensory conduction velocities of median and ulnar nerve were bilaterally low (near borderline). Discussion and Conclusions: The asymmetric distribution of the findings of axial damage supports the diagnosis of selective entrapment of the peroneal nerve behind the fibular head regardless of the coexistence of evidence in favor of a mild generalized demyelinating polyneuropathy on the ground of severe SARS-CoV-2 infection.

  6451 - Chronic musculocutaneous nerve injury: An important differential in progressive arm atrophy Top

Umer Younas, Muhammad Tawab Khalil, Rehana Yasmeen, Omar Shafiq, Imran Irshad, Farooq Ahmad Rathore

Department of Physical Medicine and Rehabilitation, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan

E-mail: [email protected]

Background: Isolated musculocutaneous nerve (MCN) injury is a rare condition. 1 Because of other elbow flexors supplied by radial and median nerves, chronic MCN injury might become a diagnostic challenge. Patient Information and Clinical Finding: 28 years old male presented with complaint of painless and progressive wasting of right arm for 6 months. Referring physician had query of cervical radiculopathy or monomelic amyotrophy. On examination he had slight weakness of active elbow flexion, wasting of biceps, depressed biceps jerk and impaired pinprick sensation in lateral antebrachial cutaneous nerve distribution. He gave history of road traffic accident 14 months back during second wave of COVID-19 and could not get access to tertiary care facility due to lock down conditions. Electrophysiological study was consistent with chronic MCN neuropathy (right). Discussion: Isolated traumatic motor neuropathy of MCN is very rare (0.05%).[1] Following acute MCN injury, patient might not report in first place as intact pronator teres and brachioradialis muscles also assist in elbow flexion. Atypical presentation of chronic MCN injury in later life might become a diagnostic challenge. Aim of reporting this case is to highlight the the critical importance of taking a detailed medical history taking, performing thorough clinical examination and then ordering appropriate investigations to reach a correct diagnosis. Conclusion: Trick movements performed by the patients having visible atrophy of arm warrants a detailed clinical history and examination to rule out the causes of atrophy.


  1. Sirico F, Castaldo C, Baioccato V, Marino N, Zappia M, Montagnani S, et al. Prevalence of musculocutaneous nerve variations: Systematic review and meta-analysis. Clin Anat 2019;32:183-95.

  Clinical Sciences – Diagnostic Approaches – Imaging Top

  7029 - Correlation between sonographic thigh adjustment ratio (star) and functional tests Top

Luisa Fernanda Castaño Herrera, Gabriel Felipe Niño Suarez, Liliana Elizabeth Rodriguez Zambrano, Jorge Arturo Diaz Ruiz, Fernando Ortiz Corredor, Juan Camilo Mendoza Pulido

Universidad Nacional de Colombia, Bogotá, Colombia

E-mail: [email protected]

Background and Aims: In order to assess muscle strength multiple devices are used to measure isolated body segments, those are expensive or not very portable which restricts their use in clinical practice. The aim of our study was to correlate the STAR with functional tests. These tests are inexpensive, accessible, provide a great deal of information and can be routinely performed in the physiatrist's office. Methods: A descriptive cross-sectional study was performed in adults between 19 and 82 years of age, without musculoskeletal comorbidities. Rectus femoris and vastus intermedius thickness was measured and divided by body mass index (BMI) to calculate the STAR. Grip strength was measured through hand dynamometry, gait speed (GS) over 4 meters, chair stand test (CST) 5 times and timed up and go test (TUG). The Shapiro Wilk test was used and Spearman's coefficient was applied to correlate the STAR with the other variables. Results: A total of 136 patients were analyzed, 60% women (F). There is a moderate correlation between the STAR index and age (F r0.55 - M r0.49) and BMI in both sexes (F r0.47 - M r0.41) and with GS only in M (F r0.29 - M r0.4). There is a weak correlation with dynamometry only in F (F r0.37 - M r0.12), GS in F, CST in F (F r0.37 - M r0.28) and TUG in F (F0.36 - M0.17). Conclusions: STAR index estimation allows to obtain additional information on the functional performance of patients in dynamometry, GS, CST and TUG. In conclusion, the use of musculoskeletal ultrasound as a complement to functional testing allows an affordable, portable and cost-effective assessment, especially when there is suspicion or risk factors for sarcopenia.

  6934 - Effect of parasport participation on hand function in wheelchair users with chronic spinal cord disorders Top

Hiroshi Yuine1, Hirotaka Mutsuzaki2, Ryoko Takeuchi3, Yuichi Yoshii4, Yukiyo Shimizu5, Natsuki Ishida6, Taku Yasuda2, Kazushi Hotta1, Hideki Shiraishi1, Kaori Tachibana7

1Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan, 2Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Japan, 3Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan, 4Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Japan, 5Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan, 6Geriatric Health Services Facility Nadeshiko, Tsukuba, Japan, 7Department of Physical Therapy, School of Healthcare, Ibaraki Prefectural University of Health Sciences, Ami, Japan

E-mail: [email protected]

Background and Aims: Wheelchair users who participate in parasports reportedly have more severe chronic wrist pain. Their activities include parasport participation and wheelchair use in daily life. Hence, clarifying the effect of parasport participation on hand function is essential to avoid overestimation or underestimation of the involved risk. Thus, we aimed to evaluate distal radioulnar joint (DRUJ) instability and investigate the effect of parasport participation on hand function. Methods: Thirty wrists of 15 wheelchair users with chronic spinal cord disorders (age, 33–76 years; mean: 58.3 years) were evaluated for DRUJ instability using force-monitor ultrasonography [Figure 1]. Hand function was evaluated to ascertain range of motion (ROM) and muscle strength for wrist palmar flexion, dorsiflexion, radial deviation, ulnar deviation, grip strength, arm and forearm circumference, and DRUJ instability using the Ballottement test. The Quick Disability of Arm, Shoulder and Hand was used to assess the difficulties and pain experienced in daily life and parasport participation. Results: Neither DRUJ instability nor hand function, such as ROM and muscle strength, was significantly different between the groups that did or did not participate in parasports [Table 1]. Conclusion: Among wheelchair users with chronic spinal cord disorders, no association was found between parasport participation and DRUJ instability or hand function.
Table 1: Comparison between parasport participants and nonparasport participants

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Figure 1: Pressure-monitor ultrasonography

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  6876 - Ultrasonography in secondary upper limb lymphedema Top

Silvia Casanovas Sotero, Barbara Maria Nuñez Garcia

Department of Physical Medicine and Rehabilitation, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain

E-mail: [email protected]

Background and Aims: Upper limb lymphedema is a common complication after excision of axillary lymph nodes in breast cancer surgery. It is recommended to follow the International Society of Lymphedema (ISL) clinical stage to assess the grade of severity, establish a treatment and identify the prognosis. Methods: In the past years, ultrasonography of the subcutaneous tissue has been used in the evaluation of lymphedema. In this report of cases we have evaluated 7 women with upper limb lymphedema. At first, we use physical examination to assess the ISL clinical stage. Then, we measure the circumference perimeter in different locations of the arm to know the severity, assessing the absolute difference volume between both arms. Finally, we practice an ultrasound examination of both arms following a specific protocol that evaluates the subcutaneous echogenicity grade (SEG) and its thickness, which we compare with the other arm. Results: 5 patients were classified as ISL II, 1 of them ISL I and the other ISL 0. Focusing on severity, 6 patients were classified as mild and 1 as moderate. The ultrasound evaluation shows 3 patients SEG 1 and 4 patients SEG 0. There is a significant difference in circometry between both arms, but there is not a significant difference between the measures of subcutaneous tissue thickness using ultrasound in this report of cases. Conclusion: Ultrasound evaluation of subcutaneous tissue can be a useful tool in the evaluation of lymphedema, specially in subclinical or mild cases and in axial locations. In contrast, it is operator and equipment dependent, and needs more time. In this case report we can not make a clear relation between ISL stage and SEG grade. Further studies may be useful to find a relationship between both scales.

  6763 - Poland syndrome, which management in physical medicine and rehabilitation? Top

Sanaa Mdarbi, Hasnaa Boutalja, Nada Kyal, Fatima Lmidmani, Abdellatif El Fatimi

Department of Physical Medicine and Rehabilitation, Ibn Rochd University Hospital Center, Casablanca, Morocco

E-mail: [email protected]

Introduction: It is a congenital malformation associating to varying degrees thoracic and homolateral upper limb anomalies. The constant anomaly is agenesis of the sternocostal fascicles of the pectoralis major muscle. Observation: A 30 year old, right-handed, non-occupational patient whose physical examination revealed: Short neck; Depression of the left thoracic wall responsible for an asymmetry of the two hemithoraxes associated with a pectus excavatum and a breast hypoplasia; Dorsal hypercyphosis with right high dorsal gibbosity; Inequality of upper limb length with hypoplasia of the left and homolateral scapula; Brachymesophalangia and symbrachydactyly of the last 4 fingers; Normal neuro-orthopedic examination. The management was based on two pillars: 1- Malformative workup: Chest X-ray showed no abnormality; X-ray of the entire spine confirmed dorsal hypercyphosis; Thoracic CT scan showed no abnormality other than a scoliotic attitude; Abdominal ultrasound did not show any abnormality; X-ray of both hands confirmed the abnormalities found on clinical examination. 2- Rehabilitation protocol. With the objective of fighting against dorsal hypercyphosis with a reinforcement of the cervical and dorsal paravertebrae and the erectors of the trunk, the fight against the rolling up of the shoulders, the axial self-aggrandizement and the work of the posture. Conclusion: Poland syndrome is a rare congenital malformation whose cause remains unknown, the diagnosis is suspected clinically, CT scan allows to confirm the diagnosis of this syndrome and to make the complete lesion assessment. It is important to know that the thoracomammary deformity of Poland syndrome is a malformative entity difficult to treat.

  6271 - Intersection syndrome: The diagnostic value of ultrasound imaging Top

Adriana Pereira1, Filipa Gonçalves2, Joana Martins3, Igor Santos Neto2, Rui Silva1, José Luís Carvalho2, Tiago Lopes2

1Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal, 2Centro de Reabilitação do Norte, Valadares, Portugal, 3Centro Hospital Universitário de Coimbra, Coimbra, Portugal

E-mail: [email protected]

Introduction: Proximal Intersection syndrome (PIS) is a rare and underdiagnosed cause of wrist pain. It is caused by repeated flexion-extension of the wrist leading to an inflammatory condition in the distal forearm where the second extensor compartment tendons cross those of the first extensor compartment. This case report aimed to demonstrate the value of Ultrasound imaging (US) in the diagnosis and management of patients with this condition. Patient Information and Clinical Findings: A 60-year-old woman, housekeeper, was referred for a PM&R intervention appointment after 3 months of physiotherapy for radial wrist pain that was interpreted as DeQuervain Tenosynovitis, without signs of clinical improvement. The patient presented pain and edema in the area proximal and medial to the radial styloid. Finkelstein's and Eichhoff´s tests were positive, but the elicited pain was 2cm further from the wrist. The US at consult revealed peritendinous fluid at the intersection level between the first and second extensor compartments tendons, confirming the diagnosis of PIS. Subsequently, a US-guided injection with 1cc of meltiprednisolone 40mg/1ml + 0,5 cc lidocaine 2% was performed. The patient was instructed to avoid heavy repetitive activity with the affected wrist for 1-week post-injection. At 6 weeks of follow-up, the patient presented complete clinical and US resolution. Discussion and Conclusions: The PIS must be differentiated from other causes of radial wrist pain, particularly DeQuervain Tenosynovitis due to its high prevalence. Although the diagnosis is clinical, US plays a pivotal role in supporting the diagnosis and treatment of this condition.

  6253 - Infrared thermography on osteoarthritic and prosthetic knees Top

David Almeida e Reis1, Joana Sousa2, Jennifer Pires3, Flávia Moreira4, Filipe Alves5, Ana Vaz6, Paulo Oliveira4, João Barroso6, Pedro Fonseca7, João Paulo Vilas-Boas7

1Department of Physical Medicine and Rehabilitation, Centro Hospitalar Universitário São João, Porto, Portugal, 2Faculty of Medicine University of Porto, Porto, Portugal, 3Department of Physical Medicine and Rehabilitation, ULS Matosinhos. Matosinhos, Portugal, 4Department of Orthopaedics and Traumatology, Centro Hospitalar Universitário São João, Porto, Portugal, 5Department of Radiology, Centro Hospitalar Universitário São João, Porto, Portugal, 6Department of PRM, Centro Hospitalar Universitário São João, Porto, Portugal, 7Laboratory of Biomechanics, Porto, Portugal

E-mail: [email protected]

Background and Aims: Infrared thermography imaging (ITI) measures the heat irradiating from the skin and its use has been explored on musculoskeletal diseases. Knee osteoarthrosis (KOA) is a degenerative disease with an inflammatory component which can increase knee temperature. We aimed to evaluate the differences on superficial knee temperature by ITI between patients before and after total knee arthroplasty (TKA) and their response to exercise. Methods: Two groups were compared in this observational cross-sectional study. Group A (n=13): patients with KOA and primary TKA surgery scheduled; Group B (n=11): patients who underwent primary TKA >9 months before. We evaluated sociodemographic, radiographic and clinical parameters. ITI was obtained for both knees of each patient before and after exercise. Results: The highest temperature (HT) of the osteoarthritic knees waiting surgery increased with exercise (p=0.049), which did not happened on TKA knees. TKA knees had higher HT than contralateral knees, both on resting (p=0.010) and post-exercise (p=0.037) conditions. TKA knees had a less pronounced raise of the mean temperature (MT) with exercise than contralateral knees (p=0.029). MT and HT haven´t varied differently with exercise between knees waiting surgery and TKA knees. However, there was a higher MT (p=0.006) and HT (p=0.034) increase on contralateral knees of TKA relatively to contralateral knees of knees waiting surgery. Conclusion: ITI can objectively quantify differences on skin superficial temperature between KOA and TKA patients' knees. Significant differences between groups were found on response to exercise. These differences can have potential clinical relevance which can be of positive value in the follow-up of post-TKA patients.

  6007 - A trifid median nerve: Case report Top

Madjer Hatia, Sergio Pinho, Duarte Calado, Frederico Moeda, Eduardo Gonçalves, Jorge Barbosa

Department of Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal

E-mail: [email protected]

Introduction: It has been described a variable number of anatomical variations of the median nerve, found with either imaging studies or at surgery. These include motor branch anomalies, multiple divisions, and variation in association with aberrant muscles. The bifurcation of the median nerve is the most common atypic variation and can be frequently seen with a persistente median artery, with an incidence of 3%. A trifid median nerve it's considered an excepcionally rare atypic variation with very few cases published in the literature. There has been found 3 published case reports describing a trifurcation of the median nerve found on ultrasonography and 1 case found during surgery. Patient Information and Clinical Findings: A 71 years old woman, right-handed, with relevant history of type 2 diabetes and arterial hypertension, with bilateral carpal tunnel syndrome for 3 years, confirmed on nerve conduction studies. On the physical examination she had pain on both hands, paresthesia on the region inervated by the median nerve and positive Phalen and Tinnel tests. She underwent ultrasonography exploration to assess the possibility of bilateral median nerve block. On the left wrist it was observed a enlarged median nerve with a cross-sectional área of 12mm2. On the right wrist it was obsreved 3 structures with the same ultrassonography appearence as the median nerve in the distal portion of the carpal tunnel. From radial to ulnar side it was possible to identify 3 bundles and a smaller round shape image with positive power Doppler signal, suggestive of a trifid median nerve with a persistent median artery. Conclusion: Neuromuscular ultrasound is a reliable and valid diagnostic modality to help identify these atypical variants and should be considered before surgical and interventional procedures.

  5993 - The utility of videofluoroscopy in the management of dysphagia patients: Early experience of a PRM department Top

Gonçalo Engenheiro, Joana Ramalho, Joana Lopes Almeida, Helena Barroso Castro, Maria Inês Táboas, Catarina Aguiar Branco

Department of Physycal and Rehabilitation Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal

E-mail: [email protected]

Background and Aims: Videofluoroscopic swallowing study (VFSS) was introduced in our PRM department in 2019. We aim to assess the utility of VFSS in clinical evaluation and treatment of dysphagia. Methods: Retrospective case series of patients referred for VFSS from March 2019 to September 2021. We consulted electronic health records, extracting data including: diet labelling according to International Dysphagia Diet Standardization Initiative (IDDS) Framework, dysphagia classification according to Functional Oral Intake Scale (FOIS), hyolaryngeal excursion, swallowing reflex andoccurrence of posterior leakage during VFSS. We compared clinical swallowing exam with VFSS parameters using SPSS. Results: In 2.5 years, 102 patients (63% male; mean age 64 years) underwent VFSS. At referral: clinical diagnosis was mostly stroke (34%); 67% of the patients were at level 0 IDDSI Framework liquid diet and 59% did not use any adaptive strategy. After clinical swallowing exam, most patients (32%) ranked 5 at FOIS; adaptive strategies were introduced in 48% cases and diet was altered in 39% patients. The comparison of clinical exam with VFSS parameters revealed: from the 49 patients with normal hyolaryngeal excursion, VFSS was abnormal in 67% (p<0.001); in the 50 patients with normal swallow reflex at clinical exam, VFSS found posterior leakage in 40% (p<0.006); VFSS did not significantly alter dysphagia ranking, neither strategies nor diet recommendations. Conclusions: The early results show that clinical swallowing exam has been important to set proper diet recommendations and adaptive strategies in dysphagia patients. We found that VFSS has an additional benefit, especially in what concerns evaluation of hyolaryngeal excursion and swallow reflex, often overestimated by physical exam.

  5962 - Cortical bone density and hip involvement in Tunisians patients with radiographic spondylarthritis Top

Hatem Themri1, Sirine Miri2

1Department of Physical Rehabilitation Medicine, University Hospital Center, Monastir, Tunisia, 2Department of Rheumatology, Mohamed Kassab Institute of Orthopedics, Manouba, Tunisia

E-mail: [email protected]

Background and Aims: Bone loss is a common complication in spondylarthritis (SpA). The altered bone metabolism is associated with chronic inflammation and a mobility decrease. The association between hip involvement and osteoporosis might be explained that the same way. Our study aimed to determine the prevalence of hip involvement in Tunisian patients with radiographic SpA and assess their cortical densitometric profile. Methods: We conducted a retrospective study including 75 patients with radiographic SpA. We evaluated for each patient the different parameters related to SpA such as disease duration, activity and functional impairment. We assessed the bone mass of the lumbar spine and the proximal femur using DEXA. Results were expressed in bone mineral density (BMD in g/cm2) and T-scores. We used the WHO classification for quantifying the bone mass loss. We used the SPSS 22.0 to analyze the results. Results: Seventy-five patients were enrolled (82,6% men and 17,33 % women), with the mean age of onset was 27±7 years. Fifty-two percent of the patients had high inflammatory biomarkers. The BASDAI, ASDAS-VS, and ASDAS-CRP mean levels were respectively: 3.5+2.4, 3.1+0.9, and 3+0.8. The mean BASRI and mass were respectively 8+4.8 and 16.4+19.4. Forty-eight percent of the patients had axial SpA, while 52% had axial and peripheral symptoms. Twenty-seven percent of the patients presented with coxitis. Analyses of T-score values obtained over the femoral neck revealed osteoporosis in 18.7% of the cases and osteopenia in 32% of the cases. There are no associations between cortical bone density evaluated by proximal femur DXA scans and the presence of coxitis (p=0.567). Conclusion: Unlike other studies, bone mineral density doesn't appear decreased within hip involvement in patients with radiographic spondyloarthritis.

  5698 - Sequential changes in ultrasound parameters in adhesive capsulitis of shoulder: A prospective single-group cohort study Top

Ji Hye Hwang, Byung Chan Lee, Seung Mi Yeo, Jong Geol Do

Samsung Medical Center, Seoul, Republic of Korea

E-mail: [email protected]

Background and Aims: Ultrasound (US) parameters such as thickened rotator interval (RI), and axillary recess (AR), is known to specific findings of adhesive capsulitis. The purpose of this study was to evaluate the serial ultrasound parameters changes in adhesive capsulitis and to determine whether there are any relationships between changes of ultrasound features and clinical impairment. Methods: This was a single arm cohort study of 39 patients with adhesive capsulitis. Passive range of motion, numeric rating scale for pain, and the Shoulder Pain and Disability Index were used for clinical assessment. RI thickness, AR thickness were measured in bilateral shoulders at baseline, 1 month, 2 month, 3 month, 4.5 month, and 6 month. The ratios among RI and AR thickness were calculated by dividing the thickness of affected shoulder by that of the unaffected shoulder. Results: The thickness of AR and AR thickness ratio are significantly decreased during follow up period [Table 1]. There were good correlations between US parameters and clinical parameters [Table 2]. Conclusions: In sequential follow-up period, AR thickness and AR thickness ratio were improved as clinical parameter improved. The changes in AR thickness and AR thickness ratio are important markers which reflect the clinical findings.
Table 1: Serial follow up of ultrasound parameters in adhesive capsulitis

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Table 2: Correlation of ultrasound parameters and clinical outcomes

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  5690 - MRI profile of cerebral palsy Top

Meriam Hfaidh, Zeineb Mrizak, Najla Mouhli, Souad Karoui, Hajer Rahali, Imene Ksibi, Rim Maaoui

Department of Physical and Rehabilitation Medicine, Military Hospital, Tunis, Tunisia

E-mail: [email protected]

Background and Aims: MRI is indicated in all cases of abnormal motor development in children (cerebral palsy) and particularly in cases of uncertain etiology. The aim of our work was to study the MRI profile of children with cerebral palsy. Methods: This is a retrospective, descriptive study including children who were followed in the Physical and Rehabilitation Medicine Department of the Military Hospital of Tunis between the years 2000 and 2016. We studied the results of MRI from the files of these children. Results: 67 patients were included. The mean age was 7.8±4.7 years. The sex ratio was 1.23. Brain MRI was performed in 50 children (75% of cases). MRI was without abnormality in 46% of cases. The cerebral lesions on imaging were anoxic-ischemic injury in 34% of cases (anoxic-ischemic encephalopathy in 32% of cases and arterial ischemic stroke in 2% of cases), periventricular leukomalacia in 14% of cases, and cerebral malformations in 12% of cases (hydrocephalus in 8%, intracerebral arachnoid cyst in 2%, and neuroepithelial dysembryoplastic tumor DNET in 2%). Conclusion: White matter injury was the most frequently found lesion. MRI returned normal in half of the patients, requiring other explorations, notably metabolic and genetic.

  5594 - Clinical significance of diffusion and magnetization transfer MRI in cervical spondylosis Top

Hea-Eun Yang1, Woo-Kyoung Yoo2, Byeong-Wook Lee1, Jane Chung2

1Department of Rehabilitation Medicine, VHS Medical Center, Seoul, South Korea, 2Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Anyang, South Korea

E-mail: [email protected]

Background and Aims: We aimed to test two sensitive modalities, the diffusion image and the magnetization transfer (MT) image, whether each has some benefit to others in detecting tract-specific pathology of spinal cord in chronic cervical spondylosis patient. Methods: 8 patients diagnosed with cervical spondylosis were enrolled. Correlations between 15 spinal cord tracts and 4 clinical measures were analyzed. We performed tract-specific analysis at the most compressed lesion level, above the lesion level and below the lesion level. Fractional anisotrophy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD) were extracted from diffusion image while magnetization transfer ratio (MTR) was extracted from MT image. Correlation between MR metrics and clinical measures were analyzed. Results: All diffusion metrics of rubrospinal tract at most compressed level correlate with power grasp. FA, RD and MTR of lateral corticospinal tract at below lesion level correlate with lateral pinch power. MTR of fasciculus cuneatus and fasciculus gracilis tracts at below lesion level also correlate with lateral pinch power. FA of fasciculus cuneatus at above lesion level was correlated with light touch and pinprick score. Conclusion: Diffusion and MT image can be used to delineate the tract specific pathology in chronic cervical spondylosis more precisely.
Figure 1: Scheme of correlation between MR metric and function

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Table 1: Tract specific correlations between diffusion metric, magnetization transfer ratio and clinical measures

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  5506 - Usefulness of median nerve to ulnar artery cross-sectional area ratio in the diagnosis of Carpal Tunnel syndrome Top

Junhee Lee, Byung Heon Kang, Jeong Min Kim, Joon Shik Yoon

Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, South Korea

E-mail: [email protected]

Background and Aims: The purpose of this study was to prove whether median nerve to ulnar artery cross-sectional area (CSA) ratio (MUAR) is correlated with existing sonographic parameters used as diagnostic tools for Carpal Tunnel Syndrome (CTS). Methods: Twenty-nine patients who newly diagnosed as a CTS by electromyography were involved in this study. We measured the median nerve, ulnar nerve, and ulnar artery at carpal tunnel inlet, outlet, and 12cm proximal from wrist crease. We also obtained several diagnostic parameters which are well-defined as CTS sonographic findings. Furthermore, MUAR of each level was collected for analyzing the validity by comparing with other parameters. With Spearman's correlation coefficients, we tried to present that MUAR shows correlation with other CTS parameters. Results: [Table 1] suggests the correlation coefficients between existing parameters of CTS and MUAR. We found that there is significant moderate to strong, positive correlation between MUAR and median nerve CSA, median flattening ratio, median to ulnar nerve CSA ratio and median nerve wrist-forearm ratio (WFR). Conclusions: In this study, we found that MUAR is as useful as other parameters which has been proven in previous studies as a meaningful diagnostic sonographic value of CTS. It can shed light on further our study on researching stable control parameter in diagnosis the CTS by sonography. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. NRF-2020R1A2C1009024).
Table 1: Correlation coefficients between existing parameters of CTS and MUAR

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  4450 - Deep learning based tracking of hyoid bone in videofluoroscopic images Top

Seong Jae Lee1, Joo Young Ko1, Dae Youp Shin1, Hyunil Kim2, Sang-il Choi3

1Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan, South Korea, 2Department of Computer Science and Engineering, Dankook University, Gyeonggi-do, South Korea, 3Department of Geotechnical Engineering Research, Korea Institute of Civil Engineering and Building Technology, Gyeonggi-do, South Korea,

E-mail: [email protected]

Background and Aims: Currently, videofluoroscopic swallowing study (VFSS) is regarded as the standard tool for evaluation of the patients with dysphagia. However, it is vulnerable to human errors because of demanding high level of concentration and fatigue. It is expected that analysis of VFSS can be more accurate and efficient by lessening human effort with deep learning based image classification technologies. The aim of this study is applying deep learning model for tracking of movement of hyoid bone, which is considered as one of the most important indicators of swallowing function. Methods: A total of 31 VFSS video files were selected from the storage database. Each files were separated into 34,772 frame images and distributed for training, validation and test at the ratio of 7:1:2. After manual annotation of hyoid bone in each images, training was performed using Unet segmentation architecture. Data was augmented by 20% rotation and 20% scaling in every training session. Interpolation was accomplished by nearest neighborhood. Results: Overall accuracy of hyoid bone detection was 99.9% (recall of 72.2%, precision of 90.3%, and specificity of 99.9%), as shown in [Table 1]. Average precision was 92.85%. Conclusions: A model for hyoid bone detection from the images of VFSS was trained successfully using Unet segmentation architecture, with significant accuracy. The authors anticipate that the movement of hyoid bone, such as displacement, velocity and angle, could be tracked by further research based on this model.
Table 1: Overall accuracy of hyoid bone detection

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  6517 - Intraarticular osteochondroma of shoulder: Case report Top

Tomás Ribeiro da Silva1, Eva Alves2, Rebeca Gomes2, Madalena Carvalho2, Ricardo Henriques2, Teresa Mirco2, Francisco Sampaio2

1Centro Hospitalar Universitário Lisboa Norte, Serviço de Medicina Física e de Reabilitação, Lisboa, Portugal, 2Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal

E-mail: [email protected]

Introduction: Osteochondroma, the most common benign bone tumor, is a cartilage-capped osseous protrusion that arises from the surface of a bone. Osteochondroma is commonly seen at the metaphyseal region of the long bones, such as the proximal humerus, tibia, and distal femur. The distal femur is the most common location. Patients typically present between the ages of 10 and 30 with a painless mass. There are few reported cases in which a patient had a limited range of motion in the shoulder joint due to an intraarticular osteochondroma of the proximal humerus. We report a rare case of an intraarticular osteochondroma involving the proximal humerus with clinical presentation of adhesive capsulitis. Patient Information and Clinical Findings: A 47-year-old man presented to us with complaints of pain on right shoulder and limited range of motion for one year long. On physical examination he reveals pain on palpation of acromioclavicular joint, bicipital gutter and greater tubercle of humerus; no palpable mass on physical examination; limitation of active and passive shoulder range of motion; positive Jobe and Palm Up test. Shoulder radiograph showed a pedunculated growth from the proximal humerus and decreased joint interline. MRI of the shoulder revealed a bony outgrowth on the lower and inner slope of the articular surface of the humeral head, with about 24 x 40 mm. Discussion and Conclusions: The authors report a rare case of an intraarticular osteochondroma of the shoulder who presents with intra- and extraarticular manifestations. We highlight this clinical case because of the frequent overlapping of shoulder peri- and intraarticular pathology, but rare when associated with intraarticular osteochondroma etiology.

  5635 - Giant ulnar nerve neuroma at the elbow: Electrophysiological and ultrasonographic findings Top

Laura Camila Pinzón, Thomas Torres Cuenca

Universidad Nacional de Colombia, Bogotá, Colombia

E-mail: [email protected]

Introduction: Traumatic neuromas may appear as a chronic complication of peripheral nerve injury specially in severe lesions leading to pain or poor reinnervation process. In the upper limb the ulnar nerve is one of the most frequent nerve affected associated with penetrating trauma around the elbow. Patient Information and Clinical Findings: We describe a case of a 68-year-old woman who presented with progressive weakness and hypotrophy of the intrinsic muscles of the right hand, paresthesia of the 1stand 2nd digit and anesthesia of the 5th digit. She had history of penetrating trauma at the right elbow 4 years ago. The NCSs studies showed absence of sensory potential of median and ulnar nerve. Motor NCSs of the median nerve to the APB and ulnar nerve to the ADM and FDI showed low amplitude potentials with slowing of ulnar nerve conduction velocity the elbow. EMG showed neuropathic motor unit potentials of the ADM and FDI. In ultrasonographic evaluation it was documented a cross sectional area (CSA) of the ulnar nerve at the elbow of 60 mm2 and 4 mm2 at the forearm without changes in echotexture o discontinuity. The median nerve had a CSA of 12 mm2 at the carpal tunnel. Discussion and Conclusions: Partial nerve injuries associated with neuroma have been related to long term functional recovery of nerve injuries. Neuromuscular ultrasound is a reliably tool that allows evaluation of continuity and localization of the nerve lesion which important early treatment decision making and follow up of chronic lesion with poor functional recovery worsening.

  5825 - In-patient rehabilitation and FMRI of an adolescent with conversion disorder: A case-study Top

Iuly Treger1, Noa Zitron-Emanuel1, Moti Salti2, Yakov Ezra3, Alon Friedman1, Ilan Shelef4

1Department of Rehabilitation, Soroka University Medical Center, Beer Sheva, Israel, 2Brain Imaging Research Center, Soroka University Medical Center, Beer-Sheva, Israel, 3Department of Neurology, Soroka University Medical Center, Beer-Sheva, Israel, 4Department of Radiology, Soroka University Medical Center, Beer-Sheva, Israel

E-mail: [email protected]

Introduction: Our aim was to investigate if there is an altered neural function specifically associated with motor and somatosensory conversion disorder (CD) in an adolescent patient, to better understand the patient's diagnosis, and create an efficient treatment program. Patient Information and Clinical Findings: We present the first case study of a 16-year-old female patient, who showed severe symptoms resembling right hemispheric CVA, diagnosed with motor and somatosensory CD. Patient was hospitalized in a multidisciplinary inpatient rehabilitation unit, and underwent an fMRI scan upon admission. Motor and somatosensory stimulations, for both the symptomatic side and asymptomatic side, where motor paralysis and loss of sensation were present. During motor tasks, no activation was found for the symptomatic, 'paralyzed' side, while a contralateral, significant activation was found in the primary motor cortex. During somatosensory stimulations, a typical somatosensory cortex significant activation was found for the asymptomatic side, yet activation for the symptomatic side was only in areas near the somatosensory cortex. We did not find self-awareness or emotional-regulation activations, perhaps also due to the patient's age, and therefore decided to focus mostly on the bodily experiences in rehabilitation, and specifically on as much physical treatments, as to not confront the patient about her symptoms, since they often feel mistrusted and not understood. Discussion and Conclusions: Our results caused the patient to feel validated, which in turn allowed her to cooperate more, and regain full function. FMRI can be an important imaging tool in rehabilitation management of patients with conversion.

  5588 - Neurophysiological study of meralgia paresthetica recording with ultrasound-guided monopolar needle Top

Jorge Diaz-Ruiz, Liliana Rodriguez-Zambrano, Nicolas Muñoz-Rodriguez

Universidad Nacional de Colombia, Bogotá, Colombia

E-mail: [email protected]

Introduction: Meralgia paresthetica is a frequent neuropathy in clinical practice. The neurophysiological study of the lateral femoral cutaneous nerve is demanding in some patients, especially if it is recorded using surface electrodes or in obese patients. Patient Information and Clinical Findings: A 38-year-old obese man, with no significant medical history, who has had tingling and neuropathic pain in the lateral aspect of the left thigh for 6 months. He denied weakness. On physical examination he presents normal muscle strength, tone and trophism. Deep tendon reflexes were normal and symmetrical. Hypoesthesia was evidenced to superficial touch, on the lateral side of the left thigh. Antidromic nerve conduction of the lateral femoral cutaneous nerve was performed, with stimulation in the anterior superior iliac spine and recording at 14 cm with surface electrodes, without obtaining a response in both extremities. Due to the above, ultrasound-guided monopolar needle recording was performed, obtaining a normal potential in the asymptomatic limb and absence of response in the affected thigh. In this way, neuropathy of the left lateral femoral cutaneous nerve (meralgia paresthesica) was confirmed. Discussion and Conclusions: The neurophysiological study of the lateral femoral cutaneous nerve is more reliable if the potential is recorded using an ultrasound-guided monopolar needle.

  Clinical Sciences – Health Conditions – Cardiopulmonary System Top

  7016 - Secondary prevention in a cardiac rehabilitation program Top

Guillem Puig1, Maria Boldó Alcaine1, Cinta Llibre2, Andrea Expósito Ciruela1, Maria José Sabariego1, Maria José Durà Mata1

1Department of Physical Medicine and Rehabilitation, Germans Trias i Pujol University Hospital, Barcelona, Spain, 2Department of Cardiology, Germans Trias i Pujol University Hospital, Barcelona, Spain

E-mail: [email protected]

Background and Aims: To analyze adherence and cardiovascular risk factors (CVRF) control prior and after a cardiac rehabilitation program (CRP) after acute coronary syndrome (ACS). Methods: Quasi-experimental pre-post study. Patient referred to Cardiac Rehabilitation Department due to ACS between 2019 and 2021 were included. Blood pressure (BP), body mass index (BMI), abdominal perimeter (AP), LDL, smoking habit, diet and drugs adherence (PREDIMED and Morisky-Green questionnaire (MGQ)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS) and PHQ9), physical activity (International physical activity questionnaire (IPAQ)) and quality of life (EQ-5D) were analyzed. Statistical analysis included descriptive analysis and comparison of the results after CRP. Student's t-test, Wilcoxon and Chi-Squared test were used. A value of p<0,05 was considered statistical significance. Results: 68 patients were included; 85% men, mean age 57 years (SD 9.5). CVRF control analyzed were (pre-CRP/post-CRP): mean systolic BP 123.5mmHg (SD 17)/127.87 (SD 13.9) (ns). Mean diastolic BP 77.4mmHg (SD 9)/78.9 (SD 8.6) (ns). Mean BMI prior and after was 28.2 (SD 4.1) (ns). Mean AP 102.3mm (SD 11.4)/101.57 (SD 10.6) (p=0.001). Mean LDL 115.1mg/dL (SD 36.9)/62.9 (SD 20.4) (p<0.001). Smoking habit 11%/13% (ns). PREDIMED mean score 9.75 (SD 1.7)/10.79 (SD 1.68) (p<0.001). MGQ 85%/82.6% (ns). HADS mean score 8.8 (SD 7.2)/ 7.17 (SD 6.4) (p=0.001). PHQ9 scale mean score 5.24 (SD 4.7)/4 (SD 3.8) (p=0.001). Low level physical activity according IPAQ 55%/26% (p=0.003). EQ-5D VAS scale mean 67.9 (SD 17)/74.7 (SD 15.7) (p<0.001). Conclusions: Control of BP, LDL, smoking habit, diet and drugs adherence, anxiety and depression levels, physical activity levels and quality of life is adequate after CRP. However, we should improve weight control.

  7004 - Correlation between handgrip strength and functional capacity in heart failure Top

Jose Simarro1, María Boldó2, Guillem Puig2, Maria Jose Durà2, Roser Coll2

1Department of Physical Medicine and Rehabilitation, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain, 2Hospital Germans Trias i Pujol, Barcelona, Spain

E-mail: [email protected]

Background and Aims: Peripheral muscle weakness and decreased functional capacity are two prevalent variables in patients with heart failure. Literature regarding its associations is scarce. Methods: Cross-sectional correlational study of patient at the Cardiac Rehabilitation clinic in heart failure unit in a tertiary referral university center between September 2021 and February 2022. Patients included had completed the initial evaluation consisting of functional capacity (6-minute walking test) and peripheral muscle strength (handgrip isometric dynamometry). Decreased functional capacity and peripheral muscle weakness were defined as values <80% predicted. Statistical analysis included descriptive analysis, Pearson correlation test and Cohen Kappa. A value of p<0,05 was considered to be indicative of statistical significance. Results: 54 patients were included, mean age 63 years (SD 12), mean Ejection Fraction 42% (SD 12) and NYHA I-III. Mean functional capacity results were 438 meters (SD 107) and mean handgrip strength, 29.8 kilograms force (SD 9.3 Kg). 50% of patients had decreased handgrip strength and 37% had decreased functional capacity. 26% of patients had decreased both variables. Having a peripheral muscle weakness was associated with decreased functional capacity (p=0.02) and both decreased variables were associated with NYHA classification (p<0.02). Functional capacity and handgrip strength showed no association with age or ejection fraction. Conclusions: Peripheral muscle weakness is related to decreased functional capacity in heart failure patients.

  6988 - Effectiveness of a multimodal telemedicine educational intervention, implemented in times of the COVID-19 pandemic, for patients with heart failure and coronary artery disease Top

Ana Posada1, Carolina Márquez-Tróchez1, Andrés Ospina-Rodas2, Luz Helena Lugo-Agudelo1, Veronica Ciro2

1Universidad de Antioquia, Medellín, Colombia, 2Clínica Las Américas, Medellín, Colombia

E-mail: [email protected]

Background and Aims: Isolation measures due to COVID-19 pandemic drastically increased physical inactivity, with greater risk of acute cardiac events. Maintaining physical activity during the COVID 19 crisis is essential for patients with heart conditions. Our aim was to evaluate the effectiveness of a multimodal telemedicine educational intervention for patients with HF or CAD, implemented in times of the COVID-19 pandemic, to maintain functioning, quality of life and achieve adherence to the recommendations. Methods: Before and after quasi-experimental study. Outcomes included adherence to medications, exercise and nutritional recommendations; Duke Activity Status Index (DASI); quality of life with the Minnesota Living With Heart Failure Questionnaire (MLWHF) in HF and the SF-36 in CAD. A multimodal telemedicine intervention (home cardiac rehabilitation), with educational videos on recommendations about exercise, nutrition and medication in the HF group and educational videos on exercise and delivery of the clinical practice guide for patients in the CAD group. Results: Comparative before and after analyzes were performed in 23 patients in the HF group and in 25 patients in the CAD group. The patients in both groups maintained adequate adherence to the pharmacological, nutritional and exercise recommendations. In the HF group, there was improvement in the MLWHF emotional domain, and in the CAD group, there was improvement in the SF-36 emotional role domain, with a decrease in the general health score. The rest of the domains were maintained in the evaluations. Conclusion: A multimodal educational intervention through telemedicine could be an alternative strategy to the face-to-face modality of cardiac rehabilitation, to maintain adherence to exercise, nutrition and medication and improve health related quality of life.

  6880 - Post-intensive care syndrome due to COVID-19-the treatment experience in a rehabilitation centre Top

Tiago Bonito da Cunha, António Neto, Inês Mendes Andrade, Carolina Barbeiro, Filipa Faria

Centro de Medicina de Reabilitação de Alcoitão, Cascais, Portugal

E-mail: [email protected]

Background and Aims: The Covid19 pandemic had a significant impact in healthcare systems worldwide. Post-Intensive Care Syndrome (PICS) is a main problema in those who needed ICU hospitalisation. Our main goal is the characterization of the sample of inpatients with PICS post Covid-19, the functional and pulmonary assessment of these patients and the their rehabilitation outcomes. Methods: This is an observational, retrospective study, from July 2020 to September 2021, composed of a population of 70 patients diagnosed with Covid-19, admitted at our center. 34 patients were excluded from the study because it was a secondary diagnosis, as well as 13 patients who were admitted to outpatient care. Results: Our cohort had 23 patients, 15 were man, mainly from 60 to 69 years old, median acute hospitalisation time was 71 days and median mechanical ventilation time was 31 days. Obesity and hypertension were the most usual comorbidities. The PFRs revealed that 62% of our cohort had a restrictive syndrome (mostly moderate restrictive patterns), 8% obstructive syndrome and 30% were normal. Deficits were various, ranging from mobility issues to dysphagia and need of supplemental oxygen. Some cognitive problems were noted. Patients were submitted to an intensive customized rehabilitation program, specially designed for post Covid19 patients. After a median hospitalisation of 41 days, all our patients were discharged with no need of supplemental oxygen and with a median increase of 15 points on their FIM score. Conclusions: The burden of severe COVID-19 and prolonged ICU stay was considerable in this cohort. Rehabilitation had a significant impact in functionality in our patients.

  6783 - The association between obesity measured using a single BMI cut-off and cardiac rehabilitation outcomes Top

Travis Davidson1, Jennifer Reed2, Tasuku Terada2

1University of Ottawa, Ottawa, Canada, 2University of Ottawa Heart Institute, Ottawa, Canada

E-mail: [email protected]

Background and Aims: Obesity has been linked to deleterious health effects across several chronic disease populations. A BMI slightly higher than 30 kg/m2 is associated with reduced mortality and better health outcomes in patients with heart failure (HF), known as the obesity paradox. The aim of the current study is to examine how the relationship between cardiac rehabilitation (CR) outcomes and obesity measured with a single BMI cut-off is influenced by the cut-off selection. Methods: A retrospective analysis was conducted of 54 participants who underwent an exercise based CR program. Patients were categorized as obese if their BMI was ≥30 kg/m2 (WHO standards) or >32 kg/m2 associated with higher mortality risk in healthy older population. Functional capacity was measured using a six-minute walk test (6MWT) and cardiorespiratory fitness (CRF) using a cardiopulmonary exercise test at the beginning and following CR. Participants who achieved a minimal clinically important difference in 6MWT (i.e. ≥36 m) or CRF (i.e. ≥1 ml/kg/min) were considered responders. Results: 6MWT distance and CRF at baseline and their changes following CR did not differ between obese and non-obese when using a BMI ≥30 kg/m2 cut-off (t-test, p>0.05). However, having a BMI >32 kg/m2 was associated with worse 6MWT distance and CRF at baseline, no improvements in 6MWT and VO2peak, (t-test, p<0.05), and reduced likelihood to respond to CR (chi-square; p<0.05). Conclusions: We demonstrated that small differences in the selection of BMI cut-offs to define obesity status can significantly alter the conclusions on the effect of obesity on CR outcomes. Efforts should be applied when attempting to dichotomize the relationship between BMI and increased adiposity to avoid inappropriate reference standard bias.

  6745 - The effect of robot-assisted gait training on pulmonary functions in stroke patients Top

Ali Orhan1, Tülay Tekdemir Tiftik2, Sibel Demir Özbudak3

1Department of Physical Rehabilitation and Medicine, Polatli Duatepe State Hospital, Ankara, Turkey, 2Department of Physical Rehabilitation and Medicine, Ankara Training and Research Hospital, Ankara, Turkey, 3Department of Physical Rehabilitation and Medicine, Estenik Clinic, Ankara, Turkey

E-mail: [email protected]

Background and Aims: We aimed to examine the effect of robot-assisted gait training (RAGT) on respiratory functions and functional status in stroke patients and to reveal possible gains. Methods: The study included 42 stroke patients who met our criteria. The patients were divided into 2 groups, 21 patients as the control group and 21 patients as the study group. It is a prospective, controlled, single-center study. Patients in the study group received RAGT (45 minutes/day, 5 days/week, 4 weeks) + conventional rehabilitation (45 minutes/day, 5 days/week, 4 weeks). Patients in the control group received only conventional rehabilitation. Pulmonary function test parameters, which were examined with a simple spirometer device before and after treatment as primary outcome variables, were recorded. As secondary outcome variables, before and after treatment, functional evaluation scores were recorded by face-to-face examination and questioning. Results: In comparison between the groups, FVC (%) value and FIM, BBS, TCT scores was found to be statistically significant compared to the control group in the RAGT group In the RAGT group, VC (%), FEV1 (%), FEV1 (L), MVV (L / min), PEF (%), FEF 25-75% (%) and FEF 25-75% (L) values although there was a more significant increase after treatment compared to the control group, this increase was not statistically significant. Conclusion: RAGT has positive features such as being able to exercise the patient aerobically, contributing to the lower limb muscle strength and balance parameters, lowering the patient's energy consumption during exercise, and not causing serious side effects while doing these. Therefore, we think that RAGT is suitable for use in combination with conventional therapy in improving both respiratory functions and functional status in patients with stroke.

  6707 - Your prehab triumvirate presents three adventures in pandemic perioperative medicine Top

Jennifer Baima1, Stephanie Otto2, Tarannum Rampal3

1University of Massachusetts, Massachusetts, USA, 2Ulm University Hospital, Ulm, Germany, 3Kings College, NHS Foundation Trust. Lead- Kent and Medway, London, UK

E-mail: [email protected]

The pandemic has forever changed not only how we deliver care, but also our relationship with our colleagues. We will provide an account of strategies for continuing multidisciplinary, multimodal prehabilitation in pandemic in three different countries from the perspective of three different disciplines: physiatry, anesthesia, and exercise physiology. Physiatry offers expertise in exercise that is not only relevant to the time before and after inpatient surgery, but the perioperative period as well. Surgical morbidity and mortality is highly tied to functional status. Physiatry should not only lead the charge for prehabilitation, but also have a role in perioperative medicine. We will offer strategies for a perioperative physiatry program forever changed by the extreme conditions of the pandemic. Anesthetists lead the domain of perioperative medicine and are most often tasked with determining surgical risk and perioperative course. Exercise is the only evidence-based treatment for perioperative deconditioning, and physiatrists agree this should be an integral part of medical care. We will describe a successful anesthesia driven multi-dimensional tele-health program in the UK targeting patients with both chronic and acute conditions during the pandemic, proving acceptability and effectiveness of home- based prehabilitation for surgical and non-surgical oncological management. Perioperative training is not always available or reimbursed, let alone during a pandemic. Perhaps the most nebulous part of exercise medicine is how to accurately measure and improve cardiopulmonary performance. Exercise physiologists have the expertise in this area. We will describe a successful exercise physiology program in Germany that provided supervised exercise to cancer patients in a variety of settings - outpatient and inpatient.

  6677 - Investigation of the association between cardiovascular autonomic neuropathy and classical cardiovascular risk factors in people with diabetes mellitus Top

Ahmad Osailan

Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia

E-mail: [email protected]

Background and Aims: People with type 2 Diabetes Mellitus (DM) are at increased risk of cardiovascular diseases (CVD). Cardiovascular autonomic neuropathy (CAN) is an underdiagnosed risk factor for CVD which is prevalent among people with 2DM and can lead to CVD and CVD-related mortality. Little is known about the risk factors associated with CAN in type 2DM. Thus, the study was aimed to assess CAN using cardiovascular autonomic reflex tests, explore the factors associated with CAN in people with type 2DM. Methods: Twenty-six people with type 2DM (60.8±10.4 years, 38.5% female) were recruited from diabetes educational classes at Brierley Hill Health and Social Care Centre, Dudley, UK and were invited for two visits. In the first visit, resting blood pressure and anthropometric measurement were performed for all participants followed by a) one fasted blood sample for analyzing serological CVD risk factors and b) five cardiovascular autonomic reflex tests (Ewing's score). During the second visit, participants completed a treadmill exercise tolerance test for determining their cardiorespiratory fitness (CRF) (VO2 peak). Results: Univariate analysis revealed a significant positive correlation between resting systolic blood pressure and Ewing's score (r=.47, p=.02) and an inverse correlation between VO2 peak and Ewing's score (r=-.64, p=.001). Multivariate linear regression revealed that a significant model which included resting SBP and VO2 peak explained 93.8% of the variance in Ewing's score. Conclusion: CAN was associated with two CVD risk factors including resting SBP and CRF which may indicate the importance of controlling these two risk factors to prevent or reduce CAN in people with type 2DM.

  6558 - Rehab while acutely infected with COVID? - A hyperacute COVID ward Top

Steven Faux, Morgan Hee, Sachittra Fernando, Yuriko Watanabe, Simon Mosalski, Christine Shiner

St Vincent's Hospital Sydney, University of New South Wales, Kensington, Australia

E-mail: [email protected]

Background and Aims: New South Wales, an Australian state, has 7.3m inhabitants. NSW had 70,000 cases, most occurring from June to October 2021. Hospitals in Western Sydney were overrun and at St Vincent's, Sydney over 200 cases were managed in 3 months. Rehabilitation physicians shared care with respiratory physicians in a hyperacute Rehab ward for contagious/acutely infected. This paper describes this model of care's development, operations and outcomes. Methods: An observational description of the establishment of the model of care with observational reports and data on rehab needs of a proportion of patients (n=14) with data on those who, were discharged to our standard rehab inpatient ward is presented. Results: The ward was established to meet both the subacute patient needs and workforce shortages in the management of COVID. A subgroup acutely infected patients had rehab needs evaluations using a hybrid tool that demonstrated care needs (modified Barthel), Oxygen use and mental health needs. This data showed that approximately 100% had rehab needs, 50% had mental health needs and 15% were referred on post-COVID rehabilitation. Data on length of stay and admission/discharge FIM were collected on patients admitted to inpatient rehab showing that their length of stay was less than average (<21.2 days) and FIM gains were modest (<28). Discussion: This paper suggests that early rehabilitation for those infected with COVID may have a positive impact on early discharge from acute care and/or better outcomes of those requiring admission for inpatient rehabilitation. Conclusions: In the management of the endemic phase of COVID19, a model of care for infected patient that allows for early rehabilitation through a hyperacute COVID ward may be beneficial.

  6534 - Frailty and complementary physical training to improve gait speed in elderly patients after acute coronary syndrome Top

Aurelija Beigiene1, Vitalija Barasaite1, Daiva Petruševiciene1, Raimondas Kubilius1, Jurate Macijauskiene2

1Department of Rehabilitation, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania, 2Department of Geriatrics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania

E-mail: [email protected]

Background and Aims: The prevalence of frailty in Europe is 18%; however, in hospitals and nursing homes reaches 45%.The aim of our study was to determine the prevalence of frailty and the impact of two different complementary resistance and balance training programs during cardiac rehabilitation (CR) on gait speed of elderly frail and vulnerable patients after acute coronary syndrome. Methods: This is randomized controlled trial. 97 participants were randomly assigned to three groups: control (CG, n=32), intervention-1 (IG-1, n=32), intervention-2 (IG-2, n=33). All the patients attended a usual inpatient CR program of a mean duration of 18.9±1.7 days, while the intervention groups additionally received different training programs 3 days a week: the IG-1 – with traditional means of physical therapy, the IG-2–with mechanical devices. Frailty was assessed with the Edmonton Frail Scale, the 5-meter walk test was used to evaluate gait speed. Results: Frailty was determined in 37.1% of participants, and 42.3% met the criteria of being vulnerable. After CR, gait speed of frail and vulnerable patients significantly improved in all 3 groups (p < 0.05). In the IG-2, slow gait speed was reversed to normal in the overwhelming majority of patients (p < 0.05), while the CG had the greatest proportion of patients who remained to be slow after CR (p < 0.05). Conclusions: A considerable part of older patients (≥ 65 years) entering CR after acute coronary syndrome were found to be frail or vulnerable. All three CR programs improved gait speed in these patients; however, complementary resistance and balance training with mechanical devices 3 times per week had a greater effect on improving slow gait speed during short-term CR.

  6519 - Impact of an exercise protocol for patients undergoing cardiac rehabilitation follow-up Top

Juan Miguel Morillas Molina, Sofia Luz Marcelino, Francisca Quintana Luque, Pablo Toledo Frías

Servicio de Rehabilitación, Hospital Universitario Clínico San Cecilio, Granada, Spain

E-mail: [email protected]

Background and Aims: Cardiac rehabilitation in patients admitted for cardiac disease has been established as fundamental in their recovery and prognosis. The aim of the study is to evaluate the association between the recommendations given at discharge from hospital and the degree of compliance assessed in the cardiac rehabilitation consultation. Methods: Retrospective cohort study. The sample was selected from the Cardiology unit patients followed for coronary disease, cardiomyopathy or insufficiency that require subsequent cardiac rehabilitation, including a total of 93 patients. Demographic variables, hospital discharge-rehabilitation time, associated risk factors, prescription of the walking protocol and its compliance were evaluated. The variables were extracted from computerized medical reports. Results: Analyzing the data, COMPLIANCE YES was found in the 43.8% of MARCHES group, compared to 49% in the GENERAL group, and 39.3% in NOT. Regarding SOME COMPLIANCE: in the group MARCHES 50% vs GENERAL 44'9% vs NOT 50%. Regarding NO COMPLIANCE, MARCHES 6.3% vs GENERAL 6.1% vs NOT 10.7%. This relationship is not statistically significant (p=0.902) (X2). When comparing the risk factors (sex, tobacco, diabetes, dyslipidemia, exercise history) with compliance, there was no statistical significance (p>0.005). The variable METs does show a statistically significant relationship with compliance (p=0.008). Our main hypothesis was not conclusive. In this hospital rehabilitation unit, there are health education programmes carry out by different specialists who provide physical exercise recommendations. Where these types of programmes do not exist, a detailed hospital discharge report with exercise recommendations could have a major impact. It would be interesting to carry out future studies that consider these factors.

  6472 - Changes in insulin resistance in response to cardiac rehabilitation in patients with coronary artery disease Top

Jose David Romero Rueda1, Rubén Darío Cárdenas Granados1, Erling Fabián Barragán Noriega2, Juan Camilo Mendoza1

1Universidad Nacional de Colombia, Bogotá, Colombia, 2Hospital Central de la Policía HOCEN, Bogotá, Colombia

E-mail: [email protected]

Background and Aims: A significant part of the CAD patients are subjects with metabolic syndrome (MetS) who participate in CR as a part of secondary prevention. The aim was to evaluate the effect of a standard CR program in CAD patients in relation to insulin resistance (IR) indices, triglyceride (TG)-glucose index (TyG) and TG/HDLc ratio (TG/H-r). Methods: 24 patients who completed phase II outpatient CR and had entry and exit exercise stress tests were included. Lipid profile parameters, fasting glucose (FG) and anthropometric measurements were evaluated at baseline and after CR. TyG was calculated as follows: ln(TG*FG). For statistical analysis, Bayesian kendall's tau correlation, non-informative prior distribution beta stretched [-1, 1] with shape parameters: 1, and Bayesian mann whitney u test, non-informative prior distribution Cauchy with location parameter: 0 and scale parameter: 0.707, were performed. Results: TyG and TG/H-r had a positive correlation with body mass index (BMI) (moderate evidence, 3 < Bayes factor (BF10) < 10) and with waist circumference (weak evidence, 1 < BF10 < 3), there was no correlation with age and functional capacity in METS. There was improvement in TG/H-r (1 < BF10 < 3; 95% credible interval (CI): -0.032, 0.904) and in HDLc (extreme evidence, BF10 > 100; 95% CI: -1.714, -0.5) before and after a CR. Conclusions: TyG and TG / H-r are useful indirect measures of IR, however, the evidence from our study suggests that they are not valid outcome measures in CR. Future research should consider the potential effects of confounding variables and explore specific components of exercise.

  6447 - Post COVID-19 deficiency and incapacity in a Tunisian population Top

Emna Toulgui1, Khansa Derbel2, Sana Sellami1, Wafa Benzarti3, Sana Aissa3, Asma Knaz3, Imene Gargouri3, Sonia Rouatbi2, Helmi Ben Saad4, Ines Ghannouchi2

1Department of Physical Medicine and Rehabilitation, Sahloul Hospital, Sousse, Tunisia, 2Department of Physiology and Functional Explorations, Farhat Hached Hospital, Sousse, Tunisia, 3Department of Pneumology, Farhat Hached Hospital, Sousse, Tunisia, 4Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, University of Sousse, Sousse, Tunisia

E-mail: [email protected]

Background and Aims: COVID-19 can be responsible for a multisystem impairment. Respiratory sequelae, in particular aerobic incapacity and decreased tolerance to exercise seem to be frequent. This work aims to evaluate the exercise tolerance in patients with hypoxemic COVID-19 pneumonia. Methods: This is a cross-sectional study involving 55 post COVID-19 patients. Anthropometric data were collected. Simple spirometry and a 6-min walk test (6MWT) were performed. Results: The mean age was 58.9±8.4 years and the mean body mass index was 30±4.8 kg / m2. The mean FEV1 / FVC ratio was 0.79±0.08. The average 6-min walk distance (6MWD) was 573.7±72.9 m (97±14%). The mean values of HR, VAS dyspnea, systolic blood pressure and diastolic blood pressure at rest were, respectively, 78±11 beats / min (55±7%), 1±1, 133±14 mmHg and 81±9 mmHg. These values increased after 6MWT with a statistically significant difference, respectively at 115±23 beats/min (67±13), 3±2, 149±18 mmHg and 84±10 mmHg (p <0.001). The mean resting oxyhemoglobin saturation was 96±2% and decreased after 6MWT with a significant difference to 94 ± 4% (p = 0.016). At the end of 6MWT, 16 (29%), 7 (13%), 4 (7%), 4 (7%) and 12 (22%) of the patients had, respectively, chronotropic insufficiency, elevated HR, desaturation, high VAS dyspnea, and low walking distance. Conclusions: Lung involvement from COVID-19 infection appears to cause exercise intolerance. A cardiorespiratory rehabilitation program could improve these results in patients after COVID-19 recovery.

  6386 - Application of mechanical insufflation-exsufflation through tracheostomy tubes in children with medical complexity Top

Sung Eun Hyun, MooN Suk Bang, Hyung-Ik Shin, Woo Hyung Lee, Hye Min Ji

Seoul National University Hospital, Seoul, Republic of Korea

E-mail: [email protected]

Background and Aims: Children with medical complexity (CMC) need advanced pulmonary rehabilitation and mechanical insufflation-exsufflation (MI-E) can be administered through tracheostomy tubes (TT). This study aimed to suggest proper pressure settings for CMC with TT by demonstrating feasibility and efficacy of MI-E use with in/ex-sufflation pressure ranging from ±15 to 50 cmH2O. Methods: Twelve young CMC with uncuffed TT, aged between 6-60 months old, were enrolled if they needed MI-E because of impaired cough with abundant secretions (>6 suctionings/d). MI-E sessions of 6 sets of incremental pressures with 2:1 s of in-exsufflation for 2 days were supplied while continuous airflow was measured. The completion rate, adverse events, peak expiratory flow (PEF), and flow bias (difference between in/expiratory flow) were analyzed in terms of pressures. Results: All participants completed up to ±50cmH2O with no adverse events. The PEF was negatively and flow bias was positively increasing with higher pressure applied [Figure 1]. The linear mixed model analysis demonstrated pressure and total inspiratory volume determined PEF [Table 1]. Conclusion: Young CMC with TT could tolerate up to ±50 cmH2O safely, reaching PEF of -2.5L/s. Higher pressure and inspiratory volume/time should be considered for a faster PEF.
Figure 1: Peak expiratory flow and flow bias during mechanical insufflation-exsufflation in children with medical complexity with tracheostomy tubes

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Table 1: Determinants of peak expiratory flow generated during mechanical insufflation-exsufflation through tracheostomy in children

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  6209 - Effectiveness of rehabilitation interventions on functioning and quality of life in survivors of emerging respiratory infectious disease outbreaks: A systematic review and meta-analysis Top

Kangping Song1, Xu Qiao2, Siyi Zhu1, Rong Liu2, Shuangshuang Huang3, Jing He1, Chengqi He1, Jan D. Reinhardt2

1Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China, 2Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China, 3Sichuan No. 5 People's Hospital, Chengdu, China

E-mail: [email protected]

Background and Aims: To identify, describe and evaluate the effectiveness of rehabilitation interventions (RI) aiming to help the recovery of survivors of emerging infectious respiratory disease (EIRD). Methods: We searched eight databases from inception to November 30, 2021. Randomised controlled trials (RCTs), observational studies and before-after studies that examined the effects of RI were included. Two reviewers searched, screened and extracted data independently. Quality of included studies was assessed using appraisal tools corresponding to the respective study design. Results: Fifty studies involving 3639 including sixteen RCTs were identified within which one was in SARS and 49 were in COVID-19. Most RI included breathing exercises and respiratory muscle training. Pooling results from RCTs in meta-analysis, RI were effective in improving respiratory function in FEV1 (MD 0.18; 95% CI 0.07 to 0.30), FVC (MD 0.25; 95% CI 0.08 to 0.43) and functional exercise capacity operationalized as 6-minute walking distance (MD 73.93; 95% CI 52.60 to 95.26). Quality of life of patients with SARS (MD 9.20; 95% CI 0.87 to 17.53) as well as COVID-19 (MD 15.40; 95% CI 11.77 to 19.03) improved after RI. Conclusion: RI appear to have improved physical function as well as activities of daily living and quality of life in patient populations with Covid-19. There is limited evidence with regard to SARS and no evidence for other EIRD. RI and settings were diverse limiting comparability. About half of the reviewed RCTs were of low quality. The importance of RI for EIRD has come into focus with COVID-19 leading to a growing evidence base. However, additional high-quality RCTs to evaluate RI are needed.

  6198 - An outpatient rehabilitation program in post-COVID patients: Impact in exercise reconditioning, fatigue, anxiety, dyspnoea and quality of life Top

João Ventura Luís, Fernanda Pinheiro, Margarida Mota Freitas, Sofia Bento, Susana Almeida

Department of Physical Medicine and Rehabilitation Service, Hospital Garcia de Orta, Almada, Portugal

E-mail: [email protected]

Background and Aims: COVID-19 can leave long-term sequelae regardless of the severity of the disease. So, rehabilitation is essential to improve patients' functionality after discharge. The aim of this work is to access the therapeutic effect of an outpatient rehabilitation program in post-COVID patients. Methods: This is an observational cohort study. Sixty-one patients referred to the outpatient clinic of a PRM Service were evaluated. We included previously autonomous adults who survived COVID-19, regardless of disease severity or need of hospitalization and who maintained prolonged symptoms with functional impairment. The sample was characterized in terms of demographic and medical information and evaluated using these scales and tests: Hospital Anxiety and Depression Scale (HADS), Modified Fatigue Impact Scale (MFIS), Modified MRC Dyspnea Questionnaire (mMRC Dyspnoea scale), 6-minute walk test (6MWT) and the 3-level version of EQ-5D (EQ-5D-3L). Results: Analyzing the results of the scales applied before and after the rehabilitation program we found an overall improvement in the mean score on every scale: 6MWT(421.7m to 507.8m, p=0.024); mMRC Dyspnoea scale(2.28 to 1.6); HADS (11.56 to 8.43); MFIS (43.0 to 29.56); EQ-5D-3L index value (0.79 to 0.87, p=0.028) and visual analogue scale (VAS) (83.18% to 67.22%, p=0.028). Moreover, age influenced 6MWT so that for a cut-off of 30m of improvement, younger patients did achieve that goal more frequently than older patients (p=0.012); on the HADS scale, obese patients had worse initial results than non-obese (p=0.028); finally, patients hospitalized more than 30 days had worse results in EQ-5D-3L VAS after treatment (p=0.012). Conclusions: An 8 week-rehabilitation program was effective in this group of post-COVID patients.

  6096 - Support in ethical decisions in cardiac rehabilitation Top

Monica Rincon-Roncancio

Fundacion Cardio Infantil Instituto de Cardiologia, Bogota, Colombia

E-mail: [email protected]

Background and Aims: The interdisciplinary team that works in cardiac rehabilitation led by the Physiatrist deals with patients who have implantable cardioverter-defibrillators (ICD), so physiatrists must know ethical aspects that are related to the end of life. Decision making at the end of life generally constitutes a moment of anxiety and fear that at the same time gives rise to conflicts which are sometimes difficult to analyze and even more so when the patient's will is not known. Methods: Semi-structured interviews were conducted with family members of patients with (ICD) of a highly complex institution in Bogotá, Colombia, which allowed the analysis of the different attitudes that the interviewees have regarding the decision to deactivate the ICDs. Results: 13 relatives of patients with ICD were included. Most of the interviewees express agreement with withdraw life-sustaining treatments. The responses of the family members show how these issues are rarely discussed within patients, it is as if there was a “pact of silence”, in some it is avoided to think about this possibility, in others it is thought but not it is expressed and the most striking thing is that this issue is not discussed with the treating physicians, when discussing the possibility of deactivating the ICD should be one of the fundamental issues in the use of this technology. All respondents consider that it is important to be told about these issues. Conclusions: Our work must be focused on the best interest of patients, but we must not forget that involving the family in treatment and in decision-making in the face of ethical conflicts is also a way to provide higher quality care, and this includes to the interdisciplinary rehabilitation team, where comprehensive treatment should include concern for the ethical aspects of people with cardiovascular disability.

  6088 - Results and meditions from a cardiac-rehab programm through bioimpedance Top

Percy Begazo1, Elena Muñoz2, Marina Gimeno1, A. Belen Morata1

1Department of PMR, Miguel Servet Universitary Hospital, Zaragoza, Spain, 2Agencia Sanitaria Costa del Sol, Marbella, Spain

E-mail: [email protected]

Background and Aims: The Cardiac-rehab program is a multidisciplinary intervention applied to differents diseases with a high evidence level with multiple benefits in short and long term. It consists in 3 phases (I:intrahospitalary, II:physical training, III primary care). The physical training (phase II) consist in two parts: aerobic training and force endurement. This study objective is to exposed the results from 150 patients evaluations using bioimpedance medition in a PM&R service with the collaboration from the Endochrinologie And Nutrition service. Methods: We made a initial and after bioimpedance medition within a 8 weeks cardiac-rehab-program in 150 patients (2018-2021), valorating the physical activity throw the IPAQ scale (International Physycal Activity Questionarie). The nutritional assessment consisted in antropometric issues (bicipital cutaneous fold, body mass index,leg and arm circumference), hand strength by handgrip.SPSS Stadistical analysis with Wilcoxon pared medias and Spearman correlationship.This study was aprobed by a local ethics committee. Results: Data collected from 150 patients. Mean age: 59.10 years (SD:6.8), 79.8% male, 48% with coronary disease and 47% with valvular heart disease.There was a significant increase in physical activity measured by IPAQ questionnaire (p:<000.5) related to METs increase in the post-program measures, increase in handgrip (p=0.035), reduction in fat mass (0.009) and decrease of the BMI (p:0.036). The increase in physical activity was significantly correlated with the increase in muscle mass and decreased fatty mass measured by bioimpedance (Rho:0.7, p=0.081). Conclusions: After this program, there is an increase in physical activity in relation with METS increase (Stress test and IPAQ) and related with increase of muscular mass and the decreased of IMC and fat mass (all measured by bioimpedance).

  5952 - Prevention of acquired pneumonia for patient with disorders of consciousness: Multidisciplinary intervention and outcomes Top

Anna Oksamitni, Elena Aidinoff, Ira Yakubov, Miri Gruber, Olga Bendit

Department of Intensive Care for Consciousness Rehabilitation, Lowenstein Medical Center for Rehabilitation, Raanana, Israel

E-mail: [email protected]

Background and Aims: Healthcare in the 21st century has been marked by significant milestones in health and preventive medicine. Even as modern medicine advances in the understanding and treatment of many ailments, it has yet to cure many chronic conditions. In the Intensive Care for Consciousness Rehabilitation Department at the Lowenstein Medical Center for Rehabilitation, the majority of patients are admitted after extended hospitalizations in tertiary care facilities following severe brain injuries of varying etiologies. Often, the patients are admitted with disorders of consciousness (vegetative, minimal conscious state) in the subacute stage marked by numerous specific complications that can delay the rehabilitation process. Pneumonia are one of the most common complications among patients with disorders of consciousness. Our goal was the Prevention of Respiratory Infections among hospitalized patients in the Intensive Care for Consciousness Rehabilitation Department. Methods: Long term data collection and analysis has provided the framework for a multidisciplinary preventive care team consisting of the infection control department, physicians, nurses, nursing aids, physiotherapists and speech therapists. The team worked in conjunction to define specific activities with high risk for aspiration. The teams were also instructed on management and monitoring of all activities. Results: The incidence pneumonia in 2016 was 2.3 per 1000 days of hospitalization. The multidisciplinary intervention resulted in a decrease of 0.3 per 1000 days of hospitalization. Conclusion: The development and implementation of a multi-disciplinary preventive care intervention resulted in decreased rates of respiratory infections and improved quality of care.

  5990 - Rehabilitation in a pediatric heart transplant recipient with symptoms of peripheral nerve lesion after surgery: A case report Top

Rita Fernandes de Jesus, Adriana Correia, Mariana Martins, Diana Torres Lima

Centro Hospitalar Lisboa Central, Lisbon, Portugal

E-mail: [email protected]

Introduction: Every year, there are approximately 400 to 600 cases of pediatric heart transplantation worldwide. The most common indication for heart transplantation in children over the age of 10 are Cardiomyopathies (CM). Following surgery, a small percentage of patients might suffer peripheral nerve injury, mostly due to compression or traction. Patient Information and Clinical Findings: A 10 year old boy, was diagnosed with dilated cardiomyopathy of unknown ethiology after experiencing symptoms of asthenia, orthopnea and persistent complaints of abdominal pain for 5 months. The patient was hospitalized and roughly 1 month after hospitalization he underwent heart transplantation surgery. On day 3 after surgery, decreased strength in the left foot was detected (grade 1 in dorsiflexion and halux extension and eversion) compatible with common fibular nerve damage along with anesthesia of the area concerned. On ultrasound evaluation there was no evident structural changes, an electromyography was not performed. During hospitalization the patient participated in daily sessions of cardiac rehabilitation along with motor rehabilitation and eletrotherapy sessions of the left foot. An ankle-foot- orthosis was manufactured for correct positioning at rest and a Boxia orthosis for active movement. Discussion and Conclusions: After almost nine months post transplant, the patient was able to recover almost fully to a grade 4 of muscle strenght in dorsiflexion and eversion of the left foot. The patient will continue the rehabilitation program via telerehabilitation while attending online school. This is a successful case of how a patient's cardiac rehabilitation was not limited by physical handicaps.

  5983 - Results of an 8-week rehabilitation program in post-acute COVID-19 patients: An ambispective study Top

Maria Rosario Urbez1, Paul Matthew Burnham2, Lucia Ros Dopico3, Marta Colado3, Daniela Alexandres3

1Department of Physical Medicine and Rehabilitation, Pulmonary Rehabilitation Unit, Hospital Universitario La Paz, Paseo de la Castellana, Madrid, Spain, 2Department of Physical Medicine and Rehabilitation, Hospital Universitario La Paz, Madrid, Spain, 3Department of Physical Medicine and Rehabilitation, Hospital Universitario La Paz, Madrid, Spain

E-mail: [email protected]

Background and Aims: Patients infected by the SARS-CoV-2 virus typically develop multi-systemic involvement, which may lead to numerous deficits affecting the cardiorespiratory, musculoskeletal, neurological and emotional spheres, amongst others. A structured rehabilitation program encompassing these areas can lead to significant improvements in function and quality of life. Methods: An ambispective study was carried out in post-acute COVID-19 patients referred to our post-COVID Rehabilitation Clinic between June 2020 and June 2021. Complete pre and post-treatment assessments were carried out to measure physical activity levels, quality of life, respiratory muscle strength, cardiovascular fitness, and neurological and musculoskeletal function. The 8-week treatment program included respiratory re-education and respiratory strength training, as well as peripheral muscle endurance, strength and flexibility training. Results: 614 post-COVID patients were evaluated; 46 did not fulfill inclusion criteria. Following an 8-week trining program(N=568), we observed stadistically significant improvements in dysnea, quality of life, maximal inspiratory pressure, perifheral muscle strengh as measured by dinamometry and muscle mass using ultrasound. This relates to 198 (35%) asymptomatic patients, 307 (54%) with mild symptoms and 63(11%) with moderate-severe symptoms. Conclusions: In our study, statistically significant improvements were observed following a structured rehabilitation program for postCOVID patients, with regards to function, quality of life, strength and cardiovascular fitness.


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  3. Jarosch I, Schneeberger T, Gloeckl R, Kreuter M, Frankenberger M, Neurohr C, et al. Short-term effects of comprehensive pulmonary rehabilitation and its maintenance in patients with idiopathic pulmonary fibrosis: A randomized controlled trial. J Clin Med 2020;9:1567.

  5943 - Is postoperative outpatient pulmonary rehabilitation beneficial to early-stage non–small cell lung cancer patients undergoing minimally invasive surgery? Top

Cho-I Lin1, Yu-Ting Tseng2, Chung-Yu Chen3, Jheng-Che Lee1, Chiung-Fen Hsu1

1Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan, 2Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, 3Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

E-mail: [email protected]

Background and Aims: Lung cancer is the second most common cancer and the leading cause of cancer death for decades worldwide. Non–small cell lung cancer (NSCLC) accounts for most lung cancer subtypes. Recently, lung cancer screening with low dose computed tomography (LDCT) provides an opportunity to early detect lung cancer patients in Taiwan, and most lung cancer detected with LDCT belongs to the early stage. Mainstay management of early-stage NSCLC is minimally invasive surgery, such as video-assisted thoracoscopic surgery (VATS). Exercise-based pulmonary rehabilitation has been proven to be effective and safe in enhancing postoperative recovery in overall NSCLC patients. Nevertheless, its role of in early-stage NSCLC patients treated with VATS remains inconclusive. Therefore, we design a retrospective study to evaluate the effect of postoperative outpatient exercise training program in NSCLC patients. Methods: Early-stage NSCLC patients treated with VATS were screened and enrolled. Every participant underwent baseline and post-intervention evaluation, consisting of cardiopulmonary exercise testing (CPET), 6-minute walking test and pulmonary function test. All patients attended initial 18 supervised center-based outpatient pulmonary rehabilitation sessions, and those who did not met the criteria of transition to solely home-based exercise received additional 18 sessions of center-based exercise training. Results: 46 patients completed the designated outpatient pulmonary rehabilitation during 2018 to 2020. After intervention, there was significant increase in peak oxygen consumption, 6-minute walking distance and FEV1 (all p< 0.001). Conclusion: Outpatient exercise-based pulmonary rehabilitation is beneficial to early-stage NSCLC minimally invasive operated patients in improving exercise capacity and lung function.

  5923 - Role of physical medicine and rehabilitation in post-COVID lung transplantation: A case series Top

Chloe Haldane, Alicia Lakey, Stacy Bhola-Reebye, Rajiv Reebye

Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada

E-mail: [email protected]

Introduction: Coronavirus 2019 infection (COVID-19) is associated with the development of end-stage fibrotic lung disease. In such patients, lung transplant is a lifesaving treatment for select candidates. We present the first three post-COVID-19 lung transplantation recipients admitted for intensive inpatient rehabilitation at our center. Case Presentations: All three patients were of male sex, had limited pre-existing comorbidities, were independent at baseline and working full-time. All patients were admitted for intensive inpatient rehabilitation and underwent standardized functional testing during their rehabilitation stay. Patient 1: 54 years old, initially hospitalized for 63 days prior to bilateral lung transplantation. During consultation by PMR, the patient was identified to have subtle left-sided weakness and found to have cerebral microbleeds likely related to venovenous extracorporeal membrane oxygenation. The patient was admitted to intensive inpatient rehabilitation for 50 days and discharged at a functionally independent level. Patient 2: 48 years old, initially hospitalized 67 days prior to bilateral lung transplantation. The patient was admitted to intensive inpatient rehabilitation for 22 days and discharged at a functionally independent level. Patient 3: 59 years old, initially hospitalized for 79 days prior to bilateral lung transplantation. The postoperative course was complicated by lumbosacral plexopathy assessed early by PMR. The patient was admitted to intensive inpatient rehabilitation. Discussion and Conclusions: The shift in health care needs during the COVID 19 pandemic, required PMR specialists to be involved in patient care earlier and in more acute settings. The post-COVID-19 lung transplantation patient population described benefited from a collaborative care model directed by PMR.

  5844 - Cancer rehabilitation during the COVID-19 pandemic Top

Krystal Song, Fary Khan

Department of Rehabilitation Medicine, Royal Melbourne Hospital, Royal Park Campus, 34-54 Poplar Road, Parkville, Victoria, Australia

E-mail: [email protected]

Background and Aims: The global pandemic of coronavirus (COVID-19) is a major public health issue since identified in December 2019. It creates unique challenges from the perspective of cancer survivors, as they often require complex cancer treatments during the disease trajectory, disease surveillance, and rehabilitation. Given the vulnerability of this population, there is an urgent need to address the impact of such a pandemic on cancer rehabilitation. The evidence for critical issues concerning the impact of COVID-19 upon cancer patients and on service delivery is highlighted in this narrative overview. Methods: Narrative overview of the rehabilitation issues and challenges faced by cancer patients so far during this unprecedented global COVID-19 pandemic including the provision of cancer care, risk mitigation, contingency measures undertaken and strategies used for continued service delivery. Results: Acute care challenges faced by cancer patients in the context of COVID-19 are highlighted in terms of symptom burden, cancer treatment effects mimicking COVID-19 symptoms, clinical presentations that complicate diagnostic work up and associated conditions such as pneumonitis, myocarditis and cardiac arrhythmias which share features of chemoradiotherapy effects. Rehabilitation contingency measures within acute care, inpatient rehabiltiation and ambulatory care settings undertaken are described and strategies used to provide cancer rehabilitation interventions during this crisis will be highlighted. Conclusions: The impact of COVID-19 pandemic on cancer care delivery and disruption of services are described, with guidelines requiring continuous updates due to the evolving nature of the pandemic.

  5707 - Synergistic effect of abdominal thrust with mechanical insufflation-exsufflation in patients with tracheostomy Top

Han Eol Cho1, Jang Woo Lee2, Won Ah Choi3, Inyeop Kim3, Seong-Woong Kang3

1Department of Rehabilitation Medicine, Gangnam Severance Hospital and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea, 2Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea, 3Department of Rehabilitation Medicine, Gangnam Severance Hospital and Rehabilitation Institute of Neuromuscular Disease, Seoul, Korea

E-mail: [email protected]

Background and Aims: Mechanical In-Exsufflation (MI-E) is commonly used to augment cough in patients with restrictive lung disease. Although it is well known that abdominal thrust (AT) is very important in enhancing the effect of MI-E in patient without tracheostomy, the synergistic effect of AT in Patients with tracheostomy has not been studied systemically. In this study, we tried to check the effect of combination of MI-E with AT in patients with tracheostomy. Methods: Twenty-two patients with tracheostomy and severe restrictive lung disease were enrolled (19 amyotrophic lateral sclerosis and 3 complete cervical cord injury upper C4/C4 level). MI-E was set to inspiration, expiration and pause 3, 3, and 2 seconds. Peak expiratory flow (PEF) of two different pressure (Inspiratory and expiratory pressure +40/-40cmH2O and +55/-55cmH2O) with or without AT were tested. A total of 3 trials were performed for each setting, and the highest value was recorded. Results: The mean PEF in the +40/-40cmH2O group with AT (144.8L/min) is significantly higher than that of +40/-40cmH2O without AT (130.0L/min) (p<0.001). Also, PEF of +55/-55cmH2O group with AT (168.6L/min) was higher than that of PEF of +55/-55cmH2O group without AT (157.1L/min) with significance (p<0.001) [Figure 1]. Conclusions: AT used in concert with MI-E increases the expiratory flow rate at about 10 percent in patients with tracheostomy. Considering that removal of airway secretion is crucial to prevent comorbidities such as pneumonia, AT is recommended to be used in combination with MI-E in patients with tracheostomy.

  5580 - Effectiveness of a tele-rehabilitation program in patients with COVID-19- pilot study Top

Antonios Kontaxakis, Kyriaki Kleanthi, Dimitra Feridou, Maria Papakyritsi, Ioannis Saramantos, Stylianos Velonas, Athanasios Koutsakis, Nikolaos Lykos, Eleni Moumtzi- Nakka

Department of PRM, 414 Military Hospital of Special Diseases, Penteli, Greece

E-mail: [email protected]

Background and Aims: The multi-system effect of SARS-CoV-2 and the significant impact on function internationally are already known. Telerehabilitation programs have been implemented with success in a variety of conditions and the first double blinded randomized control trials in Covid-19 are in place. We aimed to study the effectiveness of telerehabilitation in functional improvement of patients after hospitalization. Methods: A prospective pilot study was conducted in patients discharged from acute CoVID-19 departments. Demographic data and answers on 12 common symptoms were collected. Scales/ tests used were Sit to Stand 1min test (STS1min), Hospital Anxiety Depression Scale (HADS), Fatigue Severity Scale (FSS), Montreal Cognitive Assessment Scale (MoCA) and EuroQoL-5D-5L (EQ5D5L). Subsequently a 2month, 2 times/ week tele-rehabilitation intervention took place. Results: 8 patients took part (male- female ratio 7:1), with a mean age of 52,3 (SD:11,2). Mean duration since discharge from acute departments was 30,9 days (SD:16,3). At the beginning of the program median symptoms reported were 4, while after completion improvement was recorded in STS1min: from 16,4 (3,7) to 30,1 (6,5), p:0,001, in FSS: from 48,0 (12,3) to 22,3 (13,1), p:0,015, in MoCA: from 25,6 (1,4) to 27,1 (1,5), p:0,2 and HADS Anxiety: from 2 (3,5) to 1,0 (2,7), p:0,14, HADS Depression: from 3,6 (2,8) to 1,4 (3,3), p:0,002. In EQ5D5L disorders persisted in 1 patient, while EQ5DLVAS improved from 63,7% (8,2) to 88,1% (7,9), p=0,000. Discussion: Taking in consideration the vast number of people infected with SARS-CoV2 and the large- scale resultant rehabilitation needs, tele-rehabilitation seems an effective alternative. Reduced cost and ease of implementation deserves further research and reimbursement.
Figure 1

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  5558 - Case study: Influence of central lymphatic drainage on the absence of cytokine storm in COVID-19 infection on the example of a three-member family Top

Natalia Solovjova1, Danijela Pecarski1, Dragoslav Stefanovic1, Marija Milovanovic2

1Academy for Applied Studies (AASB), Belgrade, Serbia, 2Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia

E-mail: [email protected]

Background and Aims: COVID-19 infection is especially dangerous for the elderly population with the cytokine storm being its critical moment. The aim of the study was to show the effect of central lymphatic drainage on the quality of life and the absence of cytokine storm in covid-19 infection on the example of an three-member family (mother born in 1933, father born in 1930, son born in1960). Methods: An three member received: 33 (mother), 67 (son), and 16 (father) treatments of central lymphatic drainage between 18.4.2017 to 19.9.2018. In the period of 24.12.2020 -4. 01.2021 diagnosed with J 12.8 Pneumonia viralis, alia (B 34. 2 Infektio coronaviralis) mother and father were hospitalized in semi-intensive care where they were treated with regular internist therapy, whereas, the son rested at home from 22.12.2020 to 7. 1. 2021 with therapy using levox 500 mg * 1 daily, aspirin protekt 100 mg * 1 daily, vit. C. None of the family members had cytokine storm absent in clinical manifestations. Results: Absence of cytokine storm during covid infection- 19, saturation O2 on discharge is 96%. Conclusions: Application of treatments of central lymphatic drainage performed by a specialist doctor gave a lasting result in improved quality of life and the possibility of the Covid- 19 passing without the typical Covid-19 cytokine storm.


  1. Solovjova N. Macroscopic and microscopic analysis of the effects of central lymphatic pathway modeling in mice. In: Abstract Book of ESPRM Congress 2020. Belgrade.
  2. Solovjova N. Balneoklimatologija. Vol. 43. YU: Maj; 2019. p. 302.

  5557 - Influence of central lymphatic drainage on the absence of cytokine storm in COVID-19 infection in a person born in 1933 with numerous comorbidities Top

Natalia Solovjova1, Danijela Pecarski1, Dragoslav Stefanovic1, Marija Milovanovic2

1Academy for Applied Studies (AASB), Belgrade, Serbia, 2Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia

E-mail: [email protected]

Background and Aims: Covid-19 infection is especially dangerous for the elderly population with the cytokine storm being its critical moment. The aim of this study was to show the influence of central lymphatic drainage on the quality of life and the absence of cytokine storm in covid-19 infection in a patient born in 1933. Methods: A patient N. S. , 1933, of moderately poor condition, mobility and cardiopulmonary symptoms received 33 treatments of central lymphatic drainage between 18.4.2017 to 19.9.2018 which firstly resulted in a decrease from 4 colds per year to 0 one year after treatments and 1 two years after treatments. She caught the COVID-19 virus without receiving any vaccine and was hospitalized from 24.12.2020 to 4.01.2021 with numerous accompanying diagnoses during which hospitalization she was treated in semi-intensive care with regular internist medicine and neurological therapy with the cytokine storm absent in clinical manifestations. Results: Absence of cytokine storm during covid infection- 19, Hour O2 on discharge is 96%. Conclusions: Application of 33 treatments of Central lymphatic drainage performed by a specialist doctor in a patient born in 1933 gave a lasting result reflected in improved quality of life and also gave the possibility of pneumonia caused by Covid-19 to pass without the typical Covid-19 cytokine storm.


  1. Solovjova N. Macroscopic and microscopic analysis of the effects of central lymphatic pathway modeling in mice. In: Abstract Book of ESPRM Congress 2020. Belgrade.
  2. Solovjova N. Balneoklimatologija. Vol. 43. YU: Maj; 2019. p. 302.

  5554 - Diaphragm function in patients with post-COVID-19 syndrome: A new approach in pulmonary rehabilitation Top

Rubén Darío Cárdenas Granados1, Diego Mauricio Chaustre Ruíz2, Yamil Yasser Salim Torres3, Cristhian David Rojas Beltrán1, Gimena Ramirez2

1Department of Physical Medicine and Rehabilitation, Universidad Nacional, Bogotá, Colombia, 2Hospital Central de la Policía, Bogotá, Colombia, 3Universidad Militar Nueva Granada, Bogotá, Colombia

E-mail: [email protected]

Background and Aims: Many patients with post COVID-19 syndrome persist with respiratory symptoms such as dyspnea and fatigue. Some studies have proposed that these symptoms may derive from diaphragm dysfunction (DD). Here we evaluate the diaphragmatic function in patients with Post COVID-19 Syndrome by diaphragmatic ultrasonography. Methods: 15 patients with post COVID-19 syndrome (59.4±13.9 years) admitted to a pulmonary rehabilitation program were included. Diaphragmatic excursion (DE) was quantified during deep breathing with a 3.5 MHz convex transducer, using an anterior subcostal view. Diaphragmatic thickness (DT) was measured at maximal inspiration (DTmi) and at end-expiration (DTe) with a 12 MHz linear transducer, through the 9th intercostal space. The thickening fraction (TF%) was calculated as follows: (Tdi-Tde/Tde)*100. Normal values have been established for DE (6 – 9 cm), DTmi (>4 mm) and TF% (28 – 96). Clinical data and functional tests were recorded from clinical history. For statistical analysis, bayesian kendall's tau correlation and Bayesian mann whitney u test were performed. Results: 53.3% of patients had DD. DE had a negative correlation with Fatigue Severity Scale and positive correlation with walking distance and velocity for the six-minute walk test (6MWT) (strong evidence, Bayes factor (BF10) >10). DTmi was negatively correlated with Borg scale at rest (weak evidence, 1 < BF10 ≤ 3) and TF% had positive correlation with oxygen saturation post 6MWT (moderate evidence, 3 < BF10 ≤ 10). Conclusions: In post covid syndrome, DD is associated with decreased physical performance but not with respiratory symptoms during physical activity. These symptoms may arise from other possibilities, such as involvement of the lung parenchyma or dysautonomia.

  5394 - COVID-19 impact among the rehabilitation services in Spain Top

Percy Begazo1, Marta Supervia2, Marina Gimeno1, A. Belen Morata1

1Miguel Servet Universitary Hospital, Zaragoza, Spain, 2Gregorio Marañon General Hospital, Madrid, Spain

E-mail: perc[email protected]

Background and Aims: An important amount of patients have needed admission to ICU and long hospitalizations due to COVID-19.The objective of this study is to determine the level of adaptation of Rehabilitation Services to the increased demand of rehabilitation management of intensive care patients and inpatients. Methods: Cross-sectional study.A online survey was administered to rehabilitation departments across Spain between 22/12/2020 and 27/02/2021 (in order to evaluate the need of human and material resources for ICU patients suffering from SARS-COV-2). Sorecar (Spanish cardiopulmonary rehabilitation Society) developed the survey (ICU rehabilitation services identification). Descriptive statistical analysis was conducted using SPSS. Results: 38 hospitals from 18 cities (total: 49) participated in the study. ICUs demand average:7,38 medical consultation (MC) per week (range:2-45). Average in hospitalization: 9,63 MC per week (range: 2-55). Total worktime dedicate by physicians: 10,38 hours/week, physiotherapists: 25,95 hours/week. Only 7 hospitals (16,7%) have occupational therapists (OT) (average dedication: 5 hours/week). Average time per rehab- sessions: 30 minutes. 59,1% (n=23) of the studied hospitals had a specific rehab-consultation for patients follow-up (9,1% (n=4) are planning one). 64,3% (n=24) of the surveyed centers developed a specific protocol for COVID-19 patients, another 7,1% (n=3) were in development.48.5% (n=18) of surveyed centers there is no specific training program in ICU and respiratory rehab-areas for the MIR (Internal medical residents). Conclusions: This pandemic increase the working hours and demand of the Rehab-services. Rehab-medical doctor postICU consultant is necessary for an adequate patient follow-up. The ICU-rehab must be an important area in the actual residents training program.

  4525 - Evaluation of diabetic patients after phase 2 of the cardiac rehabilitation program Top

Sara Isabel Antunes, Fernanda Pinheiro, Melanie Lameiras, Ângela Pereira, Jorge Dias, Luísa Bento, Sofia Bento

Department of Physical and Rehabilitation Medicine, Hospital Garcia de Orta, Almada, Portugal

E-mail: [email protected]

Background and Aims: Coronary artery disease (CAD) is the leading cause of premature death in diabetic patients. It is known that these patients have a 2 to 4 times higher risk of death from CAD than non-diabetic but may decrease after a CRP. These programs aim reducing cardiovascular risk through a multidisciplinary approach. Our objective was to compare the effects of CRP in diabetic and non-diabetic patients. Methods: Retrospective cohort study of patientes who completed phase 2 CRP at the Garcia de Orta H. between 2015 and 2020. Demographic data and clinical history were obtained from the SClinic computing platform. Metabolic equivalents (METs), estimated by maximal exercise in exercise test, lipid profile (LDL, HDL, triglyceride), blood pressure, weight, BMI, waist perimeter were evaluated at baseline and at the end of the phase 2 CRP. Results: 124 patients were included in the study, 26 were diabetic (DM) and 98 were non-diabetic (nDM) with similar risk factors. DM patients had a lower basal functional capacity (medium 8.0 vs 9.9 METs). Both groups improved on the various parameters analyzed after CRP, however, the DM group showed a superior improvement, this improvement was only statistically significant (p value < 0.05) in HDL and BMI. The efficacy of CRP in the DM group resulted in better glycaemic control with a statistically significant improvement in fasting glycemia (p value- 0.004). Conclusions: Both groups improved the various parameters analyzed, however in the DM group there was a superior and statistically significant improvement for HDL and BMI. In addition, DM have improved glycemic control. These results reinforce the importance of early guidance for diabetic patients to a CRP, centered on physical exercise program and modification of risk factors.

  6760 - Clinical nurses' cognitive status on pulmonary rehabilitation and obstacles for its application Top

Yeping Zheng

The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China

E-mail: [email protected]

Background and Aims: To investigate the cognition of pulmonary rehabilitation and clinical nurses in clinical practice. Methods: Using convenient sampling method selected 644 clinical nurses from a Grade A hospital in Hangzhou.Using a self-prepared questionnaire, its general information, lung rehabilitation cognition and obstacle factors are investigated, in which lung rehabilitation cognition includes theoretical knowledge and skill mastery. Results: The total score of clinical nurses (96.94 ± 16.85), 77.55%, with theoretical knowledge (58.28 ± 10.58), 77.71% and skill mastery (38.66 ± 7.26) of 77.32%.Clinical nurses attending pulmonary rehabilitation training scored higher than those not trained (t=9.915, P <0.05), and not across different departments (F=4.403, P <0.05).Among the obstacle factors, the top three scores were the patients' insufficient cognition of lung rehabilitation, their poor self-management ability, and the lack of site and equipment support. Conclusion: Clinical nurses' pulmonary rehabilitation is at medium level, theoretical knowledge and skills are not comprehensive and thorough, and face many obstacles in the implementation of pulmonary rehabilitation.Clinical managers should strengthen lung rehabilitation training and guidance for nurses, and actively provide conditions and resources to strengthen patients' health education to promote the smooth implementation of lung rehabilitation.

  5874 - Improvement of tumor motion during radiation therapy through the pulmonary rehabilitation in lung cancer patients – Case series Top

HeeTae Shin, SeungHak Lee

Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

E-mail: [email protected]

Introduction: During radiation therapy for lung cancer, there is problem that the tumor can sometimes moves as a result of respiration. To solve this problem, Respiratory gaiting in which the radiation beam is turned on and off depending on patient's respiratory cycle is being used. The most important thing for gating is patient's breathing with endurance and consistency. Therefore We designed a case to confirm the possibility that targeting effect of radiation can be improved through pulmonary rehabilitation (PR) which make the patient's breathing regular and endurable. Clinical Findings: Pulmonary rehabilitation program which lasted 6weeks (twice a week, 60 minutes 1times a day) and consisted of 2 training sessions; (1) Regular aerobic, strengthening and flexibility exercise. (2) Breathing exercise training: training to induce constant inspiration:expiration (1:2). Three patients with non-small cell lung cancer (NSCLC) received Concurrent Chemo-Radiation Therapy (CCRT) and performed pulmonary rehabilitation simultaneously. The regularity of breathing required for respiratory gating was assessed using breathing amplitude, cycle and baseline-shift [Figure 1] and [Table 1]. Amplitude deviation and Baseline-shift outcome have improved. Grip strength and 6 minute-walk-test have also improved. Discussion: This case report provides possibility for the implementation of pulmonary rehabilitation can help with respiratory gated radiation therapy.
Figure 1: Respiratory motion during radiation therapy before and after PR

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Table 1: Respiratory motion, 6-min walking test and grip strenghth before and after pulmonary rehabilitation

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  5991 - Rehabilitation in a pediatric heart transplant recipient with symptoms of peripheral nerve lesion after surgery: A case report Top

Rita Fernandes de Jesus, Jorge Soares Dias, Adriana Correia, Mariana Martins, Diana Torres Lima

Centro Hospitalar Lisboa Central, Lisbon, Portugal

E-mail: [email protected]

Introduction: Every year, there are approximately 400 to 600 cases of pediatric heart transplantation worldwide. The most common indication for heart transplantation in children over the age of 10 are Cardiomyopathies (CM). Following surgery, a small percentage of patients will suffer peripheral nerve injury, mostly due to compression, traction or nerve ischemia. Patient Information and Clinical Findings: A 10 year old boy, with no relevant prior health history was diagnosed with dilated cardiomyopathy of unknown ethiology after experiencing symptoms of asthenia, orthopnea and persistent complaints of abdominal pain and vomiting for 5 months. The patient was hospitalized and roughly 1 month after hospitalization he underwent heart transplantation surgery. On day 3 after surgery, decreased strength in the left foot was detected (grade 1 in dorsiflexion and halux extension and eversion) compatible with common fibular nerve damage along with anesthesia of the area concerned. On ultrasound evaluation there was no evident structural changes, an electromyography was not performed. During hospitalization the patient participated in daily sessions of cardiac rehabilitation along with motor rehabilitation and eletrotherapy sessions of the left foot. An ankle-foot- orthosis was manufactured for correct positioning at rest and a Boxia orthosis for active movement. Discussion and Conclusions: After almost nine months post-transplant, the patient was able to recover almost fully to a grade 4 of muscle strenght in dorsiflexion and eversion of the left foot. The patient will continue the rehabilitation program via telerehabilitation while attending online school. This is a successful case of how a patient's cardiac rehabilitation was not limited by physical handicaps.

  Clinical Sciences – Health Conditions – Musculoskeletal System Top

  6986 - Rehabilitation after anterior cruciate ligament reconstruction: Does proprioceptive exercise affect the quality of motor recovery of operated knee at short and long term? A review Top

Sandra Miccinilli, Dorotea Manco, Bravi Marco, Fabio Santacaterina, Benedetta Campagnola, Laura Cricenti, Andrea Di Gravio, Mirella Maselli, Michelangelo Morrone, Silvia Sterzi, Federica Bressi

Department of Rehabilitation, Fondazione Policlinico Campus Bio-Medico di Roma, Rome, Italy

E-mail: [email protected]

Background and Aims: The Anterior Cruciate Ligament contributes to proprioception of the knee. Post ACL reconstruction rehabilitation aims to restore correct joint stability and range of motion, reduce the risk of re-injury, and improve the knee's function in daily life. Aim of this literature review was to evaluate how different rehabilitation programs can lead to improved proprioception after ACL reconstruction. Methods: A systematic search of the scientific articles was performed using PubMed, PEDro, Cochrane Library and Scopus. The study included full text, English written articles, of the last 10 years, concerning proprioceptive rehabilitation treatment in patients with ACL reconstruction. Extracted data included first author's full-name, year of publication, type of study, objective of the study, characteristics of population, rehabilitation intervention performed and analyzed outcome. Results: 7 final articles out of 848 found articles were selected, 6 RCTs and 1 case-control study. The total number of participants in all included studies was 253. The mean age of participants was 31.8 year. Different rehabilitation protocols and different outcome measures were reported. Proprioceptive rehabilitation program after ACL reconstruction in 6 out of the 7 included studies showed statistically significant outcomes. Conclusions: proprioceptive rehabilitation after ACL reconstruction surgery is effective in improving the recovery of the performance of the knee. Further and more homogeneous studies are needed to describe more in depth treatment parameters and proprioception measurement methods.


  1. Volpi P. Patologia del Ginocchio Nell'atleta D'élite CIC Edizioni Internazionali. 2014.
  2. Montalvo AM, Schneider DK, Webster KE, Yut L, Galloway MT, Heidt RS Jr., et al. Anterior cruciate ligament injury risk in sport: A systematic review and meta-analysis of injury incidence by sex and sport classification. J Athl Train 2019;54:472-82.

  6750 - A short-term efficacy of glucosamine-sulphate, non-animal chondroitine sulphate and s-adenosylmethionine combination on radiographic progression in patients with knee osteoarthritis Top

Zoran Velickovic, Saša Janjic, Ljiljana Kovacevic, Goran Radunovic

Institute of Rheumatology, Belgrade, Serbia

E-mail: [email protected]

Background and Aims: This study aimed to evaluate the effect of the fixed oral formulation of Glucosamine-sulphate (GS), non-animal Chondroitine-sulfate (CS), and S-adenosylmethionine (SAMe) on OA progression. Methods: A total of 75 patients were randomized in a 1:1:1 ratio to: Placebo group, 1st Experimental group (375 mg GS, 325 mg CS, 100 mg SAMe daily), and 2nd Experimental group (750 mg GS, 650 mg CS, 200 mg SAMe daily). The joint space width (JSW) and Kellgren and Lawrence (K&L) grade were estimated using weight-bearing anteroposterior 30 semi-flexion knee radiographs. JSW was measured using the manual digitization method (midpoint method) at lateral and medial condyle of both knees. Results: After 6 months of supplementation, the results showed increase in JSW in all groups (ranging from 0.09-0.19, depending on condyle/knee). Results haven't shown any between-group statistically significant difference in delta changes after 6 months [Table 1]. Regarding both knees, after 6 months, up to 95% of patients in all investigated groups had K&L grade unchanged compared to baseline. Conclusion: The GS+CS+SAMe combination do not have any effect on cartilage thickness (p>0.05) according to XR assessment. Moreover, there isn't a proven efficacy of combination regarding OA progression after 6 months. These results need to be taken with caution because we used almost two times lower doses of GS and CS comparing to previous studies. More than one imaging technique need to be utilized when assessing effect of SYSADOAs on cartilage thickness because XR have lower sensitivity comparing to MRI and MSUS.
Table 1: Radiographic assessment of cartilage thickness

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  6897 - Etiological study of pediatric trigger finger: A new assessment Top

Diana Torres Lima1, Mafalda Pires2

1Department of PM and R, Centro Hospitalar Universitário de Lisboa Central - Hospital Curry Cabral, Lisbon, Portugal, 2Department of PM and R, Centro Hospitalar Universitário de Lisboa Central - Hospital Dona Estefânia, Lisbon, Portugal

E-mail: [email protected]

Background and Aims: Pediatric trigger finger (TF) is a rare condition with poorly understood etiology. In 29% of cases it has a primary cause, including mucopolysaccharidosis (MPS). In our Outpatient PM&R clinic, pediatric TF is usual, making the awareness of primary etiologies important. The existence of a fee-free Portuguese project on MPS-genetic-testing (FIND Project) allows the deepening of the diagnosis. The purpose of this study is to present our project to find the association between TF and MPS in a pediatric population. Methods: Retrospective study of pediatric patients admitted due to TF (september 2017-march 2022). Isolated trigger thumb cases were excluded. A comprehensive medical history chart was built, focusing on significant clinical findings in MPS patients. Informatic clinical files were reviewed and telephone enquiries performed if information was lacking. Results: Seven children were included, ages at diagnosis between 6 months and 2 years. Four patients had bilateral single TF. Two had two TF in the same hand. One had multiple TFs in both hands. None of these children had previous diagnosis of metabolic disease. All clinical charts were reviewed to find history of other symptoms associated with MPS. Only one patient reported having multiple of these. All patients were asked to further evaluate the possibility of MPS, submitting to the FIND Project digit prick test. Presently the blood samples are being evaluated. Conclusions: One third of pediatric TF have a primary cause. The main characteristics of pediatric TF associated with underlying MPS are bilateral cases, multiple fingers committed, association with carpal tunnel syndrome and dysmorphic characteristics. Clinicians must be aware of these associations and do further investigation.

  6947 - How does the muscular activity of injured athletes with chronic ankle instability change their gait patterns? A systematic review and meta-analysis Top

Christina Martzivanou1, Dimitrios Dimopoulos1, Georgios Ntritsos2, George I. Vasileiadis1, Dimitrios Varvarousis1, Nikolaos Giannakeas2, Anastasios V. Korompilias1, Avraam Ploumis1

1Department of Physical Medicine and Rehabilitation, University of Ioannina, Ioannina, Greece, 2Department of Informatics and Telecommunications, School of Informatics and Telecommunications, University of Ioannina, Ioannina, Greece

E-mail: [email protected]

Background and Aims: Chronic Ankle Instability (CAI) is caused by repeated episodes of ankle sprains during athletic and/or repetitive giving way of the ankle. The purpose of this study was to evaluate the effect athletic injuries have on gait analysis and muscle activity (EMG) of athletes. Methods: All injured-athletes were compared to healthy controls. Differences in muscle activation between the two groups have been retrieved and documented. The measure of lower limb kinetics was performed by using surface electromyography (EMG) on the following muscles: gastrocnemius medius (MG), rectus femoris (RF), tibialis anterior (TA), peroneus longus (PL), soleus (SOL) and in some cases vastus lateralis (VL) and lastly biceps femoris (BF). The muscle co-contraction index (CCI), which monitors the agonist and antagonist muscles contributing to stabilizing the ankle joint and the Identification of Functional Instability Scale (IdFAI) were analysed as well. Results: Each of the 10 studies (level I-III) included in the study, showed significant reduction of the affected muscles near the ankle sprain. The EMG of PL, TA and MG was decreased after the initial injury, causing the instability of the ankle joint overall. In addition, the pooled mean difference between the IdFAI of CAI-athletes and non-CAI athletes was 20 units. Finally, the frontal plane CCI (TA and PL) was greater in the CAI-group. Conclusions: Despite the number of ankles sprains each athlete has had in the past; participants showed significant reduction in muscular activity. Through decreased TA activation, the ankle joint of CAI-athletes seemed to adapt for maintaining the joint stability resulting in changed gait pattern.


  1. Eils E, Rosenbaum D. A multi-station proprioceptive exercise program in patients with ankle instability. Med Sci Sports Exerc 2001;33:1991-8.
  2. Gribble PA. Br J Sports Med. 2014;48:1014-8.

  6902 - Do limb-salvaging procedures for patients with lower limb neoplasms lead to normal gait: A systematic review and meta-analysis of the literature Top

Panagiotis Filis1, Dimitrios Varvarousis2, Georgios Ntritsos3, Dimitrios Dimopoulos2, Ioannis Manolis2, Nikolaos Giannakeas3, Anastasios Korompilias4, Avraam Ploumis2

1Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece, 2Department of Physical Medicine and Rehabilitation, School of Medicine, University Hospital of Ioannina, Ioannina, Greece, 3Department of Informatics and Telecommunications, University of Ioannina, Ioannina, Greece, 4Department of Orthopedic Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece

E-mail: [email protected]

Background and Aims: Apart from amputation, the current arsenal of musculoskeletal oncology offers several options, such as: modular endoprosthetic reconstruction; bone graft reconstruction; bone transport; arthrodesis; and rotationplasty. This systematic review aims to assess the effect of the limb-salvaging techniques on the gait parameters of the patients, as measured by gait analysis following the surgery. Methods: Databases were systematically searched up to January 2022 for studies that performed gait analysis in patients who received any type of reconstruction surgery after tumor resection of the lower extremity and compared their gait parameters with those of healthy individuals. A meta-analysis of gait parameters was conducted calculating the summary mean differences between tumor and healthy patients using random-effects models. Results: The search resulted in 8 comparative cohort studies for endoprosthetic reconstruction involving 187 patients, 4 cohort studies for allograft reconstruction involving 92 patients, 3 cohort studies for rotationplasty involving 88 patients and no comparative studies regarding the rest of the limb-salvaging methods. The vast majority of the studies pertained to the knee, while less published literature was detected concerning the proximal femur and the ankle. Summary statistics indicated that each reconstruction technique negatively affected the gait parameters (gait velocity, stride length, gait cycle duration, cadence) in a statistically significant manner. Conclusions: Gait parameters of patients after limb-salvaging procedures are inferior to those of normal individuals. There is need for improvement of the rehabilitation programs in order for the patients' post-operative gait to become as normal as possible.

  6887 - Evaluation on the results of the implementation of a rehabilitation program for patients with anterior cruciate ligament reconstruction Top

Claudia Teixidó Font

Hospital Germans Trias i Pujol, Badalona, Spain

E-mail: [email protected]

Background and Aims: The increase in the incidence of patients with ACL injuries that have undergone surgical intervention in our hospital since 2021, motivates us to carry out this project to assess the functional results of our patients six months after starting the rehabilitation program. Methods: Descriptive study. Patients who underwent ACL plasty between April and September 2021 and participated in a rehabilitation program at our center limited by the restrictions of the SARS-COV2 pandemic. We recruited 8 patients (4 men, 4 women) with a mean age of 29.5+/-9.12 years, and analyzed the number of rehabilitation sessions performed. Functionality was assessed according to the Tegner scale (pre-intervention and 6 months after), perception of functional recovery according to the KOOS scale at 6 months and recovery of the knee range of motion too. Statistical analysis using Wilcoxon test with RStudio (p<0.05). Results: The median number of sessions was 19 [15.25-21.75]. The median value of the Tegner scale before surgery was 5 [4-6.25] and at 6 months, 4 [4-4.25] (p-value 0.2222). According to the KOOS scale (0 meaning no health perception, 100 meaning perfect), regarding symptoms was 87.95+/-9.91%, pain 90.63+/-7.99%, daily activities 95.33+/-3.98%, sports and recreational activities 76.56+/-18.04% and quality of life 53.06+/-16.33%. All patients had complete range of motion after 6 months. Conclusions: Patients who underwent rehabilitation treatment after ACL surgery in the context of a pandemic, have achieved high levels of KOOS except in quality of life and sports at six months. It is necessary to increase the follow-up time to confirm the return to the previous sport level or not.

  6586 - Functional assessment of low-back-pain patients with magneto-inertial measurement units Top

Marco Bravi1, Flavia D'Agostino2, Fabio Santacaterina1, Davide Paloschi3, Paola Saccomandi3, Carlo Massaroni4, Emiliano Schena4, Michelangelo Morrone1, Federica Bressi1, Silvia Sterzi1

1Department of Physical and Rehabilitative Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy, 2Department of Physical and Rehabilitative Medicine, Università Campus Bio-Medico, Rome, Italy, 3Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy, 4Department of Engineering, Università Campus Bio-Medico di Roma, Roma, Italy

E-mail: [email protected]

Background and Aims: Low back pain (LBP) is a very common musculoskeletal disorder worldwide and a major cause of years lived with disability. LBP affecting performance at work and general well-being it has a huge social impact.[1] Visual estimation of the lumbosacral ROM limitation is frequently used by clinicians to assess patients with LBP. This study proposes a previously validated system of 3 magneto-inertial measurement units (MIMU)[2] to quantitatively evaluate changes in lumbosacral ROM in a population with mild LBP. Methods: 11 patients (PG) who met the study inclusion criteria and 10 healthy volunteers as a control group (CG) were enrolled. Participants performed Forward Bending (FB) and Sit-to-stand (STS) tests. The 3 MIMU were placed on T3, T12, and S1 vertebrae to record spine kinematics during the execution of the FB and STS tests. The Roland-Morris Disability Questionnaire was used to rate physical disability caused by LBP. Results: PG showed a mild degree of disability. Non-significant differences were found between the PG and CG during STS test. The FB test showed a significant reduction of total ROM in the PG recorded at T12 and S1 vertebrae. The sensor on T12 detected a ROM of 119,07±15,40 for CG and 102,10±6,96 for PG (p=0.03), the sensor on S1 detected a total ROM of 71,80±9,68 for CG and 59,71±7,48 for PG (p=0.01). These results are consistent with literature.[3] Conclusions: The MIMU system is easy to use and allows to perform a quantitative and objective evaluation of lumbosacral ROM in patients with LBP. The FB task appears to be more appropriate than STS for the assessment of patients with mild disability.


  1. Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: Estimates from the Global Burden of Disease Study 2017. Ann Transl Med 2020;8:299.
  2. Paloschi D. Sensors 2021;21:6610.
  3. Jandre Reis FJ, Macedo AR. Influence of hamstring tightness in pelvic, lumbar and trunk range of motion in low back pain and asymptomatic volunteers during forward bending. Asian Spine J 2015;9:535-40.

  6520 - Measurement indications bone mineral density in children: Experience of a rheumatology department Top

Zahra Sfar, Mouna Brahem, Haifa Hachfi, Mouhamed Younes

Service Rhumatologie, Hopital Taher Sfar, Mahdia, Tunisia

E-mail: [email protected]

Background and Aims: Vitamin D supplementation from birth is necessery to improve phophocalcic capital and guarantee a bone mineral density (DMO) normal adulthood. The indication for bone mineral density (BMD) measurement arises mainly in adults in the presence of risk factors for communs osteoporosis. Methods: This retrospective study including data on children and adolescents having benefited from a BMD measurement has a rheumatology departement at CHU Taher Sfar Mahdia. Results: Eighteen patients were collected (9 boys and 9 girls) mean age 10 years. BMD was practiced for 4 children (22.2%) follow ups for hypo-phosphatic rickets, 3 patients (16.6%) followed for osteogenesis imperfecta. Conclusion: BMO retains its indications in specific bone and endocrine pathologies

  6498 - Post operative quality of life in adolescents idiopathic scoliosis Top

Emna Toulgui1, Islem Megdiche1, Mohamed Ali Khelifa2, Leila Mouelhi2, Rim Braham1, Rihab Moncer1, Mehdi Jedidi2, Walid Ouanes1, Sonia Jemni1

1Department of Physical Medecine, University Hospital Center Sahloul, Sousse, Tunisia, 2Department of Orthopedic Surgery, University Hospital Center Sahloul, Sousse, Tunisia

E-mail: [email protected]

Background and Aims: Scoliosis requires early diagnosis and appropriate management. Surgical treatment allows to correct these deformations and to improve quality of life (QoL). The impact of surgery on the QoL of adolescents with idiopathic scoliosis (AIS) remains to be clarified. This work aims to specify the QoL of adolescents who underwent surgical treatment for AIS. Methods: This is a cross-sectional study, carried out in Sahloul Hospital, Sousse, over a period of 12 years in 10 to 17 years old adolescents, operated for AIS with a minimal post-surgical follow-up of 12 months. The QoL was evaluated pre and post operatively by the SRS-22 scale. Results: Were included 23 adolescents, with a mean age of 15.5±1.8 years. and an average Cobb angle of 48.7 +/- 6.8. The correction rate was 50,3% with a final Cobb angle of 24,2 +/- 4,3. The Global SRS22 score and all sub domains showed a significant variation (p<0,01). Self-image, followed by mental health, were the subdomains where the mean differences were more relevant. Global SRS22 score, as well as the latter subdomains (Self-image and mental health) reached the MICD postoperatively. Pre and postoperative changes in both pain or activity domains did not reach the corresponding MICD. On the other hand, there was a statistically significant correlation (p<0.05) between the SRS22 global score, gender and curvature location. Indeed, the QoL evaluated by the global SRS-22 score is more impaired in female subjects and for thoracic location of AIS. Conclusion: AIS is a pathology that can be very disabling. Although its surgery is reputed to be difficult with several complications, it offers a better quality of life in long term.

  6795 - Associations between patient-reported and clinician-reported outcome measures in patients after traumatic injuries of the lower limb Top

Walter Bily1, Helena Nics2, Jakob Jauker1, Vincent Grote3, Michael Pirchl3, Michael J. Fischer4

1Department of Physical Medicine and Rehabilitation, Ottakring Clinic, Vienna Health Association, Vienna, Austria, 2Department of Physical Medicine and Rehabilitation, Floridsdorf Clinic, Vienna Health Association, Vienna, Austria, 3Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria, 4Vamed Rehabilitation Center Kitzbühel, Kitzbühel, Austria

E-mail: [email protected]

Background and Aims: Clinician-reported outcome measures (CROMs) and patient reported outcome measures (PROMs) are enabling clinicians to evaluate changes in patients due to therapy or rehabilitaion. Previous studies showed only a moderate correlation between CROMs and PROMs implementing that these tools provide different aspects of clinical information about the postoperative recovery. The aim of this study was to compare CROMs and PROMs in patients with posttraumatic lower limb limitations to provide a better understanding of the relationship between these measurements. Methods: 315 probands with traumatic fractures of the lower limb were divided into 3 subgroups (127 hips, 101 knee and 87 ankle region). They underwent 3 weeks of orthopedic inpatient rehabilitation. We describe pre-post changes before and after the inpatient program. Results: In all three groups significant improvement with low to moderate effect sizes were found in PROMs and moderate to high effect sizes for CROMs. Between CROMs and PROMs correlation coefficients were low to moderate. The cohort showed a performance consistency between CROMs and PROMs ranging from 56.7% to 64.1%. Conclusions: The calculation of an performance score represents a promising alternative approach. On the one hand, it takes into account a stratification of the health status and, on the other hand, the progression in the rehabilitation process. We believe that the T2D concept is highly relevant for many studies and allows better clinical discrimination.


  1. Bily W. Int J Environ Res Public Health 2022;19:3140.
  2. Grote V. J Int Soc Phys Rehabil Med 2021;4:118.
  3. Zdravkovic A. Qual Life Res 2022;31:303-15.

  6777 - Is complicated Baker's cyst more related with knee pathologies compared to simple Baker's cyst? Top

Jeong Min Kim, Joon Shik Yoon, Jun Hee Lee

Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea

E-mail: [email protected]

Background and Aims: Baker's cyst (BC)s can be divided into simple and complicated BCs. Previous study suggested that relapse rate after steroid injection was higher in complicated BC than in simple BC. Another study showed synovial proliferation with larger effusion in the suprapatellar recess was more associated with complicated BC than simple BC. Therefore, the purpose of this study was to assess the relationship between the type of BC and knee pathologies by using knee MRIs. Methods: We retrospectively examined hospital records, knee x-ray and MRIs in the single university hospital between April 2011 and April 2020. The exclusion criteria were as follows: younger than 40 years, infectious arthritis, rheumatoid arthritis, crystal-associated arthritis and acute knee trauma. Finally, 41 knee MRIs were included. For MRI analysis, the type, morphology and volume of BC, thickness of suprapatellar recess, presence of synovial proliferation of the suprapatellar recess, joint effusion grade, presence of meniscal tear and extent of meniscal extrusion were measured. Results: There were 14 knees in 'simple BC' group, and 27 knees in 'complicated BC' group. Volume of BC, presence of synovial proliferation in suprapatellar recess, thickness of suprapatellar recess, joint effusion grade and medial meniscus extrusion were significantly greater in complicated BC than those of simple BC [Table 1]. Conclusions: Complicated BC is more related with joint patholgies, associated with knee osteoarthritis, compared to simple BC. This study may be helpful in understanding the relationship between the type of BC and knee pathologies.
Table 1: Clinical, radiographic and magnetic resonance imaging findings in all knees with sample or complicated Baker's cyst

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  6734 - Patellofemoral pain syndrome: Interest of isokinetic in muscular imbalance Top

Zaineb Tahri, Hajar Abouihssane, Nada Kyal, Fatima Lmidmani, Abdellatif El Fatimi

Department of Physical Medicine and Rehabilitation, Ibn Rochd University Hospital, Casablanca, Morocco

E-mail: [email protected]

Background and Aims: This study aims to analyse the impact of patellofemoral pain syndrome (PFPS) on the Strength and Endurance of the Knee Flexor and Extensor Muscles. Methods: Retrospective descriptive study of 45 patients with PFPS and 20 healthy individuals, followed in the Department of Physical Medicine and Rehabilitation, from May 2015 to May 2021. The target population was made up of patients who presented clinical criteria of the PFPS and underwent an isokinetic evaluation. Results: The mean age of the patients was 33.60 years + -13.03, with a sex ratio (M / F) of 0.5. 62,2% had a normal body mass index, 95,6% were right handed. The non-dominant side was affected in 51.1%. The comparison of peak torque and total work between the control group and the group with PFPS on the one hand, and between the dominant and non-dominant side on the other hand showed a significant difference. This muscle imbalance is expressed in strength and endurance for all the testing speeds. Conclusion: The study of the various isokinetic parameters has shown a decrease of musclar knee strength, as well as an imbalance between agonist / antagonist muscles. The muscle weakness can be explained by muscular atrophy and inhibition which prevents full activation of muscles.

  6678 - The relationship between smartphone usage duration (using smartphone's ability to monitor screen time) with hand-grip and pinch-grip strength among young people: An observational study Top

Ahmad Osailan

Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia

E-mail: [email protected]

Background and Aims: The use of smartphones has become widely popular, especially among young people, for multiple purposes other than communication, including gaming and internet browsing. Hand and wrist weakness is one of the main complications associated with the increased use of smartphones. This weakness occurs due to the repetitive flexion and extension of the wrist, thumb, and fingers, leading to a significant musculoskeletal pathology. Little is known about the relationship between smartphone usage duration (using the phones ability to monitor screen time) and hand-grip, pinch-grip strength. Therefore, the study was aimed to investigate the association between smartphone usage duration and hand-grip, pinch-grip strength among young people. Methods: One hundred young males volunteered to participate in the study. Participants were briefly examined for height and weight using a portable stadiometer and a digital scale. Hand-grip, pinch-grip strength measurement was performed using a hand-held dynamometer. Smartphones usage duration was obtained from the daily average screen time reported in the last seven days. Results: Mean daily usage of smartphones among the participants was 7.8±2.2. There was a weak significant inverse relationship between smartphone usage duration and hand-grip strength (r=-.22, p=.03) and pinch-grip strength (r=-.28, p=.004). Linear regression revealed that 18.8% of the variance in hand-grip strength and 20.4% of the variance in pinch-grip strength was explained by age, and smartphone usage duration, with the addition of BMI only to hand-grip strength (p's<0.00). Conclusions: Prolonged use of smartphones was related to weaker hand-grip and pinch-grip. Despite the weak relationship, the study showed that smartphone usage duration might contribute as a factor along with age to hand muscles' strength.

  6613 - Medication regimen complexity index and rehabilitation outcomes in post-acute hip fracture patients study Top

Avital Hershkovitz1, Ran Nissan2, Michael Bachar3

1'Beit Rivka' Geriatric Rehabilitation Center, Ward “D”, Petach Tikva, Israel, 2'Beit Rivka' Geriatric Rehabilitation Center, Petach Tikva, Israel, 3Rehabilitation Ward, Loewenstein Hospital Rehabilitation Center, Ra'anana, Israel

E-mail: [email protected]

Background and Aims: Polypharmacy is a common problem amongst the elderly population. The complexity of the drug regimen refers not only to a simple medication count, but also the number of daily doses, frequency, and special instructions given for their use. Medication regimen complexity may affect health outcomes, including an increase in hospitalization rates, drug non-adherence, and mortality rates. The aim of the study was to assess the associations between the admission medication regiment complexity index score and rehabilitation outcomes in hip fracture patients; to follow changes in their medication regiment complexity index score during rehabilitation and assess whether these changes are associated with their rehabilitation outcomes. Methods: A retrospective study of 336 hip fracture patients admitted to a post-acute rehabilitation hospital. Results: Patients with low admission medication regiment complexity index scores exhibited a significantly lower rate of living in a nursing home, shorter latency time from surgery to rehabilitation and a lower rate of vascular burden and depression compared with patients with high admission medication regiment complexity index scores. These patients also achieved significantly higher admission and discharge motor functional independence measure scores, a higher motor functional independence measure score effectiveness and a higher rate of favorable motor functional independence measure score effectiveness score. A multiple linear regression analysis revealed that the admission medication regiment complexity index score was not associated with the discharge functional independence measure score. Conclusion: High medication regiment complexity which usually implies severe comorbidity should not be considered as barriers for rehabilitation of older patients.

  6399 - Quadriceps and rectus femoris thickness: Correlation with functional variables Top

Frederico Miguel Pereira Costa, Helena Tavares, João Cabral, Tiago Moreira, Hugo Amorim, João Ramos

Centro Hospitalar Universitário São João, Oporto, Portugal

E-mail: [email protected]

Background and Aims: Muscle thickness may be one biomarker of muscle strength and muscles such as knee extensors are hugely important for some functional tasks. Point of care Ultrasound (POCUS) is a simple way of measuring muscle thickness which can be used in the outpatient setting. The purpose of this study is to measure the correlation between knee extensors thickness and functional variables. Methods: Twenty-nine patients were included consecutively for a cross-section in an Inpatient Physical Medicine and Rehabilitation Unit. Four observers made four measurements of quadriceps thickness and knee extension strength and a fifth observer evaluated functional parameters such as current and previous modified Rankin (mRankin), timed up and go (TUG) test, 1-minute sit-to-stand (STS) test as well as other variables like handgrip strength and Medical Research Council Sum Score (MRC SS). Spearman correlation was done in SPSS. Results: We observed a correlation between quadriceps femoris muscle thickness and current mRankin score (r=-0.376; ρ=0.044), Knee Extension Peak Force measured with a Handheld dynamometer (r=0.511; ρ=0.005), and handgrip strength (r=0.588; ρ<0.001). Correlations were not significant for other functional variables such as previous mRankin (r=0.141; ρ=0.466), MRC SS (r=0.064; ρ=0.742), TUG test (n=16; r=-0.247; ρ=0.356) and STS test (n=10; r=0.482; ρ=0.159). Conclusions: Muscle thickness was only moderately correlated with knee extension, handgrip strength and current mRankin. Correlations were not significant for other functional variables. Previous studies found similar results; this may be because thickness does not perfectly correlate with the muscle cross-sectional area and, more importantly, with muscle quality, such as fat and fibrosis levels.

  6397 - Tight muscle mass index: A new tool for the evaluation of pediatric sarcopenia Top

Marco Paoletta, Sara Liguori, Antimo Moretti, Giovanni Iolascon, Francesca Gimigliano

University of Campania Luigi Vanvitelli, Caserta, Italy

E-mail: [email protected]

Background and Aims: Pediatric Sarcopenia is a new paradigm that has not been well investigated. Moreover, diagnostic criteria as available for geriatric people are lacking in pediatric age.[1] Among instrumental evaluation of muscle mass, ultrasound seems to be a reliable and valid tool for muscle size assessment in older people. The aim of this study is to investigate the relationship between muscle ultrasound findings and clinical features in a cohort of adolescent. Methods: Patient underwent anthropometric evaluation including height and weight. Functional evaluation was performed measuring muscle strength with handgrip strength test, physical performance with Time Up and Go test (TUG), and muscle power according to jump test measured with a wearable inertial system. Each functional parameter was weighted for BMI z-score. Muscle quantity was measured through sonography evaluation of thickness of rectus femoris (RF) and vastus intermedius (VI) of each tight. We calculated the Tight Muscle Mass Index (TMMI) adding the mean of three measures of RF and VI of each tight weighted for BMI-z score. We evaluate the correlation between TMMI and functional measures. Results: We included 23 adolescent (12 females) with mean age 15,93±1,47, mean weight 100,75±18,33 Kg, mean height 168,13±7,17 cm, mean BMI-z score 2,95±0,71. TMMI was significantly correlated with Handgrip (r=0.55, p=0.008), whereas we observed a trend toward a significant correlation with jump (r=0.34, p=0.11), and TUG (r=0,40, p=0.06). Conclusions: According to our results, TMMI seems to be an useful tool for the evaluation of physical performance in obese adolescent.


  1. Perkisas S, Bastijns S, Baudry S, Bauer J, Beaudart C, Beckwée D, et al. Application of ultrasound for muscle assessment in sarcopenia: 2020 SARCUS update. Eur Geriatr Med 2021;12:45-59.

  6393 - Evaluation of the quality of life in leg amputees after a mine explosion Top

Meriam Hfaidh, Kais Ben Amor, Najla Mouhli, Zeineb Mrizak, Hajer Rahali, Imene Ksibi, Rim Maaoui

Department of Physical and Rehabilitation Medicine, Military Hospital of Tunis, Tunis, Tunisia

E-mail: [email protected]

Background and Aims: Amputation of the lower limb is an act with physical, psychological and social consequences altering the amputee s quality of life (QOL). The particularity of amputation following a mine explosion is that it occurs in a brutal and violent way, in a young active subject, hence a more considerable impact on the QOL. The aim of our study was to evaluate the impact on the QOL in post-mine explosion leg amputees through the SF-12 score. Methods: This is a cross-sectional, descriptive study conducted in the Physical Medicine of the Main Military Hospital of Tunis (HMPIT), between September and December 2019, involving 36 patients with lower limb amputations following mine explosion. The epidemiological and demographic characteristics as well as the data of the clinical examination were noted. A QOL assessment by the SF-12 was performed. Results: The mean age was 29.4±6.9 years [22-49]. All patients were male, healthy and without pathological history. The age of the amputation was 33.7±18 months [13-81]. 21 patients (58%) were from a rural area.14 patients (36%) lived in a traditional house. Access to the house was by stairs in 28% of cases and by few steps in 42%. The 81% of patients were single. Of these patients, 4 were married after amputation and 3 were engaged. Driving, sports activities, and smoking were 42%, 94%, and 56% before amputation and 31%, 28%, and 64% after amputation, respectively. The SF12-P physical QOL score was greater than 50 in 11% with a mean of 39.8±9 and the SF12-M mental QOL score was greater than 50 in 44% with a mean of 47.5±11.4. Conclusion: Despite the significant life transitions seen in military amputees, amputation had a significant impact on quality of life by calculating the SF12, which implies early multidisciplinary management with emphasis on psychological and social assistance and support.

  6388 - The effectiveness of radial extracorporeal shockwave therapy in common musculoskeletal conditions: A retrospective single-institution study Top

Tomás Ribeiro da Silva1, Eva Alves2, Rebeca Gomes2, Madalena Carvalho2, Ricardo Henriques2, Teresa Mirco2, Francisco Sampaio2

1Centro Hospitalar Universitário Lisboa Norte, Serviço de Medicina Física e de Reabilitação. Lisboa, Portugal, 2Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal

E-mail: [email protected]

Background and Aims: Radial extracorporeal shockwave therapy (ESWT) has been widely used in the treatment of musculoskeletal pathology despite the inconsistency of the results presented in its effectiveness. With this work we intend to evaluate the effectiveness of shockwave treatment in 5 different pathologies: calcific periarthritis of the shoulder (CPS), epicondylitis (LE), trocanteritis (GT), achilles tendinopathy (AT) and plantar fasciitis (PF). Methods: The analysis was performed with data from a central hospital since 2017 to 2021 and 297 patients were included. The median age of the patients was 52.85 years with 77.8% (231) female and 22.2% (66) male patients. The Numeric Rating Scale (NRS-11) was used for the assessment of pain. Evaluation of the NRS-11 was done before and directly after the 4 sessions of treatments. Patient satisfaction with treatment was measured after the end of the 4th session. In this study, the clinical results at 1 and 6 months after ESWT treatment were not evaluated. Results: Pain reduction, as assessed by NRS-11 scale, was observed in approx. 64% of all treated patients (≥ 2 points in NRS-11 scale). The mean improvement in pain according to the NRS-11 was 3.24 ±1.16. PF and GT were the pathologies with the best response to treatment with approximately 70% of patients reporting pain reduction. 72% of patients reported being satisfied or very satisfied at the end of treatment. No severe side effects were encountered. Conclusions: Patients can achieve good to excellent clinical outcomes after radial ESWT calcific tendinopathy of the shoulder, epicondylitis, trocanteritis and plantar fasciitis. Few or none side effects and post-treatment complications were found. Physicians should consider radial ESWT as primary conservative treatment option.

  6366 - Extracorporeal focal shock wave therapy on enthesopathy of the straight rectus femoris tendon: A case report Top

Catarina Peixoto1, Inês Andrade2, Rui Peres1, Ladeira Andre1, Carla Vera-Cruz1, Nuno Silva1

1Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal, 2Centro Medicina de Reabilitação Alcoitão, Alcabideche, Portugal

E-mail: [email protected]

Background and Aims: The rectus femoris is the most injured muscle of the quadriceps muscle group.The proximal rectus femoris tendinous anatomy is complex and may be affected by traumatic, microtraumatic,or nontraumatic disorders. Clinical symptoms may range from sudden hip pain in proximal tendon rupture or during the acute resorptive phase of calcific tendinitis,to long-standing hip pain in chronic tendon tears and painful enthesopathy. Extracorporeal shock wave therapy (ESWT) is an increasingly popular therapeutic approach to the treatment of several soft tissue complaints. Methods: We report a case of enthesopathy of the straight rectus femoris tendon successfully treated with ESWT. A 54-year-old male patient, footgolf player, suffered from right hip joint pain for 1 year. The pain was non-radiating and was exacerbated with hip flexion and kicking. On physical examination, painful palpation of the insertion in the left anteroinferior iliac spine and with stretching of the rectus femoris. Results: Simple radiograph revealed heterogeneity at the anterior inferior iliac spine site in the origin of rectus femoris muscle. MRI revealed hypersignal focus on the proximal insertion of the rectus femoris, with 12 mm of larger axis, translating evident enthesopathy.Focal ESWT was applied under ultrasound guidance.We performed a total of 5 sessions at an interval of 1 week at a frequency of 4-5Hz,1500 shots with intensity of stimulation using energy of 0.1-0.2 mJ/mm2. The hip pain of patient slowly decreased within four weeks after starting the ESWT. After 8 weeks, his hip pain was completely resolved. Extracorporeal shock wave therapy has been an effective treatment for various conditions. However, it is not generally recognized in treatment for calcific tendinitis or enthesopathy around the hip region. Conclusion: ESWT could be a very good modality on treatment of this disorder.

  6362 - A rare complication after total knee prosthesis in a rehabilitation center Top

Andre Varandas Borges, Igor Santos Neto, Rodrigo Correia, Filipa Gonçalves, Miguel Correia, Ismael Carneiro, José Luis de Carvalho

Centro de Reabilitação do Norte, Valadares, Portugal

E-mail: [email protected]

Introduction: Total Knee Arthroplasty (TKA) is one of the most successful orthopedic procedures. All procedures have multiple complications. Dislocation is a TKA rare complication. The authors aim to expose the importance of clinicians in monitoring patients, prescrib a rehabilitation program and identify complications. Patient Information and Clinical Findings: A 72-years-old woman was submitted to a conversion of the unicompartmental prosthesis to TKA of the left knee. In October, the patient was admitted in a Rehabilitation Center for motor rehabilitation. On the 4th day, the patient woke up with an irreducible 90-degree flexion of the left knee. In this regard, the patient was transferred to orthopedic care. A posterior dislocation of the Total Knee Prosthesis was diagnosed. The patient underwent replacement of the total knee prosthesis. Discussion and Conclusions: The dislocation of a TKA is an uncommon complication. Traumatic events, low-energy fall or knee hyperflexion are the principal mechanism of injury. The risk factors are obesity, varus or valgus deformity, flexion contracture, and less reported peripheral or central neurological. In Physical Medicine and Rehabilitation (PMR), there is a rigorous objective examination, with emphasis on the osteoarticular and neurological findings. In this case, the main comorbidity was overweight and a varus knee. After careful evaluation, a rehabilitation program with clear objectives was prescribed. It is important to prescribe an individualized rehabilitation program adapted to the patient and the specific pathology. The specific training in PRM focus on close monitoring the patient, with regular visits to the therapeutic sectors, permiting to observe complications, guide and continue the treatments in a right way.

  6348 - Diagnosis delay of spinal meningiomas: A retrospective study Top

Ola Mohamed Fathy Kamal1, Rosa María Casado López2, Yunia Herbania Rodríguez Labrada3, Idoya Barca Fernández1

1Hospital Clínico San Carlos, Madrid, Spain, 2Hospital Nacional de Parapléjicos de Toledo, Toledo, Spain, 3Hospital de Guadarrama, Guadarrama, Spain

E-mail: [email protected]

Background and Aims: Meningiomas account for 25-46% of spinal tumors. Although most of them are benign, they have no specific symptoms and diagnosis is often confounded by more common conditions. Diagnosis delay can lead to irreversible deficits and poorer outcomes. The aim of this study was to identify the reasons for delayed diagnosis in patients with meningiomas. Methods: Descriptive retrospective study between 2016 and 2021. 23 patients with meningioma diagnosis referred to our institution for rehabilitation treatment were included in the study. Parameters analyzed were: age, sex, tumor location, ASIA (American Spinal Cord Injury Association) Impairment Scale grade upon arrival, onset symptoms, diagnosis delay and its causes. Variables were recorded from the clinical history. Results: Average age of the sample was 67 years old. 92% women. 92% thoracic location and mainly incomplete lesions (70%). The most common onset symptoms were muscle weakness, pain, sensory and gait impairment, and urinary incontinence. Predominantly patients presented a delayed diagnosis. Conditions that masked the meningioma diagnosis included: spinal stenosis, spondyloarthritis, low back pain and scoliosis. 17% of patients underwent unnecessary major spinal interventions like arthrodesis and laminectomy. Minor unnecessary interventions included low back injections. 17% presented lower-limb fractures from symptom onset until diagnosis. The most frequent reasons for delayed diagnosis were typical unspecific symptoms with a wrong diagnosis and delayed imaging. Conclusions: It is important to increase awareness among medical professionals about the clinical presentation of meningiomas and the consequences of a delayed diagnosis. It is important to recognize red flags symptoms to request the proper imaging tools and speed up the diagnostic process.

  6317 - Posture detection using machine learning algorithms – A systematic review Top

Nicolae Adrian Jurjiu1, Avram Claudiu1, Ana Maria Vutan1, Ciprian Glazer1, Razvan Dragoi2

1West University of Timisoara, Timişoara, Romania, 2”Victor Babes” Univerisity of Medicine and Pharmacy, Timisoara, Romania

E-mail: [email protected]

Background and Aims: Posture detection is used in various situations such as medical care, surveillance, virtual environment, indoor monitoring, virtual reality for animations and entertainment. The concept of machine learning has experienced great progress in the last two decades, from a curiosity started in the laboratory to a widespread practical technology for commercial use. The aim of this paper is to review the literature on the use of machine learning algorithms in the medical field for posture recognition. Methods: Articles were collected from the following databases: Google Scholar, Science Direct, PubMed and Research Gate. We included only articles that were written in English, those that were available for download in full text, published after 2010, the year in which the industrialization of the idea of artificial learning began. Articles that did not assess or recognize the posture deficiencies were excluded. Results: A total of 55 articles were eligible for the study. Following the inclusion criteria, and after reviewing using the exclusion criteria, a number of 16 articles was analyzed and discussed. Conclusions: After the analysis of the articles included in present study, it can be concluded that using machine learning we can obtain good results with high accuracy for posture recognition. Among the conventional machine learning algorithms, we noticed that Random Forest has the highest accuracy. However, it has been proven that deep learning through the Convolutional Neural Networks algorithm offers the best results, being the closest to having 100% accuracy for posture recognition.

  6308 - Ultrasound-guided corticosteroid injections in epicondylitis: A retrospective study Top

Igor Manuel P. A. Santos Neto1, Filipa Goncalves1, Joana Martins2, Adriana Pereira3, Miguel de Correia e Castro1, André Varandas Borges1, José Luís de Carvalho1, Tiago Lopes Carvalho4

1Centro Reabilitação do Norte, Valadares, Portugal, 2Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, 3Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal, 4CRB, Lisbon, Portugal

E-mail: [email protected]

Background and Aims: Epicondylitis is a common disease, particularly in middle age. To address this pathology there are many treatment strategies, such as conservative physiatric treatment and CS injections peri-tendon. This study aims to investigate the results of ultrasound (US)-guided corticosteroid injections in epicondylitis. Methods: Socio-demographic factors, previous treatment with focal shock wave therapy and Numeric Pain Rating Scale (NPRS) score pre-and post-intervention at 1, 3, 5 and 12 months (M) were collected from patients' records. Results are stated as mean ± standard error of the mean. Results: Data from 26 records of US-guided peri-tendon corticosteroid injections were analyzed. The mean age was 51 years (67.9% women). Lateral epicondylitis was more frequent than medial (92.8% vs 7.2%). Mean NPRS score at baseline was 7.5±0.3, at 1M 2.7±0.8 (n=15), at 3M 1.1±0.7 (n= 12), at 6M 2.9±1.3 (n=8) and at 12M 2.0±2.0 (n=5), with no statistically significant differences between men and women. The mean improvement rate was significantly higher in the group previously treated with focal shock wave therapy at 1M (23.0 ± 13.0 vs 83.5 ± 9.9, p=0.003). Conclusions: US-guided corticosteroid injections seem to be an efficient approach to pain, in the short, medium, and long-term in this population. there were no undesirable side effects or post-procedural complications, also following this technique. Patients previously treated with focal shock wave therapy demonstrated a significant improvement rate at 1M.

  6303 - Systematic review of factors influencing quality of life for patients with lower limb loss Top

Doriane Pelzer1, Jean-François Kaux1, Charlotte Beaudart1, Aurore Thibaut2, Stephen Bornheim1

1Department of Physical Medicine, Liège University Hospital, Liège, Belgium, 2Coma Science Group, Cyclotron Research Centre, University Hospital of Liège, Liège, Belgium

E-mail: [email protected]

Background and Aims: The aim of this study was to systematically review the literature to identify factors that influence quality of life in people with lower limb amputation. Methods: Medline (via Ovid) and Scopus were searched in October 2021 for studies assessing quality of life in lower limb amputated patients. Studies were included if they reported factors that could influence quality of life. Studies were independently identified and assessed by two reviewers. PRISMA guidelines were followed. Results: After removing duplicates, the search provided 2295 studies, of which 33 met our criteria. Seventeen of these were cross-sectional studies and eleven were either prospective (7) or retrospective (4) cohort studies. The quality of life assessment tool was most often the SF-36, followed by the WHOQOL-BREF and the EuroQoL-5D. Younger age, traumatic etiology, unilateral or below knee amputation, having comorbidities and social integration were found to influence quality of life in people for lower limb amputation whereas economic status, level of education and ethnicity had no influence. Conclusion: Various factors influencing the quality of life of patients with lower limb amputation have been identified through this systematic review of the literature. However, findings do not always converge between studies and for some factors, no common agreement is yet available. Future prospective longitudinal studies with clear a priori taking account a large range of potential factors are needed to clarify the impact of the identified factors. Factors like age, type of amputation, comorbidities and social integration should be taken into consideration in the management of amputee patients.

  6267 - Efficiency of the rehabilitation treatment associated with the oxigen-ozone-therapy and hyaluronic acid injection in patients with knee osteoarthritis Top

Chiriac Sorin, Ionescu Elena Valentina, Stanciu Liliana- Elena, Calota Nicoleta, Profir Daniela, Iliescu Madalina-Gabriela

Balneal Sanatorium and Rehabilitation Techirghiol, Constanta, Romania

E-mail: [email protected]

Background and Aims: Osteoarthritis is characterized pathologically by localized loss of cartilage, remodeling of adjacent bone and associated inflamation. A variety of traumas may trigger the need for joint to repare itself. Osteoarthritis includes a slow but efficient repair process that often compensates for the initial trauma, resulting in a structurally altered but symptom free joint. Aim of the study was to determine the importance of combining the rehabilitation program and the oxygen ozone therapy with the hyaluronic acid injections. Methods: In this randomized clinical trial between 01.03.2021 and 30.11.2021 89 patients diagnosed with knee osteoarthritis were hospitalized for 2 weeks in Balneal Sanatorium and Rehabilitation Techirghiol, Romania. The patients were divided in 3 groups: first group had a rehabilitation programme that consist in: sapropelic mud baths and hydrotherapy with salt water from Techirghiol lake, electrotherapy and kynethotherapy. The second group had the same treatment of the first group and a 25 ml oxygen ozone therapy injection a week. The third group had the same treatment as the first group and a infiltration with hyaluronic acid sodium salt 2% 40 mg. Patients were evaluated at the baseline and after 6 months using Womac scale, Health Assessment questionaire, EQ 5D scale and visual analog scale. Results: The patients in the second group had an important decrease of the pain for a short period of time. The third group had a decrease of the pain in the long term and an increase in quality of life. There were no significant differences in mobility of the knee between the 3 groups. Conclusion: The patients diagnosed with knee osteoarthrittis with the right rehabilitation program and with a better timing in injection with acid hyaluronic have a increased quality of life and pain reduction.

  6223 - Rehabilitation after tendon transfer for foot drop deformity – An early approach Top

Joana Alberto, Joana Romano, Pedro Ribeiro, Raquel Costa, Úrsula Martins, Raquel Vilela

Department of Physical and Rehabilitation Medicine, Hospital Pedro Hispano, Matosinhos, Portugal

E-mail: [email protected]

Background and Aims: Foot drop (FD) is a clinical sign related to weakness of the foot dorsiflexors with multiple etiologies. The treatment approaches can be either conservative or surgical. Surgical procedures such as tendon transfers play an important role in cases when significant nerve dysfunction occurs. Based on a clinical report of a posterior tibialis (TP) tendon transfer used to treat a FD, followed by our Physical Medicine and Rehabilitation (PMR) Department, we aim to present a protocol focusing on an early rehabilitation approach after surgery. Methods: A case description and discussion of related bibliography was conducted. Results: A 42 year-old woman presented with a FD for more than 10 years of undetermined etiology and with severe functional limitation. The patient's electromyographic studies reported a permanent peroneal nerve injury, with no findings of extrinsic compression on magnetic resonance imaging. A surgical posterior tibialis (TP) tendon transfer was performed and the patient was evaluated in our PMR Department immediately after surgery, and started a Rehabilitation protocol six days after. Our protocol was based on an early rehabilitation approach with a combination of articular mobilization, lower limb muscles strengthening and stretching, and gait training. Follow-up consultations demonstrated a progressive functional improvement, leading to full independence reestablishment 3 months after surgery. Conclusions: After a tendon transfer surgery, it is conventionally recommended a transient period of immobilization. However, it has already been demonstrated that early rehabilitation treatment did not show a higher rate of complications. We believe early rehabilitation protocols should be considered due to their promising positive effects as seen in our patient.

  6192 - The effect of myofascial-release technique on chronic common neck pain Top

Mouna Sghir, Emna Trabelsi, Aymen Haj Salah, Ikram Haddada, Wiem Dalleli, Wafa Said, Wassia Kessomtini

Department of Physical Medicine and Rehabilitation, Taher Sfar Hospital, Mahdia, Tunisia

E-mail: [email protected]

Background and Aims: The rehabilitative management of chronic common neck pain does not take into account the presence of trigger points does not usually include manual myofascial trigger point therapy. The aim of our study was to evaluate the effectiveness of this technique in the management of patients with chronic common neck pain. Methods: We collected eight patients with chronic neck pain divided into two groups A and B, randomly. Group A patients underwent conventional rehabilitation. Those in group B benefited from conventional rehabilitation combined with manual trigger point therapy. Each patient was assessed before and at the end of treatment. We evaluated pain intensity by the visual analog scale (VAS) and we noted its irradiation. We also assessed cervical spinal mobility, muscle strength. Muscle tension was assessed by the Nilson scale. The function was evaluated by the neck disability index (NDI). Results: At the end of treatment, a significant improvement in all clinical parameters was observed in both groups A and B. This improvement was greater in group B for: pain, joint mobility, muscle strength and tension, and function. Conclusion: The association of the myofascial release technique with conventional rehabilitation has proven to be effective and should take place in the management of chronic common neck pain.

  6191 - Prevalence and risk factors of rachialgia among dentists: About a Tunisian cohort Top

Mouna Sghir, Emna Trabelsi, Soumaya Elarem, Ikram Haddada, Maroua Khouaja, Wafa Said, Wassia Kessomtini

Department of Physical Medicine and Rehabilitation, Taher Sfar Hospital, Mahdia, Tunisia

E-mail: [email protected]

Background and Aims: Rachialgia is strongly found among workers adopting awkward spine postures and in particular dentists. The aim of our study was to assess the prevalence of rachialgia in Tunisian dentists and to explore factors involved in the occurrence of this condition. Methods: We conducted a cross-sectional study over a period of seven months (July 2018-January 2019) on a population of Tunisian dentists. A pre-established questionnaire was distributed to dentists working in the public and liberal sector in the regions of Mahdia and Monastirand to those who attended the second international congress of the National Association of Interns and Residents in Dental Medicine. Results: One hundred and fifty-seven dentists responded to the questionnaire. The median age was 33 years [29-39]. A female predominance (63.1%) was noted in our population with a sex ratio of 0.58. More than half of dentists (65.6%) were working in the liberal sector. The median number of years of practice was 6 years [3-12]. The biomechanical constraints noted in our population were repetitive movements in 89.8% of cases, the use of vibrating tools in 68.2% of cases and working without assistance in 65.6% of cases. Moreover, 87.9% of dentists did not use an armrest stool. The prevalence of rachialgia in our population was 71.3%.The most frequent locations were the neck (61.2%) and the lumbar back (52.7%). Almost half of dentists (48.2%) never consulted for their rachialgia and no diagnosis was made in 41% of cases. We found that the uncomfortable position of the neck at work was significantly associated with the occurrence of rachialgia (p = 0.02). Conclusion: Rachialgia is common among Tunisian dentists dominated by neck pain and lower rachialgia. Respecting ergonomic positions during work could reduce their occurrence.

  6188 - Quality of limb and respiratory muscles in adolescents and young adults with history of congenital diaphragmatic hernia Top

Alessandra Bertha Castillo Velásquez, Marta Supervia, Maria Olga Arroyo Riaño

Gregorio Marañón Health Research Institute, Gregorio Marañón General University Hospital, Madrid, Spain

E-mail: [email protected]

Background and Aims: Survivors of congenital diaphragmatic hernia (CDH) tend to have lower outcomes in cardiopulmonary exercise tests and musculoskeletal comorbidities. However, these findings not necessarily have a clinical impact when exercising. Most studies evaluate cardiopulmonary performance but information about muscles' quality are often missing, even though this is very important for participation according to the International Classification of Functioning, Disability and Health (ICF). This study aims to describe the presence of sarcopenia and limb and respiratory muscle strength. Methods: A descriptive study from patients with surgically repaired CHD born between 1997 and 2005 in Gregorio Marañón General University Hospital . Sociodemographic data was collected and clinical exam for musculoskeletal deformities and anthropometry was performed. Muscle quality was evaluated by bio-impedance, dynamometry, maximal inspiratory and expiratory pressure (MIP/MEP). Results: 13 patients, 77% (n=10) male, average age of 19.5 + 1.97 years, body mass index of 20.59 + 2.92 kg/m2 and 31% (n=4) had scoliosis on clinical exam. 69% (n=9) had sarcopenia in torso and upper limb, additionally 54% (n=7) were weak according to dynamometry. MIP and MEP were 74.07 + 16.47 cmH2O and 81.54 + 24.27 cmH2O respectively. Conclusion: Most patients with CDH suffer from sarcopenia and poorer respiratory muscle strength when compared to healthy controls. A proper follow up during adolescence/early adulthood and the accessibility to a training program could be of benefit to prevent it.

  6183 - The impact of epidemiological and socio-demographic factors on the quality of life of tibial amputatee patients after ballistic trauma Top

Meriam Hfaidh, Zeineb Mrizak, Najla Mouhli, Jihene Chmak, Hajer Rahali, Imene Ksibi, Rim Maaoui

Department of Physical and Rehabilitation Medicine, Military Hospital of Tunis, Tunis, Tunisia

E-mail: [email protected]

Backgrounds and Aims: Amputation is a major life event that can affect quality of life (QOL), particularly if it occurs suddenly, following a ballistic trauma, in a young subject.The aim of our work was to study the impact of epidemiological and socio-demographic factors on the QOL of patients with lower extremity amputation(LEA) caused by ballistic trauma. Methods: This is a descriptive cross-sectional study within the physical medicine and functional rehabilitation department at the Military Hospital of Tunis, in a period between September and December 2019, including 36 patients with a LEA, following a ballistic trauma. The epidemiological and socio-demographic characteristics of the patients and their correlations with QOL through the SF-12 score were noted. Results: The mean age was 29.4 ± 6.9 years. All of the patients were male. Twenty-one patients were from a rural area. Twenty-one patients (58%) had secondary education. Fourteen patients (36%) lived in a traditional house. Three subjects had Turkish toilets. Access to the home was via the stairs in 28% of cases and by a few steps in 42% of cases. Twenty-two patients (61%) were single. Driving, practicing sports and smoking were 31%, 28% and 64% respectively after amputation. The SF12-P physical QOL score was over 50 in 11% of cases and the SF12-M mental QOF score was over 50 in 44%. A univariate study of factors associated with SF-12 score showed that there is a statistically significant association between SF12-P score and age (p = 0.031), and SF12-M and marital status (p = 0.025). Conclusions: Socio-demographic factors including marital status can condition QOL. In our young population, the oldest amputees with family life had better QOL, thanks to the moral and psychological support offered by their families.

  6167 - Postoperative results after surgical treatment of Heterotopic ossifications Top

Najla Mouhli, Meriem Hfaiedh, Hajer Rahali, Rim Maaoui, Imene Ksibi

Military Hospital of Tunis, Tunis, Tunisia

E-mail: [email protected]

Background and Aims: Heterotopic Ossifications (HO) are responsible for functional limitation. Their curative treatment is surgical. The objective of this work is to report the post-operative functional results of heterotopic ossifications surgical treatment. Methods: Prospective study carried out at the Rehabilitation department of the Military Hospital of Tunis. All patients monitored for HO between 2016 and 2020 who had osteoma resection were included. Results: 31 HO were operated. The initial neurological lesion was traumatic brain injury (46.2% of cases), critical illness polyneuropathy (26.9%) and spinal cord injury (26.9%). The HO operated were localized to the hip (42.3%), the elbow (42.3%) and the knee (15.4%). 61.5% of the HO were immature on scintigraphy at the time of surgery. The indication for surgery has been placed in front of a functional limitation (57.6%), nerve compression (30.7%), a facilitation of nursing (11.4%) and vascular compression (1 patient). The resection was complete in 62.5% of the cases. The median length of postoperative hospital stay was 10 days. Post-operative management consisted in the use of the continuous passive motion (37.5%), manual alternating postures or/and braces in all patients and the intake of oral indomethacin (87.5% ). The evaluation at 1 and 6 months showed an improvement in joint amplitudes in 25 joints operated on. The initial FIM went from 77 to 91 at 1 month and to 97/126 at 6 months. At 6 months, only one operated HO recurred. Conclusions: The surgical excision of the HO allows an improvement of the articular amplitudes and a functional gain in the operated patients. These results are dependent on the quality of post-operative rehabilitation care.

  6134 - Winged scapula caused by a dorsal scapular nerve lesion after repetitive movements at work: A case report Top

Filipa Gouveia, Luísa Viana Pinto, Gonçalo Engenheiro, Sara Ribeiro Silva, João Carvalho, Maria José Milheiro, Catarina Aguiar Branco

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

E-mail: [email protected]

Introduction: Scapular winging is very common on clinical practice and it causes pain, weakness, limited mobility, and cosmetic deformity, leading to disability. Usually, it results from long thoracic or accessory nerves lesion, being dorsal scapular nerve (DSN) lesions quite rare. Patient Information and Clinical Findings: A 33-years-old male presented with right dorsal and shoulder pain, and limited mobility, unable to work. He reported no trauma, but his occupation consisted of repetitive heavy overhead lifting work and he reported a trapezius' asymmetry since he started the job. He presented with right trapezius' elevation and a right winged scapula, that moved laterally with arm' anterior elevation. He had a shoulder range of motion of 140° on anterior elevation, 100° on abduction, 50° on external rotation and he reached L3 level at internal rotation and adduction. Electromyography suggested a right DSN lesion. He finished a one-month rehabilitation program, which included superficial heat, transcutaneous electrical nerve stimulation, mobilization of the right shoulder, posture correction and correction of the scapulohumeral rhythm, muscle strengthening of the scapula stabilizers and stretching. Discussion and Conclusions: After our intervention, he presented with significant clinical and functional improvement, maintaining a slight limitation on internal rotation. The scapula asymmetry improved at rest, noticed with retraction with hands on the wall. His plan was to return to work, to another workstation, so he was discharged and kept home rehabilitation. DSN lesion is a rare cause of winged scapula and pain over the shoulder, interscapular or dorsal region, being frequently misdiagnosed, and it is disabling. This case report highlights the importance of a correct physical examination and diagnosis, and a comprehensive rehabilitation approach.

  5386 - Effect of the COVID-19 pandemic on musculoskeletal encounters in an emergency room Top

Marcos R. Latimer1, Kevin De Jesus1, Angel Pabon1, Juan Gonzalez2, Walter R. Frontera1

1Department of Physical Medicine, Rehabilitation Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico, USA, 2Department of Emergency Medicine, University of Puerto Rico School of Medicine, Puerto Rico, USA

E-mail: [email protected]

Background and Aims: Patients with musculoskeletal (MSK) complaints seen in emergency rooms (ER) are frequently referred to Physical and Rehabilitation Medicine (PRM) clinics. We have noted a decline in the number of patients in PRM clinics during the COVID-19 pandemic. Our aim is to assess the effects of the pandemic on the frequency of MSK encounters in an academic ER during the year 2020. Methods: ER encounters registered in an electronic database for the calendar years 2019 and 2020 were compared. We examined the frequency of M (MSK and connective tissue) and S (injury) ICD-10 codes by month, sex, and age group. Results: Total number of ER encounters decreased significantly (p<0.001) from 48,382 in calendar year 2019 to 32,301 in 2020 (-33.4%). The number of MSK encounters decreased (p<0.001) from 10,567 in 2019 to 6,779 in 2020 (-25.8%). These declines [Figure 1] started in mid-March of 2020 and persisted during the rest of the year for all age groups and both sexes. The encounter/prevalence ratio was lower for M but not S codes (p<0.001). The three most common M codes in both years were low back, shoulder, and knee pain and S codes were contusions of knee, ankle sprains, and contusions of lower back. Conclusions: The COVID-19 pandemic had a substantial negative impact on the number of ER encounters and specifically on health complaints related to the MSK system independent of age and sex. Decreases can be explained by lockdown measures, patient's fear of contracting COVID-19, and/or reduced accessibility to the ER.
Figure 1: Total number of encounters and musculoskeletal encounters in 2019 and 2020 by month

Click here to view

  4577 - Lumbar spine in CESPU office workers group: Risk factors Top

Sofia Lopes, Ana Bento, Emeric Citarella, Patricia Monteiro, Fábio Araújo, Gabriela Brochado

Escola Superior de Saúde do Vale do Sousa, Gandra, Portugal

E-mail: [email protected]

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. Nowadays, these injuries are the most frequent occupational health problem in Portugal and Europe, with low back pain being the most common cause of disability. The objective of this study 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, using IBM SPSS Statistics (version 25.0). 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 disability generated by low back pain 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 group present a moderate disability in the lumbar. There was only an association with smoking habits, discomfort during work and absenteeism with low back disability.

  4575 - Ulnar nerve palsy as a complication of conservative treatment of a distal radial fracture: A case report Top

Adriana Pascoal1, Carolina Lourenço2, Xénia Verraest2, Inês Ferro2, Pedro Sá2, João Constantino2, Jorge Laíns2

1Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, Quinta da Fonte Quente - Rovisco Pais, Tocha, Portugal, 2Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, Tocha, Portugal

E-mail: [email protected]

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 maintain a high index of suspicion and thoroughly evaluate nerve function both before and after cast immobilization.

  6133 - The prevalence of mechanical knee pain at the Settat Hospital Top

Hajar Abouihsane, Hakim Bourra, Mouad Yazidi, Hasnaa Boutalja, Zaineb Tahri, Abdelhakim Kabil, Nada Kyal, Fatima Lmidmani, Abdellatif El Fatimi

CHU Ibn Rochd, Casablanca, Morocco

E-mail: [email protected]

Background and Aims: Mechanical knee pain is a public health problem due to its frequency and consequences. The objectives of our study are to the determine the prevalence of mechanical knee pain, to evaluate the profile of patients with knee pain, to analyze the consequences on physical fitness as well as the search for possible risk factors associated with this condition. Methods: It's a descriptive and cross-sectional study, carried out within three consultations of physical medicine, rheumatology and traumatology at the Hassan II hospital in Settat, spread over four months, from June to September of year 2019. Patients responded to a pre-established questionnaire. Results: 1834 patients included in the study with 186 mechanical knee pain, i.e. a prevalence of 10.14%. The average age of our patients was 56.96 years with extremes ranging from 24 to 86 years. The female predominance is evident with 170 women, ie (91.4% of patients). The average BMI of our patients was 29.89 kg / m2 with extremes varying between 16.43 and 45.56 kg / m2. Knee pain was bilateral in 47.30% of cases. The intensity of pain was severe in 46,20%. Knee trauma was the most common medical history 79,40%. Carrying a load was the most observed risk factor 88.5%. Dynamic varum was the most common deformity of the lower limb (32.26%). Dominant knee involvement was 51.30%. The mean range of motion was 116.11 ° for flexion and 7.83 ° for extension. The mean of Lequense scores, knee score and function score were 11.96 - 66.93 and 59.66, respectively. Conclusion: The frequency of mechanical knee pain and its repercussions on the quality of life are important. Several factors are associated with this pathology prompting to undertake preventive measures for this condition.

  6121 - Correlation between knee extension strength with hand held dynamometer and functional variables – Cross-sectional study Top

Tiago Moreira, Frederico Costa, João Cabral, Helena Tavares, Susana Moreira, João Ramos

Department of Physical and Rehabilitation Medicine, Centro Hospitalar e Universitário de São João, Porto, Portugal

E-mail: [email protected]

Background and Aims: About 15% of the world´s population live with some disability, of whom 2-4% experience significant difficulties in functioning. knee extension has a major role for functional capacity. Hand Held Dynamometer (HHD) is least expensive, portable and faster to use than the gold standard isokinetic dynamometer way of measuring knee extension muscle strength. The aim of this study is to measure the correlation between knee extension strength with HHD and functional variables. Methods: Twenty-nine patients were included consecutively for a cross-section in an Inpatient Physical and Rehabilitation Medicine Unit. Four observers made four measurements of knee extension strength and a fifth observer evaluated functional parameters such as current and previous modified rankin, timed up and go test, Sit to Stand test as well as other variables like handgrip strength and Medical Research Council SS. Spearman correlation was performed in SPSS version 27. Results: We reported a correlation between the muscle strength measured by knee extension peak force in the HHD and some functional variables such as current modified Rankin (r=-0.577; ρ= 0.001), Timed up Go test (r=-0.650; ρ< 0.001) and Sit to Stand test (r=0.560; ρ= 0.002). Handgrip strength and Medical Research Council Sum Score (r= 0.480; ρ= 0.008 and r=0.466; ρ= 0.011, respectively) were also correlated with knee extensor strength in opposition to previous modified rankin (r=-0.337; ρ= 0.074) which had a nom statistically significant correlation. Conclusions: Knee extension strength on HHD was moderately correlated with most functional variables analysed. This may suggest that increases in strength may be a good marker of functional improvement over time, but prospective studies should be made to confirm this theory.

  6101 - Rasch analysis of the Arabic version of Activities-specific Balance Confidence in lower-limb prosthetic users Top

Hadeel R. Bakhsh1, Giorgio Ferriero2, Nilüfer Kablan3, Huthaifa Atallah4

1Princess Nourah Bint Abdulrahman, Riyadh, Saudi Arabia, 2Physical and Rehabilitation Medicine Unit, Scientific Institute of Tradate, Istituti Clinici Scienti, Pavia, Italy, 3Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medeniyet Unive, Istanbul, Turkey, 4Department of Orthotics and Prosthetics, King Fahad Medical City, Riyadh, Saudi Arabia

E-mail: [email protected]

Background and Aims: Accuracy of balance confidence measurement tools is essential for lower-limp amputees as it have a great influence on their mobility and participation in daily and social activities. Our aim was to evaluate the psychometric properties of the Arabic version of Activities-Specific Balance Confidence Scale using the 5-option response categories (ABC-5/Ar) for lower-limp amputees. Methods: A methodological study. A convenience sample of adult unilateral lower-limp amputation attending outpatient rehabilitation centres in Saudi Arabia and Turkey (N=166). Collected data were analysed using Rasch analysis (WINSTEPS version 4.6.5) was conducted to examine functioning of rating scale categories, item fit, reliability indices, item difficulty, and local item dependency. Results: Based on the analysis, the ABC-5/Ar 5-response option met the criteria for the functioning of rating scale categories. Most items fit to the Rasch model, except item 12 ' walk in a crowded mall' that showed overfitting value of 0.63. The person separation indices 2.95 (Cronbach's α=0.96). Therefore, scale is sensitive enough to distinguish between at least three different levels of confidence. Principal component analysis confirmed unidimensionality of the scale, however local dependency was detected between item 14 'Ride in escalator holding rail' and item 15 'Ride in escalator not holding rail'. Conclusions and Clinical Importance: Overall, the findings indicate the psychometric evaluation of ABC-5/Ar is effective with lower-limp amputees across different clinical contexts and cultures. Furthermore, The study provides clinicians dealing with Arabic speaking lower-limb amputees a validated measure for balance confidence. Further studies are necessary to improve the measure's metric quality in different contexts and conditions.

  6094 - PRP or hyaluronic acid in knee osteoarthritis: A literature review Top

Rym Braham1, Walid Ouanes1, Islem Megdiche1, Emna Toulgui1, Mariem Ghardallou2, Mehdi Jedidi1, Sonia Jemni1

1Sahloul Hospital Sousse, Sousse, Tunisia, 2Faculty of Medecine of Sousse, Sousse, Tunisia

E-mail: [email protected]

Background and Aims: Many studies have tried to compare the clinical efficacy of many treatments in knee osteoarthritis but the results were discordant.The objective of this study is to carry out a review of the literature concerning the current data relating to the use of PRP in knee osteoarthritis, by comparing them with those of the use of hyaluronic acid. Methods: The general organization of our research was based on the guidelines for writing a literature review according to PRISMA criteria. This research, performed in May 2020, concerned articles with a high level of evidence which evaluated the clinical efficacy of intra-articular injection of PRP versus hyaluronic acid in the treatment of early or moderate knee osteoarthritis. Results: Our search resulted in a selection of 10 articles. The cumulative size of all studies was 1042 patients. An objective (WOMAC, KSS, EUROQOL..) and subjective (VAS) assessment of clinical results was noted at 3, 6 and 12 months. Most of the authors found that the clinical results of these two types of treatment were comparable or slightly in favor of the PRP groups at early evaluations (at 3 and 6 months) while the late evaluations were for the most part clearly in favor of PRP. Conclusions: We were able to understand that the type of PRP would have little influence on the results, nevertheless the number of PRP infiltrations as well as their frequency played a role in obtaining better clinical results.We were able to draw a typical patient profile in whom PRP could be particularly effective and superior to hyaluronic acid; this would be a patient in his sixties, male, non-obese suffering from rather early knee osteoarthritis and in whom a protocol of multiple injections with a short interval was followed.

  6093 - Sarcopenia and quality of life in patients on chronic hemodialysis Top

Petra Kovacevic1, Karmela Altabas2, Simeon Grazio1

1Department of Physical Medicine and Rehabilitation, UHC “Sestre Milosrdnice,” Clinic of Rheumatology, Zagreb, Croatia, 2Department of Nephrology and Dialysis, UHC “Sestre Milosrdnice,” Clinic of Internal Medicine, Zagreb, Croatia

E-mail: [email protected]

Background and Aims: An important part of rehabilitation, which is often neglected, is the nephrological rehabilitation, especially in patients on hemodialysis (HD). Due to the severe chronic condition and protein energy malnutrition, patients on HD have a more frequent occurrence of sarcopenia. The aim of the study was to examine the presence of sarcopenia in patients on HD and to determine the quality of life regarding the presence of sarcopenia. Methods: The study included 100 patients on chronic HD at the University Hospital Centre “Sestre milosrdnice” in Zagreb, who underwent body composition analysis by bioimpedance, measurement of hand grip strength with a hydraulic dynamometer and routine laboratory parameters. Also, participants completed a specific questionnaire assessing the quality of life in the presence of sarcopenia (SarQoL). Results: Twenty-eight out of 100 patients had sarcopenia and the majority were males (61.0%). The results of the SarQoL questionnaire showed a significant correlation with sarcopenia (p<0,001). Patients with sarcopenia had significantly higher levels of C-reactive protein (3.45 vs. 2.70, p<0,035) and lower blood albumin levels (37.50 vs. 40.15 g/L, p<0,002) compared to patients without sarcopenia. Dialysis vintage, however, did not correlate with sarcopenia (p<0,072). Conclusions: This study confirmed the high incidence of sarcopenia in patients on hemodialysis, but also significantly reduced quality of life due to this condition. Given that SarQoL has extremely well detected patients with sarcopenia and their limitations in daily life, its more frequent use in clinical practice should be encouraged in order to detect initial forms of sarcopenia. This tool would be especially valuable when body analysis and hand dynamometer are not available.

  6045 - Artcure diffusional patch application for lumbar or cervical disc herniation in patients with type 1 and 2 diabetes mellitus: Study protocol for a double-blind, randomized controlled study Top

Hüma Bölük-Senlikci1, Selin Özen2, Rasime Pelin Kavak3, Nuri Çetin2

1Ankara City Hospital, Ankara, Turkey, 2Baskent University Medical School Hospital, Ankara, Turkey, 3Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

E-mail: [email protected]

Background and Aims: Lumbar and cervical disc herniations are common musculoskeletal problems in general population. Many treatment methods are available.[1] In refractory cases, interventional procedures or surgery should be considered.[2] However, interventional procedures are avoided in diabetic patients due to delayed wound healing or susceptibility to infection. Artcure patch contains low molecular weight lipid formation and is a treatment method that aims to decrease the volume of herniated disc following the absorption of this gel-like substance through the skin.[3] The aim of our study is to demonstrate the effectiveness of artcure diffusional patch application in the treatment of disc herniation in diabetic patients. Methods: Fourty-patients aged 20-60 years with Type 1 and 2 diabetes and with lumbar or cervical paramedian/median protruded, extruded or sequestered disc herniation will be included in the study. Patients will be given placebo and real artcure in a 3 to 1 ratio (30 patients for real artcure, 10 patients for placebo application). Patients will be evaluated by the same physician 2 times before the application and at 3rd month after the application with Visual Analog Scale, Oswestry and Neck Disability Index and the volume of herniated nucleus pulposus of the patients. Results: The duration of the study was determined as 6 months. The findings will be reported 6 months after the initiation of the study.


  1. Gadjradj PS, Smeele NV, de Jong M, Depauw PR, van Tulder MW, de Bekker-Grob EW, et al. Patient preferences for treatment of lumbar disc herniation: A discrete choice experiment. J Neurosurg Spine 2021:1-9.
  2. Delgado-López PD, Rodríguez-Salazar A, Martín-Alonso J, Martín-Velasco V. Lumbar disc herniation: Natural history, role of physical examination, timing of surgery, treatment options and conflicts of interests. Neurocirugia (Astur) 2017;28:124-34.
  3. Uğurlu M, Aksekili MA, Alkan BM, Kara H, Çağlar C. Effects of Artcure Diffusional Patch application on pain and functional status in lumbar disc herniation patients: A prospective randomized controlled study. Turk J Med Sci 2017;47:874-82.

  6090 - The role of balneotherapy in elderly patients suffering from rheumatic diseases and frailty: A literature-based update Top

Maria Chiara Maccarone1, Stefano Masiero2

1Department of Physical Medicine and Rehabilitation School, University of Padova, Padua, Italy, 2Department of Neuroscience, Rehabilitation Unit, University of Padova, Padua, Italy

E-mail: [email protected]

Background and Aims: The improvement of Quality of Life (QoL) and medical advances has resulted in increased life expectancy. Despite this, health often deteriorates in the last years of life with the frequent appearance of frailty. Frailty is a potentially reversible condition characterized by loss of reserves and increased vulnerability to stressors, that frequently precedes disability. Therefore providing innovative rehabilitative approaches and care models to this syndrome is mandatory. Balneotherapy (BT), the use of natural mineral waters, gases and peloids for health promotion, prevention, treatment, and rehabilitation, is often used in elderly patients. Since frailty is more prevalent in patients affected by rheumatic diseases largely due to chronic inflammation, we aimed at investigating the role of BT in elderly patients suffering from rheumatic diseases and the underlying molecular and immunomodulatory mechanisms. Methods: We conducted a literature review considering studies published from January 1st, 2001, to date that considered elderly subjects suffering from rheumatic diseases, treated with BT. Evidence regarding molecular mechanisms was then gathered through a review of in vitro and in vivo research. Results: Treatments in the thermal environment of elderly subjects with rheumatic diseases have been shown to improve patients' motor function, pain perception and QoL. Moreover, BT seems to contribute to the modulation of inflammation. Conclusions: BT seems to be an effective treatment in reducing pain, improving motor function and QoL of elderly patients with rheumatic diseases. Since the treatment of the underlying condition may prevent frailty, it is essential to offer these patients adequate rehabilitation protocols also taking advantage of the thermal environment.

  6084 - Platelet-rich plasma injection and percutaneous microtenotomy in the treatment of epicondylitis: Does the therapeutic effect change over time? Top

Joana Martins1, Igor Neto2, Filipa Gonçalves2, Adriana Pereira3, Mariana Santiago4, Miguel Rebelo5, Tiago Lopes2, José Luís Carvalho2

1Department of Physical and Rehabilitation Medicine, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal, 2Centro de Reabilitação do Norte, Valadares, Portugal, 3Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal, 4Centro Hospitalar e Universitário de São João, Porto, Portugal, 5UCSP Macedo de Cavaleiros, Portugal

E-mail: [email protected]

Background and Aims: Autologous platelet-rich plasma (PRP) injections are a possible treatment for epicondylitis, but results regarding its benefit have been inconsistently reported. This study aimed at investigating the therapeutic response of PRP injection following percutaneous microtenotomy in patients with epicondylitis at serial follow-up time points. Methods: Data regarding gender, age, epicondylitis side and pre and post-intervention Numeric Pain Rating Scale (NPRS) scores were collected from patients' records in our center. Pain improvement rates were calculated at several follow-up time points, namely 1, 3, 6 and 12 months post-intervention. Statistical analysis was performed with IBM SPSS Statistics. Results are stated as mean ± standard error of mean. Results: Data from 30 records of PRP injection following percutaneous microtenotomy (63% right elbow epicondylitis) were analyzed. The mean age at time of intervention was 48 years and 56% of patients were men. Overall, mean initial NPRS score was 7.1±0.3, with statistically significant differences between men (6.2±0.5) and women (8.1±0.4), p=0.004. The mean NPRS score at 1 month was 3.2±0.7 (N=16), at 3 months 3.6±0.7 (N=19), at 6 months 2.9±0.7 (N=20) and at 12 months 2.3±0.9 (N=13), with pain improvement rates of 57.5±8.9%, 45.0±9.0%, 55.0±8.9% and at 58.5±12.8%, respectively. 26.7% of the patients were refractory to the treatment, as no changes in NPRS score were observed. No relationship was found between pain improvement and baseline characteristics (gender, age and epicondylitis side). Conclusions: PRP injection following percutaneous microtenotomy was effective in the majority of the patients with epicondylitis and may be a reasonable option for the treatment of this clinical entity.

  6052 - Extracorporeal shock-wave therapy in refractory Achilles tendinopathy: Case study Top

Joana Ramalho, Luisa Pinto, Helena Barroso Castro, Gonçalo Engenheiro, Sara Silva, Filipa Gouveia

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

E-mail: [email protected]

Introduction: Achilles tendinopathy (AT) is an overuse injury that is highly incapacitating and more common in runners. Extracorporeal Shock-Wave Therapy (ESWT) is a non-invasive treatment that involves delivering shock waves to injured soft tissue to reduce pain and promote healing. Our aim is to describe the effect of ESWT on refractory AT. Patient Information and Clinical Findings: A 29-year-old female runner was referred for PMR consultation due to pain in the insertion of the left Achilles tendon with 18 months of evolution. She has had already been submitted to a rehabilitation program, including eccentric strengthening, ultrasound, electrical stimulation, and also to 2 corticoid infiltrations. However, she was still complaining of pain and disability in running and some ADL. She had pain intensity of 7/10 in numerical pain rating scale (NPRS), and scored 65/100 in Foot and Ankle Outcome Score (FAOS). Physical exam revealed hyperpronation of the left foot, pain in tendon insertion and decreased tendon thickness. She was prescribed stretching and eccentric muscle strengthening along with 4 radial ESWT sessions with r15 applicator over 4 consecutive weeks with 7-day intervals, with a frequency between 6-10 Hz, 2000 pulses, 1.8-3.0 bars, being removed from strenuous activities for 12 weeks. She was reassessed after 12 weeks, with satisfactory pain (NRPS 1/10) and function outcome (FAOS 98/100). Discussion and Conclusions: There is high evidence of efficacy of shockwave therapy in AT and it is a standard indication according to International Society for Medical Shockwave Treatment. Associating an adequate rehabilitation program may have a synergistic effect, as in the case of our patient. Therefore, ESWT may be a safe and non-invasive alternative to surgery in refractory patients.

  4541 - Low back pain in childhood and video games Top

Rihab Moncer, Leila Hamadou, Maroua Ghanmy, Emna Toulgui, Walid Ouanes, Sonia Jemni

Sahloul University Hospital Center, Sousse, Tunisi

E-mail: [email protected]

Background and Aims: Low back pain is a real public health problem. In children, it remains neglected by parents and doctors alike. The aim of this work is to study the correlation between low back pain and the practice of video games in children. Methods: This is an analytical cross-sectional study carried out over a period of 05 months including adolescents aged 12 to 18 from Sousse –Tunisia (04 establishments chosen) Our sample size is 480 children. Those who have had a spinal trauma, neurological pathologies, impaired comprehension or do not consent are excluded from this study. Anamnestic data was used to identify children with low back pain as well as those who play video games and the number of hours of play. Results: Of the children examined, 36 were excluded from the study for gibbosity. The final number was 444. The prevalence of low back pain was 22.3%. 88.9% of children with low back pain play video games against 78.2% in the healthy population, with a significant difference (p = 0.04). The mean number of hours of play was longer in symptomatic children compared to healthy ones with a significant difference (p = 0.09). Children spending more hours playing increased the risk of developing low back pain by 1.08 with a CI [1.13-3.44]. Conclusion: Low back pain in children is common with a significant functional impact. A healthy lifestyle involving a limitation of the hours of video games can promote improvement in symptoms.

  4540 - Back pain in schoolchildren: Effect of postural education and medical gymnastics Top

Rihab Moncer, Leila Hamadou, Nadra El Fani, Emna Toulgui, Walid Ouanes, Sonia Jemni

Sahloul University Hospital Center, Sousse, Tunisia

E-mail: [email protected]

Background and Aims: Back pain is a posterior pain located between the upper edge of the trapezius and the inter-gluteal fold. Its prevalence can reach 50% around 15-16 years. This work aims to identify the factors inducing back pain in children, find solutions to reduce pain and, if possible, correct deformities when they exist. Methods: This is a cross-sectional study, carried out from February to April 2019. We took care of 36 schoolchildren in a primary school from Sousse chosen randomly. We studied risk factors by a questionnaire then we realized anthropometric measurements (weight, height, BMI, weight of each satchel, type of satchel) as well as a clinical examination of the spine in static and dynamic (distance finger-ground,schober's index,chest amplification,mobility of the cervical spine) and an assessment of pain by the visual analogue scale. A preventive ergonomic approach through postural education and medical gymnastics has been applied in children with back pain. Results: The population studied is predominantly male (56%). The average of schoolchildren who have had at least one episode of back pain is 81%. 33% of the population suffered from low back pain, 39% from back pain and 28% from neck pain. Back pain affects boys (62%) more than girls. 72% of schoolchildren have had an episode of back pain because of their schoolbag. The education of children was beneficial on pain and postural disorders with improvement in symptoms. Conclusion: Reducing the satchel's weight, the way of carrying it and the integration of medical gymnastics is essential in the rehabilitation protocols of schoolchildren with back pain as well as postural education and awareness as a prevention and a cure.

  4468 - Effect of rehabilitation in geriatric patients after hip surgery Top

Ola Mohamed Fathy Kamal1, Yunia Herbania Labrada Rodríguez2, Oscar Escolante Castro2, Irene Serrano García3, Elva de Ory López2, Alejandro Diego Pérez González2

1Department of Physical Medicine and Rehabilitation, Hospital Clínico San Carlos, Madrid, Spain, 2Hospital de Guadarrama, Guadarrama, Madrid, Spain, 3Methodological Research Support Unit, Hospital Clínico San Carlos, IdISSC, Madrid, Spain

E-mail: [email protected]

Background and Aims: To evaluate the effect of rehabilitation in geriatric patients after hip surgery. Methods: Quasi-experimental study. 241 patients admitted to Guadarrama Hospital Functional Recovery Unit who underwent hip surgery from January to December 2019. Patients were assessed by a rehabilitation physician and distributed into three treatment groups according to their Barthel Index (BI) prior to and upon admission, Functional Gait Assessment (FGA), comorbidities and cognitive status. Variables analysed were: age, sex, pre-surgical diagnosis, surgery performed, BI prior to admission, upon admission and upon discharge, FGA upon admission and discharge, rehabilitation treatment groups, Functional Gain (FG) [BI upon discharge - BI upon admission], Treatment Efficiency, days of hospital stay and discharge destination. Results: The sample mean age was 83.50 years,77.2% female. The most frequent preoperative diagnosis was Pertrochanteric fracture (51.5%). Nail osteosynthesis was performed in 58.9%. Mean BI at discharge: 66.10.Mean FGA at discharge: 4.89. Mean FG: 33.71 (SD 18.74), FG of Group I: 36, Group II: 39 and Group III: 19, with statistical significant differences (p 0.00). Treatment Efficiency and hospital stay show significant differences between treatment groups (p 0.000). The analysis of FG according to surgery performed did not reveal significant differences (p 0.83). 83.4% of the patients returned home,with significant differences between Groups I and III (p 0.000). Conclusions: Good functional results were achieved in geriatric patients undergoing hip surgery, regardless of type of surgery performed. Incidence of institutionalization was reduced. These results were influenced by several factors: age, comorbidity, functional and cognitive status.

  4441 - Comparison for efficacy of exercise programs with and without electrotherapy for the management of adhesive capsulitis of shoulder Top

Sonja Nejkov1, Natasa Ðukic-Macut2, Vesna Bokan-Mirkovic1, Tatjana Matejevic3

1Clinical Center of Montenegro, Center for Physical Medicine and Rehabilitation Podgorica, Podgorica, Montenegro, 2Faculty of Medicine, University of Priština, Kosovska Mitrovica, Serbia, 3Special Hospital for Rehabilitation Ribarska Banja, Ribarska Banja, Serbia

E-mail: [email protected]

Background and Aims: Adhesive capsulitis (AC) is painful condition of the shoulder joint.The purpose of the study is to determine, whether AC-related pain could be more effectively treated by combination of electrotherapy and kinesitherapy in relation to the application of kinesitherapy only. Methods: 34 patients randomly allocated into two groups: A 16 and B 18 patients, who were treated for AC. All patients went through clinical and musculoskeletal ultrasound (MUS) examination. In all patients we look at the thickness of the coracohumeral ligament (CHL). In group A, patients were treated with combination of electrotherapy and kinesitherapy, while in group B only kinesitherapy. Kinesitherapy was administered 4 weeks 5 days a week. Pre and post treatment evaluation of shoulder pain, range of motion and function were evaluated on the pain-on-movement numeric rating scale (p-NRS), goniometry and shoulder pain and disability index (SPADI) after the first and forth weeks treatment sessions. Results: Mean value of age was 53.6±5.5 in the A group and 51.6±5.118 in the B group; mean value of p-NRS was (6.6±0.6)/(6.3 ± 0.8) and duration of pain was 4.1±0.6 and B 3.9 ± 0.4 month. CHL was visualized in 85.3% of the all patients. After the first and the fourth weeks treatment, p-NRS and SPADI showed a statistically significant improvement in both groups (p<0.05) and there was significantly more improvement in the A group compared to the B group (p=0.0001).The improvement in forward flexion in the A group was in fourth weeks treatment (p=0.001), and there was a significant difference between groups (p=0001). Conclusions: The study showed that a combination of modalitise is very effective in management of AC.

  4434 - Conservative treatment outcomes for osteoporotic vertebral fractures evaluated using Locomo tests Top

Yutaka Nakamura1, Kento Watanabe2, Masayoshi Kanai1, Rui Kitamura1, Ryoma Asahi3, Satoshi Asano1

1Saitama Spine Center, Higashi Saitama General Hospital, Saitama, Japan, 2Department of Rehabilitation, Higashi Saitama General Hospital, Saitama, Japan, 3Department of Rehabilitation, Japan University of Health Sciences, Saitama, Japan

E-mail: [email protected]

Background and Aims: For fresh osteoporotic vertebral fractures (OVF), balloon kyphoplasty (BKP) has emerged for patients where conservative treatments fail. BKP is the expanding indications require ongoing verification. This study compared conservative OVF treatment outcomes, to a similar cohort without fractures. Methods: Of 475 pts with fresh OVF who visited our osteoporosis clinic 2012.1 - 2018.12, data from 136 who were followed min. 6mos, and had standing spinal X-rays and Locomo assessment was compared with 209 cases comprising a non-OVF group. Spinal sagittal alignment was evaluated using thoracic kyphosis (T2-12), low thoracic kyphosis (T5-L2), thoracolumbar sagittal angle (TLSA: T10-L2), lumber lordosis (LL: T12-S), pelvic tilt (PT), sacral slope, pelvic incidence, and sagittal vertical axis. Assessments for Locomo Syndrome (LoS), conceptualized in Japan to raise earlier awareness of risks for requiring care services due to musculoskeletal ambulation disabilities, were evaluated as indices of HRQOL, along with visual analog scores for low back pain, bone mineral density at the lumbar spine, femoral neck and total femur, as well as height, weight, and Body Mass Index. Results: Significant differences were found only on TLSA, LL, PT and Mean BMD at the lumbar spine. Discussion: For most OVF cases, conservative treatments and rehabilitation have proven effective. For problematic cases with persistent pain or kyphosis due to non-union or progression of vertebral body collapse, and comorbidities, need for early BKP has intensified.Where risk factors for prolonged healing and pseudoarthroses have been clarified, earlier BKP implementation with its serious risks must be decided case-by-case with careful consideration for safety.

  4417 - Isolated polyarthralgia revealing occult neoplasia: About two cases Top

Sanaa Mdarbi, Hansaa Boutalja, Fatima Lmidmani, Abdellatif El Fatimi

Department of Physical Medicine and Rehabilitation, Ibn Rochd University Hospital Center, Casablanca, Morocco

E-mail: [email protected]

Introduction: The paraneoplastic syndrome is defined by a combination of clinical, radiological and biological symptoms associated with an occult or already known neoplasia, independently of its location. The aim of this study is to show through 2 observations the interest of suggesting a paraneoplastic syndrome in front of isolated polyarthralgia. Patient Information and Clinical Findings: Case 1: Mr. 63 years old, a chronic smoker, he has developed mixed polyarthralgia located at the hips, knees and ankles predominating on the right side. A biological assessment was carried out, returning to normal. A radiological examination of the painful joints had shown a deficient image in the right iliac bone. An MRI scan of the pelvis revealed a regular lacuna in the right iliac bone, strongly suggestive of a tuberculosis-type cold abscess. An anatomopathological examination of a specimen taken from the iliac wing revealed a secondary location of a well-differentiated adenocarcinoma. Case 2: Mrs. 34 years old,. who had mixed and intermittent polyarthralgia predominantly at the hips. The biological assessment was made showing an inflammatory syndrome and hypercalcemia. Standard X-rays of the 2 hips face and profile showed osteolytic images of the femoral heads. A tumor marker assay was performed that showed a high level of CA 15-3. Conclusion: Among the various signs of the rheumatological paraneoplastic syndrome are the isolated polyarthralgia, which in most cases allows for the incidental discovery of cancer by using an adapted paraclinical exploration strategy.

  4410 - Assessment of body posture in children with mild and moderate intellectual disability Top

Andzelina Wolan-Nieroda1, Karolina Cisek2, Mariusz Druzbicki2, Agnieszka Guzik2

1Department of Physiotherapy, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland, 2Department of Physiotherapy, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland

E-mail: [email protected]

Background and Aims: The aim of the study was to assess body posture in children with mild and moderate intellectual disability in comparison to a control group of healthy children. Methods: The study took into account 121 children, aged from 10 to 15 years, attending primary schools in the Podkarpackie Region. The study group consisted of 60 children (16 girls and 44 boys), all presenting with mild or moderate intellectual disability. The control group comprised 61 normally developing children (20 girls and 41 boys). On average the subjects were approximately 13 years old. Assessment of the anterior-posterior curvaturesof the spine in the sagittal plane was carried out using mechanical inclinometer. Measurement of the cervical range of motion was carried out using a CROM goniometer. Results: Analysis of the relevant parameters showed that, compared to the children with intellectual disabilities, the normally developing children present greater cervical range of motion, particularly in rotation to the left (p=0.046) and to the right (p=0.05). The L-S inclination angle differed significantly in the groups; normal results were achieved by 90.2% of the children in the control group and by 68.3% of the children with intellectual disability. No statistically significant associations were identified in the study group between the cervical range of motion or spinal curvatures and age or Body Mass Index. Conclusions: The findings show significant differences between the groups related to the parameters investigated. Children with intellectual disabilities, compared to healthy children, present poorer body posture. Greater cervical range of motion was identified in the children in the control group.

  4409 - Assessment of mandible and cervical spine mobility in temporomandibular joint dysfunctions Top

Andzelina Wolan-Nieroda1, Daria Czarny2, Mariusz Druzbicki3, Agnieszka Guzik3

1Department of Physiotherapy, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland, 2Department of Physiotherapy, Institute of Health Sciences, University of Rzeszów, Rzeszów, Poland, 3Department of Physiotherapy, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland

E-mail: [email protected]

Background and Aims: The study was designed to assess mobility of the mandible and cervical spine in individuals with temporomandibular joint dysfunction, in comparison to a control group. Methods: The study involved 40 individuals ranging in age from 18 to 50 years. The study group comprised 20 individuals with temporomandibular joint dysfunction and a control group (20 individuals) with no health issues related to temporomandibular joints or neck, matched for age and sex. Cervical range of motion was assessed using a CROM goniometer, while the temporomandibular joint mobility was measured using a millimeter ruler. The participants' quality of life was assessed with Oral Health Impact Profile-14 questionnaire. Results: The findings show statistically significant differences between the study group and the controls in the right (p<0.01) and left (p<0.05) lateral cervical flexion, head rotation to the right (p>0.005), maximum mandibular opening (p<0.05) and maximum movement of the mandible to the right (p<0.001) and to the left (p<0.001). The study group presented significantly lower mandibular and cervical ranges of motion compared to the controls (p<0.05). The study showed that the most common accompanying symptoms included cracking sounds and pain in the muscles of the neck and head. Conclusion: Significant differences were identified in the ranges of mandibular and cervical mobility assessed in the study group and the controls. The individuals with temporomandibular joint dysfunction presented significantly smaller ranges of movement of the mandible and cervical spine than the healthy individuals. The limited mandibular and cervical ranges of motion adversely affect the quality of life and contribute to neck and head pain.

  6039 - Impact of body mass index on pain intensity after conservative treatment in patients with low back pain Top

Marija Gocevska1, Maja Manoleva2, Biljana Kalchovska Ivanovska3, Biljana Mitrevska2, Valentina Koevska3, Erieta Nikolikj Dimitrova2, Cvetanka Gjerakaroska Savevska3

1University Clinic of Physical Medicine and Rehabilitation, Faculty of Medicine, Ss Cyril and Methodius University, Skopje, North Macedonia, 2University Clinic of Physical Medicine and Rehabilitation, Skopje, North Macedonia, 3Faculty of Medicine, Ss Cyril and Methodius University, Skopje, North Macedonia

E-mail: [email protected]

Background and Aims: Low back pain and overweight are two relevant disabling health conditions. There is a lack of information about the effectiveness of conservative treatment in patient with overweight and low back pain. The aim of our study was to evaluate if overweight has any influence on the effectivity of conservative treatment in patients with low back pain during a short- to mid-term time period. Methods: A total of 70 patients with low back pain participated in this study. All patients underwent a physical therapy (high-intensity laser and exercises) for 2 weeks. The weight status was classified according to the body mass index (BMI). Numeric Pain Rating Scale, and Oswestry Disability Index were used for assessment of pain and functional disability at four time points (beginning and end of therapy and after 3 and 6 months). Results: Mean age of the patients was 57 years (range, 33–64 years) with 42% males and 58% females. Concerning the results, we observed an improvement of the patients' condition with statistically significant reduction of pain and disability at discharge in the short and mid-term follow-up. Regarding the BMI groups among themselves, the differences of the data in the pain and disability scores showed generally no statistical significance. Conclusions: We conclude that a conservative treatment in patients with chronic low back pain is effective both in a short-term and a mid-term time period respectively without any significant differences between patients with a normal BMI or with overweight.

  6022 - Treatment of amputees caused by a landmine explosion in the acute phase Top

Souad Karoui1, Meriam Hfaidh2, Najla Mouhli2, Jihene Chmak2, Hager Rahali2, Imene Ksibi2, Rim Maaoui2

1Hôpital Militaire Principal d'instruction De Tunis, Tunis, Tunisia, 2Hôpital Militaire De Tunis, Service de Médecine Physique et Réadaptation Fonctionnelle, Tunis, Tunisia

E-mail: [email protected]

Background and Aims: Amputation is a surgical or traumatic procedure that involves the removal of a limb or a segment of limb with bone section. In the military environment, amputation is essentially caused by artisanal mine explosion for young subject. The objective of our work is to clarify the management of the acute phase of amputees caused by a landmine explosion. Methods: This is a cross-sectional and descriptive study carried out in a department of physical medicine and functional rehabilitation over a period of four months [September 2019-December 2019], involving 36 patients with amputation of a lower limb due to a ballistic trauma. Results: The mean age was 29.4 ± 6.9 years with male exclusivity. The amputation was performed on the day of the trauma in 92% of cases. Five patients had a surgical revision during the 1st month. Wound healing was spontaneous in 83% of cases. The use of VAC therapy, hyperbaric oxygen therapy, or skin grafting was necessary in 3%, 11% and 3% of cases, respectively. Immediately after surgery, all the patients were put on Paracetamol and a level 2. Eight percent of patients required morphine treatment. All patients have been put on Pregabalin for neuropathic pain since the 2nd postoperative day. We used electrotherapy for analgesia for a longer period in 47% of patients. Post-traumatic stress disorder was revealed in 44% of cases. 42% of the patients were put on antidepressant and 36% were put on anxiolytic. Elastic compression was put on in 94% of cases to prepare the patient for the prosthesis. Conclusions: The treatment of amputees in the acute phase aims to ensure rapid healing, to avoid complications, in particular infectious ones, and to obtain a good quality of stump in order to regain complete autonomy with good functional, psychological and social results.

  5958 - Vitamin D deficit in day hospitalization in the physical medicine and functional rehabilitation department of CHU Ibn Rochd in Casablanca Top

Rime Dades1, Ryme El Beloui2, Sara Hadir2, Ibrahim Abouhali2, Nada Kyal2, Fatima Lmidmani2, Abdellatif El Fatimi2

1Department of Physical Medicine and Rehabilitation, Casablanca Faculty of Medicine and Pharmacy, Casablanca, Morocco, 2Casablanca Faculty of Medicine and Pharmacy, Casablanca, Morocco

E-mail: [email protected]

Background and Aims: Knowledge of the physiology of vitamin D has improved considerably these last years, shifting it from a simple vitamin with a purely phosphocalcic and bone tropism to that of a hormone that plays a crucial role in many physiological mechanisms and whose deficit is involved in several pathologies. This work aims to study the correlations between the 25OHD level and the demographic, clinical and biological parameters. Methods: It is a prospective study of 43 consultants in the physical medicine department (39 women, 4 men) aged between 27 and 87 years old. We measured 25OHD, calcium and phosphorus levels. Results: These are 43 patients with an average age of 55.33 years. Hypovitaminosis D is not correlated with age, body mass index, origin, clothing, sex and phototype. For biological parameters, the serum 25OHD level did not correlate significantly with serum calcium and phosphorus concentrations. Conclusions: In our study, we diagnosed a vitamin D deficiency in 100% of patients with clinical symptoms of hypovitaminosis D. That said , they represent 9,81% of all consultations in physical medicine, highlighting the underdiagnosis of this deficiency. At the end of this study, we concluded the high frequency of hypovitaminosis D in physical medicine. This was consistent with the data in the literature. These data need to be confirmed by more powerful multi-centric studies, encompassing various socio-cultural levels and various regions of the country.

  5942 - Radial shock wave therapy with “Intelect RPW Lite” for calcifying tendinopathy of the shoulder: Comparative effectiveness with conventional physical therapy and follow up Top

Radostina Simeonova1, Zlatin Ivanov2, Naiden Padjev3

1Private Center, Plovdiv, Bulgaria, 2MC Raredis, Plovdiv, Bulgaria, 3Private Center Physiovital, Plovdiv, Bulgaria

E-mail: [email protected]

Background and Aims: The effectiveness of radial shock wave therapy for treating chronic calcifying tendinopathy of the shoulder is still controversial concerning the doses, methods and follow up. The purpose of the study is to reveal the criteria for effective treatment of this pathology and to compare it with the conventional physical factors used so far. Methods: The research has been taken on 60 people, suffering from calcifying tendinitis. A control group (CG), including 30 people, treated with basic therapy (Transcutaneous electrical nerve stimulation (TENS), kinesiotherapy and ultraphonophoresis) for 7 days and an experimental group (EG), including 30 people, treated with the same basic therapy and RSWT once per week for seven consecutive weeks. The effect of the treatment was shown by: sonographic examination before and after treatment, after one month, three months later and follow up at sixth month; physical tests for motor skills in shoulder region, scale of pain and the range of motion (ROM) at the same stages as the sonographic examination. Results: The results have high statistical significance (p<0,001) for both groups. The statistical difference between EG and CG (p<0,001) proves that usage of RSWT reduces the pain quicker and restores mobility in the shoulder region in a shorter period than conventional physical therapy and only the patients in the EG have reduction in the parameters of the calcifications and total disappearance in the follow up. Conclusion: Both methods have a pain reducing effect, contribute for better mobility in the treated area and also improve the quality of life of patients with calcifying tendinitis of the shoulder but RSWT with “Intelect RPW Lite” gives better results than only basic therapy in all tests and contributes to resorption of the calcification.

  5926 - Predictors associated with curve progression in idiopathic scoliosis: A systematic review and meta-analysis Top

Jie Shen, Yan Li, Rougang Zhao, Yunhai Yao, Jianming Fu, Meifang Shi, Xudong Gu

The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Center of Rehabilitation Medicine, Jiaxing, Zhejiang, China

E-mail: [email protected]

Background and Aims: The criteria of progressive idiopathic scoliosis (IS) is the Cobb angle increasing more than 5 of the patient in this review. This study aimed to quantitatively evaluate the predictors associated with curve progression in IS. Methods: PubMed, Embase, the Cochrane Library, Web of Science, CINAHL (Ebsco), CNKI, and Wanfang database were searched through case series studies and cross-sectional studies, regarding the associations between progressive IS and predictors from inception to October 31, 2021. The risk of bias of the included studies was assessed by the New Castle-Ottawa scale (NOS) and the odds ratios (ORs) expressing effect size were calculated by RevMan 5.3 software. Results: Overall, 1589 eligible articles were searched systematically, of which twenty-five studies (6714 IS participants) were pooled to analyze. The statistically significant predictors association between progression of IS are following: younger age (OR: 2.47, 95% CI, 1.07 to 5.71, p=0.03), pre-menarchal status (OR: 5.81, 95% CI, 3.81 to 8.86, p<0.001), lower Risser sign (OR: 5.21, 95% CI, 2.37 to 11.46, p<0.00001), larger initial Cobb angle (OR: 3.20, 95% CI, 1.45 to 7.04, p=0.004), larger apical vertebral rotation (OR: 5.36, 95% CI, 1.08 to 26.51, p=0.04), thoracic curve (OR: 1.93, 95% CI, 1.33 to 2.79, p=0.0005), and osteopenia (OR: 2.74, 95% CI, 1.80 to 4.18, p<0.001). Conclusions: Insufficient evidence showed that the progression of IS can be screened by age, sexual maturity, the severity of scoliosis, and bone mass, and more high-quality studies are needed for verification in the future.


  1. Zhang Y, Yang Y, Dang X. et al. Factors relating to curve progression in female patients with adolescent idiopathic scoliosis treated with a brace. Eur Spine J 2015;24:244-8.
  2. Di Felice F, Zaina F, Donzelli S, Negrini S. The Natural History of Idiopathic Scoliosis During Growth: A Meta-Analysis. Am J Phys Med Rehabil. 2018;97:346-56.
  3. Mohanty SP, Pai Kanhangad M, Gullia A. Curve severity and apical vertebral rotation and their association with curve flexibility in adolescent idiopathic scoliosis. Musculoskelet Surg. 2021;105:303-8.

  5869 - Functional outcomes of total knee arthroplasty in rheumatoid arthiritis patients Top

Sara Hadir1, Ryme El Beloui2, Rime Dades2, Khalid El Khaymy2, Samira Khalfaoui2, Nada Kyal2, Fatima Lmidmani2, Abdellatif El Fatimi2

1Department of Physical and Functional Rehabilitation, Faculty of Medicine and Pharmacy of Casablanca, Casablanca, Morocco, 2Faculty of Medicine and Pharmacy of Casablanca, Casablanca, Morocco

E-mail: [email protected]

Background and Aims: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that affects up to 1.5% of the worldwide population, women in particular.Total Knee Arthroplasty (TKA) has been described as an effective treatment for alleviation of pain and restoration of function in patients with RA.The aim of our study was to evaluate quality of life after TKA in this population. Methods: We reviewed the results of thirteen TKA that had been performed to eight RA patients in trauma and orthopaedic department of Ibn Rochd university hospital of Casablanca (IRUHC) who benefited from inpatient care at the physical and functional rehabilitation department of IRUHC between 2013 and 2019. We assessed the results using the Knee Society Score (KSS),visual analog scale and functional independance measure. Results: The mean KSS improved from 71.61±12.3 to 148± 19.7. Mean visual analog scale went from 5.9±0.9 to 2.3±0.7 and functional independance measure went from 58 to 81/126. We found that 37.5% of the patients regained gait autonomy. Discussion: RA is a chronic disease that primarily attacks synovial joints and leads to the progressive destruction of articular structures, particularly cartilage and bone. Rajesh M and al reported in a series of twenty six patients with end stage arthritis operated with total knee prosthesis that KSS-Function score went from 42.8±8.2 to 86.5±4.6. Conclusions: These results show that a personalized rehabilitation program as a step of a multidisciplinary approach is key in optimising the results of TKA in RA patients and as result improving their quality of life. Future research could examine the implant survival rate in this population.

  5891 - Home-based rehabilitation treatment after total hip and knee arthroplasties: Functional results under fast-track programs Top

Felip Orient Lopez, Dores Sanchez Corretger, Blanca Zeballos Buscaglia, Carlos Agudo Fernandez, Monica Fayos

Department of Physical Medicine, Hospital Universitari Sagrat Cor Quironsalud Barcelona, Barcelona, Spain

E-mail: [email protected]

Background and Aims: Our physical medicine and rehabilitation department assist a population in a Barcelona neighborhood of approximately 150,836 inhabitants, in which more than 21% are over 65 years of age. Our study aims to analyze the functional outcome of total hip arthroplasty (THA) and total knee arthroplasty (TKA) under a fast-track program, performed as a home-based rehabilitation treatment (HRT) during 2021. Methods: Prospective descriptive study. Patients under home based rehabilitation for THA and TKA (January-October 2021). Variables: age, sex, Barthel index (previous, initial and discharge), functional improvement (Barthel increase) and rehabilitation sessions performed (number). Descriptive data analysis. Qualitative variables are showed as absolute frequency and percentage (%), and quantitative variables are showed as mean and standard deviation (SD). Results: Of the 934 patients assessed under HRT, 127 were THR and TKA. THR: n = 37, women 59.52%, mean age 73.91(SD 9.18) and 40.48% men, mean age 74.33 years (SD 8.02). Average Barthel: initial 66.42, at discharge 91.19, mean functional improvement 24.76 points, with a mean of rehabilitation sessions 12.33(SD 2.01).TKA: n = 90, women 70.30%, mean age 80.01 (SD 9.18) and 29.70% men, mean age 74.2 years (SD 11.02). Average Barthel: initial 71.23, at discharge 96.93, average functional improvement 25.69 points, with an average of rehabilitation sessions 12.20(SD 1.91). Conclusions: HRT under a fast-track program for THA and TKA achieves an efficient functional outcome (Barthel increase> 20 points) with an adjusted number of sessions, similar to that accomplished at the outpatient level, avoiding the complications and costs derived from the patient's displacement to the rehabilitation center.

  5888 - The prevalence of mechanical low back pain in the department of physical medicine and rehabilitation at Beni Mellal RHC Top

Mouad Yazidi1, Hajar Abouihsane1, Hakim Bourra1, Amine Samaoui2, Hasnaa Boutalja1, Zaineb Tahri1, Abdelhakim Kabil1, Nada Kyal1, Fatima Lmidmani1, Abdellatif Elfatimi1

1Department of Physical Medicine and Rehabilitation, Ibn Rochd University Hospital, Casablanca, Morocco, 2RHC BeniMellal, BeniMellal, Morocco

E-mail: [email protected]

Background and Aims: Mechanical low back pain is a public health problem because of its frequency and its consequences. The objectives of our study are to determine the prevalence of mechanical low back pain in the department of physical medicine and functional rehabilitation (PMR) at the BeniMellal RHC, the evaluation of its epidemiological profile, and the assessment of its risk factors. Methods: We conducted a prospective case-control study of low back pain patients in the Department of PMR at the hospital of BeniMellal, for an 8 month period, from July 2018 to February 2019. Patients responded to a pre-established questionnaire. Results: In our study in the Department of PMR, over 515 included patients, 60 patients had mechanical low back pain, with a prevalence of 11.65%. The average age of our patients was 50,33±12.65 years, with a female predominance of 76.67%. 98.33% of low back pain was chronic versus one case of acute low back pain, the correlation observed significance between EIFEL score and VAS, between EIFEL and Quebec scores and also between EIFEL and ODI scores. Cessation of work was observed in 31.82% of cases. Factors associated with mechanical low back pain were: advanced age, female gender, high BMI, illiteracy, smoking, antecedents of low back pain, migraine, disturbed psychology, carrying heavy loads, and dissatisfaction at work. Conclusion: the prevalence of mechanical low back pain, its important medical, economic and socio-occupational consequences and associated factors must call for preventive measures for this condition.

  5878 - Efficacy of antiresorptive drugs on cancer treatment induced bone loss in post-menopausal women with breast cancer: A systematic review of randomized controlled trials Top

Alessandro de Sire1, Lorenzo Lippi2, Claudio Curci3, Carmen Criscitiello4, Nicola Fusco4, Marco Invernizzi2

1Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Italy, 2Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, Novara, Italy, 3Department of Neurosciences, ASST Carlo Poma, Mantova, Italy, 4Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

E-mail: [email protected]

Background and Aims: Cancer treatment-induced bone loss (CTIBL) is a common complication of cancer therapies affecting both disability and health-related quality of life (HRQoL) in breast cancer survivors. To date, the most effective treatment for improving bone health and HRQoL is still debated in these subjects. Therefore, the aim of this systematic review was to summarize the evidence on the effects of antiresorptive drugs on CTIBL in post-menopausal women with early breast cancer. Methods: PubMed, Scopus, and Web of Science databases were systematically searched up to April 30, 2021, to identify randomized controlled trials (RCTs) presenting: postmenopausal women with early breast cancer receiving adjuvant aromatase inhibitors (AIs) as participants; antiresorptive drugs (i.e. bisphosphonates and/or denosumab) as intervention; any comparator; bone mineral density (BMD) modifications as outcome. The quality assessment was performed according to the Jadad scale. Results: Out of the 2415 records screened, 21 papers were included in the qualitative analysis. According to the Jadad scale, 6 studies obtained a score of 5, 1 study obtained a score of 4, 13 studies obtained a score of 3, and 1 study with a score of 1. The studies included showed that both bisphosphonates and denosumab increase BMD; however, only denosumab seems to provide significant advantages on fractures. Conclusions: Bone health management in breast cancer survivors undergoing adjuvant AIs is a growing issue in the current literature and the optimal therapeutic approach is still debated. Further studies are needed to characterize the optimal antiresorptive drugs and treatment duration to manage CTIBL, targeting individual patients' characteristics.

  5857 - A comparative study on clinical features of congenital versus non-congenital muscular torticollis Top

Sunmok Hong, Hyung-Ik Shin, Moon Suk Bang, Sung Eun Hyun, Hye Min Ji, Woo Hyung Lee

Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea

E-mail: [email protected]

Background and Aims: Even though congenital muscular torticollis is one of the most common diagnosis in pediatric patients with torticollis, differential diagnosis from non-congenital muscular torticollis can be challenging in clinical practice. The aim of this study was to compare clinical characteristics in pediatric patients with congenital (CMT) versus non-congenital muscular torticollis. Methods: Pediatric patients with torticollis were retrospectively reviewed over 9 years (2011-2019) who undergone diagnostic examinations including ultrasonography, CT, or MRI of the neck, CT or MRI of the cervical spine in a tertiary hospital. The patients were categorized into 3 groups including CMT, ocular torticollis, and osseous torticollis. The data of clinical characteristics in these 3 groups were acquired and compared in this study. Results: Among a total of 958 patients with torticollis, the number of patients with CMT, ocular torticollis, osseous torticollis was 359 (37.5%), 48 (5%), 24 (2.5%) respectively. There were significant difference among patients with CMT, ocular torticollis, and osseous torticollis in age (months) at diagnosis (2.4 [1.3-6.5], 18.8 [9.3-35.4], 77.4 [46.1-107.9], p<0.001), and the proportion of patients with age (years) at diagnosis <1, 1-2, or ≥3 (p<0.001). Between ocular and osseous torticollis, the percentage of patients with age (years) at the first presentation of symptom <1, 1-2, or ≥3 was also significantly different (p<0.001). The proportion of patients who underwent physical therapy, other conservative therapies, or surgical treatment was significantly different between the three groups (p<0.001). Conclusion: Age at diagnosis and at the first presentation of symptoms could be important clinical factors in differential diagnosis of pediatric torticollis patients.

  5856 - Extracorporal shockwave therapy in treatment of calcific tendinopathy of the shoulder Top

Branko Vujkovic1, Branka Markovic2, Ognjen Vukadin3

1Fizikal Center Sabac, Sabac, Serbia, 2Faculty of Sport and Physical Education University of Belgrade and Fizio Vracar, Belgrade, Serbia, 3Institute of Orthopedics Banjica, Belgrade, Serbia

E-mail: [email protected]

Introduction: Shockwave therapy (ESWT) first treatments in Musculoskeletal (MSK) medicine to treat indications such as heel spur's, shoulder calcifications and tennis elbow has begun at 1994th.The use of shockwave was shown to result in a loss of pain, improvement in the overall mechanics and patient satisfaction. Patient Information and Clinical Findings: In our paper, we presented a male patient, 40 years old, who came for an examination due to pain in the right shoulder that was present 12 months ago,at certain shoulder positions, with intensifying the symptoms in last two months after physical activities-limited almost all movements, shoulder pain,when he received intraarticular corrticosteroid. Before the examination in our clinic, he did an ultrasound imaging of the right shoulder when it was described that the calcification in supraspinatus muscle was about 2 cm in size. On clinical examination the patient had tenderness upon palpation of the anterior joint line, painfull abduction from 90 to 120 degrees. Also Empty Can test was positive, so as Hawkins-Kennedy test. We have prescribed ESWT in one weekly session, during five weeks, and also collagen supplementation. Discussion and Conclusions: Two months after initial visit of patient he has no pain in the shoulder with full range of motion. On the second ultrasound check up of the right shoulder calcification was defragementated, with discreat calcifications in the supraspinatus muscle tendon. In MSK medicine ESWT has expansion during last twentie years,but we must create evidence based ESWT protocols with precise parameters of application for every indication. Shockwave therapy has a huge potencial in the treatment of pain, injuries and illness, and we should strive to implement it as a standard equipment in our practice.

  5853 - Impact of rehabilitation on neuromuscular sequalae of knee stabilizer muscles in a COVID-19 cluster of female volleyball players: A retrospective study Top

Riccardo Spanò1, Nicola Marotta2, Teresa Iona2, Stefano Fasano2, Alessandro de Sire2, Antonio Ammendolia2

1Department of Surgical and Medical Sciences, University of Catanzaro, “Magna Graecia”, Catanzaro, Italy, 2University of Catanzaro, “Magna Graecia”, Catanzaro, Italy

E-mail: [email protected]

Background and Aims: COVID-19 could induce long-term sequalae, including neuromuscular disorders, even several weeks after the initial infection. A poor neuromuscular control may cause motion asymmetry and inefficient movement strategies increasing anterior cruciate ligament (ACLI load particularly in sports. Indeed, this issue is particularly relevant in female athletes, that reported to have a 3-time higher risk than male counterparts. Aim of this study was to evaluate the impairment of thigh muscles activation, body composition, and physical performance after in cluster of female volley players that were affected by COVID-19. Methods: We recruited female professional players from the same Italian volleyball team that had COVID-19. Before (T0) and after (T1) infection, twe assessed the following outcome measures: pre-activation time of Rectus Femoris (RF), Vastus Medialis (VM), Medial Hamstring (MH), and Later Hamstring (LH), evaluated through surface electromyography (sEMG); muscle mass, using the bioelectrical impedance analysis; jump tests. Results: The 12 athletes (mean age: 20.5±6.2 years; height: 180.8±7.9 cm) had a significant delay of the activation time at T1 (p<0.05) of RF (426.42±188.23 vs 151.91±106.19 ms); VM (363.33±192.21 ms; 140.16±95.60 ms); BF (228.58±59.80 ms; 150.08±63.37 ms); MH (230.92±87.63 ms; 203.50±89.29 ms). At T1, the athletes reported also a significant (p<0.05) reduction of muscle mass and jump test performance. Conclusions: The neuromotor imbalance of the knee stabilizer muscle in female athletes after COVID-19 showed a deficit of knee stabilization. Thus, physicians should assess neuromuscular and metabolic sequelae to identify athletes with a higher risk of injury and propose a patient-tailored rehabilitation plan.

  5829 - Mobility assessment in transtibial amputees with prosthetic supply Top

Omaima Jelassi, Sofien Benzarti, Mohamed Amine Triki, Houssem Beji, Mohamed Laaziz Ben Ayache

Sahloul Hospital, Sousse, Tunisia

E-mail: [email protected]

Backgrounds and Aims: A lower limb amputation reduces mobility and may lead to dependence on assistive devices. Prosthetic supply allows amputees to preserve their functional independence. The aim of this study is to describe functional outcomes for transtibial amputees in order to determine amputee's mobility status. Methods: We conducted a cross-sectional study on patients who had been subjected to unilateral transtibial amputation in our Orthopedic Surgery and Trauma Department from 2009 through 2019, and who are currently using a prosthesis. We used the Amputee Mobility Predictor in its version using the prosthesis (AMPPro) to measure functional outcomes. The AMPPro score corresponds to a K-Level ranging from 0 to 4. Results: Fifteen patients were included. Mean age of amputation was 54.6±7.3 years. Aetiologies of amputation included diabetic foot complications (26.7%), tumor (13.3%), and trauma (60%). The mean rehabilitation duration was 8.46±5.6 months. The mean time elapsed between amputation and prosthetic use was 24.7±14.3 months. The mean AMPPro score was 28.4±3.36. Eleven patients were classified as K2-Level while four patients were considered as K1-Level. The mean AMPPro score in patients with traumatic aetiology was 28.9±3.06, while it was equal to 27.8±3.97 in patients with other aetiologies. Rehabilitation program lasted less than six months in 53.3% of patients whose mean AMPPro score was 27.55±3.84. Those who underwent rehabilitation during more than 12 months (n=3) had a mean AMPPro score equal to 31±1.73. Conclusion: Functional impairment was noted in our study as the majority of patients had a K2-Level. Thus, more research is needed to learn how to best use and apply this measure in practice in order to optimize the care and rehabilitation for transtibial prosthesis users.

  5823 - Pain and functional monitoring during balneal and rehabilitation treatments in ostheoartritis Top

Madalina Iliescu, Liliana-Elena Stanciu, Doinita Oprea, Liliana Vladareanu, Elena-Valentina Ionescu

Department of Rehabilitation, Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania

E-mail: [email protected]

Background and Aims: Our present study tries to demonstrate the importance of the rehabilitation treatment using natural therapeutic factors within a famous balneal area around Techirghiol Lake Romania on the pain and functioning parameters in ostheoarthritis (OA). OA represents one of the most frequently treated pathology within the rehabilitation departments all over the world, which involves people over 40-50, mostly overweight subjects. Methods: Our study was performed on 130 patients, 62 male and 68 female, diagnosed with OA, treated with physiotherapy, hydrotherapy and peloidotherapy during 2 weeks indoor the Balneal Rehabilitation Sanatorium of Techirghiol, Romania. All the patients were assessed using the Visual Analogue Scale (VAS) and Functional Independence Measures (FIM), prior and after the treatment. All the patients signed the consent for the study. Exclusion criteria were the major pathologic conditions that represents contraindications for physical therapies, and also associated cardiologic, neurologic and post-traumatic conditions. Results: The results demonstrate the diminish, with almost 50%, of the initial pain intensity score and the improvement of general functioning with almost 35 %. Conclusions: The natural therapeutic factors represent a nonpharmacological therapeutic way that may improve the functionality of these patients, directly related with pain intensity, with low cost and high accessibility.

  5774 - Muscle cramps: Physiopathology and management – State of the art Top

Gonçalo Ferreira Pires1, Rui Moreira Sousa2, Pedro Maciel Araújo3, Diogo Couto Soares2

1Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal, 2Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal, 3Centro Hospitalar do Médio Tejo, Portugal

E-mail: [email protected]

Background and Aims: A muscle cramp is a sudden, involuntary and painful contraction of a muscle or part of it, self-extinguishing within seconds to minutes and often accompanied by a palpable knotting of the muscle. Cramps may occur associated with neurological or metabolic disorders, acute extracellular volume depletion or medication, but also in healthy subjects (during sleep, pregnancy or physical exercise). Understanding of the mechanism behind cramps is lacking and medical interventions to treat or prevent them are ineffective. The aim of this paper is to review the existent evidence about the physiopathology and management of cramps. Methods: Research in Medline and Cochrane, using the mesh term “cramps”, was made, and reviews and systematic reviews published since 2011 were evaluated. Results: Regarding physiopathology, two main theories have been studied: the dehydration and electrolyte depletion hypothesis, which is not supported by scientific evidence, and the neuromuscular hypothesis, which is supported by the current literature. As for management, forced passive muscle stretching or voluntary activation of antagonist muscles can provide acute relief. Local heat is effective in preventing leg nocturnal muscle cramp in the elderly. Sodium channel blockers and centrally acting drugs are used prophylactically, but their efficacy is based only on a few case reports. As for magnesium or electrical therapy, more research is needed. Conclusion: Cramps physiopathology is not fully understood, although there is evidence favoring a neurological etiology. Concerning its management, though there are acute relief methods, no medical intervention has proven efficient in its treatment or prevention. Still, some drugs are used based on limited evidence.

  5778 - Predictors associated with curve progression in idiopathic scoliosis: A systematic review and meta-analysis Top

Jie Shen, Yan Li, Rougang Zhao, Yunhai Yao, Jianming Fu, Meifang Shi, Xudong Gu

The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Center of Rehabilitation Medicine, Jiaxing, Zhejiang, China

E-mail: [email protected]

Background and Aims: The criteria of progressive idiopathic scoliosis (IS) is the Cobb angle increasing more than 5 of the patient in this review. This study aimed to quantitatively evaluate the predictors associated with curve progression in IS. Methods: PubMed, Embase, the Cochrane Library, Web of Science, CINAHL (Ebsco), CNKI, and Wanfang database were searched through case series studies and cross-sectional studies, regarding the associations between progressive IS and predictors from inception to October 31, 2021. The risk of bias of the included studies was assessed by the New Castle-Ottawa scale (NOS) and the odds ratios (ORs) expressing effect size were calculated by RevMan 5.3 software. Results: Overall, 1589 eligible articles were searched systematically, of which twenty-five studies (6714 IS participants) were pooled to analyze. The statistically significant predictors association between progression of IS are following: younger age (OR: 2.47, 95% CI, 1.07 to 5.71, p=0.03), pre-menarchal status (OR: 5.81, 95% CI, 3.81 to 8.86, p<0.001), lower Risser sign (OR: 5.21, 95% CI, 2.37 to 11.46, p<0.00001), larger initial Cobb angle (OR: 3.20, 95% CI, 1.45 to 7.04, p=0.004), larger apical vertebral rotation (OR: 5.36, 95% CI, 1.08 to 26.51, p=0.04), thoracic curve (OR: 1.93, 95% CI, 1.33 to 2.79, p=0.0005), and osteopenia (OR: 2.74, 95% CI, 1.80 to 4.18, p<0.001). Conclusions: Insufficient evidence showed that the progression of IS can be screened by age, sexual maturity, the severity of scoliosis, and bone mass, and more high-quality studies are needed for verification in the future.


  1. Zhang Y, Yang Y, Dang X. et al. Factors relating to curve progression in female patients with adolescent idiopathic scoliosis treated with a brace. Eur Spine J 2015;24:244-8.
  2. Di Felice F, Zaina F, Donzelli S, Negrini S. The Natural History of Idiopathic Scoliosis During Growth: A Meta-Analysis. Am J Phys Med Rehabil. 2018;97:346-56.
  3. Mohanty SP, Pai Kanhangad M, Gullia A. Curve severity and apical vertebral rotation and their association with curve flexibility in adolescent idiopathic scoliosis. Musculoskelet Surg. 2021;105:303-8.

  5770 - Pedobarography and accelerometry as long term prognostic tools of quality of life in patients with total knee arthroplasty Top

Theodoros Bouras1, Ioannis - Alexandros Tzanos2, Mark Forster1, Elias Panagiotopoulos3

1Department of Trauma Orthopaedics, Cardiff Vale UHB, University Hospital Llandough, Cardiff, UK, 2Department of PRM, KAT General Hospital, Kifissia, Greece, 3Department of Rehabilitation, Patras University Hospital, Rio, Greece

E-mail: [email protected]

Background and Aims: The relationship between instrumented knee measurements and patient reported outcome measures is a new field. Research has mainly focused on the instrumented monitoring of knee laxity, objective dynamic instability, static and dynamic balance as well as postural adaptation, to assess rehabilitation following TKA, reporting short to mid-term results. The aim of this study was to evaluate long term Quality of Life (QoL) post Total Knee Arthroplasty (TKA) surgery correlating self-reported questionnaires, clinical examination and data from pedobarography and accelerometry. Methods: Thirty six patients with unilateral TKA were evaluated at 11.3 ± 2.3 years following surgery. Clinical examination included Range of Motion (ROM) and instrumented knee laxity measurements with the Rolimeter device. The Visual Analog Scale (VAS) for pain was also recorded. The utilised QoL scales were the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the World Health Organisation Quality of Life - BREF (WHOQOL-BREF). Instrumented analysis was performed with pedobarography and accelerometry. Univariate analysis was used for correlation of QoL with clinical and instrumented analysis data. Results: Only cadence (p=0.008) and velocity (p=0.026) affected the WHOQOL-BREF psychology domain no matter the age and gender of the patients. WHOQOL-BREF Social domain was unaffected by all instrumentation measurements except for stance phase (p=0.025), VAS (p=0.005), and ROM (p=0.028). KOOS pain was reversely affected by VAS (p=0.004), KOOS symptom by ROM (p=0.001) and median maximum pressure (p=0.033). Conclusions: QoL of patients who have undergone TKA can be correlated and assessed reliably by pedobarography and accelerometry, at the long term follow up.

  5747 - Life-style in adults with congenital deficiencies in both upper and lower limbs Top

Nobuhiko Haga1, Toru Ogata2, Sayaka Fujiwara2, Kazuharu Takikawa3, Hiroshi Mano4

1National Rehabilitation Center for Persons with Disabilities, Rehabilitation Services Bureau, Tokorozawa, Saitama, Japan, 2Department of Rehabilitation Medicine, The University of Tokyo, Tokyo, Japan, 3Department of Pediatric Orthopedics, Shizuoka Children's Hospital, Shizuoka, Japan, 4Department of Rehabilitation Medicine, Shizuoka Children's Hospital, Shizuoka, Japan

E-mail: [email protected]

Background and Aims: Congenital limb deficiencies are rare conditions disabling various ADL. In Japan, the prevalence is reported as 4.15 per 10,000 births and the ratio of affection in both upper and lower limbs are 14.8%.[1] The aim of this study is to reveal the life-style in skeletally-matured patients with upper/lower limb deficiencies. Methods: The subjects were patients with both upper/lower limb deficiencies defined in the previous report[1] and aged 16 years or older at the final visit. Among the 128 patients visiting our clinic between 2002 and 2020, six male/one female patients met these conditions. We retrospectively surveyed the type and treatment of deficiencies, comorbidities, and the life-style in adulthood. Results: Surgery for the upper limbs were performed in three patients. One with transverse deficiency of bilateral elbow used prostheses only in childhood. For lower limbs, various surgical procedures were performed in six patients. Three were diagnosed as split-hand/foot malformation with long bone deficiency, and one as amnion rupture sequence. One showed intellectual disability. At final visit, all walked without cane, though three of them showed unstable gait. Five patients used lower limb prostheses and one of them relied on his parents in donning/doffing them due to his intellectual disability. Except for this patient, all were independent in doing most ADL. Among the seven patients, two were students and three were employed at the final visit. Conclusions: Though the types of deficiencies and their treatments were variable, all adult patients with upper/lower limb deficiencies walked independently and most of them were students or employed.


  1. Mano H, Fujiwara S, Takamura K, Kitoh H, Takayama S, Ogata T, Hashimoto S, Haga N. Congenital limb deficiency in Japan: a cross-sectional nationwide survey on its epidemiology. BMC Musculoskelet Disord. 2018;19:262.

  5743 - Incidence of sacroiliitis among low back pain patients and factors influencing its management; epidemiological study Top

Naglaa Hussein1, Matthew Bartels2, Mark Thomas2

1Albert Einstein College of Medicine, NYC, USA, 2Montefiore Medical Center/Albert Einstein College of Medicine, NYC, USA

E-mail: [email protected]

Background and Aims: Sacroilitis is one of the major causes of back pain, exact incidence is not well estimated. The aim of the study was to measure the incidence of sacroiliitis among patients with low back pain and factors modifying its mangement. Methods: 402 low back pain patients -262 female (65.2%), 140 male (34.8%)- included; demographic data, pain score by visual analogue scale (VAS), Oswestry Disability Index, back exam, neurological exam, sacroiliac provocative tests were carried out. Diagnostic sacroiliac lidocaine injection for positive sacroiliac test patients & MRI if possible. Sacroiliac patients received injection (40 mg triamcinolone & 3ml lidocaine 1%). VAS, 3 weeks after therapeutic sacroiliac injection. Results: Mean age 56.22±12.63. Mean Body mass index (BMI) 33.07 ± 9.36 (21.0-76.0), Diabetes mellitus positive in 23.9%. Degenerative sacroiliitis 370 patients (92%), sciatica 234 patients (58%), lumbar spondylosis 354 patient (88.1%), lumbar fusion 31 patients (7.7%). Mean VAS before sacroiliac injection 8.89±1.37, after injection 3.99±2.48 (p=0.002). Significant relationship between sacroiliitis and sciatica (p=0.0001), lumbar spondylosis (p=0.0001), lumbar fusion (p=0.013), age (p=0.009), BMI (p=0.002), DM (p=0.0029), disability index (p=0.001), MRI lumbar facet (p=0.036). Pain improvement after injection significantly inversely related to DM (p=0.002) & BMI (p=0.001). Conclusion: Degenerative sacroiliitis is significant cause of low back pain and disability which significantly related to presence of sciatica, lumbar spondylosis and lumbar fusion. Sacroiliitis is significantly related to age DM & BMI. DM& BMI are significantly inversely affecting pain improvement after therapeutic sacroiliac injection.

  5721 - Long-term outcome of idiopathic chondrolysis of the hip – Case report Top

Andreia Silva1, Bruno Lopes2, David Coutinho2, Elisa Moreira2, Rafaela Evangelista2, Mário Vaz2, Irina Peixoto2, Jorge Caldas2

1Tondela-Viseu Hospital Center, Viseu, Portugal, 2Department of Physical Medicine and Rehabilitation, Tondela-Viseu Hospital Center, Viseu, Portugal

E-mail: [email protected]

Introduction: Idiopathic chondrolysis of the hip is a rare condition defined by a progressive and extensive articular cartilage destruction from the hip joint, presumably for an inflammatory process. Symptoms commonly are unilateral and include pain, stiffness, claudication, range of motion decrease. Diagnosis is made by exclusion of other hip diseases with similar presentation. The clinical outcome is variable and may lead to painful and disabling osteoarthritis (OA) and fibrous ankylosis of the hip. Patient Information and Clinical Findings: A 49-year-old woman presented left hip pain for several years associated to antalgic gait and pelvic obliquity. Past medical history included idiopathic chondrolysis of the hip, with surgical treatment for deformity correction at 12-year-old. Plain radiographs of the hip demonstrated severe OA. The patient underwent uncemented total hip arthroplasty complicated with severe partial femoral nerve injury, associated to sensory and motor impairment. Discussion and Conclusions: Arthroplasty is the gold standard surgical treatment for degenerative joint disease, and it may also be a valid intervention for sequelae of idiopathic chondrolysis of the hip. In this case, operative management was discussed in a multidisciplinary team given the morphological complexity and the modified biomechanics of the patient's gait. Iatrogenic peripheral nerve injury may be the result of major instrumentation. An integral rehabilitation program was essential considering the post-surgical status of arthroplasty, functional recovery following peripheral nerve injury, and kinesiological gait reeducation. Therefore, it was developed a personalized physiatric plan with hidrocinesiotherapy, physiotherapy and psicotherapy.

  5720 - US guided lumbar medial branch radiofrequency ablation, a new approach? Top

Rodrigo Correia1, André Borges2, Filipa Gonçalves2, Inês Andrade3, Luís Oliveira2, Miguel Correia2, Eugénio Gonçalves4, José Luís de Carvalho2

1Centro de Reabilitação do Norte, Valadares, Vila Nova de Gaia, Portugal, 2Centro de Reabilitação do Norte, Valadares, Portugal, 3Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal, 4Serviço de Medicina Física e de Reabilitação do Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal

E-mail: [email protected]

Background and Aims: Lumbar pain is a frequent diagnostic and has major consequences at a social and economic level. It is estimated that facet pain represents 15% of the causes for low back pain complaints. Radiofrequency denervation of lumborum rami medialis is an option for lumbar pain originating from the facet's joints. This study aims the possibility of a radiofrequency ablation (RFA) ultrasound (US) guided technique of lumborum rami medialis branch nerves as an option for this specific type of LBP. Methods: Between January 2020 and March 2021, all the patients with facetogenic lumbar pain that received US guided RFA in a Rehabilitation Center in Portugal were retrospectively analyzed. Patients with other lumbar pain causes were excluded. Visual numeric scale (VNS), reduced pain medications were used for outcome measurement before treatment and at 3-, 6- and 12-months after RFA. Oswestry Disability Index (ODI) was used before treatment and 12-month after RFA. Results: Six patients were included. All the patients had significant reduction in VNS, more than 50%. Before treatment the mean of VAS was 7, 3-months 1, 6-months 1, 12-months 2. ODI pre-intervention mean was 29,7% and post-intervention 8,3%. All the patients reduced the use of painkillers, and even 83% of them had a complete abandonment of painkillers use. No immediate or late complications were reported by the patients. Conclusion: US guided RFA of the lumborum rami medialis an apparent good and safe alternative way for the conventional fluoroscopy guided technique. Although this study has limitations, our real purpose is to bring to the table of investigation this technique. Demonstrating very interesting results in pain reduction, painkillers use decrease and optimization of quality of life.

  5697 - Serial changes in shoulder strength deficits in patients with adhesive capsulitis: 6-month follow-up Top

Seung Mi Yeo1, Ji Hye Hwang1, Ji Young Lim2, Chea Min Hwang3

1Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Seoul, Republic of Korea, 2Department of Physical Therapy, Konyang University, Daejeon, Republic of Korea, 3Department of Rehabilitation Medicine, Samsung Medical Center, Seoul, Republic of Korea

E-mail: [email protected]

Background and Aims: There have been few studies investigating the change in muscle strength over time in the adhesive capsulitis (AC). We aimed to investigate the serial changes in shoulder strength deficits in patients with AC for 6 months. Methods: This was an observational study of 24 patients with AC. Patients received physical therapy regularly and performed home-exercise for 3 months. Passive range of motion (PROM), numeric rating scale for pain, Shoulder Pain and Disability Index and maximum isometric strength of shoulder in 5 postures (forward flexion, abduction, external rotation, internal rotation and empty can) were measured using a dynamometer at baseline, 3-month and 6-month. Results: PROMs of shoulder are significantly improved by 6 months [Table 1]. On the other hand, the shoulder strength deficit was significantly reduced compared to the unaffected side at baseline and improved up to 3 months, but did not improve thereafter [Table 2]. Since there were more patients with lesions on the dominant side (66.7%), no further correction of the stronger dominant arm was required. Conclusions: The fact that the decrease in muscle strength on the affected side did not show any significant improvement after 3 months supports the need for strengthening exercise in the second half of physical therapy for AC patients.
Table 1: Serial follow up of clinical outcomes in adhesive capsulitis

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Table 2: Serial changes of relative strength deficits in affected shoulder compared to unaffected shoulder in patients with adhesive capsulitis

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  5696 - Effect of augmented reality based telerehabilitation in patients with adhesive capsulitis: Multi-center randomized controlled trial Top

Ji Hye Hwang1, Seung Mi Yeo1, Ji Young Lim2, Jong Geol Do1, Jae-Young Lim3, Jong In Lee4

1Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Seoul, Republic of Korea, 2Department of Physical Therapy, Konyang University, Daejeon, Republic of Korea, 3Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea, 4Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, Seoul, Republic of Korea

E-mail: [email protected]

Background and Aims: We developed augmented reality(AR)-based telerehabilitation and aimed to investigate the effect of telerehabilitation in comparison with the usual care for patients with adhesive capsulitis. Methods: This was a prospective, multi-center, assessor-blinded, two-armed randomized controlled trial of 65 patients with adhesive capsulitis [Figure 1]. The intervention group received 3 months of hospital-based physical therapy in conjunction with home-based telerehabilitation. The control group received 3 months of hospital-based physical therapy in conjunction with a home-based exercise described in a brochure. Passive range of motion (PROM), numeric rating scale for pain, and the Shoulder Pain and Disability Index (SPADI) were assessed at baseline, 1-month, 2-month, 3-month and 6-month. A linear mixed model analysis was used to confirm the interaction between group and time. Results: Clinical improvement was noted in pain, SPADI, PROM through the follow up period and no differences between the 2 groups were seen regarding all parameters [Figure 2]. Patients showed high satisfaction (80.4/100 points) with visual feedback, systematic step-by-step exercise, and motivation. Conclusions: AR-based telerehabilitation had no superior advantage over conventional exercise, despite of showing high satisfaction.
Figure 1: CONSORT = Consolidated Standards of Reporting Trials

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Figure 2: Outcomes at various timepoints

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  5687 - Neuro-orthopedic deformities in children with cerebral palsy Top

Meriam Hfaidh, Souad Karoui, Najla Mouhli, Kais Ben Amor, Hager Rahali, Rim Maaoui, Imene Ksibi

Service de Médecine Physique et Réadaptation Fonctionnelle, Hôpital Militaire De Tunis, Tunis, Tunisia

E-mail: [email protected]

Background and Aims: Cerebral palsy is the leading cause of motor disability in children. Neuro-orthopedic complications are frequently found during its course. Few studies in Tunisia were interested in calculating their prevalence. The objective of our work was to study neuro-orthopedic complications in this population. Methods: This was a retrospective, descriptive study, including children who were followed in the Department of Physical Medicine and Rehabilitation (PMR) of the Military Hospital of Tunis between the years 2000 and 2016. We noted from patient files the neuro-orthopedic deformations objectified in the last consultation. Results: 67 patients were included. The mean age was 7.8 ± 4.7 years with a sex ratio of 1.23. Neuro-orthopedic deformities were observed in 78% of cases. Scoliosis was objectified in 12% of cases. In the upper limb, the deformities observed were elbow flexum in 7.5% of cases, flexion deformities of the wrist in 7.5% of cases and fingers in 7.5% of cases. Deformities in the lower limb were hip flexum in 19.5% of cases, knee flexum in 34% of cases, knee recurvatum in 4.5%, equinus foot in 45%, talar dislocation in 15% of cases and flat valgus feet in 22.5% of cases. Conclusions: The equinus of the foot is the most common neuro-orthopedic complication followed by knee flexion. Orthopedic complications were more common in older children and those who were not walking.

  5670 - Heterotopic ossification as an inflammatory syndrome in spinal cord injury: A case report Top

Diogo Roxo, Alexandre Fernandes, Brandon Allan, Mónica Bettencourt, Tiago Carvalho

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

E-mail: [email protected]

Introduction: Medical complications after Spinal Cord Injuries (SCI) include heterotopic ossification (HO). This is described to occur in up to half of SCI patients, beggining in average 12 weeks after injury. The large joints below the level of injury are typically affected, most commonly the hip. Chronic inflammation is a possible pathophysiological mechanism. Patient Information and Clinical Findings: Male, 57 y.o., evacuated from Mozambique to Portugal for a penetrating atherosclerotic ulcer of thoracic aorta with intramural hematoma complicated by spinal infarction and consequent paraplegia. After being in rehabilitation center, starts fever peaks and inflammatory parameters increase that were unresponsive to antibiotic therapy. He was transferred to the hospital 3 weeks later due to an exuberant inflammatory condition of unknown origin for investigation. After being considered several diagnostic hypothesis for about 1 month, a PET-scan was performed and showed “multiple areas of HO in the region of the pelvis and thighs, suggesting significant inflammatory activity”. Physical exam showed 80° flexion of hips with hard end-feel. It was decided to start Indomethacin 75mg once a day for 3 weeks. Results and Conclusions: After introduction of Indomethacin, the patient remained apyretic and there was a decrease in inflammatory parameters, supporting the use of NSAIDs after HO. NSAIDs should also be considered for symptomatic control in non-infectious inflammatory syndromes. The introduction of Indomethacin showed safety regarding possible gastric complications. The diagnosis delay meant a setback in the rehabilitation plan. For this reason, in the presence of inflammatory signs without an evident cause in SCI, it is important to establish the differential diagnosis with HO immediately.

  5637 - Compared serum concentration of sclerostin with bone biomarkers on the spinal cord injury patients Top

Dong Gyu Lee1, Jong Ho Lee2, Jang Hyuk Cho3, Kyu Hwan Choi1

1Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, South Korea, 2Department of Laboratory Medicine, College of Medicine, Yeungnam University, Daegu, South Korea, 3Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University, Daegu, South Korea

E-mail: [email protected]

Background and Aims: Spinal cord injury patients (SCI) show a high incidence of osteoporosis, which increases fracture risk. Sclerostin is secreted by osteocyte modulating bone metabolism. Sedentary SCI has a higher serum sclerostin level than the walkable population. Recently sclerostin antibody was introduced as a target-biomarker to treat osteoporosis in spinal cord injury patients. Therefore, we want to know the trend of sclerostin serum concentration according to the duration and which factors affect sclerostin serum concentration. Methods: This was a prospective cross-sectional study. Inclusion criteria were as follows; 1) spinal cord injury patients under grade 3 modified functional ambulatory category (mFAC: patients require firm continuous support from one), 2) over one month following cord injury. Exclusion criteria were previous osteoporosis medication history within six months. Collected factors were bone biomarker (CTX, P1NP, sclerostin), clinical data (mFAC, lower extremities motor score), BMI, duration of spinal cord injury, and bone mineral density (BMD) of the hip. Results: Sixty-two SCI was recruited. Sclerostin was significantly correlated with age, CTX, and BMD of the hip. Although duration did not show a significant correlation with sclerostin, the duration of the disease showed a negative relationship with sclerostin. Lower extremities motor score did not show a significant correlation with sclerostin. Conclusion: In the acute stage of SCI, sclerostin showed higher serum concentration than a longer duration. Sclerotin also showed a significant relationship with CTX. Aging factors (age and BMD) affect the sclerostin concentration to the SCI.

  5650 - Does 2 weeks of knee compression after total knee arthroplasty have effects on motor function? – A controlled before-and-after study Top

Kunihiro Onishi1, Shigeharu Tanaka2, Yuichi Kurita3, Yasushi Miura1

1Department of Rehabilitation Sciences, Graduate School of Health Science, Kobe University, Kobe, Japan, 2Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Japan, 3Graduate School of Advanced Science and Engineering, Hiroshima University, Higashihiroshima, Japan

E-mail: [email protected]

Background and Aims: Clinically, the swelling often interferes with activities of daily living immediately after TKA, and subjects often complain of heaviness and lack of strength in the legs. The purpose of this study was to examine the effects of 2 weeks compression intervention after TKA on knee swelling and motor function. Methods: One hundred and nine subjects who were diagnosed with medial knee osteoarthritis, underwent unilateral TKA between April 2018 and December 2020 and agreed to participate in the study were included. The compression group had 46 subjects the control group had 42 subjects.In this study, circumference, knee joint flexion-extension range of motion, rest pain, walking pain, isometric knee extension muscle strength, and 10m-walking speed (10MWS) were measured preoperatively and 2 weeks after TKA. Statistical analysis compared the circumference and motor function of the compression and control groups before and 2 weeks after TKA. This study was conducted after receiving approval from the Ethics Review Committee of Tsukazaki Hospital (approval number: 191019). Results: The circumference of the knee joint was significantly decreased in the compression group (p<0.05). The other measurements of circumference, at 5 cm (p=0.642) and 10 cm (p=0.797) above the patella, and the ROM of knee flexion (p=0.708) did not significantly differ. The ROM of knee extension as well as rest pain were significantly improved in the compression group (p<0.01). There were no significant differences in walking pain (p=0.241). The muscle strength of knee extension and 10MWS improved significantly in the compression group (p<0.01). Conclusion: It is suggested that compression of the knee for 2 weeks after TKA is useful in reducing swelling and improving motor function.

  5502 - Opioids use is associated with poorer performances in functional testing in patients with chronic musculoskeletal pain Top

Lara Mendes1, Michel Konzelmann1, Philippe Vuistiner2, Cyril Burrus1, Léger Bertrand3, François Luthi4

1Clinique Romande de Réadaptation, Service de Réadaptation de l 'Appareil Locomoteur, Sion, Suisse, 2Clinique Romande de Réadaptation, Service de Recherche, Sion, Suisse, 3Service de Recherche, Clinique Romande de Réadaptation, Sion, Suisse, 4Département of de l 'Appareil Locomoteur, CHUV, Lausanne, Suisse

E-mail: [email protected]

Background and Aims: Opioid consumption is a worldwide challenge. Study purpose: investigate if opioids use was associated with poorer performances on functional tests on rehab patients with chronic musculoskeletal pain (CMSP) after orthopaedic trauma. Methods: Six-year retrospective study in a tertiary rehab clinic. Classification into three groups at entry: no analgesics (NA), non-opioid analgesics (NOA), opioid analgesics (O). Functional tests at entry: PILE test, 6-minute walking test (6MWT), Steep Ramp Test with Maximum Short Exercise Capacity calculation (MSEC), Jamar Test (JT affected side), Stair Climbing test (SCT), Five Times Sit to Stand Test (FTSST). ANOVA, linear regression (adjusting for age, gender, trauma severity, location, pain severity). Results: 3761 patients (lower limb: 43%, upper limb: 43%, spine: 14%). 83% male, mean age 44 years, coming 379 days after injury (median). NA= 40%, NOA= 40%, O=20%. For all functional tests, physical performance was highest in NA group and lowest in O group, NOA being in-between. Multiple adjusted results confirm these differences O/NA: -50,9m (6MWT), -3.7 kg (PILE), -43.6W (MSEC), - 6.1 kg (JT), -19,2 steps (SCT), + 2.6s (FTSST). Conclusions: This is the first study investigating the relationship between opioids use and performances in patients with CMSP. Performances in patients taking opioids are even lower than those observed in others rehabilitation settings (cardiopulmonary for instance). As opioids consumption is also associated with many poor outcomes (disability, depression), evaluation of these associations from clinical and research perspectives is required.

  5595 - Prostheses use, abandonment, and survival rate in lower limb amputees due to musculoskeletal tumor Top

Ana Sofia Cueva1, Pérola G. Plapler2, Juan Pablo Zumarraga1, Olavo Pires de Camargo2

1Escuela de Medicina de la Universidad San Francisco de Quito, Quito, Ecuador, 2Instituto de Ortopedia do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil

E-mail: [email protected]

Background and Aims: Musculoskeletal tumors are a cause of amputation. The fitting and adaptation of prostheses is challenging. Our aim was to evaluate the use of prosthesis and abandonment and its correlation to the survival rate of lower amputees due to musculoskeletal tumors. Methods: A retrospective transversal study based on medical records and telephone interviews of all lower limb amputees due to musculoskeletal tumors between 1999-2016 in the Instituto de Ortopedia da Faculdade de Medicina da Universidade de São Paulo. Data obtained were: gender, laterality, age, diagnosis, study level, activity previous to and after amputation, amputation level, the interval between diagnosis and amputation, sports activity, number of surgeries on the limb, metastasis, prosthesis type, rehabilitation time, number of prostheses, walking aids, difficulties, prosthesis use and abandonment, phantom limb sensation, and pain. These variables were later correlated to the survival index, prosthesis use and abandonment. Results: We included 222 patients, of which 162 received a prosthesis. Only 9,3% abandoned the prosthesis. Variables statistically significant to prosthesis abandonment were: metastasis (p=0,011), steel prosthesis (p=0,003), pain (p<0,05),hip disarticulation (p<0,001), not returning to previous job/study activities (p<0,001) and longer rehabilitation time (p<0,001). Patients using prostheses had a longer survival time (p<0,001) as opposed to those that abandoned them (p=0,002). Conclusions: Survival index of musculoskeletal tumor lower limb amputees increased with prosthetic use and decreased with the abandonment of prostheses.

  5571 - The importance of early rehabilitation in dermatomyositis Top

Duarte Calado1, Sérgio Pinho2, Madjer Hatia2, Frederico Moeda2, Eva Alves3, Ana Pereira4, Mariana Martins4, Denise Marruaz4, Miguel Martins4

1Department of PRM, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal, 2Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal, 3Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal, 4Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

E-mail: [email protected]

Introduction: Dermatomyositis (DM) is an inflammatory myopathy characterized by fatigue, muscle weakness (MW) and specific skin findings. Presence of NXP-2 autoantibodies is associated with joint contractures and calcinosis. Patient Information and Clinical Findings: 19 y.o. female, diagnosed with DM NXP-2 positive autoantibodies, with severe joint affection and calcinosis. She also presented with severe MW with respiratory impairment, dysphonia and dysphagia. Balance and gait were compromised. Heliotrope rash on the eyelids and Grotton papules on the interphalangeal joints of the hands were documented. She carried out a multidisciplinary rehabilitation program to improve her functionality. Manual Muscle Testing 8, FIM and Barthel Index were performed at admission, 3 weeks and 5 weeks of hospitalization. Photo and film records were taken, after patient consent. The patient had a favorable recovery, with documented improvement of ROM, MW, swallowing, speech, balance, gait and functional scores. Most patients with DM do not recover their previous function. Discussion and Conclusions: An early rehabilitation program seems to have beneficial effects, contradicting the classical thought that exercising may potentiate inflammation. Despite the lack of evidence to support specific guidelines, studies demonstrate that endurance exercises inhibit the expression of pro-inflammatory genes and promote the up-regulation of anti-inflammatory genes and muscle growth. Close monitoring of the instituted therapy is important, due to possible corticosteroid myopathy or osteoporosis. DM is a chronic disease with multisystem involvement, and its treatment is based on a multidisciplinary approach. Exercise recommendations do not considerably differ for the healthy population, and the rehabilitation program must be individualized for each patient.

  5569 - Time-dependent reduction of ultrasound-derived rectus femoris muscle layer thickness in critical illness survivors Top

Lise Beumeler1, Edith Visser1, Hanneke Buter2, Tim van Zutphen1, Gerjan Navis3, Christiaan Boerma2

1University of Groningen, Campus Fryslân, Leeuwarden, Netherlands, 2Intensive Care, Medical Centre Leeuwarden, Leeuwarden, Netherlands, 3University Medical Centre Groningen, Groningen, Netherlands

E-mail: [email protected]

Background and Aims: It is commonly known that muscle mass of critically ill patients decreases rapidly during the first two weeks of Intensive Care Unit (ICU) admission. However, the sequellae of critical illness on long-term muscular health are yet to be explored. The aim of this study was to describe changes in rectus femoris (RF) muscle layer thickness (mT) during the first year of recovery in long-stay ICU-patients. Methods: In this one-year prospective study, adult patients with a length of stay of at least 48 hours were included. Ultrasound-derived RFmT of the right leg was assessed at ICU-admission (baseline), during ICU-stay, and at 3, 6, and 12 months post-ICU. To analyse changes in mT over time, a linear mixed model with Bonferroni-corrected post-hoc tests was performed correcting for common potential confounders (age, sex, baseline physical functioning, and participation in rehabilitation post-ICU). Results: Eighty-one patients with a median age of 66 [IQR 60-76] were included to this study. There was a significant change of right RFmT over time (p<0.001) with adjusted means (mm) with SEM of 15.2±0.4 at baseline, 12.7±0.9 lowest in ICU, 14.1±0.6 at 3m, 13.5±0.5 at 6m, and 12.8±0.5 at 12m. Prolonged ICU stay (n=20, subgroup ICU-stay ≥1 week) did not result in a significant reduction of RFmT. However, long-term decline of mT was evident comparing baseline to 6m and baseline to 12m measures (p=0.040 and p<0.001, respectively). Conclusions: Rectus femoris muscle layer thickness decreases over time in the first year after ICU-admission independent of age, sex, baseline physical functioning, or rehabilitation activities. Targeted aftercare intervention studies are urgently needed to improve physical recovery after critical illness.

  5533 - Assessment of pain and physical activity 12 weeks after rehabilitation in knee osteoarthritis Top

Galina Mratskova1, Nedko Dimitrov2, Alexandar Dimitrov2, Petya Goycheva3, Damyan Petrov4

1Department of Medical Rehabilitation and Ergotherapy, Physical Medicine and Sports, Medical Faculty, Trakia University, Stara Zagora, Bulgaria, 2Clinic of Orthopedics and Traumatology, University Hospital “Prof. Dr. St. Kirkovich” AD, Trakia University, Stara Zagora, Bulgaria, 3Clinic of Endocrinology, University Hospital “Prof. Dr. St. Kirkovich” AD, Trakia University, Stara Zagora, Bulgaria, 4Medical Faculty, Trakia University, Stara Zagora, Bulgaria

E-mail: [email protected]

Background and Aims: Osteoarthritis of the knee joint is a common disease in the elderly. It is most often characterized by pain, stiffness and swelling of the knee, which progress over time and lead to disability,[1] which reduces functional and social activity.[2] The aim was to assess pain at rest and during movement and functional activity 12 weeks after rehabilitation with Interferential currents and therapeutic exercises in patients with osteoarthritis of the knee. Methods: The study included 54 patients (17 men, 34 women) with mean age of 65.4(9.9) with osteoarthritis grade II and III radiology of the knee joint. Rehabilitation includes ten-day treatment with Interferential currents and therapeutic exercises. Results were assessed by manual muscle testing (MMT), KJ circumference measurement, goniometry, pain (VAS) at rest, descent, ascent of stairs, walking and WOMAC Index, before, 4 and 12 weeks after therapy. Results: Statistically significant decrease in swelling(p<0.001) up to 4 weeks after therapy, reduction of muscle weakness m. quadriceps (MMT)(p<0.001), increased flexion(p<0.001), reduced pain(VAS) at rest, going down and upstairs, walking (p <0.001), and decreased WOMAC Index(p<0.001) 12 weeks after therapy were observed. Conclusion: The applied rehabilitation program effectively reduces pain at rest and movement, muscle weakness and total WOMAC and increases flexion in the knee joint for at least 12 weeks after treatment, while the swelling is significantly reduced within 4 weeks after rehabilitation.


  1. Hsu H, Siwiec RM. StatPearls. Treasure Island (FL): StatPearls Publishing; 2021.
  2. Huang KH. Rehabil Nurs 2017;42:235-41.

  5514 - Prevalence and related risk factors of chronic low back pain among health care workers in Morocco Top

Mohammed Ait Moussa, Samia Karkouri

Mohammed V University, Rabat, Morocco

E-mail: [email protected]

Background and Aims: Chronic low back pain is a common symptom in medical consultation, especially in occupational medicine. It has often a benign cause, however it remains a public health problem through its socioeconomic impact either directly through the cost of healthcare, or indirectly through the frequency of work stoppages. The frequency of chronic low back pain in the professional community is increasing particularly among healthcare workers without a clear predisposing factor. The aim of our study is to identify the risk factors for chronic low back pain among El Ayachi hospital employees and to compare the data with the literature. Methods: A questionnaire for all hospital employees was designed, to identify the various intrinsic and extrinsic risk factors in this population. Results: The outcomes will describe the population and the association in univariate and multivariate analysis between the risk factors and the occurrence of chronic low back pain.

  5503 - Chronic multimorbidity of a low back disorder or other chronic back defects in the population of the European Health Interview Survey in the Republic of Croatia Top

Jelena Marunica Karšaj1, Simeon Grazio2, Diana Balen2, Frane Grubišic2, Tomislav Benjak3

1Department of Rheumatology, Physical Medicine and Rehabilitation, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia, 2University Hospital Center Sestre Milosrdnice, Zagreb, Croatia, 3Croatian Institute of Public Health, Zagreb, Croatia

E-mail: [email protected]

Background and Aims: To assess the prevalence of chronic multimorbidity in patients with a low back disorder or other chronic back defects (BD). Methods: We analyzed data from the population-based cross-sectional European Health Interview Survey (EHIS) performed in the Republic of Croatia 2014-2015 by the Croatian Institute of Public Health. Outcome was the point-prevalence of chronic multimorbidity defined as having ≥ 2 chronic illnesses out of 14 contained in the EHIS questionnaire. Fourteen targeted illnesses were asthma, allergies, hypertension, urinary incontinence, kidney problems, coronary heart disease or angina pectoris, neck disorder, arthrosis, chronic obstructive pulmonary disease, stroke, diabetes mellitus, myocardial infarction, stroke, depression and the common category “other”. Results: We analyzed data from 268 participants with BD, and 511 without it. Participants with BD had higher relative risk for any chronic multimorbidity (RRadj=2.12; 95% CI 1.55, 2.99; p<0.001) as well as for non-musculoskeletal chronic multimorbidity (RRadj=2.29; 95% CI 1.70, 3.08; p=0.001) than participants without BD. All chronic conditions except asthma and cirrhosis of the liver were significantly more prevalent in participants with BD than in participants without BD. In population with BD, participants with multimorbidity had three to four times higher odds for unfavorable self-reported health outcomes than the participants with no comorbid conditions while the existence of only one comorbidity was not significantly associated with a worse outcome compared to the population with no comorbidities. Conclusions: Population suffering from BD has larger prevalence of chronic multimorbidity,than the population without BD and these multimorbidity are associated with unfavorable health outcomes.

  5438 - Intramedullary nailing as prophylactic measure – Case report Top

Andreia Silva, Bruno Lopes, David Coutinho, Elisa Moreira, Rafaela Evangelista, Mário Vaz, Irina Peixoto, Jorge Caldas

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

E-mail: [email protected]

Introduction: Bisphosphonates are an effective therapy for the prevention and treatment of osteoporosis by reducing the incidence of fragility fractures. Atypical femoral fractures (AFF) result from low-energy trauma and can be induced by continuous antiresorptive medication. AFF diagnosis is based on a careful history, physical examination, and imaging. Surgical approach with intramedullary nailing is the first-line treatment for a complete AFF. Prophylactic fixation of an incomplete AFF is still controversial, applied in cases of persistent pain. Conservative management may be considered in patients with minimal pain. Patient Information and Clinical Findings: A 64-year-old independent woman, who had received alendronate therapy for osteoporosis for more than 6 years, was admitted in the emergency department for right hip pain and lower limb dysmetria after falling from a standing height. A complete atypical subtrochanteric fracture was diagnosed on the right side. Radiographic features suggested a contralateral incomplete AFF. The patient underwent bilateral cephalomedullary nailing, without complications, and was integrated into a rehabilitation program. Discussion and Conclusions: AFF are a recognized complication of prolonged bisphosphonates therapy. After unilateral AFF, patients are at increased risk for subsequent contralateral fracture. Prophylactic surgical treatment can avoid progression to complete fracture and reduce hospital stay. Our patient discontinued alendronate and initiated calcium and vitamin D supplementation. Management of AFF is challenging given the morphological abnormality and dysfunction of bone metabolism. Prevention must be the focus, and despite its interventional character, intramedullary nailing can be a valid option.

  5393 - The relationship between frailty and body composition in older adults Top

Shigeharu Tanaka1, Hung Jung2, Ryo Tanaka2

1Kanagawa University of Human Services, Yokosuka, Japan, 2Hiroshima University, Higashihiroshima, Japan

E-mail: [email protected]

Background and Aims: Frailty is one of the health problems in aging society. The aim of this study is to investigate the relationship between frailty and body composition in older adults. Methods: This study included 343 subjects (259 females and 84 males). Frailty status was measured as main outcome using the revised Japanese version of the Cardiovascular Health Study. In this measurement scale, frailty is categorized into 3 stages (robust, pre-frailty, and frail). Body composition such as the percent body fat (PBF) and skeletal mass index was measured as independent factor. Logistic regression analysis was used, and this study developed two logistic regression models. In the first model (model 1), the dependent variable was the binary value of the existence of pre-frailty or frailty. In the second model (model 2), the dependent variable was the binary variable with frailty. Considering that sex might be a confounding factor in the relationship between body composition and pre-frailty and/or frailty, logistic regression analysis was performed separately for male and female subjects. Results: The percentages of subjects with pre-frailty and frailty were 43.2% and 3.9% for females and 51.2% and 4.8% for males, respectively. In females, age was a significant independent variable in models 1 (odds ratio = 1.127, p < 0.05) and 2 (odds ratio = 1.102, p < 0.05). In males, PBF was significantly associated with frailty status in model 1 (odds ratio = 1.087, p < 0.05). Conclusions: Our results showed that the association between frailty and body composition differs between females and males. In males, PBF was significantly associated with frailty in model 1. These findings could contribute to the establishment of preventive intervention for frailty in clinical practice.

  5387 - Patient prosthesis satisfaction in lower limb amputees, is fit the only factor? Top

Erwin C. T. Baars

Department of Rehabilitation, Vogellanden Rehabilitation Center, Zwolle, Netherlands

E-mail: [email protected]

Background and Aims: Many people with a lower limb amputation are not satisfied with their prosthesis. Over fifty percent are dissatisfied with the comfort of their prostheses fit, and report pain while using their prostheses. These findings make (dis)satisfaction with lower limb prostheses a highly relevant issue in amputee care. Patient satisfaction is a key indicator for the quality of care. It plays an important role in the evaluation of healthcare services. Patient satisfaction entails matching patients' experiences with their expectations. Prosthesis satisfaction is viewed as a multidimensional and dynamic construct and includes the patient's subjective and emotional evaluation of their prosthesis that is influenced by aspects including appearance, fit and use, as well characteristics of the residual limb. Hence, satisfaction with the prosthesis is a biopsychosocial construct that is influenced by all the aforementioned factors. Methods: We performed a systematic review and Delphi survey to identify factors influencing patient prosthesis satisfaction and found that they could be grouped in prosthesis related factors and psychosocial factors. The former were grouped in the domains: prosthesis appearance, fit, properties, use and characteristics of the residual limb and used to constructing a checklist for prosthesis assessment. The latter in factors concerning body image, acceptance of amputation, reactions of others and trust in prosthesis performance and care giver professionals. Results and Conclusion: We propose the use of our checklist to periodically assess factors influencing satisfaction with the prosthesis and residual limb and stress the importance of awareness of psychosocial factors.

  4371 - The flexor pollicis longus reflex - A reliable unknown reflex for evaluating C8/T1 integrity Top

Alexander Ranker, Luisa Schäck, Christoph Gutenbrunner

Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany

E-mail: [email protected]

Background and Aims: The Flexor Pollicis longus is the only muscle that can actively flex the distal interphalangeal joint of the thumb and therefore has an easily recognizable and unmistakable reflex response. Electromyographic myotome charts identify the Musculus flexor pollicis longus (FPL) as an ideal candidate for the evaluation of C8 and T1, as it is almost exclusively innervated through these. The aim of this study was to investigate the inter-rater reliability (interRR) and intra-rater reliability (intraRR) of the flexor pollicis longus muscle stretch reflex (FPLR) and compare it to clinically established reflexes. Methods: 71 healthy volunteers participated. The FPLR, biceps reflex (BR), brachioradialis reflex (BRR), and patellar tendon reflex (PTR) of each participant were tested bilaterally and rated by eight examiners (four experienced, four inexperienced). For intraRR evaluation, five examiners rated the reflexes of four volunteers at four different points in time. Results: Analysis of the interRR with Gwet's AC1 demonstrated almost perfect agreement for FPLR (Gwet's AC1=0.90), BR (Gwet's AC1=0.90), and PTR (Gwet's AC1=0.95) when using binary data (reflex present vs. absent). Only fair agreement was found for the BRR (Gwet's AC1=0.56). Experienced raters had a higher agreement than inexperienced raters when rating the BR and the PTR. The intraRR was almost perfect for the PTR (Gwet's AC1=0.94), followed by the FPLR (Gwet's AC1=0.83) with substantial agreement and the BR (Gwet's AC1=0.57) with moderate agreement. Conclusion: The FPLR is a reliable diagnostic neuromuscular test and may therefore be useful in the clinical examination for C8/T1 nerve root lesions or pathologies of the interosseous anterior nerve in daily clinical routine.

  4392 - Jumping stump: A case report Top

Maarten Rombauts1, Carlotte Kiekens2

1Department Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium, 2IRCCS MultiMedica, Milano, Italy

E-mail: [email protected]

Background and Aims: The jumping stump phenomenon is a peripherally induced movement disorder due to peripheral nerve damage. We report on a very resistant case in which different treatment strategies were applied. Methods: Case report of a 52-year old male with a below-the-knee amputation, experiencing involuntary muscle contractions in the amputated extremity, and short overview of the current literature. Results: Various drug treatments, including baclofen, diazepam, clonazepam and pregabalin, peroneal nerve block and prosthesis modifications were ineffective for our patient as was shown in literature. Botulinum toxin A treatment showed temporarily decrease of symptoms but was not repeated due to financial reasons. In our case, tibial nerve neuroma had no ectopic trigger zone, so local treatment was not indicated. Surgical interventions, based on contraction location and muscle tension, were partially successful. Eventually, due to serious functional impact, a mid-thigh amputation was performed, with complete resolution of symptoms but recurrence later that year. Relapse was correlated with recurrence of local stump pain. Conclusion: Treating this phenomenon remains challenging because pathophysiology is still not fully understood, and the available literature is limited. There is currently no definite solution, but botulinum toxin treatment is promising with temporarily decrease of symptoms.

  4098 - Statins-associated muscle symptoms rehabilitation: A window of opportunity Top

Igor Pereira de Oliveira, Rebeca Boltes Cecatto

Universidade Nove de Julho, São Paulo, Brasil

E-mail: [email protected]

Background and Aims: Statins have become the main global support in cardiac pharmacotherapy, decreasing cardiovascular risk, and mortality. Despite the undoubted effectiveness of statins, a portion of users may develop muscle symptoms associated with Statins-associated Muscle Symptoms (SAMS). SAMS cover a broader range of clinical presentations, usually with normal or minimally elevated CK levels, with a prevalence of 7-29% in registries and observational studies but it significantly impacts the quality of life and adherence to the treatment of patients in use. Methods: In 2020 a review was performed according to the Preferred Reporting Items for Systematic Reviews (PRISMA) statement searching for humans studies about Risk factors, prognosis, and clinical treatment of SAMS. No restriction of age, gender, stage of the disease, time of injury, associated complication, or outcomes will be imposed. The quality assessment of studies was analyzed by NIH Quality Assessment Criteria and Cochrane Review Criteria. Results: Only 25 studies were selected for results. Risk factors significant for myopathy and/or rhabdomyolysis included age, gender, diabetes, renal impairment, cardiovascular disease, certain interacting drugs, and mutations genes. Currently, the only effective treatment is the discontinuation of statin use or statin switching, especially to low-dose and Rehabilitation treatment to improve the myopathy and muscle lesion. Conclusion: Risk factors significant for myopathy and/or rhabdomyolysis included age, gender, diabetes, renal impairment, cardiovascular disease, certain interacting drugs, and mutations genes. Rehabilitation treatment is a window of opportunity to minimize the impacts of SAMS.

  7012 - Pseudotumor of the thigh: Tensor fasciae latae muscle hypertrophy Top

Virginia Gallart Úbeda, Mónica Jordá Llona, Luis García Ferrer

Hospital Universitario Dr. Peset, Servicio de Rehabilitación, Valencia, Spain

E-mail: [email protected]

Introduction: Gluteus minimus and medius enthesopathy is a very common cause of pertrochanteric pain, which can produce gait disorders. The tensor fasciae latae muscle (TFL) is located superficially on the anterolateral side of the hip. It is a flexor, abductor and stabilizer muscle of the pelvis in monopodal support. Patient Information and Clinical Findings: A 54-year-old woman referred to the Rehabilitation Service for right hip pain. Presents a painless tumor with progressive growth on the anterior side of the proximal femur. Pain on palpation over the greater trochanter that increases with active abduction and passive adduction, walking and with load during night rest. No joint limitation. Ultrasound: increased size and TFL hyperechogenicity with attenuation of the ultrasound beam due to fat infiltration. Gluteus minimus tendon thickened and hypoechoic. MRI: TFL muscle hypertrophy. Gluteus minor enthesopathy. Treatment: load control, exercise program and ultrasound-guided infiltration of the gluteus minimus tendon. Discussion and Conclusion: Greater trochanteric pain syndrome is a frequent cause of pain in the lateral side of the hip. It predominates in women between 50-70 years. Multifactorial etiology, with close correlation with gluteus medius and minimus tendinopathy. TFL muscle hypertrophy is a subclinical entity and a rare cause of pseudotumor. Unclear etiology,the origin is postulated as an overload of the coxofemoral joint secondary to biomechanical alteration of the gait, in the context of previous hip surgeries, proximal femur fractures or gluteal enthesopathy. Diagnosis by Ultrasound, CT or MRI. Knowing this entity can avoid unnecessary interventions (biopsies).


  1. Sutter R, Kalberer F, Binkert CA, Graf N, Pfirrmann CW, Gutzeit A. Abductor tendon tears are associated with hypertrophy of the tensor fasciae latae muscle. Skeletal Radiol 2013;42:627-33.

  6948 - Long COVID comprehensive rehabilitation program for functional improvement after 6 months of severe COVID-19: A case report from Hospital University Malaysia Sabah Top

Fatimah Ahmedy1, Rishaini Elengovan2, Aaron Perera2, Abdul Aziz Tair2, Khin Nyein Yin1, Nurul Afiqah Fattin Amat2, Frisca Aziah Francis2

1Rehabilitation Medicine Unit, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, 2Department of Rehabilitation Medicine, Hospital Universiti Malaysia Sabah, Universiti Malaysia Sabah, Kota Kinabalu, Sabah

E-mail: [email protected]

Introduction: Long Covid indicates perseverance of symptoms beyond 3 months after COVID-19 infection. Long Covid Comprehensive Rehabilitation (LCCR) program at Hospital Universiti Malaysia Sabah is an integrated rehabilitation approach for individuals with long Covid. Patient Information and Clinical Findings: A 50-year-old man acquired Covid-19 infection in April 2021 was admitted with Stage 4 lung changes. He was not intubated but admitted 5 days in ICU with one month hospital stay. Premorbidly, he was an active sportsman. In October 2021, he remained having reduced effort tolerance requiring breaks in short distance ambulation, slept on floor mattress due to lethargy while climbing up bed, persistent dry cough and myalgia. Sssessment showed slight wasting over major limb muscles with baseline 6MWT of 180m. We enrolled him into our LCCR program aiming for endurance, muscle strengthening and thoracic breathing training with patient's goal to return to sports activities. The initial exercise intensity was targeted at 55% of maximal heart rate (HR) and gradually increased to 70% with structured home-based exercise program and once-weekly outpatient attendance. [Table 1] displayed the exercise regimes prescribed to him in the first month of LCCR. At the end of 4 weeks, the 6MWT reached 250m in distance and after 3 months of LCCR, he is doing swimming laps and back to work after long medical leaves. Discussion and Conclusions: Fatigue, cough, breathlessness and myalgia are common symptoms reported in long Covid. Rehabilitation must be structured and targeted based on individual patients' needs.
Table 1: Detailed exercise training for the first 4 weeks long COVID comprehensive rehabilitation program

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  6730 - Case report: Isolated obturator internus muscle strain injury in a professional football player Top

Alexandros Toliopoulos

Rehabilitation and Sportsmedicine Clinic Evosmos, Thessaloniki, Greece

E-mail: [email protected]

The present case report concerns an isolated obturator internus muscle strain. The patient, who was a 30-year-old professional, elite-level football player, suffered the injury during the warm-up before a football match. Isolated injuries of the obturator internus are very uncommon and they are extremely rarely reported in the literature. The diagnosis was made clinically, documented by magnetic resonance imaging. The rehabilitation program was conducted conservatively with physical therapy and kinesiotherapy. The patient's return to full athletic activity took place 2 weeks after the incident.

  7008 - Polymyalgia rheumatica after ChAdOx1 nCoV-19 vaccine – A case report Top

Carolina Lourenço, Adriana Pascoal, António Paiva, Inês Campos, José Pagaimo

Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, Tocha, Portugal

E-mail: [email protected]

Introduction: Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease characterized by severe pain and morning stiffness mainly affecting the shoulder girdle. Patient Information and Clinical Findings: 75-year-old woman, previously healthy, received the first dose of ChAdOx1 vaccine and two weeks later started with pain in the shoulder and pelvic girdles and knees of inflammatory characteristics, accompanied by morning stiffness (about 1h), anorexia, asthenia and ADL dependence. She started analgesics and NSAID with no improvement. Three days after the second vaccine dose the symptoms aggravated and she was referred to our center. She presented shoulder, hip and knee active range of motion limitation at observation. We requested blood analysis that revealed an Erythrocyte Sedimentation Rate of 120 mm/h (reference value < 20 mm/h) and C-Reactive Protein of 80 mg/L (reference value < 5 mg/L). Ultrasound showed effusion on both shoulders, hips and knees. Paraneoplastic syndrome was ruled out. She started oral corticosteroids and a rehabilitation program and a month later she presented no controlled pain, normal analysis and ADL autonomy. Discussion and Conclusions: This case shows after the first vaccine dose and relapse soon after the second. As such, we consider that can be established a potential relationship between the inoculation and the development of PRM. A few cases were published reporting a PRM-like syndrome following a COVID-19 vaccine, however the underlying mechanism and prognosis are still unknown.

  6937 - A close call and a case report: Myelopathy from a congenital condition in a 39-year-old man Top

Caroline Vail, Steven Nussbaum

Shirley Ryan AbilityLab/Northwestern University, Evanston, Illinois, USA

E-mail: [email protected]

Introduction: Klippel-Feil Syndrome (KFS) is the most common congenital vertebral deformity of the cervical spine, present in about 1 of 42000 births. Over time, sequelae can include myelopathy, degenerative disc disease, or cardiac manifestations. The onset age of those with spine-related neurological symptoms is typically 10-11 years. Patient Information and Clinical Findings: A 39-year-old male presented with chronic, worsening parasthesias in bilateral arms and hands, headaches, and scotoma when looking down. His symptoms started 1.5 years ago. He stated he had torticollis as a child. He reported playing years of contact sports since adolescence and had past traumatic motor vehicle accidents without neurologic compromise. On exam he had a short neck, 4/5 left biceps strength, and decreased sensation to light touch in 4th and 5th digits. On cervical spine imaging there was marked basilar invagination into the foramen magnum, posterior fusion of C1-C3 vertebrae, and posterior displacement of the dens with severe spinal stenosis at the cervicomedullary junction consistent with the criteria for KFS. His neurosurgeon performed an endoscopic transcervical odontoidectomy, occiput-C5 fusion, suboccipital craniectomy, C1 laminectomy, and halo placement. Shortly after surgery he was cleared from halo and placed in a Miami J collar. On physiatry consult exam, the patient's neurologic complaints and findings were resolved. He has since returned to work. Discussion and Conclusions: This patient, though he recovered well, had manifestations of KFS for many years with the threat of spinal instability. Patients with KFS should avoid contact sports and high risk activities, as this patient was counselled. KFS was thought to be a very rare diagnosis however recent reports hint at an increased incidence of asymptomatic patients.

  6896 - Incapacitating heterotopic ossifications after severe COVID-19 infection: 2 cases Top

Marie Vochten, Eva Duinslaeger, Koen Peers, Fabienne Schillebeeckx

Department of Physical Medicine and Rehabilitation, University Hospital Leuven, Leuven, Belgium

E-mail: [email protected]

Introduction: Heterotopic ossifications (HO) have rarely been described in relation to COVID-19. To date only a few cases have been reported. The pathogenesis is unclear though extended immobilisation in the critically ill patient is observed. In this abstract we present 2 incapacitating cases. Patient Information and Clinical Findings: 2 patients were admitted to the ICU with severe COVID-19 infection for 48 days and 70 days respectively. After weaning, the first patient presented with diffuse HO. Knee flexion was limited to 30 degrees and hip flexion to 50 degrees. The second patient presented with similar important HO in the iliopsoas muscles, resulting in flexion limited to 45 degrees. In both patients, diagnosis was confirmed using SPECT-CT. We noted similar patient characteristics: extended systemic inflammation, critical illness polyneuromyopathy (EMG) and prolonged immobilisation in a prone position with mechanical ventilation. Auto-immune mediated myositis was excluded in both cases. The HO led to severe loss in mobility. Patients were not able to sit or carry out basic activities due to their hip flexion deficit. These HO prove challenging to treat with rehabilitation. Discussion and Conclusions: Pronounced and incapacitating HO can be seen after severe COVID-19 infection. A link with prolonged immobilisation is described in literature. These HO hinder rehabilitation and impact patients' basic functioning. Therefore, it's important to be aware of this potentially irreversible and disabling complication.
Figure 1: Heterotopic ossifications. Patient 1: (a) Bone scan and (b) CT scan. Patient 2: (c) Bone scan and (d) CT scan

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  6885 - Humeral fracture and iatrogenic radial nerve palsy after arm wrestling practice Top

David Moura1, Diana Oliveira2, Joana Ramalho2, Sara Ribeiro Silva2, Luísa Pinto2, Filipa Gouveia2, David Cordeiro3, Pedro Cubelo2, Catarina Aguiar Branco2

1Centro Hospitalar Entre Douro e Vouga, Serviço Medicina Física e de Reabilitação, Santa Maria da Feira, Portugal, 2Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal, 3Hospital Garcia de Orta, Almada, Portugal

E-mail: [email protected]

Introduction: Arm wrestling practice may be the cause of humeral shaft fractures. The incidence of radial nerve injury after humeral shaft fractures is around 12%, however with arm wrestling practice, radial nerve damage is reported in 23% of the cases. Radial nerve palsy may also be iatrogenic following fracture fixation or manipulation. Patient Information and Overall Clinical Findings: A 22-year-old male presented himself at the Emergency Room (ER) with a painful right arm after feeling a snap-like sensation during arm wrestling practice. At clinical examination, he had a swollen, tender right arm, above the elbow, with distal neurovascular integrity. Radiographs of the arm showed a spiral fracture of the distal third of the humerus and he was proposed for surgical treatment. After open reduction and internal fixation (ORIF) he presented with grade 0 (MRC scale) thumb abduction and wrist, thumb and metacarpo-phalangeal extension. He reported paraesthesia along the dorsolateral aspect of the forearm, wrist, hand, and first 3 fingers. He initiated a rehabilitation program and did an electromyography documenting severe partial radial nerve axonotmesis. After 9 months of rehabilitation he reported no paraesthesia sensations and had a full active ROM and grade 5 muscle strength in finger, thumb and wrist extension. Discussion and Conclusions: Radial nerve iatrogenic palsy associated with ORIF of humerus fractures fully recover with conservative treatment within 3 to 68 months in up to 95% of patients. Neuromuscular electrical stimulation modalities combined with passive and active mobilization and strengthening exercises were essential for the complete recovery of our patient after 9 months of treatment.

  6860 - Muscular sarcoidosis: A case report Top

Frederico Miguel Pereira Costa, Mafalda Oliveira, João Cabral, Hugo Amorim

Departmento of Physical and Rehabilitation Medicine, Centro Hospitalar Universitário São João – Oporto, Porto, Portugal

E-mail: [email protected]

Introduction: Sarcoidosis is a multisystem granulomatous disorder of unknown etiology characterized by noncaseating granulomas. Commonly presents with hilar adenopathy, pulmonary infiltrates, skin lesions, or a combination of these. Symptomatic skeletal muscle involvement (sarcoid myopathy) is rare (0.5-2.5%). We report a case of sarcoidosis diagnosed after an acute muscle weakness. Patient Information and Clinical Findings: 49-years-old female, presented with myalgias, weight loss and acute weakness of both lower limbs and right upper limb. At physical examination she presented: muscle strength grade 3 on Medical Research Council (MRC) scale in hip and knee flexion, knee extension and ankle dorsiflexion, and grade 4 (MRC) in shoulder flexion, elbow extension and flexion; pain at hip and arm palpation; diminished right ankle jerk reflex. Laboratorial study showed positivity for anti-SRP antibodies, hypergammaglobinemia and elevated angiotensin converting enzyme. Thoracic CT showed hilar and mediastinum adenomegalies, and MRI showed interstitial edema of multiple limbs' muscles. Muscular biopsy showing non-necrotic granulomatous lesions confirmed the diagnostic of sarcoidosis. Corticosteroids, immunoglobulin, and rituximab were initiated, and the patient integrated an inpatient rehabilitation program aiming muscle strengthening. Discussion and Conclusion: In sarcoidosis, muscular involvement is usually associated with other symptoms and organs involvement. We report a rare case of muscular weakness as first symptom of this condition. Physicians should be alert of the possibility of muscle weakness being part of some multisystemic pathologies as sarcoidosis, in order to optimize its early diagnosis and timely treatment.

  6780 - Conservative treatment in a complete rupture of the distal tendon of the biceps brachalis. About a case Top

Sandra Fernández1, Ana Rodríguez2, Celia Montoliu2, María Cristina Tomás2, Aitor Rojas2, María Gallego2

1Medicina Física y Rehabilitación, Hospital General Universitario de Ciudad Real, Spain, 2Hospital General Universitario de Ciudad Real, Spain

E-mail: [email protected]

Introduction: Injuries affecting the distal biceps brachii tendon are uncommon in relation to other tendon conditions, accounting for 3% of biceps brachii injuries. Although in most cases they require surgical treatment, there are times when conservative treatment can be effective. Patient Information and Clinical Findings: 53-year-old man. Sudden onset of pain in the anterior area of the left elbow after lifting weight 3 weeks ago. Physical examination: No hematoma. “Ax sign” on the anterior distal aspect of the left arm. Pain on palpation at the level of the antecubital fossa. Joint range (JR) complete without pain. Muscle balance (MB) elbow flexion and forearm supination 3+/4- /5, rest 5/5. Magnetic resonance imaging: complete rupture of the long and short bands of the distal biceps brachii tendon, with significant retraction. Treatment: the patient underwent gentle and progressive active-resisted kinesitherapy (KT) to gain MB. Evolution: the patient presents complete JR and a MB for arm flexion and forearm supination of 4+/5 without pain. Discussions and Conclusions: In partial ruptures, conservative treatment begins, and in complete ruptures, treatment is usually surgical. In the case of our patient, who presented a complete tear, it was jointly agreed to carry out a conservative treatment with rehabilitation due to the non-dominance of the limb and the conservation of mobility with a slight loss of muscle strength. After the rehabilitation, the patient achieved a MB in flexion of the arm and supination of the forearm of 4+/5, most likely thanks to the strengthening of the brachialis anterior and coracobrachialis muscles for flexion and the brachioradialis and brachioradialis muscles for supination, muscles that supply the biceps brachii in these actions.

  6779 - Tibial plateau fracture with common peroneal nerve injury: Case report Top

Diana Rocha Oliveira1, Joana Ramalho2, David Moura2, Sara Silva2, Sofia Toste2, Catarina Aguiar Branco2

1Centro Hospitalar de Entre Douro e Vouga, Serviço de Medicina Física e de Reabilitação, Santa Maria da Feira, Portugal, 2Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal

E-mail: [email protected]

Introduction: Common peroneal nerve neuropathy is the most frequent neuropathy in the lower limb. The classic presentation is foot drop. Knee dislocation associated with an injury of the common peroneal nerve due to a high-energy trauma is the most frequent cause. Tibia and fibula's fractures are associated with 1% to 2% of these injuries. Patient Information and Clinical Findings: A 53 years old female presented at the emergency department with pain in the right knee after a trauma. She had tender palpation and slight swelling. There were no signs of neurological or vascular injuries. Mobility was preserved. Radiography showed an external tibial plateau fracture and the patient was admitted for osteosynthesis. On the first postoperative day, she presented with grade 0 (MRC scale) on dorsiflexion and hallux extension. Electromyography showed axonotmesis to the deep branch of the right common peroneal nerve. The patient started a rehabilitation program, 5 times a week, with cryotherapy, passive continuous motion and neuromuscular electrical stimulation with exponential currents (20 Hz) in the tibialis anterior muscle. After 15 sessions, she presented with grade 2 on dorsiflexion and hallux extension. Discussion and Conclusions: Cryotherapy allowed pain control. Passive mobilization allowed her to regain range of motion. Exponential currents are indicated in the prevention of muscle atrophy after peripheral nerve injury. Complete recovery can take anywhere from 6 months to a year, however with only 3 weeks of rehabilitation, it is already possible to observe some recovery. We emphasized physical agents' importance in the non-surgical treatment of partial denervated muscles with great outcome.

  6571 - Patient with auto fusion of l5-s1 disc with calcified iliolumbar ligament presenting with low back pain: A case report Top

Amit Bhargava

Advanced Interventional Pain Sports Medicine Center, Maryland, USA

E-mail: [email protected]

Patient Information and Clinical Findings: IRB exemption was obtained. A 61-year-old female presented with complaints of midback pain and low back pain radiating to lateral aspect of left leg. Mostly, back pain was more than leg pain. X-ray films of lumbosacral spine revealed calcification of the right-sided iliolumbar ligament extending from the L5 transverse process to the iliac crest and partial calcification on the left. In addition, it showed fusion at L2-4 and posterior interspinous devices at L3-4 and L4-5. MRI films over the years showed progressive degeneration of L5-S1 disc. Finally, CT scan of the lumbar spine confirmed autofusion of the L5-S1. Lab investigations including RA Factor, ESR and ANA were within normal limits. She was referred for SI joint injections, which did not provide relief. She had 50% relief in low back pain after diagnostic bilateral L1-2 injection and was treated with therapeutic injections. Discussion: L4-5 disc is usually affected in Bertolotti syndrome with sacralization of L5 vertebra. This case report shows that calcification of the iliolumbar ligaments on caused degeneration at the L5-S1 disc leading to autofusion. Finally it formed one bone consisting of ilium, L5 vertebra and sacrum. The right SI joint was no more a true joint as it was a space now between the same bone (sacrum, L5 vertebra and ilium). Conclusion: Unlike sacralization of L5 vertebra which may affect L4-5 disc, calcification of the ilio- lumbar ligament may present with degeneration of L5-S1 disc leading to formation of one bone. Clinically, L5-S1 and SI joints are unlikely to be source of pain in this patient. This case study also brings out the importance of getting x-rays which provides additional information which not be viewed easily on the MRI.

  6570 - Abnormal teres minor on magnetic resonance imaging of the shoulder and EMG: A case report Top

Amit Bhargava

Advanced Interventional Pain Sports Medicine Center, Maryland, USA

E-mail: [email protected]

Patient Information and Clinical Findings: IRB exemption was obtained. A 55-year-old female presented with right shoulder pain 7 months after motor vehicle collision. She had undergone conservative treatment including medication, physical therapy and shoulder injection. Right shoulder pain decreased by 40% after second shoulder injection. MRI of right shoulder showed rotator cuff severe tendinosis; intermediate grade rim rent articular surface partial tear anterior footprint supraspinatus tendon humeral insertion; small subacromial bursal effusion; mild strain or denervation change teres minor muscle belly. There was no evidence of a mass within the quadrilateral space. Nerve conduction studies revealed very mild right carpal tunnel syndrome. EMG revealed denervation potentials in right teres minor muscle and reduced recruitment in right teres minor and deltoid muscle. Ultrasound was used for needle insertion in periscapular muscles. Patient was referred for surgical consultation. Isolated teres minor denervation has been reported in 3% of patients on routine MRI of shoulder. It may be associated with injuries of rotator cuff or shoulder joint. Discussion and Conclusion: In this study the MRI showed probably partial denervation of teres minor which was also noted during EMG. In addition the EMG showed decreased recruitment in the right deltoid muscle indicating injury to the axillary nerve. These findings may be important in further treatment of the patient with regards to shoulder stabilization during rehabilitation and after surgery. This case study shows that axillary nerve injury may present with variable pattern including denervation of partial teres minor (MRI and EMG) and affecting the deltoid muscle (EMG). This may be taken into consideration as it is an important component for rehabilitation and during the decision making process for treatment, including surgery.

  6505 - Spontaneous osteonecrosis of the knee (SONK) syndrome – possible correlation with “long COVID-19”? Top

Daniela Profir, Madalina Gabriela Iliescu, Liliana Elena Stanciu

Balnear and Rehabilitation Sanatorium, Techirghiol, Romania

E-mail: [email protected]

Introduction: Apart from acute infection with SARS-Cov-2, it's been described a “long COVID-19”, which lasts more than 12 weeks and include fatigue, breathlessness, anxiety and depression, palpitations, “brain fog”. During this pandemic there have been many attempts to establish the efficacy of different therapeutic agents. Among these, corticosteroids proved efficient in moderate to severe forms of SARS-CoV-2 infection; however, their use can be a predisposing factor for the development of avascular necrosis (AVN). At present, there are not enough data to consider AVN as a sequelae of “long COVID-19”. Patient Information and Clinical Findings: We are presenting the case of a 53-years old woman, who have been diagnosed with COVID-19 in September and December 2020; 2 weeks after she developed SONK syndrome (January 2021). At onset, clinical findings were severe pain of the left knee with no apparent cause, either walking or resting, and an important decrease of mobility, together with marked inflammation of the knee. An early MRI establish the diagnostic of AVN of the knee. After almost 3 months of no weight bearing on the left knee, the patient has been admitted twice (2 weeks every 6 months) in our sanatorium for rehabilitation. We tried to establish the pathogenic mechanism of SONK syndrome, whether is due to corticosteroids use or to the vascular alterations triggered by COVID-19 infection. Discussion and Conclusion: The efficacy of the treatment using natural cure factors as salted water and saprogenic mud from the Techirghiol lake was documented by means of assessment scales and imaging methods (progressive RMI). The patient responded very well to the rehabilitation complex treatment in our unit, clinical signs improved after first admission and no surgery was needed.

  6500 - Calpainopathy and long term physical therapy. Case report Top

Renata Czego1, Diana Jimbu2, Anca Grigoriu3, Liliana Padure3

1Miercurea Ciuc Emergency Hospital, Miercurea Ciuc, Romania, 2Balneal and Rehabilitation Sanatorium, Techirghiol, Romania, 3”Dr Nicolae Robanescu” National Clinical Center for Neuropsychomotor Rehabilitation in Children, Bucharest, Romania

E-mail: [email protected]

Introduction: Autosomal recessive limb-girdle muscular dystrophy (LGMD) or calpainopathy is a genetic disorder which affects the muscles of the pelvic-girdle, triggered by protein deficiency. Muscle weakness is symmetric and progressive and manifests in gait disturbances. Patient Information and Clinical Findings: The case of a 16 years old female patient was studied, with confirmed genetic mutation a homozygous in the CAPN3 gene, on chromosome 15q15.1, with 17X coverage at the variant site. She presented fatigue and muscle weakness with gait disturbances.Local examination found: postural and static deviations of the spine, gait disturbance, shoulder girdle laxity, right mammar hypothrophy, absence of the reflexes at the level of the lower limbs, low muscular strenght in the level of the pelvic-girdle. Laboratory findings: high ALT, AST and CK levels. Normal echocardiorgaphy. Multifactorial gait analysis, RMI scan- the posterior region of the tight presented sever muscular hypotrophy, spine x-ray, footprint assesment and postural evaluation was made and a long term physical therapy plan was presented for the patient to cure and prevent the complications of the calpainopathy. Discussion and Conclusion: With the complex rehabilitation treatment plan which combined physical therapy, weight loss and nutricional plan, orthotics and shoe inserts also a rigurous follow up of the static changes in the spine the clinical outcome was a good one, even if the disease itself doesn't have a specific cure. The prevention of the further damages like stiffness and retractions was considered in the first place also the for the remission of fatigue and gait disturbance.

  6444 - US-guided percutaneous microinvasive trigger finger release: An example of a successful technique Top

Luís Oliveira1, Miguel de Castro Correia2, Eugénio Gonçalves2, Rodrigo Silva Correia2, André Varandas Borges2, José Luís Carvalho2

1Centro de Reabilitação do Norte - Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal, 2Department of Physical Medicine and Rehabilitation Service, Centro de Reabilitação do Norte, Valadares, Portugal

E-mail: [email protected]

Introduction: Stenosing tenosynovitis (trigger finger) is a common cause of hand pain. This condition consists in the inhibition of physiological tendon gliding, leading to mechanical impingement at the level of a pulley and causing stenosing tenosynovitis. The exact underlying cause is, most of the time, unknown and most likely to be multifactorial. Initial management strategies include conservative treatments, such as NSAIDs, finger splinting and/or hand rehabilitation program. Refractory cases need local corticosteroid injection and, if recurrence, open surgical release techniques. Open surgical trigger finger release has been the best option for years and has limited success, not being absent of complications. Ultrasound-guided (US) percutaneous trigger finger release technique could be an interesting mini invasive alternative. Patient Information and Clinical Findings: A 64-years-old male accountant comes to the PMR appointment, referring pain in the right thumb lasting months, describing periods of finger locking (grade 3, Green classification). This mechanical pain remained refractory to conservative treatment leading to open surgical release proposal. At examination patient complains of painful nodule in the proximal volar area of the thumb and US demonstrates significant thickening of A1 pulley along the flexor pollicis longus tendon. History, physical and imaging findings are compatible with a diagnosis of stenosing flexor tenosynovitis. Discussion and Conclusion: A minimally invasive US-guided trigger finger release technique was performed with local anaesthesia and using an appropriate needle. No immediate or latter complications were noticed. This patient's 3 and 12 months follow-up after the procedure showed no pain (0/10 VAS), no recurrence and no physical limitation. The surgery, which initially was proposed as treatment, was cancelled.

  6416 - Hip ultrasound-guided intra-articular injection with a new association of hyaluronic acid and chondroitin sulfate: Case series Top

Calogero Foti1, Giuseppe Cannata1, Marco Monticone2

1TOR Vergata University, Rome, Italy, 2University of Cagliari, Cagliari, Italy

E-mail: [email protected]

Background and Aims: Hip Osteoarthritis (HOA) is one of the most prevalent disabling joint disorders, involving damage to the joint tissue, including articular cartilage, subchondral bone, and synovium. Viscosupplementation came forward as a novel approach to treat HOA. The technique was based upon the injection of intra-articular hyaluronic acid (IAHA) which is considered as the major structural and biochemical molecule of cartilage. Chondroitin sulfates (CS) are inhibitors of extracellular proteases involved in the metabolism of connective tissues and stimulate proteoglycan production by chondrocytes in vitro; they also inhibit cartilage cytokine production and induce apoptosis of articular chondrocytes. Until now a paper was published in 2016, regarding IAHA with CS in knee osteoarthritis. At our knowledge no papers were published regarding IAHA with CS in hip osteoarthritis. Methods: Patients with HOA evidenced with X-rays over the past 6 months with Kellgren-Lawrence score grade III or IV will be treated with a single session of hip ultrasound-guided intra-articular infiltration using a new pharmaceutical formulation of hyaluronic acid, associated with CS (Sinogel, IBSA, Italy). The patients signed a written informed consent prior to the injection, in order to inform about treatment benefits, and possible side effects. Results: The results will be considered one month, three months and six months after the single infiltration carried out. The parameters considered for the purposes of the outcome will be pain (VAS), locomotor function of the lower limb (WOMAC, HHS), and quality of life (SF-36). The first two HOA patients' treatments gave a significant amelioration in pain, functionality, and quality of life, without adverse effects. Conclusion: The study is going on in the next six months.

  6381 - Stiff person syndrome rehabilitation course: A case report Top

Alec Guerzon, Noemi Olivero, Steven Gitarts

Kingsbrook Jewish Medical Center, New York, USA

E-mail: [email protected]

Patient Information and Clinical Findings: 50 yo female with PMH of thyroid nodules, arthritis and GERD presented with worsening back pain for 1 week, spasms radiating to bilateral lower extremities and inability to walk. MRI-spine showed degenerative changes with bulging disc at L4-S1 and moderate spinal stenosis. Neurosurgery recommended no intervention. Malignancy workup prompted by unintentional weight loss, including GI, GU, OBGYN, MSK and endocrine was unremarkable. HIV, HTLV, ANA and LP ruled out other pathologies. Strongly positive anti-GAD (glutamic acid decarboxylase) antibodies of >25,000 pointed to Stiff Person Syndrome. Patient significantly improved with Diazepam, IVIG, Rituximab and IV steroids. She was discharged to acute rehabilitation where she received additional doses of IVIG. Patient's stiffness causing fixed extended knees, high foot arches and clawed toes and max assist with ADLs, bed mobility, transfers and inability to ambulate improved to modified independence in all areas. Discussion: Stiff Person Syndrome (SPS) is a rare neurological disorder characterized by fluctuating muscle rigidity sometimes with enough force to fracture bones. The cause is not fully understood. It is often associated with autoimmune diseases such as diabetes and thyroiditis. Patients with SPS are known to have heightened sensitivity to numerous stimuli which can trigger muscle spasms. If not addressed, thoracic kyphosis or lumbar lordosis can also occur. SPS affects women more than men in a 2:1 ratio, between ages 30-60. Two thirds of patients have elevated serum GAD antibodies. Intermittent contractions while awake, progressing into continuous muscle activity was also reported in EMG studies. SPS often improves with high doses of benzodiazepines, anticonvulsants, muscle relaxants, steroids, IVIG, and plasmapheresis.

  6320 - Cauda equina syndrome, a rare manifestation in ankylosing spondylitis Top

Jessia Dever

Department of Physical Rehabilitation, UZ Leuven, Leuven, Belgium

E-mail: [email protected]

Introduction: Cauda equina syndrome (CES) associated with dural ectasia is a rare neurological manifestation in patients with longstanding ankylosing spondylitis (AS). Patient Information and Clinical Findings: This article reports the case of a 67-year-old female patient with a 30-year history of AS. She had typical CES symptoms, such as neuropathic radicular pain, loss of strength, urinary incontinence and saddle anesthesia. The MRI showed spinal dysraphism, a meningocele at L2, tethering of the conus medullaris, dural diverticula and appearances of dural ectasia. The electromyography showed bilateral chronic neurogenic motor units with a gradient increasing caudally and more pronounced at the right side compared to the left. Only in the proximal S1 myotome at the right, the S2 myotome at the right and the S2 to S4 myotomes bilaterally, there was an evolutionary component, including unstable neurogenic motor units and reinnervation signs. There were no active denervation signs except in the left musculus sfincter ani externus, compatible with CES. Discussion and Conclusions: The possible treatment of CES and dural ectasia in this patient with longstanding AS is discussed with a literature review. Considering the slow progressive neurological symptoms, the treatable pain and the operative risks, a conservative treatment was chosen.

  6296 - Important scapula detachment in the facio-scapulohumeral myopathy: A case report study Top

Karima Chgoura, Lamiae El Abbady, Asma Elhanafi, Meriem Bourharbal, Abdelfettah Youness

Service de Médecine Physique et Réadaptation Fonctionnelle, CHU MED VI, Marrakech, Morocco

E-mail: [email protected]

Introduction: Facio-scapulohumeral myopathy (FSH), was first described by Landouzy and Déjerine in 1885. FSH is characterized by a predominant impairment of the face and the root of the upper limb. On the shoulders, the paralysis reaches preferentially the fixator muscles of the scapula and the arm elevator muscles leading to snapping movements of the scapula. Patient Information and Clinical Findings: Here we report the case of a patient aged 23 years old from a consanguineous marriage of a first degree. The symptomatology begun of at the age of 19 with the onset of walking weakness, particularly a long perimeter of progressive aggravation inducing repeated falls with a difficulty to carry loads without other associated signs. The clinical assessment revealed a myogenic syndrome. The patient benefited from a reeducation protocol adapted to her case at the service of traumatology for an eventual future scapula fixation in the thoracic cage. Conclusion: the fixation of the scapula to the thoracic cage allows an alleviation of the painful symptomatology, the use of antalgic drugs and the increased the endurance in the anteflexion, therefore a functional enhancement.

  6295 - Orthopedic manifestations of the neurofibromatosis type 1 (Recklinghausen disease VRH): A case report study Top

Karima Chgoura1, Asma Elhanafi2, Lamiae El Abbady2, Meriem Bourharbal2, Abdelfettah Youness2

1Centre Hospitalier Universitaire (CHU Mohamed VI), Marrakech, Morocco, 2Service de Médecine Physique et Réadaptation Fonctionnelle, CHU MED VI, Marrakech, Morocco

E-mail: [email protected]

Introduction: Orthopedic manifestations of VRH disease are frequent at any age of the patient and independently from the other manifestations of the disease. Here we report a case of a 3 years old infant from a mother with VRH with trunk deformation. Patient Information and Clinical Findings: The clinical examination showed the presence of Café Au Lait spots, left dorsal gibbosity and a pronounced thoracic cage deformation, without respiratory complications and with a normal autonomy. The radiological assessment concluded the presence of dorsal scoliosis (D5-D9-D12) with a Cobb angle of 60° approximately, along with aspects of hemi-vertebrae D8. The VRH diagnosis is confirmed by the presence of familial history with the disease (the mother), as well as the cutaneous signs associated to the spinal signs. The patient benefited from a Corset and an adapted reeducation protocol. Conclusion: Orthopedic manifestations of the neurofibromatosis type 1 should be detected at early age and need a regular lifelong surveillance.

  6259 - Benign paroxysmal torticollis of infancy – A brief review and a case-report Top

Marco Silva1, Vítor Machado Sousa2, Mafalda Cunha2, Bruna Melo2, Bernardo Moreno2, Helena Reis Costa2, Bárbara Moreira da Cruz2

1Department of Physical and Rehabilitation Medicine, Hospital Senhora da Oliveira – Guimarães, Guimarães, Portugal, 2Hospital Senhora da Oliveira – Guimarães, Guimarães, Portugal

E-mail: [email protected]

Introduction: Benign paroxysmal torticollis of infancy (BPTI) is characterized by several and sudden episodes of head inclination, self-limited, that recur over time. It usually appears in the first year and may persist until five years of age. Irritability, pallor, vomiting and ataxia are often associated. BPTI is an exclusion diagnosis, rare, but believed to be underdiagnosed. Its etiology is uncertain, vestibule-cerebellar connections seem probable, but also genetic mutations have been identified (CACNA1A and PRRT2 genes). Patient Information and Clinical Findings: Boy, 13 months old, born premature (31 weeks, low birth weight) with multiple peripartum complications (maternal ketoacidosis and neonatal sepsis) and other pathologies associated (patent foramen ovale, severe hearing deficit, cryptorchidy, and optic nerve hypoplasia). Followed and treated by PRM department from birth, by 4 months old a pronounced left head tilt and slight right occipital plagiocephaly was noted. The rehabilitation program was adjusted and 2 months later his head tilted to the other side. Cranial MRI and EEG were normal. A genetic duplication was detected in Xp22.33, classified as of uncertain clinical significance. Currently he still presents periods of severe torticollis, with spontaneous resolution and alternating sides of head tilt. Discussion and Conclusions: Awareness to this diagnosis is crucial as it is to keep precise records about the lateral fluctuation of the head tilt, to not misdiagnose BPTI. It is a benign and self-limited condition, and may be an isolated finding, evolve to migraine or it might be associated with psychomotor development delay. More quality studies are needed to fully understand this disorder.

  6241 - The role of early and adequate rehabilitation in patients diagnosed with Guillain Barré syndrome Top

Öznur Buran Fernandez

Hospital Universitario de Donosti, San Sebastián, Spain

E-mail: [email protected]

Introduction: Guillain-Barré syndrome is the most common of the polyradiculoneuritis, it is an autoimmune neurological disorder in which the body's immune system attacks a peripheral nervous system. It is the most common cause of acquired flaccid paralysis. Patient Information and Clinical Findings: A 29-year-old male patient, with a history of asthma, presented with neck pain and paresthesia in the hands and feet that were ascending and associated weakness in all extremities, from two months ago and then he was admitted with diagnosis with Guillain-Barré Syndrome and, during admission, he required ventilator support. In our examination, weakness in the upper extremities was observed, especially in the left arm with clumsiness in the hand, most limited extension of the fingers. In lower extremities, decreased muscle strength and inability to stand. In the first days after admission, multidisciplinary rehabilitation program was started, including strengthening exercises, training for sedation, and standing. Occupational therapy with the aim of improve fine motor skills in the affected hand. After rehabilitation treatment, he presented recovery of limb weakness, achieving a safe walking in short distance and improvement in thehand. Discussion and Conclusion: In patients with diagnosis of Guillain-Barré, early, timely and multidisciplinary rehabilitation plays important role in recovery fase providing benefits in terms of disability and quality of life.


  1. Khan F, Ng L, Amatya B, Brand C, Turner-Stokes L. Multidisciplinary care for Guillain-Barré syndrome. Cochrane Database Syst Rev 2010:CD008505.

  6179 - Parsonage-Turner syndrome: About a clinical case Top

Vítor Sousa, Marco Francisco Silva, Mafalda Cunha, Bruna Melo, Bernardo Moreno, José António Araújo, Bárbara Moreira Cruz

Department of Physical and Rehabilitation Medicine, Hospital da Senhora da Oliveira - Guimarães, Guimarães, Portugal

E-mail: [email protected]

Introduction: Parsonage-Turner Syndrome (PTS) is an uncommon, idiopathic and acute brachial neuritis. Clinically, it's characterized by sudden onset of shoulder and upper limb pain, with inflammatory characteristics and muscle weakness, atrophy and associated sensory changes. It's a clinical diagnosis and there are no complementary exams to confirm it. Treatment is symptomatic with pain management and structured rehabilitation (SR). Patient Information and Clinical Findings: Male, 38 years old with sudden and disabling left shoulder pain, after intense effort during work in january 2020. X-ray and ultrasound were normal and started rehabilitation program without significant improvement of pain and functional movements. Due to the maintenance of the complaints, he underwent an MRI that showed findings compatible with idiopathic brachial neuritis and was referred to PRM consultation one year after the onset of symptoms. He had left shoulder pain, with maximum pain intensity 6/10. On physical examination, supraspinatus and infraspinatus amyotrophy, limitation of external rotation, deficit of muscle strength and scapulohumeral dyskinesia. Electromyography showed moderate to severe impairment of the upper trunk of the left brachial plexus, specifically the suprascapular and dorsal scapular nerve. He started SR in the PRM department for 4 months and was discharged without pain and improved muscle strength, maintaining mild muscle amyotrophy with a structured home exercise plan. Discussion and Conclusions: PTS is uncommon, with a variable clinical course, but with a generally favorable prognosis. It's a clinical diagnosis and, therefore, a clinical history and a detailed physical examination are essential so that there is a high clinical suspicion, a correct diagnosis and the implementation of a SR.

  6166 - Management of heterotopic ossification in children: Case report Top

Najla Mouhli1, Meriem Hfaiedh2, Hajer Rahali2, Imene Ksibi2, Rim Maaoui2

1Military Hospital of Tunis, Tunis, Tunisia, 2 Departement of Rehabilitation, Military Hospital of Tunis, Tunis, Tunisia

E-mail: [email protected]

Introduction: Heterotopic ossification (HO) are uncommon in peripheral neuropathies and even less in children. We report the case of a young child who presented with HO in the acute phase of an acute sensory motor neuropathy with axonal involvement following infection with cytomegalovirus (CMV). Patient Information and Clinical Finding: Boy, 2 years and three months old, with no medical history, hospitalized in the intensive care unit of the Military Hospital of Tunis, for Guillain Barré syndrome related to a CMV infection complicated by respiratory distress requiring artificial ventilation . The initial clinical examination showed complete sensory-motor deficit in all four limbs and autonomic nervous system disorders without involvement of the cranial pairs. EMG showed sensory motor polyradiculoneuropathy with axonal involvement. Rehabilitation was started early to prevent limitation of range of motion in joints as well as complications of immobility. The evolution was marked, on D25, by a painful limitation of the hip. The dosage of Alkaline phosphatase showed their rise from 17 to 140 U / L. The bone scan confirmed the diagnosis of HO. it was decided to start treatment with NSAIDs, to stop hip mobilizations and replace them with alternating postures of this joint. The outcome at 4 months was favorable with full recovery of range of motion. Discussion and Conclusions: Close clinical and biological monitoring of patients with severe neurological deficits allows early detection of complications like HO. A rapid diagnosis allows the rapid initiation of appropriate management combining physical and drug treatment. In the absence of 1st grade recommendations regarding pediatric population, this management is inspired by what is usually done in adults, while respecting the specificity of the childcare.

  6159 - Post-partum back pain: A warning sign for vertebral fragility fractures Top

Sara Liguori1, Milena Aulicino2, Antimo Moretti2, Marco Paoletta2, Giovanni Iolascon2, Francesca Gimigliano2

1Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy, 2University of Campania “Luigi Vanvitelli”, Naples, Italy

E-mail: [email protected]

Introduction: Pregnancy and lactation-associated osteoporosis (PLO) is a rare form of osteoporosis. The most common symptoms are severe back pain and loss of height related to vertebral fragility fractures. Due to its rarity, there are no guidelines on the management of this condition. Patient Information and Clinical Findings: A 33-year-old woman (BMI = 25.64 kg/ m2), referred to our outpatient service of Physical Medicine and Rehabilitation, for acute back pain occurred two months after childbirth. A medical history of Hashimoto's thyroiditis treated with levothyroxine was reported. Physical examination showed mobility limitation of the thoracic and lumbar spine, tenderness of the thoracic and lumbar spinous processes and paraspinal muscles. Magnetic Resonance Imaging (MRI) showed seven vertebral fractures. Blood chemistry was normal. After exclusion of secondary causes of osteoporosis, PLO was diagnosed. The patient was treated with teriparatide, vitamin D supplementation and semi-rigid thoracolumbar orthosis. Discontinuation of lactation and a calcium-rich diet were also recommended. At the six-month follow-up, we observed pain reduction at the Brief Pain Inventory and the absence of new vertebral fractures at the MRI. Discussion and Conclusions: Osteoporotic vertebral fractures associated with pregnancy and lactation are an important cause of disabling back pain, with loss of function and severe limitation to the quality of life. Discontinuation of breastfeeding, supplementation with calcium and vitamin D, anti-osteoporotic drug therapy, and regular follow-up are important strategies to reduce the risk of new fractures and improve the quality of life of patients.

  6132 - H syndrome and functional prognosis: About a case report Top

Hajar Abouihsane, Hakim Bourra, Mouad Yazidi, Hasnaa Boutalja, Zaineb Tahri, Abdelhakim Kabil, Nada Kyal, Fatima Lmidmani, Abdellatif El Fatimi

CHU Ibn Rochd, Casablanca, Morocco

E-mail: [email protected]

Introduction: H syndrome is an autosomal recessive disorder caused by the mutations in the SLC29A3 gene wich encodes the hENT3 nucleotide transport protein. Patient Information and Clinical Findings: This case report is about a 14-year-old patient, seen in the department of physical medicine and rehabilitation of the University Hospital Ibn-Rochd Casablanca, referred by dermatologists for osteo-articular deformities complying with the H syndrome. Eldest of a sibling of 4 and has as medical history , 1st degree consanguinity, a celiac disease since 5 years old. There are no similar cases in the family. Clinical examination found indurated erythematous lesions evolving into depigmentation arranged symmetrically on the buttocks, the anterior and posterior side of the thighs and legs. In the osteo-articular assessment: Joint deformities in both hands involving the 5th finger: retraction of the PPI with a buttonhole appearance, presence of digital hypocratism, arthritis flare-ups in the knees and ankles, edema of both ankles with a normal joint assessment, claw toes and retained muscle strength. As for the orthopedic deformities, a podiatry assessment objectified claw toes with bilateral hallux valgus and a calcaneal valgus estimated at 10. For the hand deformities, posture splints have been prescribed to prevent possible stiffness and tendon retractions. Conclusion: Syndrome H deserves to be better recognized, particularly in patients with chronic inflammation, hyperpigmented skin lesions, deafness and insulin-dependent diabetes. Its recognition makes it possible to adapt genetic monitoring and counseling.

  6113 - EMG assisted exercise therapy for functional quadriceps palsy after knee arthroscopy Top

Stephanie Murauer

Institut für Physikalische Medizin und Rehabilitation, Paracelsus Medizinische Privatuniversität, Salzburg, Austria

E-mail: [email protected]

Introduction: The selection of effective training exercises plays a decisive role in the success of medical training therapy. Surface EMG is a suitable measurement system for this purpose. This case study of a patient with functional quadriceps paresis demonstrates its use in a clinical setting. Patient Information and Clinical Findings: A 50-year-old female patient with a functional quadriceps palsy and medial meniscus refixation is presented. 18 months postoperatively, the patient showed a limitation of the voluntary activation of the ventral thigh musculature. Active knee joint extension in the sitting position showed a deficit of > 60 and this was not executable in supine position. Climbing stairs was also not possible. Isokinetic and isometric strength tests were performed. Surface EMG measurements of the knee extensor muscles were used to identify exercises with the highest neuromuscular activation. The rectus femoris had the highest maximal muscular activation during supine and seated knee extension. The vastus medialis and lateralis had the greatest maximal muscular activation during the isometric leg press, seated knee extension, and step down. These exercises were implemented 2x/week. After 3 months of training therapy, isokinetic strength measurements at 60/s showed an increase of 60% in extension and 93% in flexion. At 180/s the strength increased about 150% in extension and 160% in flexion. Isometric extension strength increased by 50%. The extension deficit decreased by 20. Climbing stairs was possible again, and so cycling. Conclusion: Surface EMG is a successful tool to identify effective exercise in the process of medical exercise therapy.

  6131 - Inequality of the lower limbs on coxa plana Top

Hajar Idam, P. Madjidanem, S. Mdarbi, S. Khalfaoui, N. Kyal, F. Lmidmani, A. Elfatimi

Department of PMR, CHU Ibn Rochd, Casablanca, Morocco

E-mail: [email protected]

Introduction: Inequalities in length and axis disorders of the lower limbs constitute a set of acquired or malformative structural pathologies.The objective of our work was to provide an update on the management of inequality as well as to investigate possible etiologies. Patient Information and Clinical Findings: A 20-year-old man, his story began at the age of 12 with the occurrence of a fall from the height of a donkey, as he grew, he began to develop lameness on unequal lower limbs. The clinical examination had shown an inequality of the lower limbs of 3.5 cm uncorrected; muscle testing had demonstrated a deficit of the quadriceps at 4- and the gluteus medius at 3-.A pangonoramma had shown an inequality of the lower limbs estimated at 4cm. A CT of the left hip was also carried out showed an aspect related to a dysplasia of the left hip in coxa plana, without CT signs of coxarthrosis. The management had consisted in the correction of the inequality and the rehabilitation, the surgical indication of the installation of a THA was not indicated until the appearance of the pain and a coxarthrosis. Discussion and Conclusions: Therapeutic indications: i) Less than 2 cm: soles or heel or nothing so well supported; ii) From 2 to 3 cm up to 5 cm: epiphysiodesis or progressive lengthening by nail (end of growth); iii) From 5 to 10 cm: progressive lengthening (several lengthening ± epiphysiodesis), nail at the end of growth, external distractor from 9 years old. For the record, more than 15 to 20 cm or more than 50% of the length of a diaphysis: equalization practically impossible. The inequality of the lower extremities can be secondary to several etiologies.

  6130 - Urodynamic profile of urinary disorders associated with urogenital prolapse Top

Hajar Idam, P. Madjidanem, S. Mdarbi, S. Khalfaoui, N. Kyal, F. Lmidmani, A. Elfatimi

Department of PMR, CHU Ibn Rochd, Casablanca, Morocco

E-mail: [email protected]

Background and Aim: Genital prolapse is an anatomo-clinical entity that corresponds to the failure of the support and suspension systems of the female pelvic organs. The aim of our study was to focus on the urodynamic profile of urinary disorders associated with urogenital prolapse. Methods: Our work is a descriptive retrospective study, comprising 54 medical files of patients carrying genital prolapse with urinary disorders, collected the urodynamics consultation at the Department of Physical Medicine and Functional Rehabilitation of CHU Casablanca over a period of 4 years from January 2016 to October 2020. Results: On urodynamic assessment, To flowmeter: Dysuria was found in 25 patients (46.3%), vesico-sphincteric dyssynergia in 8 patients (14.8%), a post-voiding residue in 32 patients (59.2%), a normal flowmeter in 7 patients (13%). On cystomanometry: Bladder capacity was reduced in 22.2%, and normal for the rest of the patients, overactivity of the bladder was objectified in 7.5% of cases, bladder hypersensitivity was noted in 24.07%. On profilometry: The profilometry objectified urethral hypertonia in 18 patients, sphincter insufficiency in 2 patients and normal in the rest of the patients. Discussion: The recommendations of the ICS advise that a urodynamic assessment should be carried out for women with a prolapse of grade 2 or higher who are candidates for surgery. Conclusion: Urodynamic exploration remains an essential tool in the management of patients with urinary symptoms associated with urogenital prolapseby making it possible to assess vesico-sphincteric functioning.

  6048 - Sacral stress fracture in a long-distance runner. An underestimated cause of low back pain Top

Joana Páscoa Pinheiro1, Lurdes Rovisco Branquinho2, João Pinheiro3

1CHULN Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal, 2CHUC - Centro Hospitalar e Universitário de Coimbra, Portugal, 3FMUC Faculdade de Medicina da Universidade de Coimbra, CHUC, Portugal

E-mail: [email protected]

Introduction: Stress fractures are relatively common in athletes and a frequent cause of sports restriction. Sacral stress fractures, on the other hand, are rare and frequently misdiagnosed. Patient Information and Clinical Findings: We present a case of a 35-years-old male long-distance runner with a 2-month history of extreme, right low back and buttock pain. Initially, a sharp lumbosacral tenderness was present only when running, but later walking became a challenge. Besides right hip flexor weakness, no radicular symptoms were detected. Initial radiographs were unremarkable, but MRI confirmed an extensive sacral stress fracture. Lumbar spine densitometry showed an abnormally decreased BMD. After 12 months of conservative treatment, the patient reported no symptoms, being able to run again. Discussion and Conclusion: Sacral stress fracture is a rare injury, but can represent a debilitating source of low back pain. It can be seen in young active individuals and its occurrence is related to abnormal stress over a normal bone. Especially in long distance runners, metabolic disorders might be present, which can facilitate stress fractures is these athletes. Clinical presentation is usually unspecific, but an insidious low back, buttock, or pelvic pain are the predominant symptoms. At first evaluation these lesions are often misdiagnosed and interpretated as a simple lumbar pain, especially when disc disease is present. Relative rest with activity modification is mandatory to prevent fracture non-union. Complications such as sacral instability with potential risk of sacral nerve injury should be considered. Conservative treatment with an early rehabilitation program is recommended. Regarding return to preinjury activity, literature is controversial. Some studies indicate a safe return in 4 moths although others report up to 14 months for pain-free activity.

  5750 - Importance of remembering hemochromatosis arthropathy as a cause of secondary osteoarthritis – Case report Top

Teresa Gomes, Miguel Macedo, Rui Madureira, José Brochado, Júlia Ribeiro, Tomás Caroço, Joana Capela

Centro Hospitalar Universitário do Algarve, Faro, Portugal

E-mail: [email protected]

Introduction: Hereditary Hemochromatosis (HH) is an inherited metabolic disorder which results in systemic iron overload affecting the pancreas, liver, heart, endocrine glands, skin, joints and gonads. Arthropathy affects 40-70% of patients and may precede other symptoms. Its distinctive features are preferential involvement of the second and third metacarpophalangeal joints, with hook-like radial osteophytes in x-rays. The main treatment is cyclic phlebotomies, which can prevent or control the damage to the solid organs, although not to the joints. Patient Information and Clinical Findings: A 54-year-old man with previous diagnosis of Rheumatoid Arthritis (RA), medicated with methotrexate 10mg/wk and prednisolone 20mg/d, comes to a rheumatology appointment complaining of aggravating symptoms which do not respond to his medication. He has a history of mixed polyarthralgia for 10 years, associated with joint tumefaction (initially fingers and wrist) and matinal rigidity. He has had a total hip arthroplasty at the age of 52. He also complains of xerostomia and xerophthalmia. At the time of the appointment his blood tests showed elevated ferritin, altered liver enzymes and mild hypothyroidism. His x-rays had the typical hook-like osteophytes in 2nd and 3rd MCP joints, which together with the rest of the findings lead to the hypothesis of hemochromatosis arthropathy. He was given the indication to progressively stop his medication, initiate phlebotomies and get tested for HFE gene mutation, which he was positive for. After that his family was also tested. Conclusions: HH should be considered when evaluating an atypical form of osteoarthritis or RA, as an early diagnosis can raise the possibility of starting early phlebotomies preventing organ damage and ultimately reducing morbimortality.

  5910 - Oral and maxillofacial manifestations in Gardner's syndrome: What is the role of physical medicine and rehabilitation in the surgical recovery of these patients? A case-report Top

Rebeca Gomes1, Madalena Carvalho2, Tomás Ribeiro da Silva2, José Costa2, Teresa Mirco2, Francisco Sampaio2

1Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal, 2CHULN - Hospital de Santa Maria, Lisbon, Portugal

E-mail: [email protected]

Introduction: Gardner's syndrome (GS) is an autosomal dominant disorder, characterized by gastrointestinal polyps and extraintestinal manifestations, including oral and maxillofacial osteomas, odontomas and other soft tissue tumors. Maxilofacial osteomas affect mostly the jaw. When mouth opening is impaired, surgery treatment is required. The combination of surgical treatment and postoperative rehabilitation programme enhances joint recovery and prevents complications. Patient Information and Clinical Findings: This case-report is about a 18 years old woman, diagnosed with GS, presenting with temporomandibular joint disorder (TMJ), with orofacial pain, joint cracks and 10 mm of maximal mouth opening (MMO). After five years of symptoms, she was submitted to bilateral joint replacement, with a customized bilateral prosthesis, a pioneered surgery in Portugal. She was seen by a physiatrist before surgery to schedule post-surgical rehabilitation, which began while still hospitalized. After hospital discharge, she maintained a rehabilitation program, four times a week, which consisted of massage of masticatory muscles, range-of-motion exercises, laser and electrostimulation. Presently, five months after surgery, her MMO is about 31mm. She only reports pain complaints in the context of pressure differences. She has regained masticatory function, with return to normal diet. Discussion and Conclusions: GS is a rare condition, whose treatment involves a multidisciplinary approach. The combination of surgical treatment and an individualized postoperative rehabilitation programme, especially in the context of a rare pathology, plays an important role in achieving good postoperative results, regarding to joint functional recover, reducing pain and preventing possible complications.

  5872 - Foot drop following prolonged immobilisation for COVID-19: A case report Top

Pedro Ribeiro, Joana Alberto, Joana Romano, Raquel Costa, Ursula Martins, Raquel Vilela

Department of Physical and Rehabilitation Medicine, ULSM - Hospital Pedro Hispano, Matosinhos, Portugal

E-mail: [email protected]

Introduction: Patients with severe SARS-CoV-2 infection may require intensive care unit (ICU) admission for life-saving measures. However, additional injuries, such as musculoskeletal, can occur during this time. Compression of peroneal nerve at the fibular neck is frequently related to external pressure due to prolonged lying, during prolonged hospitalization, and may lead to peroneal neuropathy. In this report, we present the case of a common peroneal nerve (CPN) neuropathy following prolonged immobility in ICU for COVID-19. Clinical Findings: A 31-year-old man was admitted in ICU for SARS-Cov-2-related acute respiratory distress syndrome. Due to refractory hypoxemia, Extracorporeal membrane oxygenation (ECMO) was initiated, being decannulated from ECMO after 30 days. Once clinically stabilized, the patient was evaluated by Physical Medicine and Rehabilitation (PMR). Besides ICU-acquired weakness, dysphagia and dysphonia, a common peroneal neuropathy was clinically diagnosed, with weakness in ankle dorsiflexion, eversion and hallux extension with normal strength in inversion and plantar flexion. Hyperalgesia in the sensory distribution of CPN was also present. These finding were associated to poor immobilisation of lower limb during ECMO. A nerve block of CPN for pain relief was performed successfully and the patient initiated a rehabilitation program including muscle strengthening and gait training. At discharge, on day 53, he was capable of independent walking with a foot-up® orthosis, maintaining an outpatient rehabilitation program. Conclusions: Prolonged immobility results, in some rare cases, in peripheral nerve injuries. The intervention of PRM physicians caring for COVID-19 survivors is essential in both the anticipation of sequelae and in its treatment, allowing an early return to previous functionality.

  5749 - Physical medicine and rehabilitation approach for dysosteosclerosis: Case report Top

Youssef Zribi1, Leila Ghidaoui1, Ameni Khezami1, Ilhem Turki2, Fatma Zohra Ben Salah1, Catherine Dziri1

1Department of PMR, National Institute Mohamed Kassab, Manouba, Tunisia, 2Department of Child Neurology, National Institute Mongi Ben Hmida of Neurology, Tunis, Tunisia

E-mail: [email protected]

Introduction: Dysosteosclerosis (DOS) is an extremely rare disease with skeletal, neurologic and dental disorders. Here we report the physical medicine and rehabilitation approach for the first case of DOS in Tunisia. Patient Information and Clinical Findings: Our case is about an 11 year old girl. She was blind since the first months of her life. She presented a normal psychomotor development until the age of 10 years when she presented a sever psychomotor regression with weakness of the lower limbs muscles leading to frequent falls progressive loss of speech and sphincteric control. After the diagnosis was made the patient was addressed to our physical medicine and rehabilitation department for multidisciplinary healthcare management. The main aims of the hospitalization were: educating the parents about their girl's disorder, involving them into the care management plan and preventing neuro-orthopedic deformities. We demonstrated to the parents the correct positions in bed and in the wheelchair, along with correct positions to feed the girl. We taught them some home exercises of rehabilitation. The evolution was remarkable with parents totally involved in the health care management plan. The girl had less pain, better night sleep and became more cooperative during rehabilitation sessions. Conclusion: Achievable goals were planned for this patient. The multidisciplinary intervention in physical medicine and rehabilitation is crucial for patients with DOS.

  5732 - SAPHO syndrome: A case report of a rare syndrome with associated functional impairment Top

João Nuno Malta, Alexandra Coelho, Lurdes Rovisco Branquinho, João Faria, António Azenha

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

E-mail: [email protected]

Introduction: SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) is a rare syndrome, with unclear pathogenesis, characterized by an inflammatory disorder of bone, joints and skin. The authors report a case of a 25-year old male with osteoarticular and cutaneous manifestation of this syndrome. Patient Information and Clinical Findings: A 25-year old male student was referred to a Physical and Rehabilitation Medicine consultation, diagnosed with SAPHO syndrome with cervical spine gradual involvement over six years, medicated with sulfasalazine. There were no other associated symptoms. Physical examination showed marked limitation of neck rotation and lateral bending and mild thoracic acne, with no sign of peripheral arthritis or neurological deficits. Cervical computed tomography and magnetic resonance imaging revealed inflammatory signs involving C6-C7 interapophyseal joints and bilateral fusion of the atlanto-axial joints and all cervical interapophyseal joints and upper dorsal interapophyseal joints evaluated. He initiated a rehabilitation program aiming to improve pain control and spine mobility, with heat superficial thermotherapy, spine mobilization techniques, TENS and hydrokinesiotherapy, and clinical evolution was good. Discussion and Conclusions: Diagnosis of SAPHO syndrome is largely clinical. This is a rare and heterogeneous syndrome, so the diagnosis can be challenging. In this case, there was marked osteoarticular and mild cutaneous involvement, and other causes were excluded. There is no optimal recommended treatment for this syndrome. This case report shows the possible role of rehabilitation in managing this syndrome functional impairment.

  5723 - The role of PMR in alkaptonuria, the present and the future: A case report Top

Filipe Ermida1, Xénia Verraest2, André Ribeiro2, Sofia Moreira2, Sandra Assunção2, Sandra Oliveira2, Ana Sofia Costa3, Rafaela Evangelista3, Jorge Laíns2

1Centro de Medicina de Reabilitação da Região Centro-Rovisco Pais, Portugal, 2CMRRC-Rovisco Pais, Tocha, Portugal, 3Centro Hospitalar Tondela-Viseu, Viseu, Portugal

E-mail: [email protected]

Introduction: Alkaptonuria is a rare metabolic disorder, in which the tyrosine decomposition cascade is stopped at homogentisic acid (HGA), caused by a deficiency in homogentisate 1,2-dioxygenase. HGA is mostly eliminated in the urine, but some molecules end up irreversibly depositing in connective tissues, leading to a rearrangement of the proteoglycan matrix, and turning theses tissues dark, known as ochronosis. Alkaptonuria can manifest in early life with dark coloration of urine, if left exposed to the air, but it typically presents itself during the third and fourth decade of life with a triad of homogentisic aciduria, ochronosis and ochronotic arthropathy. The ochronotic arthropathy by degeneration of the articular cartilage is the most impactful in the quality of life, although it's associated with a plethora of systemic complication. Patient Information and Clinical Findings: We report the case of a 62-year-old male with bilateral hip osteoarthritis, with hip and groin pain worsened by movement. He was previously submitted to total knee arthroplasty on both knees. During surgery ochronosis of the articular cartilage was confirmed, biopsy of the tissue was sent for analysis, as well as 24 hour urine collection which confirmed high concentration of HGA. Discussion and Conclusions: There is no effective treatment, so the approach is symptom based and almost all patients are submitted to arthroplasties of the knee or hip. Besides rehabilitation after the arthroplasties, PMR practitioners have an important role in preserving function and reducing pain while the inevitable deterioration of weightbearing joints progress. It is probable that soon we'll have a way to prevent complications, as there are ongoing phase 3 studies to approve a drug that blocks the formation of HGA.

  5702 - Effect of core stabilization/strengthening training for improved running performance, efficiency, and risk of injury in novice athletes: A systematic review Top

Levi Roberts, Sarah Reeder, Ashleigh O'Malley, Trenton Woolcock, Garrett Murray, Ryan Romaine, Melissa Cencetti

Department of Physical Therapy, Misericordia University, Pennsylvania, USA

E-mail: [email protected]

Background and Aims: There has been a debate on the importance of proper running mechanics its effect on athletic performance and injury prevention. Many argue that running is a natural motion, athletes will instinctively adopt the most efficient running form. However, research suggests that since running is a complex full body movement, technique can affect performance and the occurrence of injury. Muscle activity imbalances altered activation patterns are associated with potential injuries and decreased running economy, which is explored further in this review. The purpose of this systematic review is to examine the effects of core stabilization strengthening exercises on running dynamics in novice athletes (12-25). We also explore potential injury prevention strategies based on the findings. Methods: A literature search was completed in September 2021 using PubMed and CINAHL Complete. Articles included in the systematic review were analyzed for quality based on the PEDro scale level of evidence scale. Results: Eight articles were chosen based on the following criteria: publication 2011 - present, novice athletes (12-25), articles that examined the relationship between core stabilization and running dynamics or risk of injury in athletes. Six additional articles were identified through a hand search. All articles were experimental, had an average score of 5.33/10 on the PEDro scale, ranged from Level I- Level IV on a hierarchy of evidence. scale. Conclusion: Currently, literature on the effect of core strength or core stabilization for running performance injury prevention has been inconclusive. This review identifies the need for continued research in this realm as well as its relationship with running performance and injury prevention.

  5700 - Plantar pressure analysis to determine the effect of insole in pediatric flatfoot: Case series Top

Homin Huh1, Junhee Lee2

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

E-mail: [email protected]

Background and Aims: The purpose of this study was to investigate the effect of changing plantar pressure by wearing on insole in pediatric flatfoot. Methods: Eight pediatric patients who radiologically and clinically diagnosed as a flatfoot were involved in this study. Foot pressure with center of pressure excursion was analyzed by insole pressure measurement system. The evaluation was conducted in two conditions, barefoot and foot with insole, and was performed in static form. Insole pressure measurement system was consisted with sixty- four pressure sensors. Especially, we focused on medial midfoot, which is the most important area in flatfoot. Maximally checked sensor pressure in medial midfoot (N/cm2) and overall area of load (%) were collected. Quantitative measurements were suggested by descriptive analysis. Results: [Table 1] shows the measurements of static pressure analysis in each condition. Compared to the barefoot, maximal sensor pressure in medial midfoot was increased and overall area of load was decreased on insole-applied status. These findings are due to the effect of insole. As insole fit to the flatfoot, it makes more