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 Table of Contents  
Year : 2022  |  Volume : 5  |  Issue : 6  |  Page : 61-118

Oral Presentations

Date of Web Publication19-Jul-2022

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

DOI: 10.4103/2349-7904.351322

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How to cite this article:
. Oral Presentations. J Int Soc Phys Rehabil Med 2022;5, Suppl S2:61-118

How to cite this URL:
. Oral Presentations. J Int Soc Phys Rehabil Med [serial online] 2022 [cited 2022 Sep 29];5, Suppl S2:61-118. Available from: https://www.jisprm.org/text.asp?2022/5/6/61/351322

  Biomedical Sciences – Biomechanics Top

  6557 - Ipsilesional upper limb reaching movements in poststroke patients: A quantitative biomechanical assessment Top

Franco Molteni1, Giulio Gasperini1, Alessandro Scano2, Eleonora Guanziroli1

1Villa Beretta Rehabilitation Center, Ospedale Valduce, Costa Masnaga, Italy, 2UOS STIIMA Lecco - Human-Centered, Smart and Safe, Living Environment, Italian National Research Council, Italy

E-mail: [email protected]

Background and Aim: In post-stroke hemiplegic patients, the ipsilesional limb has been less investigated than the contralesional. However, a better understanding of the motor capability of the ipsilesional limb may shed light on mechanisms of motor impairment and motor recovery. Methods: 38 hemiplegic patients were divided in three cohorts depending on their motor impairment (severe, moderate, mild), and assessed with a kinematic and dynamic evaluation protocol on their ipsilesional upper limb during reaching movements. Measurements were repeated in the acute and subacute phases. Ten healthy age-matched control subjects were recruited and their motor capabilities were evaluated. Healthy and patients were compared to determine whether patients' ipsilesional limb has equal performance to healthy people's limb. Results: With our assessment, we determined that the ipsilesional limb presented significantly different kinematic and dynamic performance. For the ipsilesional limb, we found: limited range of motion of shoulder elevation angles and lower energy and power outputs for both elbow and shoulder joints. Patients showed higher motor deficits in the acute phase with respect to the subacute one and the “severe” group presented highly significant differences with respect to healthy controls. Conclusion: The results of this study confirm that patients' ipsilesional limb is different from healthies', as previously reported from the literature and adding further significant assessments based on movement dynamics. These results have relevant clinical implications while treating and evaluating post-stroke subjects.

  6506 - Quality of life predictors in patients with melanoma: A machine learning approach Top

Monica Pinto<1, Nicola Marotta2, Corrado Caracò3, Ester Simeone3, Antonio Ammendolia2, Alessandro de Sire2

1Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Rehabilitation Medicine Unit, Department of Strategic Health Services, via Mariano Semmola 53, Naples, Italy, 2University of Catanzaro “Magna Graecia”, Physical Medicine and Rehabilitation Unit, Catanzaro, Italy, 3Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Department of Melanoma, Naples, Italy, 4University of Catanzaro “Magna Graecia”, Physical Medicine and Rehabilitation Unit, Catanzaro, Italy.

Email: [email protected]

Background and Aim: Health related quality of life (HRQoL) is an important recognized health outcome in cancer patients. We aimed to explore and weight factors via a machine learning approach in the perception of the quality of life in patients with melanoma. Methods: In this observational study, patients with melanoma, with no ongoing regional or metastatic disease, were recruited from January 2020 to December 2021 with a follow-up of at least one year. Demographic variables and clinics were collected, and 12-item Short-Form Health Survey (SF-12) was adopted to assess HRQoL. All the variables were processed in a random forest model to weigh at each node of each tree of this machine learning regression model, their actual weight in SF-12 score. Results: A total of 203 melanoma patients (mean age of 59.25±15.1 years, 136 [67%] Females and 67 [33%] males) were included: 56 (27%) affecting the upper limbs and 147 (73%) affecting the trunk. The model of 142 patients with no missing value, generating 92 trees (MSE = 0.45, R2 of 0.78), reported that the lesion site was the most influencing variable on HRQoL. In this scenario, we built two distinct models for lesion sites and demonstrated that the variable that most influenced the quality of life in upper limb melanoma was lymphedema, while BMI was in the trunk. Conclusions: The machine learning model for detecting the HRQoL predictor in melanoma patients indicates that the experienced lymphedema and BMI may influence the HRQoL perception.

  6503 - Comparing the association of a secondary motor and cognitive dual-task with disease severity in Parkinson's disease? Top

Karen Welman1, Chantelise Watkins2, Megon Sam2

1Stellenbosch University, South Africa, 2Department of Sport Science, Stellenbosch University

E-mail: [email protected]

Background and Aim: Turning tasks are associated with higher fall risk in individuals with Parkinson's disease (IwPD) and exacerbated under dual-tasking. We endeavoured to determine if there is a relationship between cognitive-motor (CM) and motor-motor (MM) dual-task (DT) turns and disease severity, specifically motor functioning, in IwPD. Methods: 17 IwPD (Hoehn & Yahr I-III; MDS-UPDRS: 62.2 ± 21.0 AU; Women: 6 & Men: 11; age: 73.2 ± 4.7 years) with no severe cognitive impairment (MoCA: 24.9 ± 2.3 AU), randomly completed MM- and CMDT 360° turns. Disease severity was assessed via MDS-UPDRS focusing on Motor Experiences of Daily Living (UPDRS II) and Motor Examination (UPDRS III). Participants executed 360° turns under single-task conditions, while carrying a tray with waterfilled glasses (MMDT) and a serial 3 subtraction task (CMDT). Besides No. of errors, mean Turn angle, duration, velocity and No. of turns were collected with APDM Mobility Lab®. Results: In CMDT, No. of errors showed weak associations throughout (r≤-0.34; R2≤11%) while moderate correlations were found for Turn angle (r=-0.54; R2=29%), No. of turns (r=-0.40; R2=16%) and Turn velocity (r=-0.40; R2=16%) with Total MDS-UPDRS, along with Turn angle (r=-0.52; R2=27%) and Turn velocity (r=-0.45; R2=20%) with UPDRS II (p<0.05). With MMDT moderate correlations were found for Turn angle (r=-0.42 to -0.46; R2=17-22%), No. of turns (r=-0.49 to -0.58; R2=24-34%) and Turn velocity (r=-0.40 to -0.53; R2=16-28%) for Total MDS-UPDRS and UPDRS II (p<0.05). Whereas CMDT and MMDT correlated poorly to negligible with UPDRS III throughout (r ≤-0.17; R2≤3%). Conclusion: DT turning activities imitate the complex demands of daily activities as it relates to disease severity and activities of daily living somewhat more than to motor functioning in IwPD.

  6376 - Physical and rehabilitation medicine impact in COVID-19 patients: Functional evolution analysis in continuum care Top

Bruno Guimarães1, Catarina Aguiar-Branco1, Ana Cristina Carvalho1, José Barreto1, Jorge Moreira1, Pedro Cubelo1, Joana Silva1, Bruno Guimarães1

1PRM Department ,Centro Hospitalar Entre o Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal.

E-mail: [email protected]

Background and Aim: In 2020, WHO declared COVID-19 pandemic, with relevant impact on healthcare and rehabilitation worldwide, reflected by an exponential increase in hospital inpatients. The present study explores functional effects of an early rehabilitation program (RP) in COVID-19 patients in UCI's, other hospital services and till 12 weeks after hospital discharge. Methods: Randomized, controlled, double-arm clinical trial-analysis. Patients were randomized into two groups: intervention group (IG), control group (CG). IG was submitted to an individual functional (respiratory, neuromotor) RP and CG to an immobility syndrome prevention RP. After discharge, IG had a supervised and orientated hospital tele-RP. CG was in community. Several metric instruments were applied. Results: 96 patients were considered, in a 1:1 ratio (48 CG and 48 GI). At admission, there were no differences in patients' functional level. IG showed shorter hospital stay (GI vs CG: 12.9±5.8 vs 15.6±6.7, p=0.037). At discharge, IG showed better functional status (FS) (GI vs CG; MRC-SS: 54.4±3.7 vs 52.1±4.1, p=0.005; Hang Grip (HG): 23.3±5.1 vs 21.2±4.3, p=0.032; mMRC Χ2(4) = 11.77, p=0.02). After 4 weeks discharge (wd) differences were found in FS (GI vs CG; MRC-SS: 58.9±1.1 vs 57.9±2.3, p=0.008; 6 minutes walking test (6MWT): 604±67 vs 571±57, p=0.018; Borg Rating of Perceived Exertion scale (BRPE) (after 6MWT): 11.7±2.1 vs 12.5±1.8, p=0, 048), with no differences in the HG (GI vs CG: HG: 27.1±4.4 vs 25,9±5.1, p=0.220) and dyspnea perception (mMRC Χ2(2) = 1,667, p=0.43). After 12 wd, differences were found in FS (GI vs CG; 6MWT: 639±53 vs 611±53, p=0.025; BRPE (after 6MWT):11.3±1.6 vs 11.9±1.6, p=0,025); no relevant differences in HG and MRC-SS. Conclusion: This study reflects the importance of an early RP in COVID-19 patient's functional recovery.

  6230 - Effects of cognitive impairment on dysphagia in stroke patients undergoing specific rehabilitation Top

Benedetta Basagni1, Sara Marignani1, Francesca Cecchi1, Silvia Pancani1, Andrea Mannini1, Bahia Hakiki1, Claudio Macchi1, Antonello Grippo1

1Centro Maria ai Servi, Fondazione Don Carlo Gnocchi, Parma, Italy

E-mail: [email protected]

Background and Aim: Dysphagia represents one of the most frequent symptoms in people suffering from stroke in the acute phase, leading to serious complications. Considering the heterogeneity of neurological disease consequent to stroke, swallowing impairment often has various comorbidities, including cognitive deficits. Few studies have addressed the effects of cognitive functions on the evolution of dysphagia. This study aims to investigate the role of cognitive impairment in patients attending a specific rehabilitation program. Methods: Patients admitted to four rehabilitation centres for stroke, entered a dysphagia rehabilitation program performed by one qualified speech and language pathologist. At admission the Montreal Cognitive Screening Test (MoCA) was administered. The change in the FOIS score from admission to discharge was considered as the outcome measure of the study. Results: 61 patients were included in the study. Higher FOIS at admission (β =0.222, p=0.027), younger age (β=-0.346, p=0.002), presence of hemorrhagic stroke (β=0.295, p=0.008), and higher MOCA score (β=0.512, p<0.001), were found to be significantly associated to a higher functional level of food and liquid intake at discharge. Conclusion: Our results seem to confirm the hypothesis that the outcome is influenced by the incoming dysphagia severity. Moreover, patients with a better cognitive profile upon admission had a higher FOIS at discharge than those with a lower one. Both age and type of stroke seemed to be related to the rehabilitation outcome, too. Clinical implications of our results consist in the importance to integrate a cognitive assessment to the dysphagia evaluation and to consider cognitive rehabilitation as a part of dysphagia recuperation.

  6174 - Consistency in three-dimensional gait measure interpretations between analyses performed with personal and standard footwear Top

Margaux Baron1, Baptiste Ulrich2, Brigitte Jolles-Haeberli2, Patrick Omoumi3, Julien Favre2

1Swiss BioMotion Lab, Lausanne University Hospital/University of Lausanne, Lausanne, Swittzerland, 2Department of Swiss BioMotion Lab, Lausanne University Hospital, Lausanne, Switzerland, 3Service of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland

E-mail: [email protected]

Background and Aim: During three-dimensional gait analysis, patients are usually analysed either in personal or standard footwear. Selecting the footwear condition is not straightfoward, particularly because the impact of footwear on the interpretation of gait measures is unclear. This study aimed to characterise the consistency of gait measures between personal and standard footwear, and determine the influence of age or sex. Methods: The gait of 148 healthy participants walking at a comfortable speed was recorded by a single investigator, in a laboratory equipped with a marker-based motion capture system and force plates. Both footwear conditions were recorded on the same day in a random order. Seventy-five common measures were used to describe lower-limb kinetics and kinematics. Consistency was assessed using the intra-class correlation (ICC). Sensitivity analyses were performed with respect to age and sex. Results: Good to excellent consistency (ICC>0.75) was found for 81% of the measures and moderate consistency (ICC>0.5) for 18% of the measures. Lower ICCs were generally found at the ankle and in the transverse plane of the knee. Age or sex did not affect the results. Conclusion: Personal and standard footwear generally yield consistent interpretations of lower limb gait measures, indicating that in most cases, the analyses could be performed with one or the other footwear condition. Inconsistencies were nonetheless observed for some measures, for which precaution must be taken when concluding an absence of effect from footwear. Further research should determine if consistency varies with pathological gait.

  5838 - Development of quantification methods of spontaneous movements associated with early neurological development in preterm infants Top

Woo Hyung Lee1, Hyung-Ik Shin1, Moon Suk Bang1, Sung Eun Hyun1, Hye Min Ji1, Hyun Iee Shin2

1Seoul National University Hospital, Seoul, South Korea, 2Chung-Ang University Hospital, Seoul, South Korea

E-mail: [email protected]

Background and Aim: To develop quantitative assessments of spontaneous movements in high-risk preterm infants based on a deep learning algorithm. Methods: Video images of spontaneous movements were recorded in very preterm infants at the term-equivalent age. The Hammersmith Infant Neurological Examination (HINE) was performed in infants at 4 months of corrected age. Joint positional data were extracted using a pretrained pose-estimation model. Similarity and complexity indices of joint angle and angular velocity were compared between the infants with HINE<60 and ≥60. Results: Video images of spontaneous movements were recorded in 65 preterm infants at term-equivalent age. Complexity indices of joint angles and angular velocities differed between the infants with HINE<60 and ≥60 and correlated positively with HINE scores in most of the joints at the upper and lower extremities (p<0.05). Similarity indices between each joint angle or joint angular velocity did not differ between the two groups in most of the joints at the upper and lower extremities. Conclusion: Quantitative assessments of spontaneous movements in preterm infants are feasible using a deep learning algorithm. The results indicated that complexity indices of joint movements at both the upper and lower extremities can be a potential candidate in detecting cerebral palsy in preterm infants.

  5516 - Rehabilitation in patients with lymphoma Top

Bhasker Amatya1, Fary Khan2, Michael Dickinson3, Thomas E Lew3

1Department of Rehabilitation, Royal Melbourne Hospital, Parkville, Victoria, Australia, 2Royal Melbourne Hospital, Parkville, Victoria, Australia, 3Peter MacCallum Cancer Centre, Parkville, Victoria, Australia

E-mail: [email protected]

Background and Aim: Lymphomas and its treatments are associated with physical, cognitive, psychosocial impairments; limiting patients' daily activities and participation. Currently, a range of rehabilitation interventions are trialled in patients with lymphoma (PwL). This review evaluated existing evidence from published systematic reviews for the effectiveness and safety of rehabilitation interventions in PwL. Methods: A comprehensive literature review was undertaken using a multipronged. Two reviewers independently selected and assessed potential systematic reviews for methodological quality and graded the quality of evidence using validated tool. Results: Twelve systematic reviews (with 101 primary studies; 87,132 PwL) were included, which evaluated three broad categories of rehabilitation interventions: physical modalities, nutrition and complementary medicine. There was a marked heterogeneity amongst the included reviews. Most reviews were just as of moderate to low methodological quality. The findings suggest moderate-quality evidence for exercise programs for improved fatigue and sleep disturbance and low-quality evidence for exercise therapy alone and Qigong/Tai chi for improved symptoms and overall quality of life, and an inverse association between sunlight/ultraviolet radiation exposure on non-Hodgkin's lymphoma incidence. There was inconclusive evidence for the beneficial effects of yoga and the association of physical activity and lymphoma risk. Conclusion: Rehabilitation programs are an integral part of the management of PwL. Despite a range of rehabilitative modalities used for PwL, high-quality evidence for many is sparse. More research with a robust study design is required to determine the effective rehabilitation approaches.

  4360 - Evaluation of the efficacy of intra-articular injective treatment with reticular hyaluronic acid (mo.re. Technology) in amateur athletes with over-use gonarthrosis Top

Francesco Agostini1, Andrea Bernetti1, Massimiliano Mangone1, Marco Paoloni1, Teresa Paolucci2, Raoul Saggini2, Valter Santilli1

1Department of Anatomical and Histological Sciences, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy, 2Unit of Physical Medicine and Rehabilitation, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy

E-mail: [email protected]

Background and Aim: Osteoarthritis (OA) is a chronic inflammatory and progressive disease characterized by cartilage degeneration, pain, functional disability and quality of life alterations. Intra-articular hyaluronic acid (HA) has proved to be able to improve symptoms and slowing down the progression of joint degeneration. The aim of our study was therefore to analyze the efficacy of the intra-articular mobile reticulum HA, 24 mg / 3 ml, in amateur athletes with low to moderate over-use gonarthrosis. Methods: Amateur athletes (30-70 yy) of both sexes with radiographic diagnosis of gonarthrosis (II-III K-L) were recruited. Patients underwent 2 knee intra-articular injections with HYADD®4-G, 2 weeks apart. Patients were evaluated using pain scales (VAS) and disability related to gonarthrosis (KOOS; WOMAC), at baseline, after 1 month, 3 months and 6 months since the last injection. Results: 30 amateur athletes were recruited. VAS Scale showed a statistically significant reduction in pain between T1 and T2 and between T2 and T3 (p-value <0.007). KOOS Scale, for the pain item, there were statistically significant differences between T0 and T1, between T1 and T2 and between T2 and T3 (p-value <0.001). With regard to items related to symptomatology, sports and recreational activities and quality of life, there was a statistically significant improvement between T0 and T2 (p-value: <0.047; <0.034; <0.04 respectively). Conclusion: Based on our experience, intra-articular HA injections, thanks to the innovation of the mobile reticulum, is certainly an effective and safe method in athlete management with low-moderate over-use gonarthrosis.

  Biomedical Sciences – Genetics (0) Top

  Biomedical Sciences – Molecular and Cellular Biology Top

  5664 - No blood dysimmune profiles in postpoliomyelitis patients: A case-control study Top

Isabelle Laffont1, Thierry Vincent2, Christophe Hirtz3, Pierre Portales2, Fanny Pradalier4, William Camu5, Claire Palayer6, Marion Soler7, Florence Galtier8, Valérie Driss8, Nathalie Michel2, Claire Lozano2, Claire Duflos9, Raul Juntas Morales5

1Department of PRM, Montpellier University Hospital, Euromov Digital Health in Motion, Montpellier University, Montpellier, France, 2Department of Immunology, Montpellier University Hospital, Montpellier University, Montpellier, France, 3Institute for Regenerative Medicine, Montpellier Hospital, Montpellier University, France, 4Department of PRM, Nimes University Hospital, Montpellier University, Nimes, France, 5Department of Neurology, Montpellier University Hospital, Montpellier University, Montpellier, France, 6Department of PRM, Montpellier University Hospital, Montpellier University, Montpellier, France, 7Clinical Research and Epidemiology Unit, Montpellier University, Montpellier, France, 8Montpellier University Hospital, Montpellier University, Montpellier, France, 9Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France

E-mail: [email protected]

Background and Aim: Poliomyelitis is a global disabling disease (12-20 millions of people). Post poliomyelitis syndrome (PPS) may affect up to 80% of polio survivors (1): increased muscle weakness, pain, fatigue, functional decline. It relies on aging of an impaired neuro-muscular system with ongoing denervation processes. A late involvement of humoral or cellular pro-inflammatory phenomenons is also suspected (2). Methods: This monocentric study compared PPS patients and controls on their lymphocyte subpopulations and humoral immune factors (IL-1, IL-6, IL-8, IL-17, IFN-γ, TNF-α, RANTES, MCP1, CCL20, IL-10, TGF-β). Patients were further compared according to their dominant clinical symptoms. Sample size guaranteed a power >90% for all comparisons. Results: We recruited 74 participants: 47 patients, 27 controls. The two groups were comparable in gender, age and weight. Most patients had lower limb motor sequelae (45, 95.7%), a minority had upper limb motor impairment (16, 34.0%). Forty-five were able to walk (94%), 35/45 with technical aids. The mean of the two-minutes walking test was 97.16 (± 45.86) metres. Eighteen (38%) required help in their daily life. Their quality of life was low (SF36). All described an increase in muscular weakness, 40 (85%) a general fatigue, and 39 (83%) muscular or joint pain. Blood count and serum electrolytes were comparable between patients and controls, except for creatine phosphokinase that was significantly higher in PPS patients. T and B lymphocyte subpopulation analysis and cytokine dosages were also similar between the two groups. None of these variables differed between the 20/47 patients whose late main symptoms were pain or fatigue, and other patients. Conclusion: Our results do not sustain the dysimmune hypothesis of PPS.

  Biomedical Sciences – Neurosciences Top

  6844 - Spatial neglect encompasses impaired verticality representation after right hemisphere stroke Top

Rémi Lafitte1, Marie Jeager2, Céline Piscicelli2, Shenhao Dai2, Anne Chrispin2, Patrice Davoine2, Eve Dupierrix2, Dominic Pérennou2

1Department of NeuroRehabilitation South Hospital, Univ. Grenoble Alpes, UMR CNRS 5105 Neuropsychology and NeuroCognition, CHU Grenoble Alpes, Grenoble, France, 2Department of NeuroRehabilitation South Hospital, CHU Grenoble Alpes, Grenoble, France

E-mail: [email protected]

Backgrounds and Aim: There is mounting evidence that, after stroke, impaired internal model of verticality is strongly related to spatial neglect. It raises questions as to which modalities of spatial neglect and verticality perception are related to each other? We assume that this link stems from a strong relationship between body neglect (BN) and postural vertical (PV), both referring to the body. Our aim was to analyse relationships between BN, non-body neglect (NBN), PV, and visual vertical (VV), in a series of individuals with right hemisphere stroke (RHS). Methods: We investigated a series 77 of individuals with RHS, with complete assessments of BN and NBN (four tests each), VV and PV, performed at the same time between one and three months post-stroke. Abnormality was diagnosed from at least two pathological tests both for spatial neglect and verticality perception. Composite scores were computed for BN and NBN. Results: All individuals (Median age = 67) with verticality representation impairment (n = 26) had spatial neglect (n = 52), but the reverse was not true. Whatever the modality, spatial neglect and verticality biases were moderately correlated (r ranging from -0.64 to -0.41; all p <.001). A principal component analysis revealed that data variance was mainly explained by one component, comprising all factors with the following loadings: BN = 0.88, NBN = 0.84, PV = -0.80, VV = -0.73. Conclusion: Our results reveal that spatial neglect encompasses impaired transmodal verticality perception, suggesting that biased verticality representation is a form of graviceptive neglect. BN, NBN, PV, and VV belong to the same dimension. The attentional component of spatial neglect likely explains their moderate correlations.

  6550 - The reorganization of egocentric spatial representation in patients who had a right hemispheric stroke, an FMRI study Top

Stephanie Leplaideur1, Isabelle Bonan1, Elise Bannier2

1University Hospital of Rennes, Rennes, France, 2Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, EMPENN ERL U 1228, Rennes, France

E-mail: [email protected]

Background and Aim: The egocentric referential frame is used in activities of daily living, and its impairment after stroke is detrimental. This study aimed to investigate, using neuroimaging, how patients with a right stroke perform egocentric tasks. Methods: Fourteen patients who had a right stroke within nine months underwent a functional 3T MRI scan. They achieved the subjective straight ahead (SSA) exploring the extracorporeal space and the subjective longitudinal body plane task (SLB) involving the corporeal space. Results: Brain activations were too heterogeneous to find significant results at the group level. At the individual level, we observed three kinds of activation patterns in decreasing rank: 1) bilateral activations; 2) only contralesional activations; 3) predominantly ipsilesional activations. During SSA, we located activations in the right inferior frontal gyrus, posterior cerebellum, middle temporal gyrus, middle occipital gyrus and posterior parietal cortex; and left cuneus and superior parietal lobule. During SLB, patients activated the right posterior cerebellum, middle temporal gyrus, precentral gyrus, angular and middle occipital gyrus. Left activations were found in the middle occipital gyrus, cuneus, middle temporal gyrus, precentral and superior frontal gyrus. Conclusion: Neuroimaging suggests different activation patterns in right stroke patients during egocentric tasks related to their lesion's characteristics. Studies of the networks underlying these egocentric activations could upgrade knowledge about the potential reorganization in high-level integration brain areas during spatial cognition tasks. Furthermore, identifying reorganization profiles could allow adapting their rehabilitation program.

  6372 - Comparison of EEG biomarkers in mirror therapy and video therapy in normals and hemiplegic stroke patients Top

Ahmed Adham1, Faustine Monin2, Diana Rimaud2, Pascal Giraux3

1Department of Adult PRM, University Hospital of Saint-Etienne, France Lyon Neuroscience Research Center, Trajectoires Team, Bron, France, 2Department of Adult PRM, University Hospital of Saint-Etienne, France, 3France and Lyon Neuroscience Research Center, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France

E-mail:[email protected]

Background and Aim: Mirror Therapy (MT) and Video Therapy (VT) are two rehabilitation techniques used in post-stroke hemiplegia for motor training of the upper-limb. The neurophysiological mechanisms behind their clinical efficacy have to be further characterized. The aim of this study is to identify and compare EEG markers in MT and VT rehabilitation in post-stroke hemiplegic patients, compared to healthy subjects. The influence of the motor task performed by the impaired limb is also assessed. Methods: EEG data (32 channels) from 10 chronic stroke patients and 15 healthy subjects were collected during standardized finger movements in MT (mirror) and VT (IVS™, Dessintey) during 2 randomized experimental sessions, with three distinct motor tasks conditions: passive observation, motor imagery and motor execution. Time-frequency maps were analyzed, including Event Related Desynchronization (ERD) and β-rebound. Results: In healthy subjects, a sensorimotor ERD is shown to be comparable in MT and VT, with a contralateral predominance of the ERD in VT compared to MT (bilateral ERD). In addition, there is a modulation of ERD and β-rebound according to motor tasks (observation, imagery, and execution). In patients, a still partial analysis, shows similar results, with however a variability according to the topography of the lesions and the level of motor recovery of the patients. Conclusion: The comparison of EEG markers obtained in MT and VT in healthy subjects and hemiplegic patients shows the greater ipsilesional selectivity of VT, especially regarding β-rebound. The modulation of ERD and β-rebound according to the motor task performed are potential markers of subject engagement in the clinical practice of these therapies.

  5949 - Validation of a virtual reality system to test simple reaction time Top

Ying-Chun Chen, Huey-Wen Liang

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College Medicine, Taipei City, Taiwan, ROC

E-mail: [email protected]

Background and Aim: Reaction time (RT) is known to be related to cognitive function, and has been a valuable research parameter for variable studies, for example, in visuospatial attention. Head-mounted display for virtual reality (HMD-VR) provides standardize the external visual conditions and could be a promising tool for measuring RT. The purpose of this study is to establish the feasibility, reality and validity of a HMD-VR-based software in evaluating simple RT (SRT). Methods: Twenty-one young and healthy participants volunteered the study after signing informed consents. A SRT test was created by VIVE ProEye (HTC, Inc.). The participants responded with a keyboard when a square target in random intervals for 100 trials. They performed a re-test within 1 week to investigate the reliability and a similar task with a computer-based software, RehaCom (HASOMED, Inc.) to test the concurrent validity. Median SRT was obtained was tested among each 25-trial block to test potential fatigue effect. Results: The median SRT for the first test from the VR-based and computer-based systems was 322 and 310 ms respectively, with Pearson's correlation coefficient as 0.88 (p<0.001) and significantly higher RT for left hand with the VR-based system (p=0.025 by Wilconxon signed Ranks test). The test-retest reliability of VR-based system was good, computed with intraclass correlation coefficient as 0.78 (p<0.001). Longer RT was observed at the last 25-trial block for the left hand only as computed Friedman's test with Bonferroni's correction. Conclusion: Our results supported a good reliability and high concurrent validity of this HMD-VR-based RT testing. Higher RT was observed for VR-based system for left hand only. Fatigue effect was observed for left hand for a 100-trial tests.

  5816 - Evaluating the trajectory of recovery of prolonged postconcussion symptoms with rehabilitation therapy Top

John Olver, Bianca Fedele, Rose Acher

Department of Rehabilitation, Epworth HealthCare, Monash University, Richmond, Victoria, Australia

E-mail: [email protected]

Background and Aim: Following concussion, approximately 15% of patients experience various neurological, physical, cognitive, and emotional symptoms that persist beyond three months. This is known as Prolonged Post-Concussion Symptoms (PPCS). This study aimed to evaluate the frequency and severity of symptoms on presentation, their impact on lifestyle and their recovery with rehabilitation intervention for patients admitted to Epworth HealthCare's Rehabilitation Concussion Clinic. Methods: Symptoms are assessed on clinic admission and discharge using the Oregon Post Concussion Symptom Checklist. Patients rate the presence and severity (0 – none to 6 – severe) of 23 symptoms which are clustered into physical, thinking, sleep and emotion subscale scores. Symptom presentation on admission then directs an individually tailored multidisciplinary rehabilitation program. Results: The analytic sample consisted of 222 patients with complete data. The top five symptoms reported on admission were: difficulty concentrating, headache, fatigue, feeling mentally foggy and feeling slowed down. The mean time in rehabilitation treatment was 279 days. By clinic discharge, there was a statistically significant decrease in all subscale scores and an increase in daily activity levels (from 42.7% to 76.0%). Compared to patients referred early to the clinic (≤3 months), patients with a delayed referral (>3 months) demonstrated significantly increased subscale scores and decreased daily activity levels (67.6% vs. 80.6%) on discharge. Conclusion: For individuals with PPCS, meaningful gains can be made through rehabilitation targeted at alleviating symptoms. Referral time for treatment can have a significant impact on the degree of recovery, and so a focus should be on the early detection of PPCS.

  5681 - Cortical activation of unilateral upper limb tasks: Perspectives for stroke rehabilitation Top

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

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

E-mail: [email protected]

Background and Aim: Post-stroke brain activations and their evolution through rehabilitation is a subject of major interest. Two non-invasive neuroimaging methods allow for recording the task-related brain activation for bedside use or in field monitoring: functional near-infrared spectroscopy (fNIRS) and electroencephalography (fEEG) respectively based on haemodynamic response and electrical activity of brain regions. Coupling both methods could lead to a better spatiotemporal mapping of the movement-related cortical activity to unveil underlying mechanisms of upper limb (UL) recovery. This fNIRS-fEEG study aims to depict reference activation patterns of motor cortex related to motor performance during UL functional tasks. Methods: Young healthy participants realized two unilateral UL tasks: i) a reaching target task and ii) a circular tracing task with speed and accuracy. A combined fNIRS-fEEG system was used to record motor cortex activations during each task. Results: With 20 healthy young subjects we replicated the classical kinematics results of the healthy UL movement. Neuro-imagery results provided by the fNIRS showed a co-activation of both motor cortex with a greater contralateral activity. With the EEG we highlighted power modification in the alpha-beta rhythm with a desynchronization occurring at movement. Conclusion: In parallel to the description of the reference brain pattern of UL movement, we showed that combined fNIRS-fEEG can be used in a rehabilitation unit to provide a “Holter of the brain plasticity” during functional movement. Further analysis with the older healthy subjects will give us information about ageing effects. Perspectives of this project will be the exploration of these brain-movement patterns in post-stroke patients in rehabilitation.

  5625 - Lateropulsion after hemispheric stroke: A form of spatial neglect involving graviception Top

Shenhao Dai, Céline Piscicelli, Emmanuelle Clarac, Monica Baciu, Marc Hommel, Dominic Pérennou

Department of NeuroRehabilitation South Hospital, Univ. Grenoble Alpes, UMR CNRS 5105 Neuropsychology and NeuroCognition, CHU Grenoble Alpes, Grenoble Cedex 9, France

E-mail: [email protected]

Background and Aim: To test the hypothesis that lateropulsion is an entity expressing an impaired body orientation with respect to gravity, in relation to a biased graviception and spatial neglect. Methods: Data from the DOBRAS cohort (ClinicalTrials.gov:NCT03203109), were collected 30 days after a first hemisphere stroke. Lateral body tilt, pushing and resistance were assessed with the Scale for Contraversive Pushing. Results: Among 220 individuals, 72% were Upright and 28% showed lateropulsion (Tilters=14% less severe than Pushers=14%). The three signs had very high factor loadings (>0.90) on a same dimension, demonstrating that lateropulsion was effectively an entity comprising body tilt (cardinal sign), pushing and resistance. The factorial analyses also showed that lateropulsion was inseparable from the visual vertical (VV), a criterion referring to vertical orientation (graviception). Contralesional VV biases were frequent (44%), with a magnitude related to lateropulsion severity: Upright -0.6 (-2.9;2.4), Tilters -2.9 (-7;0.8), Pushers -12.3 (-15.4;-8.5). Ipsilesional VV biases were less frequent and milder (p<0.001). They did not deal with graviception, 84% being found in upright individuals. Multivariate, factorial, contingency, and prediction analyses congruently showed strong similarities between lateropulsion and spatial neglect, the latter encompassing the former. Conclusion: Lateropulsion (pusher syndrome) is a trinity constituted by body tilt, pushing and resistance. It is a way to adjust the body orientation in the roll plane to a wrong reference of verticality. Referring to straight above, lateropulsion might correspond to a form of spatial neglect (referring to straight ahead).

  5622 - Preliminary results of an executive function training program coupled with transcranial stimulation in brain-injured patients: A single-case experimental design Top

Claire Lebely1, Sebastien Scannella2, Evelyne Lepron2, Quentin Chenot2, Alizée Lelievre3, Rodolphe Besse-Armisen3, Philippe Marque3, Evelyne Castel-Lacanal3, Xavier De Boissezon3

1Toulouse NeuroImaging Center, UMR 1214-Inserm/UPS-ToNIC, Purpan Hospital, Toulouse University, Pavillon Baudot, Toulouse, France, 2ISAE-SUPAERO, Toulouse, France, 3PMR, University Hospital of Toulouse, Toulouse, France

E-mail: [email protected]

Background and Aim: Cognitive remediations (CR) are designed to address the crucial need for symptom improvement in acquired brain injury patients with deficit in executive functions. The aim of our study is to investigate a CR using virtual reality (CoVirtua), coupled with a transcranial stimulation session (tRNS), to improve performance during ecological situations in brain damaged patients with dysexecutive syndrome. Methods: Five patients were included in this multiple single case study (SCED). Three phases A1-B-A2 followed each other over 12 weeks. Phases A1 and A2 correspond to conventional occupational therapy and phase B corresponds to the intervention under study. The start of phase B is randomised (multiple baselines). The intervention lasts four weeks and consists of four Covirtua sessions per week, each coupled with a 20-minute tRNS session (1 active electrode in the right dorsolateral prefrontal cortex and 4 return electrodes, maximum intensity 1 mA). The effect of the intervention is assessed by the Goal Attainment Scale (GAS) in the short (A1 vs B) and long term (A1 vs B+A2) with 3 goals defined per patient. Results: Visual and statistical analysis of the GAS scores show an effect of the intervention in both the short and long-term for 2 goals for P01 (“Mailbox management” p= 0.01; “Concentration” p = 0.02); and for 1 goal for P03 (“Managing a shopping list” p=0.02). Regarding long-term effects only, the intervention shows its effectiveness for 1 goal for P02 (“Following a household chores schedule” p=0.03); and for 2 goals for P06 (“Following a recipe” p=0.005; “Managing groceries” p=0.02). Conclusion: These initial results show of a positive effect of Covirtua coupled with tRNS mainly in the long term on executive functioning in daily life.

  Biomedical Sciences – Physiology Top

  6193 - The six minutes walking test is a good predictor of the VO2peak in breast cancer patients Top

Stephane Mandigout1, Elise Deluche2, Sophie Leobon2, Laurence Venat2, Nicole Tubiana-Mathieu2

1Disability, Activity, Aging, Autonomy and the Environment (HAVAE), Limoges University, Limoges, France, 2CHU Limoges, Limoges, France

E-mail: [email protected]

Background and Aim: The practice of adapted physical activity (APA) appears to be beneficial for women with breast cancer during treatment. The main objective of this study is to determine the relation between the six minutes walking test (6MWT) and the cardiopulmonary exercise test (CPET) before and after a period of 27 week with or without training program in breast cancer patient. This study was conducted in women during adjuvant chemotherapy. Methods: This retrospective study was based on two prospective studies (SAPA and APAC), including a total of 138 patients with breast cancer during their treatment period. In this sample size, 85 patients participate to an APA program lasting 27 weeks with 3 physical activity sessions (two aerobic and one strength training) per week. Before (T0) and after (T1) the training program, each participant realized a CPET to measure VO2peak and a 6MWT on the corridor of the hospital. Results: Considering all the sample size, there is a positive correlation at T0 (r=0.3, p<0.0001) and T1 (r=0.5, p<0.0001) between CPET and 6MWT. We observed the same results for the group with the APA program and the group without it. Conclusion: The 6MWT could be a good predictor of VO2peak in breast cancer patient during their treatment period. The professional of physical activity could use it regularly to estimate the aerobic capacity of the patient.

  Clinical Sciences – Complications – Other Top

  7013 - Cognitive and mental health impairment 1 year after COVID-19 Top

Sónia Tomé, Sara Ribeiro Silva, Joana Ramalho, Gonçalo Engenheiro, Vítor Costa Pereira, Luísa Viana Pinto, Catarina Aguiar Branco

PRM Department ,Centro Hospitalar Entre o Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal

E-mail: [email protected]

Background and Aim: Cognitive impairment has been described in the acute phase of COVID-19, but recent literature suggests it may persist as part of the Long-COVID condition. The aim of this study was to evaluate the presence of cognitive deficits and mental health status in COVID-19 survivors. Methods: This was a prospective uncontrolled cohort study. We selected survivors of COVID-19 evaluated in our PRM service who reported memory impairments in a previous telephone interview (n=31). They underwent multiple tests (Mini-mental [MM], MoCA, Subjective memory complaints [SMC] test, Hospital Anxiety Depression Scale [HADS-A/D] and Beck Depression Inventory [BDI]). Results: We interviewed 31 patients (48,4% female), mean age 55,48 years (min. 26; max. 73). Mean time after discharge was 12,48 months (min. 4; max. 22). Most had moderate to severe disease (26 were admitted in ICU, 4 needed intubation and 26 Helmet-CPAP). Mean time of hospital admission was 13,94 days, and mean ICU stay was 6,32 days. The 96,8% had SMC, which were not present before COVID-19. 21% had cognitive impairment in MoCA test and 61,3% had memory impairment in MoCA test. Regarding mental health status, 48,4% had anxiety symptoms in HADS, 42% and 48,4% had depressive symptoms in HADS and BDI, respectively. Conclusion: A significant percentage of survivors reported memory complaints 1 year after COVID-19, and suffered from anxious and depressive symptoms. Despite lacking a control group, our patients denied memory impairment before COVID-19 or reported worsening of symptoms. Only 6 patients had previously diagnosed anxiety or depression. Our study highlights the need of high quality controlled studies, which could help establish the potential burden for patients and healthcare.

  6702 - Prevalence of oropharyngeal dysphagia in patients admitted to intensive care for COVID-19: One-year follow-up Top

Merce Avellanet1, Esther Pages1, Meritxell Ros1, Elvira Gea2, Anna Boada-Pladellorens1

1Department of Rehabilitation, Hospital N Sra de Meritxell, Les Escaldes, Andorra, 2Hospital N Sra de Meritxell Pharmacy, Les Escaldes, Andorra

E-mail: [email protected]

Background and Aim: Prolonged mechanical ventilation (MV) is a risk factor for oropharyngeal dysphagia (OD) after endotracheal intubation (ETI). The prevalence of OD in critical patients varies between 3 and 62%. Studies in patients with COVID-19 who have required ETI hypothesize about motor and sensory alterations. The aim of this study was to determine the prevalence of OD in patients admitted to the Intensive Care Unit (ICU) due to COVID-19 and at 1-year follow-up (FU). Methods: Prospective study of patients admitted to ICU for COVID-19. Motor, nutritional, and cognitive aspects including OD were assessed with a comprehensive protocol from the beginning of the pandemic. The diagnosis of OD was established 48h post-extubation by clinical examination, volume-viscosity examination test (MECV-V modified) and/or modified BlueDye test in patients with tracheostomy and flexible fiberoptic endoscopy (EF). Results: 149 patients were admitted (110 -73.8% men and 39 -26.2% women) with a mean age of 64.15 years. Sixty-eight patients were excluded, 48 due to death before extubation, 20 patients do not required intubation. The prevalence of post-extubation OD was 53.1% (43/81). The average number of days with ventilatory support was 24.77 (5-116 SD 20.8) and 41 patients (51.3%) required tracheostomy. EF was required for diagnosis and/or follow-up in 44%. A statistically significant relationship was found between the OD and the number of days of MV and length of stay in ICU. No differences were found by age or by days of hospital admission. At 6 months FU, 6/37 patients continued with OD, and 3/23 at 1 year. Conclusion: The prevalence of OD in patients with COVID-19 admitted to the ICU was 53.1%. OD can be a sequel and should be considered. [Conflict of Interest: the authors have nothing to disclose].

  6600 - Safety considerations for cancer rehabilitation patients Top

Rajesh Yadav

Department of PRIM, UT MD Anderson Cancer Center, 1515 Holcombe, Houston, TX, USA

E-mail: [email protected]

Cancer and its treatments patients can increase the risk of exercise related complications and make rehabilitation challenging. Neutropenia and immunosuppresion can put patients at higher risk for infection and potentially increased the risk of transfer off of inpatient rehabilitation. Severe thrombocytopenia can increase the risk of physical activity related bleeding. How to safely deliver cancer rehabilitation and incorporate physical activity is a major concern for physiatrists and therapists. Fortunately, recent research publications and clinical experience can be useful guides to allow patients to safely obtain the benefits of exercise and rehabilitation. The presenters will discuss the evidence and discuss potential solutions with respect to neutropenia and thrombocytopenia (including exercise precautions and neurogenic bowel and bladder management), medical fragility of cancer patients, considerations for lymphedema patients and the use of modalities in patients with cancer.

  5705 - Pelvic floor prehabilitation for rectal cancer surgery to prevent bowel symptoms and pelvic floor dysfunctions: RCT protocol Top

Cinara Sacomori1, Luz Alejandra Lorca2, Mónica Martinez-Mardones2, Marta Natalia Pizarro-Hinojosa2, Jorge Plasser2

1Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile and Universidad Bernardo O´Higgins, Chile, 2Hospital del Salvador, Chile

E-mail: [email protected]

Background and Aim: Low Anterior Resection Syndrome (LARS) is a common complication after rectal cancer sphincter preserving surgery, presenting symptoms of fecal urgency and anal incontinence. The aim of this study is to describe the rationale for a clinical trial protocol to evaluate the effectiveness of a pre- and post-surgical pelvic floor rehabilitation program on the bowel symptoms, pelvic floor function and quality of life of rectal cancer patients (CAncer of Rectum REhabilitation Trial - CARRET protocol). Methods: Protocol for a RCT with parallel groups (pelvic floor rehabilitation versus control group). Participants and Setting: 56 stage I to III rectal cancer patients undergoing sphincter preservation surgery at Hospital del Salvador, Chile. Main outcome measures: ICIQ-B questionnaire for intestinal symptoms, high-resolution Anorectal Manometry (Alacer Multiplex 24-channel) for anorectal function, pelvic floor muscle strength with Oxford Modified Scale, and a quality-of-life test with the EORTC QLQ C30 questionnaire. Interventions: one pre-rehabilitation session (pre-surgery) and 9 to 12 sessions of rehabilitation, including: patient education, pelvic floor muscle exercises, pelvic floor electromyography biofeedback, and capacitive and sensory rectal training with a balloon probe. Rehabilitation will begin 3-5 weeks before the ileostomy is removed (four sessions) and around three weeks after stoma removal (5-8 sessions). Results: We expect the preventative protocol to prevent bowel symptoms and pelvic floor dysfunctions and improve quality of life. Conclusion: More prospective approaches aiming at preventing common cancer treatment problems are needed as to minimize disabilities among rectal cancer survivors. [Trial registration: ACTRN12620000040965].

  6452 - Limitations of functioning and quality of life one year after hospitalization for COVID-19: A prospective cohort study Top

Marianna Capecci1, Rossella Cima1, Arianna Latanza1, Silvia Mencarini1, Michela Coccia2, Michela Aringolo2, Lauredana Ercolani2, Marzia Millevolte2, Elisa Andrenelli1, Enrica Maria Magiera2, Maria Gabriella Ceravolo1

1Department of Experimental and Clinical Medicine, University Politecnica delle Marche, Ancona, Italy, 2Neurorehabilitation Clinic, University Hospital “Ospedali Riuniti di Ancona,” Ancona, Italy

E-mail: [email protected]

Background and Aim: Post COVID-19 condition is emerging as an international health concern. This prospective cohort study aims to describe the limitations of functioning and the quality of life of Covid-19 survivors at one year of hospitalization. Methods: We studied 70 out of 85 adults consecutively hospitalized for Covid-19 in non ICU wards from March 2020 (age: 63±11, 47 men). Primary study outcomes at three months (T3) and one year (T12) from diagnosis were pulmonary and neurological symptoms and functional data assessed through modified Rankin Scale (MRS), Barthel Dyspnea (BD), vocational and work activity level, SF-36. Results: 71% of survivors were discharged at home. At T3, their condition was worst compared to pre-admission (F=-4.1; p<,0001), with 19% of subjects showing moderate disability (MRS>2/5). Predictors of MRS decrease by one point at T12, compared to pre-admission, were: age, pre-Covid19 MRS score, and pneumonia severity. At T12, 28% of people still showed Covid-19-related neurological signs, like memory impairment, confusion, apathy, and tremor (F = 12.9; p = .003). Dyspnea, moderate or mild at T3 (mean BD= 91), improved at one year (p =.0002) and was the main predictor of a restriction in vocational activities, observed in 54% of subjects at T3 and 40% at T12. At T3, health-related well-being was valued 68%, on average, increasing at T12 though never exceeding 80%. Conclusion: One year after hospitalization for Covid-19, 39% of survivors showed mild to moderate disability and partial or no recovery of vocational activities. Pneumonia severity, age, and pre-existing disability are the main determinants of limitations of functioning characterizing post Covid-19 condition.

  6273 - Correlations between disease's severity and rehabilitation outcomes in patients recovering from COVID-19 infection Top

Sheer Shabat, Zeev Meiner

Department of Physical Medical Rehabilitation, Hadassah University Hospital, Jerusalem, Israel

E-mail: [email protected]

Background and Aim: COVID-19 pandemic has long-lasting deleterious effect on many aspects of the survivors' life. However, the correlations between the severity of COVID-19 infection and rehabilitation outcomes are still unknown. Methods: 61 post-acute COVID-19 patients underwent a customized rehabilitation program in a rehabilitation daycare facility. The severity of COVID-19 infection was measured according to the WHO clinical progression scale (CPS). Motor, cognitive, psychological and functional variables were measured using standard and specified scales. 19 out of 61 patients underwent nerve conduction studies. Results: Mean age of participants was 54 (range 18-84), 66% were males. 65% had severe disease according to CPS. The mean length of acute hospitalization was 5.6 ± 4.2 weeks, mean rehabilitation time and mean follow up time was 3.2 ± 2.1 months and 7.2 ± 3.2 months, respectively. A significant improvement was found in ADL functions as well as in hand motor strength and walking endurance. Cognitive and psychological findings showed minimal cognitive impairment, minimal anxiety and depression and severe symptoms of post-traumatic stress disorder and fatigue level among the survivors. A significant correlation was found between higher CPS and older age, prolonged acute hospitalization and ventilation, lower admission FIM and higher delta FIM. No correlation was found between CPS and FIM at discharge score. Moreover, lower CPS was correlated with anxiety, depression and fatigue and anxiety was correlated to lower delta FIM. Conclusion: As expected, the severity of acute COVID-19 infection affects the rehabilitation outcome in the pandemic survivors. This finding emphasizes the importance of customized multidisciplinary rehabilitation program in order to improve their daily functions and well-being.

  5987 - Impact of social distancing and changed health care practice, during COVID-19 pandemic: A retrospective cohort study of breast cancer survivors' postsurgery functional condition Top

Paola Bisoglio1, Alice Lambertucci1, Anna Gastaldi2, Manuela Marchegiani2, Bianca Mosconi1, Elisa Andrenelli1, Maria Gabriella Ceravolo1, Marianna Capecci1

1Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy, 2Neurorehabilitation Clinic, University-Hospital Ospedali Riuniti di Ancona, Ancona, Italy

E-mail: [email protected]

Background and Aim: The COVID-19 pandemic led to social distancing and changes in health care practice especially in the first half of 2020 in Italy. This observational retrospective cohort study aimed at describing possible changes in rehabilitative management of patients undergoing breast cancer surgery by comparing the functional conditions of patients admitted to rehabilitation in 2019 and 2020. Methods: Clinical records of the subjects referred to the rehabilitation facility of a Breast Unit were examined and the following data were stratified across the periods 03/2019-02/2020 and 03/2020-02/2021 for the descriptive and comparative analysis: medical visits, breast surgery-related clinical and functional problems, subjects referred for rehabilitation, rehabilitation sessions carried out and outcome. Results: Ninety-two out of 786 (12%; 93% mastectomy) subjects undergoing breast surgery were referred to the physiatrist in 2020 compared to 367 out of 866 (42%; 61% mastectomy) in 2019. They were assessed 64 days after surgery in 2020 and 29 days in 2019 (F= 8.2; p=.004). Fifty-four (60%) needed physiotherapy for the management of post-surgical complications in 2020, 196 (53%) in 2019. In the post-acute phase, women were twice as compromised in shoulder function (QuickDASH) in 2020 compared to 2019 on admission to rehabilitation (F = 8.2; p= .005). The outcome of physiotherapy was the same in 2020 compared to 2019, notwithstanding a significant increase in the number of sessions needed to achieve the goal in 2020 (15 vs 10; F= 5.1; p= .02). Conclusion: This study demonstrated reduced access to rehabilitation services due to COVID-19, which may significantly impact the functional well-being and the care burden of women in the acute post-surgical phase.

  5917 - Extracorporeal shock wave therapy, a new therapeutic tool in hypertrophic burn scar: A systematic review Top

João Santos Faria, Carla Hovenkamp, Lurdes Rovisco Branquinho, João Nuno Malta, Alexandra P. Coelho, Joana Santos Costa

PRM Department, Centro Hospitalar, Universitário de Coimbra, Coimbra, Portugal

E-mail: [email protected]

Background and Aim: Post-burn hypertrophic scarring is a common complication in burn injuries. It's often associated with impaired function and esthetic deformities. A wide range of treatments has been advocated for this issue. Extracorporeal shock wave therapy (ESWT) has been applied in the past years in rehabilitation programs. Lately, it has been proposed as a therapeutic tool in the management of scars. This study aims to review the literature for published evidence on the use of ESWT in hypertrophic postburn scars. Methods: We carried on a search on PubMed, Embase, and Scopus databases with the following terms: “(Extracorporeal Shock Wave Therapy OR ESWT OR Ultrasonic Therapy [MeSH]) AND (Hypertrophic Scar OR Burn Scar)”. The PRISMA statement was followed for optimal reporting. Results: This search found 351 articles of which 50 were duplicates. After the screening process, 40 articles were assessed for eligibility. A total of 5 articles matched the criteria and were reviewed [Figure 1]. [Table 1] summarizes the retrieved qualitative data. A total of 192 patients were included.

Conclusion: Evidence suggests that ESWT has benefits both in esthetic and functional outcomes in postburn hypertrophic scars. It's a feasible and cost-effective method that can add value to non-invasive management of these patients. Large-scale trials should be conducted to establish a standardized protocol.
Figure 1: Prisma flow diagram

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Table 1: Summary of the data extracted from the included articles

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  5861 - The PRINCOVID study – A predictive model for pressure injuries amongst critical COVID-19 patients Top

Ana Vaz1, Mafalda Oliveira1, David Almeida e Reis1, Tiago Moreira2, Ana Isabel Silva1, Afonso Rocha1, José Artur Paiva3

1Department of Physical and Rehabilitation Medicine, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal, 2Centro Hospitalar Universitário de São João, Porto, Portugal, 3Department of Intensive Care Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal

E-mail: [email protected]

Background and Aim: Intensive care support, required in up to 5% of COVID-19 patients, implies an increased risk of complications, namely pressure injuries (PI). We aim to characterize PI on critically ill COVID-19 patients, identify risk factors and develop a predictive model for PI at intensive care unit (ICU) admission. Methods: Retrospective analysis of a consecutive sample of patients admitted to ICU due to severe COVID-19, between May 2020 and September 2021. Socio-demographic characteristics, comorbidities, clinical and laboratory findings at ICU admission and presence of PI, its' severity and location were abstracted from clinical records. Results: 205 patients were included, mostly males (73%) with a mean age of 62 years old. 58% developed PI, mostly multiple (52%). PI were depicted in 14 locations, most often on sacrum (62%) and face (32%). Univariate analysis showed an association between PI and male gender (OR=2.28 p=0.01), hypertension (comorbidity; OR=1.76 p=0.04), hemoglobin (Hb) (OR=0.83 p=0.01), albumin (OR=0.92 p=0.01), C-Reactive Protein (OR=1.03 p=0.04) and Creatine Kinase (CK)-MB (OR=0.99 p=0.02) at ICU admission. On multivariable analysis, male gender, hypertension and low Hb, albumin and CK-MB were all independently associated with PI. The PRINCOVID model (male gender, hypertension, Hb, CK-MB and albumin at ICU admission) reached an area under the ROC curve (AUC-ROC) of 0.72 (p<0.01), surpassing the Braden Scale (AUC-ROC=0.61; p=0.01), with statistical significance (p=0.046). Conclusion: Predictive models at ICU admission are of upmost importance to increase prevention strategies for PI. The PRINCOVID is a multivariable model with higher AUC-ROC in comparison with the Braden Scale, that includes several factors easily assessable on ICU admission.

  5397 - The influence of pharyngeal width on poststroke laryngeal aspiration by stroke stage and lesion Top

Kwang-Ik Jung, Jane Chung, Wonil Kang, Jeongeun Lee, Eunjee Lee, Woo-Kyoung Yoo, Suk Hoon Ohn

Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Anyang, South Korea

E-mail: [email protected]

Background and Aim: The present study sought to determine whether the pharyngeal width was related to not only laryngeal aspiration but also laryngeal penetration in patients with dysphagia following stroke. Methods: Using the lateral neck roentgenograms, the average of the two pharyngeal widths, [A+B]/2, was calculated in 690 stroke patients. The patients were subdivided into acute stroke (≤ 30 days) and chronic stroke (> 30 days) groups based on stroke duration and subdivided into cerebrum (Rt or Lt hemisphere), cerebellum, and brainstem stroke groups based on stroke lesion location. After the swallowing study, the physician rated the patient on the penetration-aspiration scale (PAS). The pharyngeal widths based on the stroke stage and the stroke lesion location were compared using an ANOVA test. Furthermore, the pharyngeal widths according to the aspiration severity of VFSS were compared using an ANOVA test in each stroke group. Moreover, the optimal cut-off points were determined for predicting the penetration and aspiration so that the difference between the penetration and the aspiration could be elucidated. Results: The pharyngeal widths in each stroke group were wider than the controls (p < 0.05). The pharyngeal widths of the right cerebral hemisphere and brainstem lesion group were wider than that of the control group (p < 0.05). The pharyngeal width was larger in patients with aspiration (PAS 6–8) than patients without penetration/aspiration (PAS 1) (p < 0.05) and patients with penetration (PAS 2–5) (p < 0.05). The optimal cut-off point of the pharyngeal width was 1 mm lesser for the prediction of penetration than for aspiration. Conclusion: The pharyngeal width could be an ancillary method for detecting penetration and aspiration in stroke patients.

  5382 - Effect of frailty on hospital outcomes in cancer patients Top

Muni Rubens, Adrian Cristian

Miami Cancer Institute, Miami, Florida, USA

E-mail: [email protected]

Background and Aim: To understand the effects of frailty on hospital outcomes such as in-hospital mortality, length of stay, and healthcare cost among cancer patients using a large database. Methods: This was a retrospective analysis of Nationwide Inpatient Sample data, 2005-2014. The primary outcomes were in-hospital mortality, prolonged length of stay, and cost. We defined prolonged length of stay as stay ≥75th percentile. Propensity-score matching analysis was done to examine whether frailty was associated with length of stay and in-hospital mortality. Results: There was a total of 10,463,083 cancer hospitalizations during the years 2005 to 2014, of which 1,022,777 (9.8%) were frail. The proportion of patients having prolonged length of stay was significantly higher among frail group, compared to non-frail group (53.3% vs 25.3%, P <0.001). Similarly, unadjusted mortality (12.0% vs 5.3%, P <0.001) and hospitalization costs ($29,726 vs $18,595, <em>P<0.001) were significantly higher for frail patients. A total of $28 billion was expended on hospitalization of frail cancer patients during the study period. In propensity score-matched analysis, the odds of in-hospital mortality (OR, 1.54; 95% CI, 1.50-1.58) and length of stay (OR, style=”color:black”>2.23; 95% CI, 2.18-2.27) were significantly greater for frail patients. Conclusion: Our study found that frailty was associated with an adverse hospital outcome such as increased length of stay, mortality, and healthcare cost among all cancer types. Our findings provide valuable information for risk stratification of cancer patients based on frailty. Concerted efforts by the physiatrists, oncologists, and surgeons towards identifying frailty and incorporating it in risk estimation measures could help in optimizing management strategies for cancers.

  5381 - Impact of the suspension of neurogenic detrusor overactivity treatment with botulinum toxin due to the COVID-19 pandemic Top

Eduardo Freitas Ferreira1, Rui Silva2, Anabela Ferreira2, Maria Paz Carvalho2, Paulo Vale3, Filipa Faria2

1Department of Physical and Rehabilitation Medicine, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal, 2PRM Department, Centro de Medicina de Reabilitação de Alcoitão, Alcoitão, Portugal, 3Department of Urology, Hospital Cuf Descobertas, Lisboa, Portugal

E-mail: [email protected]

Background and Aim: The COVID-19 pandemic has imposed an additional pressure on health systems worldwide. Patients with neurogenic detrusor overactivity (NDO) were especially vulnerable to inadequate care. This study aims to evaluate the impact of the suspension of NDO treatment with Botulinum Toxin (BT) due to the COVID-19 pandemic. Methods: Cross-sectional study of patients with spinal cord injury and NDO, who underwent BT treatment in 2018/2019 and, whose scheduled administration in 2020/2021 was suspended. The study protocol was divided into two parts. Phase 1 consisted of data collection from the clinical processes and in phase 2 a standardized telephone questionnaire was applied. Statistical analysis used the McNemar test and the Wilcoxon test with a p-value ≤ 0.05 as level of significance. Results: 21 patients with mean age of 42.0 years and mean disease duration of 16.9 years were included. On average patients were undergoing treatment with BT for 7.6 years and mean inter-treatment frequency was 2.3 years. Mean time since the last BT administration was 2.3 years and mean reported BT effect duration was 11.9 months. A significant increase in the percentage of patients with involuntary urinary loss (p=0.004) and urgency (p=0.031) was found. Additionally, a significant decrease in mean catheterization interval from 4.5 to 3.6 hours (p=0.002) and increase in daily oxybutynin dosage from 8.5 to 12.1 mg (p=0.002) was found. Conclusion: Overall, no significant changes were found for recurrent urinary infections or darifenacin/mirabegron dosages. Discussion: The COVID-19 pandemic originated clinical worsening of patients undergoing regular intravesical BT treatment for NDO. Thus, interruption of intravesical BT treatment severely affected these patients and needs to be avoided.

  4547 - Neurovesical dysfunction in children with Hirschsprung's disease Top

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

1Department of PRM, University Hospital Center Ibn Rochd, Casablanca, Morocco

E-mail: [email protected]

Background and Aim: Usually in Hirschsprung's disease (HD), long-term sequelae in children are related to abnormalities in defecation. However, some of these patients also develop lower urinary tract problems. The aim of this study is to assess and define the effects of transanal endorectal pull through procedure in patients with HD on lower urinary tract function by means of urodynamic studies (UDS) performed before and after surgery. Methods: The study was conducted at IBN ROCHD University Hospital during the period from 2012 to 2019. Thirty-eight patients with HD were subjected to urodynamic studies before and after the different definitive surgical procedures. The main outcome measurements were maximum cystometric capacity, compliance, unstable detrusor contraction and residual urinary volume. Results: All patients were males with a mean age of 3 years. Urodynamic findings, were normal in 29 (76%) children, and abnormal in 9 (24%) children. In uroflowmetric study, dysuria with detrusor sphincter dyssynergia and significant post void residual urine were found in the 5 symptomatic children. In cystometric study, nine children had unstable detrusor contraction, low bladder compliance and small-capacity bladder. Conclusion: In HD, neurovesical dysfunction may exist preoperatively and though the incidence of postoperative changes in neurovesical function may appear high. Children who present with urinary problems after surgery should be assessed urodynamically.

Keywords: Hirschsprung's disease, urinary dysfunction, urodynamic study

  Clinical Sciences – Complications – Spasticity Top

  7018 - Botulinum toxin A for the treatment of poststroke shoulder pain: Randomized controlled trial Top

Marcelo Riberto1, Eduardo de Melo Carvalho Rocha2

1Associated Professor, Faculty of Medicine, University of São Paulo, São Paulo, Brazil, 2PRM Department, Santa Casa de São Paulo, São Paulo, Brazil

E-mail: [email protected]

Background and Aim: Post stroke shoulder pain (PSSP) is highly prevalent and further impairs functioning of spastic stroke survivors. Its etiology is multifactorial and appropriated treatment often depends on a multidisciplinary approach. Botulinum toxin type A (TXB-A) has been indicated for PSSP, although the literature is not definite about pain control following spaticity control in these patients. The aim of our study was to verify the efficacy of the use of TXB-A in two adductor shoulder to reduce pain in PSSP subjects compared to the injection of saline solution after one and four months. Methods: This is a prospective, double-blind, randomized and placebo controlled trial. PSSP subjects were randomly allocated for TXB-A injection in the pectoralis major and subscapularis muscles (Dysport 200 UI each muscle) or the same volume of saline injection. Baseline assessment and after one and four months used pain Visual Analog Scale (VAS), McGill questionnaire, Modified Ashworth Scale, goniometry, Fugl-Meyer scale for upper limbs (FM) and the caregiver's perception of distress in routine tasks. Results: Improvement in pain and spasticity levels were noticed in both groups, more intense in the toxin group, but without statistical significance, although there was significant improvement in caregivers' perception of daily activities with the upper limbs in the TXB-A group (washing the arm p=0.04, removing the shirt p=0.01, wearing buttons p=0.03, doing home exercises p=0.25 and removal of buttons p=0.26). Conclusion: The use of TXB-A in the subscapularis and pectoralis major muscles resulted in a reduction in shoulder pain in spastic hemiplegic patients with passive and active movement although not statistically significant. However, the burden and distress of caregivers were significantly reduced after 1 and 4 months of injection.

  6637 - Changes of spasticity across time in prolonged disorders of consciousness: A retrospective study Top

Schnakers Caroline1, Winters Benjamin2, Kuluris Bruce3, Pathmanaban Rita4, Vanderwalt Hannelise4, Thibaut Aurore5

1Casa Colina Hospital and Centers for Healthcare, Pomona, California, 2Department of Psychology, University of California Los Angeles, Los Angeles, 3Neurorestorative, CA, USA, 4Neurorestorative, CA, USA, 5Coma Science Group, GIGA Consciousness & Centre du Cerveau, University and University Hospital of Liège, 4000 Liège, Belgium

E-mail: [email protected]

Background and Aim: In this retrospective study, we investigated how spasticity developed in patients diagnosed with a prolonged DOC over almost a two-year observation period (21 months) and how it related to the patients' age, gender, time since injury, etiology, level of consciousness, and anti-spastic medications. Methods: 19 patients with severe brain injury and prolonged DOC admitted to a long-term care facility were included in the study (14 male, age: 46±15 years; 10 traumatic brain injury: 1±1 year after brain injury; 11 minimally conscious state vs. 8 vegetative state). Each patient was assessed at admission and then quarterly totaling in eight assessments over 21 months. Spasticity was measured with the Modified Ashworth Scale (MAS) for both upper and lower limbs. The Western Neuro Sensory Stimulation Profile (WNSSP) was administered to assess the level of consciousness. The other medical and demographic information of interest were also obtained through medical records. Linear mixed models were used to assess each variable's impact on the change of spasticity over time. Results: Significant differences were observed in the evolution of spasticity in patients based on their etiology for the upper limbs and on their level of consciousness for the lower limbs. Conclusion: Our preliminary results suggest that spasticity evolves differently according to the type of brain lesion and the level of consciousness. Spasticity in DOC might therefore be mediated by different mechanisms and might have to be treated differently among patients. Future longitudinal studies should be performed prospectively in a bigger cohort and starts data collection earlier after brain injury to confirm our results and better understand the evolution of spasticity in this population.

  6406 - Percutaneous needle lengthening tenotomy for the treatment of equinovarus in adults with brain injury Top

Flavia Oana Coroian1, Bertrand Coulet2, Clément Richaud1, Sylvain Fazilleau1, Isabelle Laffont1

1Department of PMR, University Hospital Montpellier, Montpellier, France, 2Department of Orthopedic Surgery, University Hospital, Montpellier, France

E-mail: [email protected]

Background and Aim: Equinovarus is frequent in adults with brain damage. It can have consequences on pain, standing, footwear, gait or walking capacities. The aim of our work was to assess the results and complications of percutaneous needle lengthening tenotomy of Achilles' tendon performed by a PMR doctor. Methods: A prospective longitudinal study was carried out between October 2017 and December 2020. Patients were evaluated at 3 months, 6 months and 1 year after the procedure, using the Goal Attainment Scale. Achilles' tendon tenotomy was performed with a 18-gauge needle in the operating room, with the patient sedated. Procedure consisted in three Achilles' tendon hemisections associated to an ankle dorsal flexion up to 0°, knee extended. A 6 weeks ankle immobilization in a resin cast was associated. The tenotomy of the toe's flexors was performed in all cases. Results: Twenty-three patients were included (12 men). Both feet were involved in six cases (26, 03%). Achilles' tendon contracure had occurred following stroke (n = 8), head trauma (n = 6), cerebral palsy (n = 4), neurodegenerative diseases (n = 5). Patients' mean age was 53.6 y (28-77). The mean equinus value was 37.14 (20-50). Varus of the hindfoot was associated in 10 cases (35, 71%). For 15 patients (60, 8%) the main outcome was walking capacities. Outcome was reached at 3 months and maintained at one year in all cases. One patient presented an overcorrection. No vascular, skin or nerve complications occurred. Conclusion: Percutaneous needle lengthening tenotomy is an efficient technique for treating equinovarus in patients with brain injuries, even if functional outcome. As previously reported, it has a very low rate of complications. Patient's sedation allows the tenotomy to be performed under better conditions. This procedure can be realized by a trained PMR doctor.

  5600 - Reduced spasticity-associated pain in adults following treatment with incobotulinumtoxin A: A pooled analysis Top

Jörg Wissel1, Alexandre Camões Barbosa2, Georg Comes3, Michael Althaus3, Astrid Scheschonka3, David M. Simpson4

1Department of Neurorehabilitation and Physical Therapy, Vivantes Hospital Spandau, Berlin, Germany, 2Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal, 3Merz Pharmaceuticals GmbH, Frankfurt am Main, Frankfurt, Germany, 4Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, USA

E-mail: [email protected]

Background and Aims: Spasticity-associated pain (SAP) of limbs post-stroke or from other aetiologies limits mobility and quality of life and impacts psychosocial well-being. This pooled analysis evaluated the efficacy of incobotulinumtoxinA (incoA) for treating upper limb SAP in adults. Methods: Pain-relief data were pooled from six phase 2 or 3 studies (four double-blind, placebo-controlled) of incoA (one to four injection cycles [ICs], each 12–14 weeks) for treating upper limb spasticity in adults. SAP was assessed at baseline and 4 weeks post-injection using the Disability Assessment Scale (DAS) for pain; response was defined as a ≥1-point improvement in score from baseline. Only data for patients with pain at baseline were analysed. Response rates for incoA versus placebo were evaluated at IC1 week 4 using a Chi-square test and logistic regression analysis (odds ratio [OR] and 95% Wald confidence interval [CI]). Complete pain relief (DAS pain score=0) at IC1 week 4 was compared between treatments using a Chi-square test. Results: Overall, 544 (incoA, N=415; placebo, N=129) of 937 patients (58.1%) experienced SAP at baseline. At week 4 of IC1, 52.1% of incoA- versus 28.7% of placebo-treated patients had a response (p<0.0001). IncoA-treated patients were 2.6 times more likely to achieve a response than placebo-treated patients. (OR 2.62 [95% CI 1.62–4.24]; p<0.0001). At IC1 week 4, 27.1% of incoA- versus 12.4% of placebo-treated patients reported complete pain relief (p=0.0006). Pain response and relief rates were sustained and showed a cumulative effect throughout the study. Conclusion: To optimize patient-centric care, pain relief may be considered a treatment goal in adults with SAP. These study results support the use of incoA to treat upper limb SAP.

  6214 - Real-life prognosis of neurologic complications of botulinum toxin used in the fields of neurology and PRM: A pharmacovigilance study Top

Vincent T. Carpentier1, Nicolas Weiss2, Joe-Elie Salem3, Charles Joussain4, Jonathan Levy4, Louise-Laure Mariani2, François Montastruc5, Julien Mahé6, Bénédicte Lebrun-Vignes7, Djamel Bensmail8, Pierre Denys8, François Genet8, Kévin Bihan3

1Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, ISPC Synergies, APHP Paris Saclay University, Garches, France, 2Department of Neurology, APHP Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, 3Regional Pharmacovigilance Center, APHP Sorbonne University, La Pitié-Salpêtrière Hospital, France, 4Department of PRM, AP-HP. Paris Saclay University, Raymond Poincaré Hospital, Garches, France, 5Centre of Pharmacovigilance, Toulouse University Hospital, Toulouse, France, 6Regional Pharmacovigilance Center, Nantes University Hospital, Nantes, France, 7APHP Sorbonne University, Pitié-Salpêtrière Hospital, France, 8Department of PRM, Regional Pharmacovigilance Center, APHP Paris Saclay University, Raymond Poincaré Hospital, Garches, France

E-mail: [email protected]

Background and Aims: The use of botulinum toxin in the fields of neurology and PRM is common. However neurologic complications of botulinum toxin can lead to respiratory failure or death. This study aims to characterize real-life prognosis and clinical features of botulinum toxin related neurologic complications. Methods: A nationwide pharmacovigilance study of all neurologic adverse drug reactions (ADRs) related to use of botulinum toxins A and B in France in the fields of neurology and PRM between 1994 and 2020. Accessing data from the unique French pharmacovigilance database allows the study of detailed narrative safety descriptions reported by healthcare professionals using share methods of causality assessment. Results: 151 neurologic systemic complications and 40 with local complications were included, with a patient's age of 53 [36; 66] years; 107 (56 %) were women. Except three miscellaneous cases, all cases presented symptoms belonging to the clinical spectrum of botulism, either as an isolated symptom (41%) or as multiple symptoms (59%), with a time to onset of 12 [7; 15] days after injection and a duration of 54 [28; 90] days. Eighty three percent of cases were spontaneously recovered or were recovering on the date of notification. Reported drugs were not different between cases with local or systemic ADRs, although the doses were higher in cases with systemic ADRs (P < .001). Serious cases were more frequent for systemic ADRs (67% versus 34%; P < .001). Three complications resulted in death, all after treatment for cervical dystonia or sialorrhea. Conclusions: Neurologic complications related to botulinum toxin are often serious, but with a good prognosis; only injections in the cervical region are associated with complications resulting in death.

  5894 - How effective is management of spasticity-associated pain with botulinum toxin in upper limbs: Do treated segments matter? Top

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

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

E-mail: [email protected]

Background and Aims: Post-stroke spasticity (PSS) patients commonly experience pain in affected limbs, which impacts quality of life. However, treatment success in reaching individual goals using Botulinum toxin type A (BoNTA) is not well documented. This study aims to analyze the achievement of pain-related goals in patients treated in the upper limb (UL). Methods: Retrospective analysis of prospectively, non-interventionally collected data of PSS patients treated with BoNTA in 2001-2021. Patients were divided in 2 groups by location of UL BoNTA injection (shoulder: G1 vs non-shoulder: G2). Mean Goal Attainment Scale (GAS) T-score (achieved and change) and success rate for pain goals (GAS≥0) were compared between groups (SPSS v.25). Results: From an initial sample of 2635 treatment sessions (288 patients), 395 were included for analysis of treatment success in UL pain goals. Mean patient age was 58.37±12.05 years, 58.2% females and 63.5% ischemic strokes. Abobotulinum BoNTA was used in 66.6%, Onabotulinum in 21%, and Incobotulinum in 12.4%. G1 included 277 sessions and G2 118 sessions. Most treatment sessions in both groups presented an expected or greater than expected outcome regarding pain goals (G1:86.3% vs G2:85.6%), this proportion was independent of the anatomical region injected (p=0.856). The mean GAS T-score achieved was better in G1 (49.17±5.14) compared with G2 (47.87±4.55) with a statistically significant difference (p=0.018), as well as the mean GAS T-score change (G1:12.68±5.18 vs G2:11.35±4.30, p=0.015). Conclusions: Success rates for pain related goals were good and similar between groups. Achieved T-scores and T-score changes were significantly favorable to G1. Spasticity-related pain seemed to respond better to BoNTA injections of shoulder muscles than other locations in UL.

  5847 - Triceps surae muscle characteristics in spastic hemiparetic stroke survivors treated with botulinum toxin type A: Clinical implications from ultrasonographic evaluation Top

Alessio Baricich1, Marco Battaglia2, Lucia Cosenza3, Alberto Loro2, Paola Morlino4, Paolo Prandi4, Marco Polverelli3, Lorenza Scotti5, Michele Bertoni6, Andrea Santamato7

1Department of Health Sciences, Physical Medicine and Rehabilitation, Università del Piemonte Orientale, Novara, Italy, 2Department of Health Sciences, Physical Medicine and Rehabilitation, Università del Piemonte Orienta, Vercelli, Italy, 3Rehabilitation Unit, AO AL National Hospital, Alessandria, Italy, 4Department of Physical Medicine and Rehabilitation, Ospedale Maggiore della Carità University Hospital, Novara, Italy, 5Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy, 6Department of Physical Medicine and Rehabilitation, ASST Settelaghi, Varese, Italy, 7Department of Physical Medicine and Rehabilitation, Università di Foggia, Foggia, Italy

E-mail: [email protected]

Background and Aims: Equinovarus foot is the most common condition in post-stroke spasticity (PSS), leading to impaired gait and poor functional performances. Notably, spastic muscles undergo a dynamic evolution following typical pathophysiological patterns, reporting fibroadipose infiltration and contractile mass loss. Botulinum Neurotoxin Type A (BoNT-A) is the gold standard for focal spasticity treatment. Due to its pharmacological mechanism, a possible role in spastic muscle evolution has been widely discussed. This study aims to assess, in stroke survivors, changes in ultrasonographic muscle structure in relation to BoNT-A treatment. Methods: we enrolled patients affected by PSS addressed to our Unit for BoNT-A treatment. We acquired images of the medial gastrocnemius (MG) and soleus (SOL). Images were processed to measure the muscle thickness (MT, cm), the cross-sectional area (CSA, cm2), the pennation angle (α,) and the mean grey value (MGV, range 0-255). Results: 53 patients were enrolled. Compared to the unaffected side, MG and SOL alterations appear to depend on the spasticity only and not on the BoNT-A treatment. In functionally preserved patients (functional ambulation classification, FAC > 3; modified Ashworth scale, MAS ≤ 2), the ultrasonographic changes of MG compared to ipsilateral SOL observed in the paretic limb alone seems to be due to histological, anatomical, pathophysiological and biomechanical differences between the two muscles. In subjects with poor walking capability and more severe spasticity, such ipsilateral difference was found in both calves. Conclusions: BoNT-A treatment, even when applied in repeated cycles, does not seem to influence muscle degeneration, which appears to be primarily related to the already reported spastic muscle evolution.

  5746 - Perioperative botulinum toxin to enhance outcomes of surgeries on spastic limbs: A review of current literature and implications for clinical practice Top

Rajiv Reebye1,2,3, Heather Finlayson4, Sepehr Saeidiborojeni1

1Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Canada, 2Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, 3GF Strong Rehabilitation Centre, Vancouver, BC, 4CANOSC - Division of Physical Medicine and Rehabilitation, Faculty of Medicine, UBC,Vancouver,Canada

E-mail: [email protected]

Background and Aims: We present the results of our recent studies regarding perioperative use of Botulinum Toxin (BoNT). Methods: We conducted a systematic review of the evidence for perioperative injection of BoNT to enhance outcomes of surgeries on spastic limbs.[1] We then published the first case series of patients with different spasticity etiologies who benefited from BoNT administration pre-, intra-, and postoperatively to optimize their surgical outcomes.[2] Lastly, we performed a cross-sectional survey of Canadian physicians with expertise in spasticity management regarding their implementation of perioperative BoNT in clinical practice.[3] Results: Our systematic review found level 1 evidence that preoperative BoNT is effective for reducing pain, spasticity, and analgesic use in pediatric patients with cerebral palsy, but that intraoperative BoNT is not. Our case series demonstrated that perioperative BoNT improved surgical outcomes in patients with spasticity due to different etiologies. In our national survey, spasticity management specialists responded they administer perioperative BoNT to improve outcomes of surgeries on spastic limbs, with optimal timing suggested to be 2-3 weeks pre-surgery, and no known perioperative complications or adverse events. Conclusions: Perioperative BoNT injections can improve surgical outcomes on spastic limbs. Our studies highlight a need for more robust research to clarify the optimal timing for perioperative BoNT injection, and to enhance awareness and collaboration among physicians and surgeons when planning surgeries on spastic limbs.


  1. Saeidiborojeni S. Toxicon 2020;188:48-54. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0041010120304098?via%3Dihub.
  2. Frost G. Arch Rehabil Res Clin Transl 2021;3:100101. Available from: https://www.sciencedirect.com/science/article/pii/S259010952100001 X?via%3Dihub.
  3. Kassam F, Saeidiborojeni S, Finlayson H, Winston P, Reebye R. Canadian physicians' use of perioperative botulinum toxin injections to spastic limbs: A cross-sectional national survey. Arch Rehabil Res Clin Transl 2021;3:100158.

  5603 - Reduced spasticity-associated pain irrespective of baseline pain severity in adults following treatment with incobotulinumtoxina: A pooled analysis Top

Jörg Wissel1, Alexandre Camões Barbosa2, Georg Comes3, Michael Althaus3, Astrid Scheschonka3, David M. Simpson4

1Department of Neurorehabilitation and Physical Therapy, Vivantes Hospital Spandau, Berlin, Germany, 2Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal, 3Merz Pharmaceuticals GmbH, Frankfurt am Main, Frankfurt, Germany, 4Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, USA

E-mail: [email protected]

Background and Aims: Spasticity-associated pain (SAP) of limbs post-stroke or from other aetiologies can vary in severity, and relief of this pain is an important treatment goal. This pooled analysis evaluated the efficacy of incobotulinumtoxinA (incoA) for treating upper limb SAP in adults by baseline pain severity. Methods: Pain-relief data were pooled from six phase 2 or 3 studies (four double-blind, placebo-controlled) of incoA for treating upper limb spasticity in adults. SAP was assessed at baseline and at 4 weeks post first injection using the Disability Assessment Scale (DAS) for pain; response was defined as a ≥1-point improvement in score from baseline. Only data for patients with pain at baseline were analysed. Response rates for incoA versus placebo by baseline pain severity (mild, moderate, severe) were evaluated using a Chi-square test. Results: Overall, 544 of 937 patients (58.1%) experienced SAP at baseline, of whom 415 received incoA (mild SAP, n=177; moderate SAP, n=175; severe SAP, n=63) and 129 received placebo (n=58, 46, 25, respectively). At week 4, response rates with incoA versus placebo were 43.9% versus 19.0% for adults with mild SAP (p=0.0007), 54.7% versus 34.8% for those with moderate SAP (p=0.0165) and 67.7% versus 40.0% for those with severe SAP (p=0.0169). At week 4, a greater number of incoA- than placebo-treated patients reported a lower level of pain severity compared with baseline, regardless of baseline pain severity (p<0.05 for incoA vs placebo in all severity groups). Conclusion: To optimize patient-centred care, pain relief may be considered an important treatment goal in adults with upper limb SAP, irrespective of baseline pain severity. These results support the use of incoA to relieve upper limb SAP of any severity level.

  4641 - Motor nerve blocks in the management of spasticity in 88 Tunisian patients Top

Ines Aloulou1, Leila Ghidaoui2, Amamni Meherzia Khezami2, Imen Miri2, Sonia Lebib2, Fatma Zohra Ben Salah2, Catherine Dziri2

1Institut Kassab, médecine physique, Tunis, Tunisie, 2Service de médecine physique réadaptation, Institut national d'orthopédie MT Kassab, La Manouba, Tunisie

E-mail: [email protected]

Background and Aims: Local treatment of spasticity with Botulinium Toxin can improve motor and function capacities. However, it's not simple to determine if inhibition of spasticity will be benefic. The aim of this study was to expose our medical approach of spasticity by Motor Nerve Block (MNB). Methods: This study was descriptive and retrospective including patients hospitalized in Physical Medicine and Rehabilitation unit in Kassab Institute, Tunis/Tunisia, from January 2018 to January 2021, having spasticity with neuroorthopedic and/or functional disorders. Data collected was age, sex, etiology and neurological status. MNB consists in local anaesthesia of a nerve by Lidocaine 1%. Clinical assessment before and after MNB included spasticity by using Modified Ashworth scale, range of motion in degrees, function of upper limb by Frenchay scale, gait for lower limb and satisfaction of the patient. MNB was considered positive if it improves range of motion and/or function. Results: We included 88 patients with medium age 31 years, sex ratio 1.4, children 26%, hemiparesia in 40% and tetraparesia in 38%. Cerebral palsy was the etiology in 50%. MNB was done in upper limb in 39% and was positive in 80%, for lower limb, it was done in 70% and was positive in 79%. Botulinium Toxin was not prescribed after positive blocks in 2% because of dissatisfaction of patients. Surgery was indicated in 5% of patients not improved after MNB. Conclusion: The approach of the assessment of muscles involved in a spasticity pattern by MNB is important before Botulinium Toxin injections. The satisfaction of patients must be considered in the decision of treatment.

  4556 - Diagnostic motor nerve blocks: E-survey of current practices in physical rehabilitation medicine in France Top

Hélène Spittler1, Isabelle Laffont2, Manuella Fournier-Mehouas1, Flavia Coroian2, Claire Jourdan2, Fanny Pradalier2, Pierre Blanc1, Xavier Capdevila3, François Feuvrier2

1Department of Physical and Rehabilitation Medicine, Nice University Hospital, Nice, France, 2Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier, France, 3Department of Anesthesiology, Montpellier University Hospital, Montpellier, France

E-mail: [email protected]

Background and Aims: Spasticity resulting from a central nervous system damage can be responsible for functional disorders, although it can be helpful. Motor nerve blocks (MNB) are used to assess spastic pathological patterns and to guide treatment options. The SOFMER and SFAR (Société Française de Médecine Physique et Réadaptation - Société Française d'Anesthésie et de Réanimation) guidelines on MNB practice in Physical Rehabilitation Medicine (PRM) were published in 2019. The objective of our survey was to analyze the impact of these guidelines on current MNB practice by PRM physicians in France. Methods: An online survey, addressed by email to PRM physicians across France, was conducted from June to August 2020 including 28 questions. Results: A total of 73 PRM physicians, from 25 different departments in France, participated. Forty-seven percent of the responders were not performing MNB before the new guidelines. The reasons highlighted were a lack of training and knowledge on the topic (87%, 27/31 responders), a lack of previous recommendations (23%, 7/31 responders) and time constraints in medical practice (16%, 5/31 responders). The SOFMER-SFAR guidelines led to an increase of the rate of MNB practiced for 20% of the responders (14/70 responders) and resulted in 14% (10/70 responders) of physicians to start practicing MNB. MNB were performed most of the time by a PRM physician (96%, 48/50 responders) and not by an anesthesiologist. Fifty eight percent (36/62 responders) found the guidelines “very useful”. Conclusions: The 2019 SOFMER-SFAR guidelines clarified numerous points and laid solid practical foundations to perform MNB for assessing spasticity. Our survey highlights the growing interest to perform MNB in PMR departments in France.

  Clinical Sciences – Diagnostic Approaches – Electrodiagnostics (3) Top

  6309 - Electromyographic findings in patients with vocal cord dysfunction; a clinical study Top

Mansoor Rayegani1, Ahmad Raeissadat1, Mahboobeh Karimi-Galougahi2, Mina Heidari1

1Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, 2Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung, Tehran, Iran

E-mail: [email protected]

Background and Aims: This study was aimed to evaluate electromyographic findings in patients with vocal cord dysfunction referred to the physical medicine and rehabilitation department, Shohada Tajrish hospital, Tehran, Iran. Methods: This cross-sectional analytical study was carried out on 27 patients with vocal cord dysfunction (between March 2019- December 2020). participants were candidates for performing larynx electrocardiogram of the cricothyroid and thyroarytenoid muscles to evaluate the outer branch of the superior laryngeal nerve, and involvement of laryngeal nerve recurrent, respectively. Demographic information and electromyogram findings were recorded and analyzed using SPSS ver. 22 with chi square test. Results: 27 subjects enrolled in which 18 subjects (66.7%) were male and 9 subjects (33.3%) were female. In terms of patient's history, 9 patients (33.3%) with the head and neck surgery history, 5 patients (18.5%) with longtime intubation, 4 patients (14.8%) with tracheostomy, 4 patients with trauma history, and 5 patients (18.5%) with other reasons were reported. Moreover, recurrent laryngeal and superior laryngeal were reported in 14 (51.9%) and 2 (7.4%) patients, the rest were defined by both nerves (11 patients, 40.7%). Regarding the EMG severity, 9 subjects (33.3%) with normal findings, 8 subjects (29.6%) with high grade and 10 subjects (37%) with low grade were confirmed. There were significant associations between the phonation with laryngoscopy findings (P=0.01), EMG severity with laryngoscopy findings (P=0.04), and vocal cord with EMG findings (P<0.001). Conclusion: Defining etiology, severity, and prognosis of nerve injuries related to vocal cord impairments, electromyographic profile evaluations would be an effective diagnostic method to reach better results in the illness management.

  4477 - Kinematic analysis and sEMG for the quantitative analysis of movements in facial nerve palsy Top

Andrea Demeco, Nicola Marotta, Lucrezia Moggio, Ilaria Pino, Annalisa Petraroli, Antonio Ammendolia

University Magna Graecia of Catanzato, Catanzaro, Italy

E-mail: [email protected]

Background and Aims: Facial nerve palsy (FNP) worsens the patient's quality of life. In individuals with FNP undergoing facial rehabilitation, methods for measuring the severity of loss of function are useful in diagnosis, treatment, and follow-up. The aim is to propose a new evaluation protocol with kinematic analysis coupled with sEMG for patients with FNP, quantifying the degrees of excursion of the facial muscles and the symmetry of voluntary movements. Methods: Kinematic and sEMG analyzes were performed on 20 healthy adults (group A) as a starting point to have a normal range and to assess reliability using the intraclass correlation coefficient (ICC), and 10 patients with facial nerve palsy (group B) followed until the end of the rehabilitation program. Results: The protocol shows high intra-subject and inter- intra rater reliability (ICC>0.9 for most part). Group B reported a significant improvement in the movement of frontalis muscle (P=0,0118) after 4-week treatment from the beginning (T0) 9,8±4,5 mm to the end of rehabilitation (T1) 16,3±5,8 mm and orbicularis oris (P=0,0143) from T0 14,8±5,5 mm to T1 20,3±3,3 mm and, a reduction of % of maximum voluntary contractions (MVC) at T1 for frontalis and orbicularis compared to T0. Conclusions: This protocol provides meaningful data in a simple, cheap, reliable and objective way for the functional evaluation of patients with PNF and guides the physician on the most appropriate treatment strategies.


  1. Robinson MW, Baiungo J. Facial rehabilitation: Evaluation and treatment strategies for the patient with facial palsy. Otolaryngol Clin North Am 2018;51:1151-67.
  2. Schumann NP, Bongers K, Guntinas-Lichius O, Scholle HC. Facial muscle activation patterns in healthy male humans: A multi-channel surface EMG study. J Neurosci Methods 2010;187:120-8.
  3. Katsumi S, Esaki S, Hattori K, Yamano K, Umezaki T, Murakami S. Quantitative analysis of facial palsy using a three-dimensional facial motion measurement system. Auris Nasus Larynx 2015:42:275-83.

  Clinical Sciences – Diagnostic Approaches – Imaging Top

  6250 - Evaluating muscle changes with ultrasound in spasticity: Utility of the modified Heckmatt scale in clinical practice Top

Rajiv Reebye1, Michael C. Munin2

1Department of Physical Medicine and Rehabilitation, GF Strong Rehabilitation Centre, University of British Columbia, Canada, 2Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

E-mail: [email protected]

Background and Aim: We modified the ultrasound qualitative echo intensity (EI) grading system of the Heckmatt scale (HS) (a tool developed for Duchenne muscular dystrophy) and validated it for use in spasticity as the Modified Heckmatt Scale (MHS) so as to obtain greater specificity between grades, as spastic muscle may not show uniform pathologic changes throughout the entire muscle. Aim of the study was to describe the utility of the MHS in clinical practice and propose that the MHS be used in clinical practice when using ultrasound for delivery of Botulinum Toxin A (BoNT-A). Methods: We describe the utility of the MHS in clinical practice. Results: The MHS is validated for the use in spastic muscles. There are four scenarios in which the MHS can be used: An initial scan of the muscle to be injected prior to injection of the BoNT-A can be useful in classifying the level of muscle fibrosis using the MHS in the muscle(s) to be injected and for visualizing hypoechoic pockets to deliver the BoNT-A injection. To assess whether changes in muscle fibrosis occur with time especially after repeated BoNT-A injections and to help in planning of injection technique into more hypo-echoic pockets not affected by fibrosis. In research studies to assess whether injection of BoNT-A into muscles with higher EI may affect spasticity outcomes measures. In allocating a MHS grade to all muscles targeted for BoNT-A so as to help data collection of muscle level fibrosis for epidemiological and clinical research. Conclusion: Future studies should be undertaken to assess whether the Modified Heckmatt Scale could be used as a spasticity outcome measure as it could theoretically help in treatment triage decisions especially for muscles showing higher EI.

  5725 - Ultrasound assessment of spastic muscles of the upper and lower extremities in ambulatory chronic stroke survivors Top

Sheng Li1, Aila Malik1, Jaskiran Ghuman2, Nuray Yozbatiran1, Gerard Francisco1, Walter Frontera3, Javier Gonzalez-Buonomo4

1University of Texas Health Science Center - Houston (UThealth), Houston, Texas, USA, 2Physical Medicine & Rehabilitation, Mount Sinai Hospital, New York, USA, 3Professor, Faculty of Medicine, University of Puerto Rico, Puerto Rico, 4Multy Medical Facilities Ponce, Ponce, Puerto Rico

E-mail: [email protected]

Background and Aims: Muscle changes occur secondary to decreased mobility after stroke. This study correlated ultrasound characteristics of spastic muscles with motor impairment, spasticity, age, time after stroke, and functional measurements in chronic stroke survivors. Methods: Ultrasound assessments of muscle thickness and echogenicity (Heckmatt scale) and spasticity assessment were performed in the biceps brachii, flexor carpi ulnaris (FCU), quadriceps, and medial gastrocnemius muscles in 28 ambulatory stroke survivors (female:12; male: 16; ages: 57.8±11.8 yr, 76±45 months after stroke). Motor impairment (Fugl-Meyer motor assessment), spasticity and functional tests (grip strength, 10-meter walk test and timed up-and-go test) were performed. Results: Muscle thickness was decreased on the affected side when compared to the contralateral side (p< 0.00028). The decrease was more evident in the upper extremity muscles (F(1,27)=15.708, p=0.00049). The Heckmatt scale was lowest in the quadriceps muscle. However, both muscle thickness and echogenicity of these muscles did not correlate with spasticity, FMA scores, age, or time after stroke. There was a significant negative correlation between residual grip strength and muscle thickness for the FCU muscle on the affected side (r=-0.489, p=0.008). The quadriceps muscle thickness correlated with ambulatory function (timed up-and-go test (r=0.4347, p=0.021) and 10-m walking test (r=0.4059, p=0.032)). Such correlations suggested a function-related muscle changes. Conclusions: In this study, ambulatory stroke survivors had a significant decrease in muscle thickness and echogenicity on the affected side. These muscle changes were muscle-specific, but were not correlated with motor impairments, spasticity, age, or time after stroke.

  Clinical Sciences – Health Conditions – Cardiopulmonary System Top

  6370 - Impact of baseline cardiovascular risk in the effectiveness of conventional and hybrid cardiac rehabilitation programs Top

Rita Santos, José Bernardo Ferreira, Filipa Januário

Centro Hospitalar de Leiria - Physical and Rehabilitation Medicine Department, Rua das Olhalvas, Leiria, Portugal

E-mail: [email protected]

Background and Aim: Cardiac Rehabilitation (CR) is a cost-effective class 1a recommended domain of care for cardiovascular disease able to improve exercise capacity, risk factors and quality of life (QoL). Besides conventional CR program (CCRP), hybrid cardiac telerehabilitation program(HCTRP) recently emerged. Risk stratification in CR programs (CRP) guide appropriate exercise intensity and assure patient safety. The purpose of our study was to determine the impact of baseline cardiovascular risk among patients on CR phases 2(P2) and 3(P3) in terms of IMC, physical activity and QoL. Methods: Longitudinal retrospective study including patients who attended CRP between 2018-2021. Patients were divided in 2 groups: low and medium-high cardiovascular risk. Additional comparison was performed within 2 subgroups: CCRP/HCTRP. Data were assessed at P2 onset (T0), P3 onset (T1) and 3 months after P3 onset (T2); T0-T2: body mass index (BMI), International Physical Activity Questionnaire (IPAQ), EuroQol-5D (EQ-5D); T0-T1: estimated functional capacity (EFC) in cardiac stress test. Results: 59 patients, 35 low risk (13 CCRP/22 HCTRP), 24 medium-high risk (14 CCRP/10 HCTRP). Low risk group showed higher adherence to HCTRP (p=0.019). BMI significantly improved only in low risk group (p=0.016). IPAQ-MET significantly improved only in low risk group (p=<0.01) with further effect in HCTRP (p=0.03). EFC significantly improved in both groups with further effect in low risk (p<0.01) compared to medium-high risk group (p=0.03). QoL significantly improved in both groups. Conclusion: We observed that low risk group had overall further beneficial effects. Subgroup comparison showed further beneficial effects with HCTRP. More studies are necessary to assess the differences between low and moderate-high risk patients.

  5964 - Assessment of sarcopenia in post-COVID patients included in a rehabilitation program Top

Lucia Ros Dopico, Daniela Alexandres, Marta Colado, Maria Rosario Urbez

Department of Physical Medicine and Rehabilitation, Hospital Universitario La Paz, Madrid, Spain

E-mail: [email protected]

Background and Aim: Sarcopenia is characterised by accelerated loss of muscle mass and function due to ageing and physical inactivity. If untreated it leads to a poor quality of life and a high mortality rate. It is a major health consequence of the COVID-19 pandemic. The diagnosis of sarcopenia rests on muscle mass measurements that evaluate muscle strength.[1],[2] The aim of our study is to present the follow-up of a post-COVID cohort with an initial and final evaluation for sarcopenia, after an structured outpatient treatment program. 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. Patients underwent an evaluation of sarcopenia that included the SARC-F scale, dynamometry, and quadriceps ultrasound measurement. An 8-week outpatient program was implemented, including respiratory re-education, endurance, strength and flexibility training.[3] Results: 615 post-COVID patients were included, of which 63% met sarcopenia criteria. After an 8-week rehabilitation program SARC-F scores had, on average, improved by 2 points. 81% of patients had significantly increased their quadriceps strength, as measured by dynamometry. Similarly, quadriceps ultrasound showed a significant improvements in the area of the rectus femoris muscle, its thickness, as well as overall quadriceps thickness. Conclusion: According to our study, significant improvements were observed following a structured rehabilitation program in patients diagnosed with sarcopenia, as measured by the SARC-F scale, dynamometry and quadriceps ultrasound.


  1. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39:412-23.
  2. Perkisas S, Baudry S, Bauer J, Beckwée D, De Cock AM, Hobbelen H, et al. Application of ultrasound for muscle assessment in sarcopenia: Towards standardized measurements. Eur Geriatr Med 2018;9:739-57.
  3. Jarosch I. J Clin Med 2020;9:156. Available from: https://www.mdpi.com/2077-0383/9/5/1567.

  Clinical Sciences – Health Conditions – Musculoskeletal System (22) Top

  6864 - Effects of repeated injections of progressively higher doses of botulinum toxin in people with stroke on functional parameters of gait and lower limb hyper-resistance Top

Clara Selves, Stephanie Dehem, Marine Devis, Thierry Lejeune, Gaëtan Stoquart

Institut de Recherche Expérimentale et Clinique (IREC), Neuro Musculo Skeletal Lab (NMSK), Université catholique de Louvain, Belgium

E-mail: [email protected]

Background and Aim: Recommended maximum doses of botulinum neurotoxin (BONT) can limit the optimal injection pattern when muscle hyper-resistance (HR) is widespread. Few studies have been carried out on the effects of repeated cycles, despite it being standard of care. This study assessed the cumulative effect of 3 injection cycles, with increasing doses of BONT on functional gait capacity. Methods: Temporospatial parameters of gait (1st and 2nd domains-ICF) and HR (1st domain-ICF) were assessed in 32 people with HR after chronic stroke who underwent 3 BONT injection cycles every 3 months, with increasing total doses (400, 600 and 800 U of Xeomeen), both on lower and upper-limbs, according to HR pattern. Evaluation of walking capacity (quantified gait analysis -QGA- and clinical evaluations: 6MWT, 10mWT, stairs test, MAS) were performed before and 1 month after each injection cycle for a total of 6 evaluations. Results: RM-ANOVA showed significant improvements (p<0.05) compared to baseline on the 6MWT (+27m after cycle 2, +43.8m after cycle 3), the 10mWT (-1.6s after cycle 2), the stairs test (-13.7s after cycle 2, -14.8s after cycle 3) and various spatiotemporal parameters assessed by the QGA (after the 2nd and/or 3rd injection cycles). These parameters were not significantly altered after the 1st cycle. Significant reduction of HR on specific muscle groups (plantar flexors and knee extensors, p≤0.01) were observed after each injection cycle. Conclusion: this study showed significant effects on functional gait capacity after 3 injection cycles of increasing doses of BONT, that were not present after one cycle, demonstrating the superiority of cumulative injections of progressively higher doses on lower limb function of people with HR after stroke.

  6553 - Type 2 diabetes mellitus, physical activity and musculoskeletal complications: A Physiatrist's perspective from eastern part of India Top

Debasish Jena, Jagannatha Sahoo, Apurba Barman

Department of PMR, AlIMS Bhubaneswar, Sijija, Patrapada, Bhubaneswar, Odisha, India

E-mail: [email protected]

Background and Aim: Musculoskeletal complications are frequently encountered in persons with diabetes mellitus. Painful conditions of the musculoskeletal system (e.g. frozen shoulder, de Quervain's tenosynovitis, carpal tunnel syndrome, etc.), painful diabetic neuropathy, diabetic foot, etc. are among the most commonly diagnosed conditions by a physiatrist. We aim to explicitly evaluate the prevalence and the predictive factors of musculoskeletal complications and painful neuropathies among diabetics. Methods: We included 376 participants who were diagnosed with type 2 diabetes for at least one-year duration. All participants underwent screening for the presence of any musculoskeletal conditions and/or painful neuropathic conditions. Demographic parameters, duration since diagnosis of type 2 diabetes, level of physical activity, HbA1C level, anti-diabetic medications, and duration since onset of symptoms were recorded for each participant. Logistic regression was used to determine any association between the prevalence of complications and other variables. Results: A total of 162 participants were having the presence of one or more complications. A significant proportion of participants (n=276; 74.59%) reported of having a low level of physical activity. The presence of complications was associated with higher body mass index, longer duration of diabetes, higher HbA1C level, and low physical activity level. Conclusion: There is a substantial burden of musculoskeletal complications in diabetics that needs timely diagnosis and intervention. The importance of regular physical activity and strict glycemic control should be a part of routine care in patients with diabetes mellitus.

  6612 - Vitamin D levels in postacute hip fractured patients and their association with rehabilitation outcomes Top

Avital Hershkovitz, Gal Maydan

”Beit Rivka” Geriatric Rehabilitation Center, Ward “D,” Petach Tikva, Israel

E-mail: [email protected]

Background and Aim: To report on serum 25-hydroxyvitamin D (25(OH)D) levels in post-acute hip fractured patients, revealed the associations between serum 25(OH)D levels and hip fractured patients' baseline characteristics and rehabilitation outcomes. Methods: A retrospective study (9/2017-9/2020) of 493 hip fractured patients. 25(OH) D levels were recorded following the patients baseline characteristics and outcome measures, including the functional independence measure and motor functional independence measure effectiveness. The sample was divided into three groups: deficient (<30 nmol/l), insufficient (30-75 nmol/l) and sufficient (>75 nmol/l) 25(OH) D levels. ANOVA and chi square test tests compared the groups. Multiple linear analysis assessed the associations between the 25(OH) D and discharge functional independence measure score. Results: 25 (OH) D deficiency was found in 20.3% of the patients. The only baseline characteristic significantly associated with serum 25 (OH) D levels was dementia. The group with deficient levels of 25 (OH) D exhibited a significantly higher rate of low education, low admission albumin levels and a reduced handgrip strength compared to the insufficient/sufficient groups. All functional measure scores were significantly lower in the deficient (25(OH)D) group compared with the insufficient/sufficient patient groups. 25(OH) D levels were found to be significantly associated with the discharge functional independence measure score. Conclusion: Routine screening for 25(OH) D levels is mandatory in post-acute hip fracture patients as it may affect rehabilitation outcomes.

  6588 - Long-term evaluation of motor performance after anterior cruciate ligament reconstruction Top

Fabio Santacaterina1, Stefano Giachetti2, Valeria De Petris1, Federica Bressi1, Silvia Sterzi1, Marco Bravi1

1Department of Physical Medicine and Rehabilitation, Campus Bio-Medico University of Rome, Rome, Italy, 2Campus Bio-Medico University of Rome, Selcetta, Italy

E-mail: [email protected]

Background and Aim: Patients undergoing anterior cruciate ligament (ACL) reconstruction often show motor performance deficits at long-term follow-ups (FU) exposing them to an increased risk of re-injury and to a failure of achieving a pre-injury sports level. The purpose of the study is to compare objectively measured motor performance of patients underwent ACL reconstruction at a long-term FU (≥9 months) with a control group of healthy participants to verify the presence of long-term deficits. Methods: The sample includes 28 subjects equally distributed in two groups: experimental group (EG) and control group (CG). Biodex Balance SD was used to assess proprioception, two X-Sens MIMU sensors to assess knee Joint Position Sense (JPS), the G-Walk sensor was used for plyometrics assessment and the Chronojump force sensor was used to assess quadriceps and hamstring strength. Results: EG showed significant deficits compared to CG in knee JPS at 60° (p=0,014), in the postural stability test with closed eyes (p=0,039), in maximum voluntary isometric strength of knee flexion (p=0,002) as well as in all plyometric tests: Counter Movement Jump (p=0,012), Squat Jump (p=0,027), Counter Movement Jump with the use of arm-swing (p=0,005). Conclusion: The deficits that emerged in EG are elements that altogether represent an indicator of increased risk of re-injury after ACL reconstruction. Therefore, it is essential to provide a complete and objective assessments of the components that characterize the performance in order to early intercept these deficits and intervene to restore the correct motor patterns.


  1. Kaya D, Guney-Deniz H, Sayaca C, Calik M, Doral MN. Effects on lower extremity neuromuscular control exercises on knee proprioception, muscle strength, and functional level in patients with ACL reconstruction. Biomed Res Int 2019;2019:1694695.
  2. Laboute E, Verhaeghe E, Ucay O, Minden A. Evaluation kinaesthetic proprioceptive deficit after knee anterior cruciate ligament (ACL) reconstruction in athletes. J Exp Orthop 2019;6:6.
  3. Herrington L, Ghulam H, Comfort P. Quadriceps strength and functional performance after anterior cruciate ligament reconstruction in professional soccer players at time of return to sport. J Strenght Cond Res 2021;35:769-75.

  6354 - Evaluation of sarcopenia's prevalence in hospitalized patients using Ishii's formula Top

Ana Sousa Cavalheiro, João Rapazote Machado, Sandra Magalhães

Centro Hospitalar Universitário do Porto, Porto, Portugal

E-mail: [email protected]

Background and Aim: Sarcopenia is defined as progressive loss of skeletal muscle mass and strength, related to age and comorbidities.[1] Worldwide sarcopenia's prevalence varies between 10-40%, being associated with functional impairment, lower quality of life and higher mortality.[1] Sarcopenia can be estimated based on age, calf circumference and handgrip strength (Ishii's formula).[2] The aim of our study was to evaluate sarcopenia's prevalence and associated risk factors in hospitalized patients using Ishii's formula. Methods: We're developing an observational study at General Ward at Centro Hospitalar Universitário do Porto. We're applying Ishii's formula to patients admitted in December of 2021. Patients with severe dementia or edema were excluded. We analyzed data with Excel program. Results: So far, we included 21 patients (57% males, mean age 74, 2 years±10). Only one patient had a previous diagnose of sarcopenia. Estimated sarcopenia´s prevalence was 61, 9% (N=13), being higher in men and people with normal weight. In sarcopenic group, 69% had 3 or more comorbidities (OR=0, 8) and 77% were functional dependent (OR=10). We'll include more patients until the end of December and then analyse relationship with hospitalization time and complications. Conclusion: Our initial data show sarcopenia's prevalence is high, but underdiagnosed. Traditional diagnosis is complex and a simple and valid tool as Ishii's formula can help to improve diagnosis. We suggest screening all patients at admission to provide early rehabilitation and nutritional support.


  1. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Aging 2018;48:16-31.
  2. Ishii S, Tanaka T, Shibasaki K, Ouchi Y, Kikutani T, Higashiguchi T, et al. Development of a simple screening test for sarcopenia in older adults. Geriatr Gerontol Int 2014;14 Suppl 1:93-101.

  6282 - Guillain-Barré syndrome: Nutritional aspect of rehabilitation Top

Neža Majdic, Petra Poloncic, Monika Vošner, Primož Novak

URI - Soča University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia

E-mail: [email protected]

Background and Aim: Patients with Guillain-Barré syndrome (GBS) seem to be at high risk for inadequate nutrition throughout their illness yet the wider impact of malnutrition in this population remains unknown. The aim of this study was to evaluate the associations between functional and nutritional status at admission to inpatient rehabilitation for GBS and to determine whether the admission phase angle (PA), the measurement of the functionality of the cell membrane, is a prognostic indicator of functional improvement at the end of rehabilitation. Methods: We included 27 patients recovering from GBS who screened positive for nutritional risk (NRS-2002) upon admission to rehabilitation. Nutritional status was assessed using bioelectrical impedance. To determine functional motor improvement during rehabilitation, we calculated mFIM efficiency. For muscle strength assessment, the Medical Research Council sum score was used. Walking ability upon admission and discharge was also assessed. Results: According to the Global Leadership Initiative on Malnutrition criteria, the majority of participants were malnourished. A decreased PA was found in 93% (mean 3.7°, SD 1.3°). Phase angle and motor Functional Independence Measure (mFIM) at admission were moderately associated (r = 0.53, p = 0.005), suggesting that PA may be an indicator of functional status. At discharge, all patients improved functional independence and muscle strength, and the majority improved walking abilities. However, the correlation between admission PA and mFIM efficiency was not statistically significant (p = 0.3867). Conclusion: We conclude that low nutritional status is significantly associated with low functional independence and muscle strength at admission. Admission PA seems to be important but not the only predictor of functional improvement.

  6085 - Platelet-rich plasma injection and percutaneous microtenotomy for epicondylitis: Do the ultrasound findings predict the therapeutic response? 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, Portugal, 4Centro Hospitalar e Universitário de São João, Porto, Portugal, 5UCSP Macedo de Cavaleiros, Portugal

E-mail: [email protected]

Background and Aim: Ultrasound-guided platelet-rich plasma (PRP) injections, as well as percutaneous microtenotomy, are becoming increasingly popular in the treatment of epicondylitis. Whether ultrasound (US) findings predict the clinical benefit is unknown. This study aimed at investigating the relationship between US findings and the therapeutic response of the PRP injection following percutaneous microtenotomy in epicondylitis. Methods: Data regarding gender, age, US findings at baseline and pre- and post-intervention Numeric Pain Rating Scale (NPRS) scores were collected from patients' records. Pain improvement rates were calculated at 1, 3, 6 and 12 months (M) post-intervention. Results are stated as mean ± standard error of mean. Results: Data from 20 records of PRP injection following percutaneous microtenotomy were analyzed. Mean age was 48 years (55% men). Mean initial NPRS score was 7.5±0.3, with no statistically significant differences between the groups with or without tendon rupture and with or without calcification. Mean pain improvement rate was significantly higher in patients with versus without tendon rupture at 3M (51.1±10.5% vs 0.0±0.0%, p=0.025), 6M (78.6±7.9% vs 21.3±21.3%, p=0.014) and 12M (85.0±11.4% vs 11.3±11.3%, p=0.002). Regarding the presence of calcification on the US, the mean pain improvement rate was higher at 3M in the group with versus without calcification (95.9±5.0% vs 22.5±9.0%, p<0.001). Conclusion: Patients with calcification demonstrated a higher pain improvement rate at 3M, as well as those with tendon rupture at 3, 6 and 12M follow-up. These findings could be predictive of the clinical response to this technique, thus allowing a better selection of the candidates. To the best of our knowledge, no studies have been published analyzing this relationship.

  6060 - Extracorporeal shockwave therapy to reduce pain and improve foot functions Top

Taslim Uddin1, Shahina Sarkar2, Sunam Kumar Barua2

1Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh, 2Dhaka Medical College Hospital, Dhaka, Bangladesh

E-mail: [email protected]

Background and Aim: Plantar fasciitis (PF) is a common cause of heel pain, affecting more females than males of about 10% of the general population. This study aims to assess the effects of Extracorporeal Shockwave Therapy to reduce pain and improve foot functions in patients with PF. Methods: This was a randomized controlled study to assess the effects of Extracorporeal Shock Wave therapy (ESWT) in patients with foot pain and functional impairments due to plantar fasciitis. The study was conducted in the Department of Physical Medicine and Rehabilitation of the largest government tertiary hospital in Bangladesh during the period of July 2019 to June 2020. Results: A total of 74 patients with unilateral PF were enrolled randomly in the interventional group (ESWT group) and in the conventional treatment group. Outcome measures were pain and foot function assessed with the Visual Analogue Scale (VAS) and Foot Function Index (FFI) respectively. The VAS scores significantly decreased from 7.36 ± 1.18 to 2.10 ± 1.19 in patients after treatment with ESWT (p <0.001). The reduction of VAS score was significantly more in ESWT group compared to conventional treatment group at 4th week, and 8th week (p<0.05). The total FFI scores significantly decreased from 49.33 ± 5.64 to 18.81 ± 5.21 in patients after treatment with ESWT (p <0.001). Conclusion: ESWT was effective in patients with plantar fasciitis to reduce pain and improvement of functions. Though conservative treatment also improved pain and function of the foot, ESWT is more effective than conservative treatment.

  5941 - Vitamin D deficiency and osteoporosis in breast cancer women. A machine learning approach Top

Alessandro de Sire1, Luca Gallelli1, Nicola Marotta1, Lorenzo Lippi2, Antonio Ammendolia1, Marco Invernizzi2

1Department of Medical and Surgical Science, University of Catanzaro “Magna Graecia,” Catanzaro, Italy, 2Dipartimento di scienze della salute, University of Eastern Piedmont “A. Avogadro,” Novara, Italy

E-mail: [email protected]

Background and Aim: Hormonal treatment in breast cancer (BC) patients might be related to decrement in bone mineral density (BMD) and increase risk of fragility fractures. Despite the mechanisms behind the osteoporosis development in BC survivors being far from being fully characterized, vitamin D could represent a molecular target in the complex pathological framework of osteoporosis in BC. Therefore, this study aimed to evaluate the role of vitamin D deficiency in women with BC and its correlation with osteoporosis. Methods: This observational cross-sectional study recruited adult women in post-menopausal status, with a diagnosis of BC estrogen receptor-positive receiving hormone therapy. We performed a multiple factor analysis that could allow the analysis of several groups of variables, allowing the clustering of individuals through a machine learning model. The following data regarding bone health were analyzed: osteoporosis and osteopenia diagnosis; lumbar spine (LS) and femoral neck BMD, and serum levels of 25-hydroxy-vitamin D, calcium, and parathyroid hormone. Results: The study included 54 BC women, mean aged 67.3±8.2 years. Given a significantly low correlation with the LS BMD value, we assess the role of vitamin D via multiple factor analysis, reporting that the BMD determined the orientation of vector individuals, and vitamin D arranged cluster analysis with the same trajectories. Thus, we found a low prevalence of patients (5.6%) with adequate bone health and vitamin D serum levels in a cohort of BC women. Conclusion: The machine learning model underlined a strict association between bone health and vitamin D status. Therefore, vitamin D should be adequately assessed and treated to reduce the risk of fragility fractures in these frail subjects.

  5912 - Platelet-rich plasma in chronic epicondylitis: A prospective study Top

Rebeca Gomes1, Madalena Carvalho2, Tomás Ribeiro da Silva2, José Costa2, Teresa Mirco2, Francisco Sampaio2

1Northern Lisbon University Hospital Centre, CHULN - Hospital de Santa Maria, Lisboa, Portugal, 2CHULN - Hospital de Santa Maria, Lisbon, Portugal

E-mail: [email protected]

Background and Aim: Platelet-Rich Plasma (PRP) act as a bioactive therapy that promotes regeneration through the use of the patient's own growth factors and has been evaluated as a potential treatment option for patients with lateral epicondylitis, who have failed to respond to conservative treatment. This study aims to evaluate the therapeutic effect of PRP in patients with chronic epicondylitis, regarding pain and functionality. Methods: This is a prospective, observational study, started in August 2021, with an estimated duration of 9 months, which will include patients diagnosed with chronic epicondylitis, with at least 3 months of symptoms based on clinical and ultrasound findings, who have failed to conservative therapy. The PRP will be prepared from venous whole blood and the final concentration of platelets will be 3 to 4 times the basal concentration. Each patient will receive a single ultrasound-guided dose of PRP injection (3mL). The clinical response, was assessed by Visual Analogue Scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) prior to injection and 2 and 6 weeks post-injection. Results: Results for PRP treatment of lateral epicondyle tendinopathy (LET) have been promising. Some RCTs have demonstrated the efficacy of PRP for treating chronic LET, with superior improvement to steroid injection at 1 and 2 years. Despite the promising results, its efficacy is still controversial. Conclusion: The study results will provide insight into the effect of PRP in the treatment of chronic epicondylitis. It would also be relevant to evaluate these patients for longer follow-up periods to assess long-term efficacy.

  5883 - Virtual reality-based serious games rehabilitation improves gait kinematics in persons with total knee replacement Top

Michela Goffredo, Sanaz Pournajaf, Leonardo Pellicciari, Debora Gabbani, Simone Criscuolo, Simone Petruccelli, Carlo Damiani, Marco Franceschini

Department of Neurological and Rehabilitation Sciences, Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, Rome, Italy

E-mail: [email protected]

Background and Aim: Individuals with Total Knee Replacement (TKR) usually show gait and balance impairments.[1] Although Virtual Reality (VR) and Serious Games (SGs) have been recently introduced for the rehabilitation of TKR patients,[2] the literature is limited. This randomised controlled trial aims to assess the efficacy of rehabilitation using non-immersive VR-based SGs compared to conventional therapy in TKR patients. Methods: Fifty-six subjects were enrolled (<10 days after unilateral TKR surgery) and were randomly allocated to the Experimental Group (EG) or Control Group (CG) for 15 sessions (45 min; 5 times per week) of non-immersive VR-based SGs (VRRS, Khymeia s.r.l., IT) or conventional balance training, respectively. Clinical and instrumental gait and postural assessments were performed before and after treatment. Two-way repeated-measures ANOVA was used (p<0.05). Results: Significant within-group differences were registered in all clinical outcomes. The gait analysis revealed significant between-group differences in the stance time of the affected limb (p=0.022) and in Gait Profile Scores of knee flexion/extension (p=0.003). The post-hoc analysis revealed within-group differences in the stance time of the affected limb in the EG (p=0.002) but not CG (p=0.834). Significant within-group differences in posturography (longitudinal Centre of Pressure range and limb loading symmetry) were found. Conclusion: Rehabilitation with non-immersive VR-based SGs can improve clinical, gait, and postural outcomes in TKR patients similarly to the conventional approach. The EG significantly improved the stance time at the end of the treatment more than the CG.


  1. Clark RA, Osteoarthritis Cartilage 2017;25:42-5.
  2. Blasco JM. Physiother Theory Pract 2019;17:1-11.

  5745 - Multidisciplinary rehabilitation for older people with hip fractures – The Cochrane collaboration 2021 systematic review Top

Ian Cameron1, Helen Handoll2, Jenson Mak3, Claire Panagoda3, Terrence Finnegan4

1Sydney Medical School, University of Sydney, St Leonards, Sydney, NSW, Australia, 2Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, England, 3John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, Australia, 4Department of Aged Care and Rehabilitation Medicine, Royal North Shore Hospital of Sydney, St Leonards, Australia

E-mail: [email protected]

Background and Aim: To assess the effects of multidisciplinary rehabilitation, in either inpatient or ambulatory care settings, for older people with hip fracture. Methods: We included randomized and quasi-randomized trials of post-surgical care using multidisciplinary rehabilitation of older people (aged 65 years or over) with hip fracture. The primary outcome - 'poor outcome' - was a composite of mortality and decline in residential status at long-term (generally one year) follow-up. We pooled data where appropriate and used GRADE for assessing the certainty of evidence for each outcome. Results: The 28 included trials involved 5351 older (mean ages ranged from 76.5 to 87 years), usually female, participants who had undergone hip fracture surgery. Multidisciplinary rehabilitation probably results in fewer cases of 'poor outcome' (death or deterioration in residential status, generally requiring institutional care) at 6 to 12 months' follow-up (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.80 to 0.98; 13 studies, 3036 participants; moderate-certainty evidence). In the ambulatory setting there is insufficient data. Conclusion: In a hospital inpatient setting, there is moderate-certainty evidence that rehabilitation after hip fracture surgery is effective. We suggest that research is best orientated towards early supported discharge and identifying the components of multidisciplinary inpatient rehabilitation to optimise patient recovery within hospital and the components of multidisciplinary rehabilitation, including social care, subsequent to hospital discharge.


  1. Handoll HH, Cameron ID, Mak JC, Panagoda CE, Finnegan TP. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev 2021;11:CD007125.

  5493 - Functional evaluation of patients hospitalized with COVID-19 before discharge Top

Maria Paz Grisales, Katalina Espinosa, Leonardo Arce, Maria Ana Tovar

Department of Physical and Rehabilitation Medicine, Universidad del Valle, Cali, Colombia

E-mail: [email protected]

Background and Aim: There are more than 220,000,000 survivors of Covid-19 infection, with frequent, long-lasting symptoms after the infection. This implies functional compromise and an increase in rehabilitation needs. Nevertheless, there is still a gap in knowledge of specific functional compromise. Methods: We present a cross-sectional study of adults with Covid-19 infection evaluated before discharge. Age, sex, comorbidities, hospitalization, ICU and intubation requirements, FIM, Post Covid Functional Status Scale (PCFS), TUG, and MMT of elbow and hip flexors, and knee extensor were recorded. The ethics committee approved this study. Results: We collected 108 patients with an average age of 60 years, 46.3% female. The most frequent comorbidity was HBP. Median hospitalization was 30 days, 81, 5% required ICU, and 31.4% intubation. FIM scores median was 108 points, with more compromise in the motor domain, and PCFS of 3, implying most patients had limitations for everyday activities. Most patients couldn't complete the TUG. Conclusion: unctional compromise in Covid-19 patients is primarily related to motor compromise leading to limitations in everyday activities.


  1. Ministry of Health and Social Protection. Colombia. Coronavirus COVID-19. Available from: https://bit.ly/2ZczkEw.
  2. Stam HJ, Stucki G, Bickenbach J; European Academy of Rehabilitation Medicine. COVID-19 and post intensive care syndrome: A call for action. J Rehabil Med 2020;52:jrm00044.

  5384 - Relationship between number of chronic diseases and low back pain severity and persistence Top

Saud Alsubaie1, Abdulaziz Alkathiry2

1Department of Physical Therapy and Health Rehabilitation, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia, 2Majmaah University, Al Majma'ah, Saudi Arabia

E-mail: [email protected]

Background and Aim: Low back pain (LBP) is a global problem that affects around 10-30% of people and limits their mobility. To date, there is little information about the relationship of chronic diseases to the severity of LBP and the extent of the pain persistence. The aim of this study was to assess the relationship between the number of chronic diseases and the severity and persistence of LBP. Methods: 2601 adults from Saudi Arabia were selected randomly (mean age 33±11, 61% female). The participants of the study were surveyed whether they had LBP during the last year, and if so, they were asked about the severity of the pain on a scale from 0 to 10, where 0 means no pain and 10 means extreme pain, and how long the pain lasted in days. In addition, participants were asked if they had any chronic diseases. Mann-Whitney U test was used to assess the difference in LBP's severity and persistence between those with and without chronic diseases. Spearman Correlation was used to investigate the relationship between the number of chronic diseases and the severity and persistence of LBP. Results: 2,601 adults participated in the survey, 2181 (83.8%) of whom had LBP either new onset or recurrent LBP within the past 12 months. 356 (16.3%) of those who had LBP had one or more chronic diseases. Having one or more chronic diseases significantly increased pain severity (No chronic diseases = 5.8±2.4, chronic diseases = 6.5±2.4, p<0.001) and pain persistence (No chronic diseases = 65.3±126.9, chronic diseases = 119.9±162.3, p<0.001). There was a weak significant relationship between number of chronic disease and both LBP severity (r = 0.109, p<0.001) and LBP persistence (r = 0.174, p<0.001). Conclusion: The presence of chronic diseases increases the severity and persistence of LBP.

  4343 - Transcutaneous osseointegrated prosthetic systems for transfemoral amputees – A six-year retrospective analysis of the latest prosthetic design in Germany Top

Alexander Ranker1, Aschoff Horst2

1Department of Rehabilitation Medicine, Hannover Medical School (MHH), Hanover, Germany, 2Department of Trauma, Hannover Medical School (MHH), Hanover, Germany

E-mail: [email protected]

Background and Aim: The Rehabilitation of Lower Limb Amputees needs a special competency and is obviously a medical field of PRM. Therefore advantages and disadvantages as well as complications of several treatment methods should be known in order to ensure high rehabilitation quality. Transcutaneous osseointegrated prosthetic systems (TOPS) after lower limb amputation (LLA) are hardly known, although they already exist more than 20 years. Especially in Germany the Implantation-rates are increasing and rehabilitative demand is higher than ever. Methods: A retrospective analysis of clinical outcomes and complication rates of 64 patients with LLA treated with the latest implant design of TOPS in Germany was performed to gain specific information on long-term complications of this treatment-method. This should highlight frequent complications and identify specific need of this group of patients regarding an beneficial rehabilitation. Results: Average observation time was 6.3(±2.2) years. The mean age of the patients was 51.8(± 12.1) years. The complications were divided into stoma problems, orthopaedic-technical (OT) problems, fractures and explantations. Descriptive statistics and ratio information about occurred complications were calculated. Stoma-associated problems had the highest incidence (7%) among all observed patient-related complications and posed the greatest challenges during the rehabilitation process. In total, 15% had technical problems, 6% had peri-prosthetic fractures, 7% had stoma problems and 3% had to be explanted due to infection. Conclusion: The analysis shows that the greatest challenges in the rehabilitation process after TOPS-Implantation are the avoidance of stoma complications and technical issues. Therefore a specialized interdisciplinary Rehabilitation-Team is needed.

  Clinical Sciences – Health Conditions – Nervous System Top

  6832 - Standing behaviors after stroke explained by posturography. Cross-sectional study of the subacute phase Top

Dominic Perennou1, Adèle Chauvin2, Camille Lemaire2, Céline Piscicelli2, Aurélien Hugues2, Shenhao Dai2

1Department of NeuroRehabilitation South Hospital, Univ. Grenoble Alpes, UMR CNRS 5105 Neuropsychology and NeuroCognition, CHU Grenoble Alpes, Grenoble, France, 2UGA UFRM Univ. Grenoble Alpes, UMR CNRS 5105 Neuropsychology and NeuroCognition, CHU Grenoble Alpes, Grenoble, France

E-mail: [email protected]

Background and Aim: The value of posturography after stroke is debated. We aimed to analyze how posturography may explain standing behavior after a subacute stroke. Methods: This cross-sectional study was ancillary to the DOBRAS cohort. Patients after a first hemispheric stroke were assessed (3 trials with and without vision). Mass distribution, position and stabilization indices in mediolateral (ML) and antero-posterior (AP) axes were computed. Balance ability in daily life was quantified with the Postural Assessment Scale for Stroke. Data were analyzed by principal component and hierarchical clustering analyses as well as multiple linear regression. Results: We enrolled 95 individuals (median age: 67.0 years; 68% males). Vision had a marginal effect on indices and only stabilization indices. Regardless of the visual condition, posturographic behavior was captured by a set of 3 indices. With vision, one stabilization index (ML or AP) gave more information (47.5%) than both position indices (ML: 26.2%; AP: 14.7%). These 3 indices identified 3 standing behaviors: 1) stable and symmetric, 2) asymmetric, unstable, and positioned backward, and 3) very unstable and positioned forward. Balance ability in daily life was explained (49%, 95%CI(35; 63)) by weight-bearing asymmetry and stabilization on the ML axis, which played an independent role (both p<10-5), with similar impact. Conclusion: Three typical behaviors allow for standing after stroke. Weight-bearing asymmetry is not the primary parameter and should not be considered in isolation as an outcome in routine care or research. Trials without vision are not necessary for describing post-stroke standing behavior. Not performing such trials could increase the feasibility of posturography used in the early subacute phase and to simplify and shorten evaluation sessions.

  6375 - Assessing the impact of vestibular impairments: How patient-reported and objective instruments correlate? Top

Mafalda Oliveira, Tiago Moreira, Ana Vaz, Susana Moreira

Centro Hospitalar Universitário de São João, Porto, Portugal

E-mail: [email protected]

Background and Aim: The impact of vertigo, dizziness and unsteadiness on individual's function and participation results in severe limitations in quality of life. Scales are fundamental tools to quantify the patients' limitations, develop treatment plans and access the progress. The purpose of this study was to assess the correlation between objective evaluations [with Berg balance scale (BBS) and number of falls] and self-reported scores [activities-specific balance confidence scale (ABC), falls efficacy scale (FES) and dizziness handicap inventory scale (DHI)], on a sample of patients with vestibular dysfunction. Methods: Cross-sectional analysis, including adult patients referred to a vestibular rehabilitation appointment due to vertigo, dizziness, or unsteadiness. BBS, ABC, FES and DHI were applied. Data analysis was performed using the software SPSS by an independent investigator. Results: 70 patients were included, mostly woman (65, 7%), with a mean age of 63 years-old. A significant correlation between the BBS and the DHI (p=0.020; r: -0.30) and the ABC (p=0.004, r: 0.40) was depicted. There was no significant correlation between BBS and FES (p=0.073; r: -0.22). Correlation between number of falls on the last 6 months and BBS, DHI, ABC and FES were also analyzed: a significant correlation with BBS was found (p=0.039; r: -0.26) though no significative results were reported with the patient-reported scales. Conclusion: We highlight that BBS is a useful tool on vestibular rehabilitation appointments, due to its' correlation to both subjective and objective measures. Patient-reported tools, such as DHI and ABC, also correlate significantly with objective measures (BBS), pointing out to the predictive value of patients complains on the clinically assessed deficits.

  6450 - Pragmatic clinical management of stroke-related epilepsy during intensive inpatient rehabilitation: An insight from the RIPS study Top

Francesca Cecchi1, Maenia Scarpino2, Silvia Campagnini3, Antonio Maiorelli4, Raisa Sterpu3, Alessandro Sodero3, Erika Guolo3, Bahia Hakiki3, Paolo Mainardi3, Andrea Mannini3, Benedetta Basagni3, Maria Chiara Carrozza4, Claudio Macchi3, Antonello Grippo4

1Department of Clinical and Experimental Medicine, University of Firenze, IRCCS Fondazione don Carlo Gnocchi, Firenze, Italy, 2Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy, 3IRCCS Fondazione don Carlo Gnocchi, Firenze, Italy, 4The Biorobotics Institute, Scuola Superiore Sant' Anna, Pisa, Italy

E-mail: [email protected]

Background and Aim: We investigated the incidence of early seizures, EEG abnormalities and Antiepileptic Treatment (AED) in post-stroke patients admitted to the Intensive Rehabilitation Unit (IRU). Methods: Prospective cohort of 166 consecutive patients followed for 6 months. We analysed the occurrence of seizures and AED treatment at the IRU admission (T0), at the IRU discharge (T1) and six-month follow-up (T2). EEG was recorded within 72 h after admission and at a 6-month follow-up. Results: We identified three groups of patients: a) patients treated at T0 in the absence of seizures (12), most of whom discontinued AED at T1 and T2 (10); b) patients receiving therapy during hospitalisation because of early seizure onset (6); c) patients receiving therapy during hospitalisation for seizure onset during IRU stay (11). At follow-up, the patients with AED reduced from 13.5% at admission to 3.2%, and the number of patients with antiepileptic treatment without the presence of abnormalities or crisis was reduced [Table 1]. Treatments with Valproic acid, Lorazepam, Gabapentin and Carbamazepine or those combined were withdrawn during rehabilitation stay, and, at follow-up, only Levetiracetam and Lacosamide were registered. Conclusion: The rehabilitation stay provides an excellent time frame to safely modify the AEDs of stroke patients, based on both the clinical evaluations and the EEG examinations. The management of post-stroke seizures can be a further aim of the Individual Rehabilitation Project, as timely and appropriate interventions may improve functional outcomes in post-stroke patients.

Table 1: Sample characteristics on the overall sample and the groups with/without epileptic anomalies and antiepileptic treatment

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  6015 - Rehabilitation of patients after COVID-19 and respiratory failure with consequent critical illness disease in Slovenia Top

Primož Novak, Neža Majdic

1Department for Rehabilitation After Trauma, University Rehabilitation Institute, Republic of Slovenia, Ljubljana, Slovenia

E-mail: [email protected]

Background and Aim: SARS-CoV-2 infection can cause pneumonia and respiratory failure with consequent Post Intensive Care Syndrome (PICS) including Critical Illness Neuropathy (CIN) and Critical Illness Myopathy (CIM). The aim of our study was to evaluate rehabilitation outcome in these patients. Methods: 50 patients (14 women, 36 men) with CIN or CIM as a consequence of COVID-19 and respiratory failure were included in the study. Nutritional status was assessed using anthropometric measurements and Bioelectrical Impedance Analysis (BIA). Patients' activities were assessed using the Functional Independence Measure (FIM), The Canadian Occupational Performance Measure (COPM), 10 Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), and the de Morton Mobility Index (DEMMI). Assessment was performed at admission and at discharge. In addition, psychological evaluation was performed at admission. Results: At admission, severe malnutrition and activity limitations were present in all patients. Psychological problems were noticed in about one third of patients. At discharge, clinically important and statistically significant improvements were found in all outcome measures and were also recognized by the patients (p<0.001). Improvement in patients' activities, as assessed with motor FIM, increased significantly with time for up to two months of rehabilitation The correlation was moderate (rho = 0.55, p<0.001). The rehabilitation efficacy, assessed with motor FIM gain, was 0.8 points per day. Conclusion: Our program seems to be effective, as, in a relatively short period of inpatient rehabilitation, patients achieved important and significant improvement in their functional status and activities.

  5996 - Randomized clinical trial to evaluate the efficacy of a new method of gait rehabilitation in PD based on the activation of the foot off moment Top

Saikal Ismailova, Semen Prokopenko

Department of Nervous Diseases with a Course of Postgraduate Education, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 1, Partizan Zheleznyak Str., Krasnoyarsk, Russia

E-mail: [email protected]

Background and Aim: The aim of the study is to evaluate the efficacy of a new method of gait rehabilitation in PD based on the activation of the foot off moment. The idea of the method is mechanical activation of the foot off moment by means of “stimulating platforms”. The platforms are fixed on the patient's leg and, thanks to the spring base, help to lift the foot from the floor, bring the foot forward, increasing the length and height of the step. Methods: The study included 60 patients with PD, 2-3 stage by Hoehn-Yahr, akinetic-rigid and mixed form. Patients were randomized into 2 groups: in the 1st group, patients walked in stimulating platforms, and in the 2nd group, patients walked without platforms in their usual shoes for 30-40'. Each patient of the 1st group had 14 sessions of 30-40' using the method under discussion. Before and after the course of rehabilitation, research methods were: neurological exam, objective assessment kinematic gait parameters, 3D Video motion analysis, UPDRS, BBS and DGI. Results: According to the objective assessment of the kinematic gait parameters, statistically significant improvements were found in the main parameters of gait: step length (before 0,47 (0,41; 0,56) and after 0,54 (0,47; 0,63) m) and walking speed (before 0,77 (0,58; 0,92) and after 0,88 (0,74;1,19) m/s;), (p<0,01)). The steps became longer (on average by 10 cm) and longer, and the walking speed increased. Conclusion: According to assessment of gait by 3D video motion analysis we observed improvement of the basic parameters of the gait: reduction the double and single support time, increased step length, walking speed, reduced time of foot off moment, increased angle of plantar extension. Positive changes were confirmed by the results of functional scales. No statistically significant changes were detected in the comparison with the 2nd group.

  5719 - Impact of the COVID-19 pandemic on individuals with spinal cord injury: Mental health and use of telehealth Top

Andrei Krassioukov1, Adam Mesa1, Mark Grasdal1, Sarah Leong2, Nikolaus Dean3, Arshdeep Marwaha1, Amanda Lee1, Michael Berger1, Andrea Bundon1

1ICORD, University of British Columbia, British Columbia, Canada, 2Treloar Physiotherapy Clinic, Vancouver, Canada, 3Faculty of Education, University of British Columbia, British Columbia, Canada

E-mail: [email protected]

Background and Aim: Limited access to healthcare services and the self-isolation measures due to the COVID-19 pandemic may have had additional unintended negative effects, impacting the health of individuals with spinal cord injury (SCI). We aimed to examine the perceived impacts of the COVID-19 pandemic on individuals with SCI living in community. First, this study looked to understand how the pandemic affected the use and perception of telehealth services for these individuals. Second, it investigated the impact of COVID-19 on mental health. Methods: Individuals with SCI living in the community in British Columbia, Canada responded to online survey. Results: This survey was offered to individuals with SCI with 71 (89%) respondents with 34% living in a rural setting and 66% in an urban setting. Telehealth use in the SCI population has increased from 9.9% to 25.4% over the pandemic, with rates of telehealth use in urban centres nearing those of rural participants. 31.0% of respondents had probable depression and 7.0% had probable generalized anxiety disorder as measured by a score of ≥10 on the PHQ-9 and GAD-7 respectively. The mean sum of scores on FCV-19S and PVD were 17.0 (6.6 SD) and 64.3 (15.3 SD) respectively. Conclusion: Telehealth use during COVID-19 has more than doubled. It is generally well regarded by respondents, though only a quarter of the SCI population have reported its use. With this in mind it is important to understand what barriers there are to further adoption. In addition, higher rates of probable depression were seen than those estimated by pre-pandemic studies in other countries, with correlations between poor mental health and fear of COVID-19.

  5995 - Lesion effects on spasticity versus impaired voluntary movement in the hemiparetic upper limb Top

Silvi Frenkel-Toledo1, Mindy F. Levin2, Dario G. Liebermann3, Sigal Berman4, Melanie C. Baniña2, John M. Solomon5, Shay Ofir-Geva6, Nachum Soroker6

1Ariel University, Ariel, Israel, 2Center for Interdisciplinary Research in Rehabilitation, McGill University, Montreal, Canada, 3Department of Physical Therapy, Tel-Aviv University, Tel-Aviv, Israel, 4Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Israel, 5Department of Physiotherapy, Manipal Academy of Higher Education, Manipal, Karnataka, India, 6Loewenstein Rehabilitation Medical Center, Raanana, Israel and Tel-Aviv University, Tel Aviv, Israel

E-mail: [email protected]

Background and Aim: Hemiparesis and spasticity are primary stroke-related motor impairments that affect upper limb function and quality of life. The neural relationship between impaired precision and force in voluntary movement (hemiparesis) and the increment in muscle tone that stems from dysregulated activity of the stretch reflex (spasticity), is far from clear. Aim of this study was to investigate whether variation in stroke lesion topography affects spasticity and hemiparesis in a similar or distinct manner. Methods: Hemiparesis of the upper limb was assessed by the Fugl-Meyer assessment (FMA-UE) and elbow flexor spasticity was assessed by the Tonic Stretch Reflex Threshold (TSRT) in 41 post stroke patients in the sub-acute phase. Lesion effects were analyzed using voxel-based lesion-symptom mapping (VLSM). Results: Both FMA-UE and TSRT were affected by damage to peri-Sylvian cortical and subcortical regions and the putamen. In addition, FMA-UE scores were selectively affected by damage to the corticospinal tract in corona-radiata and capsular levels, and by damage to white-matter association tracts and additional regions in the temporal cortex and pallidum. Conjunction VLSM analysis disclosed voxel clusters where the existence of damage affected significantly both the FMA-UE and TSRT. However, the majority of VLSM “significant” voxels were related specifically either to FMA-UE or to TSRT. Conclusion: The findings shed new light on the functional neuroanatomy of (a) movement control and (b) tone regulation. The former function is mediated by a much larger neural substrate, with only a small part of it being shared by the latter function.

  5837 - A process evaluation of patient care needs using the poststroke checklist in the rehabilitation setting Top

Bhasker Amatya, Alaeldin Elmalik, Su Yi Lee, Krystal Song, Mary Galea, Fary Khan

Royal Melbourne Hospital, Parkville, Victoria, Australia

E-mail: [email protected]

Background and Aim: Regular assessment and follow-up is integral to identifying the clinical needs (and unmet needs) of the patients with stroke (PwS). This study aimed to assess the utility of the modified Post-Stroke Checklist (mPSC) to identify impairments and care needs of PwS in an inpatient rehabilitation setting in Australia. Methods: A prospective observational design study with consecutive admission of PwS (n = 44) at a tertiary rehabilitation facility. mPSC was administered at discharge (T1) and 3-month post-discharge (T2). Further, various questionnaires were used to assess function and participation on admission, which included: Functional Independence Measure (FIM), Clinical Functioning Information Tool (ClinFIT), Euro-Quality of life (EQ-5D-5L). Results: Participants' mean age was 67.7±14.6 years (58% female).At T1, 80% reported ≥1 stroke-related problems and only 60% at T2 (mean = 5.3±3.3 and 3.6±2.8 respectively) in mPSC. The most prevalent problems included: life after stroke (62.2%), fatigue (55.6%), activities of daily living and mobility (51.1% each). Compared with T1, at T2 there was an observed reduction in all mPSC items, except pain and incontinence. Participants showed significant improvement in functional and cognitive outcomes at both T1 and T2, as confirmed by FIM and ClinFIT set scores (p <0.001 for all). The QoL and overall health of participants improved significantly (EQ-5D-5L) (p <0.001 for all), with large effect sizes. The majority of treating clinicians (87%) involved in the study were satisfied using mPSC. Conclusion: mPSC is a useful tool to identify relevant stroke-related problems to facilitate targeted intervention. It assisted in identifying patients' needs, improved communication, and therapeutic decision-making.

  5680 - One-year single center study of poststroke dysphagia: Predictive factors, impact and how to improve our approach Top

Vitor Costa Pereira1, Luís Fontão2, Gonçalo Engenheiro3, Luísa Pinto3, Filipa Gouveia3, Jorge Moreira3, Catarina Aguiar Branco3

1Department of Physical and Rehabilitation Medicine, Centro Hospitalar Entre Douro e Vouga, Rua Doutor Cândido Pinho, Santa Maria da Feira, Portugal, 2Department of Neurology, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal, 3Department of Physical and Rehabilitation Medicine, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal

E-mail: [email protected]

Background and Aim: Dysphagia is a common manifestation after stroke and seems to play a major role in clinical and functional outcomes. This study aims to assess the impact of dysphagia after stroke, not only in the acute phase (identifying possible predictors of higher degrees of dysphagia), but also throughout the first year after the event, trying to understand how we can improve our approach. Methods: We studied 311 patients admitted in an acute stroke unit. The relationship of dysphagia with different outcomes, both in the acute phase and within the first year after stroke, were investigated. Results: Our study showed, using the Pearson correlation coefficient, that NIHSS score at admission is positively correlated with the degree of dysphagia (r = 0,783; p<0,001) and total anterior circulation infarcts and age (>70 years) are also associated with higher risk of dysphagia (p<0.001). Both in acute phase and in the first year after stroke, respiratory infections and mortality occurred at significantly higher rates for dysphagic patients (p<0.001). These patients stayed longer in the stroke unit, with less chance to be discharged home. Among patients with dysphagia, 27.6% were referred during the first year after the event to specific dysphagia consultation in our department. After clinical evaluation of swallowing (including videofluoroscopy) and respective therapeutic orientation, it allowed to reduce the rates of respiratory infection, readmission and mortality. Conclusion: The presence of the above-mentioned dysphagia predictive factors should alert us to the need for an early approach to dysphagia in the stroke unit. Our study also showed that the clinical intervention carried out in a specific dysphagia consultation had an impact on the reduction of complications.

  5579 - Scimbiont - microbiome and gut dysbiosis in spinal cord injury rehabilitation Top

Maria Cunha1, Bárbara Sousa2, Fátima Gandarez1, Dário Trindade2, Arminda Lopes3, Ana Margarida Sousa2, Sandra Vieira2

1Centro de Reabilitaçao do Norte, SCI Rehab Unit, Valadares, Vila Nova de Gaia, Portugal, 2Institute of Biomedicine, Aveiro University, Aveiro, Portugal, 3Centro de Reabilitaçao do Sul, Hospital do Algarve, Sao Brás de Alportel, Algarve, Portugal

E-mail: [email protected]

Background and Aim: Spinal cord injury (SCI) is a complex and devastating neuropathology with consequences on multiple organs and systems that reduces patient's functionality and quality of life. Among the highly incident complications and comorbidities that greatly impact SCI patients' is neurogenic bowel dysfunction, and potentially gut dysbiosis. This has been correlated to immune and neurological functions and can highly impact the patients' health status. Aim of the study was to characterize the microbiome and the gut dysbiosis of a cohort of subacute SCI patients, pre- and post- a comprehensive rehabilitation program, and correlate these with neuromotor and functional recovery. Methods: An observational longitudinal case-control prospective study was performed in adult traumatic SCI patients, >T5 level, AIS A–D, enrolled when admitted as inpatients for rehabilitation (early subacute phase). Collection of clinical data and feces samples took place at admission (T1) and discharge (T2). Bacterial DNA was extracted from fecal samples and the 16S RNA sequences of the gastrointestinal microbiome determined. Main outcome measures: clinical data (including AIS classification and functional assessments), gut microbiome and neurogenic bowel management. Results: The microbiota of this cohort was characterized, and associations studies were performed between clinical and microbiota data, to improve our understanding on the impact of gut dysbiosis in subacute SCI, namely on these patients' rehabilitation. Conclusion: The gastrointestinal microbiota of the sub-acute traumatic SCI patients is altered and has deleterious effects. A therapeutic intervention on the gut dysbiosis can be a viable 'non-spinal centric' alternative that increase SCI patients' rehabilitation.

  5545 - Brain lesion correlates of poststroke delirium and spatial neglect Top

Olga Boukrina1, Timothy Rich1, Sara K. Rostanski2, A. M. Barrett3

1Kessler Foundation, West Orange, New Jersey, USA, 2NYU Langone Medical Center, New York, USA, 3Emory University School of Medicine, Atlanta, Georgia

E-mail: [email protected]

Background and Aim: After a stroke, individuals are at a major risk for developing delirium, an acute reduction of cognitive functioning, affecting awareness, thinking, attention, and memory. Right-brain stroke is linked with higher delirium incidence, which may be due to spatial neglect (SN), a right-brain disorder of spatial processing and attention. This study aimed to determine if brain lesions associated with delirium and SN symptoms affect common neural networks for attention, orientation, and arousal. Methods: 42 right-hemisphere ischemic stroke patients were assessed prospectively with validated delirium and SN assessments. Clinical or research brain scans were used to map stroke lesions and conduct Voxelwise Lesion Symptom Mapping, which identified lesion locations associated with more severe delirium and SN symptoms, independent of lesion size. Results: 8 participants (19%) met criteria for delirium and 23 participants (36%) had SN. Continuous delirium and SN measures were correlated when controlling for age. Lesions in the right hippocampus, pallidum/basal forebrain, caudate nucleus, occipital pole, and the fusiform gyrus were associated with increased delirium symptom severity. Lesions in the right fusiform, cuneus, precuneus, parahippocampal, middle temporal, superior frontal gyri, the surrounding white matter, and thalamus, the were associated with SN symptoms. Conclusion: A common disturbance to the ascending arousal network and cortical-subcortical structures that support attention and orientation may underlie both post-stroke delirium and SN. Predictive risk assessment based on neuroimaging and behavioral studies could drastically improve prevention of poor outcomes following delirium by targeting early assessment and treatment of those at risk.

  5531 - Scale-attentional U-Net for the segmentation of the median nerve in ultrasound images Top

Beom Suk Kim1, Minhyeong Yu2, Sunwoo Kim2, Seungjun Baek2

1Department of Physical Medicine and Rehabilitation, Uijeongbu Eulji Medical Center, Eulji University, Dongil-ro, Gyeonggi-do, South Korea, 2Department of Computer Science and Engineering, Korea University, Seoul, South Korea

E-mail: [email protected]

Background and Aim: To develop a neural network which accurately and effectively segments the median nerve in ultrasound (US) images. Methods: A total of 1305 images of the median nerve of 123 normal subjects were used to train and evaluate the model. Four datasets from two measurement regions (wrist and forearm) of the nerve and two US machines were used. The neural network was designed for high accuracy by combining information at multiple scales, as well as for high efficiency to prevent overfitting. We designed the model in two parts: cascaded and factorized convolutions followed by self-attention over scale and channel features. The precision, recall, Dice similarity coefficient (DSC) and Hausdorff distance (HD) were used as performance metrics. The area under the receiver operating characteristic curve (AUC) was also assessed. Results: In wrist datasets, our network achieved 92.7% and 90.3% precision, 92.4% and 89.8% recall, 92.3% and 89.7% DSC, HD of 5.158 and 4.966 and AUC of 0.9755 and 0.9399 on two machines. In forearm datasets, 79.3% and 87.8% precision, 76.0% and 85.0% recall, 76.1% and 85.8% DSC, HD of 5.206 and 4.527 and AUC of 0.8846 and 0.9150 were achieved. In all datasets, our model achieved the best performance in terms of DSC as compared to previous U-Net based systems. Conclusion: The proposed neural network yields accurate segmentation results to assist clinicians for identifying the median nerve

  5407 - Oropharyngeal dysphagia evolution in traumatic brain injury patients with severe alteration of consciousness Top

Eric Verin, Gregoire Prum, Anna Cadeau, Remi Mallart

Department of Physical and Rehabilitation Medecine, Rouen, France

E-mail: [email protected]

Background and Aim: The aim of this study was to correlate oropharyngeal dysphagia and feeding modalities and the level of consciousness in patients with a severe brain injury during reeducation and rehabilitation. Methods: The clinical data of vegetative state or minimal conscious state due to severe TBI hospitalized in a coma arousal unit were collected from 2012 to 2019. Feeding modalities were evaluated clinically and with functional endoscopy evaluation of swallowing (FEES) or videofluoroscopy (VFS). Evolution of consciousness was evaluated using Wessex Head Injury Matrix scale (WHIM). Comparison between WHIM score and feeding modalities were perform at the beginning of the reeducation and at discharge. Results: Of the 93 patients considered 33 were included corresponding to inclusion criteria (TBI, disorder of consciousness and age > 18 years). The mean age was 44.8±16.8 years, and there were 6 females for 27 males. At admission, all patients were fed by gastrostomy (n=25) or by nasogastric tube (n=8) and 27 had a tracheostomy. At discharge, 10 patients keep an exclusive alimentation by gastrostomy as 23 had exclusive oral feeding. The score of the WHIM at admission was 21.7 ± 10.9 in patients with non-oral feeding at discharge vs 21.0 ± 15.33 in patients with oral feeding at discharge (ns). At discharge WHIM increased to 38.3 ± 15.4 in patients with non-oral feeding and to 49.8 ± 9.7 in patients with oral feeding at discharge (p<0.05). Conclusion: Our results demonstrated that there is a favorable outcome of swallowing disorders in patients with a severe traumatic brain injury when there is an improvement of consciousness level.

  5395 - Effects of decompressive surgery on brain plasticity of descending motor tracts in the cervical myelopathy patients Top

Kwang-Ik Jung1, Jane Chung2, Jeongeun Lee2, Suk Hoon Ohn2, Seok Woo Kim3, Woo-Kyoung Yoo4

1Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Gyeonggi-do, South Korea, 2Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Seoul, Korea, 3Department of Orthopedic Surgery, Spine Center, Hallym University Sacred Heart Hospital, Seoul, South Korea, 4Department of Physical Medicine and Rehabilitation, College of Medicine, Hallym University, Chuncheon, South Korea

E-mail: [email protected]

Background and Aim: In this study, we aimed to find out the effect of decompression surgery on changes of motor tracts in the brain based on precise tract-based pathology of the spinal cord in cervical myelopathy (CM) patients. Methods: Spine and brain diffusion tensor imaging (DTI) were acquired once in 12 healthy subjects and twice in 20 CM patients (before and after surgery). Corticospinal tract (CST), rubrospinal tract (RST) and reticulospinal tract (ReST) were explored in the brain (cortical, subcortical and brainstem) and in the cervical spinal cord (C3 to C7). Fractional anisotropy (FA) and mean diffusivity (MD) were obtained at each region of interest (ROI)s and tracts. Group comparison was done between patients and control using independent t-test. The decompression effect was obtained by comparing diffusion metrics of before and after surgery using paired t-test. In addition, correlations between brain and spinal cord ROIs were analyzed. Results: Preoperative CM patients showed lower FA and higher MD of CST in the affected brain compared to controls. Postoperative data showed higher FA of CST and RST and lower FA of ReST in the unaffected brain compared to preoperative condition. FA and MD of CST in the affected brain correlated negatively with FA and MD of affected ventral ReST at the spinal cord lesion level, and negatively correlated with FA of unaffected RST and lateral ReST above the the spinal cord lesion level. FA of unaffected RST in the brain correlated positively with FA of ventral CST above the spinal cord lesion level. Conclusion: We found the restoration of CST and RST integrity of the brain with a decreased influence of ReST in the spinal cord, which is main effect of decompression.

  Clinical Sciences – Pain Top

  6278 - Predictors and clinical outcomes after ultrasound-guided interventions on chronic postoperative pain treatment: A single-center prospective study Top

José Bernardo Ferreira1, Rita Santos1, Alexandra Lagarto1, André Canelas1, Ana Campos2, Madalena Adrião2, Elisabete Valente2, Marta Ferreira3, Simão Serrano4

1Department of Physical and Rehabilitation Medicine, Centro Hospitalar de Leiria, Leiria, Portugal, 2Department of Anesthesiology, Centro Hospitalar de Leiria, Chronic Pain Unit, Leiria, Portugal, 3Centro de Matemática, Universidade do Minho, Braga, Portugal, 4Department of PRM, Centro Hospitalar de Leiria, Chronic Pain Unit, Leiria, Portugal

E-mail: [email protected]

Background and Aim: Chronic postoperative pain (CPOP) develops or increases in severity after surgery, persisting for at least 3 months. Many therapeutic approaches have been proposed, including ultrasound-guided interventions (USGI). However, clinician's awareness and strong evidence supporting their use are still lacking. Our aim was to evaluate the effectiveness of USGI on CPOP and to establish outcome predictors. Methods: Longitudinal prospective study, including patients with CPOP submitted to USGI (nerve, articular or peri-articular/soft tissue interventions) at our department between 2017-2021. Evaluations were performed at: T0 – baseline assessment (USGI); T1 – 6 weeks after USGI with record of patient perceived benefit (PPB) using a 5-point Likert scale. Brief Pain Inventory (BPI) and DN4 questionnaire were applied on both times. Results: 62 patients, mean age 57, 71% female, neuropathic CPOP in 47%, ultrasound abnormalities in 50%, total knee replacement CPOP in 23%. Median time between surgery and USGI was 16 months. BPI results for questions 3, 4, 5, 9A and 9D improved after USGI (p<0.05). Proportion of patients with DN4 score≥4 reduced after USGI (p=0.004). PPB was positive after USGI (p<0.001). Opioid use before surgery or USGI were associated with worse PPB (p=0.025; p=0.026). Time between surgery and USGI correlated with PPB (p=0.023). An ordinal regression model revealed that positive PPB probability decreases along time, being less likely to occur after 11 months post-surgery among opioid users (p=0.004). Conclusion: USGI were effective on reducing pain scores and increasing PPB among CPOP patients. Opioid treatment and time between surgery and USGI are relevant outcome predictors. Further studies approaching specific surgeries and USGI are needed.

  6158 - Characterization of neuropathic component of back pain in patients with vertebral fragility fractures Top

Sara Liguori1, Antimo Moretti2, Milena Aulicino2, Monia Andrea Papa2, Federica Tomaino2, Marco Paoletta2, Giovanni Iolascon2, Francesca Gimigliano2

1Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli,” Via de Crecchio, Naples, Italy, 2Dipartimento Multidisciplinare di Specialità Medico-Chirurgiche e Odontoiatriche, University of Campania “Luigi Vanvitelli”, Caserta, Italy

E-mail: [email protected]

Background and Aim: Vertebral fractures are the most common osteoporotic fractures. These lesions can cause chronic back pain due to nociceptive and/or neuropathic mechanisms. However, literature about the characterization of back pain in osteoporotic patients with vertebral fractures is lacking. Therefore, the scope of this study is to evaluate the type of back pain in a population of patients with vertebral fragility fractures (VFFs). Methods: Patients with at least one VFF, occurred for at least three months, were included. Vertebral fractures were detected by morphometric examination and assessed by Genant's classification. Pain severity and its impact on daily living activities were evaluated through the Brief Pain Inventory (BPI). The type of pain was investigated through the Italian Versions of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS) and the painDETECT questionnaire. Results: Seventy-two patients were included. Our population consisted mainly of women (88.8%). The mean age was 69.2±8.9 years. 70.8% of patients had multiple VFFs, of which 47% localized at the thoracic spine, 43.1% at the thoracolumbar level, 9.8% at the lumbar spine. The BPI showed moderate back pain (score 5-6) in 23.6% of cases and severe (score 7-10) in 8.3% of cases, with high interference (score 5-10) with daily living activities in 38.8% of cases. The painDETECT questionnaire revealed the presence of neuropathic pain in 5.5% of cases, while the LANSS scale showed that the presence of a neuropathic mechanism was probable in 23.6% of cases. Conclusion: In our study, LANSS scale appears more sensitive than painDETECT questionnaire in assessing the neuropathic component of chronic back pain due to VFFs.

  6076 - Responsiveness and minimal important change of the Quebec back pain disability scale in Italian patients with chronic low back pain undergoing multidisciplinary rehabilitation Top

Marco Monticone1, Federico Arippa2, Calogero Foti3, Franco Franchignoni4

1Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy, 2Department of Neuroscience and Rehabilitation, Neurorehabilitation Unit, G. Brotzu Hospital, Cagliari, Italy, 3Department of Clinical Sciences and Translational Medicine, Physical and Rehabilitation Medicine, University, 4Istituti Clinici Scientifici Maugeri, PRM Unit of Tradate Institute, Tradate (VA), Italy

E-mail: [email protected]

Background and Aim: There is lack of information concerning responsiveness and minimal important change (MIC) of the Quebec Back Pain Disability Scale (QBPDS). Hence, the aim of this study was evaluating responsiveness and MIC of the QBPDS in Italians with chronic low back pain (LBP). Methods: By means of a methodological research based on an observational study, 201 patients with chronic LBP completed the QBPDS at the beginning and end of a multidisciplinary rehabilitation programme. At the end of treatment, they also completed a 7-level global perceived effect (GPE) scale, which was split to obtain a dichotomous outcome (improved vs. stable). Responsiveness was calculated by distribution-based [effect size (ES); standardised response mean (SRM); minimum detectable change (MDC95)] and anchor-based methods [Receiver Operating Characteristics (ROC) curves]. ROC curves were also used to compute the MIC (based on QBPDS change score, both absolute and expressed as percentage). Results: The ES was 0.29, the SRM was 0.43, and the MDC95 was 12 points. ROC analysis of the absolute change scores showed a MIC value of 6 points, with an area under the curve (AUC), sensitivity, and specificity of 0.83 (95%C.I. 0.77-0.90), 77.7% and 80.8%, respectively. ROC analysis based on the percent change score from baseline revealed a MIC of 18% with an AUC, sensitivity and specificity of 0.85 (95%C.I. 0.79-0.91), 80.6% and 80.8%, respectively. Conclusion: The QBPDS score change (expressed in both absolute value and percentage from baseline) was sensitive in detecting clinical changes in Italian subjects with chronic LBP undergoing multidisciplinary rehabilitation. In clinical practice, we recommend –where absolute change is lower than MDC– to rely on the MIC taking into account the percentage change from baseline condition.

  5863 – Ultrasound-guided radiofrequency ablation for chronic hip pain: Six-month follow up Top

Inês Mendes-Andrade1, José Luís Carvalho2, Tiago Lopes2, Eugénio Gonçalves3, Rodrigo Correia2, Luís Oliveira2, Miguel Correia2, André Borges2

1Centro de Medicina de Reabilitação de Alcoitão, Portugal, 2Centro de Reabilitação do Norte, Valadares, Portugal, 3Centro Hospitalar Vila Nova de Gaia/Espinho

E-mail: [email protected]

Background and Aim: Lifetime risk for symptomatic hip osteoarthritis is 18.5% for men and 28.6% for women. Enough patients have contraindications to and refractory pain even after total hip arthroplasty, what implies the need to develop alternative managements. Aim of this study was to examine the effects of percutaneous denervation of hip articular nerve branches via radiofrequency ablation (RFA) in patients with chronic hip joint pain. Methods: Between January 2020 and March 2021, 33 patients with chronic hip pain received ultrasound-guided RFA of the articular branches of the femoral and obturator nerves in a Rehabilitation Center in Portugal. In this study, were included patients suffering from chronic hip pain for more than 3 months with hip osteoarthritis (Tönnis grades I-III) and patients with painful total hip replacement. Visual numeric scale (VNS), Western Ontario and McMaster Universities Arthritis Index and reduced pain medications were used for outcome measurement before treatment and at 3 months and 6 months after RFA. Results: Thirty-three patients underwent procedure, with a median age of 61 years. Of the 33 patients enrolled at our study, 91% had hip osteoarthritis and 9% had painful total hip replacement. Six-month follow-up data revealed a statistically significant decrease in VNS. Before radiofrequency, mean VNS scores were 8 (95%CI 7-9); at 3-month were 2 (95%CI 0,9-3) and at 6-month follow-up were 2 (95% CI 0,7-3). Repeated Measures ANOVA test was performed to compare the differences within groups across time F(2;1,137)=124,p<0,001. Twenty-four patients (72%) reported >50% pain relief during the follow-up and 48,5% reduce pain medication.No side effects were reported. Conclusion: RFA of the articular branches of the femoral and obturator nerves offers a new and safe treatment option with excellent outcomes for chronic hip pain.

  4504 - Comparing pain management choices of individuals with spinal cord injury living in the Netherlands and the United States Top

Jennifer Piatt1, Cedomir Stanojevic2, Melissa Zahl3, Joseph Baker2, Marcel Post4, Janneke Stolwijk-Swüste4, Charlotte C. van Laake-Geelen5, Lori Eldridge2

1Department of Health and Wellness Design, School of Public Health, Indiana University, Bloomington, Indiana, USA, 2Indiana University Bloomington, Indiana, USA, 3University of Utah, Salt Lake City, Utah, 4De Hoogstraat Rehabilitation, 5Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands

E-mail: [email protected]

Background and Aim: Pain can adversely impact quality of life health among the spinal cord injury (SCI) population. The purpose of this study was to understand treatment choices individuals with SCI make to manage chronic pain coompairing the United States (U.S.) and Netherlands. Methods: This research employed a cross-sectional survey design. Four hundred and nineteen community dwelling adults living with SCI completed a web-based survey. The survey was modified according to Heutink et al. Respondents were categorized into two groups: Group 1: individuals using invasive treatments (i.e., injections, surgery); Group 2: individuals using non-invasive treatments (i.e., pharmacological, physical activity-based (PAB) [i.e., physical therapy, yoga, exercise]), and alternative treatments (i.e. cannabis, meditation, ice). Results: Data represents a comparison between individuals with SCI in the Netherlands (N=371) and the U.S. (N=48). Non-invasive approaches were the most prominent treatment in managing pain for both Netherlands (57.1%) and the U.S. (80%). The most selected were PAB treatments in Netherlands (44.2%) where 31.8% choose physical therapy. The alternative treatments were the favored treatment approach for the U.S. (35.4%) where 12.8% choose to apply either heat or cold to the area they were experiencing pain. Conclusion: Participants favored non-invasive treatments (PAB and alternative) to reduce SCI induced pain. The U.S. sample opted for alternative treatments whereas the Netherlands sample selected PAB treatments. Although sample sizes were significantly disproportionate, it was possible to establish similar outcomes between the samples in both countries.

  5615 - Evaluation of myofascial pain in poststroke patients Top

Yaron Watts1, Michael Bahar2, Osnat Granot3, Simon Vulfsons4, Leonid Kalichman5, Motti Ratmansky6

1Lowenstein Rehabilitation Hospital, Brain Rehabilitation, Ra'anana, Israel, 2Lowenstein Rehabilitation Hospital, Orthopedic Rehabilitation, Ra'anana, Israel, 3Lowenstein Rehabilitation Center, Neurologic Rehabilitation, Ra'anana, Israel, 4Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel, 5Department of Physical Therapy, Ben Gurion University of the Negev, Beer Sheva, Israel, 6Sheba Medical Center, Pain Management and Rehabilitation, Ramat Gan, Israel

E-mail: [email protected]

Background and Aim: Physical impairments following cerebrovascular events (CE), i.e., weakness, equilibrium and gait disorders, paresis and hemiplegia, muscle tone changes and contractions, might contribute to the development of myofascial pain syndrome (MPS). MPS—a chronic regional pain disorder caused by trigger points in muscles or fascia—gravely affects patient quality of life, performance, and rehabilitation. Yet, MPS prevalence in post-stroke (PS) patients is unknown. We, therefore, studied MPS presentation in rehabilitating PS patients during hospitalization. Methods: 32 PS patients admitted to neurological rehabilitation underwent dedicated physical examinations for the evaluation of MPS at 1W (T1) and 7W (T2) after admission. Hemiplegic side and healthy side were compared for each of nine selected muscles. Medical anamneses, patient medical registration and imaging files, and NIHSS scores were used to quantify CE impairments. Pressure pain threshold and severity were determined by algometer. Results: MPS was diagnosed in at least one muscle within 28.5% of patients (18% Hemiplegic side; 10.5% healthy side). Total amount of pain in both sides was similar between T1 and T2. Pain severity in healthy side upper limbs was generally improved as opposed to a deterioration in lower limbs through time. No correlation was indicated between stroke severity and MPS. Conclusion: Over a quarter of PS patients present early development of MPS in at least one muscle, of which higher prevalence was observed for hemiplegic sides at early onset. MPS is, therefore, recognized as an important and crucial element of PS pain syndromes. Dedicated treatment for MPS may lead to improvement in patient quality of life, active treatment participance, and overall rehabilitation success.

  Engineering and Technology – Assistive Products Top

  6276 - Concurrent validity of an immersive virtual reality version of the Action Research Arm Test to assess poststroke manual dexterity Top

Gauthier Everard1, Quentin Burton2, Stéphanie Dehem3, Noémie Lebrun2, Thierry Lejeune2

1Institute of Experimental and Clinical Research, UC Louvain, 2UCLouvain, Ottignies-Louvain-la-Neuve, Belgium, 3Faculté des sciences de la motricité, UC Louvain, Belgium

E-mail: [email protected]

Background and Aim: After a stroke, experts recommend regular monitoring and kinematic assessments of patients to objectively measure motor recovery. Recently, with the rise of new technologies and increasing needs for neurorehabilitation, an interest in virtual reality has emerged. In this context, we have developed an immersive virtual reality version of the Action Research Arm Test (ARAT-VR). The aim of this study was to assess the concurrent validity of the ARAT-VR among patients with stroke and healthy participants. Methods: Twenty healthy participants and patients with stroke were asked to perform the classical Action Research Arm Test (ARAT) and ARAT-VR three times with both hands. Concurrent validity was assessed through correlations between these two tests. Usability of the BBT-VR was also evaluated with the System Usability Scale. Hand kinematic data extracted from virtual hands' 3D position allow to compute quantitative parameters. Results: Results of the first 10 patients showed strong correlations between the ARAT-VR and ARAT global score when performed with their paretic hand (r=0.9; p<0.001). Usability was found to be excellent (System Usability Scale= 80.33 ± 10.08). Conclusion: The ARAT-VR is a usable and valid test to assess manual dexterity, providing kinematic parameters, in a population of patients with stroke and healthy participants.

  5810 - Wireless instrumented knee pad for gait analysis Top

Miguel Rodrigues1, João P. Ferreira2, A. Paulo Coimbra3, Manuel Crisóstomo3, João Pinheiro4

1Department of Electrical and Computer Engineering, Institute of Systems and Robotics, University of Coimbra, Polo II, Coimbra, Portugal, 2Department of Electrical Engineering, Superior Institute of Engineering of Coimbra, Portugal, 3Department of Electrical and Computer Engineering, Institute of Systems and Robotics, University of Coimbra, polo I, Coimbra, Portugal, 4Faculty of Medicine, University of Coimbra, Coimbra, Portugal

E-mail: [email protected]

Background and Aim: Human's walking is often affected by pathologies caused by neuromuscular and musculoskeletal injuries. The gait reconstruction of patients whose movement has been harmed varies according to injury's intensity and patient current recovery stage. The use of a device that enables human gait data collection will allow to assess gait quality and quantify the evolution of the rehabilitation stage. The aim of this work was to develop and test the usability of a low-cost Instrumented Knee Pad System (IKPS) for the analysis of the knee sagittal plane angle trajectory to help a doctor to detect and quantify anomalies of the gait. Methods: The IKPS uses a precision absolute rotary encoder between two rigid plates attached to the back of each knee joint. Each IKPS has a wireless connection to a computer application that processes the data and generates a report. The output consists of: knee sagittal plane angle time plot, maximum and minimum knee angle values, range time of swing and stance phases, and the degree of symmetry of the knees' angles trajectory. Results: In a pilot study, healthy and unhealthy individuals were evaluated using the IKPS. When compared to the knee gait normal curve, the IKPS results allowed to clearly identify the unhealthy gait. The first tests showed an angle precision of around 1 degree. In large knee angle values it was found that the effect of muscle volume variation in contractions affects the angle readings. Conclusion: This IKP can quantify human gait quality through the variation of the knee angles. It also allows an objective knowledge of a patient's gait evolution, enabling a personalised and effective rehabilitation by tracking improvements in the gait recovery. [Authors acknowledge FCT for the financial support - Proj. UIDB/00048/2020].

  5766 - Personalized mobile health reminders to improve medication adherence following acquired brain injury: A randomized pilot and feasibility trial Top

Marinos Pylarinos1, Amanda Azer1, Emma Kaplan2, Maria Mawhinney2, Grace Wells2, Jenny Masmela2, Peii Chen2

1New Jersey Medical School, Rutgers University, New Jersey, USA, 2Center for Stroke Rehabilitation Research, Kessler Foundation, New Jersey, USA

E-mail: [email protected]

Background and Aim: At discharge from inpatient services, patients with acquired brain injury (ABI) are prescribed multiple medications to treat and prevent myriad sequelae. Polypharmacy can be challenging for these patients to manage, as varying degrees of cognitive and motor dysfunction impede medication adherence. To address this challenge, we examined the feasibility of providing automated text messages and personal video call reminders. Methods: Patients were screened using the following criteria: ≥18 years old, < 3 months post ABI, English as primary language, taking ≤ 8 medications daily, and able to open pill bottles that were tracked using the micro-electromechanical systems (MEMS) technology. Participants received MEMS bottles and were randomized into three groups: standard (no reminder), automated text message, and video call. Feasibility was assessed based on enrollment rate, retention rate, and usability of digital reminders and MEMS bottles. Results: 4,031 patients were screened over 44 months, and 66 (1.6%) were enrolled. 41 (62%) completed baseline analysis, and 25 (38%) completed the 6-month study (11 in standard, 7 in text, and 7 in video call). Both study team and participants reported that automated text messaging was less time consuming and less intrusive than video calls. Some participants asked to retain MEMS bottles for continued use after the study. Conclusion: The low enrollment rate may be related to the study being conducted at a single site with a 3-person research staff. The potentially intrusive nature of video call reminders may have contributed to the low enrollment and retention rates. Our findings suggest a combination of automated reminders and digital tracking bottles may increase medication compliance, which requires further investigation.

  5494 - Development of an app for android devices for nonpharmacological management of fibromyalgia: Fibroapp Top

Katalina Espinosa, Maria Paz Grisales, Maria Ana Tovar, Olga Marina Hernandez

Department of Physical and Rehabilitation Medicine, Universidad del Valle, Cali, Colombia

E-mail: [email protected]

Background and Aim: Fibromyalgia is the second cause of rheumatic disease. The treatment goals are to improve quality of life, maintain function and reduce symptoms, with more clinical evidence for non-pharmacological management. Creating an App offers a patient center option with more interaction, making it a valuable tool to achieve this objective. The objective of this project is to develop a free-charge App to deliver multicomponent non-pharmacological treatment to improve symptoms in patients with fibromyalgia. Methods: The project consists of five phases: 1: Review of the literature on non-pharmacological methods with evaluation by a multidisciplinary focus group to define the content of the App. 2. Development of the preliminary App interface including content, methodology, function, registration, and data collection. 3. Development of the Beta Version of the App: meetings with the group of engineers and focus groups to evaluate performance, interface, and content of the App, and apply until the best version is obtained. 4. Pilot study: for eight weeks 20 patients will use freely the App, including weekly evaluation of function and pain scales; additionally, patients will be contacted by telephone to solve doubts, and evaluate the App after use. 5. Develop the Final Version of App according to the result obtained in the pilot study and upload it to the App Store for the Android operating system. Conclusion: We hope that the creation of this App will improve symptoms control through non-pharmacological treatment in populations with low health-service access.


  1. Clauw DJ. Fibromyalgia: A clinical review. JAMA 2014;311:1547-55.
  2. Penson DF. Re: The impact of health information technology and e-health on the future demand for physician services. J Urol 2014;192:189-90.

  Engineering and Technology – Mobility (Wheelchairs, etc.) Top

  4324 - A novel portable and cost-efficient wheelchair training roller for persons with disabilities in economically disadvantaged settings: The easyroller Top

Marjelle F. Scheffers1, Taylor D. Ottesen2, Laurel H. Kaye2, Kimberly E. Ona Ayala2, Shevali M. Kadakia3, Jennifer M. Buckley4, Yetsa A. Tuakli-Wosornu5

1Utrecht University, Faculty of Medicine, Heidelberglaan, Utrecht, The Netherlands, 2Yale School of Medicine, New Haven, Connecticut, USA, 3California Institute of Technology Pasadena, CA, USA, 4University of Delaware College of Engineering, Mechanical Engineering Newark, DE, USA, 5Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA

E-mail: [email protected]

Background and Aim: Stationary training rollers enable wheelchair users to maintain health and train as athletes, which serves to treat and prevent immobility-associated chronic disease and improve cardiorespiratory fitness. However, conventional exercise equipment is largely inaccessible for persons with impairment in low-resource areas, primarily due to cost. The aim of this study was to develop a portable, cost-efficient stationary training device for wheelchair users in low-resource settings – The EasyRoller. Methods: Stakeholder input from wheelchair athletes, trainers, and potential commercial manufacturers was solicited and utilized to conceptualize The EasyRoller. The device was constructed from easily sourced, low cost components, following which it was user-tested with Para athletes. Feedback was analysed and incorporated into renewed prototype versions. Results: The EasyRoller creatively combines easily-sourced components to significantly cut down cost and ease both manufacture and repair for use in low-resource settings. The device is portable with a total weight of 34 pounds and total size of 42 linear inches while also affordable with a total cost of USD$199. Feedback emphasized the user-friendliness of the device and its potential to benefit coaches, athletes, and any wheelchair user interested in maintaining health. Conclusion: Through its novel and affordable design, The EasyRoller has the potential to increase physical activity in populations with impairment who live in socioeconomically deprived world regions.

  Engineering and Technology – Prosthetics and Orthotics Top

  6554 - Evaluation of kinetic, kinematic and energy cost with 2 different ankle-foot orthoses (standard carbon and custom-made AFO) in patients with hemiplegia poststroke during walking Top

Diana Rimaud1, Rodolphe Testa2, Jeremy Rossi2, Guillaume Millet2, Paul Calmels1

1Service de Médecine Physique et de Réadaptation, CHU Saint-Etienne, France, 2Université Jean Monnet Saint-Etienne, LIBM, Saint-Etienne, France

E-mail: [email protected]

Background and Aim: From literature reviews there is a consensus that an AFO may have a positive immediate effect on walking conditions after post-stroke hemiplegia. Different criteria have been recommended: walking speed, endurance, energy expenditure, kinetic and kinematic walking parameters, individual satisfaction. The objective was to compare the walking performances under 3 conditions: with a standard carbon fiber AFO (CO), with a personal custom-made plastic AFO (PO), without any orthosis (WO), in chronic post-stroke hemiplegic subjects. Methods: 15 chronic stroke subjects (59±10 years; 12M-3F; 13 years±15 since injury; 10 left hemiplegia) realized 3 randomized sessions (CO, PO, WO). Each session consisted in a 6-minute walk test (6MWT) with VO2 measurement, followed by clinical gait analysis on a 15-meters walkway equipped with force platforms and 3D motion analysis. We evaluated energy cost (EC), walking speed and capacity, spatio-temporal, kinetic and kinematic parameters. Results: Compared to WO, respectively with PO and CO: EC reduced by 15% and 14% (p<0.002); distance and walking speed on 6MWT enhanced by 12% and 10% (p<0.001). Spatio-temporal parameters were enhanced (p<0.002): length stride by 10%, length step on affected leg by 8%, swing time on contralateral leg by 7%, for both conditions; length step on contralateral leg by 12% and 13%. Stride width was reduced by 10% for both conditions (p<0.002). No significant differences on kinetics and kinematics parameters. Conclusion: Improvements in energy cost and spatio-temporal parameters indicate improved stability and efficiency during walking, with both a standard carbon AFO (after a short 15-day habituation period) and the usual custom-made AFO. A multidimensional analysis seems necessary to adapt individual benefices to patient.

  6461 - Diabetic foot complications and footwear effect: Six years' experience of outpatient consultation Top

Alexandra Lagarto, Rita Santos, José Bernardo Ferreira, Diana Fernandes, Filipa Januário

Centro Hospitalar de Leiria, Serviço de Medicina Física e de Reabilitação, Leiria, Portugal

E-mail: [email protected]

Background and Aim: Diabetic foot has an increased susceptibility to ulceration that may evolve to amputations. Therapeutic footwear has a key role preventing foot ulceration. Aim: analyse the factors related to new foot events after therapeutic footwear prescription. Methods: Longitudinal prospective study including all patients with Diabetes Mellitus diagnosis evaluated by a physiatrist to whom were prescribed adapted footwear according to feet characteristics, between 2015-2021. Evaluations occurred at T0–baseline assessment, T1 – footwear reception, T2 – 6 months and T3 - 2 years later. Results: 58 patients, median age 66 years, 75.6% male, 77.2% high risk foot ulceration. We assessed 58 patients at T0, 46 at T1, 33 at T2 and 15 at T3. At T0 insoles were prescribed for every patient, diabetic footwear for 65.5% and made-to-measure shoes for 32.8%; only 1 patient refused footwear. The most frequent foot alterations were hyperpression zones (62,1%), claw toes (24.1%), pes cavus (24.1%) and hallux valgus (13.8%). At T1, 94.8% reported good adaptation to prescribed footwear. At T2, 9.1% had ulcerations and there was a relation between new event occurrence and story of finger disarticulation in past (p=0.037). At T3, cumulative feet ulceration was 20.7% and finger disarticulation 1.7%. There was a higher incidence of new foot events in patients with a lower number of footwear by years (p=0.020). Conclusion: Our study supports that therapeutic footwear is important to avoid foot complications in diabetic patients, once that patients who require more footwear have less ulceration. It also shows that previous finger disarticulation is linked with new foot event. More studies are needed to support clinical efficacy of therapeutic shoes in preventing foot ulceration.

  5428 - Comparison of the multi-grip myoelectric hand prosthesis and standard myoelectric hand prosthesis: dexterity, user experiences and quality of life Top

Nienke Kerver1, Verena Schuurmans2, Corry K. van der Sluis1, Raoul M. Bongers2

1Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands, 2Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

E-mail: [email protected]

Background and Aim: Even though the expensive multi-grip myoelectric hand prosthesis (MHP) are commercially available over ten years, studies that compared MHPs with the cheaper standard myoelectric hand prostheses (SHP) are limited and often inconclusive. Therefore, we aimed to compare the dexterity of the SHP and MHP within a group of MHP users (phase A) and to compare the users' experiences and quality of life between a group of MHP and SHP users (phase B). Methods: In phase A, 14 MHP users with upper limb absence at wrist or forearm level (9 men; median age = 57.3 y) performed the Southampton Hand Assessment Procedure (SHAP) and Box Blocks Test (BBT) with both SHP and MHP. In phase B, the Orthotics and Prosthetics Users' Survey - The Upper Extremity Functional Status Survey (OPUS-UEFS), Trinity Amputation and Prosthesis Experience Scales Upper extremity (TAPES-upper), and EuroQol-5 Questionnaire (EQ-5D) test results of the MHP users were compared with those of 19 SHP users (12 men; median age 65.1 y). Results: The weighted linear index of function of the SHAP was significantly higher for the SHP condition compared to the MHP condition (p=0.05), while the non-weighted score and BBT score did not differ between both conditions. Scores on two TAPES subscales (general adjustment; adjustment to limitation) and the EQ-5D index were significantly higher in SHP users (p=0.00). The EQ-5D-VAS, OPUS-UEFS and scores on the other TAPES subscales did not differ between both groups. Conclusion: The MHP did not show advancements in dexterity, user experiences, or quality of life compared to the SHP. Moreover, SHP results were better than MHP results in some tests. This underlines the importance to carefully consider whether the MHP is the most suitable option for an individual.

  5609 - User-relevant factors that influence the prosthesis use of adults with a transfemoral amputation or knee-disarticulation Top

Charlotte E. Bosman, Corry K. van der Sluis, Jan H. B. Geertzen, Nienke Kerver, Aline H. Vrieling

Department of Rehabilitation Medicine, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands

E-mail: [email protected]

Background and Aim: The choice for specific prosthetic components, such as the type of knee, may influence the users' prosthesis use. Rehabilitation teams currently have insufficient scientific knowledge to determine which prosthetic knee is most appropriate and decisions are therefore mostly experience based. In order to prescribe the most appropriate knee to prosthesis users, it is important to identify which factors may influence prosthesis use. The aim of this study was to identify factors that influence prosthesis use in adults with a transfemoral amputation or knee-disarticulation. Methods: First a meta-synthesis of qualitative literature was conducted to identify which factors can influence prosthesis use. Secondly, the results of the meta-synthesis were tested during a focus group with lower limb prosthesis users. New factors that were identified during the focus group were added to create the final framework. Results: Out of 4938 articles yielded from five online databases, 14 studies were included in the meta-synthesis. This resulted in a pre-final framework of 84 factors divided over seven themes. The participants of the focus group agreed with the seven categories of the pre-final framework. Eventually ten factors were added to form the final framework [Figure 1]. Conclusion: The results provided an extensive overview of 94 factors that may influence prosthesis use. The large number of factors demonstrates that there is a great variety between prosthesis users. Therefore, it is important to take individual preferences into account for the selection of a new prosthesis.

  Engineering and Technology – Robotics Top

  6632 - Error enhancement and motor recovery: A pilot study of acute effect on poststroke patients Top

Franco Molteni1, Eleonora Guanziroli1, Alessandro Specchia1, Giulio Gasperini1, Carmelo Lentino2

1Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga (LC), Italy, 2Santa Corona Hospital, Pietra Liguria, Italy

E-mail: [email protected]

Background and Aim: Upper limb impairment following stroke involves not only the controlesional upper limb but also the ipsilesional one, which is generally considered the non-affected side. Ipsilesional upper limb deficits can persist one year after stroke and could impact negatively on the performance of daily activities of stroke survivors. The aim of this work is to verify if a single session of treatment using a new technology based on Error Enhancement theory can modulate motor planning of the ipsilesional upper limb movement in post stroke patients. Methods: Ten post stroke patients with unilateral brain injury following ischaemic or hemorrhagic stroke were enrolled in the study. They underwent a single session of ipsilesional upper limb rehabilitation using Dextreme, a robotic system that applies pre-calculated error enhancement forces during motor training. Before and during the intervention, patient's cognitive involvement was evaluated with heart rate monitoring, comparing heart rate variability (HRV) at rest and during exercise. A motor evaluation of the ipsilesional and controlesional upper limb was performed using the Box and Blocks test before and after the single session of intervention. Results: A change in HRV in terms of LH/HF ratio was observed comparing the rest and the exercise conditions with a shift towards the low and a reduction of the high frequency. No statistical significant changes in Box and Block test was measured between the two evaluations for both affected and non-affected side Conclusion: The new technology is based on the body's adaptive response to changes in environmental forces able to produce a movements correction that can modulate HRV increasing the low frequency, expression of patient's cognitive involvement.

  6484 - Effect of welwalk WW-1000 on walking independence of hemiplegic stroke patients in subacute phase Top

Satoshi Hirano1, Eiichi Saitoh1, Daisuke Imoto2, Takuma Ii1, Masahiko Mukaino1, Yohei Otaka1

1Fujita Health University, Toyoake, Japan, 2Fujita Health University Hospital, Toyoake, Japan

E-mail: [email protected]

Background and Aim: Lower limb orthoses are commonly used for walking exercise in hemiparetic patients. In severe cases of hemiplegia, Knee-Ankle-Foot Orthosis (KAFO) are used to prevent knee buckling but walking exercise with KAFO requires a large amount of assistance and compensatory movements, which causes various problems in promoting motor learning. The Welwalk WW-1000 (hereinafter referred to as WW) was developed to solve this problem. The aim of this study is to examine the efficacy of WW in walking exercise for hemiparetic stroke patients in subacute phase. Methods: We conducted a multicenter, randomized, controlled trial to evaluate the efficacy of WW in patients with a first-ever hemiparetic stroke in convalescent rehabilitation wards. The main inclusion criteria were a Functional Independence Measure (FIM) walk score of 3 or less and Stroke Impairment Assessment Set lower extremity motor item total score of 6 or less at the pre-intervention evaluation. Ninety-one patients enrolled from eight hospitals participated in this study and were randomly assigned to a group that used WW for walking exercise (WW group) or a group that did not use WW (control group) for a 4-week intervention. The primary outcome was the degree of walking independence, which was evaluated using FIM walk score. Results: Sixty-two percentage of participants in the WW group became able to walk independently at discharge, while 43% of those in the control group did. Conclusion: It is suggested that Welwalk WW-1000 is useful for walking exercise of hemiparetic stroke patients in the subacute stage.

  6226 - Factors in improving upper limb function by constraint-induced movement therapy combined with robotic training after botulinum toxin injection in chronic stroke patients with severe or moderate hemiparesis Top

Yuki Uchiyama, Saya Iwasa, Kazuhisa Domen

Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan

E-mail: [email protected]

Background and Aim: This study aimed to examine the factor of improvement on upper extremity function in combined therapy of robotic training and botulinum toxin injection with CIMT in chronic stroke patients with severe or moderate hemiparesis. Methods: This retrospective study included chronic stroke patients who underwent CIMT at a college hospital between 2012 and 2019. From one week after BTX injection, the patients received one hour of robotic training (ReoGo-J) and 0.5 hour of CIMT three per week for 10 consecutive weeks (total 45 hours of training). The Fugl-Meyer Assessments, Action Research Arm Test, and Motor Activity Log (MAL) were used before and after intervention. The changes of MAL-AOU (Amount of Use) and MAL-QOM (Quality of Movement) before and after intervention were divided into two groups with changes of 0.5 or more and less than 0.5. Between-group comparisons regarding age, days from onset to training, various upper limb function evaluations, total amount of BTX units injected, and Modified Ashworth scale of upper limb flexors before intervention were analyzed by Unpaired T test. Results: Total 13 patients were included in this study. The two groups, divided by the changes of MAL-AOU and MAL-QOM, were completely identical. Between- group comparisons showed significant differences in age and total amount of BTX units injected before intervention. Conclusion: This study suggested that CIMT combined with robotic training following botulinum toxin injection may enhance the recovery of motor function with practical significance in chronic stroke patients with severe or moderate hemiparesis after stroke. Improvements beyond the minimal clinically important difference in MAL have been shown to be affected by age and upper limb function before intervention.

  5753 - Evaluation of overground exoskeleton use in acute-subacute phase of poststroke hemiplegia (SPIRIT study) Top

Soultana Tatsidou1, Rebecca Sauvagnac2, Denis Lagauche1, Pauline Coignard3, Julie Daniel3, Céline Cuenot4, Jean Gabriel Prévinaire4, Jacques Kerdraon3

1Centre de Médecine Physique et de Réadaptation – APAJH, Pionsat, France, 2Clinical Director of Wandercraft, Paris, France, 3Centre Mutualiste de Kerpape – Ploemeur - France, 4Centre Jacques Calvé, Fondation Hopale, Berck, France

E-mail: [email protected]

Background and Aim: Rehabilitation use of robotics has been expanding over the last years and even though there are few data, they have been introduced in neurorehabilitation in early post- stroke phases, even when a functional gait training is not possible. Atalante is an overground, self-balanced, hands-free exoskeleton, designed to promote walking and balance training. The aim of this study was to evaluate the use of the Atalante exoskeleton in terms of safety and patients' acceptance, in acute-subacute post-stroke hemiplegia. Methods: We conducted an interventional, prospective, open, national, multicentric, self-controlled study. Each patient had ten sessions spread over 3 weeks with assessments at baseline, at each and/or at the last session. Outcome measures included safety perception and anxiety, functional ambulation capacity, gait, balance, donning/doffing time, as well as a healthcare professional questionnaire for musculoskeletal disorders. Results: 12 of the 14 patients included have completed the study and only one mild adverse event was reported. The mean age was 62 years old and the mean time post-stroke 40 days. All the patients succeeded the 10mWT in the last session with some improvements in the FAC and Berg scales. Patients reported a feeling of safety, low anxiety levels and a perceived effort easy to moderate. The mean donning time was 6 min 43 sec and doffing time 1 min 32 sec. Four of the 14 healthcare professionals reported a new musculoskeletal pain. Conclusion: In our study, Atalante exoskeleton seems to be well accepted and safe for hemiplegic patients and healthcare professionals. We have also recorded some functional improvements but more appropriately designed studies need to be conducted in order to confirm these results.

  Functioning and Disability – Classification Systems (ICD) Top

  Functioning and Disability – ICF Top

  6584 - Back pain rehabilitation associated changes in functioning limitations and restrictions derived from patient reported outcomes Top

Thomas Kienbacher1, Kerstin Tuechler1, Patrick Mair2, Gerold Ebenbichler3

1Karl Landsteiner Institute for Outpatient Rehabilitation Research, Rehab Zentrum Liesing, Vienna, Austria, 2Department of Psychology, Harvard University, Boston, Massachusetts, USA, 3Department of Physical Medicine, Rehabilitation, Medical University of Vienna, Austria

E-mail: [email protected]

Background and Aim: The World Health Organization (WHO) recommended the International Classification of Functioning, Disability and Health (ICF) but its use in clinical practice is sparse. Methods: 2718 chronic low back pain (cLBP) patients performed six months comprehensive outpatient back pain rehabilitation in an outpatient rehabilitation center. Roland Morris Disability (RMDQ) and Pain Disability Index (PDI) questionnaires, the percentage of patients with limitations/restrictions in important activity and participation ICF categories as predicted from a novel, well validated computer-generated mapping algorithm, bodily functional measurements, pain intensity, and anxiety/depression (EQ-5D questionnaire) were measured before and after rehabilitation. Results: At baseline, both the RMDQ and the PDI measures were within the third of the lowest disability scores whilst 80% of the patients had limitations with 'maintaining a body position' and 30 % with 'walking' ICF categories. Rehabilitation associated gains in the maximum isometric lumbar extension and flexion strength and the lumbar range of motion were overall significant, but improvements in patients' limitations/restrictions were varied. Anxiety/depression, lumbar range of motion, and extension strength all had a significant impact on the majority of the ICF categories, whereas flexion strength had none. Conclusion: Limitations/restrictions in activity/participation ICF core categories for cLBP only partly mirrored disability levels and the impact of the body function scores on these limitations/restrictions was varied. Thus, assessing problems in the activity/participation core categories is well feasible and it is of relevance to clinical practice for both treatment goal setting and intervention planning.

  5678 - Challenging cases of multiple limb amputations caused by purpura fulminans: Can we improve functionality after an intensive rehabilitation program? Top

Joselda Abreu

Centro de Medicina de Reabilitação de Alcoitão, Adult Rehabilitation Service 3, Alcabideche, Lisbon, Portugal

E-mail: [email protected]

Background and Aim: Purpura fulminans (PF) is a highly thrombotic subtype of disseminated intravascular coagulation1. It can follow severe infections, lead to multiple organ dysfunction and limb involvement2. Our goal was to analyze the evolution of PF survivors, with multiple limb amputations after a comprehensive rehabilitation program. Methods: A retrospective analysis of data from clinical files of PF survivors, with multiple limb amputations, including demographic data, level of amputations, time to admission, length of stay, need for re-hospitalization, prosthesis used, functional independence measure (FIM) at admission (adm) and discharge (dis). Results: We identified 9 cases, 56% female, 50.3 years old on average (avg). The avg time to admission was 7.5 months, avg length of stay 131 days, and 56% needed re-admission. The 89% quadri-amputees (4 bilateral transtibial (TT) and transradial (TR); 3 bilateral TT and bilateral hand finger amputation; 1 bilateral TT, left trans-metacarpal and right radiocarpal) and 11% tri-amputees (1 bilateral TT and F2 to F5 right hand). All patients had physiotherapy, occupational therapy and prosthetics management. Lower limb prosthetics was prescribed to 100% and upper limb prosthetics to 67%. There was an avg gain of 27 points in FIM (adm: 73/126; dis: 100/126): +11.4 in self-care (adm: 16.8/42; dis: 28.2/42), +7.3 in transfers (adm: 9/21; dis: 16.3/21), +5 in locomotion (adm: 2.6/14; dis: 7.6/14) and +2.56 in cognition (adm: 17.1/21; dis: 21/21). Conclusion: Rehabilitation of post-PF amputees can be challenging, however in our experience all patients had relevant overall functional gains. We strongly recommend the integration in an inpatient comprehensive amputee rehabilitation program.

  5836 - Implementation of the ICF Clinical Functioning Information Tool (ClinFIT) in routine clinical practice Top

Bhasker Amatya, Alaeldin Elmalik, Krystal Song, Su Yi Lee, Mary Galea, Fary Khan

Royal Melbourne Hospital, Parkville, Australia

E-mail: [email protected]

Background and Aim: Regular patient evaluation and clinical assessment in rehabilitation settings is needed for strategic decision-making. This study examined the utility and responsiveness of the ICF Clinical Functioning Information Tool (ClinFIT) for the assessment of functioning in routine clinical practice in an Australian context. Methods: A prospective observational study with consecutive recruitment of inpatients at a tertiary rehabilitation facility. The assessments were at admission-T0, discharge-T1 and 3-month post-discharge-T2 using questionnaires: ClinFIT, Functional Independence Measure (FIM) and European Quality of life. Extension Indices (EI) were calculated for the ClinFIT set, and responsiveness was measured as a change in scores overtime. The association between FIM and ClinFIT scores was explored. Results: A total of 91 participants with a mean age of 66.8±13.0 years (52% male, 48% with stroke) were recruited. Majority of the participants reported ≥1 issue related to ClinFIT categories. ClinFIT total raw scores improved significantly across all health conditions compared to T0 [Median (Interquartile range): 196 (110, 228)] at both T1: 69 (37, 110) and T2: 46.5 (20.8, 77), with a large effect size (p<0.001, r = 0.61 for both). There were significant changes in EI in the entire ClinFIT set from T0 to T1, and from T0 to T2 (p<0.001 for both), with large effect sizes. Analyses confirmed a significant correlation in improvements between ClinFIT and FIM scores. Conclusion: ClinFIT is a useful tool in evaluating changes in functioning overtime and across different health conditions. Implementation of such universal tool in routine clinical rehabilitation practice will potentially allow for comprehensive evaluation of health outcomes and monitoring quality of care.

  5574 - Ageing, functioning patterns and their environmental determinants in the spinal cord injury population: A comparative analysis across European countries Top

Carla Sabariego, Cristina Ehrmann

Swiss Paraplegic Research, Guido A. Zäch Strasse 4, Nottwil, Switzerland

E-mail: [email protected]

Background and Aim: Ageing with spinal cord injury (SCI) is complex. This study aims to describe functioning of persons with SCI by chronological age, age at injury and years lived with SCI as well as to identify environmental determinants of functioning. Methods: We use data from the International Spinal Cord Injury Community Survey collected in eleven European countries (N=6656). We used Bayesian Generalized Partial Models to estimate functioning scores and Random Forest to identify environmental determinants. Results: Higher chronological age was associated with decline in functioning but the extent and pattern of decline differed between high- income countries (HICs) and low and middle-income countries (LMICs). Up to age 45 at the time of injury, functioning is comparable across HICs. Above this threshold, the older the person was at injury, the worse the level of the functioning was. For HICs and most LMICs time since injury was not associated with functioning. For all HICs, limited accessibility to homes of friends and relatives, unfavorable climatic conditions and lack of or inadequate adapted transportation for long distances were among the top five environmental determinants. For LMICs, environmental determinants were relatively heterogeneous but for almost all countries lack of or insufficient nursing care was very relevant. Conclusion: The functioning levels of the SCI population were influenced by chronological age and by age at time of injury. Accessibility to homes of friends and relatives, unfavorable climatic conditions and transportation for long distances were among the most important barriers impacting functioning in HICs. Lack of or insufficient nursing care and support services emerged as an important barrier across LMICs.

  Functioning and Dzisability – Labor Market and Participation Top

  6462 - Relationship between employment, self-perceived health, and quality of life in people with spinal cord injury: An InSCI study Top

Reuben Escorpizo1, Shelly Naud1, Julia Engkasan2, Monika Finger3, Tim Geraghty4, Annette Halvorsen5, Bum-Suk Lee6, Marcel Post7, Urban Schwegler3, Cristina Sadowsky8

1University of Vermont, Vermont, USA, 2University of Malaya, Kuala Lumpur, Malaysia, 3Swiss Paraplegic Research, Nottwil, Switzerland, 4The Hopkins Centre, Research for Rehabilitation and Resilience, Queensland, Australia, 5Department of Medical Quality Registries, St. Olavs Hospital, Trondheim, Norway, 6National Rehabilitation Center, Seoul, South Korea, 7University Medical Center Utrecht and De Hoogstraat Rehabilitation, The Netherlands, 8The Kennedy Krieger Institute, Baltimore, Maryland, USA

E-mail: [email protected]

Background and Aim: Work-related disability is frequent among persons with spinal cord injury (SCI). The study aims were to examine the associations of employment with self-perceived health (SPH) and quality of life (QOL) between 22 countries and explore covariates around employment and SPH and QOL. Methods: We analyzed 9127 community-dwelling persons with SCI, 18-65 years old. We performed an adjusted regression and path analysis. Independent variable was 'employment' and dependent variables were two single -items: “quality of life (very poor to very good)” and “self-perceived health (excellent to poor)”. Covariates included Gross Domestic Product (GDP) quartile (Q1- lowest, Q4- highest), education, time since SCI, age, gender, years of employment after SCI, and SCI level and completeness. Results: Mean age of 47, most were male, and had paraplegia. For QOL, the effect of employment did not differ in magnitude across GDP quartiles. However, this was not true of employment's association with poorer scores. The association was not significant for the poorest GDP quartile but greatest for the highest. With perceived health, employment was predictive of good perception of health only in two quartiles (Q1 and Q4), but significant across all quartiles when predicting poor perceptions, with the magnitude of effect varying significantly. Conclusion: Employment is closely linked to QOL and SPH. We may positively influence the QOL and SPH in the SCI population to promote better employment outcomes.


  1. Abu-Baker NN, Al-Zyoud NH, Alshraifeen A. Quality of life and self-care ability among individuals with spinal cord injury. Clin Nurs Res 2021;30:883-91.
  2. Gross-Hemmi MH, Post MW, Ehrmann C, Fekete C, Hasnan N, Middleton JW, et al. Study protocol of the international spinal cord injury (InSCI) community survey. Am J Phys Med Rehabil 2017;96 2 Suppl 1:S23-34.

  5879 - Early support for persons with acquired brain injury or spinal cord injury in danger of dropping out from work Top

Monika E. Finger1, Katarzyna Karcz1, Barbara Schiffmann1, Reuben Escorpizo2

1Swiss Paraplegic Research, Work Integration Group, Nottwil, Switzerland, 2University of Vermont, Burlington, USA

E-mail: [email protected]

Background and Aim: Increasing efforts support persons with an acquired brain (ABI) or spinal cord injury (SCI) to return to work. However, evidence shows that stability of employment decreases over time leading to a substantial number of persons with ABI or SCI dropping out early from work. As little is known on factors influencing their sustained employment throughout the work-life, two scoping reviews followed by focus groups with persons working with ABI or SCI, interviews with employers and professionals identified 6 main topics with 31 potential risk factors. The aim of this consensus study was, to prioritize the identified factors and to formulate action items involving persons with ABI or SCI, employers, work-integration and insurance professionals. Methods: Consensus conference with 29. participants representing all three perspectives. Structured consensus process. Results: In a first step seven out of 31 risk factors were chosen as being most relevant: 1) unclear, fragmented support services; 2) no defined contact person or institution in case of need; 3) lack of understanding for special needs from employers and colleagues; 4) mismatch between work performance and expectation; 5) overuse of client's resources; 6) increasing secondary health problems; 7) lack of suitable job offers. In a second step action items were formulated. Conclusion: Risk factors for sustaining employment were identified and action steps contemplated as a first step to provide early support for persons with BI or SCI in danger of dropping out from work.


  1. Karcz K. Disabil Rehabil 2021;1-2. Available from: https://www.tandfonline.com/doi/full/10.1080/09638288.2021.1960439.
  2. Karcz K. Disabil Rehabil 2021;1-16. Available from: https://www.tandfonline.com/doi/full/10.1080/09638288.2021.1960439.

  5762 - BORA-TB: A new case management approach to improve vocational orientation in rehabilitation of patients with addictive disorders Top

Helen Ewertowski, Thorsten Meyer

School of Public Health, Bielefeld University, Bielefeld, Germany

E-mail: [email protected]

Background and Aim: The presence of an addictive disorder is associated with the risk of relapse, even after long-term therapy and rehabilitation. In care practice, it has been observed that integration into work-life can contribute to maintaining abstinence and improving social participation. The aim of this paper is to present the development and implementation of a new case management approach, BORA-TB, to enhance vocational orientation within rehabilitation of patients with addictive disorders. BORA-TB is a project led by the German Pension Insurance Funds of Westphalia, funded by the German Federal Ministry of Labour and Social Affairs within the programme “Innovative ways for participation in work-life”, called “rehapro”. Methods: Experiences from two years of development and practical realization of the project BORA-TB are summarized to describe this complex intervention within rehabilitation of patients with addictive disorders. Results: BORA-TB is set up as a case management provided in 2 different regions in Germany (urban vs. rural) by 5 so called “participation companions” (PC). In a period from the post-acute phase of medical rehabilitation (MR) in addiction treatment up to 12 month after MR, PCs support eligible patients to develop and pursue vocational aims. In the past 2 years, already 164 patients were included in the project. A scientific evaluation of the project based on standardized data and qualitative inquiries has been implemented. Conclusion: A summative and formative evaluation of BORA-TB, based on the MRC framework for the development and evaluation of complex interventions, is currently carried out to describe the key components of the case management and its success with regard to vocational and social participation of project participants.

  5610 - Swimmer – social workers in rehabilitation: Tasks, work types and settings of interactions Top

Tobias Knoop1, Nadja Scheiblich2, Stephan Dettmers3, Thorsten Meyer2

1School of Public Health, Endowed Professorship Rehabilitation Science, Health Services Research in Rehabilitation, Bielefeld University, Universitätsstr, Bielefeld, Germany, 2School of Public Health, Endowed Professorship Rehabilitation Science, Bielefeld University, Heal, Bielefeld, Germany, 3University of Applied Sciences, Sokratesplatz 2, Kiel, Germany

E-mail: [email protected]

Background and Aim: Social services are an important component of the multidisciplinary rehabilitation team. Albeit, current research indicates a distinct amount of variation in social work practice as well as inconsistent evidence about its effectiveness.[1] The research project SWIMMER (Causal assumptions about social work services in medical rehabilitation, research grant by GfR NRW) aims at explaining these phenomena. Methods: Data collection encompassed interviews with social workers and leading doctors, observations of social work practice and recordings of counselling sessions in 10 rehabilitation clinics in North Rhine-Westphalia, Germany. The research team applied a grounded theory approach. Results: Social workers tasks in clinical practice were e.g. development of perspectives for vocational and/or social participation, discharge planning and addressing basic social and financial needs. The respective social services provide these tasks in different ways by combining one or more of the following work types: e.g. information work, planning work, emotion work, net-working and supporting applications. Another source of variation is the setting of interactions (face-to-face and/or group settings). There is also an inconsistent involvement of e.g. employers and the rehabilitation team. Conclusion: This research captures the diverging role of social workers' practice in rehabilitation. However, social work's importance for the optimization of functioning in terms of participation could be seen across the different rehabilitation clinics. In an international context, this diversity should be even more pronounced due to differing health and social care systems. It is unclear, whether causal factors responsible for rehabilitation success related to social work are similar across different countries.


  1. Knoop T. DRV Schriften 2019;117:83-4. Available from: https://www.deutsche-rentenversicherung.de/DRV/DE/Ueber-uns-und-Presse/Mediathek/Zeitschriften/drv_schriften/drv_schriften.html.

  Health Policy and Systems – Community Based Rehabilitation Top

  6013 - Impact of therapeutic patient education workshops delivered by a Community Stroke Rehabilitation Team on quality of life in stroke patients Top

Amine Guediri1, Jean-Christophe Daviet2, Stéphane Mandigout1, David Bernikier2, Olivia Fasan2, Jean-Yves Salle2, Maxence Compagnat2

1Limoges University, HAVAE Laboratory, Avenue Albert-Thomas, Limoges, France, 2Department of Medicine and Physical Rehabilitation Service, Limoges University Hospital, Limoges, France

E-mail: [email protected]

Background and Aim: Stroke is a major public health problem. According to the world health organization, stroke is the second leading cause of death worldwide. Stroke patients have a low quality of life at 3-month post-stroke and it did not improve during the follow-up of a year.[1] The aim of this study is to evaluate the effect of therapeutic patient education (TPE) workshops on the quality of life in patients after stroke. Methods: A retrospective study including 121 patients who were followed by the Community Stroke Rehabilitation Team (CSRT) of Limoges University Hospital from 2019 to 2020. 92 patients have participated on several TPE workshops such as “understanding the stroke and act”, physical activity, cognitive troubles or fall prevention. 29 patients have not benefited from the TPE. The decision to be part or not of the TPE workshops is made with the patient after an educational diagnosis. The quality of life was assessed by the Euroqol scale at the beginning of the medical care by the CSRT and at the end. Results: The characteristics of the participants in terms of age and Barthel index were similar (p>0.05). The mean age was 65 years old in the two groups. The Barthel index was 90.76 (± 16.36) in the group with TPE and 88.45 (± 20.09) in the group without TPE. We have found a significant augmentation of the Euroqol in the group with TPE compared to the group without TPE (ΔEuroqolTPE = 8.8±15.7 vs ΔEuroqolwithout tpe = 6.4±18.6, p<0.05). Conclusion: The TPE program presented by the CSRT may improve the quality of life of stroke patients. Further prospective studies are needed to confirm these results.


  1. Kauhanen M. Quality of Life after Stroke: Clinical, Functional, Psychosocial and Cognitive Correlates. University of Oulu; 2000.

  5644 - Rehabilitation in the home as hospital substitution for patients needing reconditioning rehabilitation programs Top

Andrew M. Cole1, Roslyn G. Poulos2, Kerry N. Warner3, Christopher J. Poulos4

1Greenwich Hospital Hammond Care, Rehabilitation Services, Greenwich, Australia, 2UNSW School of Population Health and HammondCare, Greenwich, Australia, 3Greenwich Hospital, HammondCare, Greenwich, Australia, 44Research and Aged, Care Services, HammondCare, Greenwich, Australia

E-mail: [email protected]

Background and Aim: Reconditioning after medical illness, surgery or cancer treatment is the most numerous inpatient rehabilitation category in Australia. These care episodes have doubled since 2010, with good evidence for program effectiveness. The current COVID-19 pandemic further highlights the need for responsive rehabilitation services, with greater use of in-home care to avoid stressed inpatient care settings. We aim to design a RITH model for safe and effective service delivery, as a hospital substitution program for patients needing reconditioning care. Methods: To explore and facilitate consensus on how RITH could be implemented for these patients, a multi-round Delphi survey was undertaken with expert Australian specialist practitioners in rehabilitation medicine, nursing and allied health. To explore aspects of the RITH program development in more detail, a questionnaire surveyed patients potentially suitable for this program, while qualitative interviews of a purposive sample of rehabilitation professionals working in both public and private hospital service settings were recorded, transcribed and analysed thematically. Results: A final model including patient eligibility and selection criteria, key elements of program content and outcome assessment is being formulated, to guide RITH program development appropriate for any given service location, and embed service improvement in these programs. Financial modelling examines benefit outlay savings for RITH programs provided in privately insured healthcare settings, with cost-benefit analysis for RITH programs provided in public health settings. Conclusion: RITH for these patients is an appropriate rehabilitation service development response to increasing need for hospital care substitution approaches in the post-COVID healthcare environment.

  Health Policy and Systems – Finances, Cost-Effectiveness Top

  Health Policy and Systems – Infrastructure and Resources Top

  6268 - Utilization of rehabilitation for mental illness during the SARS-CoV-2 pandemic: A difference-in-differences analysis Top

Matthias Bethge1, David Fauser1, Pia Zollmann2, Marco Streibelt2

1University of Lübeck, Institute for Social Medicine and Epidemiology, Lübeck, Germany, 2Federal German Pension Insurance, Berlin, Germany

E-mail: [email protected]

Background and Aim: Our analyses assessed the extent to which the use of rehabilitation for mental illness declined after the German Bundestag declared an epidemic situation of national concern on March 27, 2020. Methods: Data were retrieved from the German Pension Insurance, which is the main provider for rehabilitation of working-age people in Germany. Our data represented all rehabilitations for mental illness provided in 2019 and 2020. We used a difference-in-differences model to determine the reduction in rehabilitations attributable to the pandemic. We used a Poisson regression model to calculate the difference-in-differences estimator. Results: We included 151,775 rehabilitations performed in 2019 and 123,229 rehabilitations performed in 2020. More than 60% of rehabilitations for mental illness were used by women in both years. The decline in rehabilitations for mental illness was sharpest in April and May 2020, with a decrease of 64.3% and 40.7%. In September and November 2020, the number of rehabilitations was comparable to that in 2019. In total, utilization of rehabilitation for mental illness decreased by 14.2% due to the pandemic (IRR = 0.858; 95% CI: 0.844 to 0.872). The decrease attributable to the pandemic was slightly higher for women (IRR = 0.841; 95% CI: 0.823 to 0.858) than for men (IRR = 0.888; 95% CI: 0.865 to 0.913) and more pronounced in the western federal states (IRR = 0.849; 95% CI: 0.834 to 0.865) than in the eastern federal states (IRR = 0.902; 95% CI: 0.867 to 0.938). Conclusion: People with mental illness have faced significant limitations in rehabilitative care due to the pandemic. This will impact the functioning of many people with mental illness, as exacerbation of mental illness that is not adequately treated is likely.

  5695 - How the pandemic helped rehab – The NSW response to COVID Top

Steven Faux1, Louise Sellars2, John Estell3, Sandra Lever4, John Gale5, Michael Pollack6, Sandeep Gupta7, Joanna Goodenough2

1St Vincent's Hospital, Sydney, Australia, 2NSW Agency for Clinical Innovation, St Leonards, Australia, 3St George Hospital, Sydney, South East Sydney Local Health District, Australia, 4Susan Wakil School of Nursing, Ryde Hospital, Northern Sydney Local Health District, Denistone, Australia, 5Goulburn Health Service, Southern NSW Local Health District, Goulburn, Australia, 6John Hunter Hospital, Hunter New England Health, University of Newcastle, Callaghan, Australia, 7Balmain Hospital, Sydney Local Health District, Balmain, Australia

E-mail: [email protected]

Background and Aim: New South Wales is an Australian state of 8.2m people. In April 2020, the NSW Ministry of Health formed communities of practice (COPs) in key clinical specialities to inform the NSW Disaster response. A Rehabilitation COP formed following a number of closures and repurposing of rehabilitation wards for COVID-19 patients, untimely discharge of non COVID-19 rehabilitation inpatients, reductions in rehabilitation outpatient services, and redeployment of staff. This paper reports on the activities of this COP. Methods: An observational description of the establishment and operations of the Rehabilitation COP is provided, as is a literature review supporting the documents produced. Qualitative and quantitative data from an external review of the activities of the COP is presented. Results: The COP has advocated for the critical role of Rehabilitation in the disaster response effort. The COP and its documents were used by Rehabilitation leaders in all states of Australia to inform their local responses. The prominence of the group with the NSW Ministry of Health allowed it to be a reference group for COVID-19 management in rural areas, in aboriginal communities, in the vaccination for people living with a disability and rehabilitation is now in the forefront of the post-acute response. Discussion: Early collaboration, planning and a preemptive response to state led public health measures may have a positive impact on the profile of Rehabilitation Services to colleagues, public health physicians and the public. Conclusions: The NSW experience in being proactive in disaster response and planning may be of benefit for the crucial role of rehabilitation in patient flow, health outcomes and advocacy for people living with disabilities.

  6092 - The use and outcomes of motor rehabilitation services among people with cerebral palsy change across the lifespan Top

Gwenaël Cornec1, Sylvain Brochard2, Gaelle Drewnowski3, Isabelle Desguerre4, Philippe Toullet5, Audrey Fontaine6, Yann Le Lay7, Julia Boivin3, Eric Bérard8, Maria Bodoria9, Vincent Gautheron10, Javier De La Cruz11

1Neurological PRM Unit, University Hospital of Brest, Brest, France, 2Pediatric PRM Unit, Ildys, University Hospital of Brest, Brest, France, 3Expert patient, Lyon, France, 4Hôpital Necker, Enfants Malades, Pediatrics-Radiology-Genomics, Paris, France, 5Institut Motricité Cérébrale - CDI, Paris, France, 6Physiotherapist, Paris, France, 7Physiotherapist, Nantes, France, 8Odyneo, Lyon, France, 9Fondation Paralysie Cérébrale, Paris, France, 10Pediatric PRM Unit, CHU Bellevue, Saint Etienne, LIBM, Universités de Saint-Etienne et Lyon, Saint-Étienne, France, 11Hospital Universitario 12 Octubre, Health Research Institute Imas12, ISCIII Red SAMID, Madrid, Spain

E-mail: [email protected]

Background and Aim: The provision rehabilitation programs that adapt to the individual with cerebral palsy (CP) evolving needs throughout the different phases of life is highly challenging for healthcare systems. The aim of this study was to report the changes in motor rehabilitation (MR) environmental factors, service use and patient outcomes between age groups of individuals with CP. Methods: We used data from the French ESPaCe survey to select a set of indicators for MR environmental factors, service use and patient outcomes, highlighted by patients and families in previous studies. We then compared the distribution of the indicator data between children and adults, as well as between four transition age groups: children under 12, adolescents up to 17 years, young adults, and adults over 25 years of age. We estimated odds ratios adjusted for motor involvement, associated impairments and informant type. Results: A total of 997 respondents over 2 years of age were included in this study (484 children and 513 adults). Finding an available physiotherapist was very difficult for almost half of the children, and a greater proportion of adolescents and adults. Physiotherapy was provided in a private outpatient practice for twice as many adults as children and adolescents. Multidisciplinary rehabilitation decreased sharply from adolescence and the amount of physical therapy decreased considerably at adulthood. Satisfaction with the MR program decreased from childhood into adolescence and then further into adulthood. Conclusion: Healthcare policies should focus on accessibility issues at all ages, consider adolescents as a specific population, consider a wide transition phase (12-25 y.o.), and maintain a multidisciplinary approach in adulthood. There is a strong need for national rehabilitation strategies for individuals with CP.

  5564 - How the acute care response for COVID-19 patients impacted rehabilitation services in Australia and New Zealand Top

Tara Alexander1, Steven G Faux2,3, John Olver4,5, Maria Crotty6, Ross Clifton7

1Australasian Rehabilitation Outcomes Centre, Australian Health Services Research Institute, University of Wollongong, Australia, 2St Vincent's Hospital, Darlinghurst, New South Wales, Australia, 3University of New South Wales, New South Wales, Australia, 4Epworth HealthCare, Melbourne, Australia, 5Monash University, Melbourne, Australia, 6Flinders Medical Centre, Adelaide, Australia, 7Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, Australia

E-mail: [email protected]

Background and Aim: Inpatient rehabilitation services lost beds in the health system's response to acute care of Covid-19 patients. Not all services were restored to pre-Covid levels. The Australasian Rehabilitation Outcomes Centre (AROC) is an integrated outcomes centre with a voluntary membership incorporating over 95% of all inpatient services. This study aimed to describe and monitor the impact of the acute response to covid-19 on the provision of rehabilitation services. A further aim was to enable advocacy for the restoration of rehabilitation beds and staff as services adjust to “living with Covid-19”. Methods: Following the delta outbreak AROC commenced monthly member surveys reviewing changes to beds, wards, staffing (clinical and rehabilitation nursing) and asked for positive/negative impacts. Variations in patient casemix, volume and impacts on patient outcomes were compared to pre-covid for services reported outcome data. Results: Many inpatient services (64%) and nearly all other rehabilitation services (in-reach, outpatient, RITH, Telehealth) reported impacts including reductions in patient numbers and rehabilitation services. Workforce impacts included significant re-deployments with staff not being replaced. Inpatient rehabilitation episodes submitted to AROC declined as a direct result of covid lockdowns & elective surgery cancellations. During the first lockdown cases declined 24% and fewer services submitted data. Conclusion: There are concerns for the sector's capacity to meet potential future increases in demand, e.g. long Covid or as a result of delayed medical care during lockdown, particularly if rehabilitation services are not able to return to pre-covid capacity or have resources to develop different care pathways including RITH & Telehealth.

  4628 - The relationship between adverse opioid events and physical medicine and rehabilitation expertise in the United States Top

Andrew Haig1, Samantha Wall1, Thomas Haig1, Paula Vredenberg2

1Haig Consulting LLC, 2Grand Valley State University, Allendale, Michigan, USA

E-mail: [email protected]

Background and Aim: The overuse of opioids in the United States has resulted in death, disability, criminal convictions and social disruption, worse during the COVID-19 pandemic. Physiatrists (PRM physicians), expert in non-opioid pain management, might be a solution. This study compares adverse opioid statistics to the penetration of PM&R physicians in regions of the country. Methods: Populations, number of AAPMR member physiatrists, of first-year trainees, opioid deaths, and opioid prescriptions were gathered from various sources and compared by region. Results: Physiatrists per capita correlated negatively with opioid overdose deaths (rs = -0.361, p = 0.01). Number of Physiatrists, but not Physiatrists per capita, negatively correlated with the number of opioid prescriptions (r = -0.265, p = 0.063). The number of trainees inversely related to prescriptions (r = -0.240, p = 0.093) but had no relationship to deaths. Step-wise linear regression found number of Physiatrists explained 7% of the variance in opioid prescriptions. Conclusion: The presence of Physiatrists and Physiatry training programs provides some protective effect against the adverse effects of opioids in a community. Policymakers, academic leaders, healthcare system leaders and governments should look to expansion of this role as part of a strategy to save lives and livelihoods.

  Health Policy and Systems – National Policy and Law Top

  Health Policy and Systems – Rehabilitation Accress the Continuum of Care Top

  7002 - Tele-rehabilitation with ARC-intellicare to cope with respiratory and motor disabilities: Preliminary results about usability and clinical effect (“Ricominciare” study) Top

Marianna Capecci1, Rossella Cima1, Alice Mantoan2, L Tagliapietra2, A Compagno2, G. Avveduto2, Francesca Sernissi2, Luca Ascari2, Filippo Barbini1, Paola Casoli1, Margherita Hibel1, Maria Gabriella Ceravolo1

1Department of Experimental and Clinical Medicine, University Politecnica delle Marche, Ancona, Italy, 2Camlin Italy Srl, Divisione Health, Parma, Italia

E-mail: [email protected]

Background and Aim: “Ricominciare” is a single-center, prospective, pre/post-intervention pilot study aimed at verifying feasibility and safety of ARC-Intellicare (ARC) system (an Artificial Intelligence-powered and Inertial Motion Unit-based mobile platform) in the home rehabilitation of people with disabilities due to respiratory or neurological diseases. Methods: Individuals with Parkinson's disease (pwPD) or post-Covid-19 syndrome and indication for exercise or home rehabilitation to optimize motor and respiratory function were enrolled. They underwent a session of training in the use of ARC and received an ARC unit to be used, independently, at home for 4 weeks, 45 minutes 5 days/week sessions of respiratory and motor patient-tailored rehabilitation. Usability (System Usability Scale, SUS), adherence, adverse events were primary study outcomes. Barthel Index (BI), Barthel-Dyspnea scale (BDs), 2MWT, Brief Fatigue inventory (BFI), Beck Depression or Anxiety Inventory (BDI, BAI), quality of life (HQOL) were also monitored pre- and post-treatment. Results: 21 patients (61±10 years old, 8 women) were enrolled and completed the study: 11 with post-Covid syndrome (57±13 years, 5W) and 10 pwPD (65±4 years old, 3W). The maximum level of difficulty reported was 2/10 by post-Covid patients and 8/10 by pwPDs. The mean total SUS score was 77/100. The median patients' adherence to exercise prescriptions was 80%. Dyspnea (BDs) improved significantly (p=.003), as well as fatigue (BFI) (p=.005), 2MWT distance (p=.001), mood (BAI: p = .01; BDI: p=.002) and quality of life (HQOL: p=.0083) in the overall sample without significant differences between groups. Conclusion: ARC was usable for home rehabilitation. Preliminary data suggest promising results on the effectiveness in subjects with COVID19 outcomes or Parkinson's disease.

  6814 - Describing rehabilitation services in Indonesia by using International Classification of Rehabilitation Service Organizations (ICSO-R) 2.0: A pilot study Top

Boya Nugraha1, Irma Ruslina Defi2, Luh K. Wahyuni3, Melinda Harini3, Wanarani Alwin3, Vitriana Biben2, Christoph Gutenbrunner1

1Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany, 2Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Padjadjaran-Hasa, Jawa Barat, Indonesia, 3Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia-Cipto, Jakarta, Indonesia

E-mail: [email protected]

Background and Aim: Rehabilitation services vary widely, from hospital to community level. Inequality in describing a rehabilitation service organization encourages the development of the International Classification of Service Organization in Rehabilitation (ICSO-R) by the Working Group of International Society of Physical and Rehabilitation Medicine WHO Liaison Committee (ISPRM-WHO LC). This study aimed at describing two departments of rehabilitation medicines in two different tertiary hospitals in Indonesia. Methods: The translated Indonesian version of ICSO-R 2.0 was used to describe the departments of Rehabilitation Medicine Results: The Indonesian version of ICSO-R 2.0 could describe two rehabilitation medicine departments in two tertiary hospitals in Indonesia. Conclusion: The Indonesian translation of ICSO-R 2.0 is an important tool for describing and comparing rehabilitation services in Indonesia. In the future, ICSO-R 2.0 can be used to improve rehabilitation services in Indonesia.


  1. Gutenbrunner C, Nugraha B, Gimigliano F, Meyer T, Kiekens C. International Classification of Service Organization in Rehabilitation: An updated set of categories (ICSO-R 2.0). J Rehabil Med 2020;52: jrm00004.

  6794 - On the similarities and differences of rehabilitation and prevention in light of the health strategy concept Top

Thorsten Meyer

School of Public Health, Universitaetsstr, Bielefeld University, Bielefeld, Germany

E-mail: [email protected]

Background and Aim: The proposal of rehabilitation as a health strategy[1] distinguishes among preventive, curative, rehabilitative and supportive strategies. This paper aims to analyse what preventive and rehabilitative strategies have in common, what accounts for their differences and how prevention can conceptually be integrated into rehabilitation. Methods: Analytical comparison based on current definitions of rehabilitation,[2] disease prevention and health promotion. Results: Primary object of interest in prevention is the disease, in rehabilitation it is the concept of functioning according to the ICF. Rehabilitation integrates a risk-factor model (as in prevention) and a salutogenetic model (as in health promotion) by means of the ICF. Primary prevention has a population perspective, while secondary and tertiary prevention have an individual perspective. Rehabilitation is restricted to an individual perspective. Besides diseases, preventive strategies can also relate to functioning. This type of prevention is typically integrated into rehabilitation, which has also been related to as the “medicine of functioning”.[3] In this sense, prevention related to functioning has always been part of rehabilitation practice. Disease is a dichotomous construct, while functioning is to be understood as a continuum, which results in different meanings in terms of prevention. Conclusion: While primary disease prevention should be considered a population-related public health task, prevention related to functioning should conceptually be part of rehabilitation as a health strategy and targeted to the individual.


  1. Stucki G, Cieza A, Melvin J. The International Classification of Functioning, Disability and Health (ICF): A unifying model for the conceptual description of the rehabilitation strategy. J Rehabil Med 2007;39:279-85.
  2. Meyer T, Gutenbrunner C, Bickenbach J, Cieza A, Melvin J, Stucki G. Towards a conceptual description of rehabilitation as a health strategy. J Rehabil Med 2011;43:765-9.
  3. Stucki, Bickenbach. J Int Soc Phys Rehabil Med 2019;2:S8-12. Available from: https://www.jisprm.org/article.asp?issn=2349-7904;year=2019;volume=2;issue=5;spage=13;epage=14;aulast=Stucki.

  6342 - Reduced utilization of cardiological rehabilitation due to the SARS-CoV-2 pandemic in Germany: A difference-in-differences analysis Top

Annika Sternberg1 , David Fauser2, Pia Zollmann3, Marco Streibelt3, Matthias Bethge2

1University of Lübeck, Institute for Social Medicine and Epidemiology, Ratzeburger Allee Lübeck, Germany, 2University of Lübeck, Institute for Social Medicine and Epidemiology, 3Federal German Pension Insurance, Berlin, Germany

E-mail: [email protected]

Background and Aim: The SARS-CoV-2 pandemic led to expanded treatment capacities for COVID-19 sufferers and limitations in the treatment of cardiological diseases and other health problems. Some cardiological rehabilitation facilities in Germany were temporarily closed. Our analysis examined the extent to which the utilization of cardiological rehabilitation in Germany decreased due to the pandemic. Methods: Data were retrieved from the German Pension Insurance which is the main provider for rehabilitation of working-aged people in Germany. Our data represented all cardiological rehabilitations used in 2019 and 2020. We used a difference-in-differences model to determine the reduction in rehabilitation utilization attributable to the pandemic and reported incidence rate ratios (IRR).[1] Results: We included 72,819 cardiological rehabilitations in 2019 and 62,224 cardiological rehabilitations in 2020. Compared to the previous year, the nationwide decline in cardiological rehabilitations was greatest in April 2020 (48.3%). Overall, the utilization of cardiological rehabilitation was reduced by 13.3% due to the pandemic (IRR = 0.867; 95% CI: 0.847 to 0.888). Non-post-acute rehabilitations showed a significant greater decline than post-acute rehabilitations. There were no differences in decline in sex and region (Western and Eastern Germany). Conclusion: Our analyses show a pandemic-related reduction in cardiological rehabilitations of 13.3%. It is likely that cardiological rehabilitations, that did not occur, are associated with a higher burden of disease, reduced participation, and possibly increased mortality for affected individuals.


  1. Goodman-Bacon. Surv Res Methods 2020;14:153-8. Available from: https://ojs.ub.uni-konstanz.de/srm/article/view/7723.

  6478 - The effects of obesity on complex decongestive therapy outcomes in patients with breast cancer related lymphedema Top

Pinar Borman1, Aysegul Yaman2, Funda Koç3, Ruveyda Sargut3

1Department of Physical Medicine and Rehabilitation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey, 2Department of Physical Medicine and Rehabilitation, Gülhane Training and Research Hospital, Ankara, Turkey, 3Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey

E-mail: [email protected]

Background and Aim: The aim of this study was to evaluate the effect of obesity on complex decongestive therapy (CDT) outcome in patients with breast cancer-related lymphedema (BCRL), in regard to volume reduction, functional status and quality of life (QoL). Methods: The patients with unilateral BCRL who were provided CDT were recruited. Patients were classified as having normal/overweight (group 1) and obese/morbid obese (group 2). All patients received CDT including skin-care, manual lymphatic drainage, multilayer bandaging and exercises 5 times/week for 3 weeks. The limb excess volumes according to serial circumference measurements of the limb, which were determined at baseline and at the end of 3rd week, were recorded. The improvement of functional disability and QoL scores, which were evaluated by Q-DASH and Lymphedema QoL Questionnaire-Arm (LYMQOL-Arm), questionnaires were noted. Results: A total of 81 female patients (group 1: 36 patients, group 2: 45 patients) with a mean age 53.6±10.4 years were analyzed. The mean age, median duration of lymphedema and number of patients according to stage of lymphedema were similar between groups. There were significant improvements in volumes (Group 1: 3066±669 cm3 vs. 2759±537 cm3, Group 2: 3276±683 cm3 vs. 2979±609 cm3; p<0.001), functional scores (Group 1: 40.34 vs. 34.32, Group 2: 44.54 vs. 37.34; p<0.05) and all subscores of LYMQOL-Arm (overall QoL; Group 1: 6.5±1.6 vs. 7.9±1.2, Group 2: 5.3±2.1 vs. 7.7±1.3; p<0.001), in both groups after CDT. The improvements in excess volumes and functional status were comparable between the groups while the LYM-QoL-functional and appearance sub-scores were lower in group 2 than in group 1. Conclusion: Obesity may have a negative impact on CDT outcome in regard to QoL but not to volume reduction and functional improvement. We suggest inclusion of education on weight control in BCRL.

  6298 - Development and implementation of a Clinical Practice Guideline for amputees. A knowledge translation process in a middle-income country Top

Luz Helena Lugo, Ana Maria Posada Borrero, Jesús Alberto Plata Contreras, Daniel Felipe Patiño

Department of PMR, University of Antioquia, Medellín, Colombia

E-mail: [email protected]

Background and Aim: There is a need for patients to receive interventions that have been shown to be effective. The aim of this study was to describe the process of development, identification of barriers and facilitators and design of an implementation strategy for the Clinical Practice Guideline (CPG) for the patient with a lower limb amputation. Methods: A Clinical Practice Guideline for lower limb amputees was developed by the Ministry of Health in Colombia, then, barriers and facilitators for its implementation were identified, a comprehensive care pathway (CP) was made for these patients and a project is being developed to test the effectiveness of an implementation strategy. A guideline and a mobile application were developed for patients and their caregivers. Results: The CPG included 43 recommendations based on evidence for the diagnosis, surgical treatment, rehabilitation, prescription and adaptation of the prosthesis. Five major milestones or expected outcomes were defined and a CP was developed. Barriers and facilitators were described. In a deliberative forum held with decision-makers, service providers, associations, professionals and patients, the most important barriers were: lack of governance in the health system to articulate health promoters and providers, lack of programs and integrated networks, lack of access to care specially in remote areas, the lack of skills of professionals, the responsibility of all stakeholders. Adherence to the recommendations in 100 patients was low, between 20 and 50%. Conclusion: Despite the preparation, publication and dissemination of the most effective and secure recommendations for patients, the studies of barriers and facilitators and the development of a CP, an adequate implementation has not been achieved.

  6244 - Rehabilitation needs in post-COVID 19 patients admitted to an inpatient rehabilitation setting Top

Paolo Boldrini1, Antonio Biasioli2, Orietta Cattozzo3, Massimo Iannilli3

1Italian Society of Physical and Rehabilitation Medicine, Rome, Italy, 2Casa di Cura Città di Rovigo e Scuola Specializzazione MFR University of Verona, Verona, Italy, 3Casa di Cura Città di Rovigo - Rovigo -Italy

E-mail: [email protected]

Background and Aim: The COVID-19 can lead to persisting functional limitations after the acute phase, requiring inpatient rehabilitation before discharge home. An assessment of rehabilitation needs is important to ensure proper levels of care. The Rehabilitation Complexity Scale (RCS-E v13) is a widely diffused tool to explore these aspects. In this study, the RCS-E v13 was used in a cohort of COVID-19 patients admitted to an inpatient rehabilitation unit, and was compared to two other categories of pts. with neurological (NEURO) or musculoskeletal (MSK) impairments. Methods: From Jan. 1st to Sept. 30th, 2021, 37 COVID-19 patients (24 males, mean age 66.9 y; SD 11.4) were admitted to our Inpatient Rehabilitation Unit after discharge from the acute care units. Clinical data (severity in the acute stage; Lenght of stay: LOS) were collected. Barthel score (BI), Functional Independence Measure (FIM) score, and RCS-E v13 scores were administered on admission. The scores on BI, FIM, and RCS-E v13 were compared to those of a group of 20 pts. with neurological conditions and a group of 41 pts. with musculoskeletal conditions. Results: The severity of COVID-19 in the acute stage - Median score: 3; LOS rehabilitation: mean 42.6 days; (SD 21.5). Median score on RCS-E v13, BI and FIM on admission, respectively: COVID-19: 11; 20; 58; NEURO: 12; 18; 49; MSK: 10; 50; 86. No significant differences in total RCS-E v13, BI, and FIM scores were found between the 3 groups of patients. Differences were found between COVID-19 pts and MSK patients in subscores of the RCS-E v13. Conclusion: The patients with sequelae of COVID-19 may require complex rehabilitation interventions similar to other patients usually admitted to the rehabilitation units.


  1. Rodà F. PLoS One 2017;12. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0178453.
  2. Wu J. Clin Infect Dis 2020;71.

  6095 - Telerehabilitation planning – How to design an action plan Top

Paula Amorim

Rehabilitation Center Rovisco Pais, Tocha, Portugal

E-mail: [email protected]

Background and Aim: COVID-19 pandemic left millions of people around the world without the proper rehabilitation care. One of the lessons learned was that it would be useful to have a mature Telerehabilitation plan in our health institution. There are several models that could be useful to support Telemedicine initiatives, services or research projects. The aim of this work is to review those models and to propose a model to design a Telerehabilitation Plan, considering the local/regional and national specificities. Methods: The author conducted a literature analysis of telemedicine models based on the user's (e.g., medical professions, patients, health authorities, payers) demand for information to assist decision making. Results: The Model for Assessment of Telemedicine (MAST) is one of the most used models in Telemedicine in Europe. This is a holistic model which focuses on the measurement of effectiveness and quality of care. It represents a multidisciplinary process, evaluating the medical, social, economic, and ethical aspects of telemedicine. MAST has been used in several pilot studies and is considered useful. It includes preceding considerations that should be taken into account in planification: the purpose, the relevant alternatives, the assessment of results. The second step is a multidisciplinary assessment in seven domains: 1. Health problem and characteristics of the service; 2. Safety; 3. Clinical effectiveness; 4. Patient perspectives; 5. Economic aspects; 6. Organisational aspects; 7. Socio-cultural, ethical, and legal aspects. Finally, an assessment of the transferability of results could be useful to share the good practices. Conclusion: MAST seems to be a useful model to be used for telerehabilitation planning, implementation and monitorization.

  6114 - Impact of the COVID-19 pandemic in PRM departments Top

Catarina Aguiar Branco1, João Paulo Branco2, Lurdes Rovisco Branquinho2, João Páscoa Pinheiro3

1Department of PRM, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal, 2Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, 3Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal

E-mail: [email protected]

Background and Aim: The aim of this study was to evaluate the changes suffered by Portuguese Physical and Rehabilitation Medicine (PRM) departments due to the coronavirus disease 2019 (COVID-19) pandemic in the scope of assistance, organization, training and research. Methods: A self-administered, cross-sectional online survey was sent to all Portuguese National Health System PRM departments, regarding the assistance provided to patients with COVID-19, the organizational changes that were carried out due to the COVID-19 pandemic and the difficulties experienced on the team management, training and research. Results: The survey had a response rate of 83%. The majority of PRM departments assisted patients with COVID-19, mainly in the context of inpatient general ward care and intensive care units. Changes in the assistance activity and accessibility were reported by almost all PRM departments, mainly affecting the outpatient consultation and technical sectors. There was a reduction in the number of professionals, especially by transfer to other specialties COVID-19 areas, and almost all used remote procedures, especially for patient reassessment, counseling, and monitoring. The majority of PRM departments highlighted the pandemic's impact on the training availability, as well as in the applied research and publications. Conclusion: The pandemic triggered a complete overhaul of rehabilitation departments with significant changes in assistance activity, changing routines and programmed procedures. Outpatient consultations was the most affected area, while support for hospitalization and internal consultations remained mostly operational. The use of remote procedures was high, particularly in follow-up and counseling. There was a strong negative impact on scientific research and training.

  5902 - Katz index of independence in activities of daily living, a predictor of mortality and length of hospitalization in the oldest-old Top

João Santos Faria1, Carla Hovenkamp1, João Nuno Malta1, Lurdes Rovisco Branquinho1, Alexandra P. Coelho1, Ana Rita Ramalho2, Joana Santos Costa1

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

E-mail: [email protected]

Background and Aim: A decline in the ability to perform activities of daily living (ADL) can occur with aging. The Katz index is one of the earliest and most used indices for assessing a person's functionality. Prior studies have linked functional status to major outcomes following hospital admission. We aim to find if a patient's functionality at admission, evaluated by Katz, could predict intrahospital mortality and length of hospitalization in the oldest-old. Methods: We conducted an observational retrospective study, which included all patients (n=1828) who came to the Emergency Department and were admitted to an Internal Medicine ward between March and May of 2018, 2019, and 2020. Upon admission, all patients were assessed with the Katz Index, and they were divided into three groups. Results: Median age was 87 years-old (IQR 83-90). Patients with higher and intermediate Katz index had significantly less mortality (11% and 13%, respectively) compared with the lower Katz group (23%; p<0.001). The higher Katz group had a significantly shorter length of stay (9 days) than the intermediate and lower Katz groups (11 days; p<0,001). Even though the patients in the higher Katz group were younger (p<0.001), a regression analysis showed that age is only a minor determinant of Katz (p<0.001; r2=3%). Unlike Katz, at admission, past medical history of diabetes, heart failure, chronic kidney disease, hypertension, and cancer did not influence mortality (p>0.05). Conclusion: According to our findings, functionality plays a key role in the resilience of the oldest-old, as those with higher functionality had better outcomes after hospitalization. Thus, healthcare systems should implement methods to maintain a high level of functionality in the oldest-old. Geriatric rehabilitation should be a central aspect of the standard of care.

  5706 - Differences in hazard perception during driving and street crossing between poststroke patients and a healthy population Top

Navah Z. Ratzon, Timor Amit

Department of Occupational Therapy, Tel Aviv University, Ramat-Aviv, Tel-Aviv, Israel

E-mail: [email protected]

Background and Aim: Hazard perception has been widely studied in young and old people but not among people with post-stroke. Because hazard perception is crucial for both driving and crossing the road, the research goals of this study were (a) to test differences in hazard perception when crossing the road and driving between post-stroke participants and control group of healthy individuals; and (b) to test the correlation between hazard perception post-stroke of individuals when driving and when crossing the street. Methods: The cross-sectional study included 58 participants: 30 post-stroke adults in rehabilitation and 28 healthy volunteers matched by gender and age. Both groups completed the Driver Behavior Questionnaire (DBQ), which evaluates behavior when driving, and the Pedestrian Behavior Scale (PBS), which evaluates pedestrian behavior. Participants were also evaluated with the Hazard Perception for Pedestrian Test (HPTP) and the Hazard Perception Test (HPT) for driving. Results: The findings show significant differences in “Errors” (u=590, p<0.1) and “Aggressiveness” (u=687, p<0.001) on the DBQ questionnaire, in “Positivity” on the PBS (t(56)=1.74, p=0.04), and on the HPTP test (t(56)=2.97, p<0.01). The findings also demonstrated a significant correlation between scores on the HPT and HPTP tests (r=.55, p<.01). Conclusion: The study sheds light on the reduced ability of hazard perception of people with post-stroke compared to healthy controls. Future studies should vary the conditions of similar tests. The correlation between driving and road crossing that was confirmed in the present study may lead to a new training strategy of vulnerable road users, such as post-stroke subjects who are not going to drive after the stroke.

  5508 - Reduced utilization of cancer rehabilitation due to the SARS-CoV-2 pandemic in Germany: A difference-in-differences analysis Top

David Fauser1, Pia Zollmann2, Marco Streibelt2, Matthias Bethge1

1Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany, 2Federal German Pension Insurance, Berlin, Germany

E-mail: [email protected]

Background and Aim: The provision of human and financial resources for the treatment of COVID-19 led to limitations in the treatment of cancer and other health problems in many countries. Restricted access to rehabilitative care may affect the work participation of cancer survivors. Our analyses examined the extent to which cancer rehabilitations in Germany decreased due to the SARS-CoV-2 pandemic. Methods: Data were retrieved from the German Pension Insurance which is the main provider for rehabilitation of working-aged people in Germany. Our data represented all cancer rehabilitations used in 2019 and 2020. We used a difference-in-differences model to determine the reduction in rehabilitation utilization attributable to the pandemic and reported incidence rate ratios (IRR).[1] Results: We included 148,726 cancer rehabilitations in 2019 and 115,102 cancer rehabilitations in 2020. Compared to the previous year, the nationwide decline in cancer rehabilitations was greatest in April 2020 (63.2%). Overall, the utilization of cancer rehabilitation was reduced by 18.8% due to the pandemic (IRR=0.812; 95% CI: 0.798 to 0.826). The decline in utilization was more pronounced in Western Germany than in Eastern Germany as well as for pensioners than persons of working age. There were no differences in sex and type of rehabilitation, i.e. non-post-acute rehabilitations or post-acute rehabilitation. Conclusion: Failure to seek rehabilitation after cancer treatment could have a lasting impact on the participation of many cancer survivors. We recommend a repeated cross-sectional monitoring of participation and health of people with cancer to clarify how these people can be supported in utilizing for rehabilitation.


  1. Goodman-Bacon. Surv Res Methods 2020;14:153-8. Available from: https://ojs.ub.uni-konstanz.de/srm/article/view/7723.

  5423 - Combining remote cognitive rehabilitation with computerized cognitive training for adults with cancer-related cognitive impairment: Preliminary results from a randomized controlled trial Top

Talia Maeir1, Mor Nahum2, Chen Makranz3, Tamar Peretz3, Yafit Gilboa1

1School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, 2School of Occupational Therapy, The Hebrew University of Jerusalem, Jerusalem, Israel, 3Department of Neurology and Oncology, The Gaffin Center for Neurooncology, Sharett Institute for Oncology, Jerusalem, Israel

E-mail: [email protected]

Background and Aim: Cancer Related Cognitive Impairment (CRCI) is common among non-central nervous system cancer survivors and has substantial impact on daily function and quality of life (QoL), yet it remains undertreated. This study aimed to test the effectiveness of Computerized Retraining and Functional Treatment (CRAFT), a remotely applied intervention combining computerized cognitive training (CCT) with meta-cognitive occupational therapy (OT) for adults with CRCI. Methods: Thirty-three (N=33) cancer survivors who were 18 years and over, had subjective concern about their cognition and completed their treatment at least 6 months prior to enrollment were randomized into one of three groups, receiving 12 weeks of either treatment as usual (TAU; n=8), CCT alone (n=13), or CRAFT (n=12). CCT was performed 3 times/week for 25 min each time. The CRAFT group received in addition remote OT treatment for 45 min/week. Daily functioning (Canadian Occupational Therapy Measure; COPM), QoL (Functional Assessment of Cancer Therapy; FACT-GP), depression (PHQ-9) and cognitive function (attention shifting task) were assessed before and after treatment. Results: Repeated measures analysis revealed significant time X group interaction effects on daily functioning, QoL, and depression. Post-hoc analyses showed that CRAFT had significantly larger benefits compared to the other two groups on the above measures (p<0.05) all with a moderate to large effect size (cohen's <em>d=0.59-2.2). The CCT group (n=13) demonstrated an isolated improvement on attentional shifting (Cohen's d=0.7). Conclusion: CRAFT, a combined telehealth model of CCT and OT treatment for adults with CRCI, shows promise in achieving clinically significant functional, QoL and psychological outcomes for adults with CRCI.

  4355 - COVID-19 impact on caregiver training for inpatient rehabilitation Top

Amy Ng, Jack Fu, Karissa Nedoma, Eduardo Bruera

Department of Palliative Rehabilitation and Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX, USA

E-mail: [email protected]

Background and Aim: Hospitals and rehabilitation centers around the world have been impacted by the novel coronavirus SARS-CoV-2 (COVID-19) pandemic. COVID-19 caused a rapid need for bed availability and the need for patients to discharge home from the hospital setting. It also changed visitor policies to the hospital, which meant caregivers were completely absent and unavailable for the usual traditional in person learning and training. We aim to describe barriers as a result of the pandemic on caregiver training and propose potential virtual and hybrid solutions to aid in training for safe discharges home for all hospitalized rehabilitation patients. Ideally, in-person training is the optimal preferred method, however, due to the spread of COVID-19, it has become necessary to use virtual training first. Methods: There are a series of circumstances where it is not feasible or appropriate and in-person training would be required. Considerations on the type of training may be made depending on the level of assistance needed for determining virtual or in-person training. Results: If a patient requires minimal assistance or less, consider virtual video training prior to discharge home. We propose a hybrid of virtual and in-person model for those patients who have special precautions. Finally, for patients who require maximal or total assistance, we propose a hybrid in-person plus model to bring in caregivers for actual hands on training along with the virtual component. Conclusion: We highlight the unexpected challenges of COVID-19 in providing adequate caregiver training to promote safe discharge of patients from the hospital. As pandemic continues, a combination of virtual and or in-person guided by the complexity of rehabilitation needs allows for safer patient and family care.

  Health Policy and Systems – Rehabilitation Management (Accreditation and Certification) Top

  5968 - What is the evidence for learning through the American board of physical medicine and rehabilitation continuing certification longitudinal assessment program? Top

Carolyn Kinney

American Board of PM&R; Rochester, Minnesota, USA

E-mail: [email protected]

Background and Aim: In 2021, diplomates of the American Board of Physical Medicine and Rehabilitation (ABPMR) completed their first full year of participation with a new, online longitudinal assessment program (LA-PM&R) for Continuing Certification (CC). Over a 5-year cycle, this program replaces the in-person, computer-based knowledge assessment component of the ABPMR CC requirements. The introduction of LA-PM&R was informed by a pilot study in 2019, in which ABPMR diplomates demonstrated the potential of the online platform to promote learning through question repetition coupled with immediate feedback and links to additional educational material. The goals of the current study were 1. to determine whether physicians improved their performance on previous incorrect responses when they saw similar items later in the year and 2. to analyze any performance difference among physician at different stages in their CC cycle. Methods: In 2021, 6,517 ABPMR diplomates registered to participate in LA-PM&R. Of these, 2,557 were in a performance assessment cycle; their answers will contribute to a summative assessment in cycle year 5. The remaining 3,960 participating physicians were not in an assessment cycle; their answers did not count toward a summative assessment. Results: Participants answered up to twenty questions per quarter. Initially, all questions presented new content. After the first quarter, some questions were repeated if participants previously answered incorrectly. Physicians improved correct answers on their later attempt by 55.7%. Conclusion: The full data will be analyzed after completion of Quarter 4 in 2021. In addition to presentation of the 2021 data, the theory and design of the ABPMR longitudinal assessment program will be reviewed.


  1. Robinson LR. AJPMR 2020;99:420-23.

  Social Sciences – Biostatistics Top

  Social Sciences – Disability Studies Top

  6436 - The role of FC Porto in reducing the impact of lockdown on its para-athletes caused by COVID-19 Top

Rui Martins da Silva1, Barbara Fontes2, Catarina Teixeira2, Joana Manuel Moreira2, Raquel Teixeira2, Adriana Barbosa Pereira3, Joana Teixeira2

1Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal, 2Futebol Clube do Porto, Porto, Portugal, 3Centro de Medicina de Reabilitação de Alcoitão, 2649-506 Alcabideche, Portugal

E-mail: [email protected]

Background and Aim: Sports for people with disabilities helps develop their potential, identity and self-confidence. COVID-19 pandemic led to huge restrictive worldwide measures, such as suspended training, especially for para athletes, who due to associated comorbidities, more susceptible to COVID-19. To reduce the impact of isolation, FC Porto conducted online training during lockdown. This study aims to understand the role that FC Porto played in para athletes during lockdown. Methods: A specific questionnaire was designed by FC Porto's health department, answered voluntarily by para athletes who compete, or their tutors, from June to September 2020, aimed to evaluate: general perception of the role of FC Porto, tiredness, pain, strength and specific disabilities changes. Results: Answers were obtained from 56 athletes (13 from tutors), 9 female athletes, swimming (30), table tennis (13), boccia (7) and goalball (6). Average age was 25 years. As for the aggravation of specific deficits, 26, 24 and 33 responses were obtained on spasticity, walking difficulties and manual dexterity, respectively. Results per question are shown in [Figure 1]. Conclusion: FC Porto played an active role in 100% of their para athletes' lives during lockdown. Regarding tiredness, pain, less strength and specific deficits, the majority did not show symptoms or worsening. These can be justified by their sports' excellence and online training. Thus, the professionalism and organization of a club play an essential role for athletes to achieve excellence, and in the case of para athletes, an even more global role.

  Social Sciences – Economics Top

  5541 - To what extend do income inequalities explain limitations in activity and participation in people with spinal cord injury Top

Ana Oña1, Abderrazak Hajjioui2, Merce Avellanet3, Joseph Conran4, Brigitte Perrouin-Verbe5, Andrea Boekel6, Daiana Popa7, Diana Pachecho Barzallo8, Karin Postma9

1Swiss Paraplegic Research, Guido A. Zäch Strasse 4, Nottwil-Switzerland, 2University Hospital Hassan II, Fes, Morocco, 3Hospital N Sra Meritxell, Spain, 4Karolinska Institutet, Solna, Sweden, 5Universitaire de Médecine Physique et Réadaptation, France, 6Medizinische Hochschule Hannover, Germany, 7Rehabilitation Hospital Felix Spa, Romania, 8Swiss Paraplegic Research, 9Erasmus University, Rotterdam, Netherlands

E-mail: [email protected]

Background and Aim: To estimate and compare how activity and participation differ across income groups. Methods: Data comes from the International Spinal Cord Injury survey (InSCI). This is the first-time comparable data on the living situation of people with SCI around the world. We analyzed 20 countries (N=11,529) from different income levels. We compute an activity and participation index to measure the level of limitations reported in the survey. Through a multi-level model, we adjusted the index by individual characteristics as age, sex, type of the injury, years living with the injury, comorbidities, income, lesion characteristics, and country. To better understand each activity and participation question, we used logit regressions to estimate the probability of limitations of people with SCI. Results: On average, people with SCI in low-income groups experience more limitations than people in high-income groups in all the countries. This gap is more pronounced in more unequal countries and varies by activity and participation item. Getting up off the floor from lying on your back, pushing open heavy doors and use of public transportation are the items with more probability of limitations. Conclusion: People living with SCI experience different limitations that reduce their activity and participation. Income inequalities increase these limitations being more pervasive in low-income groups (between and within countries). Less inequality was found in countries where rehabilitation services were offered, especially at the community level. Rehabilitation decreases the probability of experiencing problems in activity and participation, contributing to their overall functioning.

  Social Sciences – Psychology Top

  5896 - The mediating role of appraisal and coping in the psychological adaptation process to spinal cord injury: Findings from the inpatient rehabilitation context Top

Mayra Galvis Aparicio1, Simon Kunz2, Davide Morselli3, Marcel Post4, Claudio Peter5, Valerie Carrard6

1Swiss Paraplegic Research, Empowerment, Participation Social Integration Unit, Nottwil, Switzerland, 2Swiss National Center of Competence in Research LIVES, University of Lausanne, Vaud, Switzerland, 4Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, 5Swiss Paraplegic Research, Empowerment, Participation and Social Integration Unit, Nottwil, Switzerland, 6Psychiatric Liaison Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland

E-mail: [email protected]

Background and Aim: Despite the importance of understanding the psychological adaptation process to a newly acquired Spinal Cord Injury (SCI) to improve the provision of psychosocial support, only few studies have tested adaptation models that give insights on how this process unfolds, how its components interact, and on what are the mechanisms underlying it, particularly in the context of inpatient rehabilitation. This study aimed at testing the SCI Adjustment model (SCIAM), which proposes that the adaptation process to SCI is influenced by multiple biopsychosocial factors, and that the effect of such factors on the adaptation outcomes is fully explained by individuals' appraisals of the injury and their coping strategies. Thus, we tested whether primary appraisals (threat or loss) and coping strategies (approach-oriented and denial) sequentially mediate the impact of functional independence, social support, and psychological resources (self-efficacy, purpose in life, and optimism) on depressive symptoms among individuals with SCI during inpatient rehabilitation. Methods: Longitudinal path analyses using data from the SwiSCI inception cohort study (N = 207). Results: Different from the SCIAM's assumptions, primary appraisals and coping strategies only partially mediated the effects of psychological resources on depressive symptoms. Psychological resources and threat appraisal showed direct effects on depressive symptoms (β = -.28, SE = .07, p < .001 and β = .33, SE = .07, p < .001, respectively). Conclusion: The findings only partially supported the SCIAM's mediation mechanism. Psychological resources and primary appraisals can have direct effects on psychological adaptation outcomes and may be suitable intervention targets during inpatient rehabilitation.

  5604 - Emotional endurance in late effects of poliomyelitis: Ten-year follow-up Top

Zeev Meiner1, Anat Marmor1, Hagai Levine2, Isabella Schwartz1, Shimon Shiri1

1Hadassah University Hospital – Mount Scopus, Jerusalem, Israel, 2The Hebrew University – Hadassah Braun School of Public Health, Jerusalem, Israel

E-mail: [email protected]

Background and Aim: To examine the associations between the severity of clinical poliomyelitis symptoms and the levels of psychological health, hope, and subjective well-being in a cohort of individuals with late effects of poliomyelitis (LEoP) ten years following the previous assessment. Methods: A within-subject follow-up study. Participants were eighty-two individuals with LEoP. Methods: Outcome measures included emotional distress based on the global health questionnaire (GHQ), hope based on the Hope Scale, subjective well-being as measured by the Satisfaction With Life Scale (SWLS), and subjective health perception and severity of LEoP assessed by the Index of Post-Polio Sequelae (IPPS). Results: Mean age was 66.9±8.5 years, with 52.4% men. No correlation was found between change in LEoP over ten years and the psychological parameters or subjective well-being. Emotional distress was associated with decreased levels of hope and of subjective well-being. Individuals with LEoP who still work showed less emotional distress and higher hope and subjective well-being. Conclusion: Individuals with LEoP showed significant psychological endurance, manifested in their ability to block further decline in psychological health, despite deterioration in physical health. Hope and subjective well-being were distinctively associated with lower psychological burden in individuals with LEoP. Work appears to be an important source of strength in this population.

  Specialty Development – Education Top

  6432 - Disability in Cameroon: Educational needs in rehabilitation area and perspectives of collaboration with Europe Top

Calogero Foti1, Marco Monticone2

1Tor Vergata University, Rome, Italy, 2University of Cagliari, Cagliari, Sardinia, Italy

E-mail: [email protected]

Background and Aim: The presentation tries to assess the perception of motor disability in Cameroon, in relation to life's condition of people with disabilities, in order to adopt tools that ensure better protection and promotion of human rights of people with disabilities for their full participation in nation's life and to the need for training rehabilitation professionals whom will help disabled in their health recovery, and social life. Results: The data revealed that the deficiency of information and knowledge about health, social and psychological problems relating to disability, especially in the context of family and community, determine the persistence of attitudes loads of injury, lack of support and proper care and segregation. Because of these circumstances, today in Cameroon people with disabilities of various types and degrees, experience a passive condition and a situation of dependence, marginalization and social exclusion. People with motor disabilities in Cameroon have enormous difficulties in rehabilitation and encounter many problems, especially during their reintegration into the professional world. Conclusion: This study underlines the importance of training, in this geographic reality, those rehabilitation professionals that can help people with disabilities in their rehabilitation and social reintegration, in the framework of a general need for expansion of the area of Physical Medicine and Rehabilitation in the Public Health System.

  Specialty Development – Medical School (0) Top

  Specialty Development – Organizational Development – International Associations (0) Top

  Specialty Development – Postgraduate Top

  6380 - Overactivity of the less affected side in patients with acute ischemic stroke – Preliminary results Top

Agata Zdrowowicz1, Jakub Stolarski2, Karolina Krzyszton2, Jan Kochanowski2

1Department of Neurology, Faculty of Medical Sciences, Medical University of Warsaw, Ceglowska, Warsaw, Poland, 2Department of Neurology, Faculty of Medical Sciences, Medical University of Warsaw, Ceglowska Street, Warsaw, Poland

E-mail: [email protected]

Background and Aims: A certain group of patients with acute ischemic stroke (AIS) is distinguished by the phenomenon of the overactivity of the less affected side (OLAS). Neurophysiological methods of post-stroke physiotherapy indicate that in this group of patients it is justified to start the therapy from the side not covered by the neurological syndrome. The aims of this study were: to characterize OLAS in patients with acute stroke and to select symptoms that can predict the occurrence of typical OLAS asymmetry in sitting. Methods: Patients (n=222) hospitalized due to first-time AIS were assigned, depending on the symptoms, to 3 groups. The “A” group - 78 patients having a maximal score on Scandinavian Stroke Scale. The “B” group - 109 patients with lateralization of the neurological syndrome. The “O+” group – 35 patients, who on the first day of the physiotherapeutic evaluation presented, apart from the lateralization of neurological symptoms, characteristic symptoms for OLAS such as: asymmetry in supine, simple, repetitive movements of nonparetic upper or/and lower extremity. Results: Patients with OLAS had significantly longer hospitalization time and significantly later achieved sitting and standing position, compared to patients who do not have OLAS p <.0001. Patients with characteristic symptoms of OLAS were at higher risk of death OR=12, p<.001. Predictive symptoms for the occurrence of a typical asymmetry for OLAS in sitting were distinguished: asymmetry in supine (SENS=0,72, SPEC=0,94, AUC ROC = 0,8) and simple, repetitive movements of nonparetic upper extremity (SENS= 0,71, SPEC=0,94, AUC ROC=0,81), p<.0001. Conclusion: These results may indicate that OLAS characterizes patients with more severe stroke. There are distinguished two predictive symptoms for the occurrence of the typical OLAS asymmetry in sitting.

  Specialty Development – Research Top

  6714 - Which are the quality criteria for a publication using single case experimental design? Top

Xavier De Boissezon

Department of PRM, CHU Toulouse, Toulouse, France

E-mail: [email protected]

In recent decades, the number of Single Case Experimental Designs (SCED) increases (Barnard-Brak et al. 2020). This type of clinical trial design aims provides practitioners and researchers a rigorous method to assess therapy effectiveness (Lane, Ledford, Gast 2017). It is mainly suited for early stage intervention evaluation (Graham et al., 2012), for small group of patients with high inter-individual variability (Krasny-Pacini, Evans 2018a) and individualized cognitive interventions. The quality of the SCED design methodology can be assessed using the risk of bias scale: RoBiNT scale (R. L. Tate et al., 2013). This tool, specific for SCED in neuro-rehabilitation, is required to set up the design of this type of research protocol. It consists of 15 items that assess internal and external validity of the study. For the quality of reporting of the publications, several recommendations have been developed (www.equator-network.org, e.g. CONSORT statement for Randomised Trial). An extension of CONSORT has been established specifically to facilitate preparation and appraisal of individual and series of N-of-1 trials (CENT) (Vohra et al. 2015; Shamseer et al. (2015). In the behavioral science domain and notably in neuropsychological rehabilitation, the Single-Case Reporting guideline In BEhavioural interventions (SCRIBE) have been developed by Tate and Perdices (Tate et al. 2016). This tool provides recommendations to guide and structure the reporting relevant information from SCED research publication. These guidelines addressed both to the authors and to the reviewers who evaluate the quality of reporting of SCED publication.

  5756 - Clinical research approach in rehabilitation – From the concept to the bench Top

Susana Pinto

Rehabiliteringsmedicin, Uppsala Akademiska Sjukhuset, Uppsala, Sweden

E-mail: [email protected]

Background and Aim: Physical and Rehabilitation Medicine (PRM) is fast switching from an empiric to a scientific-based specialty. Research supports the clinical field with the latest developments while continuously acquiring the needed data. A Clinical Research Approach in PRM is presented by using the respiratory impairment and rehabilitation in Amyotrophic Lateral Sclerosis (ALS) as a bench model. Methods: Highlight relevant concepts in clinical research. Review the most significant articles published online (Medline - Pubmed) in the ALS respiratory field by the author and others that answer the why, when and how questions. Results: The clinical research model is patient centred, patient driven. Team work is the key. As clinicians, we learn from patients and peers, who provide us the questions and answers. Critical thinking is needed. Why? The main cause of death in ALS is respiratory insufficiency and its complications, and non-invasive ventilation improves quality of life and survival in these patients. Research helps in evaluating the best methods to support these patients. When? The time to act and to have a clinical research approach is now. Evaluations of the respiratory function should be done at first visit and regularly thereafter. How? A myriad of scales and respiratory tests help the physician getting a global assessment of the respiratory function and research puts the results into context. Conclusion: Identification of the existing resources (patients, personel, devices) and clinical needs drives the Clinical Research Approach in integrating both Clinical and Research fields. This mutual benefit is the key to the best care of patients.

  4635 - Creating a “research division” from the ground up Top

Anne Ambrose, Matthew Bartels, Mark Thomas, Anupuma Kurra

Department of Rehabilitation Medicine, Montefiore Medical Center, Bronx, NY, USA

E-mail: [email protected]

Background and Aim: To describe: (a) challenges for rehabilitation medicine to produce sufficient researchers who can provide the evidence-based research required to prove efficacy of our treatment protocols; (b) challenges and opportunities in creating a research environment; and (c) potential avenues and resources that can be utilized to create a culture of research in a rehabilitation program. (d) To provide a step by step process in creating a robust research environment and outline the steps to creating a research environment, i.e. (i) a participative governance structures which is non-hierarchical and decentralised; (ii) good communication and professionally meaningful relationships between team members; (iii) resources such as people, funding, research facilities; (iv) research-oriented leaders with research expertise and skill. Results: The Department of Rehabilitation Medicine made research activity a priority area at the beginning of 2021. They appointed a Director of Research, who had a strong background in funded research. She created a research infrastructure that included an internal review process to educate and guide fledgling researchers through creating research protocols, obtaining IRB clearances, running the studies and produce publications. Since the endeavor began 9 months ago, 3 large databases (from 800 patients to 6000 patients) were created. 16 new studies have been initiated by residents, therapists and faculty, many of which have been completed and presented at various national meetings. Conclusion: Developing a research infrastructure is within the realms of possibility for small to medium Rehabilitation Medicine Departments. With careful planning, vision and departmental support, most institutions can achieve this goal in a relatively reasonable time.

  4558 - Neonatal brachial plexus palsy rehabilitation - can risk factors predict functional outcome? Top

João Fonseca1, Pedro Figueiredo2

1Department of Physical Medicine and Rehabilitation, Coimbra Hospital and University Center (Centro Hospitalar e Universitário de Coimbra – CHUC), Praceta Professor Mota Pinto, Coimbra, Portugal, 2Coimbra Hospital and University Center (Centro Hospitalar e Universitário de Coimbra - CHUC), Coimbra, Portugal

E-mail: [email protected]

Background and Aim: Neonatal brachial plexus palsy (NBPP) is a disorder where functional potential is key to manage rehabilitation. This retrospective study aims to identify the association between NBPP risk factors and outcome, in a population referred to rehabilitation consultation. Methods: NBPP newborn data between January 2011 and March 2020 was analyzed, including risk factors associated with NBPP (weight at birth, maternal diabetes, macrosomia, dystocia, clavicle fracture). Type and level of palsy were based on examination and Narakas classification. Assessment of upper limb motor function was achieved using Active Movement Scale, Toronto Test Score, Medical Research Council, Mallet and Gilbert scales, for a minimum of 24 months. Any non-normal grade was considered a functional disability. Statistical analysis was performed using IBM® SPSS® Statistics 26.0. Results: This study included 224 cases, with mean birth weight of 3551,27g. Macrosomia was present in 22,48% and dystocic delivery in 64,4%. Clavicle fracture occurred in 18,3%. Right side lesion (53,1%), Erb palsy (91%) and type I Narakas scale lesion (67,1%) were more frequent. At 3 months follow-up, 84,1% had biceps function and at 24 months 53,8% had no motor sequelae. Female gender and macrosomia had 1,45 and 1,57 higher risk of motor sequelae. Active biceps motor function was associated with a good outcome. Maternal diabetes, dystocic delivery and shoulder dystocia had no association with poorer outcomes. Conclusion: NBPP is a birth complication causing motor disability. Rehabilitation is crucial to avoid and predict long-term consequences for most patients. In this study, female gender and macrosomia were associated with motor disability. Active motor function of biceps is associated with the absence of disability.

  Specialty Development – Residency Top

  5935 - PRM training during COVID-19 pandemic in Pakistan Top

Muhammad Tawab, Umer Younas, Imran Irshad

1Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan

E-mail: [email protected]

Background and Aim: Academic activities in hospital were stopped because of COVID-19 pandemic. We aim to describe the challenges faced by PRM residents, strategies utilized by them to cope up with the lack of academic activities and their role during pandemic. Methods: This cross-sectional observational study was conducted in Pakistan and online survey was sent to all PRM residents of Pakistan. Demographic details, effect of pandemic on academic activities, strategies to make up for the lack of academic activity and their role during pandemic were inquired. Statistical analysis was done using SPSS. Results: Out of total 21 PRM residents, 17 returned their responses. Mean age was 30±0.6 years. 9 were male, 8 were female. 58% of residents said that OPD was closed during pandemic for a mean duration of 3.3 months. 47.1% of residents said that inpatient ward was closed for a mean duration of 2.3 months. Learning at OPD was most affected by pandemic followed by bed side learning and didactic lectures. To make up for the lack of academic activities, 65% of residents read course text books, 24% listened to virtual online lectures, 5.9% read scientific journals and 5.9% did nothing. 77% of residents agreed that pandemic has adversely affected training. 71% of residents said that their institute did not use virtual learning platforms for lectures/ward rounds. 65% of residents managed COVID-19 patients while only 30% agreed that managing COVID-19 improved their knowledge regarding patient care. 24% of residents used telemedicine for patient care. 30% of residents were involved in developing new system of patient care and 35% were involved in hospital organization & administrative tasks during pandemic. Conclusion: This pandemic has adversely affected training of PRM residents in Pakistan.

  5657 - A Novel 40-hour neurorehabilitation curriculum for a physical medicine and rehabilitation residency Top

Michael O'Dell, Jeremy Roberts, Jason Edwards, Scott Barbuto, Akinpelumi Beckley, Kaile Eison, Cindy Volack, Christopher Visco

Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital, New York, USA

E-mail: [email protected]

Background and Aim: Neurological rehabilitation (NR) is an essential part of Physical Medicine and Rehabilitation (PM&R) residency education; however, there is little research on structured NR curricula. We report the development of a novel, year-long curriculum for our residents. Methods: A survey of PMR faculty at New York-Presbyterian Hospital explored topics appropriate for a “state of the art” NR curriculum. Next, training objectives were established. We then reviewed previous NR topics from our program 3 other US PMR residencies known for excellent NR training. Results: The Program Director allotted the curriculum 40 hours (h) for the academic year with 5 areas proposed: Core Neurorehabilitation Topics (9h): neuroanatomy, recovery principles, neuropsych. assessment, ethics, pharmacology, return to work; Workshops and Hands-On Demonstrations (11h): neurological exam, toxin injections, intrathecal baclofen, bracing, therapy techniques; Vascular Brain Injury (7h): introduction, neuroradiology; medical, neurological, musculoskeletal issues, depression/cognition, non-ischemic stroke, new research; Traumatic Brain Injury (7h): introduction, neuroradiology; medical, neurological, orthopedic issues, disorders of consciousness, concussion; Other Brain Injury (6h): multiple sclerosis, Parkinson's, brain tumors, adult cerebral palsy, neuroradiology. Learning objectives considered the new PMR Milestones 2.0. Speakers included physiatrists, neurologists, neuroradiologists, neuropsychologists, and rehabilitation therapists. A monthly NR journal club enhanced selected topics. Conclusion: This novel curriculum offers mile-stones based, NR training. Insights into our development process, content details, and resident evaluations from year one implementation are presented.

  Therapeutics – Exercise Top

  6679 - Home pelvic floor exercises in children with nonneurogenic lower urinary tract symptoms is fitball an alternative to classic exercises Top

Maria Laura Sollini1, Maria Luisa Capitanucci2, Giovanni Mosiello2, Calogero Foti1, Ugo Nocentini1

1Department of Clinical Sciences and Traslational Medicine, Physical and Rehabilitation Medicine, University of Rome Tor Vergata, Rome, Italy, 2UOS Continence Surgery and Neurourology, Children Hospital Bambino Gesù, Rome, Italy

E-mail: [email protected]

Background and Aim: Biofeedback with home pelvic floor (PF) exercises are recommended as non-pharmacologic treatment for non-neurogenic LUTS in children. The aim of the study was to investigate efficacy of standard home exercises versus exercises using fitball too. Methods: From April to December 2021 a randomized control study with 2 arms has been performed. After a clinical and instrumental evaluation, standard urotherapy and pelvic floor animated biofeedback therapy (PFABT) were proposed in all children affected by non-neurogenic LUTS. Pelvic floor program included 4 session, 1/ 20 days. After the first session, patients received prescription to repeat at home standard exercises (group A) or exercises using fitball (group B). Continence rate, PF muscles activity, adherence and satisfaction were evaluated by means of bladder diary (BD), external pubococcygeus test (PCT) and Likert-type psychometric scale (from 1=very unsatisfied to 5=very satisfied) respectively. Results: Twenty children (average age: 8 years) affected by LUTS were enrolled: 10 in group A and 10 in B. At 4th control urinary incontinence was reduced by 30% in the two group. PCT increased by 61,76% (+ 2,1 points) in A, and 53,84% (+1,4 points) in B. Adherence at home was 80% in group A and 50% in group B. Satisfaction with the treatment (4 or 5 points) was 90% in both groups. 4 patients of group A and all of group B decided to maintain home exercises including fitball. Conclusion: Our study shows that efficacy of home exercises, with or without fitball, is comparable. The satisfaction with the treatment was high, regardless results obtained, because parents and children have learned a new, interesting and stimulating way to manage urinary problems. The opportunity to perform these exercises in a different way it's an important finding for paediatric population.

  6455 - Intensity of outpatient physiotherapy and physical activity level in community-dwelling stroke survivors: Preliminary results of a multi-center cross-sectional study Top

Stéphanie Goncalves1, Morgane Le Bourvellec2, Basil Lafitte-Houssat3, NoémieDUCLOS Duclos4, Stéphane Mandigout5

1Université de Limoges, Faculté des Sciences et Techniques, Laboratoire Handicap, Activité, Vieillissement, Autonomie, Environnement, Limoges, France, 2Lab. MOVE (EA6314), Faculty of Sport Sciences, University of Poitiers, Poitiers, France, 3Univ. Bordeaux, Collège Sciences de la santé, Univ. Bordeaux, Bordeaux, France, 4Univ. Bordeaux, INSERM, BPH, U1219, “Handicap, Activity, Cognition and Health” Team, Bordeaux, France, 5Université de Limoges, Laboratoire HAVAE, Limoges, France

E-mail: [email protected]

Background and Aim: Stroke survivors are primarily physically inactive. Physiotherapy (PT) practice might represent professional support to improve this alarming lifestyle. However, evidence is scarce regarding the relationship between PT workload and stroke survivors' physical activity level (PAL). The purpose of this study was to investigate both, to seek correlations between observed data. The secondary aim was to describe key characteristics of this population and relationships with PT dose. Methods: This was an observational cross-sectional multi-center study. Stroke survivors treated in private clinics in France were included. An independent investigator measured the intensity of physical workload during two PT sessions per participant using SenseWear Armband® (SWA) and Polar H10® Sensor. PAL was also recorded for seven consecutive days with SWA. Other outcomes were time post-stroke, motor function, mobility, gait speed, fatigue, anxiety and depression, body mass index, motivation to exercise, and cognition. Results: 52 patients from 17 private PT clinics were included (median aged 64.0 (56.0-70.3) years, time post-stroke 6.0 (2.8-10.6) years) and 104 PT sessions recorded. Median energy expenditure in the session was 1,5 (1.3-2.0) Metabolic Equivalent of Task (MET), and the median heart rate was 64.1 (57.1-74.2) % of maximum. The median PAL was 1.3 (1.1-1.5) MET at home. There was a significant positive correlation (r=0.6, p<0.01) between the intensity of PT and PAL. Few links were found between MET value in sessions and clinical data. Conclusion: Our results confirm the significant correlation between the intensity of physiotherapy sessions and physical activity level. Unexpectedly, energy expenditure in therapy is little associated with the degree of disability.

  6395 - Exercise-induced reduction in depressive mood in individuals with overt hypothyroidism: A moderate intensity aerobic tele-exercise trial Top

Jeanine Watson-van Zyl1, Karen Welman1, Bernhard Sehm2

1Stellenbosch University, Sport Science - Movement Laboratories, Stellenbosch, South Africa, 2Max Plank Institute for Human Cognitive and Brain Sciences, Leipzig, Germany

E-mail: [email protected]

Background and Aim: Hypothyroidism is a common metabolic disorder worldwide and despite adequate pharmacological treatment, some individuals report persistent symptoms, including depressive mood. It remains imperative to find ways to enhance thyroid-specific health-related quality of life. Since exercise has been reported as a useful modality in the reduction of depressive mood, this study sought to explore the influence of exercise on depressive mood in individuals with overt hypothyroidism. Methods: A 12-week single-blinded randomised tele-exercise trial, delivered asynchronously, was compared to an attention-matched control (AMC) group. Individuals of all sexes, aged 18-65 years, presenting with overt hypothyroidism were included. Participants in the exercise group (EX) completed 36 sessions of moderate-intensity (45-70% maximum heart rate or MHR; 12-13 rate of perceived exertion, or RPE) aerobic exercise sessions, while those in the AMC completed 36 general wellness and health talks. Depressive mood was assessed using the Patient Health Questionnaire- 9 (PHQ-9) at baseline and post-intervention. Results: Participants (n=16) were randomly assigned to the EX (n=7) and AMC (n=9) groups. A clinically meaningful reduction of 39.62% was seen in depressive mood over the intervention in EX (MCID > 20%, p =0.25; Hedge's g =0.75) while in the AMC depressive mood increased by 6.76%. Conclusion: A moderate-intensity aerobic tele-exercise program, delivered asynchronously, may be beneficial in reducing depressive mood, which is associated with hypothyroidism.

  6288 - Visuomotor skill formation following a single bout of physical exercise Top

Orit Wonderman Bar-Sela1,2, Einat Kodesh1, Michal Kafri1

1Department of Physical Therapy, Faculty of Social Welfare and Health Science, Haifa University, Haifa, Israel, 2Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel

E-mail: [email protected]

Introduction and Aim: Priming of the motor system with physical exercising was shown to enhance visuomotor skill formation, though the optimal type of exercise, its duration and intensity, have yet to be determined. Here we compared the effect of 3 different physical exercises performed prior to learning a new motor skill on the effectiveness of learning. Methods: 50 healthy adult subjects, were randomly divided into 4 groups (a, b, c, d). In the first 3 groups the intervention included a single bout of physical exercise performed on an ergometric bicycle for 5 minutes. Exercising employed (a) continuous aerobic effort of moderate intensity, (b) repeating intervals of 20 seconds maximal effort followed by 40 seconds of recovery (light pedaling), (c) repeating intervals of 10 seconds maximal effort followed by 50 seconds of recovery. Subjects in the control group (d) sat on the bicycle without engaging in any physical activity. Following the intervention, the subjects practiced a motor skill comprised of tracing the outline of a star figure while viewing it through a mirror. All subjects had a baseline performance obtained prior to the physical exercise. Group effects were compared for speed/accuracy at the different times and in between test groups. Retention was tested 20 minutes and, 24 hours following the acquisition phase. Results: By the end of the acquisition phase all groups outperformed their baseline scores, with non-significant group effects. However, delayed retention of the learning effect showed a significant (p<0.04) advantage for prior exercising employing short intervals of maximal effort (group c). Conclusion: The type and intensity of a preceding physical exercise influence the delayed retention of motor skill learning.
Figure 1: Forest plots of differences pre-post RP: (a) cognition; (b) quality of life; (c) motor status. MiniBESTest sections: Anticipatory postural adjustments, reactive postural control, sensory orientation and dynamic gait. *Statistical differences. APA: Anticipatory postural adjustments, RPC: Reactive postural control, SO: sensory orientation, DG: Dynamic gait

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  6225 - Effect of intensive rehabilitation program in thermal water on a group of people with Parkinson's disease: A longitudinal study Top

Lucrezia Tognolo1, Roberto Di Marco2, Francesca Pistonesi3, Valeria Cianci3, Roberta Biundo4, Luca Weis3, Alfonc Baba5, Giovanni Gentile3, Chiara Tedesco3, Miryam Carecchio3, Angelo Antonini3, Stefano Masiero2

1Department of Neuroscience, Padua University, Physical Medicine and Rehabilitation Unit, via Giustiniani 2, Padua, Italy, 2Department of Neuroscience, Physical Medicine and Rehabilitation Unit, University of Padova, Padova, Italy, 3Department of Neuroscience, University of Padova, Padova, Italy, 4Department of General Psychology, University of Padova, Padova, Italy, 5Physical Medicine and Rehabilitation Unit, University Hospital of Padova, Padova, Italy

E-mail: [email protected]

Background and Aim: Physical therapy hampers the impact of motor symptoms in daily life activities (ADL) of people with Parkinson's disease (PD, PwPD), but effectiveness on non-motor symptoms is still debated. Aquatic exercise reduces the risk of harm during therapies and water viscosity represents a cue for PwPD. Moreover, thermal environment promotes muscle relaxation and endorphins production. This research aims at investigating the effect of thermal aquatic exercise on motor and non-motor symptoms in PwPD. Methods: 18 participants with idiopathic PD met the inclusion criteria (Hoehn & Yahr in off-state: 2-3; Mini Mental State Examination > 24; stable pharmacological treatment). Cognitive and motor status, functional abilities and quality of life were assessed at baseline and after an intensive rehabilitation program in thermal water (12 sessions of 45 min in a 1.4 m depth pool at 32-36°C). The Mini-Balance Evaluation System Test (Mini-BESTest) and the PD Quality of Life Questionnaire (PDQ-39) were considered as main outcomes. Secondary assessment measures evaluated motor and non-motor symptoms. Results: Participants kept good cognitive and functional status after treatment. Motor status of all the participants significantly improved (Mini-BESTest: p<0.01). The PDQ-39 significantly improved after rehabilitation (p=0.038), with significance being driven by dimensions strongly related to motor status. Conclusion: Thermal aquatic exercise prevents the impact of motor symptoms on ADL of PwPD. Moreover, PDQ-39 improvement foreshows good effects of the intervention on non-motor symptoms.

  6201 - Integration of tele-rehabilitation into clinical pathways in a day-hospital/care/clinic: About an experience during COVID-19 crisis Top

Nacera Bradai, Benjamin Bonneton, Amar-Yazd Arrada, Kevin Oger

Hôpital La Boissière Groupe Vyv 13 Boulevard de la Boissière Noisy-Le-Sec France

E-mail: [email protected]

Background and Aim: According to the Regional Health authority projects of tele-rehabilitation (Tele-R) development, our day-hospital got involved in this remote practice with their help. Starting the pilot study in February 2020 with a combination of face-to-face care and tele-care for patients with recent knee arthroplasty, we had to switch to exclusive Tele-R due to closure of our rehabilitation center during the Covid-19 lockdown. This study aims to report our experience of Tele-R into clinical pathways in a day-care unit before, during and after first Covid-19 lockdown. Methods: Pilot study aimed to include 10 patients for a 8 weeks-clinical pathway, with medical and therapist evaluation at admission, at 4th and 8th weeks. Rehabilitation protocol was composed by face-to-face care (physiotherapy; adapted physical activity; balneotherapy after wound healing) and tele-physiotherapy. Tele-R sessions were provided by ESTRAD software from Sherbrooke tele-rehabilitation team, Canada. Results: When our unit closed six patients were already included. All patients that underwent exclusive Tele-R during the 1st Covid-19 lockdown (march to May 2020) were included. Tele-R was practiced by 2 trained physiotherapists and secondary extended to every therapists and to various pathologies. Finally 35 patients benefited from Tele-R, with 7 involved therapists and 738 performed sessions. Then we decided to continue an hybrid program of rehabilitation after unit re-opening, following clinical pathway with face-to-face and tele-care. This experience showed a good adhesion of therapists and patients to Tele-R, and the interest of remote care into home living. Conclusion: Tele-R constitutes a real way of care in rehabilitation practice, whether during lockdown or not.

  5939 - Efficacy of intermittent pneumatic compression in reducing lower limb lymphedema in patients with type 2 diabetes mellitus: A pilot randomized controlled trial Top

Alessandro de Sire, Maria Teresa Inzitari, Annalisa Petraroli, Lidia Fratto, Francesco Andreozzi, Antonio Ammendolia

University of Catanzaro “Magna Graecia”, Catanzaro, Italy

E-mail: [email protected]

Background and Aim: Diabetes mellitus type 2 (T2DM) is a chronic disease associated with interstitial tissue fluid accumulation. Manual lymphatic drainage (MLD) and intermittent pneumatic compression (IPC) could play a role in the management of subjects with lymphedema. Our aim was to evaluate the efficacy of a synergistic treatment with MLD and IPC in reducing lower limb lymphedema in T2DM patients. Methods: In this pilot randomized controlled trial, adults with T2DM and lower limb lymphedema (stage II-IV) were included and randomly allocated into two groups: experimental group, undergoing a 1-month rehabilitative program consisting of MLD and IPC (with a compression of 60 to 80 mmHg); control group, undergoing MLD and a sham IPC (with compression of <30 mmHg). Primary outcome was the lower limb lymphedema reduction, assessed by the circumferential method (CM). Secondary outcomes were: passive range of motion (pROM) of hip, knee, and ankle, quality of life, fasting plasma glucose and HbA1c. Outcomes measures were assessed at baseline (T0) and at the end of the rehabilitation treatment (T1). Results: Thirty subjects (mean age: 54.1±5.1 years) were randomly allocated in the two groups. At the intra-group analysis, the experimental group showed a statistically significant improvement of all outcome measures (p<0.05). The between-group analysis showed a statistically significant improvement (p<0.05) in pROM of the hip, knee, ankle, EQ-VAS, and EQ5D3L Index at T1. Conclusion: Taken together, our findings demonstrated that a multimodal approach consisting of IPC and MLD could reduce lower limb lymphedema, with an increase of pROM and HRQoL.

  5881 - Telerehabilitation for acute ankle sprains: A prospective cohort study Top

Fernando D. Correia1,2, Maria Molinos3, Carlos Neves3, Dora Janela3, Diana Carvalho3, Sara Luis3, Gerard E. Francisco4, Jorge Lains5, Virgilio Bento6

1Department of Neurology, Centro Hospitalar e Universitário do Porto, Portugal, 2Escola de Medicina, Universidade do Minho, Braga, Portugal, 3SWORD Health Technologies, Inc, Utah, US, 4The University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA, 5TIRR Memorial Hermann, Texas, USA, 6Rovisco Pais Medical and Rehabilitation Centre, Cantanhede, Portugal

E-mail: [email protected]

Background and Aim: Ankle sprains are a common soft-tissue injury with high incidence rates, contributing to an important socioeconomic burden. Physical therapy has been shown to improve function and decrease risk of reinjury. In the present study we aimed to report the results of a fully remote digital rehabilitation program for acute ankle sprains. Methods: Prospective, single-arm, cohort study of patients referred for digital rehabilitation after an ankle sprain. Patients were assessed at baseline, program end, and at 6-months follow-up. Primary outcomes were the change between baseline and 6 months in Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure - activities of daily living (FAAM-ADL) and sports (FAAM-Sports) scores. Secondary outcomes were treatment dosage, pain and fatigue during sessions, and overall satisfaction. Results: From 104 patients at baseline, 93 (89.4%) completed the program and 79 (76.0%) were available for 6-month follow up. Mean changes were 49.8% in NPRS (-2.72 points, 95% CI -3.31;-2.13), 41.1% in FAAM-ADL (21.7 points, 95% CI 17.13;26.27) and 151.8% in FAAM-Sports (37.8 points, 95% CI 30.45;45.15), all significant (p<.001) and clinically meaningful. Among participants that completed the program, 83.9% reached full recovery. Mean patient satisfaction was 8.8/10 (SD 1.57). Conclusion: This is the first study of a fully remote exercise-based telerehabilitation program for acute ankle sprains, reporting significant improvements sustained at long-term and comparable to those published for in-person interventions. While reducing human resources demand, this digital program may constitute a viable, clinically effective and convenient solution for ankle sprains rehabilitation, particularly in pandemic times.

  5737 - Telerehabilitation versus conventional home-based rehabilitation after arthroscopic rotator cuff surgery: A randomized controlled trial Top

Fernando D Correia1, Maria Molinos1, Sara Luís1, Diana Carvalho1, Carlos Carvalho1, Rosmaninho Seabra2, Gerard E. Francisco3, Virgílio Bento1, Jorge Lains4

1Sword Health Technologies, Inc, Clinical Validation, Draper, Utah, USA, 2Department of Orthopaedics, Hospital da Prelada - Domingos Braga da Cruz, Porto, Portugal, 3University of Texas Health Science Center McGovern Medical School, Houston, Texas, USA, 4Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal

E-mail: [email protected]

Background and Aim: Shoulder pain is the third main complaint in primary care. Most cases are managed conservatively, however surgical repair may be an option in some cases, particularly common for rotator cuff repair (RCR). Post-surgery rehabilitation is paramount for RCR recovery. The aim of this study was to assess the efficacy of a home-based digital therapy program (DTP) compared to conventional therapy for shoulder rehabilitation after arthroscopic RCR (ARCR). Methods: Individuals were randomized in two groups: digital therapy (DT) and conventional therapy (CT). Both groups received an exercise-based 12-week physical therapy rehabilitation. The DT group had independent and digitally assisted sessions complemented with in-person sessions, while the CT group only had in-person sessions. Primary outcome was the mean change between baseline and 12 weeks in the Constant-Murley score (CM). Secondary outcomes comprised the QuickDASH scale and shoulder range of motion. Results: From the 50 participants enrolled (25 in each group), 41 completed the program (23 in DT group vs 18 in CT group), while 32 were available for the 12-month follow-up (15 vs 17). Although no differences were found between groups at 12 weeks, at follow-up the DT group achieved statistically significant greater improvements in QuickDASH (p=0.043) and an interaction between time and group in CM (p=0.047) was observed, favoring the DT group. Conclusion: This is the first study comparing a home-based telerehabilitation program after ARCR with conventional care. The results show that DTP provided at least similar short- and long-term outcomes as conventional therapy after ARCR, being far less demanding in human resources than conventional care.

  5736 - Telerehabilitation for chronic shoulder pain: A prospective cohort study Top

Dora Janela1, Fabíola Costa1, Maria Molinos1, Robert G. Moulder2, Jorge Lains3, Gerard E. Francisco4, Virgílio Bento5, Steven P. Cohen6, Fernando Dias Correia1

1Sword Health Technologies, Inc, Utah, US, 2Institute for Cognitive Science, University of Colorado Boulder, USA, 3Rovisco Pais Medical and Rehabilitation Centre, 4Faculty of Medicine, Coimbra University, Coimbra, Portugal, 5The University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA, 6Indiana Department of Environmental Management, McGovern Medical School, Houston, Texas, USA

E-mail: [email protected]

Background and Aim: Chronic shoulder pain (SP) is responsible for decreased quality of life and work ability, resulting in high socioeconomic burden. Digital solutions may improve access to evidence-based treatments, increasing convenience, while reducing healthcare-related costs. Herein we report the results of a fully remote digital care program (DCP) for chronic SP. Methods: Prospective, single-arm study of patients with chronic SP applying for a digital care program. Outcomes were measured as the mean change between baseline and 12-weeks on the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire (primary) and in pain (NPRS), analgesic use, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement (secondary). Results: From 296 patients at program start, 234 (79.1%) completed the intervention. Mean changes in QuickDASH 51.6% (mean -13.45 points, 95% CI: 11.99; 14.92) were both statistically (p<0.001) and clinically significant. Marked reductions were also observed in NPRS (54.8%), surgery intent (55.5%), FABQ-PA (37.7%), anxiety (50.3%), depression (63.6%), WPAI overall (66.5%), while 44.1% ceased analgesics intake. Higher engagement was associated with higher improvements in disability. Mean patient satisfaction score was 8.7/10.0 (SD 1.6). Conclusion: This is the first real-world cohort study demonstrating the utility of a multimodal remote digital approach for chronic SP rehabilitation. High completion and engagement rates were observed, which were associated with clinically significant reductions in all outcomes. These promising results support the potential of digital modalities to address the global burden of chronic musculoskeletal pain.

  5731 - Digital rehabilitation of acute musculoskeletal disorders: A single-arm, interventional study Top

Fabíola Costa1, Dora Janela1, Maria Molinos1, Jorge Lains2, Gerard E. Francisco3, Virgílio Bento4, Fernando Dias Correia1

1Sword Health Technologies, Inc, Clinical Validation, Draper, Utah, USA, 2Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal, 3Faculty of Medicine, Coimbra University, Coimbra, Portugal, 4University of Texas Health Science Center McGovern Medical School, Houston, Texas, USA

E-mail: [email protected]

Background and Aim: Acute musculoskeletal (MSK) disorders are very common, resulting on impaired productivity and high economic burden. Digital interventions can ease access while ensuring personalized, evidence-based care. Herein, we report the results of a fully remote digital care program (DCP) for acute MSK conditions affecting diverse body areas. Methods: Interventional cohort study of individuals with acute MSK pain applying for digital rehabilitation. Mean change between baseline and end-of-program was assessed in Numerical Pain Rating Scale (NPRS) score (primary outcome) and in analgesic use, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement (secondary outcomes). Results: 343 patients were enrolled, of which 300 (87.5%) completed the program. Marked reductions were observed in NPRS with 64.3% reduction (mean -2.9 points), as well as in secondary outcomes: 82% in analgesic use, 63% in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity. Steeper reductions were observed in the first 4 weeks, which paralleled higher engagement in this period (3.6 vs 3.2 weekly sessions, p<0.001). Mean patient satisfaction score was 8.7/10 (SD 1.26). Conclusion: This is the first longitudinal study reporting about the feasibility and scalability of a DCP for patients with diverse acute MSK conditions, in a real-world context. We observed very high completion and engagement rates, translating into mean reductions within clinically relevant changes in all health-related outcomes, as well as in productivity recovery. We believe this DCP represents a step further in the delivery of effective and scalable MSK care.

  5562 - The adherence to digital healthcare when it towards other's welfare: A proof via motion-detecting mobile exercise coaching application Top

Jinyoung Park1, Myung Sang Kim2, Jung Hyun Park2

1Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro, Gangnam-gu, Seoul, Republic of Korea, 2Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

E-mail: [email protected]

Background and Aim: Maintaining or increasing user adherence to digital healthcare services is a great concern. This study aims to verify the effectiveness of the donation model as a strategy to increase physical exercise adherence using a mobile app. Methods: The exercise dataset was obtained through a machine learning-based motion-detecting mobile exercise coaching app, which is based on the convolutional neural network technology. The users' exercise was monitored through a smartphone front camera giving a real-time feedback. Both donation and self-reward groups participated in a 14-day squat program. Exercise completion rate (% of participants who completed daily exercise) and the exercise completion days were compared. In donation group, when a participant completes the 14-day exercises, 6 USD was donated to the economically disadvantages. To the self-reward group, 3 people who completed the 14-days of exercises and 20 people who exercised ≥ 12 days of exercises were randomly selected and provided a goods worth 59 USD and online cash 5,000 points, respectively. Results: There were 5,618 participants (donation, 2,318; self-reward, 3,300). The average daily exercise completion rate was 1.8 times higher in donation group (donation, 41.7%; self-reward, 22.7%; P < 0.001). Days of exercise completion was higher in the donation group (donation, 5.8; self-reward, 3.2; P < 0.001). Conclusion: The donation model is expected to be an effective marketing strategy in the digital healthcare market to promote the users' adherence to physical exercise.

  5422 - A circuit class training program to improve the upper limb function in the subacute phase after stroke Top

S. G. Rozevink, C. M. Beerepoot, C. K. van der Sluis, J. M. Hijmans

Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, The Netherlands

E-mail: [email protected]

Background and Aim: Group therapy after stroke provides intensive training for stroke survivors to improve the upper limb function. Circuit class training (CCT) is group therapy using predefined workstations to train activities of daily living (ADL) using everyday objects. Pilot testing indicated that the current CCT program was not engaging enough for patients. Therefore our first aim was to expand the CCT program with additional workstations. The second aim was to perform a pilot to compare the CCT program to group Goal Directed Training (GDT); where patients work individually according to their rehabilitation goals. Methods: Focus groups were held to formulate the rehabilitation training goals of subacute stroke patients. They rated their six most important goals, which were presented to therapists, who provided their preferences. Six most chosen topics were used to construct workstations with increasing levels of difficulty. Five iterations were performed with patients and therapists to formulate the exercises. Finally, a pilot was performed to investigate the expanded CCT program compared to GDT. Main outcomes were arm function, patient enjoyment and therapist workload. Results: The new workstations were: eating with cutlery, putting on shoes, lifting heavy crate, using technology, personal hygiene and household activities. The latter two were adopted as washing/drying oneself and sweeping with a broom. First feedback showed that patients were enthusiastic regarding the new workstations and found the exercises challenging but useful. Results of de pilot will be presented during the conference. Conclusion: Patients and therapists chose similar topics as most useful activities. We expect that the CCT program will be engaging while maintaining a low workload for therapists.

  4467 - Do patients with COVID-19 benefit from rehabilitation? Functional outcomes of the first 100 patients in a COVID-19 rehabilitation unit Top

Violaine Piquet1, Cédric Luczak1, Fabien Seiler1, Jordan Monaury1, Estelle Lépine1, Lucile Chambard1, Marjolaine Baude1, Emilie Hutin1, Alexandre Martini1, Andrés Samaniego1, Nicolas Bayle1, Anthony Ward2, Jean-Michel Gracies1, Damien Motavasseli1

1Hôpital Albert Chenevier, Service de Neuro-rééducation, Créteil, France, 2North Staffordshire Rehabilitation Centre, Haywood Hospital, High Lane, Burslem, Stoke on Trent, UK

E-mail: [email protected]

Background and Aim: Functional outcomes for Covid rehabilitation have yet to be reported. This study aimed to present quantified data on the effects of rehabilitation. Methods: Monocentric chart review comparing the changes in functional parameters from admission to discharge for the first 100 patients in a specialized rehabilitation unit. Measurements included: Barthel index (including baseline value before infection), the time to perform 10 sit-to-stands, cardio-respiratory parameters and grip strength (dynamometry). Correlations between these outcomes were explored. Results: Patient characteristics upon admission in rehabilitation were: men 66%, age 66±22, mean delay after symptom onset 20.4±10.0 days, BMI 26.0±5.4 kg/m2, hypertension 49%, diabetes 29%; 26% had >50% pulmonary damage on CT scans. Mean length of stay in rehabilitation was 9.8±5.6 days. From admission to discharge, Barthel index (/100) increased from 77.3±26.7 to 88.8±24.5 (p<0.001) without recovering baseline values (94.5±16.2; <em>p<0.001). There was a 37% improvement in sit-to-stand frequency (0.27±0.16 to 0.37±0.16 Hz; <em>p<0.001), a 13% decrease in post-test respiratory rate (30.7±12.6 to 26.6±6.1; <em>p=0.03), and a 15% increase in grip strength (18.1±9.2 to 20.9±8.9 kgs; p<0.001). At admission and discharge, the Barthel score correlated with grip strength (rho=0.39-0.66; p<0.01), which negatively correlated with time spent in ICU (rho=-0.57 to -0.49, p<0.05). Conclusion: Intensive inpatient physiotherapy for severe Covid-19 patients produced substantial motor, respiratory and functional improvement without restoring previous autonomy levels. Covid-19, primarily a respiratory disease, converts into a motor impairment with persistent autonomy loss after inpatient rehabilitation.

  Therapeutics – Injections (Joint, Spine, etc.) Top

  6602 - Evaluation of the efficacy of stromal vascular fraction treatment for knee osteoarthritis: Preliminary results of an experimental study Top

Mercè Avellanet Viladomat, Esther Pages Bolibar, Anna Boada Pladellorens

Department of PMR, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Les Escaldes, Andorra

E-mail: [email protected]

Background and Aim: Knee osteoarthritis (KOA) is a frequent pathology that causes pain, swelling and decreased functionality. Mesenchymal stromal cells (MSC)-based treatments, such as stromal vascular fraction (SVF), are currently the focus of research on osteoarthritis for their cartilage-generating potential. Nevertheless, the heterogeneity in treatment products does not allow a good efficacy conclusion. The aim of the study is to assess SVF treatment's pain efficacy and safety for KOA patients. Functional and imaging changes are also evaluated. Methods: An interventional clinical trial is performed to evaluate a standardized SVF treatment in KOA patients assessing clinical (Visual Analogue Scale (VAS)), functional (Knee Injury and Osteoarthritis Outcome Score (KOOS)) and magnetic resonance imaging (MRI) changes (measured by Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scale). Pre-, 1-, 6- and 12-months after treatment assessments are done. Adverse events are reported. Results: Out of 55 patients who met inclusion criteria, 28 (11 females, 17 males; mean age 58yo) can be preliminary analysed. VAS mean differences pre and post treatment are statistically significative both at rest and activity (from 2.16±2.02 to 0.58±1.17 and 6.05±2.29 to 2.31±2.51; p<0.005, respectively). Mean KOOS also improves at any time of follow-up, being significative 1-month after treatment (from 30.5 to 38.46, p=0.05). MRI images show an improvement or stabilization of cartilage characteristics in the vast majority of cases. No adverse effects have been observed. Conclusion: Preliminary results show that SVF treatment is effective, in terms of pain and functionality, and safe to treat KOA patients. A larger number of patients and its follow-up is needed to draw solid conclusions.

  6582 - Botulinum toxin treatment for hand tremor: Effects of agonist-only injections Top

Damien Motavasseli, Valentina Mardale, Jean-Michel Gracies

AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France

E-mail: [email protected]

Background and Aim: Botulinum toxin (BoNT) injections into both agonist and antagonist forearm muscles to treat hand tremor often result in extensor weakness and impaired function. Targeting only the anterior compartment agonists may improve tremor without causing functional weakness. Methods: The charts of patients with disabling hand tremor for whom injections of onabotulinumtoxinA injections were administered into wrist flexors or elbow pronators only (no extensor or supinator targeting) were reviewed. Doses were individualized according to tremor severity. Outcome measures included: volumetric testing measuring the proportion of water remaining in a full cup held 30 seconds in the outstretched hand, blinded ratings of graphic samples using a Visual Analog Scale (VAS), tremor power and frequency spectral analysis, using rectified EMG. Results: Twenty-six injections in seven patients were identified: five patients had essential tremor, one had Parkinson's disease, and one had primary writing tremor. The average total dose per session of onabotulinumtoxinA administered into the forearm anterior compartment was 132±13 U (range 50-300 U). Following injections, the level of water remaining in the cup increased from 42±9% to 81±9% (p=0.003); VAS ratings of graphic samples improved from 45±13 to 81±11/100 (p=0.011); tremor power decreased by 53% in flexor/pronator (p=0.075) and by 69% in extensor/supinator groups (p<0.05); root-mean-square tremor was reduced in the extensors (p<0.05). Subjective transient mild hand weakness was reported after one out the 26 injections. Conclusion: Targeting solely wrist flexors or elbow pronators with BoNT injections may reduce hand tremor severity, including in the non-injected extensor/supinator muscles, without inducing significant clinical weakness.

  6423 - Platelet lysate and tendon healing: Comparative analysis of autologous frozen-thawed prp and ketorolac tromethamine' effects in the treatment of patients with rotator cuff tendinopathy Top

Raha Markazi Movaghar, Alireza Pishgahi, Fariba Eslamian, Mehdi Yusefi

Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

E-mail: [email protected]

Background and Aim: Platelet-rich derivatives are being increasingly used in the treatment of tendon-related pathologies as a rich source of growth factors which aims at providing a regenerative stimulus in the tendon. We sought to ascertain if local application of platelet lysate (PL) to augment rotator cuff repair improves outcomes compared to ketorolac tromethamine treated group. Methods: A total of 40 patients,18 to 70 years,with diagnosis of RCT and symptoms for ≥3 months were randomized to receive sub-acromial injections of PL (2 ml) every week for a total of 3 injections and two injection of ketorolac tromethamine (30 mg) every two weeks in addition to a training program.PL from all participants was prepared following standard protocols.Patients were randomized into a PL group (n=20) and ketorolac (control group,n=20).Visual Analogue Scale (VAS), Shoulder Pain and Disability Index (SPADI) and shoulder range of motion (ROM) were assessed at baseline and at 1 and 6 months after injection. Result: 40 patients completed 6 months follow-up. Within each group, SPADI and VAS scores showed significant improvements compared with baseline at all-time points (P<0001). In the range of motion measures, no significant difference after ketorolac therapy was noted. The outcomes were identical at the initial and short-term state in both control and PL groups; whereas, when considering the 6-month period, there is a seemingly remarkable superiority in PL group in all parameters. Conclusion: This study suggests that local injection of PL led to favorable clinical outcomes for the RCT treatment after 6 months and supports that PL probably has the capability of improving the symptoms and bringing back the functionality in capacities. Hence,these consequences can open doors for PL a new horizon as well as a second choice for RCT treatment in the future.

  6062 - Efficacy of ultrasound guided caudal epidural steroid injection with or without ozone in patients with lumbosacral canal stenosis: A comparative study Top

Seyed Ahmad Raeissadat1, Vahid Soltani2, Seyed Mansoor Rayegani2

1Clinical Research Development Center, Shahid Modares Hospital, Tehran, Iran, 2Physical Medicine and Rehabilitation Research Center, SBUMS, Tehran, Iran

E-mail: [email protected]

Background and Aim: Lumbosacral canal stenosis is a slowly progressive disease and the most common cause of back surgery with many complications. Therefore, it is necessary to choose a minimally invasive treatment with highest possible efficacy in these patients. Materials and Methods: A double-blind randomized clinical trial was conducted on 47 patients with lumbar spinal stenosis assigned in two treatment groups. The first group received 80 mg of triamcinolone hexavalent with 4 cc of marcaine 0.5% and 6 cc of distilled water to the epidural caudal space under ultrasound guidance. The second group, received an injection similar to the first group with addition of 10 cc of ozone (O2-O3) gas at a concentration of 10 μg/cc. The patients were followed at 0, 1, and 6 months after injection with clinical outcomes measures using Visual Analog Scale (VAS), Walking Distance (WD) and Oswestry Disability Index (ODI). Results: The trend of decreasing pain intensity based on VAS was significant in both groups at follow-up periods.The recovery process of disability in both types of treatment during follow-up was significant, and there was no difference between the two treatment groups in one month and six months.As for walking distance, the improvement process with both types of treatment during follow-up periods was significant. After one and six months of treatment, the rate of improvement in patients' walking distance in the caudal epidural steroid injection + ozone therapy group was significantly higher than the epidural steroid treatment group. Conclusion: our results demonstrated that the group receiving caudal epidural steroid injection plus ozone had a significantly higher score of walking distance index than the group receiving caudal epidural steroid alone.


  1. Hassan KZ, Sherman AL. Epidural steroids. In: StatPearls. 2019. Available from: https://pubmed.ncbi.nlm.nih.gov/30726005/.

  6383 - Long-lasting effect after ultrasound-guided perineural hydrodissection in Carpal tunnel syndrome: A prospective study Top

Rita Santos, Alexandra Lagarto, José Bernardo Ferreira, Simão Serrano

Centro Hospitalar de Leiria - Serviço de Medicina Física e de Reabilitação - Rua das Olhalvas, Leiria, Portugal

E-mail: ritaflo[email protected]

Background and Aim: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. Corticosteroid injections (CI) remain controversial as literature reports only short-term efficacy. More recently, higher volume ultrasound-guided hydrodissection (USGH) have been associated with positive and lasting clinical outcomes. Our goal was to determine the effectiveness and duration of relief using USGH. Methods: Longitudinal prospective study including patients with mild-to-moderate CTS submitted to USGH at our department between 2018-2021. Injectates were local anaesthetic (LA), methylprednisolone (M) and/or dextrose 5% (D5) with a mean total volume of 5mL. Data from DN4, NRS, Brief Pain Inventory (BPI), presence of nocturnal numbness and patient perceived benefit (PPB) using a 5-point Likert scale was collected before and 6 weeks after intervention. Duration of symptom relief was assessed using phone interview. Results: 29 patients, 90% female, mean age 59, 24% with inability to work fulltime. Total of 32 USGH, most on dominant hand. Injectate subgroups included M+LA(71%), D5+LA(19%), M+D5+LA(10%). Neuropathic descriptors, presence of nocturnal numbness, NRS and BPI (severity of pain and interference subscales) significantly reduced after USGH (p<0.01). Positive PPB was reported after intervention (p<0.01). Mean of symptom relief was 7 months with 52% and 43% of patients reporting 6 months and 1 year lasting effect after USGH, respectively. Conclusion: USGH was effective in the treatment of mild-to-moderate CTS. Moreover, our results demonstrated a long-lasting effect using hydrodissection technique (compared with the CI short-term efficacy described in the literature). Further research is needed to determine predictors, techniques and injectates associated with better outcomes.

  4399 - Two- vs. four-site botulinum toxin hamstring injections for pediatric cerebral palsy: A randomised control trial Top

Chuenchom Chueluecha, Siranya Paecharoen

Department of Rehabilitation Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand

E-mail: [email protected]

Background and Aim: Botulinum toxin type A (BoNT-A) injections are widely used for spasticity reduction in cerebral palsy (CP). The best location is the pre-synaptic membrane of the motor endplate (MEP), but there is no consensus on the ideal number of injections in hamstring muscles. We compared two-point versus four-point BoNT-A hamstring MEP injections in children. Methods: This was a randomized prospective double-blinded controlled trial at Thammasat University Hospital from 2015-2018 of CP patients aged 2 to 7 years with hamstring muscle spasticity. For the two-point group, one BoNT-A injection was 50% length from the ischial tuberosity (IT) to the lateral femoral condyle (FC) of semitendinosus (ST), with the other at 50% IT length to medial FC of the biceps femoris (BF). For the four-point group, injections were at 50% and 75% down the IT to the lateral FC of the ST and semimembranosus (SM), respectively, and at 25% and 50% down the IT to the medial FC of the BF. Results: There were 11 patients in the two-point group and 12 in the four-point. Modified Tardieu Scale (MTS) and Modified Ashworth Scale-Bohannon (MAS-B) were recorded at baseline, 4, 12, and 24 weeks after hamstring injections. There were no significant statistical differences (p = 0.801 and p = 0.752) between MTS and MAS-B each month nor overall from baseline to 24 weeks post-injection. Conclusion: BoNT-A injections at the hamstring MEP of CP patients reduced spasticity. The four-point technique appeared more effective and durable 12 weeks post-injection, although differences were statistically insignificant.


  1. Van Campenhout A, Molenaers G. Localization of the motor endplate zone in human skeletal muscles of the lower limb: Anatomical guidelines for injection with botulinum toxin. Dev Med Child Neurol 2011;53:108-19. Available from: https://pubmed.ncbi.nlm.nih.gov/20964675/.

  5772 - Management of hemifacial spasm by botulinum toxin type A: Treatment efficiency and customer satisfaction Top

Najia Hajjioui1,2, Nour Elhouda Yakoubi1, Abdoul Aziz Alfari1, Mahamadou Sokona1, Abdrrazak Hajjioui1

1Clinical Neuroscience Laboratory, Faculty of Medicine, Pharmacy and Odontology, University Sidi Mohamed Ben Abdellah, Fez, Morocco, 2Department of Physical and Rehabilitation Medicine, Teaching University Hospital Hassan II, Fez, Morocco

E-mail: [email protected]

Background and Aim: Hemifacial spasm (HFS) is an involuntary, brief contracture of the muscles on one side of the face that can lead to social, occupational, and psychological problems. Its management by rehabilitation physicians taking into consideration the International Classification of Functioning, Disability and Health, should use the botulinum toxin as a first-line treatment represents an interesting therapeutic modality. Aim of this study was to assess the efficacy and safety of botulinum toxin type A (BTX-A) in the treatment of HFS and to measure the customer satisfaction. Methods: We conducted a retrospective, descriptive study of 10 patients with HFS followed in the physical medicine and rehabilitation department of the Hassan II teaching university hospital of Fez in Morocco. All these patients received BTX-A from May 2016 to July 2021. Results: We performed 75 BTX-A injections with an average of 7.5 ± 3.17 per patient, the average total dose was 18.18 ± 4.56. The average doses for the upper and lower level were successively 13.77 ± 6.21 and 4.41 ± 1.32. A good response to treatment was observed in 90% of patients with a satisfactory resumption of daily activities and in the workplace. Based on a subjective scale ranging from 1-3, the mean overall functional benefit was 2.8 ± 0.63. The mean total duration of therapeutic response was 12 ± 3.46 weeks. The local side effects observed were comparable to those found in the literature tearing (3%), eye redness (12%) dry eye (17%). No systemic complications were noted. Conclusion: BTX-A is effective in the short to medium term in the treatment of HFS. It is well tolerated locally and systemically. This efficacy and safety make it an appreciable therapeutic alternative in the therapeutic management of HFS.

  Therapeutics – Integrative Medicine (Acupuncture, etc.) Top

  Therapeutics – Neurostimulation Top

  6623 - Effect of transcranial direct current stimulation (tDCS) in patients with disorders of consciousness: A multicentre randomized double-blind sham-controlled clinical trial Top

Aurore Thibaut1, Géraldine Martens2, Anna Estraneo3, Salvatore Fiorenza3, Quique Noe4, Roberto Llorens4, Rita Formisano5, Giovanni Morone6, Andreas Bender7, Martin Rosenfelder7, Gianfranco Lamberti8, Ekaterina Kodratyeva9, Liudmila Legostaeva10, Carmen Krewer11, Friedemann Müller11, Olivia Gosseries11, Nicolas Lejeune12

1Coma Science Group, GIGA-Consciousness, University of Liege, Belgium, 2Coma Science Group, GIGA-Consciousness Centre du Cerveau2, University Hospital of Liè, Liège, Belgium, 3Don Carlo Gnocchi Foundation, Scientific Institute for Research and Health Care, Neurorehabilitation, 4Vithas Neuro Rehab Human Brain (NeuroRHB), Fundación Hospitales Vithas, València, Spain, 5Santa Lucia Foundation, Neurorehabilitation and Scientific Institute for Research and, Rome, Italy, 6v, 7Therapiezentrum Burgau, Burgau, Germany, 8Neurorehabilitation and Vegetative State Unit E. Viglietta, Cuneo, Italy, 9Almazov National Medical Research Center, Saint-Petersburg, Russia, 10Research Center of Neurology, Moscow, Russia, 11Schoen Clinic Bad Aibling, Bad Aibling, Germany, 12Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium

E-mail: [email protected]

Background and Aim: Left dorsolateral prefrontal cortex (LDLPFC) transcranial direct current stimulation (tDCS) has shown to transiently improve the level of consciousness of severely brain-injured patients with disorders of consciousness (DOC). However, no large-sample multicenter study confirmed its efficacy. Methods: In this parallel sham-controlled double-blind randomized trial, we investigated whether 4 weeks of tDCS improve signs of consciousness in patients in prolonged DOC while being in rehabilitation LDLPFC-tDCS was applied for 20 days (five days per week for 20 minutes). We used to the Coma Recovery Scale-Revised (CRS-R) weekly and at 1, 2 and 3-months follow-up to objectify behavioral changes. We used a mixed general linear model to evaluate behavioral changes (4-week of tDCS and 3-month follow-up) between active and sham groups, accounting for diagnosis, etiology, and time since injury. Differences between baseline and week-4 and month-3 were analyzed with a Mann-Whitney test. Results: 62 patients (18 women, 30 MCS, 39 non-TBI, 37±24.5 week post-injury, 33 active tDCS) were treated without any serious adverse events. At the group level, we did not find any treatment effect after 4 weeks (p=0.19) nor at 3-month (p=0.79). Subgroup analyses revealed a significant improvement for the active compared to the sham group for patients in MCS (p=0.015) and TBI patients (p=0.023) at 3-month. No other comparisons were significant. Conclusion: Our results suggest that at the group level, tDCS applied during rehabilitation does not significantly enhance patients' signs of consciousness. On the other hand, at 3-month follow-up, the subgroups of MCS and TBI patients demonstrated a better recovery in the treated compared to the sham groups. tDCS should be specifically applied in this subgroups of patients to promote their recovery.

  6439 - Us-guided genicular nerves radiofrequency ablation as treatment for chronic knee pain after total knee arthroplasty: Case series with a review of literature Top

Luís Amaral Oliveira1, Miguel de Castro Correia1, Eugénio Gonçalves1, Rodrigo Silva Correia1, André Varandas Borges1, Inês Andrade2, Tiago Rodrigues Lopes1, José Luís Carvalho1

1Centro de Reabilitação do Norte, Physical Medicine and Rehabilitation Service, Av. Infante Sagres 22, Valadares, Vila Nova de Gaia, Portugal, 2Centro de Medicina de Reabilitação de Alcoitão, Physical Medicine and Rehabilitation Service Rua Con, Portugal

E-mail: [email protected]

Background and Aim: Total knee arthroplasty (TKA) is the surgical gold standard treatment for end-stage knee osteoarthritis (OA). Even so, reports show that 8-30% of patients end up dissatisfied. Chronic pain after TKA is a known symptom and as the number of joint replacements increase every year, different approaches are needed. Genicular nerve radiofrequency ablation (GN-RFA/RFA) is an established therapy for refractory end-stage OA pain, however its utility in persistent pain after TKA it's not well acknowledged. Methods: Retrospective review and analysis of patients with chronic refractory pain after TKA. Results: In total, we reviewed 8 knees from 8 patients which realized GN-RFA after TKA. One patient was excluded due to TKA aseptic loosening. All patients had very different clinical evolutions, all firstly exposed to conservative treatments. Follow up lasted between 3-12 months after RFA. 4 out of 7 (57%) patients had at least 50% pain improvement at 3 months evaluation. Conclusion: Each patient had their own clinical evolution with different heterogeneous biases which limits conclusions. Even so, the success rate of GN-RFA in these complex cases made it a reliable option. Reviewing recent publications about RFA in patients with TKA: Erdem and Sir applied pulsed GN-RFA to 6 patients with 67% presenting ≥ 50% improvement; Menzies, Sylvester and Protzman described significant clinical improvement in 3 case reports; Qudsi-Sinclar et al. showed GN-RFA to be as effective as cortico-anesthetic intra-articular injection; Walgea et al. interestingly demonstrated no effect on postoperative pain control if RFA is administered preoperatively. Prior knee surgery was initially an exclusion criteria for genicular nerve neurotomy through RFA, but nowadays seems to be a promising option for persistent pain after TKA.

  6157 - The effect of transcranial random noise stimulation (tRNS) combined with cognitive training on symptoms and executive functions in paediatric ADHD Top

Ornella Dakwar-Kawar1, Itai Berger2, Roi Cohen Kadosh3, Mor Nahum1

1School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel, 2Paul Baerwald School of Social Work and Social Welfare, Hebrew University,Jerusalem, Israel, 3School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, England

E-mail: [email protected]

Background and Aim: Significant impairments in executive functions (EFs) are highly prevalent in ADHD, and are considered to significantly contribute to symptoms and daily function in ADHD. However, gold-standard pharmacological and/or psychosocial interventions do not often target EF mechanisms. A recent study we completed showed that a 2-week treatment of cognitive training (CT) combined with transcranial Random Noise Stimulation (tRNS) is superior to combination with another form of stimulation, transcranial Direct Current Stimulation (tDCS). Here, we examined the potential efficacy of treatment of tRNS+CT compared to sham stimulation +CT on alleviating symptoms, EF, and resting-state (RS) EEG metrics in pediatric ADHD. Methods: A double-blind randomized controlled trial involving 23 unmedicated children (6-12y/o) with ADHD, who were randomized to receive either tRNS+CT or sham stimulation+CT. All participants completed 10 days of treatment (20min/day for 2 weeks). Participants were assessed at baseline, post-treatment, and after a 3-week follow-up. Symptoms and EF were measured by parent-reported scales (the BRIEF and ADHD-RS, respectively), as well as EF of working memory (by digit span test-WISC) and processing speed (by MOXO-CPT). Neural measures were recorded by RS-EEG. Results: Based on the results of our pilot study, we expect that the active treatment will result in significant clinical and EF improvements compared to the control treatment. We further expect that this effect will be further increased when examined at follow-up, reflecting neuroplasticity-related effects. Conclusion: This study may provide evidence for the effectiveness of a novel treatment option for ADHD. If successful, such treatment can provide a cost-effective and safe treatment option for pediatric ADHD.

  6099 - Naming therapy with and without TDCS in subacute stroke patients with aphasia Top

Tamar Levy1, Corinne Serfaty2, Aviah Gvion3, Ceela Edelstein4, Maya Weinstein5, Nachum Soroker2

1Department of Speech and Language Disorders, Loewenstein Rehabilitation Medical Center, Raanana, Israel, 2Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel, 3Reuth Rehabilitation Hospital, Tel Aviv, Israel, 4Department of Speech and Language Disorders, Loewenstein Rehabilitation Medical Center, Raanana, Israel, 5Assuta Tel-Aviv Medical Center, Functional Neurosurgery Unit, Tel-Aviv, Israel

E-mail: [email protected]

Background and Aim: Following stroke, language therapy for aphasia was shown to be more effective when combined with transcranial direct current stimulation (tDCS). The best evidence for that comes from studies conducted in the chronic stage. However, it is in the first weeks post stroke onset that enhanced brain plasticity makes rehabilitation efforts more efficient. Here we assessed the effectiveness of naming therapy combined with anodal-vs sham-tDCS in subacute stroke patients. Methods: 14 aphasic patients admitted for rehabilitation shortly after stroke onset, were randomly allocated to one of two groups. The first (n=7) received 10 daily sessions of cued naming therapy combined with 20 minutes of anodal-tDCS over the left M1 hand area. The second group (n=7) received a similar therapy combined with sham-tDCS. Language abilities were tested before, immediately after and 6-weeks following the treatment phase. These included tasks of picture naming and word recognition, among others. Normalized lesion data were analyzed with MEDx software. Results: Naming capacity improved in both groups, with no significant difference between the groups (mean %-correct ±SD at T1, T2 and T3 were: 36±24, 48±29 and 59±34, respectively). Patients showed large inter-subject variability in treatment effects, depending on baseline impairment level and lesion characteristics. Naming improvement across groups correlated with patients' baseline semantic level (r=.552, p<.05). Conclusion: Group level analysis failed to disclose an adjuvant effect for excitatory (anodal) stimulation of ipsi-lesional M1. Large inter-subject variability in treatment effects stresses the need for closer inspection of individual data in order to identify linguistic and lesion parameters predicting stimulation efficiency.

  Therapeutics – Pharmacological Agents Top

  6470 - Efficacy of duloxetine on electrodiagnosis findings of paclitaxel-induced peripheral neuropathy in patients with breast cancer: A randomized controlled trial Top

Marzieh Babaee, Marzieh Hesam, Reza Aghabozorgi, Seyyed Mansoor Rayegani, Ahmad Raeissadat

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

E-mail: [email protected]

Background and Aim: This study aimed to evaluate the efficacy of duloxetine on patient's peripheral neuropathy induced by paclitaxel in patients with breast cancer (BC). Methods: This Randomized double-blind clinical trial conducted on 40 patients with BC who received paclitaxel as their first chemotherapy session. All the patients were randomly allocated in two groups, intervention (n: 20) and placebo (n: 20). The intervention group received 30 mg duloxetine/day in the first week, followed by 60 mg twice a day until 4 weeks. Patient's neurotoxicity questionnaire (PNQ) used to evaluate the neuropathy degree. Nerve conduction study and electromyography were also performed. The evaluations performed at the baseline time and 12 weeks after the treatment. Data were analyzed using SPSS ver. 24 for windows (IBM Inc, NY). Results: Out of 40 subjects, 37 patients with no symptoms and three patients (7.5%) (intervention group: 1 case, control group: 2 cases) were reported with mild symptoms at the baseline time. 12 weeks after the treatment, 28 patients (70%) with no symptoms, 4 patients (10%) (intervention group: 2 cases, control group: 2 cases) with mild, 3 cases (7.5%, in control group) with moderate, and 5 cases (12.5%, in control group) with severe were reported (P=0.03). Significant differences between groups related to median sensory latency (P<0.001), sural sensory latency (P=0.003), sural sensory amplitude (P=0.01), median motor latency (P=0.001), median motor NCV (P=0.001), and DPN NCV (P=0.003) and study groups were reported in the study. Conclusion: Regarding the results, duloxetine would be an effective treatment on paclitaxel-induced peripheral neuropathy in patients with breast cancer and this effectiveness was detected in electrodiagnosis study.


  [Figure 1], [Figure 2]

  [Table 1], [Table 2]


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