Gouri Chaudhuri

Cardiovascular Effects of the Supraglottic and Super-supraglottic Swallowing Maneuvers in Stroke Patients with Dysphagia

The prolonged voluntary closure of the glottis during the supraglottic and super-supraglottic swallowing techniques may create the Valsalva maneuver. The Valsalva maneuver has been associated with sudden cardiac death and cardiac arrhythmias. This study describes the effects of the supraglottic and super-supraglottic swallowing techniques on the cardiovascular system. Subjects included 23 patients from an acute inpatient rehabilitation hospital. Subject groups included recent stroke, dysphagia, and a history of coronary artery disease (Group 1, N = 11), recent stroke and dysphagia with no known coronary artery disease (Group 2, N = 4), and orthopedic diagnosis with no known dysphagia or coronary artery disease (Group 3, N = 8). Cardiac status was moni-tored for 4 hours during swallowing training, regular therapy sessions, and a meal. For Groups 1 and 2, 86.6% (13 out of 15) of the subjects demonstrated abnormal cardiac findings during the swallowing session including supraventricular tachycardia, premature atrial contractions, and premature ventricular contractions. Arrhythmia subsided within a few minutes after the session and did not occur during other activities. In Group 3 (control group), none of the subjects demonstrated abnormal cardiac findings except for bradycardia in one subject. It is suggested that the supraglottic and super-supraglottic swallow maneuvers may be contraindicated for patients with a history of stroke or coronary artery disease.

Compelled Body-Weight Shift Approach in Rehabilitation of Individuals with Chronic Stroke

Abstract Purpose: This study was designed to evaluate the effectiveness of the compelled body weight shift (CBWS) therapy approach in the rehabilitation of individuals with chronic stroke. CBWS involves a forced shift of body weight toward a person’s affected side by means of a shoe insert that establishes a lift of the nonaffected lower extremity. Method: Eighteen individuals with chronic, unilateral stroke (mean age 57.7 ± 11.9 years, with a range of 35-75 years; mean time since stroke 6.7 ± 3.9 years, with a range of 1.1-14.1 years) who showed asymmetrical stance were randomly divided into 2 groups: the experimental group received 6 weeks of physical therapy combined with CBWS therapy, and the control group received only physical therapy. Both groups underwent a battery of identical tests (Fugl-Meyer Assessment, Berg Balance Scale, weight bearing, and gait velocity) before the start of the rehabilitation intervention, following its completion, and 3 months after the end of therapy. Results: After the intervention, weight bearing on the affected side (measured with the Balance Master) increased in the experimental group to a larger degree compared to the control group (9.7% vs 6.4%). Similarly, gait velocity increased 10.5% in the experimental group compared to the control group. Improvements in weight bearing and gait velocity were maintained in the experimental group after the 3-month retention period. Conclusion: The study outcome revealed that a 6-week intervention involving CBWS therapy could result in a long-lasting improvement of the symmetry of weight bearing and velocity of gait in individuals with chronic stroke.

Gait assessment during the initial fitting of an ankle foot orthosis in individuals with stroke

Purpose. To evaluate if the measurement of gait parameters, examined during the fitting of an Ankle Foot Orthosis (AFO), has a beneficial effect on the gait pattern of individuals who were affected by a stroke. Also, this study seeks to provide evidence regarding the use of the portable GaitRite® system in a clinical setting. Method. Before-after trial conducted at a stroke outpatient orthotic clinic of a freestanding rehabilitation hospital. Thirteen individuals with acute and 27 individuals with chronic stroke participated in the assessment of gait velocity, cadence, step length and stance phase. Results. AFO use significantly improves gait velocity, cadence, step, and stride length in individuals with hemiparesis due to stroke. Conclusion. The results of the current study indicate that the assessment of temporo-spatial characteristics of gait can be incorporated into a clinical routine. This will be useful for patient education, justification of medical necessity of paying, monitoring progress, and in the decision-making process of weaning patients off orthoses.

Knee position feedback: its effect on management of pelvic instability in a stroke patient.

Purpose : This is a case study of improvement in pelvic instability due to a stroke, with treatment. The patient had narrow knee-to-knee distance due to weakness in the pelvic muscles resulting in a narrow base of support. Method : Treatment was focused on pre-gait activities to improve upright posture control followed by gait training involving extrinsic auditory feedback about knee-to-knee distance. Results : After two weeks of therapy with feedback technique incorporated in a functional context of gait therapy, the patient was able to advance his left lower extremity with proper foot placement. Laboratory measurements showed that step width and stride length gotten better after treatment as well. Conclusion : An inclusion of feedback information about knee-to-knee distance could benefit gait training of patients with pelvic instability.

The Effectiveness of the "Chin Tuck" Position during the Videofluoroscopic Swallow Study

Design: Cross-sectional design. Setting: Urban public rehabilitation hospital inManagua, Nicaragua. Participants: 25 lower extremity amputees undergoing prosthetic evaluation following amputation. Interventions: Self-report survey addressing individual, surgical, and rehabilitation aspects previously recognized to impact functional outcome. Main Outcome Measures: Indication for amputation, level of amputation, post-operative complications (wound infection and need for revision), as well as duration from surgery to initiation of rehabilitation and fitting of a prosthesis were evaluated. Results or Clinical Course: Indication for amputation was evenly distributed between diabetes and trauma, representing collectively 88% of the amputations. An overwhelming proportion of amputations were above the knee (84%), with no statistically significant correlation between age or etiology and level of amputation (p>.05). 10/25 (40%) amputees reported waiting longer than 1 year for formal rehabilitation and/or fitting of a prosthesis, yet only three of the ten had suffered post-operative complications. All participants were asked whether they felt there was unreasonable delay in prosthetic evaluation, of which 88% indicated an affirmative response. The primary reason offered for this perceived delay was long wait times from referral to evaluation (54.5%), followed by the expense of a prosthesis (31.8%). Conclusions: Burden of illness from non-communicable disease is a rising concern in developing nations. Here, potential barriers to functional recovery after lower extremity amputation among people living in Nicaragua were investigated, and include apparent tendency toward proximal amputation as well as duration to rehabilitation and prosthetic fitting. Post-operative complications do not exclusively account for delay in rehabilitation. In designing local and global strategies for lower extremity amputees, consideration should be given to preventative and surgical efforts aimed at preserving more distal joints as well as early physical therapy and prosthetic evaluation.

Poster 232: Incidence of Esophageal Dysphagia in Rehabilitation Patients

management. HAQ is normal in 4 of 7, mild functional limitations in 1 of 7 and moderate in 2 of 7. 1 of 7 is moderately active on the HAP adjusted activity score (AAS), 6 of 7 are active and none is impaired. None of 7 has high level of disability on the PDI. Body weight inversely correlates (P .05) with HAP maximum activity score MAS (r -.78) and AAS (r -.78). Hip flexion inversely correlates (P .05) with HAQ (r -.79), and PDI (r -.77). Hip internal rotation inversely correlates with HAQ (r -.80). Hip extension inversely correlates with TUG (r -.61) and PDI (r -.80). Schober’s test inversely correlates (P .05) with AAS (r -.93), and MAS (r -.93) and correlates (P .05) with HAQ (r .81), and PDI (r .92). Conclusions: Adults with sickle cell anemia in this cohort have functional loss associated with decreased hip flexion and internal rotation. Increased body weight and lumbar spine flexibility correlate with decreased activity level. In this preliminary observation, sickle cell anemia is associated with functional loss (none severe) not exclusively attributed to AVN. This functional loss is likely to be ameliorated or prevented with treatment of loss of range of motion. Additional longitudinal studies are warranted.

Poster 123: First-year acupuncture treatment experience of a physiatrist.1

Abstract Objective: To evaluate the effectiveness of acupuncture treatment for pain and spasticity due to musculosketal and neurologic conditions. Design: Retrospective chart reviews. Setting: Free-standing rehabilitation hospital. Participants: 27 consecutive inpatients over a 12-month period who were treated with acupuncture for pain, spasticity, and weakness. 16 patients had painful conditions due to musculosketal and neurologic conditions, 7 patients had spasticity due to stroke, and 4 patients had weakness due to stroke. Intervention: Acupuncture treatment by a physiatrist. Main Outcome Measure: A 1 to 10 visual analog scale to measure pain, the Ashworth Scale score to evaluate spasticity, and manual muscle testing to evaluate muscle strength. Results: All musculoskeletal patients reported a 90% reduction in pain. There was a 100% reduction in pain due to neuropathic conditions. Spasticity improved modestly by 2 points (from 4 to 2). Muscle strength improved by one-half grade. Duration and frequency of treatment was 1 to 2 times a week for 4 to 6 weeks for all patients. Conclusion: It appears that pain from peripheral neuropathy and musculoskeletal conditions responded best to acupuncture treatment. Patients with spasticity and weakness from the stroke did demonstrate some improvement for acupuncture but not as much as the pain patients did.