Heather Williams

Poster 435: A UK Pilot for a Large International Prospective Cohort Analysis of the Use of Botulinum Toxin A (BoNT-A) in Upper Limb Spasticity

stroke about visuomotor learning. Design: A case-control study. Setting: A rehabilitation center. Participants: The subjects were 14 healthy people (the control group: mean SD, 43. 4.1 years, 7 men and 7 women), and 14 patients with right brain damage (the right brain damage group: mean SD, 49.5 5.6 years, 9 men and 5 women), and 14 patients with left brain damage (the left brain damage group: mean SD, 46.3 5.0 years, 7 men and 7 women). Interventions: We used a computerized motor skill analyzer (CMSA) for the lower limb that can evaluate the speed and the accuracy of movements in tracking tasks. The subjects were instructed to draw a figure-eight on the display with their foot, as quickly and accurately as possible. Procedures of practice and measurement of motor learning were as follows: (1) 10 measurement trials in the morning of the first day, (2) 10 trials of the mirror image task was applied immediately after the first measurement, (3) 10 measurement trials at 5-7 hours later, and (4) 10 measurement trials the next morning. Main Outcome Measures: Lap time and integrated distance over the time of the normal task. Results: Although the motor skills of the control group and the left brain damage group were improved the next morning, the right brain damage group did not show improvement. Conclusions: Our results suggest that the motor skill learning of patients with right brain damage are reduced by the visuomotor interference task, because the visuomotor skills in patients with right brain damage are more disabled than in patients with left brain damage.

The nuclear education of Donald J. Trump

ABSTRACT During the 2016 American presidential campaign, Democrats and Republicans alike repeatedly raised concerns at the prospect of Donald Trump being in charge of America’s nuclear arsenal based on his seemingly unstable personality. Unfortunately, this emphasis on Trump’s character distracted attention from any in-depth investigation into his long-standing interest in nuclear issues. This article seeks to remedy this shortcoming by highlighting the nuclear legacy Trump will inherit from Obama, surveying his statements on nuclear issues over more than three decades, and providing an analysis of constraining factors on his administration’s nuclear agenda, particularly domestic institutions. It finds that most of Trump’s views on nuclear issues are relatively consistent with past Republican presidents. Where he is unique, however, is in his use of social media, which has potential implications on nuclear signaling.

Strategic Stability, Uncertainty and the Future of Arms Control

The United States’ new Nuclear Posture Review reflects changes in how the US thinks about its broader strategic environment.

Prohibition and Its Discontents

States and civil-society groups pursuing a ban on nuclear weapons do not all share the same motivations.

Poster 38 The Neurological Impairment Scale: A Predictor of Functional Outcome in Patients With Severe Complex Disability

tation hospital. Interventions: NA. Main Outcome Measures: Main outcomes were Functional Independence Measure (FIM) ratings, musculoskeletal pain (numerical score from 0 [none] to 10 [worst]), length of stay (LOS), postsurgical complications, therapy participation, and discharge destination. Results: LOS was not different between groups (9.0 versus 9.9 days). The FIM rating at discharge was lower in patients who were obese than patients who were not obese (74.9 versus 82.6 points) and the change in FIM rating was 13% lower in the obese group. This FIM efficiency (points gained per day) was lower in the obese group (2.6 versus 3.0 FIM points gained per day; P .031). Discharge pain scores were lower in the obese group (2.9 versus 3.9 points; P .05).Common complications in the nonobese and obese groups were infections (13%, 17%), anemia (7%, 10%), and respiratory distress (5% for both). The percentage of days that the patients in the nonobese and the obese groups participated in therapies was 91% and 92%; therapy intensity (sessions per day) was 5.1 and 5.3 for these groups. Similar proportions of patients achieved independence or supervision only with tasks such as upper and lower body dressing, transfers, stair climbing, and walking after rehabilitation. Activities that the fewest patients in both groups were able to obtain complete independence or supervision only were walking (12.8%-14.8% of the groups) and stair climbing (1.8%-4.3% of the groups). However, 81% and 88% of the 2 groups were discharged home. Conclusions: Obesity does not preclude improvements in functional independence during rehabilitation after orthopedic trauma, which may be due to rigorous prescreening before acceptance of admission into rehabilitation. However, the rate and magnitude of improvement are less in persons with BMI 30 kg/m and should be considered when making plans of care for recovery in the home.

Poster 49 The Work-ability Support Scale: Development and Preliminary Evaluation

Concurrent end organ damage commonly occurs, as reflected by the patient’s cardiac arrest and acute tubular necrosis. This patient benefited from his acute rehabilitation course, without exacerbation, and, in fact, near complete resolution of these disease manifestations. Conclusions: Clarkson disease is a rare and poorly understood disease, with fewer than 150 cases reported. Discussions regarding the outcomes of rare and complicated diseases subsequent to acute rehabilitation are important to better establish admission criteria and rehabilitation prognosis.

Poster 14: Measuring Rehabilitation Inputs in Relation to Caseload Complexity Using the Rehabilitation Complexity Scale

impairment. Discussion: This case represents a diagnosis which is rarely seen in the rehabilitation setting. The treatment of patients with anti-NMDA receptor encephalitis in the acute inpatient rehabilitation setting has not been reported in the literature previously. Conclusions: For many patients with this diagnosis, the functional, cognitive and behavioral impairment, and prolonged recovery would make the inpatient rehabilitation setting the most appropriate level of care. This case exemplifies the management of this population in the inpatient rehabilitation setting, in particular the response to a typical brain injury rehabilitation program.