Katharine Scrivener

Effect of affordable technology on physical activity levels and mobility outcomes in rehabilitation: a protocol for the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial

Introduction People with mobility limitations can benefit from rehabilitation programmes that provide a high dose of exercise. However, since providing a high dose of exercise is logistically challenging and resource-intensive, people in rehabilitation spend most of the day inactive. This trial aims to evaluate the effect of the addition of affordable technology to usual care on physical activity and mobility in people with mobility limitations admitted to inpatient aged and neurological rehabilitation units compared to usual care alone. Methods and analysis A pragmatic, assessor blinded, parallel-group randomised trial recruiting 300 consenting rehabilitation patients with reduced mobility will be conducted. Participants will be individually randomised to intervention or control groups. The intervention group will receive technology-based exercise to target mobility and physical activity problems for 6 months. The technology will include the use of video and computer games/exercises and tablet applications as well as activity monitors. The control group will not receive any additional intervention and both groups will receive usual inpatient and outpatient rehabilitation care over the 6-month study period. The coprimary outcomes will be objectively assessed physical activity (proportion of the day spent upright) and mobility (Short Physical Performance Battery) at 6 months after randomisation. Secondary outcomes will include: self-reported and objectively assessed physical activity, mobility, cognition, activity performance and participation, utility-based quality of life, balance confidence, technology self-efficacy, falls and service utilisation. Linear models will assess the effect of group allocation for each continuously scored outcome measure with baseline scores entered as a covariate. Fall rates between groups will be compared using negative binomial regression. Primary analyses will be preplanned, conducted while masked to group allocation and use an intention-to-treat approach. Ethics and dissemination The protocol has been approved by the relevant Human Research Ethics Committees and the results will be disseminated widely through peer-reviewed publication and conference presentations. Trial registration number ACTRN12614000936628. Pre-results.

Exercise dose and mobility outcome in a comprehensive stroke unit: description and prediction from a prospective cohort study.

OBJECTIVE To describe the dose of lower limb exercise completed during admission to a stroke unit, establish predictors of dose and explore the relationship between dose and walking outcomes. DESIGN Inception cohort study. PARTICIPANTS Two hundred consecutively-admitted people with stroke. METHODS Repetitions of exercise completed throughout the admission were tallied. Possible predictors of exercise dose were recorded within 48 h of admission. Walking velocity was assessed at the beginning and end of the hospital stay. RESULTS Data were available for 191 (96%) participants on discharge. The mean daily dose of lower limb exercise was 288 repetitions (standard deviation (SD) 242), the variability in dose was best explained by age and disability level. The mean improvement in walking velocity was 0.43 m/s (SD 0.46), 26% of variability in walking improvement was explained by exercise repetitions and 29% was explained by a multivariable model including significant contributions from exercise repetitions (p < 0.01) and age (p = 0.03). After controlling for other factors, for every 100 daily repetitions of lower limb exercise there was an additional change in walking velocity of 0.08 m/s (95% CI 0.05 to 0.11, p < 0.01). CONCLUSION Exercise dose in a stroke unit is variable and can be predicted by age and disability. Increased exercise dose is associated with improved mobility outcomes.

Amount of Exercise in the First Week After Stroke Predicts Walking Speed and Unassisted Walking

Background. Predicting walking outcomes poststroke is a challenge for clinicians. Objective. To identify the extent to which exercise dose (repetitions of leg movements) in the first week of a comprehensive stroke unit stay predicts discharge mobility. Methods. A cohort study was conducted on 200 consecutive people admitted to a comprehensive stroke unit who required physical therapy. Results. Discharge and predictor data were available for 191 survivors (99%). On admission, 86 participants were able to walk, and the average walking velocity was 0.42 m/s. On discharge, the average walking velocity was 0.77 m/s, and 152 participants were able to walk. A discharge walking velocity of greater than 0.8 m/s was predicted by the exercise dose achieved in the first week after admission. Adding other predictors did not significantly increase the predictive ability of the model. Completion of more than the median number of exercise repetitions (703) in the first week of admission was associated with a quicker recovery of unassisted walking. This effect persisted after adjustment for walking velocity on admission, cognition, and comorbidity. Conclusion. Exercise dose in the first week after admission for stroke is an important indicator of walking speed at discharge and the time to achieve unassisted walking.

After-hours or weekend rehabilitation improves outcomes and increases physical activity but does not affect length of stay: a systematic review

QUESTION In adults undergoing inpatient rehabilitation, does additional after-hours rehabilitation decrease length of stay and improve functional outcome, activities of daily living performance and physical activity? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS Adults participating in an inpatient rehabilitation program. INTERVENTION Additional rehabilitation provided after hours (evening or weekend). OUTCOME MEASURES Function was measured with tests such as the Motor Assessment Scale, 10-m walk test, the Timed Up and Go test, and Berg Balance Scale. Performance on activities of daily living was measured with the Barthel index or the Functional Independence Measure. Length of stay was measured in days. Physical activity levels were measured as number of steps or time spent upright. Standardised mean differences (SMD) or mean differences (MD) were used to combine these outcomes. Adverse events were summarised using relative risks (RR). Study quality was assessed using PEDro scores. RESULTS Seven trials were included in the review. All trials had strong methodological quality, scoring 8/10 on the PEDro scale. Among the measures of function, only balance showed a significant effect: the MD was 14 points better (95% CI 5 to 23) with additional after-hours rehabilitation on a 0-to-56-point scale. The improvement in activities of daily living performance with additional after-hours rehabilitation was of borderline statistical significance (SMD 0.10, 95% CI 0.00 to 0.21). Hospital length of stay did not differ significantly (MD -1.8 days, 95% CI -5.1 to 1.6). Those receiving additional rehabilitation had significantly higher step counts and spent significantly more time upright. Overall, the risk of adverse events was not increased by the provision of after-hours or weekend rehabilitation (RR 0.87, 95% CI 0.70 to 1.10). CONCLUSION Additional after-hours rehabilitation can increase physical activity and may improve activities of daily living, but does not seem to affect the hospital length of stay. REVIEW REGISTRATION PROSPERO CRD42014007648. [Scrivener K, Jones T, Schurr K, Graham PL, Dean CM (2015) After-hours or weekend rehabilitation improves outcomes and increases physical activity but does not affect length of stay: a systematic review.Journal of Physiotherapy61: 61-67].

A systematic review of the responsiveness of lower limb physical performance measures in inpatient care after stroke

BackgroundResponsiveness refers to a measurement tool’s ability to detect change in performance over time. The aim of the review was to summarise studies of responsiveness of lower limb physical performance measures during inpatient care after stroke.MethodsA systematic literature review was conducted. Prospective studies that included participants with a diagnosis of stroke, were commenced in the acute or subacute phase of inpatient care and included a measure of a lower limb physical performance were included in this review.ResultsTwenty-one studies met these inclusion criteria. A variety of measures were investigated including the Berg Balance Scale, various timed walking tests and the Rivermead Mobility Index. Ten of the included studies had small sample sizes (50 participants or less), 2 studies used a convenience sample rather than consecutive recruitment and 5 studies excluded potential participants with poor physical abilities at baseline. Responsiveness varied between and within studies but was generally large, Effect Size (ES) or Standardised Response Mean (SRM) > 0.8. Measures displaying large responsiveness included the twelve-minute walk test (SRM 1.90) and the Modified Rivermead Mobility Index (SRM 1.31) when re-measured at four weeks after stroke, and the Berg Balance Scale (ES 1.11) and Postural Assessment Scale for Stroke Patients (ES 1.12) when re-measured at approximately six months after stroke.ConclusionStudies conducted to date have generally found physical performance measures after stroke to have large responsiveness i.e., to be able to detect changes. Further investigation of the responsiveness of measurement tools after stroke in larger prospective cohort studies is required.

Dual-task walking performance in older persons with hearing impairment: implications for interventions from a preliminary observational study

Objectives: Adults with “hearing loss” have an increased falls risks. There may be an association between hearing impairment and walking performance under dual-task (DT) and triple-task (TT) conditions. The aim of this study was to identify DT and TT effects on walking speed, step length, and cadence in adults with hearing impairment, previous falls, and physical limitations. Design: The observational study included 73 community-dwelling older people seeking audiology services. Data were collected on sociodemographic characteristics, previous falls, fear of falling, physical limitations, and walking performance under three task conditions. Differences between the task conditions (single task [ST], DT, and TT) and the hearing groups were analyzed with a two-way ANOVA with repeated measures. The influence of fall risks and limited physical functioning on walking under ST, DT, and TT conditions was analyzed with ANOVAs, with ST, DT, and TT performance as repeated measurement factor (i.e., walking speed, step length and Cadence × Previous falls, or short physical performance battery <12 × Hearing Groups). Results: Walking speed was reduced accompanied by decreased step length and increased cadence in people with more severe hearing loss. Larger negative effects on DT and TT walking were found with increasing hearing loss (speed and cadence decreased with higher DT costs). Highest DT costs were found for the walking-manual conditions. These results were accompanied by small effects of older age and more comorbidities. Conclusions: This first screening data of walking performance under different conditions for people with hearing loss warrants the need for development and investigation of training interventions to improve walking abilities. DT training may be beneficial to enhance motor and cognitive flexibility and to reduce fall risks.

Feasibility of a Nurse-Led Weekend Group Exercise Program for People after Stroke

Background. Additional physical activity including repetitive task practice can improve outcomes after stroke. The additional practice can be facilitated by therapists and family members or could also be delivered by nursing staff. Objective. To investigate the feasibility of a nurse-led weekend exercise program after stroke. Participants. Individuals after stroke, who participated in a weekend exercise program during their hospital admission. Methods. A retrospective audit of the number of referrals to and amount of exercise repetitions achieved in a nurse-led weekend exercise program was undertaken. The weekend exercise program occurs on each Saturday and Sunday for one hour. The repetitions of exercise completed during each class were documented by staff. An audit was conducted to ascertain the amount and type of exercise completed within the class. Results. During the study period 284 people were referred to the exercise program. The mean number of exercise repetitions completed per participant in each class was 180.7 (SD 205.4). The number of exercise repetitions completed by participants was highly variable ranging from 0 to 1190 per class. Conclusion. The amount of average exercise repetitions completed in the Weekend Warrior program was large but with significant variability. A nurse-led exercise class is a feasible method of delivering exercise opportunities to individuals in hospital after stroke.

Does the inclusion of visual biofeedback in physiotherapy rehabilitation sessions increase the amount of practice a person after stroke can complete during therapy

Habitat loss is viewed as a primary cause of pollinator population declines. Managed meadows and gardens provide benefits to wildlife, including pollinating insects. Given the interest in planting flowers for pollinators, lists of recommended varieties have been produced by professional organizations and amateurs alike. These lists serve as a good starting point but are often not grounded in empirical data. Coreopsis is a popular garden plant and a frequent component of commercial pollinator seed mixes. The aim of this study is to compare the ecological role of commercially available Coreopsis plants. It is hypothesized that pollinating insects exhibit preferences based on color and other floral traits. To address this question 4 species of wildtype Coreopsis and 13 cultivars were evaluated for their attractiveness to pollinating insects. Data was collected between June and August 2014 from Coreopsis plants in the Mount Cuba Center trial garden (Hockessin, Delaware). Flower visitors were observed and recorded to morphospecies. To assess which visual floral traits were correlated with pollinator visitation, inflorescence diameter, inflorescences per plant, inflorescence color and pattern, plant height, and number of flowers per inflorescence were measured. Correlating visitation with floral traits may explain the differential attraction of pollinators to Coreopsis flowers. David Ray The Nature Conservancy, MD/DC Chapter Atlantic White-Cedar Stand History and Rehabilitation Prospects Abstract: Efforts to understand the history and dynamics of Atlantic white-cedar (AWC) communities within the Nassawango Creek Watershed were undertaken to help inform various aspects of projects aimed at reestablishing and rehabilitating AWC across the ownership. We used a combination of local knowledge, aerial imagery and ancillary GIS layers (e.g. soils and wetlands), and extensive field transects to identify areas where AWC either currently exists or was known to have been present historically. This information has been assembled using GPS/GIS mapping and spatial analysis, through a dendrochronological study (analysis of tree rings), and observations of natural regeneration. Results presented in this poster suggest there is considerable potential to rehabilitate degraded AWC stands, an aspect of this effort that we have recently begun working on. Efforts to understand the history and dynamics of Atlantic white-cedar (AWC) communities within the Nassawango Creek Watershed were undertaken to help inform various aspects of projects aimed at reestablishing and rehabilitating AWC across the ownership. We used a combination of local knowledge, aerial imagery and ancillary GIS layers (e.g. soils and wetlands), and extensive field transects to identify areas where AWC either currently exists or was known to have been present historically. This information has been assembled using GPS/GIS mapping and spatial analysis, through a dendrochronological study (analysis of tree rings), and observations of natural regeneration. Results presented in this poster suggest there is considerable potential to rehabilitate degraded AWC stands, an aspect of this effort that we have recently begun working on. POSTER PRESENTATIONS Larry Murrell Air Infusion removes Biomat-Lining of Septic Stone-Filled Trench in less than Six Hours: New Protocol to Restore Impaired Septic System Function It is widely recognized that soil decline of residential properties in New Jersey follows a pattern of 1) waterlogging, 2) anaerobic-bacteria-generated toxins impairing plant health, 3) compaction, 4) rapid erosion, and 5) rising water tables. Use of pesticides and inorganic fertilizers accelerate the compaction and erosion in a vicious cycle. These negative impacts on soil health have a domino effect causing chronically high, usually perched water tables, contributing to water-logging and basement flooding. What is not widely recognized is that the soil surrounding the trenches of septic systems, also called drainfields or laterals, is highly susceptible to water-logging and the increasing water tables found all along the Eastern Seaboard. A high water table for septic fields promotes rapid formation of a 1-2” thick black biomat that forms in the surrounding soil. This biomat leads to compromised water flow from the stone-filled trench, or drainfield, into the septic field, and eventually to complete failure of the septic system. We have found that an effective way to attack the biomat of a septic system in a one-step procedure that destroys the biomat and allows the entrained waste water in the gravel train to surge into the soil of the septic field, literally saturating the soil of the field. Once this entrained waste water is transferred to the soil, natural aerobic bacteria digest the remains of the biomat and any toxins present in the field. This new protocol is effective because it saturates void spaces in the trench, and then saturates the entire septic field with aerated water. The restoration process is cost effective and takes only 6 8 hours to complete for each trench of a septic system. With our protocol, the entire biomat is destroyed by uniform air-infusion to the entire trench, and subsequently to the entire field. Samantha Nestory and Judy HoughGoldstein University of Delaware Entomology and Wildlife Ecology Mechanical control methods for Japanese stiltgrass (Microstegium vimineum) Abstract: Japanese stiltgrass (Microstegium vimineum) is an invasive grass that poses a major threat to native biodiversity and restoration efforts in invaded areas. While there are recommended control methods, few studies have scientifically quantified the efficacy of these control methods. A previous study determined that mowing any time after midsummer reduces the M. vimineum population, so we expanded upon this study to determine the effect of mowing height on M. vimineum populations. We established small plots at two sites that were dominated by M. vimineum. Vegetation surveys were conducted for each plot and then plots were mowed at one of three different heights (10 cm, 5 cm, 0 cm) in late summer before seed set. After 5 weeks, prior to senescence, all vegetation in the plots was harvested. Seed spikelets were counted, dried, and weighed. Vegetation was sorted into M. vimineum vegetation and all other vegetation, then dried and weighed. Results show that mowing at any of the three heights significantly reduced seed production and seed biomass of M. vimineum. Mowing at 10 cm reduced seed production by 85.9% and mowing at ground level reduced seed production by 99.5%. Seed biomass was reduced by 92.1% when plots were mowed 10 cm and by 99.5% when mowed at ground level. The results demonstrate that mowing below 10 cm before seeding occurs can significantly reduce M. vimineum reproductive output and could be integrated into an effective management program, which could increase the success of restoration efforts. Japanese stiltgrass (Microstegium vimineum) is an invasive grass that poses a major threat to native biodiversity and restoration efforts in invaded areas. While there are recommended control methods, few studies have scientifically quantified the efficacy of these control methods. A previous study determined that mowing any time after midsummer reduces the M. vimineum population, so we expanded upon this study to determine the effect of mowing height on M. vimineum populations. We established small plots at two sites that were dominated by M. vimineum. Vegetation surveys were conducted for each plot and then plots were mowed at one of three different heights (10 cm, 5 cm, 0 cm) in late summer before seed set. After 5 weeks, prior to senescence, all vegetation in the plots was harvested. Seed spikelets were counted, dried, and weighed. Vegetation was sorted into M. vimineum vegetation and all other vegetation, then dried and weighed. Results show that mowing at any of the three heights significantly reduced seed production and seed biomass of M. vimineum. Mowing at 10 cm reduced seed production by 85.9% and mowing at ground level reduced seed production by 99.5%. Seed biomass was reduced by 92.1% when plots were mowed 10 cm and by 99.5% when mowed at ground level. The results demonstrate that mowing below 10 cm before seeding occurs can significantly reduce M. vimineum reproductive output and could be integrated into an effective management program, which could increase the success of restoration efforts. POSTER PRESENTATIONS Monica Gagliardi Temple University School of Environmental Design ML Architect Student Oxford Wetland Sanctuary: What Nature Intended Abstract: In the era of global climate change, wetlands are a vital resource, providing the link to a resilient social, economic and environmental future. The Oxford Wetland Sanctuary goes beyond simply connecting people to nature, it uses a metric––the Evaluation for Planned Wetlands (EPW)––to restore a wetland, ensuring a highly impactful design based on science. The project incorporates creative social engagement, educational programming and economic opportunities. In the era of global climate change, wetlands are a vital resource, providing the link to a resilient social, economic and environmental future. The Oxford Wetland Sanctuary goes beyond simply connecting people to nature, it uses a metric––the Evaluation for Planned Wetlands (EPW)––to restore a wetland, ensuring a highly impactful design based on science. The project incorporates creative social engagement, educational programming and economic opportunities. Wetland mitigation banking represents an important economic component of the environmental sector, showcasing synergies between effective environmental protection and economic expansion while elevating the value of wetlands in society. The plan uses strategic micro grading and native re-vegetation to create a complex system that absorbs rainwater and slowly releases it to the aquifer; absorbs chem

How hard do people work in therapy involving technology versus traditional therapy in rehabilitation

Habitat loss is viewed as a primary cause of pollinator population declines. Managed meadows and gardens provide benefits to wildlife, including pollinating insects. Given the interest in planting flowers for pollinators, lists of recommended varieties have been produced by professional organizations and amateurs alike. These lists serve as a good starting point but are often not grounded in empirical data. Coreopsis is a popular garden plant and a frequent component of commercial pollinator seed mixes. The aim of this study is to compare the ecological role of commercially available Coreopsis plants. It is hypothesized that pollinating insects exhibit preferences based on color and other floral traits. To address this question 4 species of wildtype Coreopsis and 13 cultivars were evaluated for their attractiveness to pollinating insects. Data was collected between June and August 2014 from Coreopsis plants in the Mount Cuba Center trial garden (Hockessin, Delaware). Flower visitors were observed and recorded to morphospecies. To assess which visual floral traits were correlated with pollinator visitation, inflorescence diameter, inflorescences per plant, inflorescence color and pattern, plant height, and number of flowers per inflorescence were measured. Correlating visitation with floral traits may explain the differential attraction of pollinators to Coreopsis flowers. David Ray The Nature Conservancy, MD/DC Chapter Atlantic White-Cedar Stand History and Rehabilitation Prospects Abstract: Efforts to understand the history and dynamics of Atlantic white-cedar (AWC) communities within the Nassawango Creek Watershed were undertaken to help inform various aspects of projects aimed at reestablishing and rehabilitating AWC across the ownership. We used a combination of local knowledge, aerial imagery and ancillary GIS layers (e.g. soils and wetlands), and extensive field transects to identify areas where AWC either currently exists or was known to have been present historically. This information has been assembled using GPS/GIS mapping and spatial analysis, through a dendrochronological study (analysis of tree rings), and observations of natural regeneration. Results presented in this poster suggest there is considerable potential to rehabilitate degraded AWC stands, an aspect of this effort that we have recently begun working on. Efforts to understand the history and dynamics of Atlantic white-cedar (AWC) communities within the Nassawango Creek Watershed were undertaken to help inform various aspects of projects aimed at reestablishing and rehabilitating AWC across the ownership. We used a combination of local knowledge, aerial imagery and ancillary GIS layers (e.g. soils and wetlands), and extensive field transects to identify areas where AWC either currently exists or was known to have been present historically. This information has been assembled using GPS/GIS mapping and spatial analysis, through a dendrochronological study (analysis of tree rings), and observations of natural regeneration. Results presented in this poster suggest there is considerable potential to rehabilitate degraded AWC stands, an aspect of this effort that we have recently begun working on. POSTER PRESENTATIONS Larry Murrell Air Infusion removes Biomat-Lining of Septic Stone-Filled Trench in less than Six Hours: New Protocol to Restore Impaired Septic System Function It is widely recognized that soil decline of residential properties in New Jersey follows a pattern of 1) waterlogging, 2) anaerobic-bacteria-generated toxins impairing plant health, 3) compaction, 4) rapid erosion, and 5) rising water tables. Use of pesticides and inorganic fertilizers accelerate the compaction and erosion in a vicious cycle. These negative impacts on soil health have a domino effect causing chronically high, usually perched water tables, contributing to water-logging and basement flooding. What is not widely recognized is that the soil surrounding the trenches of septic systems, also called drainfields or laterals, is highly susceptible to water-logging and the increasing water tables found all along the Eastern Seaboard. A high water table for septic fields promotes rapid formation of a 1-2” thick black biomat that forms in the surrounding soil. This biomat leads to compromised water flow from the stone-filled trench, or drainfield, into the septic field, and eventually to complete failure of the septic system. We have found that an effective way to attack the biomat of a septic system in a one-step procedure that destroys the biomat and allows the entrained waste water in the gravel train to surge into the soil of the septic field, literally saturating the soil of the field. Once this entrained waste water is transferred to the soil, natural aerobic bacteria digest the remains of the biomat and any toxins present in the field. This new protocol is effective because it saturates void spaces in the trench, and then saturates the entire septic field with aerated water. The restoration process is cost effective and takes only 6 8 hours to complete for each trench of a septic system. With our protocol, the entire biomat is destroyed by uniform air-infusion to the entire trench, and subsequently to the entire field. Samantha Nestory and Judy HoughGoldstein University of Delaware Entomology and Wildlife Ecology Mechanical control methods for Japanese stiltgrass (Microstegium vimineum) Abstract: Japanese stiltgrass (Microstegium vimineum) is an invasive grass that poses a major threat to native biodiversity and restoration efforts in invaded areas. While there are recommended control methods, few studies have scientifically quantified the efficacy of these control methods. A previous study determined that mowing any time after midsummer reduces the M. vimineum population, so we expanded upon this study to determine the effect of mowing height on M. vimineum populations. We established small plots at two sites that were dominated by M. vimineum. Vegetation surveys were conducted for each plot and then plots were mowed at one of three different heights (10 cm, 5 cm, 0 cm) in late summer before seed set. After 5 weeks, prior to senescence, all vegetation in the plots was harvested. Seed spikelets were counted, dried, and weighed. Vegetation was sorted into M. vimineum vegetation and all other vegetation, then dried and weighed. Results show that mowing at any of the three heights significantly reduced seed production and seed biomass of M. vimineum. Mowing at 10 cm reduced seed production by 85.9% and mowing at ground level reduced seed production by 99.5%. Seed biomass was reduced by 92.1% when plots were mowed 10 cm and by 99.5% when mowed at ground level. The results demonstrate that mowing below 10 cm before seeding occurs can significantly reduce M. vimineum reproductive output and could be integrated into an effective management program, which could increase the success of restoration efforts. Japanese stiltgrass (Microstegium vimineum) is an invasive grass that poses a major threat to native biodiversity and restoration efforts in invaded areas. While there are recommended control methods, few studies have scientifically quantified the efficacy of these control methods. A previous study determined that mowing any time after midsummer reduces the M. vimineum population, so we expanded upon this study to determine the effect of mowing height on M. vimineum populations. We established small plots at two sites that were dominated by M. vimineum. Vegetation surveys were conducted for each plot and then plots were mowed at one of three different heights (10 cm, 5 cm, 0 cm) in late summer before seed set. After 5 weeks, prior to senescence, all vegetation in the plots was harvested. Seed spikelets were counted, dried, and weighed. Vegetation was sorted into M. vimineum vegetation and all other vegetation, then dried and weighed. Results show that mowing at any of the three heights significantly reduced seed production and seed biomass of M. vimineum. Mowing at 10 cm reduced seed production by 85.9% and mowing at ground level reduced seed production by 99.5%. Seed biomass was reduced by 92.1% when plots were mowed 10 cm and by 99.5% when mowed at ground level. The results demonstrate that mowing below 10 cm before seeding occurs can significantly reduce M. vimineum reproductive output and could be integrated into an effective management program, which could increase the success of restoration efforts. POSTER PRESENTATIONS Monica Gagliardi Temple University School of Environmental Design ML Architect Student Oxford Wetland Sanctuary: What Nature Intended Abstract: In the era of global climate change, wetlands are a vital resource, providing the link to a resilient social, economic and environmental future. The Oxford Wetland Sanctuary goes beyond simply connecting people to nature, it uses a metric––the Evaluation for Planned Wetlands (EPW)––to restore a wetland, ensuring a highly impactful design based on science. The project incorporates creative social engagement, educational programming and economic opportunities. In the era of global climate change, wetlands are a vital resource, providing the link to a resilient social, economic and environmental future. The Oxford Wetland Sanctuary goes beyond simply connecting people to nature, it uses a metric––the Evaluation for Planned Wetlands (EPW)––to restore a wetland, ensuring a highly impactful design based on science. The project incorporates creative social engagement, educational programming and economic opportunities. Wetland mitigation banking represents an important economic component of the environmental sector, showcasing synergies between effective environmental protection and economic expansion while elevating the value of wetlands in society. The plan uses strategic micro grading and native re-vegetation to create a complex system that absorbs rainwater and slowly releases it to the aquifer; absorbs chem

Practical ways to increase practice

Synopsis: This symposium is intended for all clinicians who are interested in seeking strategies to increase opportunities for stroke survivors to practice. This practical-focused session will provide evidence, practical examples and resources for you to use to increase patient practice opportunities. It will cover: 1. Why is practice important, what is the evidence regarding practice and skill acquisition, what strategies have been shown to be effective to increase practice; 2. Circuit class therapy (CCT) can be one way to increase practice time. Practical tips for setting up circuit classes and enhancing their effectiveness will also be presented. 3. Supplementary exercise programs are completed in addition to usual therapy, outside of the therapy environment. The PUSH and GRASP programs are examples of upper limb supplementary exercise programs. The rational for these programs and practical tips on how to implement them in a busy rehab setting will be discussed; and 4. Therapists are inaccurate when estimating the amount and type of practice completed in therapy sessions. Recording practice dose in therapy sessions after stroke can allow clinicians to accurately review the effectiveness of their interventions, identify practice gaps and aim to change the types and amounts of practice opportunities provided.