Nancey Trevanian Tsai

Rehabilitation Concerns in Geriatric Trauma

As the population ages and receives more state-of-the-art medical care, the number of elderly individuals sustaining injury becomes greater. There are extrinsic and intrinsic factors that lead to this increased incidence, including greater opportunity to live independently out of desire or necessity, and degenerative anatomical changes that lead to higher risks of low- and high-speed trauma. In order to return the patient to the highest level of independence possible, rehabilitation is frequently employed to manage the multidisciplinary aspects of functional restoration. The process of rehabilitation is not always well understood by non-physiatric medical practitioners, and its rules with regard to settings and funding can be confounding. This chapter outlines the important factors that drive rehabilitation services with a focus on concerns for the geriatric trauma patient and offers an overview of opportunities for improving the outcomes for those referred to rehabilitation services.

Poster 45: Blink Reflex Parameters in Division I Athletes at Baseline and After Head Impact

Disclosures: Nancey Tsai: I Have No Relevant Financial Relationships To Disclose Objective: Assess changes in blink reflex at baseline, at play, and after impact in Division I athletes using novel, non-invasive device. Design: Prospective, non-randomized Setting: Division I college Participants: Athletes Interventions: N/A Main Outcome Measures: 1. Evaluate changes in blink reflex parameters between baseline, at play, and after head impact; 2. Compare data to previously published EMG blink reflex data Results: The baseline latency, differential latency, and duration of the images from the device were compared with those from published EMG literature. The baseline median latency was 51ms (SD 12) compared with the published range of 40-70ms. The differential latency was 4ms (SD 7ms) compared to w12ms in prior publications. The duration measured using the device was 177ms (SD 94) compared to w200ms using EMG data. During active play, the latency was increased latency (P1⁄4 <.001, decreased differential latency (P1⁄4<.017), and fewer oscillations (P+.002). After head-impact or concussive event, there were decreases in latency (P1⁄4<0.017), increased differential latency (P1⁄4<.001), and increased oscillations (P1⁄4<.008). Conclusions: This study demonstrates that the device is a viable tool to obtain fast, objective, quantitative metrics of a blink reflex that has promise as a non-invasive diagnostic assessment of neurological health. Level of Evidence:

Blink reflex parameters in baseline, active, and head-impact Division I athletes

Abstract The Centers for Disease Control and Prevention estimates 1.6–3.8 million concussions occur each year. Research cites that 21% of traumatic brain injury in children/youth results from participation in sports and recreational activities. However, current methods to assess concussion, which includes balance, neurocognitive, and self-report assessments, provide conflicting validity and reliability. Thus, many sports medicine professionals seek more objective measures to assess the severity and outcomes of a concussive event. The purpose of this study was to utilize a novel technology to determine if there were differences in blink reflex parameters among baseline, active, and concussed athletes. Twenty-four Division I football athletes participated in this study. Routine pre-season baseline data were collected on athletes as well as assessments of their blink reflex parameters using a blink reflexometer. Significant differences were found in blink parameters between baseline and active measurements in latency, differential latency, lid velocity, log of time to open, log of number of oscillations, and log of total blink time. In addition, significant differences were found between baseline and post-head impact in latency, differential latency, log of time to open, and log of number of oscillations. In comparing head impact and active play, blink latency decreased with head impact but increased in active play and differential latency and log of number of oscillations increased with head impact but decreased in active play. The results of this study suggest that use of a blink reflexometer provides quantifiable and objective outcomes to complement the concussion assessment protocol for athletes.

Development of a Non-Invasive Blink Reflexometer

Qualitative assessments of the blink reflex are used clinically to assess neurological status in critical care, operating room, and rehabilitative settings. Despite decades of literature supporting the use of quantitative measurements of the blink reflex in the evaluation of multiple neurological disorders, clinical adoption has failed. Thus, there remains an unmet clinical need for an objective, portable, non-invasive metric of neurological health that can be used in a variety of settings. We have developed a high-speed videography-based device to trigger, record, and analyze a blink reflex. A pilot study was performed to compare the device’s measurements to the published literature of electromyographic measurements, currently the gold standard. The study results indicate that the device is a viable tool to obtain fast, objective, and quantitative metrics of a blink reflex, and has promise as a non-invasive diagnostic assessment of neurological health.

Clinical Practice Modifications Resulting from Interdisciplinary VTE Task Force at a Large City Hospital: A Three-Year Experience

per thousand members to 7 per thousand, but t his change coincided with the increase in co-pay. Conclusions: Application of a value-based benefit design to rehabilitation therapy benefits appeared to lead to utilization of benefits that more closely matched the patients’ needs while remaining at least cost neutral. The benefit can have a simple design (e.g., two groups of diagnostic codes), minimizing additional administrative burden related to errors in coding an frequent review of requested exceptions.

Poster 458 Management of Intrathecal Baclofen (ITB) Pump During Pregnancy

30 min per day for 4 weeks. Main Outcome Measures: Whole muscle wet weights (MWW) of gastrocnemius (GCM) and soleus muscles, fiber crosssectional area (CSA) were measured. The composition of MHC isoforms were analyzed using SDS-PAGE. Results: MWW of GCM and soleus muscles decreased significantly after SCI compared to that of control group. We found MWW and CSA of SCI-E were slightly greater than in SCI-S, but the difference was not significant. CSA after SCI was also smaller (34.2%) compared to control group. SCI-E showed greater CSA of 7.9% than SCI-S did. The proportion of MHC Type IIb of GCM of SCI-S (76.4 22.5%) was greater significantly than that of control (55.8 23%), but its proportion (61.5 23.2%) in SCI-E was similar to normal proportion of Type IIb. MHC type IIx proportion of GCM (39.2 42%) decreased significantly in SCI-S (21.1 20.7%), but not in SCI-E (35.3 21.5%). Conclusions: Neuromodulation by ELFES did not prevent atrophic change of skeletal muscles after incomplete SCI, but it could render MHC isoform composition near normal. We suggest ELFES has a therapeutic potential to muscle atrophy after SCI.