Santiago D. Toledo

Wii Fit Balance Board Playing Improves Balance and Gait in Parkinson Disease

To assess the effect of exercise training by using the Nintendo Wii Fit video game and balance board system on balance and gait in adults with Parkinson disease (PD).

Using mobile phones for activity recognition in Parkinson's patients

Mobile phones with built-in accelerometers promise a convenient, objective way to quantify everyday movements and classify those movements into activities. Using accelerometer data we estimate the following activities of 18 healthy subjects and eight patients with Parkinson’s disease: walking, standing, sitting, holding, or not wearing the phone. We use standard machine learning classifiers (support vector machines, regularized logistic regression) to automatically select, weigh, and combine a large set of standard features for time series analysis. Using cross validation across all samples we are able to correctly identify 96.1% of the activities of healthy subjects and 92.2% of the activities of Parkinson’s patients. However, when applying the classification parameters derived from the set of healthy subjects to Parkinson’s patients, the percent correct lowers to 60.3%, due to different characteristics of movement. For a fairer comparison across populations we also applied subject-wise cross validation, identifying healthy subject activities with 86.0% accuracy and 75.1% accuracy for patients. We discuss the key differences between these populations, and why algorithms designed for and trained with healthy subject data are not reliable for activity recognition in populations with motor disabilities.

The Equivalency of Infrared Tympanic Membrane Thermometry with Standard Thermometry in Nursing Home Residents

Objective: To compare the equivalence of infrared tympanic membrane (TM) measure of body temperature with standard electronic oral (PO) and rectal (R) measures in a nursing home population.

Lubiprostone vs Senna in postoperative orthopedic surgery patients with opioid-induced constipation: a double-blind, active-comparator trial.

AIM To investigate the efficacy of lubiprostone compared to Senna on bowel symptoms and constipation in post-operative orthopedic patients treated with opioids. METHODS In this double blind, randomized, active comparator trial, adults who required opioids for analgesia following orthopedic procedures and who were admitted in inpatient rehabilitation were randomized following baseline assessments to lubiprostone (Amitza(®)), orally twice a day or Senna (generic) two capsules administered daily for six days. Subjects were assessed using the patient assessment of constipation (PAC)-symptoms (PAC-SYM) and the PAC-quality of life (PAC-QOL) scales measured at baseline and Day 7; Subjects were assessed daily for secondary measures included the Bristol stool scale bowel consistency, specific bowel symptom score (Nausea, cramping, straining, completeness, abdominal pain, time per lavatory attempt, assistance needed), adverse events and rescue medications required. Function was measured using the functional independence measure (FIM) at admission and discharge; length of stay (LOS) and missed treatments due to gastrointestinal symptoms were also assessed. RESULTS 64 adults were enrolled; 56 participants (28 in each group) had baseline and follow up measures and were included in the intention to treat (ITT) analyses. 43 participants completed the study, 21 in the active lubiprostone and 22 in the active Senna group. The mean age of the participants was 71.5 years (SD = 11.4 years, range: 28-96 years). In the ITT analyses, participants showed significant improvement in bowel symptoms as measured by the PAC-SYM (mean ± SD, -0.28 ± 0.60, range: -1-2.33) and PAC-QOL (mean ± SD, 0.33 ± 0.81, range: -1.5-2.0) over time, but there were no significant differences between the lubiprostone and Senna groups in mean change in the PAC-SYM (-0.20 ± 0.60 vs -0.36 ± 0.61, P = 0.61 respectively) or the PAC-QOL (0.29 ± 0.76 vs 0.37 ± 0.87, P = 0.61 respectively). The mean change in each bowel symptom also did not significantly differ between treatment groups on ITT analyses, except for completeness of bowel movement, with the Senna group showing greater negative mean change in bowel movement completeness (-0.56 ± 1.01 vs -2.00 ± 1.41, P = 0.03) and for reduction of abdominal pain, favoring Senna (-0.14 ± 0.73 vs -0.73 ± 1.08, P = 0.04). Fifteen (75%) participants in the lubiprostone and in the Senna group requested rescue treatments. Participants made significant functional improvement from admission to discharge over a median LOS of 12 d, with a mean FIM change of 29.13 ± 13.58 and no significant between group differences (27.0 ± 9.2 vs 31.5 ± 16.6, P = 0.27). CONCLUSION Both lubiprostone and Senna improved constipation-related symptoms and QOL in opioid-induced constipation, with no significant between-group differences.

Do co-morbidities and cognition impact functional change and discharge needs in Parkinson disease?

Objective: The aim of this study was to assess the impact of cognition, baseline motor function, and co-morbid medical conditions on functional change, discharge destination, and discharge needs in patients admitted to acute rehabilitation for Parkinson-related impairments. Design: This retrospective chart review study evaluated the records of patients admitted to acute rehabilitation over a 5-yr period with a primary impairment category of parkinsonism. Functional status was measured at admission and discharge; 3-mo follow-up function was also collected in a sample of discharged patients. Results: Eighty-nine patients (mean age, 74.26 yrs) were admitted over the 5-yr time frame. A more complicated Medicare tier diagnosis (tier 2) was associated with lower total and motor score Functional Independence Measure gains compared with tier 3 (P = 0.009 and P = 0.016, respectively). Cognitive scores at admission were not related to need for caregivers upon discharge. Overall Functional Independence Measure gain (adjusted R2 = 0.073, P = 0.006) and Functional Independence Measure gain efficiency (adjusted R2 = 0.142, P < 0.001) inversely correlated with age. At the 3-mo follow-up, a random sample (38%) of patients contacted postdischarge demonstrated continued improvements. Conclusions: Significant improvement may be seen after acute rehabilitation in patients with Parkinson disease, irrespective of cognitive impairment. More complicated medical tier diagnoses result in less Functional Independence Measure gain, and older individuals with Parkinson disease are more likely to show less functional change. However, functional improvements are still statistically significant.

Poster 365 Does a Supervised Program in Physical Therapy and/or Occupational Therapy Improve Pain Scores in Patients with Parkinson Disease?

(r .539, P .001), METs (r .545, P .001), and speed (r .527, P .001). Conclusions: Most poly-trauma subjects had moderate PRI, and the PSD due to the PRI had a statistically significant negative effect on BBS scores. Decreasing the PSD in PTM with CNMP will significantly improve their dynamic balance deficits and overall improve physical performance. These findings suggest that the self-reported PDS sub-construct is a reliable indicator of physical performance status, and would be valuable as an alternative to PPT in a busy clinical practice. Further research into PDQ application amongst other patient populations would be beneficial.

Outcomes of Inpatient Rehabilitation in Patients With Simultaneous Bilateral Total Knee Arthroplasty.

The number of total knee arthroplasty (TKA) procedures performed in the United States is increasing each year, and the number of bilateral TKA procedures has also increased during the past 2 decades. However, few studies in the literature have investigated the rehabilitation outcomes of patients who undergo bilateral TKA. This study was performed to provide information on the benefits and role of inpatient rehabilitation for patients after bilateral TKA.

Could Kinesiotaping Function as a Geste Antagoniste in Anterocollis? A Case Report

Disclosures: Y. Shepelyak, No Disclosures: I Have Nothing To Disclose. Program Description: A 38-year-old man fell from a six foot ladder at work and presented with a complete loss of motor and sensory function in his legs. An MRI revealed fracture and dislocation of T11-12 with severe canal compromise and an epidural hematoma. He underwent posterior stabilization of T8-12 the following day. After his surgical intervention, he was started on a steroid protocol and was placed in a thoracolumbosacral orthosis (TLSO). On post-trauma day 12, he experienced severe episodes of hypotension and back pain. He was transferred to intensive care unit and was started on vasopressors. His TLSO was discontinued. Within days, his neurological level deteriorated from T9 ASIA A to T3 ASIA A. Imaging was performed and he was diagnosed with subacute progressive ascending myelopathy (SPAM). Setting: Inpatient Rehabilitation Hospital. Results or Clinical Course: Over the next three months, he was transferred to an acute rehabilitation hospital and his neurological level improved to T4 ASIA A with a zone of partial preservation to T5. His rehabilitation course was complicated by neuropathic pain at the level of injury, which was successfully treated with pregabalin. Discussion: SPAM is a disorder of delayed neurological deterioration following spinal cord injury that can occur within 3 weeks of the initial injury and involves at least four segments on MRI or at least two segments on clinical exam. Some of the signs preceding the deterioration are shoulder pain, back pain, dysphagia, and hypotension. Recovery from SPAM is often incomplete, lasting anywhere from 3 to 14 months. Most patients do not return to the original, pre-SPAM neurological level. Conclusions: After an acute spinal cord injury, SPAM is an important pattern of neurological deterioration that can be recognized on clinical exam or radiographic findings.

Poster 211 Recurrent Dislocation in Primary Total Knee Arthroplasty: A Case Report

third injection. Discussion: Platelets contain a number of proteins, cytokines, and other bioactive factors that initiate and regulate basic aspects of wound healing. PRP causes the release a large pool of cytokines, chemokines, and growth factors into the joint capsule. These factors are involved in cell signaling and in the stimulation of intrinsic repair mechanisms. PRP has been shown to be efficacious in several in vitro studies in stimulating the proliferation of bone growth, enhancing and accelerating tendon repair, and in the healing of lower extremity ulcers. In addition, several in vivo studies have shown positive benefits to the use of PRP in lateral epicondylitis and Achilles tendinopathy. Studies by Sanchez et al. reported positive results with the use of PRP in the treatment of knee and hip OA. In addition, PRP has been used arthroscopically in the treatment of avascular necrosis. On the other hand, several authors have failed to observe a positive effect with the use of PRP. One study showed no effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic Achilles tendinopathy. Savarino et al. reported no functional or clinical difference in patients with bone grafted with bone chips and PRP. Furthermore, within the oral and maxillofacial surgery literature, there are several cases that show little benefit from using PRP to promote healing or osteogenesis. However, it is difficult to draw conclusions from many of the above studies as most are limited case series that may or may not have controls, have small sample sizes, and do not define a standardized preparation of PRP. Conclusions: The limited studies in the literature suggest there is potential in the treatment of cartilage lesions with PRP; however, to date, there are no large scale randomized, long-term studies providing reliable medical evidence that supports this claim; thus emphasizing the need for further research in this area.

Poster 294 An Exploratory Analysis to Assess Dysphagia and Appropriate Screening Methods in Parkinson Disease

Disclosures: L. E. Krach, Research grants: Medtronic, Inc.; Consulting fees or other remuneration: Medtronic, Inc., (payment). Objective: Compare prevalence and progression of scoliosis in a group of individuals with cerebral palsy (CP) receiving intrathecal baclofen (ITB) with a matched group not receiving ITB. Design: Retrospective case-matched cohort. Setting: Tertiary care facility for individuals with disabilities. Participants: Skeletally immature individuals with CP who had ITB pumps implanted to treat hypertonicity and at least one year follow up. Controls matched for gender, age, dates of treatment, Gross Motor Function Classification System (GMFCS) Level. Interventions: Not Applicable. Main Outcome Measures: Presence or absence of scoliosis, Measurement of curve, location of apex of curve, spine fusion. Results: 104 subjects with ITB pumps and104 comparison individuals were identified, 40% female. At baseline there was not a difference between the two groups regarding prevalence of scoliosis, management of curve, curve pattern, or maximum curve measurement. Subjects and controls were followed for a mean of 5.6 (SD 2.1) and 6.8 (SD 3.5) years, respectively. At baseline 60.3% of those at GMFCS level V had scoliosis compared to 37.0% at level IV, and 34.2% at levels II and III (P .002). At the time of the final visit, 91.3% of those receiving ITB had scoliosis and 78.8% of controls. Of those who did not have scoliosis at baseline, 72% of controls and 86% with pumps developed scoliosis (P .077) A logistic regression analysis found that GMFCS level was the biggest contributor to presence of scoliosis at follow up. 45% of those with pumps had fusions compared to 30% without pumps (P .022). Lumbar curves were noted in 46.5% of controls and 61.6% with pumps. Conclusions: This study confirms that those with greater motor impairment are at greater risk for scoliosis. There is a trend for more individuals in the ITB group to develop scoliosis and have lumbar curves. More fusions were necessary in the ITB group.