Tatsushi Wakasugi

Gender differences in health‐related quality of life, physical function and psychological status among patients in the early phase following allogeneic haematopoietic stem cell transplantation

The aim of this study was to examine gender differences in quality of life (QOL), physical function and psychological status before and in the early phase after allogeneic haematopoietic stem cell transplantation (allo‐HSCT).

Balance function in patients who had undergone allogeneic hematopoietic stem cell transplantation

A previous study reported a 45% incidence of falling among allogeneic haematopoietic stem cell transplantation (allo-HSCT) patients during hospitalisation. We investigated balance and physical function in allo-HSCT patients. Thirty patients (18 men and 12 women) who underwent allo-HSCT between February 2013 and September 2014 were included in this study. Patients were evaluated for up to 3 weeks before and 7 weeks after transplantation. Balance was evaluated using the Timed Up and Go test (TUG) and length of centre of pressure (CoP). Physical function was assessed using hand-grip strength, knee-extensor strength tests, and the 6 min walk test (6MWT). TUG and length of CoP were significantly increased following HSCT (P<0.01). Hand-grip strength, knee-extensor strength, and the 6MWT score decreased significantly after allo-HSCT (P<0.01). TUG and length of CoP were negatively correlated with hand grip and knee-extensor strength (P≤0.05). The allo-HSCT patients in this study had worsened dynamic and static movements of the CoP after transplantation as well as decline of physical function. Rehabilitation staff, nurses, and physicians should recognize the decreased balance function of patients who have undergone allo-HSCT.

Impaired skeletal muscle oxygenation following allogeneic hematopoietic stem cell transplantation is associated with exercise capacity

IntroductionImpaired skeletal muscle oxygenation potentially contributes to reduced exercise capacity in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients during early recovery and may explain altered hemoglobin responses to exercise following allo-HSCT. We investigated whether skeletal muscle oxygenation parameters and hemoglobin parameters in the tibialis anterior decreased following allo-HSCT, and whether these results were associated with declines in exercise capacity.MethodsWe used near-infrared spectroscopy during and following a repeated isometric contraction task at 50% of maximal voluntary contraction in 18 patients before and after allo-HSCT.ResultsThe rate of decrease in the muscle oxy-hemoglobin saturation (SmO2; an index of skeletal muscle oxygenation) was significantly lower after allo-HSCT (P < 0.01). In contrast, total hemoglobin (an index of hemoglobin) was not different after allo-HSCT. Furthermore, SmO2 during and following exercise was associated with exercise capacity (r = 0.648; P = 0.004 vs. r = 0.632; P = 0.005).ConclusionThe results of this study reveal that although the peripheral hemoglobin response was not altered by allo-HSCT, skeletal muscle oxygenation was decreased following allo-HSCT. Furthermore, the decrease in skeletal muscle oxygenation was associated with a reduction in exercise capacity.

Poster 203 Allogeneic Haematopoietic Stem Cells Decrease Muscle Strength Immediately after Transplantation

Disclosures: A. Navarasala: I Have No Relevant Financial Relationships To Disclose. Case Description: A 73-year-old man with history of recurrent pneumonia complicated by sepsis presented with fevers, chills, and cough to the acute care setting. Chest x ray showed basilar infiltrates in ED suggestive of pneumonia. Following admission ID was consulted and merrem, vancomycin, and micafungin were started. During the hospital course blood cultures were positive for E. coli. On transfer to the rehabilitation hospital the patient was on chopped diet with thin liquids due to dysphagia. Video-fluoroscopic swallow study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) were performed and a Zenker’s diverticulum was discovered. Studies demonstrated penetration and aspiration on initial swallow worse with nectar thick than thin liquid from the diverticulum. Setting: Acute inpatient rehabilitation hospital. Results or Clinical Course: The FEES showed residuals in the valleculae, throughout the pharynx, A-E fold, and the intraarytenoid space. Swallowing strategies including chin tuck and multiple swallow cues improved clearance, but residual penetration and aspiration did not trigger cough. Aspiration occurred silently with nectar thick liquids vs. thin liquids, likely due to inadequate clearing. Follow up with a barium esophogram for more detailed assessment was recommended. The patient worked with speech therapy and strategies learned included alternating liquid/solid, throat clearing, controlling rate, and amount. Discussion: Zenker’s diverticulum is a rare complication in the elderly population that has a prevalence of 0.01 e 0.11% in the population. It is common in the male population during the 7th to 9th decades. Symptoms include dysphagia, sensation of food or medications sticking in the throat, unexplained weight loss, and chronic halitosis. This patient presented with complications of recurrent pneumonia with sepsis and a long history of pill dysphagia. Conclusion: In the elderly population with chronic dysphagia and the sensation of food sticking in the throat, a Zenker’s diverticulum must be ruled out. VFSS and FEES are screening methods that can be done in the rehabilitation setting to rule out mechanical causes of dysphagia which can prompt additional studies and surgical necessity. This patient was subsequently scheduled for barium swallow and surgical evaluation by an ENT specialist.

Poster 12 Therapeutic Effects of Gait Training and Gait-Related Training with Functional Electrical Stimulation for Chronic Stroke Patients: Prospective Observational Study

Conclusion: 1) Facial paralysis patients improve both subjectively and objectively after the botulinum toxin A treatment. 2) The subjective perception of improvement is not related to the initial severity of the facial paralysis. 3) The subjective perception of length of therapeutic effect is not related to the initial severity of the facial paralysis. 4) It would be advisable to add psychological impact and quality of life specific scales to the evaluation.